I now see why they drive this "art of medicine" stuff into our minds during the first two years. Now, in third year, it has become frighteningly easy to forget. After all, with so much death around you constantly, at some point you've just got to just stop thinking about it in order to function.

Is that true, or am I just trying to rationalize not wanting to think about it?

What am I turning into? Two years ago I could barely handle seeing a stroke patient, and now that reaction is gone. Oh, his urine output is low. Well, that's okay, he's such a little guy (translation: emaciated elderly man on the very brink of death) that maybe we shouldn't expect so much from him. Let him fly. Let's "see what happens." After all, he's already on like five thousand meds with no end in sight...

Sometimes I think about what it must be like to be a critical care physician. Surrounded by death. Every day. It'd probably seem like everyone who gets sick is at death's door. Almost everyone in the ICU is, after all. Even to me, in "good" health (supposedly), never before has death seemed so constantly within reach. Sometimes it feels like some sort of cruel black hole that sets you up to fail. Too many variables, not enough time.

And then there's the most unfortunate question of all, at least for patients' families, asked every day during rounds in the ICU. "What are the goals of care?" Translation: We've got to tell the family it doesn't look good, and that it's up to them whether they want to prolong his suffering for a slight glimmer of hope for a miracle. Ironically, the most frustrating thing is that those tremendously rare "miracles" do happen. Of course, that's only frustrating to me - that nothing in medicine can be said with 100% certainty. Wouldn't it be nice if it were that easy? Nice for me, anyway...

Why do I get angry? I have no reason to get angry. It's as if I'm angry at the fact that we can't work magic. Or maybe it's just easier to get angry than it is to get sad.

All this week I've wondered if I've intellectualized it to the point that the emotions are gone... until today, when I stopped by that patient's room, just to drop off a note in his chart. By chance, his family was there, my first time meeting them. And for the rest of the day, I couldn't get his wife's face - like a wordless, hopeless, unremitting plea - out of my mind.

And while I walked away in tears, it occurred to me just how easy it is for us, so constantly distracted by the details of patient care, to forget that part.

So last night was my one and only trauma overnight at San Francisco General Hospital. I will never forget it.

From about 7:00 to midnight, I helped take care of an 87 year old lady in a head-on car accident who sustained an enormous laceration from her forehead to the back of her head. While my classmate was lifting her scalp and irrigating what was basically her skull with sterile water (and I was inadvertently holding my breath), she quipped that she wished she had a mirror to see the wound. I blurted out "No you don't." That lidocaine was seriously her best friend. The wound was massive and she thankfully couldn't feel a thing. We proceeded to staple it closed and suture her forehead, and she did well.

At about midnight I scrubbed into the surgery of a 60 year old heroin addict with a necrotic skin infection in his arm. During the surgery to drain the wound, the smell of the draining fluid was so overwhelming that I had to scrub out of the surgery to avoid throwing up.

I'm glad I did, because the resident and I were then able to evaluate a new patient who had just come in at around 2:00am, a 21-year-old girl who had fainted at a club and split her forehead open from the impact of the fall. The resident, who had suddenly disappeared, must have told the oral/maxillofacial surgeon that I was excellent in suturing or something, because he came to me and told me that I would be suturing the forehead closed. Everything I had learned about suturing was rushing through my head. I remember thinking, Should I tell him I'm not ready for this? Or am I? This was not something I wanted to mess up.

We introduced ourselves to the patient, and he explained that he would be teaching me "plastics technique" and that I would be doing the stitches. He showed me a stitch, had me show him a stitch, nodded in approval... and then just left. I thought about how the patient must have been feeling that a student was doing her forehead and I said, "The good thing about having a student suture you is that unlike the surgeons and residents, I have all the time in the world, and I will make sure I take that time so that every stitch is perfect." And that's exactly what I did.

The surgeon checked on me every 15-20 minutes and told me that the stitches were "beautiful" - so much that he had the residents and students take a look at my work. It felt truly indescribable to hear that from them. I had been so scared to do it. Failing at it would have been unacceptable.

