Life begins, life ends

I get asked a lt about why I chose to become a doctor. And in truth, while I may know now what it is to the profession that draws me to it, I know that I didn't REALLY know back then. It was a sense of purpose, a sense of being that cog in the wheel to move our society to a better world that drove me to it. Of course, there was pride. My never ending pride. I wanted to prove that I can do it. But in hindsight, I now know that if I didn't come to love medicine the way it is now, I would have never made it.

Even as I lay here, wide awake, suffering fron uncertainties about Monday, I have never regrettted choosing this path. Not even the first day, not the worst days, and not now. I love what I do. There is no other profession that I will be able to watch some one being born, while watching another pass.

Yet there are so many frustrations in our profession. Limited by science, by technology, we are only applying knowledge rather than creating it. There are moments where we have to watch others suffer, powerless to stop it, though I know that everyone of us has taken ending suffering as our mission. Rationing of resources, as horrible as it sounds, it has to happen. There are more people on this earth than we can support, and to be born and living in a developed and resource rich country is the luckiest thing on Earth.

I think that along this road, I have been lucky and have made some good decisions. I will never forget how happy I was the day I was accepted into medical school, and I won't ever forget the overwhelming sense of pride as we finished our Scope and Scalpel show. I have met a lot of really awesome people, who have been inspiring in their own separate ways. And tomorrow, next year, ten years from now, I will continue to grow, to become better.

Empty

Today's society has such a short attention span. We have become confined to limited spaces. Text messaging, a conversation limited by 160 characters. Twitter, limited by 240 words. Youtube videos, usually no more than 10 minutes. Because of the information overload, we are constantly shifting out attention, so things of limited spaces have become so popular.

I remember when text messaging first came out, I thought it was so rude to look down on one's phone while conversing with people. But these days, it's almost expected that you reply right away, so you almost have to break social etiquette for such things. Having an in depth conversation only occurs when you are truly enthralled by the conversation (or the other person). And yet because of our limited attention spans, our conversation jumps from topic to topic without ever going too deep. We avoid topics that will arouse the other person's passion and instead choose to stick with easy conversations such as tv shows, sports and news. I can't decide if it is good or bad, especially when I am so entrenched it, but I do find myself longing at times to have something, anything, that can fully grab my attention away.

Today was my hermit day, which is the day that I recharge. I spent most of the day wondering listlessly from one activity to another. Play games for a while, do homework for a while, check twitter for a while, halfway maintain an online chat, oh and maybe clean my room a bit then cook for a bit. But I didn't really want to do any of these things, and in the end, I felt quite empty. I didn't know what I wanted to do, just like I don't know what I am trying to express with this blog entry. Perhaps I should leave it at that and end this very pointless and listless day by going to bed. Perhaps there will be more order in the dream world.

Loneliness

So it's not today that I realized I am lonely, but it's today that I paid attention to it. Getting up and moving to a town (or city) where I barely have any friends, far away from my family, and also without a close circle to find new friends is tough. I feel insecure, not knowing who to turn to to share these dark and lonely thoughts with, who to count on when the going gets hard, and who i can even ask to hang out with me. In many ways, being an introvert does not mean that I like being alone. I don't mond being alone, but I need a few (at least one) friends to make me feel comfortable. And really, right now, there is no such person. My dear friends are further away and busy with their own lives, my family is too far away to provide comfort, and my new co workers all have their establishe circle of friends or family already. That is the lonely part. They all have someone, while I feel like I have no one. But it is ok, I can deal with it and I am working really hard to break through this, but it doesn't mean that it isn't lonely or hard on me.

When I have thoughts of why did I chose to move so far away out here, I have to remind myself of my original resolve. I moved out here so that I could take care of my grandma. It is not the sole reason of me moving, but it probably is the most important one. I don't share it with that many people that that's the reason, but I have planned my life around how to make hers better. I considered programs that are not super busy so that I could have enough time with her. I am saving money like mad so that I can support her myself. I am trying to find a place to live that will suit her needs. It constantly is in the back pf my mind. I couldn't be there for my grandfather, so the least I can do is make his sole wish come true by making my grandmother happy.

It is hard for me share this motive because I feel that it is hard to share how close I am to my grandmother. She was my life when I was young and without my mother. My grandparents are the reason why I am who I am. My most beautiful memories are with them, and I have forever lived in the fear that I would loose them. It still is so hard for me to come to terms with my grandfather's passing, so I don't want there to be any regrets with my grandmother. I want her to be happy, to feel loved. My mother cannot understand my motives nor does she understand my grandmother's loneliness. But I made that determination three hears ago that she can live with me. I am willing to sacrifice many things to make it come true. And I don't feel that it is a sacrifice. I think I am merely trying to make things work for both her and I. I know she would be happier living in LA, but here is better for my training, and I think she will like this place better, and I will have more time to spend with her. So no matter how hard it gets, I know why I made my decision, and I do not regret my decision. If things could work out, if even I could give her hope and make her happy, it's all worth it in the end.

I am not afraid to admit I am lonely. I think that there's nothing wrong with it as I am actively trying to change that fact. I am not whining and complaining about it. I will keep working on making my life better and it will get better.

A death

My patient Mr. G passed away, alone in his room, with me watching the monitor as his heart slowed down and finally, it stopped. A flat line.

Mr. G is not the first death that I have witnessed, nor will it be the last one. I have seen patients pass away in front of me, while I was gone. I have seen patients pass from the incurable and from the lack of resources. Some hit me harder than others.

