The absent-minded medical student

Photos

2011-11-21T01:25:00.003-05:00

I just heard the my photo post a few weeks ago may have been buried. My most recent photos, including newborn photos of Masato are now in the most recent album.

https://picasaweb.google.com/jones.jefferson

First few months of San Diego

2011-10-17T00:11:00.002-04:00

My intern year of residency is very busy. It leaves me little time to blog. So here is a quick summary:

Pics

https://picasaweb.google.com/jones.jefferson

Masato was born on August 11th.

We have had visits from all the grandparents. Father-in-law will be here the longest. We also were visited from the Milonas's. Trips include many pool trips (there is one in our community), the beach, the Safari Park, the zoo, pumpkin patch, and others.

I have been rotating on inpatient and outpatient pediatrics here in San Diego. It has been a lot of fun and very busy. I like all the other residents that I work with, especially the ones that are the same year as me.

San Diego really has close to perfect weather. I bought an electric bike to help me get to the extra far places on huge hills without sweating too much because it is bikeable weather every day here. We miss family of course but the are itself is just beautiful.

We lost this gamble

2011-08-07T23:45:00.002-04:00

Keiko's mom has been visiting for the past 10 days. Se said she could get a max of 10 days off work. Keiko thought the most important thing was for somebody to be around when Baby M is born. I have 2 weeks of vacation (started last Fri) to help once we get back to the house. So we had to guess which 10 days are most likely that Baby would be born...

...

Unfortunately, tomorrow, Keiko's mom goes home and no baby has arrived. Since Keiko wanted her to be here for labor more than anything, we just had to guess. That's the way these things go.

The absent minded pediatrics resident

2011-08-01T00:24:00.003-04:00

Finally, school is over. I have finally finished medical school (and grad school) and become Jefferson Jones, MD/MPH (masters in public health).

We have moved to San Diego to start residency at UCSD. We are having a great time. The weather is perfect every single day.

Pictures and movies have been updated. Since I am a resident, I have little extra time for blogs but will try.

There are some super cute videos of Taisei on Keiko's youtube page. He enjoys singing and dancing these days:

http://www.youtube.com/user/jklohana#p/u

Pictures:

https://picasaweb.google.com/jones.jefferson

Sum of Bolivia trip

2011-05-10T19:57:00.002-04:00

I am back in the US. This is more for my records. I had to write this as an evaluation of the course. It is probably boring to read, but this is my best place for recording information like this.

Depending on the rotation, I arrive at the clinic or hospital between 8 and 9 am. Until noon or 2 pm I worked with an attending physician. There were days where it was outpatient and days inpatient. On outpatient days, I would often conduct the entire physical exam and report my findings. The attending would sometimes confirm my findings and sometimes just take my word. I only took limited histories from the patients. At times I would assist with the patient records. On inpatient days, I would participate in rounds. I would play the same role as Bolivian medical students. I would usually just participate in discussions and answer questions that the attending asked. I would receive topics to research and present the following day. Only rarely did I receive patients to do history and physicals on who were inpatients.

All physicians ended their day from about 12-2pm and went home for lunch. I would always do the same. I then had 2 hours of Spanish class in the evenings, which would sometimes focus purely on medical spanish, practicing doing histories in Spanish, etc.

The main hospital, Hospital del Nino, was about a 30 minute walk away from my homestay. There were optional other clinics and hospitals which were further. I spent one week at an adolescent clinic service which was a 1 hour combined walking and public transportation commute.

The dress code was very casual. I usually wore khakis and a short-sleeved collared shirt with my white coat as did most other foreign medical students. Bolivian medical students were casual with jeans and sweatshirts with white coats. Attendings were more formal with shirt and ties, slacks.

The attendings were quite attentive. They were always quite busy but all of mine would take the time to answer questions whenever I had them and were very kind. Most would try to find teaching points, give out handouts, and were overall excellent teachers.

The biggest challenge for me was the language. This was the reason I went but my participation was limited by my lack of language ability. My language skills did improve over the month, but I never was able to the point that I could understand all of what was said by the patients or inpatient medical teams.

My first 2 weeks I worked with Dr. Velasco in the depat of pediatriac infectious disease at Hospital del Nino. It was a combination of inpatient and outpatient. The majority of patients were pneumonias, RSV, and other diseases simlar to the US. I did see some disease less common in the US including leishmania, pulmonary and mengineal TB, and ITP.

The 3rd week I worked at the adolescent services clinic. It was mainly a prenatal care for poor, single females aged 16-25. It was primary care on the ground. She spent a lot of time working on prevention of future pregnancies, STD, etc.

The last week I returned to Hospital del Nino working in the pulmonology unit. The attending was a leader in South America for taking care of kids with down syndrome. On our outpatient days, we mainly did normal well child and sick visits for kids with down syndrome rather than a pulmonology clinic. The inpatients were nearly all various types of pneumonias.

I believe this experience will help me in 2 main areas. The first is with my Spanish. I think it has made a huge difference in getting me to a level that I will begin to be able to improve my Spanish by talking and working with patients during my residence and afterwards rather than just no understanding anything and making no improvement. Knowing Spanish may be quite important in my future career goals, as I wish to work with the underserved. My residence is in San Diego, where Spanish is very important and in the future, Spanish will continue to be important to work with underserved Spanish-speaking populations in the US.

The other main area was being able to experience a health care system with limited resources. I can have numerous examples where the care differed than that in the US because of constraints on resources. Some of them were unfortunate, such as the lack of care for most kids with cancer due to the lack of insurance for cancers. Others were good examples of using less expensive but effective drugs, diagnostic techniques, and other choices that would be good examples to physicians in the US.

Adolescent Services

2011-04-22T12:37:00.000-04:00

My 3rd week was spent at the adolescent services. It is a primary care clinic for 15 to 25 year olds. It ended up being a good review of obstretrics. 90% of the patients we saw were pregnant. It was really great primary care in the trenches. The Spanish was better for me than at the hospital because it was less technical and will likely be more useful in the future. By the 3rd day, I was largely doing the physical exam, vitals, doppler, etc. while the doctor wrote the notes and interviewed the patient. I didnt see any crazy diseases not in the US but quite enjoyed my time seeing a clinic in Spanish.

There were a few differences I saw from the US. They were much more quick to diagnose a disease and give medicine. Nearly all pregnant women with vomiting were diagnosed with hyperemesis gravidarum, a disease of vomiting too much during pregnancy. I rarely saw it diagnosed in the US and have not heard of much medication being given for pregnancy related nausea, but at this clinic anti-nausea medication was given to most people with nausea. Similarly, nearly every pregnant women with a headache (none of whom had any symptoms of a runny nose or cough) were diagnosed with sinusitus and given antibiotics. Vaginal discharge was given a slew of medications to cover yeast, bacteria, and STDs because they didnt have a microscope to diagnose if there were any disease at all.

I cant judge, especially since they have much lower rates of antibiotic resistance.

Next week I will do pulmonology.

Weekend of soccer and Tiwanaku

2011-04-21T12:20:00.002-04:00

Facebook pictures are up. I was able to fill this last weekend up with some cultural events, both old and new.

I took a trip to the old capital of the Andean region called Tiwanaku. It is thought to be the most powerful city from roughly 1000 BC to 1000 AD. It was a economic and religious center. It is thought that human sacrifices of the gruesome type were performed. A lot of the buildings and statues were destroyed by the Spanish to "modernize" their cultures. They used the stones of the temples to build churches and beheaded statues, etc. Academics still dont understand how they built a lot of the large temples with the techonolgies at the time.

I personally had a great time as I really haven´t had much experience with ruins this old.

The next day, I went to a soccer game. There are 2 teams in Bolivia, Bolivar and The Strongest. They were playing each other making for a big rivalry so some of us students decided to go. We got about the best seats in the place for 10 dollars. I bought a jersey for 5 dollars and of course routed for that team, Bolivar. Bolivar did win so it was a good day. The ends of the stadium held the hard core cheerers that were constantly singing, jumping up and down in unison in support of their teams. While certain areas of Souther America are a little famous for violence at soccer games, Bolivia seems to be pretty tame. I was surrounded by families with little kids. It was an excellend venue.

Next trip on the schedule: Uyuni salt flats.

Weekend in the city

2011-04-13T16:19:00.000-04:00

I didnt take any trips last weekend, so I stayed in La Paz. I like having time at my homestay so I have time to chat in Spanish with my host family. They are extremely nice and have the patience to work with my Spanish. My host dad has a house out a ways from the city that he is building, all by himself. It is very impressive. He is making the cement pillars for support, buying and shaping the iron girders, planning the whole thing out. He was a civil engineer when he was working. So we took the form of public transportation out their and gave it a look. Hen then showed me around the touristy parts of the city that have all the markets for souvenirs, the giant old church (St. Francisco Cathedral), while we were looking for some parts for his house. He really likes oldies so we watched some dvds that he has of some of his favorite artists: Paul Anka, Enrique somebody that apparently was the Mexican equivalent of Paul Anka, and The Platters. I know my dad would have had a good time joining us that evening. A quick note about public transportation. Traffic is so bad here that I cant imagine owning a car here. The roads are constantly congested and as I mentioned in my last post, the traffic laws seem flexible. Similar to many countries, most of the public transportation is conducted by vans that fit a lot more than they look like they would. They are only about 25 US cents to take. There are a few busses that are even cheaper. The vans look like they will stop in the middle of the road any time someone wants to get on or off. There really is only 2 things that I am not a huge fan of in Bolivia that I have experienced so far. Littering, and honking. I have personally witnessed littering a number of times, people just throwing packages on thr ground or out of their car. I heard it is just common here from people who live here. Its not something I can understand. Honking here is soooo common. Everytime traffic causes a car or 20 to stop, every car just honks until it goes, which is pretty much all the time. Honking has lost all meaning in this city as it is just one honk after the other, as far as I can tell. But dont get me wrong, I like many and most things about this city and country. On Sunday, I went to the local Latter-Day Saint church. Someone here told me that Mormonism is the second most common religion here, next to Catholicism. I would believe it, as I saw some LDS churches in some very rural places on my trip over 1 week ago. The church I went to was huge. I arrived 30 minutes early, but ended up being later, because I found out I was waiting in the wrong chapel. They have 2 entire chapels and churches in 1 building to accomodate more people. I could only understand bits and pieces, but I had a good time. There are always lots of nice people at church. One of the biggest differences was timing. I had heard that punctuality isnt stressed in much of Latin America. People slowly streamed in at the beginning of church and I dont know if it is normal, but we ended a good 30 minutes late. That being said, I look forward to going next week if possible.

Pictures

2011-04-12T16:46:00.001-04:00

I have taken most of my picturew with my phone and with my laptop acting funny, I have had to rely on my facebook app to upload pictures. Here is a public link. http://www.facebook.com/album.php?aid=2321810&id=2410201&l=ac7617ef91

Week 2 in hospital

2011-04-12T15:51:00.002-04:00

I have seen some new and familiar diseases in the hospital this week. We see a bit of HIV and TB. I have seen these before, but the main difference is how advanced they get. I think it is because these diseases are often picked up sooner in the US. People that live in rural areas have a harder time making it to hospitals. I have heard of and seen patients that have relied on traditional healers which has delayed the doctor visit. Here is a list of traditional beliefs that was given to us in a talk by one of the Boilivian doctors. (disclaimer: this talk was given in Spanish and is my translation, take it for what its worth) This is not a list of bad beliefs, just of beliefs. However, some of these do not improve the health of the Boilivian population. 1. To take and rely on herbs and teas, different ones for different types of pain. I believe chewing on coca leaves is good for stomach pain. 2. To take herbs and teas to get a baby to be born sooner. 3. I am not positive on the translation, but toss a pregnant women around by putting her on a blanket and throwing her up and and down to help the baby. I didnt understand the Spanish on how it was supposed to help the baby. 4. No bathing until 45 days after birth for the mother. 5. No light or sunshine 45 days after the birth. I think this has something to do with evil spirits. 6. Wrap the baby very tight with multiple layers. 7. Do not cut the baby`s fingernails as it has a connection with them becoming robbers. 8. Calling on spirits of dead people for help. 9. Using massage on particular points of the body to relieve stress and pain. 10. The mom makes all the medical decisions and gets all the respect and honor. There are times that I hear diseases as a possibility, or on the differential, that we would not consider in the US very often. We saw a cyst on an xray, and the doctor thought it could probably be a hydatid cyst, a type of parasite. I saw a little girl recovering from leishmania today, another type of parasite I have only read about. Today is Childrens Day in Bolivia. Per my little Internet search, it said it was to highlight the exploitation of children and declare their rights since many children are forced to work at very young ages, etc. What I have seen is a lot of balloons and clowns and games throughout the city. In the hospital, we were visited by famous soccer players from the top soccer team in La Paz, clowns, and people in zeebra costumes. One of the players I had seen on tv the previous week. I clearly was not as excited as the Bolivian medical students who knew them well, but it was fun to be a part of. A quick random fact: in Boilivia, the traffic is crazy. Lanes seem somewhat optional, like turning left from the right lane, red lights also seem optional. And there is often no stop in traffic so you just kind of have to cross the street when it seem the most possible or when there are so many cars they are forced to stop. I kind of try and stick close to a Bolivian person and do what they do. The government or somebody recognizes this and since they apparently refer to the striped crosswalks as zeebras, they have these volunteers in zeebra costumes control the traffic. I saw a car stop in the middle of the crosswalk after the light was red, and 3 zeebras surrounded the car and kind of waived their flags and shook their heads. I have to say, I like it.

