The following is a guest post by UNMC third-year medical student Eric Nagengast.

For the past eight months, one of the hardest questions for me to answer has been, “Where do you live?”

In this time, I’ve spent two months in Rwanda, three months in Boston, one month in India and the rest of the time between Nebraska, Colombia and a few other countries.

Since I’m a medical student, people wonder how I’m able to spend so much time away from school. I’m able to travel because I took a leave of absence from medical school between my third and fourth years.

Yes, it may seem crazy, but I actually agreed to put an extra year between myself and the elusive M.D. because I am spending this year as a Paul Farmer Global Surgery Research Associate with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

At PGSSC, we believe safe surgery is a right that all humans should have. Through research, advocacy and clinical assistance, PGSSC strives to bring safe surgery to the people of low- and middle-income countries.

Historically, surgical care has largely been left out of global health priorities. So our battle is not an easy one.  Our group is composed of physicians from the affiliated Harvard hospitals, fellows, residents, students and support staff from multiple schools, countries and continents.

 I am writing this post 30,000 feet above the middle of the Atlantic Ocean, four hours into a 14-hour flight from Newark to Delhi, the major leg of what is bound to be around a 30-hour trip to Guwahati, India.

In the last six months, I have grown accustomed to spending large chunks of time in airports and airplanes. One can actually get a lot done crammed between a couple of strangers for hours with no contact with the outside world (that is, of course, once one has seen every movie the in-flight entertainment has to offer).

Along with traveling, I also have grown accustomed to leaving the luxuries of the western world behind (such as hot water and easy access to food), and I am actually looking forward to my next few months abroad.

In India, my team and I are working on a number of research projects in joint partnership with Operation Smile, an international cleft-care organization. Through these projects, we hope to give a voice to the voiceless. We hope to show the great need there is for surgical care throughout the world, and we hope to show this need can be treated in a cost-effective and safe manner.

While I am in Guwahati, I will be lucky enough to scrub in to cleft surgery with some of the world’s greatest cleft surgeons. For a medical student with the goal of becoming a plastic surgeon, this experience is a dream come true.

I could not share my story without thanking those who have supported me and helped make my experience possible. In particular, I would like to thank my family and everyone behind the Nellie House Craven Scholarship.

This year is undoubtedly the best year of my life. I have met the most amazing people, I have seen the most amazing things, and I now have a vision of what I would like to do with my future. Most importantly, I am the happiest I have ever been.

I will return to UNMC a better clinician, a better researcher and a better person. I hope my story inspires more UNMC students to consider taking less traditional paths toward their degrees.  

Stay tuned for my next post on a day in my life in Guwahati, India.

You just wanted to hug those kids.

Tommy, 10. A good boy, glowing, talking about his dad’s job, and jets. “Tommy can tell you about any plane around,” said his grandfather, Tom Blake.

Lily, 8. An angel (literally; she’d just danced in the Nutcracker) in a purple snow hat with hearts on it, and sparkly boots. When her brother blabbed about how she sometimes forgets names, she leaned in, stepped on his foot and gave him a look. That little-sister-to-big-brother look.

“She was born 19 days after our boy was killed,” her grandfather said.

“Your daddy helped make you before you were born,” her grandmother, Carole Blake, told her as she gave Lily a squeeze. “He and your mama picked out your name.”

Their mama is Jessica Blake, today a UNMC nursing student. On this morning, her Policy and Leadership class was different. The class – her class – was presenting her with an Honor and Remember flag.

Navy Pilot Lt. Com. Thomas Blake died in an S-3B Viking jet crash in Jacksonville, Fla., in 2005. He was 33. He left behind a wife, a son and a daughter he never got to meet.

The flags are a relatively new movement, started by a father who lost a son. The flags go to the families of U.S. servicemen who died “in the line of duty.” The flags have been officially adopted by 16 states, the charity’s website says, and have been “endorsed” by eight more (Nebraska is among those still being lobbied). They don’t come cheap. The UNMC College of Nursing Policy and Leadership class raised $700 for two.

