The Masks We Wear

Privilege & Entitlement

2012-01-28T23:25:00.005-06:00

"The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadow of life, the sick, the needy, and the handicapped."

I came across that quote in this article, Addressing the needs of the disadvantaged in our health system. The words themselves struck me and the article is well worth a read (it's by a med student).

I linked that article to a friend and she shot it down as overly idealistic because people will find a way to take advantage of and manipulate the system. Then people will begin to feel entitled to the help from the government and stop trying as hard to pull themselves out of whatever situation they find themselves in. The public health aspect of me balked. She turned it back on me and remarked that I probably felt more entitled than her, and that her boyfriend almost certainly feels more entitled than either of us. I was confused. She stated that I must feel entitled to be paired with good physicians as my clinical teachers and that I expect certain things to happen or else. I was taken aback. This then became a philosophical discourse of sorts.

I have never really felt entitled to much past high school. I learned very quickly that things in life must, more often than not, be earned. I have never felt a sense of entitlement in med school. Whether or not I am paired with a good physician or not is purely luck (that said, I've been pretty lucky lately).

Every moment I have time to give pause I am filled by a sense of privilege. Truly, being a doctor is a privilege and one of the highest out there. In how many other professions can you ask someone to take off their clothes and allow you to touch them in ways that would otherwise get you arrested? In how many other professions will someone come to you and ask you to cut them open and do what you will inside them without getting sent to jail? In how many other professions can you ask someone about the whole "sex, drugs, and rock-and-roll" without getting them arrested?

I am aware that every time I walk into a patient room, I have mere seconds to earn their trust. It's an interaction that takes place within a few seconds' time, but it is so critical. With adults, this is an introduction and a shaking of hands. With kids, this is more subtle but can be sensed by the look in their eyes (and whether they give you a high-five or fist-pound). With newborns, it's a settling back into a calm. I am motivated by a sense of awe for the practice of medicine. For patients to allow me to listen to their stories, to examine them physically, to place trust in my words (as a M3 med student), to consent to have me assist in their surgeries and be elbow deep into their abdomens - I'm not sure words can express the sense of gratitude and privilege one can feel.

Unfortunately for many of my peers, the rigors of the training and the complexities of the patients out of our control have jaded them. To quote Dr. Walcott in the movie, Patch Adams:

"Our job is to rigorously and ruthlessly train the humanity out of you and make you into something better. We're gonna make doctors out of you."

In a profession that deals with humanity, how have we allowed it to smother out our own humanity? It's a curious thing. I would be lying if I said I haven't had my moments when I wondered why I even bother to help some patients, knowing that they will not or cannot help themselves. I would be lying if I said I haven't ever been pissed at a patient when things took a turn for the worst.

But thinking back to WHY I'm here in the first place brings me around full circle and sustains me. Everyone has a reason for going to med school, some of them better and nobler than others. I believe those who hold onto their reasons and do not lose sight of it are best able to make it through without become (as) jaded.

Well, this post has been rather long and I'm not sure it makes a whole lot of sense. I'll have more to say after my exam on Monday. Eep!

Happy New Year 2012!

2012-01-02T12:05:00.003-06:00

Hey everyone, Happy New Year 2012! I know I'm a day late, blah blah blah, but Happy New Year nonetheless. May 2012 be fulfilling and rewarding; and for those of you who had a crappy 2011, may 2012 be much much better.

Already at least one blogger started 2012 off on a bad foot. Please go over to Landyn's blog, Stuck In The Middle, and offer him your best wishes and any help you may be able to provide. He's in a really bad spot right now and could use our support.
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On a completely 180-degree note, I've got more answers to questions from Well I gotta say, Being gay is . . . (now re-named to "Normally Gay").

1. What is your favorite trait about yourself? It can be physical or character-wise.
Hmm, a tough one. My best character trait is that I'm extremely hardworking and dedicated when I need to be, sometimes almost to a fault. My best physical trait . . . my eyebrows I guess?

2. Describe your perfect man.
This is a tad tough, haha. Originally I had separated this into 2 categories: "requirements" and "pluses." Then I came to the realization that I could give a little more on the requirements and some of the pluses are really more important. So here's just a laundry list below (in no particular order, and the question did specify "perfect" man, after all):

- Beautiful eyes. I find eyes really attractive. The color isn't important, though I find green and hazel eyes particularly mesmerizing.
- Cute face with a cute smile. This is very subjective and no one face fits this description. It may be a clean-shaven face on one guy or with stubbles on another, it just depends.
- Reasonably in shape. Not too thin, not fat (a little overweight is fine), is pretty toned, not too muscle-y.
- Height -2 inches to +6 inches from my height. That'd give a range of about 5'5" to 6'1".
- Age -6 to +6 from my age. That'd give a range of 19 to 31.
- Non-smoker, non-alcoholic, non-drug user. This really is a deal-breaker. Though, I could make an exception for very occasional marijuana use . . .
- Intelligent and can hold a decent conversation. Now, I don't need a doctor or someone with a PhD (pluses though that may be, haha), but an undergrad education is pretty much a must.
- Someone who can consistently get me to smile and do things I otherwise might be hesitant to do. Really, I need someone who can put me at ease when I get too tense.
- Someone who is honest, loyal, keeps promises, and likes to cuddle.
- Is a good cook. Food is definitely one route to my heart, lol.
- Plays a musical instrument and/or speaks a foreign language.
- Likes to travel.
- Is fairly neat & organized. I flit back and forth between being a neat freak and OCD organized and somewhat lax about it all. But I don't want to clean up after a slob.
- Has an "average" to "slightly above average" dick size. That'd give a range of about 5" to 7" or so. Also, not so thick that I'd choke.
- Is uncircumcised. Honestly this is pretty low down, but it is a plus.

3. Last song you listened to?
It'd probably be this: "How to Save a Life" (with Alex Goot)

Before that, it'd be this song: Gravity - by Jason Chan.

4. Favorite thing which is green?
Until recently I would've said my 2 philodendron plants. But I recently-ish bought an "olive green" messenger bag that I really like. :-)

5. Would you ever participate in an orgy?
Umm, no. Three-way, probably.

Answers!

2011-12-21T00:30:00.004-06:00

Max at Well I gotta say, Being gay is... recently invited people to ask him questions for his celebrated 200th post! One of the questions I asked him was: "What 5 questions would you ask me?" So here are my answers:

1. Can I see a pic of this Terrible hair of yours? I don't buy it.
I actually gonna defer this here. I sent Max an email that he needs to follow up on in order to get the answer he's looking for, lol.

2. Most pleasurable sexual encounter/craziest (whichever is a better story, haha).
Considering I've only had one sexual encounter which happened about 4-5 years ago (sad, I know), I guess I'll talk about that. So I'd been chatting with a blogger for about a year (his blog is no longer active and I think he started a new blog, but I forget the URL). He happened to be in town a few days for a conference. So we decided to meet/hook up, lol.

Being my first time (but not his), I was kinda tense/nervous but he put me at ease pretty quickly. It was my first time touching another guy's dick and giving a blowjob; it felt similar yet quite different than mine, mostly because he's cut and I'm not. It was also the first time anyone's touched me in any kind of sexual way. Him touching my dick (and particularly my foreskin) sent jolts throughout my body. I'd felt nothing like it before and nothing quite like it since. I must say (and I probably speak for many/most uncut guys out there), him tugging my foreskin back and forth was probably one of the most pleasurable parts.

We proceeded to give each other blowjobs. He probably blew me for over half an hour or so before I came. I felt so close the whole time but couldn't quite go over the edge. Whoever said uncut guys cum too fast lied, lol. I came in his mouth and he swallowed. I then returned the favor but he wanted to finish off by wanking, and he came in huge spurts that went over his shoulders and splattered my wall! I had to wipe off his cum pretty quickly before it dripped down to my sheets and all, lol.

3. Last song you played on your iPod/computer/mp3 player?
The last song I played on my iPod was something from Pandora. I don't remember what it was specifically, but it was some movie soundtrack from The Lord of the Rings, Inception, Star Trek, or Crouching Tiger, Hidden Dragon or something like that.

The last song I played on my computer is the following:
Steven Sharp Nelson - Carol of the Bells (for 12 cellos)

4. Your favorite pair of underwear.
Hmm. Well, my favorite type of underwear are boxer-briefs (unless I'm doing cardio exercise, then I prefer boxers to "air out" a bit, lol). Oh! My favorite pair of underwear are these kinda seasonal dark blue boxers with white outlines of evergreens and houses.

5. Top! Or bottom, or whatever in between you prefer, or none at all!
Hmm. I've had no direct experience with either topping or bottoming, haha. I can safely say I'd have to try both before I can definitively decide which I'd prefer. I suspect I may like bottoming a little more . . . but I know I can't take dicks as big as Max can. ;-)

Mask of Loneliness

2011-12-15T16:25:00.003-06:00

Loneliness by *MikaTrta on deviantART

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:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~ Dag Hammarskjold

Yes, I've used that quote before in this post (if you recall).

Mediocrity

2011-12-06T23:00:00.005-06:00

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:

"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.

Welcome To Life

2011-12-01T00:07:00.005-06:00

Newborn Egg by !Kikariz on deviantART

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.

Land of the Little People

2011-11-21T22:30:00.002-06:00

"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.

Tribute to Life

2011-11-17T16:55:00.004-06:00

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.

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.

Respect for Death

2011-10-31T23:25:00.004-05:00

death is.. by ~er0k on deviantART

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.

Reclaiming Humanity

2011-10-20T19:36:00.002-05:00

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.

More Weddings!

2011-10-16T20:00:00.011-05:00

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!

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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.
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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.

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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---

Imagine . . .

2011-10-08T23:07:00.004-05:00

. . . 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 . . .
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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?

Introspection & Privilege

2011-10-02T17:00:00.005-05:00

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).

Amazing Week

2011-09-25T11:00:00.004-05:00

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

Darkness Before Dawn

2011-09-10T22:46:00.006-05:00

Scrubs by ~Tjelsi on deviant ART

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.

A Helping Hand

2011-08-28T10:20:00.005-05:00

a helping hand by *poivre on deviant ART

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 . . .

Thoughts?

2011-08-23T22:46:00.005-05:00

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

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?

Less Person, More Intervention

2011-08-21T23:35:00.004-05:00

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.

Pandora's Hope

2011-08-15T22:56:00.003-05:00

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.

A Good Death

2011-08-08T21:35:00.003-05:00

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?

Suck is My Life

2011-08-07T23:21:00.003-05:00

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.

The Good Life vs. the Long Life

2011-08-06T22:10:00.003-05:00

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---

Patients as Diseases

2011-07-28T21:55:00.003-05:00

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.

Nothing to Do

2011-07-25T23:27:00.002-05:00

"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. :-)

A Good Day

2011-07-15T23:40:00.005-05:00

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.

Mixed Feelings

2011-07-13T23:45:00.005-05:00

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.

The One to Make Me Dance?

2011-07-09T23:20:00.006-05:00

The dance by *klairy on deviant ART

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? :-/

Survived my First Week

2011-07-08T23:15:00.004-05:00

. . . 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.

Let . . .

2011-07-06T22:41:00.004-05:00

Breathe by ~theflickerees on deviant ART

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.

Epic Wedding

2011-07-01T10:35:00.006-05:00

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.

I Have Return from Death

2011-06-16T22:50:00.005-05:00

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!

Gender-free?

2011-05-31T01:30:00.005-05:00

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---

Homunculus of Touch

2011-05-25T01:45:00.007-05:00

Argh. Been feeling kind of defeated lately with these frustrating qbank questions. Overall I'm improving somewhat, but my scores are erratic - they spike up and then plummet and then spike again. Anyway, after studying neurology for the better part of a day, I managed to pull off a 71% on a block of neuro questions! Not sure how that happened, as I generally consider neuro to be one of my weaker areas.

Somewhat related, one of the most interesting things I remembered learning while going through neuro was the somatosensory homunculus. You see, sensation is unevenly distributed throughout our bodies and our brains form a somatosensory homunculus of it on the pre-frontal cortex. It's rather interesting. So think, what are the most sensitive parts of your body? Now look at the distribution of the somatosensory cortex:

Does it match what you thought? You'll notice that the face and hands are far over-represented. The fingers, lips, and face are more sensitive than pretty much any other part of the body. Do you notice the genitals? Hint: it's by the feet. Interesting that it comprises such a small part of the homunculus. A drawing of the somatosensory homunculus would be like this:

So I find it kind of funny how we put so much focus and attention on the penis and genitals. Yeah, sure, it's pretty sensitive given its body surface area (more so than, say, the legs), but it pales in comparison to the hands, lips, and face. One would probably expected the homunculus to be more like this:

Lol, right? Well, apparently, some recent-ish studies kind of hint that the homunculus actually is a bit more like this last version (the things you find on Google, lol). In 2005, Kell et al. attempted to update the somatosensory homunculus for males - chiefly that genital sensation is not near the feet in the somatosensory cortex, but closer to where it'd be on the body. In 2007, Sorrells et al. reported that 5 of the most sensitive parts of the penis is removed during circumcision (so it's curious, and incorrect, that the homunculus above is circumcised).

Of course, one has to wonder, what about women? It's been presumed that the number of genital nerve endings in men and women are about equal; however, there just aren't that many such studies out there done on women. There are numbers floating around in the internet (with no source that I can pin down) stating that the glans clitoris (basically the entire clitoris) has about 8000 nerve endings, whereas the glans penis (head of the penis) has about 4000; presumably, the other 4000 nerve endings are distributed along the shaft. Furthermore, the foreskin has about 10,000 to 20,000 nerve endings (and the clitoral hood somewhere around there but perhaps a little less).

What does all this mean? Who knows. Everyone experiences sensation different anyhow. Sure, there are objective ways to test sensation: 2-point discrimination, temperature, fine touch, coarse touch, vibration, etc. And there are different nerves that sense different things (apparently the foreskin has a bunch of the kind that detect fine touch and vibration). But what it all "means" is another thing entirely. I mean, though the hands are sensitive, they're not particularly sensual, am I right?

Anywho, I'm rambling. I hope you were entertained and curiosity piqued. :-P

Like a Fiend

2011-05-23T02:10:00.003-05:00

So . . . how're you all doing? It's been almost a month since I last blogged. o_O

Been a brutal month, of sorts. Finished finals (passed all my classes, phew!), took the weekend off (mostly), then began studying like a fiend for the behemoth known as Step 1 of the USMLE Board Exam.

I've been slowly pushing past the burnt out phase - that lasted about 4 days longer than I could really afford. As is, I study probably about 6-8 hours a day, on average. That's not enough. I need to get upwards of about 12 hours a day. The exam itself is 8 hours long. Ugh. Only 2.5 weeks away, eep! I must resist the urge to reschedule my exam for a later date.

Other than that, nothing special. Took a couple hours off from studying to celebrate my b-day with a few friends a couple days ago. Had teppanyaki for dinner at a Japanese restaurant. It was good. :-) Now, what do you think 9 med students talk about when they're all studying for the same beastly exam? The exam, of course. That dominated our conversations. Yeah.

---TANGENT---
On a completely unrelated note, I saw the following commercial on TV today:

I thought it was pretty sweet.
---END TANGENT---

You're Better Than Me

2011-04-29T17:15:00.003-05:00

About a week ago, I had the following conversation with Michelle on gchat (slightly edited):

Michelle: Hey, I try to be open. But when I'm not good enough to talk to someone . . . I get really irritated.
Me: Awww. I never got that sense from her. Maybe I'm just oblivious, idk.
Michelle: No, you fit into a different class of people than me. This is most certainly not the first person I've experienced this response from in our class.
Me: Lol, what do you mean by that?
Michelle: You're better than me. I'm overweight, and I don't look like I have money . . . so I get relegated to a lower class. Plus a myriad of other factors. But I'm judged on the first two sooooo quickly.
Me: How am I better than you? And how do I not meet those criteria too?
Michelle: You're more peppy than me. More positive. People like you. I don't know anyone who doesn't like you.

I was rather taken aback by her statement. While it's true that I don't know of anyone who overtly dislikes me, I'm not exactly best buds and close friends with most people in our class either. I tend to hover outside near the fringes of most social circles. It's a rather weird place to be, tbh.

Maybe I am peppy, though I don't really feel it. I try to be positive, but sometimes that's difficult. In any case, I certainly feel no better than anyone else (and very much the opposite compared to some people I know). If only personality is everything, hehe.

---TANGENT---
1. I got an iPod Touch a few days ago. We need one for use in the hospitals and clinics (apparently). I had the option of getting an iPad but I turned it down. Before you shriek, here's why: it's bigger and less practical to carry around in the hospitals. True, it fits in my white coat, but it's just this big bulky thing that I don't want to have on me at all times (and we'd be required to use it and have it with us at more or less all times). So yeah, I've been fiddling around with this iPod for the past few days. I resisted for a while before getting the Grindr app. I still don't see what the big deal is about it . . . Anyway, any "must get" apps?

2. Landyn's back (sorta)! Go read his update on his blog, Stuck In The Middle.
---END TANGENT---

Will This Work?

