A Surprising Pollutant Discovery During my Trip to Panamá

For many middle and upper-class Americans, going to another country is a vacation. People traveling out of a comparably wealthy place often expect blue skies, crystal clear waters, and cocktails served to them at a poolside bar. However, for lower class travelers and students trying to explore the world, this picturesque scene is often not in the budget. Luckily, this can very often make for a more realistic and wholesome experience when exploring a new place. I think that this may be because it indirectly helps young travelers avoid taking their “bubble” with them when they get off the plane.

Over summer break, my friends and I found ourselves traveling Central America on a tight budget in an effort to gain new experiences and collect ourselves before our senior years at UCSB. We expected to see the bright blue, lionfish filled waters at every beach once we arrived via speedboat at our popular tourist destination: Bocas Del Toro, Panamá. After the thunderstorms cleared, we were in search for a beach close to the main town, and we stumbled upon Istmito Beach. Istmito was nudged at the crossroads of the local cemetery and a low income neighborhood. At first sight, we saw Panamanian kids playing soccer downstream of a small pier, on which european travelers from the hostel around the corner were sitting and sunbathing. However, when we looked closely at the tides of this beach, strangely enough we saw thousands of tiny balls washing within the black waves. We initially thought that what we were seeing were pebbles.

My research here at UCSB in Michelle O’Malley’s lab has always encouraged me to ask more questions and to be curious about things that seem out of the ordinary. This curiosity seemed to follow me outside of the lab in this case.

After visiting this beach and coming back to UCSB, I took a look at a few of these balls and discovered that what we saw and what the kids swam in appeared to be some synthetic fiber. The resources and encouragement provided by my graduate student mentor allowed me to inspect the sample via microscope. After taking a look, it seemed that the balls were composed of cotton or another type of fiber. This fiber originates from humans, rather than my original hypothesis which was that the balls were composed of algae.

This is a less salient manner of pollution compared to what we see on the news: heaping piles of trash in the middle of the ocean and straws inside of sea turtle’s noses. However, seeing this type of pollution at a local beach raises the point that in less developed parts of the world there are all manner of pollution caused by human presence. In this case and possibly many others, we found this pollution within 2 square miles of crystal clear beaches that are often the foci of Instagram posts about paradise. Unfortunately, this pollution often accumulates and affects the beaches next to the homes of people running stores and hostels, since the town is much less concerned with losing money from tourism in these locations.

At the end of this eye-opening trip to Panamá, I came to understand that being an undergraduate researcher at UCSB has instilled curiosity into my continually developing world view. The fact that the world is saturated with questions is exactly the reason why training to become a scientist is a satisfying and endless endeavor.

A Surgery I Will Never Forget

“Tears wet my eyes. I’m a surgeon. I like solving things. But how do I solve
this?”
― Atul GawandeBeing Mortal: Medicine and What Matters in the End

I stood in front of the sink in my stained but washed scrubs, stained with what I don’t know. I turned the two nozzles to 45 and 30 degree angles to get the perfect temperature of water. I reached on my tippy toes to try pushing the soap dispenser handle down with my elbow but I couldn’t quite get it. Dr. A laughed at me, reached over and pushed it with his elbow five times, releasing five squirts of gooey pink soap onto my palm. We went over the scrubbing procedure together: rub your hands together, rub one hand over the other, put your hands in opposite directions and scrub behind your fingers, make circles with your nails onto your palms, etc, etc, etc. Dr. A then told me you have to wash your hands at an angle, always have your fingers pointed upward so the clean water never runs back down your arm. The corner of my mask was poking into my right eye at this point, I felt a burning and watering and I’m pretty sure a tear escaped. We repeated this scrubbing process three times, I was near blind during all three, and then we walked into the room with our hands held up at shoulder height. I pursed my lips and pulled them down under my mask, trying and failing to pull the sharp blue irritant down and out of my eye. We took the white napkins and dried our hands and arms one at a time. We opened the gloves, we touched the right glove with only our right hands, and we touched the inside only. I grabbed the outside of the left glove with my right hand and stuck my left hand in. Pulled the gloves over my sleeves. Dr. A was long finished at this point, kind of just amusingly staring at me struggle to unstick my thumb from the wrong part of the glove. “Can I touch my mask, I need to fix it,” I finally pleaded. “No, you can’t touch it, someone will fix it for you.” The sister came over and pulled my mask down, pinched the nose area so it would stay in its place. Then we proceeded to tie our gowns and we walked to the patient asleep on the table.

