Skepticism Against Non-Neutrality

This is a follow-up to my previous post, Media, Culture, and Half-Truths.

As I blogged that post, the media in other areas were already aflame with skepticism.  To recap from my previous post, the US CDC is considering a recommendation that medical providers should discuss the benefits of circumcision and offer it to parents and any uncircumcised male teenager and young adult (particularly those in a higher sexual risk group).  This is part of the US CDC's plan to help further reduce the incidence of HIV/AIDS.

And as I blogged in my previous post, this thread of logic is misplaced and damaging.  I even posted a comment on the US CDC's Regulations.gov site.  It's open for commenting between Dec 2 and Jan 16.  The vast majority of the comments on that site are negative towards the new recommendations.  Here's an article that reflects that:

Washington Post: Americans push back against CDC recommendation on circumcision

There is also a nice and succinct article on an Oxford ethics blog, A fatal irony: Why the "circumcision solution" to the AIDS epidemic in Africa may increase transmission of HIV, by Brian D. Earp in 2012.  It basically summarizes my thoughts from my previous post (but more eloquently written).

Again, this is not a new topic of debate.  The US CDC first began considering this back in 2009, but had delayed making notable public announcements until now.  As evidenced by an article in the Huffington Post, Male Circumcision and the HIV/AIDS Myth, by Dr. Ali Rizvi.

Heck, this topic has been covered (albeit tongue-in-cheek) by Queerty!  For example:

• If Circumcision Haves Risk of Spreading HIV, Should All Baby Boys Get Cut?
• So Circumcision Won't Help American Men Stop Spreading HIV?
• Even If Circumcision Helps Prevent HIV Transmission, Good Luck Finding American Guys It Could Benefit
• For Gay Men, Cutting Off Your Foreskin Not As Good As Condoms To Keep The HIV At Bay
• What's All This About The Government Wanting American Teenagers To Get Circumcised?

And to reference my previous post, the media can write about a single topic in two ways.  Queerty is clearly on the opposite side of the articles posted in my previous post.

So anyway, read the links if you desire.  They're there.  I'm a broken record on this topic.  No more on this until the US CDC finalizes its recommendation, one way or the other.  But for the love of democracy, please comment on the Regulations.gov link above if you have an opinion you'd like to share!

Media, Culture, and Half-Truths

This is nothing new.  Just warning you now, this is going to be an epically long post.  I've read about this before and I've discussed it before on this blog.  But this topic resurfaces rather frequently.  I see headlines such as:

Reuters "Male circumcision benefits outweigh risks, US CDC says"

The Verge "Benefits of circumcision outweigh the risks, US CDC says"

Yahoo "CDC: Circumcision benefits outweigh risks"

LA Times "Circumcision cited as defense against HIV in proposed CDC guidelines"

NY Times "Circumcision Guidelines Target Teenagers"

TIME "Feds Say Circumcision Best for Boys"

This is a controversial topic.  There is intense debate among physicians and even residents.  It's a subject that's almost taboo to talk about.  So let's talk about a few things: Media, Culture, and Half-Truths.

Media

I took a course in scientific journalism and media in undergrad, and I walked away from that class appalled.  So much so that I was literally unable to even look at a news article about a scientific or health topic without feeling an intense pang of rage for almost half a year.  Here are some things to know:

The media skews towards catchy headlines.  Sure "Male circumcision benefits outweigh risks, US CDC says" sounds pretty neutral.  But then you have the headlines "Circumcision Guidelines Target Teenagers" and "Feds Say Circumcision Best for Boys," and suddenly those pop out.

The media also has an agenda.  You are supposedly supposed to present both sides of an article (where there are 2 sides to present), but it's almost always skewed and thus almost never balanced.  Take the NY Times article, "Circumcision Guidelines Target Teenagers."  It dedicates a measly 2 paragraphs at the very end on counter-arguments, which although valid, reads as an afterthought.  Take the TIMES article, "Feds Say Circumcision Best for Boys."  There is no mention of any counter-argument.  None.  The LA Times article, "Circumcision cited as defense against HIV in proposed CDC guidelines" is actually the most balanced of the bunch.