2011-04-17T23:55:00.005-05:00

So if you recall from like a year ago, things with Jay didn't work. In retrospect, that was probably for the best.

And while I met Drew a couple weeks ago, it looks like things won't work out with him either. Apparently he had gotten back together with his ex-bf - the same guy who brings him such great highs and such great lows (it's a rather bipolar relationship). Things were rocky and last week they've broken up, again. And within the last week, he's been dating this guy he seems to really like. They go to the same undergrad, so it's much easier for them to meet up than, say, with me. Oh well, I saw this coming. I'm not disappointed, per se, I'm happy for him. But man, I still can't quite get over him (which is odd, since we never really got it on to begin with). I think he's one of those people who can connect with almost anyone really easily.
-----
At the same time, a new guy started messaging me online a couple weeks ago. I'll call him Mel. He seems like a nice guy. Anywho, a few days ago we actually met up for a "date." I say "date" because he considered it a date, but it didn't quite feel like one to me (not that I'd really know).

While he goes to school about 45 minutes away, he had to stop by my area because there's an art store near here that he needed to get supplies from (he's a graphic design and animation student). So we met at a Barnes & Noble at the mall near me. He was wearing a black fedora and a black trench coat; eh, must not judge (but really, a trench coat?). We walked around the mall a bit, making small chat. He seemed nervous and shy. He had this habit of talking in small quick bursts in a low tone, kind of how my youngest brother talks sometimes.

After a few minutes, we went to a sushi place not too far away. It was pretty good, it had been a while since I'd had sushi. The place was pretty empty since it was still a bit early for dinner. We chatted some more. I felt like I had to initiate a few times and be more upbeat, because he seemed somewhat monotone. Once we finished, we went back to the mall to mill about for a bit before saying goodbye.

I don't know. I just didn't feel like we really connected. I mean, we could be good friends but I'm not sure if it'll go any further. There was an odd disconnect in person that I didn't quite feel when chatting online.
-----
What am I looking for in a person? What am I looking for in myself? Will this work?

I suppose I have more important things to attend to; that is, working out (I've been pretty slack on P90X and it's showing, ugh) and studying for finals and my Step 1 exam in June (I'm less than 60 days away, eep!!). Tick tick tick . . .

Leave Your Mark

2011-04-11T23:30:00.003-05:00

Afterburn by `creativ82 on deviant ART

It always amazes me how some people can have such an impact on others.

A couple weeks ago I attended a dinner event to which I invited Dr. H and his team to be some of the speakers. He's just as inspiring to me as always. I asked (innocently) the panel about how we as medical providers may help patients adhere to various treatment regimens. At that, the neurosurgeon present called me naive, how we can't change people's behaviors, and how we have to meet patients where they are. Instantly Dr. H took over and agreed that we needed to meet patients where they are. Some patients aren't ready to adhere to a treatment regimen, but what we must do is to help them prepare for the day that they are ready. It's more important that they see us and stay "plugged in" to the health system than to demand them to take their drugs.

I also attended a lunch talk by an MD/MBA about his journey in getting a dual-degree. I love hearing docs with dual-degrees speak because it usually tends to reinvigorate my desire to finish my MPH (which I still fully intend on doing).
-----
A few days ago I attended the state medical society's annual meeting in the state capital. At this meeting, resolutions are debated, recommendations are made, and then resolutions are voted on. We, the medical students, have made some great changes to the state medical society's policies on a variety of things.

One student put forth an anti-bullying policy that explicitly states the position to oppose bullying in all its forms (including against LGBTQ individuals), and to encourage and support school anti-bullying training programs for students, parents, teachers, counselors, coaches, etc. The specific inclusion of the LGBTQ wording caught some controversy from a few physicians, as they felt it detracted from the "oppose bullying in all its forms." On the floor of the House of Delegates, there were some amazing testimonies from students and physicians in support of keeping the language. One physician (a plastic surgeon) stated that LGBTQ must be included in the resolution as is because, unfortunately, many people still don't see bullying against that population as a legitimate issue. And a med student said that, while LGBTQ students are bullied about as much as any other student, the severity of the bullying may be worse. In the end, the resolution was adopted.

My resolution was adopted without opposition (which is rather rare). I "merely" reworded the hospital non-discrimination policy to include: sex, gender identity, sexual orientation, race, ethnicity, religious beliefs, and disability. The original wording only included class, means, age, and gender. While this resolution may seem like a minor thing, it's really quite significant. With this, it means that every hospital in the state must be that much more inclusive in their non-discrimination policy.

There were other resolutions that we fought for. In retrospect, words can't quite convey the importance of what we were able to accomplish. To be able to, as a med student, change the state medical society's policy and stance on things is pretty impressive.

Change is possible. We are leaving our mark.

Finally!!

2011-03-26T23:40:00.003-05:00

Finally . . .

1. Shadowed Dr. P. Well, I guess I didn't actually shadow him as I shadowed his ID (infectious disease) fellow, Dr. S. She was really laid-back and really cool. Dr. P was supposed to mentor another ID fellow, but he never showed up. I was shadowing at a STI (sexually transmitted infection) clinic downtown. It's this small clinic that you'd easily drive by and never notice what goes on in there, lol.

It was really interesting, actually. Yeah, the diseases were all the same, but every guy had a different story to tell (the clinic wasn't set up to do pelvic exams, and hence few women go there). I also got to review some of my microbio with Dr. S, and now I know the treatments for chlamydia and gonorrhea pretty well (1g of azithromycin for the former, 250mg IM shot of ceftriaxone for the latter).

Afterwards Dr. P kept asking me if I was "alright" and if I was bored or not. And I was just like, "Hey, I'd much rather be here doing this than studying pathology right now." I like ID (not 100% sure that's what I'm going to do with my life, but), and I needed something to remind why I'm doing all this (the med school thing, that is). I can say though that I left that clinic with a smile. Go ahead, I know you probably think that's a bit weird, lol.

2. Met Drew. Finally!! We met yesterday at a coffee shop about 10 minutes from where he lives (and about 20 minutes away from me). I arrived earlier than him, because he doesn't drive and takes the bus, so I order a chai. Man, they took their sweet time with making that chai!

I see Drew walk in and he walks right by me. He turns around, I wave, and we say hi. The place was pretty packed, but a table had just opened up as he walked in. We sat down and just chatted. He has one of the prettiest eyes - it's a greenish hazel or something, and it's really nice if the light hits it just so. He also had an adorable smile (and his body appeared a lot fitter than I expected). He plays with his scruffy hair saying how he needs a haircut.

We start kinda joking wittily back and forth about random things, with him referencing a lot of TV shows and such. The witty banter was almost like a light-hearted game of chess - it was fun and kinda silly, hehe. Then he described his geology research (it was actually pretty interesting, however dissimilar from the research I've ever done).

It was good. Before either of us knew, more than 2 hours had flew by and he hadn't ordered a thing. He had wanted to but didn't want to spend the money on it. My friend called me wondering if I would make it to a film screening for Restrepo followed by a discussion with a Vietnam veteran. I told Drew that time was short and had to run soon. We chatted a bit more, and then I gave him a ride home since it was kinda on my way to the highway anyhow.

I never did give him that back rub. And I never collected my rein-check on that bj. But I prefer it this way - coffee date (of sorts?) with just some good talk, and the promise of more later. Later online he said, "It was nice meeting you btw, makes it easier to talk on here."

I like him. He makes me smile. I don't know if this will ever go anywhere or if it can. It almost feels like we're living worlds apart and, just for a moment late one afternoon, met at the boundaries separating us. I kept thinking halfway through, "Man, if only we had met sooner. If only we had a better/more efficient way of meeting. If only we weren't both super-busy. If only you still weren't in love with your ex, even though you know he's a worthless breath of air." C'est la vie.

3. Handing over the reigns. The new leaders for the student groups I've been heading for the last year have been chosen. All of them are competent and I'm confident that they'll do a good job. My obligations are winding down (as boards studying ever ramps up). Just a couple more events and a few "transition meetings" and I'm done!

Operation: Dragon

2011-03-19T15:45:00.004-05:00

Blue Dragon. by *Amisgaudi on deviant ART

Spring Break never lasts long enough. I only achieved about 1/3 of what I set out to do. :-/

Anyway, "Phase 2" will soon commence. Operation: Phoenix was a partial success, but now to begin Operation: Dragon. In many ways, it'll be similar to Operation: Phoenix only more intense, lol. Goals:

1. Be in bed by 12:45am (12:30am apparently was not feasible)
2. Wake up by 8:30am (8:00am apparently was also not feasible)
3. Continue the P90X program
4. Actually be serious about my diet
5. Buy a Qbank for the USLME Step 1 board exam and begin hardcore studying
6. Other

So I took a few pictures on Day 1 of P90X and like, Day 42-ish. I didn't think I'd see a huge difference but I was surprised! Now, I'm nowhere close to the amazing bodies I've seen people accomplish on the program, but the progress for me was visible (if only a tad subtle). I also apparently lost about 6-8 lbs, which was kinda surprising too. Unfortunately, I've kind of taken the last 2.5 weeks off so I'm going to restart the program from the middle of Phase 2 (instead of going right ahead to Phase 3). I'm hoping for better results this time around! (Sorry, no before and during pics for you all, hehe - still pretty self-conscious about that.)

As for diet, sigh, my body's stupid. -_- I just had my physical check-up at the beginning of the week and apparently, my triglycerides are about 2x normal. Everything else is good though. How does that happen?! o_O Apparently, I should eat fewer sweets, fewer carbs, and drink fewer alcoholic beverages. But . . . I don't eat that many sweets (generally), I don't eat that many carbs (usually), and I seldom drink. Granted, I did eat a lot of gummy bears when I'm at my friend's place in the last 3-4 weeks and I did have a few beers to celebrate a friend's b-day right before break, maybe that's the cause? Hmmm. Weird.

I've really got to get on studying hardcore for the board exam. Got to buy a Qbank and do 10-20 questions a night until May, at which point I'll have to kick it up several notches. Also, I must review my books for that exam a bit more in-depth now.

Lastly, Drew is on Spring Break this coming week and my week is fairly lax. Meaning, we will (somehow) find a way to meet each other this coming week. I've promised him a back massage, lol. I did also take a rein-check on a blowjob he offered like 3 weeks ago, but I'm not holding him to that (not right now, anyway). :-P

What Brings You In Today?

2011-03-11T23:30:00.006-06:00

So I didn't do as bad on my pharm exam as I had feared. Not as well as I'd like, but it's an acceptable score. Moving on . . .

Physician 5 by ~stitchxwitch on deviant ART

One of our courses this year is on learning how to take a history and physical exam. It is almost entirely what you make of it. I have friends who simply go through the motions of doing a physical exam and are almost unable to distinguish a normal heart sound from bowel sounds (a slight exaggeration). It is insufficient to simply go through the motions when, come July, interns and residents will ask us to do a physical on a patient and expect to trust our findings.

Last week I had a 71-year-old patient. He had a rather extensive history and an "impressive" medication list. I recognized and knew the mechanisms of action for over half the drugs he was on (because we were just tested on those drugs the day before). His physical exam was a bit tough (as for some reason geriatric patients are always tough for me). Being overweight doesn't help either. :-/

This week I had a 13-year-old patient. Have I ever mentioned how I love pediatric patients (insofar as doing physical exams)? I could hear her heart and lung sounds so clearly. Her reflexes were easier to find. I felt her abdominal aorta. I've never felt anyone's abdominal aorta before (because one has to be rather lean in order to feel it, unless one has an abdominal aortic aneurysm - in which case it's a medical emergency!). I finally figured out the ophthalmoscope and saw the red reflex and the optic disk in the back of the eyes. Looking in ears have always been rather easy for me - I even once got a 2-year-old with an ear infection to cooperate with me!

It is truly a privilege to be able to ask someone, "What brings you in today?" and "How can I help you?", and have them tell you something so intimate and for you to (hopefully) be able to do something tangible about it. It is a privilege that people allow us to touch their bodies in sometimes weird and uncomfortable ways to figure out what's wrong.

Come July, I expect myself to be able to do a physical exam to the point where I can, at minimum, tell a resident what is "normal" and what is "abnormal." Unlike my friend, I will not mistake a bowel sound for an abnormal heart sound.

P.S. I've really got to get myself a clipboard.

Defeated & Scattered

2011-03-06T22:30:00.004-06:00

I had a pharmacology exam last week. It was brutal. Memorizing 200+ drugs - how they work, what they work on, what they're for, when not to take them - is brutal. There was one question where I literally wrote: "I forget and I give up. I'd rather admit this than make up a drug like loperamine." And then I drew a sad face. With a single tear.

Yes, I felt defeated. I still kinda do. I'm tired and I'm scattered. My desk is a mess (it's an accurate reflection of my current state) and I haven't felt motivated to clean it up. And for the first time all semester, I didn't work out 6x/week (P90X) consistently. :-/

There are many things I should do. There are many things I have to do. But I can't seem to remember what most of them are right now. ::Thinks::

Haven't met Drew yet. I'm not sure when/if that'll happen. He's busy, I was busy. He's apparently been dating a couple of guys (sigh), but it seems none have what he's looking for in a relationship. Perhaps I'll have better luck? (At least I got his address . . . he had wanted an impromptu back-rub and to give a bj that I refused - why? I'm not sure.) I've told him either Monday or Wednesday this week would work for me, or else I'm calling him out on a Saturday after Spring Break (next week for me - excited to go home!). Let's see how he responds.
-----
Anyway, in other news . . .

Zheng Lab - Bad Project (Lady Gaga parody)

I found this hilarious. I could sympathize with the person in there (having worked in similar labs before). And I love how her dresses were made of lab materials, lol.

Tonight I'm Frakking You

This is hilarious as well. I think the person in the Princess Leia cos-play is pretty attractive, haha.

Life in Adagio

2011-02-17T00:00:00.005-06:00

Adagio: a slow musical tempo.

These last few days my life felt as if it's moving to an adagio tempo. Valentine's Day came and went. I spent most of the day studying for an exam the following day, ironically an exam on human sexuality.

My best friend from undergrad is getting married. I just got his save the date. He and his fiance look so happy together. I've known the both of them for the last 6 years or so. I was looking at their engagement pics earlier tonight, and I really like the theme they chose. And as I clicked to RSVP, there was a slot for how many guests and I would be at one. I hesitated and didn't complete it. I'll do it later I guess. Weddings have been really weird for me for the last 3-4 years.

I came across the following a month or two ago (on this site):
I couldn't have put it any better. I've been chatting with Drew off and on, as usual. Earlier tonight he said something like: "We still haven't met yet, this must be corrected soon." It seems like we're tentatively planning to meet up on a Friday in the near-ish future. Trying to catch him online is kind of like throwing a dart at a board with one eye covered, haha. Here's hoping for good things, but I'm not sure we'll progress much farther than "just friends." Hopefully I'm wrong, but I'm not sure how one could maintain a decent relationship during rotations.
-----
Adagio: a slow musical tempo.

Adagio for Strings by the YST Cello Choir

This is one of my favorite arrangements of this piece. It's such an expressive piece and it perfectly describes my mood these days. While Barber's Adagio for Strings has been described as one of the saddest pieces ever, I don't necessarily hear "sadness." It is, for sure, one of the most beautiful and emotive pieces I've heard with the notes painstakingly drawn out without so much as an accelerando. I hear a resignation that describes the world as it is, a kind of eternal reflection. Not necessarily sad, but it can be perceived as such.

Here's a recording of the original piece (not an original, the original as conducted by Toscanini who Barber himself requested to conduct it).

Finally, to end with a quote I found on my brother's Facebook page:

"Pray that your loneliness may spur you into finding something to live for, great enough to die for." ~Dag Hammarskjold

You've Gotta Go Deeper

2011-02-10T01:20:00.005-06:00

A few weeks ago I posted my recount of the female pelvic exam. So last Thursday I walked over to the urology clinic with other med students to do the male genitourinary exam. This is what you've all been waiting for, lol. But . . . it was rather anticlimactic.

So we walk over to the urology clinic, which is (curiously) in the lower level of the hospital. We were to examine a male standardized patient in groups of 4-5 with a resident or an attending physician. My group got this really nice and laid back resident. I especially love his preface with something like, "You know, urology is great. I never thought that I'd be doing what I'm doing, but I love it. As long as you can explain to your kids why you're not a pervert, and explain to their parents why you're not a pervert, then you're good to go. And within medicine, it's a highly highly respected field."

Some more chatter to relieve the inevitable tension of the situation (though less tension than for the pelvic!), and then we enter the tiny exam room. Sitting in our room was a guy in one of those hospital gowns. As soon as he lifted his gown, we noticed all his tattoos and he looked like your stereotypical biker guy (beard and all!). He later told us that he uses the money from doing these things to get more tattoos, lol.
So as with all exams, it begins with inspection. Some things to note: circumcised or uncircumcised, symmetry, and anything "weird" (lumps, bumps, sores, etc). This part is so important that the resident told us that if we were to ever consult urology after doing a male exam and didn't note whether the guy is circumcised/uncircumcised, then they think we didn't really do a male exam. Our guy was circumcised (unlike the prototypical picture above, and unlike 70-80% of guys on the planet - but still pretty common in the US).

