Wednesday, December 21, 2011
Thursday, December 15, 2011
Mask of Loneliness
Of all the ways to express loneliness, why have I chosen a picture of the empty park bench above? The world around it is bright and sunny, the trees and grass a luscious green, people and life moving about in the background. Precisely because it's the kind of loneliness I'm experiencing . . . and have been all along.
That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.
But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.
And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.
Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.
Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.
Until then, may this quote ring true:
That bench is like my Mask of Loneliness. It sits there, alone, in a vibrant world waiting for someone to occupy it and linger for a while. To a passerby it doesn't appear "sad" or "happy," it simply is. Only when one takes pause to notice and contemplate the situation can one appreciate the loneliness. And so too it is with me. My Mask of Loneliness often appears invisible, even when worn directly in front of you. I'm surrounded by friends and peers. I have few enemies and I get along with most anyone. I wear my Mask of Smiles even when I don't feel like it. I can now interact and blend in so flawlessly that you'll probably never notice that I'm alone.
But I notice. I feel the Mask of Loneliness on my face. I'm painfully aware that several of my friends are now married, at least one of whom now have kids. Though I don't show it, I'm actually rather awkward when I'm one of maybe 3 people in a group who're single. And though you don't notice it, I don't really care to hear about your relationship problems with your girl/boyfriend/spouse.
And no matter how much I tell myself that we all go at our own pace, how I still have time, how my busy-ness is only "for now," I can feel this Mask begin to harden on my face. It is, after all, partly my fault. I don't make a particularly concerted effort to "get out there." And the longer I wait, the more excuses I make and the easier it becomes to make them.
Lately I've begun to feel that I'm "undatable." I hung out with Drew on Sunday (he's seeing someone else now, figures) and it was . . . rather awkward. Neither of us had any particularly good conversation topics. We were just on two completely different pages the whole time. I felt like I had become so one-dimensional as the conversation topics I brought back either drew from a subset of things I knew well or otherwise drifted towards the medical. Even I wouldn't date me.
Lol, I suppose I've become more like that park bench than I thought. At first glance, I'm just made of wood - one-dimensional. But if you happen to come closer, you'll see the words etched into that wood and read the stories of my past, present, and future. And it's not like I'm intentionally hiding, I'm right here in front of you! I hope you linger a bit and keep me company, and take from me my Mask of Loneliness.
Until then, may this quote ring true:
"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag HammarskjoldYes, I've used that quote before in this post (if you recall).
Tuesday, December 6, 2011
Mediocrity
mediocrity by ~seven20 on deviantART
In grade school (K-12), I was always at the top of my class. I was pretty good at everything (except gym) and the world was full of endless possibilities. In undergrad, I understood that few people are truly Renaissance men. I learned where my strengths were and I knew where my limits were, in some cases hitting that unmovable wall. In grad school, the world - while more limited - was still full of potential. I learned what I loved and I learned what I could excel at.
In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.
Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!
I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.
I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.
As I talked to my friend, he said the following to me:
In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.
Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!
I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.
I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.
As I talked to my friend, he said the following to me:
"Don't feel defeated, you passed and you are a bad ass med school person. You're like, proving yourself beyond 99.9999% of all people in the world. Can't get too upset about that last 0.00001%."I always loved him for his perspective on things.
Thursday, December 1, 2011
Welcome To Life
Welcome to this thing called life. Open your eyes and see the love that brought you into this world. Sleep in the arms that embrace you, linger in childhood while you can, but grow up strong and healthy. You are full of the world's hopes and potential - you can become anything! What will you choose to be? You won't remember me, what with me prodding and poking you. But I hope my thoughts are etched into your heart: I wish you the best on this journey called life and I hope you are equipped with the love and the help to get through anything.
-----
I just spent the last 2 days in the newborn nursery. I had the opportunity to examine a baby less than 48 hours old. The mom handed him over to me, trusting me unequivocally that I wouldn't hurt him. He peeked at me through suspicious eyelids and went back to his tenuous sleep. Of all the people to have examined him in his brief existence, he tolerated me the best. I believe there aren't many people who have "the touch," or the ability to connect with babies in a way that they tolerate you poking and prodding them (they're still not happy, but they'll tolerate you); I'm hoping that I've got it. Really, there was only one baby who didn't tolerate me, but that was because he was fairly sick.
There is something about holding a newborn. It's the feeling of holding unadulterated potential in your arms - something so fragile and yet resilient. I mean, come on, the childbirth process is rather traumatic (for both mother and child).
And so it is that I thought the above in my head as I laid him in his bassinet next to his mom and left the room. The odds of me seeing him are next to nil, but all the same - welcome to life.
-----
I just spent the last 2 days in the newborn nursery. I had the opportunity to examine a baby less than 48 hours old. The mom handed him over to me, trusting me unequivocally that I wouldn't hurt him. He peeked at me through suspicious eyelids and went back to his tenuous sleep. Of all the people to have examined him in his brief existence, he tolerated me the best. I believe there aren't many people who have "the touch," or the ability to connect with babies in a way that they tolerate you poking and prodding them (they're still not happy, but they'll tolerate you); I'm hoping that I've got it. Really, there was only one baby who didn't tolerate me, but that was because he was fairly sick.
There is something about holding a newborn. It's the feeling of holding unadulterated potential in your arms - something so fragile and yet resilient. I mean, come on, the childbirth process is rather traumatic (for both mother and child).
And so it is that I thought the above in my head as I laid him in his bassinet next to his mom and left the room. The odds of me seeing him are next to nil, but all the same - welcome to life.
Monday, November 21, 2011
Land of the Little People
"Children are not just little adults." That's what the pediatricians would have us believe. And the converse is what other physicians assert. "Pediatrics is just veterinary medicine." That's what the surgeons say. All of this has some element of truth.
Kids are very different developmentally and metabolically compared to adults. Every age is marked with milestones, knowing and utilizing those milestones are key when "finessing" a peds patient to cooperate. And a lot of the patient history is obtained through the parent/caregiver, so in a sense it is like veterinary medicine.
I can't believe this is my 4th (and last) week of inpatient peds this year, and I still have SO MUCH MORE to learn!! Hopefully I learn a lot of that while I'm on my outpatient month coming up next. In some ways it's such a different world from that of adults, and in other respects way too similar. Like all the rotations before, there are things I like and dislike about this rotation. I LOVE my patients, sometimes I linger a bit too long in their rooms. But my team isn't as efficient as I'd like and I wish the residents had a bit more time to teach us.
So I've come to realize that I don't particularly care for hospital medicine (that is, only treating acutely ill patients in the hospital). I like a mix of inpatient and outpatient care. Peds certainly hasn't fallen on my list of things I want to go into, but this rotation hasn't reinforced it as much as I thought (or hoped). But the reasons why I'd choose peds over medicine remain true.
But that's for another post, as it's getting late and I have to be in at 6am. This month is almost like working surgery hours, ugh.
Kids are very different developmentally and metabolically compared to adults. Every age is marked with milestones, knowing and utilizing those milestones are key when "finessing" a peds patient to cooperate. And a lot of the patient history is obtained through the parent/caregiver, so in a sense it is like veterinary medicine.
I can't believe this is my 4th (and last) week of inpatient peds this year, and I still have SO MUCH MORE to learn!! Hopefully I learn a lot of that while I'm on my outpatient month coming up next. In some ways it's such a different world from that of adults, and in other respects way too similar. Like all the rotations before, there are things I like and dislike about this rotation. I LOVE my patients, sometimes I linger a bit too long in their rooms. But my team isn't as efficient as I'd like and I wish the residents had a bit more time to teach us.
So I've come to realize that I don't particularly care for hospital medicine (that is, only treating acutely ill patients in the hospital). I like a mix of inpatient and outpatient care. Peds certainly hasn't fallen on my list of things I want to go into, but this rotation hasn't reinforced it as much as I thought (or hoped). But the reasons why I'd choose peds over medicine remain true.
But that's for another post, as it's getting late and I have to be in at 6am. This month is almost like working surgery hours, ugh.
Thursday, November 17, 2011
Tribute to Life
It's been almost 3 weeks since I began my pediatrics rotation, wow! I had been debating what the "final" post for surgery should be - either a collection of quotes I've obtained on surgery, or something more meaningful. I decided to go with the latter.
A few days ago, I saw the following vid on the blog Chronically Lost in Thought.
On the doctor-side of things we reflect end-of-life decisions back to the patient and/or their family member(s). Our goal at this point in a patient's life is to ease suffering or at least prevent prolonging suffering. We don't consciously, however, consider that the family member's agony in losing someone personal, and with them, lose all possibilities of creating new memories and tying up loose ends of the past.
So just something to muse on before I proceed to the much happier world of peds.
A few days ago, I saw the following vid on the blog Chronically Lost in Thought.
My Friend Jason. from Shot at The Dark on Vimeo.
It's an interesting vid for me to watch, as it presents the same hard decision but from a different perspective - a family member's. The decision to let someone die isn't an easy one, but sometimes it's the "right" one.
On the doctor-side of things we reflect end-of-life decisions back to the patient and/or their family member(s). Our goal at this point in a patient's life is to ease suffering or at least prevent prolonging suffering. We don't consciously, however, consider that the family member's agony in losing someone personal, and with them, lose all possibilities of creating new memories and tying up loose ends of the past.
So just something to muse on before I proceed to the much happier world of peds.
Monday, October 31, 2011
Respect for Death
In a way, it's apt that I'm writing this post on Halloween, even though this event transpired about 4 days ago.
I had been following this one patient ever since we admitted him to the hospital from the clinic towards the beginning of October. He came to us after seeing many other doctors, all of whom had failed to solve his problem and relieve his pain. We promised him that we'd try, that perhaps we could finally release him from his suffering.
I had checked in on him every morning before the team, at the crack of . . . well, evening (since it was well before dawn). I saw the misery he was in every day. After the first week, we had identified the problem - an infected bypass graft in his leg. We operated and removed the graft. As a complication, a clot was "thrown" down to his foot causing his foot to become ischemic (lack blood flow) and die. We operated and amputated his toes. Every morning I changed his dressings when I rounded with the team.
We assured him that we had fixed his problem, but he was still miserable. Every day we prayed that he would get better. He wasn't getting worse, but he wasn't progressing either - just stayed in that limbo where he wore a pained mask. Last Thursday, my resident remarked, "He isn't getting worse but he's also not progressing. If he doesn't get out of here, he will die here." I changed his dressings as he waited patiently to watch The Price Is Right on TV. To me he had looked better than he had that entire week.
That afternoon I got the call that he had coded. He had a seizure or a stroke or a heart attack, no one was really sure. The resident did CPR on him for 20 minutes before the surgeon found a pulse. He was wheeled off to the SICU (surgical intensive care unit). One thing was for sure, he was in bad shape. Later he was found to be in PEA (pulseless electrical activity). He quickly approached the threshold beyond which treatment would be futile. After discussion with the surgeon, his daughter made the decision to withdraw care and at around 8:30pm, he died.
The following morning, the other med student and I stalked his chart to figure out why he had died. When he had read that his daughter made the decision to withdraw care, he said out loud, "What?! She withdrew care? His family killed him!" That infuriated me. He was in that zone where we could keep him technically alive but without any quality of life. To me, his daughter had saved her father from a week of agony in a state of painful limbo - neither truly alive nor dead. That afternoon as we briefly discussed about him, the surgeon agreed that the daughter had done the right thing. She had saved him from a miserable pseudo-existence, a kind of hell on earth.
