One night in Hong Kong

Note to self, taking a flight right after ending a busy night shift is never a good idea. As I hopped off the BART to get into SFO, my brain was working at 10% capacity, and much of the journey was a blur. Cathay pacific food was okay. Watching Another Earth and Letters to Juliet was great. Wished I finished Blue Jasmine. 

Hong Kong Airport is fairly large. The showers were located in lounges, but we could not figure out how to get in. Existing Immigration was a breeze, and definitely HK immigration is the most efficient I have ever seen. From there, the next step is to find luggage storage as I did not want to wander around Kowloon with all my sleeping gear. It took a bit of effort to find the luggage storage, which cost 10 HKD/luggage/hour. They take HKD and visa/MasterCard only, though you pay when picking up. 

From there, we took the airport express train, which costed 160HKD roundtrip. I for some reason expected a faster train, but it was reasonably fast. Kowloon Ed the second stop, and I know I wanted to head to the Temple Street NightMarket, which actually is within walking distance. 

(For directions: follow the signs to Austin Station out of the Kowloon station and shopping plaza. Once on Jordon Road, follow it North and Temple street is about 3-4 blocks down.)

The Night Market was quite bustling with people. As my sights were on food, I don't remember much about the shopping, other than that stuff in HK is expensive! And I can't seem to ever figure out if I should speak Mandarin or English to the sellers. 

However, my first awesome finding came in the form of a fruit. Fresh jackfruit in a cup! 

The actual jackfruit is an odd fruit. I initially thought it was an oversized durian, but turns out it tastes quite different! It lacks that pungent flavor and instead has a refreshing sweet taste. 

We then decided to browse as many food restaurants as possible, which is a terrible idea because things look ridiculous and finding your way back is always more difficult. After an hour of wandering, we finally decided on a dim sum place. Now kids, never ever eat dim sum at night! Worst dim sum EVER! I shall not elaborate any further and forget it.  However, we came across the best grass jelly I ever had.

The store is called Hong Kong Local Snacks, which meant a bunch of fried fish ball, chicken and other varieties. However, their dessert, which is various fruit with homemade grass jelly or various fruit with mini tapioca was quite delicious. 

Behind my grass jelly with dragon fruit is my friend's mango with mini tapioca. Both were quite delicious. I heart coconut milk. 

After that, we stopped by a bakery called King's Bakery (or some variety of it) along Jordon Road. I had the cake roll and pineapple bread the next day (which I forgot to take a picture), but once again, AMAZING~ 

We got back to the airport around midnight as the airport express stops running after midnight. There were sleeping lounges around the airport (we slept at L6's West Side). Of note, the south security gate is closed around midnight, so use the north one. I think showers were located inside the airline lounge, which is on L7 that we could not figure out how to get to. 

The next morning involved breakfast on L8 in the middle of the airport. Choices were McDonald's, which I really wanted, but not for breakfast, Donburi shop and a traditional HK breakfast with Congee and other items. The congee with Kuri and clam is preferred. The turnip cake and noodles were also quite good. 

Atlas, after many extremely satisfying food ventures, we headed off to the unknowns of Vietnam. I truly, truly will miss you HK, especially in this upcoming month... T.T

Reflection

好像最近每天都是看着日出和踏着日落回家的。坐着地铁，每天顺着相同的轨道回家，可每天观望风景的心情却又是不同的。有时的焦躁，望着风景却又退回去了。有时的疲倦，可以望着日落慢慢沉入梦乡。窗外的灯火，可以勾起无限的想象，却因为在继续前行的电车里又有摆脱尘世的潇洒。当我开车时，看到行使中的电车，总是会有奔往遥远无尽的终点的渴望。

窗外的天，只是有点朦朦亮，车窗里的倒影映出了一个渴望无尽旅行的我。 

The value of crying

I thought I wouldn't cry again. I thought I could hold my tears back. But when they told me that was his favorite hat, when they told me what he was like, when I saw how much he was loved, I think I cried because I know how much he will be missed.

I have seen so many deaths, some with peacefulness, some with despair, and some with pure sadness. As part of the hospital, I rarely knew what they were like as a person, not as a patient, so that was a protective layer. But it is when I get to know them as a person, either because I have talked and shared my laughter with them, or because their beloved family has shown me how loving my patient is in life, that is when I can't stop the tears.

I remember, all the way back to Anatomy, that was the first realization of the responsibility we carry on our shoulders. I wondered about what this person in front of us, who gave us their most precious possession, what was he or she like? They must have been loved, and loved in return, that they were so full of love to donate themselves to the goodness of humanity. This is a thread of love, of connection that transcends death and allow us to carry our loved ones forever in our heart. It is this connection that I, as a physician, had the honor to partake in. To ease the suffering that comes when a loved one transcends to the eternal beyond, to help put those that are left behind at peace, and to help preserve a person'a dignity in those last moments.

There have been days, such as today, where I wondered the value of our aggressive care on those who are inevitably headed to the grave? But it is a choice. It is a choice made because there is love, even if it is unseen sometimes, that drives one to push through the pain and suffering, to remain hopeful, and that in the end, it can still be peaceful.

There is tears rolling down my face, though I cannot even say quite why. Perhaps it is the thought of those who are left behind, just like I was, and once again, I am reminded of how death is the great divide, that I can never , ever see those I love again. Their pain resonants through me, like church bells, shaking me from the inside. All those regrets, those painful thoughts, those longing, all coming back. That slightly cool May evening, when I first heard. The shock that I couldn't push through, until I realized that we will forever be apart. No matter how many comforting thoughts, how many times I run through them, it still breaks my heart to this day.

There have been many times when I have had tears in my eyes as I am listening to the family or the patient themselves. Those are the times when I feel as if I am part of that pain. It humbles me and brings me out of the shell of cynical and self comforting that has built up with experience. There are no weakness in those tears. They are the burning wood that fuels my resolution to do what is right, always. Not just for one or two, but for all those who comes under my care, because they are not just patients, but real people just like those that I love.

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?