Was here for the American College of Surgeons conference on October 3-6.
Thursday, October 21, 2010
Wednesday, September 15, 2010
Exceptions to every rule
Speaking with my mother about cancer the other day, I told her that cancers rarely metastasize to the spleen. In fact I have never seen it nor had I even heard of it. Not more than 2 days later was an interesting case presented at one of our conferences. A CT scan showed a large tumor growing out of the left side of the pancreas (known as the "tail"), and into the spleen. There also appeared to be what were isolated nodules in the spleen which might have been metastases.
The surgeons suspected that the cancer was a pancreatic adenocarcinoma, so they removed the left half of the patient's pancreas and spleen (which is a pretty standard operation, a "distal pancreatectomy and splenectomy"). In the operating room however the surgeons noticed that the mass was softer, and did not feel fibrotic like how they might expect a pancreatic adenocarcinoma to feel.
Actually, it turns out the tumor was not a pancreatic adenocarcinoma; it was a diffuse large B cell lymphoma. In retrospect, that might have been higher on the differential diagnosis. It is indeed very rare for a GI-derived adenocarcinoma to metastasize to the spleen. Adenocarcinomas are cancers that are derived from cells that line the surfaces of the body, and the GI tract is actually a surface if you think about it - it is exposed to the outside elements. After all, the GI tract is just a long tube running through the body; the lumen of the tube isn't actually IN the body.
Alternatively, lymphomas are cancers that are derived from lymphoid-lineage hematopoietic cells, which is a scientific way of saying white blood cells. The spleen is a major lymphoid organ in the body, and lots of white blood cells end up there to be "trained" to respond to infectious pathogens. Think of the spleen as a gymnasium for your immune system. In retrospect, it isn't so surprising that a large tumor invading and "metastasizing" to the spleen actually turned out to be a lymphoma, instead of a carcinoma. So what I told my mother is only true with a qualifier: it is extremely rare for [a cancer] an adenocarcinoma of GI origin to metastasize to the spleen.
You might be wondering, if the spleen is so important for your immune system, how can we take it out without pause? Patients with splenectomy by and large retain immune function, but they are actually more vulnerable to specific types of bacterial infection. Especially bacteria which have capsules can pose a challenge to a patient without a spleen, as encapsulated organisms require a very specific and focused immune response to defeat, the sort of which requires splenic function. To compensate, we can vaccinate patients who are going to get a splenectomy for the most common encapsulated infectious organisms: streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae. Patients without a spleen do not have any problem leading a normal life.
The surgeons suspected that the cancer was a pancreatic adenocarcinoma, so they removed the left half of the patient's pancreas and spleen (which is a pretty standard operation, a "distal pancreatectomy and splenectomy"). In the operating room however the surgeons noticed that the mass was softer, and did not feel fibrotic like how they might expect a pancreatic adenocarcinoma to feel.
Actually, it turns out the tumor was not a pancreatic adenocarcinoma; it was a diffuse large B cell lymphoma. In retrospect, that might have been higher on the differential diagnosis. It is indeed very rare for a GI-derived adenocarcinoma to metastasize to the spleen. Adenocarcinomas are cancers that are derived from cells that line the surfaces of the body, and the GI tract is actually a surface if you think about it - it is exposed to the outside elements. After all, the GI tract is just a long tube running through the body; the lumen of the tube isn't actually IN the body.
Alternatively, lymphomas are cancers that are derived from lymphoid-lineage hematopoietic cells, which is a scientific way of saying white blood cells. The spleen is a major lymphoid organ in the body, and lots of white blood cells end up there to be "trained" to respond to infectious pathogens. Think of the spleen as a gymnasium for your immune system. In retrospect, it isn't so surprising that a large tumor invading and "metastasizing" to the spleen actually turned out to be a lymphoma, instead of a carcinoma. So what I told my mother is only true with a qualifier: it is extremely rare for [
You might be wondering, if the spleen is so important for your immune system, how can we take it out without pause? Patients with splenectomy by and large retain immune function, but they are actually more vulnerable to specific types of bacterial infection. Especially bacteria which have capsules can pose a challenge to a patient without a spleen, as encapsulated organisms require a very specific and focused immune response to defeat, the sort of which requires splenic function. To compensate, we can vaccinate patients who are going to get a splenectomy for the most common encapsulated infectious organisms: streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae. Patients without a spleen do not have any problem leading a normal life.
Thursday, September 09, 2010
Update - Hepatopancreaticobiliary.
For my first month at Memorial, I was on the HPB service, the focus of which is liver and pancreas. Rotating on HPB as a student is a very good learning experience because it is one of the more extreme areas of oncology. The surgical cases in HPB tend to be on the longer side. The pancreas in particular, while being a relatively small organ, is notoriously hard to get to. It also shares blood supply with other organs. The end result is that operations involving the pancreas tend to be long and complex, and usually include removing other organs as well (the duodenum on one end, the spleen on the other).
The classic pancreas operation is the "whipple procedure" which takes 4-8 hours depending on the patient. Surgeons perform a whipple if there is a tumor in the head of the pancreas. The duodenum also must come out, since the head of the pancreas and the duodenum share a common blood supply. The problem with taking out the duodenum is that it connects the stomach to the rest of the small intestine, and it also is where the bile from the liver and pancreatic juices drain into. So once the duodenum is removed, the stomach must be joined to the rest of the small intestine, and the plumbing from the liver and the remnant of the pancreas must also be re-attached.
Other times we do a "distal pancreatectomy", most commonly for small lesions in the tail of the pancreas (more to the left) which can be pre-cancerous (IPMN). Distal pancreatectomies are not easy either, and since the splenic artery runs right under the pancreas they often involve splenectomy as well.
The liver is also a major component of HPB surgical oncology. We do surgery on the liver if there is a primary liver tumor (that is, the cancer started in the liver) or there are metastases to the liver. The liver is where nutrients from digestion are processed by the body. When we eat or drink, the nutrients, toxins, vitamins, and water are absorbed in the stomach, intestine, colon. Those organs then immediately drain into the liver in what is called the "hepatic portal vein". That is why a cancer that originates in the GI tract is so likely to spread to the liver. Not all veins in the lower body drain immediately to the liver, however. Some of them skip the liver and go right to the lungs. That is why cancer so commonly spreads to the liver and lungs.
Anyway, so on HPB we see patients with colon cancer who have metastases in the liver. A general rule of cancer is that the presence of distant metastases generally means the cancer cannot be cured by surgery, but there are exceptions to this rule, and colon cancer is one of them. If a patient has a colon cancer removed, and then a year later they have a liver tumor, we often will try to take out that liver tumor. Liver surgery is challenging because the organ is so vital, and variable. The surgeon must be very aware of the anatomy and ready to avoid major bleeding, but without compromising other major vessels. Liver surgery can turn catastrophic really quickly without extra caution.
In the hands of an experienced surgeon, liver surgery is very safe. Additionally, the organ is the only in the body that is capable of regenerating, so you can remove a huge chunk of a patient's liver and the rest will grow right back. My attending on HPB is working on a project with some engineers that maps the internal blood networks of a patient's liver before hand. Then during the case, the engineers use lasers to scan the outside and contours of the liver and they match the internal blood network to the real-time layout of the liver. When the project is perfected, a surgeon should be able to take a probe and point it to any spot on the patient's liver and look at a real-time 3-dimensional screen to see where the blood vessels below are running. Right now we can get some idea with ultrasound (so don't worry, the surgeon's are not flying blind), but this would be a big improvement.