One of the most important things to learn is when not treating is the correct treatment, and when we should respect death rather than fight it. This goes against almost everything we've been taught and trained to do. We must always keep in the back of our minds whether or not aggressive treatment is worth it, especially in absence of a cure. The figures don't lie: we spend most of our health care spending in the last 6 months of life. Why? Because for one reason or another, we just can't let go when we really should.
I had been following this one patient ever since we admitted him to the hospital from the clinic towards the beginning of October. He came to us after seeing many other doctors, all of whom had failed to solve his problem and relieve his pain. We promised him that we'd try, that perhaps we could finally release him from his suffering.
I had checked in on him every morning before the team, at the crack of . . . well, evening (since it was well before dawn). I saw the misery he was in every day. After the first week, we had identified the problem - an infected bypass graft in his leg. We operated and removed the graft. As a complication, a clot was "thrown" down to his foot causing his foot to become ischemic (lack blood flow) and die. We operated and amputated his toes. Every morning I changed his dressings when I rounded with the team.
We assured him that we had fixed his problem, but he was still miserable. Every day we prayed that he would get better. He wasn't getting worse, but he wasn't progressing either - just stayed in that limbo where he wore a pained mask. Last Thursday, my resident remarked, "He isn't getting worse but he's also not progressing. If he doesn't get out of here, he will die here." I changed his dressings as he waited patiently to watch The Price Is Right on TV. To me he had looked better than he had that entire week.
That afternoon I got the call that he had coded. He had a seizure or a stroke or a heart attack, no one was really sure. The resident did CPR on him for 20 minutes before the surgeon found a pulse. He was wheeled off to the SICU (surgical intensive care unit). One thing was for sure, he was in bad shape. Later he was found to be in PEA (pulseless electrical activity). He quickly approached the threshold beyond which treatment would be futile. After discussion with the surgeon, his daughter made the decision to withdraw care and at around 8:30pm, he died.
The following morning, the other med student and I stalked his chart to figure out why he had died. When he had read that his daughter made the decision to withdraw care, he said out loud, "What?! She withdrew care? His family killed him!" That infuriated me. He was in that zone where we could keep him technically alive but without any quality of life. To me, his daughter had saved her father from a week of agony in a state of painful limbo - neither truly alive nor dead. That afternoon as we briefly discussed about him, the surgeon agreed that the daughter had done the right thing. She had saved him from a miserable pseudo-existence, a kind of hell on earth.
One of the most important things to learn is when not treating is the correct treatment, and when we should respect death rather than fight it. This goes against almost everything we've been taught and trained to do. We must always keep in the back of our minds whether or not aggressive treatment is worth it, especially in absence of a cure. The figures don't lie: we spend most of our health care spending in the last 6 months of life. Why? Because for one reason or another, we just can't let go when we really should.
Thursday, October 20, 2011
Reclaiming Humanity
When does a person become a patient become an organ or a thing - a gallbladder, an amputation, a diverticulitis? The onset was so insidious that I never even noticed the progression, especially on surgery where everyone becomes that which we operate on. When did I stop noticing the person and, to some degree, stop caring? This was not what I came to med school for.
I recently observed a family meeting with the patient, his wife, and their oldest son. The patient was terminal, his death is only a matter of time; the only surgical intervention left would mean certain death. For the first time in weeks I saw not the blank yet pained gaze through lidded eyes still heavy with sleep at 5:30am, but emotion: sadness, contemplation, and reflection. I saw not a patient who we monitored through labs, changed wound dressings on daily, and examined with the repetitive motions of a machine; I saw a father and a grandfather who, though saddened by the inevitability of his end, is without regret for living his life.
His wife asked with tears obscuring her eyes, "Can you give us a time estimate of how long?" We had no answer - it could be hours, days, weeks, months. With diagnosing complete and treatment deferred, true healing can now begin. As for me, I can start caring again and do what I came here to do.
I recently observed a family meeting with the patient, his wife, and their oldest son. The patient was terminal, his death is only a matter of time; the only surgical intervention left would mean certain death. For the first time in weeks I saw not the blank yet pained gaze through lidded eyes still heavy with sleep at 5:30am, but emotion: sadness, contemplation, and reflection. I saw not a patient who we monitored through labs, changed wound dressings on daily, and examined with the repetitive motions of a machine; I saw a father and a grandfather who, though saddened by the inevitability of his end, is without regret for living his life.
His wife asked with tears obscuring her eyes, "Can you give us a time estimate of how long?" We had no answer - it could be hours, days, weeks, months. With diagnosing complete and treatment deferred, true healing can now begin. As for me, I can start caring again and do what I came here to do.
Sunday, October 16, 2011
More Weddings!
Wow. I've been so consumed by rotations that I had completely forgotten to post about 2 very important events that happened over these last 3 months! As much as I want to bitch, whine, and moan about surgery, this post is dedicated strictly to non-medical things. So here we go!
-----
July - Best Friend's Wedding
In early July, I drove 4 hours to my best friend's wedding. He's a recurrent character on this blog, though I forgot what name I gave him. His original "code name" was JW-M, so I'll stick to that, lol. This wedding was actually referenced months ago in this post. Over the years I had come to admire his intellect, his wit, his calm mind, and above all his inner child. He's one of perhaps five people who knows exactly what to say to put me in a great mood. Only a handful of things (death being one of them) could have prevented me from attending his wedding.
The lovely chapel.
Their wedding was short and sweet, perfectly suited to the newlyweds. Several of our mutual friends were invited to the wedding (or were part of it), and it had been so long since I'd seen all of them in one spot. The reception was quite nice as well and their cake was delicious (I expected nothing less from the dessert palate of my friend, lol). At the end of the evening they had a cookie bar. :-)
This cake is no lie! So yummy!!
The married couple cutting the cake. Showing the back to protect their anonymity.
The following day, several of us drove to the lake to hang out. Since I had gone separately from most people, I headed over to the lake about 3 hours ahead of everyone else. Though it was in the 90s, it still felt nice oddly enough.
Lovely beach area. :-)
Lighthouse!
Pirate ship on the lake!
Back wandering in town.
I was glad that I went. JW-M told me that I was one of the few close friends he had made in undergrad.
-----
September - Old Friend's Wedding
About 3 weeks ago I flew home for my old friend's wedding (I'll call him TR-M here as I think I had before). We had known each other since kindergarten and we were next-door neighbors for almost a decade. We stayed friends even after I moved to the other side of town. Like my best friend's wedding, this was one I couldn't miss.
I love stained glass windows.
The ring-bearers. They were SO ADORABLE!! Especially the younger patting the older one on the back in reassurance.
There were many people at the wedding that I hadn't seen since high school! It was a very nostalgic feeling to see them and what's happened since we all graduated high school. Aside from the wedding train, we all sat at the same table . . . at the very back of the reception hall next to the bar. Though we were annoyed at being seated so far away from the head table, we had fun anyhow. The most interesting thing about the reception was the distinct lack of a wedding cake. Instead, the newlyweds had an assortment of desserts that came around quite frequently. It was differently delicious!!
Table 16/20 at the end.
This is what I had instead of cake: hazelnut creme brulee.
-----
All these pictures don't do justice to the events. But of course there are many more pics that I took that I will refrain from including. I'm glad that I was able to make it to both these weddings. This makes the 3rd wedding I've been to this year! Wow.
---TANGENT---
Remember the hot gay intern I met at the one meet and greet a few weeks back? Probably not, but that's okay. I randomly came across him on Grindr. Alas it says that he's partnered. :-( Sigh, such is my luck ALWAYS.
---END TANGENT---
July - Best Friend's Wedding
In early July, I drove 4 hours to my best friend's wedding. He's a recurrent character on this blog, though I forgot what name I gave him. His original "code name" was JW-M, so I'll stick to that, lol. This wedding was actually referenced months ago in this post. Over the years I had come to admire his intellect, his wit, his calm mind, and above all his inner child. He's one of perhaps five people who knows exactly what to say to put me in a great mood. Only a handful of things (death being one of them) could have prevented me from attending his wedding.
The lovely chapel.Their wedding was short and sweet, perfectly suited to the newlyweds. Several of our mutual friends were invited to the wedding (or were part of it), and it had been so long since I'd seen all of them in one spot. The reception was quite nice as well and their cake was delicious (I expected nothing less from the dessert palate of my friend, lol). At the end of the evening they had a cookie bar. :-)
This cake is no lie! So yummy!!
The married couple cutting the cake. Showing the back to protect their anonymity. The following day, several of us drove to the lake to hang out. Since I had gone separately from most people, I headed over to the lake about 3 hours ahead of everyone else. Though it was in the 90s, it still felt nice oddly enough.
Lovely beach area. :-)
Lighthouse! 
Pirate ship on the lake!
Back wandering in town. I was glad that I went. JW-M told me that I was one of the few close friends he had made in undergrad.
-----
September - Old Friend's Wedding
About 3 weeks ago I flew home for my old friend's wedding (I'll call him TR-M here as I think I had before). We had known each other since kindergarten and we were next-door neighbors for almost a decade. We stayed friends even after I moved to the other side of town. Like my best friend's wedding, this was one I couldn't miss.
I love stained glass windows. 
The ring-bearers. They were SO ADORABLE!! Especially the younger patting the older one on the back in reassurance.There were many people at the wedding that I hadn't seen since high school! It was a very nostalgic feeling to see them and what's happened since we all graduated high school. Aside from the wedding train, we all sat at the same table . . . at the very back of the reception hall next to the bar. Though we were annoyed at being seated so far away from the head table, we had fun anyhow. The most interesting thing about the reception was the distinct lack of a wedding cake. Instead, the newlyweds had an assortment of desserts that came around quite frequently. It was differently delicious!!
Table 16/20 at the end. 
This is what I had instead of cake: hazelnut creme brulee.All these pictures don't do justice to the events. But of course there are many more pics that I took that I will refrain from including. I'm glad that I was able to make it to both these weddings. This makes the 3rd wedding I've been to this year! Wow.
---TANGENT---
Remember the hot gay intern I met at the one meet and greet a few weeks back? Probably not, but that's okay. I randomly came across him on Grindr. Alas it says that he's partnered. :-( Sigh, such is my luck ALWAYS.
---END TANGENT---
Saturday, October 8, 2011
Imagine . . .
. . . that you've been in love with someone for 2 years. Recently you are engaged to him; you couldn't be happier, life couldn't be more perfect.
Then out of the blue, he suddenly gets intense chest pain and belly pain. You take him to a nearby hospital. The medicine doctors spend 2 days trying to figure out what's wrong, meanwhile he gets worse and worse. Then they finally discover that he has an aortic dissection, and the worst possible kind at that! His aorta, the main artery that brings blood to the body, has split open from where it leaves the heart all the way down to his groin.
Your fiance is immediately transferred to a larger hospital in town, because leaving him where he is means certain death. The cardiothoracic surgeons manage to (miraculous) fix the aortic dissection in a grueling marathon of a surgery. Afterwards, the doctors notice that his legs start to hurt, swell, and turn dark. Immediately the vascular surgeons open up his legs to relieve the pressure and restore blood flow to his legs, hoping that they made it in time. Unfortunately, it was too late.
