The Whole Wide World

Logged back in for the first time in a long time and found an unfinished draft from the first 6 weeks postpartum...and here we are 6 months postpartum. Perfectly representative of how life has been as new parents. I used to be on top of my texts and social media, but now I find myself responding to messages a day or two later...if I respond at all. Still waiting for life to find its rhythm, but so far, every day has been different. The twins sleep when they want to and don't when they don't. Sometimes they nap at the same time, sometimes they choose to take turns. It's like treading to keep your head above water and never knowing when you'll be able to take the next gulp of fresh air. 

What's happened since the last time I sat down to jot down my thoughts? 

Well the nipples are doing great now. It seems I was very concerned about these last time. I hope they can retire soon as the kiddos have started testing their new baby teeth out on solids. Something about watching them gum tortillas and fruit brings me great joy. Luna is obsessed with my coffee cup and even after I offered her a drop to taste thinking the bitter taste would turn her off, she demanded more. I may have inadvertently created a monster. When I see them tracking our food with their eyes and reaching out with their grabby hands, I feel a twinge of pride. These are definitely our little foodie babies. 

Uram's mom has been here for almost 2 months. I can no longer remember what life was like without her. She wakes up before me and has breakfast ready before I finish my first morning pump. She's like a laundry ninja, she has the load of laundry I started folded before I've had time to circle back and check the dryer. She cooks every meal for us and she actively denies us opportunities to eat out. (Her rule is once a week...if that. Also, no instant noodles. Uram is bereft.) She's in the garden, she's taking out the trash, she's freaking Roy Kent -- she's here, she's there, she's every fucking where. Her presence rounds out our team of Super Grandparents. Uram and I have looked at each other and expressed our misgivings about how our life will probably fall into shambles once she leaves in September because we've become so accustomed to her support. 

The girls have outgrown their reflux (finally). Now our next hill to conquer is the sleep schedule. It's been an uphill battle. Their naps can be anywhere from 30 minutes to 2.5 hours. We still wake them up once at night when I do my middle of the night pump. The logic is that it's better for me to wake up once then have them wake up between my pump and my alarm. Hoping we can phase this out in the next month or so...and maybe end middle of the night pumping too. 

We had our supply scares. One particularly bad clog left my boob feeling like there was an octopus latched to it. It took over a week for it to clear and for the supply to come back to normal. But now that the girls are eating more porridge and playing around with finger foods, maybe my time as the milk machine is coming to an end. I'll miss the free pass to eat whatever I want...I'll probably blow up like a balloon once my metabolic rate returns to normal. 

It's still surreal that I am a mom. Right now it feels more like we have two new pets. It's hard to conceive that these two little crying, pooping cuties will grow into sentient beings that can talk (and talk back) one day. I've heard people say it's hard to go back to work because they miss their babies too much. But let's be real, I am more tired on days I don't have work than on days that I do. Babies are exhausting y'all. More exhausting than a demanding patient panel -- and that's saying something! But I think being away helps me appreciate them more when I return. Seeing their faces light up when they see me is restorative, even though sometimes I worry that I've done nothing to deserve being their favorite person in the whole wide world. One day they might outgrow it, but for now, I'll take it!

Motherhood, It's a Trap! (unfinished)

Growing up, my mom always told me that childbirth was painful, but the pain is all forgotten the moment they place your baby in your arms. Mind you, this is a woman that delivered me precipitously sans epidural and even had a stitch torn open when the OB reached in after the perineal repair to extract her retained placenta. After giving birth myself, I have determined this is a lie. I guess my delivery was complicated and I didn't get the beautiful golden hour of skin to skin bonding because the twins were whisked away by neonatology to ensure they were OK after the dangerous drops in their heart rate while my care team simultaneously worked on stopping my bleeding. But still -- that shit hurt (even with a glorious epidural)! 

The first few days after delivery, I was taking Tylenol and ibuprofen around the clock and still wincing every time I shifted to get out of bed to hobble to the bathroom. I peed blood for a week, although the nurse "reassured" me that this was normal for up to 6 weeks. I was peeing up to a liter at a time as my body worked to clear all the fluid I had retained during pregnancy and from the IV fluids during my labor. Even after getting home, I continued my scheduled OTC painkillers for almost 2 weeks. I hated dragging myself out for even a quick 15 minute walk due to the heavy, throbbing pelvic pain provoked by standing or walking around. For days I thought my stitches had become infected due to the level of pain I was in and also because I would wake up around midnight borderline delirious with night sweats. One particular night, I woke up drenched in sweat and found myself mid-conversation with Uram, a conversation I don't remember starting. I was also holding Lyra in my arms but I couldn't figure out whose baby she was. This all resolved within a few minutes, but I was concerned enough that I called the triage line. Turns out, this is all a normal part of the postpartum course. The night sweats are caused by the drop in your hormone levels after delivery (who knew!), the delirium was just severe sleep deprivation.  Isn't motherhood beautiful?

The level of discomfort I had with just a second degree tear (skin, muscles), I can't imagine how people manage with third or fourth degrees (skin, muscles, anal sphincter). I would just die. Luckily, I didn't suffer from any constipation, although the first time wiping after delivery, I was like, "Who's butthole is this?" because the hemorrhoids and swelling had rendered it unrecognizable to the hand that has dutifully wiped it for 32 years. Pregnancy is wild. 

Now my body is fully recovered. My anemia is steadily resolving thanks to the confinement meals and nourishing snacks my family has been bringing me. (My hemoglobin jumped from 8 to 10 in 2 weeks without iron supplementation. Forget IV iron, eat pate!) I no longer require painkillers for the hoo-ha -- I can walk without pain although my stamina is so reduced I feel muscle fatigue in my legs after just one lap around the park. But postpartum life is like trading old problems for new ones. The body is healed, just in time for me to endure the trials of prolonged sleep deprivation and learning how to breastfeed. The babies sleep for 2.5-4 hour stretches at a time. If we are lucky, we catch a cumulative 7 hours of sleep a night, although most nights we are averaging about 5 hours of fragmented sleep. 

Breastfeeding is its own beast. I can quite honestly say I would rather give birth again (with an epidural!) than continue breastfeeding. The first time Lyra latched onto my nipple, I may have let out an involuntary yelp. What did I do in my past life to deserve birthing children that are part piranha, part shark? The twins will fuss around trying to find the nipple before CLAMPING down with an audible "NOMF". Lyra will also shake her head furiously to the left and right after latching -- yeowch. The pain and swelling from their attempts to nurse would slow down my supply for a day, then I would try to get back into it again in a vicious cycle of fruitless suffering. It was to the point that I would dread feedings and pumping. No one tells you this, but sometimes when you are breastfeeding, you can experience a wave of negative emotions. This phenomena is called dysphoric milk ejection reflex. I would feel like I wanted to cry and I would have no idea why. For these reasons, I ended up deciding to exclusively pump. I did it for the nips. I reasoned that the twins would still get the benefit of breastmilk and it would be more sustainable for my poor bitten off nubbins in the long run. 

