A Moment of Serenity

Today I went seeking some peace, quiet, and serenity. In the form of a cup of tea, some roses, and a bowl of blueberries, yogurt, and cinnamon bread that my dad brought home (at left). I was playing around with roses trying to figure out what to do with our wedding tables. I'm drinking decaffeinated Earl Grey. Mmmm. And of course, I am gazing at a very contented, bread-loafed cat. Tea and cats are pretty nearly synonymous with home, aren't they? I am very excited to start living with B in our new place (which we haven't found yet), but it certainly is strange to realize that the year is over and I'm moving again. Also, I'm going to miss having both my parents under one roof for the first time in 20 years (their work has kept them apart). It's so fun to call out, "Mom!" or "Dad!" and have them actually answer, no phone necessary. Of course, my little feline has been with me throughout medical school (we got her when I was 14).

This year, both the cat and I moved back to my parents' house (for the 3rd year of school), as did my dad (from Japan) and brother (from Las Vegas). My mom went from living by herself to living with all of us again! I moved back into the room I've lived in since we came back from South-east Asia in 2002, which used to be our home office when I was five and we had just bought the house. This room is the first room I ever typed on a keyboard in! Although it took all of us some adjusting and my brother decided he wanted his own place and moved out, he comes back on weekends to hang out and do laundry, and we do have some moments of peace now and again. And of course, since my parents are cooking, the meals are pretty gourmet. Yum. This is inspiring me. Maybe I'll make some gingerbread tonight for my nice mother and father (and brother, if he drops by).

I think we are actually ordering in sushi this evening, which is pretty special. My dad cleaned out our entire garage today so he could manage the people from Home Depot as they covered our garage walls in shelving units. It's going to be so tidy and neat to have storage for all of our seasonal items and things that would otherwise be stored in an attic (there isn't one at our house). He worked very hard all day, and I think as a celebration of our new, organized garage he is treating us to sushi! When we start eating, I'm pretty sure the poor cat will rouse herself and perform her sad-cat-without-sushi dance back and forth across the kitchen floor. My dad always takes pity on her (I captured this sweet shot of my parents sharing the papers in our living room).

But as I write, both the cat and I are at peace. And outside, the garden is blooming (the pink tree buds have opened)! I love spring. We have a postage-stamp size garden, but it has a rose tree, a cherry tree, a pear tree, a tiny lawn, abundant daisies, fresh mint, several jays, hummingbirds, raccoons (!) at night, and sometimes, neighboring cats. You can probably guess how our resident feline feels about that.

We do have a redwood fence that allows us some privacy, so we can have cookouts sometimes. My brother uses the barbeque frequently, and he's a very good cook. Our next-door-neighbor's flowering tree overflows from their yard and lends a nice backdrop to the grill.

One of these days I'll have to write more about the garden. It is a potentially enchanted place. With tasty barbeque chicken.

My Last Clinic as a 3rd-year Student!

Wednesday (April 20th) was my last clinic as a 3rd year student. It happened to be psychiatry. One patient was a super brilliant, highly paid, very well-educated, slightly unstable man who came in because of multiple issues that cropped up once he started working full time. It was challenging for me to interview him because he engages in many dare-devilish practices that frankly scare me and that I've never really understood, and some that I've never heard of. But it was a great exercise in finding those little handles people have that allow you to empathize with anyone -- some small preference, a place they've lived, a hobby, a pet, a belief. In this case, the fact that we were both in the healthcare field was a common reference point, so that worked nicely and broke the ice.

The second one was just a check-in from a man who had previously had such serious problems with alcohol/drug abuse that he had to enter a live-in residential program and leave his family and home behind. Somehow, miraculously, he has not only stayed straight-edge but has reconciled to some degree with his wife and she brings their daughter to visit him regularly. He has been sober for two years now. He told us tearfully (although perhaps this is fortunate) that the child is too young to remember when dad lived at home. I have nothing but the utmost respect for my psychiatry attending. As I've watched him over the year, I've realized how often he sees people at the very lowest point in their lives and then guides them back to emotional, and often physical, safety.

Because I am in a longitudinal clerkship program, I have had precepting sessions with different attending physicians in the core disciplines (Internal Med, Family, OB/GYN, Pediatrics, Neurology, Surgery, Psychiatry, Emergency) all year long and at seemingly random times of day and week. We've had a couple of inpatient experiences (2 weeks on Medicine, 1 week on OB/GYN nights, 2 weeks on surgery, 4 days of cardiology), but for the most part it has been outpatient medicine.

We also carried a core patient panel of about 60 patients each in all of these disciplines, and followed them into the hospital whenever they were admitted or on labor & delivery (via really old-school clunky pagers that would go off when any of our patients checked in for any reason at any of our affiliated hospitals). It's been amazing. Frustrating, demanding, often sleepless, awe-inspiring, touching, poignant, tearful, and just absolutely incredible. Never again will I have such complete access to all the different services of a hospital. Never again will I just be able to walk into the room, explain that I'm a longitudinal student, and then participate in whatever happens that day. In my fourth year and from now on, I will carry a label. I will become not just a student, but a student going into X specialty. And then I will be an X specialty resident, then attending, and so forth. This year, I have had the honor of being taught by some of the best and brightest minds in medicine, many of whom took the trouble because I was still an 'undifferentiated student' who had not yet decided what to do.

I have had so many 'firsts' as a medical student this year. First solo delivery of a baby with my (gloved) hands. First digital rectal exam (also gloved). First solo pelvic exam (metal speculums are less uncomfortable). First time breaking the news that someone had terminal cancer. First time a parent told me, "Thank you so much for taking care of my child." First lumbar puncture. First code. First time comforting a grieving relative. First time staying up all night for two days straight.

