Sacrificial Love

So my cousin, who has stayed with my family for the past month or so, finally left yesterday. To provide a bit of background -- she's technically my father's cousin's child. Before this visit, I'd met her a grand total of one time. From what I know, her father is a real piece of work and for all intents and purposes, she considers herself an orphan. My father has kept in contact with her for the past several years through the loss of her mother and other assorted family dramas. A few months ago, he learned that she had been diagnosed with cancer. It was found late and, by the time of diagnosis, had already spread to her lungs. My father,  being my father, instantly issued an invitation to come visit America and stay with us to keep her mind off her prognosis between treatment cycles. 

At first I was resentful. I thought about having a stranger in my home for a month. I could say I worried about the burden my cousin's visit would be on my mother, I could say I worried about my father getting too emotionally attached to someone with a terminal illness, but truth be told, I was only thinking about myself. Who is this stranger coming into my home and jeopardizing my parent's love and attention? That's mine! I want it. After weeks of soul-crushing work on the wards, I jealously guard what precious time I have to spend with my family. The last thing I wanted was to come home and have to entertain a guest, let alone one who will sleep in my room, relegating me to a mat on my parents' bedroom floor.   I knew that these feelings were wrong, but I couldn't help stewing in them while driving home for my first visit after her arrival. 

After just one day with her,  all that resentment evaporated. She was a perfect guest. She literally brought an entire suitcase of Taiwanese snacks for my family. She even brought doggie treats for Abby and Amy. She is kind, considerate, and funny. She would spend time each afternoon teaching my mom how to make felt dolls. She would go with my parents to their community garden and tend the plants. She taught us how to make pearl tea like they do in the boba shops. She was truly a blessing to my family over the past few weeks -- helping keep my parents occupied and most importantly, helping to keep my father's mind off his current state of unemployment. Her presence gave my parents purpose for the time while she was here. 

Last night, as we drove her to the airport, she confessed that she was depressed about going back to Taiwan. She was scared about going home and having to face her next round of cancer treatment on her own. She was so grateful to us for inviting her into our home and allowing her to experience family life. As we drove away, my father took a moment to thank us for helping take care of our cousin during her stay. In that moment, I felt so deeply ashamed at my initial, unfounded feelings of animosity towards her. What a selfish jerk I am. I wasn't even home for the majority of the time she was staying with us. 

Even as I was filled with self-disgust and loathing, at the same time I felt such respect and love for my father, who has always served as an example when it comes to selfless generosity and going the extra mile for the sake of helping others. While I saw only a stranger who was encroaching on my territory, my father saw a scared woman, faced with her mortality far too soon, with no parents beside her. He saw her needs before she articulated them and his first instinct was to reach out and offer whatever he could.  

My father drives me crazy a good 65% of the time and 25% of those times it's because he loves in a way I cannot. When his heart says "help", mine says "wait, but is that sustainable?" When he reaches out to give, I'm thinking, "wait, but what's in it for me?" Half of our fights are because he's unwittingly volunteered my services to help someone and I'm like "Goddamnit, I didn't sign up for this." Well, more like I fight and he gives me sad and disappointed looks. Then when I cave and help because I cannot say no to his sad and disappointed looks and I inevitably feel good because I've helped someone, I paradoxically get madder because I feel guilty for having not wanting to help in the first place-- YES I LIKE TO HELP PEOPLE, BUT I WANT IT TO BE OF MY OWN VOLITION, SONUVABITCH.

But it's experiences like these that remind me to be grateful for my father's influence in my life. Countless times I fall short and I regress to my most primitive, selfish, and hateful nature. I thank God, who knows my many shortcomings and gave me my Dad to pick me up and encourage me along this uphill battle every day. I can believe in His sacrificial love because I experience my father's sacrificial love every day.  Watching him reminds me to strive daily to be better. If I could only be half as good and half as genuine as him, I would be content. 

Deceitful Desires

So I'll be the first to admit that I'm not a regular church attendee. I tell myself (and others) that my absenteeism is due to my erratic med school schedule and splitting weekends between SF and SJ...but let's be real, there are plenty of Sundays when I'm just sitting in my apartment eating cookies and binge-watching Netflix. I've been dropping in to the same church in San Francisco since I started medical school almost three years ago....and today someone who started attending the church AFTER me introduced themselves and welcomed me to the congregation. Needless to say, I am not considered an actual member of this church.

