Last day of Lent. I should read through all my posts from Lent. The point of this was to encourage myself to journal more often. I hope it worked. We'll see.

Connie is currently executing the plan of forcing my dad to quit cold turkey. She stayed up until 2am last night and even then checked on him throughout the night. My dad is very anxious about it all. He was not expecting to give up this crutch he's used for half his life so suddenly. He would have preferred the option of cutting down slowly, but that's not really an option in alcoholics. At least not for him, he does not have the self-control to limit himself at all really.

I received the most touching text messages from her earlier today:

"I can tell he was fighting his demons last night cuz at first he was getting annoyed and started saying random shit. Around 2, I was like dad 'it's been 24 hours, see you can do it, let us help you reach 48.' He looked at me and said in the calmest manner 'you know I'm going to get mad but when I do don't be mad at daddy.' I said 'I know dad, you're going to hate me tomorrow but I still love you.:

This makes me cry. It wraps my dad up in a nutshell. My dad is deeply flawed. He is one of the least introspective people I know. But I've always known that he loves us. And though that's all that he's been able to give us, I don't take it for granted.

Mr. V is a 60 year-old man with a history of diabetes who presented with a 1-week history of RUQ pain associated with fevers found to have a liver abscess containing Streptococcus anginosis. And he was a wonderful patient. The ideal patient really. 

Poor Mr. V was in the hospital for a total of 21 days, way too long for a liver abscess. But the damn thing wasn't draining as expected and interventional radiology takes several days to take action. Then when the drain is finally pulled, that is when the attending and resident decide to get a CT of his head to look for dental sources for his infection. He was very eager to go home. 

It was a great experience practicing my broken Spanish on him. Forming sentences came back very easily to me, but everything was in present tense. I studied Spanish for a total of 5 school years, and have rarely had to use it. I taught a 3rd grader who just immigrated from Mexico how to read in English when I was an undergrad at UNLV, I took vitals on Spanish-speaking patients at Share Ourselves free clinic, and I took care of Mr. V for nearly 3 weeks. For living only in California and Las Vegas my whole life, that's not very much Spanish usage. 

Today I said goodbye to Mr. V. After the interpreter and resident left the room, I shook his hand and emphatically said to him, "mucho gusto, senor, mucho gusto." I couldn't help it - I had to hug him. And when I did, he teared up, "thank you, thank you so much." Oh you're very, very welcome Mr. V. It has been a pleasure. 

He was the nicest patient. I followed him for almost the whole 21 days. He saw me practically every morning and I was able to communicate to him his medical plan pretty well in Spanish. Seeing him tear up was the cherry on top. It confirmed that he felt the same connection with me that I did with him. That we were both worn down from his 21 days in the hospital, that I genuinely cared about him and treated him with kindness. 

He teared up because of our relationship during his 21-day hospital stay. But he also teared up because he was finally getting out of the hospital. The best Spanish words I could think of to end things with were "el fin."

A lot of Buddhist references recently. 

Last night, I explained to David the philosophy of Buddhism. Can't remember how it came up exactly but I know it had something to do with my dad. I was explaining how one becomes a buddha, an "enlightened one." One has to relieve oneself of all desire. When you relieve yourself of desire, then you relieve yourself from suffering. Desire leads to suffering. From what I've observed in my 25 years of life, human nature is incompatible with Buddhism. One has to very active and conscious to just let things go. It is not human nature to just let things go. And that is why very, very few people achieve enlightenment. 

Buddhism teaches that all things are temporary. There is no truer statement. Everything, everything is temporary. So why suffer when we lose things, people, health? When it is all temporary. 

Way easier said than done. 

Buddhist monks are the closest humans can get to enlightenment. They live their lives without material wants. They eat whatever is given to them through charity. Food is sustenance, not desire. 

What I love about Buddhism is that it recognizes that most of mankind cannot live up to this. So there is The Middle Path. The middle between poverty and luxury. I love The Middle Path. It is a huge part of who I am, it is a huge part of my value system. I want a clean, smooth-running, reliable car - not a luxury car. I want a comfortable, brightly lit, warm home - not a mansion. I want a well-made, quality purse - not a closet full of purses. 

Explaining this to David rekindled my passion for Buddhism. We need to explore it more together because I desperately want Buddhism in our lives and our future children's lives. 

Then today on facebook, 2 posts that were Buddhism-related. 

First was by Connie, "Remember that the best relationship is one in which your love for each other exceeds your need for each other.” 
― Dalai Lama XIV

Never heard that quote before, but related to the idea of not desiring. David and I confess a need for each other as well as our love for each other. I have thought about the negative repercussions of this. Not to be morbid, but I do sometimes think about how I would cope if he were to die young. And I admit I don't think I will cope well. Precisely for the reason Dalai Lama is mentioning here. I don't think my need for him exceeds my love for him, but it is a very strong need. We are a very co-dependent couple. 

