Ambulatory Medicine

This outfit is what I wore to my last day of work this past Friday, I had my white coat over it, of course. Except I wore a pair of wedge-heeled peep-toes instead of these strappy sandles which are not meant for long hours of wear, I learned from one painful experience. Normally I don't wear the likes of this outfit to work because it's too cutsey and more fitting for a garden tea party or something. Yes, why don't someone invite me to a tea party? I'll find a big straw hat to match!

August has been my amublatory medicine month. A non-medicine friend asked me if "ambulatory" had anything to do with ambulances? Actually no, I always thought ambulatory meant that patients are ambulatory or able to walk, so they are walking in and out of the clinic. In any rate, ambulatory medicine is the same as outpatient medicine, as opposed to inpatient medicine where patients for the most part have to stay inhouse and can't be walking in and out.

I have possibly re-discovered my calling, ambulatory/outpatient medicine. What a great month I've had. In a nutshell, 8-5 job, weekends off, no nights. Most people's jobs are like that, but to me, it was a nice respite, a breath of fresh air. For a month, I was not a slave to my pager, I didn't stay at work a mintue past 5pm, and my weekends were my very own. I also loved the pace of outpatient medicine, I felt comfortable, in my element and competent. Our resident clinic has a fantastic bunch. Blanca and Javier (MAs), thanks so much for being always ready to translate, Ada (MA) for making breakfast tacos on my last day, Kathy (head nurse), for being the glue that holds the clinic together, Sim and Bettina (nurse and MA) for catching my documentation mistakes. And of course my two attendings, Dr.H and Dr.M, whom I've learned a lot from, not just strictly about medicine but about mixing life and medicine.

September means goodbye weekends and hello wards (inpatient medicine). In our residency program, being an upper level on wards means working all the weekends, we take our days off during M-F only. I will be on call the very first day of the month. Being a resident on call means cross-covering for the ICU when the ICU team has gone home, supervising interns' work, doing admissions fromt ER, and heading the codes anywhere in the hospital. It's a bit nerve-wracking just typing about it. Then again, I was ever so nervous when I started off as an intern one year ago. Just as I finally got good at being a intern, the bar is raised. I never feel that I'm quite ready or tall enough to reach that bar but somehow it gets done.

Down with Step 3

I'm done, I'm done! Finally, took Step 3 today, a beast of a test that's 400 questions and 8 hours long. Now, there's that dreaded waiting period of "did I pass??!"

Dog as accessory? It's all the rage in Hollywood, just google Paris Hilton, Ashley Tisdale, Rihanna, Blake Lively and on and on. As for Hiro, he's too big, he's no micro mini maltese or teacup poodle, he won't fit into the palm of my hand or handbang. But he's a full 10-pounder piece of lovey-dovey!

I'm Proud of my Country

I have been having a taste of being a resident this past week. I thought I'd be horrible at giving orders, supervising interns, etc. It's only been what, weeks, since I was the one that had a upper level to fall back on. Suddenly, I'm that fall-back person.

Luckily, my intern is really nice and receptive. He's from India and actually have finished his orthopedics surgery residency there before coming to the states. He's the wide-eyed intern that most people are when they start. He kept saying how nice all the attendings are here and how much he likes this residency program. He has these horrible stories of residency back in India where residents are too scared to even talk to their attendings.

I'm reminded of Michelle Obama's words in a speech recently, "for the first time in my adult life, I'm proud of my country." Her comment makes me go "ummmm," in a bad way. For her to say that is rather ignorant, not to mention unfitting for a presidential candidate's wife. There are people who would leave their home country AND go through grueling residency training all over again just to be in this country. I didn't even have to ask why my intern wants to be an intern again even though he's already a fully licensed doctor in India. I know the answer, a better life. There are so many foreign medical grads that do this every year. It's what my Dad did for me when he left China in the 1980's. Wealth, democracy, equity, human rights. . .no, these things are not perfect in America, but it shouldn't have to take a foreigner to appreciate the privilege of being an American.

So, for Michelle Obama to say that she's never been proud of America until now, well, obviously, she's never been to India, China, or Mexico.

I Couldn't Resist. . .(PART II)

nice work dresses. . .

Love this dress: with smart shirt collar, geometric figures in a no non-sense neutral brown/beige color.

Paired with my white coat. So this is what I wear on days I'm not in scrubs or pants.

Where Was my Head?

This morning I went to work having left my pager at home. I did, however, remember to take along my lip gloss that matched my blush and outfit. Where was my head? I felt so terrible and irresponsible all day, missing pages from my resident and the nurses. It’s worse than leaving your driver’s license at home which I’m guilty from time to time. Well, I don’t plan to go anywhere without that pager again, it’s as good as glued to my hip.

Thoughts on a Rainy Afternoon

It's a rare rainy weekend in Texas. Unfortuately, it happens on my rare weekend off. Now, I'm inclined to just stay inside and won't be walking the dog, to my chagrin.

My Dad called me on Valentine's Day to say, "happy Valentine's day." He's never done that before! I proceeded to tell him Valentine's Day is no big deal and I'm working anyways, but he said yes it was and I shouldn't let work encroach on having a life. I suppose he's gotten sentimental with age. I was on call that day in the hospital and Paul texted me "happy Valentine's," which I thought was sweet of him. There were chocolates, cookie and cakes every where in the hospital and I gorged plenty on Valentine goodness.

If Feb 14th passed without much fanfare this year, then Chinese New Year did with even less. It's the Year of the Rat!! Again, my parents were aghast at the fact that hubby and I had no celebration plans nor holiday spirit. Holiday traditions are super important to my parents from the Christmas tree every year to the right auspicious food to eat on Chinese New Year's. One day I shall be like that, too, but at this point in my life, it just can't be done.

