As part of my Psychiatry rotation, I'm required to attend a 12-step meeting - either AA or NA. Here's my write-up for that experience:

Jenny Phung, Psychiatry Rotation #3 2012

Since I live in Davis, I chose an AA meeting in Davis. I had preconceived notions about what an AA meeting in Davis would be like. I thought it would be poorly attended. Davis is a small town of high-achieving individuals - the anonymity part would possibly be compromised because it’s a small town, and I assumed that highly educated people with high incomes have less reason to abuse alcohol. It turned out that 20 people came, and I’m very glad because it was a much richer experience than the experience I was expecting.

There were some Davis stereotypes that were met. Many of the members rode their bikes to the meeting, and all of the attendants were Caucasian except for two others and myself.  I think this latter observation might not be specific to Davis. As an Asian American, I can attest to the fact that our culture does not promote emotional expression, while Western culture does. I was very surprised to see another Asian person at the meeting. She was a senior citizen, and her English had no accent. So it makes sense that she was likely born in America or has lived here most her life, and identifies more with her American identity when it comes to sharing her struggles with others.

One of the major themes I picked up on was the necessity of insight. All of the people in the room had insight into their lives. One has to have insight to even be at an AA meeting. I don’t know what the statistics are, but I imagine that the majority of people who voluntarily go to an AA meeting are successful in the long term. Having enough insight to go to an AA meeting, to seek support in the battle against alcohol, it just sounds so counterintuitive to continue to make the same mistakes that you’ve already admitted were mistakes.

These are some of the most memorable statements from the meeting: “I wanted to die.” “I drank as long as I was awake.” “It was like, ‘feel, drink, feel, drink, feel drink.’ I drank so I didn’t have to feel.” “My last drink was 4 days ago and I’m glad to be back at AA.” “I used to tell myself that if anyone was beaten as a kid, or have been to jail, they’d be like me too.” “My daughter’s in college and I don’t even know her.” “How much of my life did I experience? How much of my life didn’t I experience?”

One of the topics that came up from the reading at the beginning of the meeting was “automatic thought” or “first thought,” which of course is drinking. That phrase reminded me of cognitive behavioral therapy – addressing what that thought is and analyzing its reasonability. AA meetings are a lot like CBT, but without the rigid structure. It’s self-CBT. Hearing other people’s stories reminds people of how unreasonable it is to drink alcohol as the answer to all problems. But no one is telling you it’s unreasonable. People are just sharing their own experiences, and it’s up to the listener to interpret how that person’s experience can be applied to himself or herself.  

I shared my name at the beginning of the meeting, but not that I was a medical student. I was never called on to share; in fact, I was the only one to not share. At the end of the meeting, a lady approached me and gave me her number to call anytime. I was so touched by her kindness, but even then, I didn’t tell her I was a medical student. I felt very out of place at the meeting. I was very respectful about the whole experience, but I felt like I was intruding. Everyone in the room has a struggle they share in common, and I do not share that with them. I have definitely grown from hearing their stories, but I worried that they were not stories for me to hear.

I love hospice. I love its mission and the purpose it serves. Humans have been dying since the beginning of time, and we still can’t figure out how to deal with death. That’s where hospice comes in.

I had the most humbling experience with a patient who was newly assigned to hospice. He’s a 46 year-old Chinese man from Vietnam. I always feel a deep connection to Chinese from Vietnam; I almost feel like they’re my relatives. He was diagnosed with ALS (amyotrophic lateral sclerosis), or Lou Gerhig’s disease, 3 years ago. He has lost all function in his upper extremities. He can’t walk or talk. He can still eat soft food, but has trouble with swallowing and drooling. It’s a really sad disease when I think about it. But when I was in his home, I didn’t feel that sad. I actually felt very peaceful and inspired.