A woman, 35 years old maybe. Had to get her kidney removed. She was septic for a week or so, hadn’t moved from the bed. That’s all I really know about her. She had already been anesthetized. Dr. A asked the sister to get a stool for me because I was more than a foot shorter than the doctor next to me without one. The patient was laying on her left side, right shoulder up and right hip pointing toward the ceiling. They had tied some bands around her to keep her in that position, and they put a sticky clear plastic wrap around her body. Dr. A, Dr. B, and I were around the table along with one of the sisters who kept giving the tools to the doctors. “Blade.” Sister handed it over. And we began.

Dr. B incised and blood started oozing out, as I always imagined. By the way, this was my first time seeing a surgery this close. I was literally right next to the patient, my hands were resting on her body. So anyway, yeah blood started oozing out. And this is where I always got confused because how do the doctors keep cutting if there’s blood coming out, wouldn’t that just cause more and more blood to come out? But they use cautery, which I should have known because I’ve seen it before. So anyways, they cauterized the length of the incision and the wonderful aroma of burnt skin filled the air in the operating room. They cut through layers of yellow fat, they cut through protective tissues and blood squirted out at some points. Dr. B turned to me, “just watch your eyes, I don’t want an American lawsuit filed against me.” (I should mention here that this experience obviously did not take place in the US). Dr. A and I laughed, then they went back and forth about how Americans are aggressive with their legal procedures. You know, more than 12% of my experience shadowing at XX Hospital has been doctors rapping on me for being American. Making fun of American politics, shows, actors, musicians, laws . . . these people keep up with American pop-culture better than I do. Anyways, after a few squirts and more cuts and more cautery, we reached the kidney! Or so we thought.

The doctors at this point literally stuck their entire hands into her body. They didn’t make any cuts but they were just rummaging around there doing God knows what. Actually I know what because I asked what. After 10 minutes of them moving their hands around and mumbling inaudibly to each other, I was like “what are you guys doing?” And then Dr. P was like, “mobilizing the kidney.” And I was like, “oh okay.” So that settled that.

The kidney was stuck in there very tightly. They couldn’t mobilize it easily. They had to keep moving their hands around and apparently it was a large kidney. After 30 minutes, they finally mobilized the anterior portion of the kidney. They took it out of the incision and a portion of it was resting on her hip. “Pretty hefty kidney, eh?” Dr. B remarked. This is where things started to get rough. The anesthesiologist started asking questions. “Are you guys pushing on the vena cava?” “Her heart rate has slowed and she has low blood pressure.” “She’s not getting any carbon dioxide output.” “I’m giving her a shot of adrenaline.” And finally, “What is that,” pointing at the organ on top of her body. The doctors were busy at this point doing something else, having another one of those mumbly inaudible conversations. The anesthesiologist asks again, a bit more aggressively, “What is that?” This is where it all clicks, Dr. B realizes they didn’t just mobilize the kidney, they accidentally mobilized the liver. He says, “this is the liver. The kidney is there, we should have gone in from here.” So that moment. That moment he realized his mistake. Everything that was done wrong up to this point and everything that should have been done for it to be right.

So the doctors stuff her liver back into her body, for lack of a better verb. They throw in some gauze as well to stop the bleeding. Dr. B is kind of freaking out this point, although he’s doing his best not to show it. The anesthesiologist is standing up, staring at the screen and announcing the patient is having arrhythmias and still doesn’t have any carbon dioxide. Dr. B asks the sisters to phone Prof C. The doctors are rummaging around her body some more, I wish I knew what they were doing but I’m not sure really. I think they were trying to reposition the liver and check if any important connections were severed. After some more of that, they found nothing was leaking and no immediate damages were found. A moment of relief. The anesthesiologist is still standing and staring at the screen, injecting some things into her body. While the doctors are still doing whatever they’re doing, the anesthesiologist says, “lets stop for a moment. If she doesn’t get better in a minute we’ll have to start CPR.” “Are you serious?” Dr. B shouts but he really wasn’t shouting, he said it in the most calm and collected voice, but really I could tell he was shouting. “Yes, that’s what I’ve been saying,” retorted the anesthesiologist. Then a few moments of silence but never stillness, the doctors were still hands deep inside of her, trying to see what was wrong and if they could fix it. The anesthesiologist gave the call and we start flipping the patient onto her back to start CPR. Her incision is on the right side of her body and as we flip her onto her back, blood oozes through the sheets we placed over the cut. Dr. B starts CPR and the anesthesiologist announces the time we started. He’s reading out information he’s gathering from the screen, “she has output now but she’s still not getting any CO2 which is what is concerning me. It’s not a volume issue. She’s just not getting any CO2. She’s not getting any oxygen now either.” The doctor is still doing CPR, he’s panting at this point because it’s tiring. There is blood dripping all down Dr. A’s hands and onto his gown, forming a puddle of dark red on the ground. The anesthesiologist tells the sisters to turn on the defibrillator and bring it to the patient just in case. They rotate out doctors doing the CPR. 4 doctors do CPR in total. As they push on her heart, her whole body contorts and then decontorts. And then contorts. Prof C asks to see her incision. Dr. A lifts his blood stained hands and we see the organs shift up and down with each push on the heart. We do CPR for 20 minutes. Nothing changes. The anesthesiologist says we must call it. He announces the time of death, 11:35 AM.

