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.