The other reason why HPB is a good service for students in oncology is that we are exposed to the less rosy side of surgical oncology. In HPB we commonly see pancreatic adenocarcinoma, cholangiocarcinoma, and hepatocellular carcinoma. All of these cancers carry a very poor prognosis. Even with complete surgical resection, negative lymph nodes, and negative margins, these cancers more likely than not will come back, and quickly.
I finished HPB last week and now I have started my second rotation, GMT (gastric and mixed tumors), which include sarcoma and melanoma. This month I am seeing a great diversity of very rare cancers and learning more about melanoma (which is not so rare). I'll update about that soon.
The classic pancreas operation is the "whipple procedure" which takes 4-8 hours depending on the patient. Surgeons perform a whipple if there is a tumor in the head of the pancreas. The duodenum also must come out, since the head of the pancreas and the duodenum share a common blood supply. The problem with taking out the duodenum is that it connects the stomach to the rest of the small intestine, and it also is where the bile from the liver and pancreatic juices drain into. So once the duodenum is removed, the stomach must be joined to the rest of the small intestine, and the plumbing from the liver and the remnant of the pancreas must also be re-attached.
Other times we do a "distal pancreatectomy", most commonly for small lesions in the tail of the pancreas (more to the left) which can be pre-cancerous (IPMN). Distal pancreatectomies are not easy either, and since the splenic artery runs right under the pancreas they often involve splenectomy as well.
The liver is also a major component of HPB surgical oncology. We do surgery on the liver if there is a primary liver tumor (that is, the cancer started in the liver) or there are metastases to the liver. The liver is where nutrients from digestion are processed by the body. When we eat or drink, the nutrients, toxins, vitamins, and water are absorbed in the stomach, intestine, colon. Those organs then immediately drain into the liver in what is called the "hepatic portal vein". That is why a cancer that originates in the GI tract is so likely to spread to the liver. Not all veins in the lower body drain immediately to the liver, however. Some of them skip the liver and go right to the lungs. That is why cancer so commonly spreads to the liver and lungs.
Anyway, so on HPB we see patients with colon cancer who have metastases in the liver. A general rule of cancer is that the presence of distant metastases generally means the cancer cannot be cured by surgery, but there are exceptions to this rule, and colon cancer is one of them. If a patient has a colon cancer removed, and then a year later they have a liver tumor, we often will try to take out that liver tumor. Liver surgery is challenging because the organ is so vital, and variable. The surgeon must be very aware of the anatomy and ready to avoid major bleeding, but without compromising other major vessels. Liver surgery can turn catastrophic really quickly without extra caution.
In the hands of an experienced surgeon, liver surgery is very safe. Additionally, the organ is the only in the body that is capable of regenerating, so you can remove a huge chunk of a patient's liver and the rest will grow right back. My attending on HPB is working on a project with some engineers that maps the internal blood networks of a patient's liver before hand. Then during the case, the engineers use lasers to scan the outside and contours of the liver and they match the internal blood network to the real-time layout of the liver. When the project is perfected, a surgeon should be able to take a probe and point it to any spot on the patient's liver and look at a real-time 3-dimensional screen to see where the blood vessels below are running. Right now we can get some idea with ultrasound (so don't worry, the surgeon's are not flying blind), but this would be a big improvement.
The other reason why HPB is a good service for students in oncology is that we are exposed to the less rosy side of surgical oncology. In HPB we commonly see pancreatic adenocarcinoma, cholangiocarcinoma, and hepatocellular carcinoma. All of these cancers carry a very poor prognosis. Even with complete surgical resection, negative lymph nodes, and negative margins, these cancers more likely than not will come back, and quickly.
I finished HPB last week and now I have started my second rotation, GMT (gastric and mixed tumors), which include sarcoma and melanoma. This month I am seeing a great diversity of very rare cancers and learning more about melanoma (which is not so rare). I'll update about that soon.
Funny!
The Onion is an online political satire site. They have a hilarious piece on New York City. Lots of profanity, but I wouldn't have it any other way.
Saturday, September 04, 2010
Banksy!
I know this is totally not the update that people are looking for. Last night, Sarah, David and I went to Williamsburg for dinner at this awesome BBQ place. Williamsburg is an upcoming area right outside of Manhattan (one subway stop under the East River) where property values will be quadrupling over the next ten years. Its kind of a rugged, artsy area that has a very unique feel even for NYC.
Anyway, we were walking into a neat looking Tea Bar and I noticed a piece of graffiti. I recognized it as the work (or an amazingly good imitation) of a world famous graffiti artist by the name of Banksy. In this graffiti there is a man holding a remote control. You look to his right and there is a giraffe with a receiver collar around its neck, implying that the man is driving the giraffe. And in the giraffe's mouth is a paintbrush, which it is using to write "vandal" on a high spot on the wall. Very cool!
Anyway, we were walking into a neat looking Tea Bar and I noticed a piece of graffiti. I recognized it as the work (or an amazingly good imitation) of a world famous graffiti artist by the name of Banksy. In this graffiti there is a man holding a remote control. You look to his right and there is a giraffe with a receiver collar around its neck, implying that the man is driving the giraffe. And in the giraffe's mouth is a paintbrush, which it is using to write "vandal" on a high spot on the wall. Very cool!
Tuesday, August 17, 2010
Friday, August 13, 2010
Thursday, August 12, 2010
Chinese docs and patients
I did a month long surgery rotation in China in April. When I came back, I told people (friends, family, docs) that American surgeons have it lucky: if the patient does not do well, the worst that could happen is we get sued. In China, you get sued and you get beat up by the patient's family.
I don't think people believed me when I told them this, or maybe thought I was exaggerating. I'd tell them that if a patient had a bad outcome, the docs in some places would wear a helmet to work the next day. And I'd get this look like "Nick, you're full of it."
Quote from a recent NYT article. "In 2006, patients or their relatives attacked more than 5,500 medical workers, reflecting wide discontent with China's public health care system."
See? I wasn't exaggerating. American doctors have it great. Our patients generally respect us. They only sue us 5% of the times when they could. And, they don't beat us up when things don't go well.
Tuesday, August 03, 2010
Memorial on York St, my apt
It is a humble abode. Two ranges, a small fridge, sink, microwave, a table, twin bed. Great location though!
Sunday, August 01, 2010
New York
During the senior year of medical school, many students opt to do visiting rotations at other institutions. There are many good reasons to do "aways", as we call them. They can provide more experience and learning before the start of residency, so hopefully leaving a student more prepared for the disaster that is intern year (intern = first year resident). Also, doing aways may give some students an opportunity to get their foot in the door at competitive programs. Aways are also useful to see what life is like in other cities, or to see how other hospital system are run.
The motivations for my China away rotation were mostly cultural - that is, I wanted to experience life in China and see how the Chinese medical system was organized. That I got to see some cool thoracic surgery cases was an additional benefit. My current away rotation in NYC will be at Memorial Sloan Kettering Cancer Center (MSK). Unlike most of the places that students do aways, MSK does not actually have a residency program in surgery; they have fellowship programs. Fellowship is where a doc is trained after residency, and it only lasts 1-2 years normally. So I won't be applying for a spot at MSK next year; perhaps I will in 6-7 years. As arguably the top cancer center in the world, there will be as many great learning opportunities at MSK as there would be anywhere. A final reason for this rotation: it is important that I figure out whether I would want to live in New York or some other crowded big city.
