Fall 2011

Upstate!!!

InauguralEdition

Baby steps towardsbecoming anindependent physician

Interview withDr. Shanley

The Fistula: Bringingfaculty and students

together

Stories from theinside

Classroom Chronicles,Bedside Manners,

Upstate Out of Mind andMORE!

of Minda student-run, student-focused publication

Fall 2011

Contents

Contributing Authors:Samuel A. SchuelerWasnard VictorDaniel C. ThomasHassan NaqviDavid M. GibbsGabe Plourde

Devin R. HalleranJasmin SahbazChas HannumDaniel Kaufman

Dominick Maggio, MDMickey DaughertyBhargav Mudda

Art by:Rachelle AntosTiffany Lee Khim

Photographyand

Layout:David M. Gibbs

Founded/Edited by:Samuel A. SchuelerWasnard VictorDaniel C. ThomasDavid M. Gibbs

Classroom Chronicles

Getting by with a little helpfrom our friends..................3

Stories from the inside:Dreaded words..................4

The Fistula

Bringing faculty andstudents together...............5

Bedside Manners

Not ready for palliativecare....................................7

Inside Upstate's RefugeeClinic..................................8

Cuse'n through myeyes...................................9

Dean's Differential

Committed to thecommitted: A conversationwith Dean White...............11

PG Perspectives

Bringing the ruckus: Or,taking baby steps towardsbecoming an independentphysician..........................12

Interview with PaulIskander, MD UpstateRadiology Department.....13

Upstate Out of Mind

Apple finds solution tophysician shortage...........15

Keys for Cancer raises14.2 trillion.......................16

MS-1 Franzon outed asCanadian spy...................18

Interview with Dr.Shanley............................19

Acknowledgements

This is a student-run, student-focused publication. But that doesn't mean we haven'treceived tremendous support, guidance, and encouragement from the faculty and staff.This magazine was officially born when we got the green light from Dean Julie White'soffice. We would like to thank and acknowledge the following individuals:Dr. Julie White, Dr. Susan Stearns, Chuck Simpson, Cheryl Alger, and Dan Dippel

ClassroomChronicles

Getting by with a little help from our friendsby Devin R. Halleran and Jasmin Sahbaz

RxMedication: After finishing an

exam, don't do anything related

to coursework for the rest of the

day. You've worked hard, so

give yourself a break!

DevinWe came into medical schoolexpecting the worst. After all,stories of gunning medicalstudents ripping pages fromlibrary-owned textbooks andpassing out study guides filledwith deliberate errors musthave been born from sometruth. It became evident veryearly on, however, that thiswas not the case at Upstate.

The first timewe came togetheras an entire class was at thewhite coat ceremony. Forbudding physicians, this ritualis a time of simultaneousexcitement and anxiety. Whatwas apparent then and remains

true today is that our class has aunique bond that is founded on asense of partnership - the samepartnership that was encouragedduring Dr. Scheinman's firstaddress to our class during theceremony. This can be seenthrough the cooperation that takesplace on the Facebook group pageswhen a question posed to the classis generally answered in a coupleminutes. It is as though there is amutual understanding that workingtogether over these next four yearsis not only better for us asindividuals, but better forour future patients as well.

Maybe more important than thepartnerships that have developedare the sincere friendships. Lookaround the auditorium next timeyou’re in MLC and see how manypeople you don’t just consider aclassmate, but rather a good friend.That we have become so close inonly twomonths truly speaks to theunique quality of people whocomprise our class. Where elsecould you sit in a lecture on thedeveloping heart next to a formerveterinarian on one side and ascreenwriter on the other?

The first two months of medicalschool have been quite a challenge,

3

Jasmin

Stories from the Inside: Dreaded Wordsby Wasnard Victor

Rx

Medication: D

on't bethat gu

y (or

girl).

It was one of those nights whenyou knew something was going tohappen. The peace and quiet wasnot here to stay. The longer itlingered, the heavier the suspense,the harder it was to breathe. It isas if a heavy cloud namedDyspnea hovered over me andconsequently I started feelingshort of breath. I was hungry too,so I decided to step outside forsome fresh air.

In my line of work constant chaosmakes you wish for some nightslike this, but like SKL once toldme “equilibrium equals death”,and I was not about to let the quietfool me. So tense, it wouldn’ttake much to throw off thishomeostasis, and then all would

go awry trying to return to thisalmost perfect steady state.Everything seemed in order, noteven a disgruntled EndothelialCell in sight. Then I heard aruckus. What’s going on?“There’s an INFLAMMATION!”I hear from a stranger rushing by.He moved so fast I couldn’t makeout whom. Then I put it together,segmented nucleus, carrying tinysacs of enzymes, definitely theNeutrophil unit; must be an acuteemergency, no wonder I didn’thear about this yet.

But what set this off? Must havebeen C5a, always too eager for afight - this is probably just aminor insult. I better get downthere and see what all the fuss is

about. I catch a cab on thecorner, Chemotaxis are alwaysthere in times like this. So off wego zooming through, trafficmoves nicely now. Nearing thehysteria, I see Plasma Proteinsjumping ship and sneaking away,leaking is not uncommon at this

but one that has certainlybeen made easier by ourever-growing circle offriends.Keep that inmind aswe move forward. Thinkback to the single file lineswe formed in the atrium ofthe Oncenter back inAugust. We were forced toleave the comfort zonesafforded by our smallnumber of friends and standnext to and interact with thetwo strangers on our rightand left sides. It is likely bythis point that those twopeoplehavebecomefriends.And we’re all better for it.