And then everyone leaves the room. It’s just the doctors, the anesthesiologist, Prof C, and I. Prof C starts talking about making arrangements for the body, talking to the family. Dr. B and Dr. A start to sew up the incision. Dr. B tries to do it but I can see his hands are shaking too badly to hold the string. Dr. A takes over, he puts large sutures over the incision, but still clean, organized. I feel kind of paused, stuck in space, just watching while everyone is running around still trying to do things. They’re moving forward. A sister walks back into the room and turns to me, “This is your first time scrubbing?” I nod. So there’s just this dead body on the table, the body of a woman who thought she was getting her kidney taken out and thought she would wake up in a few hours with pain in her right abdomen. Instead, she never woke up. It was a pulmonary embolism, the anesthesiologist said. “Just one of those things.”

I didn’t know what to do. I had to go, I had class at noon. I didn’t want to walk up to the doctor sewing up her dead body and say “I have to go, thank you and bye.” Too few words for too great of an experience. I didn’t want to walk up to the doctor and ask one of the million questions running through my head. Not the place or time. So I decided to just turn and walk out of the room without saying anything. I took off the gloves splattered with the blood of a dead woman, I took off the gown that experienced the death, and I walked out. I changed and I went to class and went to yoga and went about my day. The emotional hole you’re supposed to feel when you experience death wasn’t there because I wasn’t emotionally attached to her. I don’t even know her name. But she’s still haunting me in a weird way. Not her, but the situation. Who’s fault was it? What caused it? Could it be prevented in the future? Could we have done anything more during those 20 minutes of CPR to try and save her? Does she have a family? Does she have children? Who tells the family? Who has the job of explaining to the children? Where does the body go? Did a part of her expect this to happen, and did she prepare herself for it? Did she prepare her family for it? How do the doctors and nurses go about their day normally after this? Does it haunt them the same way it’s haunting me? Is surgery a field I want to go into? Is surgery a field I can go into? The operating room, a place that saves countless numbers of lives. Cancer, broken bones, cataracts, car accidents, paralysis, brain injuries, crushed lungs, internal bleeding. Thousands of life-threatening injuries that surgery can save you from. But when surgery goes wrong, when the opposite of what is supposed to happen ends up happening, it’s a surgery that will stick with you forever. She would have been better off not getting the surgery if she had known she would never wake up from it. But she didn’t know that. A bet on her life, but it was a bet lost.

“Surgery was the most difficult thing I could imagine.

And so I became a surgeon.”
― Abraham VergheseCutting for Stone

Did I Break My Ankle or Did My Ankle Break Me: What an Aspiring Physician Learned as a Patient

“The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated” -Plato

As my face scraped against the remembered tar of Ocean Road, I simultaneously scolded and chuckled at myself for thinking I would be able to complete the trek to the invariably clingy and overprotective Davidson Library. Regardless of my love for longboarding, it seemed as if I was on the ground more than I was on the board. I sat up to look at my friend on her bike, no doubt laughing at the clumsiness that distinguished my character, but surprisingly saw a look of horror plastered across her face. My eyes followed her gaze to a foot that was uncanny, almost disgusting in its unfamiliarity. The length of my right shin now ended in a set of five toes that were twisted 90 degrees in the wrong direction, east instead of north.

“Well, there go my summer plans.”

