Before Sunset, MD

What is truth?

Is it the truth you tell yourself so you can sleep at night? Or is it the truth you tell on social media? Is it the truth you use to sweep uncomfortable thoughts under the bed so you can move on? Is it a truth that defines you? Or is it a truth that you define?

This past weekend, I went for our program's annual 2-night, 1.5-day SPRING RETREAT. No one is ever satisfied with its location, so it switches every year. This year, it took place in Palm Springs, CA.

The Pros: I have to say overall, this was the most fun I have had at a retreat in all 3 years. I think it had to do with several things - certain malignant people being absent, it was actually WARM outside instead of windy and freezing like last year, we actually had an afterparty vs going to someone's hotel room, and just the feeling that it was my last hurrah at the end of my last year of residency! I'm also really proud of myself for volunteering to speak publicly to hype someone else during the prelim graduation ceremony! I'm so surprised and thankful that everyone loved my speech. People came up to afterwards and said I have great comedic timing and never expected it from me. I just want to remember that feeling. It's floaty. :)

I'd also like to think I've matured more. I was okay and comfortable talking with one or two other people. I didn't feel bad about not being the center of attention or not being surrounded by a large group of people. But I'm not perfect, and I did find myself looking at certain people wondering why they're not paying me more attention in a self punishing (e.g. "am I not good enough?") and resentful way (e.g. "ugh, you besh, you think you're so great"). And honestly, I'm okay with that. I don't know if I'll ever reach that level of self-acceptance and self-confidence. I would love to, but even if I don't, I don't think I am a lesser human being or any less loved. So, even though I'm not perfect, the fact that this paragraph exists in this way is proof of how far I've become, and is the reason why it's a pro and not a con.

The fact that I've decided it's a pro automatically makes it a pro. If you seek, you will find. If you believe, it will come true. See what I did there? Yeah? :)

The Cons: Oh, where to begin. There's ALWAYS drama at these retreats. It wouldn't be a spring retreat without some kind of drama. And it's not usually 1 or 2, it's SEVERAL. It's an avalanche.

I don't want to bring in details for the sake of privacy, but suffice it to say, it almost always falls from games of "he said," "she said." There's almost always miscommunication and misunderstandings, whether purposeful or unintentional, but regardless, feelings get hurt and egos get bruised. It brings up for me the notion of empathy that my favorite book, "Feeling Good," by Dr. David Burns, talks a lot about. Namely, how a lack of empathy on at least one person's part plays a fundamental role in these situations.

Honestly, I'm only 30, and so I still don't know what is the best way to navigate through these murky adulting waters. I think one chapter of my life is over and tucked away, but suddenly it rears its ugly head at me, and I realize I never resolved it.

It was a lie I told myself so I could move on.

Empathy - true empathy, real empathy - is extremely difficult to achieve. I'm not confident I can achieve that for every situation I'm in. So, I think instead, I want to try to be open-minded to the possibility that someone else may live in a completely different world of what's right/wrong, fair/unfair, true/untrue. It's not really, "do unto others as YOU would have them do unto you." It's more, "do unto others as THEY would do unto you." It’s a good start.

And yet, you only know your truth. By definition, you can only know your truth. That is a truth you have no choice but to go to sleep with at night. It is beautiful, it is ugly, it is wonderful, it is imperfect...that truth is yours. And only yours.

And yet, that doesn't mean to me it's okay to hole up and only live within that truth.

“If there’s any kind of magic in this world…it must be in the attempt of understanding someone.” — Celine, Before Sunrise

That's all we really have in our arsenal - 1) our truth, 2) our honest effort in attempting to understand someone else aka creating the magic of empathy.

But there's a balance. There's only so much you can do if the other person or group of people are not ready for it. If it's not the right time or the right place. And that's always the hardest thing to know.

When to move on.

I just came back from a quick 2-night-1-day trip to Orlando, FL for the 2018 AGS (American Geriatrics Society) Annual Scientific Meeting! It was amazing. We got to slow down a bit, learn some, meet new people, bond with our residency’s small but growing and mighty geriatrics team... and I gotta say, I very much enjoyed chillaxing on my king sized bed watching Food Network. Sigh. This is what life could be. But it’s okay - I always tell myself, I wouldn’t enjoy it as much if I really had this every day. I tell myself this for now, but I deserve more for the future... Don’t ever sell yourself short.