Even pumping comes with its own set of challenges. I couldn't figure out the right flange fit for the hospital grade pump I was given. The standard set was too small and would cause a pinching, stabbing pain that would linger for hours even after pumping. I tried sizing up, but this caused my areola to swell up, which led to clogged ducts. Clogged ducts are the devil. I tried everything. The old school of thought was that this was caused by fatty milk and to apply heat and massage to try to "clear" the obstruction. This has been replaced with the idea that the obstruction is caused by swelling and should instead be treated with anti-inflammatories and ice. I tried both with limited success.  I even started taking sunflower lecithin to emulsify the fat (Side note, I make gloriously fatty breastmilk because I am apparently a happy cow from California. I fondly refer to it as Booba milk tea). In the end, the only thing that helped was to discontinue the hospital grade pump and use the portable pump instead, which reduced the trauma to my nipples. Hours of midnight Redditing to figure all this out, guys. There is a special feeling of commiseration with your fellow internet goblins when someone asks the same highly specific question that you have 2-3 years ago and you can see all the people in the comments who are also up at 2-3AM trying to get the answers. 

Postpartum Processing

Well, here I am -- Mother of Dragons. The twins arrived in a dramatic fashion on January 9th after a lengthy induction process, a process that at first seemed to drag on before the proverbial shit hit the fan. 

Our induction was scheduled for January 7th. Naively, we thought we would pop the babies out overnight, then head home 24 hours after that. Oh ho ho, nope.

Even though  Luna's head was pretty low from the start, my cervix was only 1cm dilated so we were advised to start with a balloon placed in the uterus to stretch the cervix mechanically along with some medication to help get the body's labor process started. I've done cervical checks and placed balloons back in my days as a resident, and first and foremost, allow me to apologize to all the patients who have ever had to experience these. I would get an epidural for these alone. After the traumatic cervical check upon admit, I took their offer for a dose of fentanyl before insertion of the balloon. "It'll be like having a bit too much to drink," they said. OK, yes it was, but more like when you are clutching to your bed for dear life after a particularly ill-advised night out, praying to Jesus for the ceiling to stop spinning. Was it worth dulling the sensation of being abruptly fisted by the OB and having a balloon the size of a cutie orange inflated inside me? Maybe? Fine yes, but just barely. 

Once the balloon goes in, it is checked on in 12 hours if it doesn't fall out on its own. 12 hours is a long time to be stuck in a hospital bed chained to a monitor. Uram and I watched a few episodes of Hospital Playlist to pass the time. After seeing the frankly insulting quality of the hospital food, Uram offered to go out to pick up real food. We found out that one of our favorite taco trucks that we used to frequent in our early dating days when he lived in Sunnyvale had a location across the street. We joked about how our relationship had gone full circle now while eating my "last meal" of suadero quesadillas and cabeza tacos. I am so grateful to have a such a supportive partner in Uram. I've had to pee every 10 minutes in the final stages of pregnancy and during the induction I would have to detach myself from 3 monitors, unplug my IV, and wheel everything to the bathroom quick pace to try to avoid an accident. I never had to ask Uram to help me.  He took pride in "cable management" and I would watch him observing the monitors in typical Asian father fashion after each assessment. Even in the middle of the night, if I made the slightest movement, I would see his head pop up like a prairie dog from the pull out sofa to see if I needed help.

Once the balloon came out at 1am, the cervix was dilated to 3 cm. We continued pitocin overnight, but only advanced to 5cm by the morning. They offered more fentanyl for pain management and I was like "Hell no, but can I have some Tylenol to take the edge off?" The nurse asked me "For...a headache?" "And I'm like "No, for the labor and this giant orange lodged in my pelvis ." In the end, I requested the epidural less for pain management but just to get a Foley (urinary) catheter placed so I could stop getting out of bed to pee.  At that point, two days into induction,  it felt like we had been in that hospital room forever, but the babies' arrival was nowhere in sight. 

Then that afternoon, one blood pressure reading changed everything. I'd been having mildly elevated blood pressures in an otherwise uneventful pregnancy, nothing symptomatic or that didn't improve upon repeat. My BP was now elevated to above 160. Unlike in my field of medicine, in the OB world, this blood pressure is not something that you can just "watch and wait" if there are no symptoms. When the pressure was still above this range 15 minutes later, I was diagnosed with severe preeclampsia and started on a magnesium drip. Minutes after the first bolus of this medication was started, I projectile vomited. Bring the fentanyl back, that was a happy memory compared to this. The magnesium also burned its way along my IV line and veins. The nurse was like "Yeah, that happens unfortunately... here's an ice pack." A few hours later, my epidural stopped working. I started feeling tremendous pressure and pelvic pain to the point where I requested a cervical exam. The cervix was still unmoving at 5cm, but baby's head kept descending lower and lower. I also asked the nurse to check on my Foley output to make sure it was draining -- it turns out that baby's head had dropped so low that it had compressed and obstructed my bladder catheter. After moving the catheter around, almost a liter of urine drained immediately. I don't know if it was the draining of the bladder or the redosing of my epidural that helped, but I finally got comfortable again. 

At the next check, there were still no changes. I knew that something was looking gnarly down there because every provider that pulled back the sheets winced and went "oooh." I finally asked Uram to take a look and he shrugged and said "It's really swollen." "How swollen?" "It looks like testicles." THANKS URAM. 

The resident brought the attending to have a discussion with us. This is when I knew that things were really not going to plan. Given that the cervix wasn't changing, my water was broken, and the risks associated with pre-eclampsia, they offered me a C-section that night. The options were to wait 4-6 hours for the next check and if there were still no changes, we could pull the trigger on the C section then or, just roll back to the OR now. While having the babies out sooner rather than later was looking more and more appealing, I also thought about the recovery process after a C-section, especially with having twins. Would I be able to lift the babies in and out of the crib? I remember the painful and slow recovery course after my fibroid removal and that was only a C-section lite.  After discussing with Uram, we decided it would be reasonable to compromise and wait 2 hours and if no progress then, we would call it. We settled in to have a quick power nap. 

