Last Man Standing

Last Man Standing by *Cute-And-Bright on deviantART

Yeah yeah, I know it's been months since I last posted.  In my defense, it's been such a crazy ride I don't even know where to begin!  This residency thing is no joke, with all the days that I just want to break down and punch a wall.  To anyone contemplating medicine, my advice is: do not do it if you can see yourself doing anything else with your life.

Anyway, I've basically been on 5 inpatient rotations back-to-back, starting with NICU, then wards, then 4 weeks of night shift (6:30pm till 8am), then back to wards, then to newborn nursery (which, despite the benign-sounding name, has inpatient hours - 6:30am till 7pm).  That's basically 5 months straight of working 13-14+ hours a day, averaging 6 of 7 days a week.  I've had to work 19 days straight twice already!  Those 19 days are brutal.  And even that's an understatement.

At the end of each day I'm just exhausted.  I barely have time to take care of errands, much less myself!  My chief residents wonder why I don't feel "happy and excited to go to work every day."  Gee, it's not rocket science.  If you basically work twice the "normal" 40 hours/week and have half the number weekend days off in a month, would you be happy and excited even if it's something you love doing?  Likely not, I think.  It's not that I don't love my patients and families - I do.  They're why I haven't quit (well, one of many reasons).  And there are rare moments of joy in my day, but it's so hard to really feel "happy and excited" when it feels like you're just nose to the grindstone every single day.  At least I'm not a surgery resident . . . I'd probably have quit or committed suicide by now.

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On another depressing note, I think I may have lost a friend.  Even back in June I hadn't chatted with him in like a month or so.  Now it feels like all communication has been cut off.  He doesn't respond to Facebook messages, texts, IM's (actually, he doesn't even show up on IM or Skype anymore, leading me to think he has either deleted or blocked me), Tumblr messages, etc.  A couple weeks ago I noticed that he unfollowed me on Tumblr and blocked me, such that none of his posts showed up on my dashboard.

I'm at a loss for words and thoughts.  I don't know what I did.  I know he has a boyfriend who he's quite involved with, is busy with school and work, but it just doesn't explain why he doesn't respond to any mode of communication.  I even called him once or twice and left a voicemail.  I don't know what to do.  I haven't really tried to communicate with him much over the past several weeks, to give him some space.  I'm just at a loss as to why he cut me off like this in the first place.  Maybe it's partly cuz of what we did when we met in person, and given he has a boyfriend now?  Idk.

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On a happier note, I was lucky to have Thanksgiving off so I could go visit my family (I work both Christmas and New Year's).  It's always nice to see my grandparents and my little cousin.  It's such a world removed from work.

And now I'm on vacation visiting my brother in Texas for a few days.  Huzzah!  It's nice to sleep in.  :-)  I'll try to find time to post some pics later this week when I return to my apartment.  After 5 blocks of inpatient rotations back-to-back, these 2 weeks of vacation are sooooo well-deserved.  And I fear it'll fly by quicker than I can blink . . .

I Survived . . .?

I survived by ~CasheeFoo on deviantART

Somehow I survived my first block of wards (and my second inpatient block, the first being NICU).  Wards is basically what you would imagine hospital medicine to be like, the kind of thing you see on "House" or whatnot.

The first day I was handed 6 patients I knew nothing about, one of whom was a cluster-fuck of complicated medical problems.  The rarity and severity of her illnesses terrified me.  Within a day or two I was expected to know her inside and out.  I was literally running around the hospital trying to figure my way around and see all my patients before meeting with the rest of the team for rounds.  This was far worse than any experience I had as a med student, because as a med student you're still under the aegis of your resident who protects you - more than I had previously appreciated.  And oh yeah, I had to basically learn an EMR (electronic medical record) and use it by the end of the first day.  Not cool.

I felt so overwhelmed that by the end of the second day I was ready to throw the laptop I was working on out the window and run out of the hospital screaming at the top of my lungs and quit on the spot.  I somehow, not sure how, held it together.  The med students arrived the third day.  I held it together.  For them.  I could not show my weaknesses in front of them - I had to give them the impression that peds was a great field (it still is).  Luckily I had inexplicably hit my stride as well and starting doing alright after that.