Afterward, just after 4:00am, our resident said that my classmate and I were free to go get some sleep. Finally out of sight of my patients, it hit me how much emotion I had been holding back the entire night, especially when stitching the girl's face, and I almost cried. What a contrast that night at trauma was to the rest of the surgery rotation. In the private hospital at which I'm doing surgery, we are mostly just there to watch and aren't really needed. But in the ER at SFGH on Saturday night, we really do make a difference. And that's exactly what I want to spend the rest of my life doing.

TO EVERYONE WITH WHOM I'VE MADE TENTATIVE PLANS in 2009-2010... We have finally received our lottery-determined schedules for our third year rotations... and the luck of the draw has been kind to me for the most part:

2009
5/11-6/21 - Family and Community Medicine in Salinas, CA
6/22-6/28 - Vacation
6/28-7/12 - Pediatrics at CPMC (San Francisco)
7/13-7/26 - Vacation (East Coast!!)
7/27-8/23 - Pediatrics at CPMC (SF)
8/24-10/18 - Surgery at CPMC (SF)
10/19-10/25 - Vacation
10/26-11/22 - Psychiatry at San Francisco General Hospital
11/23-12/20 - Neurology at San Francisco General Hospital

2010
1/4-2/14 - Obstetrics/Gynecology at Highland General Hospital (Oakland)
2/15-2/28 - Vacation
3/1-4/25 - Medicine at UCSF Medical Center


The good news: boba_cha and futura_light, my east coast trip has been officially greenlighted... I'll be seeing you both this summer :) :) :)

The not-so-good news: nuriko and gentileschi, unfortunately, Fanime is now looking extremely unlikely, because I am one of the unlucky few students chosen to be stuck in Salinas during that time. There's no way for me to tell if I'll have that weekend off, let alone those four days, to be able to make the drive to San Jose. On top of that, I don't have a car, and there's no Caltrain access to Salinas cause it's out in the boonies, so if my parents don't let me borrow their old car I'm totally SOL. I've put my rotation up for trade, but I highly doubt anyone in my class will take it because I'm sure no one wants to go to Salinas. I'm sorry to have to do this, especially to you Michi for flaking so many times. If I had more control over this process I'd definitely have come through. There is still a chance that I might somehow make it, though, so we'll see.


I am so excited for third year :) :)

Sorry for the lack of real updates everyone :) My life is seriously crazy lately. However I think you all deserve to know what's going on.

A friend of mine wrote a comment in one of my public entries asking why I seem "less happy" lately. I understand why it might seem like that for people around me. I have a feeling it's gonna pass once I get past Boards (;b) and get into third year rotations (:D!). But this is basically the response I wrote to her and that I want you all to know it too.

"In answering the second part of your comment, I could definitely write a book for you, and I'd rather not ;b But I will sum it up by saying that 1) just cause I smile in those cosplay photos doesn't mean I'm happy ;) (though I *am* happy when cosplaying, haha!) and 2) while first year medical school was the happiest time in my life for many reasons, second year (this year) has been very hard on me. Here's a list:
- I've been seriously struggling academically and fear that I might not pass the Boards.
- I've also been struggling spiritually and philosophically since I've become a med student. I entered med school an agnostic, and all the things I've been learning in med school are turning me into an atheist. I really no longer believe that everything happens for a reason, or that there is a 'divine plan.' I don't really think you can use God to explain the horrible things that happen to the most undeserving of people. A child is born with a heart defect, and that's God's plan? His "punishment", maybe? A miracle will happen and she'll get better if you pray enough? All of those statements are deliberate simplifications that hold medicine and science back.
- With my serious doubt of the existence of a God established, the political events that took place at the end of last year have seriously thrown me for a loop. I can't understand how people can equate voting for morality as voting to shatter the marriages and the happiness of the 18,000 same-sex couples who married last year in California. The only argument you can make for such a horrible proposition, one that caused so much suffering and feelings of alienation in so many people, is a religious one. How does that make sense? Why should someone else's god dictate how everyone else is to live, or study, or love? (And by the way, just a straightforward disclaimer, I am not open to debating this.)

I consider this a quarter-life crisis brought on by being a medical student. I know it'll pass, but I just ask that you (and everyone around me) bear with me as it does."

Fascinating shiet.

I can't wait for my Ob rotation!

