奇恩 (Qi en)

Reggie

2011-12-14T22:07:00.003-06:00

As I stand outside the Greyhound station in downtown Cleveland, I can’t help but think how backwards the interview process seems. Here I am, staying in luxurious hotels sometimes subsidized by the hospitals, being wined and dined for dinners and fed free lunches just to find out if I am a “right fit” for program XYZ. The contrast can’t be starker as I stand outside in windy cold of December evening with my backpack and my four-wheeled suitcase in a less than glamorous part of town. Considering that much of residency is spent taking care of underinsured, non-compliant, irresponsible, and disenfranchised populations, it would make more sense for programs to introduce us to the people we would actually be serving instead of touring us around the magnificent hospitals whose ever expanding presence testify to the failure of health care in this country? Wouldn’t it make more sense to see the homeless shelters, soup kitchens, and shanties that our patients would be coming from, the crack houses, drug warehouses, and other socially unacceptable settings from which many patients would return once they left the clinic?
It seems like an awful lot of money to be spending on such a self-serving cause. A part of me would much rather learn about the cities where I might spend the next three years or learn about how I would be serving the communities around these hospitals.

And still, in the midst of the grandiose thoughts, a man calls out to me. Inside I cringe because I know what is coming. I turn around and see a black man in a black cap smoking a joint.

“Hey, did the bus just get in?”
“Yes”
“Do you know if they found a wallet?”
“They did not.”
“Can you give me some money.”
“What do you need it for?”
“So I could get something to eat. I lost my wallet.”
"Did you go inside and ask if they found it?"
"Yes, they didn't find nothing."

I loathe myself because I know I shouldn’t go down this avenue of conversation. I know I have some cash in my wallet and am not in the mood to lie. Had I thought about this more, I would have asked how he got money for that joint. Instead, the following ensues.

“Is there somewhere you could get something to eat?”
“Yeah, there’s a Subway right around the corner.”
“How much do you need?”
“Five dollars…you know they have those five dollar foot longs.”
I pause and look around for the hotel shuttle. I wished it came earlier. I walk down the street to see if I missed it. Still nothing. I turn back to him.
“What’s your name?”
“Reggie.”
“Where are you from?”
“Toledo.”
“How did you end up here?”
“I’m familiar with this area. My people brought me here. I know the food pantries around here.”
His eyes look distant. He’s probably high.

“Promise me, you’ll use this for food.”
“Yeah…of course.”

I hate myself for this comment. But in the end I give the few bucks that I have. Because of my conversation I do not notice that the hotel van has come and that the driver has actually called out for me. I get in the van.

“Didn’t you hear me?” the driver asks somewhat irritated.
“No, I didn’t. Sorry. My bad”

But at this point my mind is already lost in thinking about my encounter with Reggie and wondering what sort of drugs he’ll use the cash for next.

Love

2011-11-27T22:50:00.005-06:00

He was an elderly gentleman in the hospital who had a urinary tract infection w/urinary retention secondary to benign prostatic hypertrophy. Speculation on his mental intelligence aside, this man could not provide a straightforward, concise history. His wife attributed it to his history of epilepsy which certainly played some role in it. Most times his responses were vague and his reactions "child-like." The wife affirmed that in actuality, this was normal mental status for him. It became clear that his wife would be the sole source of meaningful medical information; she was his primary caretaker, the one straight-catheterizing him and measuring his urine output in milliliters. Turns out, she was a nurse for the neurosurgeons in town, though one wouldn't have needed to know that to affirm her intelligence.

Outside of the room, the attending commented on how she was a little surprised at how a woman like her would end up marrying a guy like him. "She's clearly in love with him still...it's cute," she had correctly observed, "but she's just so...intelligent"--her words not so much conveying confusion as much as they did amazement.

An FMG that Plays in Peoria

2011-08-28T22:02:00.008-05:00

Two weeks into my inpatient medicine subinternship, I am tempted to dwell on the shortcomings of the rotation thus far. I can talk about how few patients I get to see on my own or how I have long since given up trying to impress anyone, much less my attendings. So, when I have very little good to say about myself, it's easy to think about the people that have made this rotation memorable thus far.

In the past, the patients have ruled this forum. Tonight, this honor belongs to a senior resident--not my senior resident, but the one on our sister team who I was reunited with after having her for a week on my M3 medicine rotation.

DP was a second year resident when our paths first crossed. What struck me was how assertive and forthcoming she was in both asking questions and finding answers. She was one of those self learners who would be any educator's dream. She was one of the few residents who aggressively taught the medical students anything. I still remember the first sit down session we had on EKGs with us.

She was the first person in medical school to openly espouse Wikipidia as a legitimate source of knowledge. After all, many of the medical entries were straight from Harrison's. Her advice was as follows. Whenever she found something that worked, she would keep doing it and doing it until someone told her she was doing it wrong. If said person could then explain convincingly why his or her way was better, she would be willing to change. Otherwise, she would persist in her ways. She was the first to tell me that despite what we were taught, that closed-ended questions were essential to efficiency. Ask your questions first, then let the patient have their say. Find out what's important to you as a physician first, and then let the rest of the history guide your decisions.

I realize that while her advice seemed to fly in the face of what I had been taught, it makes sense in a lot of ways as well. Especially when one is working with high volume, indigenous, low educated populations. In fact, I saw it work for her. She was not worried about making mistakes, because she was always wanting to learn from them.

Over the last couple weeks, she has shared some of her life stories, and the stories have sharpened my understanding of her. She was top 5-10% of her state in India, meaning she got free tuition. Before then, she worked as a lab assistant in the states, learning English in the process. Her husband was also in the states pursuing education but due to their limited opportunities they were often in different states. She ended up in Alabama by UAB and she told a story of how sent 170+ emails to different labs asking for an assistantship or any kind of opportunity. Of those emails, two replied and neither with good news. One of them, however, told her that her English was terrible and that her writing was chalk full of errors. The author proceeded to rewrite her letter for her and gave her a version to send out to employers.

After medical school, she applied to 180 residencies. She received 19 interviews and went to 14. The place in New York that she ended up at was, for all health care purposes, horrendous. The residents she met all had their stories about how they ended up in a dump of a residency. Many of them were tragic and undeserved for their caliber of clinician and quality of person. There was the former ER doc who was blackballed after standing by his principles to defend a clinical decision that rankled his superiors. There was another who left years as a critical care nurse to pursue his dream. Another was from the Caribbean and fully trained EKG tech who was happy just to train in the states. Every person had their story, and despite the crap she dealt with, Dipa wouldn't have traded that one year for the world.

Eventually she transferred to Peoria to join her husband. It was during the weekends on call where I would hear her stories and listen to her rants on how internal medicine was 80% social problems and 20% clinical. She would talk about ungrateful, entitled patients, lowlifes that used and manipulated the system at no disregard to cost or others. She was tired of dealing with these people and with many of them she would not hide her disgust. On one hand this seemed appalling for a doctor to act this way, but in many other ways, it was refreshing because it showed a certain degree of conviction. She was letting these patients know that she knew what they were doing and while she would still help them, she wouldn't bend to their demands.

In the end, she wants to do GI. If not that, then a hospitalist. Wherever she ends up, this I know. I will be grateful to have cross paths with her, and in many ways, I hope that I can learn to pursue my interests with as much tenacity as she has in her own life. Stories like her's make me immeasurably grateful for the opportunities I have been given; her story gives me hope that despite my deficiencies, I have been fortunate to have people such as her who have helped me to get this far.

How I learned about medicine this year

2011-07-01T20:14:00.006-05:00

During my second year in medical school, I wrote an email to the rheumatologist with whom I spent some time during M1 year. I told her how I would more easily remember the insignificant, non-medical trivialities from my lectures rather than the testable, high yield, board-relevant material that I was spending so much time just trying to care about at times--let alone learn.

Today, as I prepare for boards, I find myself in a similar situation: fighting the urge to gloss over certain diseases, risk factors, etiologies of conditions that at times mean very little to me. Every so often I'll come across a condition that links to a friend I have, a patient I saw, or an encounter in the hospital. Myasthenia Gravis, Essential Tremors, Multiple Sclerosis are replaced with the faces of the friends and people who have played an instrumental and meaningful part in my life these last few years. For a brief moment, they become my daydream, my escape, an absence seizure from the world of medical terminology.

If you asked me about acute pancreatitis, I could not tell you Ranson's Criteria but I can tell you all about the homeless man that had it--how he was a boxer in his youth, could control his blood pressure with his mind, and how he would roam the streets at night living a life that you would only see in movies. If you were then to ask me about Meckel's Diverticulum, I could not tell you the specificity of scan to detect it (the sensitivity yes!), but I could tell you all about the anguish and cultural intricacies written all over the a Chinese mother’s face as she couldn't understand why the surgeons had performed the surgery on her son when there was no Meckel's to be found in the OR.

And so this is how it has been for much of the last year; it has seemed to me more of an experience than an education. I ask myself what exactly I did this year outside of accumulating a treasure chest of stories that I might one day dig out for the sake of good conversation.

Furthermore, in the back of my mind, I am terrified that this will not be enough--that these ruminations will be woefully inadequate for me to master the information I need to effectively convey to my future patients. I ask myself whether these reveries are but an expression of laziness that serve to convince me that I really am engaged with the material.

Having said all this I return to my letter to the rheumatologist. In her reply to me she wrote the following.

"I was always of the opinion that recall of all those meaningless trivial facts was the sure sign of a bright and inquisitive mind, one that had room for lots of stuff, not all of which came from books! I think it also means you recognize the humanity in us all, a good trait for a doctor to have! It helps to reinforce the concept that we take care of people, not just diseases, and that humanity thing is what keeps medicine interesting and relevant."

Looking back at her words, I take hope in the larger picture. For I am neither naive enough to believe that a better academic performance would have proved a greater personal dedication to my craft nor am I delusional enough to think that every mistake I've made is simply a product of a bright and inquisitive mind emerging from the chaos that is medical education.

The reason why I got into this was because of the people I met along the way. As much as I conceptualized what medicine should look like, the only reason why I am still in school is because of the people who showed me what medicine could look like. In the end, the latter is what I have to hold on to for now. With each new experience stones will shift, clouds will clear, and visions will change. That is to be expected.

For now, the words of my high school Spanish teacher ring through and through
"Lo que sera, sera..."

The Problem With Hipaa

2011-05-22T17:36:00.004-05:00

From a patient care point of view HIPAA preserves the privacy of those within the health care system. It is necessary given the sensitive nature of the medical profession. For a physician, patient privacy is intertwined with the trust that is essential in the patient-physician relationship.

At the same time, HIPAA robs the patient of his or her identity. Violia Freeland becomes VF or "63 year old Caucasian female" when I try to describe her to someone else. The absence of the name reduces the subject into a collection of symptoms and attributes, many of which aren't particularly unique, but all of which together, forms a unique narrative and a special individual. It is within a person's name that everything becomes attached- chief complaint, history of presenting illness, past medical history, social history--all of this becomes significant because they comprise parts of this person's narrative. This is why the name is important; because without it, I must try to make sense of a faceless entity. Perhaps this is why so many medical students like reading cases instead of textbooks because instead of an outline of factoids, we are reading a vignette, a discussion about a story, how this story relates to others (a differential diagnosis) and a treatment that pertains to this specific case.

As this M3 year draws to a close, I find myself thinking about the many patients I came across throughout the year. I realize that there are many patients that simply became faces in a sea of daily activity and yet there are others whose names and stories will remain with me for quite some time. It comes to me as no surprise that I often have names to attach to the latter. This isn't to say that the former were insignificant experiences--there is still much value in them yet--but when it comes down to the core of medicine, I believe that there is a significance to beginning with a name, a face, a history before the physical. While the lab work and imaging studies receive much of the attention, money, and publicity when it comes to health care, I have to remind myself that the reason why I decided to stick it out this past year was because I hope to one day assist the Leonard Andersons, William Hartwigs, and Suzanne Bowens, to continue living their lives, no matter how long or short their narratives may be.

Inpatient Medicine

2011-02-21T22:00:00.005-06:00

In the morning, we round on patients and monitor their progress. In the afternoon, we make phone calls to track down patient records, call primary care physician offices to schedule follow-up appointments, update other physicians on the progress of their patients, and on top of that try to deal with the myriad of social issues that inevitably arise with our patients. In the morning, we do what most people would imagine a doctor to do. In the afternoon, we do all the crucial busywork in an attempt to ensure some form of lasting continuity to whatever clinical improvement is made during a patient's stay at the hospital.

The term that keeps coming up in the hospital in reference to some of our patients is the word "babysitting." We make calls to their doctors when they should be doing it themselves. We repeatedly try to convince them to take their insulin when they complain they don't like getting shots to prevent one or more of the innumerable consequences of diabetes. For all the complexity that goes into learning about obscure diseases and the latest evidence based medicine, playing the social game is often just as difficult and a hundred times more draining.

It would be easy to blame all of this on patient lack of education, but the reality is that the messiness extends to all levels of society. Richer people may be more knowledgeable and compliant (and even this isn't a guarantee), but this does not always guarantee gratefulness or the ability to cope with dire circumstances. The mix of uncertainty, anger and denial will make the most educated person irrational--and all it takes an already stressed-out intern or jaded senior resident to turn a normally workable situation into an intolerable one.

It is this afternoon work that often drives many residents to do everything they can to avoid the social mess that is the modern health care system and pursue careers in outpatient specialties or more surgically oriented fellowships. After all, why should one go 200K in debt to subject him or herself to rude patients, patient who won't take their medications, chronic drug abusers who abuse the health care system as much as they abuse the drugs, and have to spend hours calling hospitals just to track down some test that was done 5 years ago that may not even end up being useful in the end? Why wouldn't you want to go into a field where you can dictate the patients you see and only have to deal with patients who actually want to see you?

Inpatient medicine is not merely Patient X has Disease Y that must be diagnosed by test Z and treated by drug 1 or Surgery 2.

No, it is much more often Patient X with disease Y will not take Drug Z for his condition Q which causes him to come into the hospital with complications A,B, and C leading to hospital stays that require expensive testing 1,2,3 that are ultimately paid by the taxpayer because Patient X is on Medicare or unemployment.

Refeeding Syndrome

2011-02-16T21:15:00.002-06:00

It was the second time they went to go see him. It was the wing of the hospital furthest from the main building, the Forest, they liked to call it. He had a lot of problems. Cancer, fungus in his blood, cystic fibrosis, and probably a multitude of other opportunistic infections. The attending followed by the intern followed by the medical student. They were the infectious disease team consulted by the primary service to manage something.

"You look a little tired today," the attending said, dressed in the yellow isolation gown.

No response. He was known for not always being particularly responsive.

"Are you having trouble breathing?" He clearly was, but was still capable of speaking. He looked at them blankly and annoyed. The physician looked at him concerned.

The intern coming up along the bedside took a brief glance at the patient. With a quizzical look on his face he turned to his attending and remarked, " I think he might have refeeding syndrome. Sometimes after people haven't eaten for a while, their body has a hard time readjusting to oral intake creating increased carbon diox--"

"Listen to me," the emaciated 25 year had spoken. His hoarse, weak voice conveying the severity of his condition.

"The reason why I'm tired is because I can't sleep. Every night I have nurses that come in a readjust this and readjust that. I'm in pain. When I finally do fall asleep, I'm woken up again at 4:30 am so they can draw blood. Then for some reason, when the nurse comes in to get my blood, the other nurses think it's a good time to come in and take my blood pressure, take my temperature. Next thing I know some doctor is coming in at 6:00 am to ask me questions. Now it's bright out. Then when everyone finally leaves me alone you guys come along and ask me even more questions, see me tired, and think I have some refeeding syndrome. Now I don't claim to know as much as you doctors with all your knowledge and training, but what I do know is that if I could actually get some sleep here, I might not be so tired when you guys come around. What I do know is that I don't have no refeeding syndrome"

Silence blanketed the room. The attending turned to the intern, "I don't know why they have to draw blood at 4:30 in the morning. We'll try to stop by earlier in the morning so that he won't be interrupted as much."

And wishing the patient well, they turned around and left the room leaving the sick man to attempt sleep once more.

Hypernatremia w/altered mental status

2011-02-15T23:38:00.006-06:00

He actually wasn't conscious when he first came in--of this we were aware. He came in last night, but that morning we met him as a team. Mouth perpetually wide open, hands wrapped in giant mittens to protect himself and others around him.

"Mister Griswolllld!" Our senior resident would yell out each morning shaking him by the shoulders. That morning he responded with unintelligible moans.

My intern whispered in my ear, "Hey Griswold. Where do you think you're gonna put a tree that big? Bend over and I'll show you!"

"You ever seen National Lampoon's Christmas?" he asked me.
"Parts of it, but never the whole thing"
"Alright. Your assignment for today is to watch some you tube clips of that movie so we have something to laugh about together."

Over the next week, Mr. Griswold would recover some form of responsiveness. Demented as hell, each morning he would be greeted and shaken. Eventually, the mittens came off when he was aware enough to stop scratching himself and pulling out his IVs. Then we noticed his hands.

"Hey, check out his lobster claw!"

His left hand sprouted three long and sinewy fingers and nothing more. The thumb, the index, and the bird.

"Watch out. Once he gets a hold of your arm, we'll have to chop it off cause you ain't getting it back!"

Those first few days we couldn't understand a word he said. Then, one morning, I went in with my senior for our daily shaking. He was already awake by the time we got there. Eyes open, he stared at us. We paused, startled at his consciousness. His ever gaping mouth slowly curling upwards, eyes fixed on her.
And then he uttered.

"IIII LUUUUV YOUUUUUU!"

"Awwwww" the inflection in her voice crescendoing as we left the room. "He said he loved me! Mr. Griswold!"

The last day I saw him we were planning him for discharge. Several steps from his room we smelled it. Clostridium Dificile. Shit. Literally.

"How you can tell it's C. Diff?" I asked.
"Just lift up his sheets and smell it."

And so he and his lobster claw were discharged from our service likely to relapse as soon as he settled into the nursing facility to which he was going, We had all come to see Mr. Griswold in a certain light. From unconscious, dehydrated admit to helpless, feces-ridden geriatric to lobster claw freak show, it's startling how little we actually knew about him.