The media doesn't understand statistics.  Now, statistics is a difficult concept for even many medical experts to grasp.  So to be fair, the media has no chance.  When presented with numbers, the media will always take the largest numbers presented.  Again, because it's catchy.  For example here, the recurrent phrase that goes "circumcision reduces a man's chances of getting HIV by 50-60%" sounds like a huge deal!  But context is necessary.  That number reported is what's called "relative risk reduction."  What matters to an individual is the "absolute risk reduction."  For instance, let's say the average uncircumcised man's risk of getting HIV is 1 in 1000 (or 0.001%).  So if he's circumcised, his risk goes down by 50-60%, thereby going from 1 in 1000 to 0.5 in 1000 (or 0.0005%).  Well, going from 0.001% to 0.0005% doesn't sound like much of a difference for that individual, and it isn't!  But both numbers could be true.  Going from 0.001% to 0.0005% is a 50% decrease - this is "relative risk reduction," but the "absolute risk reduction" is 0.0005%.  See why the media would choose to report 50% over 0.0005%?  (Note: the average man's risk of getting HIV in the US is WAY smaller than 1 in 1000).

Culture

Culture is such a pervasive and unconscious thing that few people even realize it comes into play.  The US, given his history of higher rates of circumcision, has a cultural bias towards that procedure.  Whereas comparable Western countries (Canada, Europe, Australia) don't have this cultural bias.  This is how everyone can look at the exact same studies, the exact same medical literature, and come out with polar opposite conclusions and recommendations.

Here's an excellent article rebutting the latest AAP (American Academy of Pediatrics) guideline update on this topic: "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision." 

People think of medicine and science as containing immutable truths.  Yet in reality the exact opposite is true.  We must constantly challenge and question old scientific truths in order to get ever closer to the Platonic Truths.

Half-Truths

Now on to the merits of what's been discussed/argued for in the articles.  The best quote I could find comes from the LA Times article: 

"Dr. Thomas Newman, a professor of epidemiology and biostatistics at UC San Francisco, says he believes that the medical benefits of circumcision outweigh the risks but that both are small."

This is the closest thing to the truth out there.  Let's look at the arguments on the table:

Pro:

• Circumcision reduces HIV risk by 50-60%.  Well that effect is quite small on an individual level, as illustrated above.  Plus, condoms reduces HIV risk by 90-97% when used correctly.  That "additional" 50-60% is rather meaningless.  Furthermore, circumcision offers zero benefit for those most at risk of getting HIV in the US (men who have sex with men, IV drug users).
• Circumcision reduces HPV and other STI's.  Maybe true.  But we now have a vaccine for HPV that's 98-100% effective.  And again, condoms.
• Circumcision reduces UTI's in boys during the first year of life.  This is actually true, however, the risk of getting a UTI is rather small to begin with.  In a healthy uncircumcised baby boy, the risk of getting a UTI is 1 in 100.  In a healthy circumcised baby boy, the risk of getting a UTI is 1 in 1000.  In girls older than 1 year of age, the risk of getting a UTI is like 5-7 in 100.  And how do we treat UTI's?  With antibiotics.  That said, there is a role for circumcision in a baby boy who gets recurrent UTI's (and usually there is some other anatomic problem as well).

Cons:

• Risk of complications.  I love how they kind of lumped all complications together, and then say that it's about 1% if the procedure is done before 1 year of age, 9% if done between 1-9 years of age, and 5% if older than that.  I don't know about you, but a 5-9% complications rate is pretty high.  And what are these complications?
• Infection and inflammation are a common one.  As with any invasive procedure, there is always a risk of infection.  And think for a moment, this baby's penis is healing while he's in diapers, exposed to urine and poop.  That can't be pleasant.
• Bleeding is another common one.  Well, this could be life-threatening if a baby has a bleeding disorder (like hemophilia).  I'm sure the majority of the time no one does blood tests before the procedure to confirm that a baby does not have a bleeding disorder, and often times a family history can only get you so far.
• Other risks not mentioned?  Adhesions, meatal stenosis, and accidental amputation are ones that probably should be mentioned.
• Adhesions: baby's bodies heal very well.  Sometimes parts of where the foreskin is removed will reattach itself to the glans (penis head).  This can cause not only cosmetic issues, but also functional issues.  Sometimes those adhesions are so tight that erections can be uncomfortable.
• Meatal stenosis: when the opening of the urethra (pee hole) is too small to allow urine to pass.  This problem exclusively happens in circumcised babies and requires surgical correction.  The end of the penis is not meant to interact with the outside world before puberty, and so exposure causes inflammation, which causes swelling, which causes a small hole to get smaller.
• Accidental amputations: yes, very rare, but very very tragic when it happens.  A handful of cases happen each year and it's impossible to remove this risk entirely.  It may be a 1 in a million risk, but if that 1 in a million is you or your baby, and it wasn't medically necessary, you would probably be pissed off.
• Also none of the articles mention studies that support the foreskin being a very innervated area of the body.  Whether those nerves play a role in sexual sensitivity and enjoyment is a topic of debate in and of itself, but logically it would make sense that more nerves = more sensation.

