Clinical General Opinion Public Health

Parents fight Croatian law enforcing mandatory child vaccinations | We don’t need no vaccinations, we don’t need no thought control

The Croatian constitutional court has made the vaccination of children a legal obligation. Their reasoning behind this law is that “a child’s right to health is more important than a parent’s right to choose (wrongly)”. Their words, not mine, although I do agree.

Vaccination has been a part of paediatric care in Croatia for years, and children have regularly been vaccinated throughout their education, although it has never before been officially mandatory. Now, parents have the potential of being prosecuted if they do not to vaccinate their children. In Croatia, children are vaccinated against the following: tuberculosis, diphtheria, tetanus, pertussis (DTaP), polio, measles, mumps, rubella (MMR), and hepatitis B. It was always said that vaccination was mandatory, but whenever I asked what to do with unvaccinated children, I was given vague answers. Nevertheless, the law now states that a parent’s failure to ensure the vaccination of their child will result in a fine and a visit from social services. A large group of parents, accompanied with some medical professionals, disagree with this and have called for a public discussion.

Photo courtesy of
Photo courtesy of

“Nobody wants to take the responsibility.”

This is an argument many parents have repeated when asked why they don’t want their children vaccinated. The majority of “modern” parents are best pals with Doctor Google, who has told them stories about apparently unnerving side effects of certain vaccinations. Furthermore, media dramatization and sensationalism add another factor in the vaccine debate.  Although the Internet and media in general can provide strong patient education, it can also provide highly biased information thereby providing harmfully improper patient education. Even though they are dramatic and stand out, articles reporting on a child developing a long term and/or life changing disorder or condition are quite rare. Reading such an article invokes fear in readers. Statistics are what matter in possible negative outcomes. How many stories about serious problems arising from a vaccinations exist? And how many children are vaccinated every day? And what are measles, mumps, rubella, polio, pertussis, and the other diseases like when they take hold of a child’s body?

Understandably, parents want to protect their children and don’t want their little ones to suffer any life changing side effects, short or long term. Before allowing for any vaccination, they want doctors to tell them with absolute certainty that no harm will come to their children from a vaccine. Surely parents would also like completely safe transport, but they are willing to put their children in a car, train, or plane because of the benefits of fast travel outweigh the small chance of an accident happening. It is impossible to expect doctors to claim that anything is completely safe, and “take responsibility“ if anything at all goes wrong. This is why there are patient consent forms and small directions in all medication boxes explaining possible side effects. If a parent asked me whether I would take responsibility for any possible side effects of vaccination, I would reply with another question: Would you, as a parent, take the responsibility of your child getting an infectious disease that could leave them with life changing consequences, or even possibly be a cause of death?

Although I would try and talk to people who refuse vaccination, if they continued to refuse I would respect their decision. In the end, I appreciate it is your right to decide what you want to do with your body. A friend of mine has pointed out to me that this law might limit the right of choice; therefore not allowing parents to make a choice about their children. I can see his point, and as I said, everyone should have the right to decide what to do with their body. However, this is a choice parents aren’t making about themselves, but about their children, who are too young to make an informed choice. Are their parents making an informed choice though? Do they have enough information to go against medical advice? Many countries don’t have a law about mandatory vaccination, and maybe those fighting against this law will manage to win, but I hope this whole debate will at least raise awareness and make people think about the importance of vaccination.

Featured photo courtesy of zsoolt


A Review of “Informed Consent” | A Play Regarding the DNA Tests and Lawsuits of the Havasupai Indians

Informed ConsentInformed Consent, written by Deborah Zoe Laufer and directed by Sean Daniels, aims to show the emotional, psychological, and physical dangers that can occur when researchers fail to communicate adequately with their subjects. The play focuses on the tale of the Havasupai tribe and their battle against the improper use of their blood in genetics research. Laufer has stated she was inspired to chronicle their story after reading a New York Times article from 2010 entitled, “Where’d You Go with My DNA?”1 The article summarizes the plight of the Havasupai, a Native American tribe plagued with type II diabetes mellitus. The tribe looked to researchers at Arizona State University to study blood samples of tribal members in an attempt to find a genetic link for the disease. Of note, is that blood is sacred to the Havasupai and they will not proceed to their desired after life without their blood. Though they believed to only consenting to diabetes research, the informed consent document was “intentionally vague” and researchers decided to use the blood sample for more studies than diabetes, without re-informing the Havasupai. It is this story that lead Laufer to her play, Informed Consent.  Though inspired by true events, Laufer chose to fictionalize many aspects, while maintaining the central issue: What constitutes informed consent? On March 18th, the play made its world premiere at the Geva Theatre in Rochester, New York and will be playing through to April 13th. It will be then featured in the Cleveland Playhouse in Cleveland, Ohio from April 23rd until May 18th.

