My Little Things

Little Things #31-40

Happy Monday everyone – hope this brings a little joy to your Monday mornings!

Story behind Featured Image (#30):  Being post night shift call means catching up on some sort of sleep, doing some scrub laundry, and just winding down from your night. For me, that usually means a low key evening with friends or getting some questions/reading done with a good cup of coffee. Of course, all in sweatpants or pjs!
— Home decor from Home Goods and At Home. Friends pillow from Etsys
— Vietnamese Coffee from Eatzis
— Yes Please by Amy Poehler

31. Being able to fall asleep right away
32. Feeling confident when turning in an exam
33. The smell of a barbecue
34. Discovering a new song and instantly loving it
35. Finally remembering the word you had on the tip of your tongue
36. Tearing out a piece of perforated paper perfectly
37. The feeling of relief after finding something you lost
38. Changing into sweatpants
39. When the stoplight turns green before you begin to brake
40. When someone saves you a seat

Check out/follow my Instagram for more updates. Click the Little Things (Master List)tab on the website header for the Master List.

Do you have any little things in your life? Comment below to be featured on the list!

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Uncategorized

How to Live a Happy, Healthy Residency (& The Little Things – Medicine Edition)

When you’re working 60-80 hours/week, you start to neglect many things in your life. Family, kids, significant others, friends, social life, fitness, hobbies, even personal hygiene. It’s difficult to balance all of those while working long hours and then coming home and trying to be updated on the latest in your field of medicine. Now, I’m not saying I have the perfect solution to it, but I think it’s important to create new habits in residency; habits that allow you to slowly learn to blend the important aspects of your life with work.

After all, I believe residents learn to be some of the best time managers.

UPDATES: This page will be continually updated with new lessons and pieces of advice I’ve gained along my residency journey! You can find this page again under the Medicine tab above or subscribe for updates!

How to Live a Happy, Healthy Residency (#mobgynchronicles)

  • Evening and night shifts can be hard. To start my shifts off on a high note, I always make a detour to my nearest favorite or new coffee shop to pick up a latte. Little things like this can kick off the next 12 or so hours on a good note! So indulge in something and bring it into your shift!
    • What would you bring?
  • Use your precious hours off to keep in touch and manage time with your family, significant others, friends, and your own me time. All of this is important but should be done in a way to better your emotional health and others!
  • Prioritize Me Time – to decompress, to unwind, to gather or erase your thoughts. Usually best done when you get time off when everyone else is working (early day time post night shift)
    • For me, it’s a cup of coffee while lounging in bed catching up on some reading/writing. What’s yours?

The Little Things – Medicine Edition (for residency, medical school, general medicine life)

Hoping this list will brighten up your day or let you focus on different things in the medical world that maybe the fast pace of your day does not allow you to see

  1. Getting off shift and realizing you have the next day off!
  2. Sleep after being on night call/shift
  3. The shower after a shift at the hospital
  4. When a shift at the hospital is so busy that time just flies by
  5. Doing a medical procedure perfectly
  6. When the realm of medicine proves its worth
  7. Being amazed by the world of medicine
  8. Watching how efficient medicine can be in the midst of chaos and tragedy
  9. Small medical school victories
  10. Unexpected three day weekends in medical school
  11. When patients are actually compliant with their medications
  12. Seeing a friend or co-resident at the hospital when you’re not on the same rotation
  13. Being released early from a day at the hospital
  14. Getting off a shift or call day on time
  15. Calm call days
  16. Getting off in the middle of the night or waking up super early for shifts sucks but the traffic less roads are fantastic

SIDE NOTE: If you enjoy the little things, check out the master list at the top header tabs. I post a new blog of 20 little things at the beginning of every month so follow to check that out!

Cheers,

Monica

Med School Musings

Drawing the Curtains

As we all enter residency, we are thinking of how we are going to be the best doctor we can be in our respective specialty. Regardless of the field we are going into, I believe we all have common goals: to be compassionate, patient-centered, culturally sensitive, and evidence-based. These are the qualities we will all be constantly working on throughout the rest of our careers. Despite these noble goals, I believe there is one topic incredibly important to medicine we neglect. That topic is death and dying. Thus while I will strive to achieve the common goals of being compassionate, etc., I hope to reach a point in my career as a physician where I truly understand and am sensitive to the matters of death and bereavement.

From the outsiders’ point of views, patients see physicians as people who are regularly in contact with death. Doctors give the prognosis of death, they announce the time of death, and they heartbreakingly relay the news to family and friends. Thus shouldn’t doctors be most comfortable with death? Shouldn’t physicians know how to deal with those who are grieving and those who are dying? Wrong. In fact, most doctors are extremely uncomfortable with death and are at lost on what to do to help patients through their dying processes or to console family members and friends.

“I had insinuated my hand into that mysterious nexus of stars and fate and destiny, and I had reduced that great passing of life into an arbitrarily calculated moment in time.” –Dr. Chen on the practice of announcing time of death.