4

MS1s and MS2s after an inter-class kickball game.

stage, the Leukocytes alreadyassumed their positions against thewall, margination, how typical…whatever, makes it easier for me to getthrough.Thenweget to the site, I jumpout and look around ready to engulfany intruders. The sooner we get thisover with the better…no need to turnthis into a chronic matter.

Then a unit in black jackets, helmets,boots and with batons flashed by megoing in every which way, when Irealized themiddle letterwasn’t a “G,”I knew they could only spell trouble atthis point in the process. To mydismay I saw the letters plain and clearnow…”T-N-F”! At that point I knewthis has just become worse. Unable tocontrol my anger I started heating upfeverishly, only attracting theirattention asmore approached from thedistance. Then I heard it, like trumpetsannouncing an impending onslaught,those twodreadedwords Iknewfar toowell: CYTOKINE STORM…

The Fistula

Bringing faculty and students togetherby Gabe Plourde (with contributions from Dan Harris)

We hope you like it. The newAdvisory Dean (AD) format wasconceived with you in mind. Itsconception was not immaculate nordo we expect our offspring to walkon water. There are, however,several topics that this new systemallows Dan and I to discuss with you.

Perhaps most importantly, Drs.White and Maimone recognized ageneralized discontent with the

Advisory Dean program andproactively sought to rectify it. Therewas no survey or task force, just adude—who in passing mentioned apalpable trend—and then a reaction.Drs. White and Maimone did nothesitate to seek constructive criticismof a program that they had bothinvested deeply in.

With dissatisfaction identified,volunteers from the classes of 2012,2013, 2014 sought to further

I L - 1

I L - 2 I L - 1 0

IFNIL-17IL-18

IL-­‐4 IL-13

Rx

Prescriber: W

illiam Osler

Medication: "T

he best

preparation fo

r tomorrow is to do

today'swork s

uperbly well.

"

5

delineate the sources of ourfrustration and identified thefollowing issues: lack of consistencyin information provided betweenadvisory groups, timing, relevance/pertinence, and mediums. We willaddress each point individually.

Lack of consistency – whilematerials were provided fordissemination to all the AdvisoryDeans, the conversation surroundingthe materials was highly variable andsometimes even contradictory. Thatwas an inevitable consequence ofhaving advisorswith suchdiverse andvaried backgrounds. Disseminationof critical information in a largegroupformat was deemed the best way toensure universal access toinformation. Furthermore, cen-tralized powerpoints for smalleradvisory groups could be vetted bynumerous sources and provide moreconsistencywhile allowing for amorepersonalized meeting.

RxMedication: MS1s - did you know

there is a computer lab next to

the library (room 1210) that is

card-accesible 24/7?

Timing – five o’clock waschosen as a time to hold ADmeetings so that AdvisoryPhysicians could attend.However, as many clinicianswere unable to attend the latermeetings anyway, we decidedthat meetings should occurduring the noon hour. This willhopefully alleviate some of thecommuter hassles associatedwith a 5:00 PM start and reduceany artificially lengthened schooldays. With only two of thesemeetings scheduled per year, it isour hope that physicians whowish to maintain an activerelationship with their adviseeswill be able to carve out these twohours well in advance of themeetings.

Relevance/Pertinence – one ofthe major complaints we allencountered in speaking with ourpeers was that many of us did notfind the information beingpresented at our advisory deanmeetings to be pertinent to us atthe time. Much of it appeared tolack immediacy, e.g. having aworkingCVby theendofour firstyear and was quickly forgotten.Addressing this issue falls largelyunder the auspices of the finaltopic…

Mediums – much of the advicewe found most interesting camefrom our peers in the classesahead of us. Often this advice

was sort of blended up andregurgitated to us by ourAdvisory Deans, relaying theexperiences of previous studentsand occasionally by studentswhovolunteered their time to answerour questions. This new format isan attempt to increase your directaccess to your peers, and ideally,also improve the relevance of ourAdvisory Dean meetings. Forwhatever reason, perhaps age-ism, or perhaps anti-establishmentarianism, a fourthyear suggesting that Iwork onmyCVcarries an air of relevance thatthe same statement lacks whencoming from a grown-up, evenone with a PhD.

This is a new program that willprobably hit a fewpot holes alongits journey but we ask thateveryone be proactive in theircriticism. We can further refinethis new Advisory Dean systeminto one that best utilizes ouroutstanding Advisory Deans andour peers. Also, please thankDrs.White and Maimone for being soinvested in making this work.They are a testament to both thefaculty’s and the administration’scommitment to ensuring oursuccess (As hard as it is to believewhenDr.Spring-Millshas taggeda solar plexus for identificationon the first anatomy exam).

6

Bedside Manners

Not Ready for Palliative Careby Samuel A. Schueler

Rx

Medication:

Best food aro

und campus

Pizza -Franco

's Pizza

Burgers - Chu

ck's

Catfishburrito

s - AltoCinco

Second year was a difficult time tostay motivated. Correction: It was adifficult time to stay afloat. Life,unfortunately, doesn’t stop and say“Oh, you’re a second year medicalstudent? I’ll stay off your back untilyou get through Step 1”. The coursesare equally unrelenting. Despite allthe sacrifice and time invested, manyof us spent much of the year feelinglike we still didn’t really knowanything. Then you start studying forStep 1, and your suspicions that youdon’t know anything are confirmed.