His legs are dying. They are causing him more and more pain each day, so much so in fact that it causes him to become delirious - he does not know where he is, he does not know what year it is, he does not know what's going on. He can no longer make medical decisions for himself. They turn to you, as his power of attorney, to ask if you would give them permission to cut off his feet. What do you do? What can you say? Cut off his feet in order to save his life (and his sanity)?
You agree. Days later, they come back and tell you that things are worse than they appear. More of his legs have died than they initially thought. They have to cut more off. They ask you to give permission to cut off his legs above the knees. What kind of decision is this? Your fiance will never walk again. But you agree to save his life.
And for the next several weeks, you get phone calls and every time you visit your fiance in the hospital, the surgeons find you and ask for permission over and over again to cut more of his legs off, because more has died and they can't predict or control it. What can you say? This is the person you love. This is the person you were going to marry! He no longer looks anything like his former self. But you love him . . . and you want him to live . . .
-----
This is the kind of story that I'm seeing more and more of on rotations. Being part of the care team detaches me emotionally from the situation. All we can focus on is doing what's best for the patient to help him live and move on with his life. But in the process, patients sometimes lose so much of themselves (literally) and family members have to make hard choices.
If you were the one making the decisions above for a loved one, how would you react? What would you do? Would you be strong enough to endure it?
Then out of the blue, he suddenly gets intense chest pain and belly pain. You take him to a nearby hospital. The medicine doctors spend 2 days trying to figure out what's wrong, meanwhile he gets worse and worse. Then they finally discover that he has an aortic dissection, and the worst possible kind at that! His aorta, the main artery that brings blood to the body, has split open from where it leaves the heart all the way down to his groin.
Your fiance is immediately transferred to a larger hospital in town, because leaving him where he is means certain death. The cardiothoracic surgeons manage to (miraculous) fix the aortic dissection in a grueling marathon of a surgery. Afterwards, the doctors notice that his legs start to hurt, swell, and turn dark. Immediately the vascular surgeons open up his legs to relieve the pressure and restore blood flow to his legs, hoping that they made it in time. Unfortunately, it was too late.
His legs are dying. They are causing him more and more pain each day, so much so in fact that it causes him to become delirious - he does not know where he is, he does not know what year it is, he does not know what's going on. He can no longer make medical decisions for himself. They turn to you, as his power of attorney, to ask if you would give them permission to cut off his feet. What do you do? What can you say? Cut off his feet in order to save his life (and his sanity)?
You agree. Days later, they come back and tell you that things are worse than they appear. More of his legs have died than they initially thought. They have to cut more off. They ask you to give permission to cut off his legs above the knees. What kind of decision is this? Your fiance will never walk again. But you agree to save his life.
And for the next several weeks, you get phone calls and every time you visit your fiance in the hospital, the surgeons find you and ask for permission over and over again to cut more of his legs off, because more has died and they can't predict or control it. What can you say? This is the person you love. This is the person you were going to marry! He no longer looks anything like his former self. But you love him . . . and you want him to live . . .
-----
This is the kind of story that I'm seeing more and more of on rotations. Being part of the care team detaches me emotionally from the situation. All we can focus on is doing what's best for the patient to help him live and move on with his life. But in the process, patients sometimes lose so much of themselves (literally) and family members have to make hard choices.
If you were the one making the decisions above for a loved one, how would you react? What would you do? Would you be strong enough to endure it?
Sunday, October 2, 2011
Introspection & Privilege
This weekend is a "golden weekend," so called because we have both Saturday and Sunday off. This is a golden weekend because we're now halfway between our surgery rotation here, and we're all switching hospital sites. Starting tomorrow I'll be at a different hospital for surgery. So this weekend is a temporary respite.
I'm glad that the first month is over. There are days that I was seriously doubting if I could make it to the end. On average in September, I was in the hospital about 60 hours/week. It could've been much worse . . . though I'd rather not think about it. However, a moment of retrospection brings me to my final patient on surgery at the first site.
(Paraphrased)
Patient: "I admire you all and what you do. I really do. You do so much to take care of us."
Me: "Thanks. That's our job. We wouldn't be here if we didn't want to help take care of people like you. We chose this."
Patient: "Yeah, but thanks anyway. I wish you the best."
I'm not sure if I can adequately describe in words the profoundness of that brief moment. No matter how I or others may whine, bitch, and complain, it remains truly a privilege to take care of patients and do what (little) you can for them. It is a privilege to have others trust you with their health. As one of my friends said (in a jokingly serious manner): "What other profession do you get to cut people open and touch them in such ways without getting jailed? In fact, they're paying you to do just what you're doing."
Anyway, I think it's worth a moment of introspection for us to appreciate that which society allows us to do, and understand the responsibilities that society expects us to bear (justified or not).
I'm glad that the first month is over. There are days that I was seriously doubting if I could make it to the end. On average in September, I was in the hospital about 60 hours/week. It could've been much worse . . . though I'd rather not think about it. However, a moment of retrospection brings me to my final patient on surgery at the first site.
(Paraphrased)
Patient: "I admire you all and what you do. I really do. You do so much to take care of us."
Me: "Thanks. That's our job. We wouldn't be here if we didn't want to help take care of people like you. We chose this."
Patient: "Yeah, but thanks anyway. I wish you the best."
I'm not sure if I can adequately describe in words the profoundness of that brief moment. No matter how I or others may whine, bitch, and complain, it remains truly a privilege to take care of patients and do what (little) you can for them. It is a privilege to have others trust you with their health. As one of my friends said (in a jokingly serious manner): "What other profession do you get to cut people open and touch them in such ways without getting jailed? In fact, they're paying you to do just what you're doing."
Anyway, I think it's worth a moment of introspection for us to appreciate that which society allows us to do, and understand the responsibilities that society expects us to bear (justified or not).
Sunday, September 25, 2011
Amazing Week
So it's been a while since I last posted anything, and last week was a pretty awesome week, I must say.
Sunday: Went into the hospital at 6:30am and was done by 9:30am. Got the vitals (temperature, heart rate, blood pressure, oxygen saturation, ins & outs, etc) and saw my 2 patients all in about 35 minutes. Pretty epic efficiency there! :-D The rest of the day was all mine to do whatever, lol.
Monday: There was only 1 surgery that day and the other JMS (junior med student) scrubbed in. I took that time to do some reading and studying. Pretty chill day.
Tuesday: Unremarkable day of surgery. But afterwards I headed over to the LGBT student org's meet and greet at a faculty's house. How apt that it was on the day that DADT was repealed, lol. It was good seeing people and hanging out. I met an internal medicine intern who was so hot (and hilarious). I couldn't take my eyes off him after I talked to him for like, 15 minutes. We had some great conversations . . . basically bonded over our hatred of surgery, lol. After the social, several of us (said intern had to work the next day, bah) walked down to a nearby wine shop and had some wine. I came out to one of my friends there (it was loud enough there that I don't think anyone else heard, not that I really cared). Funny that she never asked me before even though we were both on the LGBT student org board the year before.
Wednesday: Long day of lectures. That's how Wednesdays goes. No surgeries were planned for the day so it wasn't like we missed anything. Later that evening I had a meeting with a friend to discuss one of the student committees we're both heading. Some good progress was made.
Thursday: I scrubbed in an open umbilical hernia repair. I successfully proved myself to the chief resident that I can, indeed, tie knots with 2 pairs of gloves on! Pretty short and sweet surgical procedure. I like these as they last less than 1.5 hours. Later in the afternoon I had a meeting with the Dean of Student Diversity, which was interesting as always. Thankfully I didn't have to return to surgery afterwards.
Friday: I scrubbed in 2 more open umbilical hernia repairs. I was allowed to close the wound with a subcutaneous suture after the chief resident started it for me. I must say, I did a pretty good job for not having done it since we practiced on pig's feet at the beginning of the month (and it was the most difficult suture for me to learn). The chief resident complimented me. :-)
After surgery ended (somewhat early), I headed over to a friend's place for wine tasting (the same friend I came out to earlier on Tuesday). We met up with her husband and another mutual friend. I hadn't gone wine tasting before, and it was a pretty nice experience with friends. After wine tasting, we headed downtown to this new place for dinner. It was delicious!
Saturday: Headed home and attended my friend's wedding. I had known him since kindergarten and we were next-door neighbors until I moved away in 7th grade. Had a great time, will blog about that in detail later.
Overall: Again, pretty amazing week considering I'm still on my surgery rotation, lol. Evil resident was on vacation all week so I didn't have to worry about her ruining my day with her foul attitude. Chief resident was awesome, as always. We rounded late (around 7am) most days because the chief resident was tired and didn't feel like waking up any earlier than she needed to. I certainly wasn't about to object! There were fleeting moments where I actually enjoyed surgery. Shocking!! o_O
Monday: There was only 1 surgery that day and the other JMS (junior med student) scrubbed in. I took that time to do some reading and studying. Pretty chill day.
Tuesday: Unremarkable day of surgery. But afterwards I headed over to the LGBT student org's meet and greet at a faculty's house. How apt that it was on the day that DADT was repealed, lol. It was good seeing people and hanging out. I met an internal medicine intern who was so hot (and hilarious). I couldn't take my eyes off him after I talked to him for like, 15 minutes. We had some great conversations . . . basically bonded over our hatred of surgery, lol. After the social, several of us (said intern had to work the next day, bah) walked down to a nearby wine shop and had some wine. I came out to one of my friends there (it was loud enough there that I don't think anyone else heard, not that I really cared). Funny that she never asked me before even though we were both on the LGBT student org board the year before.
Wednesday: Long day of lectures. That's how Wednesdays goes. No surgeries were planned for the day so it wasn't like we missed anything. Later that evening I had a meeting with a friend to discuss one of the student committees we're both heading. Some good progress was made.
Thursday: I scrubbed in an open umbilical hernia repair. I successfully proved myself to the chief resident that I can, indeed, tie knots with 2 pairs of gloves on! Pretty short and sweet surgical procedure. I like these as they last less than 1.5 hours. Later in the afternoon I had a meeting with the Dean of Student Diversity, which was interesting as always. Thankfully I didn't have to return to surgery afterwards.
Friday: I scrubbed in 2 more open umbilical hernia repairs. I was allowed to close the wound with a subcutaneous suture after the chief resident started it for me. I must say, I did a pretty good job for not having done it since we practiced on pig's feet at the beginning of the month (and it was the most difficult suture for me to learn). The chief resident complimented me. :-)
After surgery ended (somewhat early), I headed over to a friend's place for wine tasting (the same friend I came out to earlier on Tuesday). We met up with her husband and another mutual friend. I hadn't gone wine tasting before, and it was a pretty nice experience with friends. After wine tasting, we headed downtown to this new place for dinner. It was delicious!
Saturday: Headed home and attended my friend's wedding. I had known him since kindergarten and we were next-door neighbors until I moved away in 7th grade. Had a great time, will blog about that in detail later.
Overall: Again, pretty amazing week considering I'm still on my surgery rotation, lol. Evil resident was on vacation all week so I didn't have to worry about her ruining my day with her foul attitude. Chief resident was awesome, as always. We rounded late (around 7am) most days because the chief resident was tired and didn't feel like waking up any earlier than she needed to. I certainly wasn't about to object! There were fleeting moments where I actually enjoyed surgery. Shocking!! o_O
Saturday, September 10, 2011
Darkness Before Dawn
For the past week or so I have been getting up between 4:15am and 5:30am so I can be in the hospital and ready to go between 5:00am and 6:30am. More often than not it's dark when I wake up and it's still dark by the time I walk in the hospital. Surgery rotation has begun in full. And I hate it. I knew this coming in, but I truly do dislike surgery.