My apartment is located at approximately 74th and 1st avenue. It is a couple blocks from MSK and from the NYC public library. Central Park is about 1 km away; I went for a run through it last night and happened to go past the Guggenheim. I have been craving Indian food lately, and I haven't had a chance to go get it in Indianapolis. Well, the door to my apartment is flanked by an Indian restaurant and a Chinese restaurant, and there is another Indian restaurant across the street. There are small markets everywhere, and street vendors with fresh produce as well. I think I picked a good season to live here!
The motivations for my China away rotation were mostly cultural - that is, I wanted to experience life in China and see how the Chinese medical system was organized. That I got to see some cool thoracic surgery cases was an additional benefit. My current away rotation in NYC will be at Memorial Sloan Kettering Cancer Center (MSK). Unlike most of the places that students do aways, MSK does not actually have a residency program in surgery; they have fellowship programs. Fellowship is where a doc is trained after residency, and it only lasts 1-2 years normally. So I won't be applying for a spot at MSK next year; perhaps I will in 6-7 years. As arguably the top cancer center in the world, there will be as many great learning opportunities at MSK as there would be anywhere. A final reason for this rotation: it is important that I figure out whether I would want to live in New York or some other crowded big city.
My apartment is located at approximately 74th and 1st avenue. It is a couple blocks from MSK and from the NYC public library. Central Park is about 1 km away; I went for a run through it last night and happened to go past the Guggenheim. I have been craving Indian food lately, and I haven't had a chance to go get it in Indianapolis. Well, the door to my apartment is flanked by an Indian restaurant and a Chinese restaurant, and there is another Indian restaurant across the street. There are small markets everywhere, and street vendors with fresh produce as well. I think I picked a good season to live here!
Saturday, July 31, 2010
New York
I will be living in NYC for the next two months doing surgery rotations at the Memorial Sloan Kettering cancer center. I have a new phone with a camera - so expect more pictures!
Wednesday, May 05, 2010
Monday, May 03, 2010
Hello Shanghai World Expo!
Lee
Sent from my Verizon Wireless BlackBerry
Thursday, April 29, 2010
Addendum for below post
We reviewed the paper for grammar mostly, since the researcher doesn't speak English fluently (be writes it pretty well).
Sent from my Verizon Wireless BlackBerry
Sent from my Verizon Wireless BlackBerry
Rural Lunch
Lee and I did a favor for our coordinator to review a research paper for a scientist here in Guangzhou. The paper dealt with immune therapy for colorectal cancer so it was interesting and similar to what I have been studying over the last year.
Anyway, the researcher to show his appreciation took Lee and I by van to a restaurant just outside the city for traditional rural Cantonese food. I haven't spent too much time detailing it, but I love the way groups eat in China. The food is ordered ala carte and brought out staggered and placed on a glass circle in the middle of the table. The glass rotates so we have easy access to the food items. This includes a chicken (with head and feet attached), some fish (a whole fish laying on a plate), some of the biggest oysters I've ever seen, fried tofu, and some other things. It was great.
The scientist's name is Benquiang, and he was quite a character. He did a brief fellowship at Yale in immunology. Furthermore, he was in the Chinese military and apparently rescued the president of Liberia some years ago with 2 comrades, both of whom were KIA. Or maybe captured him? Ill have to find out the specifics in a future correspondence.
Anyway, Lees friends from Purdue, Mike and Adam, arrived this morning. We are going to spend the weekend in Guangzhou and then go to Shanghai on Sunday.
Cheers,
Nick
Sent from my Verizon Wireless BlackBerry
Anyway, the researcher to show his appreciation took Lee and I by van to a restaurant just outside the city for traditional rural Cantonese food. I haven't spent too much time detailing it, but I love the way groups eat in China. The food is ordered ala carte and brought out staggered and placed on a glass circle in the middle of the table. The glass rotates so we have easy access to the food items. This includes a chicken (with head and feet attached), some fish (a whole fish laying on a plate), some of the biggest oysters I've ever seen, fried tofu, and some other things. It was great.
The scientist's name is Benquiang, and he was quite a character. He did a brief fellowship at Yale in immunology. Furthermore, he was in the Chinese military and apparently rescued the president of Liberia some years ago with 2 comrades, both of whom were KIA. Or maybe captured him? Ill have to find out the specifics in a future correspondence.
Anyway, Lees friends from Purdue, Mike and Adam, arrived this morning. We are going to spend the weekend in Guangzhou and then go to Shanghai on Sunday.
Cheers,
Nick
Sent from my Verizon Wireless BlackBerry
Tuesday, April 27, 2010
Hong Kong, Traditional Chinese medicine
I think we've started to get relatively lax about updating. Part of
the problem is that when we were in Hong Kong last weekend, our
cellphones weren't getting Internet data. Anyway, here is a brief
synopsis of Hong Kong. Its a very impressive city, and sits right up
there with London and New York in that respect. Hong Kong is
definitely a really unique blend of East-meets-West. Since it was a
British colony, most people can speak English. But in the shopping,
restaurants, and culture you can find authentic Chinese, you can find
authentic Western, and you can find mixes of the two. I for one was
thrilled to have the first real burger I've had in weeks! Anyway,
there is almost too much to write and I don't really have the time
right now, but if I was going to describe Hong Kong in one world, it
would be "capitalist". There is so much emphasis on wealth
production, finance, consumption, and really there is a lot of
extravagance there as well.
the problem is that when we were in Hong Kong last weekend, our
cellphones weren't getting Internet data. Anyway, here is a brief
synopsis of Hong Kong. Its a very impressive city, and sits right up
there with London and New York in that respect. Hong Kong is
definitely a really unique blend of East-meets-West. Since it was a
British colony, most people can speak English. But in the shopping,
restaurants, and culture you can find authentic Chinese, you can find
authentic Western, and you can find mixes of the two. I for one was
thrilled to have the first real burger I've had in weeks! Anyway,
there is almost too much to write and I don't really have the time
right now, but if I was going to describe Hong Kong in one world, it
would be "capitalist". There is so much emphasis on wealth
production, finance, consumption, and really there is a lot of
extravagance there as well.
Physically, Hong Kong is a very clean city, very well organized,
gorgeous buildings, and the best transportation that I've seen in any
city in the world. Its just very easy to get around, whether it be on
the subway, or the double decker buses, the light rail trolleys, ferry
across the river, and really cheap taxis. Great place to visit, not
super expensive. Additionally, just across the harbor is Macau. A
former Portuguese colony, Macau is a tiny island with 500,000 people
packed on. It is considered the Las Vegas of Asia, and has some
pretty cool historical sights to see as well. I was really hoping to
see Macau and feed my gambling addiction, but unfortunately we aren't
going to make it. We were originally going to go this coming weekend,
but then we found out that Lee's friends did not get re-entry visas,
meaning once they leave the PRC they cannot come back in. And I guess
since Macau is a special administrative region, going there counts as
leaving the PRC. So someday in the future I will definitely come
back, and Hong Kong / Macau will be a leg of that trip for sure!
