The Adventures Continue

This time it has been 6 months.  The delays in my posts get longer, but life proceeds at its frenetic pace.  And there is much to update y'all on.

1.  Senior Resident

It's been interesting being a senior resident and overseeing the brand new baby interns.  There are 2 overwhelming thoughts: 1.) It's crazy how much I've grown as a resident and as a doctor, 2.) I have a new-found appreciate for my senior residents when I was an intern (and I found myself doing some of the things they did!).  I've also developed an unofficial "rule" for a well-functioning team: the team that laughs together, works well together.  :-)

2.  Fellowship Interviews

For most of September and October, I've been busy with fellowship interviews.  I decided to pursue a fellowship in pediatric rheumatology after all.  There are few fellowship programs in this field and oddly even fewer applicants!  It's not a well-exposed or popular fellowship.  But hey, I guess that works in my advantage.  Here are pics of some places I've interviewed:

 Cincinnati, OH

 Pittsburgh, PA

Ann Arbor,MI

Seattle, WA

3.  Another Away Rotation

Yay another away rotation!  This time in pediatric dermatology because, well, I suck at dermatology.  And knowing some dermatology will be useful for rheumatology in the future.  See if you can figure out where I did my rotation from the following pics:

4.  Match Day

And about 1 week ago, I found out that I matched fellowship in Pacific Northwest.  That's exciting.  I'm a tad annoyed that I didn't match in the Bay Area, as my odds were higher of matching there.  Oh well.  I can't ruminate on this for too long.  I must admit, it's probably the better program.  I was willing to "sacrifice" some career potential in order to be closer to family and focus a bit more on social life, which has been on hold for so long.  But it seems that the universe has other plans for me.

5.  (Lack of) Social Life

Yup.  Still single.  Not for some lack of trying, but maybe I'm just doing it wrong?  Maybe I'll find someone in the area where I do fellowship?  Should I remain always hopeful?  I don't know.

The Fastest Longest Year

hospital floors by JESSERZZZ on deviantART

Farewell to intern year, the fastest longest year ever!  It's certainly been a crazy ride full of up and down roller coaster emotions.  And boy did the year finish with a bang!  Time to muse on a few thoughts:

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1.  Doctors incognito

I've noticed an interesting trend among us "newer" physicians: we never let anyone in public know that we're doctors.  At least not initially.  We never introduce ourselves as doctors, we never use our hard-earned titles in public, and when asked what we do for a living, we'll say something along the lines of "I work in the medical field" or "I work in the hospitals," but almost never will we say outright "I'm a resident/doctor."  Why is that?

In a twisted way, it's almost like a sense of shame or being marked.  Open your mouth and say that you're a doctor and people instantly treat you differently.  Either they ask you about your opinions on this or that (I get the "Should I get a flu shot?" question A LOT), or they ask you about homeopathic remedies, or their negative experiences with doctors comes out.  I mean, I don't go to someone who says he/she is a lawyer and say, "Man, I really hate all lawyers.  They're all scum."  Or "Are you the kind of lawyer who stands in a courtroom and all that?"

As such, I'm never offended if someone calls me "Mr." instead of "Dr."  Although, an interesting thing to note that in Britain, "Mr." is a title ascribed to surgeons whereas "Dr." is a title ascribed to physicians.

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2.  The misunderstood adolescent

I may have said this before - I'm one of the few pediatricians who actually enjoys interacting with teens.  Not all teens, mind you, but in general yes.  Anyway, this bodes well especially if I'm really intent on pursuing peds rheumatology (which skews heavily toddlers and teens).

This may be coincidence or it may be intentional, but most of the teens in my continuity clinic are males.  They're such amusing creatures.  I can get most of them to open up at least somewhat (and a handful almost way too much, lol).  I think it helps to understand where many of them are coming from.  And I may be a bit too . . . liberal in my advice to them.

Anyway, there are 3 things I always iterate to every teen guy: 1.) wash under your foreskin (most of them where I am are uncut - good for them, lol), 2.) monthly testicular self-exams, and 3.) ALWAYS USE CONDOMS.

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3.  Rising seniors

As interns we are the lowest person on the totem pole that matters (sorry med students, the hospital functions very well with or without you).  We're often abused - intentionally and unintentionally - by senior residents, attending physicians, nursing staff, etc.  It's a frustrating place to be.  But at the end of every intern year is the promise of becoming senior residents and FINALLY stepping out of the intern role.

And at the end of each intern year, it's an opportunity to reflect on the kind of senior we aspire to become.  I've had the good luck to work with one of the best and by far the most hilarious senior residents I've ever known.  Although the last month was rough, he made every day go by quickly and with enough laughter to sustain us.  I can't say I want to exactly be him, I will aspire to carry on aspects of him.

