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.

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.