So you see, the full discussion is more nuanced.  And when I counsel parents on this topic, I present it as I do above.  Thankfully the area that I'm doing residency in has a low circumcision rate, so this rarely comes up.  But it does once every few months.  Most parents who do opt for the procedure are not undecided - it's like parents who're against vaccines, their minds are made up no matter what you say.  So I counsel towards less intervention, at least insofar as this topic goes.

Thoughts?  I know I'm biased, but again, no one has a truly neutral stance on this topic.  Which makes it difficult to fully "trust" the CDC's recommendations (or anyone's opinion, for that matter) on the subject.

Where in the World is Aek?

Gosh it's been a long time!  About 3 months since I last blogged!  I would say it's because I've been super busy with residency and all that, but that'd be partly a lie.  Truthfully, I've just been lazy.  Heck, I sat on this post for the better part of a month!  So where in the world have I been?

Well, I've run the gamut from the pediatric intensive care unit (PICU) to outpatient urgent care clinic.  Such a dichotomy in medicine and such different arenas, haha. 

From there I did another rheumatology rotation, but at another institution.  That was an amazing experience!  It was great just being away in a different area, working in a different system, and exploring.  It was also awkward because I felt like I couldn't perform to my full potential because I was learning the system and the hospitals.  It was almost like being a medical student again, almost.

Then I returned and did neonatal intensive care unit (NICU), which sucks as a second year resident, I must say.  You have double the patients to yourself, your patients are way sicker, and you're expected to just know how to manage things.  And on the weekend it can be just you taking care of the entire unit with the attending, which really sucks.

Currently on pediatric emergency department (ED).  It's alright.  I can see why people would want to do it - shift-based hours, sign in/out, lots of potential procedures, patients are in and out rather quick (MUCH quicker compared to adult ED), and you don't have to worry about continuity of care and the frustrations that can sometimes present.  But this is all not quite my cup of tea.  Parents sometimes bring their kids to the ED for really silly reasons.  I mean, if it's not an "emergency" you should really bring your child to his/her primary care pediatrician first . . .  I won't give examples as that may be a HIPAA violation, but if you see and hear the things I have . . .

There's a certain degree of "brain rot" that I feel as a result.  I live for the interesting cases.  The ones that make me think, that make my mind tingle.  On the flip side, as a patient you NEVER want to be "interesting" to a doctor, lol.  And when something could be rheumatic in nature, my mind definitely tingles - like it hungers and salivates for that diagnostic puzzle.

Anyway, to be totally fair, I can honestly understand why some parents bring their kids to the ED even though it's not medically justified.  There are so many factors and when it is YOUR kid, you freak out.  I get that.  I just wished that people utilized primary care as it was intended instead of the ED as their first stop.

Anywho, next post I'll post pics of my adventures.  :-P

Please Don't Misunderstand Me

Please don't misunderstand me, I do love seeing my patients even though for every minute I see them I have 5 minutes of paperwork and other "work" to get things done for them.

Please don't misunderstand me, if I can't make it to your bedside immediately it's not that I dislike you or am lazy, I truly am quite busy doing things behind the scenes for you or another patient.

Please don't misunderstand me, as much as I love thinking and taking care of patients, I lie here right now musing over whether I've made the right choices that can sometimes be literally life or death.

Please don't misunderstand me, if I seem beaten down it's because I've worked a 13+ hour shift for the n'th day in a row often without a single heartfelt thank you. And perhaps I was yelled at for something I did or didn't do for you.

Please don't misunderstand me, as much as I could go back in time and undo med school and residency, it is truly a profession of great privilege and honor.

Please don't misunderstand me, when I say I would not redo all this again it's not out of regret, but rather sadness of all the sacrifices I've made - the art I missed drawing, the music I missed playing, the sleep I missed getting, the opportunities for love and travel.

Please don't misunderstand me, when I discourage others from pursuing medicine it's not because I hate my job, but rather I don't want others to make the same sacrifices without truly appreciating what they'll be giving up.

