We did an exercise in Doctoring today where we were given 20 notecards. On each notecard we were asked to write the following: 4 important people in your life, 4 activities you enjoy, 4 beliefs/hopes/aspirations, 4 material objects you value, and 4 pleasures/comforts.

Then we were read a scenario where we were diagnosed with cancer. Give up one card.

It feels shitty physically. Give up one card.

It feels lonely. Give up one card.

I'm angry that this happened to me. Give up one card.

And so on, until you come to terms with death and dying. Give up your last card.

What was very fitting was that my last card, my most important card was "inner peace." It took me a moment to decide whether my inner peace was more important than David. It's a hypothetical scenario where I had to choose. But quite literally, when I take my last breath, I will be leaving David, but I'll be dying with my inner peace.

"Do not let the behavior of others destroy your inner peace." - Dalai Lama

In this case, it should be "do not let things outside your control destroy your inner peace."

I'm so grateful for my health and happiness. One day I won't be so healthy, but I can still be happy. Keep calm and carry on. That's all you can do sometimes.

Last night I went to a spoken word night put on by the Davis High School Black Student Union. I was invited by the Murray-Garcias, some of my favorite people on earth. The event was fun, I am so moved by spoken word. There were some pieces that the high school students wrote themselves and they blew me away. There was one piece entitled "Who Am I" about being black in Davis "surrounded by snow." Black people stick out around here. One can't help but sometimes think "hey, there's a black person in Davis." Which subtly implies that black people aren't included when one thinks about residents of Davis. So I wonder, do they feel included? Do they consider themselves a part of the Davis community? According to the spoken word event last night, they feel different...though they also feel the same underneath it all.

The Murray-Garcias are one of the best parts of going to UC Davis medical school. I remember meeting Dr. Garcia on my interview day and him leaving such a strong memory in my mind. I remembered the gentleness, kindness, and just pure goodness he exuded. And he still does every time I see him. He then impressed David at my White Coat Induction Ceremony with a speech he gave. He just comes off as an awesome person. And now I consider him a mentor and have been to his home several times. He's one of those people that makes life better from just knowing them.

His wife is kick-ass too. Or as she would put it, "gangster." I met her when I did a 4-week program Summer Institute on Race and Health. She's just so...down. She has a passion for racial issues. Meeting her and going through the program was exactly what I needed to reconnect with my undergrad self who was so active in social justice.

I do believe in soulmates. I believe in it because I feel it between David and me. But it's also couples like the Murray-Garcias that make me believe. I love them separately and together.

There are 2 more important things I need to mention about my Ob/Gyn rotation.

The first is the first patient I ever had. Her initials were M.H. and I was on gynecology oncology. She had a big tumor taken out, and I held it in my hands. It was very heavy, several pounds. My attending gynecologist oncologist surgeon was gray-haired and seasoned, and he said it was the most difficult operation he had ever done. It was so difficult because of what we call adhesions, which is basically scar tissue. She had loads of adhesions because she previously had an abdominal surgery many years ago, where a large part of her bowel was removed and she now defecates through a hole in her abdomen into a bag. The surgeon said that his fingernail was bending trying to separate the adhesions. He also accidentally cut one of her ureters (and stitched it back together). After the operation, she kept on spiking fevers and we couldn't figure out why. Finally, we did a CT scan and saw a bowel perforation (and she was eating In N Out!). She was taken back into the OR, and when she came out this time, she was on a mechanical ventilator. I remember cleaning her saliva around the tube and happy to do it. When the ventilator was taken out, she cried to me about all the stress of these complications. When I explained to her about the adhesions, she responded that she knew it would be risky, and that's why she waited so long to get this operation. She was a great first patient to have.

The second thing I must mention is that I attended 2 funerals during Ob/Gyn within a few weeks of each other. They were for both of David's grandmothers. His maternal grandmother died the day before our wedding from an aortic dissection in her early 80's. His paternal grandmother had been dying for nearly 4 months after breaking her hip and ultimately died from pneumonia at age 74. One was sudden and very unexpected while the other had not truly been living for months. One had been excited and eager for my wedding, but wasn't able to attend. While the other attended, but wasn't really there. It was an interesting way to start a marriage, but never felt burdening. If anything, it felt strengthening. We got to say goodbye to both. I also got to say goodbye to my grandma right before medical school. These were my 3rd and 4th funerals in medical school. Sounds excessive when it's put that way - 4 funerals in 2 years of medical school. But I've surprisingly been able to handle it with the help of my wonderful partner. Between both David and me, we have one remaining grandparent - my maternal grandma in Canada. It is a traveling priority for David to meet her. Hopefully this May.

David and I had an argument tonight. Our most intense ever.

There were locked doors, threats to break the door down, and threats to leave the house until morning.

As serious as it sounds, the silly thing is that the door only stayed locked for a few seconds, and he only went so far as to put his jacket on as if he was leaving.