"I loved Mr. Griswold," our senior mused.
"That's because he told you he loved you!" one of the interns replied.
"I know..."
"But he never seemed like the sort of guy that would have a history of being arrested several times for robberies."
"Oh, Mr. Griswold."

An Interesting Case

2011-02-07T18:54:00.003-06:00

"Go meet Dr. Patel in clinic. She's seeing a patient of mine that I think would be good for learning. We're trying to decide whether she has acute or latent TB."

This is what he had been told, and like a good medical student one week into the medicine rotation, he scampered outside, through the snow, and up the stairs to the doors of the clinic.

"Dr. Patel's already in with the patient."

So down the hall and opening the door on his left he slid into a rather small room where the patient was seated in conversation with Dr. Patel.

Dr. Patel was gathering history. Have you any night sweats? fever? weight loss? hemoptysis? No, none of that, she said. She had had a hard life. Extensive medical history compounded by the common American co-morbidities. Any imaging? She thought she had some, but couldn't remember. On and on the history taking went. He picked up her medical records and glanced through them as the chatter continued.

Extensive psychiatric history. Well, given her history, who could blame her?

What did she do for a living again? Disability now, entrepreneur or something like that. They all failed though, her businesses. What were her businesses? He didn't ask.

She had been possibly been exposed to TB when she was a nursing student in the past.

Wait. What?

And then it clicked. He had seen this woman before. She did not recognize him. His memory stirred. Where?

The Ward.

She had wanted to kill herself. She was much more upset back then. He had tried to ask her about her history. She had snapped at him. Too many questions. Why did he want to know? She had left the ward and was supposed to go home but had disappeared according to police reports. That had been the last time he heard of her.

But here she was now. Sharing bits and pieces of a history not so unfamiliar. More psychiatric than medical in some ways, and more human than anything else.

Her most recent imaging turned out to be quite unremarkable. Disappointing from a medical standpoint. She would need further testing and there was no point in risking medication side effects when she was completely asymptomatic and without proper supportive imaging.

Walking back to the hospital, he thought about what she had told him before he left the room. She had told him that he would be a good doctor.

"You have a certain way about you, how you conduct yourself."

Really? Is that all there is to it? He had thought to himself. She didn't know him--just like he didn't really know her. The absurdity.

And then he remembered that this was supposed to be an interesting case. It had been, but not in the sense that he had expected--not medically or in a psychiatric dimension. He couldn't quite put his finger on how it was, and it bothered him. Another time, he would have to revisit it. Perhaps it would make sense then. In the meantime, another morning case presentation. 54 year old woman with a history of diabetes, hypertension, hyperlipidemia presenting with chest pain...

The 12 Days of Trauma

2010-12-14T21:53:00.005-06:00

Inside the hospital, the only sign of the season comes in the form of festive bake sales, the occasional floor decorations, and maybe the occasional Christmas music in the OR. For those on the trauma service, winter is most welcome because it marks a decrease in the number of traumas. Unfortunately, people will drop by for a visit. During my trauma rotation I have experienced the following:

Black people shootings.
Old people falling (while hopped up on coumadin)
Young women motor vehicles colliding (into trees, other cars, +/- intoxication)
Many bones fracturing
Much rectal examining
And healthy dose of X-ray/CT imaging.

General Surgery

2010-11-19T22:01:00.005-06:00

Having wrapped up the general surgery portion of my surgery rotation, I'm pretty glad that I had decided to not join any fantasy basketball leagues this year. Having been an avid fan since junior high, I decided last year to start playing again when a family member enticed me to join his uber-competitive cash-incentive laden league. I won that league, marking a successful comeback from my three year hiatus from fantasy sports. This year, however, I didn't think I'd have the time to really invest as I would like so I had to painfully decline the couple invitations this year.

These days, I find myself myself jumping on my computer to check on how my patients are doing. Instead of points, rebounds, and assists, I'm looking at vitals, progress notes, test results. Admittedly, these aren't the most exciting stats especially since we're not really shooting for extremes. Still, I'd like to think there's a certain head to head match up going on with death or even just surgical complications.

So every night I watch in anticipation and the following morning, I go see the results first hand. I realize it's probably not the wisest thing to compare patient care with fantasy sports, but the more I think about it, there's probably a good number of similarities that could be made. That's another post for another time.

Three things

2010-11-16T20:46:00.004-06:00

One of the surgeons came up to me today and told me that I needed to learn three new things about every surgery I attended so that by the end of the rotation, I would have accumulated a nice fund of information from which to draw.

Today, I had only one surgery--the ventral/umbilical/incisional hernia repair. This is what I learned.

1. Repair necessitates cutting through the falciform ligament
2. Mesh should have at least 5 cm around the hole to ensure stability
3. Suturing the fascia to the mesh helps with stability and hematoma development.

I also present three things from the OR discussion relating to the implementation of new CT scans/pat downs in airports and the needless radiation exposure/invasion of privacy that this will generate.

Surgeon: I shouldn't have to subject my children to this (pat downs) just because I don't want to expose them needlessly to radiation.
OR nurse: If it wasn't the government doing this, these would qualify for sexual abuse.

OR nurse: I'll take the pat-downs over the X-ray any day. Heck, I'll even do it twice.
Scrub tech: Yeah, and while she's getting them, she'll probably forget why she's even getting them in the first place.
OR nurse: Everything I've learned I owe to you.

Nurse: my (Caucasian) friend recently got patted down at the airport while a 25-year old fellow Arab passenger got through untouched.
Indian Doctor: In that case, I'll be expecting my rectal exam when I go through one of those lines.
Nurse: Yeah, you'll be like, "Hey, that's not your hand..."

Thursday morning cancer conference

2010-11-13T12:14:00.002-06:00

It was the weekly cancer conference, and it was optional. Yes, his attending would be presenting a couple cases, but this short white coat had long grown tired of playing this game of impressing his superiors. But, he went anyway. Come to think of it, he probably only went because he was chasing an interest that he really didn’t have—and, on a deeper level, a calling he could never fully embrace.
The first case presented sounded familiar: Adenocarcinoma of the lung. Brain metastasis. Post-radiation treatment VATS pneumonectomy. PFTs had checked out pre-operatively. Patient recovered relatively well. Residual ataxia from the neurological deficits.

This was unfortunate because he painted houses. How would he make a living for himself if he could not stand on a ladder? The cardiothoracic surgeon wasn’t sure. His shoulders shrugged with a hint of sadness and sympathy. This was the story that was often left untold when a patient left the hospital—even if the surgery was a clinical success.

The painter had a name, and the short white coat sat there scrolling through the list of patients he had been generating over the last three weeks. All he remembered was watching the surgeons pull his diseased lung out between the ribs, and the painter’s face the day he was discharged to go home. He remembered that the painter had voiced concern about his job, but despite all this, the name eluded him.

He played the harmonica. He had brought in his harmonica that last day to see if he could still play it after the surgery. Indeed, he had found that he could. So strange; this was all he could remember. He played the harmonica.

The purpose of the conference was to provide a venue for oncologists, pathologists, and surgeons to discuss treatment plans, to collaborate so that future patients could be better served. At the same time, these conferences became a place to commemorate those that had passed through their care. Because for every 55 year old with adenocarcinoma of the lung and brain mets, there was a painter who painted no more—a painter who was recovering at home and playing his harmonica.

Fences and Elbow Room

2010-11-02T19:15:00.006-05:00

Today while waiting for a cholecystectomy, my team of one attending, two residents, and two medical students sat in the physician's lounge chatting about various subjects. My attending raised the issue of how everyone in his affluent neighborhood was putting up fences around their yards. It was silly, my attending bemused, how our relationships with our neighbors were becoming increasingly defined by such a strict sense of privacy.

Sometime later in the conversation, my attending went on to share this story.

"So I took my kids to Disneyland and my son was all up in people's butts the whole time. I had to finally pull him aside and tell him that part of what defines Americans is how we want our elbow room," He propped his elbows up accordingly to show how he symbolically demonstrated to his young toddler the concept of privacy.

"And," he continued, "for the rest of our time there, my son was walking around with his elbows like this," he repeated the gesture a second time.

Thinking back to this conversation, I realize that the hospital is the exact antithesis of the coveted privacy that Americans pursue. Here, a patient is stripped down to their most basic needs (pain, passing flatus, urinating, ambulating, and appetite). In order to receive help, he must be examined, poked, prodded, cut open, and assisted in rudimentary clothing (the hospital gown) by strangers not of the patient's choosing. He is furthermore forced to trust strangers with their most intimate details (sexual history and social history) with really no way to ensure that their confidentiality will be preserved (nurse gossip anyone?). This is both uncomfortably alarming and yet intrinsically necessary to the current health care process (because even the nurse gossip becomes a way to preserve the sanity of the participating parties).

If people were willing to subject themselves to such treatment for the sake of personal health, how different our society would be if we were willing to place ourselves in similarly compromising situations for the sake of our fellow man?

The Bubble Boy

2010-10-30T14:54:00.005-05:00

He showed up to his first day of perinatology not sure of what to expect. He was typing notes at a work station when his eyes met those of the attending to which he was assigned for the week.

"Are you with us this week?"
He nodded his head.
"Come along, then," the doctor said gesturing in a somewhat inviting somewhat melodramatic fashion.

And so, just like Jesus called his disciples, the slightly bewildered med student pended his note and followed his attending for the morning rounds. They were soon joined by a resident, a couple nurses, and a nursing graduate student. The rounds started off as benign as any other. Patients were seen, pleasantries were exchanged, and they moved on to the next room. Rounds went quickly with little explanation of the problems and little discussion. This was expected from this attending so the medical student thought nothing of it.

Throughout the day, the attending talked with pretty much everyone in his path. He treated patients kindly, cracked dry jokes from time to time, and went out of his way to try to make sure the nursing student would be able to do the things she needed to do for her schooling.

To the medical student, he said very little, and there was no harm in this in and of itself, but when a group of them would be in a room shooting the breeze waiting for the next patient, it became evident that the attending had very little to say to the medical student. The student in the short white coat thought this to be rather strange for someone who was so cordial to everyone else, and wondered if he had done something to offend the doctor, but could not think of a single interaction that had lasted long enough to even warrant taking offense.

And this continued throughout the rest of the week. The MS3 became increasingly annoyed with the indifference, and found his attending's behavior, in some ways, to be childish. He became annoyed with the whole system of large universities making heaping sums off indebted students for a training that often exposed them to "volunteer" faculty who simply didn't care to teach And, of course, much of these loans were government-sponsored. In some ways, it was a circle of futility. No one person could be singled out and yet everyone was at fault.

and so the week dragged on. Patients were followed, discharged, and admitted. It was a daily grind on the floors with nurses, physicians, even maintenance people, scurrying about, and somewhere, amid the routine of the hospital machine, a single medical student found himself lost within a world of progress notes, shelf exams, and meaningless rounds that went on as if that short white coat was but a ghost of the imagination.

Matthew 26:6-13

2010-10-23T16:23:00.004-05:00

And it came to pass that a doctor was on duty at the charity clinic sitting in the office talking with her colleagues when they were interrupted by a nurse

“Doctor, there is a patient here to see you.”
“Oh?”
“Yes, she is in the front right now.”

So the resident left the room and came back several minutes later bearing a fruit basket and a bag of cupcakes.

“Look, the patient I delivered a week ago remembered my birthday and came by with these. Aren’t they beautiful? I feel bad because these are so nice and she shouldn’t have spent money on me like this.”
“Aww, how sweet,” another one of her fellow physicians commented.
“Yeah, and she also had brought me cake and cookies when I delivered her in the hospital. She really shouldn’t have.”
“That’s a nice gesture indeed,” their attending remarked, “Those fruit baskets are really expensive. She probably shouldn’t have even bothered.”

This last physician said this because he knew that this patient had a couple of other children to support and received monthly public aid checks--the same checks that paid for her expensive new cell phone, cigarettes, and the oral contraceptives that enabled her to carouse around with whomever, whenever. Such purchases often left the patient unable to pay her cell phone bill, which prevented the physicians from being able to contact her and follow up during her prenatal care. This was troublesome because her baby had a condition that needed consistent monitoring to ensure that it did not get worse. Of course, all of this was made possible by taxing other economically-burdened citizens who were struggling to make ends meet on a daily basis.

One of the nurses came in to the room.

“Wasn’t she sweet? She even brought cupcakes for the nursing staff. You know, it’s people like this that really uplift our spirits because so many of the people in this clinic just aren’t very grateful.”

And all of them could agree on this. Gratitude was a scarce commodity in the charity clinic. One would think that those without any health insurance would be extremely grateful for the services they received at no cost, but the reality of this situation was that many of them were non-compliant, refused to make lifestyle changes, and would simply come back with a sense of entitlement that would make even the most sympathetic health care provider shudder.

Despite this sobering reality, this was still a day to celebrate and be thankful. The doctor asked one of her colleagues if she wanted to split a cupcake and the other happily obliged.

The efficiency of social medicine

2010-10-21T14:33:00.008-05:00

Yesterday I spent time at the free clinic that the ob-gyn residents run for indigenous patients. The last patient we saw that day was a post-menopausal elderly woman who presented with chronic cystocele and rectocele issues. This patient had already had significant spinal surgeries in the past and was wary of the complications involved in the post-surgical healing process. My resident showed a remarkable amount of tact over discussing the option of surgery. From a physician point of view, it's easy to take such delicate matters lightly when discussing patient options. It would be nice to believe that the decision is a simple yes or no decision or as medical people like to put it, "a matter of doing what's best for you," but the cost of surgery is more than a financial one; it is also an emotional and social one as well. Several times over the interview, my resident repeated herself to the patient regarding treatment options and quality of life issues. On one hand, this took more time, but on the other hand, I believe it also played a role in helping the patient make her decision. In the end, the patient still had to weigh her options.

Today, I went to see an ophthalmologist in town to discuss possible cataract surgery. The group here in town has a cushy facility that is a stark contrast to the clinic I spent time in the day before. The place was packed with the elderly. Having had to deal with congenital cataracts growing up, this was an all too familiar setting.

Somewhere in the large waiting room, an elderly lady voice asked a nurse,"Excuse me ma'm. Did they forget about me?"

As I ran through the litany of eye exams--the measurements, the letter charts, the dilation drops--I became increasingly impatient over the whole process. These were the things I had gone through my entire life, but over the past couple years, my failing eye sight had become a bit of sore topic whenever it came up among my classmates who really never understood quite what I was going through. "You really should get those checked out," they would say, or "I think you need glasses or something." These were the words of future physicians of the future. Beware of such "sympathies."

The ophthalmologist was a middle-aged male physician. A brief greeting without the handshake tipped me off that he might have been in a hurry, and as the interview progressed it became even more apparent that he was probably thinking more about the long line of people in the waiting room. He took a look at my eyes and asked me the purpose of this meeting. i told him my concerns and he presented with the surgical options. Somewhere in the conversation, the "doing what's best for you" cliche came out. When I had concerns about scheduling and financing, he referred me to his nurses. When I asked him about recent studies over new lens implants, he said they were "very good." As the conversation progressed, I began to feel hurried in my questions and concerns and increasingly irritated as well. I found myself repeating similar concerns because I sensed a growing anxiety within myself, but the hurried doctor sensed none of this. The interview ended with him getting up before me and having his nurse guide me out the door.

The moment a physician begins to feel or act hurried, regardless of how behind he or she is, you lose the essence of what it means to be a physician. What you essentially tell a patient through your body language or lack of explanation is that your time and comfort is more important than their well-being. Emotions are messy; they are, by definition, inefficient. They do not fit in your 15 minute blocks that a physician constructs in his or her schedule. I have little sympathy for doctors that take on heavy schedules to make more money at the cost of quality of patient interaction, especially in a private practice setting.

Driving home, I realized two things. One, I was going to find another one of his partners to do the surgery. Two, if I ever became a physician, I hoped that I would never conduct myself in such a manner. I understand stress makes people do things they might not normally do, but the doctor left a sour taste in my mouth. It's encounters such as the one I had today that make me even more cynical about the medical profession. Fortunately, for every doc like this one, I have had the chance to be with others, such as the ob-gyn resident, who demonstrate the ideals that I struggle to hold to as I continue in my medical training.

Marginal Zone Lymphoma with Recurring Abscess

2010-08-12T18:57:00.007-05:00

This past Monday I met a marginal zone lymphoma patient and his wife. He had long grey hair that looked like it had seen better days and suspenders that one might find on the old college professor. The first question he asked after my attending introduced me was “So where are you from?”

Here in Central Illinois, my ethnicity is a conversation starter for the predominantly white population. Thanks to desensitization, my hairs no long bristle at the broaching of this topic.

Quickly understanding the question’s intent, I skipped the “Chicago suburb” formality and answered, “My parents are from Taiwan.”
“Oh.” he says, “The reason why I ask is because 12-14 of my students are Chinese. I teach piano.” And as he said this, his long, sinewy fingers played the invisible Steinway as fluidly as one could imagine possible.

The bulk of the appointment dealt with a persistent abscess that had developed in his right lung unrelated to the cancer. Though his cancer had remitted, this pulmonary lesion periodically forced him out of commission. We talked about the limited nature of antibiotics and the possibility of surgery. Our patient obviously hated how his illness forced him to cancel teaching. He pointed to his suspenders as evidence of the amount of weight he had lost over the last year.

On their way out, I felt compelled to speak with our patient again. I asked him what type of piano he taught. “Classical,” he answered. “I used to teach at universities.” When I asked him where, his wife quickly chimed it “He graduated from Julliard.” Her voice dripped with the kind of pride that remembers a spouse’s greatest moments.

I briefly told them about my musical background, and how I had a piano teacher who passed away from cancer. Before I could explain to him just how much she had meant to me, I had already begun to recall the bittersweet memories of our final lessons together. Even as the couple walked away, I could feel my dry hands chapped from freshman year gymnastics—because it always started with the hands—and those frustrated admonishments for not putting in the necessary practice. I could hear her pleading yet stern hoarse voice telling me that I needed to stop wasting both her and my time. I remember being at my sister’s condo on Michigan Ave. when I found out that she had passed, and I remember attending her funeral at her suburban Lutheran church, my back pressed up against the brick wall in the rear listening to her son uncontrollably weep in the middle of his testimony.