The other went to Pat Jameson, a nurse, and the mother of Tricia Jameson, who had always wanted to be one.

While she applied to nursing school, Tricia, a staff sergeant, was serving as a full-time health care specialist for the Nebraska National Guard. She carried a medical bag in her car, in case she came across any accidents. She taught combat lifesaver training to Nebraska Guard troops. When an opportunity came up to deploy to Iraq herself, she jumped to the front of the line.

Today, Nick Hornig is a UNMC nursing student. In 2005, he was in the 313^th Medical Company (Grounded Ambulance) in the Nebraska Guard, in Iraq, when Tricia showed up, a replacement. He helped her unload her bags.

She was the new kid; he barely knew her. She’d been with them for about three weeks when, out on the Humvee ambulance, she and her driver came across a convoy of Marines that had been hit by an improvised explosive device (IED) attack. There were casualties.

She was racing to the rescue when she was killed by another IED.

“It could have been any of us,” Nick said.

At that time it seemed like something like that was happening every day.

She was engaged to be married. She was 34.

When called to come up to accept her flag, Tricia’s mother took a breath and closed her eyes: steeling herself.

As she stood up there, Nick held his face, rubbed his hands and fought off the tears that welled in his eyes.

He’d barely known Tricia, but he knew this: he’d made it home to nursing school and she had not.

When he heard about the flags, he’d asked his classmates if they could make this happen, for Tricia, and together, they had. Keyon Royster said that Jessica should get one, too. Kate Weidemann organized a bake sale.

With Tricia’s mom, Nick was tender. It could have been him.

It could have been any of them.

Those kids. Tommy, 10, and Lily, 8. Their faces said this was a good day. They got to hear about how great their dad had been. They beamed as they held up that flag.

But those other faces – those of Jessica, and Carole, and Tom, of Tricia’s mom, Pat – those were the ones that all but knocked you to your knees.

The audible sniffles in the auditorium said they were not alone in their tears.

These people had been wounded beyond endurance, and yet, somehow, they endured. There they were. Standing.

And when it came time to click a picture, Jessica brushed the tears, lifted her head, looked right into the camera. And smiled.

Later, in the hallway, Jessica ran into Nick, her nursing school classmate, the guy who had the idea to do this to honor the fallen teammate he’d barely known.

She grabbed his arm. “Thank you,” she said. “That was really cool.”

She laughed at having made something for the bake sale, not yet knowing, at that point, one of the flags was to be for her.

And then, they were late. She was heading back into the classroom and Nick not far behind. They had a test to take. The flag ceremony was over. Quick as that, class was starting again.

Nursing school, much like life, keeps moving forward. And you remember, and smile bravely, and carry on the best you can.

We’ve all heard the phrase “There’s no such thing as a free lunch.” At UNMC, though, that’s debatable. There’s always something going on over the lunch hour, and most of the time, it’s free. Sometimes lunch is even included, SO THERE, whoever came up with the above phrase.

Recently, I was able to attend not one, not two, but THREE lunch sessions in the same week in which I learned something I could take back to my desk. And I could have attended two more events, had they not been scheduled on the same day at the same time as others.

The first was the “Superwoman is a Myth” brown bag lecture hosted by the Olson Center on Tuesday. There I learned that woman tend to feel guilty if they can’t do it all (can I get an amen?), while men tend to blame others (I’m quoting the speaker here, guys).

Sondra Dubas, owner and founder of Miracle Heart Books, was forced to stop running the rat race when her 6-year-old daughter, Ashley, suffered a stroke during surgery for a congenital heart defect. Ashley was born without a pulmonary valve in her heart. Prior to surgery, Dubas looked at it as another event on the calendar, something to get done and cross off her list. When things didn’t go as planned, her life became only about her daughter and getting her better (Ashley’s doing great now).

Dubas learned to say “no” to things that weren’t important to her, focus on “being” rather than “doing” and live “on purpose.” She stopped trying to be “superwoman” and instead became the best version of herself. She urged attendees not to wait for trauma to happen before doing the same.