We came home to Canton on Sunday night. The ride back on the bus had
to be the bumpiest ride I've ever experienced in my life. Hong Kong
is very close to Canton, but due to border crossing et cetera it is
actually kind of a pain to get there. What should take 1.5 hours
actually takes 3.5 hours. Fortunately, they are going to be building
a high speed rail between Hong Kong and Canton, which should make the
trip take all of 20 minutes. This week, Lee and I started our
traditional Chinese medicine rotation. We've seen acupuncture and
some various other techniques that we will describe in more detail at
a future date. We finish in Guangzhou this week and Lee has some
friends from Purdue flying in on Friday I think. We will spend one
more weekend here and then its off to Shanghai and the World Fair for
several days.
Cheers,
Nick
Sunday, April 25, 2010
Friday, April 23, 2010
Hong Kong
Quick update. We are in Hong Kong. It is incredible. However, for some bizarre reason neither Lee's nor my phone gets internet, email, or messenging. Very weird. Anyway, will update when we get back to China proper. Just wanted people to know we weren't arrested @ the border or anything like that :).
Sent via BlackBerry® from 3
Sent via BlackBerry® from 3
Wednesday, April 21, 2010
Esophageal Cancer
As a result, I've seen a lot of esophageal cancer cases, a few lung
cancers, and one breast cancer. The esophageal cancer cases in China
are intriguing since some of them are more proximal (IE closer to the
mouth) than ones we have in the United States (which are closer to the
stomach). I was talking to one of the senior thoracic surgeons today
and he was telling me he actually doesn't think it is the spicy food
(which I had posited as one cause in an early blog post). The reason
he thinks the cancer is not spice related is because in Sichuang
Province, the food is the spiciest in China (and incidentally some of
my favorite food here) and they don't have higher rates of esophageal
cancer. He thinks a contributing factor could be the extremely hot
tea that people in the southern areas of China regularly drink,
perhaps burning their throats frequently. Another possibility is that
eating pickled foods causes it.
Anyway, when a patient has an upper esophageal cancer, the tumor has
to be removed but something has to connect what is left of the throat
to the rest of the digestive tract. In the first step of the case,
the patient is on their right side and the surgeons go in from the
left rib cage, removing the section of the esophagus with cancer.
Then they go into the abdominal cavity, and remove half of the
stomach's blood supply (the less important half), and pull the stomach
halfway out of the body. Then with a specialized staple gun they can
actually turn the stomach into a tube. They then feed the
tube-stomach up through the chest underneath the sternum and directly
attach it to what is left of the esophagus near the mouth.
I've included three pictures. The first has a view of the stomach
after it has been turned into a tube. The second picture is of the
small section of esophagus that was above the tumor, which still
remains and needs to be attached to the lower section. Finally, I've
added a photo of a removed esophageal tumor. Keep in mind the entire
object isn't tumor; a good chunk of it is, but other parts are
actually just collateral fat and esophageal tissue.
Tuesday, April 20, 2010
Three Gorges Dam update
Rail Station to Wuhan. Wuhan is a city of approximately 8 million
people, and is a major locale in central China. Lee's friend Li Lei
picked us up from the train station in his new car - a GM Cruze. We
went to get hot pot for dinner and then Li Lei took us to one of his
favorite local bars where we had some drinks. Saturday morning we got
the standard beef and noodles for breakfast (a dietary staple for me
here) and we started driving to the dam which was 300 km away.
Unfortunately, we got a flat tire about 30 minutes outside of Wuhan.
After replacing the tire with a spare we drove to a local village
where conveniently one guy had a tire repair shop. We joked that he
had left nails on the road to get more business. It was interesting
for me to see a tiny village in China; Lee said the street reminded
him of the one he grew up on. I also noticed there were random
chickens walking around the fields by the village. Lee told me that's
because the chickens belong to someone. They will walk around freely
during the day, eating bugs or whatever. But at night they will
return to their coop and they lay their eggs in the same spot, so the
owner knows where to look. Lee also told a funny story of when he was
little, living in a similar village. He and 3 other boys teamed up to
capture one such chicken and then sold it to a restaurant for five
bucks. Apparently they can be tough to catch and it requires teamwork
and coordination. Furthermore, it was Lee who had to carry the hen
under his shirt and do the dirty work, but since he was younger he was
only given 50 cents of the 5 dollar bounty, and the older boys split
the rest. Clearly this incident has scarred him.
Anyway, the local tire shop owner actually didn't have what we needed
so we left and drove back to Wuhan to the GM repair center. After
waiting for a bit while the tire was replaced, we finally got back on
the road. The whole episode ended up delaying us by 4-5 hours, so we
didn't get into the city by the Three Gorges Dam, Yi Chang, until
late. We got hot pot again for dinner and then played a Chinese card
game in the hotel room. The game is like a supercharged version of
War, pretty fun, but I clearly didn't understand it well as I ended up
losing almost 100 Yuan to Lee and Li Lei (which is like 14 US
dollars).
On Sunday morning we woke and drove to the Three Gorges Dam which was
bout 30 minutes away. The geology approaching the dam was very
interesting. Moderate to small sized mountains but really sharp,
steep cliffs. It makes sense that a chose a site like this to build a
dam. I included a good example of the geology approaching the dam via
a photo of a crossing of a bridge approaching the site.
After arriving at the dam site they put you through security and then
you go on a tour bus. It drops you off at one location, and you get
back on and go to the next spot. Unfortunately, we didn't get to get
a close view from the base of the dam, so it was pretty hard to
appreciate how huge it was. It was also quite foggy the day we were
there so we could only barely see the other end of the dam (which is
over a mile long, anyway). Anyway, I've included two photos. In the
first one, you have a far away view of the downstream side of the dam.
In the second dam photo, we are much closer but we are upstream, so
its hard to appreciate how deep (175 meters or so) the dam is.
One of the most impressive things about the dam experience was a
painting that was drawn by a Chinese artist (this is the fourth
photo). It was a panorama of the entire upstream region of the
Yangtze that was to be affected by the construction of the dam. This
painting must have been over 100 feet in length, and it took the guy
15 years to paint it. I got a video of it and included only one frame
for this blog post. The painting, more than the dam itself, gives an
appreciation for exactly how much water the dam is holding back. The
reservoir stretches back for miles, and is quite deep.
The Three Gorges Dam is the largest power plant of any kind in the
world, supplying 3% of China's electricity needs (which are enormous).
The dam also increases navigation on the Yangtze by keeping water
levels up downstream during the dry season as the reservoir of the dam
is slowly allowed to drain. Most importantly, the dam provides flood
control for the downstream cities along the Yangtze, including Wuhan,
Nanjing, and Shanghai. One flood in 1954 in Wuhan killed something
like 30,000 people. There is a memorial to the flood, with a poem
written by Mao Zedong*, although I did not have the chance to see it.
I found a photo of it on Wikipedia, if any Mandarin speakers want to
translate it for me.
http://en.wikipedia.org/wiki/File:Wuhan-Flood-Memorial-0218.jpg
Even though over 1 million people were displaced by the dam, it is
hard to say it wasn't worth building. The number of lives that will
be saved by avoiding floods, the amount of energy generated (which
will pay for the dam before a decade), and the increased economic
activity are all huge factors. Not to mention that the energy
generated is not from fossil fuels, another great advantage in terms
of reducing pollution and keeping oil prices lower than they otherwise
might be. It's hard to argue against progress like that.