Having a med student by my side did wonders for my morale.  I'm not entirely sure why.  I guess I just wanted someone to talk to and bounce diagnostic ideas off of who won't judge me or think I'm an idiot.  Also once I discovered the most efficient path forward for me, nothing stops me.  As a med student I really struggled with finding that path, as it's not a med student's job to be efficient.  On the contrary, med students are supposed to be exceedingly thorough.  My sub-I as a M4 student kicked my ass, but in hindsight I was only able to survive wards now because of that experience.  I dare say I became the most efficient of the 4 interns on during this block.

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In other news, guys here kind of suck.

I've been stood up on a couple dates or otherwise had plans change/get delayed.  It's okay if you're going to be 10-15 min late, but 2-3 hours?!  Come on, that's just rude.  Makes me want to give up looking (as if I had the time anyway, ha!).

Been chatting with a few people, hopefully something goes somewhere.

All the Babies!

Sorry for the lack of posting, it's been quite hectic (but manageable, sorta).

I just finished a block of genetics subspecialty outpatient clinic.  Genetics is a fascinating subject as always, and I must say, this block reignited some of my former interest in the field.  I'm not sure if it's enough to make me want to pursue it as a fellowship and career, but it's back on the radar, lol.

In the middle there I did a week of nights.  I got pretty good at assessing normal healthy newborns, haha.  But man there's such a learning curve when you haven't done it in like 2 years!!  I was lucky enough to get some sleep most nights, but the schedule of nights (6:30pm to 7am) is still rough.  Takes a while to adjust and adjust back.

Now I'm in the NICU (neonatal intensive care unit).  I was terrified of it at the start, but it actually turned out to be a really nice rotation.  I'm definitely learning a lot about taking care of premature babies, often with other health problems too.  After a while they mostly become "feeders and growers," that is they're just eating to gain enough weight to go home.

Anyway, up until now, the majority of my experience has been with babies.  All the babies!  Haha.  They're pretty cute, I must say.  One just has to get on the good side of their territorial and protective nurses, lol.

I've had the privilege to see some weird and rare things, which is really cool.  I mean things that we should not be seeing because current routine medical care should have picked up these things earlier, but there are always babies that slip through the cracks.  It's quite unfortunate when a baby could be otherwise perfectly normal and healthy sees us and by then it's too late to stop the worst of it.

Anywho, enough rambling.  Must sleep.  6:30am to 7pm schedule is pretty rough too.  Unfortunately that's my schedule for the next several months . . .  As one of my senior residents said to me, "Oh wow, I'm sorry.  But the Lord doesn't give us more than what we can take."  I hope she's right.  Still, I'm soooo glad I'm not a surgical resident.

An . . . Interesting Start

A few updates are in order I do believe, lol.

1.  Moved across the country!!  Changed my driver's license, car registration, and car plates to this new state.  All within 3 hours (the DMV lady who helped me was SUPER understanding and helpful).

2.  Visited my relatives!  I had my car shipped to my grandpa's place ahead of me so I didn't have to drive across country.  That would've been brutal!  Visiting relatives is fun, I like hanging out with my little cousin here.  My grandpa is just now really seriously starting to push that I be in a relationship and hopefully marry in the near-ish future, before he gets too old and such . . . sigh.

3.  Moved into a new apartment!  It's nice having a 1-bedroom apartment to yourself.  I actually think this apartment is somewhat larger than my old 2-bedroom, 1.5-bath that I shared with my roommate in med school for 4 years, lol.

4.  Met my co-interns!  My co-interns are all super nice and funny people.  And they don't take themselves too seriously, which is good considering we're all pediatricians, haha.  Definitely a group I can see us bonding together and hanging out with during our (borderline non-existent) free time.  Only thing is that most (all?) of them are either married or in long-term relationships, so the significant others will be a major factor in our social gatherings.  I really need to get on that . . .