Wednesday, I went to a Learn at Lunch put on by HR. Though it was titled “Uniting the Diverse,” the speaker from White Rabbit Group focused on branding. While some still think of the UNMC brand as just our logo or the tagline “Breakthroughs for Life,” Mike Wagner had a more open-ended definition.

Branding is “what people remember when they remember you,” he said. He talked about the different kinds of brands: adversarial (think cell phone/cable companies), indifference (fast food restaurants), friendly, but tend to overpromise and under-deliver (car care, anyone?) and focused (where the company anticipates your wants and needs, like Zappos’ surprise upgrade shipping feature).

While we in PR can do everything in our power to build our brand image, Wagner pointed out that the real brand of UNMC lies in the people – all the people. This, my friend, means you, too.

On Thursday, I’d signed up for a session titled “Running the Catch-Up-I-Don’t-Have Enough-Time Race,” also hosted by the Olson Center. How did I know this was something I needed to attend? Well, I showed up 15 minutes late, not realizing it started at 11:30 and not noon.

Jennifer Bartlett, a certified professional organizer, had our group draw how we spend our days on a pie chart. She then asked us to write down our priorities and see if the two matched up. Newsflash: They didn’t, and I’m guessing yours don’t always line up either.

I had on paper that my marriage and health are two of my top priorities, but in reality, I make little effort to schedule dates with my husband without our two rugrats in tow, and I don’t think I have time for exercise even though I always find time for Facebook.

Bartlett then offered tips on how to marry the pie chart with the priority list by:

-using the “no” word;
-delegating;
-setting timers for activities;
-not compromising on sleep; and
-scheduling “me-time”.

Since the session ended before I expected it to, I stopped down to the first floor of the DOC and briefly listened to “I, the Siren,” an Omaha Chamber Music Society trio performing as part of the Music and Medicine series. It was a great way to cap off lunch hour, free of charge.

Check the UNMC calendar  to find out what’s going on around campus over lunch hours and throughout the day.

UNMC’s Tom O’Connor and his wife, Karen
I found out a month ago that Tom O’Connor, senior associate director in public relations here at UNMC, was chosen to receive the “Special Achievement in Public Relations” award at the PRSA Nebraska gala on Dec. 4

But there was one caveat. Organizers wanted it to be a surprise. Our department had to keep it a secret from Tom (gasp!). Keeping a secret from Tom is like playing Santa. You have to work behind the scenes and be sneaky, though no long, white beard is required.

When I asked a colleague for ideas on how to get Tom to the awards ceremony without him realizing why, she had two words for me: “He’ll know.”

 But we were a determined bunch. After some conspiring with our PR director, Bill O’Neill, we decided to tell Tom the department won an award and we needed him to accept it.

 Yes, that would do, or so we thought. Tom agreed to go, but wasn’t satisfied with our story. Being the investigative journalist type, he continued to ask for details. Details that didn’t exist. After all, this was a made-up award.

 Enter an e-mail from Bill.

 “The next e-mail that I send out will be a complete fabrication so that Tom O. will quit asking me about the award. Remember, it is Tom who is actually receiving the award for his service to the PR profession.”

 And that next e-mail from Bill:

 “Found out yesterday that the award we will receive tonight is for “Outstanding Public Relations on behalf of a non-profit” … Thanks to Tom, Lisa, Vicky and Nicole for representing our department at the PRSA gala tonight. Great job, all!”

 As for the relentless questioning from Tom about who nominated us and why, we all played dumb and it seemed to work (not sure if this is necessarily a good thing).

 The biggest coup was getting his wife, Karen, to attend without giving anything away. Her having attended 3,472 of these types of events over the years, we knew that she would normally prefer to pass. But this wasn’t just another dinner. This was one in which her husband would be receiving a Grammy for PR.