He is such a sweet man who smiled so frequently throughout our meeting. He was so polite and hospitable – wanting to turn off the TV during our meeting and saying goodbye to us at the door. I don’t know if he feels sorry for himself, but he sure doesn’t act like it. He acts like he’s making the most of the abilities he still has.

He has a very supportive family and a superwoman wife. She has an attitude of taking care of business while still being sensitive. And on top of all this, they have three children ages 10, 17, and 19. Their 19 year-old daughter plans on attending night school so she can take care of her dad during the day while her mom works full-time. It’s an unfathomably difficult situation.

I left their home so impressed by their strength.

We’re all going to die. Everyone we love is going to die. So why not make the experience as pleasant as possible?

The following is a reflection on my home visit in my Family Medicine rotation:

I gained a lot from my home visit experience because I chose the right patient. I chose a patient that I can relate to and, at the same time, learn from. She is a 62-year-old Filipina woman who was diagnosed with metastatic lung cancer last November. She came to her office visit with her husband and her sister, and I knew this was a patient I wanted to know more about. I'm Chinese, but I dated a Filipino man for over 6 years and one of my best friends is Filipina, so that influenced my decision in choosing her. I expected that I would feel comfortable in her home since I've spent so much time in the homes of Filipino families. I admit that I stereotyped her based on my life experience - I assumed she would be happy to open her home to me. And with that assumption, it was easy to ask if I could do a home visit with her. All three of them said yes, like they were a collective.

She is a former dialysis social worker with a BA and masters from Sacramento State. I was really impressed with her level of education since she was an immigrant. Her former occupation gave her a lot of insight with her current struggle, but it's still so different when you are the patient. Her husband also retired when she was diagnosed, which is financially straining. With her work experience, she knew they wouldn't qualify for IHS income because they don't qualify for Medi-Cal.

She is not able to walk because the cancer metastasized to her spinal cord. Her lower extremities were atrophic, but they still had sensation. I was happy to give her a foot rub. She sleeps on a hospital bed in the living room and her husband sleeps on a twin bed beside her. She doesn't sleep well and gets anxious, which means her husband doesn't sleep well either. Fortunately, she has a great family support system, and she has siblings who relieve her husband so he can rest. Her siblings also cook for them.

She is Catholic and uses prayer to help cope. She takes it "one day at a time." I'm not a particularly religious person, but I really respect the fact that religion helps people be appreciative of their blessings despite their tribulations. It helps people find peace.

At 24 years old, I'm not familiar with death and dying. But every year I'm in medical school, I learn to accept it as a part of life a little more. This patient is going through something very awful, but she is lucky that she is not alone. As she approaches the end of her life, she is surrounded by people who love and care for her. Not everyone has that.

Dear Dad,

While I'm on my way to being the best me I can be, I now truly understand that you're on your way to being the worst you you can be. You've been on your way...for as long as I've been alive, and I think for as long as you've been alive. I'm no longer a kid, but you somehow manage to bring me back to angry outbursts filled with disrespect and cursing. I pity you, but at the same time, I'm extremely annoyed by you. I pity you for being who you are, and I'm annoyed by who you are. I don't consider you a man. I cannot think of any other example besides the one I'm about to give that would make you a man.

You are kind to me. You love me. You are patient with me. And I am blessed. In this way, you are a man who loves his daughters.

But in every other way, you are not. You are a child...desperate for attention. You want to be heard, but you have no worthwhile thing to say and no credibility behind your words.

You are a child...needing to be taken care of. You think you deserve a life of luxury, but you don't think you need to earn it yourself. You take advantage of family, because you can and because we let you. You should be homeless. You didn't pay for the roof over your head or the food you put in your mouth. You don't contribute to your life.

You are a child...hurting people to make you feel better. You like to hurt with your words because that's the only way you can feel powerful. Mom is such a sensitive soul and you know it...you manipulate it.

I know you're my dad and I know you love me. And that is all I need between us.

There will not be peace between us until you leave mom in peace. The way you hurt her is almost evil. It makes me hate you. It disgusts me. You disgust me.