Certain patients leave an indelible mark on me and I continue to think about them way after my need to. It was this way with this patient of mine that was discharged yesterday. I woke up this morning wondering how she is faring in her new nursing home. In her demented state, she's become like a child, a very cantankerous one, outright indecent, and sometimes bordering on being violent. From knowing her in the past several days, I know she needs just the right type of cajoling and coaxing for her to be properly cared for. I hope it is the way with her at the nursing home. In the process of caring for her in the hospital, I've gotten to know her, her unsavory past, her undesirable present, the bridges she's burned with her family and friends, and her utter lack of insight into her situation. She yelled unprovoked expletives at me and I pitied her even more with a deeper drive to help her which is perhaps only a small bandage to her gaping wound.

On my day off, the going-ons of the hospital is last thing I want on my mind, but sometimes I encounter people who's journey and paths are so drastically different from those of my own life that I can't stop thinking about them. I suppose it makes me extra grateful for my own given life. I realize I'm remarkably normal and functional. This leads to think about the issue of mental health and how disorders like schizophrenia and bipolor wreck havoc on people's wellbeing and their capacity for a meaningful life. I could never be a psychiatrist and be in the middle of these people's broken situations and more often than not, there are no good answers to why or how to "fix" them. My patient is who she is today because of the series of poor decisions she made due to her mental health and its left her in the decrepit state she is in now. Truly, who's to blame, who's responsible? As healthcare workers, we can only do so much. I think about the recent college shooting in North Illinois and the predicable relationship to the mental health of the shooter, or the Virginia Tech shooter and his disturbed mind. I think the nation as a whole is at a lost for answers for how to prevent another tragedy such as these. Is it more gun control? Is it more aggressive or mandatory treatment of people with mental health disorders? Or should we take the lassie fair attitude of one commentator, "we can't change the weather, we can only change our sail."

Medicine and Religion

Should Doctors Pray for their Patients?

I haven’t read much on this topic to know the consensus agreement or the schools of thought on this out there, but this issue was brought up to me recently and I have some thoughts on it.

Someone at Bible Study wanted to know if I prayed for my patients? I said no, it is not my habit to do so. He proceeded to say something along the line of “well, you can only act in accordance with your conscience. . . without our conscience, then we have nothing.” I didn’t answer him back but just nodded, but now I am a wee bit incensed. Here’s my response to this.

While I don’t pray for my patients in the strict sense, I do have compassion and think about my patients often, many times long after I’ve come home and it is not just because my beeper from the hospital goes off. So to the best of my “conscience,” I feel like this is the right thing to do, praying or not. I am still at the beginning of my medical training, while having compassion for my patients come naturally to me, having a comprehensive arsenal of medical knowledge and know-how doesn’t and it is that latter tool I seek to sharpen everyday. I don’t doubt prayers for patients are important but I don’t believe it is my role as a doctor. There are chaplains for every religion and denomination in the hospital, there are community resources just for the spiritual needs of the sick. And of course there are family members and friends. If it was me on the other side of the sick bed, I would ask and expect all my friends to pray for my loved one. But as a doctor, what I do pray about regularly is that I don’t hurt people under my care and that God would give me the strength to do what I need to do to become the doctor the patients need. So, no I don’t pray for my patients directly. I believe what they need from me is competent medical practice and advice. Prayers help people but they don’t always treat or cure diseases, medicine and surgery do. If prayers had the track records that cardiac catherization has on heart attacks or surgery has on an infected gallbladder, then medical professionals would be taught on the mechanisms and practice of praying along with pharmacology and pathology. The fact remains, God chooses to answer very few of the human prayers for delivering people from illness. That is simply not His way. Our limited human-ness can’t understand why but that is just the way it is. What praying lacks, medicine picks up with drugs and technology. No, medical science does not cure spiritual ills, but then again it wasn’t meant to do that nor was I trained to so. I’m glad there are special gifted people who become chaplains or prayer warriors that tend to patients' spiritual needs which arguably is on par with a person’s physical needs.

Unlike my friend at Bible study, I don’t look at everyone I meet or every situation I encounter through spiritually-colored lenses. Perhaps I should, perhaps this is a mark of my spiritual immaturity, but nevertheless, it is my station in life now. Perhaps one day I will reach new heights spiritually and have a completely different view but right now I’m just not there yet.

This same said friend expressed his concern that I was becoming a back-sliding Christian and wanted to know if hubby and I could meet an extra day on a weekday with them (since I can make it on weekends only seldomly), to help me back on track, so to speak. In his usual subtle-ness, he basically said we are all busy people and if we are truly dedicated, then time wouldn’t be an excuse. Yes, I agree we are all busy, I don’t degrade their busy-ness beneath me but I also know myself and what I’m able to do and not do. I agree I don’t always use my time wisely, definitely too much time Googling such non-sense as lop-sided bunnies and watching Cashmere Mafia on-line. However, it is my winding down time and I probably won’t become disciplined enough to change. I whole-hearted am grateful for their concern for my spiritual health. They are wonderful friends to count on and to have. However, I can’t imagine adding on another regularly scheduled activity onto my plate since I’m not evening doing well with the ones already on it! What I’d love is for them to pray for me and of course their understanding for the fact that this is a demanding and exciting time in my life.

You know what else I really need? A maid!! Seriously, I’m looking for one and in the process of deciding whether we can afford one or not.

To be honest, I am most concerned these days with becoming a competent physician, most other things have taken a back burner in life. Such is the season in my life, and like other seasons, it’ll come to pass. I still know too little to be where I need to be one day but I know enough to know medical errors happen and can hurt or kill patients and I never want that to happen to me. One of the many cited drawbacks of medicine by physician themselves is the tremendous liability that we have on my minds and backs. Medical errors kill thousands of patients every year. For me, the issue can’t be overemphasized or overstated. Even as a lowly intern, because I have the power to prescribe, the treatment or medications I order or didn’t order can have detrimental effects on people. We are all human and human errors happen but I hope to never become too jaded or too careless to make such a fatal mistake.


That’s my rant.

One with Many Labels

My first fake nails!

