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Today was the last day at the second clinic. I never really knew the staff there well ’cause I was only there once a week so leaving wasn’t so sentimental, but there are a couple patients who I had seen consistently for the throughout my time there that I will be sad not to get to follow-up with. I did make my proposition to my attending, but I think the idea didn’t quite get through, so I ended up just seeing some patients on my own. We came full circle though and saw the pessary patient who I saw on the first day.

I left my lunch at home though so I went out to this taco stand and got a couple fish tacos. They were alright. Then I ate my lunch for dinner.

I also just realized I asked for the code to enter through the backdoor of the clinic today, not even thinking about the fact that I would never need it. Oh well.

We finished a bit late today, but we typically have less patients at this site so I still got out earlier that I would at the other clinic. I came home and had a pretty lazy day. There so much stuff I need to work on, I just need better triggers, or anti-triggers so I don’t default to playing games or taking naps as soon as I get home.

Tomorrow is my last full day of clinic. Need to start preparing.

Some general thoughts on the leaked Supreme Court opinion and debate further below. If you want to have a conversation about it, especially if you disagree with me, I’m happy to engage with an open mind and I hope you’ll do the same.

Ah back in the clinic. It’s routine now, but I still like it. Though today there were a lot more No Student‘s than usual, which is of course understandable and their right, but just a bit disappointing for me. I haven’t asked to see patients on my own because I didn’t want to interrupt the flow, but I think tomorrow, which I probably should have done earlier, I’m going to ask if I can lead the encounters with him there in the room, and then he will add things if needed or answer questions that I don’t know the answer to, etc. We’ll see, I feel like he may have some issues with that, but I gotta try. I only got 2.5 days left.

Another thing that’s been on my mind is the recently leaked Supreme Court opinion that does not bode well for Roe v. Wade. There are so many (mostly upsetting) thoughts that have gone through my head over this. It’s easy for me to assume things about the intentions and motives of people who were happy about the news, but I really do want to do my best to understand where they are coming from. I have yet to hear a convincing argument as to why Roe v Wade should be overturned or why it would be a good thing, but I supposed if you asked the other side, they would say the same in the other direction. Our fundamental understanding of the world is just different and unless we can somehow resolve that, coming to an agreement will be very difficult.

We gotta always try to see each other as human beings first before making judgements about each other’s character based on opinions, feelings, or decisions, or else resolution is doomed from the started. Sure, at a certain point judgement is valid from an individual point of view, but that should be secondary to trying to understand who a person truly is and how they came to be that way.

Anyway, had the leftover chickpea thing for lunch and then picked up some pho from this one place on my list on my way home. It was decent, not blown away, but also well priced. Also, I didn’t mention, yesterday I went to this cafe for coffee during my lunch break and got a blueberry muffin that was really good. The cafe was a nice place, big area and the coffee was also decent. This guy came up to me and he started asking me about what I do (assumed I was some type of surgeon ’cause of my scrubs). I explained myself and he mentioned he was a chaplain at the hospital. It was a pleasant conversation and eventually he went on his way. After he left the girl from the register came by with a chocolate chip cookie that she said was from the chaplain. I ate it after lunch today. I wonder what he thought about the news.

First day of my last week here. I was back in the hospital, this time in triage. Of the hospital days I’ve had, I probably liked triage the best. It felt the most dynamic, kinda like clinic. People came in, we’d monitor them for a while and then either admit or send home. Also the nurse I was working with was really nice and was able to teach me a lot about how the whole thing operates and then more about the relationship with the other units and the doctors. Also I feel like half the people I’ve met here have a niece or nephew who goes to UCSB. It was a relatively slow day there according to the nurses, despite the fact that they were also using triage to cover for a nurse who left and was typically responsible for performing the non-stress tests. While I wish I could have seen triage working on all cylinders, it was probably for the best so I wouldn’t have to worry about being in the way and the nurses mentioned how they appreciate the quieter days.

When I work with my attending, I always hear him get phone calls from triage where they give him the low-down on a patient and then he gives the ok to discharge or admit. It was cool seeing the other side of it. They even called him a couple times while I was there. On a side note all the nurse I’ve met seem to really like him despite his antics compared with a lot of the other docs which in a way made me a little proud to have him as my attending.

For lunch I had a sandwich that I made at home. I was hoping to go to the cheesesteak place that’s been on my radar after my shift, but turned out it was closed by the time I go out. Next time. Went back to the gym for the first time in maybe a week, and then for dinner I put together this chickpea dish with kale and broccoli in a sauce made up of sweet soy sauce, gochujang, some other spices and bit of the heavy cream I had from the other dish I made. I thought it turned out pretty good. It has a nice savory-sweet-spiciness that itches the umami/ meat craving.

