Expectations of Internal Medicine Rotation

Xixi once passed on a piece of wisdom from an attending whom I like to lovingly refer to as Mary Lou.  Though my interaction with Dr. Mary Lou is limited to having attended several of her large room lectures and anecdotal accounts from the lucky few who have been her students, I have developed an immense respect and admiration for her. She is pediatric hematology-oncologist. Some may say it's a morbid job title...a doctor who attends to the unfortunate children whose short lives are or have been plagued by cancer...but I can only begin to imagine the joy and optimism of a job that can help to grant some kids a normal childhood, longer time with their families, and perhaps a healthier future.  My preconceived notions of her strength of character, emotional maturity, and unrelenting optimism aside, I have found her advice to Xixi down-to-earth and helpful.  Dr. Mary Lou told Xixi, nearing the end of her second year in medical school, to reflect upon and document her expectations of a certain specialty at the beginning of each rotation, and after each rotation to journal the actual experience.  Though family medicine and psychiatry rotations have come and gone, I will not let yet another rotation slip by.

Inpatient internal medicine at the VA:

I have my first month of medicine at the Jesse Brown VA, the hospital where I completed practicum and psychiatry rotation.  Logistically, I am more or less familiar with the VA computer system, which should be a plus when documenting patient charts.  Other than that, my expectations of my first month is laced with fear.  Now, at the end of the coveted orange space, I cannot say I am not disappointed at my lack of academic productivity.  Though I have accomplished lots of cooking, cleaning, and driving, I have not made much progress (if any) on research or studying.  Sadly, and perhaps inevitably, the knowledge of medicine that I hastily stuffed into my brain for Step 1 is slipping from my hippocampus like a rapid, uncontrollable mudslide.  I am afraid of being asked questions by my residents and attendings and only providing answers that consist of blank stares, mistakes, and vague shadows of the knowledge that used to exist. I am unconfident of my interviewing skills, my physical exam maneuvers, ability to make differential diagnoses and order pertinent tests, let alone devising a treatment plan. And the sheer breadth and depth of information is overwhelming, to say the very least. So, my expectation is that I will need a ton of help from a mightily nice group of teachers. At the VA, it's been my experience that the major types of pathology include various forms of heart and pulmonary diseases, diabetes, chronic pain, drug use and their exacerbations. Though I would love to see a wider range of diseases, I cross my fingers and hope that my first week is a lot of heart failure and COPD.  I am also uncertain about inpatient medicine, which invariably has sicker, more severe patients that require a higher level of monitoring and care.  I am afraid of making mistakes that are irrecoverable, which can bode very unwanted outcomes.  Before I digress into discussing all the possible mistakes I'm afraid of making, I feel a sliver of excitement over the increase severity of pathology and ability of follow patients through a prolonged time course until they are well enough to be discharged.  Seeing patients get better before my eyes was one of my favorite aspects of inpatient psychiatry and I am hoping for something similar in inpatient medicine.  By hearsay, the VA medicine nurses are not the easiest to work with.  I am going to need to put my best foot and manners forward, but I am expected to do that same everywhere. So when I wake up tomorrow to head for the VA at 7:30 am, I will take a large dose of enthusiasm and courage, and hopefully be blessed with a little luck for a enjoyable and educational month. 

Medicine at Mercy:

Mercy Hospital is where my mom works as a respiratory therapist.  From her frequent gossip regarding her run-ins with the medical residents, I am dreading the experience a bit.  Most of the residents at Mercy are foreign medical school graduates.  Though I should refrain from making any judgments of their medical skill and knowledge, I can't help but have notions of decreased calibers of teaching and less enthusiasm with students.  And, a community hospital like Mercy, in my opinion won't have the rigorous application of evidence based medicine and prudent medical decision making.  Hopefully, I am wrong.  Ok, I will adjust my attitude and check in with myself a month from now. 

Final words:

Internal medicine is an important rotation for me as I will most likely become a resident in this field.  Therefore, it is important to me that I enjoy this rotation.  Yes, I have been barely lukewarm about my placement at Mercy, but that just means I will try hard to make the best out of it. My goals are to learn as much as I can and obtain a solid foundation of medicine. At the same time, I would like to keep an open mind in the event that do not enjoy this rotation. Wish me luck!

Back from my first driving lesson!

This reaffirms my desire to marry super rich and have a chauffeur drive me around.

