PGY2D14 – To the Max

This morning was the end of my first week of “Green Nights,” a week straight of 13-hour night shifts where I had to admitted patients into the hospital without the supervision of an attending. It was pretty interesting starting off my second year of residency with this because it helped highlight the growth that has occurred since the start of intern year. Did I feel grossly inept and inadequate at time, hell yes. Did I sometimes impress myself with the things I now know and feel comfortable managing on my own, also yes. It was also cool to work with some of my co-residents who are smarter than I am and learn from them. There was a group of 6 of us, 5 of us freshly minted 2nd years basically managing 60%(?) of the hospital. While I felt super behind my peers having done 1/2 the number of medicine wards blocks (and adult medicine in general) as them at this point, overall I felt ok with my performance and I definitely learned a lot.

I go back to the same thing in 1 week, and I’m kinda looking forward to another shot and trying to do better the second time around. Things I can work on are definitely being more efficient. I often found my self scrambling at the end to tie up things before sign-out, in part because I would spend so much time overthinking things through the night (often not meaningfully so), so I need to be quick with my schemas so that I can spend less time doing logistics and administrative stuff, and more time thinking which is the fun part.

After our team brunch to celebrate the end of our watch I also went home to see my new niece, Max(ine) who was born on Thursday during this stretch of nights, so unfortunately I wasn’t able to around the day she was born and I couldn’t wait to see her. So I hopped on a train home, sleep deprived, caught a couple, though minimal z’s and met the cutie. She was worth the mission and I am so happy for my sister and brother-in-law, and their beautiful baby girl. I’m very excited to be an uncle.

PGY1D365

I’m officially done with my first year of residency. Transitions are always weird for me because for all the pomp and circumstance that goes into discussing and celebrating these life transitions, I never really feel all that different. But I think that has more to do with the fact that growth is a gradual process. Taking the time now to reflect on the doctor I was at the start of residency to where I am now, the difference is pretty significant, whereas the difference between today and yesterday is pretty small. It’s been a year of constantly being pushed outside of my comfort zone, of feeling inadequate on a regular basis, a year of learning from mistakes. It’s also been a year of some amazing human connections both with patients and colleagues and of surprising myself with what I am now capable of.

I expected intern year of residency to be the hardest year of my life, in large part due to the horror stories told to me by those who have gone through the experience before me (both 1 year ago and 50 years ago). And while yes it was very challenging at times, and not to forget the fact that residency is much different today than it was 50 years ago, I’d venture to say that this actually was one of the best years of my life.

I have felt so fortunate in that I get to do a job where I am constantly learning and get to learn new things everyday. I don’t dread waking up to go to work (90% of the time) and I love that I get to work in career that allows me to continue exploring and deepen my love for science while also giving me opportunities to work with and connect with other people on a very basic human level.

I’m excited for what second year is going to bring and looking forward to the opportunities to continue growing and to mentor the next generation of doctors.

Failphobic

This may be obvious, but it just occurred to me today that the real reason 80% of Disney productions in the last 10+ years have been sequels, spin-offs, and live-action remakes (I actually calculated it and its closer to 53%, but still) is that they are afraid of failure. I always knew it was about money which makes sense given that they are business and they would rather invest in something that has a track record of success, but just never connected that to them being so afraid of a flop that they forgo creativity. It’s just a bit ironic coming from a company that is supposed to represent magic and imagination, that’s all.

PGY1D217 – A Reminder

A family member of 2 of my patients (twins) told me about an unfortunate experience they had during their admission. A staff member of the hospital, threatened not to perform their duty because the family member and one of the nurses were speaking to each other in Spanish. This was pretty shocking and upsetting for me to hear, and I can only imagine how it must have affected this family member. Our hospital serves a diverse community, but with a large majority of that population being Spanish-speaking, so the fact that someone in who works here can carry that kind of attitude in their heart made my heart sink.

I just sat for a while and listened to what this woman had to say, as she was understandably angry and shaken. What surprised me though was the good things she had to say about this hospital besides this isolated event. That, at least prior to this incident, she felt this hospital genuinely cared about the community and the patients that came through our doors. And how she trusted this hospital to see her and her family members as people, not just as patients. It was affirming to hear that many of the reason I wanted to stay here for residency, are ways the people in the community view this hospital. It was a good reminder to always do right by our community in the face of emboldening bigotry, and actively fight against it.

PGY1D214 – Spiels

One of the most interesting parts of this has been talking to parents about vaccines and some of the other routine stuff that we do for babies before they leave the hospital. It has been a good time for me to practice my spiel about vaccines and vitamin K with parents who have spent too much time on TikTok. Sometimes I’m successful in convincing hesitant parents to protect their kids against life-threatening and life-altering diseases, sometimes I am not, but the times that I am are very gratifying. Not in like an “I win” kind of way, but in a “I am doing the job that I came here to do” kind of way.

