in the garden of your mind

"If only you could sense how important you are to the lives of those you meet; how important you can be to people you may never even dream of.  There is something of yourself that you leave at every meeting with another person"

-Fred Rogers

getting better

This past week I went to see Dan Savage speak about the It Gets Better Project.  For those of you who haven't yet heard of it, it's a project he and his husband Terry Miller started in response to the trend of suicides of young, gay teenagers.  The project is a website (click the link above to check it out) of videos of adults telling teens and teens telling each other that it (meaning a life of bullying, hostile teachers, parents who don't understand, feeling like you're the only one) gets better. 

I went to a LGBT youth health training conference a few weeks ago and we learned about how to support and treat LGBT youth as doctors, and while that felt powerful (and incredibly important to my life) - 

this is so much more.

Here's the first video that Dan and Terry created as an example of how It Gets Better.  

check out the website, sign a petition, watch a video, make a video

In his talk, Dan talked a lot about the sobering statistics of bullying of LGBT youth, including that they are 4x more likely to commit suicide, and 8x more likely to commit suicide if they live in any sort of hostile or not accepting household, as well as that over 40% of all homeless teens are LGBT youth who can't go home.  He said that he felt that the reason these teens commit suicide, really why anyone commits suicide, is that

they can't imagine any joy in their future that could make up for their current misery.

In talking about why he started the project, he described the "white hot anger" he felt when one young gay man who committed suicide after years of bullying had a facebook memorial page that continued to get bullied by more homophobie and hateful comments from his bulliers.  Dan wrote a comment on the wall of this facebook memorial page angrily scolding the bulliers - and noted that most of the other comments were similarly angry and appalled until he got to this one from a girl who said 

"Billy, I wish I could have known you before, 

because then  I could have told you that it gets better".  

And it sort of hit Dan that that was the message he wanted to get out was not one of retorted hate and repulsion, but one of hope.  He (and the woman who introduced him) both quoted Harvey Milk, an activist for gay and lesbian rights in the 1960s, who in response to a question about what we as a nation should do for gay and lesbian youth said, 

"Give them hope"

so he and Terry realized that they were waiting for permission to speak to youth from a society that doesn't support adult gay people talking to children at all, much less gay and lesbian children.  But they were waiting for permission in the time of youtube and facebook and the internet; they didn't need to go door-to-door or school-to-school muscling past homophobic adults who would never let their children speak to them anyways, they just needed to post a video on the internet and let youth find it.

Now the website has over 60,000 videos (including this guy direct from the oval office) with even more comments exchanging information like where to go for help, how to get there.

One of the most profound parts of his talk was when he read a letter he received from a 15 year old girl who is a lesbian but whose parents forced her into "rehab" to convince her that her "choice" was wrong.  In her letter, she told Dan that every night she watched It Gets Better videos before she went to bed and they were helping her get through the next 3 years of her life.  Dan's response was "ha! take that homophobic parents, we are basically just breaking down your door and getting information to your daughter!" but then she wrote that the best videos for her were the ones where she saw people talk about how their parents came around and were now supportive, or even the videos where parents were in the video apologizing to their children for not accepting them, not supporting them.  She said, 

it gives me the strength to walk downstairs every morning, look at my parents, and love them for who they will be in 10 years.

Maybe There is Something to The Struggle

Question: what's the best way to study?

As I'm spending the vast majority of my waking hours (that photo is of some un-waking hours, but the books are not too far away) these days studying for the first Test of All Tests of the path of a physician - Step 1 of the Boards - I had about five different people send me an article about how best to study/learn that showed up in the NYT this week.

So much of medical school is learning how to learn most effectively - both efficiently and completely - because there's Just.So.Much information that doctors are required to (and should!) not only know, but be able to synthesize and connect and process and USE to help people regain or keep their health. It's also the first time where everyone has their own way - when I look around at my classmates who are also studying most of their waking hours, some are listening to review lectures, some are flipping through note cards, some are reading and re-reading every review book they can get their hands on.

Somewhere along the way in medical school, I realized that I could learn things as they were being explained to me if they were immediately followed by questions reviewing the main concepts. Since this is not normally the approach of most lecturers, and I could only get friends to create questions for me so much, I started making up my own. So how I would study for basically all of medical school was to take the material we were learning and create a question that got at the main concept or an important detail.

Now that we have this big test coming up, I would try to do the same thing, except that there's just too much material. Luckily, one of the main study tools that most people use is a "question bank" which is basically > 2,000 questions created to touch on all the material that could be tested. It's basically my study dream come true (as strange as that phrase just sounded) - so that's mostly what I've been doing these days. It's great, except that it's like taking a test ALL DAY every day, which can get pretty exhausting.

