Fragile...

With every end, comes a new beginning. With every event, we try to understand its purpose. At times though, I can't make sense of the things happening around me. But life after all, is lived forward, and understood backwards. However, right now, I can't run forward fast enough in time so that I can understand everything that is happening around me. It's almost like the physics concept of - what goes up, must come down - extends beyond inanimate objects. You work so hard to rise up, but then you are knocked down. Why? I don't know yet.


It's not just the circumstances around me that make me realize how fragile we all are. Everyday in the hospitals, I see babies, teenagers, young men and women, and elderly from every ethnicity being stricken down. People who were full of energy one day, keeping busy with life's little quirks and repetitive motions, and then one day God hits the pause button in their lives. To be vibrant one day, and to be counting down your days the next. I remember this one patient during my surgery rotation who came in with a two day history of severe abdominal (stomach) pain. Her CT scan (picture of her bowels for non med readers) showed ischemic bowels (dead guts). We stayed up through the night in the operating room to surgically explore if there was any way we could save part of her bowels so that she can live. Nothing. Absolutely nothing could be done. Every inch of her bowels were dead. It felt futile. The OR was dead silent aside from the noisy beeping machines and the respirator. Noises that were giving false hope of life. We put her bowels back to where they belonged and proceeded to neatly suture (close) her abdomen. We then waited for her oxygen levels and blood pressure to become even more stable. It was odd to see all these little steps taken to make sure she was medically "stable", despite the fact that she will die tomorrow. We then proceeded to talk to her son who had just flown in to see her. The surgeon explained that everything possible was done, but that she will still die tomorrow. Tears came down his cheeks. Here was a vibrant, active woman, living one day, and dead the next. The surgeon and I walked to the elevators after this sobering evening. There goes another life I thought. Another existence gone. The surgeon and I quietly walked into the elevator with our heads down. On our way up, the elevator stopped one floor above us. A mom and an adorable little boy stepped in. He wanted to push the elevator buttons, and then he was excited to see two doctors. The surgeon and I looked at his enthusiasm for the simple things in life, we looked at each other and smiled finally. With one end, comes a new beginning.

"On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are"

Live, Laugh, Love

Like my girlfriend, life is quite short. But, I also love it (and her too). This past week had a recurring theme. A theme that I thought most people would have already thought of - knowing your priorities in life. Strangely, not everyone realizes similar goals at the same time in life.

This week, the oncologist (doctor specializing with cancers) I was working with summarized her life to me. About going to university and being boy crazy, realizing she wanted to become a doctor (and all the crazy competition it took), her transition though medical school, and lastly - a point that stuck out to me. An older doctor told her - 'look, as much as you love your career, don't do what I did, don't wait too long before having kids'. I'll explain further down why this stuck out to me, after the next story.

Later on that week, I bumped into a couple of the nurses that I had worked with previously. Now I love talking to nurses, so we sat down to catch up over a quick lunch. Of course this lead to the typical questions a med student is asked - what do you want to be, are you going to work here again, are you dating/married? During our conversation, the nurses told me about doctors' lifestyles, time (or lack of), and divorces. This is when I proceeded to explain my views and priorities of life. When I finished, they strangely looked at me wide-eyed, as if I was speaking things unheard of by someone my age.

Life is short. Make the most of it. Make an impact on the world. Make an impact on the people that matter the most to you. When I talked to the oncologist, I was surprised that she didn't realize her priorities in life until someone pointed it out. When I talked to the nurses, I was surprised that they were shocked that I knew my priorities in life. When I look at the big picture, if I'm super optimistic, I have already experienced 1/4'th of my life and it flew by! This means, for the remaining portion of my life, I better know what to focus my time and energy on. The only way you can do that, is if you know what your main priorities in life are. To me they are 1) your health 2) your family. Job and money are secondary to these. By being healthy, you can feel good, you can live longer, you can as a result dedicate a lot more of your time and energy to your family!