* Henry Kissinger (Secretary of State under Nixon, coordinated the
diplomatic opening between China and the USA in the 70's) described
Chairman Mao has a poet and philosopher, with Zhou Enlai being an
administrator and executor of Mao's vision. Kissinger described Enlai
as one of the two or three most impressive people he had ever met,
which is a pretty remarkable statement considering who Kissinger met
during his exploits. At any rate, I'm curious to read Mao's poem
after learning that Henry Kissinger thought of Mao in this way.
Friday, April 16, 2010
Let's take the train!
Pic 2 = Some parts are still under construction
Pic 3 = the fastest train in the world (it goes 210 mph)
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Wuhan
It is Friday, and Lee and I decided to leave Guangzhou for the weekend to visit Lee's childhood friend Li Lei. To get to Wuhan, which is a moderately sized Chinese city at 9 million, we took the train.
Wuhan is a smooth 600 miles from Guangzhou, roughly the distance from Indianapolis to New Orleans. We made the trip in less than 4 hours for about 70 bucks. The train from Guangzhou to Wuhan is the fastest train in the world. It was completed only this past December, and is the first leg of a chain that will connect all the way to Beijing.
I've got video of the first 5 minutes of takeoff, ie the train picking up speed to its max of about 350 km/hour (about an Indy500 car). Its really really fast.
Wuhan is situated on the Yangtze River and Li Lei is picking us up from the train station (also brand new and very impressive to put it mildly). Later this weekend he is taking us to the Three Gorges Dam, which is the biggest dam in the world by a huge margin.
I especially was thrilled about the train ride because it would give me a chance to see the rest of the country. Two things really struck me. One, it is remarkable to be sitting on the worlds fastest train and see farmers working giant rice paddies with their bare hands; this is another testament to the contrasts of China. The other thing that struck me is how much construction is going on absolutely everywhere. Its unbelievable. With the amount of construction I've seen we could build indianapolis dozens of times over.
Its a shame that we have such limited transit options in the states. China is larger than the US mainland, but certainly their population density makes it more economical. Still, we gotta start somewhere. Why not a modestly fast midwest corridor connecting Cincinatti to Chicago via Indy?
Pics next week if you're lucky, or if Lee uploads a few from his camera phone :).
Cheers,
Nick
Sent from my Verizon Wireless BlackBerry
Wuhan is a smooth 600 miles from Guangzhou, roughly the distance from Indianapolis to New Orleans. We made the trip in less than 4 hours for about 70 bucks. The train from Guangzhou to Wuhan is the fastest train in the world. It was completed only this past December, and is the first leg of a chain that will connect all the way to Beijing.
I've got video of the first 5 minutes of takeoff, ie the train picking up speed to its max of about 350 km/hour (about an Indy500 car). Its really really fast.
Wuhan is situated on the Yangtze River and Li Lei is picking us up from the train station (also brand new and very impressive to put it mildly). Later this weekend he is taking us to the Three Gorges Dam, which is the biggest dam in the world by a huge margin.
I especially was thrilled about the train ride because it would give me a chance to see the rest of the country. Two things really struck me. One, it is remarkable to be sitting on the worlds fastest train and see farmers working giant rice paddies with their bare hands; this is another testament to the contrasts of China. The other thing that struck me is how much construction is going on absolutely everywhere. Its unbelievable. With the amount of construction I've seen we could build indianapolis dozens of times over.
Its a shame that we have such limited transit options in the states. China is larger than the US mainland, but certainly their population density makes it more economical. Still, we gotta start somewhere. Why not a modestly fast midwest corridor connecting Cincinatti to Chicago via Indy?
Pics next week if you're lucky, or if Lee uploads a few from his camera phone :).
Cheers,
Nick
Sent from my Verizon Wireless BlackBerry
Thursday, April 15, 2010
Pizza Hut: Sharing Good Time.
An American spin on food imported by Italian immigrants devolved into the fast food chain we know as Pizza Hut. Then the Chinese took what was an American creation and imported it themselves. But the difference is that Pizza Hut in China seems to be a relatively fancy place. More like a Maggiano's in the states. They have some decent Chinese variations on things (a smoked salmon salad was pretty good) but the supreme pizza tasted pretty much the same.
Nick
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Breakfast of Champions
sell well in the United States, is a dish called "chaun fin".
According to Lee, the name literally means cow intestines. And the
reason it is called that, is because it looks like cow intestines
(specifically, the folds in the food are reminiscent of the rugae
found in mammalian digestive tracts).
Anyway, chaun fin is just rice noodles. The cook has a small shop on
our street with this bizarre oven that holds four trays in it. The
cook takes a tray and pours the liquid rice mixture on it. Then he
can add meat (rho) or egg (daun). He puts the tray in the oven and a
minute or two later pulls it out and the rice liquid has hardened a
little bit into a spread out layer. He then takes a scraper and
scrapes the food off of the tray and into a bowl for you.
I have a video of the guy doing this, its pretty impressive how fast
he is when he has a lot of customers. Anyway, here are a couple of
pictures of it.
Nick
Tuesday, April 13, 2010
A few more pictures of the temple
actually still clips from video that I recorded with the IPOD Nano
that one of my girlfriends gave me for my birthday. The IPOD videos
are pretty cool though, as they contain ambient sounds of the
surrounding forest. If I figure out a way to upload them to the blog,
I will.
Monday, April 12, 2010
"Tiger Country"
This patient is a 65 year-old female presented with headaches, nausea and vomiting. CT, MRI and angiogram revealed a very vascular cystic lesion in the posterior fossa, which is most likely hemangioblastoma given its hypervascularity, appearance and location. This case went on for 11 hrs yesterday. It was a very tricky resection because the feeding artery of the tumor was actually hiding underneath the draining vein. The patient's blood pressure was very unstable (going from 90/50 to 160/120 in just a few seconds) during the last part of resection because the tail of the tumor was very close to the medulla. In the last photo you are actually looking into the 4th ventricle at the posterior aspect of brain stem (medulla). The patient was awake, alert and followed command this morning. This is pretty amazing since many patients with this type of surgery would be left unable to breath on their own (damage to respiratory center) or in a permanent unconscious state.
Lee
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Baiyun Mountain
Mountain, which literally means White Cloud Mountain. It has been an
important site in China over the centuries. We walked up it via a
roadway and stairs (shut up Kim) and took a gondola down. Anyway, the
neatest thing on the mountain was a Buddhist temple that is found
about 3/4 of the way up. I don't think the temple is very old,
however, or at least it has been recently renovated. Here are a few
pictures from the trip to the mountain.
Nick
Sunday, April 11, 2010
Esophageal cancer in China
I saw two esophageal cancer surgeries last week. Both were squamous cell carcinoma (a histological description) and both were in the upper third of the esophagus, closer to the mouth. To do the surgery, the section of esophagus with the tumor is removed along with some lymph nodes. Then the doctors turn the stomach into a tube with fancy stapling and attach it to the end by the mouth.
The interesting thing is that esophageal cancer in China is flipped from that in the US. In China, most cases are squamous and in the upper or middle third. In the US, most are adenocarcinoma and in the lower third, close to the stomach (gastroesophageal junction).
A diet high in spicy food and perhaps smoking and pollution explain the Chinese esophageal cancer. The American cases are caused by obesity and overeating. Those things lead to acid reflux, which causes cellular change in the lower portion of the esophagus into cells that are more resistant to acid. Unfortunately this change (called Barretts esophagus) also predisposes to the cancer that we see in the USA.