No one came to medical school to bea second year medical student. Mostofmy friendswerepushed to thebrinkat least once or twice during the year,andothers (myself included) spent themajority of the year hanging on by athread. You try to tell yourself thateverything you learn will benefit afuture patient (which I’ve found to betrue so far in third year…sorry for this

awkward tangent, but its worthnoting here that third year isawesomeand2nd year already feelslike some strange, distant memory– hang in there MSIIs), but thismindset doesn’t always hold upwhen the only substantialapplications of the material aremonthly multiple choice questionbeat-downs. Whereas 1st year endswith just three classes and nocumulative finals, second yearends with a storm of cumulativefinals. You get one weekend tocatch your breath (Read: Bingedrink for 48 hours), and then youenter a 4-7 week study periodwhich Iwon’t describehere in caseany children accidentally pick upthis magazine. This, of course,ends in one final 322-question beatdown.

With this kind of workload andpressure, extracurricular pursuits,volunteer work, and thinkingoutside-the-box would seeminglybe eliminated in lieu of survivingschool and maintaining inter-personal relationships in andoutofthe classroom. For a time, Ithought this magazine would beone such casualty.

Then I went to the Upstate VocalClub’s cabaret inNovember of lastyear. I laughed my butt off, then

came close to tears, then laughedsome more. It was therapeutic – Itook life less seriously for a fewhours. It was eye-opening – Ididn’t realize how talented andmusically inclined my classmateswere, and I was reminded of howfortunate we all are to share each-others company. Itwas inspiring –I admiredmypeers for creating thegroup, organizing the event, andfinding the time to practice despiteour heavy course load. After theperformance, I was out of excusesfor not persevering with themagazine.

I don’t really have any talent – atleast not the kind a lot of you have.My hobbies include doing spinmoves in the hallways of thehospital when opportunities arise(ask me and I’ll show you), eatingsandwiches with peanut-butter,pickles, bananas and cornflakes,and incorporating harry potterterminology into every dayconversation,Themost interestingthing I did this past week was dropa lean pocket on my leg whilewalking to the PBS building. Itgushed cheese onto my pant legand shoebefore I had to scoop it offthe ground – I wasn’t about to skipbreakfast.

7

Luckily, youdon’t have tobe themostinteresting, talented, or put-togetherperson to make a difference at a placelike this. All you have to do is openyour eyes. Go to events and concertsthat your classmates organize. Getout in the community and spend sometime improving the life of ayoungboyor girl who may not get a fair shot atgoing to college, much less graduateschool.Make this institutionbetter forfuture classes, as previous classeshave done for us.

It is on that note that Dan Thomas,Wasnard Victor, Dave Gibbs and Iproudly present you the first issue of“Upstate ofMind”.We hope you willhelp us with writing, editing,designing, and otherwords that end in–ing that belong in this sentence.More importantly, we hope thisproject will inspire you to dosomething you’ve always thoughtabout doing but never did because ofall the excuses I had before I went tothe cabaret.

Inside Upstate's Refugee Clinicby Chas Hannum

RxMedication: Weekday events

Tuesday night trivia atColeman's

Wednesday night Flip Nightat Faegan's

For refugees who settle in the Syracuse area, theRefugee Clinic is one of their first stops. Twiceamonth, students and interns fromUpstate sharethe important responsibility of assessing theirhealth before they begin their new lives in theUnited States, and you have the opportunity tobecome involved!

Volunteering at the Refugee Clinic is easy, funandeducational.The twice amonth clinic is heldon Wednesday afternoons, from 4:00 to around8:00on the second floorofUHCC.Usually eightto ten students made up of mostly MSIs andMSIIs volunteer at each session. Students startoff by taking vitals and are paired with aninternal medicine resident to perform acomplete history and physical exam. The case isthen presented to the attending physician, Dr.Peter J. Cronkright, and a plan of action ismade.

“Volunteering at refugee clinic is a really uniqueexperience,” says Connie Vernetti (MSIII), oneof two Chief Coordinators last year. “Due to thenature of the patient population, you have thepotential to see some really interesting stuff thatcorrelates nicely with what you learn about inclass.” In addition, the clinic is an excellent

place to practice the skills learned in thePracticeof Medicine course and is a great way toexperience global medicine right here inSyracuse.

In addition to Vernetti, Nikolai Kolotiniuk(MSIII) also acted as Chief Coordinator of theclinic. Helping out as additional coordinatorswere Megan Pope, Chris McQuinn and LauraAndrews (all MSIIIs) and Sean Haley (MSII),who replaced Vernetti and Kolotiniuk as ChiefCoordinator when they moved on to their thirdyear.

Theclinic runsyear-roundand is always lookingfor volunteers during the summer season. If youwill be in Syracuse, you are encouraged to comeand seewhat RefugeeClinic is all about. “Theseare the most polite, grateful group of patientswe'll probably ever have theopportunity toworkwith,” Vernetti says. “It's nice to take a breakfrom studying every once and a while andremember why you wanted to go to medicalschool in the first place.”

If you would like to have more information,contact Sean Haley at haleys@upstate.edu.

8

9

Rx

Medication: M

adisonis a ha

lf-

way house (h

alfwaybetwee

n

Upstate and

downtown).

Cuse'n through my eyesby Bhargav Mudda

"Exits 16-28A - Syracuse" - readthe sign as I was driving up 81North. First thoughts, "Sweet, Ishould never be late to work"considering the fact that I can drivethrough the whole city in 20minutes - especially if I channeledmy inner Vin Diesel. Nevertheless,my stay in the city was scheduledfor twenty five days whichwere indeed quite memorable.

I was asked to write an outsider'sperspective of Syracuse during mystay and I took the offer. I hope togive you an appetizer of what thecity has to offer. Few things aboutme: I love food. I've also lived inDallas, Miami, the D.C. area,attended school in the Caribbeanand spent most of 2011 in NYC.Finally, I'm awesome. You'll see.