5.  Had an . . . interesting start to orientation.  We had PALS (pediatric advance life support) training the first 2 days.  On the first day, 6 of us (half the intern year, mind you) came back from lunch about 5 minutes late and the mean stickler instructor lady refused to let us back in.  She told us we had to reschedule and pay for it out-of-pocket . . . that's $250!!  She was totally being unreasonable.  Our program coordinator tried her best to help us sort out the situation and when the Chair of the Pediatrics Department found out how poorly she treated us, he was furious.  It's likely that the program won't be using them next year . . .

6.  Haven't talked to my friend (mentioned in post here) for a LONG time.  I miss chatting with him.  He's out of school for the summer and started a summer job that leaves him tired at the end of the day.  I frequently see him online for short periods of time, but he rarely responds to my messages or texts anymore.  In fact, we haven't chatted in almost a month!  Not for a lack of trying on my part.  I know he's also busy with a few other things, including hanging out with his close friends who're also out for the summer, but still - it kinda hurts.  It really does feel like he's ignoring me as much as he can.  I've decided to just back off for the next few weeks/months and see if he comes around.  Hopefully so, because I do miss chatting with him.  :-(

Phew!  I think you're more or less up-to-date now.  Why're all the girls I'm interested in either married or in long-term relationships, and all the guy's I'm interested in so far away (aka another state/country)?!?!  Sigh.

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.  :-)

First Time

The First Time by ~ChadtheFab on deviantART

Welp, no longer a virgin anymore I suppose.  It was meh.  But perhaps I should backtrack.

Yesterday, a (gay) friend visited me who I haven't seen in almost a year.  I've known him for probably 4-5 years or so.  He's in the process of moving out of his town to literally halfway across the globe, so I insisted that he visit me before he left the country.  We had also flirted/bantered online back and forth about all this (sex), so none of it is any surprise.

So anyway, long story short, we had brunch, we hung out a bit, we went back to my apartment where I eventually coaxed him.  We wanked each other a bit before I ask if he was up for "something more."  I handed him a condom and lube and asked what he wanted to do - he would top, and I would bottom.

He asked, "Don't you want your first time to be special?"

To which I replied, "Meh, I'm over special.  Plus this is special in its own way."  I've been holding off and waiting for so long, I don't really care anymore.  I'd much rather it be him than some one night stand whose sexual history I know nothing about and will never see/talk to again.

So he put on the condom and lubed up . . . it wasn't enough lube.  It hurt when he tried and I told him to stop.  He applied some more lube and then slowly entered.  It was alright.  He's about 7 inches and somewhat thick.  He slowly ramped the speed of his pounding - I didn't like that too much.  He never hit the good spots (aka, the prostate) for very long back he was going faster; it felt much better when he slowed down.  Eventually I actually kinda got bored and told him to stop, and we'd just wank each other to finish.

He then did this thing to me that he discovered accidentally a while back with some other (uncut) guys.  He just rubbed the bare head with his lubed hand and I was soooo sensitive - he had me squirming and twitching.  It felt tortuously good, but it wasn't the kind of good that gets me to orgasm.  At one point I'm pretty sure I shot out pre-cum, as I felt a spray of something up to my chest and shoulder; it definitely wasn't cum.

After he finished me off, I returned the favor.  I basically tried the same thing he did, but he wasn't anywhere as sensitive (he's cut).  However, when he came and squirted all over he chest - if he hadn't sat up slightly he would've probably shot over his head - I continued to rub his penis.  He suddenly got that post-orgasm sensitivity and I thought I'd repay him for basically doing what he did to me, lol.  He actually grabbed my hand to stop me - too bad he grabbed the wrong hand, muahaha.

So there you have it, my first time.  It was meh.  I suppose it's something to get used to, an "acquired taste" if you will?  Hmm . . . I imagine first-time sex with a woman may be more enjoyable, haha.

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My time with the last guy (post here) was way more enjoyable.  I think it was because of all the kissing and cuddling, it just felt way more affectionate.  Oh well, experiences.

I Matched!!

Wow.  What a day.  The Ides of March.  Match Day.