Second was by Marie, the mother of my former student with autism, who is now a very dear friend: "Be happy for no reason, like a child. If you are happy for a reason, you're in trouble, because that reason can be taken from you." - Deepak Chopra. What poetry. I have never heard a quote with a message like this. I'm on The Middle Path with this quote. I really am the kind of person who smiles when they walk just because the full moon looked pretty in that early morning sky when the sun is almost starting to rise, just because that dog is so cute, just because I look forward to seeing my husband. I believe this trait is genetic as well as learned, my mom and most of my mom's side of the family are just cheerful fucking people. They just love to laugh. While my dad's side is much more serious and solemn. On the other hand, I can pinpoint many reasons for me to be happy: I married the right man, I'm going to be a doctor, I'm going to be financially comfortable, I'm healthy. Would I be as happy as I am now if I were missing any or all of those things? I don't believe so. I would be less happy. But, will I still be happy? Probably. I was happy before I met David and got accepted to medical school. But not as much as now. I've always been healthy, I don't know what it's like to not be healthy, thus I don't know what I'll be like if that were ever taken away from me. 

Connie had been more distant from my dad than me in the past few years. As in she talked to him 3-4x/year and I talked to him 5-6x/year. As in I live in Davis and don't see him, but they both lived in southern California and didn't see each other.

Now she's the one who has him living in her home disrupting her life. She even texted me today about how she's thinking of letting my dad drive her car while she's at work so he can do feng shui and keep busy (my dad's car-less at the moment). Now she's planning on forcing him into alcohol withdrawal this week.

Not only is it medically scary and she's responsible for taking him to the ED when it's time, he's going to throw a fucking grown-up fit when he finds out that we're cutting him off cold turkey. He is nowhere near ready to face his alcoholism head on. He said he wanted to cut back and we wanted to believe him. But he's lied too many times already in his short week with Connie, and tonight Connie found like a dozen cans of beer hidden in different parts of her apartment. He doesn't even recognize himself as an alcoholic.

He said he wanted to cut back and that his health will suffer because of alcohol...but he never thought of himself as an alcoholic? He asked me tonight if he's an alcoholic. I told him, "yes, you've been alcoholic for 10+ years."

He said what we wanted to hear. He's good at that. That's why the fuck my mom is still putting up with his shit 37 years later.

An ED visit and hospitalization is our last hope to slap him in the face to wake up. If this does not wake him up...then I'm worried we'll have to let him live alone. No one wants to or should put up with his ass. He is not worthy of the company of anyone in his family. I meant what I said last night: I want him to be the grandfather to my children if he's sober.

Boy, a lot has happened in 24 hours.

Last night around midnight, I got a very long text message from my sister telling me that my dad went berserk when he found out we're thinking of selling our house in Vegas. He said things to the effect of "I'm going to kill myself and anyone who comes to look at the house." Saying that our mom set him up by having him come down to Orange County. I was asleep when I got that text; I stayed up for 2.5 hours after reading it. My mind kept going. Then the most upsetting thought that my imagination never allowed me to realize finally came to fruition - the image/dream I have for my future does not include him. My subconscious does not include him when I imagine my future. So what upset me the most in that 2.5 hours was the thought that my peaceful, comfortable, full future that I've become very attached to will have to include my mentally ill, alcoholic dad. I don't imagine it being as peaceful or comfortable any longer.

Then Connie texts me in the morning saying he apologized and they agreed that he'll only drink 3 beers today.

Then Connie texts me again this evening saying "I'm defeated." He ended up drinking 8 beers.

I call her to talk to her. She ends up putting him on the phone too. It was spontaneous and unexpected, and part of me thought "oh shit." But I was ready, I knew what I would say. See, I have not talked to my dad about his drinking since I last saw him in June 2012 when I left our Vegas home in a rage because he was being a lunatic drunk. But tonight I was put on the spot and I was prepared. I said to him that I'm working in the hospital now and I see lots of alcoholics. They can't remember anything and they have no family in their lives, and they are very sick. "You need to stop drinking."

"Do you understand?"

"Yes."

"I am almost a doctor. Do you believe me that you need to stop drinking?"

"I believe you."

Sigh. And then...he opened up to me in a broken, choked up voice about his suicidal ideation and his depression. "I have a mental illness. I want to commit suicide, I'm very unhappy. I don't want to live anymore."

"Why are you so unhappy?"

"You and Connie are so independent now."

That was weird. First of all, he should be proud and happy that we're independent. Second of all, he really is in denial about how he fucking failed as a care provider. He cooked for us and cared for us. I'll give him that. But he is not the reason we had a roof over our heads and clothes on our backs.

In the best Cantonese I could muster: "Dad, I know you are a good person. I know you love us. I want you to be the grandfather to my children because I know you are a good person. But you must stop drinking."

That is all the truth I can offer him. And I think that is all the help I can offer him too. In those few sentences, I gave him more love, more recognition, more of a reason to live and be a worthwhile person than I have ever given to him.

