An Oasis in a Dry Field of Withered Fucks

There are many times on my rotations that I think to myself, "I should blog about that", but med school life being what it is, I rarely have the time to follow through. Today is no exception. I should probably be studying for my OBGYN shelf exam on Friday, but here I am....procrastinating.

Last night, I had the most "medical student" experience of my life when I finally caved and accompanied my surgery preceptor on an organ procurement. (He's been nagging at me for months about coming along and I've been begging off because it's a logistical nightmare AKA I love sleep too much.) Usually for organ runs, you're on call and could be heading out at any given moment. As someone who sees patients across a variety of clinics throughout the week, it would be impossible for me to go gallivanting to Fresno/Las Vegas for a procurement on a weeknight if I plan on sleeping that night (and hell yes I do). But lucky for my preceptor (and perhaps unlucky for me), I have a relatively lax schedule this week and, having no excuse in the form of a clinic the next morning, I decided to suck it up and go on this "once in a lifetime" opportunity. Yes, yes, I know -- cry me a river. All my med student friends are green with envy. But, as I once heard somewhere and have never had the opportunity to use before, I don't have a dick I need to get hard like that. (So crude. So apt.) (I'm in a parenthetical kind of mood today.)

So yes, I went to go procure (I'm avoiding the use of the word "harvest", which sounds so inhumane) a pair of lungs. Many med students imagine a dramatic trip on a private jet/helicopter to a faraway hospital, where you disembark, cooler in hand, white coat flapping in the wind, #whitecoatsaviorcomplex on full display. I was in a dark van, creeping through traffic on the Bay Bridge, to romantic San Ramon. My preceptor was playing games on his phone. I was going over flashcards. Not 20 words were exchanged between us on this 1.5 hour ride.

The one thing that struck me as we entered the OR is that I have never seen so many surgeons gathered together in such a small space. There was the cardiac team from Stanford, the liver team from who knows where, us, and the random ENT guy who had come to try to take the inner ears. Before the case began, we read a short statement from the donor's mother about who she was in life and how fitting it was for her to end her final chapter with this ultimate act of generosity. After a moment of silence, the case began -- three surgeons working simultaneously and on the clock to preserve and remove the vital organs (Not ENT guy. Nobody knows what's going on with ENT guy). With so many people working in just as many places, there was really no space for a med student who contributes nothing at the operating table. But my preceptor had me scrub in, so there I was, a medical Zacchaeus perched on a step behind the team, trying to get a glimpse at what was going on. The cardiac guy (not a doctor, everyone was sure to inform me), had pity on me and drew me to the tableside. He instructed me to grab hold of the beating heart. He knew he was making my night. He knows he's a rock star. Once he got his heart out, he took it and left.

And then there were two. I usurped cardiac guy's spot at the table and suctioned away like any good med student does. I watched my preceptor meticulously extract the lung from the thoracic cavity, then he turns to me, THRUSTS THE LIVING ORGAN INTO MY HANDS, and says "Don't drop it."

You son of a bitch.

This is the same guy who, with no warning, handed me a rib clipper and said, "Cut the goddamn rib, Abby." But I'll get into that at a later date.

Don't get me wrong, I love this guy. He's so awkward and strange, he must be protected at all costs. But his idea of a good time is performing major surgery at 1AM and mine is more along the lines of eating fresh cookies with warm milk in my pajamas while watching The Great British Baking Show and going to bed at a reasonable hour...so you might say we have vastly different ways of approaching life.

So we packed the fresh lungs on ice into a box and rushed them back to UCSF. My surgeon and I spend some time cleaning up the lungs and prepping them for transplant. When we finish, he turns to me and says "You can stay if you want to watch them put it in." Out of the corner of my eye, I see the other medical student make eye contact with me and scootch over to make room by the operating table. Um. It's 1AM. I give the med student a minute shake of my head before telling my preceptor that I'll just head out when he heads out. (My poor preceptor gets so disappointed when he's reminded that I have no interest in surgery.) And that's how I ended up snuggled in bed at 1:30AM with no regrets and a lifetime experience under my belt that gives me license to say "I did it. I never need to do this again." (I have a full pack of these medical experiences. This one will go next to "C-section", "overnight trauma shift", and "research". I'm still waiting to collect "vaginal delivery" and "CPR".)