When I imagine myself as an old man, I know that I'll look at my children, grand-kids, and lovely/bossy wife. I'll look at them proudly and I'll happily realize that this is all that matters to me. They are everything. I'll know then, that all the sacrifices, dedication, and effort put in since I was a little boy was worth it all. I won't think about my career as much, I won't think about the money I have or could have had, all those things fade. Patients will appreciate me, thank me, and forget me. Money will come and go. Your family is truly all that you'll have left. So when I tell my doctor, nurses, and friends that I want to choose a specialty that won't be hectic, that won't be too busy, that this career comes second, that I don't care about being rich, that ultimately your health and family is all that matters - I am taken aback when they have this sudden look of realization that, hey, you're right. No wonder a lot of these over worked doctors end up divorcing - how can you be happily married if you are never home? How can you raise your kids properly if you rarely see them? You can't live without knowing where you are going, and you won't know where you are going without having a sense of direction - your goals in life. Thankfully I know mine :)

I miss my pillow, my blanky, and my girl

Sleepy. That's how I would describe my week. I'm also excited. It's an odd mix. This week, I'm on call three times with only 2 residents helping me to run three hospital floors + ER. It's mad. I'm tired. I want my Christmas break fast. I want to be with my girlfriend and just say nothing, do nothing, and just feel happy. It's the main thing I look forward to with each passing day.

This CTU (clinical teaching unit/internal medicine) rotation has been very tiring. Although it's fun to think a lot, and finally feel like a doctor compared to other rotations - it certainly doesn't feel as homely/natural to me as pediatrics did. At least on that rotation I can be myself (childishly free). The amusing thing about the obstetrics rotation is that I'd end up reading the Births section of the newspaper. I wanted to see how many new babies were delivered by me. Now I find myself reading the obituary section to see if I recognize any of the names I saw in the hospital, hopefully not delivered vertically by me! That's the weird thing about medicine - you can see the whole life cycle in a day.

Well back to working on the lil lady's Christmas present. wee. Oh yeah, Merry Christmas to everyone!

Study life - quick!

Cramming for exams is not as bad as it seems. You can take in weeks worth of knowledge and within days, you know it all! Life on the other hand doesn't work like that. I'll get to what that means later on. First, let me preface this post with a habit of mine- I love to hear stories about how couples meet and how guys propose. Lately though, I've bumped into a couple of nurses, as well as older friends who have opened up about how their marriages failed. I've found myself to be more and more curious about what led to these divorces. Mainly - what changes between pre-marriage and post-marriage. From what I've heard so far, none of the people I've talked to said that they had any inklings or clues that their partner wasn't a good choice. It seems like all of them said that things changed after marriage. This is pretty scary! Does this mean that most people are fake initially and that someone's true personality comes out after marriage? Does it mean that people aren't good at reading others? I know that it takes time to get to know someone well - unlike studying, you can't cram knowing someone. You can't take decades of choices and life experiences that someone went through and assume you've figured it all out. Of course there are exceptions - I know of one set of parents who got engaged after two months and are still happily together. However, I'm generally left confused about why there are so many couples who end up in divorce. One of the Doctors that I worked with said the main reason people divorce is because they are greedy. They don't take the time to give to each other and make things work. But I think there's more to it than that. It makes me wonder - do people read in between the lines? Do they watch how their partner behaves when they're down, when they're happy, when they're angry, and when you're at your lowest point? Do they observe what their family's like? Do they watch if they put similar effort into the relationship? Do they keep mental note (I call them mental post it notes) of what their partner's like over time? If everyone does these things, and still go through divorces, then it's not an encouraging thought at all. But on the other hand, I doubt everyone reads between the lines or observes people's habits as much as I do - I remember how one of my friends didn't like that I keep mental post it notes regarding some of the things he did, whereas I thought it was absolutely normal, whatever normal means. In the long run though, I think this habit's useful to have, but as time passes by, I'm going to keep listening to life's stories. Afterall, if watching my bro get in trouble when we were kids helped me avoid making the same mistakes, then I certainly hope that my love for hearing other people's stories will help me to keep going in the right direction!

I've figured out women!

