Oh hello!

Wow, it’s been a while!

Well, I’m no longer in residency but I am still floating around. I finished chief year last year and started a new position in a new city (still in the US, still on the east coast). I’m in a non-ACGME fellowship which means I’m always confusing people if I’m a trainee or an attending (I myself am confused). This position has had lots of ups and downs, but with the semi-spring brewing outside, lately it has felt like more ups. It has given me a chance to travel to and work in a part of the States that I had never experienced before (the Great Plains) and maybe I’ll write about that a little here some day.

Part of the ups and downs of my new position (still new? I started it 10 months ago) is how different my schedule is. Residency was a non-stop blur where I was either working or sleeping. Chief year gave me weekends back (mostly) and more normal working hours, which was appreciated. Fellowship, at least this fellowship, has been a mix of intense balls to wall clinical work for a few weeks at a time, interspersed with days of unstructured time to work on “projects”. It’s like a strange mash-up of grad school and crazy clinic days.

They say that stress levels increase even when people go on vacation because it’s the change in pace that gets us internally riled up. I think that the unstructured time, after a few days, has riled up my anxieties because of how easy it makes it to procrastinate which leads to feeling unproductive which leads to those annoying existential crisis moments of what am I doing why am I doing this why am I even here?!

This is an expensive city and settling into a wooden chair in a coffee shop with a $4 drink that I could make at home for cents doesn’t make sense all the time but the alternative of staying cloistered at home seems to make everything described in the above paragraph worse. It kind of makes sense now why I’ve restarted this blog, hmm? (There is the third alternative of your lovely local public library, which I have recently discovered and praise everything that they allow drinks!)

Anyhoo, I’m glad this blog is still around to plop in a few words sometimes. Hope to keep writing more. If not, see you again in 4 years!  : )

Life and loss imagined

When I was little, my family used to drive up to Toronto on weekends to have dim sum with the grandparents and cousins, and to pick up some Chinese groceries for the week. I didn’t want to go but once I was there I didn’t want to come back either. My mom would bribe me with Chinese candies and I’d drag my feet in our Toronto apartment, enjoying the plush carpeted floors while I could. These memories feel so far away, but also so familiar as if it could happen again this next weekend.

On the drive back I’d pop in cassette tapes of Fairy Tales – readings of silly and sometimes serious or creepy stories for kids – or Classical Music for Children – famous pieces done in synthesized beeps and boops. Being the youngest, I always wanted my brothers to be my friends, and I’d hope that they’d stay up on the car ride home and be in good enough moods to sing or joke with me. When everyone was too tired, I’d just look out the window at the stars and my mind would wander.

I’d think how amazing it was that the stars were so old and everyone sees the same ones. I’d think it’s strange how each of the other sets of headlights on the road had at least one person in them. I’d think how unbelievable it was that one day I’d be older and an adult and living a life somewhere. I wanted to live in an apartment with carpet and lots of Chinese sugared jellies and chocolate original Pocky. I wondered if my mom would still be nearby. I wondered if I’d still be alive when my mom died. I’d assume I would be, and I’d feel so sad that she would die one day that I’d start silently crying to myself while my mom, alive and well and unaware of her suddenly tearful distraught little daughter beside her, drove down the 401.

Obviously I’ve always been a sensitive kid. I grew up with anxiety, a healthy level usually but sometimes a little too much. It makes me indecisive but also careful and thoughtful. The trouble is I have a hard time telling when my worries are justified or when my mind is just getting away with itself.

I was driving through the ice sheets and snow today and my wipers were iced, useless. I was thinking about loss and feeling loss of things that haven’t happened. I’ve been mourning death of memories that haven’t been made, as if these moments once had life and now are sick, shriveling. There has been so much good and happiness in my life and in friendships but I find I’m wishing to have things returned to me that haven’t even happened. “Keep your promise!” I feel, out to life, the universe, or nothing. “I have lost!” I want help finding it, keeping it, preserving it before it’s all gone.