The Truth Is . . .

medicine by bloodred on deviantART

I attended the pediatric rheumatology conference earlier this month.  It was like a mini-vacation and I learned so much!  My mind was blown at how much there was out there (and how little I knew).  I ran into a resident who's doing her residency back where we did med school, so that was a pleasant surprise.

I just finished my clinic month, which was mostly urgent care.  It was useful and my Spanish got exponentially better (because I refused to use the translator phones after a while, and like 2/3 of the parents speak Spanish-only).  But it was really bread-and-butter and much of it didn't require much "thinking."  I hate to say it, but an NP or PA could easily do what I did this month without much difficulty.  It doesn't surprise me that NPs are trying to expand their "power" and scope of practice.

But the most brutal truth is: if I could go back in time, I would NOT do med school and residency.  This is not worth it.  As much as I love my patients, as adorable as my toddlers are, as amusing as my teens are; the hours, the hospital politics, the paperwork (oh god the paperwork!) is not worth it.  I daydream of what I've given up to become a doctor.  It's not a career I'd recommend anyone pursuing.  And that's the most brutal truth.  Perhaps I'll elaborate on this more later.

I came across the following coming out video and the way the person spoke, the honesty and anxiety in his voice, really resonated with me.

Apologies that this post is all over the place.  I'm on call tomorrow (again, yay) and have to do yet another 13-hour shift.  At least I'm on with good residents who I admire and respect.  The day should hopefully not be too painful.

Mental Ativan

Today was a down day. Anxieties are flaring.

One. I take USMLE Step 3 in two days. And it's a two-day exam. Eep! I should be ready. I've been studying for the past two months (when I could and had the motivation and energy after work). I've finished the study question bank, all 1000+ questions. I've been diligently learning on my current rotation, which is a general ED (emergency  department) - so I see more adults than kids. I can't possibly see myself being more ready then now. But I still worry about that remote possibility of not passing . . . shouldn't be a problem as I padded the other two Steps soundly. But still . . .

Two. My chief residents have my on cross-cover call every Sunday for the next three months (that or back up call). I'm basically grounded in this city and can't go anywhere for the weekend. When I emailed my chiefs asking about this (diplomatically, mind you), I get a very bitchy 7-paragraph email reply. In it she basically told me to suck it up, that this hairpins to everyone and now it's my turn, I'm being difficult, and that I should be more  professional about this. Whatever. She can crawl into a hole for all I care. Good riddance when she's gone at the end of this year! I'll need to ask my co-interns for some call switches.

Three. My friend (who I've mentioned several times now) started a Twitter account. I followed him just for the heck of it, not that I'd be commenting on it much or whatever. Today I discovered that he blocked me. That hurt. It opened up the old wound. Why is he going to this length to cut off contact with me, all without ever telling me why? I just want to know why so I can have final peace.

Four. In so far away from ago of my good friends back in the Midwest (though some on the east coast now too). I dearly miss them. Facebook is a sad proxy. The other interns and I are often just too busy to hang out with each other, and they like to do their own thing - often with family if they're from this state or with their significant other. Which leads me to . . .

Five. I found out through a my mutual friend that one of my friends from undergrad is engaged. Everyone is getting married! And what do I have to show? Eternal singleness. Each passing year more and more friend are getting engaged and married, and I feel so left behind.

Like the title, I need a mental Ativan to calm me down and small me or of this funk!!

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.

A Difference in Philosphy

A few days ago, several of us got together for wine and cheese tasting and we decided to hang out afterwards.  There was a teacher, a surgeon, a pediatrician, and an MD/PhD in training.  Much of the evening was wrapped in very heated debate, from gun control, to "Obamacare," and to education.

At the heart of the debate is a difference in philosophy, not dissimilar to democrats vs republicans.  It is no secret that education in the US is in need of an update.  The question is, how to best remake the education system in the US?

On one side is the surgeon, utilizing a surgeon's thinking.  The argument: We should focus our resources on those who can best utilize them and elevate those students to their maximum potential, and not "waste" resources on the students at the bottom who cannot demonstrate improvement.  Society should strive to equip the best and brightest with the means to achieve what they're meant to.  This makes sense in a surgeon's mind, as a surgeon must be able to triage which patients are suitable for surgery and which aren't.