I woke up 2 hours later to the unpleasant sensation of my epidural no longer working on my right side. I also felt waves of pressure pain that told me that there were definitely changes. First things first, call the anesthesiologist back, because if the babies are coming out my hoo-ha, I ain't doing this with no half-ass epidural. Epidural now refreshed, the exam confirmed that the cervix was now completely dilated. We made preparations to roll back to the OR (twins are always delivered in the OR in case the second twin needs to have an emergency c-section); it is now day three of induction. 

In the OR, I remember thinking, well this is anticlimactic. With the epidural now working, I felt waves of pressure but no intolerable pain. On my left, I could hear Uram (now in an adorable sterile bunny suit) encouraging me through the pushes. I preened as the OB told me how good my pushes were -- hips flexed, pelvis opened, abdominal muscles engaged -- I am textbook, I am magnificent. (To be fair, Luna did all the work because her head was already 3+ well before the cervix was open.) Just as it sounds like we are nearing the final push, I hear the haunting sound of the baby heart monitor slowing down. The atmosphere of the room changes. They quickly consent me for a vacuum assisted extraction. From my perspective lying down, Luna's arrival is announced by a spray of blood across the OB's face shield. I don't hear her cry for what felt like far too long. But my focus is split as the OB is now telling me that the second baby is not yet engaged in the pelvis and the cervix relaxed back to 6cm. We can't push again until the cervix opens up again, but she will try breaking the second bag of water to try to bring Lyra down and facilitate this. The bag of water is broken and we wait for Lyra to "labor down" but again, we hear the heart rate monitor drifting downwards. I take as many deep breaths as I can, a human oxygen conduit to my baby. I consent for an emergency C-section, but if baby's heart rate tolerates, we can try a light push to see if that will stretch the cervix again to completion so we can complete the vaginal delivery. One push gets us to 9cm, the second push allows us to push the final remnants of the cervix behind baby's head. I am now pushing for my (and Lyra's) life. The vacuum makes another appearance. Pushes are usually done in intervals of three, but when they ask me to just keep going, I know that every push matters and we are seconds from a stat section. I should have done more arms and abs in this lifetime because it was a STRUGGLE to keep my legs up through those last pushes, but praise the Lord, because Lyra was launched into this world and the beautiful sound of her shrieking immediately filled the OR. As I threw myself down back onto the table in relief, I was mesmerized by the sight of my own blood splattered on the handle of the overhead light. Someone really needs to tell the cleaning crew about that, I thought to myself, but I must have said this out loud because the nurse to my right laughed and agreed. 

It turns out that our delivery was not epic enough, because now my uterus decided it was too tired to firm up and would not stop bleeding. It's one thing to learn about the treatment of uterine atony and even perform some of the maneuvers, it is entirely another thing to experience them. I could hear the names of different medications to stop bleeding being called out -- vague recollections of them telling me I would get a shot in my arm (eventually a second) and feel some pressure below (pills inserted in the rectum). Luckily, I was distracted from all this by another round of nausea and vomiting, an uncontrollable cough, and the worst dry mouth I have ever experienced in my life. I remember begging for water in my delirium and the providers telling me that they don't have any water in the OR. I would have given anything to suck on a sponge like Jesus. In the end, I lost a little more than a liter of blood. As things stabilized and the palpable relief filled the room, I couldn't help asking the most important question: "Do I still have a separate vagina and butthole?" Thank baby Jesus, only a second degree tear.  

During this ordeal, I kept telling Uram to go check on and bond with the twins while they took care of me, but he kept coming back to keep me company. It turns out that he was worried that I was going to die. I was slightly disappointed that this man did not cry when his twins entered into the world and were placed into his arms. I was infinitely more satisfied when I learned this man only cried after processing the traumatic delivery at the thought of possibly losing me. What a cutie patootie. This is the man who turned on the central heating for his pregnant wife a grand total of one time during 9 months of pregnancy. 

Joking aside, it is sometimes surreal to think about how this perfect stranger that waltzed into my life 6 years ago after we both swiped right over a shared love for food and cooking has come to mean so much to me. When I look at the life we have built together, now with the girls, and onward to our future together as a family, I truly feel blessed beyond measure. I see him changing every dirty diaper (He asked me if he really has to do EVERY diaper and I asked him how many of our babies he carried and expulsed from his body), letting me sleep through some nighttime feedings because I am so dead tired that I am not even roused by the sounds of our babies crying, and nagging me to take my medications and take care of my myself, and I can't imagine doing this with anyone else. 

It truly takes a village. Here we are three days postpartum. My parents and sister have been bringing me a different herbal soup and other delicious foods/snacks every day during my confinement. Uram's parents check in from Korea frequently to make sure we and the babies are surviving and thriving. Friends are constantly asking how they can help.  It's so comforting to know that it's never been just the two of us, even more so now that two became four. 

I've never been more tired -- not in medical school, not in residency. But for the first time in my life, I have never questioned whether the struggle or adversity are worth it or whether I could have been happier doing something else. When I look into my girls' faces, my sassiness mixed with Uram's anxious eyebrows, I know I have been gifted with a new purpose. 

It's a new year, new me, new bigger family. 

Woah! We're Halfway There

It's week 27 and a lot of things have happened since my last post.

For one, the number of impending babies has multiplied from one to two. Imagine our surprise when we are happily scanning our developing fetus with my POCUS and Uram points in the corner of the screen and asks "What's that second thing?"

No. No way. Must be an artifact. I'm not great at POCUS anyways.

1 week later we look again and I definitely see a second cardiac flicker. Cue panicked texts to my co-resident and coworkers. Can you review this ultrasound? I'm hallucinating right? That's just one big thing, not two little things, RIGHT? 

Finally, we had our second ultrasound with the midwife and I try to play it coy: "I think there might be twins. Call it a hunch". We see two distinct heads right when she slaps on the probe. Holy shit. It's one thing when you're looking at a grainy blob on your pocket ultrasound, but once confronted by the reality of the crystal clear image on the office ultrasound, we couldn't live in denial anymore. OK, change in plans, we're going to be a family of four.

Uram's first reaction when we found out we were going to have identical twin girls: "...three Abbys?"

Yeeeaaaah, boiiiii.

I don't have previous experience for comparison, but I have been told twin pregnancy is much worse than with a singleton. First trimester was no picnic in the park. 16 weeks of gagging and food aversion. I couldn't smell beef without feeling violently ill. I couldn't even tolerate chopping garlic. The potpourri hanging in the bathroom had me retching on the toilet. Poor Uram thought I had developed a vendetta against the food of his people. We were convinced the baby was going to Mexican or Indian because I was only eating plain quesadillas or tikka masala, nothing in between. 

