One of my surgical attending is intimidating and intense on service, but then says things like this

"I don’t care about what grade you get on this rotation. I just hope that throughout your 3rd year, you remember why you’re here and approach all your patients with compassion. Treat your patients like your family. You’re getting up at 3am to go to the hospital because that patient is your mom… It can get tough, there’s going to be bad parts to every rotation, but don’t let that bring you down, don’t let that stay with you. Take the best parts of everyone you meet, appreciate them, let those stick with you, and develop your own style from there."

He’s totally and completely my attending crush/role model forever xoxoxoxoxoxoxoxoxo.

Random stuff from the middle of surgery in the middle of winter

• Something I’ve learned recently: seniors including attendings, fellows, and residents are not necessarily right and if you have a different thought, you should speak up for yourself (nicely but still persistent) for the patient’s sake and for your own sake.
• The more I go through 3rd year, the less sure I am about what I want to go into. There has to be a balance between doing what you like and the lifestyle you desire. I like surgery, but I hate the lifestyle of most attendings I see and the patient populations I’ve encountered. But today, I was made aware of the nice lifestyles and the healthier populations that some specialized surgeons encounter (e.g. breast oncology surgeons, endocrine surgeons). I also love that it’s not just about the surgery, but to be a good breast oncology/endocrine surgeon, you need to be strong in clinical medicine—deciding when to cut/not to cut, when to biopsy/not biopsy, what alternatives could be better, and working well with multiple specialties. I want to follow a breast oncology surgeon for a day before my surgery rotation is over.
• I used to go to sleep as a child dreaming about the awesome life I’ll lead when I grow up. Now that I’m relatively “grown up,” I dream less and think about what’s important less. I’ve been pretty unhappy recently, being on surgery rotation in the middle of winter notwithstanding. I hope to find that child inside of me again.
• I’m excited to finally find a Chinese speaking drama that’s enjoyable to watch (我的自由年代). I can finally improve my Chinese in a fun way…I can now watch the most recent episode over and over obsessively while waiting for next week’s episode without feeling guilty hehe.
• Remember that when life is hard, when it feels like you’re just suffering all the time and not enjoying enough, remember why you’re going through this for, why you’re here—remember your long term goal. Remember your dream.

Medical Student Perspectives: How relationships in medical school will make you a better doctor

…the best advice I can give for relationships in medical school is to really have them. By “really,” I mean honestly putting your heart into them…I’m referring to all of your personal relationships…Your family and close friends will understand if they’re put in the back seat, or if the quality of your exchanges changes. True bonds are difficult to break. However, for that reason alone, they deserve more of you…Relationships help you reflect on a personal level, making your compassion more human, and develop the values you will rely on during your career. Surely, you will learn the most from your patients, but patients need someone with whom they can relate.

Here’s a sappy, feel-good (must read) article to offset the bitter, ranting post I made a few days ago…

Link: Medical Student Perspectives: How relationships in medical school will make you a better doctor

Ways to save money in medical school or other tight times

In light of increased discretionary spending for my good friend’s wedding as one of her bridesmaids, which I’m more than happy to do but that doesn’t change how strapped for money I am, I’m trying to find more creative ways to save money and still have a life. Here are some good ones I found on a simple google search (in no particular order)—

1. Sign up for membership at stores you frequent whether it’s grocery stores, convenience stores, department stores, clothing stores, etc.
2. Always bring your student ID in case you can get a student discount.
3. Eat at home.
4. Pack lunch & snacks everyday.
5. "Textbooks 2.0": online, electronic versions; renting textbooks; borrowing from/exchanging with friends
6. Shop at thrift shops.
7. Set a limit on how many times you can go out per month. Mine will be 3x/month. Maybe I can cut down to 2x/month.
8. Exercise whenever possible. Whenever I find a free slot in the schedule, I’ll go to the gym. There, less chance of spending money and at the same time it’s healthier! (Tip thanks to Jimmy Ng.)
9. Pass on watching movies in theater. Rent some movies from Redbox you’ve been meaning to see but never got to before they stopped showing in theaters…for 1/10 the price!
10. "If you save your change, at the end of the year you can take it to Coinstar and exchange it for a gift certificate without paying the fee they charge for changing to cash - Amazon.com has everything you could want to buy for Christmas presents." #
11. Learn how to take advantage of the Shell gas station Giant grocery store gives you! And other savings programs like this.
12. "Do all my shopping in one trip every three weeks. Fewer trips means better planning, less impulse buying, and less gas use. I make a list of what I need and stick to it UNLESS there is something I KNOW I will use that is seriously on sale. I also know which stores have the best prices on the things I buy regularly." #

# Tips thanks to Ohio State University School of Medicine Financial Services website.

Hope this is helpful for you! I will personally try to work on 6, 7, 9, 11, and 12.