Night out on the town

2011-04-10T16:21:00.000-04:00

I decided to join some other students who went out to a restaurant that has live music and dancing, traditional style. It was very entertaining. The first half was traditional Bolivian dancing. It is somewhat similar to Spanish and Mexican dancing but has its differences. I heard it can be called Andean dancing, as a lot of the culture comes from areas surrounding the Andes Mountains. Very fanciful costumes were probably the most unique part. Other students took pictures which I will try to get soon. At times, they invited us up to join the dancing, which I was able to take part of. The second half was a live band. It was 4 guitars of diffent sizes and drums. They were all very good and did great harmonies. Much of the crowd was from Latin America and knew a lot of the songs that were played. Our table of North Americans and Asians was a little more quiet as we couldnt sing along and did not understand all of the jokes, as everything was in Spanish as you would expect. They would ask where everyone is from and play some songs from your country. They played Only You (the old romantic song) and some Elvis for the US. I really enjoy being home in the early morning and evenings because that is when my host parents have time to chat. I am trying to balance getting out and seeing the city and enjoying some Spanish with my host family.

Patient log

2011-04-09T16:11:00.002-04:00

As part of our program, we are asked to keep a blog of our experiences in the hospital, including the types of patients that we see. Since I already, have a blog, I am just going to add it to my personal one. I have spent 4 days in the hospital so far. I spent it in the division of infectious diseases. I am hoping i will see some cases that I wont really see in the US. I have seen and heard of patients in the hospital that I hadnt seen in medical school. For the most part, the hospital is fairly similar to US hospitals. I have been going to the main referral hospital for children in Bolivia. At this time of the year, they are beginning to enter winter, and have a lot of bronchiolotis-RSV patients, a viral infection of your smaller airways. There are also patients with meningeal tuberculosis, adenitis, pneumonia, and some other infections. We had a grand rounds (basically a presenation in the auditorium for all pediatricians) where they discussed a case of rheumatic fever. When you get strep throat and it isnt treated, it can turn into rheumatic fever, which is a serious infectious that can effect the heart, joints, skin, and other parts of the body. That is the main reason to treat strep throat. It is very rare in the US. We also had a referral for a little girl who has bruising all across her legs for no reason (there is no suspect of abuse), called purpura. We just found out her platelet count (the part of the blood that keeps us from bleeding) is normal. I gave a little presentation in Spanish on what can causes this and on a benign tumor we saw called a nevus sebaceous. There are times that I understand most of what is being said and there are times that I understand nothing. The times that I understand most is when they are discussing a topic that I already know about. I have the most medical experience out of all the students here so they often discuss topics that I already know. Overall, my Spanish is slowly coming along. I can often carry 1 on 1 conversations about simple topics or medical topics, but that is about it. My grammar is decent, but my vocabulary is not too good since I havent really been studying for too long and havent taken formal classes where they pound new vocabulary. I have noticed enough progress to not get discouraged at least.

Weekend trip to the island of the sun

2011-04-07T15:52:00.002-04:00

Over the weekend, I joined a couple of other students on a trip to a place called Copacabana. There are a few in the world now, but the first was in Bolivia. It is a popular tourist location with lots of restaurants, shopping, and it is on the water and a beautiful location. I am afraid the camera I brought wont turn on so I am using my phone for my pictures. I cant find an easy way to upload them to picasa, so I am just using facebook for now. I uploaded a bunch of the photos on facebook, so for those with access, feel free to take a look. We spent most of the time travelling as it was a little far for a 2 day trip, but the travelling was full of natural beauty. I am in a place at a very high elevation. There are lots of lakes, fields, and snow covered mountains. We took a bus and a boat to get to Isla del Sol, or Island of the Sun. According to Incan tradition, this is where the sun was born. We were able to see an ancient Temple of the Sun, which was built about 1250 AD. The oldest ruins were built in about 2200 BC. I will post more pictures once I get them from my friends. There are many islands in the area. It is in the famous Lake Titicaca, which gets its name because it looks like a puma hunting a rabbit. It is the highest commercially navigable lake in the world. The islands are all very and to use them for farming, they built terraces into the sides, like giant steps. It was said to have taken hundreds of years. Unfortunately, it still didnt work very well and most of them are not used today.

Eating in Bolivia

2011-04-01T12:13:00.000-04:00

So far I have loved the food here. There is a fair amount of fresh fruit and vegetables used and always a lot of flavor. Breakfast we usually have milk, tea, and bread. The bread here is not bought in loaves but in separate pieces, kind of like rolls but flat and a little larger. Sometimes we have eggs. My host mother always makes fresh juice with her blender. My host family eats quite early as they leave for work from 6 to 730 am. Lunch is the biggest meal of the day. It is often a little late, from 1 to 2pm, and is very large. It is one of the biggest cultural differences that is easy to see. Most people return home from work and eat lunch with their family, and return to work later. All of the offices I see have office hours from like 8 to 12, and 230 to 6. It is a given that there is a break for lunch. We have had several different items, some familiar and some knew. There is almost always a salsa type of spice that we can put on. It is homemade salsa and is delicious. The spice level may be too much for many Americans but for me it is often just right. They dont use too much meat either. It seems to me a fairly healthy diet. Dinner is light, often just some bread or leftovers from lunch. I have been told that due to the high altitude (we are up in the mountains) it is hard to digest at night. For me, I always like a large lunch and light dinner any ways since my stomach feels better that way in general. I have to say, the food and eating schedule seems a great fit for me.

Hola from La Paz, Bolivia

2011-03-31T11:56:00.002-04:00

I have arrives safely in La Paz, Bolivia. It was a bit of a wild week to get from Japan to Bolivia. I got a high fever the day I was supposed to leave but managed to keep it down with medication to last me through the flight. As soon as I arrived in the US, a stomach virus manifested itself and kept me bedridden the whole time I was in Seattle. I managed to recover just in time to go to Bolivia but could have used some more time to rest and prepare. It is not easy to get to La Paz from Seattle. I had 2 layovers on the way there and will have 3 layovers on the way back. My last flight was delayed about 4 hours (in Miami). 1 week with 2 time changes and 2 redeye flights has left me a little disoriented but that is just improving now. I am in Bolivia for 6 weeks to study Spanish so that I can be more prepared and be able to take care of Spanish speaking patients as soon as possible. If I recall correctly, the childrens hospial in San Diego has upto 70% Spanish speaking patients. Unless I want to rely on a translator every day of my life, I better get some Spanish skills. I have always wanted to learn Spanish and am excited of the prospect of being fairly fluent by the time I am done with my 3 years of residency in San Diego. The program is through a organization called Child Family Health International. I chose this program because it combines Spanish school with working time in a childrens hospital. It has a great reputation. Northwestern University even offers funding to train in a developing country. This week I am purely working on my Spanish and starting next week I will daily be spending time in a pediatric hospital or clinic. I am staying at a homestay with a family of 4. They are roughly the same age as my family with a daughter and son who are my age. They are extremely nice. I have formed somewhat of a routine where I chat with the father every morning and evening. He has the patience to work with me through my elementary Spanish. Luckily, Spanish has so many similar words that we are generally able to have concersations on fairly complicated topics. Since I have mainly been using the Internet and mp3s for studying and have had relatively little speaking experience, I am able to say far better than understand. I hope that my listening and uderstanding skills will make vast improvements over this 6 weeks. I have my own room but will get a roommate this Saturday, another student of he same program. I am fairly old for the program as I think most students are either premed or early in medical school. It is of course hard being away from Keiko and Taisei but this is kind of a trial for us. I can see myself in 2 jobs with very different schedules in the future. Many public health jobs require long periods of travel but while you are home you work a fairly regulated 40 hr week, as they are usually government jobs. If I work in a university hospital then I will likely work far more than 40 hours a week, but will travel little. This experience may help me know if I can still enjoy travelling even with a family. Keiko keeps me updated with pictures and videos. They are having a great in Japan it seems.

Farewell Japan

2011-03-31T11:48:00.002-04:00

I had a great time taking it easy in Hiroshima for 3 weeks. I was able to spend more time with Taisei than I ever have, eat lots of good Japanese food, and try and prepare for Bolivia by studying Spanish. We met up with some of Keiko´s friends, went out to all of our favorite restaurants, did a bit of shopping. I love shopping in Japan. In America, I always struggle to fins something that is only slightly too big. In Japan, my size is always available and affordable. I started to learn the Japanese game of shogi. It resembles chess is someways, but has some major differences that made it fairly difficult to learn the strategies. Keiko´s dad is quite a big fac so I thought it would be a great way to spend some time together. He of course killed at it every time but I had a great time learning. I actually won once, but only after getting some hints and being able to take back some moves. I am a little hooked on it now, and have downloaded it onto my phone so I can play against a computer (who also usually beats me). Taisei really looks like he will walk soon, but it didn´t happen by the time I left. I am hoping he can put off his first step and first words until we meet up again in May. Hiroshima remains completely safe from radiation. However, just to be on the safe side, Keiko and Taisei may come back to the US early.

My destination for residency

2011-03-20T02:21:00.002-04:00

Keiko and I will be going to San Diego for the next 3 years. We are very excited. We are also sad that we will be away from any family. The residency and hospital seem as good as any in the country and I think Keiko will be very happy in San Diego. There are many Japanese people, it has wonderful weather, and I there is also a decent LDS population. I hope there will be some Japanese LDS members in the area.

We start around June 20th. I was pleasantly surprised to find about half of the 18 interns (first year residents) who will be joining me are male. Pediatrics is a very female-dominant field these days, but I have found that I get along very well with other males who choose a relatively low-paying specialty.

Rent appears to be pretty high and I think expenses will be one thing we will have to struggle with a bit. The rent in San Diego appears to be pretty high and a resident's salary is not much. I imagine we will have to live a little distance away and buy an extra car for commuting to be able to afford the rent for a family our size.

I'll post more as I learn more.

I'm off to the US in 2 days and will be in Bolivia in a week.

Impressions of being a doctor in Japan, the Japanese medical care system

2011-03-13T09:03:00.000-04:00

https://picasaweb.google.com/jones.jefferson/NonTaiseiJune2010March2011#

The last 7 pictures are of Keio University hospital.

These are the responses to a form I had to submit to my school after finishing my time in Japan as a medical student. It is a little detailed but for those interested, feel free to peruse.

I had a very thoughtful and detailed schedule set up for me before I arrived to the hospital. I rotated in the pediatric department. I worked Mon-Fri, 9-5pm on average. It was divided into 10 half day blocks. Keio has 3 pediatrics wards: the NICU/step down unit, hem-onc and cardiology, and general pediatric floor. I would generally show up for morning rounds and then would have a discussion or see patients for the rest of the half-day block. Many days had special conferences or meetings that I would attend. The schedule was very flexible so that I could change it as I wanted. I requested more outpatient time and was given several days to see various outpatient pediatric clinics. I requested to see the ED and was able to spend a day in the ED. On my application, I made it known that I was interested in infectious disease and public health. I was included in the weekly infection control rounds and weekly HIV rounds. I sometimes attended the infectious disease outpatient clinic, also. Every day was different so it is hard to describe the “typical day.” Regular rounds I attended were morning NICU rounds 1x/week, daily review rounds in the pediatrics general ward, and the most educational rounds were probably the teaching rounds that happen twice a week. Once a week the chief and associate chief of pediatrics each take a half a day and have most of the pediatrics patients presented by a student or resident to them and the rest of the rotating medical students. The professor then critiques the presenting and asks questions about the patients while making educational points. Other attendings and specialists are present to answer questions as needed. When a very interesting teaching point or something that no one knows the answer to comes up, the topic is assigned to a resident to present to the department later. I feel that these rounds were very educational and could be quite useful in America. Once a week (on Tue evenings) there is pediatrics teaching conference, probably the equivalent of grand rounds. Here all the assigned topics during teaching rounds are presented along with grand round speakers and other topics that come up.

Most visiting students are given living quarters a short walk from the campus. Since I brought a wife and child with me, we had to find our own living quarters. It was about a 30 minute walk from campus. The dress code is the same as most hospitals in America. White coat, dress shirt, and tie.

I was assigned a specific mentor during my time there. He was a pediatrics infectious disease specialist. He provided me with his home and cell number and went 110% to make sure I was comfortable 24 hours/day. He invited me to conferences that were in neighboring prefectures that he thought I might be interested in and paid for my train fare if we travelled together. He answered all my medical and Japanese medical policy questions, or referred me to someone else who could answer them. He created my whole schedule and adjusted it. Since I trained at the CDC, he even pulled some strings so that I could talk to people at the CDC equivalent at Japan.

At other times, there was usually someone there to help answer questions when I didn’t understand the language or just had something I wanted to know in each ward I rotated at.

Since I had studied Japanese for 10 years and lived there previously, my language made it possible for me to participate in rounds. I am not sure what adjustments are made for those with limited Japanese language skills. All physicians have English skills and there are a good proportion that have trained in America.

I did not get to see patients independently. You only can observe patient-physician interactions as far as I know.

My wife and I would love to live in Japan at some point. I wanted to find out what kind of opportunities there would be to work in Japan if I wanted to work there. I found out that I would have to pass the Japanese national board examination for medicine but if I did, I could probably find a job there.

There are some aspects of working in Japan that make it less appealing. Japanese doctors work very long hours. During residency, they have no days that they don’t have to come to the hospital unless there are special circumstances. The pay is significantly less than salaries in America, often less than half.

I am very interested and may be involved in public policy at one point so the following are things I learned about the Japanese health care system that may affect how I approach health care policy or possible practice in the future.