By week 17, things settled down a little bit. I could eat normal foods again (hallelujah!). I wasn't experiencing itchy hives on my hands or feet anymore. I wasn't quite showing yet. It was like I could forget I was pregnant. I would clutch my belly with every flutter wondering if it was the babies or gas (probably both). 

But here we are at week 27 and pregnancy is once again showing that it is NOT cute. I knew I was going to be big as a house, but hot damn, it's one thing to imagine it and one thing to live it. Lying flat has me wheezing as my occupied uterus does its best to encroach into my thoracic cavity. Lying on my side leaves me with severe carpal tunnel symptoms. I wake up in the middle of the night 2-3 times to pee, sometimes discovering that I did not in fact need to pee, but instead someone's head has so rudely decided to settle on my bladder. Not to mention, my hands are swollen all the time. Have you ever been unable to rip toilet paper because you can't close your fingers together in a pincer grip?  I have to spend the first minute of my morning flexing my fingers to restore my range of motion so that I can make a fist. I invested in a pack of compression stockings (and I learned the best way to convince patients to wear them is to show them that you're wearing them yourself!) 

Uram and I had to have a whole discussion about what we would have to do if one day I became so expansive that I was unable to reach my own butt to wipe. He is surprisingly down to lend a hand (boop!), I guess that's true love right there. This launched a whole other discovery that I have been wiping my butt wrong my entire life. My sister and I have been living a lie because we both grew up reaching between the legs from the front but our parents both reach from the back. WHO TAUGHT US?WHO DID THIS TO US? Anyways, I have since started reaching from the back and wow what a gamechanger. Y'all been living like this? 

OH AND THE HEMORRHOIDS. You know those mochi donuts? ...Yeah.

Me: "Waaaah! They're like grapes!"

Uram: "What kind of grapes?"

Me:" KYOHO."

Uram: "NO."

They say these are supposed to get better after pregnancy. THEY FUCKING BETTER. I can now feel my butthole touching the seat when I sit down and I could have gone my entire life without knowing this sensation.

We have one guest room that has just become dedicated baby storage. We are so grateful for the generosity of our friends and family. People have just arrived with bags of hand-me-downs and things that they found useful in pregnancy -- cribs, carriers, baby bouncers, strollers, clothes -- SO MUCH CLOTHES. I feel like we are at the point where we don't even know what we don't know, but we know that our village has our back. 

So here I am, incubating two cauliflowers today. My OB says she would be thrilled if I make it to 37 weeks and that twins can come "whenever." (Triggering an Uram panic attack) So maybe we're a little more than halfway there, but man it feels like a lifetime. 

I'm scared shitless but at the same time I feel like if I survived medical school and residency, there's not much that can faze me now. HUBRIS. 

One thing is for sure -- when I look at Uram, I know there's no one else I would rather be setting off on this adventure with. He has been incredibly supportive this entire time. He has wordlessly taken over the dishwashing duties . When I was feeling sick, he made sure there was always something for me to eat or snack on. One time, I was so hungry in the middle of the night that I felt viscerally ill. He got up, went downstairs, heated me a plate of dino nuggets, and even included the dollop of BBQ he knows I love. Even now, he puts up with my tossing and turning all night without complaint. When I wake up with a cramp, he helps me stretch my leg and massages my calf while half-asleep. They say that stressors can put a strain on a relationship, but I am so lucky that, time and time again, experience has shown me that this man is one that can weather the storm. I couldn't ask for a better husband and I know our daughters will have the most loving and doting dad. 

I figured I should update before the pregnancy brain fog fully kicks in; before the happy honeymoon period of the second trimester is fully over and I become a cranky inflated witch. 

Is it time for the epidural yet?

Tentative Joy

It's been a week since two little lines on a stick changed my life, and this time it isn't COVID.

I'm still in disbelief, even though it was something we've been actively working toward for the past 3 months. A part of me is thrilled, ready to start this next chapter in life with our growing family. The other part of me, the childish part that still thinks of daily responsibilities as "adulting", is freaking out. I am growing a ticking time bomb inside me. Our days of freedom where we can drop everything and make spontaneous trips on a dime are now limited. That glorious DINK disposable income now earmarked for childcare and college funds. 

But then I daydream about little baby Two-ram (this is what I've come to call the fetus mentally) that will have the same untamable cowlick as their father, his easygoing demeanor, or his propensity to chatter endlessly until his throat is sore and he needs a cough drop. At the same time, I dread that they will have my temper and stubbornness -- that my karma has finally come and it will become my turn to be called into the principal's office, this time as the shamefaced parent rather than the incalcitrant troublemaker. 

And sure, everyone thinks it's great to be a pregnant doctor, because you know what to expect when you're expecting. But no one thinks about how much more doctors stress because we know too much -- when you know the statistical probabilities of everything that could go wrong. We told our family early because we are pathologically unable to keep secrets. But I've forbidden them from telling anyone or getting too excited -- wait until the ultrasound I say, wait until the second trimester. It could be a molar pregnancy, there could be fetal abnormalities incompatible with life, genetic disorders, miscarriages, don't get too attached yet. The pessimistic physician part of me tells me to guard my heart, but I also don't want to rain on Uram or my family's parade. And so I would classify my current state as "tentative joy". 

Now when I see babies in the wild, I envision what our own little chubby-faced cherub will look like. 

When I was in residency, Uram said he always knew when I was on an OB rotation because I would come home, measure his head, and deep sigh. My beautiful husband who subjected his teeny tiny mother to a c-section because his head would simply not fit through her pelvis. I say prayers for my intact perineum, already imagining the ice-packed diapers I'll have to wear for weeks if I somehow successfully deliver his freakishly large-headed progeny vaginally. I have cold sweats and flashbacks to the time I witnessed a third-degree tear in the delivery room, the audible snapping sound as the baby's head rushed through, pushing through layers of muscle and skin. Nature is metal, man, but I am soft. I live perpetually in fluffy pajamas and I need to wear slippers or my feet will hurt.  I can only exist peacefully between 65-75 degrees Fahrenheit. I like my shrimp pre-peeled and my beverages hot but not too hot. I can't eat  sandwiches that are too hard or tortilla chips too quickly because they cut up the roof of my mouth. The list goes on. Definitely not the sterner stuff necessary to push a watermelon through a toilet paper roll.

