Instead of finishing notes today, I really cannot focus.

I am mentally exhausted.  How does one do self-care when there are all these demands coming from all angles?  I must be horrible at managing my time...  clinical duties, administrative duties...  research duties which I've essentially put aside at this point...  personal life...on hold.  most friends...on hold.  This is a horrible year.

The death certificate last week gave me a bit of closure to my intellectual self.  It is still so hard to believe that he is really gone.  I wouldn't say that I was close to him, but I am still really sad.  I feel that I really got to know him a little bit better over the last 2 months.  I feel really fortunate that he shared with me some of his deepest thoughts about humanity in the weeks prior to his death.  It may be one of the few times when he really experienced compassion.  I think he was happy that he came to that conclusion before he died despite the fact that he was already in his 70s.

With all of these...there is another layer of sadness...  He told his wife that they would have to maintain the balance in a relationship.  An interesting choice of word...  Balance.

He will always live in my memory.  He is actually quite a sweet man.  He is a little shy, a little reserved, not the best at expressing his feelings.  He is actually one of the most forgiving and kind person that I've ever known...  I wondered if he ever struggled with the consequences of the past, but I think he found way to resolve the conflicts in his mind by accepting the facts and letting them go, because everything needs a balance.  I think he probably learned at young age that a lot of things in life are not worth stressing about and that it is better to live a life stress free and be happy.  He is also a planner and a thoughtful person...  I think he probably anticipated that the day will come when he wouldn't be around and his wife would have to handle everything by herself...  To alleviate some of the anticipated stress and chaos, he wrote down everything that she would have to do, just like what you would see in a science lab instruction book, step by step.

I will remember the monkey king story on his porch in the summer, the trip to bear mountain/west point, many routine trips to the malls in the afternoons, random snacks (including pizza but without the topping or cheese) in the food courts, the cabbage and pork on the soggy noodle, the aspirin question, the pecan pie, the smile and happiness on his face with my occasional visits...  His insistence on driving to the Palisade Mall during the busy holiday season, so that I could get some air...  His insistence for me to leave the hospital only 10-15 minutes after I arrived, because he didn't think it was safe..

Don't worry.  I will keep my promise...

It has been a very long time since I last wrote.  This is to thank many people in my life, including those who encouraged me to write again, those who lend me their listening ears during this difficult time, those who know my family, those who are in my family.  Mostly importantly, this post is dedicated to my grandpa who recently passed away.

I don't really know where to start.  It is really as if I carry a black cloud over my head over the last month and a half- loved ones getting sick and dying.  Some people suggested that I write down events, emotions, etc, as my family go through this difficult times.  I honestly don't really know how to describe my emotions.  It definitely hit all of the things in the process of grieving.  As with my grandpa, I think there is definitely some surprise (not knowing that he was hospitalized, and hearing from my aunt), anger (that my parents tried to protect me), sadness, and acceptance.

In April, I was in palliative care rotation.  The first week was just heart breaking.  It was difficult to counsel others when I was so wrapped up in emotion myself, just coming back from a vacation with my usual separation anxiety and sadness because I know that I am not going to see my parents for quite some time again.  Watching a loving wife dealing with a dying husband who knew that he was dying but still supportive of his wife was heart breaking.  Watching their adult son's close relationship with the couple, supporting the patient's wife, and yet dealing with his own emotion was heart breaking.  I learned from him that it really sucks not to be able to breathe and to feel like he was suffocating.  We promised him that he would not have to go through that at the end of his life, whenever it may be.  I would be a bag of tears at the end of the day each day...  reflecting on my own life, thinking how horrible if would be if I don't get there in time for my parents when they are dying.  How one of them would handle the situation...and truth be told, the living may not tell me until after the fact, because he/she will want to protect me from knowing death.  I've seen death...many times.  Held the dyings' hands as they took their last breathes.  Gave their loved ones some tight squeezing hugs (if they prefer hugs) or be present with their loved ones during that very last moment of life.  I do believe the spirits live on...within the hearts of the living ones.  Hopefully, not to ever haunt them, but to bring some joyous memory to them as they move on with their lives.  I hope my parents never protect me, but they do.  Most parents do even at their last moments.

