Cardio: It's Not Just Physical Torture Anymore

Another block down, another blog post. I think this is how it's going to go from now on. But what a block it's been. Holy crap. Cardio has been a whirlwind of drugs and pathology, but the best part of cardio is the clinical experience. We had the chance to do patient simulators, both with live standardized patients and mannequins, as well as shadow real doctors in a clinical setting. With every physical examination and patient history I gather, the reality starts sinking in. In other words,  shit is getting real, folks! I'm going to be a doctor!

One of the most eye-opening experiences so far has been shadowing an ER doc at SFGH. When I found out I had been placed in the Emergency Department for my preceptorship, I was super disappointed. I wanted something in primary care, something administrative maybe, something that was low stress and chill. My classmates were unsympathetic. As one friend put it, "Some people would kill for your spot." OK, fine. No more complaining. Still, images of amputated limbs, gunshot wounds, and traumatic head injuries flashed through my mind. While these cases may make other medical students tremble with glee, frankly, I'd much rather be filling out paperwork or constructing an immaculate excel document.  Luckily, my first day was relatively gore-free.

When I headed into the ED with my preceptor, he joked that others called him a "black cloud". Whenever he came in for a shift...bad things happened. His reputation definitely held that day, as back to back traumas soon began to flood the emergency wards. There were three cases I witnessed that stood out to me the most.

1.) A little old Asian woman was brought into the ED by her husband. He had come back from an errand to find her at home, half of her face drooping. He rushed her to the hospital, where doctors, fearing the worse, whisked her off to get a CT scan in case it was a stroke. However, the scans came back clear. In the end, it turned out to be Bell's Palsy, a relatively non-life threatening form of facial paralysis caused by inflammation of the facial nerve.

What stuck out to me in this case was the language barrier the patient faced and how it negatively impacted her care. As she was wheeled in, the ED had already called an over-the-phone translator. When asked what language they spoke, the husband repeatedly replied "Chinese". "Yes sir, Cantonese or Mandarin?" "Chinese." Going off statistics, the resident dialed for a Cantonese translator. As we listened to the dial tone and waited for a translator to come on the line, the resident asked the woman to do a few diagnostic tests, mostly directing the patient with slow/loud English and exaggerated movements.  Just as the translator comes on the line, another Cantonese translator walks through the door with the husband. We hang up on the over the phone translator. The in-person translator starts interrogating the husband for details. If you've never heard Cantonese in person before, it sounds very aggressive. "Thank you for these flowers, they're simply delightful!" sounds like "I'M GOING TO DISEMBOWEL YOUR FAMILY." The ED is already a very loud environment, but the room was soon filled with the sounds of the translator alternating between yelling at the husband and yelling at the wife. After about 5 minutes of yelling, the translator reveals that the patient and her husband actually speak Toisan, not Cantonese.

As in any cases that involve elderly Asian patients, I am reminded of my parents and grandparents. I imagined my Mom sitting in that ED, bewildered and confused, not knowing what the doctors wanted from her while they manhandled her and spoke to her in a foreign language. I thought about what would have happened if the patient was actually suffering from a stroke. What consequences could those precious wasted seconds have caused?

I want to emphasize here that the ED docs did everything right. They were patient, they did the best to ensure patient understanding and consent. They were respectful to the patient, even though they were visibly frustrated by the language barrier. But what can you do when the patient is unable to give you the information that you need to give them the best treatment possible?

2.) When the ED is overcome with traumas, it is often the patients presenting with low-urgency needs that suffer. One patient had come in after suffering a serious work injury on the job. He had waited hours to be seen and in that time did not receive any pain medications. When he was finally escorted to a room, he was again asked to wait. While he waited, he asked for a blanket because the room was cold. The nurse nodded, but never came back. After a while, he complained to another nurse that he had been waiting for hours and asked when the doctor would be by to see him. This nurse replied, "This is a free hospital. You're going to have to wait."