This character driven play features five actors, each jumping into different roles throughout the show. Their impeccable performance is matched by a beautifully rendered set design. Created primarily of cardboard, the set aims to depict the base of the Grand Canyon−the home of the Havasupai. In contrast to the sand colored canyon, there are white rectangles scattered throughout the set, juxtaposing nature with the sterility of the science research lab.  While the actors’ performances are strong in conveying the strife endured by the Havasupai, there are occasional parts that take away from the brevity of the content. This is seen with random background interjections from actors not involved in certain scenes. It seems as though Laufer attempts to add comic relief to the script; however, it is misplaced and hardly receives any laughs from the audience. Lightheartedness is out of place when addressing such a sensitive topic based on true events.

Of note is the lead female protagonist, Gillian, who conducts the research with the Havasupai. It is because of her ill-guided decision to use the blood obtained from the Havasupai for more than diabetes research, which is all that the tribe agreed to, that she inflicts pain on a tradition-dependent group. She is painted as self-centered and career driven, allowing nothing to stand in her way to get publications in lofty journals such as Nature and Cell. She goes so far as to publicly deny the creation story of the Havasupai, which the tribe has passed down for hundreds of year.

While some may think Gillian is over caricaturized, it is easy to see parallels in the everyday medical world. It’s the doctor who asks for a urine sample without telling the patient what he is testing for. It’s oversimplifying or leaving out details because a doctor thinks it is “best for the patient.”  I even saw this in myself on the night of the show. After the play, there was a “talk-back” session featuring the director, a clinical geneticist, and a Native American man, not from the Havasupai tribe. When asked about DNA, the Native American man stated that he was “skeptical” of DNA and that he did not place much trust in its usage. I nearly jumped out of my chair. How could one not “believe” in something with such tangible proof? In that instant, I was Gillian, the overzealous scientist with tunnel vision whose sole perspective is scientific. Though momentarily shocked, I was pleased with this experience for play aims to make individuals realize the importance of respecting differences in opinions and beliefs. It will be through the understanding of patients’ perspectives throughout our careers as physicians that we will gain insight into their lives and, hopefully, provide them with the best personalized care we can offer.

Featured photo courtesy of Moyan Brenn

Narrative Reflection

On Anatomy Lab

For a medical student, anatomy lab is a rite of passage.

Everything about it is a test: Can you withstand the sharp sting of formaldehyde at 8 AM? Can you differentiate between the vagus and the phrenic nerves? Can you delicately dissect the muscles of the forearm?

Can you make that first cut?

Human emotion fascinates me and my psyche just so happens to be a complex, peculiar, and interesting specimen to study. The psychological effects of working in the anatomy lab had a profound impact on me, even with scalpel in hand two months after my first day. Day one of lab went just as I had anticipated: I kept my cool until someone broke my composure by casually asking how I was doing. I fought back tears after the harmless inquiry until I could isolate myself and let it all out in a corner between a large window and a countertop covered in plastic model brains. I had been trying to make a positive first impression on my lab group by keeping a composed demeanor despite being in an environment worthy of vast displays of emotion. Clearly, this was no simple task. Although mixed with a bit of embarrassment, I immediately felt relief upon the crumbling of the emotional dam that I had worked so hard to build. I would have stayed in the corner longer to release all of the fear, sadness, and confusion had I not felt so guilty about leaving my group within the first five minutes of lab. I typically use distraction techniques to rid myself of negative thoughts but the impending return to the lab table invalidated those tricks. Instead, I accepted that I had nothing to be embarrassed about, that I could sort through my feelings on my bike ride home, and that it is okay to let my classmates see me cry. One deep, cleansing breath later, I rejoined my group and together we embarked on our seventeen-week journey.