 Bill called to clue her in at the last minute, giving her the scoop that it was actually Tom, not our department, who would be honored. While he was on the phone with Karen, Tom walked in the room. Bill quickly hung up. He covered by telling Tom there was now an extra seat at our table and asked if Karen could fill it. Figuring she wouldn’t want to go, he called her anyway.

 And this is when Karen put on an Academy Award-winning performance. She moaned and groaned and even threw in some colorful language for good measure. Karen knew that if she said yes right away it would be obvious something was up, so reluctantly she agreed to go. It was exactly what sold Tom on the idea that this was a general awards dinner.

 Fast forward to that night. During the cocktail hour, Tom still wasn’t satisfied with our vague description of what we were winning and questioned me again. My response: “I think it’s an award of merit…or maybe excellence…Bartender, more wine please!”

 Later, Tom, Karen, Vicky, Lisa Spellman and I took our places at the table. They began to announce award winners and UNMC’s name was never called. I wondered when Tom would start to get suspicious, but he didn’t until the moment they read his bio from the podium.

 “…36 years of media relations experience….. credible, friendly and reliable….helps place more than 2,000 UNMC media hits per year.”

 Tom turned to his wife and said: “I think they’re talking about me.” With a huge grin on her face, Karen replied, “They ARE!”

 Tom stood, and sheepishly walked to the podium. First one person stood, and then another, then a few more and finally the whole room rose to their feet and applauded everyone’s favorite media relations guy. T.O. received a standing ovation. On his way back to the table, it got quiet for a second. Someone then started a second round of applause. It was a special moment to be a part of.

At the conclusion of the ceremony, it was clear Tom never suspected a thing. I believe he uttered something like, “Ya got me.”

 Ever the PR man, Tom sent a gracious email around the next morning.

 “It was a great honor for me. But, I say this in total sincerity, I owe it all to UNMC and the great people I have been lucky to work with in PR. You make me look way better than I really am. Way better.”

 And that, my friends, is the story of how the PR Department “pulled one over” on our very own Tom O’Connor.

When you’re having problems with your eyesight, there are probably worse places to work than on a university campus that has just opened a state-of-the-art eye care facility.

And I’ve always had problems with my eyes.

I remember when I first realized my eyes were bad. I was an entertainment reporter for a small newspaper in upstate New York, and I’d been sent to review an opera.

To help the uncultured, the opera was translated via subtitles. As the mezzosoprano belted out the Italian aria, an English translation ran across a thin screen hanging high above the stage.

The problem? I couldn’t read a word. And no one around me was having any trouble at all.

To that point, I’d never realized I had a vision problem. Sure, things got blurry in the distance, but at some point, doesn’t everything? I never knew that my definition of “too far to see” was much closer than a normal person’s.

Still, no long-term effects. I got a pair of glasses, spent a week or so marveling at how crisp the lettering on stop signs was, and life went on.

Many years later, I was put on prednisone for a medical condition. The drug did what it was supposed to do, and I was pleased – but apparently, one of the possible side effects of prednisone is that it can cause cataracts.

I began to realize something was wrong the following summer, when it became increasingly hard to see people’s expressions clearly — especially if they were facing me with bright sunshine behind them. (It was a problem most common in the late afternoon.) A trip to an ophthalmologist showed that I had what the doctor described as “classic” cataracts.

So two cataract removals later (I’m counting one per eye), I was fitted with a pair of trifocals and sent on my merry way, once more able to ascertain whether people were smiling at me after 4 p.m.

Oh, it wasn’t a perfect situation. To remove the cataracts, they also had to replace the lenses in my eyes.

I wouldn’t have cared, because quite frankly I was beginning to feel that my eyes had been letting down the team through the years – but in one area, they’d always been perfect.

There was a point of focus maybe two feet in front of me, right about the place you’d hold a book, where my vision had never wavered. But as a result of the surgery, that point of focus was lost. Now, to read, I would have to wear glasses. (And I read a lot.)

Still, I’m nothing if not adaptable. And the advent of Kindle, with its adjustable type sizes, has made reading super easy. So my eyes and I were going along quite nicely together, although let’s face it, I no longer trusted them.