I, or more accurately my parents, paid good money for today's 2 hour lesson with Nova Driving School.  Marcelo, my instructor was quite prompt in picking me up from my house...so prompt that I was still in my PJs with black pepper in my teeth from wolfing down the pasta I just cooked.  My dad studied Marcelo and then the car from our window while I was trying to brush several stubborn knots from my hair.  "Ok, it's a big car, good!" Dad said.  Oh goodie, I thought, wouldn't it be cool to learn how to drive with a huge SUV or one of those small trucks.

Swift as lightning, I grabbed my permit and purse, put on some Grandma shoes and ran out the door only to find a Kia Soul, probably the ugliest car ever made, inconveniently shaped, and awkwardly sized, parked behind Marcelo.  Marcelo looks like how his name sounds, a short hispanic man cleanly dressed in argyle sweater, concealing a little bit of a plump belly.  After a few pleasantries, and a quick mental status exam, I decided it's a go.

The lesson went more or less how I expected.  We sat in a parking lot above Home Depot and practiced how to hold a steering wheel, how to rotate it using the "hand over hand" technique, adjusting mirrors, making turns, and how to brake without jolting the both of us out of the front window.

And, it was time to take the road.  I am less nervous than I expected. Leaving the parking lot through a steep ramp, which according to Marcelo I handled well, I am immediately presented to the large multi-laned Roosevelt road.  Things were going well until I was stuck at a red light in a middle lane with a large SUV poised to make a left turn on my left and a giant bus, swelling out of its own lane one my right. I looked at the bus driver.  Could he see my face? Does he know I am only 24 and haven't traveled to Europe yet? Can he tell that I'm a medical student who can be a good doctor in the future and maybe save a few lives? Please give me some room and don't squish me! As soon as the light turned green, I perhaps over-zealously stepped on the gas peddle and our Kia Sour roared forward.  A short lived spark of exhilaration rang through my veins only to be smothered by Marcelo's brake peddle on the passenger side.  I am scolded and told to be easier on the gas and to stay in my own lane. Apparently, I tried to cut off the bus so it has no way of driving in parallel with me...

The rest of the lesson was uneventful.  I disliked having to step on the brake peddle at the right light for so long, I felt unsatisfied with the moderation my calf muscles had to exercise when pressing the gas peddle, and I was impatient with pedestrians sauntering slowly across a crosswalk when I am waiting at the stop sign.  Driving probably isn't going to be an enjoyable activity for me but I'll hold that judgment for later.

No more lessons for now.  I will study for the road tests how I study for my other tests: find out what's going to be tested and cram beforehand, then pass the exam and learn it later.

Here's to you, Rice Monster

Rice monster [rahys MON-ster]
noun

1. A large, grotesque, and frightening mythical creature or life form that arose from grossly mutated rice Oryza sativa.

2. Someone who eats a lot of steamed rice and loves it.  Often used as a term of endearment for a person, most likely of Asian origin, who unabashedly eats bowl after bowl of rice.
Note: rice is filled not only to the brim of the bowl but also protrudes upward like a hill, doubling the capacity of the bowl. 

I was fortunate enough have met a Rice Monster that fit the second definition from the dictionary.  A true Rice Monster is rare for he has characteristics that are inherent to his being, which cannot be defined by a mere dictionary.

A Rice Monster is kind and understanding.  He bravely weathers the fiercest of my temper tantrums that devastate like a sudden tsunami.  He takes bullying, unkind words, and dismissive comments with stride and finds a silver lining in the worst misuses of the English vocabulary and abuses of immature impulses. With a penetrating infrared gaze of a honey bee (or was it fruit fly?), he see beyond icy shells of crusty pessimism, devilish horns of intolerance to the kinder inner warmth that I'm not positive I possess.   Thus, he zealously forgives whatever rash mistakes, selfish transgressions, and punishable sentiments that even I myself sometimes cannot because not everyone can be as kind, loving, and rice-loving person as he.

He is willing to sacrifice time, energy, and comfort so that others like me can reap in its rewards. Yet he asks for nothing in return but a home for his heart to belong. A request extremely difficult to deny...The reason is perhaps the following. Though at times begrudgingly, he willingly plays the weaker characters in videos games whose skills mainly consist of blind, stun, and a few soft punches that might be able to destroy enemy monsters before they die of old age. This is so I can play the stronger one, so I can kill enemy hordes by the second, and so I can boast about my unquestionable, unparalleled skill.