I got my nails done last weekend. The picture is not an actual picture of my real nails as I'm too lazy to get the camera and take a pic, but my nails look just like that. I was convinced I wanted the new gel overlay french manicure but the Vietnamese lady convinced me acrylic tips would be stronger and longer lasting. The truth is, not many people are experienced enough to do gel overlays which takes longer and costs more. After a week, I'm happy to say my nails still look like they were just done, not even a scratch! They really stand up to any activity you put your nails through. Acrylics rule!! It's nice because because only the very tip of every nail is glued on, the rest of the nails are my own, albeit reinforced with a a very strong yet clear layer of acrylic mixture. Ingenious! I love how my nails look so feminine and clean! So, they should last about 3 weeks until new nails grow out after which I have to spend oodles of money again and get them re-filled.

January is gone for good. It's been a good month in the sense I was on Pulmonary and had my weekends off, but the bad side is my days were 12-13 hour days. I rarely saw the sun since I left home in the darkness of dawn and returned to an already darkened sky. Not a schedule I liked at all, but it's over for now. I'm back on wards, yes, I'll have to spend some nights in the hospital but atleast the other days I get to come home at a decent hour.

But boy did I make up for lack of sun today! It was a beautifully sunny day and I took Hiro out for a much needed walk. No amount of begging could deter hubby's resolve to study for his exam on Monday (can you believe it?), so I went out alone with Hiro. I discovered a great walking/jogging trail nestled in a nearby apartment property! How happy I was to get away from the hustle and noise of street cars and enter the sanctuary of quiet squirrels and ducks! A rather unfortunate thing happened, though, I lost my phone along the way. When I found it, it was already ran over by a car!:( Looks like I will be shopping for a new phone tomorrow.

Of course anyone would agree, there are a lot of depressing things in the hospital, but to me, people on dialysis and people on ventilators have to be some of the most depressing. It's just a feeling I get when I step into the hemodialysis quarter or the ICU. Sometimes I step back and think, how far medicine has come to be able to take over the function of a whole organ system, like the kidneys and lungs, when they fail. It's a bit unnatural and awe-inspiring at the same time. Anyways, just some of my random thoughts.

I was warned about Dr. H, the pulmonologist, before I started working with him in January. "He will pimp you to death, " is his reputation. He deeply humbled me into realizing how much I don't know. Most of the time, I had no pride to be hurt because the way I see it, everytime I find out I don't know something is an opportunity to patch up that gap in my medical knowledge. Dr .H is not a natural-born American (he's South American, I believe) so he has a peculiar way of being honest and probing. Like when he talks to patients who are smokers, "so, are you going to stop smoking, or is that too much to ask?", he would say with a straight poker face. To this question, the patient would usually give a laugh and pause. Then Dr. H would continue, " I just want to know because I don't want to waste my time." The other thing he likes to do is to calculate for patients how much their smoking has cost them, monetary-wise. "Oh my, you could have bought a house!" or "for that much money, you could take a vacation in Hawaii. . .with your daughter." Somehow, Dr. H has a way of sizing you up and do it unapologetically. I have only seen that kind of straightforwardness and honesty in foreigners. Americans are very big on political correctness and politeness, a kind of fakeness that we get comfortable with and expect from strangers and professionals. Hmm, just another observation.

Another random observatin of mine: I can't believe skinny jeans are still in!! Makes me want to go and buy another pair! Should I or not? Decisions, decisions. . .

I'm working with another nice resident this month, wohoo!! He is giving us five days off, one extra day than usual!:) My attending, however, is one I would rather not work with, and I will just say that much. But oh will, sometimes we win, sometimes we lose.

I will end this post with this quote:

" Happiness in life is nothing more than a good health

and a bad memory."

New Month, New Moments

A new month also means a new team, new resident, new co-intern and new attending. And this month promises to be a very promising one. First of all, I love my co-intern, an anesthesia intern whom I worked with in October as well. When I think of S, I think of calm. She's African-American with a great sense of style and a head of hair to envy. She must live with a hairstylist or something because her hair is always amazing. One day she comes in with dreadlocks, another day with a bun, then the next with a updo in a head wrap. As for me, my hair is always the same, tied back with a rubber band. I must get to the bottom of what's her tress-rific secret. Ha, I love that pun!

Second of all, my resident in December is the super-great CK. I worked with her in July, yep, she was my very first resident in my very first month of internship. I couldn't have asked for a better resident during the overwhelming "First Month." What's more, CK gave S and I the day off today!!! Just like that, CK said, "we are on call on Sunday, so why don't you take Saturday off and I'll see all the patients." Oh my gosh, I had to ask, "are you sure?!" I was afraid if I said too much, CK would change her mind!

I hardly knew what to do with myself today. I slept in, of course. After hubby went to his Saturday class and usual date with badminton, I went shopping --just for work clothes. (Any new clothes in photos are loot from earlier shopping trips of months past). I picked up a couple of new sets of scrubs and a new white coat. When it comes to scrubs, there are name-brands, you know the Calvin Kleins of medical wear, and then there are the no-name brands of the Target variety. Even Grey's Anatomy and Katherine Heigle now have their own lines of scrubs and white coats!! Back in summer, Malini and I visited this little uniform shop (Scrubs-N-Chef Uniform Depot on N. Stemmons) hidden in a half-abandoned shopping center. The store owners are an old Indian/Pakistani couple. Although not a glamorous place to shop, but for only $16.99/set, I have discovered that the scrubs I bought there fit very well and have stood up to the test of time and frequent visits in the laundry machine. So today I went back for more and also picked up a generic 37" white coat. I have discovered that the life of a white coat for an intern/resident is 6 months, at most. My white coat is my single most frequently worn piece of clothing and after several months, it just won't wash clean anymore. It's rather nasty looking and probably colonized with every hospital germ there is. So I was really glad to see a new whiter than white white coat today and decided to get my name and speciality embroidered on it in the store. Unfortunately it was seriously botched!! The lines are lope-sided and a little too high. I didn't realize this until I came home. Maybe that's why the Indian lady gave me some free scrunchies!

As for what I did rest of the day. . .I cleaned up our home a bit and took some frivolous photos.

Mixing the old with the new:

Cropped black jacket with 3/4 sleeves and ankle boots are these seasons trends, but the tee and jeans are last years.

Black n' white jumper dress, black tights and ankle boots.

My new tan cold-weather boots with last year's jacket and jeans. These boots have been "in" for the last couple of years, but I love them, perfect for the snow days.