My relationship with church has always been hot and cold. I grew up in church, where I spent years trying to reconcile my father's religion with my own. After years of mission work, I decided to get baptized. Then I came out as bisexual, which put some stress on my relationship with God and the church. And while I can honestly say that God and I are mostly aiite, my relationship with the church is still somewhat estranged. Nowadays, I treat church like confession or therapy. I go when I feel I especially need some Jesus.

I've mentioned it before, but one of the things I've been struggling with the most recently is apathy. Maybe emotions function like muscles or neurocircuitry. Use them or lose them. I spend a lot of time suppressing negative emotion because who has time to deal with that shit? If I spent time dwelling on my many crippling insecurities -- my tepid academic performance, the yawning abyss that is my love life, my Pillsbury-doughboy-meets-Michelin-Man physique, the gnawing feeling that I can never do enough, never BE enough -- I'd be a perpetual black cloud of neuroses. So I put those feelings in the industrial-grade Instant Pot that resides deep within me, to be vented on those rare, controlled occasions that are usually instigated by a Thai insurance commercial or Youtube videos of soldiers being welcomed home by their dogs.

On this particular occasion, I was driven to church by my growing conviction that I'm going to die alone. The last two dates I went on didn't pan out, which I know on a rational level isn't my fault, but I can't help but think that something is wrong with me, that at the ripe old age of 25, I have only had one real relationship...that ultimately failed rather spectacularly. That one was my fault. This feeling of inadequacy, coupled with my latest truly dismal shelf score (I passed an exam by a margin of one point) and my general unhappiness in medical school, has literally been keeping me up at night.

So I went to church. To find rest in the bosom of my Lord and Saviour. (But for real though.)

Despite my attendance being erratic at best, I do love this church. The pastor advocates for Christianity as a vehicle for social justice and his sermons makes me want to snap my fingers and stomp my feet and yell "YAAAS PREAAACH!"

Today's sermon was on Ephesians 4:17-32. In particular, one of the points that the pastor made about verses 22-24 really spoke to me:

22 You were taught, with regard to your former way of life, to put off your old self, which is being corrupted by its deceitful desires; 23 to be made new in the attitude of your minds; 24 and to put on the new self, created to be like God in true righteousness and holiness.

He asked us to think about what was keeping us from discarding the vestiges of our old, corrupt self. He described "deceitful desires" as those things in our lives of which we tell ourselves, "If I just had ___ , I could be happy." If I just had that promotion. If I just had the new iPhone. If I just had a 260 on my Step 1. If I just had my first-choice residency. If I just had a life partner. Maybe I'd be happy.

But the Word reminds us that these desires are deceiving us into looking for happiness in earthly goods rather than in God. Settling for the temporary when He has promised us the eternal.

On my way to church, I prayed that God would speak to me and help me overcome my struggles. I'm not saying the sermon today caused all my fears and doubts to instantly evaporate, but I definitely did receive some much needed spiritual and emotional healing.

While driving away from church today, I suddenly felt, with both clarity and conviction, that I didn't want to stay in academic medicine. I thought about how unhappy I've been in medical school, or really, how unhappy I've been since education ceased being fun after high school. I've been feeling like a square peg forcing myself through a round hole, futilely sanding away at my edges to make myself fit in with my peers who just love learning and are just brimming with intellectual curiosity. Maybe it was the way I was raised. My parents were never invested in their careers. They were invested in family, in us. I don't see myself as someone who will ever glean satisfaction from prestige or recognition in my career. I don't derive happiness from my job. My job will always be something I do so that I can continue to feed my true source of happiness -- my family.

I've been torn between shooting for a prestigious residency or leaving academics for an organization like Kaiser. Half of me feels like doing a residency at Kaiser would be selling out, like I was choosing lifestyle and money at the expense of the care of my future patients. The other half of me continually questions my motives in applying for a program like UCSF. I'm miserable in medicine. Would I just be doing it to prove that I can? To shout to my peers "Hey look, I'm choosing Family Medicine and I'm just as intellectually capable as the rest of you"?

But as I made my bi-weekly pilgrimage to my Mecca (Costco), in that moment of clarity, I thought -- "Why the hell would I put myself through 3+ more years of this?" And I felt peace. And I felt liberated.

So that's where I am now....but I'm hopelessly fickle so let's see where I will be tomorrow. I can only continue to pray that God will (firmly, but gently) guide me along the path He has in store for me.

