Drama Vacuum

Today, while waiting for my patient to be roomed, I thought I heard my grandfather down the hall.

For those of you who don't know, this would be impossible. My grandfather died in April.

But as I entered the exam room, I was struck by the similarities between this stranger and my late grandfather -- from his chunky old-school frames down to the raspy timbre of his voice -- all that was missing was the spicy smell of my grandpa's pomade.

I remarked on the resemblance to my preceptor after the visit and told a few of my favorite stories about grandpa. There was the time where he was diagnosed with a benign fatty tumor of the liver, after which he called all the long-lost relatives in mainland China, whom he hadn't talked to since he fled from the Communists to Taiwan, to tell them of his imminent demise. We had no idea until we started receiving calls from sobbing cousins and distant relatives. That was grandpa.

My preceptor chuckled at the story and said, "I don't envy your grandpa's doctors. I wouldn't want to be them, that's for sure."

Me, being me: "He died. In April."

I savored the awkward silence before I had mercy and uttered all the qualifiers to placate the unexpecting receiver of someone else's bad news -- "he was in his 90's", "it was his time",  "it was peaceful" yadda yadda yadda.

But then I was struck by a thought.

"He's probably the reason I went into medicine."

And it's true. The story about his liver tumor and his hypochondriac tendencies was the central theme of my personal statement for both undergrad and medical school. I remember thinking, "Well someone's gotta take care of him." Saving on his hospital bills would probably have financed my entire medical school education. Out of all of my family members, I know he would probably have been the most likely to abuse my medical knowledge. Reflecting on this made me feel a twinge of regret that he never got to see me graduate and become a doctor. I never got the opportunity to slap unnecessary medications out of his hand or head off needless specialist visits....now I'll never get the satisfaction. I never had the chance to sit down and explain his various symptoms and syndromes to him and soothe his hypochondriac mind.

For a man who feared death so much and did everything he could to prolong his life, in the end, his passing was as billions before him. Uneventful. Unremarkable. Quiet.

He checked into a hospital because he wasn't feeling well. He died in his sleep.

I guess if grandpa had to choose a way to go, that would have been it. (Well...he probably would have exhausted every loophole to avoid death first.)

I learned a lot of things from grandpa -- both in life and in death. Many were lessons in what NOT to do, but I feel like these lessons are almost more valuable:

He taught me to be generous and to give freely with no strings attached and no expectation of return.
He taught me to invest wisely and to plan for the future.
He taught me the strength of the pen and that the value of education comes in opportunity.
He taught me not to hide behind anybody else and to take responsibility for my actions. In that same vein...he also taught me how useful it can be to delegate. heh.
He taught me to place family first -- to seek to unify rather than divide, to love my children unconditionally and equally.
He taught me to marry well -- to find someone who will love and cherish me despite my many faults, someone who I will honor and respect until the end of my days.

I miss watching him and my dad play Tank on the old-school Nintendo. I miss the cultured ancient Chinese proverb insults they would exchange while playing billiards. I miss those random moments where I run into him in random cities, crossing the street with his heavy overcoat on and his communist-looking felt cap.

Most of all, I miss the stories. Every day of grandpa's life was fodder for an amazing anecdote. That time he ate so much that his intestines stuck together and he had to have them surgically repaired. (Saying "that time" is inaccurate, as I'm fairly certain this happened more than once.) That time he administered an injection to uncle's buttock and accidentally paralyzed him temporarily. That time he took too many of his hypertension pills and passed out at the Thanksgiving table and Dad got to slap him across the face to rouse him before the paramedics arrived.

Grandpa's life was theatre. Without him, there is a drama vacuum that the universe has wasted no time in filling. But alas, those are stories for another time.

RIP Grandpa. Don't worry, you'll live on forever in the stories you've left behind. Love you.

Life is Crazy Like That

So I survived two weeks of  In-Patient Surgery (I capitalize to emphasize the magnitude of this feat).

...Aaaaand it wasn't as bad as I thought it would be.  *Cue dramatic dun dun duuuuuun.*

Yes, the hours were terrible. For two weeks, I woke up at 4AM to drive to Mission Bay in the dark and braved rush hour traffic to get home by 7ish. Despite the hellish hours, I honestly feel that I learned and did more in those two weeks than a month and a half on outpatient medicine (like learning how to parallel park).

I went in thinking surgery was this enigmatic, unassailable obstacle that I would have to endure. My mind was filled with images of the cinematic OR -- a tense, fast-paced, high-stress environment, where every decision meant life or death for the patient on the table.  Such is not the case. In actuality, the OR is a place where mistakes can be made and fixed; surgery is not as precise as legend may claim. I can still pinpoint the moment I came to this realization. We were running the intestine looking for metastasis of a renal cell carcinoma and we found a few bumps. The surgeon and the chief resident conferred and the conclusion was: "The tumor is aboooout here. Let's cut this much just to be safe."