He is fiercely confident, though not arrogant, often a difficult balance to strike.  He believes that as long as he has rice, he can just Kimchi this and Kimchi that to make everything taste good.  He believes that as long as he keeps loving, giving, understanding, caring, and forgiving, he will prevail.  I am inclined to believe it is true. Once a Rice Monster reveals his true form, he is dangerously contagious. He steadily and patiently instills willingness to give, readiness to forgive, and a growing confidence to love. Hand in hand with a rice monster, obstacles are undaunting and the will to persevere is strong. So let's Kimchi this and Kimchi that for many years to come...and eat lots of rice.

Here's for you, Rice Monster!

Black Rice with Raisins and Goji Berries

Ingredients:
2 cups of black rice
2 cups of gluttinous white rice
1 cup of large raisins
1/2 cup of dried goji berries
water
honey

Instructions:
1. Soak black rice overnight in rice cooker
2. Add in gluttinous white rice, raisins, and goji berries.
3. Fill rice cooker with water as if you're steaming 4 cups of regular rice
4. Press a button to cook rice mixture
5. Drizzle some honey over the top of rice (if you want, though I think it's sweet enough without honey)

My favorite childhood rice snack (without the oil and sugar)!!

One step closer to normal, functional adulthood

Today, I obtained my instructional permit, a much coveted document by most normal 16 year olds.  I, however, spent most of my mid and late teens painting self portraits with oil colors and grappling with those existential dilemmas of Kafka, Sartre, and Nietzsche.  So, whatever time I wasted not learning the rules of the road and how to drive a car, I will make up sometime in the future by not going through some type of midlife crisis or having to find myself...hopefully.

Getting my permit today wasn't an easy feat.  After giving the road signs a cursory glance this morning, I rushed to the multicolored, peculiarly shaped JR Thompson Building on Clark and Lake (a bit of an eye-sore, in my opinion, definitely not the best of Chicago architecture).  I hoped and hoped that there would be a short line at the Secretary of State office because with each passing second, road signs and rules were slipping out of my brain.  Do you turn your wheels towards the direction in which you're hydroplaning or no? What did the "slow moving vehicle" sign look like? Shoot.  My cheeks reddened with embarrassment as the prospect of failing this exam shot thru my head.  And then my heart sank. The line was almost out of the door!

Did I tell anyone I was taking the exam today? No one has to know if I failed, right?

When it was my turn in line, a lady, overworked and nonchalant, gave me a service ticket that read F658.  "Wait for you number to be called," she mumbled and waved me away.  Completed dejected by my bad luck, I found a seat next to a couple who were not afraid to exhibit PDA...

I waited and waited. I used up all of my five lives on Candy Crush, killed a few zombies on Plants vs. Zombies 2, listened to 4 chapters of my new literature adventure Far from the Tree by Andrew Solomon, while in the background, the intercom intermittently announced "now serving A027 at counter number 3", "B223, D024...". I grew more and more restless.  I stretched my calves and pointed my toes to avoid DVT and then began to nervously shaking my legs due to impatience and need to use the restroom.

Finally, during my third attempt to beat my high score in Temple Run, F658 was announced.  I was positively fuming by then.  There will be no pleasantries, no smiles, and if anyone gave me an attitude, I will not hesitate to call the manager...I will take this matter up with Jesse White if I have to!  I stomped to counter number 10, laid down my state ID, and announced, "I am here for my driver's permit." The little white lady, almost too short for the height of the counter, gently took my ID and said, "Oh, first time, honey? Don't worry, it's easy." She smiled a smile that showed her gums and sharp canine teeth not so different from my own.  The sheet of ice that surrounded me shattered and fell into the ground as water.  "Oh really? I hope I pass!" I smiled so sheepishly that I think my small eyes disappeared into my face.

And, everything was fine and dandy from there.  The "slow moving vehicle" sign is a weird yellow triangle with broken orange borders around it, and I still do not how to go control my car if it's hydroplaning. But, I passed with flying colors and got myself a Chick Fil-A meal for a pat on the back.

Get ready, world! I have graduated the sidewalks and will take over the streets in a storm! Under the speed limit, of course :-)

My very first pie!

Double Chocolate Berry Pie

Inspiration: "Lonely Chicago Pie" and "Strawberry Oasis Pie" from the movie Waitress. 

I didn't follow a recipe because I was missing a lot of ingredients like butter, milk, cinnamon, and nutmeg.  Worry not, my pie turned out extremely well!  My parents, who are by not means desserts people, have been raving about it all night long :-).  And, this recipe is super simple! 