And I'll never say these words to you in the depth I have written them here. Language barrier affects my relationship with my family so dramatically. But I had to write it down. Because one day, I will have to make the decision whether or not to take care of you. I probably will, but it won't be with open arms. It will be with resentment and obligation.

Your Daughter

SIT

What surprised me recently? Receiving a big, fat check from a good friend in Las Vegas. Anyone who is this supportive of my marriage will be a life-long friend. But I was especially surprised because we're not especially close. We are friends who keep in touch (thanks facebook), and who see each other occasionally. But we're not best friends. Doesn't matter...I deeply sincerely cherish her gift and will now look at our friendship in a whole new light.

What inspired me recently? Watching "Weight of the Nation" on HBO about how fat America is. I was inspired to respect my body and my health and my youth. I'm also inspired to teach my future children to respect food and to not succumb to mass media brainwashing to eat sugar and fat.

What touched me recently? I met a 29-year-old woman who gave birth to a very sick baby. The baby died after 1 week. She was with her husband and her father when I met her, and they were a great support system. I saw pictures of the baby boy, and they were very proud to show him off like they would have been if he hadn't passed away. He was very, very cute.

People say life is short. But really...life is kind of long. I am 24 years old. And if all goes well, I will live all the years I've lived at least 2 more times. I will get a lot done. I will impact a lot of people. I will grow a lot.

At 24 years old, I look at older people in my life and see their flaws and strengths. If I learn from their flaws and incorporate their strengths, I expect to be perfect by the time I reach their age. hehehe...I wish I could say j/k, but I'm only half-joking. I know I can't be perfect. But I also think that I'm paying enough attention to becoming the best me I can be, that I might just become the perfect me.

Flaws I've observed:
- voicing your opinion when no one wants to hear it
- smoking cigarettes
- demanding the spotlight (without even knowing that you're an attention whore)
- being in a pissy mood majority of the time
- expecting others to live life the way you would

Strengths I've observed:
- being loving
- being joyful
- letting others be
- not gossiping
- being generous
- saving money
- being mindful
- being strong

Good thing the strengths list is longer than the flaws list. Or else I'd consider myself cynical.

For me, one of the most important strengths I'm still working on is letting others be. I'm getting a little better. When someone (or a group of people) makes choices that upset/annoy/frustrate/anger me...but it doesn't affect my life...I'll just remind myself, "let it be."

This will come in very handy, not just in my personal life, but in my career. I'll be on my Labor & Delivery rotation next month and I will likely meet "mothers" who didn't get prenatal care or who used drugs during their pregnancy, and I won't dwell. I can't turn back time. It was their choice to make. Whatever happens, happens.

Reminds me of a post I saw on facebook once:
- Do you have a problem? Yes.
- Can you fix the problem?
     - Yes ---> then don't worry about it
     - No ----> then don't worry about it

Que sera, sera.

Whew.

When it rains, it pours.

That's a good phrase. In the span of one month (actually less):

  1. I took my Step 1 medical licensing exam (and did above the national average, just FYI).
  2. David's maternal grandma passed away from an aortic dissection. It was very sudden and unexpected. It was the day before our wedding.
  3. I got married to the one. The perfect man for me. The person who makes life easier.
  4. I went on my honeymoon to Yosemite.
  5. I began my third year of medical school.
  6. I scrubbed in on an operation for the first time, which was the most difficult of that surgeon's career.
  7. And David's paternal grandma passed away last night. 3 weeks after the other grandma. I said to David for the first time, "She was like a grandma to me." She really was.

In 6 days, I'll be attending my 4th funeral since starting medical school, my 5th ever. And somehow, I'm fine. I'm sad, but good. Life is still good, but different without those people in my life. Life's continuously changing, and change scares me a little. But I need to remind myself how adaptable I am...especially with David in my life. "Home is wherever you are," we say to each other.