This is an extremely offensive statement for several reasons. SFGH is not a free hospital, but it is a public hospital. This means that doctors are obligated to provide care to any patients that need it, regardless of their ability to pay. By saying this, the nurse is making an assumption that the patient is unable to afford care. This turns out not to be the case, as the patient angrily informed us that his employers are footing the bill. Offended and in pain, this patient eventually stormed out of the ED to seek care at Kaiser instead, where he has always been treated respectfully and promptly. Before the patient left, my preceptor assured him that they would file a report about what the nurse had said. "That's not how we operate here," he told me later, "I'm very disappointed that this happened to him."

Rudeness aside, long wait times are unavoidable at the ED. As you walk into the ED, the first thing you notice are dozens of patients in beds lined up against the walls in the corridor. These are for patients who need to be observed but aren't in need of urgent care. This way, doctors can keep an eye on them as they walk around. The ED has to wait until rooms open up in the wards above (internal medicine, OBGYN, etc.) before they can transfer patients over, opening up room for other patients who are still in the waiting room. So patients get mad at the ED staff about long wait times, when in fact, the ED has no control over how long it takes for patients to be seen.

3.) At UCSF, we first years are coddled. In all our sample cases, patients survive and go on to live blissful and fulfilling lives. (I've heard that they wean us off these idealized cases starting in second year.) Of course, with my luck, I witness a death on my FIRST day in the ER.

I'm in the CT room waiting for patient #1 to get her scan when my temporary Momma Duck (the provider I was currently following around) gets a code. He looks at me, "This one should be fun. Come with me."  We race back to the ED and on the way we see four policemen running in the same direction. "Uhh, Curt, are you sure we want to head in the same direction as the cops?" He just grins at me and keeps running. (It turns out the cops are heading to the same place, but for an unrelated case.) We get to the empty trauma room. I quickly find a vacated corner tucker behind Curt and try to make myself as unobtrusive as possible. Soon, a unresponsive patient is wheeled into the room and hoisted onto the bed. He has already been intubated and the team immediately commences CPR.

Everything that you've seen on television is a lie. There is no beeping sound of the ECG. The room is eerily calm, the only sound you hear is the huffs of exertion as compressions are given. Every once in a while, my preceptor would pause CPR to see if the patient's heart would start spontaneously.

"Do we have a pulse?"
"I feel a pulse!"
"OK, the pulse is weak."
"I don't feel a pulse."
"Let's do some more compressions."

This lasted for about 40 minutes, during which time they must have given epinephrine at least six times. They tried to defibrillate the patient twice but to no avail. Finally, my preceptor surveyed the room, "Does anyone have any objections to calling this?" The room is silent. "Time of Death, 17:42"

There was no dramatic sound of the ECG flatlining. There were no grieving family members waiting outside. We held a moment of silence for this stranger who came into our lives so turbulently and left so anticlimactically.

Afterwards,  the patient's family was contacted by a social worker. My preceptor and I decided it would be inappropriate for me to shadow the resident as she delivered the news. It turns out that the patient had just gone out that day to run a few errands and never came back. While he had collapsed in the middle of the sidewalk and was rushed to the ER, as strangers did their best to restart his heart, his family was sitting at home, going on with their lives, none the wiser. In fact, they would not know about his passing until over half an hour after it had occurred. This is inconceivable to me.

I made sure to give my parents a call that night as I left the ER.




I definitely feel very blessed now that I have been given the opportunity to shadow in the ER. It's not about seeing gory cases or cool medical abnormalities -- it's about seeing what real doctors do every day to serve those who need it the most despite tremendous limitations. It's the humanizing of a practice that is known for fostering God complexes.

I know I kind of just verbal diarrhea-ed all over this blog, but my brain is still recovering from that last Cardio test. There are still several experiences I want to blog about and hopefully I'll get the chance when my family and I get back from our Death Valley/So-Cal road trip!

Surviving Prologue

Wow, a lot has happened since I blogged last. Let's see...there was my White Coat ceremony, first real week of classes, first exam, my birthday, second exam, and here we are -- all done with my first block of medical school. So much for faithfully chronicling it. As it turns out, med school is BUSY. Who knew? I think I have read more in the past few months than I have in the past few years. Before my first exam, I literally read the equivalent of a large textbook in a weekend. This is my life now.