A big reason I went into medicine was not just to help heal people or cure disease, but to bridge the gap between the science of medicine and the humanity of the people in front of me. Not to prescribe meds and run blood tests just because the guidelines say so, but to help people understand why a certain med or test might be helpful, and be a resource and a guide to help them live they life that they want to live.

If You Wait Long Enough, The Heart Will Suffer

These were the words if my attending today. Of course, here he was talking about the literal heart in the context of cardiorenal syndrome (specifically type 4, which is technically more of a renocardiac syndrome), but it kinda hit me hard on a figurative heart level. Recently (but also chronically) I feel like I put off doing things that move me in the direction I want to go with my career, my relationships, and my life in general, often for the sake of more transient things. And over time, that “lost” time weighs on me more and more as the dreams I had for myself become more distant, and that hurts my heart a bit, ya know?

Don’t get me wrong, I’m very happy with my life overall right now. I love the work that I do and I feel lucky to have so many good and fulfilling personal and professional relationships, there’s just a part of me that feels like I could and should be doing more, not sure for myself, but for the people I care about and for my community (locally and globally). But if I keep holding off on working towards the things that I think I have to offer this world, I may well go into acute heart failure which as we know requires some diuresis (of like ideas, as in I need to do the things [or maybe forget about some] so that they don’t just build up inside me).

Just Words

Now that we’re a couple weeks out from it, I wanted so share some of the thoughts I had following the night of the election:

Words can’t fully capture how I feel right now, so these are just words. I’m angry, sad, disheartened, disgusted, appalled, furious.

I’ve been hearing a lot of talk and seeing a lot of posts on social media about people no longer wanting to associate with anyone who voted for him. First of all I want to acknowledge that this is a valid sentiment for any individual who feels this way because yesterday the majority1 of our country essentially invalidated multiple marginalized and vulnerable populations (and some that have been disregarded regardless of yesterday’s outcome), which includes a lot of people who I hold dear.

Another part of me thinks the solution to the situation we are in cannot be to further isolate into our echo chambers. This is not meant to shame any one who has decided that they no longer want any part of the population that has in invalidated their existence, you have every right to do whatever needs to be done to protect yourself and your wellbeing, and no one should be telling you how to feel or how to act in this moment. For myself, who has the privilege of being a cis-hetero-man, a US citizen, educated, from an upper middle class family with all the opportunities in the world afforded to me by the work put in by my immigrant family (some of whom are supporters of his), I feel like I can’t step away. I owe it to all the people I hold love for — my family members, my patients, and everyone else out there who are going to suffer because of the direction our country may head in these coming four years — to fight the affliction of heart and mind that has seemingly taken hold in so many people.

Despite what the election results show, I (perhaps naively) choose not to believe that all those people are hateful, idiotic, misogynistic, sexist, xenophobic, transphobic individuals. It’s possible that a large number of them may be one or multiple of those, but they are also people with their own priorities who were made promises through cult rhetoric of a better life for themselves and for their loved ones.

Something is missing. I ask myself, How can intelligent people, people who I have at least at one time called my friend, support a man who represents so much hatred and idiocy? There has to be as disconnect. Maybe not… perhaps every single one of those supports are themselves representative all those things. But if so, then where do we go from there? Because based on how this country elects presidents (i.e. the electoral college), leaving both sides fester in their own bubbles will not turn out well for progressive ideals, as we’ve seen. And something tells me that process is not going anywhere soon — call it a hunch.

It’s so easy nowadays to shut off and shut out beliefs and perspectives that differ from out own. Algorithms, socials media, likes, and follows all exacerbate this, if they are not indeed the root cause.2 Unlike, unfollow, report; sure it makes us feel better because then we no longer have to see it, but rarely will that stop it from existing, and those who do resonate with that content will find it and come together, free of any dissenting thoughts thus hardening their beliefs, and making it inconceivable that anyone else of sound mind would think differently.

The change we need comes in culture shifts, not in elections in and of themselves. Culture shifts come through changes in believes and values. Those changes can only come when you are challenged by beliefs and values that differ from your own. It comes from not demonizing other people for having a different world view or having different lived experiences. It comes from finding common ground, as difficult as it may be. It comes speaking up, but perhaps more importantly, from listening. It comes from being disruptive for the sake of change, as well as being open to change.