I've finally finished my OB-Gyn rotation, and I'm going to miss it a lot. The moms are wonderful patients, delivering babies is an indescribably happy and cozy experience, the doctors are happy, and the nurses were very friendly! During the days when I worked at the OB-Gyn offices, I had some time between patients to sit down and flip through some of the magazines women like to read. So based on the number of magazines I've flipped through - I've accumulated a general picture of how a woman looks, how they think, and what they want. So first of all - all women look like models, women are constantly worried about their feminine hygine and need pads wherever they go - especially for horseback riding! Women are constantly worried about their weight, and about how to satisfy/keep their man.
Magazines for pregnant women also get pretty interesting - the last magazine I saw had this pregnant lady (a model of course), sitting on a beach in a nice weaved gown with water reaching her feet (and prob soaking her bumbum). The magazine of course had more exercise tips, but at least it wasn't as bad as the general women magazines from above. However, I do find that pregnant women in general either worry about - "oh no, I'm gaining too much weight", or "oh no, I'm not gaining enough weight" - I haven't met a satisfied one yet. I think my jaw will drop when I hear a woman say "I'm happy with my weight gain so far". But to get back on this topic, I honestly don't get how women can flip through these magazines and feel good at all. For one thing, half of the magazine is advertising - full of semi anorexic models and a lot of photoshopping, and the remaining pages are full of topics regarding how you're too fat, how you can try harder to satisfy the person you're with, fashions that you probably can't afford (and look funny in most cases), and a reminder of how your monthly cycles make you a smelly leaky person.
All of this reminds me of what we learned in psych in first year undergrad - it takes only 2 minutes of flipping through a magazine for a girl to lose her self esteem. Which makes it confusing for me - why even read these magazines? I guess I don't understand women :P

Oh baby!

Two weeks have flown by on the labor & delivery (L&D) floor. I can't really remember the number of vaginal deliveries & c-sections that I assisted in or done first hand. This ward is not about numbers to me, but about an experience that's hard to put into words. This is especially true for vaginal births. Why? Well unlike c sections, which feels like any other surgery, vaginal births feels like a rollercoaster of emotions! If I had to summarize what I observed about most vaginal deliveries, I would have to break it down into six phases:

• Phase I: most moms seem happy, excited, and with a hint of nervousness (more of this last ingredient for first time mommies). During this phase moms have to wait for hours for the cervix to dilate (the passage in the uterus/womb that the baby has to get through). The pain hasn't fully kicked in, so most of the moms seem pretty happy and chatty with me. The partner/husband often looks calm at this stage.
• Phase II: Pain starts to set in as the baby comes down more and the cervix dilates more. I can tell this stage as soon as I walk in the room because the moms are no longer smiling as much. The partner/husband (if it's not a single parent), are now more serious looking and semi confused about what to do as they watch mama endure some pain. Some partners try to be supportive by holding mama's hand or rub their hair. Others sit back and either look helpless or guilty for making the lady pregnant.
  
• Phase III: This phase exists for most moms. This is when most moms receive epidurals to relieve the amount of pain they're going through. Without reading the charts or asking the nurses, I know all about phase III when I see the moms smiling and/or looking more at peace again. As soon as I enter the room, I tell them "Hey! you're back to smiling, you must have an epidural now!" (and then I'll tell them all about my phases observations), to which they'll laugh and tell me "yup! the epidural's in".
  
• Phase IV: This is the phase when the contractions are more frequent and stronger. There's something very humbling about this phase for me. Pregnancy as a whole is a tiring and long event for moms. As if 40 weeks wasn't enough work, there comes the whole process of pushing the baby out. It's humbling to see this last push of effort from the moms - the exhausted facial expression of the mom, yet pure determination to break down that last brick wall - it just leaves you with nothing but pure admiration for moms everywhere.
  
• Phase V: This is where a crazy turn happens in the rollercoaster of baby delivery. As soon as you catch the baby and place him/her on mama's tummy, the humbling feeling of trying to break down a brick wall from phase IV suddenly changes to an almost post-struggle celebratory mood. It's not exactly a party-excited type of feeling, it's more of a 'finally we are free' sense of peace.
• Phase VI: This phase occurs the day after delivery. When I visit the mom and new baby (+/- partner/husband), the room has a warm sense of peace to it. Most of the rooms have that sense of accomplishment, 40 weeks of work, and now here's the new baby! The moms look tired, sleepless, but when they hold their baby wrapped up in their blue/pink blanky, they have this look of peace as if nothing else in the world matters except the bond between them. When the Dr. and I come in to check the baby, it feels great to hold this new wrapped bundle of joy. It's cozy to hold this warm sleeping baby, to watch him/her move their lips as they instinctively look for food, and to feel their little legs move inside their blanky as I hold them in my arms. A warm little bundle of life! I can only imagine how much nicer it must be to hold your own baby one day. This phase definitly makes obs/gyn a rewarding career!

