holy moly

it's been a crazy few days.

1. Diseases
Pt came in with weight loss of over 20 lbs in the past 2 months (5'3", weights 80 lbs now oh my gosh); a bad cough; etc. Turns out she has tuberculosis.

Yeah. And since I was the first one who saw her and didn't know what she had, I had no mask. I have to now to get checked for TB. Ughh...

2. Boards
Something an attending talked about was DIRECTLY a question. Wow, I love it when this stuff happens!

3. Tired and not sleeping well
I've been getting these weird dreams whenever I have increased real-life-base-level-worriedness. They're always vivid and full of not so fun stuff like car crashes and waking up noon on a workday and getting yelled at by an attending. But also just weird, like dancing on someone's face, trying to get a group of people to feed animals, walking around a miniature desert in a single file line, etc. I dunno. My brain is weird. I could not make this stuff up even if I tried. And it's so vivid. It's just weird.

4. TIRED.

5. (Cont.) evaluations

I never realized how much this could impact me, but it does. I am not one to hold too much stock in what other people say about me unless it's repeated from multiple sources or there's some sort of reason to back up what they're saying. Essentially I have trust the person's words before I accept almost any feedback. 

But reading evaluations from preceptors and attendings and residents is just... Scary. Because what they say, I have to trust that this is how I am coming across in clinic. It's not, "is this true?"  It IS. Because it's about impressions now. It's not about if I actually am this or that. It's if I appear this or that. And that matters. 

Reading positives things makes me uneasily happy. What a weird contradiction. Uneasily happy. Because all those good things, I don't even if they're all actually true. I just appear like so. But at the same time, I am bowled over at how good the words are. And I can almost understand now how people can be so appreciative of compliments. Ugh. Need more time to unpack this thought. Later. 

Easy

Is there anything in life that comes easy?

Grace, you say.
I nod, but what comes after grace is obedience to God's will - which is not, and never will be, easy.

Laughter, perhaps.
Maybe. But for me, social situations are never a matter of rest, but of anticipation and consideration.

Love, then.
I laugh. Never. Love is not easy. It is emotions and responsibility and working through things together. It's dedication and persistence. And is any of that easy?


Selfishness, perhaps, comes easy. And apathy. And all of the negative traits that settle on me like a layer of dust when an object never ever moves.

I suppose sleep comes easy after a long day as well. Or maybe enjoyment. Enjoyment can be easy sometimes.

Everything in life feel difficult right now.
Effort.
Responsibility
I ought to do so.

I envy the people that make it look so effortless. Of course it might not be for them, but all the same.

touch base

went to a dinner party/friend's engagement party. It was a lot of small talk, oh how are you, I haven't seen you in 10 weeks. What rotation are you on, do you like it? Surviving? Any crazy stories?

And so on.

I guess what do you expect when you are in a room full of 3rd year med students.

These are the type of relationships that need this kind of conversation to "touch base".
It's not about how the rest of your life is doing or if your family or friends are doing alright and what else is bothering you.
It's the second layer of conversation. Not the first layer surface talk that doesn't matter at all, but just important enough that it impacts you and yet is still socially appropriate to talk about in a crowd.

I have much to learn about social grace.

Despondent

Feeling despondent and overwhelmed.

Even Philippians 4:13 seems like a distant comfort rather than something I can sink my soul into.

My heart has not learned the secret of being content in any and every situation even if my mind already has.

Future thinking is overwhelming. There is always so much to be done, so much self expectation, so much burden.

Such is life.

It is possible.
It is doable.
It is worth doing.
I can do all this through him who gives me strength.

Repeat this enough and hopefully it becomes truth instead of platitudes.

-edit-
several hours later...

Doing okay now. See? Emotions are fleeting. It is important to never make lasting decisions in the middle of fluctuating emotional states.

Interlude

Sometimes I wonder if I am stupid or something.

I know, it's that whole "impostor syndrome" where you feel like everyone around has got it down pat and you're the only one who doesn't belong.

But man, I'm feeling it so much these days. I just feel like the gap of knowledge between me and the resident and the attending and heck even the PAs is ridiculous. Or in didactics, I'm just like... am I the only one who didn't know that?

Or why can't I remember things? I know I've learned them, and it is so freaking obvious when the answer is shown. But in the moment, I'm just sitting there and my mind doesn't know where to go.

