Another sleepless night in Las Vegas. Ugh. Without my husband and without herbal assistance, falling asleep is very hard for me in my adolescent-hood home. I was able to do it last night in about one hour, but tonight was painfully unsuccessful. There are several reasons for my failure to sleep tonight. I think the strongest reason is that I couldn't stop thinking.

I am probably going to see a former friend tomorrow who I have not seen in 5 years exactly. I've been invited to a surprise graduation party for our mutual friend Ambika and I can only assume this former friend of mine is invited too. She was a fear-inducing friend and I have let myself succumb to this attribute I remember most strongly of her. I fear seeing her tomorrow (well, today). I do not think she will attack me, and I hope she doesn't give nasty stares. But I fear the awkwardness, which is a silly thing to stay up all night for. I'd be fine without talking to her, but can I really get away with that? If not, who starts the conversation? What would the conversation be about?

I think the anticipation has been built up because though we haven't been friends in 5 years, I have an occasional recurring dream of us meeting up again and calling it out directly, "hey, so we're not friends anymore." I hate these dreams because I think they imply that I want her back in my life and that is not true at all. I don't know why I have these dreams, maybe it's because we were so close before and it never feels good to lose a friend. But with her, it felt okay at least.

I also couldn't stop thinking about how uncomfortable my fucking legs are. I have this new skin rash I've never had before and I'm almost positive it's not infectious in nature. I don't know my skin diseases well, but I worry that it's autoimmune. Autoimmune diseases scare the shit out of me - my own body attacking itself? Fuck. It's caused me quite a bit of distress and I think it continues to worsen. I've recognized many times throughout my 3 years of medical school how fucking lucky I am that I'm healthy. Even shit like ear infections don't happen to me. I have acne and some mild knee pain with running - I'll take it. But with this new skin rash, my image of my health has been shaken and I don't like it. It also doesn't help that part of me is hesitant to schedule a doctor's appointment in fear of upsetting my senior resident or attending on my next Radiology rotation. But I gotta do it, so I'll make an appointment ASAP. I need an answer, I don't know what the fuck this skin rash could be.

What's really ironic and annoying is that I was sleepy when I went to bed. My eyelids were heavy and I felt the sensation of sleepiness. But as soon as I got off the phone with David, it went away. I just hope I don't have bags under my eyes if/when I see this former friend.

Earlier this week, I witnessed dying. There's this phenomenon called "air hunger." Even if a patient is obtunded, you can still see them gasping for air. Their lips curl inward and their tongue sticks out a little while you can see the muscles in their neck working to help them breathe.

The family knew her time was coming based off the glistening of tears in their eyes. But this was the type of family that held onto hope until the very end. They requested that she receive suctioning of her mucous to help her breathe more comfortably. When suctioning didn't improve her breathing, then they actually finally accepted it. The glistening in their eyes became full on sobbing and wailing. They held her head up in grieving and wiped her forehead with a damp towel.

My tear ducts have a physical reflex when I see others crying. I was able to control the tears from running down my face for a few minutes, but the family's full on sobbing eventually got to me and I had to step out of the room. Then when the whole team regrouped afterwards, I had to let my tears flow freely for a little bit. The team was supportive asking me if I was okay. I was okay, I just can't help but cry sometimes.

The family was Mien. And I felt that extra connection to them being Asian. I thought about my very stoic uncle who practically never shed a tear for his wife who committed suicide. He wasn't heartless, he was the eldest male in m Asian family, he just doesn't cry.

And I thought about David's grandma Betty who had to be on a BiPAP machine to help her breathe while she was dying. I didn't notice the air hunger at that time, she had been dying for months, so I didn't notice that she was actively dying the last time I saw her. For my patient, our team said that a BiPAP machine would be unethical/harmful/uncomfortable. It was probably true for Grandma Betty.

I'm going to be dealing with death a lot in my career. And for professionalism sake, I should try to keep my tears under control. But I'm trying to imagine what my reaction would be if I were the patient's family and I saw the doctor shedding a little tear. I don't think it would be so bad. I think shedding a tear is okay. But only a few tears, doctors have to maintain their composure. Have to.