Mr. G's death was different in its own light. Mr. G had cancer, very bad cancer. He was scared and afraid of death. The night before he passed, he said: "I am scared. I know this is it, but I am scared." Mr. G, in many ways reminded me of my own aunt. I was 16 when I was told of her diagnosis. I remember being confused, not understanding what cancer really meant. I remember visiting her in the summer, six month before she passed away, worried, but not knowing what I could do. There was the rest of the family, each silent and at lack of words. When I sat with my aunt, I didn't know what to say, how to comfort her. I spent at two weeks at her place, but somehow I don't remember talking to her at all.

And then, six month later, on a dreary winter day, the news came. She passed in her home, with her husband at her side, and my grandparents there too. That's when it hit me. She was gone. I cried and cried and cried. I couldn't even cry in front of any one because we were so deep in our grief that to share in anyone else's would be too much to bear. And in some ways, I felt guilty, that I didn't spend enough time with her, that I couldn't do anything for her.

I will never forget that winter day in Iowa. The sun shining on the mountains of deep snow that never melts, the endless stretch of the cold, snowy land. My grandmother's tears, my mother's sorrow, and my uncle's broken heart. Her death forever changed our lives. She lived far away from us, so I didn't see her very much, but I will always remember the fun memories of her laughing, her kindness and motherly attitude to me, and how much in love she was with her husband. That was why I didn't want to see her after she passed, because I wanted to remember her for who she really was.

Taking care of Mr. G was hard because of how similarity there was. His unwillingness to give up, his family's distant but sorrowful faces, and even the young age that he was. Was my aunt scared in her last moments? My grandmother always said that she was hopeful, goig through the rounds of chemo and radiation, until her doctor told her that there really was no options left. She said that that's when she changed, and not saying much for her last couple days, for she passed not too long after that. I don't know if she ever received any palliative care or hospice, but I understood Mr. G's family's request to not inform him that there is no choice left. Let him be hopeful until the end. But I also understood what my attending had wanted him to come to terms with dying peacefully. For certainly, there would have been no dignity with dying after rounds and rounds of endless CPR.

I remember stating in my ps that I wanted to help my patients not only live happily, but die with dignity. Our medical advancements can prolong life to a certain extent, but where is the dignity of dying on a machine without even the basic joys of life such as eating and talking? And would one really want to pass with blood spluttered everywhere, body almost cracked open from being pounded on? We will all die someday, and would one rather go in peace with dignity, or to go after endless torture of medical machinery?

A family member once asked me, "so is this it?" and sometimes, that question is hard to answer with certainty. There are always exceptions to the rule, but would an extra month on a machine with a hole in your throat in a nursing home be better than passing peacefully? The hard part of the job is making the predication of will the patient be the lucky 1% who makes it out of the hospital or the rest of the 99%? But I know that we will all die some day, and I think that it is part of the job to help the family see and understand how the future will likely unfold.

Mr. G actually lived well beyond what his physician had predicted for him (by about a year), but at what cost? I do not blame him for being scared, but I wonder, is undergoing the extra pain and living in fear worth it? I would have chosen differently, as I understood what the future would have evolved. But if this was my mother, could I have counseled her to make that choice? I can only imagine how scared he must have been, and I can see how much pressure the family must have been in the past year, to keep trying, to continuously face his fears and live with their own fear. But to give up on someone, to have to face grief early, it takes a tremendous amount of courage.

I know how I want to die. I want to pass away in peace, as if forever entering into one of my action packed, crazy dreams. And I want to look pretty as my body turns to ash and be sent into outer space, where I cannot travel to in life. But there are many more people who haven't witnessed death as much, and they probably never gave dying a thought. It is a unbearable burden to be the family member that makes the decision to let the person die in peace, to not undergo the likely useless interventions. There is such an amount of guilt that is carried with that decision. The what-if's combined with the grief, these are such hard decisions. And it is an equally hard conversation to have with a loved one, to make them face the possibility of losing you one day. But it should be a mandatory conversation, as how we live is just as important as how we die. And do we not want to die in dignity?

2AM: Airpot

The Dulles airport is surprisingly busy at 2AM. Travelers who are just arriving, picking up baggage, the noisy sound of carts rolling down the long hallway, the janitor's vacuum, the non-stop, repetitive TV advertisement, the elevator music ringing through the overhead, it makes for an incredibly terrible place to sleep in. Not that I am sleeping anyways. Though I do feel bad for the many people who are slumbering next to me. The girl with the pink suitcase is sleeping with her feet elevated on her suitcase to keep track of her suitcase. The mother-daughter/sisters pair behind me keeps making phone calls on speakerphone, and the annoying female voice of "your call has been forwarded to an automated voicebox..." shows up every 5 minutes. Oh, and there's the sound of kids screaming their displeasure of not being able to sleep at this awful early, or is it late, hour. The inconsistent music that plays with certain commercials, sometimes ringing loud enough to cut through my noise blocking headphones, then disappear off as if saddened by the lack of attention from its looped video. And then, there's the chilling wind coming down the hall, wrapped with the scream of the little girl in red, reminding us that we cannot hide from the certain winter that is raging outside the thick concrete walls. Shops, dark and sleeping, oblivious to all this commotion, though they do refuse to rest quietly, with pulsating lights to grab the attention of the tired and worn travelers. How the night seems to drag on without resolution, the clock ticking oh so slowly. My foggy mind, struggling to clear a path, still bombarded by the sensory overload of this surprisingly busy airport. My heart, beating faster with excitement, thinking of when I finally get to take off and be carried away from this dreary gray and white scene, screeching with unbearable senses. --A practice piece. Clearly smeared by lack of practice and sleep deprivation.