Am I just an idiot who can't synthesize the material and apply it, while everyone else can? What is going on?

Ugh. I don't like these types of days.


-addendum-
i just need to shut my face.

sometimes i just want to say something because i feel like it's witty or clever - but then it just comes out half mean, half deadpan, and 100% not funny.

Today is just not my day.

Senior Trip, Part II

I am tired but glad. Life is a lot of blessings. I think emotions are labile and everything is fleeting. So that makes this moment -this one, right now- something to be thankful for.

Continued on with this ridiculous transcription of senior trip because if I don't get it done now, I never will.

----
Day 2 - May 4th

Woke up at ~9 AM. Great sleep ^^
Got the continental breakfast with Heaven (eggs, sausage, yogurt, pastry). Dana skipped to shower.

Left the hotel (I tipped) and went straight to Carnival area to drop car & baggage off. Got a little turned around when trying to park/leave baggage, but it all worked out.

Walked out and went to the French quarter.
So beautiful, really~
Street musicians & artists and little niche stores with masks and flowy dresses and fortune telling and art galleries. The street performers like statues, the magicians. All against the backdrop of a worn down city colored brightly with pastels. The crumbling cobblestones and rusted metal. But oh the beauty of the detailed fences and the living greenery and the music playing down the street in lilting strings or soulful blues.
I love it, I love it, I love it.
[French quarter of New Orleans is a beautiful place in my memory. It has a certain old timey feel to it where even the air feels drenched in history and charm and depth. Art and beauty and sleeping dreams. If I could, I would want to go back.]

Went to Cafe Amelie, but the wait was long so we left for the Cathedral Jaucson - a beautiful Catholic church - white and stained glass.

Went back to the cafe and finally got seated after another 20 min wait - whereupon I talked to a friend's friend about politics.
The food was not worth it. Got gumbo, but it was too salty. Still yummy, but not worth the price...

Walked back to the cruise and finally met up with the whole gang as we boarded the ship. [I seem to remember security stopping David because he brought his full water bottle - and then didn't want to "waste water" so he started chugging H20. I remember us joking about Dana's passport and if there was going to be any trouble.]

Just like the last one! Everything is the same! [same as the cruise as the one I went with my family. Down to the very same stairs in the entrance to the lobby areas, so familiar!] We wandered around, stared at things, oriented ourselves, and went to dinner.

Ate so much. Ate escargot and duck; pork chop; and a ton of desserts.
And after, we tried to walk around, but Dana, Aurelia, David, and I sat down to eat fruit, cheese, and tea.

Tired.... a little tired of people. Also I am a little pissed off thoughtful and of the mindset that I'll never ask [this person] for food. I don't think [that person] cares at all. Effort is all I ask. But now I am tired and recharging. Feeling full but happy.

I was so happy in New Orleans. Everything was so beautiful and so inspiring. I hope to remember this.

-later-

Went back to the room to journal, but at around 10 pm, we were scheduled to return to the library to play; but I stayed until 10:30. There, we played Nerts and talked a little. I left moderately early around 12 AM to sleep.

So tired.

-end of second day-

Senior Trip, Part I

It's a little ridiculous, but I've been meaning to type up what I wrote down about senior year of college's senior cruise trip. And I just finished using up the entire journal, so might as well transcribe it now.

----

May 3, 2013 - Day 1 of Senior Trip

Drove 5.5 hrs from Houston to New Orleans with Dana & Heaven. Heaven got us bagels (blueberry with blueberry cream cheese for me). I forgot to keep the logo.

Stopped off at Taco Bell for lunch (and got the $5 box deal with Dorito Taco Locos).

Made it to New Orleans, seeing a ton of trees in the middle of water (Dana kindly pointing out it's a swamp) along the way.

Parked at a strange park location ON the sidewalk & nearly banging my car against a sing & rode off on a shuttle (i.e. school bus) to the Jazzfest.

As 3 girls who don't listen to jazz, we were there for Maroon 5! Dang that man is hot ^^ [I am a little surprised I wrote that. I suspect being influenced by Dana.]

Realized quickly that we should have brought rainboots. There was hardcore mud everywhere. & it was actually windier & colder than I'd expected from almost summer. Walking gingerly aroudn to avoid mud, we wanted to eat. Lol.