But of course you can’t tell all of this to a patient because life must go on (and lest we forget, the insurance companies will certainly remind us). As we age, we learn to be content with vignettes—if we’re lucky short stories—from each individual that steps through the door. Our fellow man, therefore, gives us snapshots by which we extrapolate the past, and we, in turn, are endowed with a memory through which we begin to move forward in the present.

And for a moment I found myself speechless, wishing that time would stop and let me ponder all of this further. Unfortunately, time halts for no one, and as we began to move on to the next patient of the afternoon, I gave thanks for the people that imbue our lives with meaning

the shrink's office

2010-07-22T17:19:00.003-05:00

Perhaps the most depressing part about a psychiatrist's office is that it has become a medical McDonald's serving medication. The time constraints compounded by the medical profession's inherent inability to deal with social problems makes this one of the saddest places to visit. Psychiatry has essentially reduced human suffering to the brain because it is much easier to throw medication at the brain than it is to deal with the complexity of people's lives. The most insidious part of all of this is that patients and physicians alike come to believe in the power of medication.

I try not to be so pessimistic about this but this is what psychiatry has become. You can speak of genetic predispositions, chemical imbalances, or even the glory of psycho- and behavior cognitive therapy but in the end, you are still dealing with a spiritual creature. Psychiatry categorizes disorders with nice lists. Meet 5 of 8 of these conditions for 6 months and you have this episode or that personality disorder. People were never meant to be viewed in this manner. But, psychiatry protests and fights back. It tries to defend its validity with more diagnostic criteria, more brain studies, and more drug trials that show "progress." It kicks and screams while its progeny stare back with their flat, constricted, ghost-like affect.

"home"

2010-07-05T22:09:00.002-05:00

I went back up to Chicago this past weekend to spend time with other people's families. One of my high school buddies has to move back to the burbs this weekend to take care of his sick mother. Ironically, his dad and two older brothers are all doctors/doctors in training but for various reasons are unable to be home that weekend. So, my friend, the high school English teacher, was ironically the only one that was able to make it home to fulfill his filial duties. I am thankful that I don't need much to be amused and so I have no problem catching up over running errands for his mom, ping-pong wars, and even the obligatory basement poker night with high school acquaintances. In addition to playing many games of rummy with his mom to help keep her mind off her illness, we even have time to scurry downtown to play some ball with his city friends, which turns out to be an excellent opportunity to remind myself of the extent of my physical decline. Yes, it is 90+ and humid but even I can't blame that for the tightness I feel in my hamstrings.

The next stop this weekend was at my college roommate's parent's house in Naperville, IL. The reason why I am here instead of his place in the city is another family matter--his seven year old cousin from India needs baby-sitting. I am able to spend time not only with my college buddy but also get to see his younger brother and girlfriend who are here for the summer. Not that my friend anticipates having children any time soon, but watching him and his girlfriend take turns reprimanding, teaching, and playing with him gives me that eerie feeling of how fast time has flown by--and as if I didn't need any more reminders, my college buddy's younger brother is going to college next year.

Third stop takes me about 15 minutes south to my another friend's parent's place to meet more college-bound siblings and another girlfriend/fiance. Dave's family has always been pretty fun to hang out with, but at this point of the weekend, this theme of family (and the absence of my own) is starting to gnaw at me. It's hard to precisely define the exact feeling, but even if I am the type that is always trying to not get boxed into a specific category or group, growing up these last couple years has precipitated a sense of isolation that has caused me to yearn for familiarity and withdraw from initial discomfort of new experiences.

Last stop is to see my nephew and niece. I find myself almost envying their ability to play all day with few worries. Watching them grow up gives me the ultimate sense that time passes quickly My nephew is beginning to cry when it's time for people to leave. He hugs my leg repeatedly and I have to stop my own tears as I turn to leave to drive back to Peoria. I hate to say it but I'm not enthralled about third year--perhaps this is why weekends like this one are so bittersweet.

A book opens itself as much as it is read

2010-06-28T21:54:00.004-05:00

As a mentioned in my last post, the phlebotomist at the clinic I spent time at was a memorable character. To me, she was a hidden story tucked away in a room between the kitchen and the area where patients were seen--a quiet yet bubbly woman who waddled in and out to get her blood draws. She would spend her free moments burying herself in a novel or knitting a pillowcases as wedding gifts for friends. Whenever I came by, I would trade pictures of my nephews and niece for her children. She always had stories to tell, beginning them as if they were a continuation of a previous conversation. What always struck me was how surprisingly detailed her succinct stories always seemed. Perhaps it was my vivid imagination that gave pictures to her words--images not drawn from prior experiences but perhaps conjured from a separate life that had merged with a collective conscience.

One story that struck me in particular was one that she shared about her mother when she passed away. She and her sister had decided to live with her mom during those last weeks trying all the while to hold themselves together emotionally. Alcohol was as as abundant as the grief. Mom used to bake pastries and pies all the time for the family, it became a family tradition of sorts. So during those last days, the two daughters baked pies for mom and when alone drank in the melancholy of the moment.

When I hear stories like this, my somber soul insists that somewhere therein lies a serenity that supersedes sadness. I can't quite grasp how this is logically possible, but if sacrifice can surrender to salvation, then something about this must be true.

Perception of Competency

2010-06-21T18:33:00.008-05:00

During my M1 year, I shadowed a local rheumatologist in the area. She was pretty good at explaining concepts, most of which I wouldn't learn until my second year. I remember talking to her secretary and how she said that this doctor could have done anything she wanted: surgery, other medicine specialties...she was that good. Based on what I saw and heard from my personal conversations with her, I could believe it.

This past year I was able to spend some time in clinic with one of the FPs here in town. He worked at the federal clinic, and though I spent most of my time with my preceptor, I also had the chance to talk to the staff around the office. During my first week in clinic, the phlebotomist (who actually let me stick her because I needed practice drawing blood) remarked that "nothing seemed to faze him." Throughout my three weeks in clinic, however, I couldn't shake the feeling that there were many times where he wasn't sure what to do with certain patients or when I had questions, he didn't have an answer. To be fair, perhaps some of these questions were more geared towards specialists (I mean this is why they have extra training, right?) or the patient he had was indeed a difficult case. I could think of a plethora of variables to consider (town vs. gown, indigenous population, etc.) but the bottom line is that I began to realize that just like any other profession, there exists a wide range of competency when it comes to medicine.

I think this fact disturbed more because, to me, this seemed to insinuate that there are doctors out there who might be better off not practicing. I think about my own classmates and I see a wide range of ambition, competence, and motivation. I look at myself these past years and wonder where along this spectrum I will fall. I sometimes think that if people knew where doctors came from, we wouldn't be nearly as trusting of the medical profession as we are.

The second thought about all of this was the different levels at which people view their doctors. The FP had plenty of patients that had been with him for a long time and loved the guy. Certainly, this not only suggested that he was helping people medically, but that they saw something either about his personality or professional demeanor that led them to believe that he was doing a satisfactory job. The phlebotomist felt like the physician was always on top of things or at least in control. I, on the other hand, saw things differently.

the problem with blogging

2010-06-14T16:42:00.004-05:00

I remember the first time I started this whole online "journal" thing it was like I found the golden ticket to meaningful mind dumping. Unfortunately, I soon realized that like most forms of electronic correspondence, this can easily translate to babble or really. bad. writing.

In addition to general negligence, I think part of my reluctance to write here is the ever present anxiety that comes with being vulnerable to an unknown audience. Context is so crucial when writing about anything meaningful that it can be the difference between generating incendiary remarks and constructive dialogue. I had a wake-up call a couple summers ago when one of my former co-workers said that my summer job boss came across one of my blog entries about my work experience. Of course, it was pretty much a harmless, feel-good post at the time but it has made me much more wary of the type of things that I talk about.

Still, in weighing the pros and cons of spilling out details of my life on the internets, I have decided that I would like to make a more concerted effort in keeping this thing going. This doesn't necessarily mean I'll be posting about that girl that I'm currently dating (because if I did, it would be, among other things, a total fabrication at this point) or like a twitter account.

Another reason for starting anew is that I will most certainly always find myself behind when it comes to corresponding to people individually (email, phone calls, etc). For those of you to who are waiting (or have given up on reaching me), my lack of responses have been due in part to a paucity of words these last few months. I find that especially this past year, written words are hard to come by. I won't blame school on this one but there is something about a style of learning that embraces study books and bullet point memorization that has squashed my expressiveness. Even when I journal on occasion, mind dumping comes at a much reduced flow rate and with much higher resistance--a "literary constipation" if you will.

So where to begin? I have finished my second year of medical school and am preparing for national examinations on the 24th. I won't bore you with all the details, but I have lost count of how many times I have asked myself if medicine is really for me. School starts almost immediately after boards and as of now, I am giving myself another year before taking any drastic action.

I have occasionally found myself at church on Sunday mornings, but usually sneaking out pretty soon after. It's been a unique experience for me in terms of the interactions I've had with the people there. The church is small enough that everyone is aware of me, but I think three of them actually have spoken to me or know my name. I recall the weekend of Palm Sunday where they were handing out palms during the last song of the service and one of the ushers got to my row with the palms (I was the only one in that row), stared at me somewhat awkwardly, and then moved on to the next row. The couple in front me of me actually got a palm for me, but looking back, I think this epitomized the type of detached relationship I've had with this congregation. Considering that the church is so small, I'm sure I am known as "that Asian guy that sporadically shows up."

hello, there, still in Peoria...quite so.

2010-02-09T15:13:00.004-06:00

I've been admittedly poor about updating this thing and I'm not sure who still reads this. This will probably be the easiest medium to write to the largest number of people, and since I've come to realize that my one email to one person ratio is becoming increasingly impossible, I'll have to settle for this. Hey, at least I haven't settled for constant one liners on Facebook.

Concerning this whole keeping in touch thing, I've realized that the combination of my introversion with the excuse called school has provided a ripe environment for scarce updates. I'll do what I can in the next few months leading up to boards (another wonderful excuse) and see how it goes.

I just had my History OSCE this morning which is an examination of our history taking skills. Aside from running out of time at one of the stations (I didn't get a chance to take the woman's temperature), I was able to get through each patient with varying degrees of accuracy. I realized sometime in the last few days that it will be difficult for me to really polish any sort of bedside manner until I've become comfortable enough with the basic skills involved in history/physical exams. I find that I either spend too much time trying to be friendly that I overlook certain details or that I become too business like to really crack a smile of some sort. And, I'm okay with that for now, because, I need to get good good at figuring out what's going on with the patient before trying to show them what an awesome person I am.

Second year has been admittedly difficult in terms of learning large amounts of material. Part of that is discipline, and part of it is trying to figure what's really important. I've been fortunate to have some friends here without whose help I could be really struggling--even more than I am now. I these last few years have taught me anything, it's that I've become more comfortable finding help.

I'm currently waiting to find out where I'll be doing 3rd year. I signed up to do my rotations in a rural community somewhere in Illinois. The pros are that I would have a specific preceptor who i work with (Family Med) on a day in day out basis, and that I would get a lot more hands on learning which I am finding is much more effective for me. I'm even finding that my most effective learning this year has come from discussing topics with friends and that my efficiency from reading has quite literally gone down the tubes (scary).

At the same time, I am also wary of moving to an even smaller town especially since my time in Peoria has been a mix of both lonely at times and busy. Of course if I got to know the people there and found a niche, it could be great. Many possibilities. I'm supposed to hear back about whether there will be enough spots to do this next year. Either way, I've come to a certain degree of peace about the whole situation, even if I can't completely understand it.

I'm thinking primary care, but am also interested in medicine. There is a part of me that thinks that I would need to work even harder if I were to go into primary care precisely because it is the gateway from which all referrals are made. Specialists (at least in medicine) seem to have a more focused spectrum of topics to deal with. This kind of makes things exciting, but given my ability to grasp material this year, it's also intimidating. As for surgery, I'll just wait till next year.

It goes without saying but I miss the familiar faces whether it's family or old friends. I know that it becomes harder to really get to know people as one gets older. I am not in any hurry to date anyone but I acknowledge the perks of having a lifelong companion. I realize that there's still so much to learn when it comes people and that I have a tendency to want to fit people into stereotypes not simply because it simplify things, but because somehow it becomes a sort of stabilizing pillar in my attempt to make sense of the world around me. With my parents in California and one of my sisters soon to be moving to Hong Kong for a couple years, I have been increasingly aware of my solitude (even if it is only a perceived one) and no doubt that this has contributed to this loneliness.

As for my faith in God, that continues to be a sort of mystery. I wish things could be much simpler in this regard. If it is not possible to straddle the fence, then i do not know where I am. I am well aware of my own limitations, as well as other peoples limitation, and I know that I can never fully depend either on own strength nor on the infallibility of otehrs. If God is that stabilizing force (and much more I presume), then I can only trust that he will find me in all of this.

Peoria Two Months In

2009-10-22T17:24:00.002-05:00

It is said that it's not good, no matter how pleasant it was, to dwell on the past at the expense of moving on in the present.

Agreed.

However, I find that I will forever be viewing the present with relation to the past, and that I will no doubt try to recreate (but not necessarily duplicate) the pleasant experiences that made just a few years ago, a time to remember for the rest of my life.

A noun, as School House Rock tells us, is a person, place, or thing. Thing is too generic, though, so I will stick to describing the first two.

People:

I realize that the older we get, the more we become the person that we were in our younger years. The insecurities, the sensitivities, the quirks, and the characteristics that define us in other's eyes only become accentuated in social circles. People form an opinion of you and it becomes difficult to change unless you develop significant friendships that give others an in depth understanding of who you are. I have found this to be true of the teachers, classmates, and pretty much everyone else that I have met here.

I also think about the type of people I would like to be around as a physician. The school offers a Rural Preceptor Physician track in our third year for all students (including those not necessarily going into rural). The pros: more individualized attention, more self-driven learning. The cons: small town, primary care emphasis (assuming you're not inclined toward either of those things), 8 monts away from classmates. I don't know if I want to practice rural medicine, but a few months removed from Dixon, this option certainly appeals to me more than it has in the past.

I think about Christians that I have met here. The preceptor I had during my recent primary care immersion week grew up in Africa, went to Wheaton College, did med school here in Peoria, and decided to practice urban medicine here. His children are/were homeschooled and they attend a non-denominational church here in Peoria. He strikes me as caring, a little soft spoken, and, in certain social settings, a little awkward. (I suppose this description could easily be a projection of my self-image but that's an entirely different issue). I went sailing with him and a couple friends last weekend, and the friend that owned the boat gave us all writings that amounted to a testimony and stories of faith. I remember reading them later and thinking to myself, "this is totally something that I could see my mom doing...in Chinese of course."

Places:

I could begin with school. I spend lots of time there everyday. Sometimes I'm awake and sometimes I'm sleeping. Often, I'm somewhere in between. I've been to my friend Jin's parents' restaurant a couple times...it strikes me as the type of place I would go often even if there were other restaurants that had better food simply because familiar faces can make the simplest foods taste better. The pastor at the church I have been attending was kind enough to make a key for me so that I could get access to the church piano whenever I wanted. This has brought back memories of college when 24 hr. access to the music building made life that much sweeter. Speaking of piano, I hope to meet up with one of the music professors at the local university here who says that he may be willing to take me on. My time in medical school has showed me that I am unable to give up the piano...as if there were still so much that I need to learn. .

End of the Soup Kitchen?

2009-07-22T22:40:00.002-05:00

Today, I received an email from Jeff about how the Catholic Worker House is planning on closing down the soup kitchen. The phrase "different priorities" came up in describing the reason for this. I wonder what those different priorities are?

Weddings!

2009-07-11T20:37:00.006-05:00

A good high school friend of mine got married today.

Ah, there's so much I could say about today. I got to stand in a wedding for the first time, and, admittedly, there's something unexplainable about watching a friend stare into the eyes of the love of his life. As Hugo says in Les Miserables, it's one of those moments when the infinite above comes in contact with the infinite below. Hugo uses these words to describe prayer but I'd argue that it's just as applicable when it comes to love.

Bride and Groom

Turns out that I was the only high school friend there which placed me at a wonderful awkward and lonely position considering that most of the young people there were either college friends or part of the extended family. Still, at any given moment, it was hard not to be happy for my friend and it's nice how in celebrating the guests of honor, it becomes much easier to forget momentary discomforts. Plus, it's always fun to hear potentially embarrassing family stories.

Groom and Best Man, the morning of

Wedding Cake-- white, carrot, and chocolate

Rehearsal Dinner-- Hanger Steak

Oak Community Church-- listed as Hinsdale Baptist in my GPS (another one of those denominational drops)

Closing Thoughts and Miscellaneous Pics

2009-07-06T22:19:00.006-05:00

Today, I was able to spend some time with an Internist, and, by chance, essentially got to spend time in all the other departments that I hadn't had a chance to spend time in before. This was because Dr. Khan was covering for two other Internists and was in ER-backup call. So, I ended up spending time in the ICU, and Med/Surg floors while also seeing a code blue down in the ER.

I had a fantastic time partly because Dr. Khan was an excellent teacher and he took the initiative to go over history taking and pointing important things along the way. It turns out that he just joined the volunteer faculty for Peoria for 3rd years, which means that should I want to come back to Dixon, I could request him as a preceptor. Dr. Khan did his US residency at Cook County Hospital in Chicago (Now Stroger) in 1991 and so he probably falls into the old-school breed of physicians. I think patients like him because he is very clear, very direct and assertive, and explains everything thoroughly (as evidence to his complete med-student like histories which usually take up at least three pages when transcribed). He has a remarkable mind and doesn't need to write any of his patient's data down when he takes histories. I spent time with Dr. Khan both in the clinic and in the hospital, and if I hadn't checked out at 9 pm, I would have also ended up in psychiatry with him. We even went to a physicians meeting that lasted all of 30 seconds when we finally got there (they needed a quarum to vote on some issue).

Regarding one patient Dr. Khan made an interesting point. "This patient is so thankful and says that I have saved her life five or six times. That's nice, but I don't think I am saving her life. I am just doing my job." Even though it sounded kind of strange at first, I realized then just how much the man loved what he did.

