Little Miss Klara Klein

I usually don't put a lot of stock into first impressions. Looking back at meeting some of my best friends over the years, we didn't always get off on the right foot (or any foot for that matter). To recount a just few, I'm fairly certain that Josh Hafkin and I each thought the other was an ass for a good bit before seeing the light. It took Phil Owen two years of college to even speak to me (Phil, I hope you're reading this over there in Western Samoa. See you soon!). And if you read "To Keith and Denise Laabs," it should be quite obvious that I don't always make the best first impressions.

But let me tell you a little something about how I met Klara Klein.

On the second day of orientation, our "college" (or "House" if you speak Harry Potter) ate dinner at Franklin Street Pizza and Pasta. UNC-SOM is divided up into five advisory colleges, and the icky first years of Dimock College were to dine together at this Franklin favorite with their prefects. Being only Day 2, we weren't totally sick of meeting new people, and I was attempting to learn the names of all my fellow classmates sitting at the table. I remember sitting next to Kevin Pearlstein and Andrew Wallace, because I was calling Andrew Kevin and Kevin Andrew (I still mix them up just for fun). Sarah Pierrie was there, Justin Woodlief as well, and my goal was to learn at least half our college's names by night's end. Then suddenly out of nowhere, this feisty vixen comes out of left field with a challenge!"

"You are NEVER going to remember my name."
"Oh really?"
"Yeah"
"What is it?"
"Klara."
"Klara what."
"Klara Klein!"

Saaaaay whaaat?? Are you kidding me? I wasn't going to remember the name "Klara Klein?" It's an appellation straight out of Diagon Alley! Plus the challenge, well, there was no way I would forget. Now the next part is a little hazy, but at some point the ish escalated. The pugnacious Klara Klein had set forth yet another challenge for the evening: she told me she was going to kick my ass. At this point it important to keep in mind that we were all sitting down at the table. The second we stood up to "throw some bows," I realized that Ms. Klara Klein was a solid 5'0'' in heels, and thus we had apparently fought in different weight classes in college. Upon reflection, it is probably good we didn't make a scene that evening. I'm not sure I would have come out of that one unscathed (might have lost a knee perhaps). By the next morning, the Klein/Swendiman tandem was running for class president.

I learned quickly that Ms. Klein packs a lot into her 4'3'', 76 lbs. frame (rough estimate). She is what we normies call a "MUD-PHUD" or MD/PhD candidate. Klara will spend the first two years of medical school with us schmos, then take approximately 4 years to pursue her PhD. She will come back (and join the Class of 2017?) as a 3rd year before completing med school and her subsequent residency. Post-medical training, she most likely will return to academia and discover the cure for cancer or the common cold, or perhaps follow in the footsteps of her great-great-great-great-great-uncle's grandfather, Nicolas Flamel, and attempt to discover the Elixer's formula for true immortality with the Philospher's Stone. If you don't believe she has the gumption for this research, in 2007/2008 she "investigated a novel method for transition metal catalyzed pyrrole synthesis using vinylogous diazo esters and nitriles" (sounds like some crazy ass Harry Potter stuff to me!). Anywho, Klara is one of the 8 or so smarty-pantses in our class that are here for the long haul.

Klara left her home state of Georgia to serve four years in Palo Alto, California as an undergraduate at Stanford. There she was awarded a B.S. in Chemistry (Biological Sciences minor), met her lifemate Evan Zeitler (now an MS1 at UNC who continually eludes his inevitable demise on the tennis court - I'm coming for you), and learned "glove box techniques" (the handling of biochemical terrorist agents in space suits through the large rubber gloves that protrude through safety glass, who knew). Klara also won Stanford's most prestigious Chemistry award, the S.S. & I.M.F. Marsden Memorial Prize, given to the most outstanding undergraduate student who has been involved in significant research in the department. If she had not been accepted into medical school (highly unlikely), she would have opened a novelty bakery and pastry shop which I would have frequented daily if only to see Klara peer at me over her 1970s register.

Since becoming soul mates in that first short week, I've enjoyed too few dinners, coffee dates, and small group sessions with Ms. Klein, and ass-kickings by her hubby Evan in tennis. How she balances school, life, and a new puppy, all whilst going to bed before the sun goes down is an enviable miracle. She is living the dream, and I reap the benefits of a wonderfully one-sided relationship: I get freshly baked cookies during small group, a tennis partner in the summer months, and the whole UNC Cardiology team to look after my big, loving heart (Papa Klein is like the chief baller cardiologist here in Chapel Hill). In return, I distract Klara and the rest of the Dimock from learning anything during small group sessions and Potions. When Klara asked today what the difference between a "heave" and "thrill" on a cardiac exam was, my response was that "I sometimes heave after a night of thrills." As usual, I bring little to the table at our morning sessions.