Japan’s healthcare program has become the standard for multi-payer national health insurance systems due to its consistently low costs, easy access to healthcare, and comprehensive benefits package. Ranked 10th for overall health system performance, 1st in level of health attainment, and 6th in level of responsiveness by the World Health Organization in 2000, Japan possesses among the longest life expectancies at birth at 82 years (2003) and highest per capita number of physician visits (WHO 2005). Moreover, Japan only devotes 7.9% of its Gross Domestic Product to health expenditures while simultaneously maintaining one of the highest computed tomography (CT) and magnetic resonance imaging (MRI) technology distribution rates per capita (WHO 2005; Yoshikawa and Bhattacharya 2002).

So how does a country with an aging population provide such great care and spend so little? I am not 100% certain of the answer, but I asked everyone I talked to. The government sets the rates of payment. Hospitals or insurance companies cannot change how much is charged for 1 hospital day or a medicine. These costs are extremely low compared to America. Going to the ER will usually cost a Japanese person $100-300. Some possible answers I heard were that Japanese people go to the doctor a lot. They are not afraid to go because they think they might be sick. Perhaps they get treated before diseases turn serious. Some physicians thought it was because Japanese doctors work for little money and long hours. Some think it is because hospitals are usually 8+ patient beds/room, they often have older technology and avoid high spending. There are no IV access teams or several different nurse practitioner specialists added to the work force. Another reason might be that there is universal health care. Medical care and insurance is provided to all Japanese citizens, regardless of income. A big factor is probably that Japanese culture is healthier in general. There is less obesity, the diet contains more fish and vegetables, and people walk (to the train station) and ride their bikes rather than use cars.

There are many things I experienced that made me wonder how they managed to spend so little. They keep patients in the hospital for very long periods of time, especially for end-of-life care. I’m not sure of the laws of DNR orders and such, but it seems very hard to impossible for doctors to pull the plug on patients. I was told that even if there is a DNR order, they could still be sued. So there are patients in the hospital for 16+ years, some in comas the whole time. Even for less severe disease, people stay in the hospital longer. Women regularly stay in the hospital for over 1 week after giving birth. 1 week is common for influenza or any common pediatrics infection. CT scans and MRI scans seem pretty common and easy to order.

They also order lots of medicine for everything. Anyone who has a cough gets special cough medicine that decreases the amount of fluid secreted by the airway. Every patient with influenza gets anti-viral medication. I was told that patients strongly desire medicine so they have to give something to them.

Strengths:

-Adjust schedule to student’s preference

-Excellent attending supervision

-Lots of educational rounds, meetings

-Heavy student involvement in rounds and discussions

-Good food in area

Weaknesses:

-Might be hard with limited Japanese skills

-Little patient interaction (if you stress you want more, you can get more though)

-Expensive cost of living

Schedule this week

2011-03-13T07:58:00.002-04:00

March 13th: Taisei's 1st birthday

March 14th: Keiko's birthday / White Day (Japanese holiday)

March 15th: When I wake up this day, I should have an email saying whether or not I matched to a residency program. It is Monday, March 14th in American time zones. I will not know which residency program at this time.

March 18th (17th in US): Email will arrive by the time I wake up that will inform me which residency program I will be working in for the next 3 years. Keiko says she already is feeling very nervous. Thankfully, it is still far enough that I am pretty calm at this point. I don't know if I'll be sleeping the night before, though. Update to come.

Japanese earthquake

2011-03-13T07:48:00.003-04:00

As many of you have probably seen in the news, there was a powerful earthquake this last week in Japan. It was in the northeast part of Japan. It affected Tokyo, where Keiko, Taisei, and I were a few weeks ago, but did not affect Hiroshima, where we are now. We have friends in the area and are making efforts to make contact with everyone to make sure they are okay.

In church today, most of the talks were on the earthquake. One mother was talking about her daughter who is on a mission near the epicenter of the earthquake. It was a very emotional and spiritual talk. Her daughter is fine. Some of my friends at Keio said there houses took some pretty bad damage. The statue of Moroni on the Tokyo temple made a 90 degree turn. Given the possibilities, I haven't heard anything too bad.

We are all feeling very thankful to have a roof over our heads, food to eat, and our health. Please send your thoughts and prayers and any other assistance you can to those in Japan. Thanks.

Overall schedule until residency starts

2011-03-09T09:02:00.001-05:00

My 4th year schedule:

July-November: Take all required courses to graduate. For Thanksgiving, 2 weeks in Baltimore/DC for interviews and hang out at Chris's place for the holiday.

December-January: Interview at pediatric residencies across the country. Spend Christmas in Seattle. Keiko and Taisei accompany me to southern California and Utah, but no place to stay in northern California.

End of January-February: Elective rotation at Keio University Hospital in Tokyo. Keiko and Taisei join me to live in a rental apartment in Shinjuku, one of the busiest places in Tokyo.
February: List of ranked pediatrics programs due

March: Spend first 3 weeks in Hiroshima with Keiko's family. Finish Master of Public Health paperwork and final essay. Study Spanish.
March 17th: Match day, the day I find out which program I will be training at for the next 3 years.

End of March: Return to Seattle for 1 week and prepare for trip to Bolivia.
April: A total of 6 weeks in Bolivia. Work at clinic and hospital and study Spanish.
May: Return to Seattle and meet Keiko and Taisei there.
End of May: Graduation, MPH presentation.

June: Move to pediatric residency location.

July: Start pediatrics residency.
August: Baby #2 is born.

Programs I interviewed at

2011-03-08T07:46:00.003-05:00

I don't want to say which ones I ranked at the top, so I will just kind of mention the programs I interviewed at and some thoughts I had in geographical order.

Seattle Children's Hospital, University of Washington: This is a fairly famous program. It is the only non-military pediatrics program in Washington and covers 5 states: Washington, Wyoming, Alaska, Montana, and Idaho. In fact, you spend a few months living in a rural area on one of these states during the residency. This is possibly the only program in the country that has this unique program. I had mixed feelings about it, but the residents all say it is one of the best experiences of the 3 years. It has a special global health and community health training. Many of the residents are older because they have done things outside of medical school to enrich themselves. My parents and possibly older sister's family live in the area.

University of California, San Francisco: This is a famous academic center. UCSF itself has a highly specialized center for sick kids on it's main campus. It is building an independent children's hospital, but won't be available soon. You also rotate through some community hospitals, including the main county hospital. It has a special program called PLUS, Pediatric Leadership for the UnderServed. You learn special leadership and management skills and have dedicated time for doing projects dedicated to the underserved. They also have a global health program. My interviewer was Japanese and gave me some connections of people to visit in Japan. They give the biggest living expense stipend and probably have the highest living expenses.

Oakland Children's Hospital: Not associated with any university. It has the main emergency room and is the only children's hospital for the bay area. Like other children's hospitals, it has a combination of rare and common diseases. Although I didn't know it at the time, one of the people who interviewed me was part of the same drum/dance group I did in college, Boomshaka. I can't believe it never came up.

Univ of California, Davis: This was one of the smaller programs I interviewed at, in size of residents. You rotate in hospitals in the area, but they are all very close. It is an academic center. It is probably the most afordable of all the places I looked at, living expense wise, located in Sacramento. It also has an EIS-trained attending who interviewed me.

Univ of California, Los Angeles (UCLA): An Academic center, fairly famous residency.. It is similar to UCSF in some ways. It has a very specialized center at the UCLA campus, but you rotate at several community hospitals in the area. It has subsidized housing which is easier to get if you have kids. It has a special community health program (CHAT). One of my friends from medical school is an intern there this year (since I took a year off for the CDC). One of the community hospitals is where movie stars from Hollywood would take their kids.

UCLA / Harbor County Hospital: This was also a small program. It is exclusively at the county hospital. Keiko is a little afraid of a county hospital because of watching ER, the old TV show. I was interviewed by a CDC-trained pediatrician here, too. At a county hospital, you generally treat uninsured patients, focusing on the needy. I would definitely learn a lot of Spanish. You probably get more independence than at other programs.

Children's Hospital Los Angeles: This is the children's hospital of the LA area, including the main pediatric emergency department. Fairly famous residency. It seemed very resident focused. It has a dormitory/apartment for the residents that is next to the hospital and very affordable. They are proactive with public policy. Residents were very nice and social. Heard that they work very hard, but the resident's at the program say they think that is a thing of the past.

University of California, Irvine and Children's Hospital Orange County: This is a combination of a children's hospital and academic center. Since it has a children's hospital, there are no need for community hospitals. However, next year will be the first year the 2 have been combined. They have been trialling it over the last year with good success. The children's hospital is very close to Disney Land and has many connections with it, including themes and visitors. You can see the fireworks from the hospital. They had an emphasis on a good balance of work and enjoying life and were very creative on how they treated us on interview day (we had an ice breaker including saying what is your favorite drink at a coffee shop, then the drinks appeared later in the day). Very enthusiastic residency director. Known a little for working hard and playing hard.

University of California, San Diego: This is a program that has a few hospitals, including an academic center at UCSD, the naval medical center, and the children's hospital in San Diego. Everyone I have ever mentioned San Diego to says what a wonderful place it is to live and they would love to go back. The residency director was extremely nice and seemed willing to go the extra mile for the residents. They mentioned they have connections with the local health department, the AAP (public policy group), and even biotech companies.

Primary Children's Hospital, Salt Lake City, Utah. A Children's Hospital that is independent but associated with the University of Utah. You basically rotate at the hospital. The rent is fairly cheap in the area. They have good AAP/policy connections. The chief of the infectious disease service trained at the CDC and does great research. They allow 1/2 day a week for research. I have a lot of extended family in the area and it's the only place in the country with a Japanese LDS church or ward. I liked the residency director a lot.

Northwestern University, Children's Memorial Hospital: Famous residency in Chicago. I went to this medical school and know the hospital well. The program goes out of its way to make it pleasant and social. They have bbq's every Friday for the first while and make sure all first-year residents are free to attend, even if they are on-call. While having rare diseases, the residency has a focus on service to the community and education to the residents. I know I like the residents well, because I have worked with them. Will finish a new children's hospital during my first year of residency.

University of Chicago: They have a new children's hospital. Work with a largely underserved population in South Chicago. Have a focus on creating leaders in pediatrics, including research, public health, and public policy. The residency director is very enthusiastic and humorous. They also probably get the award for best gift, a 2gb flash drive. While the University of Chicago has a reputation for overserious hard workers, the pediatrics residents seemed extremely nice and pleasant.

National Children's Hospital in Washington DC. Being in Washington DC, it is close to capital hill and the center of policy. They have a fairly large program in community health that gives time to be involved in policy. It seems very resident-focused. They will have formal education for the residents working night shifts. Also, my brother and his family live nearby.

My final rankings were from this list. There were some programs I got interviews at but cancelled, and some programs I didn't get interviews at.

Choosing a residency

2011-03-07T07:24:00.004-05:00

Now that I know I want to do pediatrics, I have had to find a residency. There are several things to consider when choosing a residency. Pediatric residencies have some unique aspects to consider. Here are the things that I thought about.

1. Geography: This is probably the most important thing that all medical students consider. In my case, I wanted to be in a place with family (Boston, Baltimore, Seattle, or Utah, recently New York) or at least near family. I also wanted there to be a decent Japanese community for Keiko. And as long as I can pick, I wanted it to be warm. Keiko definitely wanted a place to be warm. I'd get to use/learn more Spanish in southern California.

2. How famous is the program: There are some hospitals that are famous because everything is famous there and the programs are also good (Boston Children's with Harvard, Stanford, UCSF) and there are programs that are particuarly famous for children's programs (Univ. of Cincinatti, Children's Hospital of Philadelphia).
This matters to me because I want to do a fellowship. The more famous the residency, the more famous the fellowship for a pediatrics specialty you can get into.

3.Children's hospital: There are basically 3 types of programs I saw. Children's hospitals and academic centers/community hospitals.
At a program with a children's hospital, I generally only have to rotate at that hospital. If I live close, I can ride my bike or walk rather than buying an extra car. The hospital is clearly for children. Nearly all the doctors are specialized for children. The nurses and techs all know how to deal with children. There are Wii's and Xbox's, disney movies, murals on the walls, toys everywhere, ways to distract the kids to keep them from noticing needles, etc. The personalities generally fit with what you would expect. Also, they often have the main pediatrics emergency rooms so that you get good emergency training, which is something I value.
At an academic center, I usually rotate at 3-6 hospitals. One hospital is the academic center that has the rare diseases and very complicated diseases. Cancer, transplants, etc. But you also need to know how to take care of flu, asthma, upset stomach, so you visit other community hospitals that see less severe sicknesses. You learn several different hospital systems and patient populations so that you are prepared to have a job in any sort of environment. At a children't hospital, you learn how to work in a children's hospital.

4. The "fit": this is universally called the most important thing to look for. It is basically do you feel this program is fit to your personality or not. Will you get along with the residents? What is your gut feeling?

5. Things I personally look for: CDC-trained attendings, public health research, a connection to American Academy of Pediatricians including working on public policy, global health curriculum, are there enough guys in the program. Pediatrics is quite female-heavy. I prefer a program that is 1/3-1/2 guys as opposed to 1/20 guys. I'd also like to use some Spanish since I have been trying to learn it.

6. Other: insurance, salary, vacation, benefits. Some programs feed you every day so no sack lunches necessary. Keiko was a big fan of those programs.
How much does it focus on residents? Do they make sure residents treat patients that you learn from or do you treat the same disease over and over? Do residents control the treatment plan, or is done by fellows? Do fellows do the procedures or do residents?
Do they allow time for research or are you swamped with patient care you can't even study or read.

I didn't have this thought our in this amount of detail until I interviewed at a few programs. The next step is to rank the programs I interviewed at and upload them into the national system online.