Petunia Festival

2009-07-06T22:06:00.004-05:00

Every year, as part of the Fourth of July festivities, the people of Dixon have their "Taste of Chicago"-like event . I happened to go on the first day of festivities so there wasn't too much going on since the carnival part hadn't opened up, but as you would expect at an event like this, there was an assortment of overpriced food vendors and kiddie entertainment

The event took place right by Dixon high school (pictured above) which looks more like a castle than a school. I hear that it's not the best school district (of course this was told to me by a doc who was responding to my comment that his eldest college-bound son was probably a pretty bright kid).

One of the "games" there was this nifty contraption. Yes, that's a toilet on top.

As my contribution to the Dixon economy, I purchased this 10'' Italian Sausage for 7.00 (which isn't all that bad for an event like this) but my stomach was questioning the decision beginning from the first bites. Still, after downing a smoothie that was supposed to be a berry blend but tasted like bubble gum instead, I was able to keep things under control.

Basketball Jones Origins

2009-06-30T22:05:00.003-05:00

Tonight at the Y, I played ball with one of the Dixon natives that I've met over the last few weeks. He just graduated from high school and has been working an assortment of jobs this summer for the income. I'm about five years older than him, and while I can pretty much take him off the dribble any time I'd like (the height advantage helps too), he certainly has me outpowered down low (now only if he could learn to dribble and finish in the post I'd have some serious issues). Still, we have a pretty good time playing 21 and I get a chance to try out some of the things that I try to work on during the week.

When I stop to think about it, all of this reminds me of when I was in elementary school--in the first grade to be exact. This was back at our old house when my parents had gotten me a basketball hoop for the driveway. My parents bought the hoop from Service Merchandise (which is now out of business) and I remember the agony endured between its purchase and its installation. We had decided to get the hoop cemented but rainy whether kept delaying the debut. When that final day did arrive, I remember standing in the driveway as the repairmen drove their pickup truck out of the driveway for the final time and staring up at the hoop with the red trim around the edges, the crsip white net, and the Jerry West logo imprinted on the lower left hand side of the backboard.

My neighbor across the street also went to the same elementary school. He was in fifth grade, and so, naturally, I looked up to him. I believe he was half Filipino and half Chinese (last name Wong, first name Alex). He used to come over after school and play ball with me. When he moved onto junior high, his bus would always come later than mine and so I would always eagerly rush outside and shoot around waiting for him to get back. When the yellow bus did drop him off, I would always stop and stare towards his driveway expectingly, ocassionally say hello, but always hoping that he would utter those magic words: "I'll be right there."

When I think about, I don't know why Alex played with me as much as he did. Perhaps he was simply a good friend, an older brother figure of sorts, or maybe his mom encouraged him to do so. The important thing is that he did spend those many afternoons with me, challenging, encouraging, and, in those moments of frustration, admonishing me.

This summer, both at the Y and at the Rural Health Camp, I've played ball with high schoolers and it still feels strange that I would be the oldest one on the court. I find myself trying to get everyone involved, even if it means encouraging people after an ugly shot or horrid pass, or drawing up a play to get someone an open shot. All of this makes me reflect on the days where I was the young, timid one on the court--getting patted on the back after a made shot and looking for the encouragment of the older people who ruled the courts. But now, I realize that in settings like these, I inevitably become a different person, though I can't completely describe why this is.

So here I am now, with many of the same frailties that remind me of the child I still am and with ever increasing reminders that I am not altogether the same person I used to be. Lord knows those childhood basketball days have passed me by, save for those nights where I find myself dribbling and shooting in the empty gym, imagining that I'm back on the cement driveway, fighting the gusty crosswinds while swishing up game winning shots just before the final buzzer sounds in my head.

Family Medicine Reflections

2009-06-29T18:05:00.004-05:00

Today was my last day with Dr. Myers and Reckamp at the KSB Oregon Clinic. I don't know if it's because it was my last day, but, for whatever reason, I felt pretty engaged throughout the day. I don't think I would want to treat small children (because as cute as they are, the fussy ones make these pretty miserable), but there's something to be said about getting the first stab at spotting all sorts of various ailments or simply following up on a pregnant woman throughout the course of her pregnancy. Maybe this is a reflection of my own interests, which tend to be scattered all over the place. Both docs that I spent time with had pretty different personalities, and in the end, I respected both of them for their distinguishing qualities. Most of the patients that we had were pretty pleasant people, which was quite a contrast to the ER where people came in with some sort of trauma/extenuating circumstances that contributed to their sometimes unpleasant dispositions. I remember a couple weeks in, I wondered if I might get bored doing Family Practice, but, after today, I am certainly entertaining the notion.

"Crop Circle' Festival

2009-06-27T12:26:00.009-05:00

Every year the city of Oregon invites artists from all over to come make designs out of the cornfields that litter the farming landscape. This morning, I went on this plane at the Ogle County Airport to go see their creations

Turns out one that my fellow passenger was a photographer for the local newspapers and he took pictures as a hobby. With my Powershot (SD850 IS), I still managed to capture a few photos of Oregon, Byron, Mt. Morris and the other towns in the area.

Here are some of the designs that we saw. There were actually only four of them but considering that the artists only have a few days to do this, it's pretty impressive. My favorite is probably the last one with the bison/buffalo, wolf, and whatever that last one is. I'm not really sure what the one in the first pic (left side) is.

Nothing screams rural town like nuclear plant. Here's one that's in Byron, which is supposedly a pretty nice area and has good schools (whatever that means these days).

These are photos of the Rock River, and as you can tell, it's pretty brown. One of the locals told me that they periodically get notices about Radium levels and other fantastic substances.

This last pic I found at a store that I went to today.

I also had a chance to visit a local soap shoppe in Oregon. The owner used to be a nurse for a while and then decided to that she wanted to open her own store. She has been able to use medicinal knowledge in making her own soaps, and her daughter who helps out at the shop is, coincidentally, going into pharmacy school at UIC Rockford (after, of course, she has her baby in September). I had a fun time smelling the different soaps and learning about what all these strange chemicals do. There were soaps for "stinky pits," "insomnia," "chocolate," and any kind of skin condition you could think of. I was given a sample of "study soap" which has peppermint, which is supposed to wake you up, and lemon, which improves concentration and reduces mental errors. Apparently, in China, they are infusing lemon over the ventilation system for computer workers and it has been found that the number of errors has been reduced 54%. That's certainly a lot cheaper than blowing cash on Ritalin or other ADHD drugs, and I'm sure there's a lot fewer side effects.

Update of the various sort

2009-06-26T22:07:00.005-05:00

The internship is quickly coming to a close and there's almost an anti-climactic feel to the whole experience. This past week I spent in time in psychiatry which was a rather eyebrow-raising experience. Most of the patients I saw were pretty much people you might meet in the classroom, on the streets, in your homes. The only difference is that society has diagnosed these people as in need of psychiatric help--or at least in need of protection against themselves (in the case suicidal thoughts). Still, when I think about this whole notion of suicide, I think about the lady in the clinic who argued that all of us, at one point or another, entertain some sort of suicidal thoughts--what distinguishes one from the other is whether or not one actually decides to carry it out. Perhaps it is because I find myself of a more somber disposition that I tend to agree with this assumption, or at the very least, I could just as easily find myself in a psychiatric ward arguing with the psychiatrist that despite all the meds he can cram down my throat, he still will never really understand my "psychological state." Aside from having one of the patients hit on me, I was able to talk to the social workers, nurses, and music therapist that worked there. While I can't always see how what they are doing helps, I can at least acknowledge that I myself, at this point in time, wouldn't have the patience to deal with some of the cases that I saw that day.

As part of our community service learning project for this program, we compiled and designed a community health services guide. The cover features a picture that I took of the Rock River. Here are some of the pics that my roommate and I took.

As for the basketball saga at the YMCA, that's still been going. All of the games have been limited to games of 21 and 32 partly because there are usually no more than three of us there at a time. Plus, we're all a disproportionately different levels to even entertain the possibility of a competitive game. Still, it's better than nothing.

Every week I on my way up to Oregon to the clinic, I pass by this farm along the highway. When the sky is clear and the sun is just rising, there's nothing like seeing green crop fields littered with a cluster of farm structures. I haven't gotten a chance to try to capture the sunrise but one of these days, I'm going to have to try to do that. In the meantime, here's what I've gotten so far.

Flattery

2009-06-20T16:49:00.002-05:00

I was getting an ultrasound today and it seemed like the tech was taking a lot more pictures than I would have expected. I asked him why he was doing that and he told me that he likes to take lots of pictures so it will be easier to detect changes if the next time should reveal some unwanted developments.

He then added that he likes to do so because, unlike most people, my organs are really clear. "See?" he says, and then he proceeds to show me my gall bladder, liver, and pancreas as I stare up at the screen.

To put it mildly, I was flattered.

The Basketball Jones saga continues: in which I find someone with a helluva lot more basketball jones than me

2009-06-18T22:08:00.004-05:00

Tonight at the Y I met JJ who recently moved to the area from Wisconsin. He played college ball at a DII school in Wisconsin as well as football. In short, he was much better then the three of us who played with him, but I haven't had this much fun playing competitively since the last time I played ball with a whole bunch of superiorly-athletic black people last summer. And the best part of all of this is that we may finally have ourselves some regularly ballers at the Y. Is JJ holding back at times? Sure. Do I still need to develop an inside game? Definitely. Do I still need to add some more muscle so my skinny frame doesn't go flying against the wall at the slightest bump? You betcha.

I guess if there is a silver lining in my game it's that I've managed to develop a somewhat consistent mid-range game. The lost art just so happens to be my only art.

Pharmacy

2009-06-16T17:34:00.003-05:00

The pharmacy rotation today probably was the most instructive in terms of seeing how the microbiology and biochemistry fit into clinical practice. Blood clotting and antibiotics primarily came up in terms of in-patient medication. I spent most of the day with Rob, who I thought would be a great teacher in any kind of setting. I learned a lot from him--including how much I still needed to learn. I also was able to sit in on some department meetings that included discussion over incident reports and specific drug usage. I saw how open communication between health care workers is crucial for patient care and how stubborn physicians can tack on a few hundred dollars per patient or even lead to poor medical decision making.

Basketball Jones meets some locals

2009-06-15T23:12:00.003-05:00

During my daily trip to the YMCA, I ran into three graduating high school students on the court. Unfortunately, I forgot their names, the white guy and the white girl, but I did remember the black guy's name--LaShard. We played some casual two on two (and I mean casual) but it was really nice to actually play a game with some people who did play a little ball--even if we didn't keep score or really up the intensity (and played with a woman's ball). I talked to the WB (white boy--let's call him this until I find out his name next time) a bit and he told me that there indeed is not much to do around here, aside from drinking and working out. All of them don't intend to go very far for college (if they are going), and the girl tells me that she works at Subway year-round. The WB works on a temp basis at the Rayovac plant in town. I hope to see these folks more often, but who knows whether this little interaction tonight becomes a saga of some sort or remains merely a short story.

Physical Therapy (Last Tuesday)

2009-06-15T17:48:00.003-05:00

This was one of the most engaging days in the program. In the morning, I shadowed one of the PTs in the clinic and was exposed to the Neurocom machine, a $100,000+ machine originally designed by NASA for its astronauts to gauge visual and vestibular functioning. Essentially, this was like a simplified virtual reality game. The afternoon was spent driving around the area with Jeff, the PT who does the home care visits. We visited three patients and each was pretty memorable. Among these patients we essentially hit three spheres of society--the wealthy upper/middle class, the mid-lower blue-collar working class, and the farm. Between homes, I enjoyed some delighful conversation with Jeff ranging from his "Magic" cruise (he plays the card game), how he ended up from Dixon after growing up in Wicker Park near the city, and many other random topics. Below are some photos from a farm in Harmon, IL that boasts a population of 300 or so.

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One thing that stuck with me was Jeff''s reason for coming to Dixon after spending much of his life in the city. What he had realized was that after spending time in both settings as a student, he realized that he would be doing the same exact thing in both settings and that the only striking difference between Chicago and Dixon was the people. People were "nicer" in Dixon. In Chicago, most people were "just civil" at best and he didn't want that. The home visits were also pretty memorable because, as Jeff put it, we were entering an intimate setting and helping people in the environment where they felt most comfortable and could be the most vulnerable, in contrast to the sterility of a doctor's office. What more, home visits enabled the health care worker to see the environment in which an individual lives and understand even the simplest obstacles that a person must overcome on a day to day basis when dealing with a medical issue

Rural Health Camp

2009-06-10T19:57:00.004-05:00

For the last couple days, I was in DeKalb, IL (another one of those MON places--but more along of the lines of the rural university town) for a Rural Health Camp put on by Northern Illinois University. I helped out as a camp counselor for a group of kids the included 39 and 7 high school girls and boys respectively. The students are nominated by counselors/teachers in their communities to participate in this two day event which exposes them to different health care fields including speech/hearing, nursing, physical therapy, clinical microbiology, and a few other fields. It's really a neat camp that I wish I would have gone to when I was in high school.

Many of the kids participating in these programs come from poorer areas of Illinois where the expectations educationally are rather low. In addition, these are areas where higher education is often viewed in a negative light. It isn't surprising, then, that many of these kids came bearing family/social-related problems that extended far beyond the classroom. This camp reminded me of my friends who are currently teaching in underprivileged settings, both rural and urban and also reminded me of how these children are desperately searching for positive role models in places where they are scarce. And, of course, seeing the limitless potential in some of these children made the temporality of these last couple days that much more difficult to handle.

Coming back to Dixon this morning brought back memories of those afternoons after getting home from one of those youth group church retreats. It's a strange feeling to be around so many kids at one point and then come back to silence. On one hand it's refreshing and relaxing, but, on the otherhand, it also produces a lonely effect that hopefully blows away at the start of a new week.

What I've been doing when I haven't been checking out flea markets or chilling at the YMCA

2009-06-07T22:44:00.003-05:00

Um...I should also add surfing the net and watching TV to the heading as well, but then I wouldn't have anything else to say here.

I suppose, I could just give some general observations from my stay here.

1. Hospital food- we get it for free here. Breakfast, lunch, and dinner is all paid for. I've never gotten so many non-water drinks with my meals in my life. My favorite so far is the "all natural" Mango Snapple. We've had some weird dishes though. The "Mexican Lasagna" with corn in it jumps to mind. When in doubt, there's always a decent salad bar. I'm a big fan of cherry tomatoes, kidney beans, and cottage cheese. One of the cooks is a professional chef and he makes all sorts of pastries that are pretty good.

2. Foreign doctors- there are a lot of them here. Residents and post-training physicians alike. The big winners here are the Indians and Arabs. Unfortunately, the hospital's website could use some cultural competency. One of the listed languages for the Indian docs are "Indian" and for one of the Filipino docs, his language compentencies include "Filipino." Needless to say, within the health care system, there's quite a spectrum of "diversity." Of course, the hospital's motto isn't "Hey, we're PC" but rather "It's the people." So I guess in this respect, a little ignorance doesn't hurt.

3. Antique shops and dollar stores- there are a lot of them here. I am a sucker for them. This past weekend I spent a lot of time in them. Until the weather clears up, these will be my source of entertainment.

4. Super Walmarts- there are a couple around here. They remind me that I have still some connection to civilization.

5. On probably being the only non-physician Asian here-- I think I want to be the only here because it would make me special. Until I see another one, I will continue to think this and revel in my uniqueness.

6. Public health issues-- Over the last week I've been exposed to many of the issues that I have learned about when it comes to underserved populations. Seeing them firsthand, through the physicians interacting with patients, watching the hospice/home care/physical therapy/medical discharge teams collaborate, or even walking around town, I realize that sometimes, I'd rather not face these issues and leave them for other people to take care of. But that's stupid, right? I shouldn't be in medicine if I didn't want to deal with them in the first place.

7. This morning, I noticed that there were literally five churches along two blocks. There are 39 churches in a town of 16,000. I don't know what to make of that.

Flea market bonanza

2009-06-06T17:20:00.034-05:00

Today, because we are in the MON (middle of nowhere), my roommate and I drove about 15 miles west to the neighboring city of Sterling and its twin city across the river, Rock Falls. Sterling used to be considered the "hardware capital of the world." Thus, we did manage to find a lot of abandoned factories. Economically, Sterling and Rock Falls (which is across the river) is poorer than Dixon and has about 10% below the poverty line, and is one of those cities that over the last few years has been hit pretty hard by the economic downturn. The main reason why we went was because they had an indoor flea market (shown here) there that I wanted to check out. I got a lot of amusing photos for your enjoyment in addition to some pictures of the somewhat shabby city. There were some true historical relics on the four floors of this building, which used to be an old bank. I couldn't believe some of the things people would actually try to sell.

What did I find? Dear reader, I am so glad you asked...

Nothing screams traditional girl toy like Barbie and the one I found had a hometown twist. I have a friend back in Chicago who has practically every Barbie known to women but I'm guessing she doesn't have this one. In retrospect, I should have probably gotten this for her but I prefer to keep these anatomically distorted figurines in their rightful place, on the shelf and sealed in a box in some musty basement. Speaking of dolls, I never actually saw Bride of Chucky because I was only in junior high when this came out and hadn't really begun watching Rated R movies yet. Still, I had heard enough from the older guys in my youth group about the original Chucky to be a little unsettled by the notion of freaky dolls.

I have fairly fond memories of eating Jello growing up. Even if it was just made out of water, pig fat, and sugar. One of my high school friends really liked Jello and he really liked apes. This other book is probably a must-have for college students because if there's anything worse than BS-ing assignments, it's doing a poor job of BS-ing.

The great thing about flea markets is that you're never quite sure what you'll find. I'm not sure why people sell empty beer cans at a flea market, and I can only speculate as to why someone would be trying tell old porn magazines.

I think it would be great to hang these two signs in a classroom. The second one offers sage advice.

Sterling has a historical mural society so we came across many buildings that had murals on them. Here's one of the presidents that had visited Sterling.

There's not much of skyline in Sterling or in Rock Falls. We did find lots of these, though. As you might assume, the downtown area that we were in was pretty much empty and aside from the pubs, all the stores here closed by 4pm. I used to complain that St. Louis was pretty dead on the weekends but what we saw today just blows that out of the water. Even the shots from the bridge that separates Rock Falls from Sterling were not so hot.

Hopefully, when the weather gets a bit better, we'll be able to go visit some of the state parks and take some more memorable pictures. When the main attraction of a town is its Super Walmart, you know there are some issues. Still, I know that part of the reason why it seems like I'm in the MON (besides the fact that I am) is because I don't know to many people here and when it comes down to it, it's really about who you're with as much as it is where you are.