Perhaps the biggest thing I can takeaway from my time here are thepeople of Syracuse. I think there'ssomething to say about theenvironment around you. NewYork City is tremendous in all thedifferent things it has to offer.There is no other place in the worldthat will let millions of people stayin an area so confined and stillmanage to co-exist, but it comeswith something extra. It’s aworkinghypothesis ofmine that theconstant hustle-n-flow of the cityhas a lasting impact on its own.Youkind of become the non-stop,moving machine that the city is.Every step seems faster than theonebefore. Syracuse is on the other end

of the spectrum. The people hereare so warm and genuinelywelcoming that it allows you toslow down to a comfortable pace.

I grew up in Texas where we taketons of pride in "Southernhospitality" and it’s refreshing tosee it extend to the far North. For anoutsider likeme, itwas so importantto be in an environment thatallowed me to settle in and performat a high level. In fact, it put me insuch a goodmood that I might havetaken it too far. Let me frame apicture, I DON'T run. I hate it – it’sso boring and mundane. Actually, Ijust suck at it. Playing sports hasalways been a way to stay in shape.But one day, as I was going to thecafeteria, two of the nicest ladiessitting in the main lobby startedspeaking tome. Tenminutes later, Isigned up for a 5K run in potentiallysub-40 degree weather for BreastCancer Awareness. Wait what?How did we get here? The run wasterrific although cold. Every time Itook a break, I'd see a group ofmothers stroll their babies byme. Aproud moment for the athletewithin me. Don't judge.

I had ONE opportunity to go out ona Friday night. I know – it’s veryunfortunate but I haven'tcompletely formed an opinion onthe nightlife yet. I have a simpleformula for agoodnight for anyguyin his mid-late 20's. You have to hit66.7% ofmy 3 question scale. Howcheap are the drinks? Am I gonna

have stimulating and/or thoughtprovoking conversations withmembers of the opposite sex?Where are we getting food after?Let's just say I went 1/3. I wastaken to PJ's on the Friday nightSyracuse University was playingWVU in football. The place waslively as SU was beating a rankedteam, a tone-setter for the evening.As the night came upon us, thelights got dimmer and the DJ (Iwonder if his name was DJ PJ)started reaching into the good olebag of Late 1990's - Early 2000'ship-hop. He had me at "Oooh thatdress so scandalous................."

I lived one exit away from themallandyouknowwhat thatmeans - it's"Don't cheat yourself, treatyourself" day, everyday. CarouselCenter is the mall here and it's goteverything you need x 3. Iremember one Saturday it tookmemore time to find parking thanwalk the mall. Pretty sure half ofCanada migrated to do someshopping for some reason on thatday. Sidenote: there's an ongoingturf battle between two Chinesefood establishments in the food

10

court. All I know is that they were a few sample chickenpieces away from having an all-out toothpick war.

I also had a chance to eat at probably the best BBQrestaurant EVER.DinosaurBBQ. Iwalked in and orderedsomefoodaftermy5Kfor takeout:A3/4 rackof ribs, freshcut fries, and mac-n-cheese. Let's just say I woke up 14hours later. If you like Thai - try Lemon Grass. If you likeSushi, try Ichiban on Old Liverpool Rd. If you like applesmake sure you hit up the annual Apple Festival which Ididn’t haveachance togo to.People love their appleshere.I wish my stay here was longer so that I could see all thebeautiful lakes I've heard so much about. Also nearby istheCornell campus - amust see. I hope that I have a chanceto one day come back to this city. There are way toomanystones unturned and lots of apples left to take a bite out of.

Committed to the committed: A conversationwith Dean White

by Daniel Kaufman

By all accounts, Dean of StudentAffairs sounds like a prettyweighty title. There is no denyingthat this office holds enormousimport to student life here atUpstate, having a hand (or seven)in events ranging from orientationto graduation, and everything inbetween. One might thereforeexpect Dr. Julie R.White to have ademeanor concordant with theserious nature of her position.Fortunately for the Upstate studentbody, the levity evident in Dr.White’sunrelentingsmile suggestsotherwise.

As the Dean of Student Affairs forthe last three and a half years, Dr.White has and continues to be oneof the most visible and pleasantfaces of Upstate’s administration.She describes her position as“uniquely challenging anduniquely gratifying,” attributingthe intricacy of her job to thecomplexity of the student bodywith which she has the pleasure ofworking. “The students herecomprise a strange and focused

organism,”Dr.White remarked.“And Ihave the privilege of ushering themthrough their experience here, fromcradle to grave—orientation tocommencement.”

In speaking about her job, it becameabundantly clear that Dr. White doesnot regardwhat shedoeshere atUpstateas work, but rather as an experience.Though the experiencemaybewroughtwith commotion, it is one thatunfailingly cultivates growth. Whiledescribing her role as the Dean ofStudent Affairs, Dr.White spoke of theten different offices in the division ofStudent Affairs, shrewdly identifyingthe common denominator: advocacy.

Dr. White considers herself, as well asthe dedicated people with whom sheworks, to be student advocates, first andforemost. She earnestly described thesynergistic partnership that she strivesto develop with the students here,principally outside of the classroom.

