The 2011 Yearbook is done. What a year! You can see all the albums from the year here.
This years edition clocks in at 108 pages – the longest yet. I hope you enjoy it, as I know Tiff and I will for years to come!
You can browse the pages below.
110 Photos
99 Photos
82 Photos
78 Photos
66 Photos
One degree wasn’t enough for President’s Scholar and 2004 graduate Tiffany Link (then Tiffany Potter).
She left CSULB with a B.S. in biochemistry, a B.A. in chemistry, minors in biology and communications, and the honor of being the Outstanding Graduate in the College of Natural Sciences and Mathematics. It’s no wonder she earned acceptance into graduate school at Yale, Cornell, Dartmouth and others before choosing Johns Hopkins’ M.D.-Ph.D. program. Come May 2012, you can address her as Dr. Link.
“I finished my Ph.D. research in Mike Caterina’s lab in March of 2010,” she said. “I am currently back in medical school, completing my clinical rotations. I am concurrently working on research in pediatric dermatology, looking at the treatment of infantile hemangiomas,” which are benign birthmark tumors. Her work earned the Hopkins’ Michael A. Shanoff Award for the best Ph.D. thesis and first author credit for a research article in the journal Nature Immunology.
Read the whole thing. Here’s my favorite part:
If that wasn’t enough, Link met her husband, Jed, when they competed as rivals at speech and debate tournaments—she for CSULB and he for USC.
Yeah, Mrs. Link pretty much rocks. That’s from the Spring 2011 CSULB Beach Review which is sent around to all the zillions of CSULB alumn.
My girl’s wicked smart!
The 2010 Yearbook is done. Another 60 or so hours of work in the layouts over the course of the year (again, this year, I tried to do them as we went). This is a monumental undertaking, but the final product has always been worth it.
This years edition clocks in at 98 pages – largely because once Tiffany left her PhD program we both started doing things on our own. Since 80 pages is the limit allowed by PhotoWorks, we had to look for a place that would allow us more pages. And we found Viovio.
You can browse the pages below.
The Yearbook Accounts of the year in words is below:
During my dermatology rotation, I rotated through a variety of areas including pediatric dermatology, general adult clinics at downtown JHH and Bayview, inpatient dermatology, with splashes of cosmetic dermatology and dermatopathology. I felt like a kid in a candy store. Each experience was so rich and gave me another reason to love derm.
Pediatric dermatology was awesome because I love kids. I think they are some of the coolest people on earth. I saw a baby with a disfiguring hemangioma receive one treatment with propranolol and we noticed an improvement the very next day. I saw kids with port wine stains receive laser treatments to lighten and eventually eradicate for some, so they weren’t teased at school anymore or weren’t so embarrassed of what they looked like. Coming from the research, and particularly the basic science world, immediate gratification was not something I was used to, but man, I could really get used to that. The doctors that I worked with on Peds Derm were some of the smartest and most caring physicians I have had the pleasure to work with. Their passion for the science of dermatology and compassion for their patients showed me the kind of doctor I want to be.
During outpatient clinic at JHH, I got to see the residents shine. They saw about 80 patients a day (the attending saw each and every one of those 80 patients) and still had great rapport with the patients even though their interaction was time-limited. I was able to help their since as a medical student, you are not pressured to see X number of patients. I made some great connections with patients, so much so that several actually asked me to be their dermatologist. Needless to say, this was incredibly flattering, but I had to inform them that it would be a great many years till I could legally (if ever-come on derm residency) practice dermatology. I was also able to see various tests and biopsies the residents performed (punch, shave, KOH preps for fungal infections, ect.). I even got to participate in a couple of treatments, like liquid nitrogen freezing of precancerous actinic keratosis, electrocauttery or cutting of skin tags, suturing biopsies, ect.
Outpatient clinic at Bayview was very similar except the patient populations were slightly different. More bread and butter dermatology at Bayview, whereas JHH had some pretty rare disorders. Bayview was different in the fact that in addition to outpatient clinic, you are also inpatient consult. During my time we had some very interesting inpatient consults as well, diagnosing several drug-induced rashes, a couple of vasculitides, and a lady with cutaneous B-cell lymphoma.
