and when she speaks
Saturday, December 13, 2008
I went to see my favourite patient Mr.S.He was more drowsy today and more disoriented. I fear he's getting more encephalopathic.I know weekends or weekdays do not make any difference to him, because he is stuck to his bed.He cannot move anywhere else. The nurses do everything for him, clean him up, bathe him.
All he can move is his fingers to feed himself. Even then, he usually asks me to bring his home-brought food over to him and open the containers up for him. Yesterday I helped him dial his son's home number, and I saw the look of disappointment and I felt so disheartened when it was a voicemail message.He said frustratingly in a sad tone 'They're always so busy'I said 'I know.'I usually stay awhile with him to chit-chat because I know being alone in the hospital, and the only people you talk to are the nurses every once in awhile, that can get very depressing...You feel really isolated. I can imagine... I mean, where's the quality of life left? Being stuck to a bed and being alone 24/7... that's cruel, especially when your own family members are unable to amke time for you.I stay with him for about 20 minutes everyday if I can.Today was extremely busy with many new consults, but still, I won't be seeing him this weekend and on the days next week when I'm off to Boston...I asked him 'So, Mr.S, do you have any questions for me at all?' smilingly.He said 'No' at first, then changed his mind 'Yes, where do they make such beautiful faces?' looking at me.I laughed at him and replied 'Oh Mr.S, you're such a sweet talker!'He exclaimed 'It's true', trying to look sincere ;)Then, I put my hand over his heart and said 'Well, you've got a heart of gold'As usual, before I left, he said to me 'Take some ...'I finished his sentence for him ...' chocolates' :) 'I know Mr.S, you don't have to tell me' ;)And then, I share my chocolates with Simon.I once told Mr.S his chocolates spread joy, and he smiled in return.
her
STORY,
her ALIBIS
4:51 AM;;
Friday, December 12, 2008
This evening around 4pm, I was told to quickly see this new consult up in the cardiac critical unit.
She was an old lady who is rapidly going downhill with recently diagnosed complex leukemia, with neutropenic fevers, complicated with acute renal failure with worsening oliguria, fungal pneumonia, recent heart attack with pulmonary edema... and many more things going on.
I read through her entire chart and went to see her.
I gowned up and walked into the isolated room.
Her husband was angry, upon seeing me enter... and her son was in that room too.
I could see he had a lot of things he wanted to say. I walked to him, shook his hand and introduced myself. Her son tried to calm him down, understanding that I'm a medical student, who does not have much power to change any medical decisions for the patient.
The son said
'Let's step out dad' and so, both of them towering over me, led the way out of the room into the isolated space outside her room. I followed behind. This was going to be a discussion between the three of us.
I could tell he was very very concerned, very confused.
The only thing I fear is talking to the family members about their dying loved one. Especially when it comes to their end of life matters, it is very much the most difficult thing for me... and it never becomes easier.
He asked 'how long does she have left?'
'How will she die?'
'What will happen to her body?'
'If we don't dialyse, what's going to happen to her?'
'We just want to know from point of view, what should we do?'
The medical questions I have no problems with, but these questions I find are the hardest to deal with. Because you are dealing with people's emotions and people caring for their dying loved ones... it's hard.
I sometimes am so fearful of telling them how much time their loved one has left because you can never be too certain. They might just hold on longer than you'd expect them too. We've seen it happen, and we never doubt 'unfinished businesses' or 'divine interplay' when it comes to the dying process.
And I myself am not sure too. I have only, with the not-so-much experience and exposure that I have, recently become more comfortable with gauging how much time left before they die.
The doctors all know this. They know if that patient has less than a week left, or less than 3 days left.
Now I know too. But I am not confident enough to tell the families for fear if I give them the wrong number, I might raise their hopes too high or cause them grief too early in the process...
I don't know.
I hate these things.
I want so much also to tell them our recommendations, but we can only say so much, because it is ultimately their decision (the patient is pretty much somnolent, unarousable, unresponsive and not in a state of 'being' you can say)... and litigation is such a big issue in the US that we, as health care professionals cannot give recommendations. We can only simply tell you the risks and benefits associated but you have to decide for yourself or for that loved one of yours whether to go ahead or not with the procedures...
Which is so difficult for the family. And thats why I understood his concerns, his fears, his guilt, his difficulty with making the decisions and ultimately holding the responsibility in deciding his loved ones' management plan... They want to hear from us our recommendations but we cannot do that... which I think is so silly, because most families just want to hear their doctors thoughts and then, go ahead with the doctors decisions... but unfortunately in US- that's hard to come by for the doctors to do.
It's sad.
Anyway, I said what I had to.
I emphasized that they are the patients' advocate. They should do what she wants done/not done to her.
I explained about how her kidney failure can lead to her death. I said she might have a week left or less. The dread I felt overpowering me as I said that...
'I am so sorry to tell you this Mr...'
I hoped I did a good job. I hope I said the right things. I hope they got away with the right messages...