So even though David was moderately angry with me - the angriest he's ever been - we still argued in our usual style. Our style being that I get mad to the point of being sad, and he concedes because he hates to see me sad and because I'm right.

We've only had a handful of arguments in our 4 years together. This is if you define argument as both parties raising their voice in anger. Otherwise, it's usually me getting angry with him. I give myself credit for toning down the bitchiness over the past couple years. I recognize if I'm upset at something trivial, but I struggle with switching off the anger on command. It lingers even after I acknowledge that I shouldn't be upset and I'm acting childish. But I'm getting better...these episodes are significantly less frequent now.

We have a rule in our relationship: we can't go to bed mad at one another. (inspired by the Ne-yo song) It's a great rule. A very smart rule. It defines the baseline of our relationship. At the end of the day, everyday, we will always reconnect. We will always close whatever distance is between us. We do this sooner rather than later if there is a rift between us. I don't think we've had a "heated discussion" for more than a couple hours.

We make up pretty quickly.

Going on 10 months of marriage here, and it hasn't been too difficult. We can easily handle occasional "heated discussions" that only last at most 1-2 hours. We're always back to baseline or we even develop a stronger bond afterwards. It makes me very confident about my decision to have married him.

Considering third year of medical school has been one of the most rewarding, stimulating, and interesting years of my life...and considering it's nearly 5/6 over...my personal documentation of growth during third year has been abysmal. AKA I really need to blog more often.

So for Lent this year, I decided to add something instead of give up something. I'm going to blog everyday for the next 40 days. And my first post will be about my first rotation on third year: Ob/Gyn.

I have to start out with discussing one of the most amazing experiences of my life: delivering my first baby. I hope I'm clear in that I was at the receiving end, not the pusher. People on facebook misunderstood me. Anyway, my first baby belonged to a Spanish-speaking family. I can't remember what country they were from, but it wasn't Mexico. I can't remember her name either, but I remember mom saying the baby looked "china." Haha. I was under the supervision of Dr. Zhang, whose son is in the end of The Avengers, and came up with his lines himself. But I digress. I drove home that day squealing every few minutes from the pure exhilaration. I just helped introduce a new existence into the world. There was a sperm and and egg, and now there was a soul. Wow. For my second delivery, I am not proud of how I ended up delivering a baby. I just walked in. I never met the parents beforehand. My memory is hazy (thus my Lent goal), but they were never told a medical student will be delivering their baby. It just happened. And the parents were still very happy nonetheless. I must note that class played a huge part in these experiences. These were low-income families with health insurance for low-income families. And medical students use it to their advantage. 

Hypocritically, though I do honestly mean it when I say "pure exhilaration," I should also add that it involves fear and complications. Or in my case: fear of complications. That's something I continue to struggle with in general. But it's slowly getting better. 

Also, Ob/Gyn's can be bitches. There must be something about working with all that female energy that just brings out the bitch in some women. Not true for all Ob/Gyn's, but enough of them for me to get a feel for what 4 years of residency with these women would be like. 

Delivering 2 babies was one of the most exciting things I've ever done, but from the looks of most of the attendings' faces, that excitement was gone. 

And for the life of me, I still have trouble feeling for a uterus.

A write-up for my Doctoring class, I completed an Advanced Directive with David:

I completed the exercise with my 27 year-old husband, who has not given much thought to end-of-life issues at all. He answered "I'm not sure" to several of the questions because they placed him in situations he had not yet imagined he could be in, such as questions about dialysis. He was familiar with mechanical ventilation however because his grandmother was placed on one before she died. Coincidentally, the website showed a video of a gaunt, elderly Caucasion woman on a mechanical ventilator, who very closely resembled his grandmother on her last days. This vivid image struck such emotion within him that he passionately answered all questions about mechanical ventilation as "unbearable." This exercise is a very valuable experience for any couple to complete, but having been formally educated about its importance, I feel especially relieved that I've finally completed it with my husband. He appreciated the necessity of the advanced directive, though the seriousness of the topic did noticeably weigh him down. However, when we were provided the print-out that just had to be notarized, we felt very accomplished for officially completing such an important task. 

One of the interesting subjects we differed on was our wishes for our bodies after we die. Having gone through anatomy lab and organizing the Body Donor Memorial Service, I am certain that I want to donate my body for education, transplant, or research. My husband was not so sure. I can definitely understand people's attachment to their physical bodies, even post-mortem. Imagining my cadaver being dissected on does not feel pleasant. Also, the idea of not being in an urn or a burial site might make one feel that their existence in the world will be forgotten

I do believe that it is the physician's duty to encourage their patients to communicate their end-of-life wishes to family members. Many families just simply do not address end-of-life issues. Doctors are educators, and patients and their families need to be educated about the complicated issues that arise when someone becomes really ill. Like my husband, many families just do not imagine themselves in such circumstances, and thus aren't prepared for them. Doctors would be providing good care if they help prepare families for these potential situations. 

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