Well, my parents protected me from learning about my grandfather's rapid decline for several days until I found out from my aunt in NY that my grandfather was in the hospital.  She did not realize that my parents did not tell me.  It was upsetting...but I know why they did that, because they knew that I was dealing with another very seriously ill family member.  My grandma did not want me to go back...  I don't know if my grandfather did or not, because I could not really have a real conversation with him.  At least I had a chance to say goodbye.  It seems like it was the last condolence that could appease me in this horrible situation.  Bound to NY because of sick family member here...at least I said my goodbye.  Mom called me at 1AM on a Thursday morning...5/8/2014...  woke me up as I just fell asleep.  I saw the number, almost did not pick it up, until I recognized that it is from Taiwan.  "Must be important" went through my mind.  I answered.  Mom said that it is time for me to say goodbye.  She told them (dad and uncle) my wish to live without regret and to be able to say goodbye, since I don't want to repeat what happened with grandma almost 16 years ago.  I am so thankful that she advocated for me...  She put me on speaker phone and told me that he cannot talk because he is on the mask.  I asked him to nod his head to them because I was not sure that he could hear me since he is so hard of hearing.  They said that he nodded his head.  I told him that I love him, that I wish I was there with him, that if I were there right now, I would give him the biggest hug ever.  There was a long pause until I found my word and courage to say it in the speaker phone, in front of my parents and my uncle.  I told him that I wish and hope that all of his wishes would come true, because Mom had said to me that he wrote "Let me go" in English...  I said goodbye to him that night/morning.  That was my last time speaking to him.  I don't think I have regret.  I called my dad the next day....  He sounded heartbroken.  Both he and I knew that the time is coming.  Both he and I have seen many deaths.  Like any boy about to lose a parent, he sounded scared and worried.  He wanted to help but did not know how other than to not do anything invasive to cause more pain.  I told him that suffocating is one of the worst feelings in life...according to those whom I have worked with and told me before they died.  I told him about what to do for breathlessness...  I told him about the things he should tell grandpa.  He told me that he understood.  What I really wish for at that moment, is really to be there for my dad, to hug him or hold him...  It is never easy to lose someone that you love and care about.

To be honest, I don't really think I know my grandpa very well.  He is quiet, does not express much of his feelings.  Occasionally, when the situation is right, he cracks some hilarious jokes (which my mom never finds funny...as they don't get along).  When I was in high school...he told me a lot about his life growing up in China...the paintings and antiques that greatgrandfather collected, the Japanese people living across the hills, the Japanese school that he went to, his amazing calligraphy compared to the Japanese school children's, his college, the bomb shelters, and the escape from the communists, the life of a history teacher..  He told me about his father's feat on reclaiming lands for the Chinese government from the Japanese.  One thing that he showed me was a nice carved stone stamp that used to belong to his father...  He did not tell me about his father's capture or disappearance, nor his TB.  I do wonder if grandpa would tell me more about his life and stories if I had grew up in Taiwan.  I will never find out.  He was fond of me for doing all the things that I did, for being a good daughter who made the family proud.  He never told me that he loves me.  He doesn't have to.  It is not something he grew up hearing or saying.  It is his chuckle or smile that tells me that he loves and cares about me.  The old Chinese way of expressing love is embedded in questions such as "have you eaten?  eat more!  are you sleeping?  Get some rest!"  It is embedded in actions like, cooking my favorite Chinese dish, putting an extra piece of my favorite food in my plate, making me eating an extra piece of their favorite foods even though I might be completely full or even though I might not like their favorite food at all.  I will remember that the last dinner we had around Chinese new year in 2013, as we walked to the car, he held my hand and told me that he thanks my mom for everything she's done for Yee and I.  It was really from the bottom of his heart, and it was his way of trying to apologize to my mom for whatever he said to her back many many years ago.  I hope that as he moves on, mom will also learn to forgive whatever conflicts that they had in the past.