Loving, compassionate, pugnacious, my vertically opposite Meyer's-Briggs twin, Klara Klein is a playful pitbull in the body of a shitzu. It was fate that brought us together, and I will never forget the indelible first impression she made. And as we both seem to be on the ten year Chapel Hill plan, I will enjoy every heave and thrill we have together during our tenure, as well as all the schmos we meet along the way...

Real Life: On the Wards

I have to apologize upfront for last week's bitter, angsty, and hurried blog post. I am indeed settling into this lifestyle, but I'm not going down without a fight. The material is coming very quickly, and the amount of information that has accumulated builds and builds. It will be a daunting task to master the amalgamation of these past two years of coursework for one big exam at the end of the year. Last week, after a solid 4-5 days of re-reviewing the slow and fast tissue action potential diagrams in the myocardium, Ronnie and I each savored a Budweiser in the Health Sciences Library 4th floor study room. Just a simple reminder to ourselves that there is indeed a light at the end of the tunnel. Nothing says "outward rectifying potassium channels" like the king of beers. Fortunately, I am not alone. Although contact with the mothership has become less frequent, my mother always seems to find another person (someone's brother's uncle's daughter who just finished med school) who shares the same disdain for the second year of med school. It is all well! Third year is a blast and almost upon you! It will be here before you know it.

My mother will be extremely pleased to know that I have found other means of release besides consuming America's greatest beverage whilst watching lecture capture. My "white cloud" status in the EMS world is slowly lifting. Last week we finally transported a patient on my shift (first time in many weeks), and a lovely middle-aged lady who was severely inebriated told me that I was the "most sweet and wonderful person she had ever met." After some friendly medical banter, she proceeded to put her hand on my knee and whisper her desire to have rampant intercourse with me if I were so inclined (no quotes allowed, since her exact words would preclude me from keeping this blog open to those under the age of 18). When I told the nice lady that I was not so inclined, she offered her daughters up instead. Luckily, by that time we had reached the hospital, and she could find another "handsome young man" to whom she could propose coitus. What can I say, at least they're getting younger. When I worked in Cary I was a hot commodity in the nursing homes, if I do say so myself. Could have gone on quite a few bingo dates.

Perhaps most rejuvenating was my brief trip to see an actual patient at UNC Hospitals. This year we take Introduction to Clinical Medicine II, and a few times a year we spend a couple hours "on the wards." This allows second year students to (for the first time!) venture into the hospital and interview/examine a REAL person. I emphasize the word "real" because until this day, we have mostly interviewed "standardized patients," SPs or actors that pretend to be sick. These characters evaluate our demeanor, personality, and professionalism, while a physician watches us through little cameras in the wall. Students are graded based on the thoroughness of their examination and overall personability. On community weeks we have the opportunity to see "real" patients, but there is something different about actually being in a hospital. The vast majority of children I see in western North Carolina really aren't that sick. They come for well-child checkups, or for a sore throat (pharyngitis) or ear ache. Once you've been admitted to the hospital, that's much more serious in my mind. In my case, I interviewed a patient who had been diagnosed with a terminal illness just days ago.

Our preceptor had scouted out a couple of the upper floors of the main hospital, looking for patients who would be willing to talk to second years (fresh meat, greenies, and wet behind the ears, you might say). Ms. Q volunteered to chat with us for a few minutes in the afternoon. We waited until her attending and residents finished explaining her diagnosis and treatment options before walking in wearing our freshly white coats. Ms. Q was in terrific spirits, and simply told us she would kick us out if she got too tired. Her family stayed in the room with us, so Matthew Wofford and I were able to hear her whole story from multiple sources. She was in her late eighties, and woke up a few nights ago unable to breath; she was at the Emergency Department hours later. A couple months ago, at her annual physical, she was given a clean bill of health. Now she's terminally ill; just like that. Her resilience was powerful; she chose to divulge her entire life story to us, solely for our benefit, not hers. We asked our questions, checked out her heart and lungs, and made small talk before it was clear Ms. Q was petering out.

I won't go as far as saying we made a connection, but as I took her pulse, I was reminded again of the human aspect of medicine. I get a very different feeling in the back of the ambulance, where I can work through algorithms and protocols before transporting patients to the hospital. I love it, but my basic skills and knowledge are so limited. I like the fact that there is so much more out there. In my white coat, with my stethoscope around my neck, the idea of becoming someone's last line of defense is tangible, and I realize how underprepared I am. Reading Lilly's Pathophysiology of Heart Disease or reviewing factoids in First Aid detaches me from the human aspect of medicine, but these encounters make its utility so much clearer.