As for that operation I scrubbed in for, the patient lost 6.5L of blood. Think three 2L soda bottles. She's a very sweet lady with a bunch of medical problems. And I got a text today on my way home that says she had to return to the operating room for bowel perforation. She'll be fine, but she was ready to get out of the hospital (her first operation was 6 days ago). And I feel guilty. It's illogical guilt. I'm just a medical student who doesn't make the decisions or the incisions. But I feel like I represent something much bigger than myself. I represent the team who is taking care of her, the UC Davis Medical Center, the health system in general. I'm really more scared than anything. I'm scared of facing her after what she's went through, because I represent the ones responsible for the things she went through.

I know I'm sounding very self-centered considering she's been through 2 operations. But this is my blog, and I have to be honest. I care too much about what others think of me. Hopefully, with enough training in this very un-glamorous profession, I'll care less and less.

I will end every blog with this, and I encourage you to end all your days with this:

S.I.T.

What Surprised me today? Getting a letter from Cordell in the mail that read in beautiful calligraphy "Mrs. Jenny Phung-Payne." I was also surprised to receive a text about my patient going back in for an operation. I knew she had an infection and her recovery was slow, but I just don't expect/want to believe that something really bad could happen.

What Inspired me today? I was inspired to write this blog entry today when I was very aware of my solemness over my patient and Grandma Betty.

What Touched me today? When David told me it meant a lot to him that I said she was like a grandma to me. And when David told me his half-brother told him "I love you," for the first time since he can remember. 

I'm on such a natural high right now. I feel soooooooo goooooood. It's like pure happiness is bursting out of me through my smile. It's better than I even imagined.

I don't know what my Step 1 score is yet. But I feel I did well. My confidence in my performance reflects the amount of effort I put into studying.

I didn't feel this good walking out of the MCAT. There are several reasons for that.

1. I know this material better than I knew the MCAT material.
2. I'm already in medical school and my future's a lot more secure.
3. I have been told that I just finished the hardest, most important exam for the rest of my career.

I feel so emotionally light right now. Like...any negative emotion or situation or thought does not matter. They do not compare to these feelings of relief and euphoria. I'm ecstatic.

I wondered, if I feel this good now, how will I feel after I get married? Though it may sound bad, I don't think I will feel this way after the wedding. Step 1 was an Everest. It was a serious responsibility that comes with the privilege of becoming a doctor. It was a measure of my capabilities. It was something to dread. As David said, I conquered my Everest. And thus, I feel on top of the world (pun intended).

Getting married will be totally different. I don't dread it. And it's not an endpoint. My Everest in this situation would be to stay married for the rest of our lives. Maybe when one of us dies, then I can be euphoric about our accomplishment. That should help with the grieving process.

I don't know how I'll exactly feel after getting married. But I know I'll be in disbelief for awhile. I will have a different identity. I'm ready for it. I just don't know what "it" is.

Man, I haven't updated this blog for awhile, whoever is reading this. I haven't had the complete motivation to update even though so much has happened. Maybe I was too exhausted. Well, let's just say I had some herbal inspiration tonight. And if you're a cop reading this, I hope I'm being vague enough so that a judge will believe that I mean tea.

I'm pretty right smack in the middle of my boards studying period. My big, big test is 3 weeks from yesterday. Big, big sigh. I'm just being a head case right now because I don't think it's the test itself that I'm freaked out about, I think it's just how everyone talks about the test in such a freaked out tone. When I recognize I'm freaking out a little bit, it's when I'm comparing myself to my classmates. Partially comparing what they might score and I might score, but also comparing our attitudes about this big, big test.