Main take-aways from last night's experience:
- I'm probably done with red snow cones for a very long time.
- Organ donors are amazing human beings who are saving multiple lives with their selflessness. I'm registered as an organ donor, you should too!
- I'm definitely not going to be a surgeon....buuuut it wasn't as bad as I thought it would be.
- I HELD A BEATING HEART IN THE PALM OF MY HAND. (I thought I would be cool about it, but nope, geeking out.)
- Lungs are a lot lighter than they look
- If you give me cookies and a hot chai, I'll endure just about anything.

I would say this was probably the coolest thing I've done/witnessed as a medical student. There's definitely always good and bad with any experience but I feel like I focus very much on "the annoying" when it comes to med school. Moments like this remind me that I am in a position of privilege, that not everyone gets to be in the room where it happens, and I should appreciate every opportunity that comes along, even if I would rather be sleeping. (If I tell myself this enough times, maybe I'll start to believe it.)

I'm probably the laziest med student in the world, but God continues to bless me with these learning opportunities despite my terrible attitude and dry,withered field of fucks. So I'm grateful and I'm taking it one day at a time in hopes that sometime in the not-so-distant future, I'll crawl across the finish line of the triathlon that is medical school -- battered, bruised, but better for it -- as a decent doctor. Because that's all we can really hope for.

...and now back to the vagina.

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.

I Hate Adulting.

So I just spent the weekend recovering from a hell of a week. Remember when I was all optimistic about third year being a great time to gain clinical knowledge and learn what it's really like to be a doctor? Yeah, well, that is still true, but little did I know, it sucks.

I recently listened to a podcast about people glorifying their lives on social media, glossing over hard times with instagram "candids" on the beach and curating updates to only include the #blessed moments. Well fuck that. I'm all about finding the instagrammable/Facebook post-worthy moments in the shit-pile that is life, but I also want the dirt. I want to acknowledge the truly terrible times so that one day I can look back and remind myself that I've made it through some shit, but life turned out alright.

Remember that time I failed my driving test 3 times? Now I love driving (in safe, non-metropolitan areas with wide lanes. And no parallel parking. Parallel parking is the devil.) But thanks to the limitless memory of the internet, I can revisit the nausea-inducing, hand-shaking terror that came with preparing for each test, followed by the self-hating rage that followed each failure. Yeah that was a rough time. But I made it.

Remember that time I didn't know a soul at Hopkins or the state of Maryland and I hated it and I deeply regretted ever making the decision to move to the East Coast? Guess what, now I think it was the best decision ever. I now have friends in every state (that matters...as well as New Jersey, I guess. heh) and a much broader worldview than I had when I left.

And here I am now. I just received the disappointing results from Step 1. Though I was/am devastated, I am also reminded that I still have a chance to stay in the Bay Area...though probably on a divergent path from the ROAD to happiness. The only person I've disappointed is myself, and I should be used to that by now.

Med school has been hard. Most times, I feel average or less than average. I know, cry me a river, just another person feeling entitled to success and achievement because of my educational background. Perhaps this too is strengthening, this constant feeling of inadequacy and impotence. But most times I feel apathetic. Other times I feel anger, like a toddler who is told that he can't play so he breaks all the toys. Whatever, I didn't want to play anyways. Funny how trying to adult drives me to regress.

Every time I can make it home, it's like a breath of fresh air. It's grounding, it keeps me sane. But at the same time, being at home reminds me that my priority will never be my education or my career. My family will always come first. Compared to my peers, maybe I just don't want it as badly. I've never yearned to be published. I've never wanted to meet famous scientists -- in fact, I can't really name many beyond the venerated Bill Nye. The word "networking" evokes the same set of emotions elicited by the phrase "deep dental cleaning". Some may call this willful ignorance. Am I proud of it? Hell no. I wish I enjoyed or even wanted those things. But as Ali Wong would say, "I don't want to lean in...I want to lie down." Maybe academia isn't for me. I just want to work 9 to 5, doing the same thing, help people, and make a steady paycheck that I can bring home to my family. Having coworkers I tolerate would be a bonus! Is this too much to ask?

Anyways, back to rotations. There are good times and there are bad times. Yes, it's shitty to get up early and commute for an hour in my monkey suit (business cas shoes are the bane of my existence). I'm hungry all the time and the hunger soon evolves into hanger. It's hard to remain positive when the people around you start to look like a rack of ribs. I also know that there are many others who wake up far earlier and get home far later than I do....but people who say that means I can't/shouldn't complain? FUCK YOU. That's bullshit. I can complain if I want. If I lose a finger in a tragic accident and someone else loses a hand, does that mean I'm not allowed to complain about my limited nine-fingered existence? Heck no. You can bet I'll be throwing them middle fingers up to the world (Unless the finger I lost was a middle finger, in which case I will be throwing one solo middle finger and one stump.) I'll be throwing them up for that poor chap that lost a hand too, because solidarity.