Recipe

Ingredients:

10-15 fresh strawberries diced (sorry, I lost count of strawberries because I ate some along the way...)

1 1/2 cups of fresh blueberries

1 1/2 cups of semisweet chocolate chips

1/2 cup of brown sugar

1/2 cup of soymilk (was a bit nervous about this but all is good!)

1 egg, beaten 

1 teaspoon of vanilla extract

1 tablespoon of cornstarch

1 9-in graham cracker pie crust (from the store)

Instructions: 

1. Preheat oven to 400 degrees F

2. Combine beaten egg, brown sugar, soymilk, vanilla, and cornstarch. Mix well.  Then mix in strawberries and blueberries

3. Pour mixture into a small pot with medium heat and stir for ~5mins or until everything is mushy and gooey

4. Melt 1 cup of chocolate in microwave for 90 secs and spread liberally over the bottom and sides of the pie crust

5. Pour berry mixture from pot into pie crust, on top of melted chocolate. Do not mix.

6. Bake pie at 400 degrees F for 20 mins

7. Melt remainder 1/2 cup of chocolate chips in microwave for 60 secs and spread liberally over the top of pie

I know modesty is a virtue but YUM! 

Time to make a pie...

A few days ago, I sort of mindlessly watched the movie named Waitress on an obscure channel.  The plot is probably nondescript and not worth mentioning.  However, the quirkily named and mouthwatering pies are.  Strawberry Oasis, Marshmallow Mermaid Pie,  I-Don't-Want-Earl's-Baby-Pie, Falling-in-love Chocolate Mousse Pie, just to name a few.  One particular pie caught my eyes, taste buds, and heart: Lonely Chicago Pie. This pie was made in the setting of a gentle and caring love affair between the pregnant protagonist and her gynecologist.  Bittersweet chocolate melted into a thick and velvety bed on top of which the lovingly crushed raspberries, blackberries, and strawberries snugly cushioned themselves.  My salivary glands were so active that I ran to the fridge for my last cup of rice pudding and devoured it.

My brain soon tucked The Lonely Chicago Pie, along with the rest of the movie into the "to be discarded" section (it seems to be discarding a lot of stuff lately...).  However, an unexpected set of events jolted the pie back into consciousness.  

1. Mooncakes! For Mid-Autumn Festival, Xixi's mom made mooncakes of all different fillings.  When Xixi presented them to me, I voraciously took a bite of nearly every mooncake, hoping that my parents would forgive my indiscretions when I brought them home later.  Each bite was delicious, mooncakes filled with nutty goodness, mung bean paste, red bean paste, smashed dates, etc. They were one of the best mooncakes I've had in a long time.  I immediately asked Xixi to steal the recipe for me from her mom so I could make my own, all the time knowing it would be impossible at my current skill level. Though I could not admit this to Xixi, I resolved I will make something simpler, with a bigger margin for error. 

2. Finally bought a Bike! Finally!! I've wanted a bike since April.  I wanted one to ride to practicum at the VA, to the library when I am studying for the Step 1, on the lakefront in the scorching summer heat, to family medicine clinic, to VA again for psychiatry.  But, all that's come and gone, and bike riding days are almost over.  They weren't over for me.  After a unnaturally large meal of all-you-can-eat hotpot with my parents at Sweet Station, I was determined to purchase a bike and ride it home for exercise.  Though I haven't done any research, we marched over to Target and browsed their surprisingly large selection of mass produced bikes. I wanted a girly bike that'll allow me to get on and off most gracefully.  My dad selected a deep blue mountain bike with shock absorbers everywhere, to which I said no.  My mom selected a teal bike with a huge cushiony seat, and a spot to put a basket in the back for me to try...Too bad the front wheel was not completely round on that one.  Then I saw them, my 2 dream bikes. A pink and yellow bike with "Lulu" written across it, decorated with yellow flowers. Were the wheels white and pink? I can't recall. And another, a cute yellow bike, reminiscent of Bumblebee; it just screamed my name.  With these 2 bikes, I saw myself riding in the meadow with flowers in my hair and a basketful of fresh berries that I just picked from some random bushes...Following my gaze, my parents shook their heads adamantly and I snapped back to reality.  In the end, I settled on a sandy-colored bike, sitting quietly in the corner.  Though it wasn't as girly as Bumblebee or Lulu, it was girly enough.  And I can get on and off without much trouble...not so sure about graceful.  The best part was I could put my two feet on the ground without getting off the bike or falling to either side.  Sandy was coming home with me. Because I took so long to pick out a bike, it was already dark outside and my parents decided to put the bike in the trunk and drive home.  The problem was, there was no place left for me in the car.  I managed to squeeze into the trunk, pressed up against the back window like like a sad creature who wanted to run outside and play.  Anyhoo, Sandy is sitting downstairs, waiting for me to take her out for a stroll, to explore Chicago, and to buy ingredients for pie!