After I came back, when I was posting my AGS picture up on IG with the conference hashtag, I flipped through some other posts via the hashtag, and became jealous and started comparing myself with this one fellow (?) from Harvard. All my past insecurities came back to haunt me. Here she is, looking like she has everything - presenting a poster AND a talk, enjoying dinner with a large-ish group of people. But then I realize what I’m doing. And honestly, it doesn’t take me too long to stop going down the spiral. 

Even though residency in Los Angeles has not been at all what I thought it would be like, and I’ve suffered a lot while I’ve been here for one reason or another, I definitely feel like this has been a huge learning opportunity for me. It’s important to not only know what you want but also what you need to thrive, what you don’t like, and what you can live without. So even though I’ve had a tough few years in California, I feel proud of myself for going through a lot of personal growth, which I really needed in retrospect.

Without further ado,  here’s a list of key things I’ve learned these last few years:

I’ve learned what is important to me - what I need to keep me happy in the darkest of times - which is family in physical proximity; close friends in physical proximity; and/or a supportive, passionate, positive work environment. I don’t necessarily need all 3, but ideally 2/3 or at the very minimum 1/3. (And I definitely consider my fiancee to part of the definition of “family”.)

My Volt Planner prompt for September:

What good things would you like to have more of? How can you create habits or foundations that will support the things you want?

My answers:

I want to focus more on the good of people. Remember and take away what they were good at. Learn from the good parts of them.

I want to focus more on my goals, on ideas that are productive vs how people/things have wronged me. How can I make this work for what I want? How can I make the most of this so that I have no regrets later on?

To achieve this, I’m going to do a version of 5-minute journaling where I journal at the END of the day as opposed to the beginning focusing on what went well that day and what I want to do to make tomorrow better so that I already have a plan going to bed.

So to start that change today, here’s my 5-minute journaling for today, 9/3/2017:

I am grateful for...

The steadfastness of my fiance

Living next to such a beautiful park/lake

Being alive in the time of BTS’ era

What was good about today?

Chores: I fixed the bathroom cabinet door; changed out the kitchen towel; took out trash

Bought November vacation tickets returning to LA

Took a lovely walk after dinner with my boo around the park next to our apartment

Watched a lot of BTS and Park Bo Gum videos :P

Started to focus and get my life together again

How can I make the most of tomorrow? What is 1 thing I want to accomplish tomorrow?

Compile a list of to-do’s tonight and prioritize a reasonable list of to-do’s to tackle for tomorrow with an anti-procrastination worksheet and/or activity planner

https://www.change.org/p/yelp-remove-online-reviews-of-doctorsThis article points out the issues why I always thought online reviews of medical professionals are flawed on a fundamental level! It goes along with the same idea that our healthcare system is flawed and falling apart because we treat it like a consumer market.

There’s a petition link at the end of the article to stop reviews of medical professionals including doctors on Yelp. Here’s the link for your convenience: 

I think what makes me whole and excited for life is the hope, anticipation, dream for something greater, more meaningful in the future. Something I look forward to bringing into fruition, that has a possibility of being born into reality.

And I think the sad reality is that I haven’t had such a hope or dream for a while.

Maybe it’s burnout from year after year of schooling and training. Maybe it’s depression that I never fully recovered from, further deepened by feeling alone in a city without my family and close friends from back home. Maybe it’s a lack of time to really pursue what I actually want to do. Maybe it’s jadedness building up over the years and deadening my prior dreams.

Maybe it’s all of it.

To be honest, I dread going on this interview trail. As soon as I submitted my ERAS fellowship applications and paid that sunk cost, I started regretting it. I’m tired of trying. Trying to impress people I don’t even know who supposedly have things that I want. Do they really? Because I don’t even know what I want. I feel like I applied because that’s part of the plan, that’s just what I’m supposed to do next. I actually feel like a robot, which is not a good sign. I mean, don’t get me wrong, I love geriatrics, and I know that I want to get this training no matter what at some point in my career, the earlier the better. But I wished I decided to wait a few years and just let myself live. I’m almost in tears as I’m writing this.

The funny thing is, I didn’t intend for this to be a depressing post. I was actually inspired by how I felt a little bit better after I made a list of favorite dramas as well as unwatched dramas that I’ve been meaning to try. That made me feel better, because I was a little sad thinking I didn’t have any good dramas or shows to watch to destress. Then just making a list made me feel significantly better. I was going to joke about that. My ongoing obsession with Korean dramas. 

A list - when you believe in that list and actually plan to act on it - is like a person’s hopes, anticipation, dreams distilled into bullet form. 

