No right answer for things.

Today, a daughter and mother had to decide whether to give the unresponsive elderly father a feeding tube through his abdomen into his stomach or whether to bring him to hospice care. Before coming to the hospital he had advanced dementia but would sing songs to his family. When he came to the hospital he has been sleeping and has minimal brain activity. The mom, elderly, only speaks Italian and during the family meeting today we weren’t sure if she didn’t understand the situation or if she wasn’t absorbing it. The daughter, who is the health care proxy, was at one point made it very clear that he was full code. But today, crying, she thought perhaps keeping him alive for as long as possible no matter what may not be the best decision. I remember the first time I saw the patient in the emergency room. His elderly wife next to him, so little small and seated in the plastic chair, waiting for her firey daughter to finish reprimanding the medical team for not keeping her in the loop at the start so that her daughter could translate everything that was going on to her. When everything had been smoothed out with the attending and the daughter, the attending asked if the daughter or mom had any other concerns. The mother reminded the daughter of something and the daughter translated that the mother was concerned because her husband, hypoglycemic and unresponsive, still hadn’t had his flu shot. I felt so sad that moment.

things change

i saw my grandma today (dad’s mom) who has alzheimer’s and has been in the hospital after a few falls and pneumonia, then a high fever. she’s on palliative care and was sleeping a lot, but lately she has been having occasional days where she’ll be wide awake and even talking to people! before the fall she wasn’t talking to anyone!

my mom and i visited her today, me for the first time. she looks different but not as different as i expected. she still has all the features i think of when i think of her, the things i’d picture when i think of her. chubby cheeks, a round eyelid like mine, and a contented smile. she was awake but suspicious looking when we first approached her bed. my mom tried to talk to her a bit in mandarin, and my grandma just fiddled with the paper towels she was holding, her pillow, her legs, and rubbing her ear. then, my grandma started to smile and chat a little bit. she would look up at me but not know who i was. until i handed her her paper towels and she looked up then started smiling really big at me! she patted me and said “xie xie ni” (thank you). i don’t know for sure if she recognized me, but i think she might have! she kept her eyes on me for a while, smiling. maybe she didn’t know who i was exactly, but that she knew me and i was close to her. my mom told her that my brothers had visited, and my grandma repeated my brother’s nickname. after that she was chatting lots with my mom, just about things she was seeing, complimented my mom’s shirt, and so on. she patted my mom’s face. i thought of how she had told me years ago that she had always wished for a daughter but had 3 sons instead. that she thought of my mom as the daughter she never had, and when my parents divorced she cried so hard over the christmas cards she’d write us.

all in all though, it was so heartwarming and comforting to see that my grandma was content and doing alright in her hospital bed. she seems happy even, like a child. i guess she’s just always living in the moment now, literally, and has no worries.

i’m starting clinicals in 2 weeks, surgery first for 12 weeks. another big change. it’s funny being so aware of time going by, and the process of growing older and living your life. i still have moments where i feel so sad that one day i’ll have to die, and everyone i know will too – the same as when i was little and so sad that my mom would die one day that i’d cry in the car for 2 hours as she drove us home from visits in toronto. i’m tearing up now just thinking about it! geez.

one of my brother’s best friends works in the hospital my grandma is in. he happened to be walking by when we came in the doors, so he chatted with us as we went up to my grandma’s floor. when i told him i was starting clinicals in 2 weeks he gave me this look and told me “oh, wow. good luck.” not unkindly, but in the same way that i would probably react if someone told me they were starting med school. kind of like when someone is in puppy love for the first time and gushes to you. “oh.. you are so fresh, so young. you’re going to have soul-crushing moments. but hopefully you’ll get through it wiser but not bitter. good luck.”

really though, i’m excited. when i was heading to the pool today the olympics were playing at my gym and the 200m women’s breaststroke race was on. i watched it, the only part of the olympics i’ve seen so far. i forgot how cool swimming looks from underwater. i felt… funny. i swam, and thought of when i was at 2008 olympic trials. i was so scared and going so wacky with my fear. on the verge of tears, couldn’t stop thinking about how i didn’t deserve to be there, i didn’t belong, i was too old, i was so embarassed to be there, i was a joke, everyone else looks like they belong but i’m just the bottom of the barrel. even the nice brand new racing suit i was given, the new gold-coloured cap my coach gave me, the massages, everything – made me feel worse and more undeserving.

what was my deal? i wondered today, swimming. why was i so freaking scared? what was there to lose?

i had 1 really good race, my first one. and after that i fell apart. i was scared of the pain and so full of doubt that it all seemed pointless.

looking back, i know i felt bad about how my swimming career was finishing, and disappointed in my last races in varsity. i guess i felt scared of letting myself down again, then of the pain during a race, standing beside 13 and 14 year olds behind the blocks, later being so far behind in my heat.

but today i was swimming, thinking about what an amazing week trials was, thinking of the things i’m scared of today, wondering what my future self would say.

My first flu shot

I have such a great big brother.  He came by this morning to get his flu shot from my mom but he agreed to let me give it to him instead!  I don’t know whose idea it was.. maybe his.

I was a little nervous but just pretended it was no big deal.  I’ve always had a big discomfort around needles that sends creepers up my spine every time I see an uncapped syringe.  It helped that I told Andrew it might take a little a while and he didn’t mind.  I didn’t tell him it might hurt more than usual, but I’m sure he figured.  I watched my mom give a shot to Andrew’s girlfriend, and then it was my turn.  We took some practice shots with the cap on, just getting the motions down right.  Wipe with the alcohol swab.  Stretch the skin.  Pinky on the shoulder to steady the hand.  Pop in the needle – “Bok!  Bok!  “Bok!  Just like that”, my mom advised me, miming the wrist action in poking in the needle.  Pull out the plunger slightly to check for blood (don’t want to inject into a blood vessel, better into the muscle).  Then ease in the vaccine, and pull out the needle.  Easy peasy.