Nick
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The interesting thing is that esophageal cancer in China is flipped from that in the US. In China, most cases are squamous and in the upper or middle third. In the US, most are adenocarcinoma and in the lower third, close to the stomach (gastroesophageal junction).
A diet high in spicy food and perhaps smoking and pollution explain the Chinese esophageal cancer. The American cases are caused by obesity and overeating. Those things lead to acid reflux, which causes cellular change in the lower portion of the esophagus into cells that are more resistant to acid. Unfortunately this change (called Barretts esophagus) also predisposes to the cancer that we see in the USA.
Nick
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Elevators
This morning I failed to squeeze my way into the hospital elevator since there were like 25 people in front of me. So, I had to climb 13 flights of stairs in a shirt and tie to get to the neurosurgery floor ... Definitely not doing that again.
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Sent from my Verizon Wireless BlackBerry
Saturday, April 10, 2010
Guangzhou taxis
Two points. One, they are cheap. They are priced in Yuan about the same as they are in the states in dollars. So a twenty dollar ride is 3 bucks for us - that rocks.
Two, they are extremely unsafe in my opinion. Why? For starters, the back seats don't have seatbelts. Its like they went out of their way to remove them actually b/c the belt is physically there, just the buckle is removed.
But its worse than that, because not only are there no belts, but there are solid steel barriers between the front and rear seats. These are designed to protect the driver from mugging I guess. But in any sort of accident, even one that wouldn't normally have the force to throw the unrestrained driver from the car, a person will be thrown headlong into the steel bars right in front of them and crack their skull like an eggshell falling on a tile floor.
Oh, I forgot to mention a third thing. Everyone drives aggressively, at least by my standards. Also, lanes are more of a suggestion than anything resembling a traffic law.
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Two, they are extremely unsafe in my opinion. Why? For starters, the back seats don't have seatbelts. Its like they went out of their way to remove them actually b/c the belt is physically there, just the buckle is removed.
But its worse than that, because not only are there no belts, but there are solid steel barriers between the front and rear seats. These are designed to protect the driver from mugging I guess. But in any sort of accident, even one that wouldn't normally have the force to throw the unrestrained driver from the car, a person will be thrown headlong into the steel bars right in front of them and crack their skull like an eggshell falling on a tile floor.
Oh, I forgot to mention a third thing. Everyone drives aggressively, at least by my standards. Also, lanes are more of a suggestion than anything resembling a traffic law.
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Friday, April 09, 2010
Fyi
Bud diesel is considered high class in this city. So at an expensive place in the states, you know how someone will order a bottle of Patron? Here, they order 12 budweisers. No, I'm not kidding.
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a Guangzhou Artist
was painting on the street. He was a double amputee and he was
painting very pretty Chinese watercolor pictures (thats what Lee
called them). He was selling them for 20 Yuan each, which is about 3
US dollars. That is relatively expensive by Guangzhou standards for
something that is relatively abundant and easy to come across.
However, from a Western perspective, I've hardly seen anything like
them and I thought they were really pretty. So it occurred to me that
they are worth much more to me than 3 dollars, so I went back
immediately to buy more.
As it turns out, the local police had booted him and his wife from
their spot near the Martyr's Park. He was walking toward me and his
wife was still behind, yelling at the police. He smiled as I passed
but I indicated to him that I wanted more. Getting his wife to stop
yelling at the police took him a bit and then she let me look at the
stack of paintings they had. I got to choose the ones I wanted, and I
bought 5 more watercolors for 100 Yuan. Additionally, he had
watercolors of people and animals that were more complex but were
selling for 50 Yuan. I offered to buy one for only 20 Yuan as that
was about all I had at that point. While the man quickly agreed
(after all I had just bought 6 of his other ones), his wife kept
insisting on 50. I finally showed her that I
only had pocket change left and the man hushed her and agreed to my 20
Yuan offer for a nice watercolor of a farmer.
Honestly, I would have bought his entire stack if I knew I could get
them all home safely. I am worried that they will bleed into each
other or that they will get damaged; Lee says they won't bleed, but
they are very fragile. I will try to find a way to protect them. At
any rate, 7 beautiful Chinese paintings for 17 US dollars, each of
them very frame worthy. In fact, if I was more of a capitalist, I
would have gotten his contact information and had him mail these
paintings to America and I would sell them for 100 dollars each and we
would both get rich. Anyway, I've attached a photo of him painting
one of the watercolors. Very impressive.
Thursday, April 08, 2010
The other great thing about travel
Especially in a country where you don't know how to do anything and only a few people speak broken English: you feel like such a dumbass, all the time. I feel like they could make a Mandarin sitcom where they follow me and watch me try to order food, pay the bill, get on the subway, et cetera.
It can be a humbling experience. Its good practice perhaps for being a surgical intern in a year.
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Wednesday, April 07, 2010
Spine tumor case
*No HIPPA violation here, all identifying info have been removed, you got a 1 in 1.3 billion chance to figure out who it is.*
Lee
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Tuesday, April 06, 2010
Nice
First morning rounds, and I was sitting in the top attending physician's seat. Luckily I had the foresight to ask my friend Dr. Ela if it was anyone's seat so I got up before making a fool of myself by having to be told. :)
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Ordering food
Lee taught me some basic chinese characters. I can recognize chicken meat, chicken egg, beef, noodle, and rice. But I ordered tonight by myself, and the best I could do is point and grunt. I would order like that all of the time if I could get away with it.
Nick
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Walk sign
When the walk sign counts down, and hits zero, you had better be out of the way in this city because there is no delay.
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Monday, April 05, 2010
Hot pot
See third picture posted by Lee for reference for this post. The first two pics give a good feel for how crowded some of the streets are.
Hot pot is basically Chinese fondue. We went to dinner last night and had it. Its basically a bowl w two sides (spicy and mild) over a heat source. Full of all sorts of goodness, like garlic and peppers and herbs. Then they bring out raw stuff and you heat it in the boiling pot w chopsticks and enjoy. For example we had beef, lamb, seafood dumplings, Chinese mushroom, and some other vegetables and things that I'd never seen before but that were good.
It was a lot of fun, but its a very communal and slow way to eat. People share the pot and the trays with food. People can go to get hot pot in groups as a fun social occasion. I'd love to find a restaurant in the states that does it.
We had beer with the hot pot. An interesting thing I learned is that the beer stems from the early 1900s. When western powers invaded China during the Boxer Rebellion, the Germans came too. And they built breweries, from which the Chinese picked up the beer thing. I am grateful for that, as good beer is enough to keep me happy anywhere!
I've also learned to be more careful when I chew and swallow. Chinese food here is almost universally spicy (and if it doesn't come that way I make it that way). But while not super hard on the tongue, the particular spice that they use will absolutely decimate your throat if it gets anywhere near the windpipe, and you will be coughing and burning.
Nick
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Hot pot is basically Chinese fondue. We went to dinner last night and had it. Its basically a bowl w two sides (spicy and mild) over a heat source. Full of all sorts of goodness, like garlic and peppers and herbs. Then they bring out raw stuff and you heat it in the boiling pot w chopsticks and enjoy. For example we had beef, lamb, seafood dumplings, Chinese mushroom, and some other vegetables and things that I'd never seen before but that were good.