Next was palpation. So basically, just feel along the penile shaft for any lumps/bumps that can't be seen, and gently open the meatus of the urethra (pee hole) to make sure nothing's wrong there. Note that it's "patent."

Then examine the testicles. There's a particular technique to "trap" the testicles between the fingers so it's easier to feel without causing (much) discomfort. Feel for lumps/bumps, find the epididymis, the spermatic cord, etc. Ask them to cough and then feel for any varicoceles.

And finally, do a hernia exam. This was actually a tad tricky, because you have to follow the spermatic cord back into where it goes into the body (and it's not as easy as it'd necessarily seem) and then ask them to cough. Our guy had to constantly tell us whether or not we were in the right area. Often he'd say something like, "You've gotta go up and you've gotta go deeper." Yeah, that was a bit odd, lol.

We didn't do a prostate exam on him. Instead, everyone did a prostate exam on a plastic model. Eh, chances are I'll never really need to do one anyway (in peds), so whatever.

And that's that. Clinical, short, easy. Like I said, rather anticlimactic and not very exciting. Our guy could've used some lotion on his penis, it looked rather dry to me (especially the glans). ::Shrugs::

Mask of Ideas

2011-02-08T23:35:00.005-06:00

i used to have great ideas by *Formor on deviant ART

"We are told to remember the idea, not the man, because a man can fail. He can be caught. He can be killed and forgotten. But four hundred years later an idea can still change the world. I've witnessed firsthand the power of ideas. I've seen people kill in the name of them; and die defending them."

I just watched V for Vendetta (finally) last night. It's definitely one of the best movies I've seen. I can't believe it's taken me this long to watch it! I love the premise of the movie. That an idea can be so powerful and consuming is certainly thought-provoking.

And so I ask: what was the last idea that you felt was worth fighting for? The last idea that was worth risking something for? Sacrificing something for?

While there are few ideas of mine that involve much risk, ideas have been consuming my time of late. Before this year, I never considered myself an advocate of much. There were few ideas that I felt passionate about to actively champion. But here I am, advocating for change and improvement. That ideas can be so enrapturing and form a mask is very real.

As I may have alluded to in the last few posts (or maybe not, I don't know), the idea of "diversity" has become my cause. Diversity competency has been slipping from the medical curriculum here, and that's not a good thing. It's such an easy thing to cut since with advances in medicine, there's more to learn and as they saying goes, "Something's gotta give." But as the patient population becomes more diverse, we must be keeping pace with being comfortable and competent to treat any patient that walks through our doors. As such, I've been working with the Office of Diversity, with the student Diversity Committee, with other students in the AMA (American Medical Association) to push for resolutions in the state medical society, and within my own student organizations.

And I never imagined I'd be doing what I am now, that this would be my idea and cause. I always thought that someone else with greater passion than I would take care of it. Clearly it hasn't been done, and so I step up.

But in that same quote above, follows the next line:

"But you cannot kiss an idea, cannot touch it or hold it. Ideas do not bleed, it cannot feel pain, and it does not love."

And this makes me wonder. What am I missing/sacrificing? That line rings true. I can't kiss, touch, or hold my ideas. They're intangible thoughts and only their actions can be become manifest, not them themselves. And sadly, I haven't experienced this thing known as "romantic love." I don't really know how to go about it. I run into walls and barriers every time I try. Have I, perhaps, diverted that energy towards an idea/cause bigger than myself instead? Who knows.

And coming back from school today, I thought to myself: what is the idea behind our white coats? What does it mean and symbolize? All I see is something that gets dirty incredibly easily but fortunately has a ton of utility (in its many pockets). The white coat doesn't make me better or smarter than anyone else, I am no different, it doesn't make me impervious to anything, so is there an idea behind there that I can rally behind?

Because you see, in pediatrics, few people (residents and beyond) wear their white coats and they often seem relieved to not have to . . .

Such existential questions behind this mask.

Happy Chinese New Year!

2011-02-03T22:50:00.003-06:00

Zodiac The Rabbit by ~Dei--dara on deviant ART
新年快乐！恭喜发财！身体健康！

So yeah, I hope everyone had a great day. More posts coming soon (I hope)!! :-P

On the Wings of Progress

2011-02-02T23:45:00.003-06:00

Well, it's been a while, hasn't it? My apologies.

You see, my life is nothing if not busy (even if being busy means playing a video game when not studying . . .). Much has happened since I last posted here, too much to cram. Most important is that which ride on the wings of progress.

Right after my last exam, I had a meeting with the Dean of Student Diversity here. She's by far my favorite dean to work with. We discussed what changes need to be implemented to make the medical campus more LGBT friendly and promote diversity in general. Some key issues included: admissions, visible signs to show tolerance, improving the curriculum to better meet the needs of a diverse patient population, recruit more diverse standardized patients, and anything necessary for the new medical educations building (e.g. a unisex bathroom for transgender people). I left with a very positive feeling that things will change, that things will improve.

Later that week, I met with some students to write resolutions to be presented to the state medical society (the body that governs the practice of medicine within each state) that focused on LGBT. One resolution I helped write was to edit an existing resolution in order to include "sexual orientation" and "gender identity" in hospital non-discrimination policies across the state (because "gender" isn't the same as "sexual orientation" and "gender identity"). Another student wrote a resolution to promote anti-bullying programs in K-12 schools.

And now for a couple things I came across on Facebook earlier this week:

Gay Marine's husband surprised at respect shown by Naval Academy

Zach Wahls speaks about family

This is quite a moving and powerful speech he gives.

---TANGENT---
So I'm still doing the P90X program. I'm about halfway through the 4th week. I haven't seen (or felt) that many changes. I suppose my arms are a tad leaner, my legs a bit more muscular, I'm a bit more flexible, and you could perhaps see the shadow of abs underneath the flab. That's about where I'm at right now. I've found the "yoga" and the "ab ripper x" particularly difficult. Yoga because it's just so long (I haven't been able to complete it from start to finish yet)! And the ab exercises are just so difficult that I simply can't do the number of sets at the speed that they go at. :-/
---END TANGENT---

Righteous Fury

2011-01-20T23:45:00.006-06:00

Righteous Anger by *kysius on deviant ART

This has been a post that I'd been sitting on (at least, in my head) for quite some time.

All throughout last semester and into this semester, I've put for so much effort into pretty much everything. I've been able to accomplish pretty much everything I set out to do. I kept my promises and made things happen. And so when someone tells me that they want to do something but wasn't able to, I feel a pang of something akin to righteous fury.

One med student announced that she had wanted to expand a program to other high schools, especially more inner city schools. Never mind that I gave her a couple contacts that I had made at such schools that were interested in her program. That, to me, demonstrates a lack of effort or follow through. Another med student told me that she no longer wants to organize an event that she had been in charge of since day one. All because she was unable to contact a particular person. There are so many other physicians out there who can speak on the topic!!

There have been days where, either sitting in meetings with med students or at events, that I wanted to almost scream out, "Step it up! Do what you said you'd do and follow through. Take responsibility. Use your best judgment. You're going to be a doctor one day and be responsible for patients' lives."

Anyway, enough ranting on that. I've an exam next Monday on hematology. Ugh, I hate hematology with the fury of a thousand suns. Anemias, leukemias, lymphomas - they all sound the same to me, and they all have similar presentations!! For the first time, I feel like I'm actually in danger of failing an exam in med school (or otherwise doing really poorly). T.T

At least I got my 2nd choice for my M3 rotation schedule. I actually like most of the people in my track. Incidentally, my crush is in my track! o_O He's like the only guy in my class that I have an attraction to. He's also one of the nicest guys I've ever met - he always has a smile and is just a happy-go-lucky guy. Too bad he's straight and is living with is his girlfriend. ::Sigh::

Operation: Phoenix

2011-01-09T23:30:00.007-06:00

Phoenix by *Ahyicodae on deviant ART

The phoenix is a mythical bird of fire that is said to consume itself in its own flames, turning back into an egg amongst the ashes and becoming reborn anew. As such, the phoenix is a symbol of rebirth.

One of my New Year's resolutions is to undergo a personal kind of "rebirth," as it were. My attempts in the past have often only meet with lukewarm successes, at best. This time, I shall stick to a more short-term but more intense schedule. Specific aspects of this include:

1. Sleep (aka, be in bed) by 12:30am every week night
2. Wake up by 8:00am every week day
3. Do the P90X (specifically the "P90X lean" program) every morning before breakfast
4. Be more cognizant of my diet

Operation: Phoenix clearly focuses on diet and exercise. With so much going on this semester, I need to focus on getting myself in order first. The theme of the semester is routine. And since I just schedule my USMLE Step 1 board exam (eep!), that's going to be the other monster I need to handle.

I've heard great things about P90X (as long as one sticks to it), so I hope it works for me as it has so many others who've stuck to the program! I'm aiming for a bare minimum of 60 of the 90 days of the program. That'll be right before Spring Break for me (not that I'm going anywhere where I can show off my hopefully "new" body anyhow, alas). Also, the link above for "before breakfast" is to an article on the benefits of exercising before breakfast. It's actually doubly nice since by working out first thing in the morning I: 1.) can't avoid it easily, and 2.) get it out of the way.

With some luck, I may get a body similar to the ones below (I don't remember where I found the following pics):

And so, let Operation: Phoenix begin!!

Now You Feel It!

2011-01-07T23:00:00.006-06:00

This semester really hit us fast and hard. I was (and still am) unprepared. And before you proceed with reading the rest of this post, steel yourself; because you see, we just learned how to do a female pelvic exam. Proceed with caution.

It's definitely something that I'm sure many of you reading now will never have the "pleasure" of experiencing (because you're guys and likely gay/bi). I can't say that I blame you. The female pelvic exam is one that every med student is uncomfortable and nervous about the first time. But, after actually doing it (and seeing it done 5 times before I did it), I can confidently say that it's not that bad - as long as you're aware of a few things.

One, know the planes of the female anatomy. See, here's a cross-section picture from Netter's Atlas of Human Anatomy:

And here's the same picture turned 90 degrees:

A few things to notice: 1.) the uterus points "up" towards the belly/ceiling, 2.) the vagina tilts "down" towards the floor, and 3.) the bladder is in front of the vagina and uterus. All of this is critically important.

Two, be ever conscious of everything you say. Never say "oops" or "I think." Those are key words to get you kicked in the face while you're down there.

Three, go slow and be careful! This is one exam where you can actually hurt a patient. And you see, because the vagina is tilted down, you don't insert the speculum straight in but angle it down as you go.

Four, the cervix, uterus, and ovaries aren't "fixed" in place and can move about a little inside the body. That can make finding things a tad tricky . . .

Okay, with those 4 points in mind, the pelvic exam! Our volunteer patient wasn't the "ideal" patient as she was heavier, older (post-menopausal), and had something called a "retroflexed" uterus where instead of pointing "up" it curled over and pointed down. BUT she was an amazing patient otherwise. I also got stuck holding the speculum for everyone. -_-

The exam is pretty straightforward. First examine the external genitalia. I don't know what the big deal is, but the clitoris actually isn't hard to find. Then do the speculum exam, keep in mind the points above. All that was the easy part.

Now, the harder part (IMO) is the bimanual exam, where you stick 2 fingers into the vagina, have your fingertips behind the cervix, and push "up" so that the uterus bumps up against the abdominal wall. I was skeptical about being able to feel the uterus (and especially the ovaries). Because I was the last of 5 students to go, our patient's bladder filled up and pushed her cervix and uterus to the right - which made it difficult for me to examine, grrr. At least our patient told us every time we felt her uterus/ovaries (she was very in tune with her body). She'd say with an odd smile, "Now you felt it!" And we'd all be like, "What? Let me try that again. I feel something, I just don't know what it is."

Anyway, that's that. TMI perhaps, but I just had to share. It's not every day that you can say that you've had your fingers down a woman's vagina and felt her uterus and ovaries (which I still can't distinguish from other things in that region internally). And truly, it was a good learning experience because the patient and physician were both awesome.

Questions? Yes, it smelled a bit but not too bad, hard to describe though. Also, different sex positions suddenly make a lot of sense, lol (light bulb moment for sure).

Re-Introduction: The Masks We Wear

2011-01-02T23:20:00.004-06:00

Mask by *Samurai-PET on deviant ART

Many of you have followed this blog for some time since its inception 4 years ago. Some of you may be new followers or just stumbled across this. I've witnessed the rise and fall of many blogs, and somehow mine endures and survives the tests of blog-time. Though lot has happened in these last few years, this blog's purpose is still unfulfilled; thus, it endures. And so, a re-introduction to The Masks We Wear.

I'm Aek (my pen-name here), an Asian-American born and raised in the Midwest USA (and still slowly clawing my way out of this frozen north). I'm 24-years-old, and that makes me old enough to have friends getting married and to have witnessed the deaths of a few friends and acquaintances. Life is a stubborn yet tenuous thing. And I feel older than I should be.

Over these last few years I've worn or displayed one of several of my masks, each tailored for a specific situation or to reflect/hide a different aspect of me. And through these years, I've slowly witnessed several of my masks consolidate or else become supplanted by my Mask of Medicine (accursed med school!).

Where I've been, how far I've gone, how far I've yet to go, you're all welcome to read - to join and follow along as I begin to take off some of these masks. But you see, there are some masks that lie underneath my outermost masks. Will you see more than my eyes this year? I wonder.

2010, What a Year!

2010-12-31T22:45:00.005-06:00

Here it is at the end of 2010, minutes until 2011 (yeah, I'm blogging now since I've nothing better to do). I must say though, 2010 was full of ups and downs, and I welcome the new year with mixed emotions. On one hand, I can't wait for 2010 to be over, on the other, I'll miss it. It's been one heck of a year looking back!

Early in the year, I had met a guy online and met him for a coffee date of sorts. Alas, it wasn't meant to be and ended almost as fast as it started.

I shadowed Dr. P in ID (infectious disease) for the first time, and that was a great (albeit, somewhat nervous) experience. I'm going to make it a point to shadow him again in the next month or so, now that I know some more!

I visited some of my friends in DC over Spring Break. It was one of the best Spring Breaks ever, and I sooo needed it.

I became the president for 2 student groups, APAMSA and LGBTPM; and co-chair for 2 student-run programs. It's been A LOT of work, but somehow everything happened more or less as planned.

To begin the summer, my roommate and a friend took a weekend trip to Chicago.

I spent 8 weeks over the summer on a pediatric externship. First in peds ID, then in primary care peds, then in peds rheumatology. It was one of the most meaningful learning experiences in my life to date.

To top off my summer before heading back to school, I visited 2 of my friends in NYC, another amazing (albeit too short) trip!

In September, Dr. P helped pay for all but my plane ticket to San Diego for the GLMA Conference. It was a pretty eye-opening experience and a great one to meet so many diverse people. Also met blogger Mike of Random Thoughts In My Life while I was there!! :-)

And lastly, my friend's starting up a non-profit in 2011, and he's asked me if I'm willing to sit on his board of directors. So it'll definitely be one heck of a way to kick-off 2011!

With that, HAPPY NEW YEAR!!! :-)

Step Into the Light

2010-12-27T23:55:00.004-06:00

Step Into The Light by ~eMadman on deviant ART

If you haven't noticed by now, my blog layout has changed (rather dramatically). In the past, the color scheme has always been within the darker palettes. In some way, that conscious decision to keep this blog with the darker color palettes has reflected something within me.

And now I feel like it's time for a change. It's time to step into the light. Things have shifted around a bit, but the core content hasn't changed. Only the blog title panel designed for me by a blogger who blogs no more remains as a relic of the past.

I'm not yet sure how this change in the blog layout will reflect the direction of this blog going into the new year, and its fifth year. Wow, have I been blogging that long?! Anyway, to those who've been following for a while now, step into the light and walk with me for the fifth year. Let this change represent a rebirth of sorts, let it refresh within me the reason(s) why I blog and within you why you choose to follow.

Lastly, I came across the following while passing through some blogs:

Greyson Chance - Waiting Outside the Lines

You never enjoy your life
living inside the box.
You're so afraid of taking chances,
how you gonna reach the top?
Rules and regulations
force you to play it safe.
Get rid of all the hesitation,
It's time for you to seize the day.

---TANGENT---
If you haven't been over to Ron's blog at I'm Keeping Score, do so NOW. He's having a tough time (as you can read from his last few posts) and can really use the support right now. Many of his greatest fears have materialized and we need to help him through this dark time.

Send him lots of hugs and show him the true light of support and love that we all are able to provide.
---END TANGENT---

Agent of Change

2010-12-21T22:35:00.005-06:00

change the world by ~moshimoshimoo on deviant ART

Have you ever had the feeling that you're on a journey to seek out your purpose in life? That there's something you can do to change the world, in whatever small way you can? That something out there needs to change?

It's a feeling that's been growing in me recently. I read articles about things like the Embrace baby warmer for premature infants, designed by a group of engineering students at Stanford, or about the gay teen in AZ changing things for LGBT youths posted over at You Could Have It So Much Better, and I kinda wonder what I've been up to these last few years. Sometimes I feel like I should've accomplished more by now.