Sometimes when I write things, I get attached to the way I wrote it the first time. When I go back to edit, I more or less keep the structure and just maybe change out some word choices or try to add in a new idea in a way that doesn’t require me to completely rewrite it in an efficient way. Maybe it’s laziness, or maybe arrogance, or maybe there’s just a particular way that I like things to sound, at least in my head. In any case, here’s to letting go of holding on.

I feel like I say this kinda a lot. Half as a joke, but also partially in genuine awe of the things we are able to do as conscious beings that happen to be alive during this time period. Today I was back in Sequoia National Park for the second time in the span of 1 week. As we were driving up the winding road up to the top for what in the moment felt like a long time, I couldn’t help but think about how crazy it is that we are able to just go up to this beautiful forest for a day and then come back home. I imagine people way back when taking days or weeks to get up to see the Sequoias, if they even knew they existed. And the trip probably was not all that pleasant. Beyond that we are able to fly across the countries and oceans to see all these amazing parts of the world that were largely unknown to most people anywhere. Of course, embedded in this is also the privilege to be able to do so which should not be taken for granted. Our planet is truly an amazing place.

Didactics in the morning, yaaay. Ok today wasn’t so bad. We covered some really important topics around ethics, culture, and biases. Partway through I got a text from my attending saying there would be a C-section right at the time that our Zoom lectures were supposed to end. I told him I would be there. I switched my Zoom presence from my desktop to my phone and made my way to the hospital. Luckily the last lecture ended a little early, so I did have to miss any content.

When I got to the hospital I rushed to the C-sec room. I put on a bouffant cap (not a beard cover like last time) on my head and went into the lobby of the operating area. No sign of the doc. I looked around, probably with a look of panic, to see the surgical techs chillin by the desk. I asked if he had come by yet. Of course not. So I went over to Labor & Delivery, where he most likely was. Just as I entered the unit I saw him fast walking in his Mr. Bean-esque way down the hallway and I hurried after him. I caught him just before we entered the room of the patient about to have the surgery. After a quick check-in we Bean-ed our way back to the main area of L&D to work on some of his notes until it was time for the surgery. He gave me his excuse for why he didn’t call me yesterday for the C-section, saying it was emergent and the patient had to be rushed to the OR, which made me feel a bit better (selfishly).

Once he got called for the surgery, we headed back to the C-section operating room. This was my now my 3rd time actually scrubbing in and I was determined to get to the patient’s side without a hitch. I did pretty good. I knew what I was doing, even if they felt like they had to walk me through it, but it was good on their part cause of course I’m by no means an expert at this point. I felt a little more comfortable in the sterile operating area, but still was more of an observer. This one was a little more complicated than the first one I saw, but more or less went very smoothly. It’s still crazy how something so intense and amazing is so casual and normal for the people involved. We literally cut open this lady’s belly and pulled out baby, and then sewed her back up in less than 30 minutes. Oh and she was awake and conscious the whole time.

Anyway, afterward we headed back out to the clinic and finished up the day.

After clinic I met up with my roommate and we hit up a couple breweries and spots I’ve been wanting to try. We got into this decently interesting conversation with the owner of one of the bars about the area and his plans for the some of the other downtown properties that he has.

Overall was a good, eventful day. I’m just excited to go to bed.

Sometimes I wonder if it’s a test. Today after clinic we went to the hospital to check on a patient in labor. Looked like it was going to be while, so my attending suggested I go home and he’ll call me when it’s time to deliver. I agree and then hours later nothing. Then I find out the delivery is over. This isn’t the first time this has happened as you may know if you’ve been reading these. So I wonder sometimes if he’s testing me to see if I would stick around to wait for the delivery. I’m pretty sure he went to the gym or something after he sent me home, so maybe it’s all in my head. Or other stuff happens where I’m like maybe I’m supposed to assert myself more. Anyways when I left the hospital, I emphasized with him to call me or at least text because I really wanted to be there. Nada. Next time for sure though I’m just going to hang around and wait ’cause that’s probably the only way I’ll get to see more stuff. Or maybe he doesn’t have confidence in me and doesn’t want me to be there. That’s also a concern that crosses my mind.

Whatever the case, I won’t let it stop me, just gotta keep on pushing to get more experience, and maybe try to spend a bit more of my downtime preparing for the big stuff.

Today for dinner I had some adobo that Mom brought when they visited last weekend. It was very good and a much-needed taste of home.

The days really feel like they just go by so fast. Part of it could be that the days are relatively short/ flexible compared to other jobs I’ve had, but only by maybe 2 or 3 hours on the shortest days. The days I spent in the hospital shadowing on the other hand at times felt much longer. And then even on the days where I spent hours after clinic in the hospital it never felt like I was doing busy work or tedious work.