Thirty hours in a hospital bed, some insipid hospital meals, a few hours of drug induced comatoseness, a never ending stream of mental breakdowns, 3 fractures, 1 severely torn ligament, 9 screws and a plate in my foot later, I got a taste of freedom.

And now here I am, 8 weeks post-surgery, 19 years old and relearning how to walk on two feet.

As an aspiring physician, this experience offered stirring insight on the doctor-patient relationship I had previously failed to consider. When visualizing my future as a doctor, I imagined myself drowning in textbooks and paperwork, pulling boundless hour shifts, and cutting open bodies to perform life-saving procedures. I seldom considered the exhaustive state of vulnerability my patients would be facing. Lying on an emergency room bed with a contorted ankle and pain piercing every nerve in my body, I was surprised at how much trust I was placing in a man I had not met until a few minutes ago to knock me unconsciousness and snap my foot back into its place.

During my thirty hour stay at Cottage Hospital, one emergency room doctor, one orthopedic surgeon, one anesthesiologist, one physical therapist, and three amiable nurses all told me the same thing: in order to be a great doctor you have to be a patient first, a lesson I hope my peers take away from this article instead of having to learn the hard way.

Relating to a patient’s fear is not easy. Whether it is a terrified parent bringing in their toddler crying of a stomach ache or a naïve high schooler who blew off their hand trying to light a firework, the job of a doctor extends much further than curing the patient’s injuries. A doctor must create a connection with the patient and their families, doing their best to assuage the pummeling stresses of treatment, recovery, hospital bills, short and long term consequences, necessary medication, insurance compliance, physical therapy, the list is truly never ending. Losing control of one’s own body is a sensation mentally and physically taxing, and it is a great physician’s duty to take a few moments to relay trust in the patient who is being forced to trust them.

And I guess that envelopes the lessons I have learned this summer. Despite a lack of a summer job, a rescinded acceptance into a research lab, a forced cancellation of summer courses, and five weeks mostly spent on chess.com or binge reading Game of Thrones, I realized life is as simple as a broken foot. The nature of existence is defined by resilient circumstances beyond our control that will continue to penetrate our bubbles of comfort until the day we die, and all we can do is adapt. This broken foot has taught me to accept the things we cannot control, and try our best to control the things we are able to accept.

The Highs and Lows of a Research Project

One of the enticing facts that drew me to UC Santa Barbara was that it was one of the top schools for research. It sounded interesting, but I didn’t have a great idea of what you actually do in research. When I imagined what a research project was like, I imagined a “grown-up” version of my fourth grade science fair project where I compared mung bean plant growth in sunlight and in shade. It wasn’t until I completed my own small research project that I learned how difficult but rewarding research actually is.

During the summer of 2016 I took EEMB 170: Biology of the Marine- Land Interface. This was the most challenging and the most fun science course of my undergraduate career so far. I experienced firsthand what it’s like to do fieldwork and conduct a research project. This class had lectures with set material that we had to learn, but in the labs I had the opportunity to be creative and learn independently by designing and conducting an independent research project. Compared to previous classes, I never felt as much responsibility for my learning than when I was working on the research project.

Soda Bottle on Clam Gun

Something as simple as a 2L soda bottle can become a cutting-edge research tool!

The final project was a research paper about some aspect of the beach food web. I wanted to study something I had no experience with, so I studied blood worm abundance and distribution. The experiment was conducted with a partner, while the analysis of the data was done individually. We would use clam gun to take a few cores at a site at different times for a few days, and count the number of blood worms found in each core, as well as the depth each blood worm was found. However, when we tried sampling the sites, we found that this project would be much harder to accomplish.

I thought that sampling would be easy because we had planned it out well, but it required a lot more problem solving. I learned that the provided tools may not be enough, so I had to make my own. When we released the cores into a dish pan, the sand would crumble instead of holding the cylinder shape of the clam gun.

The solution? Find a container the exact diameter of the clam gun. We would place the clam gun in the container, shake out the core into this container, and this would allow us to dig out the blood worms and note their location. We brainstormed different ideas, like cutting a PVC pipe, or shaping a sheet of plastic. I spent a few hours at the Home Depot trying out different cylinder-shaped items, but I couldn’t find anything that really worked. Luckily, I found that a 2-liter soda bottle is the perfect fit for a clam gun.