After that episode, I dreaded returning to the chilled tank that housed the body of a woman who could have been my mother: same age, same surgical scars, same body type. In the seven-day interim, I pondered her life. I wondered about her family, where she had worked, what made her choose to donate her body. I wondered if she died in peace or in pain. I thought about the people in my life who had passed away. Each of their deaths was sudden, painful, unanticipated, and unjustified, and left me with an incredibly significant sadness. I wondered if my perspective on death was natural, if it was normal for me to feel such heartache in the presence of a deceased stranger. I eventually concluded that there is no perfect answer because there is no norm by which to judge my perspective. With that understanding, I made peace with my emotions.

My sadness subsided over the subsequent weeks as I found myself head-over-heels in amazement and respect for the human body. I felt like a pilgrim finally reaching a sought-after shrine, seeing for the first time with my own eyes the conglomerate of vessels, nerves, organs, and muscles that until then I had only ever read about. Despite the body’s collective complexity, the individual parts seemed unbelievably simple and incapable of carrying out the multitude of physiological functions required for life.

As we uncovered one pathologic finding after another in our hunt to determine our cadaver’s cause of death, I began to involuntarily formulate a mental scenario of this woman’s final years, months, and even the day she died. Soon enough, each physical finding that suggested a potential cause of her death was accompanied by an imagined reproduction of her life. One half of me was determined and anxious to uncover new pathology that might lead to a stronger differential and the other half wished it could painlessly declare natural causes. In the histology lab, I encountered yet another emotional challenge. One minute I was eagerly anticipating visible signs of liver metastasis and the next I was welling up behind the eyepiece of my microscope, imagining our young patient receiving the news that she had five months to live.

No two medical students have the same anatomy lab experience. For me, the past nine weeks have altered my view of death and further sensitized me to human suffering. Death no longer seems personal, but rather a fundamental biologic process. It is the suffering that often precedes death that has consumed me as an anatomy student. Death undoubtedly brings about a suffering all its own—which was my initial source of heartache at the beginning of lab season. Who did this woman leave behind? Are they still grieving over her passing? But as we uncovered her countless medical problems, I wondered what was harder for her family and friends: to live with her absence, or to live with her suffering?

When it comes to anatomy lab, many medical students would express that there is nothing to it — it is simply another requirement. For others, it is unashamedly so much more. It is said that the cadaver is the medical student’s first patient. I only wish I had the opportunity to thank mine.

Featured photo courtesy of UC Davis School of Medicine

Lifestyle Narrative Reflection

Time | The Balancing Act of Medical School

Not too long ago, I was rushing from one informational meeting to the next, trying to gather the scoop on medicine, medical school, and what exactly it meant to be a pre-med (I found it strange that these three rungs on the medical ladder were not necessarily complementary with each other… Did acing a nit-picky orgo exam really hold any bearing on my future abilities as a physician?). During my data-gathering in college, I soon saw a common theme emerging from all of the advice I accumulated.

Regarding the medical school experience: Medical school is tough.

Courtesy of Dalya Munves:
Courtesy of Dalya Munves:

I was told that the material would be overwhelmingly vast, that I would spend most of my spare time with my nose in the books, memorizing, and that I should not even think about third year yet, because that was a whole ‘nother story. I was not deterred—I had found medicine (or rather, medicine had found me) and I could not imagine myself pursuing any other field.  I was a little afraid because I knew I was not much of a memorizer.  But, I would try my best.  This all happened after my sophomore year of college, when I finally decided to “go pre-med.” (My path to choosing medicine will have to wait for a future blog post… stay tuned!).

I couldn’t imagine being busier than I already was. I was already heavily involved with three extracurricular activities, was starting to go into a lab to do research, and had a full course load. Yes, medical school was probably going to be busy—everyone said it would be—but somehow, I couldn’t wrap my mind around a life busier than what I was experiencing in undergrad.  If I had been a more pro-active of a pre-med, I might have planned for the time-suck that I heard medical school was going to be. Maybe I would have started studying anatomy on my own, flipping through an atlas over the summer and starting to put down to memory muscles and nerves. Maybe I would have freshened up on my biochemistry or genetics.