However, this article in the New York Times this week by Pam Bullock (that so many of my favorite people so kindly sent me) seems to support my style of learning. whooohooo. But because this is my style of learning, I thought that the most interesting part of the article was when Bullock discussed how the struggle inherent in being forced to recall something helps to reinforce it - that there's something about the struggle that's good for solidifying knowledge.

“The struggle helps you learn, but it makes you feel like you’re not learning,”“You feel like: ‘I don’t know it that well. This is hard and I’m having trouble coming up with this information.’ ”

By contrast...when rereading texts and possibly even drawing diagrams, “you say: ‘Oh, this is easier. I read this already.’ ”

right now I really appreciate anything that supports "the struggle" being a good thing.

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"you gotta be bad, you gotta be bold, you gotta be wiser

you gotta be tough, you gotta be stronger,

you gotta be cool, you gotta be calm, you gotta stay together,

all I know all I know is love will save the day"

-desiree, you gotta be

7th graders teach medical school

because a lot has been going on, this post is mostly lists, but I wanted to make sure I got these thoughts out there - and those of you who know me well, know that sometimes I think in lists!

a day of medical taught almost entirely by 7th graders - pretty much the greatest idea ever.

example: one girl is trying to answer a question about her favorite subject in school. while she's thinking the boy next to her goes, "well I know what her favorite activity is: kissing brian samuels". She rolled with it so well, and just dismissed him with, "actually it's soccer" ohhhh 7th grade.

then we asked them how doctors could be better with adolescents. they had great suggestions including:

*don't use big words we don't understand

*ask us questions that don't sound like you're interrogating us - like, about not just our medical health but our LIFE

*wait for us to talk - sometimes it takes us longer

*ask about our friends

*ask if we're worried about anything

*don't talk to us like we're not real people who know a lot

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"I guess this is going to be a jigsaw kind of year"

-from one of the poems read to us by the 7th graders today

How To Teach Everything

Do not try to satisfy your vanity by teaching a great many things.
Awaken people's curiosity. It is enough to open minds; do not overload them.
Put there just a spark. If there is some good flammable stuff, it will catch fire.
-Antole France, Nobel Laureate in Literature

My mom and I were talking the other day about the extreme skill of people who can synthesize lots of information and break it down into just what's important and just what you can remember. It came up because we had been talking about translation and culture in my Medical Student Leadership Group and I told them about an experience I had with translation over break:

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One of my mom's friends who is a Somali refugee had just had double bypass surgery in the hospital. Bypass surgery involves having at least one, but sometimes more of the major arteries that provide blood to the heart replaced, in this case with a vein from his arm, which is very atypical. Usually a vein from the leg is used because you have so many more of them) only to discover a few days after his discharge that he was almost seizing in pain. He returned to the hospital to learn that he had fluid building up in his pericardium (the sac of tissue that surrounds the heart and keeps it separate from the rest of the contents of your abdomen), which he had to have drained over the course of a few days in the hospital. He was then discharged again with a list of nine medications to take.

And here is the real problem: the discharge paper wrote the medicines as their brand names, whereas the pharmacy gave him the generics. I'm not sure if the pharmacy explained it to him but I know he didn't understand and they gave him no written material with any explanation of which drugs are which and which to take for which. When I got to his house, his son (who speaks and reads more english than his father) showed me the sheet that he had created from what he heard the doctors say the medications were for. We googled the medications to find out what they were - but we still weren't sure which were important for keeping him from having another heart attack and which were for discomfort (one of the medications he was prescribed was zolpidem, which is an anti-anxiety medication that is used to make you sleep).

So we called the cardiologist on call (a different one)and asked him which medications were absolutely vital and could he please tell us the generic names of them. He immediately said three medications were absolutely vital (in the true sense of the word), but the others were more flexible. There were even a few that he only needed to take if he was in lots of pain (oxycodone) or couldn't sleep (zolpidem) or had heart burn (omaprazole). When we explained to the doctor that he had an incomplete grasp of the english language, the doctor totally got it and just broke it down into the most basic (and like he said, most vital) components.

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When talking to my mom, we were recounting the best teachers, doctors, lawyers we knew and how all of them shared the quality of not giving people information to look more knowledgable but in a way where they knew it was being absorbed. I used to think that professors that simplified things were less expert, but in medical school my favorite professor yet spent an entire class talking with us about a bathtub metephor he had for homostasis, the ability of the body to re-balance itself after being thrown out of whack.

Plus, I like the part in the quote about a spark.

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"I could teach a monkey calculus - you just have to find a way of relating it to something someone cares about. For example, so you like the WWF, right?..."
-my favorite quote about education, from the movie Road Trip