Fast forward to this past year, when I began working at UNMC (and receiving health care here), and you find me interviewing a medical student about the VISION Clinic. In the course of the interview, we talked about how people often put off their vision care.

“They don’t realize how bad it’s getting,” UNMC medical student Matt Maslonka told me. “They don’t realize that their field of vision is shrinking until they start walking into things.”

Oh, (insert expletive here). As my colleague Elizabeth Kumru – who has a corner cubicle — can tell you, I walk into things constantly – particularly her cubicle as I’m turning the corner. I used to consider this a result of my preoccupation with deep and meaningful thoughts, such as “Is anyone ordering Jimmy John’s today?” Now, I was wondering if my evil eyes were letting me down again.

So, you may not have heard, but UNMC has this really big, really new Stanley M. Truhlsen Eye Institute, with state-of-the-art equipment and internationally known ophthalmologists and all sorts of cool stuff.

Even though I hadn’t had my initial eye surgery at UNMC, I decided to amble over to the new building one afternoon to see if our UNMC ophthalmologists could tell me what was going on.

The verdict: My left eye had some buildup – “capsular haze” was the term the doctor used – on the lens. Apparently, when you have cataract surgery at a young age, it’s common for the eye to try to repair itself even though a new lens is already in place. Laser surgery would be needed to clear away the gunk that had built up behind the lens. Speaking with Vikas Gulati, M.D., who is on the faculty at Truhlsen/UNMC and a glaucoma specialist, and who would be performing the procedure, I got the impression that it would be as easy as squeegeeing slush off a windshield – with lasers!

In reality, it was even easier.

For one thing, it was an outpatient examination, and the “laser-into-my-eyeballs” machine (actual name: Nd:YAG, or neodymium yttrium aluminum garnet laser) looked just like any other eye exam equipment. Dr. Gulati had me look through the machine – why do ophthalmologists always want you to look at their ears? – and a couple of bright flashes later, I was done.

Walking back to the 4230 Building from the Truhlsen Eye Institute, I was amazed at how quickly my vision had improved, and how much.

It was something, I realized, I should have taken care of much sooner. The improvement was almost frightening – just how bad had I let my eyes become?

Maybe this time, my eyes hadn’t let me down – maybe I’d let them down.

A few years ago, Oregon Health & Science University Ph.D. candidate Katy Van Hook wrote a blog that struck a nerve. She called it Forget baseball, there is DEFINITELY crying in science.

Van Hook, who has since earned her doctorate, was talking about the fact that she was so stressed out by the life of a student at an academic medical center that she occasionally broke down and bawled in her mentor’s office.

I’ve cried in front of my boss, the director of my graduate program … countless friends, several thesis committee members, and a couple qualifying exam committee members if I’m not mistaken.

It was a brave admission, but the response was cathartic. The comments poured in, saying she was not alone:

first year ohsu grad student here: found myself sobbing alone in the bathroom today after a humiliatingly failed experiment, feeling like my life was unraveling before my eyes – your post really goes a long way to reassure me that maybe I’m still on track after all.

Have you, as a med student or grad student, felt the same way?

Well, chances are, you have, says a study (yes, an actual study!) done by Harvard Medical School, Crying: experiences and attitudes of third-year medical students and interns.

Sixty-nine percent of students and 74 percent of interns self-reported crying for reasons related to medicine. For both, the most common cause was “burnout.” … Seventy-three percent of students and 68 percent of interns thought discussion of physicians’ crying was inadequate.

One of the conclusions was: Trainees want more discussions of crying.

So here we go.

Here’s a blog titled First day in the OR, aka crying in public:

Here’s the confession: I totally cried.

I won’t go into the details, but suffice it to say that someone with more seniority than myself (not hard to achieve that level of seniority, by the way) made a mistake, and it was blamed on me.  And the scrub nurse was not happy. Not happy at all.

So I cried. I was so upset – I knew how unfair it was, and I knew it hadn’t been my fault, but still – someone was yelling at me, and telling me I had done something wrong.