Okay, I cannot end this post without a mini-rant:

To friends/acquaintances of medical students: please do not peer pressure us into spending more than we want or waft away our worries of being in debt with your thoughtless, “oh you’ll be rich doctors soon and pay off all your loans soon.” Yes, that will come (more) quickly for those of us going into radiology/anesthesiology/ophthalmology/dermatology but some of us will be filling the much demanded posts of primary care and will still be paying off our loans 10 years down the road… Please take your head out of the sand and read all the reports on how investing in medical education has one of the worst pay offs around. Also, realize that we’re not in debt for the 4 years of medical school, but at least 7 years because we still have residency afterwards where we get paid barely enough to keep ourselves alive much less start paying back loans. Unless you’ve been in our shoes or similar ones and know the feeling of watching your interest accumulate and compound year after year while knowing that you won’t even have a chance to do anything about it for another 5 years, please be more respectful of our financial decisions. And if you treat us to dinner or help us pay for something, trust me, we’ll remember and that generosity will be paid back to you 100-fold. Karma.

To other medical students: don’t let people who don’t know what they’re talking about peer pressure you. They’re not paying for the decision you make, you are.

Pimping

Rotations started last Monday. Been 1 week. Some thoughts—

• There’s so much…I don't know. I recall the keynote speaker at our clinicians ceremony saying that the firehose of info that’s been fired at us first two years has now been turned to full blast. I recall thinking that’s hard to believe. I confirm now that’s totally true.
• My first rotation is internal medicine. Sure, there’s a ton to be learned from it, but I don’t know if I'm in love with it as much as I thought I’d be. Maybe emergency med or OB/GYN is right for me?
• I'm frustrated that I can’t remember facts much less speak up quickly on rounds…I don't know. I need to review more? I need to stop overthinking? I need more quality rest time?

Final thought of the day: So I got brutally pimped today. I knew my info, but the amount of detail the attending asked of me was the level of a fellow—the senior resident told me so afterwards, and even the attending at the time acknowledged it, but he did it anyway. Now I know hyperthyroidism & Graves’ disease like the back of my hand. However, as prepared as I was, there are things I wish I did differently today—and it’s always the same—be confident in the things you do know. For things you don’t know, don’t be afraid to say, “I don’t know.”

"Clinical Judgment"

So much of clinical judgment is subjective. It doesn't just encompass making difficult decisions based on evidence based medicine and undeniably correctly interpreted results/physical exam findings/history, it also encompasses the actual interpretation of the aforementioned… how much epigastric pain do you believe he’s really having if he’s eating so well? Did he really have a 40 lb weight loss over 1 month if you had to dig that info out from him, and even then you had to ask if his belt & clothing size changed to assess how much weight loss he had? This is why no amount of evidence based medicine and technology will ever replace physicians, and why we have to be so careful about who we give the privilege of becoming physicians to..

Stress

= cortisol = me. Yeah!

Symptoms and effects of hypercortisolism

• Facial acne—def have this right now…
• Fat redistribution, e.g. truncal obesity, thinning of extremities, moon facies
• Hypertension—scared to check mine
• Immune suppression—better not! cannot risk getting sick before the big ole exam
• Osteoporosis
• Abdominal striae
• Hyperglycemia
• Emotional disturbance

^Self portrait. Jk. Obviously, my situation is not that extreme. People who have some constellation of these symptoms usually have something more serious going on—adrenal hyperplasia, pituitary adenoma, cancer somewhere that’s secreting ACTH as part of a paraneoplastic syndrome, taking steroids as treatment for another disease, etc.

So, too much stress is no good! …Yet not enough cortisol isn’t good either…it’s what keeps you alive after a stressful event like an illness, surgery, or trauma. So it’s not much different from what we learned in middle school about emotional and physical well-being, haha. I swear, we learned everything important about life in elementary and middle school.

Coincidentally read this while going through psych section. Good review for postpartum mood disturbances. I think this is pretty important awareness to have especially since the symptoms of postpartum depression/anxiety can be easily mistaken with “normal” stress associated with caring for a newborn (“I just feel ‘blah’.”). And especially since suicide & homicide rates are scarily high for postpartum couples…except that’s more highly associated with postpartum psychosis, which is not discussed in the interview, but still relevant.

ucsdhealthsciences:

Do New Dads Get Blue, Too? Three questions for our expert

Much is known about the sympathy symptoms men experience when their partners are pregnant –everything from weight gain to nausea. It’s called Couvade syndrome and has been used as fodder for plots in many a romantic comedy or television sitcom.  But what about after the baby is born?