It's been a crazy ride.  I'm SO glad that my med school doesn't make students read where they matched out loud to the entire class.  So many people would've completely broke down crying (in joy or sadness).  Instead, my med school puts all the match envelops in a bin and chooses out names at random.

As each of my friends go up to get their results, I see their faces downcast as they matched their 6th or 8th place.  Finally one of my friends matched her #1 and I was called shortly after.  I was SO nervous - like nauseated and heart palpitations.  Imagine my (shock and) surprise when I matched at my NUMBER TWO rank!!  :-D

It's not my #1, but it's (obviously) the next best.  I had psyched myself up for my #1 so much in my head that really almost all of my other ranks paled in comparison, which is unfair.  It's unreal.  Even now I can't quite believe it.

Actually I'm starting to have irrational doubts now.  Will I be okay with the culture shock of moving so far away?  Did I make the right choice in the order of ranking my programs?  Did I lower myself as a candidate for not ranking more "prestigious" programs higher?  Will I have the time and energy to have a social life outside the hospital?

Like I said, irrational.  In retrospect, this may be the perfect match for me, even though it's #2.  It's a smaller (but not "small") program without fellows, and so more attention can be paid towards teaching me and mentoring me.  It still has all the sub-specialties represented and is a free-standing children's hospital - so my training is automatically solid.  And it's still in the state I want to be in (albeit not quite in the area of the state I'd prefer to be in, but that's okay).

It was a tough match this year.  Lots of disappointed people who applied to a surgical programs, or even medicine programs.  The number of American med school graduates keep growing, but the residency slots are static (some programs may even have shrunk a little as a consequence of the crap going on at the federal government level).  It's only going to get tougher but at the end of the day, most people match, which means most of us will become the clinical doctors that we went to med school to be.

In about 2 months, I will have an MD and have a spot as a pediatric resident.  :-)

To Hold and Be Held

Held so tightly by ~TopScoff on deviantART

I had been debating whether to post this or not, but I've decided that I want to remember the event as vividly as I can.  The following will get graphic, so if your sensibilities are easily offended, please skip this post.  I assure you, I will blog again soon.

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I met him online months ago, in a forum not unlike this one.  We messaged for a while before we added each other's IM.  I had half-jokingly agreed that if I got an interview in his area, he must visit me and I'd take him on a date.  Sometimes the stars do align, if only briefly.

Several weeks ago I went to an interview near him.  When I arrived at the train station, he was sitting there waiting for me in a black hoodie and jeans.  He was thinner and slightly shorter than me with dark brown hair, mesmerizing grey eyes, and a short goatee.  We first stopped by my hotel to drop my things off then went to a nearby Thai restaurant for lunch - his first time having Thai food.  Afterwards we went to a local natural history museum; I totally geeked out and I think he was amused by it all, haha.  It was a tiny museum and so we decided to stop for coffee on our way back to my hotel.  We chatted for a while over our coffee - him a mocha, me a chai latte.

There were still several hours before my pre-interview evening event, so we headed back to my hotel to see if there was any good movies on.  As he flipped through the channels, I positioned myself behind him to give him a back massage.  He had been so stressed lately and there were so many knots in his back - there were knots in places I didn't know a muscle could knot!  I began on his shoulders and kneading his upper back, working the knots out.  As I moved down, I found knots between his ribs and in his lower back.  At this point he laid on his stomach so I could get better access to his lower back.  I got a bit daring and went further, massaging his butt and upper thighs - wouldn't you have known, he had knots there too (somehow)!

I gave him a thorough massage for a good 30 minutes or more before he sat up.  He leaned back into me until we were both lying on our backs on the bed.  He turned towards me and wrapped his arms and legs around me like a koala to a tree, and laid his head in the crook of my neck.  I rested my head on his, smelling his hair.  To hold and be held like this, to cuddle, was such indescribable pleasure and relaxation.  As he cuddled I stroked his back and arms with my arm that was wrapped around him.  This guy really loved cuddling.  It's on par with a little kid/toddler in the amount and quality of physical affection, and it was awesome to hold and be held like that.