And that’s when I realized that was what I’ve been missing. Not necessarily a list for my life. But the hopes, anticipation, dreams part. The possibility of a better future. I’ve always felt better after making plans with people even if it was a few weeks away. I don’t mind staying in or spending time by myself - I actually need it - but having the concrete possibility of something to look forward to always lifted my spirits. Whether it’s just coffee with a friend or if it’s big plans for my future career. 

But now I feel like I have neither. Other than my fiancee, I don’t have good friends that I can count on to regularly enjoy their company over coffee/tea. I also find myself no longer wanting to try to make friends. I can feel myself retreating into myself, protecting myself, by not caring from the very beginning so that I’m no longer vulnerable to getting hurt if it turns out I care and want a friendship more than the other person. I also don’t think I really have a dream for my future career anymore either. I mean, I graduate from residency, I complete fellowship, I find a job, I work, I make money. And then what?

I don’t know anymore. 

I’m realizing that one of the scariest things in life is to be devoid of dreams.  

It is amazing that in spite of all my depression, I was able to fall in love with an amazing man. I guess it goes to show that you can fall in love whenever, and that these things are never planned. You never have it completely together when things like this happen to you, and that’s good, because I believe few of us would ever fall in love if that were to be a criterion. 

The fact that my fiance is still so supportive of me despite me going through all this crap is so indicative that I’ve found the right man.

Also, this has made me realize how much power someone can have, how much hurt someone can cause... if you let them. This experience has taught me to be more careful of what I say or do, but at the same time to not feel too responsible for other’s feelings, because REALLY? You’re going to let one little girl dictate your friendships and if and how you’re going to make friends in the future? You’re going to let one person have that much power over you? Is this really how you want the rest of your life to pan out, Karen?

Not long ago, I read this really nice update on China's primary health-care reform (Lancet) that hit a lot of points for me. (For those that don't know, China's Ministry of Health is investing a lot in the country's health care system from the rural to urban areas and involving its health insurance programs for the marginalized in addition to, well, reforming primary care delivery. Hmm...this sounds oddly familiar...I think some other country is also trying to do the same--I wonder how she's doing.)

I wonder if I'm going to get anything for using a picture of China that includes that little island opposite of 福建省.

It just bothers me a little how similar China's proposal to strengthen its primary care system and make it the gate keepers of health care sounds exactly like one of U.S.' more popular proposals...

I don’t know if showers bring on awesome thoughts, or showers just make normal thoughts seem awesome because hot water rushing over your entire body makes anything and everything infinitely better. 

Here were my shower thoughts this evening, in no particular order, in absolutely no logical sense (just the way they came):

KCon LA was AMAZING. And crazy. But amaaaaaaziiiiing!!!!

I’m so good at recalling the 1,000 things to make me feel bad, even though I’m an awesome person and neglect to recall the 2,000 things that are good about me. Thus, I’m going to make a list of reasons why I’m awesome and look back on it often, especially when I’m sad!

Cutting communication especially work related from your mobile phone makes a huge difference to my sanity. It’s surprising I didn’t do this sooner.

We talk so much about gender equality and breaking the glass ceiling, but girls have a problem of being bitches to each other. I find that girls are so good at sabotaging each other not just in the workplace but even in seemingly benign settings like social media, and are often terrible at lifting each other up and advocating for each other. We can really be hypocrites and shoot ourselves in the foot. I don’t discount the effort that men also have to make to make equality a reality, but our own daily attitudes towards the other women in our lives need to change. We need to look at our girlfriends with more respect, desiring to make a new awesome friend who you can be proud of to call your friend as opposed to finding ways to compare them down and feel better about yourself and shove them down into the footnotes of your story as someone who was worse than you in such and such. Why not make her the subject of a chapter who changed your life and you hers for the better or even a short paragraph where you shared a short, meaningful, and witty conversation, parted ways, and felt great about yourselves? I think that those who regularly make you feel bad have significant ego and self-confidence issues. What to do? Feel bad for them, empathize with them, say a kind word to them, but then move on. They don’t deserve you in their lives. Find other girlfriends who can bring out the tiger in you, make you laugh so hard you cry, dream with you over long coffee dates, give you the push when you’re scared, and/or just be there for you when you need them the most. :) Those are the women that will move mountains. And you’re going to be that awesome friend handing them a bottle of water and towel and cheering them on. And vice versa. 

How much should I reveal?

Clinical burn out is real. You have to take care of yourself before you can take care of other people. #loveyourself was never truer. (BTS, you’re a genius.)