Getting the sense that my dad needs extreme measures to stop his extreme drinking, I suggested to Connie to let him go into alcohol withdrawal with requirement for medical care. Alcohol withdrawal is serious and possibly fatal. Yet I am so okay with it. Maybe I don't fully appreciate how dangerous it is because all I get to see are the ones who make it to the hospital, get treated with Valium and do fine. Desperate times call for desperate measures. And there is no better word than "desperate" to describe my dad, and even my mom too.

That blog yesterday really did help my willpower. I had no problem with avoiding the cookies in the workroom table this morning. I looked at it several times, but never contemplated it.

Anyway, my blog today is about my mom. My strong, hard-working, wise woman of a mom. I can almost think no more highly of her than I already do. Almost. Her weakness is my dad. "Weakness" is the perfect word - it works as the opposite of her strength and as the thing she allows herself to succumb to. She does not have the heart to kick him to the curb. She literally does not want to be "black-hearted," which means evil in Cantonese. She has never been able to separate herself from him completely. They've known each other since 10-11 years old, he's part of her identity.

My mom was very wary about my marrying David. She did not want me to follow in her footsteps by marrying someone I would have to take care of financially. There's a huge difference between David and my dad though. David has always put me and us #1. My dad has been putting himself before my mom since 10-11 years old. I might be the breadwinner, but David is worthy of my income and I am worthy of his love and kindness.

My mom recently began sharing with me deeper and more thorough thoughts and emotions than she ever has before. It's all related to my dad and his downward spiral into severe mental illness. She's not hiding her tears from me. She's asking for my opinion about what she plans to do with my dad. She's freely expressing how much she dreads the idea of him returning and how it's weighing on her heart. But, she also told me today how happy she was. My Aunt Vicky and Uncle Steven are visiting and invited her to go with them to the Grand Canyon. My mom spontaneously took a sick day today and went with them. But, he comes back in 2 days. Sigh.

She needs to get away from him. NEEDS to. I wish I could get her out sooner. I'll have my MD in a little over a year, I just keep on hoping she can see the light at the end of the tunnel. This fucking dark tunnel.

So all that she shared with me is beyond anything I've ever experienced with her before. She has always protected me from the truth about herself. I knew this, understood why, and accepted it. I am the youngest crybaby daughter in medical school. Connie is her rock. I am her secretary (inside joke - I pay all her bills online). Connie is the one who is burdened by my mom's suffering. I am the one who can pretend to be blissfully ignorant. I had come to the conclusion that all my mom wanted from me was that I think about her and want to hear her voice several times a week. I was happy to oblige this very easy duty.

But after the past few phone calls, I must now face our changing, maturing relationship. I can't be a crybaby forever. I knew I had to be my mom's rock one day, but I thought it was going to be when she was old and sick...not now with my dad's alcoholism.

I've had an off week with my nutrition and exercise. It's been 7 days since I ran. I did a 1-hour P90X core synergistics video yesterday and played tennis for 30-45 minutes today. I've been eating poorly - bought curly fries yesterday, ice cream today. Two nights ago, I even ate a hamburger patty with cheese AND a hot dog with Lay's potato chips....AFTER I ate a fucking gardenburger with salad for dinner. Wow, typing this all out is really helping with my motivation to step it up this week.

I also see the results of this week in the mirror. Don't know how accurate it is, but my belly just looks/feels more pudgy, my arms look a little less slim, my waist seems a little more wide.

David and I had dinner at the home of our friends Susan and Jeff. They're an interesting couple for us to be friends with. Susan is about to turn 50 and Jeff is 55. They are old enough to be our parents. Being friends with them actually reflects our values and priorities a lot. They're kind, generous, dog-loving, active vegans. They really live their lives well and I just love having quality people like them in our lives. Anywho, they're the ones who most inspired me to be vegan for Lent last year. So eating their vegan dinner with them tonight reminded how good it feels to just fill your intestines with vegetables. It's literally enlightening.

It's hard for me to squeeze in runs because I am rightfully physically tired after work. But I need to make good nutrition choices. Besides my goal of completing the full marathon, I have another goal: to take fucking sexy pictures in the sexiest body I can get by December 2014. Why December 2014 you ask? Because David and I are going to start trying to have kids in 2015. I just need those photos before I get pregnant because I have a feeling my skin will not be very elastic, and I'll always have those photos to look back on.

A few weeks ago I wrote about my internal conflict with how I relate to the homeless.

I have gained some additional perspective while on the TEACH service, which has a sizable homeless patient census. Conversations with my colleague Brittany have also allowed me to express my struggle to someone else, and I get to learn about her perspective as well.

Most of our homeless patients have problems with substance abuse. We had one patient who was an alcoholic and smoker in congestive heart failure. He doesn't take medications because he can't afford them. I understand you can't give what you don't have (courtesy of Dr. Garcia), but medications cost $4/month and $10/3 months at Wal-mart and Target. How much do alcohol and cigarettes cost?