Here's Sandy!

3. My aunt and cousin are coming to visit from China in just 4 days! I am eagerly awaiting their arrival, made all the more sweet with a perfected Lonely Chicago Pie :-)

Won a book on Goodreads!

As a part of my Orange Space adventures, I signed up on Goodreads yesterday to extend my reading scope beyond the bullet-pointed medical review books. Goodreads offers free Giveaways of books recently published for a lucky few to read and review.  Much to my happy surprise, I was one of the winners of the free Giveaways- a book called Hospice Voices: Lessons for Living at the End of Life by Eric Lindner.

Being well on my way to becoming 3/4 of a doctor,  I will undoubtedly witness and be a part of the care of terminally ill patients.  Medical school will teach me what tests to run, which drugs to give to make patients most comfortable and without pain in their last moments. However, most of the issues regarding dying, dying with respect and dignity, dying with an acceptance of the life one has lived, lessons learned, and perspectives gained, medical school does not teach.  Though, I've gotten a peek into the end of life experience from reading Dying Well by Ira Byock, a medical doctor, it's time to see it through Eric Lindner's lens, a hospice volunteer.  Though this book isn't going to deviate wildly from the medical realm, I hope it will give me a glimpse of the humanities of a very medical phenomenon.  I am eagerly awaiting my book! Please ship it soon! 

In the meanwhile, I will try to finish reading the Rules of the Road today.  It is not surprise I still have not gotten my driver's license at 24...the reading material is not in the least bit interesting. Oh, but it will get done! Must just chug along! 

Orange Space

Orange space is a much anticipated period of 2 weeks in which nothing is scheduled. Two rotations and twelve weeks into my third year in medical school, orange space couldn't have come at a better time. No more rushing to the hospital before the residents, who arrive before the attending physicians to talk to all my patients and make sure no "acute events" occurred overnight. No more becoming zombified at the end of a workday from trying to keep everyone happy and impressed with my medical prowess. No more overzealous nods towards the attending, no more "I'll look that up for you!" towards the residents...just empty orange space for a precious 2 weeks.

So it began, a celebration with friends that have re-emerged into their respective hospital and clinic routines. Scrumptious and carbohydrate rich meals at Mia Francesca's, Grand Lux Cafe, and Oiistar wine and orange-mango drinks with Korean sweet potato cake, car-rides filled with laughter and songs, a steadfast marathon of the Twilight Saga, gut renovations of our respective rooms that somehow look like the aftermath of WWIII are all coming to a close on the 5th day of orange space.

Then it hit me. An uncanny yet familiar feeling, a mixture of ambition, action, rebuke, stress, and hope that slithers into my head in the middle of all long weekends, holidays, and unstructured breaks--the five stages of orange space. It starts with ambition: I will exercise for 1 hour everyday, make unprecedented progress on my research project, obtain my driver's license (FINALLY!), purchase a bike, plan an awesome trip for my aunt and cousin visiting from China, read novels, start a blog...Highly motivated and well-rested, my ambitions are coupled with plans and actions, with behaviors that are not so different from a short-lived hypomanic episode. Yet, at the tiniest speed bump, I am derailed, too discouraged to let go of small failures and complete other activities. Then the devilish voice taunts, "see, I knew you couldn't do it". Having received a credible insult to my ego, physiological signs of stress begin to show--the lack of patience and short temper, oilier hair, acne around the chin plague my once bliss-filled orange space. But I refuse to let this cycle become vicious. I am hopeful that just because I didn't go to the gym today, I will surely go tomorrow. I will do a literature search for my research project and read the handbook of driving rules.

The reasons, therefore, for restarting a blog is multi-pronged. One major reason is to use this as a way to keep me more adherent to my goals for orange space. Perhaps when my goals are published in an nebulous cyberspace that no one will probably read, I'll be more motivated. Another, equally major reason is the urge to write something that does not always sound something like "patient presents to the clinic with...patient has past medication history of...patient denies..." I missed writing complete sentences and embellishing those sentences to sound pretty and pretentious. So here I am, easing myself into non-medical vocabulary and proper grammar. Wish me luck!