Keiko's videos of Taisei 7-12 months

2011-03-06T21:37:00.003-05:00

There are just too many videos, so I am too lazy to put them on the blog and will just provide the link to Keiko's youtube site.

http://www.youtube.com/user/jklohana#p/u

View them at your leisure. I put this off for too long and she has described them in youtube for the most part.

Taisei 7-12 months

2011-03-06T20:04:00.003-05:00

So I know this is long overdue. The pics are already up on facebook. Keiko's blog (http://ameblo.jp/jkfamily/) has narratives for many of the pictures.

Here are the links to the photo albums on Picasa:

Taisei 7-8 months, last bit of time in Chicago:
https://picasaweb.google.com/jones.jefferson/Taisei78Months#

Trip to Baltimore/DC for interview and Thanksgiving at Chris's place:

https://picasaweb.google.com/jones.jefferson/BaltimoreDCTrip2010#

Taisei 9-10 months: Includes trips to Southern California and Utah for residency interviews and Christmas in Seattle

https://picasaweb.google.com/jones.jefferson/Taisei910MonthsSoCalSeattleChristmas#

Taisei 11-12 months: Time in Tokyo, including little trips in the area.

https://picasaweb.google.com/jones.jefferson/Taisei1112Months

Trip to Hokkaido, the northern most island (of reasonable size) in Japan to attend the Winter Festival:

https://picasaweb.google.com/jones.jefferson/HokkaidoWinterFestival2011#

Here are all my non-Taisei pics over the last 8 months, such as my pics of the sunset from out apartment in Chicago, picture of the drive from Chicago to Seattle (so much snow) when I moved last December, friends I met while interviewing, pictures from the plane of cool cloud formations, San Diego, Oakland, Tokyo, many pictures of Tokyo stores, my mentor at Keio hospital in Tokyo.

https://picasaweb.google.com/jones.jefferson/NonTaiseiJune2010March2011#

And here come the videos.

Taisei enjoys playing games, like being chased.

He has developed some lungs, which makes for a cute big laugh among other loud voices and sounds...

Taisei and the daughter of a on missionary companion.

Taisei likes to act real cute before bed and try and extend his bedtime.

One of his favorite things to do is rearrange the furniture.

Enjoying some swing with the Milonas boys.

More games with mom

Taisei-zilla destroying a village of cars in Seattle

Taisei loves his Grandpa Roush, who is probably the best person I have ever seen at getting a kid to sleep.

And here you see the magic at work

Enjoying the jumper in Seattle. It's the same way he dances to TV shows and mp3's.

A little tickle from mom:

Hand-slap game with "Uncle Ward"

And there are plenty more to come from Keiko's Youtube account. I'll get to them later this week.

Choosing a specialty

2011-03-06T01:12:00.005-05:00

As most of you know, I have had to pick a specialty for my career over the last 8 months. I had it down to 3 specialties:

1. Pediatrics
2. Emergency medicine
3. Radiology

My first 3 rotations of my 4th year of medical school were those 3 specialties. I liked them all a lot. I found out during my year at the CDC that I might not need to see patients every day to be happy as I enjoyed that year a lot. This means that radiology might be a good specialty for me.

Radiology was a lot of fun. The attendings and the residents are all very nice and all laid back. They are all very smart and incredibly important in modern day medicine to the diagnosis and daily management of patients.

The emergency department is a lot of fun. You have the enjoyment of seeing patients for the first time. No one knows what the actual problem is. You work quickly to fix them or admit them to the hospital. In most cases, you know what the problem is by the time they are done with the ED. You get to do procedures which is fun. I really liked seeing a patient, hearing what there problem was, and trying to get it fixed quick. If my team couldn't fix it, we sent them to someone who could and on to the next patient. You really feel like you are helping.

Then there is pediatrics. The attendings and the residents are generally the nicest of them all. Pediatrics, or peds, is generally a specialty that pays as little as any. A pediatrics cardiologist gets paid less than an adult cardiologist and a pediatric dermatologist gets paid less than the adult counterpart, etc. But there are several things that I like about peds. These are generalizations, not black and white facts.
-Kids are so cute. If you have to be at the hospital every day, it is nice to see cute kids every day. Even if they are sick, some may cry, but there are a lot more happy cute kids than you might expect. I get a lot of energy from that compared to older patients.
-I could be wrong, but I felt like there were more acute and less chronic problems. At least in my experience, more kids come to the hospital looking and feeling really sick, you make them feel better, and then they go home. Adults more often had problems where you patched them up until they return to the hospital next time.
-When you prevent a child from dying or becoming disabled, you are making a large contribution to society. That child will likely become a working adult in the economy and contribute many productive years. This is a little different than prolonging patients lives near the end.

A point for pediatrics versus emergency: I can always do a pediatric emergency fellowship later. If I want to do something besides emergency, it is difficult to do after an emergency residency.

A point for pediatrics versus radiology: I am very interested in global health, in preventive medicine, and public health. Radiology has a lot of potential but not a lot of opportunities currently. There is a good chance I might end up returning to the CDC and pediatrics is much more suited for a global health career. If I end up at a public health department or agency, a more general field like pediatrics would be better suited for looking at patients overall status. Also pediatrics has a shorter residency and lower pay so switching to public health wouldn't be as big a sacrifice.

If you can't tell I have chosen pediatrics. I realize I am giving up future salary and possibly working harder hours, but I am quite sure I will live with more fulfillment and happiness.

I am quite sure I will do a fellowship and specialize. The main possibilities are
1. Public health/global health, returning to the CDC
2. Pediatrics infectious disease
3. Both 1 and 2
4. Pediatric emergency medicine
5. Pediatric cardiology

Now I just have to match to a residency program.

Taisei 6 months

2010-10-03T21:17:00.002-04:00

Here is an update of pics and videos.

We had some professional photos taken at a lakeside park with the backdrop of the Chicago skyline:
http://picasaweb.google.com/jones.jefferson/ProPics6Months#

Here are the rest of our pics:
http://picasaweb.google.com/jones.jefferson/6Months#

And videos:

Soon to crawl?

Naked Taisei in a jolly mood

Taisei likes to dance whenever we take his clothes off:

You will have to take my word for it, but Taisei was loving the beat boxing before the camera went on, as he usually does.

He isn't saying anything yet, but he likes to hear the word "papa" the best.

For now, Taisei seems to like to keep his right leg straight as he practices crawling.

Very first solid foods. He doesn't like the first taste but seems to perk up after he swallows or something.

Taisei often stops laughing when he sees the camera so we tried a little hidden camera action

TICKLE ATTACK

Keiko's translated blog

2010-09-05T21:09:00.001-04:00

Keiko has gone through her recent blog posts and translated them into English, just for our American friends and family, so please enjoy them and turn on the fun. (inside joke)

http://ameblo.jp/jkfamily/

Taisei 4-5 months

2010-09-05T18:49:00.003-04:00

I finally have finished one of the more busy months of my life and preview of next year. It's called sub-i, or sub-internship, a month where you are supposed to act like an intern while you are a 4th year medical student. I worked 95 hours my first week and worked 16 of the first 17 days. My schedule has calmed down a lot since then.

Updates on Taisei:
-He got his first teeth, the 2 on the bottom
-He can move across the room! No, not crawling. He can roll over both ways, but only one way. This means that he continuously goes one direction so he rolls around the room.
(see pics for both of these)

Pics from the last 6-8 weeks: http://picasaweb.google.com/jones.jefferson/Taisei45Months?authkey=Gv1sRgCNqrtJKC3Lr5fQ#

There are 6 weeks of movies here, and I am too lazy to split them up into different posts. Highlights include:
-learning to roll over from back to front, then front to back
-starting to sit up
-Games and tickling
-Taisei's bathtub wiggle dance
-Japanese style pat-a-cake

This is a very long but hilarious video of Taisei just kicking around and laughing.

He can sit up with some support now. He's beginning to enjoy some of his older toys.

I wonder how long until he crawls.

Reading to Taisei. We do this every night.

I tried out "the claw" from Liar Liar and it worked pretty good.

Taisei likes to do a wiggle dance in the bathtub.

Taisei makes an excellent test subject of a healthy baby exam.

Keiko is excellent at making Taisei laugh:

Keiko playing with Taisei, who was in a good mood.

Taisei loves baby einstein. He'll watch a whole episode no problem.

Taisei has gotten quite ticklish (at times).

Throwing Taisei up in the air.

Blowing on Taisei's belly

Taisei loves to play with sheets. We give him a sheet or blanket in his crib and sleeps great. (we remove it once he is asleep)

This was about the first time he was able to roll over.

This was him learning to roll over from front to back.

Getting much better at rolling over now.

Taisei loves this Japanese game, kind of like pat-a-cake, "The Lost Kitten"

Taisei's first drink of water (for constipation...)

Taisei 3 months

2010-07-18T22:21:00.004-04:00

More pics and videos. He is laughing a lot more and becoming more interactive, which is fun for Keiko and I. My postings may become more scarce now that I'm in medical school which means there will be a bit of a pileup, so here is lots of videos.

pics:
http://picasaweb.google.com/jones.jefferson/Taisei3Months

Videos:
Taisei has become quite the talker. Here is 2 minutes of Taisei talking to his mom for about 10 minutes straight.

He also likes to talk when he is playing.

Taisei laughs at different things every day. (although those same things also become very uninteresting to Taisei randomly)

Keiko and I rotate reading to Taisei. One night is a Japanese book, the next is English. This video is Good Night Moon.

I thought it was Dad's job to make the kids laugh, but Keiko is much better at it.

Taisei has discovered his hands.

He loves playing (biting) with is oball.

Not quite 4 months, and already turning over... sometimes.. and he can only do it when he has no clothes on. But still, that's a lot of weight to turn over.

He is just learning peek-a-boo, but he gets so nervous when he can't see his mommy.

This is average Taisei, doing his chillaxin' thing. He is just one good baby.

If you can ignore the skinny pasty man in the background... Taisei appears to not like our apartment's pool.

Moving day has arrived

2010-06-27T15:30:00.002-04:00

My time in Atlanta has come to and end. Our apartment is full of boxes. Sigh... we move to Chicago on Tuesday and then will move to Seattle in November. My father is kind enough to fly in and assist with the move.

Here are some pics, mainly of Taisei of the last 2 weeks or so:

http://picasaweb.google.com/jones.jefferson/Taisei100Days#

Here are some summaries of Keiko's blog which has a bunch of pictures:

My dad mentioned Taisei's resemblance to the Pillsbury dougboy. So Keiko did a little research to who this doughboy is:

http://ameblo.jp/jkfamily/entry-10561735264.html#main

We joined in on a friend's yardsale to sell some dishes, our microwave, and some other items to lighten our load for 2 moves in 5 months.

http://ameblo.jp/jkfamily/entry-10569123687.html#main

Keiko's reaction to Taisei being called "round." She defends him as being round and tall :)

http://picasaweb.google.com/jones.jefferson/Taisei100Days#

We had recent ending party for my graduation. We also had a going away party at work. At both, Taisei was present and became the center of attention.

(pics on the picasa website link above)

Here are some videos. His laughing has gotten bigger.

Keiko playing with Taisei. He is getting a little heavy for her.

This baby loves to jump. He has quite a funny laugh now.

The US team's play in the world cup is inspiring a new generation of soccer players.

A little nose-to-nose contact gets Taisei talking (for the first half of the video):

This is how Taisei tells Keiko he is hungry. Too bad for him it is so cute, Keiko and I have fun just listening and watching him rather than feeding him.

You might have to turn the volume up. Sounds of Taisei sleeping:

This is how Taisei wakes up. He pulls his legs up, gains some power, and throws his legs back on the floor.

A pleasant Taisei in the car.

Happy 3-month bday Taisei

2010-06-13T21:41:00.002-04:00

On this weekend, I had my CDC Experience fellowship graduation. My dad came down to Atlanta and joined us. Taisei and Keiko joined me at the CDC for my presentation I have at the ceremony.

Also, Taisei turned 3 months today. He's big enough for 4 or 5 months, but that is his age.

Here are the pics.

http://picasaweb.google.com/jones.jefferson/CDCExperienceGraduationWeekend#

Keiko took some AMAZING videos this week. I'm sure you will enjoy.

Taisei's new laugh. He is in a great mood until he sees the camera. At that point, he seems to lose all interest. It's a common theme:

Probably my favorite video: Taisei smiles so cute whenever he looks at his dad but whenever he sees the camera he looks sooo serious. And this changes instantly depending where he looks. It goes back and forth a few times:

Playing with Taisei. He is a fun baby!

Tickling Taisei

He just started this headbutting thing

Taisei kicks around in preparation and then does his SUPERMAN pose

Starting to enjoy his toys

Taisei's favorite pose

2010-06-09T21:56:00.001-04:00

Recently, Taisei loves to stick out one arm straight with a fist, like he is flying off like superman. Keiko took pics from all different angles, very cute.

http://ameblo.jp/jkfamily/entry-10550755452.html

Taisei 2 months

2010-06-06T19:15:00.003-04:00

The amount of pictures being taken has decreased a bit. Here are some from Taisei being about 9-11 weeks old.
http://picasaweb.google.com/jones.jefferson/Taisei2Months#
(also on facebook)

We also have a few videos.

We believe you'll agree he is becoming cuter.

Taisei is telling me his problems. However, whenever he sees the camera he instantly gets mesmerized and becomes silent.

Caught him in a ticklish mood

Keiko LOVES these pajamas, mainly because of the little rhino feet.

Keiko likes this video... Taisei being entertained by staring at me surfing the net.

New Orleans and other recent pics/videos

2010-05-30T16:10:00.003-04:00

I have put up our pics of our New Orleans trip. We had a lot of fun. I think New Orleans is one of the most unique cities in the US. There are plenty of family-friendly options, the food is wonderful, and there is tons of antebellum architecture all over the place.