On a day to day basis during this study period, I have let myself be somewhat lazy most days. I am supposed to be waking up around 8:30 with books open by 9:00. Most days haven't been like that. I am supposed to be studying 1-2 hours after dinner...I study during commercial breaks. Even tonight when there wasn't anything I wanted to watch because Modern Family was a rerun, I let myself talk to one of my best friends Randy for over an hour. Now I love him and it's always worth it to catch up with your friends, but there were many silences in the conversation that should have prompted me to study. But I am pretty studious during the day, and I'm seriously learning this material. But maybe not seriously enough? I've heard of classmates with 12-hour study days. And I bet the real big gunners probably review material before bed. Big, big sigh.

Okay, I'm just going to spin this on it's head. For the ones who are studying 12 hours a day, they are human. That is seriously too mentally demanding and they will more than likely burn out. Oooh, maybe I'm being vindictive. Ughh. Maybe I just need a conversation with myself.

Okay Jenny. Do you feel like you know the material well enough? No. Do you think you will master the material by the time of the test with the same amount of motivation you've been having? Possibly not.

Possibly not. Okay, how important is it to you do your absolute best on this big, big test with all the motivation you have within you? Important.

Alright, Jenny Phung. You are going to have your books open by 9am and you are going to review before bed.

It always helps when I write it down.

Progress! I had a very productive conversation with my mom a couple nights ago.

So I called her to tell her that David got me a ring. I wanted her to know that we're very serious about getting married. (I actually chose the ring and ordered it off a website, because I can't trust someone else to make that decision for me.)

Then she immediately asked, "You got it then?" And she wasn't talking about the ring. She was talking about the pre-nup.

Then she went on to repeat herself about how you never know what the future holds. "You're only 22..." We were talking over each other by this time, so I firmly said:

"Mom, can I say something?"

"Tell mommy what you have to say."

"I'm 24. And I have spent every day with David (practically) for the past 3 years, I know him and he knows me very well." (I didn't know how to say "each other" in Cantonese)

Then I told her that in California, you must be married for 10 years before you have to split everything in half. So if I'm not happy at 9 years, I can get out.

She was content that I did my research to protect myself, "oh, so you looked into it, that's good."

"Mom, I know you're worried about me. I understand that."

Silence. I was choked up, and the silence on the other end of the line meant she was choked up too.

I told her David and I wanted to visit her at the end of February. And this time, timing didn't work in my favor. My maternal grandmother from Canada will be visiting and staying only until mid-February.

When I told David about the unfortunate timing, I realized something for the first time: I only have 1 grandparent left. I never thought of it that way before. Both my grandfathers died before I was born, so when my paternal grandmother passed in 2010, I thought of it as a single loss. I didn't think of it in terms of having only one person from that generation left in my life. Sigh.

Anywho, I think my mom's pretty content with the divorce laws I told her about, but I'm not 100% sure. We'll find out at the end of February.

I have quite the dream to write about. And it'll be a perfect segue into my next important topic: how my mom feels about David and I getting married.

Just like they say in Inception, this dream starts in the middle...

I wake up in Emerson's bed. (yes, my on-again-off-again ex-boyfriend of 6.5 years) We kiss softly for several long seconds. No tongue, just lips gently pressed. Then he puts his lips on the curve between where my neck and shoulder meet and he blows. Like how you would blow on a child's belly to tickle them, I don't know if there's a verb for that. And it feels good. Dangerously good. Next thing I know he's whipped out his penis and is looking for a condom. As he struggles to tear open the Trojan ultra-ribbed condom in the gold package, I say, "I don't know if I want to do this." He tries to change my mind with words and caresses, and I thought about giving in. I thought, "this will make him happy. I owe him this. David doesn't have to know." Then Emerson starts to put on the condom and I snap out of it. I think, "I'm not that person anymore. I don't have to do this. I have to live with myself." So I tell Emerson "no." He gets angry and storms out of the bedroom. I get dressed (couldn't tell you when I got undressed) and it's a struggle to get my pants on. I'm not coordinated in my dreams. As I'm struggling to clothe myself, I hear my mom's voice on the other side of the door. She's giving food to Emerson's mom and telling her how to prepare it. I think, "shit! If she sees me here with my pants off, then she's really not going to like David and me getting married."