At this point, all I really wish for is that my dad will be okay.  Monday, 6/9/2014 is the funeral.  Almost a month after grandpa's death.  I am not going back because grandma asked me not to and dad ultimately asked me not to.  I have to respect them and not to go back.  Taking a day off, so I can remember him...  a man with pure white hair and very white and very long eye brows, who held my arm and told me that he was proud of me.  Thanks for being a part of my life...

Aging

The first few weeks after starting residency, I started to notice the numerous strands of graying hair on the right posterior side of my scalp.  It is always the spot where new gray hair appears.  I would pull it out, in a way to defy the fact that I am getting old.  It would grow back in the same spot several weeks later.  

Many people do similar things as they age- anti-age cream, botox, face filler, face lift, skin tugs, wigs, etc.  People do all sorts of things to themselves, looking for the magic solution to aging, so their physical youth can stay the same.

Looking at my own reflection in the mirror nowadays, I do notice the subtle changes over the last 10 years, perhaps accelerated over the last 8 years from intense medical schools and the lack of sleep/stress during residency.  The fat on my face disappeared.  Sometimes my eyes appear more sunken than normal, and now, I have these tiny bags under my eyes and tiny lines at the end of my eyes when I smile.  I lotioned and creamed my face, but I don't think these things really work.  To be blunt about it, I think it is all marketing- targeting people's fear of aging.

Is aging that bad?  Is a face that has lines and wrinkles ugly or less beautiful?  What's wrong with aging?

I don't think it is bad, nor does it equates with ugliness.  There is nothing wrong with aging, except for the potential debility that comes with it when one becomes frail.   

I see older persons on a daily basis because of work, but I never really consider them to be "ugly".  There is also nothing bad about it.  These individuals all have so much to offer.  Each line on their face tells a story- some tell you the hard life they had when they were younger, others tell the story of an avid outdoor explorer, and some are simply the story of domestic lives.  There is nothing wrong with aging.  It is simply a part of life.  

Some fear it like it is the end of the world and end up living an discontent life.  Many of the times, I notice that those who fear it are younger or those who just start to recognize the changes to their bodies.  Others embrace it and/or allow natural to take its course, and these folks are perhaps much older.  Most of the older persons that I've met seem quite content with the ways they are, or at least, they no longer fight it.  I sometimes wonder if there is a age threshhold or a time in one's life when this revelation finally occur to them and they end the struggle to fight aging, but rather to walk with it.

I think when one goes with the flow of time and accepts it openly then one gets to appreciates life better.

I find myself to be an angry person today after talking to my mom on the phone.

She was rambling on about how busy my father is, now that he is working almost 24-7. She says that she never get to talk to him and when she does talk to him, he makes her feel that she is wasting his time. He is never home and she never sees him. Yet at the same time, she feels that he is happier now that he is busy at work.

I am frustrated that my mom was the first person who told him to accept this new job. Of course, ultimately, it was my dad's decision. She did encourage him though. She should have known that there is a trade off- busy at work = sacrificing the home. Now, she is back to square one, spending most of her time by herself. Moving things by herself...yes, and with the new apartment/house. My dad was very unsympathetic about how she was not feeling well with her sciatica acting up again. Today on the phone, I don't think she was asking for help but only asking someone to listen to her, but it was so hard to just listen and not be angry at both of my parents. One is too busy and buried in work that he lost his empathy for people, especially the one who lives with him. The other is too kind and too weak to just pick up and leave. I wonder if he is even going to know it if my mom just packs and comes.

Looking at my own parents, and reflecting on what's been going on with my life, it is no wonder why I am so bad at making commitment. On the one hand, I fear that I will turn out to be just like my dad who gets wrapped on with work only and forget about the existence of others around him. On the other hand, I look at the result of my parents, supposedly a "happy couple" per some family friends, and I just cannot see either of them to be happy. Do I want to subject myself to that kind of strained relationship? Not really. Because of that, I really am not excited about jumping into a relationship. Yet, over the spring break, my dad was telling me that I should not be alone... Well, if I can have a peace of mind and be single for the rest of myself, why not? I would rather not deal with the mess that is associated with a relationship.

