Goodbye to Intern Year

I looked down at my iPhone as it marked mile 6…I know this is where magic happens. It’s when my legs stop hurting, when my lungs stop burning, and I am lost in the soft churn of the sunrise and the sound of the breeze.

I took up distance running during the busiest year of my residency in internal medicine. Something inside me signed up for marathons.

Maybe that something was anger – the day I heard my patient yelling at me after a 16 hour work day “I hate this hospital, and I deserve all your time!” I sat inside the facility room and cried, my dad was hospitalized and I didn’t have time to see him and just be a daughter. My dad deserves all my time.

Maybe it’s exhaustion – Obama care had brought so so many patients who had not seen a doctor in 20yrs, and in my 15min appointment, they have a list of 10 problems, and you just feel so so small and overwhelmed.

Maybe it’s the darkness – for a good 2 months of this past winter, I didn’t see the sun. My work started before the sunrise, and rolled well into the sunset. Living in darkness was isolating.

Maybe it’s the other things – that boy you loved that broke your heart but you walked bravely into another 14 hour work day, and all the friends you lost cause there’s no way they can understand why you can’t attend their wedding, their birthdays, and their worst days.

Maybe it’s grief – that day when you watch a daughter show her dad their childhood videos as he slips away. That day when a wife crawl into bed to hold her husband as he took his last breath. Or the family that finally overcame their resentment of each other, and unite at their parent’s death bed.

Maybe more times than not it’s pure joy – the day you watch someone wake up from a horrific illness, and know they’ll be alright. The day your patient made up a medical problem so they can have an appointment just to say you’re the best doctor they’ve ever had. And every single time you watch your patients leave the hospital safe and sound.

Back in high school, I ran for the races. Now I run for all the things in my life that I win and those that I can not. I run for those magical moments in time when everything feels wonderful and nothing hurts. At mile 6, I know that this run…it’s for me.

What Medical School Forgot to Teach Me

My adorable grandparents, who raised me for almost a decade of my life <3

My adorable grandparents, who raised me for almost a decade of my life❤

My 89 yr old grandpa, with a history of type 2 diabetes, very well controlled, spiked a blood sugar in the 500s (normal is in the 100s) on a Monday in February. He was a little more fatigued than usual, and my mom called me for advice. I was concerned about any infections. His primary care doctor ordered 2 doses of insulin that day.

Day 2, he appeared sicker and sugars remained high. I talked to his doctor’s office asking  very nicely for an infectious workup which includes blood work and cultures, chest xray, and urine studies. The nurse on the phone sounded younger than my sister, and did not know what hyperglycemia meant. The doctor ordered only one part of the labs that evening – a blood culture, and told his nursing home there was no need for a chest xray to assess for pneumonia.

Day 3, the results have returned and the nursing home said they were unable to reach the doctor.

Day 4 AM, my grandpa was in septic shock from aspiration pneumonia, and was admitted to the ICU. He never fully regained consciousness.

My mom called me, and I drove home to LA. The doctor’s excuse for 4 days of delay in care was “he’s old…I don’t want to be aggressive.” He offered no apologies. For the first time in my life, I cried because I was furious. I kept thinking of what my neurosurgery chief once told me “one day, you will know that your job as a good doctor is to protect your patients against the morons in the hospital” and his other advice “the worst prognosis is a nice patient with a nice family.”

I spent my time in the ICU since Valentine’s day. He became vent dependent meaning he needed a machine to breathe, he got tuberculosis (when he tested negative all his life), he got a feeding tube and then had a massive stomach bleed, and finally DIC, a condition indicating severe illness. He also assumed decerebrate posturing, indicating possible stroke, a likely complication of his severe shock. In between all these episodes were his doctors telling us to take him off of life support, a conversation they never fail to deliver when they somehow forget to discuss any other test results or procedures conducted.

My grandpa is on comfort care now, meaning there is no more treatments or blood draws. He gets a morphine drip and some IV. He is dying, paralyzed, and semi-conscious due to gross medical negligence. 

I thought of how much medical school failed to prepare and discuss with me: 

-How our treatment can hurt as much as it can save a life.

-How machines and medications and procedures can prolong not the living, but the dying process. 

-How the consequences of our inaction and negligence, ignorance and fatigue is real. 

-How not to sue another physician, a doctor who’s negligent at the end of his career at 65yrs old, who makes a very humble living as a primary care doctor in a country in gross shortage of primary care physicians. 

-How to act as a family consult with medical knowledge, and objectively decide to terminate treatment for someone I love deeply. 

-How to deal with my mistrust and anger toward members of healthcare when I myself am a physician. 

-How to advocate firmly for the correct course of care when it’s in disagreement with another physician. 

-How important it is to encourage patients and their families to be vocal, and strong advocates irregardless of how stupid it sounds. 

