SPORTS
Pharm Students Take on a Tough Mudder
TABULA
IN THIS ISSUE
The Literary Arts Issue News Briefs » PAGE 3 Tap into the power of Journal Club » PAGE 5 literature to change our world Puzzles » PAGE 11 » PAGE 6
Synapse
People actually do this for fun? » PAGE 3
The UCSF Student Newspaper
Thursday, April 24, 2014
synapse.ucsf.edu
Volume 58, Number 28
TABULA
The Literary Arts Issue
“I
t is difficult to get the news from poems yet men die miserably every day for lack of what is found there,” wrote the iconic physician-poet William Carlos Williams. Williams points out in these lines an intangible power of literature—of all art—to change our world. Through artistic expression, we can appeal to emotions, arrive at harder truths, and importantly, we can plant the seeds for change, both within our individual selves and society as a whole. Indeed, reading literary fiction may significantly improve readers’ empathy, as determined by two separate studies in 2013, one from the Netherlands and another from the New School. The researchers divided study participants into several groups and asked to read a passage of literary fiction, commercial fiction, non-fiction or nothing. Afterwards, they asked the participants
to complete several tests to determine their ability to recognize and respond to other people’s emotions. The group that read literary fiction before taking the tests consistently did better. Here at UCSF, we can harness this power of the literary arts to improve our experience as (future) health professionals and as well-rounded human beings. More importantly, we can use these lessons to improve the experiences of the people around us and bridge the gap between providers and patients. For inspiration (and as an appropriate end to National Poetry Month), we present this year’s Tabula, the annual arts issue of Synapse. Patients reflect on their harrowing experiences with illness. Medical students write about and help restore the humanity of patients who have fallen through the cracks. These pages contain a wealth of such poems, stories, essays and photos by talented members of the UCSF community. Happy empathizing. For more, turn to Page 6. Jenny Qi Executive Editor
Photo by Sarah Paris/ UCSF staff
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EVENTS MISSION BAY EVENTS FOOD TRUCK THURSDAYS AT MISSION BAY
Thursday, April 24, 11 a.m.-2 p.m., 4th Street & Nelson Rising Lane, Mission Bay Join the food truck lunch party every Thursday at Mission Bay and explore the tasty culinary options to break up your routine. Each week will feature two different vendors, so there will always be something new. Grab some friends, get some food, and take your lunch experience up a notch.
AAAS SCIENCE & TECHNOLOGY POLICY FELLOWSHIPS
Thursday, April 24, noon-1 p.m., Byers Hall, 513, Mission Bay Learn about resources for pursuing opportunities in science policy, and get advice from past policy fellows. To RSVP, go to: aaaspolicyfellowships.org/event/ucsfinformation-session.
NEGATIVE RESULTS SYMPOSIUM
Thursday, April 24, 5:30-7:30 p.m., Genentech Hall Auditorium, Mission Bay Join the Science Policy Group at UCSF for their first-ever Negative Results Symposium! Celebrate the data that doesn't make it into the papers by attending or presenting at our Negative Results poster session, and enjoy talks by Professor Stanton Glantz, PhD of UCSF and Elizabeth Iorns, PhD, of Science Exchange and the Reproducibility Initiative.
SYNAPSE NEWSPAPER
Friday, April 25, noon-1 p.m., Graduate Division, CC-310, Mission Bay Synapse is looking for Mission Bay and Parnassus writers, bloggers, photographers and designers. Come to the lunch meeting, share your story ideas and enjoy a free lunch. RSVP to Steven Chin, synapse@ucsf.edu.
MUSLIM FRIDAY PRAYER SERVICES
Friday, April 25, 1-2:30 p.m., Helen Diller, 160, Mission Bay The Muslim Community at UCSF holds regular Friday prayer services (Jum’a) for the UCSF Muslim community every week. Come join your fellow brothers and sisters for prayer, lunch and socializing. All are welcome.
MISSION BAY RIPS
Friday, April 25, 4-5 p.m., Genentech Hall Auditorium, Mission Bay Research In Progress Seminar is a seminar series at which one student and one postdoc present their current research. Talks are 15 minutes in length and are preceded by a 20-minute social. Snacks and beverages are provided.
MISSION BAY FARMERS’ MARKET
Wednesday, April 30, 10 a.m.-2 p.m., Gene Friend Way Plaza, Mission Bay Shop healthy, shop fresh, shop Californiagrown at the UCSF Farmers' Market, every Wednesday (rain or shine). Sponsor: Pacific Coast Farmers' Market Association.
UCSF CAMPUS STORE ONSITE SALE
Wednesday, April 30, 11 a.m.-2 p.m., 550 Gene Friend Way, Mission Bay To make shopping easier, the UCSF Campus store comes to YOU! First 50 customers who make a purchase with the UCSF Campus Store receive $2 in Carrot Cash to spend at the Mission Bay Farmers' Market.
campuslifeservices.ucsf.edu/retail/21/the_ campus_store_comes_to_you
PARNASSUS EVENTS CHANCELLOR¹S CONCERT SERIES
Thursday, April 24, noon-12:45 p.m., Cole Hall, Parnassus Looking for a place to study or relax between classes? CLS Arts & Events has got just what you need. The Chancellor's Concert Series on Thursdays is a great place to set up your laptop and study or just take a break from classes while listening to classical music. Seating beings at noon. If you are unable to come, you can now listen to the music through live stream. http://bit.ly/MY05SW
PRECISION MEDICINE DISCUSSION
Thursday, April 24, noon-1 p.m., Health Sciences West, 303, Parnassus Dr. James P. Yee, MD, PhD will discuss the evolution, science, utilization, and implications of the AlloMap test -- a product based on gene expression profiling of RNA designed to assist the long term management of heart transplant recipients. This talk will share the journey of evolving AlloMap® test utilization to assist the long term management of heart transplant recipients and the emerging roadmap for future personalized diagnostic products that may enhance the outcomes of other solid organ transplant recipients.
QB3 ENTREPRENEURS DISCUSSION SERIES
Thursday, April 24, 5:30-6:30 p.m., Medical Sciences, 214, Parnassus The QB3 Entrepreneurs¹ Discussion (QED) series inspires, connects, and educates entrepreneurs. QED talks feature leading entrepreneurs, venture capitalists, and industry experts on how to launch a successful startup. QEDs also provide a venue for members of the QB3 incubator network and Bay Area biotech community to meet entrepreneurial students, staff, and faculty. Register: http://www.eventbrite. com/e/qed-kevan-shokat-ucsfintellikinetickets-11144683047.
EXPERIMENTAL DANCE THEATRE WORKSHOP
Thursday, April 24, 8:30-9:30 p.m., Millberry Fitness Center, Studio 2, Parnassus Come dance with the Experimental Dance Theatre group! One of their members will be leading an all-levels workshop in American ballroom and Latin dance! No experience necessary.