My new favorite outfit these days b/c it's super comfy: mini jean skirt with black leggings, and black flats.

New work clothes: the ever popular ciel blue scrubs and my new crisp white coat. Even in this poor picture, you can see the screwed up embroidery.

Weighed Down

Yes, "weighed down" is exactly how I feel right now. Like a sinking anchor, a balloon that won't stay afloat, a bag too heavy for the back. And maybe even like what a lot of patients often tell me, "it feels like there's an elephant on my chest!" It's only the 3rd week into my 13 weeks straight of ward medicine, and I'm already "weighed down," on the verge of burnout. Ha, can you tell I'm a countdown person? I was at the store the other day, and a singing Christmas tree told me it was 74 days 'til Christmas. But no, I was not quite in the holiday spirit.

I am weighed down by all the patient care duties, all the work hours, demands of my pets at home. The pager calls from the hospital while I'm trying to feed myself and the animals at home, the insanely early wake-up calls, the regularly scheduled sleepless nights, aggg!!! What's worse, I have a BIG test this Friday that's woefully unstudied for and Kitty is getting sicker, quickly spirally out of our ability to take care of her. At work, it's one patient after another, admissions upon admissions. At home, it's books piled high to be read, and Kitty's intestinal mess to be cleaned up day after day. Thank God that Hiro has stepped up and leaving his business for me exactly where I want him to. But Hiro is getting older, and he needs professional obedience training now which I have not yet secured for him.

I've finally spent some time today realizing I'm overwhelmed and coming up with some ideas to fix this. My upcoming free weekend, although already planned full, is so much more needed now. What I need is just a little time off and then get into action:

1. Prioritize my to-do's
2. Cut down on the daily non-essentials
3. Maximize my spare time at home
4. Re-focus on the really important goals.

Ha ha, my life is sounding like a business plan, if only I had come up with a cute acronym. I'll be okay, a concoction of sleep and wise stategizing will do wonders for being "weighed down."

As Luck Would Have It

Last week this time, I was preparing myself mentally for the onset of another month of wards, but at the last minute, the chief switched my schedule. So instead of doing calls and 80-hr weeks in September, I'm on my easiest month of the year (elective) with a week of mandatory vacation at the end. I was quite upset. You see, it means I will have 3 months of wards back to back, (Oct to Dec). I was also hoping to "save" my week of vacation when I really need it, a.k.a. burnout time. I had thought (and told all family and interested friends) that the worst schedule I have to get through this year is wards medicine 2 months at a time. But now, it's actually three months of calls with nearly no weekends all at once, which sounds soul-wrenching! The feeling I had was like being handed an unfair prison sentence.

They say every cloud has a silver lining. . .and in this case, it's actually true, just have to look at the bright side. Here are my silver linings:

1. I had my one holiday of the year off, Labor Day! And I enjoyed it thoroughly, although I didn't step out of my door and mostly cleaned.

2. Also, my car broke down so I was able to take a day off from my ultral-light schedule and get it serviced. I just imagine if I was on wards and discovered my car was not working one early morning, I think I would just break down myself and cry. Car problems should not happen to people with stressful jobs! (That would be a law if I ever become Queen of the Land). As luck would have it, I was able to spend a leisure day at Starbucks sipping a pumpking spice frappacino while my car was being fixed next door. BTW, the PS frap was good, nothing like it to welcome fall!

3. "Linda, I think you dodged a bullet on this one." This was the response I got from an intern after I told her I wasn't on wards with a certain resident in September. Apparently, this said resident is very difficult to work with. After hearing a few horror stories from this poor intern who had to work with this resident, I was completely convinced that I, indeed, got very lucky. Your upper level (aka resident), at best, is a good boss, and at worst, a slave-driver.

4. Lastly, I was able to hang out with Malini at a rather posh shopping area in Plano on this free weekend of mine. We walked around the boutique shops, chatted our way through aisles of hand-made jewlry and overpriced but unique T-shirts and then headed to Stonebriar Mall to actually purchase stuff from Macy's big Labor Day Sale. It was so good to catch up with Malini. Even though we see each other at the hospital almost everyday, we hardly get to talk. It's always running to this and that, body and mind running to several different directions all at once. We are bonded by a common experience, something that I just don't share with anyone else in my life. It's an exciting and trying time, intern year is. She totally gets me when I tell her about a particularly difficult attending I had. I can't sympathize more when she shares the story of how the night before her last call of the month, she sat down with her mom to have a good talk. "It was like preparing for war, I had to get some strength and encouragment from my mom."

So, all that is to say I'm very grateful at this turn of event even though it means I will suffer a little deeper later on. Happy Fall!

People.

Today I learned what truly makes me love my job. People. People like Mr.H and Mrs.A, whom I saw in clinic today. On the flipside, there are people that make me feel the opposite about my profession.

“I’m going to be 83 soon and God hasn’t taken me yet, I guess he just doesn’t have room up there for me yet.” Said Mr. H, who has had his big share of medical problems in his long years including a brain tumor that was removed in open brain surgery.

Full of stories that could only come with years of life, Mr.H said, “After my brain surgery, there would be people that look at me on the streets, sometimes they don’t say anything but I know they are curious and want to ask me what happened to my head and why I have a the scar. I’d say to them, ‘my brain was too big and the doc had to take some out!’ ” Ha ha, I thought that was so funny. I wasn’t following up on his brain surgery today but rather his diabetes, hypertension, etc. He is what we call a very compliant patient, takes his meds and follows up with all his docs, and entertains the staff when he comes to visit the clinic, no less.

Another patient was a woman I first met in the ER and admitted to the hospital. She knew she had diabetes a year ago but decided not to get any treatment. In fact, she hasn’t seen a doctor in over a year. Her blood sugar in the ER was through the roof. We stabilized her and on her day of discharge I gave her my lecture on the importance of getting her diabetes managed by seeing a doctor regularly. “Since you don’t have a PCP (primary care physician), you can come to see me in the clinic.” I told her. As I said this, I hoped she would follow up, but with the population we see in the hospital, I knew it’s a slim chance. But today in clinic, I recognized her name immediately on the schedule. She proudly reported she’s been taking all the medicine I gave her and even came with a pen and notepad to jot down changes I made to her medicines. Mrs.A is on the reserved side and her expression is rather flat most of the time, but today I knew she cared about her health and was ready to do what’s right for herself.