To be fair, surgery is actually rather cool and most of the people have been surprisingly nice: chief resident - amazing, intern - really nice, attending surgeons - amazing, nurses - really amazing. As a med student, I don't get to do a whole lot in one sense. I hold the retractors (aka, the "learning sticks") a lot to keep the surgical sites open, I got to stitch once, I get to cut sutures, and I help dress wounds. Nothing particularly exciting. Although I must say that operating the camera for laproscopic procedures is pretty darn cool. I've decided that laproscopic procedures are my favorite (and quicker recovery for the patients too!). Our other major responsibility is keeping "the List" updated. The List is a list of all our surgical patients in the hospital, and we have to update it every morning with the 3 sets of vitals over the last 24 hours.
That said, my experience has been sullied mostly because I have to wake up before dawn every day (NOT cool) and "work" 12 hours most days. This week alone I've been in the hospital in some fashion for over 60 hours (a "light" week, and only 20 hours shy of the residents' work hour restriction). Also, one of my residents is rather cold towards the med students and frankly, kind of a bitch. I don't use that term lightly.
Today she was:
1. Very dismissive of me. Nothing I reported (other than vitals) seemed to matter to her. After we finished rounding on our patients and she was covering for another team, I went to touch base with her and let her know that I was going to do some charting and such. Her response before I could get more than 3 words in were, "Is this urgent? I'm busy, I do NOT have time for this right now. I don't have time for you right now."
2. Very rude to me and the nurses. In the elevator she complained to one of the attending physicians how the nurses aren't properly caring for one of our patients. Now I can't say if that's true or not, but ya know, nurses have a tough job too! Stop being so stuck up.
3. Was unprofessional towards an emergency department physician. The ED doc called us for a consult on a guy with a hernia. She basically chewed him out for not knowing how to "reduce" a hernia and told him to read a textbook, as that's knowledge that he should've learned as a med student. Then she sent me down to see the patient. I was able to reduce the hernia (yay!).
It took a lot of self-control not to talk back to her and be like, "No, you do have 20-30 seconds for me because I'm your student. I'm trying to learn, I'm getting work done, and I just wanted to keep you updated on what I'm doing. I'm trying to get work done FOR YOU so we don't have to stay any longer than necessary." Argh. I really dislike working with her. At least in the OR (operating room) she's not in any position to chew me out.
I'm counting down the days to my next rotation. I'm so done with surgery and I'm only a little over a week into it! I HATE waking up to the darkness before dawn. I HATE standing for hours on end in the OR (my feet, back, and shoulders get sore). And I HATE having work with this resident who gives us such attitude, and I have to work with her for the entirety of this month! Ugh. I miss medicine. And I CANNOT WAIT until pediatrics come November. And I've come to realize that I enjoy talking to my patients more than operating on them. I'll linger a little longer than perhaps I should each time I talk to one of my patients.
At least this one patient I saw today was super nice towards me. As we were waiting for the attending surgeon to come fix his wounds, he told me that the surgeons are great and great teachers (all true). And then I must've had this look on my face, cuz then he told me how glad he was to see so many fresh young people going into medicine and that I'll be a good doctor one day.
To be fair, surgery is actually rather cool and most of the people have been surprisingly nice: chief resident - amazing, intern - really nice, attending surgeons - amazing, nurses - really amazing. As a med student, I don't get to do a whole lot in one sense. I hold the retractors (aka, the "learning sticks") a lot to keep the surgical sites open, I got to stitch once, I get to cut sutures, and I help dress wounds. Nothing particularly exciting. Although I must say that operating the camera for laproscopic procedures is pretty darn cool. I've decided that laproscopic procedures are my favorite (and quicker recovery for the patients too!). Our other major responsibility is keeping "the List" updated. The List is a list of all our surgical patients in the hospital, and we have to update it every morning with the 3 sets of vitals over the last 24 hours.
That said, my experience has been sullied mostly because I have to wake up before dawn every day (NOT cool) and "work" 12 hours most days. This week alone I've been in the hospital in some fashion for over 60 hours (a "light" week, and only 20 hours shy of the residents' work hour restriction). Also, one of my residents is rather cold towards the med students and frankly, kind of a bitch. I don't use that term lightly.
Today she was:
1. Very dismissive of me. Nothing I reported (other than vitals) seemed to matter to her. After we finished rounding on our patients and she was covering for another team, I went to touch base with her and let her know that I was going to do some charting and such. Her response before I could get more than 3 words in were, "Is this urgent? I'm busy, I do NOT have time for this right now. I don't have time for you right now."
2. Very rude to me and the nurses. In the elevator she complained to one of the attending physicians how the nurses aren't properly caring for one of our patients. Now I can't say if that's true or not, but ya know, nurses have a tough job too! Stop being so stuck up.
3. Was unprofessional towards an emergency department physician. The ED doc called us for a consult on a guy with a hernia. She basically chewed him out for not knowing how to "reduce" a hernia and told him to read a textbook, as that's knowledge that he should've learned as a med student. Then she sent me down to see the patient. I was able to reduce the hernia (yay!).
It took a lot of self-control not to talk back to her and be like, "No, you do have 20-30 seconds for me because I'm your student. I'm trying to learn, I'm getting work done, and I just wanted to keep you updated on what I'm doing. I'm trying to get work done FOR YOU so we don't have to stay any longer than necessary." Argh. I really dislike working with her. At least in the OR (operating room) she's not in any position to chew me out.
I'm counting down the days to my next rotation. I'm so done with surgery and I'm only a little over a week into it! I HATE waking up to the darkness before dawn. I HATE standing for hours on end in the OR (my feet, back, and shoulders get sore). And I HATE having work with this resident who gives us such attitude, and I have to work with her for the entirety of this month! Ugh. I miss medicine. And I CANNOT WAIT until pediatrics come November. And I've come to realize that I enjoy talking to my patients more than operating on them. I'll linger a little longer than perhaps I should each time I talk to one of my patients.
At least this one patient I saw today was super nice towards me. As we were waiting for the attending surgeon to come fix his wounds, he told me that the surgeons are great and great teachers (all true). And then I must've had this look on my face, cuz then he told me how glad he was to see so many fresh young people going into medicine and that I'll be a good doctor one day.
Sunday, August 28, 2011
A Helping Hand
A couple days ago in the resident's lounge, one of the physicians came in to round with his team (of residents and med students). Because the lounge is rather small, I overheard most of what they said.
They discussed this one patient in his 30s who didn't finish high school, has uncontrolled diabetes, has peripheral neuropathy (numbness & tingling in fingers and toes) as a result, has chronic pain, and is taking narcotic pain meds in order to bear it all. According to the med student and intern taking care of him while in the hospital, they report that he is unpleasant/uncooperative to work with, appears to be "throwing away his life," and just want his pain meds. The physician took this as a moment to ask, "Why?"
This segued into a discussion from the physician about here is a guy who's slipped through the cracks of health care. He takes narcotics for the pain, but narcotics likely make him sleepy and also feel not great, throwing him into an endless loop. His PCP (primary care physician) likely tried to truly help him once, but since he's uneducated and doesn't know how to manage his diabetes, thus his health deteriorated. In his frustration, his PCP likely labeled the patient as "non-compliant," which is technically true - but again, why? It became easier for the PCP to just refill his narcotics and send him on his way. His PCP is also an older physician who's likely jaded from seeing so many of his own patients fall despite his care.
Here, said the physician, was an opportunity for us - med student or intern - to turn the guy's life around. Here, in the hospital, where we have "control" we can say to him, "You need to get your act together and turn your life around." Here we can extend a helping hand and spend the time to give him the education necessary to manage his diabetes. He's a young guy and has a shot of doing well years down the line, why should we also abandon him just because he has a label of "non-compliance?"
I have friends who call their patients "idiots" for smoking and having a BMI of well over 40, and then gets admitted for pneumonia. Or for being alcoholics and developing acute pancreatitis as a result. Sometimes I look at one of my friends, who's overweight and gets winded after going up 2 flights of stairs (how sad . . .), and say "Dude, you get winded after 2 flights of stairs. When was the last time you exercised?" To which his response is, "I've been busy and I just don't feel like it." How dare he call his patients idiots for ballooning up to a BMI of 40+ (FYI, that's more than morbidly obese), for telling them to exercise and eat healthy, when he doesn't do the same and could be in their shoes 10-20 years down the line.
Anyway, righteous indignant rant over. We all, medical and non-medical alike, have an opportunity to turn someone's life around. We all fail from time to time, but that doesn't mean we no longer deserve help. Even so, I'm beginning to feel myself become jaded with adult medicine after just 2 months . . .
Tuesday, August 23, 2011
Thoughts?
So I read from time to time, as I'm wont to do. Today I came across this article:
No surprise for bisexual men: report indicates they exist
No surprise for bisexual men: report indicates they exist
Lol, the title amused me. Of course bisexual men (and women) exist! The only way the title could've been better is if it had the words "Well, duh" somewhere in it. Some may be offended that it took a study like this to "prove" or "validate" our existence, but I'm rather amused. The study does have some limits, as all studies do. It basically assess those who're "perfectly" bisexual rather than people who self-identify as bisexual but may have a skewed attraction towards either men or women.
Thoughts?
Circumcise or don't? Quandary for parents
Fairly balanced article for something that inherently has a lot of bias. A fellow med student friend (at another med school) and I briefly discussed the article/topic. He's of a neutral opinion and would follow whatever medical recommendation would be at the time of his future son's birth (assuming he'll have a son). My opinion is basically the same as any other surgical procedure - if it isn't medically necessary right now or in the near future, then don't do it. 99% of the time, circumcision is not medically warranted (that is, there's something so wrong with the foreskin that circumcision is the only option). I then asked him if, in the future, the medical recommendation is as "neutral" as it is now, then what'd he do? He said that he tends towards conservative treatment, and hence would likely leave his son uncircumcised unless there were some very clear benefits that outweigh the risks (there aren't, as of current medical literature).
Thoughts?
Why medicine actively and legally stifles innovation
This was a particularly interesting article. The author certainly utilized a unique health care delivery model. Definitely worth a read. I find the idea of such innovation to kind of operate outside "the system" refreshing. It's a funny thing - they tell us (the med students) to think about every possible diagnosis in the differential for a patient's disease. Then the physicians proceed to systematically dismantle almost every suggestion we come up with except the most likely/obvious ones. I can't say they're wrong in doing so because if you keep asking a med student for something "outside the box," you're going to eventually hear ridiculously rare diseases that very few people ever get and very few physicians ever see. I don't question their knowledge and clinical judgment over mine, because it's obvious that they know far more than I do (almost more than I can possibly imagine myself ever knowing!). What I do question is the system at large that seems to repeatedly fail patients and ends up producing jaded physicians. There must be some way to rectify the system and this article was one step in that direction.
Thoughts?
Thoughts?