I hate independent learning about things I don't care about. I miss the days when they just gave me a list of topics that I needed to know. Now I need to figure out myself what I need to learn about? UGH. THE WORST. Bring me a cheeseburger. (Read above RE: me, not cut out for academia.) Also, I hate all the pomp and circumstance that comes with working in the hospital. Yo, cut it out with the "ecchymoses" and "conjunctivitis" shit. The kid's got a bruise and pinkeye. This one kills me -- "erythematous". IT'S RED. SAY IT'S RED. Why do I have to wrack my brain to come up with fancy mumbo-jumbo technical terms when you're going to have to spend the same amount of time deciphering the jargon in your head. Just say what you mean. Christ.

But I need to remind myself that there are things that I enjoyed this week too. I enjoyed being able to translate for a Mandarin-speaking patient. I enjoyed working in the Peds acute care clinic with the wee little (and blessedly silent) kiddies. (Maybe because I didn't have to do most physical exams on account of a common childhood fear of stethoscopes and otoscopes.)  In the ED, I got to see a peer stitch up a wrist laceration, through which you could see exposed tendon/nerve. That was badass, even though my legs were getting jello-y with the patient's every grimace and wince.

I also noticed that all of the clinics I enjoyed gave me free food.... I got cake/cookies from ALS clinic, the most terrible tasting (but deliciously free) naan and Indian food from the acute care clinic, and a piece of donut from the ED.

Hopefully things will get better with time...though I doubt it because I'm starting inpatient Surgery next week. That's going to be fun. Kill me.

Celebrating Love and Life

I keep telling myself that I'm going to blog after the next momentous occasion, but it seems that those occasions are less momentous in retrospect than daunting in apprehension. But better late than never, I guess.

Step 1 is now behind me and my general attitude has been to forget that it ever happened at all. My score doesn't come out until later this week, so in my typical avoidant fashion, I'm going to focus instead on the amazing, yet bittersweet weekend I've had.

This weekend, my good friend from college made a life-long commitment to the love of his life. It's crazy to think that, just a few short years ago, we were naïve college kids digging cars out of the snow with garbage cans to make midnight Taco Bell runs; laying out butcher paper so we could spread out our glorious feast of 100 chicken nuggets; belting out showtunes in the car -- wait, we still do all of these things...I guess the only descriptor that no longer applies is the "college kids" part. It felt so great to reunite with DtFnD (the nD is very important to emphasize, we've discovered) and celebrate one of our own graduating to the next stage of life, from boyfriend/fiancé to husband.

As it is with good friends, it felt like no time passed as all. One hug is apparently all it takes to bridge two/three years of separation. And in typical DtFnD, we caught up over food and alcohol...and dancing. Hours and hours of dancing. I start my rotations tomorrow and I think I've slept less than 10 hours in the past three days combined. NO RAGRETS.

The wedding itself was gorgeous. As we rose to greet the bride, I was able to sneak a look down to aisle to catch the groom's expression upon laying eyes on his radiant wife-to-be. It was impossible to miss the naked adoration on his face. Witnessing this wordless exchange of love, I felt a sudden and sharp pang of insight as to why people get married in the first place -- why people choose to bind their heart to another when one was serving them just fine to begin with. I am so, so proud of this couple and their commitment to each other before God. (I don't think I've been attended a more God-centric wedding, and I have once attended one that ended with the bride and groom leading worship, but alas that's a story for another day.)

It was a great weekend catching up with old friends. We may be scattered across the states, but we haven't changed much. "We still fit together like puzzle pieces," I remember thinking to myself as I cuddled with John, shrouded in the gentle haze of a good buzz. "Ratchet, ratchet puzzle pieces," I amended as Rudy crawled over to offer us another sip of straight rum from his cup....or he may have crammed a garlic knot slathered in marinara into my mouth. Or was that later? Memories are a funny thing. Nonetheless, you know it's a great night when it ends with hash browns and waffles at Waffle House at 1AM. God bless 24-hour diners.