It was a lot of fun, but its a very communal and slow way to eat. People share the pot and the trays with food. People can go to get hot pot in groups as a fun social occasion. I'd love to find a restaurant in the states that does it.
We had beer with the hot pot. An interesting thing I learned is that the beer stems from the early 1900s. When western powers invaded China during the Boxer Rebellion, the Germans came too. And they built breweries, from which the Chinese picked up the beer thing. I am grateful for that, as good beer is enough to keep me happy anywhere!
I've also learned to be more careful when I chew and swallow. Chinese food here is almost universally spicy (and if it doesn't come that way I make it that way). But while not super hard on the tongue, the particular spice that they use will absolutely decimate your throat if it gets anywhere near the windpipe, and you will be coughing and burning.
Nick
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Shopping in Shang Xia Jiu Ave
Lee
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Day one continued
So I accidentally hit send before I was done with the last post; it wasn't supposed to end so abruptly. Here is part two from day one in the markets.
After the mall, we then decided to go to another shopping district. We got back on the metro and went about 8 stops west to one popular shopping district there. This place was pure insanity. So many people. So many shops w/ ridiculously cheap shoes, clothes, or whatever else you'd want. There were also restaurants, food markets, thousands of people - and this went on for blocks and blocks, on multiple streets.
Through the entire day I must have seen hundreds of thousands of people, but I saw exactly one other caucasian westerner. It drove home the point that Guangzhou is not a tourist destination (it will be in several years I predict). Its not that it isn't safe or welcoming, because it is both.
The city just hasn't experienced a tourism boom yet. While many people speak some English, it seems like the less educated residents don't, which is fine. But they're the ones running the shops, restaurants, and transit. I've been travelling around thus far with three other fluent mandarin and english speakers but I feel like without them I'd be having an extremely tough time. This is all a good thing of course. I feel like I'm getting an incredibly unique experience here, really feeling how culturally powerful a huge city in China can be. But I know it is an authentic experience as well, since there aren't any watered down tourist havens that I've been in yet.
Anyway it is 7 am and my first day in the tumor hospital is today. The hospital is one of many and is absolutely gigantic. Will post pics soon hopefully :)
Nick
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After the mall, we then decided to go to another shopping district. We got back on the metro and went about 8 stops west to one popular shopping district there. This place was pure insanity. So many people. So many shops w/ ridiculously cheap shoes, clothes, or whatever else you'd want. There were also restaurants, food markets, thousands of people - and this went on for blocks and blocks, on multiple streets.
Through the entire day I must have seen hundreds of thousands of people, but I saw exactly one other caucasian westerner. It drove home the point that Guangzhou is not a tourist destination (it will be in several years I predict). Its not that it isn't safe or welcoming, because it is both.
The city just hasn't experienced a tourism boom yet. While many people speak some English, it seems like the less educated residents don't, which is fine. But they're the ones running the shops, restaurants, and transit. I've been travelling around thus far with three other fluent mandarin and english speakers but I feel like without them I'd be having an extremely tough time. This is all a good thing of course. I feel like I'm getting an incredibly unique experience here, really feeling how culturally powerful a huge city in China can be. But I know it is an authentic experience as well, since there aren't any watered down tourist havens that I've been in yet.
Anyway it is 7 am and my first day in the tumor hospital is today. The hospital is one of many and is absolutely gigantic. Will post pics soon hopefully :)
Nick
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Day one in the markets
Lee and I started the day making a loop around campus and our street. We had a breakfast of spicy beef and noodles with a 24 oz beer. It was very good, in a tiny shop off the street with a sleepy old man cashiering. The whole breakfast cost us like 3 US dollars for both of us.
We then met our SYSU medical friends who have been showing us around: Kristina Lee and Jue Wang. We boarded the metro stop at Martyrs Park and took it two stops east to the Tee Mall, which was the biggest in Guangzhou. It puts Circle Centre thouroughly to shame. It is a very nice mall from an infrastructure point of view. If I had to guess I'd say its 2-3 times the size of circle center. The contrasts were stark: some shops had expensive imports that wealthy Americans can't afford, others had very cheap wares.
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Sunday, April 04, 2010
Supporting the Chinese Economy
Thank you Sallie Mae!
Lee
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Saturday, April 03, 2010
Finally in Guang Zhou!
Lee
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Test
I have concerns that my gmail email access and/or my blogger access will be blocked in China. If this works, I guess that means they aren't blocked because we just landed in Guangzhou!
Nick
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Mmmmmmmm
Octipus / clam / shrimp / tofu seafood soup, kimchi, rice...and god knows what else: the breakfast of champions! Lee will have to upload the picture later.
Cheers,
Nick
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Seoul
Lee and I landed in Seoul, South Korea after a 14 hour flight from Chicago. Not bad at all, slept most of the flight.
Leaving for Guangzhou in 5 hours.
Lee's birthday was yesterday (april 3) but it only lasted for 12 hours. Mine is today. Cheers!
Nick
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Friday, April 02, 2010
Hello Chicago!
Lee
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Lee will be posting too!
Ok so Lee and I are going to share this blog for the trip. he has a camera phone (which oddly, my blackberry doesn't) so he can also send pictures directly to the blog.
Cheers,
Nick
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And we are off!
Lee and I are sitting in Indianapolis airport. We fly to Chicago, then to Seoul (South Korea), and then to Guangzhou!
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United Airline
Plane delayed from Indy to Chicago on a sunny day with 84 degree weather. Starting the trip on a high note... More importantly, go bulldogs!!
Lee
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Saturday, March 27, 2010
Less than one week to go!
I hope my gmail account is not blocked in China! Or the blogs and twitter for that matter.
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Sent from my Verizon Wireless BlackBerry
Sunday, February 28, 2010
Koblenz and Mainz, 2009
After leaving Amsterdam, Sarah and I arrived in Koblenz, Germany. The most striking thing about Koblenz to me was the enormous statue of Kaiser Wilhelm I, built at the end of the 19th century and destroyed during WW2.
I was exciting to see the city as it was used as a major staging point for the invasion of France during WWI. However, the city struck me as not very lively, and it only has a population of 100,000 people or so. There is a castle in the city proper, but the day we were there it was closed. The most memorable thing about Koblenz was our taxi driver, an elderly German man who went on vacation every year to the United States. To do what, might you ask? Feed his addiction for American Nascar events. I kid you not.
At any rate we got a room at a hotel where an Indian man had a joint Italian-Indian restaurant. Sarah had cheese pizza and I had spicy curry with rice. The food was all around pretty good, so I guess if you can pull that sort of thing off, more power to you.
Anyway, we weren't inspired to do much in Koblenz because things seemed relatively quiet, so we went to bed and woke up the next day for our Rhine boat ride. This was a lot of fun; the boat has a restaurant on it so there are plenty of food options and good beer. The downside of the boat ride is that while the first 3-4 hours were great, and we got to see plenty of castles and small German towns along the Rhine, the trip to Mainz was a long one and we were on the boat 6-7 hours total. That is longer than you want to be on a boat, especially when you keep eating and drinking beer. So anyone looking to replicate the Rhine boat tour experience should plan a 3 hour ride, or about half the distance from Koblenz to Mainz.