And scene.

I was anticipating telling my mom about David and me getting married for weeks. I knew I would see her in December, and decided that's when I would tell her. I was very nervous. She's always been critical of David. Literally almost every time she mentions David, it's about him going to school. Rather, it's about me pushing him to go to school. I had very good reason to be nervous. The worst-case scenario I imagined was her response being, "Not until he goes to school." The worst-case scenario didn't happen. And if I look at it that way, it makes the actual scenario a little easier to bare.

I told her, "I've been thinking..."

"Tell mommy what you've been thinking."

"I've been thinking that I want to marry David this year."

And I gave her the reason that I thought she would understand or agree with the most: he needs health insurance. We can't afford to pay for his work's health insurance.

Her immediate response was: pre-nup. She explained herself: you never know what will happen in the future. It'd be great if you love each other forever, but you really don't know that.

I know where she's coming from. She's the female breadwinner who was married to a cheating, voluntarily unemployed bum. She only owns half the house that she pays for in full. I know, mom, I know you're trying to protect me from repeating your mistakes.

But she doesn't know where I'm coming from. And it's not her fault. She's only met David a handful of times and hasn't spent any significant amount of time with us together. She doesn't know us. She doesn't know that we're the best couple in the world and that literally everyone we know isn't surprised by our wedding announcement. Even my uncle Bak Fu knows us better than my mom does.

So the plan of attack now is for David and me to visit Vegas. Show her what we're all about. 2 days isn't very long, but it'll have to do. Because after the visit or at the end of it, I'm going to tell her we are not getting a pre-nup.

I started the new year off on a good foot in terms of courage and conviction. Though the story I'm about to tell you happened before midnight last night, it was already 1/1/12 somewhere.

David and I spent New Year's Eve with just the 2 of us. Enjoying each other's company as we approached the double whammy that is New Year's day and our 3rd anniversary. During dinner, for some reason, I brought up a story of when we went to Disney World and David saw a man purposely litter. This guy was pushing a child in a stroller with his wife (presumably), and deliberately tossed a plastic cup onto the ground as he continues walking. I brought this up because I said to David that we should speak up the next time we see assholes like that doing something inconsiderate and irresponsible. By not saying anything, assholes will continue inconveniencing others with their ignorance and laziness without ever having to think that they're ignorant and lazy. Just speak up and put that thought in their head - "hey, you did something that makes you look like a small person."

Literally minutes before midnight, I see a white guy with glasses exit his car, drop 2 plastic cups on the curb, and goes on his merry way. I said to him "hey, you dropped your cup." His response was, "yeah I did," and continues to walk away. So he did it on purpose. So he doesn't care about littering or the environment or keeping the world we live in a nice place. But he knows littering is against our society's moral code, or at least against what we teach our children at school. And he might never care, but at least I reminded him that his action was one of a small person.

Less than 15 seconds after he walks away, someone walking behind him picks up his cups for him. I wonder how he felt to return to his car with his trash having been picked up. I wonder if he thought, "ha, I got someone else to pick up my trash for me," or, "I'm an adult and I'm embarrassed that someone cleaned up after me." Either way, I'm proud of myself. I loathe confrontation, but that needs to change if I am to be a doctor. Maybe I accidentally made a new year's resolution?

I mention that he's a white guy with glasses because assumptions and stereotypes are so powerful. When I first saw him, I assumed he was nerdy, and therefore educated. By assuming he was educated, I expected that he would be relatively mature and responsible. I don't know what his nerdiness or education level are, but he surely didn't act mature and responsibly. Anywho, I immediately correlated the assumption I made of him with the stereotype that Asians aren't the ones who are followed around in a store for fear of shoplifting. I must admit I used this stereotype to my advantage in my heyday. And this guy probably uses his appearance to his advantage too.