On the other side is the teacher and (peripherally) the pediatrician.  The argument: We provide all students the necessary resources to succeed - for the bottom of the class to reach the middle, and for the best and brightest to soar.  Every child in society deserves a fair shot at an education, with resources devoted to the struggling as well as to the gifted.

The problem with the first argument is that it is in danger of creating a tiered caste society, only widening the achievement gap into a chasm.  The problem with the second argument is that there simply aren't enough resources or political will to make it a reality everywhere.

My personal issue with the first argument is that I believe that all children deserve a fair shot, not just some.  And yes, some children need more help and resources to achieve, but it is possible.  I have seen it.  I have worked with a charter school that - rather takes the best of the best students - takes the worst students in public schools and demonstrates that they can at least achieve to the middle.  These are students who dropped out of school due to LGBTQ bullying, teen pregnancy, domestic violence, mild mental health issues, etc.  Given the right learning environment, they are not hopeless.

On a more personal note, I have a good friend growing up who went to the same schools as me for most of our K-12 lives.  I was almost always in the honors/AP courses.  He was barely scraping by in the regular courses.  His educational experience was vastly different than mine.  My teachers expected us to push hard and succeed.  His teachers treated him as though he could not achieve and would never amount to anything much more, that learning wasn't as important for him.  This negatively impacted him until he had a moment where he was determined to change his fate.  He transitioned from a 2-year college to a 4-year state university, and from there got a good stable job helping others in bad social situations.  He was able to succeed.  Is he the next Steve Jobs or Bill Gates?  No.  But neither am I.

The reality of the current status in education is neither - currently the system is more and more being set up to "teach to the test," thereby aiming to bring the bottom up but also inadvertently bringing the top down, both meeting in the middle.  Critical courses such as creative expression (art, music, theater, etc) and physical activity (gym, recess) are being cut out in order to cram more math and science to satisfy the tests (and I'd argue that science isn't even being taught properly on the whole).  Current education is trending towards mediocrity as more tests are implemented to demonstrate achievement and teachers are being paid for performance (an oversimplification and generalization, but I'm not in education so this is just what I hear).

I don't know the answer to "fixing" the system, just as I don't know the answer to fixing healthcare.  Obamacare is one answer, but I'm not convinced it's the best or final answer.  The alternatives aren't much better though.  What I do know is that the answer depends on the philosophy we choose to take, both on a personal level and as a society.  Are only some worthy of the resources?  Do everyone get the exact same resources?  Or is the answer more nuanced?  I don't know but I do know that the answer is a difference in philosophy.

Oddly Chaotic

M4 year has been oddly chaotic.  Where to even begin?

1.  I finished my peds sub-I last month.  The last week and a half were awesome and really renewed my desire to pursue peds.  While on night float it was just me, a senior resident, the nurses, and the attending physician that I rarely saw or talked to.  I liked the smaller team structure and I enjoyed interacting more closely with the nurses and got the opportunity to know all the patients on the service a bit better.  I also became really efficient literally overnight and that efficiency carried over when I returned to the day shift.  Unfortunately I'm still worried that my comparatively poor performance the first 3 weeks caused irreparable damage to my grade and comments, which could pose an issue later when I interview for residency programs.

2.  I'm taking USMLE Step 2 CK at the end of this month.  I'm so not ready!!  I keep hearing that most people do better on Step 2 CK than on Step 1, and I desperately hope that's true because I didn't do nearly as well on Step 1 as I had expected.  :-/  Must study study study!!!

3.  I'm working on my ERAS application to pediatric residency programs.  I'm partway through but I honestly expected to be mostly done by now.  I just haven't had the energy to dedicate sufficient time towards it.  There's so many little things to do and complete!  And I have to really do some introspection into what kinds of programs are a good fit for me.  Ugh.

4.  I have to touch base with all my writers for letters of recommendation.  In addition I need a letter from the Chair of Pediatrics.  Fortunately, in an oddly deus ex machina fashion, that bit worked out far better than I could've dreamed.  So now I'm just waiting for one letter writer to get back to me as to when he can meet with me to finalize things.

5.  I went out on a date with this guy a couple weeks back (he considered it a date, I thought we were just hanging out having brunch - clearly I suck at such things).  He's about my age, is a good conversationalist, is witty.  We've been flirting a little bit back and forth via the app we first chatted on (he has limited texts, so I avoid texting him too much).  Hopefully there may be more?

6.  Last month I visited a friend in a city about an hour west of me.  It was a lot of fun.  I also ended up (unintentionally?) jacking him off . . . while his boyfriend was out of town.  Oops.