I could have done more, even if it wouldn’t have changed the outcome of this election. I failed to speak up in casuals conversations for fear of embarrassment, retribution, or not being knowledgeable enough to back up my beliefs. I stayed in my comfort zones only engaging in spaces where I knew my ideals would be validated. These are things that need to change, even if they are coming woefully late. I anticipate that 9.5/10 times doing any of this work will leave me frustrated, hopeless, angry, and desperate, but the alternative is equivalent to me personally giving up and choosing to live with my privilege relatively unscathed, which beyond complicity, would be an injustice and waste.

Again all of this is just words. Words that are basically meaningless in light of what is at stake, and in the absence of action.

I know not all the people who read this will share my perspective. If you are one of them I want to hear your thoughts. I can promise to come into the conversation with an open heart and an open mind, and I hope you can do the same.

1Which might not be quite true anymore, but that doesn’t change the outcome.
2The roots cause is human nature, these technologies just feed off of and augment it.

PGY1D87 – A Good Doctor

It’s been a little over week now that I finished my first block of medicine wards as a PGY1. Med wards thus far is the most similar to what I expected residency to be like. The days were long and the tasks seemingly endless often times, and yet the days also flew by because there was always something to do. Not all of those tasks were “doing medicine” in the way most probably think of it. It’s not like I spent 12+ hours per day prescribing medicine, doing procedures, reviewing blood test results and body scans. Many days the “medicine” seems to be the minority of of the work, with the rest being talking to patients, talking to families, coordinating care, and preparing for next steps. Through all of this, I couldn’t help but feel like this is where I am meant to be.

In my last week, one of the patients, Mr. P, who was on since the start of this block was being discharge to a SNF for rehab. He wasn’t the easiest patient, but not because he wasn’t an agreeable person, in fact he was a lovely person. He just had some difficult and conflicting medical problems. On top of that he mainly spoke Vietnamese, making it difficult to communicate with him at times, even with the use of a translator. I did the best I could to take the time to make sure he understood what was going on and address any questions or concerns that he had. He often took up the most of my time, despite being one of the most medically stable patients on my list at any given time.

On the day of his discharge, I went in to give him the news and say goodbye to Mr. P. After again answering any questions and addressing his final concerns I shook his hand and said goodbye. As I did, he held my hand tightly in his and in his broken English said, “Thank you… You are good doctor.” My gaze went from our hands to his eyes which were welling up with tears.

I wasn’t the one who fixed his broken leg, or the one that delivered his pain medication, or changed his dressing, but I suspect I was one of the few people who came in throughout the day to listen to him and talk to him, not just perform a task. That to me is what the art of medicine is about, and I’ll never forget Mr. P for reminding me of that.

PGY1D43 – Some Time

Hard to believe my last post was over a month ago. Time feels like it has gone by really quickly, but at the same time I feel like I’ve been in residency for months already. I’m writing now because I’m on the night shift in the NICU which is not as busy as it may sound. Similar to nights in the MICU, most of the primary tasks are done during the day and at night we are just responding to calls and questions from the nursing staff, etc. We also go to any deliveries that happen overnight and admit any babies to the unit that need it, but nothing so far.

I keep telling people that ask that NICU while super different from the MICU in so many ways, is also kinda similar. The patients don’t talk to you and you are just kinda managing them without much input from them (of course if the adults are awake and conscious and have capacity they are always involved). There’s a lot of thinking and physiology talk which I like.

What is nice about the NICU is in most cases the patients are able to go home, and of course the babies are (usually) very cute.

There is a lot of optimization that happens here too. We are always looks at and adjusting patients in’s and out’s (I/O’s) which theoretically need to be carefully balanced, especially in the premature ones. We are constantly looking at their nutrition and how many calories babies are getting, how many macronutrients they are getting and how many electrolytes/ micronutrients they need, and assessing/ changing these things on a daily basis. It is interesting stuff, just very different than on the adult side where we do pay attention to this stuff, just not as closely.

As a side note, I had a really rough weekend personally. Still having a tough time, but kinda thankful to have work to distract me. Nothing I feel like elaborating on now because I’m still going/ working through it, just wanted to make a note of it.

PGY1D8 – Weekend Warriors

It’s crazy the difference 2 people make in the workflow of our team. Then again it’s also crazy how easily the rest of the team is able to pick of the slack. Today also was pretty busy because we were down 2 people (it was their day off), but busy is good, it makes the day go by faster and I get to see more interesting stuff. That said there are definitely task that I don’t look forward to, or times when I don’t want to be perceived doing the things I need to do (talking to patient, calling consults) it in almost all cases I have either a senior or someone else right next to me whether they are actively engaged in my conversation or not. Anyways overall, this has been a pretty nice way to transition into this new role in the hospital. I get a lot of model examples of what the work should look like and can easily determine whether or not I am meeting a certain standard, while also being in a safe space for mistakes and stupid questions, because here lots of people have my back.