Why do we suck at this? After dealing and being in the presence of death multiple times over years, physicians should have developed some sort of method to handle this heavy part of being in medicine. Unfortunately for most physicians, the method has been to become unfeeling, detached, or awkward.

Who can blame them? Dealing with death is hard. Hard does not even begin to describe it. Regardless of the Kubler-Ross stages we are taught, every person deals with death differently – every family does. The ways people approach death and grief depend on family dynamics, culture, personality, and past history. The process is not the same for any two people.

Many years ago in my death and dying class in undergrad, we had to pick a death/bereavement topic and write a paper on it. During that time, I had some recent developments in my life, and I saw my family go through a personal, heartbreaking loss and then something else I’ve never seen them go through before. I’ll spare the details, but the memories I have of those moments of black, white, kneeling, despair, and anger-anger-anger-anger drove me to look into how the Khmer Rouge affected modern-day Khmers’ grieving processes.

For context, my parents and their brothers and sisters fled Cambodia in the 70’s to America because of the Khmer Rouge. Cambodians went through a horrific, terrible time between the years of 1975-1979. The civil war/genocide was a nightmarish time of bodies left stranded on the roads, humans violently killed, and mass graves left to rot. By the end of the war, around one to two million people died; about 20% of Cambodia’s population. There was no way to bury a family member, and many surviving Cambodians were left not knowing where the bodies of their deceased family members were, and not knowing how to properly bury and grieve for them.

Grief was interrupted for many of them and left unresolved. Many never had any closure and many felt guilty over not being able to give their family members a proper burial. Then years later, the mannerisms of Cambodians changed; they became more secretive and closed off. Articles stated that as they became more closed off, Khmer families began to approach death with anger and resentment. It was a way of coping with grief adopted from the war where many blamed deaths on Pol Pot (the leader of the genocide).

What’s my point of bringing this up? Just to show that death and bereavement is complicated with each person.  Each human has a history that a doctor most likely won’t be aware of, and thus there is already a lack of understanding from the start. It’s a puzzle, a never ending dark maze that physicians get dropped into – they don’t know the beginning or the end.

So how do we, as future doctors, act in these situations? How do we make our patients the most comfortable when they are in a painful area no human should be at?

There is no right answer.

But there are some good answers.

The quote I used above is from one of my favorite books called Final Exam: A Surgeon’s Reflections on Mortality by Pauline W. Chen. As a brilliant, compassionate transplant surgeon, Dr. Chen reflects on her experiences and from them, I take away many messages but one story stands out particularly to me.

While still a resident, Dr. Chen said that she usually found herself pulling away during the last minutes of a patient’s life, making herself busy while waiting for her patient to die all the while watching family members move in and out of the rooms with teary faces and bunched up tissues. One night, however, as she left the room again of another dying patient, she watched as her attending resident drew the curtains around himself and the wife and the dying husband. Curious, she peeked into the room to see the attending leading the wife to the bedside and then slowly whispering something to her as she cried. Those words, as she found out later, were words explaining how life leaves the body, giving the patient a peaceful death. Days later, she received a letter from the wife thanking the team for ensuring her husband’s peaceful death. Dr. Chen described it as an experience that showed her a new world of medicine; it showed her that she could do more as a physician than just cure or diagnose. Ever since then, she states that she’s never left the dying and the family alone. She drew the curtains around all of them, spoke to the family slowly, and touched and hugged family members.

Dealing with this will never be easy, but I pray, as a future doctor, that I will have moments like this that unveils to me a different way to approach death. A different way to provide something to patients when I have nothing good left to give. Let us always remember to not run from death, but to take it on, and to morph it into something compassionate and dignified. This will be one of my main pursuits in becoming a physician.

“By evading death, we miss one of the best opportunities for us to learn how “to doctor”, because dealing with the dying allows us to nurture our best humanistic tendencies.” – Dr. Chen

And that says it all.

-M

Education, Med School Musings, Uncategorized

Dear Third Year Student

Dear upcoming third year student who must be so incredibly thrilled to be done with the Kreb Cycle,

Welcome to the year of being ‘The Wallflower’! Now bear with me before turning the page and shaking your head in disbelief. Dictionaries define ‘wallflower’ as someone who is shy and thus blends into the sidelines. I think the word, if you take out shy, defines third year in a nutshell. You’re about to embark on a year of switching rotations. A journey of constantly feeling uneasy and then comfortable only to have to fall back into that uneasy emotion in a matter of days or weeks. You’re going to pass through every emotion in the book. The bad ones (nervousness, awkwardness, discomfort, confusion, pity, anger, fatigue, sadness, apathy, helplessness, jadedness), but I promise, also the good ones (pride, awe, wonder, curious, comfortable, confident, decisive, empathy, sympathy, appreciative, contemplative, joy, happiness)!

Now you must be thinking, ‘What a depressing letter to read’, but I urge you to forge ahead.  Third year means you’re the least experienced of the medical team. You’re going to have plenty of moments where you don’t feel like you’re helping or that you’re actually more of a burden. Residents and attendings will discuss plans at rapid fire, and you’ll feel lost to the terminology, trying desperately to figure out when is the right time to ask a question or rapidly browsing through UpToDate to figure out what exactly is happening with a patient. As the patient workload increases, you’ll start to feel like someone just merging with the sidelines. A wallflower.