Ms. Q remarked that for most of her life she has been mildly anemic. For the first time in my life I actually ran through a differential diagnosis in my head, reminding myself about the mechanism of anemia and what labs and tests I would need to run to determine its etiology. I think for me, every once in a while it's important to remember why all the hours of studying are so important. I just wish that the "every once in a while" came more often.


(Note: some details concerning "Ms. Q" were subtly changed for her privacy.)

Block II: the HemOnc-ster

She is pictured left, the HemOnc-ster. Block II (out of eleven total) has the reputation of being one of the toughest in the second year. After the "wake-up, let's roll" introductory class (Block I: Tools for Diagnosis) where we were in lecture from 8am to 5pm almost every day, the more typical MS2 schedule began with Hematology-Oncology. Case discussions were every morning from 8-10, followed by two or three lectures through noon. The professors' PowerPoints were essentially 1 disease for each couple of slides (60 or so slides per lecture), and these pathologies would be the topic of case conferences the next morning. HemOnc is especially notorious for its amount of memorization and commitment to minutiae, and we weren't disappointed. The final exam average was around a 79 (the reason previous classes have dubbed this exam, "the HemOnc-ster"), which is the lowest average on a test that I can remember. I don't think the average has ever been below an 80 (and if I'm wrong, an angsty med student will surely correct me). The test questions were extremely detailed and a bit picky, so quite a few people I know thought they had a better grasp on the material than their performance gave them credit for (including myself). My least favorite question-types on these exams are, "Which is MOST CORRECT?" or "Which is the LEAST CORRECT answer choice?" All the answer choices my be right, but one of them is less right. Wonderful. I can't wait for my first patient to present to the emergency room with a multiple choice notecard on her forehead that says:

I am sick. I MOST CORRECTLY have:
a) TB
b) nodular-sclerosing Hodgkin's lymphoma
c) CHF
d) otitis media
e) all of the above
f) some of the above
g) none of the above - now i'm dead thanks to you...

But hey, moving on. There's no multiple choice in real life.

This year has certainly been a wake-up call. Ever once in a while, folks that I knew in my previous life (aka college) ask me how it's going. I usually say, "It's going, it's going. This year is a helluva lot tougher than last year. Way more studying." For some reason I expect a modicum of sympathy from this response, like I didn't choose this career path. Or perhaps I shouldn't have to put in all these hours in the coffee shops and library. I don't know why I am looking for sympathy. I know that this is a demanding career. I know that I didn't sign up for a nine-to-five or other normal job, and med school is supposed to be difficult. I guess I just simply wasn't ready for my free time to dwindle so rapidly. The pass/fail system made last year extremely easy (excluding biochemistry), and I had plenty of time to undertake many other endeavors. The material wasn't as important, and tests were biweekly. Now it feels like I'm studying for a test every few days. I told Mike Wilson that this would be a tough fall, and he said, "Good. I don't want my doctor to be an idiot."

Fair enough.

So, slowly I have settled in. Very slowly. I recognize now that I won't be able to do the same things as last year, and I'm going to have to put in a lot more work. Next year the days will be even longer (although I won't be sitting on my ass all day reading!), and residency will be the toughest. But mentally I've started to get my head around the fact that this is life. This is what I've gotten myself into. And maybe, just maybe, I'm ready.

So bring it on, Cardio.


(I was later corrected that the lowest average we've had on an exam was a 78. It was on the cardiovascular test during physiology this past spring... thank you angsty med students!)

To Keith and Denise Laabs

Based just on first impressions, I am very lucky to have been invited to this wedding at all. It was Junior Nationals, spring 2004 in Orlando, FL. I had been following TarHeelBlue.com trying to figure out who had committed to UNC, and whether or not I was fast enough to join the team (I was not). I knew that Keith had signed his letter of intent, so obviously I stalked him all the meet. Of course the most opportune time for me to introduce myself was as he was walking up to receive his metal on the podium after 200 back. "HEY HEY HEY, ARE YOU KEITH LAABS? HUH? ARE YOU KEITH LAABS???" I tapped furiously on his shoulder (if you are imagining a really annoying 18 year old kid in the back seat of the car kicking the driver's seat, asking 'if we're there yet?!' then you've got the right concept going). "KEEEEEEITH! KEITH LAABS!" Keith looked at me quizzically and answered hesitantly: "Yes?" As if I wasn't ready for this response, "Oh. Well. I'm Robby Swendiman and I might be going to UNC next year!" (squeaky voice). It was still March, and I wasn't even sure if I would go to Carolina at that point; I'm not sure why I felt the need to accost him right then and there.