Both the “baby blues” and postpartum depression and anxiety (PPD/A) are characterized with irritability, restlessness and anxiety in women who’ve recently given birth. PPD/A is a more serious condition with lasting symptoms that can range from hopelessness to confusion to fear of harming the newborn.

If dads-to-be can experience nausea, fatigue and weight gain concurrent with moms-to-be, can new dads also experience PPD/A?

We’ve asked Katie Hirst, MD, director of UC San Diego Health System’s Maternal Mental Health Clinic, three questions about the baby blues, postpartum depression and new dads.

Question:  First things first, what should women be aware of in order to discern between the “baby blues” and PPD/A?

Answer: “Baby blues” is related to the combination of a few major events that occur around childbirth: 1) you have a baby! (a pretty big emotional impact); 2) there is a massive drop in hormones immediately after the placenta is delivered, which can make chemicals in the brain go haywire for a little while; and 3) sleep deprivation from the third trimester and labor/delivery. The majority of women find that, within a few days of delivery, these three factors lead to tearfulness (often for no clear reason), irritability, mild insomnia and/or anxiety.

The important differences between “baby blues” and PPD/A  are severity and duration: “baby blues” does not impact your ability to take care of your newborn or yourself, and does not last for more than 2 weeks postpartum. In contrast, PPD/A typically starts anytime in the first 6 weeks postpartum and (if untreated) can last for months or even a year. Women with PPD/A may be too depressed or anxious to take care of their newborn like they would normally be able to do, and almost always feel very overwhelmed and/or irritable.

Q:  A 2010 study in the Journal of the American Medical Association (JAMA) reported that up to 10 percent of new dads may experience PPD/A. Are the symptoms in men similar to those in women or are there specific factors that new parents should be on the look-out for?  Does it differ from feeling overwhelmed by new responsibilities of fatherhood?

A: Just as with women, men with PPD/A report feeling overwhelmed and are typically irritable or “snappy” as a result. While most people expect a depressed mother or father to feel sad, both men and women with PPD/A often deny feeling sad but do report less enjoyment in their everyday life. I commonly hear statements such as, “I just feel ‘blah,’” “nothing excites me anymore,” and “I’m just going through the motions.”

While most new fathers feel tired and overwhelmed, and couples can certainly get a bit snappy with each other from the stress of caring for a newborn, a father with PPD/A feels all of this much stronger than expected. Guilt over not being the “perfect dad” in his mind, feeling trapped and losing the ability to concentrate are also common. The most notable (and frustrating) symptom is often difficulty sleeping—either trouble falling asleep or waking up even though the baby is sleeping. New dads are tired, for sure, but this is even worse with insomnia.

Q: Men are notorious for not seeking medical care and especially mental health care.  If PPD/A is suspected in a new dad, what can friends or family do to help?

A: Talking with a new dad about how he is feeling, and letting him know that fathers are almost as likely as mothers to have PPD/A are the most important first steps. Just as women think “it won’t happen to me,” men often think “it can’t happen to me because I’m a man.” Awareness is the first step, then acceptance—letting him know that it’s a common occurrence and that getting better will help him be the best father possible. Giving him the articles and website listed below may show him that he is not the only man to go through this.

T-7

In one week from now, I will be taking my Step 1 of the USMLE. Be still, my heart… I have more to review than I thought I’d have but today will be a good day.

Just for today
Do not get angry
Do not worry
Be thankful
Work hard
Be kind to others.

…and to yourself. Smile!

To Isaiah

This speech was given at the Harvard Medical School Class Day, Boston, Massachusetts, May 24, 2012.

I really really like this,

Antoine de Saint-Exupéry wrote, “To become a man is to be responsible; to be ashamed of miseries that you did not cause.” I say this: To profess to be a healer, that is, to take the oath you take today, is to be responsible; to be ashamed of miseries that you did not cause. That is a heavy burden, and you did not ask for it. But look at the facts.

In a word—empathy.

I also like this one a lot:

I am not blind to Isaiah’s responsibilities; nor was he. He was embarrassed by his failures; he fought against his addictions, his disorganization, and his temptations. He tried. I know that he tried. To say that the cards were stacked against him is too glib; others might have been able to play his hand better. I know that; and he knew that.

But to ignore Isaiah’s condition not of his choosing, the harvest of racism, the frailty of the safety net, the vulnerability of the poor, is simply wrong. His survival depended not just on proper chemotherapy, but, equally, on a compassionate society.

(Emphasis added.)