Circumcise or don't? Quandary for parents
Fairly balanced article for something that inherently has a lot of bias. A fellow med student friend (at another med school) and I briefly discussed the article/topic. He's of a neutral opinion and would follow whatever medical recommendation would be at the time of his future son's birth (assuming he'll have a son). My opinion is basically the same as any other surgical procedure - if it isn't medically necessary right now or in the near future, then don't do it. 99% of the time, circumcision is not medically warranted (that is, there's something so wrong with the foreskin that circumcision is the only option). I then asked him if, in the future, the medical recommendation is as "neutral" as it is now, then what'd he do? He said that he tends towards conservative treatment, and hence would likely leave his son uncircumcised unless there were some very clear benefits that outweigh the risks (there aren't, as of current medical literature).
Thoughts?
Why medicine actively and legally stifles innovation
This was a particularly interesting article. The author certainly utilized a unique health care delivery model. Definitely worth a read. I find the idea of such innovation to kind of operate outside "the system" refreshing. It's a funny thing - they tell us (the med students) to think about every possible diagnosis in the differential for a patient's disease. Then the physicians proceed to systematically dismantle almost every suggestion we come up with except the most likely/obvious ones. I can't say they're wrong in doing so because if you keep asking a med student for something "outside the box," you're going to eventually hear ridiculously rare diseases that very few people ever get and very few physicians ever see. I don't question their knowledge and clinical judgment over mine, because it's obvious that they know far more than I do (almost more than I can possibly imagine myself ever knowing!). What I do question is the system at large that seems to repeatedly fail patients and ends up producing jaded physicians. There must be some way to rectify the system and this article was one step in that direction.
Thoughts?
Sunday, August 21, 2011
Less Person, More Intervention
A couple days ago I was at an advisor's apartment to welcome students of the incoming M1 class. His wife, who has acute myeloid leukemia, was also present. By any statistic you can quote she has beaten the odds more than once. She's a tough one and still fighting on.
Almost 3 years ago when she first greeted me and others as freshly minted M1s, she was lively, warm, and motherly. Now, bald and weak from chemo, tanned as if her skin had been baking under a desert sun, and also on dialysis, she appeared so frail and mortal. I've seen this before - the frailties of the body, broken by disease and worn from treatment and intervention. But also peering through are the embers of a once-strong soul. I could tell through her heavy-lidded eyes that she wanted to be healthy enough to interact and engage with all of us, instead of lying on the living room couch. I could tell that behind her wearied smiles that she's fighting off her own suffering.
I read a blog article the other day by a doctor who experienced what it was like to be a patient. What he wrote seems to mirror some of the patient's I've seen. Being a patient in the hospital must be one of the most frustrating things in the world. You rarely fully know what's going on with you, nurses are poking you every 15 minutes to 4 hours, and doctors order things to be done on/to you as you lay helplessly. We just need to remind ourselves that, at the end of the day, we can go home. Our patients often can't.
It's easy to correct an electrolyte imbalance. It's easy chase a blood culture. It's easy to track labs. But it gets harder and harder to see patients as people and not a "bag of symptoms." You look at someone and you don't see a mother, a sister, a father, a brother. You look at someone and you don't see a baker, a chef, a nurse's assistant, a student. No, instead you see an alcoholic, a morbidly obese individual, a body part, an organ, a pulmonary embolism, a cancer. All of which is true, one can't objectively deny any of it.
But in the ICU (intensive care unit), I've seen people become less and less person and more and more medical intervention until all that's left is a body on a ventilator with an NG tube, a Foley catheter, an arterial line, a central line, and a telemetry attached. In that state the soul has probably fled and all that's left is a shell of a person kept alive, not for the patient's sake, but for someone else's (whether it's the family or the medical personnel).
A woman was brought in to the ICU today. Full code, meaning CPR and the whole deal. She should have been left to die in peace. As my senior resident said, "This is a special place of Hell that people are forced to suffer through when someone calls the code."
That said . . . people occasionally do get well enough to regain their humanity and go home.
Almost 3 years ago when she first greeted me and others as freshly minted M1s, she was lively, warm, and motherly. Now, bald and weak from chemo, tanned as if her skin had been baking under a desert sun, and also on dialysis, she appeared so frail and mortal. I've seen this before - the frailties of the body, broken by disease and worn from treatment and intervention. But also peering through are the embers of a once-strong soul. I could tell through her heavy-lidded eyes that she wanted to be healthy enough to interact and engage with all of us, instead of lying on the living room couch. I could tell that behind her wearied smiles that she's fighting off her own suffering.
I read a blog article the other day by a doctor who experienced what it was like to be a patient. What he wrote seems to mirror some of the patient's I've seen. Being a patient in the hospital must be one of the most frustrating things in the world. You rarely fully know what's going on with you, nurses are poking you every 15 minutes to 4 hours, and doctors order things to be done on/to you as you lay helplessly. We just need to remind ourselves that, at the end of the day, we can go home. Our patients often can't.
It's easy to correct an electrolyte imbalance. It's easy chase a blood culture. It's easy to track labs. But it gets harder and harder to see patients as people and not a "bag of symptoms." You look at someone and you don't see a mother, a sister, a father, a brother. You look at someone and you don't see a baker, a chef, a nurse's assistant, a student. No, instead you see an alcoholic, a morbidly obese individual, a body part, an organ, a pulmonary embolism, a cancer. All of which is true, one can't objectively deny any of it.
But in the ICU (intensive care unit), I've seen people become less and less person and more and more medical intervention until all that's left is a body on a ventilator with an NG tube, a Foley catheter, an arterial line, a central line, and a telemetry attached. In that state the soul has probably fled and all that's left is a shell of a person kept alive, not for the patient's sake, but for someone else's (whether it's the family or the medical personnel).
A woman was brought in to the ICU today. Full code, meaning CPR and the whole deal. She should have been left to die in peace. As my senior resident said, "This is a special place of Hell that people are forced to suffer through when someone calls the code."
That said . . . people occasionally do get well enough to regain their humanity and go home.
Monday, August 15, 2011
Pandora's Hope
I've witnessed Pandora's Hope with my own eyes,
staring at its immortal form behind its mortal guise.
A blessing, a curse; making us toil long after the day is done,
pushing us harder through a battle that can't be won.
I can only guess at its motives and its reason
since its release from its God-wrought prison.
I have seen it visit you on the edge of death
as you lay gasping with each labored breath.
With your eyes tightly shut in silent pain,
Pandora's Hope burrows deep into your vein,
snaking its way from your arm to your heart
and leaving its eternal mark within your chart.
Defeated, futilely struggling, there you lay.
Can you even hear us and what we say?
Our words of strength reach not your ears,
in your unconscious darkness of pain and fears.
Lifeless are your feeble and atrophied limbs,
your vessel subject to Hope's every whim.
It's not your pain - your suffering - that Hope allays,
but rather our fears and insecurities that It keeps at bay.
And before we realized, before we even knew,
Hope, and Artifice, have crept their way into you.
Hollowed out, Pandora's Hope has made you its shell,
And all for us It traps you - here you dwell.
staring at its immortal form behind its mortal guise.
A blessing, a curse; making us toil long after the day is done,
pushing us harder through a battle that can't be won.
I can only guess at its motives and its reason
since its release from its God-wrought prison.
I have seen it visit you on the edge of death
as you lay gasping with each labored breath.
With your eyes tightly shut in silent pain,
Pandora's Hope burrows deep into your vein,
snaking its way from your arm to your heart
and leaving its eternal mark within your chart.
Defeated, futilely struggling, there you lay.
Can you even hear us and what we say?
Our words of strength reach not your ears,
in your unconscious darkness of pain and fears.
Lifeless are your feeble and atrophied limbs,
your vessel subject to Hope's every whim.
It's not your pain - your suffering - that Hope allays,
but rather our fears and insecurities that It keeps at bay.
And before we realized, before we even knew,
Hope, and Artifice, have crept their way into you.
Hollowed out, Pandora's Hope has made you its shell,
And all for us It traps you - here you dwell.
Monday, August 8, 2011
A Good Death
My last patient died yesterday when I was post-call (aka, I wasn't in to the hospital).
This morning when I logged on the EMR (electronic medical records), I thought it was odd that it listed him as "discharged." I thought to myself, "Why would anyone discharge him? He's far from being stable enough to go home!" Later during rounds, the attending told me and the intern taking care of him that he died Sunday night.
I wasn't surprised (he was in really really bad shape with zero hope for recovery) but it still shocked me a little. The family had decided to declare him DNR (do not resuscitate). Within 24 hours of his death, most/all of his family had flown in from all over the US to be with him in his final hours. He was put on palliative care right away, but since the palliative team doesn't work on the weekends (wtf is up with that?), my attending began standard administration of morphine to ease the pain. His breathing rate was high and the morphine actually brought it back down to normal. He died some time later.
I almost cried a little but it wasn't the time and place. I had only known him for about 3 days and we did everything right by him. As the senior resident later remarked, "I'd rather be dead than live on through that." His rights were respected (his son had the power of attorney) and by all accounts, he died a good death - quick, and not drawn out like with cancer.
What do you think? Is there such a thing as "a good death" and if so, what is it to you?
This morning when I logged on the EMR (electronic medical records), I thought it was odd that it listed him as "discharged." I thought to myself, "Why would anyone discharge him? He's far from being stable enough to go home!" Later during rounds, the attending told me and the intern taking care of him that he died Sunday night.
I wasn't surprised (he was in really really bad shape with zero hope for recovery) but it still shocked me a little. The family had decided to declare him DNR (do not resuscitate). Within 24 hours of his death, most/all of his family had flown in from all over the US to be with him in his final hours. He was put on palliative care right away, but since the palliative team doesn't work on the weekends (wtf is up with that?), my attending began standard administration of morphine to ease the pain. His breathing rate was high and the morphine actually brought it back down to normal. He died some time later.
I almost cried a little but it wasn't the time and place. I had only known him for about 3 days and we did everything right by him. As the senior resident later remarked, "I'd rather be dead than live on through that." His rights were respected (his son had the power of attorney) and by all accounts, he died a good death - quick, and not drawn out like with cancer.
What do you think? Is there such a thing as "a good death" and if so, what is it to you?
Sunday, August 7, 2011
Suck is My Life
Well that was a bust of sorts. Such is my life. :-/
Was supposed to get together with Dan today. When I got there, he had some of his (gay) friends present. They were kinda amusing, lol. He was trying to fix one of their computers, unsuccessfully. Then because we were all there and bored, we decided to go to the giant mall complex near his place. I never got to say what I wanted to.
Oh well. At least I bought some jasmine oolong tea (we went to a tea shop and I had been wanting to buy jasmine tea for a couple days now, what a coincidence, lol). And two of his gay friends play the cello, that's always a plus in my book, lol.
Was supposed to get together with Dan today. When I got there, he had some of his (gay) friends present. They were kinda amusing, lol. He was trying to fix one of their computers, unsuccessfully. Then because we were all there and bored, we decided to go to the giant mall complex near his place. I never got to say what I wanted to.
Oh well. At least I bought some jasmine oolong tea (we went to a tea shop and I had been wanting to buy jasmine tea for a couple days now, what a coincidence, lol). And two of his gay friends play the cello, that's always a plus in my book, lol.
Saturday, August 6, 2011
The Good Life vs. the Long Life
A couple days ago a fellow JMS (junior medical student) and I were conversing. Yes, I am aware that my posts have all lately become medically-oriented; heck, who're we kidding, it's been this way for most of the last couple years, lol. Anyway, we were conversing about the kind of doctor we want to be - one who helps patients live a longer life, or one who helps patients live a better life (as in, better quality of life).