In less than a week, I'll be considered a "senior resident" and I'll have no idea if I'll be a good one or a bad one.  The best advice I've heard was, "Remember what you liked in your senior residents and do that.  And especially remember what you hated done to you as an intern and don't do that."

Janus at the Gate

Janus by ~luka-basyrov-art on deviantART

Janus, the Roman god of Gates, whose two faces look towards the past and the future, and for whom the month of January is named after. An very interesting and apropos Roman god for the new year. 

2013 has been a year of ups and downs. Meeting new friends and saying farewell to close ones. A year that marked the end of one era and the beginning of the next. One filled with pride, accomplishment, and excitement. One full of anxiety, doubt, and frustrations. A year I would do all over again and yet would never wish it repeated. 

I left 2013 and entered 2014 on not the best of notes (what with issues with my student loans servicer and a laptop that's crashing far too often). And least of which I was working on both Christmas and New Year's (actually at work now). What kind of year will 2014 be?  Surely one we make, right?

Lately I've been left feeling so out of balance and it's difficult to find the way back, much less time to look for the way. But 2014 needs to be a year where I can center myself, refocus my energy, find my motivation, and let the wounds of 2013 scar over. Time heals all wounds, but the scars they leave serve as constant reminders of what was. 

I have no particular resolutions. I'd just make the same ones as I do every year. Eat healthier. Work out more. Lose weight. Find love. Explore more. Travel more. Easier said than done when I'm still figuring things out day by day, week by week. 

I do not mean this post to be a depressing one. I am a realist, and reality isn't rose colored. There are some positive things to look forward to this year. In many ways, after the first couple months there is only up. But I must not rest my laurels, vigilance is still needed.

If I am so lucky, so bold, maybe - just maybe - I can achieve some that which I hadn't been able to for several years now. Let the new year begin!

Officially an MD!! Now What?

Last Thursday: Was hooded by my faculty adviser.  Apparently these academic hoods were useful back in the day (not so much as hoods, but as a means to keep the neck and shoulders warm, and a place to put one's wallet, lol).

Last Friday:  Graduated!!  Now officially an MD, woohoo!!

Last Saturday:  Pack pack pack.  Friend's wedding.  Pack.

Sunday:  Pack pack pack.  Last brunch with friends in town.  Then drive 6-7 hours back to my parents' place.

Today:  Happy Birthday to me!  Well, my birthdays tend to almost always be lackluster, so whatever.  It was pretty chill.  Watched the new Star Trek movie with my brother, that was good.  :-)

The Next Stage

Wow.  Graduation is in less than a week.  In less than a week I'll have my MD.  And in a month from yesterday I'll start orientation for residency in a state across the country (at least it's not as far away as Alaska or Hawaii? lol).

The last 3 months have flown by.  It's like I blinked and I'm here.  Doesn't help that it's still a bit cold outside even now in May, haha.  I'm not sure I'm mentally ready for this next stage - for financial independence, for having a real job, for being responsible for the life (and death) of patients.  It's only in retrospect that I can appreciate how far I've come, but I've still got a ways to go in so many respects.

I was never one of those people who hurried to grow up.  In fact, just the opposite.  I did NOT want to grow up.  Childhood is so short, adulthood is so long and fraught with issues that no one else can solve but you.  Maybe this is part of the reason why I'm doing pediatrics, who knows.

At these critical junctions I find myself reflecting in nostalgia - what would and could have been if my life had taken a different path.  What if I decided to take a year off and complete my MPH?  What if I decided not to pursue medicine?  What if, instead of being paralyzed in fear and confusion, I had decided to date her in undergrad?  What if I had decided to come out to my parents?

I have little regret in the things I have done.  I only regret the things I haven't done or haven't been able to do.  They say that medicine is one of the ultimate delayed gratifications.  You spend the majority of your 20s studying your ass off, working long hours, often putting life and health on hold.  This continues (or perhaps worsens) in residency, and in the blink of an eye, you're in your 30s.

It's okay though.  There's still some of my 20s left.  Sure I may not have much time off each year, but that just makes each day off that much more precious.  With my salary, with my own money, I will have the ability to do many of the things I want without having to consider the debt looming over my head (which will get paid off in time).  And with the new duty hour limits of 80 hours/week, I may even have time to develop a social life if I'm efficient.

So it's alright, I can't stop the flow of time just as much as I can't reverse it.  I have just begun creating a bucket list and I'll be damned if I'm unable to do every one of those items!  This wasn't the post I originally meant to write, but here you have it.  Sorry for the scattered thoughts.

Re-examine

Re-examine by ~Meow2puchiko on deviantART

On Saturday I went to a friend's wedding.  It's the 6th wedding I've been to in the last 5 years.  It was a small, intimate, outdoor wedding of family and close friends.  Though the forecast threatened scattered thunderstorms, the weather couldn't have been more perfect.