MUSLIM FRIDAY PRAYER SERVICES
Friday, April 25, 1:30-2 p.m., Medical Sciences, 178, Parnassus The Muslim Community at UCSF holds regular Friday prayer services (Jum’a) for the UCSF Muslim community every week. Come join your fellow brothers and sisters for prayer, lunch and socializing. All are welcome.
CAMPUS EVANGELISTIC FELLOWSHIP
Friday, April 25, 7-10:30 p.m., Nursing, 517, Parnassus Join the Campus Evangelistic Fellowship for its weekly meeting, with Bible study, hymn singing and fellowship.
OCPD:PSR: PREPARING A K99/R00 APPLICATION
Monday, April 28, 1:30-4 p.m., Health Sciences West, 302, Parnassus The K99/R00 grant, also called the Pathway to Independence Award, provides funding for the last 1-2 years of your postdoctoral research training, followed by transitional funding for up to 3 years once you obtain an independent research position. Dr Bill Balke will outline specific tips for preparing all components of a K99/R00 application, using a real K99/R00 award application as an example. On-site registration. Cost: $17 for UCSF Trainees/$27 for non-UCSF Trainees.
PARNASSUS FARMERS’ MARKET
Wednesday, April 30, 10 a.m.-3 p.m., ACC, 400 Parnassus Ave. Shop the Farmers’ Markets on Wednesdays to pick up locally grown produce and more. Sponsor: Pacific Coast Farmers’ Market Association.
MOTHER’S DAY CARD MAKING
Wednesday, April 30, 11:30 a.m.-1:30 p.m., Millberry Union Conference Center, Parnassus Sharon Tong-Robinson will demonstrate how to create special cards using stamps, ink and cutouts. Give one of your handmade cards to the UCSF Medical Center. Your card will brighten the day of a patient in the hospital. Craft supplies and sweet treats will be provided.
SYNAPSE NEWSPAPER
Wednesday, April 30, noon-1 p.m., Millberry Union 123W, Parnassus Synapse is looking for Mission Bay and Parnassus writers, bloggers, photographers and designers. Come to the lunch meeting, share your story ideas and enjoy a free lunch. Email synapse@ucsf.edu to RSVP.
7TH ANNUAL CHANCELLOR'S LEADERSHIP PANEL ON DIVERSITY & INCLUSION
Wednesday, April 30, noon-1:30 p.m., Cole Hall, Parnassus Please join Interim Chancellor Sam Hawgood and Vice Chancellor Renee Navarro as they share important updates on the diversity initiatives at UCSF. You may also watch the event via live stream (lecture.ucsf.edu/ special-events/diversity-panel-2014/). A Q&A session will be included. Please submit questions in advance to DiversityOutreach@ ucsf.edu.
UCSF RUN CLUB
Wednesday, April 30, 5:30-6:30 p.m., Millberry Union Central Desk, Parnassus Please drop by and join UCSF Fit & Rec for a run. Each Wednesday night, the Run Club runs various distances (from 3-6 miles) at 9 to 11 minutes per mile.
ENGLISH CORNER
Wednesday, April 30, 6-8:30 p.m., Clinical Sciences, 130, Parnassus English Corner is an informal conversational English class given as a free community service and provided on a voluntary basis by both people born and raised in the United States as well as many people who have, at one time in their lives, experienced life as a new immigrant to the United States.
J-1 ORIENTATION
Thursday, May 1, noon-2 p.m., Rock Hall, 102, Mission Bay J-1 immigration regulations mandate that all new J-1 visa holders who have started their appointment at UCSF must attend one orientation. You will learn about traveling during your program, employment and reimbursement policies, extending your program and other helpful information doing research. Hosted by Kevin Long, Adviser. Bring your passport and your DS-2019.
OFF-CAMPUS OFF THE GRID: UPPER HAIGHT
Thursday, April 24, 5-9 p.m., Stanyan and Waller Streets, SF Off the Grid is a roaming mobile food extravaganza that travels to different locations daily to serve delicious food, with a free side of amazing music, craft and soul.
ANNOUNCEMENTS APPLY TO BE A UCSA STUDENT REP: DEADLINE APRIL 29
The University of California Student Association (UCSA) is recruiting for UC System-wide Committee Student Representatives, Student Observers to select Regent Committees and Collective Bargaining Program Representatives. Join thousands of others fighting for the quality, accessibility and affordability of the UC system. Apply today: ucsa.org/get-involved.
UCSA UC REGENTS LOBBY DAYS
Tuesday, May 13, 2014 9 a.m. - 5 p.m., Sacramento Join the UC Regents during their lobby days in Sacramento! The UC Student Association (UCSA) is organizing a delegation of students from the UCs to lobby with the Regents during their legislative lobby days May 13-15. Reasonable costs will be reimbursed. Contact Christoph Hanssmann, GSA External Affairs Co-Chair, if you are interested in learning more. christoph.hanssmann@ucsf.edu.
NOMINATE A SUSTAINABILITY CHAMPION FOR UCSF SUSTAINABILITY AWARDS: DEADLINE APRIL 25
Nominate a deserving champion of sustainability in you midst. Do you know a faculty, staff, student or a team who consciously models sustainable behavior and influences others to do the same? Nominate them! http://sustainability.ucsf.edu/1.128.
ARE YOU A FIRST GENERATION TO COLLEGE STUDENT (FG2C)?
Register with the First Generation Support Services Office, for access to all of the First Generation Support Services and to help the office advocate for you. Register before April 15 to be entered to win one of three giveaways! bit.ly/firstgenregister.
FG2C BROWN BAG MENTORING
This Brown Bag Mentoring program is designed to help UCSF first generation college students connect with first gen faculty, postdocs, residents, fellows and alumni who have generously offered to meet with you over lunch. Sign up at bit.ly/brownbagmentor.
FREE SYNAPSE CLASSIFIEDS
UCSF students and staff can now post online classified ads for free on the Synapse website. All you need is an @ucsf.edu email account. Try it out! synapse.ucsf.edu/classifieds.
WALK WHILE YOU WORK IN THE PARNASSUS LIBRARY
The Parnassus Library has installed two new Walkstations so that you can walk while you work on a computer on the second floor of the Technology Commons. library.ucsf.edu/ content/new-walkstations-available-librarytech-commons.
EPOSTERPALOOZA
Thursday, May 1, noon-4:30 p.m., Millberry Union, Parnassus ePosterpalooza! is an annual scientific (digital) poster presentation for students of all four UCSF schools.Sponsors: Pathways to Discovery & Clinical and Translational Research Fellowship Program. ctsi.ucsf.edu/ festival/eposterpalooza.