I watched "Monster" (with Charlize Theron) last night and I've been unable to stop thinking about it (and feeling mildly depressed/teary) all day today. Very few movies do that, but this was one of them.

This made me want to ask you all: What movies have you seen that have hit you at the core and stuck with you for days, weeks, months?

My quick list off the top of my head:
- Monster
- Requiem for a Dream
- Carrie
- Perfect Blue
- Brokeback Mountain

How about you?

I was in a bus accident last night :/ Around midnight, Joy and I were on a bus home from the Metallica concert which was speeding quite a bit (maybe 30-45 mph). There were only three passengers on the bus, so it had been picking up speed b/c it wasn't making any stops. We stood up to get ready to exit when the bus suddenly had to brake because a car in the intersecting road had run their stop sign. Without warning I flew over 15 feet and landed on my back, hitting my head very hard on the bus floor :( (I instinctively tried to land with a slightly rounded back to protect my head like I was taught in gymnastics when I was a kid, but the force was so strong that my head snapped back and hit the ground anyway :/)

Luckily Joy happened to have had a strong grip on one of the poles and didn't fly like I did. She and the bus driver immediately ran to me, and the driver asked me multiple times if I needed medical attention, but because I was fully mobile and alert and there was no blood, I figured that I didn't. Joy was crying though :( She felt guilty that she "couldn't save me." It was an accident; it couldn't have been helped. Even the bus driver couldn't have done anything about it, as he would have crashed the car if he hadn't stopped. And it definitely could have been much worse.

I woke up this morning with really painful whiplash. I had plans to fly to Irvine (I'm in So Cal now btw, if you want to hang out :), and when I arrived and told my parents, they immediately freaked out and bought me a neck brace. I'm sure it's fine because I don't have any spinal tenderness, just moderate neck muscle pain (and no more headache whatsoever at that!), but at the urging of my parents I'm going to the doctor tomorrow to perhaps get some imaging done. ;b

Two weeks ago I was really angry, and definitely experiencing feelings that I don't necessarily feel anymore. I knew from the get-go that I'd calm down once the smoke died down and I was able to see more clearly, but I wanted to get my feelings out on "paper" anyway, inflammatory as they were, because I want to remember them as a piece of my history. Truly, I never wanted to alienate anybody, but in the struggle to remain on the high road I still wanted people to know how I felt about that horrible proposition that passed.

A member of the UCSF LGBT listserv posted something I want to share with everyone, something that helped me remember the diversity of the religious community, something so easy to forget since it seems that the Christians I hear about every day are only the ones that are the most cold-hearted ones, resistant to understanding those who are different.

"I engaged a religiously conservative work colleague of mine on Friday in a
dialogue that lasted two hours. We talked about how we'd come to our
respective places in our lives, me as a gay man, he as a religious man. Me
from my stable, two-parent, two-sibling, loving, caring home, and he from a
broken, isolated home in search of meaning to his life. Both of us looking
for ourselves and where we fit in best.

A couple of interesting things came out of it:

- he naïvely voted 'yes' believing that he could vote his religious beliefs,
but naïvely thinking that the proposition wouldn't pass, and so he'd be able
to say he stood up for his religion, but that the civil rights of his fellow
man were maintained
- he did not see his vote as being something that could hurt someone, but
since the election, realizes that it has
- he realizes now that he probably shouldn't have cast a vote one way or the
other on Prop 8

He asked me about many of the falsehoods that were in the 'yes' ads, like
about religious people being charged for hate speech for preaching against
homosexuality. We talked about the protests, the vitriol, the Mormon
church's support for Prop 8, their tax-exempt status. I made the case that
by opening the door to majority tyranny against minorities, those who
supported Prop 8 may have shot themselves in the foot when it comes to their
own civil rights protections under the constitution.

After our discussion, I sent him some reading material on how the 'yes' side
distorted information and lied, about the health benefits that come along
with marriage, and even an article touting a conservative Christian case FOR
supporting same-sex marriage framed around our common desire for strong
civil-liberties. I told him that I'd be happy to answer any future
questions he had, and would talk to others in his church about this if they
wanted to listen.