I sat (as I usually do) next to friends I knew in undergrad - some of them married, many of us single.  My friend sitting next to me remarked, "Every time I come to a wedding, I feel like I have to re-examine the course of my life."  And I sympathize with him 100%.  It seems like friend after friend has been getting married, and where am I?  Where are the rest of us?  Even if it's not entirely true, it feels as though we're lagging behind in "life progress."  It's rather unsettling at times.  I'm so far from marriage that I can't even see it in the distant horizon.

At least my other friends (married couple) spoke the truth that as we get older, our dating pool only increases (formula: minimum age of dating partner = 1/2 your age + 7).
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The following day I met up with another friend (also married) on my way back from the wedding.  We chatted for a while on politics and catching up and all that.  He always relished my medical stories, especially the gory ones, haha.  His wife was a trooper too with my descriptions.

After a while when it was time for me to go, he gave me the location of his brother's grave, the same brother I had considered one of my closest (and longest) friends.  It felt strange driving to his grave.  I found it rather easily.

There I stood on the road, looking between two small stone walls along rows of graves.  The sun was bright, the sky blue, and the trees and grass green.  At the far end stood a statue of Martin Luther.  And there I saw his sign, a temporary placement for his headstone not yet finished.  Standing at the foot of his grave, I could see it was a recent-ish burial as the grass had not fully grown in the spot.  I had brought no gifts, no tokens.  I saw a single black feather and placed that under the sign.

And I began to say my last words.  It was weird, talking to no one but the breeze.  I wasn't even sure of what to say, my ramblings barely coherent even to myself.  And then I teared up as I admitted that I was bi, something I never got around to telling him while he was still alive.  The words choked, stuck in my throat as I said, "I know I never told you, but I thought you should know . . . I'm bi, probably more gay than straight but I'm working on figuring it out.  I know you would've been okay with it, you would've helped me figure it out in your own way, but there's no way to know now, eh?"

It was awkward, but what does that say?  What does that mean?  That even now, even talking to no one but the air, those words would be so damn hard to say?  I suppose I really haven't changed too much since the beginning of this blog.  I don't see an endpoint.

Having too much time makes idle thoughts wander, too much time to re-examine and yet still do nothing.

Ending with the Crazies

Ya know, I could say how I've been busy and whatnot.  But that'd be a lie this time.  I've just been lazy.  The year has been winding down for some time and I just couldn't be bothered, lol.  And as it is, I end the year with the crazies (aka, psychiatry).

It actually wasn't a bad rotation.  Spent 2 weeks on child/adolescent psych, 1 week on eating disorders, and 1 week on adult psych.  As the director of the place told us several times, "Most of these patients ain't dumb, they ain't crazy, they just have had crazy things happen in their lives and couldn't handle it, and that's why they're here."  On about day 3 I realized how true his words rang.

The vast majority of psychiatric patients I saw aren't crazy.  Most of them aren't schizophrenic, they don't hear voices other people don't hear, they don't see things other people don't see, they aren't foaming at the mouth or anything (that said, the couple of schizophrenics who weren't taking their medications really were sometimes kinda scary crazy).  Most of the people I saw actually had mood disorders - anxiety, depression, irritability, etc.

The best way I can describe most patients' situations is that crazy things happen in their lives - a kid is witness to domestic violence or is abused (verbally, physically, emotionally, and/or sexually), a teen feels out of control when her parents divorce and start restricting her eating, an adult couldn't handle the pain from multiple surgeries and turns to drugs - and their minds just can't take it.  Something inside breaks and they snap.  These people try to resolve things and find an outlet for the trauma of their minds and find themselves repeatedly bashing their heads against a proverbial wall.

And when they're at their lowest, when there's not much further down to go, they come to us at an inpatient psychiatric hospital.  Here we control the environment, take the responsibility out of their hands for a time, talk to them, counsel them, prescribe medications.  And these medications often work (it may take some fiddling around to find the right drug and dose for the right person, but it works out more often than not).  They kind of reset the imbalance in the brain and allow people to think clearer, calmer, and more rationally.  They smooth out the edges of emotions so one doesn't soar as high or dip as low.

Mental health.  It's a real thing.  Sometimes all one needs is some counseling, and sometimes it requires medication.  In that regard, it's not really any different than diabetes or hypertension.

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Oh yeah, I'm 3/4 of an MD now!  :-D  Unfortunately the other aspects of my life have been less interesting than the things I witness when I'm in the hospital.  Still a few things here and there worth blogging about in posts to come.

Oh yeah, PPACA (aka, Obamacare) survived the Supreme Court ruling.  Thoughts?  Also for another post, lol.