It was a rollercoaster of a day. As much as it felt like I was leaving a dream behind at my geriatrics rotation, it felt good to be back among familiar faces. I woke up early, got to clinic on time. I had a meeting with our Chief of Medicine, and let’s just say...I came out of it feeling really honored. I also bumped into an attending I worked with recently on wards, and he again told me I was one of the best residents he’s ever worked with. One of the residents also noticed I lost a lot of weight, and said I look good. ^^ I’m not saying this to brag, but I sort of am, but really it’s to make myself feel better before I get hard on myself on what’s to come next...

As I’m about to finish up in my afternoon clinic, I get a super long text from the resident I just worked with on geriatrics who is still on service telling me about a patient I discharged for him when he was off. Basically one of his insulin medications got dropped off from the final discharge medication orders, and his blood sugars have been in the 400′s at the assisted living facility where he’s staying and there’s a whole email thread trying to figure out what happened. I felt like I was to blame, or that the brunt of the responsibility was on me. However you want to word it, but it feels TERRIBLE and honestly unfair. I actually worked so hard on getting this patient’s discharge medication just right, and it still didn’t work out. I honestly don’t know what I personally could do next time to ensure a safer transition of care. This goes to show how important quality improvement, transitions of care, and supportive collegial environments conducive to productive constructive improvements are. We are still so weak in those areas.

After all was said and done, I really loved the rotation. I loved that the focus was on the overall clinical picture, from goals of care to figuring out what is really the underlying problem that led to a patient’s decline, like depression or dementia. These are things that general internists or family medicine practitioners often overlook and/or don’t have time for, but is actually important for everyone involved including the providers to figure out and address. I also love that we work with other disciplines and value their expertise to make the patient better. It’s such a supportive environment, and I don’t know - I just love working with other people vs by myself!

Today on my 40min 15 mile commute (classic for Los Angeles), I listened to Christine Chen’s and Regina Fang’s podcast Perfectly Imperfect, specifically episode #25 “Finding Your Soulmate and Home with Wendyslookbook ❤️.” (Ahhh!!! My post got deleted after this point because I put in the less than 3 heart sign that was originally in the podcast title which Tumblr took as html code and didn’t register any of the text I put in thereafter!!! So the remainder of this post is actually my best attempt at remembering what I wanted to say, but I think it’s missing a lot of the “in the moment” feelings I had when I originally tapped this post up on my phone. ARGH. Anyway...) 💖💖💖💖💖💖💖 I love these girls so much. This podcast completes me. I feel so validated in feeling like there is such a thing as having a relationship with a city. It’s like what my sub-intern said, who’s also not from LA, that individually, people are fine, but all together, LA is not our scene. Sometimes, it’s not me. Sometimes, it’s you, LA. 

It made me feel like where I grew up, people valued more and bonded more over each other’s uniqueness and struggles. But I feel like in LA, people valued sameness more. For example, if I were to meet someone and I find that they don’t use any kind of social media, only read newspapers, and is a true philosophy buff, I dig that and I want to get to know them more. But I feel like in LA, if the average Angeleno (or Angelena) somehow by chance dug deep enough to even figure that much out about someone they just met, their response would be more, “That’s so weird. Why aren’t you on social media? Don’t you realize you’re missing out on all the food truck events and trendy festivals around the city? Oh, you’re a philosophy buff...that’s cool, I guess. *hair flip* *adjust trendy hipster sunglasses* “

Okay, I admit, I’m totally stereotyping. But as the saying goes, stereotypes are stereotypes because they’re true...

But, really, at the end of the day, what I come away from this podcast is that I’m not alone. Other people have gone through this - moving to a new city, feeling lost, finding that things are just not clicking, and still somehow moved on (and out) in the end and got to better places (literally) in their lives. It’s not forever. And it’s not about you. Sometimes, a city is just not your soulmate. 

Today, I bought myself my first pair of sunglasses over $15, like WAY over $15 (Gentle Monsters). I’m telling myself this is a treat for myself for finishing my month long geriatrics rotation, but I don’t know if that’s completely true. Maybe some part of it is that I’ve become more vain and superficial over the last 2 years living in LA and dealing with stress in less than healthy ways - shopping sprees and splurging on things that make me look good but don’t necessarily make me a better person or make me feel good. If I’m brutally honest.

But ain’t no bitch going to tell herself that she doesn’t deserve it. Especially after I’ve already bought it. Ha.

Today, I also decided I’m going to try to blog or journal every day for 365 days. It’s really going to happen this time.