The homeless man I pass often when running under the bridge is usually smoking cigarettes or drinking beer. He has a personal landfill of cigarette butts and beer cans under that bridge.

This makes me very comfortable with my decision to not give out money. Though I know not all homeless have problems with substance abuse, it doesn't mean that giving them food instead of money is any less generous. I would much rather give people food than cash.

I'm not claiming that I'm going to start doing this regularly, but it's something that I intend to try.

David's parents sent him a check for $450 so he can buy a shotgun. Another example of how different our backgrounds are. I actually don't mind David owning a shotgun, which surprises me because I used to say I would never have a gun in my house. But I do have my limits. Maybe, he can own a few shotguns, but I do not want a full-on collection. And we will never, ever have a handgun in our house.

When people want to own guns as a hobby, I get it. When people say they want to defend themselves, I don't think so. Being as open-minded as possible, I believe that they believe that they need guns to protect themselves. I also acknowledge that I've lived a violent-free, almost crime-free life and never ever felt that I was in such danger that I needed a gun to protect myself. I acknowledge that that's not everyone's life experience.

My life experience has shaped my opinion that guns aren't necessary. And my medical training has gone even further by shaping my opinion that owning guns causes more unintentional harm than actual self-defense. A study published in a medical journal found an association between suicides by gunshot in households that didn't lock up their guns or store their ammo separately from their guns. When I was on child psychiatry, I treated a 13 year-old who was shot...by his dad...while his dad was cleaning a gun.

I don't know the statistics. How many people are shot accidentally? How many people actually have needed a gun in self-defense? The media doesn't talk about these numbers. They do report that 30 people die everyday from gunshot wounds. Again, not knowing the statistics, I imagine that the majority of deaths are in poor, communities of color, who obtain guns illegally.

Shooting guns at a shooting range is fun I admit. I'll leave it at that.

I am so sleepy right now that I can hardly keep my eyes open. So I'm actually typing this joural with my eyes closed. I know this appears very odd, "some possessed shit right there." says David. Excuse my typos.

I skipped blogging last night also because I was exhausted. I could not skip 2 nights in a row. I'm sually very compilant with Lent and this year has been my worst performance so far. I mean worst adherence so far. Anyway, skipping blogging 2 nights in a row is pushing it. I actually enjoy freewriting with my eyes closed. It's kinda fun.

On the TEACH service, we get a high percentage of patients with  substance abuse problems. A lot of alcoholics who have drank so much their memory is shot and their speech is slurred and their reality is questionable. I see where my dad is headed. We have a 46 year old man who looks like he's in his sixties and thought it was 1999 and that he was 33, weirdly the math adds up. He doesn''t know he's at UCDMC even though we tell him everyday. We cna't find his family. I can't see any other future for mdad than this one if he continues drinking. Of course we'll always be around for him, we won't be unreachable like this guy's family but his brain is turning into mush.

I teared up in front of paitnets a couple times today. First, was Ms. C who is a twenty six year old prostitute who has two sons in Louisiana that she doesn't talk to regularly. She freely shared with us that she was not in a good mood today and it's because she felt like she failed them. That made me tear up. Second was this tough looking guy who is here for anosebleed and turns out he's in Stage Five kidney disease. On top of that he's lost three homes in the economy in th atpast year and his faincee died seven months before they were supposed to get married. He also said he felt like such a failure. I teared up at the fiancee part.

Dr. Garcia has been a wonderful doctor to them. I'm so honored to see him in action. He says the exactly right things to them and they always feel better after talking to him. I hope to have that much impact over people someday. I know I'll touch people, but I don't think I'll ever match Dr. Garcia's grace.

For Internal Medicine, I'm currently on the TEACH service, which stands for Transforming Education and Community Health. They specifically serve patients with county insurance or who are uninsured. By default, the service attracts a certain patient population.

The patients come in 2 flavors (but most are a mixture of the 2 like chocolate-vanilla swirl): very appreciative for the free health care or demanding for pain meds. Of course I love working with the appreciative ones. They make me want to provide them care. On the other hand, I dread seeing the drug-seeking ones. I find myself having such a hard time connecting with them. As soon as they're labeled "drug-seeking," everyone's perception of them is colored by that label.

I still treat them with kindness and respect. But I might not be providing them the same quality of care as I would other patients. I spend less time with them, I don't ask about their pain thoroughly, I don't have deep conversations with them about their coping. This applies to the patients who are mainly only that flavor. If they're a mixture of the 2 flavors, then I can still connect with them...but I still don't address their drug-seeking.

I think it's because I haven't been trained well yet in addressing this topic and because attendings have had many more years of experience dealing with these types of patients. I've already imagined myself when I'm a practicing family physician prescribing opioids to a patient for their first time. I imagine myself having a very thorough conversation about the risks of starting these medications (e.g., addiction, overdose, tolerance, side effects), using a pain contract to make clear what doses I am willing to prescribe and how often, explaining to them that I want to treat their physical pain with these medications, but too often people use them to treat their emotional/mental pain. Pain is real, but I do believe in the mind's ability to at least decrease pain to a tolerable level.