So yeah.  Oddly chaotic beginning to what's supposed to be the best year of medical school.  But these first few months are death.

The Truth of the Matter

About a week ago, I was having lunch with some friends (most of them in med school with me). I can't recall how, but we arrived on the topic of "conventional" vs "alternative" medicine.

We had all read at least some excerpt of Anne Fadiman's book, The Spirit Catches You And You Fall Down. It's a biography of a Hmong girl who develops seizures and about the divide between Hmong culture and and Western medicine culture. Interestingly, my friend and I took away very different messages from the book.

He cited a quote from a surgeon towards the end of the book saying to the effect, "Western medicine works" and claims Fadiman ignores that fact and moves on. He believed that all of the alternative medicine and cultural beliefs of the Hmong in the book were essentially crap and that Western medicine was the one true solution to the girl's seizures, and that everything else got in the way. Western medicine is the only thing that works. I disagreed on two points: 1.) it doesn't really matter if Western medicine is superior or not if the patient doesn't want to take it, 2.) not all alternative medicine is necessarily crap - a lot is just unproven medicine.
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1. The truth of the matter is, patients don't always think highly of doctors. It's our fault, really. Doctors can be so dismissive and so readily "reduce" patients to numbers, diseases, and organs. We can appear cold and disengaged. It doesn't matter if Western medicine is the only thing that works - if patients don't take the medicine we give them, the effect of our medicine is zero. We must negotiate without patients, we must compromise with our patients, we must work with our patients to get them the best medical care possible.

There's a great article written on KevinMD.com (a great medicine/health blog) titled, Stop the Us versus Them mentality in medicine, that speaks very well to this point.

2. The truth of the matter is, not all alternative medicine is crap. A little over decade ago, acupuncture was scoffed at as a sham and now it's routinely used as an adjunct to treat pain and some other conditions. Though the research on acupuncture can be argued as not being the most rigorous and powerful out there, it did demonstrate real potential. Garlic has some medicinal properties and so does St. John's wort.

Herbal medicines and teas can augment or interfere with the effects of our conventional drugs. It behooves us to know what these herbals may do, so we may advise patients accordingly. More research needs to be done. There a lot more alternative medicine out there than research is able to elucidate its true effects. There's a lot of untapped potential that needs to be refined into a product that can reliably and safely work - to disregard it all as "for hippies" or "essentially placebo" is a disservice to patients and the spirit of science and medicine.
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Another friend at lunch remarked, "Do you know what alternative medicine that's proven to work is called? Medicine." I disagree somewhat. There's a difference between the word "alternative" and "integrative and complementary." Not too long ago research showed that a tablespoon of honey in a cup of hot water helped temporarily relieve symptoms of sore throat and cough. But these things alone usually can't suffice, and hence are integrative and complementary. Alternative implies a divergence from conventional medicine.

This article, The Believers, that my friend sent me yesterday unsettles me a little. It may seem hypocritical of me to say that, given what I've argued above. But I am by training a scientist. I acknowledge that there is a world outside what research has touched (because if research has touched it all, there would be no further research). I believe that many alternative therapies warrant further scientific research to see if it truly works or not.

Anyway, the truth of the matter is, we shouldn't dismiss alternative medicine so readily because we don't always have proof it doesn't work. Also, if we dismiss it so readily, patients may take offense and refuse to take the medicines we prescribe. And if they don't take our medicines, that have research backing that they work, then what's the end effect? Oh yeah, nothing.

Mediocrity

mediocrity by ~seven20 on deviantART

In grade school (K-12), I was always at the top of my class. I was pretty good at everything (except gym) and the world was full of endless possibilities. In undergrad, I understood that few people are truly Renaissance men. I learned where my strengths were and I knew where my limits were, in some cases hitting that unmovable wall. In grad school, the world - while more limited - was still full of potential. I learned what I loved and I learned what I could excel at.

In med school, I am mediocre. During M1 and M2 years I did pretty average on exams. Actually, no, I often did below the class average (though, my end grade was "average"). Even the classes that I had a solid background in and did above average I usually was still not among the top. But this didn't deter me as I had come to learn that grades don't necessarily equate with how well you know, understand, and appreciate the material. Then on the USMLE Step 1 exam I did below national average. While this was a hit, I eventually shrugged it off because I still passed, which was what truly mattered. Plus, since I would likely be going into pediatrics (or possibly internal medicine or both), it didn't matter SO much as long as I passed.