But then I realize that I should step back and take things into perspective. What is the kind of difference and change I want to make? What have I done? What can I do? What might the future hold? Time, energy, and effort are all limited resources. So with some perspective, a few things come to mind.

First, short-term are the various things I'm doing through student organizations. Patient Education was on the verge of being axed from the free clinic. T_T However, since we changed the flow of the program 3-4 weeks ago, the managers have agreed to let the program survive another year. Phew! Hopefully we'll be able to reach out to more uninsured patients at more than one free clinic in the city, and educate them on how to take control of their own health. Also, basically reviving the LGBT group to a semblance of a group from practically nothing is no simple feat.

Second, in the near future, my friend - who I've known since kindergarten - is starting a non-profit. He has asked me to be one of his board members. The central idea of his non-profit is simple (aren't all great ideas simple?): to provide kids with someone who will move with the kid through grades 1-5 and provide guidance, encouragement, and help. I'm incredibly proud and honored to be considered to help him with this endeavor! I could go on and on about the merits of his idea, but perhaps in another post.

Third, in the far(ther) future, my friend AG-F and I will make our video game project a reality. Over a year ago, we had drafted the concept of a video game to educate kids (and adults) on genetics. Now AG-F works practically across the hall from the professor for whose class we wrote the project for. Evidently we made a big impression as he keeps talking about it now! So yes, we promised each other that one day we will finish what we started as just a class assignment.

And so, I think in each of our own small (or big) ways, we can become agents of change. For the better or for the worse, that's up to us to decide. As Gandhi said:

"Be the change you wish to see in the world."

---TANGENT---
In case you haven't heard the news (as if it's possible miss something this big), DADT was repealed!! About time. A lot of human resources were wasted in the military as a result of this silly legislation. Listen to one soldier's account here, it almost moved me to tears. I don't think when that was recorded months ago, that he thought a repeal would happen within the year.
---END TANGENT---

Lost in Conversations

2010-12-12T12:05:00.004-06:00

Well, no comments on my last post. Whatever, no answers for you. :-P
-----
Anyway, a couple days ago I called my best friend from undergrad to wish him a belated birthday and to just catch up. We've both been quite busy, what with me in med school and him in grad school halfway across the country. Now I'm not normally the kind of person who likes chatting on the phone for hours, but we chatted for almost 2 hours!

I could chat with him for hours. I always appreciate his perspective on things and he's probably one of the like five people who I can let my guard down and be completely open with. And that's saying something. After being surrounded by med students day and night, constantly discussing and whining about classes, it's refreshing to talk to someone whose background is just so radically different (he's doing his PhD in political science). We talked about anything from arsenic-eating bacteria to parasite-carrying flies in Africa (to which he suggests a genocide of all the flies) to Liu Xiaobo to the idiocy of certain Midwest governors for refusing federal dollars for constructing an interstate high-speed rail system.

I also found out that his fiance doesn't have texting. People without texting unite! Lol.
-----
On another note, remember Online Guy 2 (Drew)? Well, we've been chatting here and there online for almost a year now. And I still haven't met him in person. :-/ He doesn't have a car and doesn't particularly care to travel halfway anywhere to meet up. Or should I say, didn't?

I had previously discounted a possible relationship with Drew for a variety of barriers. The least of which is the 30 minutes or so that separate us (rough estimate). But he had been having some very rocky months with his ex-boyfriend and almost every time I chatted with him he wasn't in a good place. Recently things have been looking up though since they broke up for good.

Last night we chatted online for a few hours. We first talked about our desire to travel and such. And then he wrote, "Maybe we should finally meet in person, get to know each other, and do something like that [camping]." Apparently he likes camping and I've never really gone. That sounds fun (though certainly not in these winter months here), and thankfully the only real thing I have to worry about is Lyme disease, lol.

So progress? Hmm, we'll see where this goes (if anywhere). It'd be nice if he'd want to meet up somewhere for a coffee date or something (except I can't remember if he said he liked coffee or not). Our conversation then became quite sexual, which it never had in the past. I guess we were both kinda horny. It was kind of fun making him even hornier online, hehe.

---TANGENT---
So I recently came across this:

It Gets Better by Chris Salvatore

He's really attractive and has a great voice. Though, he makes some rather over-exaggerated facial expressions when he sings, haha. He's also not afraid to bare it all either!

There are some parts of this song that's quite cheesy. However, I like the following refrain:

We will make it, we're stronger,
for all the pain they put us through.
Words won't hurt us, no longer,
our dreams will be what get us through.
And when it feels like your whole world is ending,
remember me and all the other ones saying,
"It gets better, believe me."

---END TANGENT---

Power to the End

2010-12-08T00:30:00.003-06:00

- Health Fair: check
It's good to finally be done with the Health Fair. That event took more effort to organize than I expected! It also takes a lot of people to make the event a success. Alas, the snow thwarted even the best in planning; as a result, not as many people as anticipated showed up, but it was still fairly sizable. I'm in the process of writing a manual of sorts for next year's students, such that it can be even more successful (despite any potential snow).

- Autopsy viewing: check
This morning my group finally got called to go in to see an autopsy. We had been on call for a week now, and it was annoying having to get up earlier than necessary just to wait for that page. I must say, viewing an autopsy is rather gruesome. And all the coroners have rather dark humor. That first cut into a freshly dead body smelled worse than the preserved cadavers we worked with in anatomy lab last year (and I thought that smelled bad!).

- OKCupid profile: deleted & re-made
So last night, my friend asks me about my OKCupid profile. I had never revealed that I had such a thing to her or anyone else in my class. But someone in our class had come across my profile and forwarded it to her. Naturally I freaked out a little inside. I have some personal info on there that I don't want anyone in my class to gossip about. Hence, I promptly deleted my profile and created a new one that's still in the process of being fleshed out. This time, I'll be more cautious, especially with pics.

- Exams: next week
So final exams are next week. Ugh. Cumulative microbio final won't be fun. But, just gotta power through to the end. Can't wait until they're over. Also, I should probably register for the USMLE boards this week . . .

---TANGENT---
So, a few days ago, a friend of mine here in med school linked me to the following (her friend is the lead singer):

Muse - Resistance (A Capella by Uni. of Chicago)

The original is here.

Is our secret safe tonight?
And are we out of sight?
Or will our world come tumbling down?
Will they find our hiding place?
Is this our last embrace?
Will the walls start caving in?

I love that first stanza. Something about those words just echoed with me. Maybe it's the loneliness talking, who knows. There's something romantic about it.

Anyway, I realized like a month ago that I now have 101 followers! :-) Thanks for following! I think for my next post I'll do something special. Hmm. So I pose this request: comment in this post and ask any 5 questions you want, and I'll answer them (to the "reasonable" questions). So go! You've only got a couple days, as I'll get sick of studying for finals at some point and will need a break anyhow.
---END TANGENT---

By Starlight

2010-11-29T00:21:00.005-06:00

Orion Constellation by ~Eric-P on deviant ART

A few days ago, I managed to catch up with an old friend who I had known since kindergarten. We were next door neighbors for years until my family moved to a different part of town just before 8th grade. We had drifted apart - it being in the years before cellphones and high-speed internet (I almost can't believe that!).

I had told him how, upon returning to town, I looked up at the clear night sky and for the first time in perhaps years, I saw the stars. I saw the constellation Orion, clearer than I had ever seen it before from home. In response, he told me how a while ago, while backpacking with friends up north, he looked up to the clear moonless night and saw only the stars. There was so much starlight that everything around had a soft glow. And not just your typical stars, but stars of different colors - reds, oranges, yellows, blues - that you'd normally never see. It was later under this same starlight that he proposed to his fiance. Words could not describe how beautiful the world looks under nothing but starlight.

And I thought to myself, when was the last time I had that sense of amazement? Or any sense of amazement, really. I remember looking up at the stars as a kid and reading about every constellation, every star, every nebula, that I could look up. I wondered, when was this sense of awe and amazement quenched? When does growing up suffocate the curiosity and wonder of childhood? Becoming an adult is a perilous thing to the capacity of kids to dream.

Recently, I had a brief moment of amazement (granted, a somewhat twisted version). You see, viruses amount to nothing more than RNA or DNA, some proteins, and perhaps less than a dozen genes. And yet, without consciousness, without cognitive intent, viruses naturally just infiltrate our bodies and subvert our own cells to serve their own ends. How curious that we all share the same building blocks of life, the same atoms, and yet we must be so antagonistic. And on a loosely related note, how all thought and sensations are but the products atoms interacting. There's nothing of substance to our thinking, and yet like magic we make real what's only illusion - we materialize it in words, sounds, writing, actions, etc. To think that an orgasm or love are just chemicals interacting with each other at the right time and place, now there's some awe in that.

You may not think so, you may not agree, you may not even care or are thinking "wtf." But when was the last time you took a moment to take in something and think deeply about it - to reduce it to it's simplest elements and marvel how something so complex and, indeed, miraculous came about?

Anyway, enough of my rambling.

Thanksgiving, Finally

2010-11-23T00:25:00.004-06:00

Hey all,

Still alive . . . somehow.

Micro virology exam: check.
Laundry folded: check.
Things packed: check (mostly).
In bed before 12:30am: evidently not.

Anyway, this is perhaps the last chance I'll get to blog until I get back from Thanksgiving break. Not much to say, really. Did alright in my micro exam. I didn't do as well as I wanted, but not bad either. The class average better not be higher than my grade (of 86%)!!

I finally finished watching Top Chef: Just Desserts. Not as good as the original Top Chef, but entertaining nonetheless. I must admit, I partly watch it because of Yigit Pura. God, his desserts on that show are as delicious-looking as he is! Okay, that just sounds weird, but whatever.
Here are some links to more pics of (several shirtless :-P) and info on him: Project Q, Bravo TV, The Advocate.

And here's his YouTube blurb for the It Gets Better Project:

Lastly, for anyone who's ever played the game Pokemon, listen to this. You will be blown away.

Alright, that's all for now. Kind of a random post. Happy Thanksgiving!! :-D

Life is a Boat

2010-11-09T00:25:00.003-06:00

Rie Fu - Life is a Boat

Nobody knows who I really am
I never felt this empty before
And if I ever need someone to come along
Who's gonna comfort me, and keep me strong?

We all are rowing the boat of fate
The waves keep on coming and we can't escape
But if we ever get lost on our way
The waves would guide you through another day

(Japanese)
Far away, I'm breathing, as if I'm transparent
It would seem I'm in the dark, but I was only blindfolded
I give a prayer as I wait for the new day
Shining vividly up to the edge of that sea

Nobody knows who I really am
Maybe they just don't give a damn
But if I ever need someone to come along
I know you would follow me, and keep me strong

(Japanese)
People's hearts change and sneak away from them
The moon in its new cycle leads the boat again

And every time I see your face
The ocean heaves up to my heart
You make me want to strain against the oars
And soon I can see the shore

Oh, I can see the shore
When will I ever see the shore?

I want you to know who I really am
I never thought I'd feel this way towards you
And if you ever need someone to come along
I will follow you, and keep you strong

(Japanese)
And the journey continues on quiet days as well
The moon in its new cycle shines on the boat again
I give a prayer as I wait for the new day
Shining vividly up to the edge of the sea

And every time I see your face
The oceans heave up to my heart
And make me wanna strain at the oars
And soon I can see the shore

(Japanese)
We are all rowing a boat of fate
but the waves keep attacking us
But isn't this that still a wonderful journey?
They are all wonderful journeys

Translation found here. Sometimes certain songs just resonate, you know? I wish I could be beyond the 3rd stanza of this song, oh well. Anyway, I first heard this song as the ending theme to the anime, Bleach.

Here's a vid of it:

I'll Let You Take the Lead

2010-11-02T23:45:00.003-05:00

Well, I don't know. Still here. Still stressed. Still sending out a ridiculously high volume of emails. Still just pushing on through. Nothing really new to update.

The above two have been stuck in my head for the last 2 weeks or so. I actually printed the sheet music for the cello part to the first piece, though I haven't had a chance to sight-read through all of it. The second song my friend described as, "I'm sorry but this is so the kind of stuff when I went to gay clubs back in LA." I was amused.

This is all.

Catharsis

2010-10-25T16:20:00.004-05:00

Now that this round of exams is done, the "what I learned at the GLMA Conference" post, as promised.

I just talked to Dr. P about it earlier today and how to move forward with the info we (I) learned. I've basically grouped it into 3 categories: immediately useful/actionable info, good to know info, and personal.

1. Immediately useful/actionable info
Students. 29% of LGB students aren't out, mainly because it's: nobody's business (fair enough), fear of discrimination, and fears of not getting into a residency of choice. About 60% of transgender med students aren't out. Few med students feel that med school curriculum has adequately prepared them to serve LGBT patients. Students want more clinical exposure, more cases, lectures, and supportive faculty that they can turn to. On average, med schools in the US and Canada spend about 5 hours over 4 years on LGBT health issues (not including HIV).

Med schools. Deans of med schools have a different view on things. Most (68%) have LGBT content interspersed throughout the 4 years. It should be noted that 79% of med schools have no LGBT clerkship rotation sites. Transgender health issues are rarely taught. The good news is that 52% of deans are willing to improve curriculum; but, they aren't too keen on developing new stuff (because it's time-consuming and hard).

Allies. The barriers to being an effective ally must be addressed. This might be: a desire to avoid controversy, afraid to be called gay/associated, and not asked to speak up. Some strategies to help remedy this include: getting educated about the issues, talking about it, have some symbol of support (like, a small rainbow pin or something), learn the "language," ask the right questions, assume nothing, and discuss confidentiality upfront.

Some of things that can be done here right now include: working with the Office of Student Diversity, working with the Admissions Office, working with the new curriculum committee, safe spaces/ally training, and just continue general awareness. Incidentally, I somehow ended up on the student diversity committee. I just happened to attend the one meeting - a case of being at the right place at the right time I guess.

2. Good to know info
I didn't learn much about LGBT issues and health care reform, though I went to a couple sessions. I did attend a few transgender health sessions though, and they were actually really interesting.

Transgender kids. Toddlers start developing gender identity around age 3-4. This process evolves until the kid's about 7. This process appears intrinsic. That said, some kids are "just in a phase" or gender-fluid. Thus follow-up and just observation over the years are important. These kids tend to get distressed between age 2-5 and again at puberty. To treat these kids, one gives them hormone blockers to delay puberty until they're old enough to make a decision about transitioning or not. Apparently only about 10% of "gender variant" kids do end up transitioning. The point is, that up to 33% of transgender youths attempt suicide. But by showing acceptance, support, and delaying puberty until age 15 or so, it greatly reduces the rates of suicide and depression. Furthermore, the medical home concept is quite apropos for these kids.

Transgender care. Holy crap it's complicated! Someone's got to do it but I do NOT want to be among them. When to give hormones, how much to give, how to pay for them - it's all so overwhelming. Don't get me wrong, I like endocrinology and all that, but this is like endocrinology on steroids (lol, pardon that pun).

Also, HPV can apparently survive under the fingernails for a while (apparently that's how straight guys can get anal cancer, who knew?). I need to remember to buy Purell . . . Don't know if on that random off chance I'll get HPV from shaking someone's hand.

3. Personal
So Dr. P asked me if the Conference did anything for me personally. I suppose it did. It was nice to just be away from the Midwest and meet new people and not talk about classes and such. Yeah, still surrounded by medicine and such, but at least it's not worrying for this exam or complaining about that lecturer or something comparatively petty like that. He did concede that in hindsight it was perhaps a bit too overwhelming for me to experience that all at once, lol.

But then it was also incredibly cathartic. I disclosed more about my personal life/struggle to him than I had anticipated or expected. I suppose I wanted some kind of answer from him, but I didn't get what I was looking for (whatever that was). There were moments of long silences - of him staring at me and me staring back, of him staring at me and me staring off in the distance to avoid his gaze. Words just abandoned me and the silence doesn't force him to say anything to break it.

It felt like the more he subtly pressed against my walls, the more I wanted to crumble. He didn't tell me anything new or anything I didn't already know about myself. Other than perhaps suggesting that going to a therapist might be good (though how I'd pay is questionable). In a way I guess he forced me to realize just how uncomfortable I still am with all of this and how lost I still feel.

This catharsis was paralyzing and deafening. I've clearly still got some work to do. It never ends. :-/

It Gets Better

2010-10-17T19:00:00.006-05:00

I came across the It Gets Better Project yesterday. It was started by Dan Savage in the wake of the much-publicized recent LGBT youth suicides, and it basically collects video stories from people on YouTube telling LGBT teens that "it gets better."

Although I don't have a message to share, per se, there are a few I'd like to share (and I've quoted some of the lines they said that I could relate to). The first 2 are from the It Gets Better Project and the last one is a very emotional and moving vid.

"It gets better . . . well to be honest, I still have to believe that in myself. But I think it's gonna get better. And sometimes it feels like you're the absolute only person left in the world to care for yourself and even then you don't want to care for yourself. But, something you've gotta remember is that somebody out there needs you as much as you need somebody."