I asked many questions throughout this research project and I had the advice of two research professors, a graduate student, and a lab assistant to brainstorm with and answer all of my questions. I also had help from the members of the lab I intern. I thought research projects were more of a solo effort, only involving the researchers. It was a nice surprise to realize how collaborative the process really is, and the support was encouraging. I learned so much from asking questions, and this helped me the most when writing the paper.

The hardest part was figuring out how to use Excel and how to understand my data. The most interesting part was reading about other research projects that people have done on blood worms. From one of the papers, I learned that blood worms have practical use as biological indicators for environmental management. I had no prior knowledge of or experience with blood worms, but after reading through many research papers, I ended up learning more about blood worms than I needed to write my paper.

Blood Worm

A sandy beach blood worm. It gets the red color because the molecule it uses to transport oxygen, known as hemoglobin, turns red in the presence of oxygen. Sound familiar? We have hemoglobin in our red blood cells!

I’ve learned that research is about repeatable results that can be clearly interpreted, so it was interesting to see how my partner and I drew different conclusions from the same data. I thought that we could neither prove nor deny our hypothesis, while she thought that our hypothesis was correct. I thought that data was made of solid facts, so there was only one way to understand it. It seems that data doesn’t always speak for itself, and that research projects won’t always have simple answers.

I hypothesized that blood worms burrow vertically into the sand when the tidal level rose. After sampling and analyzing the data, I didn’t have a definitive answer. It only led to more questions that led to ideas for future research, which I found to be exciting. I wondered how researchers find so many topics to research about. It seems that, while the purpose of a research project is to answer a question, it often leads to more questions. There’s always more to learn, and I think that’s something to look forward to.

My experience in this class, and especially with this research project, has validated my decision to pursue a science degree. I thoroughly enjoyed the learning and the challenges I faced in this class. Finishing this research project felt like more of an accomplishment than any success in a more traditional class setting.

The Layers of Medicine: My Summer at Stanford

“Can I get a 5:0 Monocryl and 6:0 Fast Absorbing Gut?” I thought after hearing Dr. Aasi repeat the remark over fifteen times a day through the span of my internship I would get tired of the phrase, but the request was precedent to surgery and watching Dr. Aasi perform surgery was number one on my list of preferred summer pastimes. During the short amount of time I was able to spend at Stanford Medicine shadowing Mohs practitioner and surgical oncologist Dr. Sumaira Aasi, I learned more about the nature of doctors and their teams than I did about the details of medicine. Of course I was intrigued by the effectiveness of Moh’s medicine in removing basal cell carcinomas and the many reasons skin grafts can die after being sutured to an open wound and the exact temperature of liquid nitrogen–all fascinating topics of conversation–but the paramount take away from my summer at Stanford was being able to observe the intricate workings of a hospital clinic.

Dr. Aasi and her team resemble a house of cards. It seems as if they can read each other’s minds, always knowing the whereabouts of every patient’s wandering family members and the next tool Dr. Aasi needs placed in her hand. The team flows, with every factor of the equation solved for. One nurse enters a room as soon as the first exits, the rooms are prepped just in time for the doctor to enter, and the slides are presented at perfect moments between surgeries. There is an unspoken understanding of the way things need to go. My first few days of the observership I was following Dr. Aasi around like a lost puppy, equally befuddled and awed at the clockwork that was their clinic.

The Outside: What Field of Medicine?

Dr. Aasi performs surgeries regarding lesions on the skin that can take the form of basal or superficial squamous cell carcinomas, cysts, lipomas, or keloids. Basal and squamous cell carcinomas are skin cancers that are contained in the outermost layer of the skin, the epidermis. The cells on the topmost layer of skin are called squamous cells, which are constantly shedding and being replaced by basal cells, located in a lower layer of the epidermis. Basal and sqaumous cell cancers are most commonly developed from sun exposure and poor sun protection. They are found in areas such as the face, back of the neck, arms, ears, or hands. The most  common type of skin cancer is a basal cell carcinoma, a slow growing cancer that is minimally invasive and rarely spreads throughout the body. A squamous cell carcinoma is less likely but has a higher likelihood of spreading to other parts of the body because it is found in deeper layers of the skin.