If you had to choose one, would you choose a good life or a long life? Of course ideally we'd want both and patients often demand both. But try as hard as they can, they're only human and in the short run will almost always sacrifice a potentially long life for a good life. This got into a discussion of medical philosophies. In medicine we can do many things to prolong life but often at some cost of a good life. In some surgical specialties, such as orthopedics, they work on getting people back to their normal baseline or in some cases improve upon that - that is, an increase in their quality of life.
It's not easy being a patient. Some of my friends simply don't understand that. You can't just tell a patient to take xyz drugs for their health problems and expect them to be even 67% compliant. It's not easy taking 5+ different medications every day, each of them taken at different times and some with certain conditions/restrictions. It's easy to forget which ones you've already taken and which ones you forgot to take. On top of that, you have to maintain a more restricted diet and have a exercise regimen at all. Because, as we all know, medications only gets us so far; the rest of the way is all on our own. And with each pill we have patients take, with each side effect they may present, we decrease a patient's quality of life in order to increase their lifespan. One could argue that we increase quality of life over the long term too, but in the short term it still kinda sucks.
So is there some way to have one's cake and eat it too? Yes. In pediatrics, the general rule is that kids are usually healthy. The goal (in primary care peds) is to keep kids as healthy for as long as possible, and hopefully transition them into healthy adults. The other JMS who's on the same service as I am this month currently has a patient who's about my height but weighs 198kg . . . That's over 400lbs!! This morning I just looked at her (the patient) and thought, "If I hollowed you out, I could fit about 3 of me inside of you."
This woman also has some young kids, all of whom are normal-sized for their age. The other JMS recounts to me, "Did you see her kids? They're all normal. No kid starts out life that fat. What's the difference between them turning into her? Oh yeah, 18 years."
So if I truly desire to go into peds, I have about 18-21 years to prevent my patients from turning into their parents and developing the same health problems their parents either have or will have. It's possible. It won't be easy, but it's possible. I don't think we honestly try hard enough to counsel patients on preventative medicine - eating right, exercising, not smoking, cutting back on drinking, safe sex, etc. It's difficult in primary care, I know, what with the 15-20 min office visits. That's practically impossible! But we must still try.
Perhaps I'm being too idealistic. I wonder if it'll all crush me.
---TANGENT---
I'm meeting Drew for coffee tomorrow. Perhaps this time I'll dredge up the courage to tell him how I truly feel about him. Hmm . . .
I'll let you all know how it goes, maybe . . . lol.
---END TANGENT---
If you had to choose one, would you choose a good life or a long life? Of course ideally we'd want both and patients often demand both. But try as hard as they can, they're only human and in the short run will almost always sacrifice a potentially long life for a good life. This got into a discussion of medical philosophies. In medicine we can do many things to prolong life but often at some cost of a good life. In some surgical specialties, such as orthopedics, they work on getting people back to their normal baseline or in some cases improve upon that - that is, an increase in their quality of life.
It's not easy being a patient. Some of my friends simply don't understand that. You can't just tell a patient to take xyz drugs for their health problems and expect them to be even 67% compliant. It's not easy taking 5+ different medications every day, each of them taken at different times and some with certain conditions/restrictions. It's easy to forget which ones you've already taken and which ones you forgot to take. On top of that, you have to maintain a more restricted diet and have a exercise regimen at all. Because, as we all know, medications only gets us so far; the rest of the way is all on our own. And with each pill we have patients take, with each side effect they may present, we decrease a patient's quality of life in order to increase their lifespan. One could argue that we increase quality of life over the long term too, but in the short term it still kinda sucks.
So is there some way to have one's cake and eat it too? Yes. In pediatrics, the general rule is that kids are usually healthy. The goal (in primary care peds) is to keep kids as healthy for as long as possible, and hopefully transition them into healthy adults. The other JMS who's on the same service as I am this month currently has a patient who's about my height but weighs 198kg . . . That's over 400lbs!! This morning I just looked at her (the patient) and thought, "If I hollowed you out, I could fit about 3 of me inside of you."
This woman also has some young kids, all of whom are normal-sized for their age. The other JMS recounts to me, "Did you see her kids? They're all normal. No kid starts out life that fat. What's the difference between them turning into her? Oh yeah, 18 years."
So if I truly desire to go into peds, I have about 18-21 years to prevent my patients from turning into their parents and developing the same health problems their parents either have or will have. It's possible. It won't be easy, but it's possible. I don't think we honestly try hard enough to counsel patients on preventative medicine - eating right, exercising, not smoking, cutting back on drinking, safe sex, etc. It's difficult in primary care, I know, what with the 15-20 min office visits. That's practically impossible! But we must still try.
Perhaps I'm being too idealistic. I wonder if it'll all crush me.
---TANGENT---
I'm meeting Drew for coffee tomorrow. Perhaps this time I'll dredge up the courage to tell him how I truly feel about him. Hmm . . .
I'll let you all know how it goes, maybe . . . lol.
---END TANGENT---
Thursday, July 28, 2011
Patients as Diseases
Yesterday I had a sudden strange epiphany: we tend to treat patients as diseases. The people who've come into the hospitals have "become" their diseases. We're more likely to say something like, "my diabetic patient" as opposed to "my patient with diabetes." Subtle difference perhaps, but a difference nonetheless.
It just hit me. Outside of their diseases - there sole reason for coming into the hospital - I knew next to nothing about my patients. I didn't know that my HIV patient was once a baker and a tanner (it said so in his chart). I didn't know that my DVT patient lives with his son and grandchildren (he randomly told me one day). I didn't know my patients as people, only as pathologies. It suddenly didn't sit particularly well with me.
On the one hand, by focusing on their pathologies, I can do my job more efficiently and figure out what's wrong and how to (hopefully) fix it. But on the other hand, there's so much more to the patient than their diseases and there's an element of humanity that's somewhat missing. I mentioned this to one of my friends who's on the same rotation track as me, and he says, "Welcome to the real world."
Yesterday my attending and I were rounding one of our patients with diabetes. She'll likely need her toe amputated because it's basically dead and rotting. And she started crying. My attending says to her (paraphrased), "You have become your disease. You have to get your life back and control this, don't let your disease control you. Knowing what it is is half the battle. The hard part is what you do, and I know it's not easy. But you must not let your disease control you."
We're all so wrapped up in the medicine, in the problems, that we fail to see the bigger picture of the world we live in. I don't know if knowing my patients as people would contribute to better patient care. Maybe it would help me understand how and why one of my patients became so obese that she could no longer sit up, roll on her side, or walk. And maybe, just maybe, it'd give me that small window of opportunity to help my patient manage her health once she leaves so that I never see her again.
It just hit me. Outside of their diseases - there sole reason for coming into the hospital - I knew next to nothing about my patients. I didn't know that my HIV patient was once a baker and a tanner (it said so in his chart). I didn't know that my DVT patient lives with his son and grandchildren (he randomly told me one day). I didn't know my patients as people, only as pathologies. It suddenly didn't sit particularly well with me.
On the one hand, by focusing on their pathologies, I can do my job more efficiently and figure out what's wrong and how to (hopefully) fix it. But on the other hand, there's so much more to the patient than their diseases and there's an element of humanity that's somewhat missing. I mentioned this to one of my friends who's on the same rotation track as me, and he says, "Welcome to the real world."
Yesterday my attending and I were rounding one of our patients with diabetes. She'll likely need her toe amputated because it's basically dead and rotting. And she started crying. My attending says to her (paraphrased), "You have become your disease. You have to get your life back and control this, don't let your disease control you. Knowing what it is is half the battle. The hard part is what you do, and I know it's not easy. But you must not let your disease control you."
We're all so wrapped up in the medicine, in the problems, that we fail to see the bigger picture of the world we live in. I don't know if knowing my patients as people would contribute to better patient care. Maybe it would help me understand how and why one of my patients became so obese that she could no longer sit up, roll on her side, or walk. And maybe, just maybe, it'd give me that small window of opportunity to help my patient manage her health once she leaves so that I never see her again.
Monday, July 25, 2011
Nothing to Do
"Nothing to do." NTD. At the end of our day, we leave a small blurb to the night team taking over on our patients. That's the phrase for most of our patients since we already did the majority of their work-up during the day. Basically all the night team has to do is monitor our patients and make sure nothing major goes wrong, lol.
Anyway, last week I felt like a total bum. The new attending I'm working with is starting here brand new and was getting used to the system. She didn't really let me do as much as my first attending and she relied on the PA a lot. That's okay, I understand. But for the better part of that week I felt like I didn't have any "ownership" over my patients, which I didn't like. So for most of last week I had "nothing to do."
I'm regaining that again now and most of what I did under my first attending. One of the things I did do last week was call ID (infectious disease) consults. A lot. We kept getting patients with unknown sources of infection and whatnot. On Saturday, the ID fellow and Dr. P (remember him?) came by to round on our patient. I hadn't seen Dr. P in a long while, so it was great to see him! :-)
Anyway, my pharmacist friend linked this vid to me and I like it a lot:
And I'm not sure where I found this vid, but it's also very cute. :-)
Anyway, last week I felt like a total bum. The new attending I'm working with is starting here brand new and was getting used to the system. She didn't really let me do as much as my first attending and she relied on the PA a lot. That's okay, I understand. But for the better part of that week I felt like I didn't have any "ownership" over my patients, which I didn't like. So for most of last week I had "nothing to do."
I'm regaining that again now and most of what I did under my first attending. One of the things I did do last week was call ID (infectious disease) consults. A lot. We kept getting patients with unknown sources of infection and whatnot. On Saturday, the ID fellow and Dr. P (remember him?) came by to round on our patient. I hadn't seen Dr. P in a long while, so it was great to see him! :-)
Anyway, my pharmacist friend linked this vid to me and I like it a lot:
And I'm not sure where I found this vid, but it's also very cute. :-)
Friday, July 15, 2011
A Good Day
It's been a good day.
1. I finally had an adult patient with a "fix-able" disease. He had pseudogout, which is readily cured with medication. I called the rheum consult and happened to be there when they came by to examine the patient. So I went in with them to see what I could learn. I had forgotten how much I liked rheumatology, haha.
2. I was able to answer most of my attending's questions without sounding/feeling stupid. This feels like an achievement for me because sometimes I feel like no matter how much I read, I fail to recall what the attending determines to be the most salient points. But today I was prepared (or at least phrased my answer in an acceptable way if I didn't exactly know the answer).
3. My attending gave me feedback on my performance. She told me how proud she was of my progress from day 1 to today. I went from an unsure and kind of shell-shocked student to someone who's confident and proactive in taking responsibility in my patient care. And I do feel like a different person since day 1 last week (I almost can't believe I've been doing this for 2 weeks already!). I chose the hospitalist service precisely because I knew my attending would throw me into the fray and force me to be an independent learner without training wheels, and I got what I wanted.
4. As such, my attending offered to write me a letter of recommendation for residency later! She told me how she's written LORs and how she's called residency programs to give her former students an extra edge. Now, when an attending offers to write a LOR, that means that the attending truly regarded you highly. I hope I can continue this momentum with future attendings on rotations down the road.