Tomorrow is my last call/shift of my geriatrics rotation. In a way, I’m relieved, but in a way, I’m a little sad. I guess I really did enjoy it, which is a good thing. The feeling is akin to finishing vacation and going back to reality, but not that extreme. It really does feel like I’m going back to harsh reality - the reality that is the DHS, underserved health care system though. It is nice for everyone when the system works, when there’s money. It’s nice to be a “have” and not a “have-not.”

There are so many ways to define this. You are often asked to talk about your own experiences in your medical school secondary applications. For me? Today, I re-learned that professionalism is about

* punctuality (personal daily struggle...I’m definitely a CLIP - chronically late insane person, refer to http://waitbutwhy.com/2015/07/why-im-always-late.html)

* but more importantly...in the realm of doctorly things - never calling people names or badmouthing other services. Essentially disrespecting other services who you are trying to get help from (consults) or who are working hard to take care of their patients (primary teams). It seems like it takes an outsider to really appreciate this, and this is sad. I think my favorite trauma attending from medical school said it the best, “Whoever is in the right or wrong, just don’t do or say anything that would make us look bad. Don’t make it so that I can’t come to bat for you. If you do that, if you keep it professional, you know I would come to bat for you no matter what. I’ll have your back.”

Author Unknown

Risk acting a fool, risk rejection, risk showing your bleeding heart, risk showing your vulnerability and risk not being rewarded for it.

But I’d rather risk that than to not having lived and truly taking advantage of living in Los Angeles. I’d rather not end up regretting how I spent my time here.

Whatever the other person’s faults, imperfections, whatever the unfairness, don’t have anything to blame for. Don’t be at fault. No matter what, be the person you want to be friends with, the one you’d be excited to discover. Be Zhou Jieqiong, still bright, smiling, and supportive of her friends even when her chances for debut were looking slim. Be bellywellyjelly who is so bright and optimistic even though I’m sure she goes through tough times. Be that girl who cares, who cares to live her life the way she wants.

And to do that, you have to take risks. Take leaps of faith.

But as this article wisely says --

“Establish guidelines and don't waste your time. If I meet someone new and our first hangout seems like a success, I’ll follow up with a friendly email. I’ll even suggest making future plans. After that second meeting, though, it’s up to the other person to reciprocate. I learned this the hard way when I first moved here. I met someone that I clicked with and she always said yes when I asked her to hang out. But I realized that I was the only one doing the asking, which is not a good foundation for friendship. I moved on and focused my attention elsewhere. Also, don’t feel obligated to hang out with people you don’t particularly like just because you crave interaction.”

Be kind to each other, but don’t forget yourself - be kind to yourself.

Journaling: it’s so wonderful to indulge in your own mind. It’s like taking a walk after a long day of sitting at a desk. You forget you had such wonderful muscles/thoughts.

Learning so much from my attendings (my old ICM preceptors…we go way back)…Dr. H and Dr. S have both taught me so much about not just diagnosis and management of specific disorders, but clinical thinking and management. Here are some examples -

Be mindful of the labs & tests you order: Don’t order a set of labs just because some preceptor at some point taught you to do so, think about whether or not the results would actually change your treatment plan. For hyponatremia, if you have a clinical diagnosis of true hypovolemia causing a hypotonic hyponatremia, then just start a trial of IVF hydration, and see what happens…if they respond, then that confirms your diagnosis! If you actually got labs, and the results point more toward SIADH, then what are you going to do with that information? Give the patient a vaptan or demeclocycline when they’ve already responded to IVF hydration? No.

Just because a patient’s outside PCP or previous physicians have decided that the patient is at her baseline but she’s clearly still hypertensive or hyperglycemic, don’t just assume this is just her normal. It’s not normal! Don’t give into clinical inertia!

Anticipatory medicine: even though the bump in creatinine might not be technically acute renal failure (>0.3 increase in Cr, >50% increase in Cr, or UOP <0.5L/kg/hr over <48 hours), doesn’t mean it won’t be by the next AM labs.

Look at everything in the patient’s clinical context! If the patient is floridly psychotic and/or unstable, you worry more about their mildly abnormal lab values and vitals than if they’re clinically normal and at baseline. You widen your differential to include more rare and scary diagnoses, and order more labs to rule them out.

Even when I’m at my loneliest and most down-trodden moments, I’m so appreciative of the support and love I have from my friends. Remember that love. Remember all the moments we’ve shared together and will continue to have together and let that give you strength!