A Sudden Farewell

At around 10pm on May 1st, one of my closest friends committed suicide.

I learned that fact from his older brother on Facebook.  There were and are no words that adequately describe my shock.  There are so many questions left unanswered.  What warning signs there were (if any) were subtle.  But this much I do know.

My friend, who had a promising career in directing/acting, went to Los Angeles in December to seek career opportunities and to "find himself."  From piecing together snippets of conversations from several of his friends, his brother was able to figure out that his mental state had begun to decline.  While in isolation each of the conversations he had with people were nothing out of the ordinary, together they may have foreshadowed this event.  In fact, even earlier on May 1st he had lengthy and rather ordinary conversations with people, including his brother.  Such is the curse of hindsight.

I have promised his brother not to say much more, at least not until after the funeral.  I have an unfinished document sitting on my laptop that I had meant to send him - a document that he will never be able to receive.  We didn't talk too much these days, because of our very busy schedules and the distances that separated us.  But he was a friend I had known practically my entire life.

My last memory of him was at his brother's wedding back in September.  Although it has been months and I wasn't able to talk to him and say another goodbye, it was good seeing him back then and he shall remain in my good memories.

Farewell, my friend.  You will be missed.

Tribute to Life

It's been almost 3 weeks since I began my pediatrics rotation, wow! I had been debating what the "final" post for surgery should be - either a collection of quotes I've obtained on surgery, or something more meaningful. I decided to go with the latter.

A few days ago, I saw the following vid on the blog Chronically Lost in Thought.

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

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.

Less Person, More Intervention

A couple days ago I was at an advisor's apartment to welcome students of the incoming M1 class. His wife, who has acute myeloid leukemia, was also present. By any statistic you can quote she has beaten the odds more than once. She's a tough one and still fighting on.

Almost 3 years ago when she first greeted me and others as freshly minted M1s, she was lively, warm, and motherly. Now, bald and weak from chemo, tanned as if her skin had been baking under a desert sun, and also on dialysis, she appeared so frail and mortal. I've seen this before - the frailties of the body, broken by disease and worn from treatment and intervention. But also peering through are the embers of a once-strong soul. I could tell through her heavy-lidded eyes that she wanted to be healthy enough to interact and engage with all of us, instead of lying on the living room couch. I could tell that behind her wearied smiles that she's fighting off her own suffering.

I read a blog article the other day by a doctor who experienced what it was like to be a patient. What he wrote seems to mirror some of the patient's I've seen. Being a patient in the hospital must be one of the most frustrating things in the world. You rarely fully know what's going on with you, nurses are poking you every 15 minutes to 4 hours, and doctors order things to be done on/to you as you lay helplessly. We just need to remind ourselves that, at the end of the day, we can go home. Our patients often can't.

It's easy to correct an electrolyte imbalance. It's easy chase a blood culture. It's easy to track labs. But it gets harder and harder to see patients as people and not a "bag of symptoms." You look at someone and you don't see a mother, a sister, a father, a brother. You look at someone and you don't see a baker, a chef, a nurse's assistant, a student. No, instead you see an alcoholic, a morbidly obese individual, a body part, an organ, a pulmonary embolism, a cancer. All of which is true, one can't objectively deny any of it.

But in the ICU (intensive care unit), I've seen people become less and less person and more and more medical intervention until all that's left is a body on a ventilator with an NG tube, a Foley catheter, an arterial line, a central line, and a telemetry attached. In that state the soul has probably fled and all that's left is a shell of a person kept alive, not for the patient's sake, but for someone else's (whether it's the family or the medical personnel).

A woman was brought in to the ICU today. Full code, meaning CPR and the whole deal. She should have been left to die in peace. As my senior resident said, "This is a special place of Hell that people are forced to suffer through when someone calls the code."

That said . . . people occasionally do get well enough to regain their humanity and go home.

Pandora's Hope

I've witnessed Pandora's Hope with my own eyes,
staring at its immortal form behind its mortal guise.
A blessing, a curse; making us toil long after the day is done,
pushing us harder through a battle that can't be won.
I can only guess at its motives and its reason
since its release from its God-wrought prison.

I have seen it visit you on the edge of death
as you lay gasping with each labored breath.
With your eyes tightly shut in silent pain,
Pandora's Hope burrows deep into your vein,
snaking its way from your arm to your heart
and leaving its eternal mark within your chart.

Defeated, futilely struggling, there you lay.
Can you even hear us and what we say?
Our words of strength reach not your ears,
in your unconscious darkness of pain and fears.
Lifeless are your feeble and atrophied limbs,
your vessel subject to Hope's every whim.