À la prochaine fois!

H is for Happy

It has been one week so far since clerkship began (third year medicine). Everytime I enter the hospital, I feel excited, happy, enthusiastic, and motivated to learn. Although we haven't begun our actual rotations yet, I'm pretty confident that the same attitude will carry on throughout the year. Sure I'll be tired, sleepy, hungry, but that's all part of the fun! I believe what makes a hospital a happy environment for me, is that I get to serve people and I get to think. Both of those are big reasons why I entered medicine. Sure there are a lot of careers where you get to to serve and think, but there's no other career where you get to know someone on such a personal level during critical times of their lives, and to depths that even family members don't have the privilege of knowing.
If there's one thing that I've noticed about myself over the years, it's that I like to serve people. I guess there's a certain level of joy and pride in seeing the result of my actions, and that motivates me to learn more and do better. By the same token though, this means that when things go wrong, which I'm sure they will as a third year student, it'll be a bigger blow to me. But that'll only motivate me to work harder. One of the surgeons who was teaching me how to suture yesterday told me if everything you do goes as you were taught or as you read, then you've simply gained knowledge. However, it's only with mistakes, or when thing's don't go as planned, that you finally gain experience. I thought it was some nice words to live by. We'll see how next week goes! :D

I have a new pet!

My new pet's name is peeves! So now that I finished cramming two years of medicine into my head in the span of 4 weeks for a licensing exam, I must do a little rant. There were two main issues that actually frustrated me during this exam period. The first being Adobe Professional (7.0). Now as some people know, I study purely off my laptop. All of my notes & books are in adobe format. Adobe makes me angry. Why? Well because no matter how good my computer is, no matter what year I buy a computer, it seems the newer and faster processors, and more RAM can't handle the new ways that the Adobe software engineers come up with to make their product slow and sluggish. In all honesty, when I go to buy a new laptop, I don't just look at the specs, but I do one main test: open an adobe file on the computer and see how long it takes. I can only imagine these software engineers sitting around, coming up with new 'creative' ways of making Adobe more user friendly and full of new options, and probably getting some weird sexual gratification out of it. Look! just make the product work in a reasonable speed and not eat up 90% of my RAM.
My second pet peeve would be related to medicine. When you have to cram everything known in medicine into your head, you appreciate it when the name of the disease gives away what the disease is all about. For example "X-linked agammaglobulinemia." tells me it affects men, and it means your immune system doesn't work. Great! the name gives it away for me. But when you get stuff like "Paget's disease" - what memory does that trigger in my head? It triggers the frustration memory. Why? Well because Mr. Paget has several diseases named after him - Paget's disease of the bones, Paget's disease of the nipple, and Paget's cyst. Honestly, why! Clearly they weren't thinking of med students when these names were made up. Make the name of diseases memorable! Med students these days have a lot more to learn than they did 100 years ago, so any help would be appreciated. Honestly, if I discover some disease down the road, I'm not going to stamp my last name on it. Instead I'll make it obvious, i.e. itchy bum syndrome. Treatment? stop sitting there waiting for Adobe to load your file.

Hug addiction # 2!

First of all, my apologies for the long delay in writing something. I've been busy studying for a licensing exam. Studying during the summer time is as painful and difficult as delivering babies. Yes yes, I have experienced it. Anyways, so during my procrastination cycles (roughly every 10 minutes of study), I stumbled upon this site www.justgiving.com/hugoflove. This was the only site I could find when I was trying to figure out the record for the longest hug. In any case, these two lovely couples hugged for 24 hours! Since I love hugs, I immediately knew that I must outdo this world record. Is it doable? why not! I have two of the three ingredients I need so far: 1) I love hugs 2) I can stay up for over 24 hours if I had to (hey that's part of being in medicine anyways!) What is the third ingredient you ask? Well, I'll need an enthusiastic hugger too. I figure once I find my dream girl then perhaps we can set out to beat that record, and fundraise some money for a good cause too! How do I know the girl I'll be with will be a good and enthusiastic hugger? well, I wouldn't date a bad hugger! If I go out with a girl on a date and she's not a good hugger, then she's got a loooong way to go before I have to reconsider my thoughts. Well I'll keep the world posted about my big plans! I'm very excited to do this one day!