Anyways, here is a brief rundown of all the awesome things that have happened to me in the last couple weeks/months:

- Finally got the coveted white coat! My parents actually dressed up for the ceremony, and if you know my family, you know that never happens. I'm pretty sure they wore shorts to my last graduation. And of course, we celebrated afterwards by getting some quality soul food. That oxtail though! WHOOWHEE!

- Passed my first medical school exam ever. Studied way too hard. Went home the weekend after and slept for 12 hours. Med student down.

- Celebrated my 23rd birthday by telling absolutely no one in order to avoid being cornered as a crowd of people sing me the dreaded birthday song. I mean, what the hell am I supposed to do during that? Twiddle my thumbs? Cringe as people sing in approximately 20 different keys? Furthermore, do I clap with everyone when it's over? Do I say "Thank you" afterwards?? PLEASE SPARE ME THE AGONY.  In typical Abby fashion, I grabbed my free birthday drink from Starbucks ($7, fuck yeah), and went to class like a good girl. Even went to the evening review session -- now that's how you treat yo'self on your birthday. 

Haha just kidding, I did celebrate my birthday a little bit. My good friend Tina came up with her partner and my sister to take me out to dinner that Wednesday. We ate to the pain at Espetus (OMG, those chicken hearts though!) I would include a picture of us there, but my sister does this thing where pictures in her camera don't see the light of day for at least half a year. Sigh. Then, my parents picked me up that Friday and took me to House of Prime Rib. I got the King Henry cut, thinking it was the only one that came with the dessert slice. Not only could I have settled for the House of Prime Rib cut, but I also was never offered a dessert slice!! UGH. I couldn't have eaten a single more bit, but STILL. The principle!!

A formidable foe

I am always so grateful to have such an amazing family and such great friends. They treat me right. Like a baby. A very hungry baby.

Honestly, med school has been a blast so far. I've met some of the most awesome and authentic people who challenge me to see from new perspectives and never settle for less than my best. Whether we're freaking out in the Anatomy lab, checking out the faculty members in Histology lab, kayaking, paddle-boarding, hitting the gym, or shamelessly inhaling free samples at Costco, I am so grateful to have these people in my life. 

I mean, look at these goobers. Kayaking study break in the Bay!

But let's get real for a moment here. Med school is also hard. Many people here are feeling the pressure and it just reminds me how important it is to be open and honest to your peers. When I'm struggling, I ask for help. Just as importantly, when I get it (rare as this may be), I offer to help others. That's how we stay sane around here. Someone wise once said, "Never compare your insides with somebody else's outside." This could not be more true in med school. Everyone is coming from a different background. Some have had science courses every day for the past four or five years and even continued to do research in relevant science fields for countless numbers of years after that! Others have been out of school for years, working in the real world in a field that may or not even be related to medicine or science. It's not always rainbows or butterflies, sometimes people are dicks, sometimes people get hurt, but the most important thing is that you do you, boo. Whether it's rearranging your priorities, avoiding toxic people/environments, or actively constructing a collaborative and supportive social circle, you got to do what you need to do to 1.) stay sane, 2.) be the best that you can be, and 3.) be a positive influence on those around you. 

It sounds simple, but it can be so hard, especially when you're having a bad day or week. For example, a few weeks ago, I fell behind on my reading because I was having too much fun celebrating my birthday with friends and family. I skipped going to the gym that week and I cut back on sleep in order to make time to catch up. During that entire week, I was constantly tired. I felt like I couldn't concentrate or think and my eyelids would start feeling heavy whenever the lights were dimmed. By the end of the week, I just felt burnt out. I literally went home and slept for 12 hours straight. I can't imagine doing that or feeling that way every single day for any more than a week. I changed how I study, I cut back on gym time instead of cutting it out entirely, and I make sure to go to bed by midnight each night now. I feel more energized, more sharp, and most importantly, more positive about everything that I have to do. 