It's kind of cool that I daydream about how I'll practice medicine. It took me awhile to believe that I will be a doctor.

My sister Connie and I have been getting along better than we ever have in our lives. It's for the sake of our parents and I'm very proud of us.

My dad agreed to go live with Connie temporarily in Fountain Valley. They're having honest, intense conversations about his alcoholism. I'm really impressed that they seem to already be making progress. He said he's been trying to cut back. I highly doubt that's true, but the fact that he recognizes it as a problem is promising. He can't stop cold turkey, so they've come to an agreement of how many beers he'll have tonight. Connie suggested that she keep the rest in her room to reduce the temptation. He blatantly told her this made him nervous and he got very anxious.

Maybe all this sounds like progress to me because I'm finally starting to understand my dad's relationship with alcohol and I feel empowered by it. I had imagined a worst case scenario where he was completely in denial about his problem.

I'm really thankful to Connie for doing this. I really like having a mature, respectful sisterly relationship with her.

One of my best friends Cordell called me today to tell me that he had to put his dog of 15 years, Moose the dachshund, down. It meant a lot to me that he called to tell me this. It made me feel like a very useful friend. We had a wonderful, thought-provoking, introspective conversation like all our conversations are, as seldom as they are. Our friendship is so rewarding because we both feel privileged to know the other. Through each other, we learn about ourselves and we grow. We find each other intellectually stimulating and have so much respect for one another. We are best friends.

I only have a handful of close friends and thus I consider them all my best friends. And none of them overlap, that is, none of them are friends with each other. I wonder if my subconscious did that on purpose.

Not only do they not overlap, my friendship with each of them is very specific, like my friendship with Cordell.

I have a best friend who is my oldest friend. I've known her since third grade and I love her very much. Our friendship is based on nostalgia. We've lasted this long, we're going to last our whole lives.

I have a best friend who I have a lot of fun with and care about deeply. We might not have the deepest conversations, and we might not know how the other is truly feeling...but we care about each other and our friendship so much that we don't need to. It sounds a little superficial, and it is. It's actually one of my friendships that is hardest to maintain.

I have a best friend who just shows me so much love. He shares with me very personal, intimate information no problem. He even shares these things in front of David and I love that my friends see him as a friend.

I have a best friend who is one of the nicest people you'll ever meet. We don't have a lot in common except our overall niceness (which she has more of than me). But she's a truly good person and I love having her in my life.

I have a best friend who I click well with in so many ways. We connect as married women of color in medical school. We keep it real.

I have a best friend who is very interested in international current events and we also connect on a personal level. We are both very thoughtful in our conversations. We're both educated but in different fields and it allows for great perspective. We both have troubled fathers and it's a very special commonality we have.

I have a best friend who is happy for my happiness. But she has a history of getting in these funks where she makes those around her walk on egg shells. I've considered cutting her out of my life after she severely offended David. I never really knew this side of her until after college. We became friends in high school, but grew up separately in undergrad. I didn't know until later that she gets these mood swings. I decided against cutting her out of my life after I realized that even though she has issues, she really is a good friend. Why cut someone out of your life that cares about you?

I don't see any of my friends regularly. Sadly for some of them, I don't even contact them regularly. I wonder if that implies something. Can you call someone best friend if you know very little about their lives? Am I over-thinking it and we are both just busy? I don't see a problem in holding onto a friendship for the sake of holding on to the friendship. I obviously can live without these people considering my communication with them is so seldom and they aren't part of my day-to-day life. But who would I be without them? I'd be a married woman with no friends. No, thank you.

Tomorrow is Match Day for the 4th year medical students. It's a day when medical students across the country find out where they'll be going for residency. It's pretty dramatic. The whole nation opens their letters at the same time. The east coast opens theirs at noon and the west coast opens theirs at 9am.

Our school does it with breakfast. =) http://www.youtube.com/watch?v=3oNBDMfOj3E

It's a very emotional day. Just thinking about it makes me a little choked up. I cried instantaneously when I got the phone call from Ed Dagang, the admissions director for UC Davis med school, asking me "how would you like to go to medical school?" I remember it so clearly. It was one of the best moments in my life. http://heyitzjenjen.blogspot.com/2010/06/some-time-in-past-month-i-should-have.html#comment-form

And now Match Day is one year away for me. I know this year will fly by just like the last 3 years have flown by. And then...I'll be a doctor.

I'm surprisingly kind of ready. Third year has really shown me what life as an intern and resident will be like. Not the whole picture, but the clinical picture. I actually feel very capable to eventually do what they do. The learning curve is steep, but I will learn.

If anything, I worry about practicing medicine after residency. As a resident, by definition you're still training, you still have attendings to ask for help. Then after that, it's all on me. All physicians are forced to be lifelong learners, but the actual responsibility for my patients will be all on me. No more training status to fall back on.