It's not your pain - your suffering - that Hope allays,
but rather our fears and insecurities that It keeps at bay.
And before we realized, before we even knew,
Hope, and Artifice, have crept their way into you.
Hollowed out, Pandora's Hope has made you its shell,
And all for us It traps you - here you dwell.

A Good Death

My last patient died yesterday when I was post-call (aka, I wasn't in to the hospital).

This morning when I logged on the EMR (electronic medical records), I thought it was odd that it listed him as "discharged." I thought to myself, "Why would anyone discharge him? He's far from being stable enough to go home!" Later during rounds, the attending told me and the intern taking care of him that he died Sunday night.

I wasn't surprised (he was in really really bad shape with zero hope for recovery) but it still shocked me a little. The family had decided to declare him DNR (do not resuscitate). Within 24 hours of his death, most/all of his family had flown in from all over the US to be with him in his final hours. He was put on palliative care right away, but since the palliative team doesn't work on the weekends (wtf is up with that?), my attending began standard administration of morphine to ease the pain. His breathing rate was high and the morphine actually brought it back down to normal. He died some time later.

I almost cried a little but it wasn't the time and place. I had only known him for about 3 days and we did everything right by him. As the senior resident later remarked, "I'd rather be dead than live on through that." His rights were respected (his son had the power of attorney) and by all accounts, he died a good death - quick, and not drawn out like with cancer.

What do you think? Is there such a thing as "a good death" and if so, what is it to you?

2010, What a Year!

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!!! :-)

I Am Done With This

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
-----
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).

So We've Come This Far

Today was the first day of classes for this semester. We sure hit the ground running, lol. As I was talking to some old friends over the Winter Break, I found it kind of unbelievable how far we've come.

So over the Winter Break I met up with two old friends, JR-M and JS-M. I suppose for the purposes of this (and future) post I'll refer to them as John R and Jake S, respectively. I've known both of them since elementary school; John R was my next-door neighbor for at least half of my childhood and Jake S was a good friend throughout elementary school.

I first met John R for a really late lunch. We got caught up on each other's lives a bit. For a long time I considered him one of my best friends and definitely still one of my closest friends, though physical distances between us over the years has caused some drifting apart. He graduated last year with his B.A. in communications and film studies. He wants to get into the film industry and eventually become a director one day. Alas, in this economy work is hard to come by for him. So in the mean time he's going to this "film school" to learn more about being a cameraman and such things. I hope he catches a break and gets his foot in the door, because he's one of the most creative people I know and passionate at what he does. I've read and seen some of his stuff, and I think they're quite good.

He also updated me on one of his older brothers (he has 2), Tom R. So Tom R also graduated last year (I think) with his degree in public policy, and is currently working in some kind of social work with their mom. He doesn't really like it anymore, lol. He wants to get into public administration of some kind. He'll probably continue working for a couple years before going back to school for his Master's in some program.

The following day, I met Jake S for yet another late lunch. We had gone to the same elementary school and middle school, before I moved. Then we met up again briefly in high school. We ended up going to the same university for undergrad, though it was such a large place that we never got to hang out much - a little bit freshman year as he lived in the dorm across the street from mine. He's currently a first-year dental student back at my alma mater. He's looking to go into oral surgery or something. He also updated me on some other old friends from our hometown - several people are in med school or will be entering med school next year.

My dad commented how our little 4th grade soccer team has come quite far. Several of us had played soccer together in elementary school - Tom R, Jake S, others and me. A few of us are on the med school track, Jake S is on the dentistry track, and Tom R in public policy. It's pretty impressive I must say. We each arrived at our destinations through very different routes and at different times and places. One day I'll call these old friends my colleagues as well. We're growing up. ::shudders::
-----
All this introspection has me wondering. I've come this far in blogging. This year my blog would turn 3. Woah, that's like the Methuselah of blogs! I mean, Courage of A Beautiful Addiction is leaving, Mirrorboy of Mirrorboy's Blog is leaving, and Jay of Sun in my Face is already gone without so much as a goodbye!!

So I wonder, now that I've come this far, how much farther is there to walk? How much longer will I be blogging? Do all blogs have a "shelf life" as it were? I wonder if mine's nearing its expiration date. And if so, what then? It's not as though I feel like I've made any critical contributes to the blogosphere, which is fine as it wasn't my original intention anyway. And it's not like many people would miss me (though there are a handful of you out there, I'm sure).

Food for thought. No plans of closing my blog as of yet. But I do wonder what direction (if any) I want to take this blog in 2010. And most other blogs as old as mine are already long gone. Hmmm.