Either way, I don’t think it would have prepared me at all for the balancing act that attending medical school has been. (In any case, I’m glad I didn’t fritter away my summer with a Grant’s Dissector.) It’s true that I’ve never been expected to memorize so much material in such a short period of time ever before. And that my attending lecture, small groups, and mandatory clinic sessions have resulted in much more class time (and hence, less free time) than in undergrad. Yet, these challenges are singular, and I have come to accept them as essential parts of the path I have chosen to take. The real challenge arches over other aspects of my life.  It is the challenge of prioritization.

Most, if not all, doctors would agree that in order to keep sane, they’ve had to prioritize activities other than studying during their medical career. Often, it’s working out, cooking, sleeping, watching TV, or spending time with friends and family. It’s ultimately all about balance.

Being a medical student is like this: a teetering balancing act that may lean or sway more towards one activity or another on a day-to-day basis, but ultimately, in the big scope of things, stays firmly upright. This dynamic, rocking state of being is what balance truly is.  I’m still awful at memorizing, and binder-loads of lecture material still catch me off guard. Yet, the biggest challenge of medical school has been learning how to best use the limited time I have in the most fulfilling way for me.  It’s about learning to promote balance in my life.

In C. Dale Young’s poem, “Gross Anatomy: The First Day,” he begins the poem with an anatomy dissection instructor telling his students to:

“Begin with bone and muscle to discern exactly what you need to memorize. Each region has so many things to learn.”

He ends the poem with a snapshot of a sentiment too often felt by medical students:

“…You have many things to learn:
procedures, facts, new words at every turn.”
His introductory words elicit sighs.
Begin with bone and muscle to discern?
There is no time—too many things to learn.”

If I were to give advice to my naïve, pre-med self, I would sit her down and look her in the eye. I would tell her with confidence that she will be able to handle the course load of medical school just fine, that she will one day wield a stethoscope and call herself student-doctor without a second thought. But I would add, after motioning her to listen carefully, that she should make sure to pay particular attention to what is important to her. I would urge her to not let those things wither and to make finding balance a priority during medical school.  Then I would share some sage advice I have gotten from fourth years past, “The extra hour you spend studying may not help you become that much of a better doctor in the long-run, but the extra hour you spend with your friends/your significant other/your family/your hobbies can make all the difference for your current and future happiness. Either way, you are going to get that MD. How you get there is yours to choose.”


Guinea’s Ebola Virus Outbreak | Connecting the Classroom to Current Events

Guinea, Africa. Photo courtesy of cjlvp user.
Guinea, Africa. Photo courtesy of cjlvp user.

Ebola Virus Outbreak in Guinea

Medical students spend hours upon hours in the classroom learning about the transmission, diagnosis, treatment, and prevention of infectious diseases on a daily basis. While it is important to learn as much as possible from professors and textbooks in order to be successful doctors, it is equally imperative for medical students to stay informed about current events, especially those that are medically related. Of note, there is currently a dangerous outbreak of Ebola virus in the country of Guinea in West Africa that has led to over 100 infections and already 83 deaths in the past month alone. In fact, there have been multiple reports of the virus spreading to the densely populated capital city of Conakry, which is troubling due to the fact that it has historically only been seen in rural parts of the world. In light of this deadly disease, here are a few points of information about Ebola virus that are important to know:

What is Ebola?
Ebola is a virus that belongs to the Filoviridae family of enveloped and single-stranded, negative-sense RNA viruses. Since 1976 when Ebola was first reported in the country formerly known as Zaire, there have been 5 documented species of Ebola virus known to cause infection. Each one is classified by the country or region in which they were found to have caused an outbreak of disease, which include Sudan, Uganda, Cote d’Ivoire, and even Virginia, where lab primates imported from the Philippines were found to have been infected.

What are the signs and symptoms of Ebola Virus Disease?
Upon entry into a human host, the virus causes damage to the blood vessels of the body leading to an array of different symptoms. The incubation period usually lasts between 2-21 days. Initially, the clinical presentation involves intense weakness, fever, muscle pain, and other influenza-like symptoms. As the virus damages the circulatory system and elicits inflammatory responses by the human immune system, more severe issues such as hypovolemic shock and hemorrhagic fever develop.  Of note, this viral disease has a 90% fatality rate.

Transmission electron micrograph causative RNA filovirus of Ebola. Photo courtesy of CDC:Cynthia Goldsmith.
Transmission electron micrograph causative RNA filovirus of Ebola. Photo courtesy of CDC:Cynthia Goldsmith.