With my other arm, I stroked his chest, his stomach - first over his shirt then under.  Then I moved my hands down to his hip and around under his boxer-briefs to grab his fuzzy butt a few times.  He didn't object.  To test the limits of this, I moved my hands around to the front until I felt the head of his cock, already hard and completely wet with precum.  I massaged it a bit with my fingertips until he rotated himself till he was on top of me.  He undid his belt and unzipped his jeans, the tip of his cock peeking above his underwear.

He leaned in for a kiss.  It was awkward at first on my end, as it has been a really long time since I had kissed anyone.  As we kissed I had my hands on his cock, giving it a few strokes.  He then took off his shirt, pants, and underwear, revealing his entire cock for the first time.  It was one of the most beautiful uncut cocks I had ever seen - he was so hard that his foreskin had pulled back entirely.  He claimed it was about 6.5" but it looked closer to 7" and was quite thick.  He leaned in to kiss again before reaching into my pants to find my cock hard and wet with precum (I don't usually precum much, unless I'm very aroused - which I was).  He undid my belt, pulled off my pants, gave my cock a few strokes, pulled back my foreskin and put my cock in his mouth.

He knew what he was doing, sucking and licking my foreskin in such an oh-so-exciting way.  He stroked me a bit before I had him lie back to return the favor.  I gave his cock a good squeeze and saw a large drop of precum bead at the tip.  I pulled his foreskin over and licked the tip in circles before pulling it back and tried to suck as much of his cock as I could.  I put my tongue between his foreskin and the head and licked in circles, causing him to moan a little.

At some point he was above me and we tried to 69 . . . it was hilariously awkward because we couldn't quite coordinate ourselves.  We mostly ended up sucking and playing with each other's balls and asses for a bit.  He had me stop a couple times because he was close to cumming, so I paused while he kept going on me.  I would've given myself completely over to him had he a condom on him.

Maybe an hour later I was close to cumming.  It's weird being on the edge of cumming but not quite being able to because someone else is in control and they switch it up between oral and different strokes just as you're about to go over the edge.  It had been a week since I had gotten off (not much time what with the constant traveling, dining, and interviewing) and I was soooo sensitive.  When I started to cum, it came out like a flood - it gushed with each spasm but in between it felt like cum was still pouring out.  One of the best orgasms I've had.

He had laid himself across me in such a way that my cum splattered his chest.  It was my turn to return the favor.  Soon he was moaning and riding the same edge that I had just been - almost there but not quite.  Finally I got him over and his cum sprayed all over.  I teased his cock head a bit - knowing it'd get super sensitive post-orgasm - until he told me to stop.  We cuddled for a little bit in the afterglow before quickly deciding that we should shower and clean up, haha.

He decided to spend the night with me after my dinner with the residents rather than drive back home.  We cuddled in bed for a while as we chatted and got sleepy.  We crawled under the sheets and he wrapped himself around me.  It felt nice, but . . . I failed to realize how warm another human body could be.  So I kind of overheated haha, and the AC/heater unit thing was making such a racket all night that I barely got any good sleep.  That said, I tried to cuddle every chance I could get without overheating (it's surprisingly awkward to sleep next to someone if you don't position yourself just so).

Happy Chinese New Year!

Take Care little Sister 2012 leaves 2013 by =ShadowSaber on deviantART

新年快乐!  恭喜发财!  身体健康!!

Happy Chinese New Years everyone.  The Year of the Dragon now gives way to the Year of the Snake.

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Apologies for the lack of posts of late.  Transitioning from interviewing and vacation back to rotations is tough, and to a surgical sub-internship no less!  My hatred for surgery is nowhere near as intense as it was last year, though my . . . displeasure for surgery is 90% in the hours (specifically how early I have to wake up).

That said, this surgery site is pretty chill all things considered.  I love taking the surgeries that don't have a resident in them because I get to be first assist and do more (and see more).  The attending surgeons here let me do a fair bit more than I was allowed to as an M3 last year.  I can see how one would love doing surgery; however, I still hate waking up before 5am and standing for hours on end putting strain on my lower back.  I should start doing some yoga . . .