5. I met the city's oldest woman cop/detective! She quickly became my favorite patient (though she wasn't technically my patient). She was great to talk to. :-)
-----
Yesterday I hung out with Drew a bit. I picked him up from his house and we went to a coffee shop. We sat down and chatted and people-watched. He kept pointing out all the cute guys and guessing which were likely gay. Btw, I still don't get what people see in asses/what they notice about it; it's simply a body part that I rarely pay attention to. Someone enlighten me?
Anyway we had some good convo. He told me about this guy he likes and likes him back, but they both agreed that neither were in any position to date the other. I suppose that keeps the window open for me a bit, but Drew alluded to the fact that he just got comfortable being single again and would like to stay that way for a bit longer. I'll respect that . . . and also I couldn't get the right words I had wanted to say out of my mouth, lol. And I still couldn't get a feel if I even have a shot. Fail.
I did, however, manage to get him to take his shirt off in front of me. But I assure you it's for a legit reason. He had this rather nasty cough on and off as well as some sinus issues. I just so happened (unplanned, I assure you) to have my white coat and stethoscope in the back seat of my car. So he humored me in allowing me to listen to his lungs and heart. His heart sounded good but his upper lungs did sound a bit congested to me.
All in all, it's always great to hang out with him when we manage to align our schedules.
2. I was able to answer most of my attending's questions without sounding/feeling stupid. This feels like an achievement for me because sometimes I feel like no matter how much I read, I fail to recall what the attending determines to be the most salient points. But today I was prepared (or at least phrased my answer in an acceptable way if I didn't exactly know the answer).
3. My attending gave me feedback on my performance. She told me how proud she was of my progress from day 1 to today. I went from an unsure and kind of shell-shocked student to someone who's confident and proactive in taking responsibility in my patient care. And I do feel like a different person since day 1 last week (I almost can't believe I've been doing this for 2 weeks already!). I chose the hospitalist service precisely because I knew my attending would throw me into the fray and force me to be an independent learner without training wheels, and I got what I wanted.
4. As such, my attending offered to write me a letter of recommendation for residency later! She told me how she's written LORs and how she's called residency programs to give her former students an extra edge. Now, when an attending offers to write a LOR, that means that the attending truly regarded you highly. I hope I can continue this momentum with future attendings on rotations down the road.
5. I met the city's oldest woman cop/detective! She quickly became my favorite patient (though she wasn't technically my patient). She was great to talk to. :-)
-----
Yesterday I hung out with Drew a bit. I picked him up from his house and we went to a coffee shop. We sat down and chatted and people-watched. He kept pointing out all the cute guys and guessing which were likely gay. Btw, I still don't get what people see in asses/what they notice about it; it's simply a body part that I rarely pay attention to. Someone enlighten me?
Anyway we had some good convo. He told me about this guy he likes and likes him back, but they both agreed that neither were in any position to date the other. I suppose that keeps the window open for me a bit, but Drew alluded to the fact that he just got comfortable being single again and would like to stay that way for a bit longer. I'll respect that . . . and also I couldn't get the right words I had wanted to say out of my mouth, lol. And I still couldn't get a feel if I even have a shot. Fail.
I did, however, manage to get him to take his shirt off in front of me. But I assure you it's for a legit reason. He had this rather nasty cough on and off as well as some sinus issues. I just so happened (unplanned, I assure you) to have my white coat and stethoscope in the back seat of my car. So he humored me in allowing me to listen to his lungs and heart. His heart sounded good but his upper lungs did sound a bit congested to me.
All in all, it's always great to hang out with him when we manage to align our schedules.
Wednesday, July 13, 2011
Mixed Feelings
Today was a day full of mixed feelings.
-----
I got my Step 1 USMLE Board Exam score. I passed . . . but I didn't do nearly as well as I was hoping or expecting. In fact, I did almost 20 points worse than estimated. T.T I really have no choice but to accept my score because once you pass this exam, you can't re-take it. I did solidly below average for all medical specialties, even pediatrics and internal medicine.
For a few hours I had some serious doubts about my aptitude and ability to just know/remember medical knowledge. I had doubts on whether or not I really "belong" here. Then I remind myself that it's just one test, just one number. I have chances to redeem myself on my residency application in a couple years - I've already done a lot my first two years, I've held quite a number of leadership positions, I'll have an MPH behind my name as well. All I need to do now is obtain amazing letters of rec and rock Step 2 next summer . . .
It's not over quite yet. I may still have a shot at a top 10-15 pediatric residency spot (I just have to work even harder for it)!!
-----
And for the past couple days I've been taking care of a patient who's been getting increasingly agitated. Last night he refused all medical treatment. When I read this in the nurses' progress notes I went to his room to talk to him. I explained to him why he's here, what we're trying to do, that his meds are working, etc. He didn't believe me. So I asked him what he thought his problems were and how we could better help him. I wanted his perspective of his health. But he snapped back that "I'm not the doctor! Don't ask me! I don't care about no perspective."
I reported all of this to my attending, who then went with me to see the patient again. He was judged "decisional" and he just wanted to go home. He left a few hours later AMA (against medical advice). In a way it felt like a "loss" because there was nothing I/we could do to improve his medical problem, because we can't force care upon someone who doesn't want it and is competent to make his/her own decisions.
Later I recounted this to my pharmacist friend, and here's a snippet of our convo that followed:
Her: "Awww. But wow, [Aek], I am seriously impressed. You're going to make an awesome doctor."
Me: "Lol, impressed by what?"
Her: "I've seen attendings handle difficult patients like that. But not residents. And definitely not med students."
Me: "But isn't that what we're supposed to do? . . . Like, that's part of the job description, lol, to talk to patients and see what's going on."
Her: "Yes, lol."
Me: "And try to help."
Her: "But you seem to have said all the right things. Even though they didn't work. Some people are better at it than others."
I'm glad that she has faith in me. I'm glad that my attending seems to be giving me some positive encouragement/feedback, even when I feel like a dumbass some days when I can't answer her questions as satisfactorily as I think she would like. All I can do is try my best and do what's best for my patients. Knowledge isn't everything, but knowing how to find and utilize knowledge is. Perhaps there is hope.
-----
I got my Step 1 USMLE Board Exam score. I passed . . . but I didn't do nearly as well as I was hoping or expecting. In fact, I did almost 20 points worse than estimated. T.T I really have no choice but to accept my score because once you pass this exam, you can't re-take it. I did solidly below average for all medical specialties, even pediatrics and internal medicine.
For a few hours I had some serious doubts about my aptitude and ability to just know/remember medical knowledge. I had doubts on whether or not I really "belong" here. Then I remind myself that it's just one test, just one number. I have chances to redeem myself on my residency application in a couple years - I've already done a lot my first two years, I've held quite a number of leadership positions, I'll have an MPH behind my name as well. All I need to do now is obtain amazing letters of rec and rock Step 2 next summer . . .
It's not over quite yet. I may still have a shot at a top 10-15 pediatric residency spot (I just have to work even harder for it)!!
-----
And for the past couple days I've been taking care of a patient who's been getting increasingly agitated. Last night he refused all medical treatment. When I read this in the nurses' progress notes I went to his room to talk to him. I explained to him why he's here, what we're trying to do, that his meds are working, etc. He didn't believe me. So I asked him what he thought his problems were and how we could better help him. I wanted his perspective of his health. But he snapped back that "I'm not the doctor! Don't ask me! I don't care about no perspective."
I reported all of this to my attending, who then went with me to see the patient again. He was judged "decisional" and he just wanted to go home. He left a few hours later AMA (against medical advice). In a way it felt like a "loss" because there was nothing I/we could do to improve his medical problem, because we can't force care upon someone who doesn't want it and is competent to make his/her own decisions.
Later I recounted this to my pharmacist friend, and here's a snippet of our convo that followed:
Her: "Awww. But wow, [Aek], I am seriously impressed. You're going to make an awesome doctor."
Me: "Lol, impressed by what?"
Her: "I've seen attendings handle difficult patients like that. But not residents. And definitely not med students."
Me: "But isn't that what we're supposed to do? . . . Like, that's part of the job description, lol, to talk to patients and see what's going on."
Her: "Yes, lol."
Me: "And try to help."
Her: "But you seem to have said all the right things. Even though they didn't work. Some people are better at it than others."
I'm glad that she has faith in me. I'm glad that my attending seems to be giving me some positive encouragement/feedback, even when I feel like a dumbass some days when I can't answer her questions as satisfactorily as I think she would like. All I can do is try my best and do what's best for my patients. Knowledge isn't everything, but knowing how to find and utilize knowledge is. Perhaps there is hope.
Saturday, July 9, 2011
The One to Make Me Dance?
Today I drove about 4 hours to make it to my friend's wedding. In fact, my best friend from undergrad and my roommate freshman year. But more about that later when I've returned home and had time to process the pics I took a bit more.
I can't remember if I've mentioned this, but I always have mixed feelings during every wedding I attend. On the one hand, I'm really happy for the new couple and the potential of their lives together. But on the other hand, I'm also rather sad for myself and still being so so single. This is only accented during the dancing portion of the reception, which I utterly dread.
First all, I feel rather awkward with/in my own body (hands aside - years of playing the piano and cello have mediated that, lol). And second, I usually don't have anyone to dance with because I attend most of the wedding solo too; and if I did have someone to dance with, I'm also not sure what to do. It's all just a really awkward moment for me unless I've had 4+ shots of alcohol within the last 30 minutes or so, haha.
I'm still looking for that one person who can make me dance and not feel like an utter fool. Where is this person who can motivate me onto the dance floor and dance with them (or at all)? A part of me is sick of just sitting on the sidelines waiting. And a part of me is just too comfortable not exposing myself like that on the dance floor. I mean, I even feel embarrassed attempting to dance in the privacy of my own apartment!
-----
Anyway, on an unrelated note, Drew is now single. Again. Things didn't work out between him and his boyfriend and they broke up on friendly terms. It's been about 2 weeks since the break-up. In the intervening time, at least 3-4 guys have asked him out on dates, all of whom he had soundly rejected. For good reason! They should've given him at least 2 weeks to get over his last boyfriend - such quick rebound is good for no one.
But now 2 weeks are up. I don't know if I should make any kind of move while this window is still temporarily open. I don't want to be yet another guy asking him out on a date as I think that'd hurt our friendship (or at least make things a tad awkward in the future).
What I really want to do is just ask him if he'd ever consider dating me. And depending on his response I'd then ask him out (or not). But I also feel like it's cheesy to do that. Yet again, I don't want to be "yet another guy." Argh. What to do?!
I may ask him if he's free to hang out this coming Thursday afternoon/evening (because that's the earliest time during this week that I know I have some time off from rotations). I could ask him on the spot then. If he said yes things would actually work out nicely because I get my Step 1 board exam score this Wednesday, so he'd be either celebrating or commiserating with me depending on my score, lol.
He's one of the few people I've met who doesn't fail to make me smile and laugh when we hang out. I really enjoy spending time with him even as just friends. He may be one who can make me dance, lol. Argh, I don't want to mess this up. What should I do? Would things work out anyway since we're both so busy? :-/
Friday, July 8, 2011
Survived my First Week
. . . of my medicine rotation.
It's actually not too bad. I'm on the hospitalist team, so it's just me, a physician's assistant (PA), and an attending physician. There are no other med students, interns, or residents on my team. And the hours are surprisingly nice - 8am until whenever I finish (usually between 3pm and 4:30pm) and no call. But man, talk about throwing you out to the wolves! On day 1 I had to do an independent history & physical (H&P) on a newly admitted patient. On day 2 I had to follow-up with the patient (now "my" patient), write a medical note complete with non-retarded assessment and plan for his treatment while he was in the hospital.