I'm thankful for my amazing partner and our village. The other day, I told him I was going to vacuum and he said "don't work too hard." I thought to myself, "He has never said this to me in my life, pregnancy has changed him." I look forward to taking turns picking up heavy items in the future, seeing if his sciatica symptoms are worse than the damage wrought by the 30-lb pumpkin strapped to my front. 

The news could not have come at a better time, his parents are currently visiting for a month. I have never been better fed in my life. They force me make sure I have breakfast, lunch, and dinner every day. My mother-in-law gives me the yellow parts of the kimchi -- the sweetest and most tender bites. She resists my protests when she ladles large portions of protein and soup for me and scrapes the bottom of the pot for her own serving. She body checks me out of the way when I try to wash the dishes. My laundry basket magically empties while my closet fills when I am at work. 

My mom pesters me for the due date so she can plan ahead and make a baby blanket. She'll have to make two, she tells me. One to swaddle the newborn and a bigger one because the baby will quickly outgrow the first. She is already asking if I want to do my postpartum confinement in my childhood home so they can take care of me and the baby. "Dad will make you chicken soup!", and of course the stewed pig's feet for lactation.  

I already know that our baby will be showered with love. 

I can't wait to see Uram crying his eyes out while holding our child for the first time

I am excited but I am also waiting for the other shoe to drop because a part of me cannot accept that life can be this good. My mind turns over the macabre daily, runs through the contingency plans. But for now I'll keep counting my blessings.

Trapped His Ass

 Well, Ali Wong would be so proud of me because I finally did it, I trapped your ass! 

Even though we have been officially (secret) married since October of last year, it still felt momentous to exchange our vows in front of our closest friends and family. I still remember laughing at how "romantic" it was to repeat our vows before our starry-eyed county clerk, crammed in front of window 11 at what looked like the DMV. When it came time to say "I do", instead you said "Yeah!" and we laughed at that too. Also, let's talk about our official wedding date -- you tried as hard as you could to get married on the same day as my birthday so you could lump the celebrations together for the rest of our lives and I both love and hate that about you. 

Leading up to our big day, we fought more than usual. I was stressed about coordinating the final details of the wedding, you were stressed about making sure your parents had a good time. We fought over the little things like being late to meet my parents and blocking the path while taking tourist photos. But even when we argued, I could see the qualities about you that I first admired and fell in love with. I loved seeing how close you were with your family, even though you moved to the US from a young age and saw them sparingly over summer and winter vacations.  I could see how much it meant to you that they had a good time. We were late because you didn't want to rush your parents out of the house; you wanted them to relax on their first vacation to the US together in 30 years. You said your father was the happiest you had ever seen him when he was taking pictures at Oracle Park (his first baseball game in the US!) and I could see that joy reflected in your eyes -- the question of whether it was the right thing to splurge on those fancy tickets completely banished from your mind. And even though we were occasionally annoyed with one another, I always welcomed the tethering weight of your hand in mine at the end of the day. 

I always joked with you that if you didn't cry at our wedding, I was going to walk back up the aisle and go home. I can't say I wasn't disappointed when you turned around for our First Look and there was nary a tear in sight. Like, I endured two hours of hair and makeup, not to mention the very uncomplimentary groans of Amy and Jiejie as they struggled to strap me into my dress, for this? "Oh wow, nice!" But then as we tried to appear natural for the camera, you leaned forward to inform me that you were very anxious about the photobooth setup, one of two Very Important Jobs I had assigned to you that day. And again I felt that pang of unexpected affection for you and your dang inability to multitask. I can't wait to look at those First Look pictures with you so I can point out your Anxious Eyebrows and give you a hard time about your dry eyes and how ugly you must have thought I was. 

My disappointment dissipated quickly the moment I walked down the aisle and saw you bawling at the end waiting for me. All the worries I had about whether there would be shade for our guests, whether the ceremony site would be too plain without decorations, whether I started the ceremony too late waiting for our last minute guests -- all thoughts gone in a moment of sudden clarity as my vision tunneled down the aisle to you. You hate it when you cry, but from the very first time I saw you cry, after we visited your grandmother together for the first time and she asked for Jol for the first time in years, I loved you more for it. Your tears have never been a sign of weakness, but instead a manifestation of your love, whether it be for your family or for me.  And as my Dad gave you a hug and passed you his own handkerchief to wipe your tears, I thanked God for gifting me another perfectly sentimental and sensitive man in my life. 

The rest of the reception passed in a blur. When we finally got home that night, I was so tired from the emotional burnout of the preceding week and just ready to pass out. But instead, we sat with your family and decompressed with another round of beers. We shed some more tears as your parents shared their wisdom and their blessings.  As my vows to love your family as my own echoed in my head, I was struck by how similar our family values are. I remembered feeling so deeply grateful that I married into a family that blended so seamlessly and effortlessly with mine. 

Now here we are, not so secretly married anymore. The stress of planning a wedding and coordinating your parents' visit conquered, but the new stress of finding an apartment together and eventually buying a house looming. But I'm not worried, in fact, I've never been more confident in something in my whole life.  I've doubted myself, my performance, and my abilities, but in the past 3 years and change, I have never doubted us. Whatever lies ahead, I know we can tackle it head on together.  

Love you, Oppa. <3  

Doom and Gloom Loom

I can't believe it's the end of my second week of classes and I am halfway through my mini "vacation" from work.  As my teacher says, "el tiempo pasa rápido cuando te diviertes."

One thing that I've appreciated over the past two weeks is the difference I see in myself during this time away from the relentless demands of the hospital and clinic. I was supposed to check my work inbox while away, but due to technical difficulties, I haven't been able to remotely access it. Even as I struggle not to think of the trash fire that is inevitably developing, this complete disconnect from my work life has been doing me good. Each day, I adhere loosely to the same schedule. I spend my mornings at school, explore a different place for lunch every day, and study Spanish at a cafe or at home in the afternoons. If I'm tired, I siesta. If I'm bored, I hang out with my host brother and play checkers. There is no pressure from deadlines or grades, the only marker of my performance is the increasing degree of comprehension I attain at the dinner table. Life is so much more relaxing and the future bright when the most stressful decision you have to make each day is what you want to eat for lunch. 