I think Keith responded cordially with an "Okay," or perhaps a "Cool." Either way I'm not sure. It probably should have been a "get the hell away from me, you freak," but as I later learned, Keith is a gentleman of the highest order. I do know, however, that he promptly walked away and accepted his award, while I became cognizant of the loss of my dignity.

Fortunately, I had 6+ years to make up for that first impression and it has given me the opportunity to get to know Papa Bear as a devoted friend, superb leader, and a man who has really filled in his body over the past few years. When I look back at the better half of a decade of knowing Keith, I realize we've been through some pretty challenging times, but many truly wonderful years together. From struggling to be leaders as junior captains on the team, to jumping over fires on Franklin Street together after a National Championship, it's been a heck of a ride.

After an unfortunate miscommunication at the rehearsal dinner, I immediately regretted not giving a toast to the almost-wed couple. I started thinking of what I would say if I could go back and have the opportunity to speak. Our class has had some crazy, ridiculous, unbelievable times these past few years, and it is a true testament to all our friendships that the 8 of us were invited and flew out to celebrate with Keith. So how do I classify all these moments? There were so many of them. In a moment of nostalgia, I started going through my pictures in an attempt to pick out some of the best. Oddly, I started to realize that I've seen Keith in a lot of different outfits. And these outfits represent who Keith is as a human being. Perhaps it was not the clothing itself (as you will see), but these moments have helped me define him as someone everyone looks up to.

A Leader in a Thong. Yes, I have seen Keith, or in this case Officer Fagoo, in women's panties. It was the night of Century Club our freshman year (if you don't know about Century Club, don't worry about it); all the first-years had to make sure that after each shot of beer, we all slammed down our glasses at the exact same time. After tens of failed attempts for all 13 of us to coordinate this motion, Keith stepped in. Every person in that room remembers to this day his deep booming voice: "THREE, TWOOOO, ONE, DOWN!" Everyone was terrified of Keith at this point. "THREEEE, TWOOOO, ONE!" He owned the room. He led, we followed. Two years later Keith would be one of the few junior captains in UNC swimming history. He has been a leader since day one, and he still is.

The Capped and Gowned Intellectual. We have a wonderful picture of our class at graduation. All of us have on our Baby Blue Best, ready to turn that tassel. Keith was then off to work in Atlanta, GA at a terrific job with Bain & Company as a consultant. A year or so later he aced the GMAT, and will surely be accepted at the top MBA programs in the country. From thong to cap and gown, Keith is also a smarty-pants.

A Friend in Women's Clothing. How can anyone forget when he was dressed up as one of the "Ho-Jo-No Ho's" ('Hinton James North Whores' for those of you who don't)? I wish I could say otherwise, but Keith is an absolutely ugly woman. I think he was in some tight tube top and a short skirt of some sort, with an atrocious wig. But he was there with all of us for an amazing Halloween on Franklin Street. There are a ton of parties I could go back to and remember all the phenomenal times I had with Keith; but for some reason when I recall our friendship, the image of a 6'5'' 220 lbs. man in drag stands out.

A Competitor in a Speedo. During most of our relationship, I've seen Keith half naked (apparently even when we weren't swimming I saw a LOT of Keith...). He is a true competitor, and naturally gifted. Mark Laabs was right at the wedding; Keith and Denise are going to have some damn athletic kids. I vividly remember Keith's 200 back at prelims during ACCs our junior year. I was getting out of the warm-down pool and looked up at the scoreboard. Few times in my life have I been so inspired to swim. I had had an abysmal meet up until that point, and his race was the reason I mustered up the energy to get my first Senior National cut. A competitor in the pool, and a leader by example.

A Man in a Tux. Most recently I remember the man standing across from his wonderful and gorgeous bride. Even in his Sunday best Keith cannot come close to matching Denise in her dress, but he does pretty well. Whilst in the waiting room with his groomsmen, he sat patiently: no anxiety, no sweaty palms, no hesitation. He is a man who knows exactly what he wants, and is confident in the decisions he makes. We may have been a bunch of kids running around Franklin Street during college (some of us still are), but there was a man standing in that church. We have looked to Keith and Denise's relationship as an example to which we all aspire. And although I've only known Denise as mostly an acquaintance for a short time, everything I needed to know I saw Saturday. The way Keith and Denise looked into each other eyes, it was self-evident. Trust, love, respect, equality, and God. It was all there.


And so I propose a toast. Please raise your glasses to Keith and Denise. May you be leaders, intellectuals, friends, competitors, and loving human beings for the rest of your lives. Cheers.