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SPORTS
These Pharmacy Students Are Tough Mudders By Chris Foo Staff Writer
I
f you’re an active runner, chances are you’ve heard about the explosion of “fun runs” that have swept across the nation. Heck, if you have a Facebook account you’ve probably seen pictures all over your newsfeed of your friends participating in these events. These runs come in all shapes and sizes— people dress up as zombies, get splattered with colored chalk and even adorn themselves with glowing accessories for night runs. Yes, fun runs are the latest craze, but some of them seem to be less about the “fun” and more about the “challenge.” A couple weeks ago, some pharmacy school classmates and I participated in the annual “Tough Mudder,” held in Diablo Canyon. Tough Mudder is more than a simple race. Participants run more than 10 miles conquering muddy obstacles. They face challenging wall climbs, tubs of freezing ice water, insanely steep hillsides and, of course, the electroshock. That last one wasn’t a joke— people run through dangling electrical wires and try not to get shocked, which results in muscle paralysis. Some get through the course without falling, but most people end up eating a face full of mud along the course. As hard as it sounds, this race was the most fun I’ve had in a while. In fact, there are a wide variety of other “tough” races out there as well. The Spartan Race has participants complete actual challenges like spear throwing, boulder carrying and rope climb-
Photo by Mouang Saepha About a dozen first-year pharmacy students and their friends celebrate after completing the Tough Mudder race earlier this month.
ing. A shorter, more condensed alternative is the Warrior Dash. It’s only 3-4 miles but with 12 extreme obstacles crammed in. I plan to check out the “Run for Your Lives” Race, in which zombies chase you throughout the obstacles. You’re given a belt of flags, and if the zombies “eat” all of them, you’re out! These are just a few of the many tough runs out there. Perhaps one of the best aspects of these events is that they often support charities. In particular, Tough Mudder has raised more than $6 million for the Wounded War-
rior Project, a program that supports the transition of injured soldiers returning home from military conflicts. There’s nothing like the satisfaction you gain from knowing your sweat raised money for a good cause! After experiencing Tough Mudder, I am inspired to do more of these crazy challenges. It’s quite daunting at first, but I wouldn’t be surprised if more people catch the bug after completing their first race. Hopefully I’ll see you in the muddy trenches!
Chris Foo is a first-year pharmacy student.
MEDICINE
UCaSeFiles: Clinical Cases from the UCSF Wards Welcome to UCaSeFiles, a column in which short case vignettes are submitted by UCSF medical students, residents and attendings based on the stories of real patients seen on the wards, with each vignette followed by a brief discussion of salient learning points. Some cases are rare diagnoses; others are common ailments that might have had a unique or puzzling presentation. All are welcome to
submit your medical mysteries to Theresa Poulos (Theresa.poulos@ucsf.edu) for editing and final submission.
By Theresa Poulos and Jenny Cohen Staff Writers
Contraceptive Switch: Tri-al
Synapse
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The UCSF Student Newspaper synapse.ucsf.edu STAFF
Yi Lu | EDITOR Jenny Qi | EXECUTIVE EDITOR Angela Castanieto | ASSOCIATE EDITOR Akshay Govind | ASSOCIATE EDITOR Steven Chin | MANAGING EDITOR
About
Synapse is the UCSF student-run weekly newspaper, which runs on Thursdays during the academic year and monthly during the summer. Synapse seeks to serve as a forum for the campus community. Articles and columns represent the views of the authors and not necessarily those of the Board of Publications or the University of California.
Submissions
Announcements and letters should be submitted six days before publication. All submissions can be either emailed or mailed. All material is subject to editing. Letters to the Editor must be signed by the author.
Subscriptions Subscriptions cost $20/year ($40/outside US).
Advertising
Paid advertisements do not necessarily reflect the views of Synapse. Synapse and its editorial board reserve the right to decline advertisements promoting false or misleading claims, known health risks, or content deemed by the editors to be antithetical to the interests of UCSF students or the UCSF community. Synapse does not accept advertisements from tobacco or alcohol manufacturers, or sexually oriented personal ads. Synapse reserves the right to run any ad with a disclaimer.
and Error
Case submitted by Theresa Poulos, MS3 The Patient: A 26-year-old woman presented to primary care clinic complaining of “feeling like a crazy, emotional wreck.” Since switching from monthly Depo-Provera birth control shots to the Ortho Try-Cyclen oral contraceptive (OCP) four months ago, she describes having uncontrollable fits of tears and reactions that are out of proportion to the situation; she is worried that her husband is growing increasingly frustrated with her moodiness. She notes that these symptoms are the worst when she starts her week of sugar (placebo) pills. She had been on the Depo shot for six years, but made the switch to the OCP because she and her husband plan to start trying to get pregnant within the next year. Otherwise, the patient is in good health with no other complaints and nothing of note on physical exam. The Diagnosis: Combined OCPs are birth control pills that contain forms of both estrogen and progestogen. They come in two major flavors: monophasic, which contains the same doses of hormones throughout the 21pill cycle, and multiphasic, which contain varying doses of hormones. Ortho Try-Cyclen is an example of a multi phasic — more precisely, a triphasic. A month’s cycle of pills includes seven days each of three differently dosed hormones, followed by a week of placebo pills. Although the changing hormone levels are intended to reflect the changing hormone levels in a woman’s natural cycle, many patients experience moodiness as a side effect from hormone level variations, particularly when going from the highest dose (third week of pills) to the placebo pills (no hormones).
UCASEFILES » PAGE 5
NEWS BRIEFS Campus Trader Now Available to all UCSF Affiliates
Campus Trader, an online community that brings buyers and sellers together to trade, sell, or give away items, has now become available to all UC San Francisco affiliates. This service brought to UCSF by Campus Life Services and powered by Trade Away, is similar to Craigslist, in that users can list an item along with photo and price. Furniture, clothes, appliances, and other personal items can be listed and browsed. The pilot program started in 2013 available to UCSF housing residents and was so successful that it is now open to the entire UCSF community. Creating an account is easy and free. Campus Trader provides users with an anonymous user name, so your real name and email address is not shown until you want it to. All monetary transactions take place between the seller outside of the website. For more information and to start selling or buying, visit: campustrader.tradeaway.com.
Harm-Reduction Program Optimizes HIV/AIDS Prevention, UCSF Study Shows New research from UCSF and the San Francisco AIDS Foundation has found that clients participating in a harm-reduction substance use treatment program, the Stonewall Project, decrease their use of stimulants, such as methamphetamine, and reduce their sexual risk behavior. Harm reduction is a public health philosophy and strategy designed to reduce the harmful consequences of various, sometimes illegal, human behaviors such as the use of alcohol and other drugs regardless of whether a person is willing or able to cease that behavior. “We found that even when participants were using methamphetamine, they reported engaging in HIV risk-reduction strategies such as having fewer anal sex partners after enrolling in Stonewall,” said the study’s lead investigator, Adam W. Carrico, PhD., UCSF assistant professor of nursing. The research findings appear online on April 18 in the Journal of Urban Health. The Stonewall Project, a San Francisco AIDS Foundation program, serves substance-using gay and bisexual men as well as other men who have sex with men.