Got a crawfish pie, a crawfish enchilada, & a andouille gumbo. Heaven loved the gumbo seafood & strong spices. Yum. Dana mostly ate the crawfish enchilada (too cheesy for Heaven). I like the gumbo too :)

Got to the concert area for Maroon 5 early and ohmygosh the people. Traffic >.< Just like getting out of Houston. We used our asian small girls power to squeeze through but stopped because of the mud. Ack.... so much mud. We were literally sinking when we stood still. Thank heavens - I love platform flip flops.

I ran back out to go use the restroom (re: porta-potty) & came back with white chocolate bread pudding & crawfish strudel. Good, but probably should have got the gumbo again. [... isn't it "gotten? What is wrong with my grammar?]

But when I got back to the same place... they were gone >.<
So saddd.
Tried calling/texting, but no signal. I just stood around with food in one hand, phone in the other, always going on tip-toes to look for 2 asian girls.

Finally! spotted them after a good 15 minutes sigh. [I also seem to remember dropping my phone in the mud around here too. Was wiping mud off my phone for days after.]

And the concert started!

He sings really well (not as good as Bruno Mars, but still).
But we kept sinking... stupid mud.

Loved it, except for the tall people in front waving their arms and taking pictures.

Left. Not as muddy as I thought as we would turn out.

Went to Zoe's kitchen for dinner even though not hungry.

Chicken rolls were pretty good. Heaven added too much vinegar balsamic to her salad -> she hates sour things. Dana stuffed her face so she can't even remember what she ate (steak sandwich).

Left to the movies to see Ironman 3. So Good!

Back to hotel (Best Westin) to crash and shower. Ah, great start!
Can't wait for the rest ot get here.
And a whole bed to myself! ^^

Cheers to a great fantastic trip! & praying for other's safety when getting here.

-end of first day-

a thought to consider

What exactly differentiates a flaw in personality versus a quirk in personality? 

Someone who is introverted - we can just call that part of her personality. But if it is to the point where it is detrimental to social interaction or making relationships or whatever, is that flaw?

Are there even such things as "flaws in personality"? But surely there are some things, otherwise how can there be so many "improve yourself" books. 

People who say, oh I'm just truthful -- can very well just be an asshole without empathy. Truth is not always right at certain times.

People who say, oh I just have a hard time keeping up with old friends -- can very well just suck at making lasting, deep relations with people. We can call that social butterfly, or social ease. Not actually a "flaw", but wouldn't it be "better" if you were able to keep up with old friends? And if the positive if better, then isn't the lack thereof a negative? 

People who say, oh I'm just quiet and slow to warm up -- or could just be socially awkward. Again. Isn't it better if you could easily warm up to people?

Not necessarily, of course. And this is probably all touchy subject because who wants to be told that they have a flaw in their personality? Or eh, it's fine - that's just the way I am. Or eh, it's actually a positive because [we need truthful people to call out things, quiet people to understand how to listen, etc etc etc].  

Making peace

Not a rant today.

There are good things about family med.

You do get to see a variety of patients. Pediatric to geriatric. From acute to chronic. Mild to life threatening.

There is much to learn, much to say, much to do.

In this place, you decide how far you want to go with a patient. Take the time to talk about prevention and explain the disease behind it all and walk through the medications with the patient? Or just diagnose, write a script, and discharge them. There difference is potentially so, very large.

Can't you see how easy it would be to burn out here?

The continued raging against family med

Changed clinics, so I am no longer at the poor continued care clinic that lost its grant funding to pay for uninsured patients. Now I'm at an acute care clinic, which makes it oddly like weird mutt of the family medicine and emergency medicine breed. We only care about acute complaints, but we don't mind seeing you again in a couple of days.

Yeah. I am frustrated and sad and disappointed in what family med can do for patients. And it's at this clinic too. So what does that even tell me? Is it just these two clinics? Gosh. Just gosh.