While I spent the weekend celebrating the birth of a new relationship, the weekend was also marked by the death of my grandfather. On the morning of my flight out to Atlanta, I received a FB message (what's with me always receiving death notices via social media? Not cool.)  from my aunt letting me know that my paternal grandfather had passed away peacefully the night before. This comes less than 4 months after the passing of my paternal grandmother. Though our family's relationship with my grandfather was sometimes contentious, it does kind of feel like the end of an era. My father is an orphan now. I can't even begin to imagine what he must feel, having lost his only remaining parent before he had the chance to finish processing the passing of the first.

I don't have much to say about my grandfather. He was not a perfect man, but I know he loved his children, even if he didn't always know how to express it. I hope he is now in Heaven with my grandmother, all earthly conflicts laid to rest.

In other news, I start my first day of rotations tomorrow. I'm not feeling particularly nervous or excited...but then again, a weekend of drinking and no sleep does tend to mute most emotions. I look forward to blogging again after my first day of being a real doctor (kinda)!

Passing of a Nasty Woman

My grandmother is dead.

It wasn't unexpected. It wasn't sudden. And in my opinion, it wasn't necessary, but that is neither here nor there anymore.

My parents received word that my grandmother had 2-3 days left to life. They immediately bought tickets and left for Taiwan the next day. I thank God that they made it just in time to say their goodbyes. My grandmother breathed her last as her youngest son (my father) and daughter clasped her hands in theirs, sang her favorite hymns, and whispered assurances that they would be there with her until the very end.

As peaceful as her death was, her life was anything but. My grandmother was a fighter, and in many ways, she never stopped fighting. Never give up, never surrender, that was Nancy Soong. She fought the Communists. She fled China and left her family at the age of 19 to follow my 18 year old grandfather to Taiwan. She fought the Japanese. If my grandmother wasn't fighting, she wasn't living. She was a true #nastywoman of her time.

One of my favorite stories about my grandmother took place when my grandparents were still struggling to make ends meet. The landlord came to collect rent, one thing led to another, suddenly my grandfather and the landlord come to blows. My grandmother sees a man on top of my grandfather beating him, and being no wilty flower, she brazenly thrust a hand between the two of them, grabbed a hold of the landlord's family jewels, and squeezed. He clambered off my grandfather real quick.

That's another thing about my grandmother. When she loves, she loves 100% and she loved my grandfather. When I think about my childhood trips to their apartment, I always see my grandfather sitting in his favorite lounging chair, while my grandmother was constantly moving around the house. Was my grandfather warm enough? She got him another jacket. Was he parched? She put on the kettle for tea. Anything he wanted was just an order away.  Whenever my grandfather was hospitalized (which was often, as he has always been somewhat of a hypochondriac), my grandmother could not be persuaded to leave his side. Even though she was a tiger in her own right, she served him because she loved him, and I've grown to respect that.

(That is not to say that she never unsheathed her claws. Another one of my favorite stories is about how the neighbors would always come running to beg them to stop fighting. Once, they came in to find a broom stuck in the ceiling.)

My grandmother also loved God. When my dad was still a wayward soul, my grandmother would sneak Bibles into his luggage whenever he left for trips overseas. He would discover them, curse, and throw them overboard. (My grandmother is single-handedly responsible for the conversion of legions of marine life.) But her persistence paid off (like it usually does, because my grandmother's persistence is bottomless). When I think about my grandmother's voice, I remember her emphatic "Amens" during prayers, singing Chinese hymns to herself, or just shouting "Hallelujah" out of nowhere. Every time I was about to embark on a new challenge, like moving away for school or going on a mission trip, she would tell me, "If you are ever afraid or in doubt, just call upon the Lord's name. He will hear you." Sometimes, I think she believed enough for the both of us.

My grandmother was a silly woman, but never intentionally. My family once attended a talent show hosted by my grandparent's senior center. My grandmother, who must have been around 80 at that time, announced that she was going to ribbon dance. When it came time for her performance, they couldn't get her audio track to work due to technical difficulties. Undeterred, my grandmother decided that the show must go on. She did her ribbon dance anyways -- a cappella. I don't think I had ever seen my father turn that color before.

She decided to get her driver's license later on in life. We begged her not to do it, but she insisted. Life became a game of "How to Avoid Getting Into Grandma's Car At All Costs". My cousin Jacky didn't get this memo and on one of his first visits to San Jose, he asked my grandmother to drive us to the mall. My sister swears to this day that that ride scared 5 years off her life. I must confess I blocked out most of the memories of that traumatic ride, but for some reason, I can still hear the echoes of someone screaming, "YOU CAN'T CROSS THE DOUBLE YELLOW!"