Just two weeks ago, I would text Uram daily by 10AM, already complaining about my day in clinic. At the start of my third year of residency, one whole year into this crazy little thing called COVID, you can call me toast because I am burnt out. Now the memory of rushing from one room to another to stay on time, the spike of annoyance when I couldn't extract myself from a patient fast enough, the feeling of despair when there's 15 messages in my box at the end of a busy day are so distant that it almost feels like someone else's life. They say you can see someone's true nature when they're faced with adversity and it makes me despair -- is that who I really am? There are days I feel truly devoid of empathy and compassion, when I have a knee-jerk reaction of rage whenever a request is made of me, when I reflexively deploy cynicism as my first line of defense. There are days when it's difficult to be kind, when it feels taxing to do the bare minimum let alone go the extra mile. Let's just say I am no longer the idealistic college grad who applied to medical school because I wanted to help people and wrote essays about feeling called to primary care. Instead, there are times I ask myself why I should keep working so hard to help people when it feels like they couldn't be bothered to help themselves. 

It's funny, I can't pinpoint when exactly I stopped thinking like a patient and transitioned to thinking like a doctor.

Don't get me wrong, this is by no means an announcement that I am quitting my job and leaving residency. (Let's be real, momma needs money to buy a house if she wants to stay in the Bay Area.) But this opportunity to divorce myself from the myopic world of work and academia has been eye-opening. Some people in my shoes would say the experience is "freeing", but for me, it's been quite the opposite. As much as I am enjoying my time now,  I can't help but be aware of the ephemeral nature of it all. The knowledge that I must return to reality looms over me and has forced me to think critically about what it is exactly that I dread going back to.  I feel I may have lost my sense of self trudging through residency and now I have been granted the chance to take a step back and better examine my own motivations and aspirations. I always joked that I didn't have any dreams, no 10-year plan. The truth is that none of my dreams take place at work and that I have started to view work as a necessary evil to achieve my dreams -- - getting married to Uram, buying a house, and having kids. 

Maybe the timing is perfect. I have interviews lined up during the week after I return to the US. No better time than the present to figure out what I'm looking for in my future job environment...and how to make the necessary a little less evil.  And who knows, maybe tripling my salary will triple my tolerance for work shenanigans :P 

Kindness of Neighbors

I thought I wouldn't have much to do this weekend, but oh boy, things can definitely change in the blink of an eye. It's a three-day weekend here in Costa Rica due to Independence Day; it's the 200th anniversary of Costa Rican independence. My original plan was to spend a day exploring Heredia, a day wandering San Jose and maybe hitting up Chinatown, and another day lounging and studying at home. I mentioned these plans to my Mama Tica while our neighbor Don Jose was over, and Jose exclaimed, "Don't go to San Jose! It's ugly and dangerous." 

Don Jose lives down the street and he helped pick me up from the airport with Papa Tico. He also comes over almost every afternoon to teach classes remotely, probably because we have better wifi. We had bonded over our love for nature and he had painstakingly showed me every picture from his most recent trip to Tortuguero. Every. Picture. From blurry pictures of nothing, to close-up selfies of his unsmiling visage, sharing these pictures on his tiny, cracked phone screen reminded me that no family is complete without that funky uncle to always keeps you entertained. Don Jose offered to take me and my host sister Mia to see various vistas around Heredia and I asked if we could maybe visit the Catarata de la Paz, a nearby waterfall that is a hot spot for locals and visiting tourists. "Don't tell your school," says Papa Tico, "but going with Don Jose is probably going to be a lot cheaper than going with their tour." Oh hell yeah, traveling with friends and for cheaper, count me in!

So Sunday morning, Don Jose arrives in his old clunker to pick up Mia and me. "I'll give you the complete tour, don't worry!" He was 100% not joking. As we put-putted our way up the steep, windy mountain roads, Don Jose would slow down at every field, flower, or vista and exclaim "Mira, mira!", "Look, look!" As a stressmuffin, I could barely enjoy the view from my spot sunken deep in the back seat as the number of cars held captive behind us began to accumulate. At one point, a truck hauled ass to pass us. "Don't worry, " Don Jose reassured us, "we are tourists today." I didn't need to convert 15 km/hr into mph to understand the road rage that was brewing behind us. 

After a few scattered episodes of honking and re-enactments of fast and furious that occurred around us, as well as a brief breaking and entering into a coffee field so we could see coffee beans on the plant, we finally arrived at the waterfall. Usually, entry tickets to the waterfall are $48 per person, however, Don Jose took us to the local viewing site where we could enjoy the sight of the fall as it enters the creek below for free.

La Catara de la Paz

Just a short jaunt away from where we parked, we were able to walk behind the waterfall and enjoy the roar of rushing water up close. 

Mia, Don Jose, and me enjoying the view from behind the waterfall

After taking pictures of the waterfall from every angle, we couldn't resist a local vendor selling skewers at the base of the falls. 

Mia and our pork and elote skewers, about $1.50 each

On our way back home, Don Jose pulled over at what appeared to be a random restaurant by the side of the road. There was a little wooden gazebo built overlooking the valley and we were astounded by this amazing view.

Straight out of Jurassic Park

Of course pictures can never capture the magnitude of the real deal, but I will never forget the feeling of peering down into this verdant landscape while watching the wind whip the wisps of cloud around as easily as it did the errant strands of my hair. 

Once we arrived home, we asked Don Jose how much we owed him for this day of adventure. Homeboy whips out his uber app and calculates how much it would have cost to travel to the waterfall. So for a whole day of driving and adventuring, all he wanted was $40 and the price of a beer. (The cost for the school trip is closer to $95) Sign me up for the next trip with Don Jose!

There's no school today, so I'm spending the morning enjoying a Costa Rican latte at a local cafe. I'm living my best exchange student life as I work on my blog and enjoy my latte with a small slice of cake. Tonight, I plan to make picadillo for the family. (They made me Costa Rican picadillo on my first day so I wanted to share the Mexican version with them...also it's hard to find Asian ingredients here to make Chinese food.) Hopefully they like it, but I have no qualms about finishing the whole pot by myself in this rainy weather. 

Looking forward to another weak of learnage! 

One Week in Costa Rica

Well it's the end of the first week of classes and I am headed into my first weekend in Costa Rica. Oh the things I have learned! From how to turn on hot water in the shower to how to order casado, every moment of the day has presented an opportunity to experience something new. To think that I arrived on Sunday, never before having spoken a complete sentence in Spanish. Besides the occasional "Duele?" and "Como se siente?" I would shamelessly use to expedite my morning pre-rounds, I really had never had the occasion or confidence to speak Spanish at all. Here, the teachers are super good at speaking slower and in short, simple sentences so it makes me feel like I almost understand Spanish. Almost! 