-How important it is for physicians to apologize in times of error, not because of policy or fear of lawsuits, but because the patient and their family deserves it. 

In 2 months, I will become a full time internal medicine doctor. I thought of all the families who have yet to come under my care, and all the things that can go wrong. I didn’t know…4 years ago…when I first began medical school, what tremendous responsibilities this lifetime was going to entail.

Match Day 2013: Dreams Do Come True

(Match Day: every year, medical students across the country will open an envelope on 3/15 to find out where they will go for the next 4-10 years of their training in their chosen specialties. The hospital and student preferences/selections are determined by a computer algorithm after 3-4 months of grueling cross the country interviews for desired candidacy.)

Match Day!

Match Day!

26 years ago, my mom loved me enough to leave me in China with my amazing and loving grandparents. She came to America alone to pursue an education and a future for me. She wanted to bring me to a place where any of my dreams can have a chance. I came to America 9 years later.

In 7th grade, Mr.Honda had a farm of chickens, rabbits (with countless bunnies), and a classroom iguana. I fell in love with biology the day he made us plant vegetable gardens on the back alley of Paul Revere Middle School. I touched a giant potato bug, screamed and almost threw up (please google potato bug).

At 13, I remember calling 911 and a random lady drove by and stopped to hug me while I panicked in front of my house. Later that night, I stood in the corner and watched some Kaiser critical care doctors save and stabilize my grandma. My prayers for more time with her were answered. I thought it would be “cool” if I became a Kaiser doctor one day.

At 17, I was jumping with my little sister on my bed after opening my UCLA acceptance e-mail, I was going to my dream college.

On my 19th birthday, I listened when Annie told me that my best friend and roomie, Karen, passed away from cardiac arrest, 4 hrs after I told her no one dies from coughing, 8 hrs after watching her laugh over my bday dinner. Her mom came to clean up her room, and I will never forget the face of a mom who had just lost their child. In that place of guilt, and pain, I chose to become a doctor…selfishly hoping I will never be that helpless again.

4yrs ago, I was in Washington DC on my Georgetown interview when I received the call that I was accepted to my dream medical school UCSD.

On 3/15/2013, I opened an envelope on match day that realized a lifetime of little hopes and once impossibly long term dreams. I will be starting my life as an internal medicine resident physician at Kaiser Permanente.

Every doctor tells me I will never forget my match day. I thought of my amazing family who gave me the love, and support to pursue dreams that are often so out of anyone’s control, and so distant. My friends whose crazy shenanigans, and advice allowed me to survive the last 4 grueling years with sanity and fun. My incredible teachers who taught me to be passionate and perfectionist with my education.

And lastly, God, for giving me the beautiful and truly wonderfully blessed life that I do not deserve.

On Finding That Little Voice (for Ms.Lynne Aidikoff)

I came to America at age 9 not speaking a word of English. Liberal art classes were obviously my least favorite. All that the school system cared about was reading a passage and answering some stupid questions about main characters and plot. Needless to say, I didn’t thrive in school.

Then came the 6th grade, junior high. Ms.Lynne Aidikoff was my writing/history teacher. Somehow in all my grammatically incorrect assignments, she saw something worth reading. My dad had a meeting with her during the school year, she told him I can write (who knew?!). I received my first A in English since coming to America that year.

So I kept on writing, and reading so I can keep on writing. I wrote words that she loved which delivered my heart and my opinions. The type that was shamelessly honest and vulnerable. I wrote my way into UCLA, through upper division romantic lit classes in college, and then to medical school.

This year, during my residency interview, the program director remarked “I read 1000 essays this year, yours is the only one I remember.” I can’t help but think of Ms.Aidikoff and how her encouragements brought me here.

We’ve been in contact via facebook over the past few years. She left little comments and messages filled with proudness, joy, and always encouragement. I found out today that Ms. Aidikoff passed away recently. I wish I told her what an amazing adventure in literature, writing, and life she had sent me on. What unbelievable empowerment, release, and comfort writing has brought me in the darkest times of my life.

Looking back, I only realize now that she had given me the single greatest gift that a student can acquire in education, a voice.

A Beautiful Morning

Hello 2013! You’re a big year for me:

1.matching for residency (internal medicine) 3/15

2.graduating from UCSD 6/2 

Skyline <3

San Diego, California

Both of these I consider life defining events, and in-between all these things will be getting Step 2 CS results, submitting my research paper, ICU rotation, and figuring out my residency rank list which I set out to do this week. As I’m wrapping up my interview season, I’m becoming more and more certain of which geographic region I want to be, but more confused which program will be the perfect fit for me. Everything I set out on excel to measure how well a residency program will fit my personality has been trampled by my ultimate gut instinct preferences (which strangely, is the exact opposite of the excel score sheet).