It also helps that I am working now (a small federal work study job), which gives me a feeling of financial stability -- I can treat myself to Jamba Juice once every blue moon now with less guilt -- while also allowing me to continue pursue my other passion, teaching. It's only 4-8 hours a week, I get paid for my transportation time, and I get to work with elementary school kids to help them strengthen their reading skills (which is what I did with Americorps during my year off). It literally could not be more perfect -- God is great!

One more thing -- I'm still figuring out where I stand with God and with the church. I've visited the campus fellowship and it seems like they are a great group of people. But committing to stick around on campus on Friday nights is difficult, especially since I live so far away. Also, not having a campus church is another huge obstacle. Most of the people from the fellowship attend church in the Mission by Dolores Park and that is a 45-60 minute bus ride away for me. Seems pretty impractical. Hopefully, I will find a good church to visit in Inner Sunset for those weekends in which I stay in SF instead of traipsing home for good food and company. 

So yes, it's becoming abundantly clear that medical school is going to be a looooong journey --more like four back-to-back marathons, really. But I'm excited to be here and I'm hanging in here! For now. 

First Steps in the Right Direction

I tried to write a blog yesterday to talk about how awesome the past two days of orientation were, but my thoughts were too jumbled in my head. How could I possibly convey this sense of excitement, positivity, optimism, and exuberance -- all sentiments usually stored in a dusty corner of my emotional repertoire. Now the first day of school has come and gone and I am still in disbelief that this is real. I'm at my dream school. And it's everything that I hoped and imagined it would be.

The purpose of orientations is really to set the tone for the rest of the program and UCSF blew it out of the water. Most orientations consist of 500 dry presentations about policies, program details, and technology broken up by icebreakers. Painful. Icebreakers. There were definitely still awkward icebreakers, but there wasn't a single passive moment. Instead, UCSF invited dozens of faculty members to volunteer their time and work with the first year medical students in small groups to discuss issues concerning diversity and bias. I was really struck by the fact that UCSF doesn't waste time (or money) on pomp and circumstance but instead hones in on real issues that plague our institutions. They are truly training us to become empathetic physicians who are firmly rooted in the communities we serve. In our small groups, we discussed difficult scenarios about racial discrimination and shared true stories of times we each had been hurt in the past. To learn more about our biases and perspectives, we talked about our backgrounds (our origin stories, if you will) and shit got real. Because of the heavy nature of the topics, we were able to dispense with small talk and really represent our genuine selves. I am so thankful that I have the privilege of attending a school that encourages discussions about controversial topics, a school that acknowledges that it doesn't exist in a void but instead bears a responsibility to the community to advocate for and model positive change. 

The conversations I had with my classmates over those two days has really affirmed that these are the people I want to learn and grow with over the next four years. There's a Chinese saying, "近朱者赤,近墨者黑", which roughly translates to "He who stays near vermillion is stained red, He who stays near ink is stained black." It's a fancy Chinese way of saying that you take on the "color" or characteristics of the company you keep. If you hang out with good people, you naturally start to adopt their good behavior, but conversely, if you hang out with bad people, you will start to take on aspects of their bad behavior. More simply put, you pick up the attitude, perspective, and behavior of the people you spend time with.

I think this past year, I picked up a lot of bad habits like having a poor attitude, assuming negative intent, and talking shit. These past few days have reminded me that's not who I am or who I aspire to be. Meeting these amazing UCSF physicians who are the best in their fields yet take time out of their busy schedule to invest in me and my fellow first-years has been transformative -- these are the role models I look up to, these are the physicians I strive to emulate.

I've said it before, but I can't stop thinking this to myself every day I'm here: I definitely made the right choice to come to UCSF. Don't get me wrong, going to Hopkins could also have helped me to become a good doctor, but I strongly believe that coming to UCSF will place me on the path to becoming a better person. 

It was a whirlwind of a first day. I've never felt this way about school before; It was always something that I had to do, not something I necessarily wanted to do. It feels like I've been eating the vegetables off the plate of life and now I've finally gotten to the best, meaty part that I've saved for last. And who knows, maybe afterwards, I'll have dessert!