"I struggled a lot in high school with mostly myself, I suppose; I didn't have a lot of problem getting picked on, but I knew it wasn't acceptable or really smiled upon. So I struggled with feelings of guilt and shame and all that stuff that is very unpleasant and hard when you feel alone . . . and it's rough."

"My favorite memory is watching the sun rise on a mountaintop with this boy I was in love with and it was amazing, and if I didn't make it through high school I wouldn't've been able to do that. . . . Thank God that I'm human and able to experience this." Something about this bit really got to me.

So this post is for any of you readers out there who're having a difficult time. This is for you bloggers/ex-bloggers. This is for me. This is for us.

That Which Resonates

2010-10-13T23:35:00.003-05:00

Earlier today, I organized a lunch panel discussion. Or rather, I emailed Dr. P months ago asking him if he'd be willing to give a lunch lecture on coming out. He said yes. Then he recruited one other physician to co-talk with him, and then about 2-3 weeks ago he decided to turn it into a panel.

Although I can't say with certainty why he decided to go the route he did, I suspect that he did it partly for me (and any others "like" me in the audience). There were 5 physicians and 1 bio-ethicist who was the moderator. The physicians included: 3 gays, 1 bi woman, and 1 lesbian. Many of the issues they talked about were in some way directed at me - whether they knew it or not.

They each gave their own personal coming out experiences in med school and beyond, if/when applicable. The one gay ED (emergency department) doc's story really resonated with me. He wasn't out in med school except to a few friends. He dated in med school but kept his private life separate from his professional/med school life. In residency he was out to a few more friends and co-residents, but still didn't make a huge thing of it. After residency he still didn't talk about it much, even though he had a partner, because it never really came up. Only when he was moving and told his boss why did he really come out. And since then he didn't look back.

The primary reasons why he didn't come out sooner was because: 1.) he wasn't fully comfortable with himself yet, 2.) it was no one's business, 3.) he had no pressing reason to, 4.) no one asked. It wasn't that the environment around him was anti-gay or not accepting, it was simply for those reasons listed.

And I think that's where I am with all this. It just hit me that that could be me. That that is me (minus dating and a partner). Some people know and do something about it. Others need more time. I think I've come a fair way since beginning this blog years ago. But I still have a ways to go. I won't pretend to say that I'm not scared, or that I don't know what to do, or how to do it, or what's next.

---TANGENT---
So, a cursory look at the blogs on the sidebar here seems to indicate that many of them are no longer active, as their authors haven't made a post in months. Where has everyone gone? I guess I may have to do some "cleaning up" with my blog roll. There are new blogs I came across and meant to start reading, but alas too busy. Also, I sometimes wonder if some are worth starting since they may end in the near future. Who knows.
---END TANGENT---

GLMA Conference

2010-10-10T17:50:00.005-05:00

Okay, now or never. The long-awaited post on the GLMA Conference.

So if you recall, a few weeks ago I flew halfway across the US to San Diego, CA, for the GLMA Conference (9-22 to 9-25). I still haven't found the words to describe the experience. I'll do a separate post on what I learned there, rather than make this already lengthy post even longer.

Thursday, 9-23-10
Because of an obligation Wednesday night, I had to leave the morning of the 2nd day of the Conference. It was not a particularly good day. About 8 hours before my flight left (at about 6am), my roommate decided he was too tired from playing Settlers of Catan with some friends and didn't want to take me to the airport. Instead, he told a mutual friend to take me and that he'd pay $10 and I'd also have to pay $10 for this favor. He told me all this via another mutual friend on gchat.

Stressed as I was, I exploded. I was furious. First, my roommate decides he was too tired from playing a board game. Second, he decides to tell me this less than 24 hours before my flight leaves. Third, he gets me a ride from another friend who I'd have to pay (and he called it a win-win for everyone). Fourth, he didn't tell me any of this in person. Yeah, I was pissed.

I got another friend to agree to take me. So I woke up around 4am, checked that I had packed everything, and got ready to leave. I hear my roommate running down the hallway and enter our apartment just as I was finishing up. Evidently he "felt bad" and decided that he'd take me to the airport after all. I was still pissed. The whole ride there he kept saying how unfair it was that I was angry at him and that I shouldn't be expressing my frustrations towards him. -_-

Anyway, I got to the airport, got on my flight, and arrived in San Diego in one piece. I was tired from the flight and hadn't slept much at all. I keep forgetting how beautiful California is.

I call Dr. P soon after arriving and again once I got to the hotel. He came down to meet me and paid for my room (I still have to give him the hotel receipt so he can get reimbursed). I must've looked like shit. I register (Dr. P pays again), went to one session, then took a nap instead of getting lunch. I then attended whatever sessions interested me for the rest of the day.

The highlight of Thursday was meeting 2 people. The first was someone I took Spanish with in undergrad. She goes to med school where we both did undergrad. I'll call her "Lindsey" for this post. Anyway, it was good running into each other near the elevators; we exchanged numbers and went our separate ways that day.

The second person I ran into is "Keith." Keith is an Asian 3rd-year infectious disease (ID) fellow. He was apparently looking for me since Dr. P told him to say hi to me. He was really nice. It's possible that I could become Keith in 10 years, except he's way cuter and is a great dancer (more on that later). Perhaps that's why Dr. P sent him my way.

The rest of the day was uneventful. I didn't meet many other people, except a few friends of Keith who just finished residency. I was so tired that I decided not to go out with everyone. I just went to bed, and also I hadn't eaten anything all day.

Friday, 9-24-10
I woke up actually feeling pretty good, for once. I went down to get breakfast before the first plenary session. I ran into Dr. P and Lindsey there. Lindsey introduces me to the other 6 students from her med school there. I go into the first plenary session and sit with Dr. P and his physician friends. All of them had their iPhones and/or iPads out, and were typing on them or playing a game intermittently throughout the session. This included Dr. P at one point. I was amused.

As the session ended, Dr. P told me to find him around noon for lunch. We went our separate ways to different sessions. It just so happened that the session before noon was one that both Dr. P and I attended, so we sat near each other. Afterwards I just followed him out. We met up with his friends (and one of their med students in tow), and walked down the street for lunch.

The people in attendance at lunch were: Sports Med doc (from NY), Internal Med doc (from NY), Med-Peds doc (from OH), Dr. P, Dr. P's partner (a nurse), and another med student (also from NY). They were all great, and it was awesome listening to their stories and about their lives. Sports Med doc talked about his experiences with Latino patients, Internal Med doc talked about his practice in the LGBT community, and Med-Peds doc talked about starting up a clinic for LGBT patients in OH. They were pretty hilarious - especially Sports Med doc. He goes to the Sports Med conferences and he always wonders where all the gay guys are, but "at least there's a lot of eye candy there."

Then Dr. P mentions that I don't have texting. Instantly they all gasped and were like, "What do you mean you don't have texting?! You're just weird!" That was a bit embarrassing, lol. It was (apparently) inconceivable to them that any LGBT person wouldn't have texting. As Sports Med doc left, he told his med student to text him. ::facepalm::

I ran into Lindsey again after lunch and we went to one of the sessions together. A trans-woman M4 (Kelly) comes and chats with us. Apparently her mom, also a trans-woman, is the current president of GLMA (but I didn't figure that out till later).

In the evening, I hang out with Lindsey for a bit at a lesbian reception thing. Keith was there and introduced me to some residents. After the reception, Lindsey, a lesbian med student from IL, and I met up with other students to share a taxi to Urban MO's where the students' reception was being held. I'm not a huge fan of bars/clubs, but whatever - in a different city, an experience I'll likely only have once, so why not? Besides, Dr. P more or less "ordered" me to go, and he was going to stop by later to say hi.

We get there, wander a bit looking for other students, and finally find them towards the back of the bar near the dance floor. The Conference had opened and paid towards a bar tab, so the first x number of drinks we got were free. Lindsey was tipsy/drunk after her first drink. I get my second drink and gave just a bit to her to taste. I think each drink had to be equivalent to 2 shots - they just added so much alcohol in there! By the time I finished my second drink, I could finally feel the alcohol hit . . . and with that, the music and dancing. It seems I need about 4 shots to get me on the dance floor, lol. And even then I'm still aware of my incredible awkwardness, but I just seem to care less.

After a while, I saw the residents, fellows, and some physicians filter in. I saw this one anesthesiologist on the dance floor who had given a talk the day before. And then I spotted Keith. He had changed clothes in the interim and - maybe it's the alcohol or something - he was way attractive there on the dance floor dancing. I make my way over and ask if Dr. P was around, and soon after Dr. P comes up and says hi. Alas, I didn't see him drunk or dancing. He actually left for a different bar pretty soon after with other physicians. I dance with Keith for a little bit.

More dancing and I was feeling the alcohol wear off. I make my way to the bar and another med student (from OH) gets me a rum and coke. He was pretty drunk by then . . . I worried for him later that evening, but he somehow made it back to the hotel okay. As the night wore down, Lindsey and IL lesbian were getting quite into each other. I gave them their space and left with 2 med students and the Conference photographer (who's also an anesthesiologist). We chat in one of the hotel lobbies for a bit before retiring for the night.

Saturday, 9-25-10
The last day of the Conference! The sessions weren't as interesting as they were the previous days, but still pretty good. I met up with a med student (Frank) who I'd been chatting with for a few months since he came across this blog. It was good to finally meet him in person, though we didn't get much of a chance to hang out or talk at length.

At lunch, I went down to the pier and snapped a few pics. Here are some of them:

Later in the afternoon, I meet up with blogger Mike for a late lunch/early dinner somewhere in Hillcrest. We walked around and chatted, then had Thai. It was nice to meet in person after chatting online for years. He's pretty much exactly as I had pictured him. :-P

When I got back, it was time to head over to the Gala Banquet. I went with Kelly since she had her car there. We got lost for a little bit but finally found our way. It was a nice event, though I felt uncomfortably out of place. I sat at a table with this really attractive Australian lesbian (I assume she's a lesbian anyhow). There was more dancing, and this time many of the older people were on the dance floor. Imagine your mom or dad grinding on the dance floor. Yeah . . . I have a couple pics, but I won't post them here.

Sunday, 9-26-10
Since Frank and I had the same flight, we decided to ride to the airport together. I chose to get some sleep while he decided to go out (and didn't sleep). I set my alarm on my phone but I didn't wake up to it! So when he knocked on my door I literally shouted "Shit!" and leapt out of bed. We did make it to the airport shuttle on time. Phew! If he hadn't knocked on my door I would've sooo missed my flight.

Alas we sat at opposite ends of the plane. The guy sitting to my left was rather large and his arm overlapped onto me. Ugh. This is why I like aisle seats (or window seats).

And that's the GLMA Conference in summary.

OCPD

2010-10-04T23:40:00.004-05:00

OCPD = Obsessive compulsive personality disorder (not to be confused with OCD)

- Become so preoccupied with details and rules that the major point of an activity is lost.
- Display perfectionism that interferes with task completion.
- Have inflexible values and are overly conscientious.
- Unable to discard worn-out or worthless objects.
- Reluctant to delegate tasks.
- Miserly spending style.
- Display rigidity and stubbornness.
- Excessively devoted to work.

Taken directly from my psych notes (exam tomorrow morning). Hmm, kinda sounds like I might meet some of the criteria for this. o_O Anywho, it's been over a week since I returned from the GLMA Conference. I should probably blog on that soon before I forget stuff . . .

Secrets & Fears

2010-09-27T23:50:00.003-05:00

So I'm back from the GLMA Conference. I feel better though not 100%. Perhaps 60-70%, which is still much better than most of last week. This post will serve 2 purposes: to answer A Wandering Pom's questions in his comment on my last post and to prep you all when I do talk about the GLMA Conference in my next post.
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1. Secrets & Fears
All you had to do is ask. Many of my secrets you all know pretty intimately. Many of my fears I've already shared here, as they're often related to the secrets.

That I'm bi/gay is no surprise here. But I don't know which (if either or somewhere in between) I am. I fear that, busy as I am, I won't get the opportunity to face that fear and answer it. And so I may be left to wander in confusion. I can't "attach" myself to a particular identity, or perhaps I won't allow myself to be.

That I've never had a romantic/sexual relationship also shouldn't be a surprise. Correspondingly I'm a virgin in every sense but oral sex. I fear that I'll always be alone in this regard - to never really know what it's like to cuddle/be cuddled, to kiss/be kissed, to feel someone else's body intimately (in a non-clinical way), to have sex.

I also fear that I may not be able to open up and let myself become vulnerable. I may not recognize love; I might not be able to truly loosen up and relax, not be able to completely trust someone. I fear that I can't let this go - can I ever let someone get that close? It goes against everything I've done in my life; there's always some defense, some wall, some checkpoint, some guard - usually with very good reasons. I'm afraid to even try, as every time before has been met by some barrier that I learn about the moment I get close enough.

I feel frozen, stuck in the routines of my life but not knowing which way to go, which direction to walk in. I feel life passing me by as I advance in a single straight line. I fear that perhaps 10 years from now, when I am a doctor, I'll look back and regret the things I didn't do . . . the things I wasn't able to do for any of the reasons above. I fear that perhaps I try so hard to validate something, to prove something to someone who isn't even there.

I want someone to pull me out of this and away from this.
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2. "Prep"
So, GLMA is a largely medical organization. As such, most of the people there were med students, residents, and physicians (there were some nurses, social workers, advocates, etc). And to understand the nuances of what I may say in my next post, one should perhaps understand the hierarchy of medicine.

Med students
M1 - first year med student
M2 - second year med student
M3 - third year med student, aka "junior med student" (JMS)
M4 - fourth year med student, aka "senior med student" (SMS)

Residents
PGY1 - first year resident, aka "intern"
PGY2 - second year resident
PGY3 - third year resident (and so on)

So after med school, one moves on to residency. Most residencies are 3-5 years. The first year of residency is the intern year. After residency, one may specialize in something like "infectious diseases." When one does their specialty training, they become a Fellow. Many/most fellowships usually last 3 years. Finally, after that one becomes an Attending (if one goes into academic medicine).

I should come up with some name or key for all the people I met at the Conference, but that'll have to wait till later. I'm heading to bed now.

Mask of Smiles

2010-09-22T00:05:00.005-05:00

It seems I'm within arm's reach of that wall - that glass wall that easily cracks with the slightest touch and the gentlest breath. I thought I had survived, that I can trudge through this last stretch. But now I'm not so sure. And yet, I'll smile.

So many things depend on me to move forward. Decisions to be made, emails to be sent, things to delegate, people to coordinate, people to talk to, people to smile at. But I'm slowly crumbling inside. And yet, I smile.

I say I'm tired, that I'm exhausted, that I'm stressed. You agree and say "What a long week it's been or going to be." But I can see that you don't really share my frustrations. You don't share the same burdens of responsibility or whatever it is with me. You certainly must think "Oh, it can't be that bad." Because I smile, because I'm smiling. And you can't see past that. Deep down perhaps you don't believe me. It's okay, no one really hears what I say when it matters.

Right now I wish I were the patient and you are the doctor who comes and heals me, fixes me, mends my cracks. Someone to hold my hand and say "It's okay" and walk me through this step-by-step. Someone to give me a hug or at least a reassuring hand on the shoulder. Someone who knows what's to come and will be there with me. Someone who sees past the mask of smiles and asks those questions to open the box of answers that I cannot freely give to just anyone - perhaps not even to myself. Ask me for my innermost secrets and darkest fears. And show me, not just tell me, what I'm supposed to do.

Until then, I'll keep up this Mask of Smiles. Because at least then it's only I who suffer. Because at least then I can pretend that I'm not so close to that breaking and crumbling wall. And because it's a test that you must pass to let me know that you truly know and care without me having to say it first.

And because you read this, you've already failed. These false smiles shall persist yet.

I Knew You'd Ask

2010-09-16T23:50:00.004-05:00

It's going to be a LONG week ahead for me. Thankfully, the second of several events between now and next Sunday has passed. The turn-out was rather good, considering it was the first time we put on this event. Anyway, it's over now. Phew! Next one tomorrow, then Monday (plus an exam on Monday), then Tuesday, then Wednesday, then GLMA Conference Thursday through Saturday. o_O

After the event tonight, Dr. P (who graciously volunteered) and I were chatting privately in the halls. And he asked: "So, are you gay?"

I had to laugh and said, "I knew you were going to ask that! You've always given me this look." Then I answered him something to the effect of that I'm bi but not quite sure. That took another moment to explain but I think he understood where I was coming from and was satisfied.

He's all excited about this Conference and I think he almost sees it (in some way) as a vacation of sorts that he's giving me. It's kind of amusing to hear a physician tell me to just enjoy it, have fun, and forget about coursework for a few days. Things will probably still linger in the back of my mind, but I will try my best. :-P

So yeah, I'm out to Dr. P now. Happy now?

Anyway, I'm freaking out less now. I think I've exhausted most of my "freaking out-ness."

This Really IS Happening

2010-09-15T10:05:00.004-05:00

Wow. This really IS happening. o_O

All of this feels surreal still. Tomorrow, Friday, next Monday, next Wednesday, and next Thursday through next Saturday. Things will be okay, they'll work out.