The only rotation of third year I haven't blogged about is Surgery. I didn't intend to avoid writing about it, but today I realized I subconsciously didn't want to revisit it.

I don't want to write much about the specifics of the rotation. Kind of like my blog about Primary Care, here's some general thoughts and feelings I had during the rotation:

It is a privilege to see inside the human body, dead or alive. This is something I felt strongly about during anatomy, but by the time I reached my surgery rotation, I forgot. Luckily by the end of the rotation, just in the nick of time, I remembered. If I were to undergo an operation especially under general anesthesia, I would be so, so nervous. My heart's racing just thinking about it (I'm reminded of my wisdom tooth horror story). I would have to use all my strength to not cry in anxiety. But I didn't think much about how my patients were feeling while on my surgery rotation. I was nice and friendly to them, and that didn't hurt. But I don't know if I ever showed genuine concern for them. I had many patients with cancer, and never really thought about how hard it would be to know you have metastatic cancer. That's horrible.

I adopted the attitude of a surgeon just because I was on my surgery rotation. I had to present well, study for the shelf, show enthusiasm, constantly worry about my answers being wrong, wake up early, come home late...because I wanted to get honors. I could never show any implication that I was lazy, even if it's truly that I just don't give a fuck about becoming a surgeon. I held a grudge towards the culture of medicine while on surgery. A grudge that nearly burnt me out.

I'm actually glad for the experience. I was starting to worry that med school had been too easy on me emotionally and that I'd get my M.D. without paying my dues. Now I don't worry about that. Now I know what almost burn-out is.

Now that I'm on Internal Medicine and even during Peds, I have re-learned how to care. Wow, never thought that me of all people would have to do that.

Today was my first day working with Dr. Garcia. He is so seasoned in his interview skills, he does it effortlessly and gracefully. He talked to two patients about their substance use, and they didn't get defensive at all. One of them even opened up and shared that she's thought about ending her life but can't leave her kids behind. This patient's been on our service for several days now and this was the first time we heard this.

She has cirrhosis from Hepatitis B. She's Southeast Asian. Her husband died a few years ago. She uses methamphetamine. And yet, we didn't address her psychosocial issues with her until today with Dr. Garcia. Boy, is that humbling.

Another reason I am not cut out for the hospital setting. While we can plant seeds in the hospital, we can't support change long-term. Dr. Garcia proudly proclaims himself as a primary care doc, but he sure tries his best to get through to patients in the hospital too. I'd much rather follow this patient long-term and know how she's dealing than say goodbye to her forever after she's discharged from the hospital.

Sigh. My dad has become the most pathetic version of himself I've ever known.

His alcohol use is uncontrollable, his memory is shot. His behavior is inexplicable. I am no longer angry towards him. I pity him.

I hurt his feelings because I never invited him to join me and David in Canada for a make-up Canadian wedding reception. Not only would I like to avoid spending a week with him on "vacation," he's making my mom miserable on a daily basis and he would counteract any joy she'd get from seeing her family. My dad threw up at my Canadian cousin's wedding reception in the middle of the banquet room a few years ago - no one will care that he's missing. Only he does.

He's literally threatening to buy his own plane ticket to Winnipeg. "You and mom don't own the city of Winnipeg, anyone can visit there if they want. What if I want to?" Brrr, that's so disgusting it's giving me chills. I specifically told him that I want mom to be happy when she sees her family and him coming would make her unhappy. "What if mom says I can come if I buy my own ticket?" "Fine dad, if she says that, you can come."

Well, my mom told him no. And he's still going to try to buy a ticket. One obstacle against him is that he doesn't know the dates we're going. But sadly, he's been told twice. The most recent was this afternoon around 3pm. He forgot by 5pm. Not only did he forget the dates, he forgot that he had called me. "I only called Connie earlier. I never called you."

If he genuinely doesn't remember a phone conversation from 2 hours prior, that is very, very dangerous. If my mom goes and finds a 1-bedroom apt or bedroom to rent just so she can keep her sanity (even though she owns half and paid for all of the house he'd continue to live in), he will seriously deteriorate very rapidly. And I've already accepted that. My mom needs to get out. She is living in hell everyday. That is #1 priority for me. My dad's deterioration is not. At this moment in my life, I cannot help him. I cannot take care of him nor pay for him to be taken care of. I will not feel fully guilty for whatever happens to him. He will have a roof over his head, and somehow we'll pay for his food and utility bills. But his mental health is not something I can fix right now. It will take so much time and effort. And I will be the best one for the job with my background. But not right now. I cannot (or will not) give him that much of myself right now.

Week 1 of Internal Medicine over and I end it with a very rewarding patient experience. 

I had been following A.B. for 4 days now. He was admitted for biopsy of a lymphoid mass behind his sternum. He's also homeless with a history of depression and suicide attempts. He lost his job awhile back after passing out at work. Then he and his wife separated and she took their 3 young daughters ages 3-8 to Utah. 