The two main surgical procedures to treat these carcinomas are Mohs surgery and excisions. The Mohs procedure is practiced when there is a skin cancer present on visible areas of the face. Mohs is beneficial because it preserves as much healthy skin as possible and keeps scarring to a minimum. This treatment involves subsequently removing layers of skin that contain malignant cancer cells and immediately sending them to the lab for analysis of leftover tumor. If cancer cells are identified under the microscope, the doctor goes back in to remove another layer of the skin, and the process is repeated until there are no leftover cancer cells. Similar to removing a rotten chunk of an apple, the removed portion is tested for residual impurities. The process is repeated until the patient’s slides are all cleared, Dr. Aasi averaging between one to three stages per patient.

An excision surgery is performed when the skin cancer is located in more conservative areas of the body such as the back, chest, or abdomen. The procedure removes a larger portion of the skin and cuts deeper than Mohs procedure. The doctor incises around a predictable margin for the tumor and immediately sutures the incision without waiting for lab results. Then, the sample is sent to the lab and the team notifies the patient of the results in a few days.

The Middle: What I Learned from Watching Surgery

The first surgery I watched was a Mohs procedure on the outer cartilage of the ear. After the nurses numb the area by administering shots of lidocaine with epinephrine, Dr. Aasi enters and incises around the tumored area. She gently holds and lifts the thin layer of skin using a pair of tweezers. Next she makes systematic cuts under the lifted layer of skin and runs them smoothly up the incised area until the entire sample is cut loose. Dr. Aasi also makes two grid-like cuts along adjacent sides of the incision to orient the sample in relation to the patient’s body. These grid marks help her understand what she is seeing under the microscope. The practice seems routine, almost too easy for Dr. Aasi’s experienced hands. Her steady, composed form makes the evidently complex operation seem simple.

The nurses take care of most residual duties such cautery and pressure dressings between stages, while Dr. Aasi is usually out the door and already halfway to the lab before I can even turn toward the exit. After each stage, the clinic sends the sample of skin to pathology where Dr. Aasi sketches the shape of the sample and applies a different color dye to each edge. These preliminary duties help her visualize a general map of the sample under the microscope. By adding the blue, black, and red dyes, Dr. Aasi distinguishes top from bottom and left from right in relation to the sketch, which is always drawn in regard to the patient’s left shoulder. The pathologists flatten and cut the sample of skin into several slides that are put through an automatic dye machine and then arranged for the doctor to read.

The first time I observed Dr. Aasi viewing specimens under the microscope I was baffled at the speed at which she zipped through the slides and made calls to clear the patient. While all the cells looked like identical blobs to me, she was able to differentiate between  the misshapen island cells of a tumor and the sweat glands, hair follicles, nerves, and normal skin cells the body produces. Over time Dr.Aasi taught me how to distinguish the cluttered, island like appearance of cancer cells from the rest of the body’s creations. Usually colored darker than the surrounding areas, they show up in clusters, resembling nests of irregularly shaped cells. If any tumor is seen under the slide, Dr. Aasi determines which area of the original sample the tumor is in based on the grid marks and dye she placed on the specimen. Characteristic of Mohs, in subsequent stages Dr. Aasi removes skin only from areas where tumor is still present, preserving as much healthy skin as possible.

The Inside: The Lessons That Changed How I View Medicine

While Dr. Aasi operates on patients she often strikes up conversations about random yet intriguing topics. We find ourselves talking about how classy the Obama family is one minute and the next Dr. Aasi will be reminiscing her college days and how she actually had to go to the library and read a book to do research. These spur of the moment exchanges characterize my most valuable glimpses into Dr. Aasi’s life. She discloses stories about her career in medicine, ranging from her experiences as an attending, the hardships of adjusting to new hospitals, and some of the scariest moments she’s had in an operating room. These stories inspire through character, they mean something because they make the hospital come to life, and it’s stories like this I hope I’m able to tell someday.

Through my time at Stanford I learned so much more than I thought I would. Not just about the nature of dermatologic surgery, which proves to be a job for a doctor, artist, and perfectionist all in one, but also about the unforeseeable speed at which life moves and the pure joy that comes from being able to help people. From hearing the stories of hundreds of patients and watching the doctor cure their illnesses, I got a firsthand glance into the miracles of medicine. After witnessing the pain and suffering associated with cancer, I was moved by the resilience of patients faced with circumstances beyond their control. I was stirred by the selflessness of doctors and the amazed by the rhythm of hospital clinics. I learned more from this experience than could ever be written in a textbook, urging me to learn by facing a constant rollercoaster of emotions. But most importantly I learned to never forget sunscreen.