Mainz was a very fun city and much more lively, and we stayed there for a couple of days. It is a tourist city, but for German tourists. Thus we really only ran into one obnoxious group of Americans. Incidentally, we ran into those Americans at this fantastic German brewery / restaurant, the Eisgrub-Bräu. They serve two beer types: light and dark, and they put them in enormous towers on the table (assuming you order it). The food is great. I saw them bring out something for the table behind us. I didn't know what it was, but I knew that I wanted it. It turns out it is called schweinshaxe, and it is fried pork knuckle, served with saur kraut. So good.
Mainz is also home to the Gutenberg Museum (Gutenberg, born in 1398, invented the printing press). The museum had a very impressive display of ancient books and texts. Lots of bibles, some of them over a thousand years old. There were also sections for other cultures; a Chinese section had ancient Chinese documents that were thousands of years old. It really feels like looking into history when you see things like that.
We stayed in a small bed and breakfast hotel that was situated right at the heart of the city. It was actually situated adjacent to St. Martin's Cathedral, a fantastic 1000 year old Roman Catholic building. On the other side of the Cathedral is the town farmer's market (at least when we were there, in early June) so we had some great lunches. Finally, as one would expect in a tourist city, there was plenty of shopping, restaurants, and taverns in Mainz. Definitely an enjoyable place to visit; 2-3 days is perfect and relaxing.
I was exciting to see the city as it was used as a major staging point for the invasion of France during WWI. However, the city struck me as not very lively, and it only has a population of 100,000 people or so. There is a castle in the city proper, but the day we were there it was closed. The most memorable thing about Koblenz was our taxi driver, an elderly German man who went on vacation every year to the United States. To do what, might you ask? Feed his addiction for American Nascar events. I kid you not.
At any rate we got a room at a hotel where an Indian man had a joint Italian-Indian restaurant. Sarah had cheese pizza and I had spicy curry with rice. The food was all around pretty good, so I guess if you can pull that sort of thing off, more power to you.
Anyway, we weren't inspired to do much in Koblenz because things seemed relatively quiet, so we went to bed and woke up the next day for our Rhine boat ride. This was a lot of fun; the boat has a restaurant on it so there are plenty of food options and good beer. The downside of the boat ride is that while the first 3-4 hours were great, and we got to see plenty of castles and small German towns along the Rhine, the trip to Mainz was a long one and we were on the boat 6-7 hours total. That is longer than you want to be on a boat, especially when you keep eating and drinking beer. So anyone looking to replicate the Rhine boat tour experience should plan a 3 hour ride, or about half the distance from Koblenz to Mainz.
Mainz was a very fun city and much more lively, and we stayed there for a couple of days. It is a tourist city, but for German tourists. Thus we really only ran into one obnoxious group of Americans. Incidentally, we ran into those Americans at this fantastic German brewery / restaurant, the Eisgrub-Bräu. They serve two beer types: light and dark, and they put them in enormous towers on the table (assuming you order it). The food is great. I saw them bring out something for the table behind us. I didn't know what it was, but I knew that I wanted it. It turns out it is called schweinshaxe, and it is fried pork knuckle, served with saur kraut. So good.
Mainz is also home to the Gutenberg Museum (Gutenberg, born in 1398, invented the printing press). The museum had a very impressive display of ancient books and texts. Lots of bibles, some of them over a thousand years old. There were also sections for other cultures; a Chinese section had ancient Chinese documents that were thousands of years old. It really feels like looking into history when you see things like that.
We stayed in a small bed and breakfast hotel that was situated right at the heart of the city. It was actually situated adjacent to St. Martin's Cathedral, a fantastic 1000 year old Roman Catholic building. On the other side of the Cathedral is the town farmer's market (at least when we were there, in early June) so we had some great lunches. Finally, as one would expect in a tourist city, there was plenty of shopping, restaurants, and taverns in Mainz. Definitely an enjoyable place to visit; 2-3 days is perfect and relaxing.
Tuesday, January 26, 2010
To Guangzhou!
I have no difficulty keeping up with my politics blog, but I have been pretty atrocious about updating my travel blog. I started the blog in 2006 when I first went to Europe, and it was logistically difficult to update the blog. It wasn't exceptionally challenging to find internet cafes, but it still took some effort. Also, European keyboards have subtle differences that make typing much slower and very frustrating. More importantly, since I was news-deprived during that vacation, I'd spend at least the first hour of my time reading news and political commentary to catch up on the latest. There wasn't always time left over to blog about my travels, and writing after the fact isn't as effective. I did go back to Europe again in 2009 and was again lax with keeping up the blog, but to be fair I had Sarah with me and I knew she would be keeping everyone updated so I didn't need to.
However, I've revived my travel blog in anticipation of a new trip I will be taking in April. Things will be different this time! I found a way to update my blog directly by sending a simple message from my blackberry phone, so I will have no excuse. All of my old Europe posts will still be found on this blog, and I plan to continue to update the blog from that end, writing about specific cities that I went to in Europe either in 2006 or 2009. Additionally, during my fourth year of medical school I'll be traveling all over the country for residency interviews, so I'll blog about those experiences as well.
So what trip scheduled in April could have inspired me to this extent? I am headed to China! I am going to be one of the first two IUSM students to participate in an exchange program with the medical school of Sun Yat-Sen University in Guangzhou, China. Guangzhou is the third biggest city in China, with approximately 12 million people. The city is also known as Canton, and is located in Guangdong Province, southern China.
I will be working at SYSU for 1 month, in the surgery department. Hopefully, I will be in the surgical oncology section (which is what I want to do), but that isn't guaranteed yet. Apparently SYSU is right in the middle of the city, so we will be within walking distance to tons of things. Additionally, Hong Kong and Macau are each barely an hour away, and I hope to visit those two cities at least. Hong Kong in particular has been on my 'most wanted places to visit list' for years now. Here is something I put together to get an idea of the relative locations of Guangzhou, Hong Kong, and Macau:
More updates will come before the trip, although they probably won't be super exciting. I may periodically do a "retro blog" about one of the various European cities I went to either in 2006 or 2009, so keep an eye out for those.
However, I've revived my travel blog in anticipation of a new trip I will be taking in April. Things will be different this time! I found a way to update my blog directly by sending a simple message from my blackberry phone, so I will have no excuse. All of my old Europe posts will still be found on this blog, and I plan to continue to update the blog from that end, writing about specific cities that I went to in Europe either in 2006 or 2009. Additionally, during my fourth year of medical school I'll be traveling all over the country for residency interviews, so I'll blog about those experiences as well.
So what trip scheduled in April could have inspired me to this extent? I am headed to China! I am going to be one of the first two IUSM students to participate in an exchange program with the medical school of Sun Yat-Sen University in Guangzhou, China. Guangzhou is the third biggest city in China, with approximately 12 million people. The city is also known as Canton, and is located in Guangdong Province, southern China.
I will be working at SYSU for 1 month, in the surgery department. Hopefully, I will be in the surgical oncology section (which is what I want to do), but that isn't guaranteed yet. Apparently SYSU is right in the middle of the city, so we will be within walking distance to tons of things. Additionally, Hong Kong and Macau are each barely an hour away, and I hope to visit those two cities at least. Hong Kong in particular has been on my 'most wanted places to visit list' for years now. Here is something I put together to get an idea of the relative locations of Guangzhou, Hong Kong, and Macau:
More updates will come before the trip, although they probably won't be super exciting. I may periodically do a "retro blog" about one of the various European cities I went to either in 2006 or 2009, so keep an eye out for those.
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