Those two patients are bright examples of what makes me love my job. They take control of their own health and are in partnership with their doctors. When I encounter people like that, I don’t mind taking that extra step or coming early and stay late in the hospital for them. The patients are in the driver’s seat, I can only give them directions. It’s up to them to get themselves from point A to point B, where they should be. Sometimes, it’s that very point that makes medicine so hard and makes me wonder if I would have gone into medicine 8 years ago knowing what I know now. Take Mr. D.

Mr.D was the last patient that I admitted on a 32 hour call (from 8am on Sunday to 4pm on Monday). I haven’t had dinner, didn’t have breakfast the next morning, and of course no sleep. On top of that, I had all the nervousness of trying my hand at placing my first central line on a patient in the ICU that night. Before that, a patient of mine coded and after 40 minutes of CPR, drugs, and shocks, the patient expired. The whole family was there, crying and bawling, the chaplain came, we told them we did everything we could. It’s was a bad night. Then came Mr.D at 3am, a 40-something homeless cocaine abuser who had abused his heart all the way into failure. He was barely alert enough to answer my questions. I thought, “If it weren’t for you, mister, I would be getting a couple hours of much needed sleep right now instead of trying to talk to you.” I was genuinely miffed, but I took care of him the best my groggy brain and hands would allow me. What’s more upsetting is this fact: Mr. A, this relatively young guy who has no other health problems except for cocaine-induced heart failure gets hundreds of thousands of dollars in procedures and treatment, free, because he’s penniless and all the while another patient of mine who’s responsible and has a job doesn’t get the same life-saving heart catherization that Mr. D received all because she happens to work and makes a little too much to qualify for government assistance but not enough to pay for the procedure. She is saving up her money for a heart cath while Mr.D will likely go back on the street tomorrow and shoot cocaine and abuse his heart. Okay, it begs the question, where does Mr.D get his money for his drug habit?! Yes, this is the kind of system that I learned that our country has, the system that I work under. “Unfair” doesn’t seem to begin to cover it.

All in all, I choose to focus on lovely people like my two patients in the clinic. They show me that I am working 80-plus-hour weeks, sleep deprived, and bone-tired for good reasons. At least most of the time.

(New) Facts of (My) Life.

1. Eight-hour work days are my short/part-time days. Those days are rare.

2. If I don't write it down, it doesn't get done. I've become a religious list-maker.

3. There is such a thing as being too busy to eat. . .or to answer other calls of nature.

4. Holidays are not an entitlement, it's a privilege. . .a privilege I didn't have for Fourth of July, nor will have for Thanksgiving and Christmas. That goes for weekends and nights, too.

5. I love my job, so far.

6. Patients don't get well on medicine alone. Only half of my job is about knowing why a patient is sick and what treatment he/she needs. The other half is social medicine: figuring out what medicine a patient can or can't afford, calling family members to check that they are ready for their loved one to come home, making sure patients get home health or nursing home care after discharge, etc.

Random Blurb

The day starts out with good intentions: I'd put on mascara, and my pointy-toed pumps that go clikety-clack down the hospital halls. By end of the day, the white coat weighted down by PDA, stethscope, books, papers, pens, cell phone, and pager feels like a potato sack on my back. My cute heels have become little torture chambers for my feet. Worst of all, I come home and realize my face has turned greasy in 13 hours and the mascara has made a panda of me!

Yes, tomorrow I go without (embellished) lashes and I wear my Dansko (funny) clogs.

Sometimes You Win, Sometimes You Lose

*Warning: Sarcasm and Whining ahead*
(but sprinkled with optimism)

I’ve got some good news and some bad news. I found out yesterday that I passed the clinical exam that I took in Philly 12 weeks ago!! Yeah, it took them long enough to let me know! I was all but convinced that I had failed, but anyways, moving on to the bad news:(.

Today was the first day of our short orientation at our hospital before our start date of Sunday, July 1st. Umm, what about church?! Church, what church?! Yeah, that’s not happening. Anyways, that’s NOT why I have bad news. It turns out that the call schedule has been totally revamped since I’ve rotated and interviewed at Methodist. Instead of the split call method of day call and night call which makes each intern have night call once every 10 days, now it’s only night calls, Q5! (Q5=every five days) That means we have a 30-hour shift from 8pm to 2pm (the next day) every 5 days. For example, my month of July schedule shows that I’m on call (30-hour shift) SIX times with 4 days off. The reason for the change is that this is the more traditional internal medicine call schedule and previously the interns were too swamped on their shorter calls so now the work is more spread out over a longer call. Hmm, during my interview, the speech was “we really work hard while we’re at the hospital, but we have more time off compared to other programs.” Now I'm hearing, “there’s too much work to be done, so we are doubling your night calls, which is the normal IM schedule at most programs anyways.”

Yes, I should not be such a complainer . . . but I will anyways because I want to vent. Both M (my good friend/co-intern) both lamented over the fact that one of the major reasons we chose this hospital was because of its nice call schedule. (I was in my 'all-about-work-life- balance' phase). To have that changed on us on the first day of our orientation is just, well, upsetting and disappointing!! When you are married and have a home, it’s ever so important to maximize your time with your loved one, and it frankly makes me angry to think that it's taken away. But you know what hubby said at the news? “Oh, that’s good news; you’re getting longer and better training.” No, I didn’t physically harm him, but I did flash a very dirty look while thinking, ha ha, that means more scooping Kitty’s litterbox for you while I’m spending my nights at the hospital!

Okay, *deep breath*, I'm done. I still love the hospital, it was good to be back there, like good memories rushing back to my head. I met some of the other interns, a nice bunch, I think. In the end, it’s all about sacrifices and dedication, and I’m ready. I just had to vent a little, you see.