For narrated pics, Keiko's blog is the best:
http://jklfamily.blog28.fc2.com/
Ask me and I'll send you the password if you don't have it.
I'll also add some captions to Facebook pics.

The more complete pics are at:
http://picasaweb.google.com/jones.jefferson/NewOrleansWithTaiseiAndKeiko#

I will post all of our recent videos though.

A good smile:

Almost smiling:

While in New Orleans:

Enjoying the car ride:

Getting tired in the car:

Possibly my favorite. Keiko tickles Taisei and he really likes it until he sees the camera. After that it seems like he is laughing out loud out of duty while staring at the camera.

A rather noisy tummy time (2 months-old):

Just learning to put suck on his fist (getting in on camera was a little hard at first):

He got much better at it:

2-month old Taisei (with Goonies in the background)

Starting to learn to like lights

He is a professional vitamin taker.

CDC Fellow Picnic

2010-05-09T19:47:00.004-04:00

It was the birthday of one of the my fellow CDC med students and her husband planned a picnic at Piedmont Park, a big park in downtown Atlanta.

It was Taisei's first picnic.

It's a beautiful park.

Taisei made lots of friends.

This is one of my favorites. Taisei hanging out with Tony.

Keiko saw this swinging bench and said we had to get a picture.

We had hamburgers, cake, played frisbee. Taisei seemed to be interested in dogs. Taisei did great. He managed to be quite friendly for the entire 3 hours.

Thanks Tony. That was a great picnic.

Taisei videos/pics weeks 5-7

2010-05-02T19:48:00.003-04:00

I have updates to try and help far away family and friends feel like they know who Taisei is.

A lot of these are just catching him when he is in a good mood. Most of them have descriptions if you click on the screen to go to Youtube.

And I uploaded all my pics to picasa:
http://picasaweb.google.com/jones.jefferson
Facebook has the brief version of the photos.

I hope you enjoyed these!

Videos 2-3 weeks

2010-04-12T20:20:00.000-04:00

Here are the videos that have been uploaded to youtube:

Starting with my favorite:

And last of all, thanks for the swing, Lindsey. Works like a charm:

Taisei 2-3 Weeks

2010-04-12T19:30:00.001-04:00

Here are a few selected picture from the Taisei 2nd and 3rd weeks of life.

I have uploaded a few videos to youtube: http://www.youtube.com/user/jonesjefferson

A family photo outside our apartment.

A Furushima 3 generation shot.

Taisei the bear with his Grandma.

Taisei in his swing from Lindsey.

Taisei with his dad.

And with his mom.

We got a nice smile from him. Too bad the focus was off...

But he was happy to hang out with Grandpa.

Here he is in his team Grandpa outfit.

He also loves to study and play with Dad.

Dad liked to give Taisei baths.

And then we play games but Taisei is a little too competitive for me.

I lose every time.

Grandma came to visit as well.

Taisei is all set for the future. He has his stethescope, surgical booties and cap, and is ready to save some lives!

Stresses of Fatherhood part 2

2010-03-30T17:32:00.000-04:00

We FINALLY get released from the hospital with the instructions to follow up with our pediatrician the following day since the bilirubin (cause of jaundice) was a little high for Taisei. At the pediatricians, we are told we have to go to the ER because the bilirubin has continued to rise and is nearing a dangerous level.

What I thought would be an ER visit turned into getting admitted overnight. Then I hit the lowest point of my experience with the health care system. After being admitted so that Taisei could receive UV lamp treatment, the nurse said we should use formula during the stay and that if we really wanted to nurse she would allow 15 min every 2hours maximum. Really?! We are already having trouble starting and they want to limit breastfeeding to 15 min/2 hours. They did not even mention the clear alternative of breast feeding while using the lamp. And then we couldn't comfort Taisei as he cried himself horse while on the lamp. Talk about a miserable experience.

We were released the next day and brought a lamp home with us. The bilirubin continued to drop. Breastfeeding eventually started to work out as normal. I can finally say we have reached some level of normalcy.

I just hope I can hear a cough without thinking of pneumonia, asthma, sepsis, congenital defect, inhaled object, etc. etc.

Stresses of Fatherhood part 1

2010-03-28T15:47:00.000-04:00

Taisei turned 2 weeks old yesterday. I can assure that fatherhood has its share of stresses, some of which may be more severe as a result of being a medical student. Medical students are known for taking any situation and thinking of all the rare diseases that are possible. It is not the best frame of mind to be in as a new father.

On Thu, March 11th, Keiko thought her water may have broke but did not want to go the clinic. So I spend the next 24 hours thinking of the risks of infection (chorioamnionitis) that can occur.

On Fri, March 12th, I have a presentation at work at the Georgia dept. of health. I have my phone on silent but I hold it in my hand the whole time just in case she calls so I won't miss it. Exactly 15 minutes after my meeting has officially ended, I get a text from Keiko that her water has definitely broke. I had to take a train to get to my car to drive home, so I was in a major rush. The traffic is so bad downtown that the train is definitely quicker than a taxi. Keiko is very calm and collected.

I pick her up and take her to the clinic. They said we had to go the clinic before the hospital since if it was false labor, our insurance will not cover the visit. The clinician confirm that Keiko's water broke. I am in a definite rush to get to the hospital and these are the words from Keiko:
"Do you think we can still go eat ramen and to the baby shower?"
One of our friends in church had planned us a baby shower and we also had plans to meet some friends at a ramen restaurant. While I am nervous as can be, Keiko, who still has no labor pains, is ready to go out to eat.
...
...

With a little coaxing, we head to the hospital. A couple more hours pass and there are still no real contractions. My mind is going "infection infection infection." The contractions finally start and Keiko says "this isn't so bad. I probably don't need an epidural." A couple hours of pass and the offer comes for an epidural again.
"How much longer do you think it will be?" Keiko asks.
"8 hours or so" they respond.
"8 hours?!?!? I'll take the epidural.

Keiko was able to take a few hours nap with the epidural but I couldn't rest at all. The midwife came and said it was time to push. Pushing lasted for about 1 hour with no results.
"We'll have to take the epidural away to help with the pushing."
And 15 minutes later, Keiko goes from no pain to the real deal. It was very painful to watch. The news keeps piling on.
"Oh you've spiked a fever so we'll have to give some antibiotics."
"The pushing has to progress or we'll have to go to a c-section."
"The baby had a stool movement (meconium) in the womb so we will want to hurry."
And Keiko is in the biggest pain in her life and I can only hold her hand.

I HATED the labor experience. I found myself thinking: "C'mon, baby. Just work with Keiko and get born already. Use some force." A little illogical but I couldn't help it.

When he was finally born, he wouldn't cry. He was having a little trouble breathing and the pediatricians were calling him "too limp." I could think of about 5-10 reasons for this, and all of them were bad. Of course he ended up being okay but every time I noticed him having a little trouble breathing by grunting a little, the nostrils flaring, etc. it made my heart jump.

Most things went okay after this but hospitals are so terrible about encouraging breastfeeding. They say they want all women to breastfeed but they are absolutely ridiculous about allowing. 3 days after being born, Keiko hadn't got a full supply of milk and Taisei had lost some weight so they were already talking about supplementing. I figured the lactation counselor would be helpful but she saw us once and heard the word pump and was already selling us on the brand the hospital used for pumps. We were told that we may need to pump for 1 day and she said we could rent a pump from the hospital for like $70/month. I felt so much negativity that Keiko should be producing more milk and that we should consider pumping and supplementing.

The result of all this: every time Taisei was nursing, it was a big adrenaline rush. How is he latching? Is it going okay this time? Is there milk this time? Something as natural as breastfeeding becomes this big drama show every 2 hours or so.

The biggest positive of this whole experience is that it will certainly help me as a doctor, particularly if I become a pediatrician. I know many of the symptoms Taisei had like breathing trouble, stool in the womb are quite common and rarely lead to anything bad. However, because it was my child it that much more stressful. You just want everything to go perfect so badly. I know they should have listened to us more about the desire to breastfeed and not pushed supplementing so much or build the atmosphere that you won't be able to breastfeed.

Unfortunately, this sort of thing only continued...

Taisei Linus Jones

2010-03-21T14:09:00.000-04:00

Taisei Linus Jones was born at 8:07 am on March 13th, 2010. He was 7lb 8oz, 20 inches.
Keiko and the baby are doing fine but it was a tough week.

For a more detailed bilingual blog of the happenings of the last week: http://ameblo.jp/jkfamily/

For pictures: http://picasaweb.google.com/jones.jefferson/TaiseiLinusJones02#

For videos: http://www.youtube.com/user/jonesjefferson

Thanks for all the support!

Baby shower

2010-02-25T21:38:00.000-05:00

Some of Keiko's friends from church through us a baby shower. We had a great time. Here are some picture from the event.

Baby decorations abound

We had 3 Japanese families (not including Keiko) and 1 Korean that attended. The food was spectacular.

Here is the diaper cake that was prepared by Keiko's friend.

Keiko made this dessert.

This is a Japanese cake. I like them a lot more than American. They are much lighter, less butter.

I'm all ready to go. This little fella is also half Japanese.

Hand made baby blanket.

Thanks everyone!!! We had a great time!

see details at Keiko's blog: http://ameblo.jp/jkfamily/

The car seat

2010-02-24T20:37:00.000-05:00

Thanks to the kindness of our friends, we are slowly losing any extra space in our studio apartment. So, I decided to put the car seat in the car. After all, the baby could come in day.

When I went to the parking lot after work today, I was looking for my car and couldn't find it. Seeing the car seat through the window of our little red Corolla, it just looked like it couldn't be my car. I'm not old enough to drive that car. It made me laugh a lot as my key unlocked it and I entered the car.

(Keiko's blog has pictures)

Full Term

2010-02-23T20:33:00.000-05:00

Our baby is now full-term as of today. Last week, he was estimated to be about 6 1/2 pounds. So it looks like he can come at any time. Bring it on; I am as ready as I'll every be.

The baby and pyelectasis

2010-02-22T20:16:00.000-05:00

For those who are curious about how the baby is going, I am going to be lazy. Please read Keiko's blog. She has been great about consistently writing her blog. It has lots of pictures, including recent ones shower her belly:
http://ameblo.jp/jkfamily/

On a related note, a few weeks ago, the midwife casually told us we would need to get another ultrasound because they notices a blip on the ultrasound months before. As a patient, I scrutinize the doctors and nurses quite a bit. They only told us enough to make us worried.

So I spend hours looking up pyelectasis. It's a when part of the kidney gets dilated. There are many causes but most of the time it goes away on it's own. At our next ultrasound, it did go away.

It left me thinking, how would I handle this situation or how should they have handled it. 1) They should have told us about it in the first place. When our 20 week ultrasound was done, they said it was all normal even though it wasn't. That is not okay. 2) They should know enough about it to say that most of the time it goes away on it's own, but it may need to be looked at again after the baby is born (which is still true). I had to look through multiple medical journals to find this stuff.

I know it's kind of common to speak fancy medical terms to patients, but I learned a good lesson of the need to explain any words you use or not use them and about the need to explain the prognosis of any problems given.

On the patient side at the ER

2010-01-24T20:22:00.000-05:00

I was a patient in the ER last week. It was a fun, yet unfortunate weekend.

Friday night we had a delayed New Years Party with Keiko's Japanese friends and families. It made for a party with 6 adults and 3.5 kids including Ao (keiko's nickname for our child). It was a mix of American and Japanese games but it is great to see Keiko make good friends in all the cities we have lived in.

Saturday my brother, Chris, and his family came down. We always have a good time together. Chris's wife, Corie, does an excellent job of talking with Keiko; she makes sure Keiko understands everything she says. Chris and I generally play with their baby, Emily, and play video games a lot. Good times all around. for pics see: http://chrisandcorie.blogspot.com/2010/01/last-weekend-we-went-to-visit-uncle.html

Emily was unfortunately a little sick... But we still managed to have a Japanese BBQ which everyone seemed to enjoy.

Unfortunately, starting Sunday mid-morning I started to feel a little sick and nauseated. It got worse and worse until without going unto details, I lost a lot of fluid. I'm not sure if it was something I ate or caught it from my cute niece, but it was bad. I started to get pins and needles throughout most of my body like my whole body was asleep and it was painful. This has never happened before so I called my boss, who is an infectious disease doctor. She instructed me to go the ER.

I have terrible insurance. Med student insurance seems to be pretty bad on the whole. It generally doesn't cover anything until you have paid a ton of money first (a large deductible.) So I avoid going to the doctor like the plague.

However, I was getting worse and worse and had some unusual symptoms and couldn't keep any fluid down for about 5-6 hours. I finally had a glass of some sugar-water but only felt worse. So I had some people from my church come over and give me a priesthood blessing. I was so weak at this point I couldn't walk so they had to carry me to the car to take me to the ER. During the car ride, I started to feel better and better. By the time we reached the ER, I was able to open my eyes and carry a conversation. By the time the nurse saw me, I started to have "buyer's remorse" as I called it about going to the ER. They gave me an IV and I began to feel pretty chipper in about an hour. I ended up being a pretty annoying patient because I knew what I had and REALLY didn't want any tests that I would have to pay for so I rejected about anything they offered except the IV.

I had some fun talking with the physician's assistant who examined me and reviewed some of my medicine skills. Luckily, we were out of the hospital a few hours after we arrived.

I wonder if I'll run into patients who really regret ever coming to the hospital the moment they arrive...

Random events Fall 2009

2009-12-13T15:55:00.000-05:00

Keiko has a pure Japanese blog and I can write quick blog entries by copying her pictures and making my own versions. Here are a few of her blogs from the last couple of weeks.