UCSF Study Finds Codeine Often Prescribed to Children, Despite Available Alternatives Despite its potentially harmful effects in children, codeine continues to be prescribed in U.S. emergency rooms, according to new research from UCSF Benioff Children’s Hospital San Francisco. As reported in the May issue of Pediatrics, solutions include changing provider prescription behaviors to promote the use of better alternatives to codeine, such as ibuprofen or hydrocodone. “Despite strong evidence against the use of codeine in children, the drug continues to be prescribed to large numbers of them each year,” said Sunitha Kaiser, MD, UCSF assistant clinical professor of pediatrics at UCSF Benioff Children’s Hospital San Francisco and lead author. “It can be prescribed in any clinical setting, so it is important to decrease codeine prescription to children in other settings such as clinics and hospitals, in addition to emergency rooms.” Codeine is an opioid used to treat mild to moderate pain and suppress cough. Because of variability in how children process the drug, about a third receive no symptom relief from taking it, while up to one in 12 can accumulate toxic amounts causing breathing to slow down and possible death.
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synapse.ucsf.edu | April 24, 2014 | 5
UCSF JOURNAL CLUB Recent research by UCSF scientists By Taylor LaFlam Staff Writer
IMMUNOLOGY: Integrin-mediated interactions between B cells and follicular dendritic cells influence germinal center B cell fitness. Wang, X., et al. (Cyster). J Immunol. 2014 Apr 16. Epub ahead of print.
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TISSUE ENGINEERING: Effect of collagen nanotopography on keloid fibroblast proliferation and matrix synthesis: implications for dermal wound healing. Muthusubramaniam, L. et al. (Desai). Tissue Eng Part A. 2014 Apr 11. Epub ahead of print. Most of the time, a scar is at worst mildly unsightly. For a minority of individuals, however, it can lead to a keloid, in which the scar tissue grows beyond—sometimes far beyond—the site of the original insult. Keloids can be painful and difficult to treat. Previous studies have found that cells in a keloid undergo more proliferation at the edge than in the center. The edge borders normal skin that contains unaligned collagen fibers, whereas in the middle of the keloid most of the collagen fibers are aligned. In this paper, the authors seeded keloid and normal fibroblasts into different collagen scaffolds. They found that keloid fibroblasts in the presence of aligned rather than random fibrils had lower expression of genes associated with cell proliferation and collagen production. They plan to investigate whether collagen-containing dermal patches may be an effective therapy. BIOCHEMISTRY: Hst3 is turned over by a replication stress-responsive SCF-Cdc4 phospho-degron. Edenberg, E.R., et al. (Toczyski). PNAS. 2014 Apr 8. Epub ahead of print.
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During an infection, many B cells head to lymph node structures called germinal centers and undergo rounds of mutation and selection such that they produce higher-affinity antibodies. This process is known to require interactions between B cells and follicular dendritic cells. In vitro studies have shown this interaction involves two particular integrin heterodimers on B cells, but their importance in vivo had not been determined. In this paper, Wang and colleagues found that while removal of a single heterodimer had no effect, removal of both heterodimers resulted in less efficient B cell responses in germinal centers when competing with wildtype B cells. Simultaneous removal of both VCAM1 from follicular dendritic cells and a single heterodimer from B cells had a similar effect.
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In eukaryotes, DNA associates with a set of proteins called histones. A variety of chemical modifications to these histones have critical biological functions. Acetylation of lysine 56 of histone 3 (H3K56ac) is important in DNA replication and repair in yeast. Previous research revealed that precise, rapid changes in the amount of the protein Hst3, which removes the H3K56ac modification, are essential. It was known that varying Hst3 transcription contributed to these changes but less clear if post-transcriptional mechanisms were also involved. Here, Edenberg and colleagues reported that Hst3 is targeted for degradation by SCF-Cdc4 through recognition of two short stretches containing phosphorylated amino acids. They further observed that these same recognition sites were also required for replication stress-induced increases in Hst3 degradation. CELL ENGINEERING: Synthetic control of mammalian-cell motility by engineering chemotaxis to an orthogonal bioinert chemical signal. Park, J.S., et al. (Lim, W.). PNAS. 2014 Apr 7. Epub ahead of print. Precise homing of specific cells plays an essential role in a host of biological processes, from immune reactions to germ cell development, and an ability to direct cell migration would be a powerful tool. G-coupled protein receptors frequently play a role in stimulating cell movement. Recently, various such receptors have been modified to no longer respond to their natural ligands but instead to an artificial molecule. In this paper, members of the Lim lab demonstrated use of such a receptor to control cell migration. Expression of the modified receptor allowed several different cell types to respond to the artificial ligand. Furthermore, T cells engineered to express the receptor homed to a subcutaneous implant of the ligand in a mouse, suggesting this technology might one day have therapeutic applications.
Taylor LaFlam is a fifth-year MSTP student.
UCaSeFiles » FROM PAGE 3
Because this patient wanted to try for pregnancy within the next 12 months, she was not a good candidate for an IUD or the Depo shot (which she had been using happily for the last six years), since it may take months to regain fertility after discontinuing those methods. Other options for hormonal birth control include a progestogen-only pill, which needs to be taken at the exact same time each day, and is therefore a difficult option in terms of adherence; or, a monophasic combined pill, which is often reported to have fewer moodrelated side effects because of the stable hormone levels throughout the cycle. Barrier contraceptives were also discussed, however
the patient and her husband preferred a nonbarrier approach. After discussing the various options with the patient, the decision was made to switch from the triphasic pill to a monophasic formula. During a follow-up phone call five weeks later, the patient reported greatly improved mood stability and satisfaction with her new contraception.
Theresa Poulos is a third-year UCSF medical student and Jenny Cohen is an MD (R1 – UCSF Internal Medicine).
TABULA
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a patient’s wish threads of cloud drape the hill like lace over a crib drops of cloud fill the puddle like pearls in a bowl of tea drape my face fill my mouth be not the cloud against the orange sky drifting away
Photo by Daniel Raskin, retired, is a member of Poets on Parnassus.
~ Alice Cabotaje Chaplain, Spiritual Care Services UCSF Medical Center and UCSF Benioff Children’s Hospital
Teddy and Mark.