How is it spread?

Although there is still controversy over the natural reservoir of Ebola virus, it has been well documented that fruit bats (Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata) are the most likely candidates. In many rural parts of Central and Western Africa, fruit bats are considered a delicacy leading to the initial infection in humans. In addition, the handling of other exotic animals such as non-human primates and rodents that have been infected, has been reported to further spread of the disease. Once a human is infected, the virus can be transmitted from person to person through direct contact of blood, mucous membranes, or bodily fluids.

How is it treated/prevented?
There is currently no vaccine or antiviral agent to prevent or treat Ebola virus disease. If an outbreak is suspected, quarantining is vital to limiting the spread of infection. In addition, raising awareness of the potential threat of infection to those who are risk is also an important task, which includes educating people in rural areas to avoid consumption and handling of exotic animal meat.

Is there ongoing research to come up with a vaccine?
Many pharmaceutical companies and academic laboratories are currently working on creating both effective vaccines and treatments against Ebola virus. In fact, an article recently published in the International Business Times reports that a Canadian pharmaceutical company called Tekmira Pharmaceuticals Corp3. has begun clinical trials for a drug called TKM-EBOLA to treat Ebola viral infections. According to the article, “in January the company dosed the first human subject in a clinical trial” and in March received a “fast-track designation” from the Food and Drug Administration to expedite the trial process.


Clinical General Innovation Opinion Public Health

A Quick Guide to HPV Vaccination

ThinPrep of CIN 1/HPV Photo from Ed Uthman
ThinPrep of CIN 1/HPV
Photo from Ed Uthman

Human papillomaviruses (HPV) are non-enveloped, double-stranded DNA viruses which infect human mucosal and epithelial tissues. They survive well in the environment and can be spread through direct contact with a wart, a fomite (ex. doorknob or toilet seat), or when an infant passes through the birth canal.  HPV is now the most common sexually transmitted infection in the US1. Even though most infections resolve spontaneously without further progression, it can lead to the formation of skin warts and has been associated with cervical cancer since the 1990s. HPV-6 and HPV-11, two types of HPV, are known to cause genital warts and low-grade cervical abnormalities, while HPV-16 and HPV-18 cause about 70% of cervical cancers. Despite the prevalence and potential severity of this viral infection, there is no specific treatment for HPV. Medical intervention involves treating clinical manifestations of the infection, including removal of warts or cervical neoplasias.

The spread of HPV can be reduced, but not prevented, through the use of condoms and other methods of physical barrier protection. In addition, two new inactivated subunit HPV vaccines, Gardasil and Cervarix, were recently approved by the FDA. The vaccines have no therapeutic effect on those who are already infected and the duration of vaccine protection is unknown, but studies are underway to determine if immunity wanes as time goes by. Both vaccines use the L1 capsid protein, which is produced through recombinant technology. This capsid protein then self-assembles into noninfectious virus-like particles (VLP), which function to elicit a memory immune response.

In 2006, Gardasil, a quadrivalent vaccine (HPV4), was approved by the FDA for both males and females of ages 9 to 26. Gardasil is composed of HPV6, HPV11, HPV 16, and HPV 18 and is administered in a 3 dose course. If a patient has not had all 3 vaccine doses by the age of 26, the remaining rounds can still be administered. HPV4 vaccination is also recommended for all immunocompromised males and men who have sex with men under the age of 26. In 2009, Cervarix, a bivalent vaccine (HPV2) containing HPV 16 and HPV 18, was approved by the FDA. HPV2 is approved for females ages 10 to 25, but is not approved for use in males. Neither HPV4 nor HPV2 contain any preservatives or antibiotics, and more than 99% of those who are vaccinated produce an antibody response to the viral types present in the vaccines.  Prior infection with one of the virus types does not diminish the protection against the other types of HPV present in the vaccine.

The vaccines should not be administered to those who are allergic to any vaccine components, are acutely ill, or pregnant women. If a woman becomes pregnant prior to completing the 3-dose vaccination, the remaining doses should be postponed until the completion of the pregnancy. Side effects of HPV vaccination include pain or swelling at the site of vaccination and fever. Overall, no serious adverse reactions have been documented.