Keiko met her visiting teacher companion recently. That night, we got a call that she needed an emergency babysitter as she is a nurse and her normal babysitter and backup were unavailable. So Keiko got a taste of things to come.

I hope our kid is as well-behaved as this cute little girl.

Keiko had out kid early... not really but this is the baby of Keiko's friend, a Japanese women married to an American.
This might be a familiar site after March...

We had a wonderful dinner at their house. This was kind of our Thanksgiving since we spent Thanksgiving Day itself by going out to a restaurant. So this was our get-together meal.

It's Fall. This is a pic showing what it looks like outside our front door. It's actually much brighter since the leaves have fallen and allow the sun in more.

Christmas Decorations

2009-12-12T15:45:00.000-05:00

Even though we have a studio apt., we never took the time to put up the few stashed Christmas ornaments last year. Since we are gone for Christmas, what is the point? was our thinking. But this year, we decided to do this on Thanksgiving weekend, to give us time to enjoy them. We don't have much, but it feels more like Christmas.

Thanks to Chris and Corie for the German ornament, and to Ryan for the tree. We have some more ornaments from my parents, but still no room in the inn for them. I imagine we'll have a bigger place next year.

Birthday Blog

2009-12-10T15:51:00.000-05:00

This is a few weeks late, but I am now 27. Keiko surprised me with a wonderful meal and home-made cake when I arrived home. Did I mention I like Japanese cakes better than American ones? They aren't as sweet and generally have a lot of fruit. As a child, I generally never had cakes at my b-day parties and preferred the giant cookies instead. But Keiko makes a great cake.

Also, she also made a wonderful lasagna dinner.
I'm such a lucky guy. :)

CDC Trip Final: People, Kids

2009-12-09T15:39:00.000-05:00

In general, I really like the island culture or Micronesian culture. As you heard with my wallet story if you read earlier entries, it is a safe place to be. I felt very comfortably walking after dark alone. They highly value family, are quite friendly. Hopefully you can get a hint through pictures.

On a random note, there is a very high percentage of LDS members in these islands. They have a stake on an island of 30,000 people and several missions spread throughout this part of the world. I saw several churches on the one road of the island.

This is just a compilation of pictures that our group took of various people we met. More often than not, it is some kids who either wanted a picture or who were taken randomly.

The most popular sports (or the only sports as far as I can tell) are basketball and volleyball. People are playing them all the time. I recall in the MTC (LDS missionary training center) that many islanders were playing volleyball and basketball there too.

The rest are more random pics:

This is what it looks like in areas that have no buildings. On other islands, the flora is much thicker. They do some farming in this area.

I can't remember what type of crab, but there were many of them.

The English that does exist is close, but often a little off.

Here are what they sell at the souvenir shops. I liked the shops a lot because you would see the women making these items in front of you. You know it's authentic and not made in some sweat shop owned by a foreigner on some other island.

This is the only airplane that flies through. 3x/week for going east or west.

It was a wonderful trip. The CDC would be an exciting place to work in the future.

CDC Trip 7: The Hotel

2009-12-08T15:38:00.000-05:00

Most of the time, I stayed at one hotel called Robert Reimer's Hotel. It is owned by a family that does everything on this island from making soap to filtering water, fishing, pearl farms, and probably anything that can be imagined.

The hotel was about as nice as are offered on the island. It had it's up and downs.

Here is the outside of the hotel.

It was on the water as everything else is on the lagoon side of the atoll.

My fist room had a fairly nice view, nice and green. But it was usually to hot and humid for me to spend much time out here.

Inside of the room. Not too bad. However, I did have my fair share of cockroaches and ants. But they are much smaller than American cockroaches, little dark red guys.

This was the restaurant across the street. Copyright laws must not be very strict here. They did sell chicken. That is KLG, but the G looks pretty close to a C.

My last week I was moved to the nicer rooms. These felt a little fancy. They were similar to the places I stayed at a fancy place in South Africa on their giant animal reservation for safaris (Kruger National Park).

You were closer to the water here. There was a actually some wider parts of the island near the hotel and other larger parts of the biggest parts of the city. So there were actually some places you couldn't see water due to the trees and/or buildings.

No cockroaches, but there plenty of lizards. I preferred the lizards.

CDC Trip 6: The Islands of Paradise

2009-12-01T15:36:00.000-05:00

These are pics of various islands that I saw. It's a truly unique place in the world.

This is the biggest "city" or most developed place I saw. Those are the biggest buildings in the background.

This is a beach I went to. I'll mention it later in a bit of a miracle I experienced.

The next few pictures are right outside the hotel I stayed at.

I had quite the adventure my 3rd week in. The following pictures are a beach I went to for snorkeling and relaxing. I had a great time but when the group was getting ready to go back to the car I searched and searched and couldn't find my wallet. I spent a long time looking everywhere until we gave up and head back. I had bought some water on the way there at a tiny shop on the way there so we checked there to see if my wallet was there. So I had to give up and was looking into how to cancel my credit cards etc from this tiny island.

I could think of 2 places that my wallet could be: I either left it in the shop and they lied to me or I had left it in my swimming trunks in the pocket and it fell out while I was snorkeling. I felt that it was probably the latter and gave up. This meant I might be able to avoid cancelling my credit card so that I could pay for my hotel since they had my info. My CDC companions offered to loan me money for food and other expenses to last me as we only had 1 week left at this point.

That night, I developed a sore throat and a 103 F temp. It was likely influenza, so I just stayed home and had plenty time to dwell on my wallet. However, I got a call at about 11am in the morning from the US embassy. They told me a man had found a wallet on the beach. Inside that wallet, he found a card saying "Church of Jesus Christ of Latter-Day Saints" and he had a neighbor who a member of that church. That neighbor gave the wallet to the missionary headquarters for that church who passed it onto the US embassy as it didn't belong to any missionary. That was my temple recommend. The US embassy called the CDC who gave them my cell phone number.

WHAT A MIRACLE!!! I traveled to the US embassy and found my wallet: soaked, full of sand, with a little mildew and very smelly. It still had $300 in cash and all my credit cards. My best guess is that it truly did fall out in the ocean and get washed on shore. And my temple recommend (church card) guided it back to me.

I'll write a little more about the safety of the islands in the next couple of posts.

This is the beach where I lost my wallet snorkeling.

CDC Trip 5: The 2nd Atoll

2009-11-30T15:34:00.000-05:00

The 2nd week, we went to another atoll. This one had an island with a lot of American influence, so it was much more developed. It seemed like it would be quite pleasant to live here.

Here is the residential part of the island.

This is the public beach.

This was after a little snorkeling at the beach.

We had a BBQ at the beach with one of the local doctors.

We had fish, vegetables, and veggies on the BBQ. It was delicious!

99% of people use bikes to get around, although it's small enough to walk everywhere.

I had the opportunity to go sport fishing while I was there. I got a greeting before we left from the competition for the fish.

There were a lot more of them at "shark's cove."

Out on the sea.

This was an old sunken ship (the grey part you see).

According to local tradition, you have to eat the raw heart of the first fish you catch, or you will have bad luck fishing for the remainder of your days. That was a challenge I couldn't resist (and only me on my team). They got a kick out of it so took a bunch of pics of me in action. I also learned how to gut a fish and basically prepare it for cooking.

I got the heart in my hand.

Hmmm, not too bad.

Not bad at all.

This is the ferry we used to commute to the less developed island every day.

And here is the neighboring island where we did our work. It was very different from the island I was staying on.

It's a beautiful island with clear clear water.

CDC Trip 4: The Work

2009-11-29T15:30:00.001-05:00

It wasn't all play. But as soon as we got there, we were greeted by members of the local public health program who gave us a greeting ans some gifts.

The work was to investigate an outbreak of a disease. Our group split into 2 groups. One group (the epidemiology team) went and interviewed friends and family of people with the disease to find out how they might have gotten the disease and who they might have given it to. Once you find out who they might have given it to, you test those people for the disease. On this island, there were often over 30 people living in one house, which meant a lot of people needed to be tested. If any of those people have the disease, then you set up treatment for them.

There was another group (the surveillance team) that tried to find any people who might have the disease that haven't been recorded. I was on this team for 2 of the 3 weeks I was there. We looked through hospital records, emergency room records, public health records, and tried to find any people that might have the disease. We put all their information into the computer.

Most of my work pictures are of me looking through the patient records and putting data into our data set. I also had the responsibility of taking care of the master list and cleaning it up, getting it ready for analysis. These next few pictures are of the team working on the patient records.

We had a lot of computers working together.

The second week I got to be on the epidemiology team and go out and interview family and friends. It was a bit more exciting because you get to go out and be with people. We had to use translators as English is somewhat common but limited.

Here we are working with some children.

This is our transport to get from house to house.

Now we are working with some adults.

Back to the office. That's a lot of records (maybe 1/2 of what we were looking through).

Getting some testing done. The local public health workers eventually did most of the work after they were trained.

Here we are working on island #2.

More records to look through.

On the right is hundreds of x-rays to examine.

A drink from a coconut was quite a refreshing break.

Looking through some x-rays with one of the MD's on my team.

These next 2 I posed for specifically to send to the CDC for advertising for my program, The CDC Experience Applied Epidemiology Fellowship.

This last picture was from a team member. Some of the interviews were in really remote islands with no roads besides what is seen. This is as developed at this island got.

CDC Trip 3: Skuba diving

2009-11-23T17:29:00.000-05:00

The first weekend most of my team had not arrived. They were in a conference in Guam and since there are not many flights to/from the more remote islands, they weren't able to make it until Monday night. So I basically had free time that first weekend. I decided to scuba dive.

I had never been scuba diving before in my life. The hotel lobby suggested a scuba shop. Once I arrived, I realized that everyone who worked there was Japanese. They spoke English, but it became apparent that we could communicate better in Japanese than English. My Japanese finally became useful outside my home.

The price of the day included rental of equipment and a meal. We passed all these completely beautiful secluded islands on the way out. I took a few pics with me in them all decked out in the wetsuit.

This is the whole island. Beyond those trees is the ocean

We started out in the lagoon. There is little to no current, it's shallow, and has a nice sandy beach. We did my first scuba lesson on a sandy beach. You first just make sure you can equalize the pressure of you ears by blowing with your nose plugged and mouth shut (Valsalva maneuver).

We then went out into the sandy beach and saw some amazing stuff. The water is between 87-90F. The beach feels like a bath. I had never experienced anything like a warm warm ocean before.

The ocean was as clear as you can imagine.

We are getting all prepped.

Once inside the water, there was often schools of fish all 360 degrees around me. The Disney in me was thinking of The Little Mermaid where Ariel is spun around by a bunch of fish. That was what it felt like. The lagoon part of the atoll is a sandy floor with bunches of coral here and there. All the fish congregate in the coral so it's easy to see huge numbers of them.

We had a total of 4 people, 2 customers and 2 instructors.

The other guy with me was a Japanese scientist. We saw this sunken ship and got to explore it a little.

Thumbs up was the sign for saying we were okay and since it was my first time I am pretty much giving the thumbs up sign in every picture.

We also had a plan that had been sunk to explore. It was so interesting seeing all the coral and fish growing all over it.

You can see the back of the broken fuselage behind me, along with a huge school of fish.

For our second location, we went to the ocean side of the atoll. It's great because it is so different. While the lagoon, is a shallow, sandy beach, the ocean side is all coral. It has big waves and currents. After the instructor had jumped in and tested the currents to make sure they were calm enough, we followed after.

Now we can't even see the bottom. It's just a steep wall of coral. The fish are more spread out, but there are tons of them and many are quite big. There are supposed to be a lot of sharks, but we didn't see any that day. We did see a dolphin briefly but they are pretty shy out here.

With the wall of coral in the backdrop.

"Aerial" view

The lent us their underwater camera to take some pics of the favorite fish we saw.

This was a good shot to get an idea of the sheer volume of fish. It certainly doesn't give the incredible feeling of being there, but is the best I have.

I liked the long skinny, guys.

This was one of the largest piece of coral I saw.

There were these seas of sea urchins as far as the eye can see. The idea makes Keiko hungry, she says.

These guys were really close to our hotel actually.

This was from the Internet, but it was a good pic showing what the lagoon looks like.

Same with this one.

I didn't do this, but there my name was...

CDC Trip 2: An atoll nation

2009-11-22T21:09:00.000-05:00

Have you ever heard of an atoll? This is the wikipedia animation of how they form. Per wikipedia, an atoll "is an island of coral that encircles a lagoon partially or completely." I give some pretty good pictures in my scuba blog.

Here is a great example of what an atoll looks like from my favorite source:

So on any point of the island, you can pretty much see water on both sides. Nothing but beach front property. It is so beautiful, just the paradise that you see on all the movies. And I was able to stay there for 3 weeks. I felt so lucky the whole time (at least when I wasn't missing my wife).

The next few pics are from the airplane.

Here is the first island we went to. You can actually see buildings if you look close. This is as developed as it gets.

Other pictures are of various islands we passed over on the airplane. You can see the basic structure of the islands though.

The ring that forms is split up so that you have some parts of it covered in water, leaving these secluded islands just like in the B.C. comic strip or"Cast Away."

You can see how long these islands can be.

There will be more pics like this, but just a little close up. The plants are very thick.

This island is rented out for tourists and locals.

This is an example of housing.

They have unique trees there. And palm trees are naturally everywhere.

I believe this is called breadfruit. One of the more unique native fruits.

Basketball on the beach,.

CDC Trip 1: Hawaii

2009-11-15T16:56:00.000-05:00

Part of my training this year at the CDC is disease outbreak investigations. Well, one occurred. So I have spent 3 weeks in some remote islands in the Pacific between Australia and Hawaii. The plane trip was so long from Atlanta that there is a rule that you need to rest on the way there. So I stayed at Honolulu.