Winter Lullaby I adore your gentle breathing, lying in my bed; My plant has chosen you with drops of water on your head. I adore you leaning over, blowing out the light; Your lips will be my candle, burning through the night. I adore that you adore all creatures meek and wee; I adore the firelight that shines on you and me. I adore you leaning over, blowing out the light; Your lips will be my candle, burning through the night. I adore your voice beside me biking to the sea; I adore you, darling, every moment you’re with me. ~ T. Booth Haley Dental School/4
Untitled 1 I lost you at hello Photo by Sarah Paris/ UCSF staff
Waiting for the Novacaine The root still lives but the tooth is shaved off, capped in plastic, awaiting its crown of GOLD, not porcelain like the other two but the GOLD of Rushes, and bouillon, and dead bodies, like the prison ones in books that are robbed of fillings, an experience unchanged from the days of Dickens. Like the pennies on dead eyes that I suddenly saw the purpose for at my mother's bedside, and how, when her jaw fell, I knew why Jacob Marley had that toothache rag around his face. I told this to my sisters that night, who never knew before how useful reading can be. ~ Phoebe Grigg UCSF staff
Nephrostomy (for my aunt) No OFF-button on the frickin' remote; the tv hangs like an eye which you watch prophilactically, in case it might fall. (Surgery no picnic at seventy-five, not even an after-dinner mint) Rough green swabs clear the tongue's thick coating. No liquid except through tubes. Past scars of past wars foiled the surgeon, squashed passages, leaked infections. The only answer a new hole to add to the old hole, drainage, catheter, four bags attached now, hanging. Already editor for the Ostomy Society, no one in your district has this most exotic one.
Nefertiti of the Ostomies.
Always did have to be different. ~ Phoebe Grigg UCSF staff
Palmistry
~ Terri Mason UCSF/retired
Untitled 2
My mother was never superstitious until she lost faith in her body— with each new opaque mass, her doctors uncovered another dark star.
Scars knit intended wounds over time under clothes same as accidental
She started aligning furniture with compass rose gardens, invited stone guardians to roar at hidden ghouls, built doors she instructed to greet the morning sun.
~ Terri Mason UCSF/retired
Her body she cleansed until the insides burnt raw. Nightly, she traced lines in her palms like a prayer, never doubting her palms would betray her too. ~ Jenny Qi BMS/3 “Palmistry” first appeared in What’s Your Sign? in 2013.
Wishful Ending Let me die in winter Let me die in solitude past midnight with a flask of spirits a cigarette that won’t kill me winking at the stars Let me die with my back against a tree, snowdrifts hushing all sounds sit in stillness become stillness nothingness ~ Sarah Paris UCSF staff
synapse.ucsf.edu | April 24, 2014 | 7
World Backwards As a young medical student, I sat across from my patient in the old neuro ward. A retired high school English teacher, I knew she was once quite sharp. Post-stroke, with signs of early dementia, It was obvious that her mental faculty was waning. She now silently sat in front of me, With a recently stabilized small bleed in her brain. She stared at me and spoke: “My world… my world is… I looked into her eyes as if I understood. “I don’t belong… to this world. They know that… that the system. It’s not the system… for me.” Photo by Daniel Raskin, retired, is a member of Poets on Parnassus. Woman with Cart
Had the Wind Not Blown July 11, 2005
Into her chaotic eyes, I was lost. Did she even realize where she was? With her white spindly hair and wrinkly stained hospital gown, Was she revealing secrets from some otherworldly mind?
By Eileen Brazil, age 18 Edited by Akshay Govind
T
Again she chimed, “This is my… world.” Halt. I stammered, “Mrs. S, I understand what you’re going through.” To myself I thought, “my words… so trite!” I couldn’t even begin to understand Her mind oblivious to space or time.
here are these two bugs—a caterpillar and an ant. Despite these differences, the two are best friends. They do everything together. They hardly ever exchange a word (perhaps this is because they are bugs) but that is not necessary in their friendship. One day the two bugs were walking along the forest floor. The ant was slightly ahead of the caterpillar because, let’s face it, ants are faster than caterpillars. The ant was making his way over a leaf when a great gust of wind blew. The leaf flew away, taking the poor, unsuspecting ant with it. Of course, the slower caterpillar had not reached the leaf when the wind blew. He was left on the forest floor as his friend flew off into the distance. Neither ever really understood what happened; they just understood that their friend was gone. The two never saw each other again. They both went on to make new friends and successfully move on with their lives. In spite of their short bug memories, the two never forgot each other. Sometimes they would reminisce about what could have been, had the wind not blown.
Again she chimed, “This is my… world.” Halt. I stammered again, “We’re going to take care of you Mrs. S. I know things must be difficult for you now.” Trite, trite, trite. Here I was, clawing at uncertainty. Trying to peer into her fragile mind, A strand of silk flailing aimlessly in this bustling, monolithic hospital, Safe haven where delirium and delusion wed reality.
Eileen passed away from complications of cancer therapy a year and a half after writing this story. I like to think of her as the caterpillar.
It seemed as though she ascended to an ethereal state. To some, she was hopelessly crazy, useless. But the block in her mind weighed heavily on me.
From the Bedside By Elieth Martinez
O
ne hour into my first ED shift, my attending suggested, “go in there, examine your first patient and tell me what you find.” Instead of performing a physical exam, I listened to what Alejandra said: “I hate hospitals, and the doctors that come along with them. ‘I have an appointment available January of next year,’ said the receptionists. ‘Next year I’ll be dead,’ I should have responded. I take the appointment and attempt to go as a walk-in the next day. I can’t walk a block without stopping, holding on to any rails I find, and waiting for my lungs to catch up. I have a drain placed on the left side of my back, but fluid keeps leaking out. I just want someone to take a look at it. The pain in my right thigh and knee doesn’t help either. No, I don’t know what brings it on, no, I didn’t have trauma to it, and no, nothing makes the pain go away. Stop asking me these same questions. I just want someone to tell me I’ll be ok. I’m only 24, but my grandmother can outpace me. I’m on my third round of chemo with five more to go. My 25lb stage 4 ovarian mass went unnoticed, not sure how.