It seems I've bought a ticket to San Diego, CA, for the GLMA Conference next week. And it seems that Dr. P is paying for everything but the plane ticket. I'm not sure how this is all going to work out, but I need to tell myself that things will be okay and they'll work out.

I should be grateful, and I am. More so than anything. I should be ecstatic. But I'm not - why do I feel unworthy of this extreme generosity? Why do I feel so nervous? Why do I feel like crawling under a rock?

It's okay, it's not like any of you will see the above on my face. Like an oncologist delivering bad news, we in the medical field out of necessity develop great masks to hide our own feelings outwardly. I just hope mine doesn't crack.

And I'm still waiting for that one thing that'll bring me back to normal. But if I told you it wouldn't happen. And so I wait.

Method to My Madness

2010-09-12T00:45:00.005-05:00

I'd like to take a moment away from studying for my immunology exam (on Monday) to address the comments in my last 2 posts.

First, I Blame the Wine
Where to start. Understand that I've erected several mental walls throughout the years, often without realizing it until I find myself running and banging my head against them. It takes effort to break them and it takes time to reduce them to rubble. It's taken a number of years to get comfortable enough with public speaking, something I'm still not 100% comfortable with at all times. It's only in the last few years that I've found a way to put on a mask of sociability when in large social situations. And it's also only in the last few years that the thought of coming out even existed in my mind.

There are things that come easy to people, and there are things that don't. The above are all things that don't (or didn't) come easily to me. They required a significant amount of active energy. There's this sense of dread that washes over me - increased heartbeat (tachycardia, if you will), a shakiness, a rush of panic afterwards. It's uncomfortable and not a natural feeling. It's oddly similar to guilt.

Is there a good reason for this reaction? Probably not. The human mind is irrational about many things, no matter how we would condition ourselves. That I'll come out to Dr. P at some point is practically an inevitability. The question is simply when and under what situation.

Second, In This Regard, I'm Quite Lucky
Yes, I've been under overwhelming stress being the president/co-president of 2 student organizations and the co-chair of 2 student-run programs. Pardon me for caring. Pardon me for re-vamping a program with my co-chair to better serve uninsured patients (and med students) at a free clinic. Pardon me for wanting to promote health education/awareness in a community that's difficult for people outside the community to access. Pardon me for trying to organize a health fair in the inner city. I can do all this because, amongst the other presidents, I have a skill for systematizing how I organize things down to practically a protocol with a series of flexible deadlines.

I'm well aware that the USMLE Step 1 is paramount. I need no reminding. I refuse to freak out about it like many of my peers (many of whom are aiming for the more lucrative fields of medicine). Overwhelmed and stressed as I seem, I do have a plan. In fact, my plan is manifold. As they say, there's a method to my madness. You see, dear commenters, the vast majority of the events I'm heading occurs this semester. By January I'll only have 2-3 more events to organize/run. By April I'll have already transitioned my position to M1s. I'll have a pretty solid 2.5 months to focus on nothing but the Step 1 (well, not counting class exams).

So as my involvement in extracurriculars winds down as the months wear on, my effort towards studying for the Step 1 will be ramping up. Also, I've decided to participate in my school's Step 1 Review program with 2 of my friends; and that program will probably start in October or so. As you can see, I have things currently under control. And besides, I don't need a high score to place into a pediatrics residency. Though, of course I've no intention of settling for just passing.

In This Regard, I'm Quite Lucky

2010-09-06T21:05:00.006-05:00

I'm going to take a brief pause in whining about my overloaded life, though even this post is related to that life. :-/

So yesterday, I was discussing with my friend, Michelle, over the program we've basically re-vamped, sorting things out and whatnot. Michelle is in the process of finding and contacting physicians to be mentors in a unique program through AMSA (American Medical Student Association) that focuses on cultural sensitivity in clinical practice. She's been having difficulty identifying the right physicians to contact.

By happenstance, I knew of several physicians who might be useful for her to contact. These include:

Dr. P = infectious disease - HIV/AIDS patients
Dr. Pi = family medicine - LGBT patients
Dr. S = pediatrics - inner city (most African-American) peds patients
Dr. H = peds infectious disease - HIV/AIDS peds patients
Dr. C = peds infectious disease - internationally adopted peds patients
Dr. L = family medicine - Hmong patients

So right there, 6 physicians who deal with "special populations" in a sense. I've had the pleasure of meeting 5 of the 6 and the privilege of interacting with 4 of the 6 in clinic/on the wards. There are many other med students who can't say the same thing. And so in this regard, I'm quite lucky.

While my interests laid the groundwork, luck played its part in my encounter with each of them. Had I not been interested in pediatrics, infectious diseases, and a diverse patient population, I probably wouldn't have met most of them. And several of them have had a part in shaping what I might want to end up doing.

And so you see, I have this grand ideal career I'd love to have, but I have no expectation whatsoever of ever getting there. To get where I want to end up would require more luck than should be allowed in that I need to be at the right place at the right time and meet the right people and say the right things.

Because you see, what I want do involves the following:
- Clinic 3 days a week, with one of the days being at a clinic in a Chinatown somewhere
- Teach a class 2 days a week
- Be the director of a program (probably public health in nature)

Sounds simple, but it's not. I wonder what the future brings and where it'll take me (hopefully away from here).

---TANGENT---
P.S. People have brought up interesting points in their comments to my last post. Perhaps I'll devote a post to answering or at least giving my thoughts on the topic. We'll see . . .
---END TANGENT---

I Blame the Wine

2010-09-03T00:20:00.003-05:00

So, 2 days ago, we hosted an opening social for the LGBT group at a physician's house. Dr. P was there helping the physician set up and all. Kat and I arrived early to help out, though we didn't end up doing much. (Kat has been surprisingly upbeat these last couple weeks, I hope it stays that way.)

The turnout was actually really good, considering that pathology tutoring for M2s was the same night and the anatomy tutors moved the mock anatomy practical for M1s from Thursday to Tuesday this year (which sucked, since this meant that no M1s would be attending). Surprisingly, one M1 did make it! Our other faculty advisor came with her partner. I must say, they make a really attractive lesbian couple. o_O For a while, there were almost the same number of physicians as med students . . . awkward. But then more med students started filing in, which was good.

Halfway through the social, Kat wanted me to make an announcement to thank Dr. P and the physician whose house we were at. I drank some more wine. I'm no orator. I can be terribly awkward in such situations. I can be quite awkward in social situations, but I somehow managed to talk to almost everyone in attendance, which was no simple feat for me! Thankfully the wine helped. All 6-8 glasses of it (granted, the glasses were small-ish).

Also, I don't know if it's the wine or not (but I blame it anyway), but I had a mini-crush on Dr. P that night. o_O I mean, him + polo shirt + shorts = swoon (also, he's only in his mid- to late-30s). He has really nice arms and legs; well, he's just really nice overall. But, he has a partner, and it'd be a very bad idea to let this get any further considering our respective positions. Partway through the social, he leaned in close and whispered in my ear, "I know this isn't politically correct, but are there any gay M1s or M2s?" I answered, "I honestly don't know because I didn't make it a policy to ask."

I must admit, it made me a tad uneasy. Every time he asks me a similar question, I feel like he's looking into me for answers or a confession or something. I've wanted to come out to him so badly, but I just can't seem to. How odd. I just want to chat with him about life and let myself vent and ask him for guidance, or something. But I don't think that's going to happen in the near future. What's holding me back?

When Kat and I left (we carpooled), we talked about Dr. P's whispered comment to me. There's a reason why there are so few openly LGBT students. If you come out, you are the gay student. You are the gay person that everyone looks to and you have to be the "model" gay med student. You become the reference. It's not a burden most would want to carry.
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Anyway, my thoughts feel very disjointed. I'm beyond overwhelmed with things right now. Something just doesn't seem quite right inside at the moment. :-/

Hanging in There

2010-08-31T00:25:00.003-05:00

Man, it's been a crazy week. And it's only just become Tuesday! Already it's been full of ups and downs.

Down: So, the anatomy tutors brilliantly scheduled their anatomy practice lab practical the same evening as we scheduled the LGBT opening social event. This means that practically no M1s will be attending. Grrr. The same thing happened last year, so we tried to avoid that situation this year. But the tutors decided to (conveniently) move the event. -_-

There was much swearing and cursing on my part (in my head anyhow) and on the part of my treasurer (verbally).

Up: Because we needed to generate M1 involvement for the LGBT group, I've decided to schedule an "ad hoc" general meeting if you will next week. Thankfully I was able to reserve a room at a decent time. Now I just have to hope someone, anyone, shows up.

At least APAMSA is a group I don't have to worry about. So many M1s showed up! And not only that, so many of them volunteered to be on the various committees!! Last year I remembered the then-M2s were practically pulling teeth trying to get our class to volunteer for stuff. This year, totally different situation. Also, there are about twice the number of M1s on committees as M2s. Crazy!!
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Classes are going okay. Today, for the first time, I sat through immunology and was totally lost while still being awake. :-/ At least pathology is easy for now because the topic is largely review for me (inflammation, cancer, cancer genetics).

I need more sleep. Tomorrow and the day after are going to be LONG days, bleh.

Thus concludes this update. Still hanging in there!

Rant: Frustrations

2010-08-25T00:35:00.004-05:00

Blargh. Day 2 of classes and already I'm stressing out hardcore, but not over classes. Oh no, classes wouldn't stress me out quite as much as some of the people and drama around me.
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1. I don't know why, but I've been really snappy and short at my roommate. Little things he does seem to set me off in a corner of my mind. He doesn't understand that my family is quite strapped financially this year, and he even suggested that my brother or I get a part-time job. But we're med students . . . there's precious little time for adequate decompressing, much less a job.

Also, he keeps stating how talking about psychiatry and medical ethics are worthless unless we're immediately faced with those dilemmas. I vehemently disagree, as I believe that understanding how people think and how to reason through even hypothetical ethical conundrums are useful. He argues that because we're reasonable people with common sense, that those qualities alone are generally sufficient. Well, if they were truly sufficient we wouldn't have a need for ethics committees. I could go on and on, but I don't want to sound like I'm foaming at the mouth.

I've decided that I can't discuss such matters with him. He never accepts anything I say as valid and tries to "light-heartedly" discount my points, and I just get frustrated. I'm putting my foot down: I'm not discussing this with him from now on.
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2. There's tension between one of my friends, her roommate (my treasurer for one of the student groups I'm in), and me. Let's say my friend is M and her roommate is K.

So K sent both of us a rather bitchy email earlier telling us that she doesn't like how we've been talking about her to each other. M gets furious at this email. And I must admit, it did cast a dark cloud over my head for several hours.

I reply to K's email and tactfully apologize. She is pacified by this. Then M sends me a message on gchat asking me why I bothered apologizing. I replied that it was a tactical decision, not a personal one. I needed to be on good terms with K because we still need to work together, and if she's mad at me then things I've worked really hard on over the summer will fall apart. M isn't satisfied by this and is furious at K.

Then later I send an email to one of the deans, K, and M concerning a program that M told me about. Apparently, I had misinterpreted the reason that M brought the program to my attention in the first place, and she would've rathered that I hadn't sent the email before consulting her. Argh. Clearly, in my good intentions some grief has backlashed onto me.

Well, I had to apologize to M, of course, and explain that the intent wasn't to usurp her student group's program, but rather to bring it up as an example/model to develop an elective curriculum on. After my apologies and explanations, M seemed more or less pacified. She at least understands the good intent with which I sent that email.

Why are women so hard to deal with?!?! With guys, decisions tend to come quickly and easily with no feelings hurt (usually). With women, one must take into account their MOODS.
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At least with small-ish issues, I can resolve things pretty quickly and have people forgive me fairly easily. It's the larger issues that tend to linger and dwell on my mind for way too long.

It's only the 2nd day of classes, and already I'm at wit's end standing dangerously near the precipice of sanity looking over the chasm of insanity.

Frustration by ~stabTyler on deviant ART

NYC: In Pictures

2010-08-20T18:20:00.012-05:00

This post will be long enough without my usual text, so I present (in pictures) my 2.5-day trip to NYC to visit a couple friends there one weekend.

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Day 1 - Flushing

World's Fair grounds in Flushing Meadows Corona Park

Hotpot for dinner!

Flushing's Chinatown at night

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Day 2 - NYC (Manhattan)

Times Square

M&M Factory

Columbus Circle

Central Park

McSorley's

Washington Square Park

(Cute) pianist and contortionist street performers

Tic & Tac - twin performers

Chinatown

(What's left of) Little Italy

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Day 3 - Brooklyn

Green-Wood Cemetery - entrance

Green-Wood Cemetery - Statue of Minerva (looking at Statue of Liberty)

Green-Wood Cemetery - Leonard Bernstein's grave

Grimaldi's Pizzeria

Brooklyn Bridge

Ikea ferry + Statue of Liberty (viewed from Red Hook)

Red Hook street food vendor (where we got pupusas)

Brighton Beach

Coney Island

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It was a whirlwind of 2.5 days, but it was well worth it. :-D

Les Jours Tristes

2010-08-17T23:10:00.004-05:00

I've found a new theme song! :-D

Les Jours Tristes by Yann Tiersen

The title of the song translates to "The Sad Days" (according to my friend who took French) and it's from his album, L'Absente (2001), and the instrumental of this song was featured in the French movie, Amelie (great movie, go watch it if you haven't!).

I feel like the lyrics of this song perfectly fits my life right about now, considering all the recent events and dramas. Things have settled down a bit now, at least in my head. So that's good. There's a lot of things to update, but I've been having spotty internet at home due to a "feud" between my youngest brother and my dad. So I have to be umbilical cord-ed to the ethernet cord when I can manage.

---TANGENT---
So, I have a Yahoo! email account. Nowadays when I see the log-in screen, they have various backgrounds including this one:
I must say, that's one attractive guy. :-P Alright, that's all. Hopefully I'll be able to update on some of the things that happened in the last 2-3 weeks.
---END TANGENT---

Can't Outrun These Clouds

2010-08-11T20:10:00.003-05:00

Can't Outrun These Clouds

Run, faster faster, no respite
no time to relax
no time to stop.

These clouds approach again,
but the umbra of their gloom
has already taken me.

Beat beat beat, my heart drums
as I can't outrun these clouds.
I thought I had escaped
I thought I could relax
I thought I could sleep.

No.
The clouds linger
and follow me still
even as I leave,
even as I'm gone.

I am weary and nearly broken.
I have toiled under this gloom -
under these clouds
too long, way too long.

I long for the sun
I long for the clarity of sky
I long for a chance to stop
I long for escape -
to get away, far away,
from it all.

But these clouds haunt me
even while I'm away.
I just can't seem
to outrun these clouds.
Soon they will overtake me
again . . .

Should I give up?
Just let these clouds
engulf my sky?
I just . . .
can't outrun these clouds.

I Am Done With This

2010-08-03T23:01:00.003-05:00

So in my last post, G, the girl who parks next to my spot, has continued to harass me. In fact, she has caused me to lose sleep over this incident. I probably didn't fall asleep last night until past 2am and woke up at around 6:30am. I have had enough. I am done with this. Here are more of our exchanges below:
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Her reply:
A,

You have parked poorly about 90% of the time when you parked next to me, giving me dangeously enough room for my small car. The night of the accident you knowingly did not give me enough room. You even stated "I was hoping you wouldn't arrive until after 6" which is a sorry exuse. I noticed my spot was tight, and I was very careful, and once the nose of the car and the SIDE VIEW MIRROR made it clear, I figured I had just enough room so I continued. And then the scratch happened. As you did not give me the curtisy of straightening out your car when you were parking, you are at least 50% resposible for the scratches, as you were the one illegally parked. Another important point: YOU COULD HAVE PARKED IN YOUR OWN PARKING SPOT!!!!!! You CHOICE not to, and you have to deal with the consequences of your actions.

I agree I was the one driving, so I think a very resonable compromise would be splitting the cost 50/50. That would mean both of us pay $198.

My answer:
Hi G,

I appreciate your response and I would like to address your concerns.

First, if you contend that I parked poorly about 90% of the time (which I disagree with), it should've been all the more pressing that you preemptively ask me to move my car. As I said before, I would've gladly complied. I should also state that the car parked to the left of my spot routinely parks very poorly and sometimes even a little into my spot, which was the sole reason for my parking that night. I would still like to point out that even that night I was always within the lines of my spot. Thus I don't see how I could've been illegally parked.

Second, you yourself said that you figured you had just enough room to continue, which contrasts against your claim that I "did not give [you] enough room." It was, unfortunately, an error in judgment that resulted in your scratch. Third, while it's true that I typically park in a spot farther away, there is no rule (that I'm aware of) that restricts me to one of the two spots allotted per apartment - as who parks where is between my roommate and I. And so, out of courtesy, I shall refrain from parking next to you in the future unless absolutely necessary.

In deference to my first point, if you would like me to notify the car that's parked to the left of my spot, such that you could work out an arrangement with him/her, let me know and I shall do so. I still do not believe it to be fair for me to pay for scratches that you incurred on your car.