Basketball Jones Remix

2009-06-05T10:15:00.002-05:00

I went running the other day looking for a trail along the river. Unfortunately, the path that I took ended up taking me through residential areas. When the weather is nice, the river is a beautiful site. They also tell me that the water in Dixon has some issues, something about receiving mail notices about traces of radium and arsenic in the water. Beauty kills, I suppose.

The YMCA here has a basketball court and for the first time in while, I have finally found an indoor court that is pretty much people-free during the summer. In the suburbs, this is pretty much impossible and, what more, memberships are kind of expensive. Unfortunately, I am pretty much alone here and, had I not been in Dixon, IL, I would have called up my buddies to come here and play ball. Aside from the interesting glances I get from the natives here who probably don't see too many Asians, let alone Asians on a basketball court, I'm pretty much left alone.

Shooting around has brought back so many childhood memories: from playing on the varsity basketball team in junior high (we had a small school) to coming in early in the mornings so that my gym teacher could help me work on my form. In some ways, solitary shooting has been therapeutic and running suicides, euphoric (um, ok, that's a stretch).

I have decided that I want to learn how to throw behind the back passes this summer in addition to regaining an erratic stroke that I used to have sometime during high school. Obviously, it would be nice to have some pick-up games but so far it seems that playing ball doesn't seem to be popular thing here.

Nursing or Medicine #2

2009-06-02T17:24:00.006-05:00

I feel like I ought to preface this entry with something that says that what I experienced wasn't anything that I wouldn't have expected, but the fact of the matter is that today was draining in many ways. The nurses ended up having me shadow a resident, Dr. Diana (insert long Ukranian name here) since they knew that I was a medical student,

I saw a variety of patients throughout the day including an assortment of children, a ninety-five year old lady with 13 great grandchildren who had lived all over the world with her now-deceased husband who was in the military, and a diabetic who called everyone "brother." Maybe it was because I had to stand up all day (most of the rooms didn't have enough seats) or perhaps I found the procession of patients kind of boring but I was ridiculously tired by the end of the day. Days like this make me wonder if family practice is for me.

The last patient of the day was known for her frequent visits. She wanted a letter that permitted her to find another job without being fired due to stress. If she were to be fired, she would lose unemployment, health insurance, etc. The woman had two young children and a husband who worked. She said that she worked at a company where there were eight people left in the department, among which four were expected to be let go. Her job involved some sort of commercial writing and she had been recently admonished for making errors in her work despite the fact that, unlike her boss, she lacked a second pair of eyes to look over her work before the final submission. Her father had recently passed away and she confessed to needing to always be active but could not handle the stress of her job and the repercussions on her family if she lost her job. She had been taking medication for her anxiety attacks but they seemed to have limited effect and she did not want to drug herself up. When asked about seeing a psychotherapist, she said that wasn't a route she wanted to go down ("I don't need a psychiatrist, I need relief"). She cited the economy and a criminal record as reasons why she couldn't find another job (two very good reasons might I add). In addition, she talked about feeling bored with life, that the idea of having a job, coming home to the family, and preparing for the next day all struck her as meaningless ("As religion would say, I'm looking for truth"). Still, despite her suicidal thoughts in the past ("I think everyone has suicidal thoughts at some point in their life...they just don't act on them") but would never do so because of her responsibility to her family. At the same time, she confessed that if she lost her job, there's no telling what she would do in such a moment of desperation. All this time she is telling us this, her young child is jumping around, throwing things, and adding to the frustration in the room. Needless to say, you needed to be there to experience the full drama of the moment.

It turns out that this woman had this same issue at two previous jobs and that the company that she says she is currently at is not the place where she is now. The doctors wanted her to see a psychiatrist before moving foward with anything, but, in reality, they are just fed up with her. I believe when one of the nurses was telling me about her at the beginning of the day, her description was as follows: this woman is crazy.

Before discovering these last few facts, I couldn't help but empathize with this woman's position. The line between insanity and sanity (at least as our society tries to define it) in this woman's case seemed almost Dostoevskian. Societal services such as medicine, social work, psychology all seemed useless in this situation partly because they relied on a particular rational framework. Although this woman turned out to be less than genuine didn't diminish the ideas and issues that she had raised because no doubt there are many people in situations like these. Of course, one might point out that it is in these situations where religion can become as much of crutch than a solution, but, at the same time, I cannot see how medication, "learning to cope with stress" (almost in a Buddhist, pain-transcending sort of way), or reason can help most people cope with these situations.

Medicine Rotation #1

2009-06-01T16:30:00.012-05:00

Now that I have my camera, I've been eagerly looking for unique shots as I drive around Dixon and the surrounding cities. Today, I had to go to Oregon, which is about 15 miles north of Dixon to follow some family physicians. This morning was gorgeous, it was one of those mornings when the sun peaks through an assortment of clouds, shining off hills, trees, and water, painting a breath-taking picture. Unfortunately, I was not able to pull over and snap a few as I would have liked but, rest assured, I won't let the opportunity slip through my fingers next time.

I ended up having a fairly short day since this afternoon was to be dedicated to 120 high school physicals. This morning, I was reminded of the pitiful plight of primary care in addition to being reminded of how much I had forgotten over the last nine months. As I had been told by other physicians in the past, the primary care scene certainly presented with a variety of patients: young, old, infants, pregnant, mentally retarded, very old, etc. I suppose it would have been cool to have taken pictures of all these people, but, unfortunately, that would have been difficult to pull off without repercussions of some sort.

This photo was taken as I sat in the drive-thru at a hot-dog stand in Oregon. I suppose a picture of the food joint would have been more stimulating but this picture highlights the interesting juxtaposition of luxury and more modest housing that is fairly prevalent in this area. Pictures like this, in addition to the abundance of nature, remind me that this isn't quite the suburbs.

The next few photos I took from the bridge that crosses the Rock River that runs through Dixon. These photos are from behind the hospital and represent some rather pathetic attempts to capture unique perspectives of otherwise boring subject matter. One of them shows the YMCA where I signed up for a membership today.

These last couple photos were taken near my apartment. One of the photos includes a piece of the Berlin Wall. One of Dixon's sistertowns was in Germany, and this little historical relic made its way to Dixon after its demolition.

Orientation 2

2009-05-28T19:20:00.004-05:00

Today, as part of orientation, we drove around Dixon and the surrounding areas to get a better idea of the area. We were fortunate enough to have two members of our team who have lived around here for quite a while and so they were able to take us around Dixon and Oregon (home of the Liberty statue, the second largest monolithic concrete statue in the world). Since one of our teammates is from Oregon, she was able to fill us in on all the different things that go during the summer, including a one day festival where artists come in and turn corn fields into works of art (think Signs!) that can be viewed by helicopter. Other potential activities included visiting a dude ranch, an organic farm, or a swine slaughterhouse (okay, so that last one doesn't sound nearly as appealing).

As for the program itself, it looks like we'll be spending time with preceptors in different health care professions (public health, hospice care, social work, pharmacy, nursing, physical therapy, and additional time for our own designation), with an emphasis on our own area. The medicine rotation takes place at a primary care clinic in Oregon, IL with a couple of physicians who also help out with the Rockford campus (I'm going to be in Peoria). We will also be working on a community service project that involves figuring out how to disseminate information from a health services directory compiled by last year's interns, and we'll be helping out at a health camp for high school students at NIU for a weekend sometime in June.

The directors also took us out for dinner at a local steakhouse, and we were able to hear a lot of their stories. One of them is an allergist in Rockford who works as faculty in the medical school there and the other works with Hispanic/other underserved populations in addressing health care disparities. As I sat at dinner (I had a rack of lamb) listening to the conversation, I couldn't help but wonder how different my summer would have been had my initial plans had stuck. The fact that I initially turned down this internship only to come back a month later and find that my spot was still open still makes me wonder, and after today, I am even more excited for what these next few weeks will bring.

Having said all this, I'm looking foward to going home this weekend to celebrate a few birthdays.

Orientation

2009-05-27T17:11:00.003-05:00

I arrived in Dixon, IL for orientation for my summer program. After sitting through about two hours of hospital orientation videos (although they did provide chocolate chip cookies during the showing), we were given a brief tour of the hospital. The hospital is a 90 bed facility that seems to do pretty well for itself, about 5,000,000 in revenue a year, It looks like they will have us working on some community service project (details to be discussed in the next couple days) while rotating through different departments, including Medicine, Social Work, Physical Therapy, Pharmacy, and Public Health. So while I probably won't be getting the hands-on clinical experience one might hope for, I hope to get a pretty good idea of different departments and how they function within the scope of patient care.

My fellow interns include a couple of nursing students, a undergraduate biology major, and a recent Masters of Social Work graduate. A couple of them are locals to the area and all of us, at this point, don't really know what to expect.

The hospital itself sits on the Rock River. The tourist attractions that I've come across so far include Ronald Reagan's home, the yearly Petunia Festival (can it get any more rural sounding that that?), and that arch you see above.

The nice thing is that I can go home on the weekends, but I hope, once I get my camera which I left back home, to stick around, explore a bit, and maybe snap a few photos as I get a better feel for the town. If nothing else, I can do a better job of this than I did in the U-C and so maybe I won't be as eager to leave as I was this past school year.

Gracie

2009-05-17T20:34:00.005-05:00

I was lying when I said that David was the only other Asian. There is also Gracie, a short, elderly, wrinkly, ashen-faced Chinese woman who comes to kitchen every week. Gracie does not speak very much, but when she does, most people cannot understand what she is saying. She often lingers at the house after meals and sits in a chair reading and keeping to herself. In some ways, she is in her own little world.

Once, Gracie had been sitting at the table for a long time and people in line were getting upset. Someone tried to say something to Gracie and she began screaming and yelling at the person. The rest of us just kind of shrugged...there wasn't much that could be done; she was going to take as long as she wanted to drink that bowl of soup and that's how it was.

Rumor has it that Gracie used to be a professor at the university. They say that she had a PhD in math and then something happened. Society calls this "losing one's mind," but for some reason, I want to believe that it wasn't so simple.

David

2009-05-14T15:32:00.005-05:00

David is the only other Asian in the soup kitchen. He is also the only one who is there every week. Part of this is because he lives in the adjacent housing complex, and in exchange for the new housing he is supposed to help out in the soup kitchen. Still, he says, most people don't really help out. I sense a twinge of resentment.

David's job is the dishes. He is proficient at what he does, to a frighteningly frantic degree. As he puts it, in addition to the jolly rancher kool-aid and coffee, he doesn't do anything else.

Whenever he needs to wheel the coffee cart out into living room area, he tells me to stand by the door until he comes back. Then he opens the door and scurries into the throng of homelessness and scurries back, making sure to shut the door quickly, always with a look of nervousness on his face.

New volunteers are always nervous around David. I was no exception. David tends to give the impression that he's bossing people around. I don't think this is the case. Some will just follow his directives and others will ask "what gives?" Shaun was one of the latter. He and David are not on talking terms. Shaun insinuates that David is afraid of black people. His suspicion may not be without warrant.

I tell David that my parents are moving to Cali.
"Oh yeah, where?"
"Laguna Niguel"
"Oh, I've heard of that..."

Turns out, David is from Cali.

"What's it like?"
"It sounds like one of those new developing, ritzy suburbs..."

Douglas

2009-05-14T15:17:00.003-05:00

Douglas shows up to help out. He is dressed in a three piece beige suit. I'm a little confused, even if it's his first time on the job. Douglas is 16. He and Shaun are supposed to help me out with the bag lunches, but the fact that the two are classmates reduces the effective help I receive. Douglas needs to go take a smoke break--before we start. It is 9:30 in the morning and this will not be his last one.

I think about how lonely of an activity smoking is. Then again, most addictions tend to isolate people from the rest of society, unless we're talking about online gaming--but that's another point altogether.

Douglas is from Mississippi. When I ask him what he likes to do in his free time, he says "this." He can't wait to get his own car and get his own place in his name.

Shaun and Douglas chat while they bag chips. Shaun tells Douglas that there's this thing that some bands do where they go out into the woods and jam.
"I ain't goin out to no woods with no white people...I ain't never gonna come back!"
Shaun points out that he's black too, and that this is different. Douglas still isn't satisfied.

Shaun recounts at time at school where some speaker comes in to talk about equality (I assume racial equality). The speaker had said something to the effect of "I know you guys want equality..." to whcih Douglas had shouted out "We don't want equality, we want payback!"

He's a nice kid, this Douglas. He came out of jail and like Shaun, seems to have come from some unstable family situations. When I ask Shaun why he [referring to Shaun] kept coming to the Catholic Worker House, he tells me he liked "the people." I imagine if Douglas keeps coming, it will be for the same reason.

Immunology

2009-05-03T14:09:00.002-05:00

Many of our lectures involve discussion of various experiments that have been aimed at determining what causes a particular disease. Different treatments will aim at blocking particular mechanisms so that the body doesn't respond detrimentally. While there is no doubt that some of this research has lead to remarkable progress in treatment (for example, rheumatoid arthritis). I often wonder how much of these new drugs/therapies, while precisely targeting the molecular causes of a disease, are also merely addressing the symptoms of greater lifestyle issues. I know that saying that a person has disease "x" because he eats Oreos everyday isn't altogether true, but by the same token, I wonder if for the individual, the sandcastle of medical research is only as good as the periodic tides of social ills allow it to be.

In other news, school wraps up on the 22nd and it looks like I'll be spending some time in Detroit, the city that everybody is fleeing, and Irvington, IL, a rural town where few live to begin with. In between, I'm looking forward to spending time at home before heading out to Peoria in August.

Grocery Shopping Win

2009-04-02T17:13:00.002-05:00

Today I went to Schnucks to get some groceries and saw that Kashi had come out with new flavors of TLC bars. My mom used to buy large 24 packs from Costco that included the honey flax, trail mix, and peanut butter varieties. It turns out that there are now three new flavors: pumpkin spice, dark chocolate coconut, and chocolate raspberry. Excited, I decided to get the latter two because they were on sale (3 for 8).

However, when I looked at my receipt, I noticed that they had mischarged me for the Kashi bars so I went over to the customer service booth to get a price check. Of course, Schnucks was wrong. Furthermore, I was pleasantly surprised when the girl behind the counter told me that because of the incorrect scan, I would get the first item back for free. Elated, the first phrase that came to my mind as I walked out to the car was "Grocery Shopping Win." The second thought that came to mind was "Man, too much Failblog."

Jumbled thoughts

2009-03-23T23:30:00.002-05:00

The following is a series of thoughts that could have each been blog posts in its own regard, but because of the quantity of them, never made it out at their full weight (think Octamom).

1. Why do people have one month or two month or three month parties for their babies when the majority of the time consists of trying console a crying baby who is terrified at encountering 10 to 20x the number of people that he/she is used to seeing?

2. When Christians talk about being encouraged by someone else's testimony, is it because they believe the person who is telling it or is it because the message, regardless of whether the teller is credible, in and of itself speaks to a truth that is undeniable?

3. It seems like it's easier to get upset at the companies that continue to abuse taxpayer money for bonuses than it is to point the finger to the administration that keeps feeding money to these same companies in the first place. Perhaps, even more difficult is to point the money to the millions of Americans who decided that they needed a house when, in actuality, they were in no position to buy one in the first place. My guess is that it's not good for the party.

4. Why haven't the Bulls gotten rid of Joakim Noah, Ben Gordon, and just about everyone else on the team outside of Derrick Rose (and perhaps Brad Miller/John Salmons)? I hope that the Bulls are a lottery team this year because they would be wasting their time getting the butts swept by Lebron (and yes, I only say Lebron because he IS the team).

med school bracket

2009-03-21T19:55:00.002-05:00

Some people in our class have a pool for March Madness, five dollar buy in. I was looking over the current standings and noticed someone had entered two brackets. The first thought that crossed my mind was, "Dude, this guy really wants to win." Then I looked at the name. Turns out this guy is a graduating MD/PhD student who is going to Brigham and Women's for Emergency Medicine. A bright guy to say the least. Having had this guy as a TA for physiology and knowing him to be a bit uptight (and that's being generous), I can't say I was terribly surprised.

And if you're curious, I had UConn winning it all.

and to think, if I hadn't worked that temp job this summer, I wouldn't have known why this is funny

2009-03-17T23:16:00.001-05:00

Faried, the Ohio Valley Conference’s defensive player of the year, led a team that relies on balance and rebounding to get it done. Morehead State dominated the boards 50-27.

The senior center chose to go to Morehead even though he thought someone was playing a joke on him the first time he heard the school wanted to recruit him.

“I’m from northern New Jersey, and to hear about Morehead—that was amazing,” Faried said. “I thought it was a pretty funny name, that they were playing around with me. I didn’t know who they were.”

sleight of grammar

2009-03-17T19:12:00.003-05:00

Two friends of mine enlightened me today about how they received help during anatomy dissection.

"We used to just clean everything out, get Martha (the anatomy guru/prof), and say, 'So Martha, what do I got here?"

Eventually, Martha got fed up with this display of academic laziness and told them to look in the book for themselves. Undeterred, my friends adopted a new strategy:

"So what we did was clean everything out, get Martha and say, 'So Martha, I think I found {insert anatomy part} but I'm not sure..it looks abnormal...it looks like..."

And in-between these false expressions of conjecture, Martha would eagerly jump in and say "Oh yes, this is a great example of..." and so on.

Talk about playing the system.

"they're just haters"

2009-03-14T21:48:00.002-05:00

A friend of mine told me today that instead of telling his mom to pray for his schoolwork, he should just tell her to pray for the rapture.

"What about the other people," I ask.

"The rapture won't happen until everyone has heard the gospel," he says. "Besides, they had their chance. They're just haters."

a rarity in the lecture hall

2009-03-13T00:48:00.003-05:00

Recently, my histology professor made a comment during class for which, if I hadn't been so startled that he made it, I would have applauded. The lecture dealt with the reproductive system (testis, vagina, etc.) and he was talking about the increasingly strange cases that he had seen over the years as a pathologist. He said that we should be more concerned about all the different chemicals and substances being used in industry (food, specifically) which are absorbed into our tissues than about global warming. And on days where temperatures are hitting in the low teens in mid-March, I think I'd have to agree.