And the metastasis to my lungs were treated as a UTI, not sure how. I get my prescription, and with my cane I shuffle down the stairs to the pharmacy. It’s 5:15pm, I’m the last one to get there, and the doors are half locked before they finish assisting me. ‘Your medications were not entered in the computer.’ I just finished seeing Dr. G, so my pain meds should have been in. With the little strength I had left, I caught the elevator back to the second floor, but already doors were locked, lights were dimmed, and providers slowly trickled away. I knocked, I yelled, I even kicked that damn door. People don’t get sick only from 8-5pm. Have you ever dived into the bottom of a 20ft pool, looked up from its floor with the last few seconds of air left inside you. You know you’ll eventually surface and are unlikely to drown with so many people around you. I thought this was true, until last night. My mother wheeled me into the ED. I was quickly placed in a room, changed into one of those hospital gowns that hundreds before me have worn, and had two different IV needles in each arm. I have no idea what was going into my body. Initially, doctors came in and out, mumbling all kinds of jargon, examining my lungs, examining my chest tube, and exam-
She then chimed solemnly, “This is my… world.” Halt. Still pools in her eyes, turned turbulent, cascading down. A stroke of misfortune and now the breakthrough arrived rudely, brashly, unannounced.
ining my naked body stuffed in that cigarette box room. I even saw Dr. G. She went straight to the computer and talked to another physician in the room. Didn’t acknowledge me or my mother, didn’t ask how my pain was, and assumed those prescriptions went through. I hated her. I looked over my shoulder, my mother with tears drowning her eyes, wanted to fight back. An apology would have been more therapeutic than narcotics filling the IV. Neither of us had strength left, so we remained quiet. I visited Alejandra multiple times, even after she was no longer my patient. Each time I found her mother leaning over her baby, an aunt demanding answers to questions I didn’t have, her sisters reminiscing over baking sessions long gone. I followed her as she was switched from room to room, and I read each nurse, physican, dietician, and chaplain note documented. One night, after my shift, I headed towards room 643 and approached a group of people pacing in front of a locked double door. They were here for Alejandra. I fumbled with a leaking pen in my coat pocket to distract myself from their anxious faces. I hated my white coat then, hated the false hope it gave them for their dying niece, granddaughter, and
BEDSIDE » PAGE 8
She repeated now, calmly, in a way, matter-of-fact: “This world... is not my world.” Nodding my head, my thoughts bled with uncertainty. I stared into her motionless eyes, as if something in those deep blue pools would reveal, A part of her secret madness to me. Though I had studied her MRI images, black, white, and gray, no secret to this show was revealed. Why couldn’t I enter into that void in her eyes, As she expressed herself so unashamed, unabashed, so proud? “I want to understand what’s happening Mrs. S, but I can’t…” With the glaze of fire fading fast in her eyes, she stopped. “You try… your best.” As if reading my thoughts, she knew I wanted… To understand her mind. To understand her thoughts. To understand what made her tick. I froze in that room that day thinking about her mind. If only my efforts could bring me closer to understanding This alien new world that she has inherited, A world that we want to destroy. ~ Antonio Moya Medical School/4
8 | April 24, 2014 | synapse.ucsf.edu
‘Stop Torturing Me’ By Ali Saadi
A
s is usual practice at the Multi-Service Center, a homeless shelter in the heart of San Francisco, I was sent out to recruit patients from the men’s floor. My goal was to recruit residents with health concerns, triage them, and invite the most pressing cases back to the homeless clinic that operates out of the first floor. I entered the men’s floor, welcomed by lines of dusty bunk beds that hugged four despondent walls. Finding patients is usually an easy task: shelter residents are quick to spot clinic volunteers, with their crisp white coats and dangling stethoscopes, and freely approach them with concerns. This day was different. Most of the residents were busy watching a film in the recreational room, the rest dozing in their skinny green bunk beds. I asked the staff member working the floor if there was anyone who had requested medical attention. A burly man, he raised his eyebrows in thought, then shrugged, but then, as if recalling the obvious, said, “ya, there is a weird one over there, who has problems with his eyes.” He pointed to the back room, and led me there. We reached an unkempt bed, with a man hunched up on it. The burly staff member called out a name. No response. He then proceeded to give the man on the bed a hard shake. The man on the bed jolted and turned towards us. “He’s all yours,” said the burly staff member, and walked away to his post. The man on the bed looked a mess— hair disheveled, yellow crust hugging his eyelids and the bridge of his nose. His skinny frame was draped in a shirt three sizes too big that reeked with a choking aroma. He motioned to his left eye, which
was slightly edematous and streaky red. What was more perceptible was the man’s shaky, disjointed movements as he pointed towards his eye. His hands moved with marked tremors, and his head with sudden jerks. He had minimal control of his body. It was as if his hands were dancing to a slow tune his mind didn’t register. In many ways he was a prisoner in his own body. He tried to speak, but had difficulty. He gargled his words, letting them slowly, but incomprehensibly, trickle out. I brought the man on the bed back to the clinic for a complete examination. I didn’t know what to make of his presentation. It struck me as a neurological deficit, but the manner in which the disease presented was different from a stroke, Parkinson’s disease, and other common deficits I had learned in school so far. I ran through the months of medical school training, running all the patterns I had learned to exhaustion. Nothing. I then proceeded with what I was trained to do best, which was to garner a detailed history and complete a thorough examination. The history was jumbled, as the man was hard of hearing and had trouble speaking. The physical proved more enlightening. I went through the neurological examination, checking religiously for cranial nerves, cerebellum function, muscle bulk, movement, and reflexes. I concentrated on the muscles—the instruments that give life to our thoughts. The more deficits I observed, the more fascinated I became. The more fascinated I became, the more detailed my physical exam turned, and the more excited I became trying to identify other problems with this man’s body. I told the man to sit here, stand there, hold this, feel that. He did as told, exerting
to overcome the tremors and jerks. I told the man to squeeze my fingers, testing for distal strength. He tried to squeeze, with little strength. I encouraged him to squeeze harder. He tried but could not muster any strength. At this point, the man, with concentrated effort and difficulty, spoke three words that, like a shriek whistle in the night, halted my meticulous exercise of being a doctor and shattered my sense of importance— “stop…. tor..r..r.r.. turi…ng…me.” It was the last thing I had expected to hear. I froze and stood there motionless in front of the man with the tremors and jerks. He wasn’t looking at me—could not—his head would not allow him to stare at anything for too long. I was glad he couldn’t, because I felt cold and ashamed. As I struggled to regain self-composure, the man struggled to remove a wrinkled scrap of paper from his pocket. His hands lacked fine motor movement, and would swipe at his pocket, hands flopping like a branch withstanding a storm. I reached into his pocket for him and removed the paper. With exerted effort, he motioned for me to read it. I did. It read: “Hi, My name is J, and I have Huntington’s disease.” He then motioned to his eyes. Everything began to make sense: the man wanted to get his eyes checked out, that was all. It was no surprise to him that he had Huntington’s disease, or that his body was degenerating. He did not need to be reminded. He must have been an object of awe to medical personnel, many, as my preceptor later informed me, likely had never seen a case (the prevalence of Huntington’s disease is 5.7/100,000).
He must have felt like a teaching specimen, being worked on, tested, retested every time he went to a clinic—being told to sit here, stand there, hold this, feel that. And here I was doing just that, in the moment of excitement, delving into my own thoughts rather than his, trying to identify a cause for his jerks and spasms, losing sight of the person in front of me, Mr. J. I put down my instruments of torture— the stethoscope, tuning fork, penlight, and reflex hammer, and looked closely at his eyes.