A

Her reply:
A,
You were definitely, without a doubt, over the line that day. And you frequently were parking ON the line before. I have a small car, so while it was inconvenient for me, I decided not to bother you until this incident. Further more, I have NEVER EVER had this problem with your roommate. He either knows how to park properly on his first attempt, or he is curteous enough to straighten out. And once again, as you were using two spots at the time, and you see that you are infringing on my spot (as you were, I did not actually measure but a conservitive guess would be at least 6 inches into my spot) then you should have used the other spot, as no one else was using it. Your car being partly in my spot is the reason why the rear passenger door scraped the pole. You even admitted at the time that you were partly in my spot, so I do not know why you are lying now. We have a difficult parking garage, and I was so used to you on the line that I assumed this would be another tight sqeeze, and was perhaps more confident in the size of my parking spot than I should have been. I am accepting part of the blame and that I am partly responsible. I talked with R the manager, and he agrees that you are partly responsible for my car getting scratched given the circumstances. Out of being a good responsible human being I would appreciate your taking responsibility for your actions and helping me pay for fixing my car.

G

My answer:
G,

I've tried to be civil but I have only been met with accusations and insults. I do not appreciate you accusing me of lying. I did not change my story. Although I might have once expressed regret that I was close to/on the line, I have never said I was over it. I have consulted with many people, including a lawyer, and they all agree that I was not at fault and that I owe you nothing. I also talked to R earlier today and he contradicted the last message you sent me. I ask that from now on we both leave R out of all this as it's not his job to arbitrate. I understand that you are upset, but I am well within my rights and it was completely unreasonable for you to ask me to pay 100% or even 50% of the damages for an accident you caused. I am done with this. In the name of common decency, please let it rest.

A
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I should add that my final reply was proofed by up to 5 friends and my friend's lawyer dad. For at least a few days, I shall ignore her. I've altered my Facebook settings to specifically prevent her from viewing certain content on my Facebook page as well as restrict/disable her ability to comment on my wall and such. Finally, I've altered my Facebook settings such that I won't even get notifications of messages being sent to me; thus, unless I specifically check Facebook, I won't know if she replies or not. She's pretty passive-aggressive and hasn't stopped by my apartment to confront me in person (other than the moment right after the incident), so I'm counting on that she won't.

I need to obtain a few more pictures of the "scene." While the pictures won't be as informative as they would've on the day of the incident, they may still prove helpful in the future. Thank God for comparative negligence laws being on my side (at least, they seem like they definitely would be in this situation).

The Gall!

2010-07-31T23:50:00.004-05:00

First of all, please write a comment to my last post here. Post as anonymous if you so choose.
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Now, to the meat of this post. Yesterday (Friday), a girl in my class sent me a Facebook message. This is what it read:

Her:
A,

I am going to make the appointment to have my car repainted on Tuesday morning and was wondering if you could pay me this weekend. The total will be $396, including tax. You can put the check under my door (apartment XXX)

Sincerely,
G

My reply:
Hi G,

I would like to clarify a couple things:

First, while I empathize with your situation, I do not feel it is fair for me to pay for the scratches on your car. I was not in my car, my car was not in your space, and you could have asked me to move prior to you incurring the scratches if you had any doubts about getting into your own spot. Furthermore, both my car and the pillar were stationary; thus, it was the driver’s responsibility to avoid them and I am not at fault.

Second, I'm not sure why you are asking me to pay for damages when I didn't incur them on your car. I had always been within the lines of my spot. It's true that on occasion the car to my left was slightly over the line into my spot, causing me to park closer to my right line (but still within my lines). If you had any doubts about getting into your own spot safely, you could have talked to me and asked me to preemptively move my car, which I would've gladly complied. In this way, this current situation would never have happened.

I hope you can understand my perspective on this issue.

Bests,
A
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Seriously?! A message like that via Facebook?! The gall! That's not classy at all. The supposed incident as described above happened about 2 weeks ago. Last week she confronted me in the parking garage under our apartment complex about this. She thought it was fair for me to pay for 75-100% of the cost of the scratches that she made on her car. I wasn't going to negotiate right there and then because her step-mom was also present next to her.

Now, I've consulted numerous friends and all of them, without fail, have told me that I shouldn't pay. Even one of my friend's dad, a lawyer, tells me that I should only pay 10-15% at most to keep the peace if I felt compelled to pay something. But after that Facebook message - and what read to me as a sense of entitlement to the payment - I won't give over even a cent.

The aftermath of all this has been pretty calm. She hasn't responded to my reply and she hasn't otherwise confronted me yet. Hopefully she sees my point and how ridiculous it is for her to ask for payment concerning something I didn't do. And I hope she leaves me alone. But I'm bracing myself for the imminent hatred that'll now radiate from her towards me. Whatever.
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Lastly, please post a comment to my last post here!! Thanks! :-)

I Need Your Help

2010-07-30T17:56:00.003-05:00

Hi all, a quick question for all of ya.

Prompt: Medical interviewer from hell

Could you please tell me about a few bad experiences you've had with health care workers (e.g. nurses, doctors, etc)? Is there anything you wished that health care workers would do/address?

Please leave your answers as a comment to this post (or you may email me). Your answer need not be very personal/specific. Anonymous comments are encouraged.

Thanks!!

P.S. I'm gathering bad experiences from people to give to a dinner speaker of an event I'm organizing. Hopefully, this will help med students become better and more empathic when interacting with any and all patients.

Popping In

2010-07-27T23:31:00.002-05:00

Hey all,

Just popping in here for a bit. It's been a busy few days. Last week was one of the most frustrating weeks I've had in a long time. The corner of my left eye still intermittently twitches uncontrollably from time to time, even now. I won't go into all my frustrations, for there are many. And the moment's passed anyhow.

But, this week has been better thus far. I won't say much more than that right now. One thing I've learned is that I should never proclaim good things, because I jinx myself and things don't turn out as wonderful as I predict, lol.

Also, Inception, amazing movie. Go see it!! I couldn't stop thinking about it after seeing it on Sunday, and that might be why I didn't sleep too well that night, lol.

Alright, last week of peds rheum. And I have to give a 10-minute presentation on something on Thursday. That PowerPoint is almost done . . .

Learning to Smile

2010-07-18T17:36:00.003-05:00

When I was little, I was told that I had a goofy smile, that it looked a bit weird, and that I showed my teeth in an odd way. I was told to smile better but I didn't know how. So for years I avoided smiling on demand when asked - the only smiles I had were those spontaneous one that you couldn't control, the ones that weren't taken in photos. For years I refused to show my teeth. I had to learn to smile, learn to be comfortable with it. I feel like I've finally reached a point where I could be comfortable smiling.

And because it took me so long to learn how to smile, I also had to learn how to hug. I avoided contact and gave people their space. It was weird and awkward for someone to invade my personal space or for me to invade theirs, wanted or unwanted. Even now, hugs feel strange though I crave the feeling. Even now, touching another person is somewhat awkward. But I'm learning how to hug and I think I'll get it soon.

And because I'm still in the process of becoming comfortable hugging, I have yet to learn how to dance and be comfortable within myself. And so dancing is incredibly awkward for me. It makes my heart race, it makes me sweat, it makes me nervous - for who would be the one to notice and laugh and send me back to square one? It may be a while yet before I learn how to dance.

And because I have yet to learn how to dance - to feel comfortable with my own limbs - it may be too early for me to be involved in a relationship. To first feel comfortable enough to smile, then comfortable enough to allow contact, then comfortable enough with one's limbs, and finally comfortable enough to be vulnerable to another - this is a long road that I started way too late. What have I been doing all those teen years?
-----
Last Friday I went to a wedding, one of my labmate's from anatomy lab. Two other labmates went with me, and they each brought their significant others. I was alone because the final labmate bailed on me.

He looked so happy getting married. He's usually someone who's calm and level, who doesn't let his emotions shine through. He had a great poker face. But there were no poker faces that night, and his smile was the brightest in the room. He was marrying his best friend whom he had known since they were both 4-years-old. And during the reception, as he gave a toast, he almost let himself cry - his shell broken for a brief moment. And it was endearing.

And throughout the entire day, we all had to smile, and hug, and dance. While I was okay with the first two, dancing was rather rough the couple of times I was dragged on the dance floor. It was a lovely wedding and I am truly happy for the both of them.

The last few weddings have left me with mixed emotions. Happiness for the bride and groom, sadness for myself. Optimistic that there are such things as happy endings, pessimistic that I'd be so blessed to enjoy one.

I have a ways to go. To learn how to dance, to love, and to be vulnerable. To find my best friend with whom I'd gladly spend eternity. The question is a trial of time. This is one future that I can't even predict. How many long years will it be before I reach the edge of where so many already are?

Though I think that at the end of the road, I'll come full circle and learn to be a little kid again - to smile, to hug, to dance, and to love as they do. Because they are uninhibited. Perhaps society makes us unlearn that which is innate, and it's only through struggle that we re-learn that which we've forgotten . . .

The Rheumatological Posse

2010-07-14T21:40:00.004-05:00

So, I meant to write this a while ago. Alas, that didn't happen since I've been unusually busy and things have been rather hectic. My peds externship is already more than half over! Wow how time has flown.

I'm on my pediatric rheumatology (peds rheum) placement for the remainder of this month. And while I don't think I'll go into peds rheum, it's pretty interesting. All the people I've been working with the last week and a half have been great as well.

Last Tuesday I met with Dr. N, the attending who's responsible for me, and two of the fellows, Dr. K (1st-year fellow) and Dr. C (2nd-year fellow). Peds rheum is a 3-year fellowship that one does after a 3-year pediatrics residency. I must say, Dr. C was adorable! He's this cute little Asian dude who has an adorable smile and voice. Yes, I may have a tiny crush on him. Alas, he kept pimping me last week.

What is pimping you might ask? Well, pimping is where a senior medical person asks a series of questions on medical facts to a younger medical person to test the limits of their knowledge. Often it's done in a way to embarrass the younger person and "put them in their place." Earlier, Dr. N and Dr. C had discussed an article that came out called The Art of Pimping. In there is a section on how to defend oneself from being pimped; I particularly like The Muffin, lol. Anyway, Dr. C pimped me on shingles, which I hadn't formally learned about but because I know a little bit about it in the past, I got all but one of his questions correct. Later in the week he pimped me on how aspirin works in the body. I blanked and couldn't remember, but I finally gave the correct biochemical pathway (whew!) after he kept pressing me for an answer. If only he weren't so nice otherwise and adorable . . .

Anyway, my peds rheum placement is quite amusing. There are so many of us on this month! There's me (representing M1 and M2), a M3 who's in clinic once a week, a M4, 2 interns (1st-year residents or PGY1s), 1 second-year resident (PGY2), 1 first-year fellow (Dr. K), 1 second-year fellow (Dr. C), and 1 third-year fellow (Dr. S) in addition to the 5 attendings. I spent a lot of time with the M4 and she's been great in explaining things to me and how rotations work during M3 and M4 years. The residents and fellows were all great to get along with as well.

So my time in peds rheum is devoted between 2 primary things: clinic, and inpatient wards. Of those 2, the majority of my time is spent in clinic. On the first day I had no idea what peds rheum was all about, except childhood arthritis. By the end of the week, through clinic, I learned that peds rheum covers a lot of diseases, such as: juvenile idiopathic arthritic (JIA), psoriatic arthritis, spondyloarthropathies, Raynaud's phenomenon, and lupus amongst many others. By the end of the week, I had seen at least one kid with each of those. Since there are lot of us, often 2-3 of us would go in with a fellow or attending to see the patient. I'm sure many (if not most) of those kids felt overwhelmed when 3-4 people walk into a room together.

Inpatient wards generally aren't busy because peds rheum don't get many consults. Last week we only had one kid that we were consulted on. I'm going to call this kid "Kid of the Week" or KotW. So we, the 8-person rheum posse, see this kid on Tuesday. He presents with some minor neurological symptoms, and we don't really suspect anything rheumatological going on with him. So we leave a note suggesting it might be CNS vasculitis or something and leave it at that. The thing was that the areas of his brain that're affected made it practically impossible to confirm CNS vasculitis without destroying brain matter along the way to finding out.

By the following morning, the kid had several mini-strokes and his neurological symptoms had worsened, so they sent him down to the PICU (pedatric ICU). When we arrived we encountered a very irritated critical care attending. Shortly after we arrived, the neuro consult team arrived. The critical care and the neuro attendings started arguing in the hallway about how to care for this kid who's rapidly deteriorating in front of us. After the critical care guy calmed down a bit, we talked to the neuro team and see if they also agreed that it was CNS vasculitis. Neuro sent KotW down for an angiography of the brain while we started his treatment, even though we didn't have a definitive diagnosis (but to not treat him was less risky than the possibility of him worsening, so we decided to treat what was most likely the problem).

The following day, the results of the angiography seem to "confirm" our diagnosis. Of course, the fellows and the attending on service were skeptical because CNS vasculitis is very difficult to "prove," and it technically couldn't be proven in this case since it was so atypical (apparently). Also, none of us could interpret the films, so the rheum posse trekked down to radiology so we could find someone to interpret it for us. I do not want to be a radiologist. The room they were in looked and felt kind of like a bat cave. It was very dim so that the radiologists could see their computer screens more clearly. The only other source of light were desk lamps pointed away from the screens, which gave an odd ambient glow. Also, the radiologists were talking in low voices into their microphones to dictate their findings and notes; it kind of sounded like a low constant drone or perhaps chanting . . . as if they were all in a cult or something.

Well anyway, it seemed that the radiologists couldn't help us, so they directed us to interventional radiological neurology (I didn't even know one could specialize that much). So, someone there explained the films to us, and we mostly nodded in agreement because we had no clue what we were looking at (I'm sure even the attending with us had no clue - all those tiny tiny blood vessels just look like squiggly messes to me). So long story short, we think our diagnosis is correct and that KotW was getting better. They decided to keep him over the weekend to monitor him and see how he did.

5-Day Weekend

2010-07-05T23:45:00.003-05:00

I'm now done with primary care pediatrics in the inner city, and I'll be starting pediatric rheumatology tomorrow. No idea what it's going to be like, so this'll be interesting to say the least.

Because the primary care pediatrician I've been with the last 2 weeks only works Mondays, Tuesdays, and Wednesdays (albeit, from 8am to 8pm), I got Thursday and Friday off. I also got today - Monday, July 5th - off as well. So all this translated to a 5-day weekend for the 4th of July. :-D

I've been taking it easy the last few days - hanging out, cleaning a little bit, and working out a little. I don't remember if I talked about this, but apparently I lost about 6lbs during my 2 weeks in pediatric infectious disease, and then gained 3lbs in primary care pediatrics, and now lost those 3lbs again (until I gorged myself during lunch today, alas). Curious. Since I'll be in the hospital for 4 weeks, I'll probably lose more weight (here's hoping?).

Anyway, on Saturday, I saw the new The Karate Kid movie with a friend. I actually thought it was a pretty good movie - I thought that the acting was great and the music was good; Jackie Chan did a really good job. It would've made more sense and been more aptly titled The Kung Fu Kid, but I read somewhere they changed it to The Karate Kid later on. According to my friend, they apparently call it The Kung Fu Kid in China, or something like that. And today, I watched the original The Karate Kid with some friends, just for comparison because it's been years since I last saw the original, and didn't remember it well. Honestly, I thought that the new remake wasn't bad and didn't do a disservice to the original - other than karate having absolutely no role in the remake. Ah well. It's still a movie I think that's worth watching.

Later on Saturday, I went to a outdoor live music festival by the lake with a friend to watch the city fire off fireworks. I've rarely been close to seeing fireworks, so it was really nice to see them go off by/on the lake. :-) The local fireworks were today, so a few of us got a good view of them. However, there were also LOTS of mosquitoes out, so we were all pretty much doing our mosquito-be-gone dance. I really like fireworks.

Yesterday, I watched Infernal Affairs and The Departed with a friend at his apartment. The Departed is an American remake of the Chinese Infernal Affairs. There were certain scenes, plot elements, and even lines that were almost verbatim translations. That was amusing. I personally liked Infernal Affairs better because the exposition at the beginning is shorter, the good guy/bad guy distinction is a bit more nebulous at first (adding to the mystery), and the two main characters were easier to sympathize with. Also, in seemingly classic Asian style, the movie was a bit more psychological and there was more display of high-tech/using wit scenes (if that makes sense at all). The movie had English subtitles, and it took me a little while to get used to them while hearing Chinese. I translate Chinese differently in my head, so the English subs messed with my head a little for a few minutes, haha.

Lastly, Jake (my best friend from undergrad), is now in Beijing. I meant to call him before he left, because I needed his counsel. Alas, I missed my window of opportunity. However, he told me that about a week ago he proposed to his girlfriend and now they're engaged!! Their wedding is about 1 year from this Saturday. I'm so happy for them!! And I'm soooo not missing their wedding, even if it means a lower grade on a rotation (though, I "shouldn't" be on service over a weekend . . . maybe on call? I really need to somehow figure all that out . . .).

I'm Tired . . .

2010-07-01T00:25:00.004-05:00

. . . of pushing my APAMSA co-president along. He's pretty lazy and only gets things done when I demand them to be. It's been a while since I last checked up on him, I wonder if he completed the goals we set out for ourselves back in early June.