A Malaysian lady comes in for generalized pain all over her body and tells us it's been going on for almost a year, unexplained weight loss of 10 kgs, general malaise, etc. (I mean, hey kinda suspicious for cancer, or I'm thinking maybe a little fibromyalgia or something even though that's by exclusion). Not good stuff, y'know? But she says she got all her labs done in Malaysia, etc etc. I go back and tell my attending. Doc and I walk in and he just has to clasp his hands together and tell her that we need to repeat all the labs and imaging because she's not in the US system. But, she stares at him a little blankly, I had all the labs done.
But not here, he tells her.
I am just standing. A medical student. A bystander. It's like watching a car crash.
They go back and forth saying the same things.
I know the results.
But I can't do anything without the standardization here. To another doctor's eyes, it would look like we haven't even checked all the basic labs.
But I've done all of the basic labs.
I know. But not in the US.

I don't know what to say. How much more silently can I stand? What could I say?

My gyn checked by blood and hematocrit and he always does an ultrasound of the kidney.
Did you bring the results?
No... but they came back normal. And he always does it. I had them done in June.
Your gyn is in Malaysia, right?
Yes...
Ma'am, every country's lab standards are a little different. We would still have to repeat them even if they were normal there.

It seems like no one will give. But then she says:
How much would it cost?
He hesitates but says, for a CBC, a thyroid test, you would definitely need a colonoscopy, and a mammogram for the lump on your breast, we would want a CT.... $5,000?
She gasps.
She turns and looks at me incredulously.
I am sure I look like a stupid medical student just standing as if I could become a potted plant.
Each of those were $50 in Malaysia!
I know, ma'am. But we would need to go off data in the US.
She is silent for a long time, just twisting her fingers together and apart.

They exchange a couple more words, and he leaves her with a hope of getting a free mammogram some way through some charity and a written order for a colonoscopy that she might have to go back to Malaysia for. And I follow him out the door.

The strength in her smile that she gives me as I walk out is heartbreaking.

....
Now you see... I don't think I wrote the doctor justice. His tone as he spoke was not callous. Nor was it frustrated or mean or spiteful or anything of that sort. It was just "my hands are tied and what can I do, here is the information i have" sort of tone. And I feel for him. What could he have done? No doctor that wants to defend/justify their treatment plan would treat without some sort of labs or imaging. What could he have done?

But I am just so tired of feeling such sadness for the patient. What could she have done?

These questions hurt so much.

The doctor who says helplessly: What can I do?

and the patient who says in pain: What should I do then?

WHY IS IT LIKE THIS? Tell me, why is it like this?

Trust

When do you decide that it's okay to trust this person, that it's safe?

It is a leap of faith. A leap between silence and spoken words.

I don't trust enough.

I think I have trust issues.

Maybe this is why I hate being dipped.

Idle Thoughts

1. I think the older I get, the more and more I appreciate my parents. (Or it that distance makes the heart grow fonder? not sure.)

2. I'm sick to my bones of studying. Woke up at 8:30 on a long weekend because that's how my body rolls now. There's an infinite amount that you can study. It is never enough, to be honest. I will always be behind. 

3. Dancing

- Okay, lots of thoughts here. But I think I really, really enjoy two stepping because it's a partner dance. They talk about it like it's a conversation. And that's just so interesting. Movement as words, intentions in the pressure of the hand, preempting movements, waiting and receiving, what you do if you misread a cue. It's a conversation of body movement and I love it. And the most interesting thing is just how different each person can dance. It's like intonation of your voice, or an accent, or the pacing of your sentences. The verbage that you choose. Do you slide or shuffle? A hitch to the right or a swagger of the hips? A strong grip? Sure, it's all the same dance, but it's different with each person. 

How well can you lead? How well can you follow? A firmer touch? Or a refusal to follow? Nobody is "right" or "wrong", but you can definitely mess up a step. Who's fault is it? Maybe nobody's. 

It's all about timing and being receptive to cues. 

I had a fantastic time trying to lead for a little bit. It kinda screws with the head a bit because you're playing opposite day and going with the other foot, other hand. But also your cues need to direct! It is definitely harder to be a guy in this case.  

--

continued:

4. Yoga is very calming.
- My favorite quotes:
"I don't need to do this out of hatred for my current self, but out of love for who I want to be."
and
"Everything is practice. You are exactly where you are supposed to be."

5. Cooking
- going to try moussaka because of S-. I just might have to go and try to make all the mother sauces for different recipes at this rate!