Inpatient consults at JHH was what I wrapped up with and that was a really neat experience as well. You essentially are like Batman, sitting at home (in the resident room, finishing any outstanding dictations) until the batsignal (your beeper) goes off, and you speed off with your tool belt (your bag of biopsy supplies, ect), jump in the batmobile (walk across the busy hospital) and go to the rescue (diagnose at the bedside).
The Hopkins dermatology residents deserve their own paragraph. These are some of the smartest most motivated doctors I’ve met. They are incredibly hard working and dedicated, and still find time to help teach a lowly medical student. Their work load is incredible. I will backhand anyone who call dermatologists lazy. You heard it here first, backhand. They were amazing, inspiring people, and certainly the kind of people I would want as colleagues. The field of dermatology is in good hands.
Sorry for the length of this one, but since it is the field that I hope to be in the rest of my life, I thought detail was in order. Until the next rotation: Geriatrics (aka Chronic disease and disability)
As promised, here are my reflections of the Hopkins Internal Medicine rotation. This is a rotation that I had been worried about for some time because of all the things (both good and bad) I had heard about it. The stories of “The O” (standing for Osler, the service was named after the famous Hopkins Internist) are legendary. I had heard that the rotation is malignant (meaning you will be a miserable person during it) with horrible hours. I had also heard that you will never learn more medicine in such a short time and that this is the rotation where “Hopkins” physicians are really made. So understandably, I was both really looking forward to and dreading this rotation. The rotation is broken up into two parts, while it is all inpatient care (hospitalized patients), half of the time (one month) is spent at the Hopkins Bayview campus and the other half (one month) is spent in the Downtown Hospital (the Osler service). I started at the Bayview campus first, which was supposedly the less hard core of the two. The medical team consisted of me, another medical student, two interns (first years after medical school), a second year resident, and an attending (the in charge physician). My whole team was awesome. They really encouraged us med students to be the main doctor for our patients and take responsibility for them. I met some really lovely people and it was truly a rewarding experience. The people at Bayview were pretty laid back and really supportive of eachother. We typically worked 12-14hr days and were on call every 4th day. What that means is that every 4 days (yes even if it falls on a Sat or Sun), the whole team stays in the hospital overnight and admits the new patients that come in. Us medical students weren’t allowed to stay the whole night, but we usually got out close to 10-11pm, then had to read about our patients, put in any orders that were to be carried out overnight, and make a plan for them. We would wake up early and go see our patients before any of our team would see them (called pre-rounding) and find out how they did overnight and how they were feeling. We would then present them in the morning to our team when we “round” on our patients, seeing all of the old and the new patients admitted overnight. This usually took us until noon because it took a while to discuss every patient’s plan, and they usually had some sort of learning point for the interns and med students. Then, most of the afternoon is spent in lectures and making sure the orders are all carried out for patients.
The best lecture I had at Bayview was given by the director who spoke to us about how disease takes power away from people. When the come to the hospital, power is also taken from them. They have to wear what we tell them to wear, eat what we tell them they can eat, stay in the room that we assign them, usually not alone, and have very little privacy with people coming at all hours to draw blood, check vitals, ect. This is an aspect of medicine that we as medical students, young and relatively healthy, never had to think about. It made me realize that many times when patients are “non-compliant”, meaning they don’t agree to go along with the medical plan, it is usually because they are trying to take back what little power they have left. When we remind the patients (and ourselves) that we work for the patient; that we do not tell them what to do, but merely make the best recommendations based on our training and experience. They make the ultimate decision. I thought that was a really nice reminder, not just when we need patients to do what we want them to do, but for all patients to view us as partners in their health, rather than the primary decision makers.