Yet when I come home there’s still so much to do, a lot of which feels like tedium. Whether it be studying or doing research or whatever. These things are important for me to be able to actually be able to be a doctor at some point, but it’s all just so unrewarding in the moment.

Today I got to see a lot of patients who I’ve seen in the past sometime from the first week to last week. It’s nice to be there for the follow-up and a little heart-warming when they say they remember me, though it’s probably not hard to forget the awkward med student from just the other week, or they are just saying so.

As I go a long in my medical career, I hope I don’t develop the cynicism that I often see in medicine. It’s easy for healthcare providers to recognize patterns among their patients and which creates certain expectations as far as outcomes, patient adherence, patient perspectives, and attitudes. It’s natural. It’s what we do as humans. We recognize patterns and think and act accordingly.

I’m speaking very generally, but I’m just saying, when it comes to helping patients reach their health and life goals, I can approach each individual situation with a genuine optimism for success.

I’m strangely starting to feel a bit of sadness with the realization that this rotation is getting close to its conclusion. I have this week and then one more. I’m going to have to say goodbye to the people I’ve met here and likely not see them again. It’s weird how life it like that sometimes. People who play such huge roles in isolated point of our life all of a sudden disappear. I realize it’s perhaps weird that I am getting sentimental over this, but that’s just the way I am I guess.

Today I finally asserted myself to see some patients on my own. It went pretty well I thought. My attending would go off to see a one patient and I would see another, and then he would come in at some point. When he came in, he basically would just do the whole encounter over again and it was reassuring in that it meant what I talked about with the patient was pretty comprehensive. There would be things I would miss here and there, but all things to keep in mind for next time. It did seem like the EMR problems persisted and we ended up getting a bit behind, so I held off a bit as not to be a further source of anxiety with the record keeping complications. We’ll shoot for some more tomorrow.

Also getting more comfortable with the flow and process of Nexplanon insertions and removals. I feel confident that I could do either on my own, except I would just be very nervous with the patient there or being watched while doing it.

For food still making my way through leftovers, though now I’m down to all home-cooked stuff. We’ll see if it makes it to the end of the week.

Yesterday I sent a reminder to my attending that I was scheduled to be at the hospital all day and so would not be at in clinic. He told me that he would be performing a Cesarean section the next morning (today) if I could make it. It was schedule for an hour before my “shift” at the hospital. I’ve never been to a see section before, so I had no idea how long it would take. The doctor said I should make it in time for my shift, but I wanted to go early to check-in the nurse I was going to be shadowing to see if she would be ok with me coming in a little late if the surgery went long. Which meant I would have to get up a little earlier with no guarantee that she would say yes and no idea if she would even be there at the time I was planning on going.

Long story short I got her approval and got to go the surgery. It was more bizarre than anything I’ve experienced during this rotation so far. After I was scrubbed in, with less snafus than the first time, I realized we were slicing open this lady’s belly while she was fully awake. She couldn’t feel a thing of course and I couldn’t see her face during the surgery, but occasionally there would be evidence of her the position of her upper body or moving her arms that made the situation a bit uncanny.

It was cool to watch as he cut through all the different layers of the belly and being able to follow along as he did so, identifying at what point we reached the uterus and then the amniotic sac.

Once the baby was out, which as an amazing thing in a totally different way from vaginal delivery, the cord was cut and baby was given to mom and dad and we started the process of closing her up. This was were when the consciousness-open belly juxtaposition was most apparent because mom was talking and moving and laughing and there we were on the other side of a cloth barrier using a needle and a bunch of clamps to sew her back together.

This was a procedure my attending seemed very comfortable with (perhaps obviously) based on the speed with which he was throwing sutures and tying knots. It’s always inspiring to watch someone engage in a skill that they have spent a long-time mastering.

I got to be involved in a few small ways. I got to hold some of the tools in place and I got to use the cautery tool to stop some bleeding vessels. Thankfully I wasn’t asked to do any suturing, still not comfortable doing it myself on the live person, but after watching once I think I would be ok to do at least a few bites worth if asked.

The rest of the day was spent with the nurse taking care of post-partum mothers. Similar to all my other days in the hospital, it was informative and interesting to see this side of patient care, and again it gave me a stronger appreciation for what goes on in the physicians’ absence. Looking forward to being back in the clinic again though.

For lunch I ran back home to eat some leftovers from the weekend. My family came to visit and so I got to check out of few more food spots that have been on my list. Dinner, more leftovers. I have enough food right now to probably last me until the end of the week without needing to buy or cook food.