Every day, I wake up at 7am and am greeted in the living room with a homemade breakfast. Sometimes it's eggs and toast. Other times it's a smoothie with yogurt and fresh fruit. Breakfast is always served with a cup of hot coffee and an enthusiastic "Buenos dias, Abby!" I eat breakfast with Mama Tica and Armando, my host brother. Every morning, Armando eats a giant crepe smothered in maple syrup and 1/4th of his meal is shared with the family dog, Mofy. After Armando rides off to work on his motorcycle, I start packing my backpack and leave for school at 8am. It only takes 5-7 minutes to walk to school, but sometimes I take little detours to catch Pokemon or spin stops. I'm probably gaining a reputation in the neighborhood as "that Asian girl in a yellow raincoat" who is always on her phone. Once I'm at school, I make sure to have my precious APT (papaya will do wonders for your digestion) before classes at 8:30. 

At the orientation on the first day, they told us that those of us who are in group classes alone, will have our classes truncated from three to two hours. I guess no one passed the memo on to my teacher because we are still having 3 hours of classes, followed by one additional hour of private Medical Spanish lessons. Well, I ain't going to be the one to tell him. 

After classes, I usually leave my backpack and valuables at school and wander the neighborhood in search of lunch. So far, I've eaten the majority of my lunches at the Central Market. They sell fresh fruits, meat, and baked goods there, but my favorite stores are the sodas. These are small, usually family-owned, diners where you can order casado, or a Costa Rican plate with meat, rice, beans, and salad. Once, I wasn't too hungry so I tried to order just a tortilla with cheese, but something must have gone wrong in translation because I ended up with a giant platter of food. I have yet to return to that stall due to mortification and shame. One day I will return for you, tortilla!!

The afternoon is my own, but I haven't had much opportunity to explore on account of the rain. When it rains, it pours in Costa Rica. It rained so hard my first day that my raincoat soaked through. (J.Crew is full of lies and deception.) Hopefully, I will have time this weekend to wander through Heredia and San Jose during the warm and dry mornings. It's a long weekend because of Independence Day, but according to my teacher, everything will still be open to promote commercialism during the pandemic. We shall see -- there's a waterfall park and several cafes/restaurants I have a hankering to see. So far, I've been taking the free classes offered at school to kill time in the afternoon. I took the dance class once but I don't think I'll do it again -- much too sexy for me. lol. We learned basic bachata but the moment they made me hold strangers' hands, I was further outside my comfort zone than I would have liked. I like several Jesuses between me and everyone else, thank you. During cooking class, we learned how to make pan de queso, which I would describe as a cheese cookie that is best enjoyed with a cup of coffee or tea. 

In cooking class, one student claimed that we didn't need to wear masks if all of us have received the COVID vaccine(s). Whatever Costa Rica is doing, they're doing right, because the cook Janette shut that down real quick. Before I could decide whether to say something, she said, "Even people who have both doses of vaccine can get the delta variant. My daughter-in-law is pregnant and I'm high risk so I'm not going to take any chances." 👏👏 Yaaaas girl, you tell him. You tell him to pull his mask over his stupid-ass nose. I haven't met a single Costa Rican yet who is against masking. In fact, they usually complain about the foreigners that refuse to wear their masks correctly. I've been asked, "Why are Americans like that?" and I have no good response to that. 

After afternoon class, I walk home in the pouring rain. If it's early, I'll try to study or blog a little before dinner. Otherwise, I'll ask if I can help out in the kitchen. Reynor will sometimes entertain me and let me stir something. Unlike in the US, where we have specialized tools for every purpose (spatulas, whisks, tongs, etc.), in Costa Rica, it seems like the only tool they use is the spoon. I want to cook a meal for my host family but thinking of cooking without a spatula and a wok is giving me a pre-headache. I've also noticed that my host family rarely eats together. I don't know if this is specific to my family, but they put all the food on the stove and people help themselves when they want to eat. It's a little strange to me when I'm eating something different from everyone else, as if they have to prepare different food for me because I am a guest. 

In the evenings, I like to watch Mexican dramas with Lilli. I only understand 30% of the Spanish but I understand 100% of the drama. Every night, Armando goes to the gym. Most of the time Fabian goes with him, but when he is too tired, he'll stay home. On these nights, he will challenge me to checkers, a game I have literally not played in over a decade, but am learning to play now out of sheer spite. Nothing humbles the spirit like losing repeatedly (and badly) to a 16 year-old. 

My favorite thing about this family is perhaps their penchant for going to bed early. Reynor goes to work at 6am, so he'll usually head to bed around 8pm and the rest of the family soon follows. I usually head to my room around 9pm to squeeze in a nightly chat with Uram before bed. 

Well that's a breakdown of my day to day! Yeah, I'm pretty boring but you know me, I love a routine. Hopefully I will have more exciting news to share after this weekend. 

Ciao! 

Hola Desde Costa Rica!

Miracles of miracles, I have made it to Costa Rica!

This was a trip I've been planning since May but there was no guarantee it would actually happen until literally the day before my flight. First, I had to gain approval from Stanford by convincing them it would benefit my clinical practice and that it was something I couldn't do in the United States. Second, I had to make sure they wouldn't suspend my salary since I wasn't doing anything clinical for a month. And, perhaps the biggest obstacle of all, I had to renew my passport...

Three weeks before my flight, tickets booked and everything, my sister came downstairs with my passport in hand and asked me: "Are you aware your passport expires in two days?"

Um, no? I haven't looked at my passport in almost two years thanks to this COVID nightmare. Shit.

Before COVID, you could get your passport renewed in 6 weeks and expedited in 2. Now in this pandemic-induced dystopia, the wait time looks more like 18 weeks and 12. Nuts. After much frenzied internet research, it turns out that you can call the passport agency (>1 hour hold time) 2 weeks before your set travel day and try to book an in-person appointment for within 72 hours of your flight departure time. After a cumulative 3 hours spent on the phone, I finally snagged an appointment day on the Friday morning before my flight out Saturday night. For two weeks, I agonized over whether I would be able to walk out with my passport on the same day or if there would be another unforeseen delay that would cancel my trip. But come Friday, praise Him, I walked in to the San Francisco passport agency with my hopes (and important documents) in hand, and walked out at 3:30pm with a freshly minted passport! 

I'm so grateful for the encouragement and support from Uram, family, and friends. If Amy hadn't realized that my passport was expired, I would not have even looked at my passport until the day of travel. Uram literally waited on hold with me for over an hour as I stressed over whether I would be able to reserve a coveted appointment. He also woke up at 6 AM to drive this bundle of stress to the passport agency. Multiple friends offered words of encouragement and reassurance that it wouldn't be no thang and I would get my passport, no problem. Thank you all again for keeping my neuroses in check. 