One of the "tensest" moments I experienced on the OR during those two weeks** was when we were doing a splenectomy and the surgeon nicked an artery. I saw a gush of arterial blood and I thought "OH FUUUUUUCK." The surgeon just sighed, calmly walked around the table, stuck his hand in the port, and staunched the bleeding. LIKE A BOSS. The surgery went on like nothing had gone amiss.

**I will say though that I stood in on a planned C-section that progressed into a crash C-section unexpectedly. That shit was cray. When the nurse dumped a bottle of iodine on the patient's belly and the team of OBGYN surgeons came running in, I knew shit was going down. They had that baby out in a matter of minutes as I just stood there in mute horror.

There were bad moments in the OR too, but they were mostly the result of me psyching myself out. Like the time I stood in to observe on a surgery with another team and naively thought this meant I wouldn't have to do anything so I chose to put on larger (more comfortable) gloves BUT LITTLE DID I KNOW I would be called on to tie down a drain and I could literally do nothing but stare in horror at the strings in my useless, uncooperative, impotent fingers. The chief resident had pity on me and took the strings back, but FUCK that was embarrassing. I went home with a pair of gloves and practiced until I couldn't taste the shame at the back of my throat anymore. Took a while.

But that's another thing about me that I've come to realize. I'm not motivated by ambition or pride. I'm motivated by shame. For example, just the other day, I rolled into my second Psych clinic session ever, fresh out of my in-patient experience and literally stepping out of the OR earlier that morning. Long story short, I got owned. During the first session, which might I add, took place over three weeks prior, all I was expected to do was observe. Potato that I am, I had high hopes that the second session would be more of the same, with maybe a slight step up in my expected involvement. Oh ho ho, how wrong I was. From the moment I walk into clinic and the preceptor says, "Have you had a chance to read over all the patients for today?", my heart began a slooooow descent that would continue throughout the afternoon. I was grilled on psychosis. Tested on SSRIs. With each "uhhhh" I uttered, I could see my disappointment in myself reflected in my preceptor's eyes. I got some serious flashbacks to my childhood. I vowed to myself that the next session would be better. And it was. Because I studied my ass off. But if I hadn't failed so spectacularly, if my preceptor hadn't expressed his profound disappointment -- almost apologetically like he was saying, "I'm sorry, but I have expectations" -- would I have changed? Nope. I AM MOTIVATED BY FEAR AND INTIMIDATION. And shame. Because I'm Asian and I am nothing but a product of my upbringing.

Another thing I've come to realize: Being a doctor will always be something that I do, not something that I am. I am not fascinated by research and discovery. I don't wake up every morning, spurred awake and energized by the realization that I'm going to save a life today. That's just not who I am. Yeah, those things are cool. But I do them to meet a requirement. It's a job. It's not what I do for fun. It's not satisfying and fulfilling in and of itself. At least not yet. And I think I've been having difficulty accepting that over the past few years of my medical education -- something that has occasionally taken its toll on my mental and emotional health.

A tidbit the pastor touched on in his sermon today. When you're in a good place, you transition from unstable to stable, rigid to resilient, reactive to receptive, and detached to empathetic. These are definitely things that I've been seeing in myself over the last few months. Before my first day of rotations, I was so resistant to my roommate's suggestion to read over my patients before I went into clinic that I almost threw a fit. It wasn't that I thought I didn't have to, but there was a stubbornness that latched on because I didn't want to. I was tired. I didn't want to give more mental energy to this task because I hated the idea of giving more to medicine than I felt it had already taken from me. I didn't care about the patients in that moment, because they were a burden that I didn't feel ready to handle. Just more people who wanted something from me, people with expectations that I wasn't sure I was equipped to meet. Unstable. Rigid. Reactive. Detached. I was all of these things. On top of all this, I was thrust into the strenuous environment that is inpatient surgery.

But what is that expression-- something about boiling water softening the potato but hardening the egg? I guess this potato blossomed into an egg.

I thought surgery would destroy me, that I wouldn't last. But instead, surgery showed me that things aren't as terrifying and impossible as I make myself believe. I actually thought to myself, "I can do this." And I don't think change of heart is anything that I can claim credit for. If anything, it was the amazing team that I had the privilege of working with in those two weeks. I'm self-deprecating and insecure when I feel out of my depth, but they made sure to take the time to reassure me that I was capable, built me up with every learning moment, and most importantly, they gave me opportunities to prove to them, and myself, that I was competent. Those two weeks could have gone very differently and I thank God for His looking out and having mercy on my fragile state. More on me and God at another date.

So I'm resolving to move forward with a more positive and hopeful attitude. I hung out with some friends for the first time since rotations started and Kirk joked, "What if our entire anatomy group goes into surgery?" If you had said this to me during first year, I would have laughed in your face. But now who knows? Life is crazy like that.