. . . of pushing my LGBTPM secretary along. He's very hesitant about taking responsibility. He keeps trying to get away with doing less. That's not acceptable because he barely does anything to being with compared to the rest of us.

. . . of reassuring my LGBTPM community chair that we're okay, that even if we've over-extended ourselves, we'll still be fine. She's constantly worried that we're too busy with our ambitions for the groups, but she's only chiefly responsible for 2-3 events.

. . . of making sure my LGBTPM treasurer doesn't explode on me and quit. Apparently, she hates that I send out emails so frequently (not once a day, like she claims). She's a pretty high-strung person, and I always tread carefully around her. She's been really stressed lately, but she has the advantage that most of her events are in the Spring semester - so she has more of a time-buffer than some of us.

. . . of being guilted into doing more work by my FMSA Patient Education co-chair. She is way overburdened this summer with many things, but she hasn't held up her end entirely. She feels that she's doing disproportionately more work than me for this program. In our last email volley summing up our latest meeting together, this appears true on the surface. But, it's her own fault. She keeps adding things to her to-do list that we hadn't originally agreed to deal with; and I keep asking her to tone it down - to deal with our top priorities first and leave her "extras" alone. Does she listen? Not really.

. . . of being responsible for my brothers. I was engaged in a long phone call with my mom last night. My brother in Hong Kong is miserable.

It's hot, humid, and rainy there; he's working 6 days a week, from early morning (I'm guessing 8am or 9am) until 7pm or so; he doesn't know what he's doing at work because he's the only person working on the programming assigned to him; he has no friends there; our relatives eat a lot of veggies and little meat, no juice, and no milk (cuz those things are expensive); and he's clearly homesick. Sending him to Hong Kong for 3 months was a HUGE mistake. And I told my mom this. He's been there for 2 months already. Had our parents sent me or my other brother, we would've been okay - we would've adapted and toughed it out. But my youngest brother, he wasn't ready for this. So my mom begged me to call him in Hong Kong to lift his spirits, to make sure he's eating right, to make sure he drinks enough water, to make sure he survives. So my mom tells me that I'm the only one he really listens to and that only I can help him now.

Knowing my brother, knowing that he'd rather starve himself than eat things he dislikes, knowing that he's miserable, it was a call I was fully prepared to make. Thank God my prayers were answered and he got on an early flight back to the US some time either today or tomorrow. He'll spend a few days/weeks in California with our relatives there - and I know he likes it there almost as much as I do (even if he doesn't show it).
---
This wasn't the summer I intended to have. I'm tired of being responsible for others when there's no one giving me the kind of support I need.

Every day while driving back from work, I wish there were someone waiting for me when I returned, or someone's door I could just show up on to hang out. Instead I return to an empty apartment. Instead I return to loneliness.

The long days at work I actually enjoy. At least while I'm working my mind's preoccupied. But how I envy all the people working there who have people to return to at the end of the day. And just like that, I've let myself become my work to distract me from my loneliness. And just like that I keep myself busy to hide the fact that there's no one here for me. And just like that I hate myself a little more.

I can't deal with this right now. I'm not sure I can even deal with this in the morning. I think it's time for an "emergency" call to my best friend before he leaves for Beijing for the rest of the summer on July 4th (what a terrible day to leave the country).

YouTube Time-Sink

2010-06-26T19:50:00.006-05:00

Every now and then I tend to browse YouTube. It's a surprisingly effective time-sink. Here are some YouTube vids that I particularly like.

Pink Glove Dance

I think this vid is really cute. I wish my med school did something like this. I especially love the part at about 0:54 minutes - the lone black male researcher in what appears to be a lab of otherwise only women. That's just priceless to me.

JK Divorce Entrance Dance

This is a spoof of sorts in response to this vid. I thought it was pretty hilarious, especially towards the end. :-P

Muse - Time is Running Out

This song has been stuck in my head for . . . weeks. Particularly various string versions of it. Notably, I like the arrangement by The Section Quartet, but the version by Vitamin String Quartet is also pretty good.

Lady Gaga - Greatest

I'm not generally the biggest fan of Lady Gaga, but I do like this song. I think, moreover, I like the lyrics. So if you don't to listen to the song, fine. Just go to the YouTube page for it and read the lyrics under the vid.

Not Medicine, But Life

2010-06-23T11:35:00.004-05:00

Well, it seems no one read (or cared) about my inner issues from my last post. That's fine, not like I expected anyone to care about my ranting and whining. Kind of like I wasn't invited to a friend's wedding, even though I've known him for 4 years in undergrad. Granted we weren't really close friends, but we hung out and chatted and all that. My best friend from undergrad (his best friend) was really mad that I wasn't invited - but such is the story of my life.
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Anyway the purpose of this post is to update you all on my last week and a half of my externship. What I saw was surprisingly little medicine, and a lot of life's psychosocial issues. What I saw were mostly "special populations."

Pediatric HIV patient
Last Monday I observed a patient in Dr. H's pediatric HIV clinic. The patient had contracted HIV via mother-to-child and was slowly being transitioned to adult HIV care (being 24-years-old already). I was in there with Dr. H and 2 of his HIV nurses. It was clear that Dr. H had known the patient for many years - 10 years at least I think.

Of the 1-hour or so visit, surprisingly little time was devoted to HIV care. Most of the time went towards helping the patient resolve personal issues - with her relatives, with getting a job, with her boyfriend, etc. She broke down more than once and cried on Dr. H's shoulder. All this was necessary such that she'll be able to get herself out of a rut and take her meds regularly again.

The following morning, Dr. H left me with some words of wisdom:

When a doctor or a student says, "The patient won't take his/her meds," change "won't" to "can't" in your mind. Think, "The patient can't take his/her meds."

Powerful words indeed. I could go into a whole post on those words and what he asked me to look up after the clinic visit, but I may save that for some other time.

Children's Court
Last Wednesday I went to Children's Court with several other externs. A retired judge met us there and gave us an introduction to Children's Court and what they did. They handle cases such as: juvenile delinquency, child physical abuse, child sexual abuse, negligence, etc. Their "goal" is to eventually reunite parent and child, even if the parent is . . . less than perfect. Usually - and curiously - the alternative (foster care) tends to be much worse for the kids.

I'm glad I was able to get an opportunity to sit in on a few hearings, though the presiding judge seemed rather annoyed at our mere presence in the courtroom. It's an opportunity not many get (at least, not in such a manner). It really is kind of like how it is on TV, lol. As such, I'm really glad I didn't go into law - the procedural stuff isn't for me.

International Adoption Children
Last Friday I accompanied the head of the pediatric infectious disease department (Dr. C) to an international adoption clinic. He had me read 6 chapters of a book the night before (which took me forever to get through - all but one of the assigned chapters was about infectious diseases). The 2 clinic visits were . . . interesting.

The first clinic visit went pretty smoothly. The adopted baby was quite cute and playful, and seemed to be adjusting alright. Dr. C did seem a bit concerned by the kid's "hyper-geniality," that is, he's too friendly with strangers. In the reading he assigned me, this could indicate lack of attachment to caregivers, which is a problem as kids can wander off with strangers too easily. The child psychologist agreed that it was something worth watching.

The second visit was kind of bizarre. The 5-year-old kid was adopted from Hong Kong and knew very little English. An interpreter was called in (alas, I can only understand but not speak Cantonese). The kid had so many issues, mostly behavioral. The parents seemed at wit's end at times during the 1-hour visit. On the way back to the hospital, Dr. C told me that, while most parents probably mean well, they don't fully think things through when they adopt international kids. Often times these kids are "damaged" in some way - either inherently or as a result of institutionalization (orphanage, foster care, etc). Dr. C only saw disaster for this family in the future.

Inner City Kids
This week I began working on my primary care pediatric mini-rotation . . . in the inner city. I get this feeling that all of us externs are to do our primary care bit in the inner city. While the last primary care pediatrician I shadowed was in the suburbs (where almost all his patients were white), this time I'm in the inner city where almost all the patients are black. And also, a lot of the patients are younger in age - so I saw a lot of babies.

I mean, today most of the patients were 1-month-old babies. One of the dads yesterday looked at me and said, "You don't have a kid, do you? You have that look on your face." I asked a lot of dumb questions about babies because, again, I know nothing. It's nice to know that the medicine we're taught has such an emphasis on adult care that pediatrics often get shuffled to the side (or at least that's how it feels to me). ::Insert sarcasm::

At the end of the day yesterday (the pediatrician I'm working with now works 8am to 8pm on Mondays, Tuesdays, and Wednesdays), he held up 5 billing sheets and told me: "See these? These amount to about $600 because all these patients are Medicare. If they all had private insurance, it'd be closer to $2000." What's frustrating (to the pediatrician and me) is that in primary care, we have to treat the patient population as richer and poorer. And that dichotomy greatly affects care no matter how neutral doctors try to be.

He also told me that where he did his residency (in Illinois somewhere, I forget), the hospital system was in a bit of financial trouble and needed more revenue for whatever reason. So the hospital implemented a program to increase the number of circumcisions they did because each one brings in hundreds of dollars, it's relatively easy to do, and it's billed more because it's an elective procedure (that is, it's not necessary to one's well-being). And it's totally unethical - we were both in agreement on this point. It's almost like trying to promote appendectomies on healthy individuals. It infuriates me to think about it more. Note to self: avoid that residency program.

For health care consumers, I suppose you should be careful if a doctor or nurse pushes too strongly towards a surgical procedure when none is needed or when alternatives haven't been considered - there may be something more behind that than "good medicine."

Behind the Masks

2010-06-19T00:40:00.005-05:00

Behind the Mask by =roundarosie on deviant ART

Sometimes I wonder . . .

Sometimes I wonder if there was ever really a face to the person behind the masks. Sometimes I wonder if the person forgets that he is wearing masks, like people wearing glasses sometimes forget. Sometimes I wonder if the person remembers that he is an independent entity apart from his masks. Sometimes I wonder if this person is able to separate himself from his masks . . .

I've blogged for so long now that it has itself become a mask - one through which I allow people who I've never met become my friends, one through which I let strangers glimpse some of my most personal thoughts and memories, and one through which I let the world read my secrets. Reflecting on this blog, it has seldom been me at my least restrained. More often than not, my posts are mere amplifications of my many masks.

Can I even dissociate myself from the masks I wear? Is there Aek without a love of biology, languages, and music; without medicine; without desire to help; without inner sexual conflicts; without confusion; without secrets embedded deep inside? Am I these things, or are they me, or is it both?

As children, the mind is amorphous and does many things - all things - simultaneously. As we age and become adults, the mind solidifies onto certain paths, narrowing options while enforcing those paths. And so I wonder, has parts of me been slowly chipped away by time and age, such that all that's left are the parts of me still attached to my masks? What is Aek when he's not a med student? What is Aek when he's still not sure if he's bi/gay/other? What is Aek behind the masks . . . behind that name?

Though it may not seem like it, though I may not always say it . . . there is still much vulnerability and insecurity to the face behind the masks. I'm still waiting for someone to take them off and look me in the face.

Infections Everywhere, Oh My

2010-06-13T18:15:00.004-05:00

On Monday I started my peds externship, starting with 2 weeks of peds infectious disease (PID). I think I'll talk about particular people/events rather than detail my day-to-day, as doing the latter would make this post too long.
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First a cast of characters for this week:

Resident. Resident is a 2nd-year med/peds (internal medicine and pediatrics) resident currently rotating through PID. I spent most of my week with Resident. Resident is amazing - cute, adorable hazel eyes, a great smile, very intelligent and conscientious, very nice, and loves to teach. I learned and reviewed a lot with him this week - stuff that I learned (and too often forgot), some stuff I feel like I should've learned, and some stuff that I probably won't learn until M3 year. He gave me some tips for the USMLE Step 1 that I'll be taking this time next year. Also, he told some things I hadn't yet learned (like Cushing's triad) so I could "impressive" Dr. H and say I learned something from Resident. At least when Dr. H pimps us, he pimps nicely (sorta). I think I had a mini-crush on Resident, too bad he's on vacation next week. :-/

Dr. H. When I told Dr. P that I'd be working with Dr. H for 2 weeks, Dr. P was like, "Good. He's the guy to work with. I'll send him an email and let him know about you." So Dr. P hyped me up for Dr. H and that's kind of amusing. Dr. H is a quirky guy, and brilliant (maybe that's why he's quirky). He's been super-busy most of the week, hence why I've been rounding with Resident a lot (not that I'm complaining - Resident is awesome). One of the things I love about Dr. H is how he always makes a point to explain things to parents so they can understand the full situation. He'll sit down and explain any lab values and any radiology images (x-ray, CT, MRI, etc) until the parents understand. And the parents always appreciate it, because rarely do anyone else explain things in such detail.

HIV Nurse. On Thursday, I went with HIV Nurse to the local HIV/AIDS resource center for a management meeting with other nurses. So the management meeting is where nurses (and doctors) manage HIV cases - by adjusting meds, dealing with follow-up care, dealing with psycho-social issues, etc. I sat in on a peds HIV management meeting and this one for HIV+ women in the area. Then I went on a home visit with the HIV nurse. This poor woman takes more drugs than I think I've taken in my entire life combined. HIV meds, hypertension meds, insulin, and more. I'm really glad that HIV nurses exist to help patients manage their meds (and other life issues), but I certainly do not envy their job.

Doctors often prescribe a bunch of meds, but there's no real way to know if patients are actually doing them. So these HIV nurses are like the "executors" of the doctors' orders - making sure patients actually take their meds regularly and such. It's hard work, and I think it was a really good experience for me so I can appreciate the difficulties involved "downstream" after the doctor's visit. And from the HIV nurse I also learned that all the HIV management Dr. H does is for free, since that service can't be billed. So Dr. H spends a lot of his time doing stuff for patients that he isn't getting paid for; but, he must still somehow see enough patients to meet his salary. That's rough, but I only have admiration for what he does.
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So, because I'm on PID, all I see are infections. Infections everywhere!! By the end of the first day I learned that there are different kinds of MRSA and that there are 4-5 main antibiotics commonly used in the hospital. Also, by the end of the first and second day, my feet wanted to assassinate me and walk away - it hurt so much to stand for so many hours. But I got used to it by the third day.

PID is basically endless rounds and consults. You don't really have any patients of your own; all your patients are referred to you from another physician/team as they ask you for a consult. The number of patients you'd see is actually rather small, but you do a lot for them and you spend a lot of time with each patient. A few patients we hovered around for a good hour or so, and also spent a lot of time talking to the (very worried) parents. So as a PID doc, you're basically a consultant (that does a lot of work).

I also saw several kids with pneumonia, and I got better at reading chest x-rays. I spent a little bit down in peds radiology to look at images with Resident and Dr. H, so that was cool. I must say, the radiology offices are dark - vampires could probably comfortably live there, lol. The radiologists also have interesting-looking (and possibly ergonomic) chairs that they sit in. o_O

Most of the kids I saw were quite sick, and several of them were in the PICU (pediatric intensive care unit). This one poor kid was sedated almost the whole time I was there and had like, 4-5 lines in him that were all infected. And he had this really uncomfortable-looking rash over his entire body except for a patch on his left arm.

Another kid was in the HOT (hematology/oncology/transplant) unit, and he was so adorable. It sucked that he had cancer and was scheduled to get chemo, but he seemed otherwise healthy and fine. We were looking into a mystery lung thing that produced no noticeable symptoms. That was truly curious. Just as curious as the teen who came in whose only complaint was a fever that persisted for 2 weeks and no other symptoms. :-/

The most interesting case I saw was a kid with tetralogy of Fallot. When I learned about it first semester, I never thought I'd see a case of it and here it was!! Alas, when Dr. H asked me what 4 features define it, I could only list 2 and he gave me a disapproving look. I also couldn't list the 5 cyanotic heart defects (though I'm pretty sure we only learned 4 of them anyhow). This kid came in with a brain abscess (likely of infectious origin), and so I found the neuro exam really interesting. Ipsilateral ptosis, downward gaze, and small pupil; contralateral muscle weakness. Very interesting. Bonus points if you can guess the location of the brain abscess on the CT. :-P

I also touched some babies' fontanelles! Babies are so cute. ^_^ The fontanelle feels different depending on how old the kid is, and also can bulge out if there's intracranial pressure (that's kinda freaky). Alas, at least one of them was in with bacterial meningitis, but I think he'll make it out okay. He was already on his way to recovery. That's something I do like about PID. At the beginning of the week all I saw were sick kids, but by the end of the week, 2 of them left our service because they got better and were discharged to go home.

Lastly, a funny note. Dr. H asked me how I knew Dr. P, and I said I met him at some event held at the med school and I shadowed him twice a few months ago. On the first day, we ran into a pediatric hospitalist I knew while she was on service. Dr. H was like, "Do you know everyone?" The following day, I ran into one of the faculty advisors for APAMSA while walking down the hall with Resident, and even Resident commented, "Wow, you do know everyone don't you?!" I was amused.
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Okay, this post was longer than I thought. Ah well. So filled with medicine/health stuff, but that's the whole point. Remember folks, wash your hands. Germs lurk everywhere, and infections aren't fun.