One more piece of good news because I want to end this on a good note. I’ve been meaning to write about Blacky, the lovable stray I took care of months ago. Joyce, the amazing cat rescue lady, found him a forever home! Actually, I’ve known for weeks now but just haven’t written about it. I received an e-mail from Blacky’s new owners and they just love him to death. Joyce finally surmised that Blacky was a victim of animal abuse because of his scars. Also, his new owners continue to call him by my last name, but he’ll always be Blacky to me. The story just warms my heart everytime I think about it. Blacky was headed to euthanasia but by God's lucky timing, he went to Joyce, his guardian angel, instead. Yeah, in this life, you really do win sometimes, and lose sometimes and I think I’ve own more than I’ve lost.

The Big Day

The Big Day is coming. Preparations for it have been ongoing for many many weeks, years, really. After all, life will not be the same again and she needed to prepare herself mentally and physically. There were many many shopping trips buying loads of new clothes. “We all have to wear something.” she consoled herself at the money that’s spent. She readied her home in numerous ways, buying a new dark curtin instead of the sheer ones they had. This promotes restful sleep, she reasoned. She even stocked up on items like toilet paper and detergent, just in case they run out and she can’t steal a moment away to buy them.

She thought of the new responsibility that’s dawning upon her. She’s stepping into a new role, one that she’s never been in before, all the preparation in the world aren’t quite enough, but a role that she has to be ready for anyways. She thinks of all the sleepless nights that come with being a caretaker. There is still so much to learn, everyday will be something new and different. Those thoughts are equally exciting and scary to her right now.

Recently, she got together with a couple of friends in her same shoes. They had gone to classes together, swapped advices, and partied together in the days before the Big Day. This night, they shared pictures of their big overseas trips with each other over fruit tart dessert. Mel and Omar had gone to Europe for three weeks, while she and her husband had gone to Asia during that same time. There were many happy memories and funny stories that accompanied the pictures. “Ahh,” they all signed afterwards. They all knew it would be many many years until they would have that much time to take trips like that again. They talked and reminiced to almost midnight, knowing that there’s nothing to do the next day except for sleeping in. But those days are to be over soon.

“What day do you have to go to the hospital?” She asked of her friend.

“On Monday. I can’t believe how early I’ll have to wake up from now on.” Mel said.
=========================================================


So, what is the Big Day? While it’s NOT the arrival of a new baby, the first day as a medical resident in many ways is similar to becoming a new mother. The tremenduous responsibility, the sacrifices, big and small, sleepless nights, fatigue, lack of personal time, and all the new knowledge. Yes, motherhood and resident-hood are both overwhelming. No, I’m not saying that having a child and having a new job is the same thing, but just very similar in their demands. I draw this comparison because of the many female friends around me that are new mothers or soon-to-bes. There are even a small minority of students I know that are welcoming BOTH new roles of being new parents and new physicians at the same time. As much as I want kids and moan at my delayed motherhood, I don’t envy those colleagues. One day I shall have both, kids and career, but now it would be almost impossible to me.

One of the couples in our Bible study group just announced they are nine-weeks pregnant. Their happy news is only overshadowed by the fact that she’s having hyperemesis gravidarum. She’s overcome with nausea and vomiting all day-long. I feel bad for her that she can’t enjoy her pregnancy right now, but only see and feel the dark side of things. With the announcement of K & J’s pregnancy, Paul and I are now the only childless couple in the group. Yes, there are the questions, “so when’s your turn?” I feel a little miffed at having to explain to them time and again that we can’t really have a baby while I’m in residency. I will soon be the only working woman in the group as the only other working mom is quitting her job. I suppose I feel a little jealous, not at the pregnancy but at the fact how everyone rushes in to give her advices and share their experiences. We talked for hours about how much coffee per day is allowed during pregnancy, why eating pineapple is contraindicated is Chinese medicine, how long it takes to lose the baby weight afterwards, how to combat morning sickness, etc. Well, I wish the ladies would come to my aid and tell me how I can keep my home clean while working all week or easy recipes I can manange on a weeknight or how to maintain my marriage while under stress at work. I suppose I felt rather alone last night at Bible study.

Apparently, I am practicing what is known as “delayed motherhood.” I didn’t know there’s a name to it, certainly didn’t plan on it, but here I am, one of those women in modern times choosing “delaying motherhood.” I don’t like to be labeled, but I can’t argue its appropriateness. Sometimes, I think of all the girlfriends of mine that are stay-at-home pregnant women and moms. It seems I’ve strayed so far compared to them. My body reminds me of my ticking clock each month as I lose more eggs, eggs that I’ll never get back, eggs that mark my decreasing fertility. I feel a little sad and anxious. Then, I spend time with my fellow female doctor friends, and realize I’m not alone. I called Malini this past week, and we talked about buying new scrubs and comfortable shoes for the hospital, our upcoming ACLS (advanced cardiac life support) training, etc. I’m so grateful she’s with me at residency. While I don’t have Chrisitian mentors in the medical field, but I do have some really good medical friends to share and vent.

Everything will be okay. There’s a time and season for everything under the sun, the Bible says, and my time is not yet here for motherhood. Meanwhile, I have my own Big Day to prepare for. There are no congratulatory hugs or baby showers, but it’s no less signifcant and life-changing for me.

Insomniac Thoughts

As I watched (with my newly minted LASIKed eyes) my bedside clock beams out “4:41am”, I knew I had drank some seriously strong coffee this evening. I simply can’t fall asleep! The coffee was in an effort to sound my approval for the latest study showing that coffee drinkers have less cancer. You know how when you can’t fall sleep, every physical discomfort is magnified ten-fold? My head turned and tossed and all but protested to the cumbersome goggle I have to wear in bed post-LASIK. My body heat was all but unbearable because the customary ceiling fan had to be turned off also due to post-LASIK instructions (my eyes will dry out, said the doc). Funny, hubby had Starbucks Espresso and a can of COKE, but he seems to be unperturbed in his slumber! My caffeine-driven insomnia would have been perfect for one of those on-call nights I’ll be doing in the soon future. “The ER has another new admit at 4am? No problem!” I would be energized, feeling chirper, ready to go . . .if only I was on call tonight.