I’m not sad about anything that’s happened, which makes all this so strange. I’m so happy for everything. Yet I feel so much loss right now and I hope it’s just my mind getting away with itself but I think that I need to just let myself be quiet and let myself see that life continues to move and all it is in the end are memories made – lived, lost, and yearned for.

Halfway through intern year

Here are a few things I’ve done so far:

– felt cynical

– been humbled

– felt guilt

– went by someone else’s opinion instead of my own, and was burned

– cried at family meetings

– cried on the drive home

– hid in a bathroom and cried some more

– yelled at a patient

– felt disrespected/intimidated/supported/appreciated by other healthcare staff

– felt bad about myself for not knowing a fact

– treated someone rudely because i had just been rudely treated by someone else

– pronounced people dead

– broke it to an old lady that she had syphilis

– watched families watch their loved ones be coded

– felt like I should have been able to do more for someone

– felt like there was nothing else I could do for someone

– fetched drinks for patients

– gagged while examining someone

– woke up with anxiety cramps

– seriously questioned being a doctor

After 6 months of excitement, self-doubt, and growing pains, my morale had hit an all time low. I felt alone, isolated, and stuck. I thought it was maybe the weather, or maybe just me. I’ve wondered why I’m doing what I’m doing and why did I want this so badly – was I totally wrong? Is this what my life is going to be like forever?

It was a rough few weeks.

I’m not sure when things started to shift. Maybe it was from hearing so many co-interns mention something about feeling tired, feeling burnt out, feeling like they didn’t know why they were doing this. There was that time a 3rd year overheard us talking and sat with us for an extra hour after night clinic had finished, to tell us that he understood how we felt, that he was sorry, but that it’d be ok. He drew that graph someone had drawn for him, telling us that it’s half way through the year, the days are dark, and everyone at every level is feeling low. It’s expected and it’s ok. The more I confided in others, the more they confided in me that they too had been feeling dark and down, questioning themselves and where they are, lonely yet reclusive. In groups we wanted to appear confident and capable, but one-on-one we were openly vulnerable, anxious and insecure. One day while driving, it occurred to me how ridiculous it was to feel I was a bad person for not knowing something. Then you named this perspective and put this conflict into words.

A friend, a co-intern, told me of waking up devastated and guilty for not remembering what he had read the night before. Another told me of feeling it was time to quit. Another told me of anger over not being trusted, or fear of being thought of as not performing. And another told me how alone he felt. We all wanted so badly to show what we are capable of, to be told we are capable, to feel capable. We were falling apart.

It’s halfway through the year, and it’s some long dark days. But I’m feeling new. Newer than before when I felt like I was all untapped potential; vast and mysterious, awaiting the dramatic reveal. Now I feel like a sprout; little and very green. But earnest. Nothing more, nothing less.

Lucky in a way

I was sad a few weeks ago as I prepared to leave Brooklyn for Hamilton for a month.

Now its coming into my last week in Hamilton and as I see old friends, I’m sad again to go.

Just like the child who cries when leaving for camp, and is crying coming back.

I wondered tonight if this lonely feeling is sustainable. But on the other side of feeling sorry for myself, is the fact that the painful feeling of missing people and places can be a blessing; a reminder not to take people or good memories for granted.

When you feel like you don’t want to leave, wherever you are, it’s lucky in a way.

Halfway through sub-i

Well I’m halfway. Last week I worked every day of the week. A patient coded while myself and my co subi were alone on the floor. Backup came, of course, but it was terrifying nonetheless. Next time we’ll know what we can do, instead of just auscultating while the patient is struggling to breathe.

I’m getting into the flow of things. Said bye to some patients I’ve grown fond of. One patient has her adult daughter by her side almost every moment day and night. Her daughter feeds her, changes her diaper, and keeps her company all through the night. I felt happy and sad to see them go. Will I get to ever know what happens to them? That’s goodbye for real?