He didn't vote the way he did out of hatred, and I don't think many others
did, either. Some, of course, did. However, just because a person voted
'yes' on 8, it doesn't make them a hateful bigot. People fall back on what
they know, and he knows his church and his religion, and we just didn't make
a good case to him to get him to vote 'no' or not at all. He doesn't know a
lot of gays. So of course, who is he going to listen to?

But now, now that we've had our talk, my hope is that he can go into his
church and talk to to his community and maybe be more of a proponent for our
side than he would have been before. It wasn't through yelling and
screaming at one another that we reached an understanding. It was through
one-on-one dialogue. This is going to take a long time to get people to
realize that we have more in common in-so-far as this being an important
civil rights issue for all of us. We need to make the other side realize we
have more in common in keeping our civil liberties intact than we have
separating us with regard to our personal beliefs.

There does not seem to be much concerted effort on the part of whatever
leadership there is in our community to engage to 'other side'. This is
really unfortunate, as I do believe we can slowly make in-roads and help
them see our side of things more clearly."

Fuck the Christian Church. Every single sect, every single denomination, every single land plot wasted for a church where there could have been a hospital, or a laboratory, or a library.

I have been implored time and time again by my Christian friends (including my own girlfriend) not to let the judgmental, callous hearts of the seeming majority of Christians ruin my view of the Church and/or its teachings. I must admit. It is very, very, hard. And it really shouldn't be. I have been baptized and confirmed in the Catholic church. Really, they've had my entire life to convince me.

This is a church that preaches that morality is stealing away the legally-bestowed marriages of 18,000 committed couples, many of whom truly exemplify the meaning of love. This is a church with such power and influence in the minds of the people that it is somehow able to twist the measure and convince the people that THEIR rights are being taken away... as opposed to those of same-sex couples. But perhaps the most egregious thing that I just can't get over is the way no one seems to remember or care that time and time again, the Church is involved in scandals so shocking, shit for which any other organization would be promptly shut down. The Holocaust. Argentina's Dirty War. The 2002 sex scandals. Really, nothing is atrocious enough to destroy the church; it simply has too much power. And no matter what it does, it still somehow, beyond all reason, retains enough credibility to convince people it knows what is best for everyone.

I choose to continue to live my life in the example of Jesus Christ, who I continue to believe is the ultimate role model. I will never stop fighting for the ability of all Californians and all Americans to be able to live their lives as they see fit - even those I disagree with the most. But mark my words, I resist the power of the church - any and all incarnations of it - to invade my life and my freedoms. All of it twists the minds of the people, giving them a simplified framework on which to judge others as good or bad. And that is absolutely unacceptable.


I'm leaving comments open, but if it's not obvious, I am in a very unstable mood right now and really don't consider this an opportune time for a debate.



On a brighter note, I did celebrate the earlier announcement for Obama's victory and I was truly happy then. Funny how something amazing can become so bittersweet, so fast.

http://moviesblog.mtv.com/2008/10/07/anne-hathaway-and-helena-bonham-carter-head-to-tim-burtons-wonderland/

I'm excited :)

( ...and will continue to do so until November 4 )

And on a brighter note (...not really ;b), Sarah Palin can't name a newspaper she reads.
Please. Even if I was the reddest, far right conservative on the face of this Earth I'd still be scared as hell to see her elected. It's not even about her platform anymore. The woman has far too little education and experience.

http://www.newsweek.com/id/160689
"Clay Aiken's Overdue Honesty"

Clay Aiken's coming out has been all over the news today. Why is this headlines? We all knew it, and even for those of us who didn't, I ask again... why is this headlines?

And then I see opinion articles like this, that claim that he "failed his fans" and even that he is a "liar".

"Why should Aiken deserve to be praised for coming out at the age of 29? You could say that a person's sexuality is nobody's business. But unlike other gay celebrities who have come out recently, like Neil Patrick Harris or Lance Bass, Aiken denied that he was gay long beyond the point of ridiculousness, and he did it in a way that bordered on homophobic."

Yes, actually, it IS no one's business. People can talk - like I said, we all suspected it - but in the end, no one should pass such judgement as this because no one but he can possibly understand his experience. Homosexual people have reasons for being out or not being out. Clay Aiken never owed the world such a private confession; it is simply our privilege that we have it.