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French toast:)

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Blackberry pancakes:)

So, I decided to spend the morning with friends, having a yummy breakfast, and…taking my own new year resolutions to heart…see the ocean, and taste some goodies (so amazing!)

The view is incredible! (Pacific Beach)

The view is incredible! (Pacific Beach)

My Baby Sis

My parents have shaped so much of who I am today. They’ve given me a safe home, and (like all awesome, competitive, A-type personality Asian parents) bought me some hobbies in art and music and dance. They’ve taught me the importance of education, to seize the best opportunities, and to take risks. Everyday, I become more deeply grateful that I come from a beautiful home. But, if there was one thing that I am the most grateful for, it’s the fact that my lovely parents gave me siblings.

Up until age 9, I seriously thought the world revolved around me. I had the full love and attention of everyone in the family..24/7. I would shed a tear, and the next moment, I would get whatever I screamed for. My grandpa once cooked 3 separate dishes for me…cause I wasn’t willing to eat any of them. I was…spoiled (ya think?!)

Then came my sister, a rotund 9lbs of boneless chub. My parents and grandparents busied themselves with the everyday activities of a newborn. When she cried, I got in trouble. When she learned to walk, she started keeping my stuff. When there was something yummy, she always got the last piece. And yet… I came to love her so so…so so much.

Because in the midst of the annoying crying, nagging, intrusion of privacy, unwanted touching and attention she brought to my life, my sister taught me to love more than anyone else in this world. She shaped the way I loved at the time in my life where everyday I was molding my heart and mind to the person I would become.

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From the sharing of things I didn’t want to share, she taught me about generosity and how I can give without expectations of anything in return. From those stubborn fights, she showed me that apologies aren’t here to prove who’s right, but to show us that relationships and forgiveness matter more than what we want to agree on. In exerting her carefree, social butterfly, “whatever” – personality, she taught me to accept and appreciate people simply for who they are despite how different our dreams, priorities, and lifestyle may be. From those hours of parental attention I did not receive, I learned to be introspective and to rely on myself to learn from my mistakes. Trying to live up to the unrealistic and incomprehensible amount of admiration she carried for me, I hold myself to a higher standard in everything that I do. This fall, when my “baby” sister went to college, and started partying, I learned what it feels like to wear my heart outside of my body.

Lizzy taught me so much about love, the type of love that I always hoped to give to the people I care about. When I see all the wonderful things that my parents have given me, I am most thankful for my darling baby sis. Because whether she knows it or not, she taught me how to deliver the single greatest experience of our human existence…unselfish love.

For Mrs.S

 

I appreciate your candor and thoughtfulness…and lastly, I hope you’ll find a life of happiness.” 

Mrs.S passed away last night, and her family handed me a small white card with cherry blossoms (my absolute favorite), and those were her last words to me.

Mrs.S came in 2wks ago screaming in pain from metastatic ovarian cancer that she fought brilliantly for 10 years of her life, beating all the odds and statistics we love to throw at our patients. Her CT scan showed that more concerning than her shoulder pain, was her entire right chest was crushed by a gigantic tumor mass. The pulmonary doctor chuckled to me “she’s all yours, that’s the worst lung I’ve ever seen.” Mrs.S had almost no lung left. She went to Mexico to receive dendritic cell treatment, which did not work. It was clear on that night, she did not have much time on her side.

Over the next 2 weeks of my internal medicine rotation, I sat with her. There was no cure, there was no particular medical miracle I can offer her except pain control. She began to tell me the stories of her life. she met her husband at age 26, when he was 19. They spent a lifetime touring together as musicians, and they have no children. Some winters in Michigan, they would spend months indoors next to the fire together because it was painfully cold outside. They told stories and read novels to each other to pass time. They spent their 25th anniversary in the hospital over a liquid diet. She spoils her niece like crazy. She hated Spy Kids movies…we laughed over all these details of her life.

Then one day, sitting in the green armchair of the hospital room, she got serious. She looked at me and said she was afraid, not of death, but of leaving the love of her life all alone.

I looked at this woman who is more than a lifetime ahead of me in experience and age, standing less than a week from dying, being afraid for the pain this would cause her husband. As she spoke these words, her husband, working intently on his computer at the other corner of the room, came over. He told her that he had a lifetime of “happiness and love”, and he’ll be okay.

There are defining moments of our lives where everything we do just makes sense. As I watched a loving husband comfort the fears of his dying wife, I fell in love with internal medicine. There was no where else in the world I would rather be, nothing else I would rather do despite the months of indecision over my specialty options for residency applications this year.

And dear Mrs.S,

Your husband is busy driving across the country to take that trans-America trip you wished for. That’s how he chose that morning to celebrate your life.

As for me…I too, hope I’ll find a lifetime of happiness.