Dr. John Kreider's son and grandson with a historical marker recognizing Dr. Kreider and Dr. Mary K. Howett's work which lead to the development of the HPV vaccination. Photo courtesy of PennStateNews.
Dr. John Kreider’s son and grandson with a historical marker recognizing Dr. Kreider and Dr. Mary K. Howett’s work which lead to the development of the HPV vaccination. Photo courtesy of PennStateNews.

Despite the fact that HPV-16 and HPV-18 are highly associated with cervical cancer, controversy has surrounded the HPV vaccines. In general, parents are understandably reluctant to vaccinate their children against a sexually transmitted infection at such a young age, perhaps because the duration of the protection resulting from vaccination is still unknown. Dr. Diane Harper of the University of Missouri-Kansas City School of Medicine does not believe the vaccine should be mandated by law since only 5% of women infected with HPV develop cervical cancer2. While that seems valid logically, the basic principle of vaccination is to prepare the body’s immune defenses for eliminating virulent agents before they can lead to harmful medical conditions. As an example, consider poliovirus. Poliovirus affects each individual differently, with up to 95% of the total cases being inapparent or asymptomatic3. Only a small percentage of those who are infected with poliovirus get paralytic polio, the condition which was seen in the public eye so often.  Even though infection with poliovirus rarely leads to paralytic polio, parents do not usually hesitate to vaccinate their children in order to prevent this outcome. So, both vaccines prevent a serious outcome which rarely occurs as a byproduct of viral infection, yet polio vaccination has general support around the globe. Despite the fact that the HPV infection doesn’t always result in cervical cancer, parents should not overlook this vaccine, as it drastically reduces the risks of this serious complication even further.



General Lifestyle Narrative Reflection

Stop, Look, Go | An Approach to the Medical Student Lifestyle

Medical school is not what I expected. I’m neither saving lives day in and day out, nor am I the most knowledgeable person in my class. I’m not performing medical miracles and I’m not revolutionizing medicine as I envisioned I would be (yes, with just my twenty odd years of “life experience”). Instead, I feel as though I am trying to drink from a full powered water hose that won’t shut off. I am continuously faced with my own idiocy, ineptitude, and more importantly, fear. I see these super-human, overly capable figures who bear the name of doctor and wonder if I’ll ever be able to stand beside them. And then I stop, look and go.

Stop, Look and Go” is a theory discussed by a monk who goes by the name of David Steindl Rast. He believes that the key to happiness is to be grateful for every moment that one has in life. However, he stipulates that this can only come about once one realizes that in every moment there lie an infinite number of opportunities at ones disposal. Now, keep in mind that this is, of course, easier said than done. I am far more comfortable wallowing in my self-loathing guilt-infested thoughts about all the opportunities I’ve missed, than focusing on the promise of the moment at hand. Rast’s ideas challenge human beings to do more−all by employing a simple rule we learned to follow as children before crossing roads.

So, what do I gain from the application of said rule? Here is an example of my utilization of this theory, albeit on a rather small scale:

When I Stop, I allow myself to be in the here and now. I am not thinking about the amount of material I have to learn over the next few days, or what I neglected to go over the night before. I am simply absorbing what is provided to me in this moment in time.

Then I Look. Of course, this requires so much more than simply looking. It requires the utilization of every sense to, as Rast puts it, take in the enormous amount of richness provided to us. Looking is the process of making associations and enjoying the present. It requires full awareness. For example, I happen to encounter a patient with inguinal hernias in a clinical setting, after just learning about the condition in the classroom setting. This is a highly enriching experience−an invaluable experience.

Finally, I Go. Now that I have grounded myself in the present and made associations about the overlap of opportunities of that present, I move to motivate myself to do something with this newfound peace and knowledge. This ranges from sharing my thoughts with a colleague who might appreciate them; to renewing my interest in a subject matter I am studying thereby incentivizing myself to continue studying when weary.

For some, all of the above may very well prove to be an exercise in futility and I certainly do not know if everyone will take from this theory what I have−wise monk or not. What I will say is that this has very much widened my perspective on the power of purposeful action and, in my opinion, enhanced my ability to learn and absorb the waterfall that is medical knowledge. To me, medical school is a lot of things. Some days it’s a nightmare, other day the bees knees. Some days it’s taking over my life, other days it is my life. It is difficult but awe-inspiring; fun but tiring. If it were a drug, I’d be an addict and if it were a person we’d be in a torrid love affair.  Overall, medical school and being part of the medical profession is surely an invaluable opportunity and I strive to remind myself of my fortunate position as often as necessary, fueling my daily work and propelling me into the future. Thank you brother Rast.