“Upstate’s students demonstrateunwavering commitment and com-passion, qualities that are infectious. Ihave been struck, not only by theobvious intellectual ability exhibitedby the students, but by the fact that theyare genuinely good people.” Dr.Whitemakes her best effort to make studentskeenly aware of the support that isalways available to them. “I want our

students to know that this office issafely accessible to them, not onlyduring the extremes of need andaccomplishment, but in the middle aswell.” She excitedly described thetypical highlight of her day as theconversation with a student who dropsin unexpectedly, just to say hello. Dr.White also spoke passionately about“all the fun stuff we get to do.” Fondlyrecalling her involvement in eventsranging from Orientation DinnerDances, tomonthly comedy shows, Dr.White described the sense of inclusionshe feels from the students with a widesmile. “That’s when I know I’ve madeit.”

The energy and enthusiasm withwhich Dr. White carries out herresponsibilities is infectious. Lifeexists beyond the academic rigors thatstudents face, and Dr. White worksrelentlessly to ensure that our livesare as enjoyable as they arechallenging. Uniform throughout theaccounts of her time at Upstate wasthe use of the word “we.” Studentsshould rest assured that in Dr. White,we have not only an advocate, but apartner in the experience at Upstate.When asked to identify the song thatbest describes her, Dr. Whiteresponded “I’m not sure about that.Whatever it is, the word ‘fun’ woulddefinitely be in it.”

DifferentialDean's

11

THE FOLLOWING SECTION HAS BEEN RATED

PG PerspectivesBY UPSTATE OF MIND STAFF

Bringing the ruckus: Or baby steps towardsbecoming an independent physician

by Dominick Maggio, MDThe statement, “Doctor, what would youlike to do?” is probably the mostfrightening utterance an intern can hear.The assumption that it carries is thatmedical school trains you to become a free-standing mini-physician, who iscomfortable making independentdecisions based on a solid foundation ofpractical knowledge. In reality,most of ourknowledge is theoretical, not practical, andwe are entirely uncomfortable, notcomfortable, with making independentdecisions. Our discomfort stems fromlearning our clinical skills by bouncingideas off attending physicians. The daycomes for every intern where their opinionis the last stop in the line of decisionmaking; this experience is one of the mostexhilarating and awkward points in youreducation.

As a theoretically educated medicalstudent inmy third year I remember feelingbrilliant as I presented the biochemistry ofdiabetic ketoacidosis (DKA) and laid outmy plan for IV fluids and insulin. As aresident, I’ve stumbled on grading theseverity of DKA, on which labs to get andat what time, on the amount of IV fluid toprovide, and on how much insulin to give.As a resident you receive your patients asnakedpathology fromtheoutside,meaningthat nothing but your history, physical andlaboratory tests canguideyou towardsbothdiagnosis and treatment. I received anoutstanding foundation of training atUpstate, and I largely blame myself forfailing to imagine myself as the sole

provider for a patient during my medicaleducation. Luckily, each awkward,unintelligiblemoment Ihave in thehospitalcements a practical lesson in my patienthandbook. Even luckier, it seems thateveryone else suffers from the sameproblem, so I’m not alone.

The spectrum of comfort with independentdecision making is also large. Imagineyourself watching an asystolic patientwheeling into the ambulance bay straddledby a paramedic providing CPR. Nowimagine that the next words from yourattending’s mouth are to the paramedics,“Gentlemen, this is Dr. Maggio, he will berunning this case”. Frightening, right?Unfortunately, from the smallest abscessto the largest code, your taste ofindependence as a medical student willbring you only to the threshold of comfortwith these situations. Everyone learns thehard way, and I’m just beginning my pathof sweating under the bright lights ofindependence.

I’m also learning the consequences of thisindependence. In the busy emergencydepartment I’ve already made plenty ofmistakes: I’ve snowed[1] many patientsbecause I didn’t yet understandhow todosepain medication, I’ve tried to discharge anasthmatic on beta blockers, and I’vepunctured the carotid arterywhile placing acentral line. I’m miserable with everymistake, but my memory of the pain I’vecaused, the missed diagnoses, or the minormishap keeps me diligent in my approach

to the next patient with the samecondition.

One of the hardest lessons to learn wasthat I will make mistakes. However,mistakes are expected from residents,and are guarded against by yoursupervisors; the leash is never longenough for you to hang yourself.

I’ve commented on two of the largestdifferences I’ve experienced betweenmedical school and residency, thegrowth of practical knowledge andmaking autonomous decisions. Bothtopics are anxiety provokingbecause nostudent wants to be wrong. However,there comes a time early in yourresidency where you realize that thesedifferences are the primary motivatorsfor you becoming a capable in-dependent provider. Once taken in thislight, you’ll understand that thesemoments will be more worthwhile toyourcareer thanany timespent studyingin the library. We are privileged toengage in these experiences with ourpatients, and I look forward to hearingyour stories of growth in the future.

[1]Snowing is a term describing over-prescribing medication to the point that yourpatient falls asleep.

12

Dominick Maggio was theClass of 2011 President and iscurrently an emergenymedicine resident in California.

RxMedication: Did you knowyou can go all the way fromthe West Garage to Marshallstreet without stepping footoutside?

Interview with Paul Iskander, MDUpstate Radiology Departmentby Daniel C. Thomas

Q: A first-year medical studentmight not have a full grasp on whatis involved in radiology, aside fromall the coffee needed (thank you,Dr. Cohen). What is a typical dayfor you?

A: Radiology is a bit different fromother specialties in that there are norounds tomake or progress notes towrite. Your day typically starts at7:30 with a morning conference.After that your day begins,primarily reading studies oninpatients that were performedovernight. Patients in the hospitalas well as outpatients are alsoroutinely imaged throughout the

the day, so often you will see yourworklist get longer before it getsshorter. Each resident typicallylooks at a handful of studies(depending on which section youare on and what level resident youare) and then reviews them withthe attending, after which youmove on to the next handful.