And shame on the author for suggesting he should not be praised for coming out at the elderly age of 29. Of course he should be praised. People go from being borderline homophobic to coming out all the time. Coming out is a process - and it should never be an expectation.

My emotionally-toned political bloggings, copied and pasted from my facebook notes.

( If you're Republican and having a good day, it's probably best you skip over this entry. That said, I do invite debates with friends if you're down for it. )

Of note, the McCain campaign has really sunk to new lows in the last week. Please don't fall for his distorted and rather disgusting Obama smears.
http://www.youtube.com/watch?v=IH0xzsogzAk - Distortions vs. truth
http://www.youtube.com/watch?v=0zAbeu3v3Wc - Obama's own response to the "lipstick" ad

Guess who called and completely cheered up an otherwise not-so-good day?

None other than STEPH, to tell me that she is ENGAGED!!!

Congratulations to my best friend, my l0ve, my honorary big sis, the one girl I share absolutely everything with and who has always had my back no matter what... I love you Steph, and I wish you all the happiness in the world!!!!!

AHHHHHHHHHHHHH!!!! :D :D :DDDD


EDIT: AND I AM THE MAID OF HONOR!!! HOLY SHIET!!!!!!!

When I stepped on the plane to fly to Argentina on July 4, 2008, I had no idea what to expect - which is exactly the reason why I chose to go to Argentina in the first place. I had never been to South America, let ALONE Argentina, and I knew slim to nothing about Argentine culture. All I knew was that my parents didn't want me to go there, and weren't happy with my staunch decision to study Spanish there. Argentina has some terrible history - during the late 70's and early 80's, the government kidnapped up to 30,000 people and made it as if these people just disappeared off the face of the Earth. My parents have Argentine-American friends who don't even like to speak about their home country or even hear it mentioned because of what happened during that time.

But I knew there must be more to the country and the culture than a Dirty War, Evita, and tango - which is the principal reason I chose to study in Córdoba, a much smaller and far less touristy city than Buenos Aires.



( Argentina: select pics and a short report )

Somehow even now that I've been back for three weeks I'm still thinking about Argentina. How people dance literally all night, until 10 or 11 in the morning. What it is like to live in a country so far removed from the United States that there is close to no American influence (nobody knew what an iPhone was, and the only American companies I saw were McDonalds and some fashion/beauty brands here and there). How much I learned about a people whom, three months ago, I knew absolutely nothing about. I was happy to be back in San Francisco, and God knows I was missing it while I was there, but now that I'm back here I can't stop thinking about Argentina. I just can't win, can I? ;b :>

For the rest of my pics with more specific captions and detailed anecdotes, go see my (four) albums on my Facebook :D

As you may or may not know, I have been living (studying abroad) in Córdoba, Argentina for the past month. Yesterday I had no way of getting to my internship because all forms of public transportation were halted due to a working class protest taking place blocks away that became violent.

http://www.timesnow.tv/Newsdtls.aspx?NewsID=12413

I heard the bombs from my bedroom but I thought that they were construction workers or something. I had no idea that they were actually people throwing bombs at buildings just blocks away! 20 people were injured and a bunch of buildings are completely ruined, including a bookstore I was just at the day before!

So instead of going to work I just hung out at school - indoors. ;p Things seem to be better today.

When I get back, I´ll write a full report including pictures of life in Argentina =)

I am leaving for Argentina for six weeks on the 4th of July :D I could be at AX the day before (Thursday), but I don't have a really good reason to be there at this point in time... so if any of you will be there on Thursday and want to meet up (cosplay or no cosplay)... let me know :>

( Recent pix of me and Joy )

One of the best things about med school is that it really does change how you look at the world; at least, it has for me. It really puts in front of you just how the same all of us are - what binds us as human beings - in a way that no other field of study does. I never want to take this experience for granted even for a moment; already it has been one unlike any I have ever had.

I haven't performed on the cello in over 5 years.

And now in less than four hours I'm going to be performing for our med school's cadaver memorial service (yup, cadaver memorial :>)

AHHHHH!!!


...at the very least, learning the cello really is like learning to ride a bike... I remember everything from the six years I studied the cello... and weirdly enough a lot of stuff that seemed impossible for me before is a lot easier now... weird!!