Narrative Reflection

Ghost | Reflections on Anatomy Lab

The towel felt heavy the first time I lifted it,
Weighed down,

I held in my breath while we grabbed the ends of the white damp cloth and peeled it back,
In part from the acrid smell of formaldehyde,
And in part because of,
The fear.

Its chin was jutting upwards to the ceiling,
The black buds of a sloppy row of stitches closed the deep fissure running along the clavicle and towards the midline.
This was where the blood was drained.

I braced myself,
The cold iron table sucked the life through my hands and from my body as I braced myself on the dissection table.
And then I saw it.

I felt nothing.
Just a floating,
Lightheaded feeling,
As I begun the ascent,
Levitating into the ethereal space that fills the gap between the world of the living and the world of,
The dead.

Like purgatory,
I was completely still.
Dissected from reality.
Cutting away,
Just naming—
The structures.

Then later,
The day was done.
We coated it with formaldehyde through a spray-bottle.
Like gardeners tending a plot,
As though the skin we just eviscerated would sprout back.
And then we covered it with the white towel and hosed that down too.

My foot was poised on the step-lever to hoist down the dissection table,
But I was disturbed.
There was the white towel in front of me.
What was underneath it?
Her body outlined a humanoid shape along the matted towel.
She was someone that was loved, and had loved.
Where was the gash where she bled?
She was someone’s daughter.
I could not dissociate dead from alive anymore.
The idea of what was underneath,
The idea of life,
I had touched a ghost.

The thin white veneer that wrapped the outside of her body,
It was a canvas.
Upon which you paint an image of an offshore breezy fishing town.
She lived there for a while, I’d like to think.
In that little idyllic village off the coast.
With her husband,
A hardworking man with a stout jaw,
A stern and powerful jaw.
He was an Irishman by blood,
And made a living off the boats.
Often he was away from home but he always brought her back a handful of daffodils on his way from the marina.

There wasn’t much pollution there,
If any it was from the tugboats wrangling along unwelcome fishing seiners.
This was evidenced by the lack of carbon pigment deposition on the lung tissue,
Seen on gross dissection and histological analysis.

The years weighed on and on like lead,
The grief of the love that passed on and along the waves more days than not.
No longer did love linger lightly on her like the tiara of trillium I always imagined she wore on her wedding day.
So her back bent and broke under the load of grief.
Anterior T12-L1 compression fractures secondary to osteomalacia,
Evidenced by post-mortem CT imaging.

When her neighbors asked when her old man would be back,
And joked of a love affair with a mermaid.
Her back started hurting again.
Tears welled in her eyes.
And the lump in her throat made it so hard to—
That one we excised out.
The lump.
It was a thyroglossal duct cyst.
Characterized by the presence of parafollicular cells seen on an H+E stained tissue sample.

Through the many years she was still a good woman to him.
Though he died one day,
The way that things usually die.
According the literature women live longer than men.
Approximately by an average of 5 years.
She lived.

I had to slip underneath her right arm to cut open her neck,
In her icy embrace I swore I heard her speak to me in that moment.
We had cleared the cobwebs from her throat.

General Innovation MSPress Announcements

Welcome to the Medical Student Press: Letter from the Editor-in-Chief

Dear Readers,

I am delighted to welcome you all to the Medical Student Press through the launching of the MSPress Blog. In merely five months, the MSPress has grown to have an international team of medical students serving as editors, peer reviewers, graphic designers, and writers. Our journal has had countless submissions and our diverse blog writers are eager to share their experiences with the medical student community at large. We have made incredible strides and welcome all of those interested in supporting the scholarly expression of medical students to join our team (see application: here).


This project was inspired by of one of my dearest professors at Stanford University, Professor John Willinsky. In my junior year, I decided to take a course entitled “Learning, Sharing, Publishing, and Intellectual Property” through the School of Education. I found myself in a beautiful turret providing a beautiful view of the sunset. In this course, Professor Willinsky taught about the classical and current debates within the publishing world. He explored modern methods of sharing educational resources, and taught us the specifics of John Locke’s theories concerning the commons (Professor Willinsky’s book on this topic is currently in the making). I stayed in the course for the rest of the semester, enjoyed the sunset, and gleaned as much as I could from this publishing giant.

