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.