I was brought up by parents who worked themselves to the bone every day and have pulled themselves out of extreme poverty in rural China to wealth in the suburbs of America. They have little respect for people who are still poor and believe it to be their (the poor’s) own fault. And that of course has affected how I feel towards the poor (& socialism). Yet, especially this summer, I feel myself changing a little after seeing so many inner city poor come into the hospital so sick and helpless. And how this affects their family. And their dignity. The above quote is a reflection of exactly how I feel. Yes, we do have a choice to work hard and make our lives amazing, but the reality is that people on average are human, and people on average have a hard time rising through the bad hand that’s been dealt them. Yes, we should applaud and support those amazing people who are able to rise above their means, but that doesn't mean we should condemn those average humans, those very human humans, who don’t.

(Note: This is a draft I started last summer around the end of my palliative care fellowship at a community teaching hospital. For some reason, I stopped writing mid-sentence and never published this. I finished the last sentence to the best of my memory and am finally posting this now. I sincerely sincerely wish I took the time to write more last summer. That fellowship was amazing.)

Step 1 Studying

My friends for the past month: Lao, Lange, Sattar, USMLE World. You will not be missed.

 It’s been exactly one month since I started studying for the boards, and let’s just say I never want to go through this again. This past month has been unreal. If I thought MS1 was crazy (study/eat/sleep/repeat), that was nothing… I admit I’m learning a lot, but this day-in day-out studying has made me appreciate that I’m going to see more people in the future and will have less nose to book/computer screen time (hopefully…but that’s another worry for another time…GAH).

So much of the path to becoming a doctor is about "delayed gratification"—suffering now to have a more secure and fulfilling future. I think I’m good enough at doing it but not really thinking it; I’m always complaining/whining in my head and sometimes out loud too, haha. But what I’ve realized and what I want to believe is that being happy now, being helpful towards others now, being selfless now, living in the now will make you a better doctor—heck, it’ll make you a better person.

Midnight snacks for studying.

My tea haul to keep me alive through this hell.

At the beginning of this studying spree, it was kind of exciting (wc?) to have this challenge of stuffing an impossible amount of knowledge into your head, but I’ve definitely burnt out…and as I burn out, I remember what’s important to me, so it’s not completely a bad thing. I think it’s like when you’re young (i.e. in high school, in college), you’re so full of ambition, wanting to do everything, but as years go by and you experience life, and you don’t get to do everything you want exactly the way you want it (not necessarily because you’re incapable but simply because the time-space continuum won’t allow it)…and so you start to prioritize.

Family, friends especially friends you don’t see often, laughter, being there for each other at the right time at the right place, not (always) delaying gratification, my dreams for improving healthcare in China…these are what’s important to me. I want to do well on this test, but time is so limited, many times, I make decisions on what I’ll regret more. Even though I was already incredibly behind in my studying, I decided to spend a day hanging out with my family friend that I haven’t seen for over a year. It sounds silly now as I write it, but trust me, it wasn’t an easy decision to make. But I’m glad I did it. Nothing can replace late night talks about life, love, and career.

That aside, what keeps me up at night is not so much the exam itself, but what I have to look forward to after this test is over. This is so different from how I felt after MS1. Because MS1 was such a successful year for me—I came out swinging, with so much hope for the future. MS2 was an antithesis to MS1 in almost every aspect. I was unhappy. And it permeated through everything I did. I think that’s why I wrote less (sorry!) because I only had energy and time to push forward. I never thought I deserved to sit down and just write. I was delaying gratification, ha. But things can change right? I desperately hope so.

I’m liking these quotes right now—

“I have lived my life according to this principle: If I’m afraid of it, then I must do it.”

and

Seek ye first the good things of the mind, and the rest will either be supplied or its loss will not be felt.

(First quote—Erica Jong via quotesandnonsense; second quote—Sir Francis Bacon from Will Durant’s The Story of Philosophy, which I’m finally reading now after discovering it in high school. Maybe after I’ve read more of it, I’ll make a post about what I think of it.)

As I’m writing this post, I don’t feel my worries crumbling away, I don’t feel that much different from 30 min before. I still have the same worries. I’m just choosing to put them aside right now, because there’s simply little I can do about them right now. I need to live in the now, relax, and focus on passing acing this exam. The thought that calms me is this—I will be back. What’s happened to me this past year has hurt me a lot. But I will be back. I will not give up. And that will be my revenge.

Anyway, I know my life isn’t like many other’s, and I’m glad it isn’t, because it’s pretty miserable, but if you’re having a tough time, remember it’s okay to treat yourself once in a while and be happy now. Be brave.

Took a break to celebrate 1 year anniversary with my boo