New Chapter New Layout

So after five years of on and off blogging, I have finally changed the layout of my blog. This blog has always been a public diary of sorts, an outlet for my younger self. But now that I'm grown and attempting to adult, I think it's time that my blog grows with me as well.

Many things have happened since I blogged last and I honestly regret not tackling my writer's block to keep a more faithful chronicle of events passed. Looking back on experiences I wrote about like interning at the Mennonite Christian Hospital or my first days at university, I realized that I had forgotten about so many things and events that had made those experiences so meaningful at the time. And now, over a year from my last post, the only written account I have about my year of service at Reading Partners through Americorps is a saved draft with one sentence written -- "Tomorrow I start work with Americorps as a Volunteer Coordinator with Reading Partners!" Paltry effort, past Abby, shame on you. In any case, there may come a day when I try to go back and revisit my time with Reading Partners, as well as the whole medical school application process, but for now, let's fast forward to today: my first day of orientation at UCSF.

When I was in undergrad and people asked me what my dream med school was, my guarded answer was always "In an ideal situation, UCSF? Super unlikely, long shot, but a girl can dream right?" So when I was waitlisted in December, I simply told myself that I couldn't be disappointed because it was what I had expected all along. Then, one day in March when I was driving home from work, I get an email notification from UCSF that read "Status Change". Opening the email required me to log in with my UCSF ID and information, something I had neither the hands nor the multitasking skills for. I called my sister, frantic, begging her to check for me but she was still on the BART. Finally, at a red light, breaking all sorts of traffic violations, I got the email to open. I had been accepted.

I didn't scream. I didn't cry. I just drove calmly home and delivered the face steaming device that my Dad had requested for his congestion. As I handed him the box, I said, " I got you a gift." As he took the box, I repeated myself, "I got you a gift." He held up the box. I shook my head. "I got into UCSF." He said "How much was the face steamer?"

...

I should always know better than to surprise my parents. I looked him in the eye and said very slowly, "I. Got. Into. U..C..S..F!" He made the cute little face he always does when he's surprised. We ran over to tell my Mom. They were ecstatic. It seemed like a sure thing that I would be attending UCSF in the Fall.

When I received my financial aid package from UCSF, I was disappointed. I knew better than to expect a package comparable to Johns Hopkins from a public institution, but it looked like I would have to pay over $20,000 more per year to attend my dream school. (Hopkins' financial aid package would have covered everything, including housing, except $3,000.) It seemed inevitable that I would return to Baltimore for another four years.

Now I know this is the ultimate first world problem/humble brag. Oh, my life is so hard, I have to choose between attending the two medical institutions ranked #3 in the nation. Boo freaking hoo. I know both options were great, but I had to figure out which was best for me.

I won't go too into detail about that decision at this time, but it ultimately came down to student culture and school atmosphere. When I visited Hopkins, the message I received was "Look how lucky you are to be here at our amazing institution!" whereas the message from UCSF was "Look how lucky we are to have you!" I know that's not a big thing and that I could very well have been equally happy at both schools, but after both second look weekends, I knew that UCSF would be the better fit for me, even if it meant condemning myself to over $100,000 in loans.

Here I am, sitting in my room (fondly nicknamed "the closet with a closet") after my first full day of orientation and I feel at peace with my decision. Meeting my fellow classmates and taking a tour of the anatomy lab, I genuinely look forward to learning and embarking on this four year journey with my peers. I look to my left and to my right and I am still coming to terms with the fact that these people may soon come to be my closest friends. Maybe I felt this way when I first started program orientation at Reading Partners, but now, a year later, I can't unremember each inside joke or take back each earned nickname. I guess that's why I want and need to start blogging again -- so I can document and preserve a true snapshot of my feelings along this journey; so I can look back a couple months or years down the road and laugh at each awkward moment and interaction; and most importantly, so I can retain the value of each new experience, even after memory has long failed.

So I'm renaming this blog: "An Adventure of Accidents". Because I never dared to dream that I would end up here. Because I don't trust that I've ever done anything deliberately in my life to deserve this. Because I'm still not sure UCSF hasn't made a horrible mistake.

But I'm excited to see where this path leads...