Next, I went to Hopkins, the infamous Osler service. Again, my team was incredibly awesome, but the team structure was slightly different. Instead of the whole team being on call together, only one intern was on call each night. Again, us med students (med studs are we were frequently called) were on q4 call (every 4th day) and occasionally q3 call. The patient population was slightly different at the downtown hospital. Not so much the bread and butter medicine of bayview. We got to see a lot of the “zebras”. In medicine, we have a saying, “when you hear hoof beats, think horses, not zebras” meaning that when you see a constellation of symptoms, think of the most common things that cause those symptoms instead of the really super rare things that can occasionally present with those symptoms. Many people ultimately come to hopkins because they are a zebra that no one had figured out at that point. They daily schedule was pretty similar to Bayview, but there was much more pimping (when doctors rapid fire medical questions at med students and you feel stupid if you don’t know the answer). The people were unbelievably smart, worked incredibly hard, and I learned a ton from my time there. I learned what it was to truly care for patients. Our chief attending bought a Foreman grill, tons of food, and a toaster oven for one patient (with anorexia among other issues) refused to eat. I really enjoyed by time on medicine, but I do enjoy having weekends again, and seeing my husband and cat on a somewhat regular basis. 
I knew I wanted to be a doctor since high school and always thought I would go into pediatrics. Working at Disneyland, summer camps, children had always been a passion of mine. As I went through medical school, I became interested in other areas: Neurology, Pathology, Dermatology. As I finished up Ob-Gyn and started thinking about my next rotation, pediatrics, I became excited again.
“Kids are not small adults” was the first thing they told us on day one of peds and man was it true. The awesome thing about peds is that every patient is entirely different and must be approached differently as well. The newborn exam is completely different from the 10 mo old exam, the 7 yo well child check up, or the adolescent check up. Each one has different medical and emotional needs and each one has different abilities to be involved in their own medical care. Each patient was a new experience for learning and kids are just plain awesome. How can you not adore a patient who tries to eat your stethoscope?
Kids are a naturally healthier population of patients in general which is nice. You don’t usually have to balance a long list of diseases and medications. The things that they do come down with are also generally different from those of adults: mostly infectious diseases vs. chronic diseases, asthma, allergies, ect.
I spent the first half at the Harriet Lane Clinic where I did Outpatient care (kids coming in for immediate problems like a cold, rash, ect. or well child care). The days were crazy busy and I worked about 12hrs a day, but no nights or weekends which was nice. I saw all sorts of cool things: scabies, bed bugs, hand foot mouth disease, various genetic illnesses, among other things. Coming off of Ob-Gyn, I was much more comfortable with adolescent kids than even most of the other residents, so if a kid came in ages 14-21 it was called a “Tiffany special”. I spent many hours giving teens literally bags of condoms and discussing all the different birth control options. I really feel like I had the opportunity to make a difference in these kids lives. It was a very humbling experience. The newborn exam was also a lot of fun. They are so small and dependent it’s quite extraordinary and it was awesome to be able to help out new parents and be able to tell them that its okay and even necessary to take some time for themselves.
Pediatricians are great people to work with. They tend to be very nice, kind people. Doctors tend to be very busy, overworked, and extremely stressed and that tends to make a formula for not the most pleasant people to work with. I never got this vibe from any of the Pediatricians I worked with. They were all so supportive and passionate about their work, it was a great environment.
The second half of my rotation, I went to Howard County to do pediatric inpatient service. My typical day was to get in by 6-7am and pre-round on my patients. This means I check up on anything that happened overnight, vital signs, how they are progressing, perform a physical, and speak to the patient on how they are feeling and make sure they understand the plan. We then presented the patients to the attending physician and discussed the plan for the patient and saw them again together. It was a great learning experience. I saw kids with croup, abcesses in their throat, babies with jaundice, difficulty feeding, ect. It was an amazing learning experience. When we were done with the inpatient side, I would go across the hall and work in the pediatric emergency room. Unlike the adult emergency room, I didn’t see a lot of stab or gun shot wounds, drug overdoses, or heart attacks. Mostly it was kids with broken bones, cold symptoms, asthma attacks, high fevers, and things of that nature. The case which sticks out most in my mind are a little girl who came in with balance issues. She couldnt walk straight or stand up well on her own. Other than that, she had very little symptoms. MRI of her head showed no evidence of trauma or internal bleeding, but did show a very subtle darkened area near her cerebellum (part of the brain responsible for balance) that looked abnormal. In fact, the radiologist read her scan as completely normal. The only reason we picked up on it is the ER doctor I was working with was stressing to me the importance of reading all of your own films first before you jump to the radiologist’s report when he noticed it. We went back to the radiologist and they admitted that they had entirely missed that abnormal area. If the ER doc hadn’t read the film themselves, that little girls brain tumor would still be undiagnosed and could have been inoperable by the time it was finally discovered. Fortunately, it ended up being benign and the fantastic neurosurgeons at Hopkins were able to completely remove the tumor.