Ali Saadi is a fourth-year medical student.
Bedside
» FROM PAGE 7
cousin. All the skills I’d accumulated these past three years in medical school were useless. I found her mother in a corner of the room. No progress was made from the ED visit, only regression. Alejandra was slouched in the bed, head tilted down, and oxygen slowly seeped through her nostrils. A blue Hello Kitty tattoo peaked out from the drooping shoulder of her gown. The narcotics and anxiolytics were doing their job, and the stage 4 was making its final act. I gently shook her leg and asked, “Do you remember me? I met you in the Emergency Room.” Her eyes sluggishly opened and a smile slowly drew across her face.
Elieth Martinez is a second-year medical student.
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synapse.ucsf.edu | April 24, 2014 | 9
Reflections in the Psych Mirror By Desire Takawira
I
n my native language Shona, a popular aphorism advises “seka urema wafa.” Roughly translated, it means “laugh at a cripple when you are dead.” In Shona, idioms like this are called tsumo. As with this example, most tsumo are as demonstrative as they are jarring, being rich in metaphorical meaning yet terse in expression. Tsumo collectively represent a form of cultural wisdom in Zimbabwe that older generations use to instill values and ideals in the minds of the young. In a sense, they are not so different from many American idioms. This particular tsumo calls to mind several American-isms most of you probably know, for example: “what goes around comes around”, “life is like a box of chocolates”, and “you reap what you sow.” Therefore, late last year when I learned that I would be spending my clinical interlude in a psychiatry ward, I was both curious and fearful of exploring how my upbringing might color my new relationship to mental health as medical student. In Zimbabwe, mental illness is rarely discussed in public and is dealt with in a more familial way that might seem unstructured to most Americans. Zimbabweans do not distinguish mental illness. Different dialects aside, in Shona there are mostly two words for mental illness: “kupenga” (madness) and “urombe” (an all-encompassing word denoting irresponsible/reckless/abusive/deprecating behavior). Contrasted with Western modalities, where mental illness has many labels such as anxiety disorder, mood disorder, psychotic disorder, eating disorder, impulsive disorder, and so forth, I can see why my tradition shies away from such practices: one cannot avoid “laughing at the cripples” if one goes about meticulously labeling everything. Kupenga/Urombe may take one of two forms: congenital malformation of the mental faculties or degeneration from “normal” to literally “losing it.” The latter is seen, for example, in men who beat up their wives, or drink away the entire pay check, or have sexual relations with livestock.
Despite the all-encompassing nature of either kupenga or urombe, neither term was ever intended to represent depression or anxiety, two of the most common conditions in Western culture. Perhaps ignorance is bliss, but I do not believe that depression and anxiety are common occurrences in villages where one is hardly ever alone. When the sweat and toil of your brethren and of your own making determines what food is on the table, there is no time or space to be very lonely, or to have eating disorders. Unfortunately, Western culture and urbanization is seeping through everywhere, leaving Zimbabweans no choice but to use the same jargon to express newfound mental illness. As a medical student conducting patient interviews, I have come to appreciate asking what a patient thinks is behind his or her illness. This so-called patient’s explanatory model of sickness is rich with all sorts of beliefs. Zimbabweans’ explanatory model is either witchcraft or spirit possession. It is the spirit of an aggrieved dead person that causes mental illness. Perhaps it was a murder committed by a close relative or a jealous relative who has cast a spell. The cures? Traditional healers and family courts. The work of these healers and the strategies used by great uncles and aunts in family arbitration are beyond the scope of this piece. There are successes and failures. If brewing beer and dancing the evil spirits away cures mental illness, then I approve. Or perhaps if the answer is that family should fast and have an all-night prayer, then I’m all in. Sometimes the charm is drinking a tea concoction or two and spending an afternoon covered by a blanket and burning some incense or leaves. In reminiscing over mental illness in Zimbabwe, I realize that my tradition ensures that mental illness is self-evident. The U.S. society, on the other hand, has a harder time detecting mental illness. We watch excessive media coverage of violent crimes committed by people, though often suffering from mental illness, are known only to others as “such a good kid” or “a loving neighbor.”
For me the opportunity to spend time with the “gatekeepers” tasked with the responsibility of keeping the public safe from “crazy” people—was very intriguing. What I saw at San Francisco General Hospital (SFGH) shattered my expectations. I still have no clue how as a society we can identify people with serious mental illness before they harm themselves or others. However, it was evident that once one steps into the focus of the SFGH Psychiatry team, everyone has reason to cheer. The Psychiatry team is devoted to the gargantuan cause of keeping both the public safe and the patients safe on the road to mental health. I saw men and women who toil insanely for sanity, for respect, for pleasure, for a smile, for sensibility, for self-worth, for self-preservation. What I saw were patients so close and yet so far, so beautiful and yet so maimed, so right and yet so wrong. Frustration and relief were intermingled, hope and despair entangled, presence and absence intertwined. The patient charts and files are but a snapshot of who they are. Their hopes, dreams, struggles and triumphs can sometimes be gleaned from the expressions on their faces, as are those of their caregivers. Diagnoses are made and remade, medications administered, trust developed, sanity reinforced and relationships forged. What I saw in the Psychiatry units at SFGH is a society of misfits in a delicate dance; a wrong step here, and a two-step there. Tip tap, tip tap tap. It can be beautiful, it can be ugly. Often victories are short-lived, and the dance begins anew. Yet they persevere, they keep at it, two sides of the same coin always trying to meet in the middle. It’s a love-hate relationship, sometimes one-sided, yet it’s clear that they are both working on it. As impressive as all this was, there was no mistaking the fact that money, politics and the law throw wrinkles into the dance and yet as a society we expect nothing but positive outcomes. As a professional walking the cultural divide, I know that my future patients could very well benefit from either traditional psychotherapy and healing practices or from evidence-based, ethical Western biomedical treatments, or both. The new mantra in medical school teaches the biopsychosocial model of disease—the idea that patients are biological, psychological and social people. All future doctors will become experts at the first part, but the latter two are something else altogether. We can talk about cultural competence or immersion into the social fabric all day, yet the truth is that it’s easier said than done. Among the many experiences during my clinical interlude, perhaps one of the most thought provoking was the dedication of mental care facilities for HIV/AIDS patients. Being from a country where many HIV inflicted patients do not share their diagnosis as much as they might do with other types of news, I realize that there is plenty of anxiety and depression that can be associated with such secretive, isolationist behavior. Moreover, the stigma attached to the diagnosis simply predisposes people to depression and serious mental anguish. As such, I feel championed and empowered to emulate the model I saw at SFGH. How that will be implemented in a setting like Zimbabwe is a challenge I will face for the rest of my career. All in all, my life and career span vastly different belief systems; I can scarcely grasp my own culture, yet I am expected to understand and embrace so much “otherness.” In spite of the ever-changing world around me, I need to hold on to my identity while also assimilating qualities that affirm my Hippocratic oath. I must swim with the current, yet be able to flap my own fins every now and then. What about you? Dare I say “seka urema wafa?”