First time cauterizing a liver in the OR. First person to see someone who had psychotic hallucinations. First time I've seen a terminally ill child. First time I've had to explain why a woman in her twenties had to have her uterus emergently removed and will never again have children -- the day after her would-have-been wedding day. First time someone said "no" when I asked if they were safe at home. First thank-you letter from a patient. First time someone explained to me that they had to choose a Christmas tree OR presents for their children this year, and so couldn't afford their seizure medication. First time I've seen a husband and wife in back-to-back appointments -- in the oncology clinic. First home visit (to a healthy and robust man in his late 70s).

The Girl in the Orange Hat (first child I delivered, held by proud mama & papa)

It's been a memorable year in such a visceral way, to experience these human beings and their stories. I remember their faces, the feel of a spine, the smell of blood, phrases they used, the sound of their coughs. I look at a patient's belly and see my own sutures holding their wound closed. I look at an infant and remember catching him or her, soaking wet and newly born. It is a huge, enormous, incredible privilege to be there when people are feeling their worst, or hear the most terrible news they ever will hear. Likewise when the wonderful things happen: miracle recoveries, successful treatments without side effects, a false alarm. The thing about our longitudinal clerkship, though, is that I've also been there for the in-betweens: the colds that drag on through the winter when a patient is immunocompromised, the thyroid medicine that's never quite right, the lady who everyone thinks is "difficult" due to a lanuage barrier. These are the daily lives of the people of this city, and it's amazing to be so involved.

The next two weeks will be calmer: we have an end-of-year course focusing on healthcare policy and planning our careers. I have more tests to look forward to, as well. I am taking Step 2 of the national licensing boards soon. Clinical Skills (CS) will be in about 2 weeks, and then I'll probably take Clinical Knowledge (CK) some time in July. CS is pass/fail, whereas CK is most certainly not. I'll be studying hard for that one! Also in the next two weeks comes apartment hunting, wedding planning, and recovering from sleep deprivation. I'm SO looking forward to the idea of a class breakfast tomorrow morning, when I'll see how everyone is doing as compared to last term.

After a year of ups and downs and struggling to glean a tiny bit of this terrible, beautiful beast that is clinical medicine, it is such a pleasure to sit here with a cup of tea and write to you, knowing that spring has finally arrived.

Mail from the White House!

I was hoping that would get your attention. You may have heard that you can send a wedding invitation to the White House and receive a response. B & I decided to test this out for ourselves, and we received a very timely response from the Hon. President Barack Obama & Mrs. Obama. Squeee!!!

You can't tell from my scanned-in version, but the border is dark gold and 'The White House, Washington' is dark blue. I am so excited that our wedding will happen during the Obama administration so we can have the above keepsake for our scrapbook. I think it's neat for B given his lawyerly interests. It's really cool for me because I only became a US citizen in 2006. Did you know only US citizens are eligible to receive White House greeting cards?

Anyway, next time you'd like to invite the President & his family to your special function (wedding, baby's delivery, 100th birthday party, graduation, etc), write to them at:

The Honorable Barack Obama and Mrs. Obama
The White House
Greetings Office Rm. 39
1600 Pennsylvania Ave.
Washington, DC 20500

I was thinking some more about why I switched blogs. Somehow I felt that my old one had gotten too negative. There were a lot of posts when things weren't going well, and very few when they were. So I started a brighter and cheerier blog, inspired by murder mysteries with happy endings that you read with a cup of tea, and have made the following resolutions for a more uplifting blogging experience:

Nia's Blogging Resolutions

1. I will post more positive material than negative material. My own blog will therefore not depress me.

2. I will post posts of some substance, not 'tweet posts' that run like this: "I'm so tired. I'm still alive. Medical school is hard. Kthanksbye."

3. I will try to include a substantial bit of news or a new fact, etc. in each post. This is primarily to avoid #2 and also to convince myself that I'm learning. Something. New. Every. Day.

4. I will attempt to post at least once a week. Oh, boy, I can't believe I just typed that out loud.

5. I will respond to all comments made in earnest by anyone who takes the time to leave them.

How about you? Have you ever started a journal/blog/diary only to find that it gets you down more than it acts as an outlet? How do you lift yourself out of a funk?


Your friend,
Nia

A Bend in the Road Deserves a New Blog

Half Dome in Yosemite

Hello friends! Welcome to my new blog. I decided to start fresh because of an upcoming Bend in the Road. The three years of our pre-clinical, MD-master's program were very educational (to read about them, visit my old blog), but also very different from the clinical world I have been immersed in over the past year. My first clinical year of medical school has been eye-opening. It's been amazing, frustrating, demanding, and awesome. I think I have finally started to come to terms with my identity as a future physician, and I wanted to celebrate that by starting a new chapter in my blogging life.

In addition, two important and exciting things are coming up, each of which deserve a new blog perspective: I'm taking a sponsored research year to study how bones interact with the immune system (yay!), and I'm getting married next month (yay!). In the next year, I will also be trying to decide what kind of doctor I want to be: which specialty, how much clinical practice vs. research vs. education, etc.

My desire is to use this blog to share what I learn as I continue along this (slightly daunting) path. Anything is fair game, but as the title suggests, my focus will be on my daily life of medical school, matrimony, and the mayhem that is bound to ensue! As always, comments are gladly accepted and insights much appreciated.

Hugs,
Nia