I wasn't aware I've been holding my figurative breath for months until I felt the wave of relief wash over me the moment I saw someone waiting at the airport terminal with my name on a giant sign. This is finally happening, I did it, I'm going to study Spanish for a month in Costa Rica! 

The experience is already better than I anticipated. I love my familia tica -- Papa Reynor is a forensic pathologist (I KNOW, I WANT TO KNOW EVERYTHING), but also maybe a mortician? Mama Lili can't really cook but makes up for it with enthusiasm, lol. Their older son Armando will shyly correct our broken Spanish but unabashedly walk around the house shirtless. Their younger son Fabian is a genius and likely future Olympian, equally speedy at the Rubik's cube and on the track. The moment I brought chocolate into their home, I was a welcome guest. (I have never seen anyone destroy a bag of Ghiradelli so quickly.) From the very first day, they urged me to treat their home "como su casa". I am also blessed to have another American student in the house, Mia. An English teacher from Indiana, her Spanish is so, so much better than mine and it's a lifesaver when I'm trying to express more complex thoughts to my host family. It's also nice to have someone to decompress with at the end of the day and keep me accountable for studying Spanish in the evenings. 

I originally signed up for a group class with 1 hour of private lessons in Medical Spanish. The group classes are split up by Spanish level and I was fortunate enough to be placed in a class by myself. (The assessment of my Spanish level was "Basic...pero no es cero.") My teacher Samuel is from Peru and I LOVE HIM. Our conversations always somehow veer off course from vocabulary and conjugation to a range of modern day topics like new abortion laws in Texas or the broken American education system. He patiently waits as I try to Google translate new vocabulary and gently corrects my atrocious grammar/conjugation. If any of y'all looking for an awesome Spanish teacher, he teaches remotely on the DL! 

Anyways, can't wait to see what else Costa Rica has in store for me! I already have a map drawn up of all the places I want to eat...not sure if I'm going to succeed in losing weight here as I originally planned... 

 

Hiking the Hoodoos

It's been a long, long first year of residency (Okay, okay, 6 months). It feels like I spent half the time lamenting my life choices, wondering if I would have been happier as a librarian, a personal assistant,  or a professional food blogger. On my darkest days in the hospital, I sometimes wonder if I care about my patients at all -- or if I'm just telling myself that the apathy is an emotional defense mechanism to distance myself from bleak outcomes and poor prognoses. 

At the midpoint of PGY-1, which marks 1/6th of my journey to attending-hood and becoming a "real" doctor, I was blessed with the opportunity to break free from the soul-crushing confines of the hospital and re-adjust my perspective with some much-needed nature therapy. 

                                    

We were ambitious. 4 straight days of hiking. 33 cumulative miles. What are we, athletic or something?

As I huffed and puffed my way up the first of many sets of brutal switchbacks, the stillness of Nature interrupted only by the sound of my heart protesting fiercely in my chest, I could feel myself metaphorically climbing my way out of my funk. After six months of constantly questioning whether I'd chosen the right career path or whether I would ever measure up -- countless nights waking up from vague nightmares about wrong clinical decisions and missed deadlines with half-formed nonsensical differential diagnoses on the tip of my tongue -- it was so refreshing to feel physical anguish rather than mental despair for once. Call me a masochist if you will, but I would take feeling like I am dying over feeling like I want to die any day.

Surrounded by (literally) breathtaking scenery, I was reminded why I fell in love with hiking in the first place.

Even as my lungs burn and legs scream, as I take a look around, I can lose myself in the beauty and vastness of Nature. Every step takes me toward another vista, every turn offers a different view. I am reminded that my suffering is temporary. I am reminded that I am small. Doubts and insecurities that poison my self-worth seem insignificant in the shadows of the canyons and valleys that lie before me.



I never feel the presence of God so tangibly as when I'm awestruck by the works of His hands and these stunning rock formations took me straight to church, y'all.

Stone spires artfully crafted by centuries of wind, rain, and snow -- and for what purpose? 

I can't speak to His divine plan, but as I plunked myself down in a snow embankment for a brief respite, I felt a sense of being in the right place at the right time. For the first time in a long time, the inner turmoil was quelled. It was as if I'd stumbled into a quantum leap. The weight of the worries that had been plaguing me incessantly and the stifling specter of upcoming inpatient months, not vanished, but suddenly manageable. I guess it's what the wise Dr. Rai Sr. would call a Valley to Everest shift in perspective. 

I realized that no matter what comes to pass in the hospital -- those days when I feel harassed by the constant demands of the wards, belittled by consultants, emotionally drained after the fourth or fifth family meeting in a week in order to appeal for a patient's right to dignity in dying -- these canyons remain unchanged. Each time I wake up and I think to myself, "I can't do this for another day" -- the mountains are unfazed. A hundred years from now, when I'm dust and scattered into the wind -- the valleys keep doing as they do. 

I'm not saying this is Nature's equivalent of honey badger don't care. 

I guess there's just something comforting to know that even if I crash and burn -- if I drop out of residency today and become a comedian --  in the grand scheme of things, nothing will change. Everything will continue. Everything will be OK. Eventually. 

Who knows how or why God sets the rivers' course? But He made me who I am and, and even though I may doubt myself, my faith remains in the Alpha and the Omega, the One who is, and who was, and who is to come. 

I was reminded too of the blessings that He has placed in my life. 

I can hardly believe it's been one year since I met Uram (On Tinder, of all places. God works in mysterious ways despite my best efforts to walk the wayward path).  I used to think that my heart was made for my family, God, and myself -- that to place any newcomer on even the same level would be a betrayal to those that had already laid claim to my love. But then again, the idiot I was then (I'm a whole new kind of idiot now, thanks) also subscribed to romance novel logic and allure. He is nothing like I ever imagined but everything I've always needed. He has taught me that love is not linear nor additive, but infinite.  When I am having trouble loving myself, he lends me his eyes to see myself in a way I do not yet believe I am, but hope that one day I can be. (Who knows, I'm incredibly short-sighted and his vision is 20/20.) From him, I've learned that love is more than just lip service but actions and time invested -- not just doing what is obligatory, but losing hours daydreaming up ways to make someone smile.  I am so, so blessed to have him and though I used to curse the days of being #foreveralone, I can honestly say he is well worth the wait. 

So yes, it's been more than a year since I last posted and it's sure been a wild ride. In many ways, I'm the same person I've ever been. In others, I'm slightly better or worse off than I was before. But I'll keep trying to bump myself out of tired old orbits, dig myself out of ruts, wander off the beaten path. And if that requires an annual pilgrimage to the wild to make it happen? I've heard Banff has some good views. 

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.

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.