I got to do all sorts of awesome things like stapling head wounds, sewing up lacerations and reducing dislocations. The coolest thing I got to do was this 17 year old kid was at a concert at nearby Merriweather Post and came in after another kid elbowed him in the face. The kid had braces so fortunately (or unfortunately) the four dislodged teeth were hanging in his mouth by his braces, rather than being swallowed by him or lost at the concert. When we called his orthodontist, he told us to put the misplaced teeth, back up into his sockets and he would repair them the next day. The stiffness of the wires meant that I needed to use pliers to grasp the teeth and shove them, one by one, back into their respective sockets. I was nervous, but tried not to show it. I numbed his mouth, grabbed the pliers, and went to work. It was hard because of all the blood, but I was ultimately successful! It was pretty nasty!
My time at Howard County was some of the best of my life in regard to medicine and can see myself working in a place like that. Pediatrics is definitely still in the running as far as potential future specialties go.
So, I realize that I’ve been “back to school” for a while now, but life has been so crazy that I haven’t had much time to blog about it. It was a strange transition from finishing up my Ph.D to beginning medical school again. During my Ph.D, I spent 3.5+ years becoming an expert in a small field of science. Presumably, no one in the world knew more about my subject that I did. I was consulting multiple labs who were starting to work with macrophages, and things were great. Then I started medicine. I remember basically nothing from my first two years of medical school (or so it feels like sometimes) and I’m coming in to an already formed class full of people four years younger than me; some of who I taught histology to during my Ph.D. Needless to say it was a bit awkward to begin with.
I started back with Ob-Gyn. Most people laughed when I told them this, and now that I am finished with my first rotation, I know why. Ob-Gyn has a reputation of being somewhat an unfriendly and intense rotation. The benefit is that it is somewhat of a mix between medicine and surgery in a very limited way, so its good for the experience. I found that the residents weren’t unfriendly but were overworked. Some, in fact, were quite friendly, but it was hard for them to find time to teach us a ton. I quickly found out that I as a student, am relatively useless. That was a hard first reality. I had never done any of the procedures before and came in with no real knowledge of the subject. We rotated through 2 week rotations for a total of 8 weeks. There was a definite trend to the rotations. I was lost at first and slowly became more useful. Just when I was starting to get the hang of what was expected of me, we switched rotations and I was plunged into a brand new area that I knew nothing about, and the process repeated.
At the end of the day, I’m sure most of my younger counterparts had similar experiences, but it was definitely tougher than I thought it would be. As I Here are some of the highlights and lowlights of my ob-gyn experience.
The hours were variable, but mostly pretty rough. Especially when on labor and delivery nights. Jed and I NEVER saw each other during that week. I literally left for work before he came home and got back after he left for work. That was a rough week. It was a particularly rough rotation because I felt so alone. I didn’t really know anybody and it was tough to go through this without being able to talk to anyone who understood about it. For example, I lost a patient on the gynecologic oncology service. That was really hard for me and was the first patient whose care I was involved in who died. I came home and dumped on Jed a bit, and he handled it as much as he could, but he couldn’t really understand. The residents were all business and didn’t really have time to talk.
On the other end of the spectrum, I ended up enjoying the rotation more than I thought I would. My reproductive endocrinology and infertility rotation was awesome. The people were amazingly friendly and helpful and the rotation in general was awesome because we were helping people realize their dreams of having children. On the same note, one of my favorite experiences was labor and delivery. Getting to be a part of what could be considered the most important day of some one’s life was such a harrowing experience. Delivering a baby was truly a miracle. The first 10 to 20 seconds were terrifying because they come out blue and not really moving or screaming, but after that, they turn pink and mostly are very healthy after that. We immediately hand the babies off to neonatology and tend to the afterbirth (which is as gross as it sounds). I frequently found myself sneaking a peak over at the baby.