I feel like a job is done when patients leave, but really its just that my part is done. They are rarely completely healed, just stable and safe to go home.
It feels good to feel myself becoming more efficient, less afraid, growing. But I also feel myself hardening a bit. Like things don’t affect me as much. It partly comes with experience I guess but mostly just helps to work faster. There are limitations to hospital care and as much as I love the pace and intense patient care, and I love the interdisciplinary work, but I also feel sometimes like just a pit stop or a bandaid. Are the changes I make going to impact their health down the road? Will their primary care doctor make any changes? Will they follow up? Are they any more healthy?

Two Mondays to go.

Bout dem kids

When the kids are good its the best feeling! When they’re misbehaving I can’t stand them and want them out. Some people don’t like treating adults because they often are contributing to their illnesses. But I have more empathy for a smoker with lung cancer than a child throwing a tantrum.

Stars in Brooklyn

Did you know you can still see the stars in Brooklyn?

In other news, I saw an Argyll Robertson pupil today, the so called prostitute’s pupil.

The third New York

There are roughly three New Yorks. There is first the New York of the man or woman who was born there, who takes the city for granted and accepts its size, its turbulence as natural and inevitable. Second, there is the New York of the commuter— the city that is devoured by locusts each day and spat out each night. Third, there is the New York of the person who was born somewhere else and came to New York in quest of something. Of these trembling cities the greatest is the last— the city of final destination, the city that is a goal. It is the third city that accounts for New York’s high strung disposition, its poetical deportment, its dedication to the arts, and its incomparable achievements. Commuters give the city its tidal restlessness, natives give it solidity and continuity, but the settlers give it passion and each absorbs new York with the fresh eyes of an adventurer… —E.B. White, Here is New York, 1948

End of life

Yesterday I teared up on rounds as we were discussing end-of-life care.

We were talking about the end of life and how the caring for the person at that point changes when you are balancing quality and quantity of life. More specifically, we were discussing people who are imminently dying and whether or not they feel thirsty or hungry, and whether feeding them and providing fluids for them was doing more harm than good. My attending was telling us that feeling thirst at the end of life isn’t correlated with the amount of fluid the person needs, and that the thirst can often be alleviated by swabbing the person’s lips and mouth with a moist sponge. Over time, people tend to stop feeling thirsty or hungry at all. She described a common scenario where the family of the dying patient are alarmed that their loved one isn’t being fed or given fluids anymore, even if the family understands that the patient is imminently terminal. There’s an instinctive cross-cultural urge to continue feeding the loved one, thinking that it’s needed to be kept comfortable and alive. I was trying to focus on her point which was that when it comes to people who are that far gone, feeding them can lead to more discomfort with increased salivation and GI secretions that can predispose them to choking, infections, increased interventions and potentially a more drawn-out and painful death.

But I was just picturing my grandma in the hospital bed asking over and over for hot water. But she was NPO because they were worried she’d aspirate. I finally wet a gauze and put it in her mouth. She sucked on it and didn’t ask for water any more. A few days later she died, they said it was because of aspiration pneumonia. I cried because I thought I had contributed to that since I had given her a bit of water when she was thirsty. Even though people told me the small bit of moisture in her mouth couldn’t have caused her aspiration, that she already had food remnants in her esophagus before coming to the hospital, and even after hearing from my attending on rounds that providing a swab of water helps relieve the thirsty suffering without risking them aspirating, I still felt sad and teared up.

Funny experience, standing on the ward floor in our white coats and steths around our necks, discussing studies and evidence for this or that medicine or treatment or intervention, while feeling such dramatic emotions inside. We talk about these things without talking about how it makes us feel. It’s ok to bring up previous experiences with patients, but we don’t bring up personal experiences with our own family or friends. Even though I think one of the most important things is to be able to feel what you’re talking about, to be emotional, to empathize, I still struggled hard to dissociate any feelings from what we were talking about, and to look at it as just facts.

Home

It may be cold but there is snow on the ground and the people feel so normal.