More posts coming up soon (hopefully).  I have an unfinished one drafted.

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.

Another Step Taken

Another step by ~F1rstcl4ssn00b on deviantART

Step 1: check.

Step 2 CK: check.

Check off each step taken towards my medical license.  Hopefully I passed Step 2 CK, but I won't definitively know for almost a month.  Blah.  I shudder to think about retaking that 9-hour long test (not to mention how much it costs!).  With some luck, I did markedly better on Step 2 CK than on Step 1 last year.

Steps left to go: Step 2 CS and Step 3.  After that, it's just the re-certification exams every 10 years to be board certified.  Yay.  Endless testing.  -_-

But for the moment, I have a short window of freedom (and a short vacation coming up!).  So I'm going to enjoy this while it lasts.  Alas I also have to work on ERAS applications for residency programs.

Hardest Month . . .

Precocious Patient by ~ThirstyEye on deviantART

M3 year has flown by.  Sometimes I still can't believe I an M4 now and on my pediatrics sub-internship.  This is by far my most difficult month of med school yet, more so than even surgery.  I literally act as a functional intern on one of the pediatrics ward teams, except all my orders have to be verified by my senior resident.

There are rewarding moments.  There are moments and areas that I feel I shine at.  But all that is overshadowed by this constant anxious feeling that I'm not doing enough, or not doing things the right way, or not thinking fast enough.  It's terrifying.  Being the one responsible for a child's care in the hospital is daunting.  It's not that I don't basically know what to do, it's that I'm unable to instantly anticipate all possible (worst) outcomes and prepare for it.

I'm able to prioritize tasks fairly easily, to do what needs to be done, but I can't prioritize my thoughts as quickly when someone asks me a question or I'm asked to present a patient.  The information is there, but it's not organized the way I (later) type it up and it's unfiltered because I just ramble all the information - pertinent and non-pertinent.  I don't know why I'm getting flustered and blanking.

I'm now 2 weeks in to the rotation, about half-way done.  And I feel like I haven't significantly improved despite working my ass off.  Today was the worst day.  I showed up and was instantly handed 5 patients I didn't know, didn't have sufficient time to read through their chart, and on top of that I was the one admitting a new patient and had to do her whole work-up.  I was a mess and constantly second-guessing everything I said the whole day after that.  It took me way longer to catch up than it should.

Words can't express how defeated I feel right now.  How stupid I feel.  How slow I feel.  How not cut out for this I feel.  Maybe I should consider switching fields.  This was not how I expected to start M4 year, and definitely not how I expected this month to go.

Welcome To Life

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.
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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.

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.

Reclaiming Humanity

When does a person become a patient become an organ or a thing - a gallbladder, an amputation, a diverticulitis? The onset was so insidious that I never even noticed the progression, especially on surgery where everyone becomes that which we operate on. When did I stop noticing the person and, to some degree, stop caring? This was not what I came to med school for.

I recently observed a family meeting with the patient, his wife, and their oldest son. The patient was terminal, his death is only a matter of time; the only surgical intervention left would mean certain death. For the first time in weeks I saw not the blank yet pained gaze through lidded eyes still heavy with sleep at 5:30am, but emotion: sadness, contemplation, and reflection. I saw not a patient who we monitored through labs, changed wound dressings on daily, and examined with the repetitive motions of a machine; I saw a father and a grandfather who, though saddened by the inevitability of his end, is without regret for living his life.

His wife asked with tears obscuring her eyes, "Can you give us a time estimate of how long?" We had no answer - it could be hours, days, weeks, months. With diagnosing complete and treatment deferred, true healing can now begin. As for me, I can start caring again and do what I came here to do.

Introspection & Privilege

This weekend is a "golden weekend," so called because we have both Saturday and Sunday off. This is a golden weekend because we're now halfway between our surgery rotation here, and we're all switching hospital sites. Starting tomorrow I'll be at a different hospital for surgery. So this weekend is a temporary respite.

I'm glad that the first month is over. There are days that I was seriously doubting if I could make it to the end. On average in September, I was in the hospital about 60 hours/week. It could've been much worse . . . though I'd rather not think about it. However, a moment of retrospection brings me to my final patient on surgery at the first site.