Let’s address some common

medical student stereotypes ofRadiology:

Q:Many students consider radiologyto be a field with minimal patientcontact. How often do you interactwith patients and do you have thechance tomake personal connectionswith patients?

A: There are a few parts of radiologythat do actually involve patientcontact. The most notable isinterventional radiology, where youroutinely see patients before, during,and after each procedure. In somehospitals, the interventionalist willalso round on their own patients.

There are a few other parts ofradiology where patient contactcomes into play that are not aspopularly known. One of these ispediatric radiology, where a largeportion of the imaging studies(primarily fluoroscopy andultrasound) involve direct patientcontact and patient cooperation inorder to be performed properly.

Nuclear medicine is another areawhere you routinely see yourpatients. At Upstate, we see and treata good number of patients withthyroid cancer as well ashyperthyroidism [requiring radio-iodine therapy] . As part of treatment,we will typically review the imagingwith our patients aswell as discuss alltreatment options.

Q: Radiology is known as one of theE-ROAD specialties that is said tohave better hours and is easier tohave a life outside of medicine. Haveyou found this to be true duringresidency?

A: Yes. Call can be quite busy, butotherwise you do have more nights/weekends off than you would expectin some other specialties. While thismay translate into more time topursue a life outside of medicine,keep in mind that the averageradiology resident has to hit the booksmuch harder than some otherspecialties (1-2 hours of reading per

13

night is typical).

Q: How did you decide to choose radiology? Whatfactors lead you to radiology?

A: Radiology formewasa latedecision.Likemanyothermedical schools, it was not a mandatory rotation at myschool. My first exposure to radiology was duringinternal medicine where we routinely had radiologyrounds for new admissionswith imaging. This continuedintomy surgery rotation. By the end of the core rotations,I had become very interested in what a radiologist does.The way I saw it, imaging was a large part of the patientworkup, and instead of asking for the radiologist’sinterpretation, I decided I would rather be the oneproviding the interpretation.

Future plans:Q: What do most radiology residents do after theirtraining? What are someof themore popular choices forcareers/fellowships?

A: There are accredited and non-accredited fellowshipsin radiology. Most are universally recognized byacademic institutions and employers, with the biggestdifference being the ability to take a CAQ exam(certificate of added qualification) in the accredited

fellowships. These are neuroradiology, pediatricradiology, nuclear radiology (nuclear medicine), andinterventional radiology. Other very commonfellowships include body imaging, women’s imaging,MRI, musculoskeletal.

Most residents graduating from our program pursue a 1year fellowship after residency. The most popular inrecent years aremusculoskeletal, women’s imaging, andneuro-radiology.

I personally have a pediatric radiology fellowshipalready lined up.

Q:What has been the most positive aspect of radiologyyou’ve encountered in residency?

A: Sometimes you’re the only personwhocan figure outwhat’s wrong with patient X.

Q: What has been themost negative aspect of radiologyyou’ve encountered in residency?

A: Sometimes your work doesn’t matter.

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UpstateOutofMind

Upstate! Out of Mind Practicing only the best speculative journalism without the need of “facts” for over 1000 years.

Apple finds solution to physicianshortage

by David M. Gibbs

Mutant Academy

“With great power, comes great responsibility”For great responsibility comes

years and years of training,

Like a story beginning with one dark night

Or several nights constituting many years spent in

twenty-four hour libraries

Just to be the chosen few, selected to be trained…

In the Mutant Academy of Syracuse

Of all those who apply only a lucky

13% make it to training

They successfully equipped their

utility belts with sharp #2 pencils,

Used initially to defeat the first villain

The Mad CAT

On induction day

short white capes are granted and worn

To play Robin to the Long White Cape of Batman

Soon gadgets such as super hearing devices and reflex

mallets are fancied for the trainees

First year is spent learning

the terrain of Gotham City

In the Gothamony lab

2nd year you learn the ways of jokers, riddlers,

scarecrows, and the like

of how they invade and penetrate the city, especially

taking advantage of any

Breaks in barriers

You learn of the tools you have to

exploit their weaknesses,

of how to keep the order in the midst of the

malady of riot, chaos, cytokine storms, and more

3rd and 4th year you get to change your guise in

telephone booths

and test your short cape,

but still not long enough to fly.

On foot you make your way

Soon the academy is over and you’re ready to go…

WAIT!

No X-ray vision, web spewing, or

adamantium claws, you say

No worries, there are specialties for that…

we’ll save those stories for

Another Day

By Wasnard Victor

SCRANTON, PA - With the release ofApple's new iPhone 4S only a fewweeks old, individuals and companiesare already scrambling to findinnovative uses for the best-sellingsmart phone. One hospital in Scranton,PA has discovered a way to addresspersonnel shortages in theirEmergencyDepartment.

Patients can describe their symptomsdirectly to the iPhone using Siri, therobotic voice recognition programreminiscent of themurderous computerHAL in Stanley Kubrick's 1968 film2001: A Space Odyssey. Siri thenutilizes a complicated algorithm tosearch the web for a variety of well-respectedmedical references including

Wikipedia, WebMD, and episodes ofHouse, finally arriving at a most likelydiagnosis.

"It's great," respondedPhilFickel, chiefadministrator for the Scranton hospital."We can buy a phone for the fraction ofthe cost of an actual doctor and paysomeone towalkaroundholding it up topatients. It's really going torevolutionize medicine."

Response by the AMA revealedconcern over the new direction themedical field was heading. Applereleased a statement yesterdayreassuring doctors that their jobswouldnot be at risk, stating "We will alwaysneed someone to hold the phones."