6. Profound Loneliness
- I think loneliness is a creeping thing. There was a poem that captures how I feel better than I could put in words:

"do not
put
your hand
in the mouth of loneliness.
it’s teeth are soft
but it will scar you for life."

(Nayyirah Waheed)

The conversations that say nothing at all make me lonelier than silence and being alone.

 7. Keyboard. I really, really want a keyboard with me right now. But I don't know if I can justify dropping 200+ just to satisfy a hobby/desire. Ugh money. It's weird because I am really starting to see where people put there money and their importance/priorities. Lesson for me before I start making any money. 

Family med take two

Can't sleep so might as well blog.

I can overwhelmed by frustrations. Maybe it's just where I am, the kind of clinic that I'm at right now - because one of my classmates is at a private, well to do clinic and is loving it to the point where she's considering it for residency. But on the other hand, she doesn't have the same problems as my clinic. 

The phrase that makes me want to cover my eyes: "I don't like taking medications so I stopped. Can you fix me?" 

I mean. I have all the empathy in the world for disliking meds. I grew up in a very "meds are only for highly cannot bear this at all I feel utterly horrible moments". I'm super wary about NSAIDs even now. But how can I get the point across that YOU ARE DIABETIC AND PLEASE TAKE YOUR MEDS! Please please please! All I want to do is see your glucose come down and you to be happy and healthy and I know meds suck, but please take them!! Or blood pressure. Or mood stabilizers. Yes please take your mood stabilizers. 

I just don't know what to do at this point. I almost want to ask, what are you expecting of us? Not in an accusatory way. Just a genuine curiosity, almost desperation, if you won't take our (highly) recommended medications, what are you expecting...? 

I will listen my heart out if that is what you want. Or we will try another med? I just don't know. I just don't know. 

Money. How much can I say that I hate America's health care? Because I loathe it with every single cell of my body. I was just horrified. No, maybe just disappointed or sadly surprised, a few days ago. Patient comes in with what is likely to be diaphragmatic pain. Acute, but not life threatening. We sent her to the ER because our clinic doesn't have the tools to do further diagnosing. We can't do a CT, no imaging here except for KUBs which she doesn't need. I am just shaking my head. My roommate went through ER last rotation and was saying how all the ER docs hate it when the patients come in like its primary care. Yeah. Well I'm IN primary care right now and we sent the patient to the ER for something that is not at all meant for the ER as it ought to be used. She will probably have to wait there because it's not life threatening. She already took hours to go through our clinic already. I am just so upset. It's so useless and broken and we can't even diagnose/treat this?

The attending was telling me this: that a lot of the doctor burnout rates are due to doctors progressively dealing with issues that are not medically related. Fighting tooth and nail with insurance companies, trying to schedule follow ups with patients who disappear. And I believe it. Even in these few weeks, I am already sick of this stuff and I don't even have to deal with the meat of the problem. 

On a tangential side note. I am so frustrated at myself that I did not learn Spanish in high school or spent more time with it in college. A patient started crying in the middle of the visit, and I felt so helpless just sitting there with a box of tissues and squeezing her hand. And all I could think of was que pasa or dolor? Or ayudar. Trabajo difficile? All of which do not fit the situation, are wholly incorrect, and are completely useless and insufficient - and one word which I'm pretty sure is French. I mean. Que es la problema (is that even correct?), but how does one comfort in a language barrier? I am not a touchy sort of person, but I had to give her a hug before she left. And I am still sitting here feeling helpless and wondering what could I have said or done differently. 

I am just frustrated. It is not "difficult" per se. But I am emotionally not happy with this rotation so far. I feel like family med is so useless. (I know, I know it's not). But it FEELS that way right now. And the worst thing is we need more family med docs right now. But who would want to go through this every day? 

Inconsequential complaints

1. I made real food, but there's ice cream in the fridge and all I want for dinner is mint chocolate chip ice cream :(

2. I forgot my coffee in the car. And I know I am literally two minutes away from going back to my car to get it... but I already sat down with my books and got comfortable. :(

3. I finished probably 80% of my work, but now I really, really don't want to do the last 20%. :(

4. I have such a good schedule right now, but I'm still tired.
... mostly because I'm staying up later than I know I ought to. :(

5. I'm trying hard to be a positive, upbeat person... but I just want to complain :(

Obviously my life is good enough right now to complain about stupid things. So there's that :)