By the time I met him, he was already in a different place mentally and emotionally. His life was stabilizing, he was no longer homeless...but now he has a mass concerning for lymphoma. Even still, he is pretty content with whatever the future holds. He wants to fight it, whatever it is. He feels he's grown so much just by the way he has reacted to his medical circumstances. I could tell he was proud of himself. 

The first day I met him, I told him I knew about his history of depression and suicide attempts. I encouraged him to feel comfortable enough with his treatment team to tell us if he's struggling with it. I think he appreciated this and it set the tone for our relationship. 

He was discharged today. He asked if he'll see me again if he returns to the hospital. =) 

That made me feel like an awesome person. I know I'm good with people. I know I'm compassionate. But doesn't mean I know I'll be a good doctor. I won't know until I actually am a doctor. But it's very likely. This patient is evidence of that. 

Update on that angry patient, he apologized profusely. I knew he would. I sensed kindness and decency in him. I can't imagine receiving news that I have cancer with a bunch of medical students standing and watching me receive the news.

I actually have a hard time imagining being a patient. I have seen patients through scary operations, bad news, and just many different trying situations. While I'm as compassionate and empathetic as I can be, I don't really know what it's like to be on the receiving end of the health care I give.

I think the closest I've gotten is when I was with David's family in the hospital for both his grandmothers. I was hyper-aware that I was not part of the health care team, I was part of the patient's family. For his maternal grandmother, the one who died the day before our wedding, we waited around for hours for the doctor to come discuss with us our options. We didn't know for sure when he was coming. We were patient and no one seemed irritated by it. But I don't like the idea of making my patients and their families wait for me without knowing what time I'd be coming, especially when someone is dying.

In the hospital, we round on our patients in the morning. If the family members happen not to be there when the doctor rounds, then you don't get the update from the doctor for the day. Of course they can request to speak to the doctor face to face, but it's not logistically easy.

I know I'm an outpatient kind of doctor. I don't like working in hospitals. It's fine as a medical student while I'm just learning, but the idea that I see my patients for a few minutes in the morning, then don't check on them for another 24 hours, unless I need to, makes me uncomfortable. I think I don't like inpatient because you are responsible for your patients the whole time they are in the hospital. All the decisions you make get done whether it be medications or treatments or procedures. So the outcome is practically determined by you. In the outpatient setting, it is up to the patients to modify their lifestyle and take their medications, I'm really acting more as a consultant and educator. I like that.

Besides being with David's family in the hospital, I've had little personal experience with serious illness.  When my grandma was ill before she died, I would visit her. But I didn't think of myself as healthcare provider since this was before medical school, nor did I understand the healthcare system yet. I also didn't visit her for extended lengths of time.

I've been really lucky with my health. I barely ever get sick. I've had it really easy. Just recently though, a few months ago, I had my wisdom teeth taken out while completely awake. It was hell. So hellish that after what felt like 30 minutes (and it was close to that) working on just one tooth, I started sobbing in the dentist chair...while he was still working on my tooth. I cried intermittently for the rest of the night, I was very traumatized. I think I've been so used to being healthy that I don't cope well with being physically vulnerable at all. I will get seriously ill one day and I better develop coping skills by then.

I had my angriest patient in all of third year today. And I totally understood where he was coming from. Everyone has limited patience. He was just being human.

He's a 38 y/o man who was diagnosed with colon cancer. He is visited by surgeons, my attending, my resident, and me the medical student. He gets woken up every few hours, his roommate is loud (maybe mentally ill). He has a 9 y/o daughter.

He's well past his threshold of irritability and it's totally understandable.

He yelled and cussed. Said he felt like a "guinea pig," felt like he was being disrespected. "Go cash your check." I don't think he meant everything he said, which is true for any of us when we're angry.

The resident handled everything. She made it a point that she would not be disrespected when all she's doing is helping him.

I was actually looking forward to talking to him again in a few hours after he had calmed down. I felt very capable. I thought my compassion would show and he would feed off of it. I never got that chance. The attending thought it would be best if he's bothered as little as possible. I totally get it. Now I'll never know how I would have done.

I'm a little surprised at my confidence and eagerness to deal with an angry patient. I think it's because his anger was natural and I don't think it's who he is at his core. I usually avoid confrontation, it makes my heart race. But this was the complete opposite reaction with him. Hm, that feels good.

Psychiatry Rotation #3 Part 3

My second site on Psychiatry was on the inpatient Child Psychiatry consult service. I also went to clinics in the afternoon.

I saw a cool case of conversion disorder. It was a sweet 11 year-old girl who suddenly lost the ability to walk. A close family friend of hers who was only 17 years old died a few weeks earlier. The day after I met her, she was able to walk again. It was fascinating. Conversion disorder means she wasn't consciously not walking, she really couldn't walk, but there was nothing biologically wrong with her.