2009 in Summary, 2010 Resolutions

end of the line by *Blepharopsis on deviantART

It's now the close of 2009 and the just before the beginning of 2010. Let's take a look at my 2009 Resolutions. Hmm, seems that I was quite successful on some points but woefully failed at others. Such is to be expected I suppose. Let's see how 2009 went (using the 2008 in Summary template):
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2009 in summary (and this is by no means an exhaustive list):

Winter Semester (January - April):
- Got a new roommate (or apartment-mate, I suppose). He was alright, except when he cooked, then the apartment reeked of kimchi.
- Was a GSI for the undergrad Intro to Genetics course. Was totally kick-ass at it! :-P Read about some of it here.
- Got over 10,000 views on my blog! Not particularly exciting, just being amused.
- Went to China over Spring Break with other public health students and faculty. It rocked!! Read parts I, II, III, and IV.
- Was performing poorly in research, but was able to get a second chance to redeem myself. I hope I actually did redeem myself . . .
- Worked on an epic final project with my friend, AG-F, for a class. Read about the genius here!
- Got straight A's (somehow) in all my grad school courses. Grad school wasn't so hard . . .
- Said my farewells to the city of my undergrad. :-( Pictures here.

Summer (May - August)
- Was going to travel around in China! Then the swine flu scare, and my trip got canceled. T.T
- Saw the Star Trek movie twice, lol; the first time with a friend (YY-F), the second time with another friend (SR-F) and my brothers.
- Saw Up with my brothers.
- Went to my old roommate's, AW-M's, wedding in July.

Fall Semester (Late August - December)
- Started med school.
- Volunteered at a free clinic (with pretty much all the other M1s, lol).
- Gave an obesity presentation at a nearby high school.
- Joined the LGBTPM (LGBT Persons in Medicine) student group.
- Came out to my labmate, Leslie.
- Visited SN-F in Chicago when SR-F came to visit. :-D
-> Saw Where the Wild Things Are with SR-F and the roommate.
- Got a pediatrics externship for summer 2010!!
- Finished first semester of med school. :-O
- Saw Avatar in 3D with SR-F and my brother. Good movie!
- Saw Sherlock Holmes with both my brothers. Good movie!
- Met an old friend, JR-M, for a late lunch. Caught up a bit. JR-M had been my next-door neighbor for 7-8 years of my life.
- Met an old friend, JS-M, for a late lunch. Caught up a bit. I had known JS-M since elementary school.

Year-Round
- Met many great (new) bloggers and have had the wonderful opportunity to chat with several of you online. You make my days and I'm so thankful for getting to know you. :-)
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2010 Resolutions

I'm going to take it easy on the resolutions this year. I'll try not to make "benchmarks" for myself.

1. Be healthier. Eat healthier, exercise at least 3-4 days/week. De-stress more. Hopefully the rest will follow.

2. Take more pictures, record more memories.

3. Keep in contact with friends. Solidify new friendships.

4. Keep up in med school. Do a bit better academically, take more advantages of certain things.

5. Pursue what may be (I hope) the beginnings of a relationship. It's a secret. Well, I guess it isn't so much now that I've mentioned it here . . . but no details for you till later. ;-)
-----
Now to plug some new blogs that I've recently began Following. I'm still catching up in reading all their posts, but all in due time.

A Beautifool Chaos
Frozen with a Heart on Fire
Rock James Bottom

If you haven't visited them, definitely stop by and say hi in 2010!!

1/8th of a Doctor!

Finished my last couple exams about 2 hours ago. I think I did alright. It's been a long week and I'm glad I'm done.
---
Monday

Biochem exam. That was absolutely brutal. I barely passed though, thankfully. Enough said. For future reference, I'm asking a pharmacist - it's their job to know more than me in this arena.

I also shadowed my mentor, a pediatrician. Speaking of which, I got a position for a pediatric externship for the summer! It's actually a really cool program: 8 weeks, $2500, shadow a primary care pediatrician for 2-4 weeks, shadow 1-2 pediatric subspecialists for 2-4 weeks, and maybe some clinical research. The coordinator really works with each extern (there are 8) and tailors their experience to their interests, so I'm really excited for that! Anyway, back to the mentor shadowing. It's was alright, pretty much "bread-and-butter" pediatrics (strep throat season it seems). Learned some interesting things, but to protect patient info (not that I know them anyhow) I'll just mention some of the things I've learned:

- Be careful when diagnosing strep throat. Using antibiotics when it's viral won't help and may make things worse. Not using antibiotics when it is strep throat (bacterial) is dangerous - kids can develop rheumatic fever (which affects the heart) as a result of a strep infection.
- A lot of kids have innocent heart murmurs that go away spontaneously as they get older. No idea why that is . . . I should ask the next time I go in.
- Kids can be born with a cataract. And sometimes these cataracts don't impact vision at all.
- Kids can be born with 20/20 vision in one eye and 20/200 vision in the other. They have to wear an eye patch over the good eye to force the brain to "fix" the bad eye - they way they probably won't need glasses at an early age.
- A strep infection can lead to PANDAS, where they develop sudden-onset OCD (or other mental health issues). Treating the strep infection promptly can remedy the mental health symptoms. Who knew that mental health issues may sometimes have an infection as the root cause?