Another tale-tell sign of insomnia is when your mind can’t be shut off, there are thoughts racing through my head like horses on a race track. I was thinking about the wrong things I said during Bible study tonight (I can be such a loud blabber mouth) and my future in medicine. I was also thinking that if I ever have another blog, maybe a private and personal as in my-eyes-only blog, I would name it “Journey to Heaven.” Isn’t that what life is all about to a Christian, our journey to heaven, the much awaited eventual destination? Once I heard a person say that our short life on earth is just a preparation for eternity. I don’t know if I totally accept that statement, but it is how I would like to think of and live my life. The people I meet, the ones I befriend, the man I marry, the strangers I encounter, the children I raise, the patients I treat, the family I love. . .they are all part of this journey that leads me back home, to God. Through the laughter, the tears, the frowns, the smiles, and the anger, the sadness, the jealousy, the joy. . .through the weddings, the funerals, the graduations, the birthdays, the quarrels, the vacations, the rainstorms. . .all the emotions and occasions of life are all slow, small, and sure steps to that one eventuality we will all face one day, death and standing before God.

I had some lofty thoughts of finding a new church family close to our new home. Not just a “church”, which sounds like any other place of establishment I frequent, like a hair salon or grocery store. No, a “church family” implies that I would get plugged in, as they say, I would know people who calls me during the week and hugs me on Sundays. I would volunteer in an area of ministry and have prayer partners. But reality is not so lofty. Actually, I would be working six days a weeks, and my day off not always Sunday but different every week, and I’ll be on call every fifth day. So, if I find a church, but don’t show my face, I’m guessing the “family” part of “church family” won’t really happen. Should I even find a church? Should I just focus my time on the Christian friends I have in my current small-group family-based Bible study?

If I was to be more honest and think deeper, which I apparently have plenty of time to do now, the truth is that once residency gets started, my schedule gets rolling and regimented, likely I won’t even be pondering these questions of church searching and spirtual journeying. I just won’t have the time, I know myself under stress.

I think about my life in medicine, and the specialty of internal medicine I am now bound to. The great arena that is internal medicine, sometimes referred to simply as “medicine.” It’s so encompassing, unlimited by organ systems and disease types. Except for obstetrics and gynecology and pediatric conditions, internal medicine covers everything else that might plague the human body. I don’t think I can just ignore the medical aspect of the female reproductive system and kids from now on, because as a female and mother-to-be, these topics are inherent to who I am. Professionally, however, I won’t be bothered with gyn and peds, so to speak. “Professional,” that’s what I am now. Before, I have been a professional student for many many years, but now I’m just a professional. Yes, I am looking forwarding to being a doctor. With gratitude and excitement, to be sure, but I’m not facing the future with full embrace, but with tender reservations. My heart is at home, but I’ve given myself to a profession.

I read through my resident contract for the first time today, it’s still a little unreal to me, to be paid for what I do. Me?! I’m 27 years old, and I’ve never been paid for anything I do except part-time minimum wage jobs. Well, technically, it’s a stipend, as the contract calls it, but it’s more money than I’ve ever seen attached to my name. I’ll be the bread earner for our small family of two no less since hubby will be quitting his job and reverting to full-time student status next week. I worry, just a healthy amount, about our finances. We’ll make do, after all, we have no plans of buying new cars or planning another wedding in the near future like we did the last couple of years. This is just temporary, my being the sole money maker. I am glad that hubby is pursuing his dreams. We bought a study desk for him in the spare bedroom, which can now be legally called a study room and I see things coming together for him.

So, how can I be a sojourner to heaven in light of all this? Do I continue to be a distracted sojourner? Will my prayers be just fleeting thoughts while on the road to and from work? Will my Chrisitiany be just a label to my identity? Will God be that distant figure in my head?

To Philly and Back

I was literally in Philly for like 24 hours. I did have plenty of time at the airport before heading back to DFW. So I did the one thing people should do when they visit Philly, eat a famous Philly Cheesesteak Sandwich! Does one from an airport counter count? Maybe I’m just not that much of a chopped- beef- on- bun person or maybe it’s the airport location, but I was not impressed with the sandwich! After I got on the plane, I liked the mini pretzels with cranapple juice better for a meal.

Here are some things I’m grateful for the trip:

No flight delays on the way there
Did not get sick
Hotel was super comfortable and clean
Felt relatively rested

Then there’s the exam (COMLEX PE or CS). . . I hated it so much! I was nervous and felt like I left out very important questions and steps. I just pray and pray and plead that I passed!! However, after having hours to think and re-live the whole day at the airport and then on the plane home, I’ve resigned to the fact if I failed and need to retake it, then so be it. It’s out of my hands now so I’m not going to torture myself with “did I pass?”, “what if I failed?” for the next three months until I find out my score. Hubby had dutifully practiced with me and I went through a couple of review books, so I did what I can do.

Besides, I have a whole list of to-dos this month. . .

Dentist appointment
Buying wedding presents
Look for apartment
Find suitable luggage for Asia trip
Plan our 3-days stay in Japan
Start on a knitting project
Get in shape and pass the Army fitness test

. . .so you see, I have no time to worry over spilled milk. . .until when I find out I've actually spilled the milk.

Learning is Fun

I have been working on CS cases/scenarios all day. One of those cases was on domestic abuse, and I learned that as a physician I should never tell an abuse victim to leave her husband/lover. I would have failed that one because that’s exactly what I thought of doing! I should only offer support, let her know domestic abuse is illegal, and let her make her own decisions. Well, this is why I’m practicing with these cases so that next Monday I’ll know little details like that.

I have also been reviewing and learning a slew of medical mnemonics today.

To assess domestic abuse: SAFE

S = Safety. Do you feel safe at home or in your relationship?
A = Abused or Afraid. Are you being abused or are you afraid?
F = Family and Friends. Do your family and friends know your relationship problems?
E = Emergency plan. Do you have an emergency escape plan if needed?

To assess a drinking problem: CAGE

C = Have you tried to Cut down on your drinking?
A = Have you been Annoyed by people who criticize your drinking?
G = Do you fedl Guilty about your drinking?
E = Do you need an Eye-opener in the mornings to cure a hangover or steady your nerves?