When I get older, I want to be able to enjoy my work and ALSO have a life outside of work. I want to make sure there is a clear line drawn between the two.

Well, now that I've vented, I feel much better.

Saturday was one of those few days when I actually felt like a doctor since I started. I felt like a real primary care doctor... Not because I diagnosed someone with a diseased condition or cured someone of their illness (rarely...afterall, primary care deals with mostly chronic diseases), but because I went to a funeral. A funeral of my favorite patient.

I remember meeting her for the first time in the summer last year, and I was young and inexperienced, worried about doing things wrong and asked for a lot of supervision. She came with a lot of abdominal pain that her daughter thought was very strange, so did I. Then, by October, we confirmed the return of her breast cancer, now with metastasis...

Somehow, she faced this whole situation with steadfastness and courage. We talked about her prognosis, which is not good. I don't think I ever gave her a time line, but only told her to enjoy her time with her family as much as she can, because it is too hard for me to tell. We talked how she was coping with the illness and whether she felt more support is needed. We talked about ways to make her feel comfortable so that she could do things that she wants. She planned out everything and prepared her children for the inevitable. Every time I saw her, a little more of her inner strength shined through her failing body. She insisted that she wants to see me on a monthly basis. I almost offered to visit her at home, but I am not sure if it would be allowed.

Then, before her hospitalization, she told me, "I am not going to take this cancer medication anymore." She was determined. She did not want to have cracked hands and feet anymore. I contacted her oncologist about it. A few days later, she was hospitalized with a pneumonia. She got better, and went home with hospice.

A couple weeks later, before her appointment with me, I received an e-mail that she had passed away. Her daughter called and asked me to attend the funeral..."My mom really wants you to come. She told me that you are the only doctor who has understood her..."

I skipped post-call for 1 hour after getting permission from my resident. Went to the funeral and caught the 2nd half of it. Her brother and her daughter talked about her... It was a very peaceful ceremony, but I couldn't hold back my tears... It was almost like losing a friend. I have learned so much from her over the last 10 months, above love, courage, and the "zen" in her. I felt very special in the sense that I was considered to be her doctor who knew her. Her daughter later introduced me to her entire family... There was definitely some sort of connection going on between the family and I, but I don't have the word to describe it. It is my patient who attached that invisible string for us. We stood there, without much words, but we all understood that connection.

So...this is what being a primary care doctor is like...

I have not posted for a very very long time.

It's now 1/2 way through PGY1. Where to begin?

Lots have changed since I started medicine. It has definitely given me plenty of opportunity to look at the complexity of medicine and the art of practicing medicine. I think what I have found to be the most rewarding part is actually outpatient medicine where I have my own patients. It is gratifying to be able to develop relationships with them, even though some of them drive me nuts and even though I complain a lot about them at times... Most of my complaints have to do with my frustration at the cultural differences and people's perspective on medicine and their expectation from their physician.

There is one patient on my mind that I just want to spend a lot of time with right now... This is something I really did not realize, but as a physician, especially a resident, it is really hard to spend as much time with patients as I would like.

So I witnessed what cancer can do to someone... 3 months ago, my patient stood up straighter and appeared more vibrant. Now, after the diagnosis of metastatic cancer and only several times of radiation, she looked so much smaller and weaker. This is without chemo because she didn't want to have it. It makes me really sad to watch how she withers away with rapidly replicating crazy cancer cells. But knowing her prognosis, I secretly commended her for her brave decision. What makes me even more amazed is the inner strength that she has dealing with this whole situation. She has accepted and chosen to be at peace with it... I wish that some day I will have that too...

One is happy as a result of one's own efforts once one knows the necessary ingredients of happiness: simple tastes, a certain degree of courage, self denial to a point, love of work, and above all, a clear conscience. -George Sand [pen name of Amantine Aurore Lucile Dupin], novelist (1804-1876)