But still, whatever was in that Italian sausage that I had today was pretty tasty.

the pianist

2009-03-09T21:26:00.003-05:00

I recently met a fellow who graduated from a small liberal arts school in Minnesota who graduated in English Literature and Piano performance. Part of his music degree required participation in an ensemble and because the piano is one of those instruments that stands alone (especially in the classical realm), he was forced to join the choir.

It would seem natural the piano's size would relegate it to a life of solitude, but, as I think about my own experience with the ivories, I cannot help but feel the twinge of melancholy when I think about all the hours spent alone in the practice rooms knowing that I had no fellow orchestra buddies or larger ensemble to which to look forward.

What more, the sheer size of the instrument only highlights the fact the pianist is a slave to his craft. While others can carry their instruments with them, the pianist adapts his schedule to the availability of his instrument. He must go where his master calls--be it to large echoes of concert halls, the soundproof rooms of practice buildings, or the warm confines of a home. No doubt every art demands a degree of solitary confinement, a social sacrifice of sorts. As his reward, the pianist receives the undivided attention of all his listeners; he has no woodwinds or strings or percussion with which to share the stage; his fate rests only to him. Even in the occasional concerto, there he sits front in center; all glory belongs to him.

At the end of the day, the pianist is left only with the voice inside his head that evaluates and re-evaluates, and he is left to return to his place at the piano bench, alone. As he warms up with scales and drills his passages, his mind immersed in the music, other times worlds away. Yet as he plays through the wee hours of the night there still remains a hope that somewhere out there a passerby might stop and listen, and in that moment where each is aware of the other only in spirit, share an intimacy that is all too often lost in individual recognition; it is music belonging to no one but speaking into the hearts of all.

Soup ponderings

2009-02-23T21:17:00.004-06:00

As we are cleaning up, Jeff asks me to help him move some soup containers from the fridge upstairs to the freezer downstairs. This week's variety comes in two sorts: clam chowder and beef and veggie. The soup is partitioned in gallon containers that used to hold ice cream so it's only fitting that these containers return to their old home bearing new substance. The clam chowder is no stranger to me. It was I who portioned it out in the first place. The beef veggie was someone else's doing. I eye it suspiciously, if only because some of it sits lazily in a Ziploc bag.

Jeff cracks open the freezer. It is full with all sorts of goodies. One of these goodies includes a bag of pork bones labeled from February 2008. Jeff recognizes the handwriting as his own and wonders aloud why exactly he had thought it fitting to store such a commodity in the first place. Soup, of course, it had been kept for a future soup, a soup that was never realized.

And then, there's the issue of vacancy. As I stand there, Meijer ice cream gallon containers in hand, Jeff continues,

"Hm...and so we are left to ponder what is to be done with this soup."

His thoughtful assessment elicits my laughter. Simple moments like this, seemingly frivolous , are priceless.

Wayne meets his match

2009-02-23T21:10:00.003-06:00

Wayne is talking to one of the volunteer workers as we eat this week's lunch leftovers. He tells her that he's working on his memoirs and, in his exuberance, challenges her to name something that he hasn't done.

"How about skydiving?"

Apparently, that's one thing that Wayne hasn't done.

And to think I was about to propose "dunking a basketball."

Stupid homeless people

2009-02-18T22:29:00.003-06:00

Two classmates were in the computer lab talking about the upcoming small group discussion on TB. One of the risk factors is being in close contact with those that might have it...for example, being around homeless people. I am working on some summer applications involving experiences in underserved areas. i am working feverishly but, by virtue of proximity, am not excluded from the conversation.

A classmate of mine says he has TB. It's stupid, he says. He never had it before and then he volunteers at a homeless shelter and then he tests positive soon after. I'm never doing that again, he says in his fluent but fob-accented English. Yeah, he continues half-chuckling, I bet they were intentionally trying to give me TB.

Stupid homeless people, I say sarcastically.

Writing

2009-02-18T22:18:00.005-06:00

Wayne lost his job when the factory closed down. Now he works at Taco Bell on University, but the one further down on Neil. He rides his bike around to the Union on campus or sometimes to the newly constructed public library. He tells me he learns stuff by listening to the students and watching the news on the tvs. He's also decided to start writing his memoirs. He's got free time, anyway, what else is he supposed to do?

"Tell me something a man can do," he challenges me, "you name it, I've done it." My mind fails me and I manage a look of stupidity, baffled by the simple question. Easter bunny? Done it. Santa Claus. Yup

I ask myself: can the richness of life lie not as much in what we do but how we do it?

homosexual?

2009-02-11T23:37:00.002-06:00

One of the things that i've noticed in medical school is that like any other social group, there is a considerable amount of gossip that goes on.

One issue that has come up is the issue of someone being gay. Mostly this has come up in describing certain males in our class. There have been several conversations that I have sat in where the sexuality of a particular classmate has been questioned, whether it has been with regards to how one dresses, talks, or the physical features he possesses ("that boy has man-boobs").

I realize that the definition of what it means to be homosexual has expanded over the years. With more prominent public exposure. I guess this happens when a society such as ours becomes confused over what it means to be masculine and feminine I will be the first to admit that I used to think certain people gay if they exhibited flamboyant behavior and speech, but I have realized over the years that this is just as poor as good as an indicator as a male who can knit and cook or a woman who can bench press 300. I don't think that someone is a homosexual just because his or her mannerisms don't fall in line with what our culture defines to be male or female. Unfortunately, much of what it means to be homosexual in our culture has to do as much with one's fleeting feelings rather than one's actions, and, no doubt, that has contributed to the supposed ambiguity.

tales from the soup kitchen

2009-02-08T21:13:00.002-06:00

So I've been spending some time at a local soup kitchen that's affiliated with the Catholic Worker Movement. I was able to spend some time taking with one of the homeless folks there., His name was Doug his pal was Verne. Doug is fifty years old, has a prominent belly, has smatterings of facial hair, looks like he's from the streets, but is still rather respectably dressed. Doug wanted to know where I was from. I told him. He asked me, really, where I was from, I told him again. This went on for a bit, and he gets a little exasperated and says he's just trying to make conversation. I realize that he's trying to ask me what ethnicity I am. Fine. I'm Chinese (But I was born in America).

Doug is a jack of all trades sort of fellow. He makes jewelry, works as chef, does whatever he needs to do to get by. He shows me his prized masterpiece which is a work in progress. He has it around his neck. He takes it out and, lo and behold, it's a large gold plated dollar sign. I almost laugh at the absurdity, even though, when I think about, it's not that absurd.

He asks me what I think about all these people who come to this place. I give a safe politically correct answer. He tells me that he thinks that most of these people are lowlifes who come here because they know they can get a free meal and then go spend their money getting drugs.. This makes me think about all of us who are better off financially who use our money, time, whatever, because we can or even just the rich suburban kids who buy drugs because they are bored and want a thrill. I want to tell him that these people he is talking about are really not so different than the volunteers who are serving them lunch. Sometimes the similarities are too striking. It is hard not to be cynical.

One of the elderly volunteers here had a seizure after I left last Saturday. He is in the hospital and has supposedly had a pacemaker placed in. His name is Jim. This soup kitchen has become a second career. The people that eat here know him by name. All of this makes me think about doctors: we learn about seizures and other people suffer them.

Doug tells me how he met Verne. Doug had just got out of prison and was wandering the streets when he runs into Verne. Verne says, "come with me, you're going to be my bro" and that was that. They've been brothers ever since. Brothers are hard to find these days, let alone good friends.

Doug asks me for cash. I don't have any. He asks for a check, credit card, anything. I say i'll bring him something next time. Doug says, "See how I just played you? I can do the same thing to people out in the park and make a good amount of money every day." When I hear this, I think about how if this had happened to me years ago, I might have been upset. Instead, I think about how I can't live life always being afraid that I'm being cheated. I think about how people probably give him money because his presence makes them feel bad. He plays of their guilt, and why shouldn't he?

We are sitting in the living room having this conversation. There is a upright piano in the room against the wall separating the eating area from the rest of the house. It is old but in tune. I think about how i haven't played piano much since getting to Urbana Champaign. Maybe I finally a good reason to start again.

Whenever I leave the soup kitchen, I have a particular smell. I think it's bleach. This usually would bother me but after spending hours in the anatomy lab this week, I don't care so much.

It is 9:37 now, I should get back to work, or at least check the laundry to see if it's done. Tomorrow is a new week. Sometime during this week I need to cut my hair. I did a pretty good job on my last one. I hope you are all well. I miss you all, and if I haven't gotten around to sending you an update yet, I'm glad that we know each othe well enough that I won't feel like we've lost touch.

old doors, old friends

2009-02-02T14:00:00.002-06:00

These last few days I've been facebook-ing some old high school friends and aside from drowning under the flood of memories that comes with cracking open old doors, it has caused me to go back and reevaluate the person I have become over these last few years. When I look at the past, it is easy enough to say, "Well, I was pretty immature and insecure back then" or "Wow, I can't believe I was like that." At the same time, there are other areas where I say to myself "Goodness, he/she shared "x" or "y" interests? if only I had known..." Besides looking for changes, it's also intriguing to try to catch glimpses of the person you knew back in high school, recapturing the caricatures that made these people so memorable in the first place.

I think I'm beginning to understand all those writers who compose those "coming of age" novels that I dreaded reading in high school/junior year.

epiphany

2009-02-02T01:00:00.002-06:00

I want to be my own person, and so I avoid what i perceive as conformity, even if these expressions of conformity are good or aren't even expressions of conformity at all. Perhaps that is why I avoid being around large Asian groups, be it in churches, youth groups, etc. This is all so silly because this is just another way of saying that I don't want my social circles to define I who I am, when, in reality, this is inevitable.

I also want to be at home, but this is hard because I avoid tight-knit groups that might be considered cliques. This is why I have friends in many different groups but nobody that I could consider my core group. So, just as I want to view myself as an individual, even my closest relationships are with individuals and not group. This is not a bad thing, either--just an observation.

And as I contemplate these things, I know that I cannot possibly be the only one who thinks about these things or thinks this way, but because at times I think that I must be unique for thinking this way, I have a mistaken sense of what makes me different. Unfortunately, even in incorrectly perceiving this uniqueness, I isolate myself from others.

"you from the suburbs!"

2009-01-28T17:40:00.002-06:00

Today, I was with some friends of mine in the library when a discussion broke out about where people were from. Of course, I got singled out as the only one being from a cushy suburb and going to a cushy public high school (Naperville/Oak Brook, Hinsdale Central). Everyone else either fit at least one of the following criteria: 1) black 2) latino 3) from the city 4) from the "ghetto." At one point, someone exclaimed "Ya see, we got to go up against all these people from the suburbs!"

I suppose if I was from a part of town where most kids couldn't read past a third-grade reading level and people got killed every week, I'd view my current situation in medical school with more than a little self-satisfaction. That being said, this whole exchnage reminded me of how there exists a certain degree of segregation in our M1 class based on socio-economic status, which isn't to say that people aren't friendly to one another. This makes sense. Sharing a similar background breeds a degree of comfort...I'm going to skip the related discussion about race and culture that would normally follow.

I decided over break that I would commit to writing more this semester on this blog or in my own journals about what I am thinking and the things I see. I fantasize that perhaps one day, I'll produce a collection of writings that will be publish-worthy but of course, the only way I see that happening anytime soon is if I go on a serial-killing rampage which ends with my suicide. And even if that were to happen, I'm sure my diaries would make for some maddening reads considering that they're often devoid of punctuation, grammar, and, well, sense.

A warm way to usher in the new year

2009-01-06T19:22:00.003-06:00

The following was reported by the BBC today:

Rajini Narayan, 44, is alleged to have doused her husband, Satish, with a flammable liquid while he was sleeping.

When she set him alight, Mr Narayan jumped out of bed and knocked over the substance, causing the fire to spread.

Mrs Narayan told the court she had not intended to kill her husband but to punish him for his alleged infidelity.

Prosecutor Lucy Boord said Mrs Narayan had confessed to her neighbours, telling them she was a "jealous wife" and believed her husband was having an affair.

"I just wanted to burn his penis so it belongs to me and no one else, I didn't mean this to happen," Ms Boord quoted Mrs Narayan as saying.

The fire, on 8 December 2008, caused damage to the couple's house estimated at 1m Australian dollars ($715,000, £490,000).

Mrs Narayan was initially charged with arson and endangering life - including the lives of her three children who were in the house at the time.

The charge was upgraded to murder after Mr Narayan died from his injuries last week.

She has been held in police custody pending the results of a psychological assessment.

Stories like these make me feel better about being single. Stories like these also make me hope that should I eventually marry that significant other, she won't be crazy enough to do something like this. This isn't exactly an isolated incident by any means. Just last year the following article was reported in Reuters:

MOSCOW (Reuters) - A woman set fire to her ex-husband's penis as he sat naked watching television and drinking vodka, Moscow police said Wednesday.

Asked if the man would make a full recovery, a police spokeswoman said it was "difficult to predict."

The attack climaxed three years of acrimonious enforced co-habitation. The couple divorced three years ago but continued to share a small flat, something common in Russia where property costs are very high.

"It was monstrously painful," the wounded ex-husband told Tvoi Den newspaper. "I was burning like a torch. I don't know what I did to deserve this."

Moral of the story: don't cheat, don't associate with crazy women, don't piss off your girlfriend/wife (no pun intended), and, for heavens sake, have some regard for human life.

Advent season

2008-11-30T09:03:00.004-06:00

Basketball Jones

2008-11-28T22:02:00.003-06:00

Thanksgiving break has afforded me the opportunity to watch some of the Chicago Bulls films from the championship years. What made those six championships to memorable was not simply Michael Jordan, but also cohesive the entire team was. Take the two stars, Scottie and Michael, for example. I can't recall a time where the two publicly feuded (at least to the extent that we see players today do so). This isn't necessarily meant to be a dig on Kobe and Shaq but I can't recall another modern basketball dynasty that involved two star players who were on the same page (though I was a big fan of the David Robinson/Tim Duncan duo for those couple years). Plus, I can't recall such a memorable set of role players. Take Dennis Rodman. Yeah, he had the colorful hair and tattoos and even kicked a cameraman in the groin but, dude, who else can say that they've crushed Bob Costas!

As for this season, when I haven't been gushing over Derrick Rose, I've been admiring the team effort of the San Antonio Spurs. I was able to watch a couple of their games when Ginobili and Parker were out and, though it was pretty vanilla in terms of offense, the team game was solid. Plus, they have managed to find another potential stud in guard George Hill (and Roger Mason) who could really be something special. Props to Coach Popovich for assembling what normally would seem to be a bunch of no-name players to surround the trio of stars. I've always been a fan of the Spurs brand of play, boring as it may seem to fans.

Some memorable Bulls moments:

Sharing the spotlight with the short, white, role-player. I was at a church retreat and there was a bunch of us huddled around the radio (since we had no TV) listening to this game.

The flu game 1997 Finals. Unforgettable image: Jordan collapsing into Pippen's arms after hitting a three-pointer to seal the Jazz's fate...serious brotherhood. This NBA 2k9 rendition is pretty much spot on.

The Last Shot/Shove/Game Winner

Whatever you want to call it, everything about this was pure art. Even the graceful shove of Bryan Russell (poor guy never had a chance!) simply becomes part of the final image along with Jordan holding and posing for the follow through. As far as I'm concerned, Jordan's career ends here and his stint with the Wizards never happened.

And who could forget this gem!

Following the news

2008-11-16T22:42:00.005-06:00

They say that M1 year leaves little in terms of having a life, but I find that there is still time to do plenty of other things as well, even at the expense of studying. One of things that I find myself doing more than I ever did in undergrad is following the news. Ever since the election, pretty much every headline story concerns the economic situation both domestically and abroad. There's so much talk of people that are looking simply to survive, to make ends meet financially (and I would suppose emotionally as well too). It reminds me that most of humanity would be content to have a job and make a living doing it--and that's commendable. Whatever discussion of finding the "right" career seems to be secondary to the overriding need to have food to eat and a place to sleep. The hyper-practicality for which ABCs chide their parents bears some of this wisdom.

Having the opportunity to do what one wants is a privilege and the ability to make ends meet is a blessing. Furthermore, having the chance to safely wallow in uncertainty is just as much a gift that not everyone can enjoy.

The wonders of graduate school

2008-09-25T19:30:00.002-05:00

I think of the best parts of medical school so far has been being able to see how so many things a related to each other. No longer are the days where one could view school as an assortment of individual, unrelated classes. For example, today in Immunology/Microbiology, the professor played this song to help us remember the sugar-loving nature of lectins (or sugar binding molecules/receptors) on cells.

The class before, we had just talked about glycolysis in Biochemistry, which also involves sugars. Later, as I was reviewing over the lecture from Biochem, this song came to mind:

Not to be outdone, our Histology professor tried to turn the auditorium into a dance floor by turning off the lights, demanding that the class come down to the front of the room while using the sound system to blare the following:

2008-09-15T20:46:00.002-05:00

"There is only one salvation for you: take yourself up, and make yourself responsible for all the sins of men. For indeed it is so, my friend, and the moment you make yourself sincerely responsible for everything and everyone, you will see at once that it is really so, that it is you who are guilty on behalf of all and for all. Whereas by shifting your own laziness and powerlessness onto others, you will end by sharing in Satan's pride and murmuring against God." -- Zosima from The Brothers Karamazov

In school, if certain people were "jerks," you had the option of not being around them. You could just as easily spend your time with more preferable and edifying company. One thing that has struck me in medical school is that you realize that if such people do exist in your class (and most certainly there are people of questionable character in every setting!), there's a possibility that so and so may end up being a physician to someone you do care about, and God forbid that anything horrible come out of that predicament. So in ignoring a jerk, it is quite possible to harm a loved one.

Happy Birthday

2008-09-13T16:42:00.005-05:00

to two friends who have enriched my life
to two men who I am privileged to call brothers.

And we're off (part 2)...

2008-08-29T21:55:00.002-05:00

During this first week of school, I have caught myself surveying the lecture hall and noticing the different groups in which people have settled. Because I sit in the middle row in the middle seat with a fellow classmate. I have an ideal perch from which to look over my fellow classmates. People, for the most part, are friendly here, though I have noticed that we've gotten to the point where if we pass a fellow M1 in the hallway who we do not yet know, we are quite comfortably able to avert the eyes and shuffle past one another.