Every time grandma would see me, she would clasp my hand between hers and squeeze it firmly, like an orange at the supermarket. "Ah, you have thick hands (I tried not to take offense), these are the hands of a rich person." My dad would chastise her for believing in these superstitions. Maybe my Chinese isn't so great, but I think what she meant was that my hands were rough (rough and thick can be indicated by the same word in Mandarin...I think), which are a sign of a hard worker, and that my hard work would bring me to prosper. That's how I interpreted it anyways...so I put my head down and worked accordingly.

When my grandparents decided to move to Taiwan, we discovered that my grandmother was a greater hoarder than we had realized. My dad told her to throw away anything she didn't need, but as with many people of her generation who had to abandon everything once to flee hardship, it was hard for her to part with anything that she might...need later. We thought she had thrown out the most of it before she left for Taiwan. One day, weeks and weeks after their departure, my Dad discovered a stash of items that grandmother had hidden away in a small enclave outside our front door. She had literally driven over to our house, snuck up  to the front door, and tossed a bunch of items into the small fenced off area that holds our water/electricity meter. That's grandma -- never give up, never surrender.

Sometimes my grandparents would visit our home while we were out. They would drop off treats on their way back from Ranch 99 or Costco. But we would always know they had visited because inevitably something will have moved. Never anything conspicuous. Just a feeling that something was off...then you would get a whiff of mothballs and grandpa's aftershave. Sometimes the signs would be more overt. I still remember the first time I found a small innocuous package wrapped in tissues. I picked it up and unwrapped it, still young enough to believe that all surprises were good surprises. My mom later chastised me, not for screaming, but for throwing grandma's dentures across the room. "The floor is dirty," she scolded as she washed them off and started phoning grandma.

When I first heard that Grandma had died, I was lying in bed. It was 2AM. I felt nothing. I woke up the next morning, talked to my sister about it, and still felt nothing. Feeling nothing was almost worse than feeling grief, because the emptiness became filled with guilt. When Sonatina died, I cried for a week, if not weeks. And now my grandmother is gone, and I can't even muster up a single tear.

We weren't close in the last five or so years. She and my grandfather moved back to Taiwan. We hardly spoke, and when we did, it was over my dad's shoulder as they talked on Skype -- him writing his responses to her in large black script on scratch paper so that she could see because her hearing had long started to deteriorate. We did a lot of waving. Forced smiles. The small, shrunken figure I saw on my dad's iPad screen seemed to bear less and less resemblance to the formidable woman who used to kick my ass at ping pong every weekend.

Even though the last few years had their share of acrimony and exasperation, I reflect now on all the ways she expressed her love. In fact, up until two sentences ago, I had forgotten that my grandmother was the one who taught me how to play ping pong. She used to bring over pickled daikon and carrots all the time because she knew I liked them -- either that or that was one of two things she knew how to make. Lucky for her, I really liked her 八寶粥 as well. Whenever we went to her apartment, she would be sure to have ice cream on hand. I think she would get them just for us -- little plastic cartons of strawberry and vanilla or chocolate swirl that you ate with a small wooden stick. She would always bring over extra things from her senior center brown bags, even when my mom would beg her not to. That was grandma's way.

I really don't know how to say goodbye. Because of her, I never lacked a strong female role model in my life. I could never complain about hardship because grandma was once shot at as the military arrived to break up a protest. If birthing and raising five children couldn't break grandma's spirit, I could sure as hell survive an organic chemistry lab practical. Nasty woman runs in my blood y'all.

I don't think I've processed this enough to cry, but I don't think Grandma would want me to cry. Especially in times like these, grandma would want me to fight. Because if I'm not fighting, I'm not living.

Queen Fibroid

It's been two days since my first surgery -- a laparascopic uterine myomectomy, or in layman's terms, a fibroid removal. I've been meaning to write about this since I first found out about the fibroid in October, but as usual, life, school, and my own laziness have gotten in the way. Now the pain is pleasantly muted by some truly A+ narcotics, my mind is warm and cottony, and I'm going to do my best to provide a faithful account of my experience.