Well back to hugging my books.

This really blows

There are inventions that are so amazing and practical, i.e. like Velcro, and some inventions that I simply don't comprehend. One of those inventions would be the leaf blower. It's unbelievably noisy, annoying, it creates a lot of pollution, and is just asinine. A leaf blower seems as intuitive as sweeping a pile of floor dust not even from one corner of your house to underneath your carpet, but to another corner of your house! I watch people in the neighborhood who spend hours standing there blowing random leaves from their front lawn onto the sidewalk, or their neighbour's lawn. I can only assume that later on, the other neighbour will return the gift with their noisy leaf blower. If not, mother nature will do its job with this device known as 'wind' to redistribute leaves back all over the lawn. Honestly, who invented this machine? How about getting some exercise and raking the leaves - i.e actually removing the problem! How about using a lawnmower to chop up the leaves on your lawn so that as it decomposes, it fertilizes your lawn? Or someone out there, make a machine capable of efficiently vacuuming up the leaves, wouldn't that make more sense?
What a strange world.

On an unrelated note, I'm happy, life is good. yay.

I'm too muscular to smile

Going to the gym is a bizarre experience. On the one hand, I love that feeling of accomplishment (aka achy muscles) at the end of a workout. It's also nice to feel like you're doing something good for your body (and for looking even better too). However, the people at any gym always seem to have a serious look. Most men tend to walk around their arms spread out like they're carrying invisible purses underneath their armpits. They also have this serious constipated look the majority of the time, especially if they're working out alone. The women don't look too happy either, and seem to love the stair/climb master machines and anything cardio related. They don't tend to smile too much either, but it's probably a good idea because the muscle heads like to gawk at them as they walk by. I'm sure a smile would be misinterpreted by muscle men as a signal to 'hey come over and flirt with me'.
Yesterday at the gym, this cougar lady who keeps smiling at me since I started working out in 2003 spotted me again! It's kinda creepy, but it's not a big deal, I suppose I can take it as a compliment about the way I look.

Update: today at the gym I saw a man perfectly exemplifying what I wrote! Except he was walking around with invisible duffel bags underneath his armpits, not purses. He was walking on the treadmill with the most serious face known to man - almost a zoolander like look of determination, and he would wave his arm stiffly in an ape-like fashion. Honestly, who walks around like that?!

European Odyssey - Journal Day 1 - Paris

After a couple of hours of travel on some English highways,we made it to Dover (where the famous white cliffs of England are). I'd like to visit England one day and go to the castle at the top - it looked quite beautiful! The ferry ride took another two hours before we reached France. The ride was fun, but the constant rocking of the ferry can make you feel like a drunk man. I began to think about the physiology of the inner ear that we learned in neurology. I then reminded myself that the next two weeks, I shouldn't think about school at all - I have a lifetime of that! During the ferry ride, I chatted with the other tourists that I would be spending two weeks with - there were a lot of Australians! During the ferry ride, I got to people watch, which is always fun. Old couples are fun to observe - they don't seem to chat much, they sit there, eat and people watch too. Either they've run out of things to say, or it's some sort of comfort to know you don't have to say anything to fill the silence.
Calais, France was beautiful, especially the bus ride on our way to Paris! During the bus ride, I discovered why the lemonade drink my brother and I bought tasted so strong and detergent like, it turns out it's concentrated so that you dilute it in 9x the amount of water!! No wonder our throats burned!
When we arrived in Paris, one of the first things I noticed was the amount of graffiti and garbage thrown everywhere! If this is a city of romance, then I better start throwing trash in my room! During the bus ride, we drove past many of the famous buildings in Paris, such as the Eifel tower, Sacre Coeur, Notre Dame, National Music Hall, Arc de Triomphe, etc.. Those buildings were beautiful and clean, such a huge contrast from the rest of the city! Our night ended with a get together at a local pub beside our hotels. Day 2 here we go!