As for me, I have found that though I may have sat in the same spot this week with the same friend, my thoughts have been constantly on the different groups around me. I see different parts of myself scattered in the different circles; I want to be good friends with people who are parts of circles that may never intersect.

As I continue to try find consistency in my interactions, I think one of two things is happening: I am either losing myself in an attempt to change who I am or I am finding myself anew in becoming part of new social network.

And then I wonder to myself if there is a third possibility: in achieving the latter, am I also accomplishing the former?

More classroom tidbits

2008-08-27T21:16:00.003-05:00

Today, the TAs for the different classes came in to talk about what to expect from classes and how to interact wiht professors/TAs.

The TA from Medical Statistics admitted that his class was the one that receives the least attention, concisely calling the course "not a ball-breaker." Upon uttering this last phrase, he paused to think about what he wanted to say next, and, as the snickers and outright laughter permeated the lecture hall, turned to the dean heading up the Q&A session and said, "does this need to be censored?"

One of the biochemistry TAs, an enthusiastic Indian chap clearly from overseas, was prompted by the dean, "I have all these stupid questions that need answers. Where can I get help? Who can I go to?" Almost immediately the student began his response with "You can still ask them..."

Free lunches are nice, but, Lord willing, I think I'm going to boycott pizza for the rest of the semester.

And we're off.

2008-08-25T14:56:00.003-05:00

The following conversation took place between two of my classmates concerning going in to see the cadavers when another group mate was assigned dissection duties for the week

A: I mean I wouldn't want to get in the way.
B: Yeah, but you can just go and ask if they could show you a few structures.
A: Ok. So we can just make friends.
B: Yeah, cliques are forming already. I hate this shit. You gotta get on it.

There you have it, M1 is officially underway. Registration says 21 credits. The deans say it's the equivalent to 35 undergrad credits. I'll see for myself soon what kind of workload this entails.

"Cooking" v.1.0

2008-08-22T20:58:00.003-05:00

Tonight I cooked my first meal in the dorm kitchen down here. If any of you know me, you can probably guess what went in it. I also recently got a new camera, to replace the one that died two years ago. I claim neither to be a good photographer nor a culinary god. Still, everyone likes visuals so here you go:

I don't even know if the ingredients I put in really go together (ginger, garlic, and honey were fine...but white pepper?). It's been a while since I've cooked for myself like this. As a result, the extra water I added to dilute the soy sauce and the excessive amount of onions thwarted any attempts to pan-fry the chicken breasts. I was also too lazy to flatten them out or cut them into smaller pieces so I ended up over-cooking them (in an addition to the green onions) in an attempt to makes sure the insides were cooked. I suppose the only criteria for a dish like this is: am I okay eating this for the next few days?

Urbana! Champaign!

2008-08-21T20:26:00.002-05:00

It's been four days since I set foot on the campus to which, if you had asked me freshman year at WashU, I might have considered transferring. As it is, I will get my chance to experience a DI college-town, and having begun to explore the campus on a run this afternoon, I'm beginning to see how such a large campus can also manage to be endearing.

I checked out a couple of the workout facilities here. Three words: Rock. Climbing. Wall.
I like the set up of the campus. The layout is well-organized, sitting a grid of east-west, north-south streets. Many of the buildings have a healthy patch of lawn, and the quads, all three of them, are bigger (and nicer) than what I used to have in St. Louis.

I'm expecting the food to disappoint. Still, Korean BBQ stir fry isn't too shabby for a first meal. I suppose the caveat is that this is considered the best that the dorm food has to offer. I believe I will start eating more tofu in an attempt to reduce the time spent in the kitchen.

I met one of my neighbors the other day. Amanda Heredia, a woman most likely in her 50s, who is doing her masters in bilingual education. She wants to go back to Chicago, where she's lived since immigrating from Colombia many years ago, to help the schools down there. We need more people like her.

My classmates? I believe the best i can do is make some general observations. People seem to form their little groups quickly, and it's easy to see who hasn't found their group yet. I seem to be hesitant to stay with any one particular group of people. Besides, classes haven't started yet, and I'm sure that's when core groups will start to form more aggressively. That's not necessarily a bad thing either.

I realize that the last four years have made me more acutely aware of certain groups around me. Whether it's the cooks at the cafeteria, the cleaning people in my dorm, or even the student clerks behind the desk, I try not let myself to obliviously pass them by. Sometimes, I enjoy these interactions more than the ones with my classmates. It hasn't been since freshman year that I've asked so many people the questions: "Where are you from," "Where do you live," and "What's your name again?"

I appreciate very much old friends who are down here for various schooling, jobs. I think the word "family" is fitting.

I also wonder if at such a big school, the urgency to find your "group" becomes even more important. I think that if I had come here for undergrad, issues such as "Asianness" wouldn't have been as big of a deal to me. I wonder if I will have time to have such thoughts once school starts.

Open and Closure

2008-08-15T12:34:00.002-05:00

Today, I had to go to the hospital in order to get a liver biopsy. The nurses at the hosptial made the time much more enjoyable. They were warm, friendly, and humorously sarcastic. The doctors did their job adequately, and given the quick nature of the procedure (we're going to stick you with a needle into your liver 3 times), I suppose I shouldn't expect much more. Whenever possible, I like watching the needle, whether for a shot, IV or something else, as it's stuck into me. Perhaps it's a personal challenge to increase my pain tolerance. The actual procedure did hurt a bit. I suppose when they take samples of your liver it'll do that. In terms of intensity, the pain wasn't as sharp as when I got my in-grown toenail ripped out by the podiatrist but, it still hurt enough to warrant attention.

I also got to see an old friend in the supply department where I volunteered in high school. Back then, I had purposely chosen the supply department because I wasn't interested in getting "medical exposure" just for the sake of college applications but still "needed" (as my mom put it) volunteer experience. I was able to get pretty close to two of the workers there, Leo and Luke. I saw Leo today, and I wrote this about Luke. Reflections on time, growing up, friendship are all applicable here (Concerning these things, I don't mean to be trite but I'd rather not go into too much more detail about such themes).. One thing that Leo said struck me. He made a comment about how volunteers they get now aren't like they used to be in the past. It made me wonder if this wasn't a reflection of the self-serving nature of volunteering these days.

I wasn't able to see Luke today. He passed away a couple years ago, found dead in his apartment (complications of his diabetes?). If you refer back to that entry I wrote about Luke on my Xanga, you'll know why he meant so much to me. Praise God he is in a better place now. Till we meet again, my friend.

In case the link doesn't work, I've included the entry that I wrote on Luke below

Back in high school, I remember one of the last things that my mom "made" me do. Like everything else that I found myself coerced in (and what a blessing they were), I came away with much more than hours to record on college resume. My junior and senior years of high school I volunteered at Hinsdale Hospital in the SPD (supply department). The SPD was in the basement of the hospital and, really, wasn't exactly the most happening place. Back then, I didn't worry about having "engaging" experiences or complained about doing menial tasks. I was there to deliver supplies to the different floors--everything from long tubes to IV pumps. Sometimes I took the elevator, and other times, when I was bored and anxious, I would sprint up the stairs and time myself. Back in those days, things seemed much more carefree. My biggest anxiety was inviting my supervisors to a praise night at my church even though one was Catholic and the other was also a believer. The two supervisors I worked under were Leo and Luke.

Tonight, I reflect on Luke.

Luke Guralski was a middle-aged man of medium build. He liked to bike, which resulted in him getting into a pretty bad wreck, but he was, nonetheless, a rather robust and yet he struck me as a simple man. He was usually quite clean shaven and yet you knew, should he allow it, he could grow a pasture of a beard. He had a fiancee who suffered from bi-polar depression. There seemed to be an endless number of futile consults and medications in her history but to no avail. Luke himself had mental disorders of the type which would cause him to suddenly forget recent issues. He never completely described his full-fledged condition but I know that whatever it was, it caused neurological abnormalities and deep depression in a life that, for all intensive purposes, really didn't need any more. Because of his girlfriend's medical condition, marriage never materialized and even Luke realized the futility of the situation. Still, he wanted to stay committed to her even though she would try to push him away, and no doubt this took its toll emotionally on Luke even when he let go.

The last time I talked with Luke was after my freshman year. I called his house and shared with him that I was going to China and that I wanted to give him a support letter. I remember talking that night and catching up on the how the last year had brought such new and unexpected things in our lives. That was the last time I talked with him. When I tried to call again, his number had been disconnected.

Yet one thing that made Luke such an encouraging man was his faith in Christ. I saw his care and concern for those around him in the hospital. He was one who voiced his opinions and yet refrained from gossip. He spoke openly about truth and its importance in life, and though at the time, I might have considered his perspective rather naive, I look back at it an see it as refreshing.

The last contact I had with him was a letter he sent to me with support for my trip to China. I knew that he did not make that much and yet he gave cheerfully. Yet his words in the letter, though I cannot recount them specifically, spoke even louder of God's faithfulness through his life to me. I came to the hospital to "do" community service, but I left it with an experience and glimpse of the divine work of which, as I sit here contemplating the future, I want nothing more than to be a part.

There is always a part of me that would like to know where Luke is now, a part of me that wants to recapture the past for the sake of delaying the present and future. And yet, I suppose that I, too, must learn to let go.

Dark Knight

2008-08-06T22:37:00.004-05:00

(Warning, possible spoilers below)

Okay. I admit it. I was sort of suckered in by the 94 percent rating that the movie had on Rottentomatoes. This was, in part, due to the fact that I was rather satisfied with the last movie I saw, The Visitor, that was rated a 93 on the same site. Additionally, almost everyone who I had talked to about the movie could only gush and rave about it ("Yeah, it's long, but you don't even notice").

I think many of my thoughts are stated already by this observant critic from the New Yorker.

To reiterate, the movie didn't really build after Joker is put in jail the first time--it just kept going (kind of like the Departed, plus about two endings), Christian Bale made Batman's voice kind of funny in a sad sort of way (I know Batman has issues but it's not like he's sick with strep throat), and the movie could have done just as much with less (less endings, less privacy-invasive sonar devices, etc.).

And finally, I was disappointed that Harvey Dent's death had to be covered up the way it was in order for the people of Gotham to have their hero preserved. Then there was that line about the people needing something more than truth (which, in the case, is a lie). I think this part is just as disturbing as the Joker's nihilistic tendencies. Let the people live their lives believing in something that doesn't exist (because we simply can't handle the truth that human nature is twisted). Still, I liked how Batman sacrifices his hero status for the sake of the city, becoming both protector and scapegoat.

Overall, the movie was entertaining but I know that's because I've been a Batman fan since childhood. I probably won't go see it again or even buy it. I'd almost prefer the first one over this one. Hopefully, the next movies will learn from past mistakes and try to weave together a story that is both compelling and, of course, entertaining.

Working

2008-06-10T18:08:00.002-05:00

This past Monday, I started my summer job. What do I do? I download computer software onto computers...lots of computers, and then I repeat this over and over again while my brain goes on standby until my next procedural slip-up. Despite their brain-deadening moments of boredom, jobs like these introduce me to so many people, and, since most of these people are older than me, they generally have life stories worth telling. Take Shawn, one of the several well-built black dudes at work. He grew up on the Southside of Chicago and spent his post-high school years (seven of them to be exact) in the military (four in the Marines and three in the Army). Shawn, however, is one of the most relaxed and chill military guys I've ever met. He credits his personality to spending his years in the Marines in a post with officers who were even more laid back than he was, who called each other by their first names, and, for better or for worse, told a then intense and tense Shawn to lighten up a bit. Shawn is an entrepreneur at heart; he has always wanted to run his own business. He's hoping that this job will give him the income to continue pursuing his dream. Then there's Lynn. She had to quit college because she had kids, four of them to be exact. She grew up in Lisle, which is where I live now, but currently lives in Westmont, which is roughly where I grew up. Her husband is a minister of a small church that meets at Benedictine University, which is practically in my backyard, because they don't have a building. Her kids are separated by roughly two years, the eldest being seven years of age. As you can tell, the only thing that has kept me sane through the first couple days have been meeting these people, and trying to at least reflect on what is so easily can be a thoughtless job. Perhaps by the end of this summer, there will be more to say about this.

Grandpa

2008-06-08T22:41:00.003-05:00

After two years of Chinese in college, I have tried, since I've been home, to use it as much as possible. Tonight, during dinner I was able to do so with my parents. And tonight, I thought I'd share a story about my mom's dad, which I found, for many reasons, quite powerful.

My grandpa was in Japan during his college years studying, working, and supporting his relatives back home. His family was hardly a wealthy bunch. The more he worked, the more he money he earned to send back home. But, he also had to support himself during school but working to support relatives took away money and time that would have helped and supported him in school. In the end, his studies yielded a failing business that drove him to the brink of suicide.

It was at this time that my grandpa remembered as a child living off the shores of Taiwan, a preacher coming to their village and staying with them. This preacher taught my grandpa the Bible and shared the gospel message with him, but, at the time, my grandpa's mom was vehemently opposed to any stranger coming in to convert them. So, my grandpa, as a small child, never went to church.

My grandpa, recalling this, decided to go to the Salvation Army post in Japan. Back then, the Salvation Army could legally share the message of Christ to the people it served, and so, it was here, that my grandpa was reintroduced to the Scriptures. He quickly read through the Bible, soaking everything in, but, in the end, came up with the following conclusion: "I believe everything that the Bible says is true except that I cannot believe that miracles such as those performed in the Scriptures really happened."

Now my grandpa was a TB sufferer; he many times ate ice in a futile attempt to soothe the pain. It was during this time that he said to God, "If you make it so that I do not have to eat ice again, then the money I used for the ice, I will give to you." Some time later, my grandpa was sitting on a train when a mother and her children came on. As he was offering them his seat, he saw a figure at the end of the train declare to him boldly, "Your sins have been forgiven." From that point on, my grandpa was cured of his disease.

My grandpa, now a believer, would return to Taiwan and meet my grandmother, who was not a Christian at the time. They would marry anyway (in part because her family had money--it was the trend back then), and my grandma would eventually accept Christ. Then, they had my mom, and the rest of the story continues today.

I never met my grandpa; the only memory I had of him was having my parents call my school to tell me when I was in the third grade. And yet, it's family stories like these that really help me understand, in part, why my parents believe what they do. It helps me realize what drives them to be the type of people they are. Its stories like these, the very same testimonies that I might here over and over again and not think anything of it, that help me realize that to follow Christ is about living a life that is transformed and that serves as a testament to his glory.

A story

2008-06-08T18:24:00.005-05:00

Somewhere in the Chicagoland suburbs, a student was "pumping iron" at a gym on a hot muggy afternoon and was about to begin his final exercise. Before starting, he glanced at the weight on the machine, and, muttering to himself, said "That's too much; I won't be able to do that" and proceeded to replace the weights with smaller ones. Halfway into his routine, he found himself unable to finish the second set. Slightly annoyed, he stopped, a bit embarrassed by his overestimation of his own strength and, by the same token, the underestimation of his weakness.

After brief contemplation, he decided to further reduce the weight, but went when he went to do so, he realized that the original weight that he had originally perceived to be too much had actually been what he had been lifting all along. He had mistakingly taken the rack to be part of the lifting apparatus (and vice versa), and so he had mistakenly placed the smaller weights on the racks while placing the heavier ones on the machine itself. The student sat there momentarily reflecting on his mechanical incompetency, and, upon further evaluation, decided to finish up the last 1.5 sets without making any further changes, taking his time as needed.

home = church browsing

2008-06-03T23:53:00.003-05:00

One of the things that I have dreaded about coming home over the last four years is that I would have to decide where to go to church on Sunday. I won't go into all the details but due to moving about twenty minutes further west since high school and the fact that my home church from high school split since I had last attended regularly, I have lacked a church to call home.

So what did I do this past Sunday? I checked out the smallest church I could find because churches here in Yuppie-town Suburbia are gigantic (two to three services minimum, which often include traditional, contemporary or a funky blend of both services) and big churches, though not necessarily all bad, are not exactly my cup of tea.

The church I attended quite possibly had the ugliest building I had ever worshiped in. The entire building was brick, which wasn't necessarily a problem until I went into the sanctuary. The entire interior of this room was brick with small slivers of windows along the sides, and the floors consisted of this dark red tile with concrete fillings. There was not a single Christian symbol to be found. I am not an interior design guru, but as I stared ahead at the bare brick wall behind the pastor, I kept thinking to myself, "So drab..." The service itself was rather slow and grave. I'll leave it at that.

To be fair, the church is undergoing a change in leadership. It switched pastors last fall, and, having been a part of church that has done the same, I know that the process is often difficult and not without its consequences. Still, I have to admit, sitting through the service made me feel old. And, as much as I look forward to being older and wiser, this is not quite what I had in mind.

On a more positive note, the people were pretty friendly. One of the elders personally made it his goal to accompany me and introduce me to everyone he could think of. He had the demeanor of the gregarious and gentle grandfatherly figure and he certainly made me feel welcome. The church was having their monthly fellowship meal and so I joined them. Lunch was quite enjoyable; there's something about sharing a meal that imparts a deeper significance to typical conversation.

Before I took off, I remember this elder telling me that he was glad that I came and that I should come back to visit. As he put it, "You're among friends here." It was this last comment of his that resonated with me. I may have intended to come just for Sunday, but he had reminded me that, in the body of believers, I am always welcome.

the difficulty in leaving

2008-05-25T17:25:00.003-05:00

"It may be possible for each to think too much of his own potential glory hereafter; it is hardly possible for him to think too often or too deeply about that of his neighbour. The load, or weight, or burden of my neighbour's glory should be laid on my back, a load so heavy that only humility can carry it, and the backs of the proud will be broken. It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you can talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree, helping each other to one or other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. You have never talked to a mere mortal. Nations, cultures, arts, civilisations--these are mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub, and exploit--immortal horrors or everlasting splendours. This does not mean that we are to be perpetually solemn. We must play. But our merriment must be of that kind (and it is, in fact, the merriest kind) which exists between people who have, from the outset, taken each other seriously--no flippancy, no superiority, no presumption. And our charity must be a real and costly love, with deep feeling for the sins in spite of which we love the sinner--no mere tolerance, or indulgence which parodies love as flippancy parodies merriment. Next to the Blessed Sacrament itself, your neighbour is the holiest object presented to your senses. If he is your Christian neighbour, he is holy in almost the same way, for in him also Christ _vere latitat_--the glorifier and the glorified, Glory Himself, is truly hidden."