This story actually starts over a year ago, before I started medical school. One of my goals before entering medical school was to lose some weight, because let's face it, no one will take advice about obesity from an obese doctor. I started to go on morning runs in the nearby park. Every once in a while, if I ran too far or too fast, I would get really bad cramps followed by some spotting. Sometimes, the pain would be so bad, I would have to sit down on a bench and breathe through it until the episode died down. My mom convinced me to go to a doctor to get it checked out. At the time, I had insurance under Americorps, so I figured, why not, preventative care is free.

When I told the doctor at North Eastern Medical Services (NEMS) about my symptoms, she told me it was most likely a fibroid. She said that she could give me a referral for a ultrasound, but mostly likely, the ultrasound would only confirm the diagnosis. My symptoms were relatively mild and, in most cases, doctors choose to leave the fibroid in unless it is seriously detracting from the quality of life. I wasn't about to pay $100+ for a test that would only tell me something that I already knew, so I filed away this fibroid business to the back of my mind and just accepted the cramps as a part of exercise (No pain, no gain, and all that).

Fast forward to three months ago, when I started learning about pelvic exams in school. We were taught to palpate the inguinal region to see if we could detect any bumps (we shouldn't) that could correspond to problems with ovaries or even the uterus. As any good med student would do, I immediately went home to palpate the heck out of my inguinal region. I lied in bed and followed the oblique line of my inguinal ligament until my fingers pressed upon a large lump. Deeper pressure elicited a crampy sensation. A general rule of thumb when detecting a lump/abnormality is to check for symmetry. If the abnormality is equal and present on both sides of the body, it's less likely to be something bad. I checked hopefully on the opposite side and felt nothing. Crap.

I lied awake in bed and contemplated my own mortality.

The next morning, I made an appointment at the Student Health Center. The physician was super helpful and confirmed the presence of the lump with a bimanual exam (something that the doctor at NEMS never did). Things moved relatively quickly from that point on. I was given a referral to the radiologist for a pelvic ultrasound. The ultrasound revealed that the fibroid was larger than my uterus (11.5cm x 11.6cm), but fortunately, it was pedunculated (or attached by a stalk) so it would be relatively easy to remove. I tried to make an appointment at the UCSF OB-GYN, but they informed me that the earliest appointment would probably be in December. I may have shamelessly pulled the "I am a medical student, please help me so that I can get this done before I take Step One and disappear off the face of the earth, Queen Fibroid and all" card. Miraculously, the doctor called me the next day and squeezed me in for an appointment in early October.

Those two weeks seemed surreal. I didn't tell anyone about what I had found or what I was doing. If it turned out that I didn't need to have surgery, why worry my family prematurely as they waited for news? I confided in my sister after I scheduled my appointment with the OB-GYN, but we decided that I would tell my parents only if it turned out that I needed to have surgery. It was a time of high stress and uncertainty. Two weeks, three appointments -- it felt like I had more things inserted in my hoo-ha than I have had in my entire lifetime. (Let me tell you, pelvic ultrasounds are NOT fun. The ultrasound technician may have laughed at my face of horror when she showed me the transducer.) I would get asked the same questions over and over again: "When was your last period?", "Is there a possibility you might be pregnant?", "Have you ever had an STI?" My personal favorite is the doctor who asked me if I might be pregnant, to whom I responded, "Not unless Jesus is coming again." and then she proceeded to give me a STI test just in case. Thanks for the vote of confidence, ma'am.

Once I met with my OB-GYN in October, she confirmed that I would be needing the surgery. Though I wasn't having the worst symptoms (heavy bleeding, bad cramps during menstruation), the fibroid was large enough that it was compressing my bladder and they had concerns that it might continue to grow. When Dr. Illagansakare (YEAH. TRY PRONOUNCING THAT. Took me at least three encounters to get that right.) told me about the bladder compression, I was like "OMG. That's why I always need to pee!" Rotations are looking up, y'all.

I was scheduled for surgery on December 15th. A huge shout out to all the school admin who helped coordinate everything -- to Dean Jones who met with me personally to express his support and to Dr. Hyland who was so sweet about rescheduling my exam and checking in on me.

After all the dates were set, I was able to forget about the surgery for a good month or so. I had a minor scare with the insurance company two weeks before the scheduled date, when they rejected my insurance claim for the surgery. When I received the call from UCSF, I was incensed. I was ready to sue everybody. Who are these people to deny me this surgery, telling me it's medically unnecessary?? TELL THAT TO MY BLADDER. I spent an hour on hold with the insurance company the next day, and it would later turn out that there was a mistake on UCSF's part. They had coded the procedure as a hysterectomy and my insurance company, seeing I am a healthy 24yo F, was like "Um. Why are you removing her healthy viable uterus? Let's re-think this."