And on day 4 I had two newly admitted patients for which I had to do H&P's, write their medical notes, call consulting services, write orders for labs and meds, get consent, and learned how to write an admission note. I've learned and done a lot in this short week - possibly more than I had all of M1 and M2 years combined (or so it feels, lol).
It's been a great experience so far. I've really had to take responsibility and ownership over "my" 3 patients, and I'm slowly figuring out the system. I know I have friends with me on our medicine rotation at different locations who've done less for each of their patients. I've been so busy that I don't even notice how hungry and tired I am until I leave each day - I've just been in this kind of hyper-focused state to do what I can for my patients (if that makes any sense at all, lol). I hope at the end of each day I truly did something to help them and contribute to their care while in the hospital.
Time for bed. I've been granted the weekend off so I can make it to my friend's wedding.
It's actually not too bad. I'm on the hospitalist team, so it's just me, a physician's assistant (PA), and an attending physician. There are no other med students, interns, or residents on my team. And the hours are surprisingly nice - 8am until whenever I finish (usually between 3pm and 4:30pm) and no call. But man, talk about throwing you out to the wolves! On day 1 I had to do an independent history & physical (H&P) on a newly admitted patient. On day 2 I had to follow-up with the patient (now "my" patient), write a medical note complete with non-retarded assessment and plan for his treatment while he was in the hospital.
And on day 4 I had two newly admitted patients for which I had to do H&P's, write their medical notes, call consulting services, write orders for labs and meds, get consent, and learned how to write an admission note. I've learned and done a lot in this short week - possibly more than I had all of M1 and M2 years combined (or so it feels, lol).
It's been a great experience so far. I've really had to take responsibility and ownership over "my" 3 patients, and I'm slowly figuring out the system. I know I have friends with me on our medicine rotation at different locations who've done less for each of their patients. I've been so busy that I don't even notice how hungry and tired I am until I leave each day - I've just been in this kind of hyper-focused state to do what I can for my patients (if that makes any sense at all, lol). I hope at the end of each day I truly did something to help them and contribute to their care while in the hospital.
Time for bed. I've been granted the weekend off so I can make it to my friend's wedding.
Wednesday, July 6, 2011
Let . . .
Breathe by ~theflickerees on deviantART
Come here, lay with me,
Inhaling our breathes
together
On this lazy summer day.
Let the sun
caress us
in its warm embrace,
Let the breeze
fill us
with the breath of life.
And we may gaze
at the clouds
And imagine
sweet dreams of tomorrow.
Let us enjoy this day
together;
Nothing to do,
Nowhere to go,
Just lounging around
in each other's company.
Let us close our eyes
and pretend,
Just for a moment,
That the world
stopped turning
And that time
gave pause.
That it is just
you and me -
Whoever you are,
Wherever you are,
Exhaling with me
the breath of yesterday.
Inhaling our breathes
together
On this lazy summer day.
Let the sun
caress us
in its warm embrace,
Let the breeze
fill us
with the breath of life.
And we may gaze
at the clouds
And imagine
sweet dreams of tomorrow.
Let us enjoy this day
together;
Nothing to do,
Nowhere to go,
Just lounging around
in each other's company.
Let us close our eyes
and pretend,
Just for a moment,
That the world
stopped turning
And that time
gave pause.
That it is just
you and me -
Whoever you are,
Wherever you are,
Exhaling with me
the breath of yesterday.
Friday, July 1, 2011
Epic Wedding
This post is long overdue. A couple weeks ago I drove down to St. Louis, MO with Michelle for a mutual friend's wedding. Michelle has a relative who lives near St. Louis, so we crashed at his place for the first night we were there.
That first night, we went to the Mehendi ceremony where the women got henna done. The bride's henna was really cool all over her hands.
The following morning was the Christian ceremony (groom's side) at Graham Chapel at Washington University. Though we left early so we could get there early, the universe didn't want that to happen. The highway I took narrowed down to one lane at one point and we were stuck in pretty much stand-still traffic for a good 15-20 minutes. I took the first exit I could find only to find the bridge I had to cross was demolished. I just went back on the highway and surprisingly it was fine after that blockade.
The Christian wedding was pretty sweet and short. After that wedding and taking a few pics, we went to the hotel where the rest of the events were held to attend the luncheon. By the way, almost every meal was provided buffet style with Americano and Indian options. Both were delicious and I was stuffed after every meal without fail. Probably gained like 10 lbs from all that food . . .
Anyway, after the luncheon there was a couple hours' lull as they set up for the Hindi ceremony later that afternoon. Unlike the Christian ceremony, which was about 40-45 minutes long, the Hindi ceremony was about 1.5 hours long. It was really cool though as I had never attended an Indian wedding before.
Finally, after the Hindi ceremony came the reception, which was really nice. Throughout the 2 days, the bride wore a total of 3 dresses, 2 of them being saris. She looked so good in all her dresses! I was so stuffed from the food that I couldn't finish a small slice of cake and attempting to dance was painful. Oh well.
The following morning, Michelle and I checked out of the hotel and decided to see some stuff around in St. Louis before heading back. We first went to the Shaw Botanical Garden where a really awesome tour guide gave us a most excellent tour of the gardens. It was such a beautiful place.
After that, we headed for The Hill area for lunch. But being Sunday and in a heavy Italian district, most places were closed. We did find a pizza place that was open (which was delicious) and then topped that off by going to a gelato place afterwards.
Finally before heading out, we had to see the Gateway Arch, probably the most iconic symbol of St. Louis. We didn't go up to the top but we took plenty of pics around it. All in all, it was a great trip with a couple of minor bumps along the way.
Thursday, June 16, 2011
I Have Return from Death
Okay, so I took my USMLE Step 1 exam last Thursday. It was a beast. 15-minute tutorial followed by 7 one-hour blocks of 46 questions and a 45-minute break that can be divided up however one wants. It was going alright until I encountered a heart sound question that required audio and . . . the audio on my computer didn't work. T.T That threw me for a loop. Good thing there was only 2 questions that required audio.
Overall I think I did alright. Hopefully, with some luck, I met my target of getting a score of 225+ (national average is usually between 220 and 223). There was a moment in the middle of the exam that I wondered whether or not I'd pass it, but apparently that's pretty much how most people feel coming out of that exam.
And with that, walking out of the exam dazed, I have returned from Death!
-----
On Saturday I met up with Drew for coffee. I had promised that I'd get him coffee for his birthday that was about a week earlier. We chatted for a few hours before heading back to his house. His mom and dad were home, which was just a tad awkward for me. We went down into his basement where he proceeded to show me all the music compositions he had written (most of them fragments of would-be melodies).
Then we listened to some classical music on YouTube while I gave him a back rub. For almost an hour. I didn't know that a person could get such knots in their back (I could clearly feel that his muscles had knotted up in ways it shouldn't)! This guy has clearly been under some stress and his boyfriend terribly sucks at giving back rubs.
Man, it sucks that I still like him in a way that's potentially more than just friends. And he's quite happy with his boyfriend, crappy back rubs notwithstanding, lol.
-----
I've been a bum for most of this week and it's great, haha. I had intended to do a bunch of things but I simply haven't gotten to them. Not sure if I will or not. Tomorrow I'm on my way to a friend's wedding in St. Louis. Going to drive down there with another friend. Hopefully everything goes smoothly!
Overall I think I did alright. Hopefully, with some luck, I met my target of getting a score of 225+ (national average is usually between 220 and 223). There was a moment in the middle of the exam that I wondered whether or not I'd pass it, but apparently that's pretty much how most people feel coming out of that exam.
And with that, walking out of the exam dazed, I have returned from Death!
-----
On Saturday I met up with Drew for coffee. I had promised that I'd get him coffee for his birthday that was about a week earlier. We chatted for a few hours before heading back to his house. His mom and dad were home, which was just a tad awkward for me. We went down into his basement where he proceeded to show me all the music compositions he had written (most of them fragments of would-be melodies).
Then we listened to some classical music on YouTube while I gave him a back rub. For almost an hour. I didn't know that a person could get such knots in their back (I could clearly feel that his muscles had knotted up in ways it shouldn't)! This guy has clearly been under some stress and his boyfriend terribly sucks at giving back rubs.
Man, it sucks that I still like him in a way that's potentially more than just friends. And he's quite happy with his boyfriend, crappy back rubs notwithstanding, lol.
-----
I've been a bum for most of this week and it's great, haha. I had intended to do a bunch of things but I simply haven't gotten to them. Not sure if I will or not. Tomorrow I'm on my way to a friend's wedding in St. Louis. Going to drive down there with another friend. Hopefully everything goes smoothly!
Tuesday, May 31, 2011
Gender-free?
A person's sex is biological, primarily determined by XX or XY. A person's gender is largely a social construct, or what being of one sex or the other "means."
This may be old news, but it's interesting nonetheless. A couple in Canada decided to withhold their newborn's gender from the world and him/herself. The idea is to let the child discover his/her own gender and decide for him/herself. It's an interesting "experiment," to say the least, and one that has drawn a lot of controversy.
Personally, I think the child will be all right. S/he will figure out gender, as it's been shown that a child's concept of gender is innate and becomes cemented by the time they're 4 or so. A child "knows" if they're a girl or boy. But what does it "mean?" That can be challenged.
I'm not sure I agree with the way the parents are withholding the child's gender from the child and the world. I think they'd be better off treating the child in such away to avoid gendered stereotypes. Because, honestly, gender stereotypes (to me) seem to be getting less distinct and less important. But maybe that's just me. There's a related article on masculinity that's an interesting read.
---TANGENT---
On a completely different note, I came across this recently:
Oh to have a body half as good as that, lol. Yeah, it's totally unrealistic for the vast majority of us to ever have a body remotely like that. And I can accept that. Doesn't mean I/we can't try to get halfway there (which, honestly, is more than good enough). :-P
Btw, Chris Fawcett is HOT. It's mostly his eyes to me, and less his body.
---END TANGENT---
This may be old news, but it's interesting nonetheless. A couple in Canada decided to withhold their newborn's gender from the world and him/herself. The idea is to let the child discover his/her own gender and decide for him/herself. It's an interesting "experiment," to say the least, and one that has drawn a lot of controversy.
Personally, I think the child will be all right. S/he will figure out gender, as it's been shown that a child's concept of gender is innate and becomes cemented by the time they're 4 or so. A child "knows" if they're a girl or boy. But what does it "mean?" That can be challenged.
I'm not sure I agree with the way the parents are withholding the child's gender from the child and the world. I think they'd be better off treating the child in such away to avoid gendered stereotypes. Because, honestly, gender stereotypes (to me) seem to be getting less distinct and less important. But maybe that's just me. There's a related article on masculinity that's an interesting read.
---TANGENT---
On a completely different note, I came across this recently:
Oh to have a body half as good as that, lol. Yeah, it's totally unrealistic for the vast majority of us to ever have a body remotely like that. And I can accept that. Doesn't mean I/we can't try to get halfway there (which, honestly, is more than good enough). :-P
Btw, Chris Fawcett is HOT. It's mostly his eyes to me, and less his body.
---END TANGENT---
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