Reflection

Do not be fooled by what you hear. People will tell you that you are talented and clever.
Do not believe them.
People will say that you are stupid and do not work hard enough and you will never amount to anything.
Do not believe them.
Even your friends will tell you words and phrases. And you might start to believe them. They will say you are easy to talk to and so very nice.
Strangers will say passing remarks about your reticience and your shyness and tell you that you need to speak up more, you are too shy.
You are not.
Do not start believing the words that are repeated in your ear.
Do not fall into the cage of spoken words that try to define you, to limit the edges of you are.
You know who you are.

Family med

I take it back. I hate it. I really freaking hate it.

I hate how the attendings don't listen and just talk over the patient. Or talk AT the patient and then the patient just nods. I hate how I can see that the patient won't "be compliant with medications and orders" because they can't afford it. I hate how useless I feel. I can empathize and listen all I want. But what good does it do if they're not going to get actual medication. They're not seeing us for a psych consult. 

I hate the pace of this place. It's not patient focused at all. 

I hate America's health care. How can someone not afford to get diagnosed with diabetes because it costs too much? Why is it that we just watch someone get neuropathy and retinopathy because insulin costs so much? Or just try to make do with $4 HEB drugs because that's the only why we know for sure that the patient can afford it? 

Why do we have to spend over 1/4 of the visit talking about how to afford the medication and if it is cheaper to pay the bill before or after? 

Why does it suck so much?

---

This is the first time where I thought: Please don't let me be like that in 10 years. 

Quick thoughts

1. Busyness
- I think I am always happier when I am busy. I don't know if this because too much reflection makes me think more negative thoughts or if it's because I just like getting things done and there's that sense of accomplishment. Who knows. Regardless, I like third year a lot.

2. Family Med
- I really hated my first week for a various number of reasons. But it's the second week and I am not as annoyed. There is a lot of listening and guided questioning that needs to happen. I don't think I will ever like it, but I think I can end up doing the things I need to well.
- does empathy ever burn out?
- how much of the conversation should talk about money and cost?
- how much of a difference do you make?
- it's so slow....

3. Perceptions
- I realize that now even I have lost some sense of "normal weight". When I see on the chart that the patient is 300 lbs, I think okay, big guy. I see the actual person and I'm like, oh well, I've seen much worse. Isn't it weird? That the extremes of an obese person can severely change the perceptions of other people (who are still obese) just because of comparison.

4. Appreciation
- I appreciate a lot of little things right now.

5. Worry
- I worry too much. Or is it that I think too much?

6. What kind of dancer am I?
- I asked this to my partner. The response was this: You are sensitive to cues, but sometimes you read into cues that aren't there.
- Is this true for other aspects of my life?

7. Pediatrics
- If I hate everything else, I would love to be a specialized pediatrician. There are definitely more than one attending that I would really not mind being in 10 years.

8. Prayer
- God knows that I am weak. So He has given much.
- Prayer needed, prayer given, prayer for family and friends

9. Excited for visits!

Family

If there's one thing that's true about my family, it's that we don't know how to ask for help.

Not me, not my brother, not my mom, not my dad.

It is probably pride. Or I don't know... some sort of asian reticence?

I've told this story to a couple of people, but when I was younger (oh I don't know, maybe 3rd grade? definitely something in elementary), I wouldn't accept anything unless it was offered three times. Do you want a fry? Casually offered like any 10 year old might to their friend.
No thank you.
But in my head, I really did want one. 
Are you sure?
Yes, thanks.
One more time, ask me one more time please.
And that was the end. I ended up not getting a fry that day. I don't know why I remember that particular scene in my life. But I do. Pretty darn clearly too.

In high school, I tried not to answer real questions about myself unless it was asked three times. (I don't know why three. Just because?) Because that's when you knew they really wanted to know.

I don't know where this philosophy came from. Certainly nobody ever told it to me. And I'll ask for a fry if I want one now (maybe). I'll answer questions now too (if you ask twice maybe lol).

And I guess this is why I just don't trust anyone's first answer to my questions.

But my family is so bad at asking and accepting things. Or maybe it's that we just don't know what kind of help we should be asking for. That old adage of not knowing what you really need.

I just need to be more perceptive. And more preemptive.

Two stepping.

I had. SO. Much fun. 

Yadada shelf exam and all that, blahblah prep for next rotation. 

Whatever. 

Two stepping. I really looked askance at this when I got to San Antonio. Thought it was super hick, too much country music, very not my scene. Well.... I really like it lol. I think it's more fun than dancing at a club, tbh. Thank goodness I have some musical background and can count beats. And I guess I'm glad I'm a girl because it's pretty easy to follow steps. 

It's pretty interesting to see how different guys lead and set their cues. As a beginner, I def prefer the stronger leads with helpful nudges in the right direction. Danced with a guy that "hitched" his steps and I seriously could not follow (because I couldn't count the darn beats!!). 

Overall, a fun night out :)

Not my day

Today is just not my day.

Woke up late.
(had to skip breakfast >.<)
Got stuck in traffic.
Kept choosing the "wrong" lanes to merge into to avoid the traffic. (you know what i mean).
Kept forgetting to ask about recent labs.
Mangled my spanish and felt like a fool.
More traffic.
Dropped half a cup of coffee all over my white coat and my white shirt. ughhhhh.
(thereby losing my cup of coffee too. noooooo.)

... surprise laundry I guess.

Because this is cute

From one of my case studies:

"About half of the weight gained during the first 4 months of life is in the form of fat, making the 4-month-old infant the fattest healthy human, with about 25-26% of weight as fat."

Isn't that adorable? haha

First Impressions

In the first few minutes of a clinic visit, I can already tell the tone of the family. When I'm smiling and rattling off the automatic phrase of yon old medical students ("hello! my name is __ and I am a third year medical student. I'll just be asking you a few questions to get a better understanding of-), I can already tell....

If the parents care about the kid

If the kid cares about his own disease

If the mother doesn't really want to talk to me and is secretly wondering where the real doctor is

If the dad doesn't give a damn

If the kid is sweet and raised well

If it's a happy and supportive environment...

Don't you think it's crazy? Surely someone shouldn't be able to see so much in so little time. Aren't there extenuating circumstances? That I don't know the struggles or the problems behind the scenes (oh, but don't I? from past notes and the list of psych meds?). 

I've always wondered if I could transcribe a person into words, if I could be written down in black and white and a thousand little letters. I imagined, if anything, it would be a leather-bound book of stories and dreams and half-sensed allegories of the depths of each person. (If anything, I am a romantic at heart. Unfortunately.) 

But, let me just say... a medical record is pretty darn telling if the kid has been sick a lot. Social history, family history, notes about how the mother has taken away privileges, birthdays, school notes. It might not all be there, but I can almost see how some medical students have made the mistake of thinking they knew the patient before they even laid eyes on the very person. 

But oh, how much I think I know the patient!

---

And then the perspective flip.

How much can the patient know of the physician? The few minutes where I think I already know so much about the patient... does the patient think the same? 

If the physician is warm and inviting

If she is impersonal and cold

If he is smart and knowledgeable and concerned

If she cares about the patient at all?

---

Is it all just first impressions?