Surely come M3 year, with largely subjective evaluations, I should do better! Alas, it appears that I'm still relegated to being mediocre. It seems no matter how hard I try, how hard I study, how excited and motivated I appear, how much I care for my patients, I am only "mediocre." I am only "average." And this befuddles me. Here I am compared against my peers, many of whom I KNOW do not care for their patients in the same way that I care for mine, and yet we end up with the same grade (and sometimes they do better than me). What gives?!

I'm kind of afraid. I really really wanted to excel on my pediatrics rotation. I've mustered every ounce of excitement, enthusiasm, motivation, genuine care for my patients, willingness to do scut work (aka, the residents' bitch work), willingness to receive feedback to improve . . . and yet I'm not sure I can make it out with more than "average." I'm afraid that no matter how hard I try I will remain in the same place.

I am tired from my months on medicine and surgery. I've worked my ass off in hopes that I'm able to mask my exhaustion and put on a face of enthusiasm. And I honestly did care for my patients. I don't know what else I could do, I don't know what other well of strength I can draw from.

As I talked to my friend, he said the following to me:

"Don't feel defeated, you passed and you are a bad ass med school person. You're like, proving yourself beyond 99.9999% of all people in the world. Can't get too upset about that last 0.00001%."

I always loved him for his perspective on things.

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.

A Helping Hand

a helping hand by *poivre on deviantART

A couple days ago in the resident's lounge, one of the physicians came in to round with his team (of residents and med students). Because the lounge is rather small, I overheard most of what they said.

They discussed this one patient in his 30s who didn't finish high school, has uncontrolled diabetes, has peripheral neuropathy (numbness & tingling in fingers and toes) as a result, has chronic pain, and is taking narcotic pain meds in order to bear it all. According to the med student and intern taking care of him while in the hospital, they report that he is unpleasant/uncooperative to work with, appears to be "throwing away his life," and just want his pain meds. The physician took this as a moment to ask, "Why?"

This segued into a discussion from the physician about here is a guy who's slipped through the cracks of health care. He takes narcotics for the pain, but narcotics likely make him sleepy and also feel not great, throwing him into an endless loop. His PCP (primary care physician) likely tried to truly help him once, but since he's uneducated and doesn't know how to manage his diabetes, thus his health deteriorated. In his frustration, his PCP likely labeled the patient as "non-compliant," which is technically true - but again, why? It became easier for the PCP to just refill his narcotics and send him on his way. His PCP is also an older physician who's likely jaded from seeing so many of his own patients fall despite his care.

Here, said the physician, was an opportunity for us - med student or intern - to turn the guy's life around. Here, in the hospital, where we have "control" we can say to him, "You need to get your act together and turn your life around." Here we can extend a helping hand and spend the time to give him the education necessary to manage his diabetes. He's a young guy and has a shot of doing well years down the line, why should we also abandon him just because he has a label of "non-compliance?"

I have friends who call their patients "idiots" for smoking and having a BMI of well over 40, and then gets admitted for pneumonia. Or for being alcoholics and developing acute pancreatitis as a result. Sometimes I look at one of my friends, who's overweight and gets winded after going up 2 flights of stairs (how sad . . .), and say "Dude, you get winded after 2 flights of stairs. When was the last time you exercised?" To which his response is, "I've been busy and I just don't feel like it." How dare he call his patients idiots for ballooning up to a BMI of 40+ (FYI, that's more than morbidly obese), for telling them to exercise and eat healthy, when he doesn't do the same and could be in their shoes 10-20 years down the line.

Anyway, righteous indignant rant over. We all, medical and non-medical alike, have an opportunity to turn someone's life around. We all fail from time to time, but that doesn't mean we no longer deserve help. Even so, I'm beginning to feel myself become jaded with adult medicine after just 2 months . . .

Righteous Fury

Righteous Anger by *kysius on deviantART

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

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

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

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

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

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

Method to My Madness

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

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

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

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

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

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

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

Rant: Frustrations

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

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

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

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

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

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

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

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

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

Frustration by ~stabTyler on deviantART

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

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

The Gall!

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

Her:
A,

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

Sincerely,
G

My reply:
Hi G,

I would like to clarify a couple things:

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

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

I hope you can understand my perspective on this issue.

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

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

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

I'm Tired . . .

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

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

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

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

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

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

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

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

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

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

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