To assess geriatric ADLS (activities of daily living): DEATH, an unfortunate acronym

D = Dressing. Can you dress yourself?
E = Eating. Can you eat by yourself?
A = Ambulating. Do you have trouble walking?
T = Toileting. Can you go and use the bathroom by yourself?
H = Hygiene. Can you take a shower or bath by yourself?

To assess geriatric IADLS (instrumental activities of daily living): SHAFT

S = Shopping. Can you go shopping by your self?...you get the idea
H = Housekeeping
A = Accounting
F = Food preparation
T = Transportation

And finally, my least favorite one.

To assess depression: SIG E CAPS

S = Sleep. Do you have trouble with your sleep?
I = Interest. Have you lost your interests in life?
G = Guilt. Do you feel guilty?
E = Energy level. Do you feel more tired than usual?
C = Concentration. Do you have difficulty concentrating.
A = Appetite. Has your apetite changed?
P = Psychomotor. Agitation or retardation of movements?
S = Suicide. Do you want to kill yourself? Previous attempts? Plans?

That’s all for now. Back to studying!

What's Next

I received a list of my intern class from the residency coordinator today. There are two classmates from my class, two girls, who also matched at Methodist! One is my good friend M! I knew she was going into internal medicine but because I haven’t talked to her for so long that I didn’t even know she was applying to Methodist. M was one of my closest friends from med school, but we didn’t have a single rotation together in the last two years and I guess we just lost touch. She threw me an awesome bridal shower in second year, and we often made the hour-long trip together to north Dallas where her parents lived and where I visited Paul on the weekends before we were married. She is sweet to a fault, and is serious about her studies. I can’t wait to get in touch with her again as we will be spending the next three years working together. The other girl, A, is an outstanding and outgoing student, being on the dean’s list and an officer in the internal medicine club. I have never spoken to her that I remember of, but I know she’ll be a great co-resident. A is someone that I can see becoming our chief resident in the third year. The rest of my intern class of nine comes from other UT medical schools, New York, Tulane, and South Carolina. There are six of us girls and three guys.

The news of the Match is still sinking in within me. I had every intention of matching into Baylor FM. Once shopping, I even bought a fleece jacket that would match the dark blue scrubs at Baylor! I believed that FP (family practice) was my future. I told everyone who asked that I was going into FP. Hubby and I even started looking for housing in the Garland area! All those talks with Dr.T, the PD (program director) at Baylor, and all that time getting to know the residents, and I came so close to signing a pre-match contract with them! I would be at Baylor now if it weren’t for the fact that they decided not to extend a pre-match offer to me but told me that I’d have a place with them for sure if I go through the match. In a way, I was relieved because in all honesty, I didn’t feel 100% at peace with pre-matching there although I knew I would be happy there once I matched. Does that make sense? So I ranked Baylor second and trusted that I would go there believing that I have only a small chance of getting into my first and more competitive choice, IM at Methodist.

I have been conflicted for a long time about FP vs. IM. I always believed my personality and desired lifestyle fitted with that of a FP doc working 8-5 in an outpatient clinic. (Except I imagined myself working part-time.) And then there’s the life of a hospitalist. In simple terms, I fell in love with the hospital. I love the fact that I get to take care of sicker patients in the hospital setting. I love the role of coordinating care across the spectrum of specialists. I love that during their short stay in the hospital, I help patients get back to their baseline so they can get back to their lives. There are many differences between working in a hospital vs. clinic: continuity of care, patient compliance, levels of sickness, work hours, etc. My ambivalence was not helped by the conflicting advices I received from different doctors. “IM is the way to go.” “You can’t work part-time in IM.” “FP is the most family-friendly specialty.” “FPs are not respected.” “IM docs are just gloried interns/slaves.” “Future of FP is in the hands of mid-level practitioners.” I knew I could never sort out all the pros and cons myself because I don’t know the future and I have my limitations in decision-making as a human being. I’d like to believe that going into IM and matching at Methodist is God’s plan for me. So perhaps not pre-matching with Baylor was meant to be. But I don’t know for sure because who really knows how God works? But I just trust in Him that I am where I’m suppose to be.

So here I am, an internal medicine doctor to-be. I am still trying on this new identity for fit. Like a new pair of shoes, it’s a little awkward at first, but I expect to grow into it. In a short few months, I’ll have a new title (Dr.) before my name and a degree (D.O.) behind it, all embroidered on a long white coat. No longer will I introduce myself as “Linda, the medical student,” but I’ll say “Hi, I’m Dr. C, one of the interns here, and I’ll be taking care of you.” I’ll be writing orders in the charts, signing prescriptions, have nurses page me with questions. Am I ready for all that? The answer is a resounding “No!!” The responsibility to me right now is staggering. But like I said, I will grow into it.

The day I found out I matched, I was baking a cake and looking at blogs on fashion trends! BTW, Yellow cake mix + mashed bananas + milled flaxseed = yummy-ness. Also, wide-leg pants and jumpers are forecasted to be making a comeback. I have been way too indulgent with my time: my countless trips to the mall, obsessions with my clothes, blogging too often etc. While part of me says, “guilty, guilty, guilty,” another part of me justifies it with “if there is ever such a time to indulge in such things, this is the time.” To further exonerate myself, I have been productive by being in charge of cooking, cleaning, grocery shopping, etc. In just a short few months, however, everything will change. I have thoroughly enjoyed my time as a home-maker/free person, not to mention hubby has benefited and appreciated my investment. I can even say I wish I could be like this forever, until I have children, of course. In a second life, I would have been perfectly happy to be a full-time, life-time housewife and mother. But I know it’s not to be for me. I have to get back to my first dream. The hospital, not home, will be my world. My daily concerns will not be what to cook for dinner but what treatment is best for a patient. No more indulgences or frivolousness!! My life is about to take on a more serious note. The bottom line is that I want to be a good doctor and the next three years of my life will be largely devoted to that goal. I pray that God will use me in the future and that he’ll give me the wisdom and strength to prepare me for such a purpose.