What I gained most from this rotation though was meeting 5 teenagers who attempted suicide. I remember being very nervous about meeting the first patient. What does a stranger medical student say to a teenager who just attempted suicide? Realizing that their attempt was really a call for help helped me get over the nervousness. I remember 2 teenage girls who were relieved that I asked these invasive questions. One of them was raped before she attempted suicide and hadn't told anyone until she told me and my attending. The other girl was diagnosed with lupus and had been struggling with suicidal ideation chronically with previous attempts, and she requested to be put on antidepressants.

This rotation was my most rewarding one in 3rd year so far. I am very proud to be the kind of person people can open up to about the most serious topic of wanting to end one's life. I couldn't help my aunt, but I can help many others.

Speaking of my aunt, one of the clinics I went to in the afternoon was the Transcultural Wellness Center - a mental health clinic that specifically targets Asian Americans. MIND BLOWN when I found out such a clinic exists. I truly, deeply love the purpose of this clinic. What they do is pure goodness, they are filling such a huge need. After rotating there, I was torn. I was torn between Family Medicine and Psychiatry. The TWC reminded me that at my core, what I want to achieve most as a doctor is to promote mental health of Asian Americans.

I've gone back and forth too many times to count. Somewhere along the way, for some reason, I stuck with Family Medicine. And I'll miss Psychiatry. My interest in it was genuine, and my interest in it reflected who I truly am. But sadly, my limited experience in Psychiatry has shown me that having an M.D. and treating mental health means prescribing psychiatric medications. I'll do that as a family physician too, but I don't want to do it all day everyday. "They" don't want to pay M.D.'s to do therapy. Anyway, I'd rather be at the front lines anyway. I'd rather be the primary care physician who knows my patients well enough to educate them about mental health. And hopefully I'll have a lot of Asian patients.

I met with my Healer's Art group tonight. We talked about respite. I spoke about my last blog post - how when David and I do have free time together, we don't use it well, in a way that strengthens our relationship. But we're conscious of it and are trying to work on it. We both want it, we both do want to spend quality time together, but it's easy to forget in the chaos of life. 

Then spontaneously Leon took Thanh and me gay bar hopping. It is Leon's 29th birthday. It was so fun and unexpected. I was totally digging the whole experience. How it was a Sunday night around dinner time, and there were surprisingly a lot of people in the bars/clubs, how it was an out-of-nowhere idea, how it was perfectly the night before I start Internal Medicine, and being with Thanh and Leon. 2 people I really dig. I dig a lot of people in my med school, but have only gotten really close to 2: Melissa and Maria. 

I've been surprisingly shy in medical school. But maybe it's not so surprising considering I wasn't good friends with anyone in the whole School of Biological Sciences in undergrad. This is a scary observation about myself, but I subconsciously avoid becoming super-friendly with people who have excelled in the same fields I have. I think it gets into even deeper issues I have with not liking people who possess qualities I do. So weird. But I've also noticed I prefer having a handful of best friends who aren't friends with each other. That's probably why I have almost no drama with my friends anymore. I used to be a trio with Lil and Tiff and there was some drama, but since Tiff isn't good at being a long-distance friend, it's only Lil now and no drama. Fascinating. 

I do like hanging out with a good number of med school friends who belong to overlapping groups. It's always fun when I do, and it feels good to feel included in the social part of being in med school. I'll try to make a point of it in 4th year. 

ANYWAY, then Leon, Thanh, and I went to dinner at The Old Spaghetti Factory. Had nice conversation, got to know them a little better. It was an awesome night. Simple, meaningful, positive night. 

Two nights ago, I asked David, "Is our marriage okay?" 

While it was a serious question, I didn't mean that our marriage was seriously not okay. Poor David though interpreted it as the latter. 

I've claimed that marriage has been relatively easy, not much different to pre-marriage and living together. The hardest thing has been figuring out what kind of relationship I can have with my mother-in-law, and that's still evolving. 

But lately, I've been a little less happy. I think I've been hyper-aware of falling into routine. Being so busy that when we have free time one day a week, we choose to spend it apart. When we do spend time together, it's in front of the TV. And to be thorough, sex is not as often as I would like. We've never gone less than once a week, but I'd much prefer at least twice a week. 

I think it's the being busy part that is the root cause of it all. But we need to be busy and we should be busy. It's the P90X he does every evening at 8pm. It's the marathon I'm training for, it's the studying I have to do. It's the fishing that he's starting to do regularly. Besides doing P90X with him sometimes, the rest are activities we do separately. 

This is the first time in 3rd year I've felt this way. I didn't even feel this way on surgery. Now I have internal medicine to look forward to with overnight call every 4th night. And looking even further ahead, residency is going to be even more time-demanding. 

I'm glad we addressed it now early in our marriage. We addressed that we just really need to try. Try to spend more time together doing activities and try to have more sex. 

We bought tennis rackets and we love playing tennis together. He agreed to initiate sex more. Now I want to add in bike riding to the picture. 

Poor David had nightmares about my question. He woke up in the middle of the night asking if we're all better and he doesn't even remember asking it. He's so scared of losing me and isn't afraid to show it. I love his commitment.