Another blog:

In med school… wow, it happened a lot. After exams, before exams, just randomly in the locker room. I remember during my surgery clerkship, we were having a workshop on tying knots, and one student was having trouble with her knots and burst into tears. I still remember what she said: “I don’t even feel that sad. I’m just SO TIRED.”

So, go ahead. Let it out. You aren’t alone. Take advantage of the resources offered by the Counseling and Student Development Center. And share some of your own “crying in science” stories in the comments. We’ll all feel better.

Monty Mathews, M.D., assistant professor of family medicine, is on duty. He’s not wearing a white coat. He’s not wearing scrubs. He’s wearing a baseball cap, emblazoned with a Nebraska-Omaha Mavericks “O.”

The doc is on duty on a soccer sideline, Caniglia Field, on the UNO campus. He stands with trainers, with coaches, with players (the subs), looking out onto the field. On the green faux-grass, Division I college soccer is being played, bodies slamming, tendons straining, lungs screaming. Mastodons vs. Mavs.

A young boy, wearing a Jr. Mavericks soccer jersey, also was there on the sideline as a special treat. “I didn’t know sports teams had doctors,” the boy said.

As long as Dr. Mathews has anything to say about it, they do.

And he spends a good deal of his free time making sure that they do.

“It’s my passion,” he said. “My hobby.” His real job is here at UNMC, but this is how he spends his weekends and nights.

And thanks to the season we’re in, his volunteer workload is heavy on UNO men’s and women’s basketball and hockey.

But Dr. Mathews is also the team doctor for the Triple-A Omaha Storm Chasers baseball team. When they won the pennant, “I was out there when they were squirting the champagne,” Dr. Mathews said.

And when the minor-league football Omaha Nighthawks were in business, he was on their sideline, too.

He’s worked marathons and rodeos. He’s at every Brownell-Talbot football game.

These days, more and more sports teams are entering into partnership relationships with orthopedic clinics, and that makes sense. A good deal of sports medicine is knees and shoulders, ligaments and bones.

But then, a good deal of it isn’t. And it also makes sense to have a good old-fashioned primary care, family medicine doc there, too.

That’s why Dr. Mathews keeps showing up.

For instance, all this talk about concussions? “I feel very comfortable evaluating head injuries,” he said. Not every M.D. does.

He’s undergone special training to become a Credentialed ImPACT Consultant (CIC).

Dr. Mathews is not the only practitioner at the med center doing sports medicine. There’s a whole team, headed by athletic trainer Rusty McKune, The Nebraska Medical Center’s sports medicine program coordinator. And providers from UNMC, TNMC and UNMC Physicians have staffed national athletic events in Omaha, like the U.S. Figure Skating Championships, the USA Swimming Olympic Trials and the North, Central America and Caribbean Volleyball Confederation (NORCECA) Continental volleyball championship.

They all work together, the way Dr. Mathews works with athletic trainers and orthopedic docs.

The Mavericks have a great training staff, in this case, Phil Dennie. Dennie and his fellow trainers could easily handle 95 percent of what might come up during the game. But that five percent left over?

“I can handle 90 percent of that,” Dr. Mathews said.

Meaning, he could initially evaluate, diagnose and treat nine out of 10 of the injuries the training staff would ask him to look at. Beyond that, he would ask for assistance from emergency personnel or other specialists if athletes needed to be transported to the hospital for central nervous system, spine, major bleeding or complex orthopedic injuries.

Luckily, at the soccer game, none of it comes up.

But it wasn’t his only appointment of the night. He also was set to be the team doc at the Mavericks’ hockey game down at CenturyLink Center. Would he have to hurry?

Doctors know better than to hurry.

“I’ll have to be efficient about it,” was the way he put it. And he was. After it was over, after the Mavericks had won 4-0, Dr. Mathews double checked with the training staff, to make sure there wasn’t anyone he needed to look at. Then he did the same with the visiting team. And then he was gone. Off to his next sideline. Off to make sure another sports team had a doctor in the house.