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Keys for Cancer silences critics by raising adeafening $14.2 trillion

by Anonymous

SYRACUSE, NY (AP) – Afterarduous months of meticulous,coordinated, and above all, efficientplanning, the night had finally arrivedfor the inaugural event, Keys forCancer (KFC), showcasing the muchanticipated Music ‘N MedicineInitiative at SUNY Upstate MedicalUniversity. Thousands were expectedto attend this landmark event, andindeed, hundreds filled out theaudience. Earlier that day, USGpresident Samantha “Sam” Shoellerwas quoted as saying, “I was reallyimpressed at how a ragtag bunch ofstudents were able to put aside theiregos, and through a lot of hard workanddedication, pull off this impressiveevent… Oh, wait, you were askingabout Keys for Cancer? I haven’theard of that. When is it?”

The Syracuse Symphony Orchestrawas scheduled to open the show. TheUpstate Vocal Music Club was the

first to take the stage and surprised theaudience with a medley of autotunedclassics including Cher’s un-forgettable Life after Love, T-Pain’scontroversial Buy U a Drank, andnational anthem runner up, Seasonsof Love from the musical Rent. Oncethe tears had dried, pianist MichaelBattle grabbed the spotlight and theaudience let out a collective sigh,finally understanding the brilliancebehind the event’s namesake. Whenasked following the performance,Syracuse native Jim Boeheim said,“Ohhh, like piano keys! Huh? Oh,yeah, the [expletive deleted] on thepiano was pretty good, too.”

But it was Dean Scheinman’s PinkFloyd cover band, Schein On YouCrazy Diamond, that stole the show.The set included fresh takes on PinkFloyd classics, such as Wish YouWereHere (InMy Proximal Tubule),Comfortably Numb (After MyEpidural), Welcome to the (Dialysis)Machine, and Have a Cigar (YouProbably Shouldn’t). Following theperformance, 2nd year medicalstudent Kurrin Keeley said, “MyMLC grade will probably suffer forsaying this, but those guys rockedway harder than last year’s similarlythemed cover band, Shanley and theRolling Kidney Stones.” The crowdwas once again brought to its feetwhen Scheinman came back on stagefor an encore, threw his trademarkmen’s sartorial accessory into thecrowdand closed the showwith “Mo’Bowties, Mo’ Problems,” ahigh energy throwback to his

residency days.

Initially, KFC was met withresistance throughout the Syracusecommunity, due to its perceived pro-cancer agenda. Said 1st year medstudents Allan Taylor and ChrisGuanine, “I haven’t taken ethics yet,but somethingdoesn’t feel right aboutraisingmoney to give people cancer.”However, once news of the eventwent national, a key corporatesponsor, Kentucky Fried Chicken(KFC), joined the cause and turnedthe tide of public opinion. “Once Iheard that KFC was sponsoringKFC,” said systems analyst ColinSanders, “I couldn’t wait to get myticket… along with two free sides.”

From there, no dose of vitamin Kcould stem the hemorrhage ofdonations from the Syracusecommunity. Ticket sales soonshattered expectations, and after justthree days, the programwasmoved tothe Upstate Cancer Center Stadium,with construction on the UpstateCancer Center delayed indefinitelydue to lack of funding.

In addition to achieving their goal ofproviding all pediatric patient roomswith clean running water, the surplusfunds were used to fund the GolisanoConcert Series featuring Three 6Mafia, DMX, and Celine Dion, payoff the national debt, and establish theKFC endowed professorship ofBariatric Surgery.

16

"Laughter is not the best medicine. Medicine is."

Under new leadership, the organization planning the event transformed from atangled, clotted arteriovenous malformation into an anastomosis throbbing withstrokevolumesofpotential.Theclub that broughtyouTHEGROUPRUN(meetsin front of theCABat 5:30) is alreadyplanning their next event.Honey forHobos,a Food Drive/Meet and Greet, is set to take place this coming Valentine’s Day atthe Amaus clinic to benefit the local homeless population. When asked forcomment, the club spokesperson said matter-of-factly, “Those who don’t put adollar in the pumpkin will have blood on their hands.”

While Keys for Cancer failed to raise any actual funds for the Upstate CancerCenter, revenue from this event far surpassed previous fundraising attempts,including “Shave Smith’s ‘Stache” and “Scheinmann Wears a Neck Tie.”Adding insult to injury, this year’s edition of the critically acclaimed Patients ofGeriatrics Swimsuit Calendar was sidelined due to HIPAA violations.

Despite all of the pleased patrons, one in particular expressed dissatisfaction. Dr.Vertino released a statement after the events which read, “Guys, why wasn’t Iinvited to perform? I already have a real band. Y’all got nothin’ on Ace of BasalGanglia!”

17

MSII Dan Harris is not dejected even though his guitar shrunk in the washing machine.

When Organs Go Bad

Drawing by Tiffany Lee Khim

MS1 Franzon outed as Canadian spyby David M. Gibbs

Left: Bordeaux-Le Châtelier photographed at the United States Embassy in Ottawa, Ontario.

Right: Classmates who had no idea Franzon was a spy.

"Congenital Mega Colon"

SYRACUSE, NY—The Upstatecampus is still reeling from newsthat one of its own students isactually an operative working fora foreign government. The reportcomes in the wake of a massivesting operation conducted by theCIA that resulted in theapprension of current MS1 TomFranzon, Canadian national andagent for the Canadian SecurityIntelligence Service (CSIS).