Desire Takawira is a first-year medical student.
Last Night (On Call) Last night I was called to the front lines where life and death battle it out and no one ever knows who will stay, who will go or what, in the end, it’s really all about I had little with which to defend myself and no one I could save not with my words, my touch my sighs, my gaze not even with the flesh and bones prayer spilling from my lips, from heaven or from the battleground down here For the young Algerian mother with seizures who cannot drive her daughters to school who finally said no to the man who beat her for a decade who finally had the strength to make him go For her, some kindness and a copy of the Quran that’s all there was to givenothing more than a feather and a spoon for the one with so much light for her courageous fight to live Then there was the black-skinned woman who, to save her kidneys, has lost all her sight Not knowing how she will continue in this life, not knowing what to do I held her hand and prayed with all my might God, give her strength, help her through this dark and lonely night Finally the elderly, Russian man grey-faced and barely alive slumped in a chair in the emergency room pain and anguish in his eyes his wife, the victim of a stroke suddenly, frightfully close to her demise For him, a gentle touch on the shoulder and the words, “You are not alone, I am so sorry for your distress” What else could I say? What else could I do? Anything more? Anything less? Last night I was called and I answered but there were spaces I could not fill my pockets were empty, my human desire no match for the Divine will All I had was a book of holy words a touch, a look, a smile the sound of my voice, the prayer of my heartbeing a comforting presence for a while Maybe this is all we ever can give maybe this is what’s meant by true love and in the mystery of life and death and loneliness maybe it’s all there is, and it’s enough ~ Rita Glassman, Chaplain Intern Spiritual Care Services UCSF Medical Center
10 | April 24, 2014 | synapse.ucsf.edu
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UCSF DEPARTMENT OF SURGERY
27th Annual
Resident Research Symposium Friday, April 25, 2014 9:00 am – 2:00 pm Resident Presentations
2:00 pm Keynote Presentation
“Observations from the American College of Surgeons Quality Improvement Programs”
THE STRENGTH TO HEAL
3:00 pm Awards Presentation
starts with our scholarship.
TOLAND HALL
Capt. Ana Morgan, M.D., HPSP Medical Recipient Brooke Army Medical Center, Texas
You can begin training for the career you’ve always dreamed of with financial assistance from the U.S. Army. Through the Health Professions Scholarship Program (HPSP)*, you could be eligible to receive a full tuition scholarship for an accredited medical program. The HPSP provides reimbursement for books, laboratory equipment and academic fees. You’ll also receive a sign-on bonus of $20,000 and a monthly stipend of $2,157. During breaks, you’ll have the opportunity to train alongside other members of our health care organization. To learn more, call (650)347-3967 or visit San Mateo Medical Recruiting Center 400 S. El Camino Real, STE 450 San Mateo, CA 94402 Email: usarmy.knox.usarec.list.9e3j@mail.mil www.goarmy.com/amedd.html
*Certain requirements and eligibility criteria apply. ©2013. Paid for by the United States Army. All rights reserved. Information subject to change.
533 Parnassus Avenue, U‐142 San Francisco, CA
Clifford Y. Ko, MD, MS, MSHS, FACS
J. Englebert Dunphy Visiting Professor Director, Division of Research and Optimal Patient Care Director, National Surgical Quality Improvement Program (ACS NSQIP) American College of Surgeons Professor of Surgery, University of California Los Angeles
The Resident Research Symposium is an annual event showcasing the laboratory research of residents, fellows and medical students in the Department of Surgery. For more information, visit our website at: http://www.surgery.ucsf.edu. This event is sponsored by educational grants from the Howard Naffziger Surgery Fund. UCSF D EPARTMENT OF S URGERY R ESIDENT & M EDICAL S TUDENT E DUCATION O FFICE Telephone: (415) 476‐1239 Email: EducationOffice@ucsfmedctr.org
synapse.ucsf.edu | April 24, 2014 | 11
PUZZLES
The Weekly Crossword
ACROSS 1 Mop the decks 5 Paintball sound 10 Comic vignette 14 Rush follow er 15 Witchy w oman 16 ____-de-camp 17 Creole veggie 18 Ground compactor 20 Chef's measure 22 Caning need 23 Women's magazine 24 Point on a diamond 25 Four pecks 28 Rock artisan 32 Open, as meds 33 Foundation 34 Hula hoop? 35 Barrel of laughs 36 Rustic abode 37 Wrestling hold 38 Man the oars 39 Buckboard, for one 40 Concert locale 41 Bystander 43 Deep Sea explorers 44 Playw right Cow ard 45 Moneyed one 46 Steer clear of 49 High-principled one 53 Pigmentation 55 In a lazy manner 56 Use a big rig 57 Woodshop machine 58 Kindle competitor
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by Margie E. Burke
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Copyright 2014 by The Puzzle Syndicate
59 Columnist's 9 Tidew ater turtle 37 page 10 Like some peanuts 60 Play w ith clay 39 61 Jane Lynch TV 11 Bagpiper's garb hit 12 Vision 40 13 Gull's cousin DOWN 19 Caravan stop 42 1 Word after big 21 Chick's cry 43 or buck 24 Bathroom fixture45 2 Heard reveille 25 Grand Canyon 46 Week of 4/21/14transport - 4/27/14 3 Mystique 47 4 Military bigw ig 26 Bargaining 48 group 5 Move w ith a 49 mouse, maybe 27 Angry look 50 6 Alcohol 28 Repair bill line measure 29 Unescorted 51 7 Bank offering 30 Happen again 52 8 Beatles hit, 31 Uh-oh! 54 "___ I Love Her" 33 Breakfast roll 36 Sure thing
Bricklayer's activity Serenader, maybe "____ Las Vegas" In phone limbo Mended socks Uproar Canyon sound Daytime TV fare Tip-off Smidgen Object of w orship Tart fruit Sitter's charge Vacation souvenir
Edited by Margie E. Burke
Difficulty : Easy
HOW TO SOLVE: (Answer appears elsewhere in this issue)
Copyright 2014 by The Puzzle Syndicate
Piled Higher and Deeper by Jorge Cham
Solution to Sudoku
title: "Scratch" - originally published 3/12/2014
www.phdcomics.com
12 | April 24, 2014 | synapse.ucsf.edu
Solutions
Solution to Sudoku
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You’re Funding Fun! A portion of every dollar you spend at campus retail vendors helps support Arts & Events at UCSF
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