(Paraphrased)
Patient: "I admire you all and what you do. I really do. You do so much to take care of us."
Me: "Thanks. That's our job. We wouldn't be here if we didn't want to help take care of people like you. We chose this."
Patient: "Yeah, but thanks anyway. I wish you the best."

I'm not sure if I can adequately describe in words the profoundness of that brief moment. No matter how I or others may whine, bitch, and complain, it remains truly a privilege to take care of patients and do what (little) you can for them. It is a privilege to have others trust you with their health. As one of my friends said (in a jokingly serious manner): "What other profession do you get to cut people open and touch them in such ways without getting jailed? In fact, they're paying you to do just what you're doing."

Anyway, I think it's worth a moment of introspection for us to appreciate that which society allows us to do, and understand the responsibilities that society expects us to bear (justified or not).

Amazing Week

So it's been a while since I last posted anything, and last week was a pretty awesome week, I must say.

Sunday: Went into the hospital at 6:30am and was done by 9:30am. Got the vitals (temperature, heart rate, blood pressure, oxygen saturation, ins & outs, etc) and saw my 2 patients all in about 35 minutes. Pretty epic efficiency there! :-D The rest of the day was all mine to do whatever, lol.

Monday: There was only 1 surgery that day and the other JMS (junior med student) scrubbed in. I took that time to do some reading and studying. Pretty chill day.

Tuesday: Unremarkable day of surgery. But afterwards I headed over to the LGBT student org's meet and greet at a faculty's house. How apt that it was on the day that DADT was repealed, lol. It was good seeing people and hanging out. I met an internal medicine intern who was so hot (and hilarious). I couldn't take my eyes off him after I talked to him for like, 15 minutes. We had some great conversations . . . basically bonded over our hatred of surgery, lol. After the social, several of us (said intern had to work the next day, bah) walked down to a nearby wine shop and had some wine. I came out to one of my friends there (it was loud enough there that I don't think anyone else heard, not that I really cared). Funny that she never asked me before even though we were both on the LGBT student org board the year before.

Wednesday: Long day of lectures. That's how Wednesdays goes. No surgeries were planned for the day so it wasn't like we missed anything. Later that evening I had a meeting with a friend to discuss one of the student committees we're both heading. Some good progress was made.

Thursday: I scrubbed in an open umbilical hernia repair. I successfully proved myself to the chief resident that I can, indeed, tie knots with 2 pairs of gloves on! Pretty short and sweet surgical procedure. I like these as they last less than 1.5 hours. Later in the afternoon I had a meeting with the Dean of Student Diversity, which was interesting as always. Thankfully I didn't have to return to surgery afterwards.

Friday: I scrubbed in 2 more open umbilical hernia repairs. I was allowed to close the wound with a subcutaneous suture after the chief resident started it for me. I must say, I did a pretty good job for not having done it since we practiced on pig's feet at the beginning of the month (and it was the most difficult suture for me to learn). The chief resident complimented me. :-)

After surgery ended (somewhat early), I headed over to a friend's place for wine tasting (the same friend I came out to earlier on Tuesday). We met up with her husband and another mutual friend. I hadn't gone wine tasting before, and it was a pretty nice experience with friends. After wine tasting, we headed downtown to this new place for dinner. It was delicious!

Saturday: Headed home and attended my friend's wedding. I had known him since kindergarten and we were next-door neighbors until I moved away in 7th grade. Had a great time, will blog about that in detail later.

Overall: Again, pretty amazing week considering I'm still on my surgery rotation, lol. Evil resident was on vacation all week so I didn't have to worry about her ruining my day with her foul attitude. Chief resident was awesome, as always. We rounded late (around 7am) most days because the chief resident was tired and didn't feel like waking up any earlier than she needed to. I certainly wasn't about to object! There were fleeting moments where I actually enjoyed surgery. Shocking!! o_O

Darkness Before Dawn

Scrubs by ~Tjelsi on deviantART

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.

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.

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?