Franzon, who we now know isactually named François

Bordeaux-Le Châtelier, wasapparently on a long-termassignment to infiltrate the UnitedStates. Le Châtelier was raised bycover family Astrid and OlofFranzon (aka Amelie Gaspard andJoseph Hubble), and although theultimate goals of the operation areunclear, the CIA speculates thatLe Châtelier was attempting toacquire “cooler” sports for hisnative country, said a CIAspokesperson Tuesday.

Apparently a principle part of LeChâtelier's plan was maintaining aconstant state of equilibriumbetween his life as a medicalstudent and his secret life as a spy.

However, Le Châtelier's coverwasn't as strong as he believed.None of his classmates were allthat surprised.

“I literally had no idea Tom, erFrançois, was a spy,” said DanFinnin, MS1 and fellow classmateof Le Châtelier’s. “But it makessense. He is entirely too athletic,

good-looking, and persuasive tobe just an ordinary medicalstudent. I know this fromexperience.”

Le Châtelier had maintained anice balance between his medicalschool obligations and CSISresponsibilities until a recent classtrip to Toronto for a Yankeesgame. There, his equilibriumshifted when he inadvertentlyblew his cover to his classmates.They then promptly reported himto the CIA.

The CSIS declined to comment onthe incident, but disavowed allknowledge of Le Châtelier or hisprinciples.

Rx

Prescriber: D

avid M. Gibbs

Medication: S

pies like Le

Châtelier can

be reported t

o the

CIA's anonym

ous tipline at

1-(800) I-SNI

TCH

18

Interview with Dr. PaulShanleyby Hassan Naqvi

Artwork by Rachelle Antos

Ode to Shanley:

A Haiku

by Mickey Daugherty

Lupus does it all

Glomerulonephritis

Corticosteroids?

Do you think that new technologylike the new iPhone will replacedoctors?

PS: Have you seen this ad aboutWatson, the IBM computer? They startout with saying there are thousandsand thousands of diseases andbasically try to awe us with thecomplexity of medicine, of which weare all aware. So this computer, whichapparently can interpret naturallanguage, has access to all existingdatabases, and is very quick, whichwould likely make it better atmedicine than we would be. Somemight say that you would still have tohave somebody do the physical examto give it the data. The patient’s storyis the patient’s story, and although itcan interpret natural language, it maynot be able to interpret body language.

...What about replacingpathologists?

PS: That’s probably easier, actually. Interms of picking up data visually off aslide, which can be digitized andcompared to others, what dopathologists really do? Steve Landassometimes says our job is like

matching wallpaper... which Idon’t completely buy into, butthere is an aspect of it that is “itlooks like this, so there it is” inpathology. [Dr. Shanley picks upthe iPhone.]What if you hadsomething like this that picked upthe heartbeat and printed out aphonogram for example? Andwhat would stop you from havingthe thing be an echo machine?[Dr. Shanley puts down theiPhone...] I don’t know whichside is up...

[Laughter]

I’m obviously not going to be theone designing this...

I’ve seen seven seasons ofScrubs, so I know a lot aboutmedical specialties.PS: Okay...

But not all of the students haveseen Scrubs...PS: Nor have all the faculty!

So what can you tell them aboutpathology and why you chose itas a speciality?

PS: I’ve been interested, almostfrom the start, in the biology ofdisease. It seemed to me inmedical school that the biology ofdisease was most closely going tobe dealt with by pathology, andthat probably turns out to be true.I have some issues... I’m colorblind for example, so I went intosomething in which the histologyis almost unimportant. I quicklystarted to diverge into researchand a very esoteric specialitywithin pathology. Kidneypathology is more integratingmultiple modes of informationand trying to put together apathophysiological diagnosis. Tome that has meaning... as opposedto just recognizing something.

What would you say to studentsthat want to know what they’resupposed to get out of MLC?

19

PS: I want you to start talking andthinking like physicians. So how do youdo that? The approach which I’veendorsed and made a course out of isjust to say dive in and see the distancebetween yourself and the goal of beingable to talk and think like whoever iswriting this case. Phonics versus wholereading is the same controversy: Doesthe teacher sound out everything and tryto teach the fundamentals of letters andsounds, or does the teacher just get youto start reading? In my view, five yearolds, medical students, or sixty year oldpathologists, we all have to learn bytaking on things, struggling with them,and figuring out how to learn.

Let’s give you a case! 21 year oldmedical school student presents witha bad case of ‘drowning in medicalschool.’ What professionalrecommendations would you givethem?

PS: Why would a student be drowning?

A student might be overwhelmedwith the amount of work and at thesame time know that the work onlyincreases over time.

PS: The problem that we have inmedical school is that we have a bunchof high achievers... You come in duringthe first exam and half of the class wasin the bottom of the class. Maybe thesefeelings have to do with expectationsthat are not realistic... either for howmuch effort you were going to put in orultimately what you were going tocome out with in terms of class rank orcareer. If you learn to love the stuff ofthe profession, I think it will be a lotless frustrating than if your ambitionsare driving you. Learning to love thestuff and accepting your own limits...That is a fun ride... But trying toachieve something that is out of yourreach and constantly being frustrated...that’s not a fun ride and I think that’s atthe bottom of a lot of it.

Even the person who graduates at thebottom of their medical school class iscalled a Doctor, right?

PS: That’s true! There’s a lot of room inmedicine for different careers. Noteverybody has to be a neurosurgeon.

If you could be one organ, which onewould you be and why?

PS: I have no idea...

You cannot choose the kidney.

PS: I guess the exclusively human thingis the brain, so there would be no reasonto be without one I suppose. I wonder ifyou could be one all by itself, in a jar orsomething.

Dr. Shanley (left) recommends a bit of light reading to Hassan Naqvi (right).

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