The run-in with the insurance company gave me another moment to reflect on how lucky I am. After a day of despair and anger, I was able to sort out the situation and eventually get the procedure that I needed. I can't imagine what would have happened if I didn't have the medical/bureaucratic literacy to navigate the system or the inherent inflated sense of entitlement to be like "No. I am getting this procedure." Or if I wasn't a student and I didn't have time to just spend essentially 1.5 hours on the phone with the insurance company during business hours. Or if I didn't have the necessary English proficiency to negotiate with the insurance representatives. This minor headache could have been a real nightmare.

The two or three days before the surgery, I had the worst sleep of my life. I was nervous about my exam and anxious about the surgery. By the morning of the procedure, I was almost looking forward to it -- sedation guaranteed the best sleep of my life.

The worst part about the whole surgery was the IV. I have the worst veins. Every phlebotomist I have ever encountered has called me a "hard stick". Once, a nurse told me that if I exercised more, my veins would be bigger (Dis Bitch. I now run 3 miles a day and lift and still have no palpable veins. All that exercise for NOTHING). Anyways, it took them three sticks to get a usable IV. A nurse tried, then the anesthesiologist's nurse assistant, and finally the anesthesiologist got it to work. I was super close to begging them to just give me laughing gas before they stuck me to their heart's content. Once the IV was in, they rolled me down the hallway and to the OR.

Upon getting in the OR, I remember them telling me to get up on the table. I remember saying "Wow, this table is super comfortable. I want one of these pillows for my bed." I remember someone saying, "I don't think anyone has ever said that before." Then laughing, then nothing.

The next thing I remember is coming to in the recovery room, distraught about everything. My nose was stuffy, snotty from apparently crying for the past 30 minutes. My sister and Dad were there trying to comfort me. I had just found out that I had to stay the night in the hospital, and I remember moaning, "I'm OK. I can go home. I can go home, I'm fine. I want to go home." My Dad told me they got a parking ticket and I think I cried about that for another hour. My sister claims I cried for 3 hours straight. Of course, she provided ample video documentation.  At the risk of tearing my stitches, I watched these videos and I can attest that they are hilarious. I'll wait before I'm completely recovered before I share them. Too good, comic gold.

A brief preview:
Me: "TICKET!!!! (sobs)"
(brief pause)
Me: "Is there Wifi?"

or

Me: (look of intense betrayal) "You took my phone?"
Me: (Throws head back dramatically and starts sobbing)

My family has been super supportive through the whole thing. My sister took two days off work. She spent the night before my surgery with me in SF and took me to eat wings to help me keep my mind off things. My parents left San Jose at 4AM to take me to the hospital at 5AM. My family sat with me in the hospital as I humiliated myself and cried all the way from the recovery room to my hospital bed. My sister brought me jajangmyun and fried chicken for dinner (I hadn't eaten since midnight the night before. The doctors didn't believe I would be up to eating for a while...I proved them wrong.) Amy also stayed with me overnight in the hospital, brought me my First Aid book when I deliriously requested it in my semi-conscious state, and was an overall trooper through this entire experience.

I cannot express how thankful I am for my family for being with me from the start to the end. Even now they insist on feeding me foods I like and making soup "for my recovery". I also appreciate all the friends who have checked in or stopped by to drop off home-cooked meals and pray for me. I definitely feel the love!

As for the procedure itself, it was a success. They got Queen Fibroid out completely and we are now waiting from the report from Pathology to know the final weight. The surgery was supposed to be laparoscopic but I was losing too much blood so they had to make a fourth, larger incision from which to remove the fibroid in strips. They kept me overnight in the hospital to monitor me for any negative effects from the blood loss.

The doctor gave me a truly gnarly picture of the fibroid, cut into strips. Let me know if you want to see it, I would love to share. hehe. I am so used to showing this picture to med students who are like "AWW YISSSS. OMGGGG. THAT'S HUGE. WELL DONE." that I forgot when I was showing my childhood friend and she gasped and clutched her chest and was like "Warn a girl first!!!!" Oops.

Anyways, yes, I am now home eating donuts and doped up on Norco. Overall, a happy recovery! Another big thank you to everyone who has supported me along the way. I really appreciate you guys being in my life. :)