Mock lab practical. So after the biochem exam, and after mentor shadowing, I still had to go into the anatomy lab with about 100 other med students and identify stuff on the cadavers in practice for our exam on Wednesday. By this time in the semester we aren't really phased by the dead anymore.

But I'll say one thing: there was this body with the largest penis I've ever seen. Seriously, the head (more properly - the glans) was the size of like a jumbo-sized chicken egg. o_O Way to make all the living guys in the room feel inadequate, lol. In all actuality, we don't envy his . . . penile prowess. It looked way too large to be comfortable for his partner. The 2 girls next to me were like, "If I saw that on a guy, even if he was totally hot, I'd take one look and be like 'Alright, peace. See ya.' And run away."
---
Wednesday

I went to lab early to raise the body, only to find all the bodies already raised and arranged for the exam later that afternoon. Well, that just cut an hour's worth of sleep I could've gotten instead. :-/ It's very cold in the mornings here now. I'm talking single digit or below zero Fahrenheit. Brrr . . .

I did pretty well on the lab practical, only got 2 out of 46 wrong. Mildly annoyed I wasn't able to identify the pudendal artery, but whatever. One of the structures tagged was the vagina, and we had a discussion about it afterwards . . .

My labmates and I were discussing the lab exam. And one girl was like, "I know this is really really embarrassing, but was that structure the vagina? I've just never bothered looking at one in the hemi-section." We agreed. We thought it was too easy for it to "just" be vagina. We were all looking on our structures list to see if they were different parts of the vagina on there (yes, there are different parts like vagina vestibule or anterior vagina). But no, it was just vagina. And that made it easy. :-)
---
Thursday

And this brings me to today. :-)

I set my alarm for 6:30am, so I could get up and study a bit more before my last 2 exams: anatomy written and human development (devo). I didn't get up until 6:50am or so, at which point I heard this NPR story on correcting lower limb defects (e.g. clubfoot, congenital displacement of the hip, etc) in Honduras. Seeing as part of the devo exam is on limb development and defects, I saw this as a divine sign to get up.

So yeah, the exams came and went. Weren't too bad, I hope I did better than I thought. I'm usually a pretty good judge of how well/poorly I do on exams, so I have high-ish expectations for these exams.

Alright, have to leave in a little bit to celebrate Michelle's birthday. Going out to lunch with her and other friends, then to her place for cake and wine. And later tonight, there's apparently a triple birthday bash somewhere in the city. I don't know the city at all, so we'll see about that. Could/should be fun though, and my labmate Leslie is planning it (as she's one of the 3 birthdays coming up). Maybe there'll be some interesting development(s) between now and when I go home Sunday morning, but don't bank on it. :-P

So Gross

Wednesdays are always rough - 8:15am until 9pm. Yuck. Anyway, the title says it all. Today was so high yield in terms of material to blog about! You thought the last post was bad, but today's anatomy lab was one of those we've been dreading. Proceed with caution, this stuff is NOT for the faint of heart. There's stuff at the end too, so if you want to skip the explicit dissecting details, don't feel like a wimp for jumping past it. BUT please read the first paragraph blurb so you know what the details are all about.

Abandon all hope ye who enter here . . .

---EXPLICIT DETAILS---
Today's anatomy lab involved the dissection of the perineum region. For my lab group this involved 2 things: removing the sigmoid colon and rectum (this part's unrelated to the perineum), and cutting off the scrotum and penis (because our cadaver's a guy).

1. On Monday the lab professors bisected everyone's cadavers axially (horizontally) such that the lower half of the body was disassembled from the upper half. The small intestines and colon were also cut. But they left part of our descending colon, our sigmoid colon, and rectum in. Unfortunately . . . it was full of poop.

So we have to remove as much of the colon and rectum as possible. I tied up the free end of the descending colon, but I must've missed some poop because as I was tightening the string, poop oozed out of the open end of the colon like gross brown toothpaste. I grabbed more string and tied it further down and we lopped off a good chunk of colon filled with poop.

Later a lab professor came by and told us that we still needed to remove more, as much as we possibly can. So I got more string, but we had to tie it now so close to the rectum/anus that it was hard to get the string down there. My labmate (future surgeon guy) deftly used 2 tweezers/foreceps and tied knots around the lower rectum, just like a surgeon would tie a knot or suture. We then had some difficulty cutting between the 2 strings we tied to ensure poop didn't leak out of either end. Unfortunately . . . we accidentally cut our last string. Thankfully his rectum and anus were mostly clean of fecal matter. I quickly threw away the second poop-stuffed colon "pouch."