My mom was going to prepare the needle but Andrew insisted I do as much as possible.  There was a tiny bubble in the vial of the needle that I couldn’t get out and I was concerned about sending in an air embolis to my brother and killing him with a flu shot (i.e. your typical med student moment where one’s textbook knowledge reveals one’s lack of understanding the relative importance of things and one’s inexperience in clinical realities shines).  My mom took a look and said it was “insignificant” but she still flicked it out like a pro.

Andrew’s girlfriend took some pictures (again, Andrew’s suggestion) as my mom, Andrew and I hammed it up for the camera with shot poses.  I was kind of nervous still, but the two of them were breaking the tension.  Finally I was looking at Andrew’s freshly swabbed and shiny skin, the point of the needle pointing at the slope of his deltoid.  I had nothing left to do but Bok! in the needle.  I hesitated then unconsciously thought to pretend like this is no big deal and it’s easy, and suddenly it felt that way.  The needle went in and I felt a slight give and pop as the skin broke.  My mom suggested I push the needle in a bit further so I did and it slid in quite easily.  I adjusted my other hand so I could use the plunger, and the needle slid a milimeter or two out.  I was surprised how easily it was sliding in and out.

I had asked my mom ahead of time what it was that made taking needles painful.  She said it’s when the needle is pushed in and is slid horizontally, parallel to the surface of the skin, which leads to more broken nerve endings.

I pushed in the vaccine (which I know from experience is the most painful part) and then it was done.  I quickly slid the needle out and a red blob of blood quickly replaced it.  Some gauze on it and that was it!

Andrew was impressed, saying it was a pretty good job and didn’t hurt at all.  I was shaky afterwards but so happy — it was even kind of fun!  The pop of the skin is like popping bubble wrap.

In the pictures everyone looks relaxed and jokey, while I look a little gaunt and stiff.  My chin is pressed to my chest, my neck stretching back as if my body is trying to get closer to the needle and shoulder, but my brain is still trying to get away.

My second needle given, my first flu shot, and now a little less scared of needles!

A vaccination in action

Just finished.

Post vax dim sum - curry squid, leechee/goji berry jellies (shaped as fish), and yes a hello kitty mango pudding with condensed milk.

From Baba

Hello ,

Your birthday is coming up.

 

It’s not funny.

During today’s 8am Clinical Skills and Physical Diagnosis lecture, the professor was demonstrating various gaits and the class would guess which gait he was performing.  There was the hemiplegic gait (one foot sweeps out and around, kind of like a dragging on the floor), the Parkinsonian gait (stooped over, short shuffling steps), the paraplegic gait (scissor gait, criss-crossing legs) and the sensory ataxia gait (i.e. drunk gait, wide steps as if your feet are magnetized to the ground).

Maybe it was because it was 8am and a poorly attended lecture.  Maybe because we all looked disinterested and he was feeling desperate to get us to pay attention.  For whatever reason that seemed good to him at the time, after demonstrating Parkinsonian gait he joked “It looks kind of like a retard. Do I look retarded?”

My grandma died the winter before I started med school from complications of Parkinsons.  It was a slow but dramatic decline that spanned over a decade.  I remember my mom and my aunt arguing with my grandma about why she needed to take her medications.  My grandma didn’t want to because she was afraid of the side effects.  I sided with my grandma because she seemed so upset, and told my mom maybe she should leave my grandma alone because she really didn’t want to take the drugs.  I was about 11.  When I was in high school I went with my mom and brother to see my grandparents off at the airport to Hong Kong.  My grandma was put in a wheelchair for the first time and my grandpa told me and my brother in Cantonese that they loved us.  It was my first time hearing that from them.  They never came back to Toronto.  We finally sold their house this year.  For the last few years before she died, my grandma could no longer shuffle “like a retard” and was completely bedridden.  Her mind was still sharp but she spent her days staring at the ceiling of her bedroom or choking on food during meals.  She had told my mom she wanted to die, and had nightmares every night – another complication of her Parkinsons.  After my masters me and my brother and my mom visited my grandparents in Hong Kong, just as she started bleeding profusely from her GI and was hospitalized.  We spent our mornings and evenings sitting in her hospital room with masks on.  Sometimes she chanted Buddhist prayers under her breath and waved her skin-and-bones arms, sometimes she stared at the cartoons flickering on the TV in the corner, but mostly she slept.  They went in to scope her GI and found food and crushed up pills stuck in her oropharynx.  My grandpa, with his OCD tendencies, could barely get himself to visit her in the hospital because he was so afraid of germs.  She died with my mom, cousin, uncle, grandpa and my grandpa’s secretary in the room.  Me and my brother were outside joking around on my mom’s computer.  I was making a cartoon about him.  My mom came out and said “Paw Paw died.”

She was totally different when I went in to see her, just a body.  I was so acutely aware that her life was gone.  It was scary to look at her.  I thought she might jolt up, zombie-style.  I kept thinking “This is now an object.  We are just objects.”

Ten minutes after calling the Parkinsonian gait “retarded” the prof made a joke about Schizophrenic patients wanting to tear up and eat a sealed and stamped envelope, rather than mailing it like a reasonable person (part of the mental assessment test for judgement) and people in my class who are studying to look after people of all illnesses mental or physical, laughed.

I visited my grandpa last summer, just me.  It was my first time visiting him without my mom there, and he opened up to me about my grandma’s death.  He told me how she was the love of his life, that they were together for 80 years and that she had dropped out of high school to marry him when the war started and he needed to move to Macau to run the family factory.  He told me after she died his heart has been broken and he thinks about her every hour, 24 hours a day.