I showed up at the hotel and I think because it is a low peak season, but they upgraded my room to a suite in a corner room facing the ocean and the city.

These are some pics of Waikiki beach from my room.

I also was able to hang out with some friends I knew in Hawaii. The same rule applied on the way back. My CDC team took a trip around the Oahu to see the various beaches, eat the famous garlic shrimp and shaved ice, and had a great time.

Hotel lobbies are done right in Hawaii.

Construction trouble

2009-10-10T18:48:00.000-04:00

We've had a few troubles with our apt. We had our tub resurfaced, and I'm not sure what happened but it looked far worse after it was finished than before it was done. It went from peeling to have bits of the metal surface showing. So they came to do it again. However, we can't shower for 48 hours and have to vacate the premises for 6 hours.

Our apt does seem to have quite good customer service. They put us up in their guest suite (they rent it out like a hotel for $100-150/night) for 2 days while we waited. It had internet, a giant flat screen with cable so I wasn't going to complain.
Here it is:

Even though it's Atlanta, we don't really have to use our A/C because our place is surrounded by hills. However, we wanted to test it out a while ago and realized it doesn't blow cold air, only air. So we called about that and a guy came to fix it. After he came, it started to blow cold air but was dripping a decent amount from the vent.

He's been back since and has fixed that.

Let's hope for no problems for a while...

Vacuums: Japan vs America

2009-10-07T11:00:00.000-04:00

Has anyone done much vacuum shopping? Due to having a Japanese wife, I have done a LOT of research on the web, at least 4-5 hours of reading.

The average vacuum in Japan weighs about 7-12 lb. The ones advertised as lightweight are even less. In America, feather-light vacuums are about 14 lb.

But the biggest difference is canister vs upright vacuums. They ONLY use canister vacuums in Japan.

This is an example of a canister vacuum. So when the whole thing is 10 pounds, the part you are manipulating most of the time is much lighter. Canister vacuums in America are usually over 20 pounds. And most canister vacuums in the US are advertised being for large houses with lots of upholstery, stairs, and hard wood floors.

We live in a studio that's primarily carpet except the kitchen and bathroom. And canister vacuums are always more expensive.

By the way, the don't really have thick carpet like we do in Japan. At least traditionally, they only have hard wood floors and tatami. If there is carpet, it is like the really thin carpet you see in offices, so it's natural the vacuums would be different.

Anyways, I weighed our vacuum that works perfectly well: 17 lb's. The 3 lb difference than the lightest vacuums I could find is not close to enough to invest 100+ dollars. So I kept on looking. I found a random blog that was saying Eureka makes the lightest vacuum in the world. So I started to look at reviews for Eureka vacuums.

Then I found a vacuum with perfect reviews on multiple websites.

It is cordless and weighs 5.5 lb. It's kind of like an oversized dustbuster. But times have changed. I looked at all the reviews and while advertised as being used like a canister vacuum to clean furniture, rugs, etc., people are buying it for their college apartments, dorm rooms, and some for their larger houses. For us, this should work just fine. It seems to work for 20-30 min with one charge which is more than enough for our place. So I went and bought one.

Keiko seems to love, so life is good :)

This is a pic from her Japanese blog where she says she is rather impressed, despite it being American technology. She has lately been putting baking soda on the carpet to do something with the smell of carpet (don't ask me) and it sucked all the baking soda up.

When I vacuum, I'll still use the bigger one as it's wider and will take less time. But 17lb vs 5.5 lb and no cord to worry about... I can see how this works for Keiko.

Is public health in my future? (plus a little public health 101)

2009-10-06T19:13:00.000-04:00

I'll start off with the infamous analogy of public health:
A doctor is at a river bank. He notices a body floating down the river. He dives in, pulls the body out, does CPR, and saves the person's life. Soon as he is finished, another body floats down. So he jumps in again, repeats CPR, and saves another life. His friend, the public health epidemiologist walks up and sees the doctor. A third body floats down the river. The public health epidemiologist starts to walk off and the doctor says, "where are you going?" The epidemiologist replies "I am going upriver to see how these bodies are getting in the river."

Doctors have very important jobs. People get sick and they need somebody to help them. But a far smarter approach is to prevent the sickness in the first place. Sometimes this is works out great. Rather than treating millions of kids from getting measles, you can develop a vaccine so that no kids get measles. But when obesity is causing arthritis, heart attacks, diabetes, strokes, etc. getting rid of obesity is easier said than done.

So here I am, at the public health center of the country at the CDC. I've been here long enough to get a taste of what it's like. I am sure 1 year is a lot longer than 6 weeks, but here are some thoughts so far.

It is so much more relaxing. I know of lots of doctors who ended up staying in public health because they didn't want to take call and avoid the stress. It is way less stressful so far. I have a 40 hour work week that I get to pick. I can work at home if I want. Last week I worked from 6:30am-3pm. (I was giving a high school boy a ride to seminary. His family is from Congo, his dad works graveyard shift, and our church has a class that starts at 6am from 9th-12th grade).
I get to see Keiko so much more than during medical school. It's definitely nice.

Doing projects where we use computer programming to analyze data is definitely something I am more of a natural at than memorizing. Medical school is all about memorizing lots and lots of facts and being able to put them together. I now depend on logic to solve problems. I definitely feel more of a natural at it and this has been reinforced by comments from my supervisors.

But you do feel a little distant after spending time in a hospital. I am mainly working with numbers and charts, rather than with people. I personally feel that you save far, far more lives through this kind of research than working in a hospital, but you don't meet the patient and their family so it's a little harder to feel the gratification.

So where does this leave me? If I absolutely love public health and working at the CDC I have a good plan:
-Finish at the CDC, finish 4th year at medical school, and apply to pediatrics.
-Do a pediatrics residency
-Possibly do a pediatric infectious disease fellowship
-Return to the CDC to work as an Epidemic Intelligence Service Officer, which is a 2-yr program that almost all the people who work here start by getting trained through this program.

If I think i might want to do public health, but want to do a residency first, I probably will stick with the same plan.

If I don't really want to do public health...
-I may switch to surgery. I am kind of thinking pediatrics vs surgery. I haven't met a surgeon at the CDC yet.

We shall see... we shall see...

My job at the CDC

2009-10-05T18:59:00.000-04:00

I have been here a little bit now. I'm starting to know what I will be doing here the whole year. I have a few different activities.

1. Outbreak investigations
This is probably the most exciting part. I am on the tuberculosis team and when there is an outbreak of tuberculosis and they request the CDC's assistance, then I accompany the team. We try and find out who has the disease, how much it has spread, and get people started on treatment and look for ways to control for outbreaks in the future. These trips are usually in the US, but can be anywhere in the world. (Tuberculosis outbreaks happen in the US more than I thought, often in homeless shelters or prisons.)

I am actually leaving for 4 weeks to investigate an outbreak on some small islands in the middle of the Pacific, leaving in mid-Oct. Keiko will be visiting her family in Japan during that time.

2. Analytic Epidemiology
This means I analyze data to try and come up ways to solve public health problems. The most common thing I have seen is people look for risk factors for diseases. For example, the CDC found out that lacking folic acid was a risk factor for many types of birth defects (mostly dealing with the spine). Now folic acid is in many cereals and lots of foods and those birth defects have drastically dropped.
All tuberculosis cases have data reported to the CDC from the whole country. It's a lot of data. My job is to look at it and try and find ways to help improve tuberculosis prevention. I have a few projects going on right now.
Most of the actual work for this is using computer programming, which I get to use more of my engineering hat for which is a nice break from the straight memorizing of medical school.

3. Surveillance
These are projects where we collect data or monitor a disease. I will be doing a project of doing tuberculosis surveillance of islands in the Pacific.

4. Public health education
We have many classes and seminars to help us learn. It's kind of up to us what to take. I can take classes on Microsoft Excel or computer programming, etc. I can go to conferences to learn about tuberculosis. Unfortunately, the dates don't work out for almost all the conferences my supervisor had planned for me.

5. Publications and presentations
I am supposed to present and write about the research I do. I hopefully will be able to fly to a research conference in New Orleans this spring and present some research and get an article published in a medical journal. Maybe even more than one.

CDC museum and some CDC history

2009-10-04T23:05:00.000-04:00

The CDC had a museum day recently. I decided to take Keiko to show her the only part of CDC that has any interest to see. It has many campuses. The one I am on is only office buildings with cubicles and offices, truly nothing interesting to see as far as I can tell. The original campus has some impressive buildings, a museum, and a bunch of things that are pretty cool to see but you need special permission to get into, like the emergency operations center or microbiology labs.

This is the current logo for the dept of health and human services and the CDC. They have a few, but I was hoping this was the one they would have for clothes to sell but this wasn't it.

There was one item that used something similar: anyone want a CDC onesie?

Here are some pics of the main entrance.

They check your car for bombs by looking in the trunk, hood. I was a little surprised. We went to the museum and these were pics Keiko found interesting.

The CDC started out as a branch of service that was purely for the military. It was also originally purely for malaria control. It was costing a lot of money to the military as they had lots of malaria problems in their training camps. While most of these organizations were in DC, the CDC decided to form home base where the problem was the worst, the south. Emory Univ donated a bunch of land and the CDC has been in Atlanta ever since. It eventually branched out into other infectious disease and now does all public health problems, including obesity, asthma, and works in many other countries.

The first is of a poster of a public health message to soldiers to drink only clean water.

This is a machine that was known as the iron lung. It was one of the first artificial breathing machines. It was very common when polio was a common disease and all the children who were paralyzed (including breathing muscles) had to be put on these until they died or regained control. FDR made this disease famous (that's why he was in a wheelchair).
The CDC has helped eliminate polio from most of the world. It remains in only a few countries where 100% vaccination has prevented it from being eliminated.

All CDC entrances have security guards and airport style security places. Keiko can't get into many buildings because she isn't a US citizen. She can't even visit me at work.

This kind of shows what I do on outbreaks for tuberculosis or HIV. We found people who have the disease, interview them to find people they might have given to or received from and then go to all those people to test them for the disease. Anyone who test positive gets interviewed and we branch out to find more people. You can then find out who has the disease and treat them. You can also find certain places like churches, bars, homes where disease like tuberculosis might be spreading.

Keiko is out to save the day from a terrible ebola virus outbreak!!!

We are making pals with mosquitos, a diplomatic way to control malaria.

This poster explains how dangerous diseases are transported. There are a lot of layers.

Keiko was interested in small pox. As you may know, it was a terrible disease for a long time. It was also the first disease to have a vaccine. A farmer and doctor noticed people who got cowpox from the cows on the farm never got small pox and figured it out from there.

Small pox still exists in labs and some are afraid that some countries or militant groups may want to use it as a weapon so the CDC still stocks vaccines and has to be prepared for it.

If anyone has a question about the CDC, feel free to ask.

Here is the emergency operations center. I got a tour of it. It looks like NASA's central command. This is where they manage emergencies, like swine fly or 9/11. It was rather impressive looking.

Memories of Grandpa Timothy

2009-09-27T23:19:00.000-04:00

My aunt is putting together a collection of memories. He's alive, by the way. Not to confuse you with the title. Anyways, here what I put together, a happy happy part of my childhood:

I'll do my best to recall some of my best memories.

As a child:

"Grandparents are there to spoil their grandchildren" represents the majority of my my memories with Grandpa Timothy.
I took many many trips either by myself or with my brothers and sister from Seattle to Portland. "Good 'ol Knowles" was what we always said as we drove up to Knowles St. where Grandpa lived. I had my favorite place to sleep: his couch in his basement. The couch was old and well-used so that it was squishy and soft that you just sank right down into it. In this room, there were 3 tv's: one for Super Nintendo, one for Sega Genesis, and one for cable television. There were a few traditions that I will never forget during my trips to Portland. I remember the most the times when I was able to go by myself and do these things just the 2 of us.

-Go to the grocery store and buy a box of cereal of my choice. My parents only let me eat 1 bowl of cereal per day. This would often force me to poor cereal into the bowl, crush it with all my weight so that I could poor more cereal on top of it and get as much cereal as possible into the bowl. At Grandpa's, I could eat to my heart's content, which usually meant at least 2 meals a day. And I got to pick whatever cereal I wanted, no matter how sweet or unhealthy, which usually meant Fruity Pebbles or Captain Crunch Berries. Especially if I was with my brother Chris, we would go through an entire box of cereal at one sitting, and the milk would disappear just as fast. Having that kind of freedom to choose whatever I wanted was so fun.

-There was also unlimited soda in the giant fridge in the garage, including all my favorites: grape, orange, strawberry.

-Often on the same trip we would stop at a Toys 'R' Us and buy any game that I wanted. This was easily one of the things I was most excited to do. I could pick one of the newest games out there no matter how expensive. And I was able to play as many video games as I wanted at my own sleep schedule. Truly a boy's dream.

-We would go out to the same restaurant every time. It was an old diner, and I would get a breakfast like waffles or french toast every time. We would play Kino every time. And I would get to keep the money. He would pick my birthday for numbers. I never made more than $5, but that was a lot to me.

-We went to this local pizza place. It had arcade games and Grandpa would give me loads of quarters to use. This place eventually closed. It was a sad day.

-He would definitely joke with me every time we passed Dancing Bare, the strip joint with a giant sign with a bear. It would make me laugh every time. "You want to go to Dancing Bare this time?" He would always joke about girls with me since I could remember, ask me if I had any girls that I liked etc. When I grew up, he didn't understand why I would like any girls who weren't tall and blonde until he met Keiko, my wife. Then he finally understood.