2. The perineum region is the area (on a guy) below the penis and above the anus. Basically, the "taint." Future surgeon guy and I took a side and began cutting off his scrotal skin, all the while wincing. One of the girls had to leave early so we quickly "recruited" the only girl left in our group, Leslie, to "help" us. See, we had to cut around and under the penis, and it was just sticking in the way. So we had her lift the penis straight up as we cut away the scrotum under it.

The moment she held the penis up, several guys came by and commented on that, lol. It was quite amusing. I had remarked something like, "I wish we could induce an erection in death, because his penis is just in the way." That somehow became the quote of the semester in our lab group, lol.

So after we cut away the skin of his scrotum (of which he had lots - his balls were rather large), we cut deeper into the fascia until we could pull out the testicles. Again his testicles were pretty big. o_O We then tried to cut away and find the small thin muscles at the base of the penis. But the penis was in the way. So . . . future surgeon guy decided to bisect the penis at mid-shaft. I protested vigorously, but to no avail. So now we had a disembodied penis tucked somewhere elsewhere in the body. The look on both our faces must've been priceless, because this is just not something any guy would want to do.

Later we also bisected the penis ventral-dorsally (top to bottom), so now the stub of penis left connected to the body is bisected in half. We "had" to do that because sometime soon the lab professors are going to bisect the pelvises of practically every body down the midline.
---END EXPLICIT DETAILS---

P.S. If I ever discover that the above is against HIPAA or something, I'll of course have to delete it. I don't think it is because there aren't any identifiers, just the "procedures" we did on this cadaver.

Now I have two convos I'd like to share briefly. The first I found interesting, the second I found hilarious.

1. Background: our cadaver guy is uncircumcised. This is (mostly) the convo between the 2 girls (the 3rd girl was home sick . . .) in my group about it. Girl #2 is Jewish.

Girl #2: Why does his penis look bent like that?
Girl #1: I think it's because he's uncircumcised.
Me: Of course he's uncircumcised, that's obvious.
Girl #1: Well, I've never seen an uncircumcised penis before.
Girl #2: Really?! Wow, really? Never?!
Girl #1: Yeah. I mean, I've seen my fair share of penises, but none of them were uncircumcised.
Girl #2: I can't believe you've never seen an uncircumcised penis.
Girl #1: Well, my sample size is pretty limited to just [insert Midwest state here].
Girl #2: My first bf for 5 years is uncircumcised.
Me: Wasn't that the guy you would've married?
Girl #2: Yeah. I probably still would.

2. Background: I went to a patient care panel in oncology dinner thing tonight. One of the guys had pretty aggressive prostate cancer (he's in his late-40s to mid-50s). He's obviously alive and well, surgery and chemo went fine and all.

Him: "The surgeon gave me this little blue pill [Viagra]. And I told him it just wasn't working. He then referred me to this other doctor."

*goes to see this other doctor*

Doctor: "You need penile rehabilitation."
Him: ". . . What does that mean?"
Doctor: "You need to masturbate every day."
Him: "o_O Where were you during high school?!"

---TANGENT---
There are a couple blogs that have closed recently, and a few more that haven't updated in a while so I going to assume they're abandoned/closed, at least for now. I still follow all the blogs, but I follow anonymously if they're not currently active.

So farewell to:
Just me
MSTP Bound

And I hope to see the following blog again soon:
A Popular Dude's Secret Life
fictional

Lastly, I'd like to welcome a new blog on my blogroll by a blogger who's no stranger here. Head over to Welcome to Inglewood to see what that's all about.
---END TANGENT---

Farewell "Overrated Integrity"

There were other things I was going to blog about but this takes precedence. Randy over at Overrated Integrity has posted his last post. His abrupt leave reminds me of a poem by Antonio Machado, "Proverbios y cantares XXIX" in Campos de Camstilla. Here is a translation below:

"Proverbs and Songs XXIX"

Traveler, your tracks are
the road, and nothing more;
traveler, there is no road,
one makes the road by walking.
By walking one makes the road,
and by glancing behind
one sees the path that never
will be stepped again.
Traveler, there is no road,
but wakes in the sea.

I hope that your journeys are safe, that your wanderings bring you enlightenment, that your path brings you closer to what you seek, and that your travels eventually bring you back to us. Wherever you are, wherever you go, don't forget us because we won't forget you.

I will not forget your final words on your blog:

"Never under any circumstances take your freedoms for granted, never under any circumstances trust those who say they do things for the better good, and never under any circumstances blindly accept a decision that you know deep down is wrong."

So Randy, take care, be safe, and I hope we meet again.