Soon, I began working closely with Professor Willinsky and one of his projects: Open Journal Systems. This open-access software enables editorial teams to collaborate within a seamless online platform. Further, it publishes content that is widely-indexed, thereby providing journal submissions with the opportunity to be widely read and cited. I worked with OJS during my Stanford years as EIC of Intersect: the Stanford Journal of Science, Technology and Society. After the journal was live for three years, it became international and was strongly cited by other scholars (see the Intersect citation line-up here).

The Medical Student Press

The Library of Babel Illustration by Erik Desmazieres
The Library of Babel Illustration by Erik Desmazieres

An MS1 at the University of Rochester School of Medicine and Dentistry, I was determined to find a way to continue working with publishing. The MSPress began as a collaboration between myself and Gabriel Glaun, an MS1 at the University of Central Florida College of Medicine. We were both involved with scholarly publishing in our undergraduate years and sought out an opportunity to continue this involvement as medical students; a search I assumed would be similar to bumbling through Jorge Luis Borges’ Library of Babel. While we easily found well-established medical publishers, we surprisingly did not find any large-scale projects that were exclusively for and by medical students. Further, the collaboration between international medical students was one that was seldom seen. A well-indexed, organized, easily accessible, international, and approachable medical student publishing organization was clearly needed, and so our work on the MSPress began.

After a great deal of work and support from other medical students, I am elated to make our medical student publishing organization live. We operate using Open Journal Systems and support open-access publishing through our use of a Creative Commons license for all of our content. Currently under our auspices are The MSPress Journal and The MSPress Blog.

The MSPress Journal accepts research essays, theses excerpts, interviews, scientific papers, medical ethics essays, creative writing, sound pieces, and visual art pieces.  This platform runs directly through the Open Journal System, ensuring our articles are widely disseminated and strongly published.

The MSPress Blog supports those students interested in long term writing, as well as those interested in occasional writing. This platform accepts informal pieces, narratives, sound pieces, visual art pieces, news articles, and pilot studies.

Recognizing that medicine is dynamic, we aim to support the ideas of all students. Get in touch with our team to share your creative ideas. The education of medical students continues far after class and clinic sessions are over. Remain engaged, expressive, and innovative by contributing to the MSPress. We are proud to support the scholarly expression of medical students and welcome all readers, contributors, and creative minds.

We are a versatile team with an exciting new project that is full of potential, so to stay up to date with us, follow our blog, our Facebook page, and our website.


Cheers to the scholarly expression of medical students,

Mica Esquenazi

The MSPress, Editor-in-Chief


MSPress Announcements

Join the MSPress Team

Interested in becoming a blogger, editor, or public relations liaison for Medical Student Press? Get in touch with our editorial board through our online application.

NOTE: To complete your application, you must email your CV to
If you are interested in becoming an editor or writer, please also send along a writing sample of at least 500 words, the subject of which is at your discretion.

Editor: Editors work closely with the Open Journal System software which we run our editorial process through. This includes assigning and communicating with peer reviewers. Once a submission is accepted, the editor moves to finalize the submission via author communication. This requires strong writing skills. As we are a new publishing group, editors also have a role in public relations. To apply for this position, please send along a CV and a writing sample of at least 500 words the subject of which is at your discretion.

Copy Editor: The copy editor is the final reader of all submissions, ensuring no grammatical or writing errors. This requires attention to detail and strong writing skills. To apply for this position, please send along a CV and a writing sample of at least 500 words, the subject of which is at your discretion.

Web/Graphic Designer: Our primary systems run via CSS in conjunction with Open Journal System and WordPress. For those interested in this role, prior experience is appreciated but not required. To apply for this position, please send along a CV.

Blogger: Bloggers are required to submit a writing piece once a month. These pieces will be posted on our WordPress blog site. The posts will be informal, but still edited by the editorial team. To apply for this position, please send along a CV and a writing sample of at least 500 words, the subject of which is at your discretion.

Peer Reviewer: All medical students (including residents and fellows) are eligible to be peer reviewers. Simply register via our website with your credentials and hospital email address to enter our pool of peer reviewers.