Med School Is Like a Box of Donuts

It's been a whirlwind of exams. It seems that every time I finally bite the bullet and take one, it's about time to start studying for the next. I'm nowhere as busy as a real medical student (I call PISCES life Med School Lite), but it's been a while since I've had the time to catch my breath. OK, that's a lie. I watched 4 seasons of Grace and Frankie while procrastinating for my Surgery shelf. I also got sucked back into playing Tetris and 2048, but in my defense, these are the outlets that are keeping me sane at this moment, aiite?

Last week, we had a reflection session at PISCES school to talk about "meaningful" encounters. I found it extremely difficult to identify one. It's not because I haven't had any meaningful encounters thus far in my medical training. Far from it. On one hand, I think it's because most of these "meaningful" encounters have been meaningful to me, probably not so much for my patients. Let's be real, how much impact am I making in my patients' lives? At the end of the day, I'm not their doctor. I'm just the person who came in and asked them questions before the doctor came in and asked the same questions all over again. Maybe I held a few hands. Maybe I exchanged a few comforting smiles or sympathetic grimaces. Most of my patients would have been happier if I had been a box of free donuts in the corner. Hell, I'd be happier if I were a box of free donuts in the corner. Donuts make everything happier, but I digress.

Other students talked about ways in which they had directly improved patient care. Times they had stayed after hours to do something extra for their patients -- true advocacy through action. Feeling contrary in the way cornered animals do, I declared, "I can't say I've had any meaningful encounters." Then feeling defensive at the pointedly leading questions and prompts I began to receive ("You know, anything that confirmed that you wanted to be a doctor, that moment."), I may have responded flatly something along the lines of "I don't get off on saving lives.", but I'm sure less crude. Maybe.

I had nothing to share because a.) I have an attitude problem and I don't like feeling compelled to over-sensationalize my experiences for the sake of "aww" moments, and b.) all the moments that came to mind felt self-centered and insignificant to anyone other than myself.

After the session, I wracked my brain. I know I've had meaningful encounters throughout my time in medical school. I have phantom memories of tightnesss in my chest, burning behind my eyes, leaden weights settling in my stomach, excitement bubbling at the back of my throat, a buoyant skip in my steps -- but no concrete memories, no names to faces -- entire narratives dissipated into the ether.

I fucked it up. I got so caught up in the stress of the moment -- there's never enough time, always something else to do, something else to study for  -- I failed to take the time and truly reflect on my experiences. And everyone knows my long-term memory is god-awful. So I made a resolution to start more faithfully reflecting on patient encounters that make me feel something. Because God knows I've been struggling with apathy. 

A few days ago in surgery clinic, I met a patient who had terminal esophageal cancer -- an insidious growth that was compressing his windpipe, prevented him from swallowing, and had robbed him of his voice . He already knew that the cancer would eventually kill him, his only question was how much time he had left. For his physical exam, I dutifully noted that the patient was breathless and audibly having difficulty breathing. My preceptor frowned. Having never met the patient before, I was unaware that this was a new development...and made for a terrible prognosis. I found myself standing mute in the corner as the surgeon explained to the patient that, should breathing get more difficult, he should report to the ED right away for a tracheotomy, a hole cut in the windpipe to facilitate breathing. The patient, an elder gentleman who hoped to live long enough to officiate his son's wedding just a few weeks away, didn't meet anyone's eyes as the surgeon explained the necessity of the tracheotomy. "Suffocating is a horrible way to die." My surgeon paused. "You don't want the trach." It was more of a statement than a question. The patient shook his head. His wife pressed his shoulder and urged him to take some time to think about it, reconsider. "Think about the kids. It will be hard for them to see you like that."

After they left, my surgeon made a few calls to try to squeeze the patient in to see another specialist who might be able perform the tracheotomy later that day. But even if the specialist agreed to see him, it was ultimately up to the patient whether or not he would agree to have the tracheostomy placed.

It was an important moment for me because I was reminded that sometimes the patient and the provider have different goals for treatment. A tumor is gradually paralyzing your vocal cords and you can no longer breathe -- it's OK, we'll cut a hole below the obstruction and buy you some time.  The cancer will kill you in weeks, months even. Not being able to breathe will kill you in minutes. Our goal is to prolong your life. But to the patient, this means an invasive procedure when he already feels weak and drained, breathing out of a tube that protrudes from the front of his neck, suctioning mucus that he can't cough out from a literal hole in his neck. If this isn't a life he finds tolerable, then why are we seeking to artificially prolong it?

At the end of the day, it is the duty of the doctor to make sure that the patient has all the information they need to make a decision. Once that decision is made, we must respect the autonomy of our patients. As someone who gets off on being always right, this is excruciating. But it's something I need to learn how to accept.