Fortunately, my next rotation (which really began yesterday-6/4) is Pediatrics which I think I’m going to love. Already, its been much better, partly because I’m much more interested in the subject and partly because there are like 4 other MD-PhD’s with me which makes a HUGE difference. I feel like we really have each other’s back. We are currently talking about getting a guide together (or rather finishing Azana and Jordans guide) for the transition from the PhD to MD and the third and fourth year of medical school. I’m really looking forward to my Peds rotation. Its what I came into medical school thinking I was going to do. Let’s see if I can put my Disneyland experience to any use. I’ll try to be good at updating on how it’s going.
This year, Johns Hopkins is instituting its enormous revamping of the medical school curriculum. This means that I will be in the pilot group of students trying it out. It also means that I’m going to get a bit screwed in the process since I did my first 2 year of medical school under one curriculum, and will be doing the last 2 under another. The old curriculum was particularly student-friendly in that students could choose when they would do their basic clerkships (medicine, OB-Gyn, pediatrics, Emergency, surgery, pyschiatry-neurology, ambulatory) at any time during the 3rd or 4th year, so long as they completed all before they graduate. This allows them to experience electives (any other specialty, basically) during their 3rd year, in time to gain enough experience to make an informed decision as to which specialty to pursue. The new curriculum now dictates that all basic clerkships must be completed during the 3rd year, and only 1 block can be taken for electives. This means that if you don’t happen to like the one elective that you took in your 3rd year, you have to wait till your 4th year (after you have begun to apply to residency programs) to take another. For example, if you are interested in Dermatology, Radiology, and Anesthesiology, but unsure how to decide, you can only pick one to do a rotation in before you have to apply to residencies. Don’t like that one? Oh well, hope you like one of the other two.
There are a variety of reasons for this. One is that when 4th year students took basic clerkships, they pretty much already decided their specialty, so it is hard to engage them in your subject when they’ve already decided against it. This is the best one I’ve heard, that isn’t exactly my conspiracy theory.
My theory is that Hopkins is trying to push us medical students into primary care specialties such as internal or family medicine, pediatrics, ob-gyn, ect. By not giving us a chance to experience an “elective” specialty, it ensures more will go into the ones they have experienced and have had time to prepare a strong resume for. While I understand the need to do this, maybe 10% of Hopkins graduates went into a primary care specialty when my med school class graduated (not uncommon), I feel that rather than force us into it by limiting our options, we should be working to increasing the incentives to go into a primary care field. Helping humanity at ridiculous hours and poor pay doesn’t pay back the 300K+ worth of loans you racked up in med school alone. I hate for it to come down to that, but it does. However, you tell students that you’ll pay off their loans or even a good portion of them if they go into primary care specialties, I guarantee that you’ll people flooding into to them. I really just bristle at people telling me what I can and can’t be when I grow up, even if its just by making those other choices less available. It is the start of an extremely alarming trend, in my opinion.
I had my latest thesis meeting last month and my committee gave me the green light to graduate from my PhD in March of 2010. This was great news because it means that I will be able to return to 3rd year medical school at the same time as the now 2nd year class will be entering 3rd year. This is strategically good for me because we will all be starting at the same level theoretically, so they won’t have more experience than I do.
In order to schedule my return, there were quite a few people I needed to talk to. For starters, I needed to inform the coordinator of the MD-PhD program of my return, so she can switch my payroll from graduate, back to MSTP (medical scientist training program) funding, which is a different source. Then I needed to speak to my graduate program coordinator to see what was required of me before I finish (which is quite a lot- I’m sure it will be its own post) and what paperwork is necessary to be done. I also needed to talk to my “College” advisor (the medical school is broken up into different “colleges”- sort of like the houses in Harry Potter) to help me understand and maneuver the new curriculum (I’ll post on that next- 
) and to help me schedule the next two years of my life. In addition to him, I had to meet with the student liaison and residency coordinator for dermatology to help me schedule my next two years assuming an interest in eventually applying to dermatology residencies. Needless to say, my last three weeks have been filled with meetings. While I am excited to complete my PhD and return to the MD, I find myself a bit overwhelmed by the amount of sheer bureaucracy to do so.
I’ll try to keep you posted on how things are going.