Something that comes to mind in these last few days in St. Louis

2008-05-23T10:06:00.005-05:00

A friend once told me that a friend is, loosely speaking,"not someone you love but someone who loves you" and that, furthermore, a friendship is "a covenanted relationship that binds people together as surrogate family."

Thank God for friends, praise God for family.

Elementary Lessons after Undergraduate Graduation

2008-05-19T23:49:00.003-05:00

I remember hosting a summer Bible Study one week at my house during high school. My youth group, needless to say, did not do a very good job of keeping things clean. In addition, most of my relationships in youth group were not very substantial. Many of the people I had grown up with had been replaced by a completely different group by my junior and senior years in high school. I had very few if any deep connections. Taking into consideration these two things, I became extremely agitated and upset at them. Furthermore, I became frustrated at the fact that something seemingly so simple as letting people come over to my house had become such a burden. Why was it this difficult? Why did I have to be so meticulous and uptight? I remember expressing these sentiments and many more to my youth pastor afterwards, and, in the midst of the conversation he asked me, "But do you love them?" to which I replied "I want to...if I don't now, I really want to be able to say that I do."

These last few days, it's been nice having people crash our place on their way in and out of St. Louis; there's a sense of home and hearth that the dorms will never replicate. At this same time, this has reminded me of my own reluctance to give up my own comforts. This includes everything from offering food that my mother has brought from home to needing to be quiet when people decide to sleep early. Whether I get anxious over the increasingly cluttered nature of the apartment or simply wishing that I could have friends over for dinner without feeling the need to cook for an additional 3-4 people that I don't know as well, I am learning that to be hospitable is not simply doing what I already want to do (like hosting people I would already enjoy hosting) or giving up something that I'm already accustomed to giving, but it is intentionally and willingly offering up that which I value so that Christ can be honored more.

I have been blessed to have so many friends that are generous with their money, time, and possessions, and I hope and pray that I will continue to learn to do the same.

Current Status

2008-05-05T18:35:00.004-05:00

Setting: Arts and Sciences Computer Lab Printing Pick-up Counter

Student Clerk: So does anyone have a job that they're waiting on?
Me: Yeah, I do. I printed from the one-sided printing station. It should 11 pages.
Student Clerk: Okay, let me see...is it the one called Russian...Death?
Me: (after slight pause) Yeah, that's it...and I know you're just dying to read it.

Student Clerk smirks

Two exams and one paper to go.

Thoughts on John (part 1)

2008-04-28T21:51:00.000-05:00

So this year, my small group co-leaders and I decided to go through the book of John. Though we weren't sure at the time if going through a single book would be a good idea (since we didn't know who would be showing up consistently), I think it's safe to say that God blessed our time going through it. And, having wrapped up the final chapter about a week ago, I figured that it would be appropriate to have a few inevitably incomplete reflections or two about what I learned. And besides, it's finals time, which for me means it's paper time, and I'm willing to concede that this is a paper of some sort. And that's just how it is.

So without further ado, here goes.

John 1 opens up with the reality that "in the beginning was the Word, and the Word was with God, and the Word was God. He was in the beginning with God" (v.1-2). And then we are told that through the word "all things were made" and in the word "was life" and that this "life was the light of men" (v. 3-4). And if that wasn't enough, we're told that "The light shines in the darkness, and the darkness has not overcome it" (v. 5)

Of course, Jesus's words and fulfillment of Scripture (the word of God) throughout the gospel are powerful. It is with words that Jesus summons his disciples. "Come and you will see," as he tell them to follow him (John 1). It is his words that command the wedding servants to fill the jars with water so that he can turn them into wine, the sick man at the pool in Bethesda to get up, Lazarus to "come out" (John 2, 5, 11). With words of anger does Jesus cleanse the temple and fulfills the psalmist's words: "Zeal for your house will consume me" (John 2). It is his words that reveal him to the Samaritan woman and his word given to the official to believe so that his son might be healed (John 4). Most assuredly, it is his words, repeated to Peter, that reaffirm his disciple not only of forgiveness but his status as a child of God (John 21).

Jesus also calls himself "the light of the world" (John 8). He is a light that reveals and condemns the hypocrisy of the Pharisees (John 8), exposes the fragile (but not necessarily disingenuous) faith of the thousands that try to follow him (John 6), a light that shows his disciples how they "also are to love one another" (John 13). He is the light of all men, drawing all people to himself, among which are Samaritans, Greeks, and skeptical teachers of the law. Where else do we hear of light. A city on a hill. A light to the nations (Matthew 5). While the Pharisees, afraid of losing their light, refrain from defiling themselves in the heathen Pilate's presence, Jesus is unafraid to associate with the unclean, to let doubt touch him and believe (Thomas). Jesus goes so far as to eat meals with and wash the feet of his betrayer (Judas), of his denier (Peter). Jesus is the light that shines in the darkness. It is in the dark of night that he meets with Nicodemus to share the good news of the kingdom of God (John 3). He is the light that prays for his children on the night before he is to be crucified.

The Word is light. Summoning, cleansing, revealing, reaffirming, giving, healing, exposing, condemning, associating, meeting, and praying (and most assuredly, in the process, doing many other things as well).

why i need to get a camera phone

2008-04-26T18:31:00.000-05:00

I friend of mine at church took this picture of me during church a week ago.

go here to see it

My thoughts?

1. I think I'll give a little drool next time for an added effect.

2. I still remembered the sermon.

3. Who doesn't sleep when they're at home?

Less than a month until graduation.

Goodness.

Ward No. 6

2008-04-18T00:13:00.000-05:00

In Chekhov's short story, Ward No. 6, a conversation between the doctor Andrei Yefimych and the mad psychiatric patient Ivan Dmitrich takes place. Andrei is insisting that a person's environment has little to do with his security and peace of mind. Therefore, there's no need to be surprised at anything or get overwhelmed by the troubles of life. He says, "There's no difference between a warm, cozy study and this ward...A man's peace and content are not outside but within him."

Having already denounced the Stoics in their previous conversation, Ivan Dmitrich responds:

"To scorn suffering, to be always content and surprised at nothing you must reach that condition"--and Ivan Dmitrich pointed to the obese, fat swollen peasant--"or else harden yourself with suffering to such a degree that you lose all sensitivity to it, that is, in other words, stop living."

"A convenient philosophy: no need to do anything, and your conscience is clear, and you feel yourself a wise man...No, sir, that's not philosophy, not thinking, not breadth of vision, it's laziness, fakirism, a dreamy stupor..."

and most poignantly

"Christ responded to reality by weeping, smiling, grieving, being wrathful, even anguished; he didn't go to meet suffering with a smile, nor did he scorn death, but he prayed in the garden of Gethsemane for this cup to pass from him."

So I actually read Chekhov's story last summer as I was applying for medical school, ironically enough. As I re-read the story for my Russian Lit. paper, I am struck by how much often blunt insight that Chekhov and yet there's a constant tension between allowing his words to wholly resonate within me and guarding against a perceived excessiveness of cynicism that often comes out in his works (or at least in the ones about physicians). One thing remains. Sensitivity to other people's pain is paramount in our ability to love another. The ability to experience the peaks and valleys of life is what makes us human. And as I find these undergraduate years quickly coming to a close, I pray to God that I do not allow maturity to become infected with stoicism or wisdom to be equivocated with insensitivity to the stark realities around me.

Or, as Bum put it, "emotional retardation"

What Happens in a Pontiac Vibe

2008-03-21T00:23:00.001-05:00

In 2003, my parents bought this Pontiac Vibe.
In 2004, I began my university days in St. Louis.
In 2006, I was given this car to use in St. Louis.
Two years later, I'm driving with Dennis on our way to Trader Joe's. He wants pita bread and a specific type of cheese. Ray wants raspberry and strawberry jam. I'm like an giddy kid going to the toy store; I'll grab whatever looks cool.

It's a gorgeous sixty-plus degrees in St. Louis. It has been raining miserably all week. It's supposed to rain tomorrow on Good Friday. Good riddance.

We're driving south on Big Bend about to turn onto Clayton. I realize that something has gotten loose in my window causing it to go all the way down. A bit perplexed I try to bring the window up and it gets stuck half way with the window obviously out of its regular frame. I cautiously tug on the window to see if it will pull up when **KSHHHH **(tinkle tinkle) the window utterly shatters. Small bits of glass everywhere; most of it on me.
I decide not to turn onto Clayton and keep going south.
Dennis and I pause in bewilderment.
The question "What just happened?" is clearly not worth asking at this point.
The window just shattered. Duh.

After about fifteen seconds of sobering silence, Dennis bursts out laughing. I ask him what's so funny, but that's another question with an answer I already know. The peculiarity of the situation is ridiculous. To hell with asking questions that already have answers.
What the heck just happened?

I remember that there's an auto dealership repair shop at Big Bend and Manchester. I continue driving. The three minutes it takes to get there can't pass by fast enough. I miss the first turn before Manchester. I take the next one and circle around. I'm still a bit bewildered. I believe the way I deal with unfortunate events is the exact opposite of hysteria. Sobriety. Bordering on dead wonder.

Eventually, I pick my way out of the car. The guy helping us out (his name is Josh) gives me a rough estimate and tells us that there's a waiting room in the back. Oh, and there's popcorn and soda back there too, hot chocolate and coffee if you want it.

Popcorn and Soda??

The situation is getting more humorous.

Dennis is helping himself to the amenities. First the hot cocoa, then the popcorn. He's making the most of the situation. Apparently he hasn't eaten all day. I call my parents, and that's when the phone games begin. It's back and forth between dealerships and my parents. Looks like the car might be under warranty still. Need to find the nearest dealer. My mom calls me back. Here's the number for the GM driver's assistance. I ask Dennis if he has a pen. "I have my mind," he responds smugly.

I find out the nearest dealer. They close at six. It's 5:45 and my drivers seat is still full of glass. They don't know if they'll cover it. But it's broken because something in the window was loose, I say. Well, they don't have an appointment until Monday. Sigh.

Ray and Joyce have gotten here. Ray's wearing a cutoff and short shorts. I haven't had the chance to say hello. I'm still on the phone.

I try another dealer, they're scheduling for Monday too. Can I get you down for Monday? I'll call you back, I say. I call my mom to explain that even if I did take the car there, it wouldn't be secure in the lot because of the busted window. Isn't that the same as this dealership? Yes. Sigh.

Sometime during this conversation, Ray comes up to me. I ask Ray if he has plans for tonight. He just wants to know what's going on. They're going to have had to wait a little longer than they thought. I'm too busy on the phone to give him a thorough response. It's way past six at this point. Now I can't even talk to the service department at the GM dealerships anymore; they're closed. I call the Driver's Assistance and start to talk to lady. I explain and she arranges for a towing service. I have further questions, but my phone battery is dying. I give her the phone number to the auto center that I'm at but realize that it won't work if it's an automated menu. My phone dies. I need to go find Dennis or Joyce to use their phone. Ray doesn't have his. I find Dennis and Joyce and ask them to use their phone so I can ask my parents what the number is again. Dennis blurts out, "Why don't you just ask me. I have a memory of a monster."

What?

It's the 1-800 #, I say. He dials the rest of the number into his phone and hands it to me.

Lord.

I sit down and talk to another rep. Yeah, she says. We have everything taken care of, they say. The towing company will hold onto the car until tomorrow and then deliver it to the dealership. Okay. Thanks.
I drop off the car key with the guy at the front desk to give to the towing company when they arrive. Dennis wants to go to Riddles. He must go. Or he'll be sad, says Joyce. We climb into Ray's car.

15 minutes later we arrive. It hasn't been 24 hours since last night when I went there with Dennis and Ray to see Ptah Williams and eat homemade ice cream. Fabulous jazz pianist. I find out that Ray's attire is due to his anticipation that he would pick me up right away and go running as soon as returned to campus. No worries, the high school next store to the dealer had a track. He got in a good 15 laps. Imagine that.

Dinner is good. Elias and Lily join us. Dennis dominates the conversation. He might has well. I have no complaints. I remember praying for the food. Thank you for everyone here. I pause.

Thanks.

There's so much to soak in. There are so many blessings to be found in this afternoon that they are no longer disguised. Good weather, a car under warranty, a friend with a freakish memory, with an even freakier sense of humor, a track so that a friend can get in his daily exercise, helpful people at the auto shop, no injuries to report, friends and family on whom I can depend without giving a second thought.

Ray drops me off after dinner. Thanks dude. Let me know when you need to get your car. Handshake that turns into embrace. They should have chest-bumped, I hear Dennis say from the backseat.

Even now, I sit here. A bit overwhelmed. Somber. But for an entirely different reason.
I revisit fall of junior year when my ceiling collapsed. I remember sitting in my room with my head burrowed in my knees thinking about how dreadful the semester had been until then, feeling quite alone. At the end of that semester, I remember finding a care package of fruit from my parents on my front porch after bombing two consecutive finals in the same day and breaking down into tears because I felt so undeserving.

But before I get too lost in thought I remember my family here in St. Louis. And what a family it is. I remember my God, and what a God he is.

Tomorrow is Good Friday. Sunday is resurrection. Today, is grace. Grace revealed, manifested, embodied in bits and pieces of glass. Broken for me so that I might remember the God that I serve, that I might remember my Savior who was broken so that I might be made whole.

Thank you.

Girard on Dostoevsky

2008-03-18T02:15:00.000-05:00

Finishing up my paper on Crime and Punishment. After four years in college, I can't believe that quotes like this one strike me profoundly:

"Dostoevsky does not claim to escape from the underground. To the contrary, he plunges into it so profoundly that his light comes to him from the other side. 'It is not as a child that I believe in Christ and confess him. It is through the crucible of doubt that my Hosanna has passed.'"

But I've come to realize that this is why Dostoevsky resonates with me.

Christ in all things: in certainty and in doubt.

Dual personality and week-end reflections

2008-02-24T17:18:00.001-06:00

I'm still jumping between Xanga and Blogger. Most of the people that I might write for still live in Xanga-land. Comparatively, the blogger world seems to be a vast expanse of unknown people. Someday, I'll have to make a decision.

Had a little more time this week than usual (or perhaps I made a little more time this week). Caught up with friends here and there and, in the process, remember God's goodness to me over the past few years. Next year is still in limbo and, at this point, even when med-schools come back in March or April, I know things won't be any less straightforward.

In the meantime, it's time spent with people. It's hard not to think about the past whenever I spend time with people in the present. It's been like watching a movie where every scene is supersaturated with flashbacks. Whether it's sitting in a brother's room reading for class or heating up Trader Joe's Mandarin Chicken and steaming some zucchini while chatting with another friend or playing Scrabble with a cousin who just happens to be a school friend as well (heck, I even got to play outdated video games with a buddy too), all these moments remind me that this phase in life is ending quickly and that schoolwork, career choices, and everything else that comes with growing up are all fine and good, but not terribly important at this point in time.

In John 14, Jesus's disciples ask him three things.

"Lord, we do not know where you are going. How can we know the way?" (v.5)
"Lord, show us the Father, and it is enough for us." (v. 8)
"Lord, how is it that you will manifest yourself to us, and not the world?" (v. 22)

How does Jesus comfort them?
He tells them that he is the way, the truth, and the life; he tells them that whoever has seen him has seen the Father; and he tells them that the Holy Spirit will teach them all things help them remember everything that Jesus has told them. It's the Trinity at work. And the work is good.

The disciples are worried about the future because they are uncertain as to how God will provide for them. Jesus tells them that his departure to the cross, to the grave, and to his Father are the means by which their future will be secured. Rejoice because "peace I leave with you, my peace I give to you. Not as the world gives do I give to you. Let not your hearts be troubled, neither let them be afraid" (v. 27). Does that mean the disciples know where they will go tomorrow or what they will be doing ten years from now? Of course not. But, what Jesus does tell them is that they will not be alone as they strive to obey his commandment to love one another as Christ has loved them. As Christ reminds them in chapter 16, he says these things so that they "may have peace" because he has "overcome the world."

This past week also reminded me that I have still have time left for the school year so I'll try to make the most of it. I'll take things as they come. I'll trust God with the decision-making process.

But as these past few years have taught with regards to maturing in my faith, it'll take time.

Remind me

2008-02-04T19:01:00.000-06:00

Remind me of the day when I first woke up,
A little dazed, a little clumsy, but happy to be alive.

Remind me that though the destination is not the road itself,
the road is part of the destination.

Remind me that for every slip up, 'fess up, hiccup I make,
life through death,
resurrection through sacrifice
shall daily, more and more, suffice.

Remind me in the gathering around the table,
communal, ceremonial, and celebratory,
is a frame in the film,
and the film itself is glorious.

And the filmmaker, well,
he's been beaming since day one.

thoughts from today

2008-01-23T00:07:00.001-06:00

1. I don't like excessive psychoanalysis of literary characters who really don't deserve such mutilation of their character.

2. Shuttles are great when it's cold outside. Public libraries are even better.

3. Food that I don't have to cook is good, especially when you can eat it with other people.

4. The only solution to lots of reading is lots of reading.

5. Trying to reconcile my past with the present, as with my understanding of the Christian life, is often undesirably tiresome and repetitious in nature.

6. Chopin's Scherzo No. 1 will be a nice senior year piece.

A Thought During Chinese Class

2008-01-18T15:45:00.000-06:00

One of new vocab words for Chinese today was "tian-zhen" or innocence. We spent a good 20 minutes discussing if children were really innocent.

What I wonder is, in the strictest sense, there really a difference between innocence and ignorance?

Blogs and Classes and Cold

2008-01-15T09:29:00.001-06:00

blogs can be like a special letter to an close friend.
And that close friend is, quite simply, everyone.

Classes so far this semester seem to be shaping up:

Science of Sleep
Chinese III (Yeah, interchangeable section times)
Issues in the History of American Medicine
19th century Russian Novel (Writing Intensive and, imho, Reading intensive)
Problems in Philosophy (eww...sacrifices must be made)

Currently: on the butt end of St. Louis schizophrenic weather