-Sitting out in his hot tub. Having a hot tub in your house was exciting enough, but I was able to use it at my will. Good times.

There were many more fun things that we did, but these were the must-do's every trip.

These are memories as a teenager/adult:

-Getting to buy a video game every time we visited....just kidding. But I still loved to play his video games and eat cereal when I visited.

-When I had some musical or other music event I was in, grandpa always wanted to watch the whole thing. He would always pay attention and give such great compliments. There weren't many people I would rather show my music stuff to than grandpa.

-I remember having the worst injury of my life. It was a giant hematoma or collection of blood that dried up in my leg. I was in junior high and my mom had some conference to go to so she dropped me off. I needed way more pain control because I was sweating from pain 24/7. I just had my grandparents to rely on. Luckily they were there for me every second. I remember how much I appreciated it to this day.

-Scrabble tournaments: i don't think I have ever won a game to this day, even when I get to use the dictionary. Grandpa even teamed up with my Japanese wife and beat me. The other game we played alot when lots of family gathered was PIT. Grandpa wasn't quite as skilled at this game as you could always tell when he had the bear or bull cards.

-I love listening to Grandpa's stories from his mission or other stories from his youth. He has led such an interesting life. The things he could do as a missionary are also so different than what is allowed now: it's fascinating.

-Thanksgiving on Grandpa's ping pong table. The largest family meals I can recall.

Keiko's best memory:

Kara was working on Disney cruise and has some amazing discount. Grandpa decided he wanted to go but there weren't too many people who could go. Keiko was one of them. So Keiko and Grandpa went on a cruise, just the 2 of them :). They had a great time: going to all-you-can-eat buffets, seeing the Carribean, touring various islands, watching Disney shows, playing ping pong.

He also has helped Keiko alot with her English. Keiko stayed in Seattle to learn English. It was often only the 2 of them at home. Grandpa used his expertise to help Keiko with hard sounds like L and R. Gorilla gorilla gorilla, squirrel squirrel squirrel. I love him. :)

Things I like about grandpa:

-The love he shows for us grandkids, whether through
-watching our musical events,
-buying us video games and cereal
-or just joking around with us and treating us like his friends and grandkids.
-His amazing personal history
-His patience

From the CDC: orientation

2009-09-25T19:37:00.000-04:00

I guess I've been here long enough that I can talk a little bit about the CDC.

The first 2 weeks was an orientation. It was 8am-5pm. The mornings were mainly lectures. Some of them were a review of epidemiology, the methods of how we are going to do studies on various diseases. Some were on how outbreak investigations were done. Others were done by famous epidemiologists that told stories of how they discovered now well-known diseases (e.g. Legionnaire's Disease) or investigated swine flu when there was an outbreak in 1the 1970's. One speaker is advising president Obama on swine flu.

The afternoons were case studies, or we would would slowly be given real evidence step by step and work through problems. For example, we were given the actual evidence when physicians were first trying to prove that smoking caused lung cancer. These were always really fun, like you were the first people to see this data and make the discovery.

One of the best parts was getting to know the other fellows. I have definitely noticed that public health is generally full of people who are extremely nice. All the fellows have something in common and I’ve found it quite easy to make friends. There are 9 of us. We are from all over the country, every one a different medical school.

Just from hearing all the amazing stories and feeling "I'm at the CDC!" made me really excited about it all. If that feeling continues the whole year, there is a good chance I could end up here again.

Biking in Atlanta

2009-09-22T21:41:00.000-04:00

I always planned to bike here. I knew I would have more time than in medical school and I could really get in shape and save on gas if I biked.

I live about 5.5 miles from where I work. however, the first 2 weeks I went to a different building which was 8-9 miles away. And I had no car, so I got a rather intense introduction to biking in Atlanta.

Unfortunately, biking it Atlanta is a famous for how bad it is. That goes the same for pedestrians. The train here is very sparse and doesn't go many places. Most streets, including big ones, don't have sidewalks for most of the time, and bike lanes are quite sparse.

By pure chance, possibly the only street with a bike lane around happens to be one that goes almost right from my apartment to my work. It's truly amazing. However, there is a problem with bike lanes in Atlanta.

atlanta.mybikelane.com

While cars ignoring bike lanes is a problem, my biggest problem is mainly bushes and trees growing into the bike lane, or the fact it seems to just disappear at times. Or people leave their garbage and recycling in the bike lane.

Forbes recently rated Atlanta #1 worst traffic in the country. This can't be helping.

I plan to stick with it whenever it doesn't rain. Which lately, has not been enough to keep me in shape. My brakes don't work in when they are wet, so I have little choice. I do have a nice helmet and lights both on the back and front of my bike, so don't worry mom. :)

Flooding in Atlanta

2009-09-22T19:23:00.001-04:00

I've been trying to ride my bike to work most days. But I haven't rode once in 2 weeks. It has rained every single day...

I thought maybe this is how Atlanta is this time of year. But on my way to work yesterday, one of the major highways to work was covered in water. I made detour and got to work. I got an email at 3:30pm or so that we were all excused to go home that day and take the next day off. I turned to the news and learned several people had already died that day from flash floods, nearly all of them having their cars swept off the roads.

I decided to take their advice and headed home.
I tried to take my main route home: blocked by a tree that had fallen over and blocked the entire road.

My first detour: the whole road blocked by flooding. I went completely by guessing the general direction and eventually made it home.

My sidewalk in front of our apartment had at least 2 inches and with the forecast of more and more rain, I was getting to be pretty worried.

I also saw a home just a couple blocks from our apartment covered in rain, about the same as this pic:
blogs.creativeloafing.com
There were at least 3 interstates that were completely covered and blocked. And many schools are closed for a while due to damages.
This community isn't far from where we live:
Some excellent pictures at: http://www.cnn.com/2009/US/weather/09/22/southeast.flooding/index.html?eref=rss_topstories#cnnSTCPhoto

We did, unfortunately, have someone in my CDC group whose home was hit pretty badly. I, for one, am a little more grateful for my apartment and safety.

Atlanta Sight-seeing

2009-09-08T14:53:00.000-04:00

My dad was here for the last 10 days. Now we have a car and a free Saturday, we decided we should take the opportunity to see the sights. There are tons of things to do in Atlanta, with Keiko having an interest in only a few of them. So we started out with those. The World of Coca-Cola and Georgia Aquarium are both new and were built next to each other. So they have combo tickets to save money. These were Keiko's picks.

As long as we were there, I wanted to see a few things nearby, namely Atlanta Underground and Centennial Park.

We started out parking at the cheapest place, which was Atlanta Underground. It is basically a mall that is where older Atlanta used to be before they built on top of it. Not a terribly special mall besides it's location. There are bunch of places to learn about Atlanta history, but no Japanese translations so we skipped out on that.

We passed by CNN center. This is also a popular tourist attraction as they have tours you can go one and see the sets etc. We didn't make it to this one today.

We did make it to Centennial Park. This park was built in preparation for the 1996 Summer Olympmics in Atlanta and infamous for the bomb. It turned a rundown part of Atlanta into a big tourist attraction. It now has free music and festivals.

We did realize this was going to be a big crowded weekend. What we didn't know that on this Saturday there were several events, all attracting tens of thousands of people each.

-The Alabama Virginia Tech football game. All I could see were jerseys from these schools. The South is nuts about football.

-Atlanta Braves game, with the stadium nearby

-Georgia tech football game

-NASCAR on Sunday

-Everybody else that comes for the 3-day weekend

This is a Virginia Tech fan that has really gone all out.

The Centennial Park was where ESPN had made base for their college football show. It was filled with people rooting for their schools. It was fun to show Keiko a little American culture about tailgates and football fever.

This is the Olympic fountain.

The G-fish stands for the Georgia aquarium. From the website, "On November 23, 2005, Georgia Aquarium officially opened its doors to the public. As the world’s largest aquarium, Georgia Aquarium features more animals than any other aquarium in more than eight million gallons of water."

Apparently, this was due to contribution by Home Depot.

I have nothing but good things to say about this aquarium. It was a little pricey, but it truly was the most impressive aquarium I have ever seen. It had several tanks with just huge giant glass windows to the tank, like bigger than movie theater screens. It had a great variety of wildlife, tons of things for kids to do including just a play area when kids just need to run around, etc.

This is the map. It is very easy to navigate because you can see every section of the aquarium from the center lobby. My favorite was the one in the top right of the map because it had a giant glass tunnel through the water.

Pictures of Keikos favorites incloude these little guys that just come out of the dirt to feed.

Dad and I in the tunnel

Sawfish above the tunnel

The center plant is actually a fish

Touching a sting ray (and a shark)

We then went on to the World of Coca-Cola. It is a combination of a museum and great marketing/advertising.

Here is the giant building.

Keiko found a Japanese coke machine

An example of all the artifacts they have

Our souvenirs. They have a automated factory at slow speed so you see the bottles being put on a conveyer belt, being cleaned and photopraphed for quality, where the syrup is combined with carbonated water, the filtering, and then you see the filling of the bottles and it being capped and get to take one home with you.

Highlights of that for me were this 3-d Star Tours kind of ride where the seats move and you get sprayed with water and mist and poked by "bugs" in an effort to discover the recipe of Coke.

They they have a room with soda fountain dispensers of Coke products all over the world. Really all over the world. Some taste pretty good, some taste pretty awful. We did this after not eating lunch and after having 64 flavors of Coke and Coke products at 3pm with no lunch was not the best idea.

So we went to a 50's style diner and filled up. Keiko seems to like American food more than me. I got some Greek lasagna and Keiko got lamb and potatoes. Since being pregnant, she seems to like meat more.

THANKS DAD for the great day!

Our apartment from the outside

2009-09-06T15:48:00.001-04:00

Keiko took a bunch of pics of our apartment complex.

Welcome to outside the apartment.

These stair lead up to the parking lot. So we live on the "1st" fl but it's really more like the basement.

The path that leads to the stair from our door.

The opposite direction to the pool and office.

This is the view from our window/patio. It's beautiful, but it has lots of bugs...

"Garbage can"

Outside post boxes

Parking lot

Gate into the complex

Gym

Pool

Tennis court

Shows how we live in the basement.

Many paths to walk around the area.

And you can see how we have a patio with screens surrounding it.

Thoughts on a specialty at the end of 3rd year

2009-09-05T14:01:00.000-04:00

I have finally finished one of the busiest, most interesting, most useful, and most exhausting years of my life. Unfortunately I still don't know what I want to do for the rest of my life, but I have some thoughts.

Medicine or peds, that is how I started the year out. I thought I valued having more time to talk to patients that anything. Then I did medicine and it didn't seem all that enjoyable to me. The internal medicine clerkship director says we shouldn't judge internal medicine on our 3rd year experience. But that's all I have to judge. That left pediatrics, which I really enjoyed.

Then I did surgery. I did 1 month of trauma surgery, 1 month of urology, and 1 month of orthopedics. vascular surgery, and ENT (ears nose throat). I actually had a really great time. I got better evaluations from my residents and attendings than I had received all year. The flow worked for me well. You see the patient, ask them only pertinent questions, make a plan to solve the one problem that you as a specialist can solve and move on to the next patient. Surgery is a quick-fix. In general, you do surgery, the problem gets better, and you are done.

I realized that I wasn't a "I just want to talk to patients as much as possible" kind of guy. I like to get things moving. So, surgery is for me: right?

Well, surgeons spend a good portion of their time in the operating room (OR). Do I like doing surgery? I have no idea. For the most part, I haven't done much more than sew the skin at the end of the surgery. Frankly, the OR has in general been pretty long and boring. Sometimes the procedures are really interesting and look like the would probably be fun to do but standing for hours on end just watching is not my idea of a good time. I really have no idea if I would like to do surgery as a career and am not sure how I will figure this out.

There is one more specialty that I find very appealing: emergency medicine. I will get a chance to really experience it until 4th year but emergency medicine is a nice balance. You get to think a lot and try and figure out what the diagnosis is for lots of different problems, you see quite a bit of action and get to do various procedures during emergencies (like sewing up cuts, putting various tubes into people, etc. but I'm not really sure to tell you the truth).

And there is the final possibility: working at the CDC permanently. If I enjoy my next year immensely I could end up doing public health for the rest of my life. This is a real possibility. Maybe even working in a foreign country. I won't be able to judge this much until I see how much I like next year in Atlanta.

But no matter what specialty I choose, I hope to be able to do research and advance the field. It's one of my favorite parts of medicine: the possibility to improve awaits, and that results in more lives saved.

Our apartment in Atlanta, all moved in

2009-09-02T20:59:00.000-04:00

Here are some pics of our place in Atlanta:

Entrance way with little place to put our shoes and I stick my bike helmet. I have a healthy 5-8 mile bike ride to my work, depending on the day. I feel much more fit than med school :)

To the right of the last pic, our dining area.

At the center of the last pic, our kitchen. It's nice because it is easy to study or do something while someone is cooking as sound doesn't travel far from here, but a little lonely for the cook... :(

Looking from the doorway, our entrance into the patio which can be seen during the day in the Japanese BBQ entry.
http://oldisland2.blogspot.com/2009/08/yakiniku-japanese-bbq.html

Moving to the left, our "living area." And thanks to my dad, I tried to hook up the cable again after our Internet was connected and found we got basic cable after all.

Our closet isn't quite as big, so we tried to stuff a bunch of stuff behind our bookshelf. I feel like it's hardly noticeable unless someone takes a picture of just this and points it out...

A few stairs leads up to our bed.

Then we have our desk and bathroom (and someone hiding)

Bathroom

Closet connected to bathroom

Marriage pics in the bathroom

Marriage pics in the living room (too many perhaps?)

We live in a beautifully green area. Pics soon to come.