I write this letter to remind you all that when you’re starting to feel like that, please remember that this is not a bad thing. Your duty as the third year medical student is to not come up with drug dosages or perfect solutions to a patient’s decompensating heart failure or treatment of ovarian cancer. You are there to learn. To be constantly curious. To observe. As the wallflower, you get a special advantage over residents and attendings. You have more time with patients and more time with your thoughts. So use that time wisely, open your eyes and ears, reflect, and truly take in your surroundings.

On emergency medicine, understand how swiftly death and disability can fall upon humans and build compassion for those patients lost in the frenzied haze of white walls and numerous diagnostic tests. On neurology, appreciate how intricate the human brain is but also understand that complex neuro terms fall on deaf ears of patients. On surgery, acknowledge every kind of fear people have going under the knife and be in awe of how intricate the human body is. On medicine, think beyond the heart failure and cirrhosis to what living and social situations your patients will encounter post-hospital. On pediatrics, embrace your inner child, revel in the innocence of babies, and step into the shoes of a worried mother or father. On family medicine, truly wonder why a patient is not progressing in care – transportation, culture, unsafe neighborhoods. On OB/GYN, be awed by the miracle of childbirth and learn to be gentle with sensitive matters of unwanted pregnancies, miscarriages, and vaginal bleeding. On psychiatry, draw up your empathy and do not let their illnesses define who they are.

Appreciate the residents and the attendings. Be in awe of how they juggle their patients and their home lives. Thank those who take time out of their busy hands to teach you. Be grateful to the nurses, PAs, NPs, techs, and support staff who guide you in the right direction. Welcome the caffeine and infrequent extra sleep hours. Hold the patients’ hands that want to be held. Offer a tissue to those who are crying and return the hugs rarely given by patients. Smile. Make eye contact. Communicate. Listen.

This year will be the game changer in your medical career. You’re going to learn what specialty is right for you, and you’re going to learn so much about medicine and human nature in general. Just remember to take with you the lessons you’ve gathered and observed and let it guide your future practice.

‘The best way to find yourself is to lose yourself in the service of others’ – Mahatma Gandhi

Enjoy third year!!!

Best,

M

(I write this as I come to the end of my fourth year of medical school as a piece for the upcoming third year students at my med school as well as a reflection on what MS3 was like)

Med School Musings, Travel - Asia, Travel - Indonesia

The Other Side of Substance Use

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In our last week of neurology/psychiatry module, we covered substance use disorders. The lectures went from 8am to 12pm and they focused on the symptoms of intoxication, symptoms of withdrawal, and treatments. It was rather dry, and while the professors tried to do their best to have us understand that substance use is a disease, the message fell short.

In that cold classroom with my addiction notes in front of me, I was transported back to the coolness of Bandung and the tables outside the treatment center where I would hang out and share coffee with the “druggies”.

I will admit that the area of substance use and addiction was a topic I was very unfamiliar with before I signed onto the Indonesia Initiative project. For those of you just reading this, I worked with Rumah Cemara (RC) this previous summer. RC is a community-based organization that focuses on fighting stigma against HIV/AIDS and substance use. I spent my summer interviewing and learning the stories of the clients at the treatment center. In lack of better terms, my time there changed the way I view this population.

It’s so easy for society, whether it’s Indonesia or America, to take a look at these drug-users and immediately judge them and cast them aside. These kind of reactions are some of the reasons why many drug users relapse again and again. Society does not accept them, and they are labeled as outcasts. They are seen as people who did this to themselves. They walk around experiencing discrimination everywhere – family, community, and the workplace.

Regardless of the motives behind their initial drug using, these “druggies” are still humans. Addiction is a disease characterized by constant relapse and horrific withdrawal symptoms that can really push the human body to the limit. Many of them struggle with mental illness and mood disorders. A majority of them lack a home, a support system, money, and love. So tell me, if you were in those circumstances, wouldn’t it be so easy to pick up drugs again?

I write this specific blog just to bring some more emotion and shed some humanity onto the dry substance use lectures we receive in medical school. These “druggies” made me laugh and smile and so welcomed. They had amazing stories of trials and hope. They all had a fighting spirit that was so admirable.

Now many would argue with me that not all drug users are like that – motivated and hopeful – and I agree, but it does not give us the right to stand from afar and judge and pretend like we know their background stories. Cast them off as hopeless and not worth the time.

My time and work with RC has not only opened my eyes to the world of substance use, but it has given me a newfound respect for this population. I hope to be able to carry this demeanor into the clinical setting when I rotate through psychiatry and beyond the grounds of medical school.

And I challenge my friends to do the same. Don’t just walk out of a room with a substance use patient shaking your head. Take the time to truly ask how they are. Shed a little compassion.

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Once again, I thank Rumah Cemara and my amazing Indonesia team (Teresa, Anum, Omer) for inspiring this blog.
-M