Most importantly, I hope they trust themselves with making the right decision for her.
her
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her ALIBIS
4:31 PM;;
her
STORY,
her ALIBIS
4:14 PM;;
It goes without saying that it's the support of my family and friends and mentors who have helped me all along the way, that I'm here, capable of doing what I have always dreamt of doing and enjoying the road that I'm treading on right now.
Without hardships, you don't become stronger.
Without tears, you don't appreciate the joy and happiness around you.
Without sacrifices, you take things for granted.
Without hard work, you don't achieve your aspirations and goals.
Without rejection, you don't learn that sometimes you don't always get what you want.
Without company, you realize that you cannot function on your own-that the workings of the world is made up of relationships.
Without love, you are empty.
Without friends, you are solitary.
Without family, you are alone.
So, live with joy, love, hope, faith and belief and have dreams.
Live and learn.
Live and love the people who are around you.
Your parents. Your sisters. Your dear friends. Your companions. Your teachers.
If people can accept you for who you are, all your strengths and weaknesses, you should be able to do the same.
Thanks to those who have been there to hear me whine. hear me swear *especially all my blardy hells* ;) . hear me complain. hear me asking for assurance sometimes. hear me reminding friends to scold me if I'm not grounded. hear me talking crap.
Thanks to those who know how pathetic I am with directions. Thanks to those who offer help before I ask.
Thanks to those who listen. Who really listen.
Who hug me when I need one. Who lets me lean on them when I just want to lean on someone.
Who wraps their arms around me when I'm cold- this one only close close friends, not any tom, dick or harry!
Who keeps me company when I don't want to be alone :)
*muacks*
her
STORY,
her ALIBIS
3:54 PM;;
Thursday, December 11, 2008
I've been terribly unhealthy here.I actually lost some weight on my first two days... Then I became super comfortable around David and ended up eating too much crap with him, and going out with him & Brian last night was B.A.D. cos I ended up finishing two of the large slice cheesecakes by myself.*grumble mumble- blardy hell!*Leaving the girl to wallop both hundreds-of-calories laden cakes -.-'Today's interview went well.They called 5 people at the end to stay back although everyone was leaving to the elevators.I was upset when I heard my name mentioned last 'Lai'.Cos' that meant I too, had to stay back.I didn't know what was going on. But I heard loud whispers... and they were saying that meant it was a prematch.That means they want you to sign the contract there and then, because they really liked you today.5 seconds later, my name was called first amongst the five.'LAI''Here!' I enthusiastically replied.I stepped up and went into the room. He introduced himself as the 'Recruitment officer'; one of the the senior doctors.They were right. It was a prematch.I was shifting uncomfortably... Because I didn't want to legally bind myself to any hospital yet.I was 'Erm... I really liked your program today...BUT I really liked every other program I interviewed at too'I didn't want to decide now. I've still got many interviews more to go and I want to keep my options open.I've other good interview offers too.He could sense I wasn't going to sign today.He gave me his card.He asked me what other ones in Chicago I have- I replied 'Rush'...That's a big-time hospital in Chicago. He said 'Choose one which will appreciate you. Where you can go very far''You interviewed very well today.''You have the luxury to choose. You have a nice personality, so everyone will like you.'And then, he went on to add 'Sometimes big hospitals don't give you the big break you deserve. Whereas, here, everyone is on the same level playing field...'I listened on.I love both Program Directors though. They're both so nice.Rush was insistent on us choosing the best program for ourselves and never once pushed us to choose them.I shook his hand and thanked him.And walked away from his room.I gave my girlfriend a hug once out from the room and told her 'Congrats' cos' she's also one of the 5.She shook my hand thinking I signed the contract already.I shook my head and said 'I didn't'. She was shocked and in disbelief..and said 'I'll never forget you' and we said our goodbyes.Out by the elevators, two other interviewees congratulated me... I smiled and calmly told them I didn't sign it. One of them was obviously not happy with me. For whatever reason- maybe the fact that he thought I was taking the opportunity for granted or that he would have jumped at the offer... I don't know- but I walked away from the hospital, happy with my decision.Boston, next week.David laughed when I told him; 'Too confident huh?' ;PI said 'I guess all the hospitals I've interviewed at so far feel I'm what they want in a future resident.' =)
That said, I feel I have been very lucky.
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her ALIBIS
5:50 AM;;
Wednesday, December 10, 2008
I came home from the interview today, with a personal email message from the Chief Resident which was awfully nice of him. The Program Director came up to me this morning during breakfast and I was really impressed- he knew exactly where I was from. 'So, you're from Nova Scotia huh?' I couldn't help but wonder if he had read my file beforehand.. I definitely felt very honored because he came up to me and initiated the conversation, in a room with 30-40 other interviewees.The email was such a personalized message and it goes to show how much effort and initiative they're putting for us applicants.I definitely was very happy with the email. And it really shows their dedication.I left the interview today feeling really good. The Program Director was really honest and extremely nice. There was a video film at the end showing the camaraderie between the residents and the faculty staff and they all looked so joyful. So close. So supportive of each other.I clicked with the residents I hung out with and really enjoyed myself thoroughly today.The interviews with the two faculty staff members went really well. My second interviewer just read my file and said I had extremely great letters of recommendations and she saw my scores and said 'This is the best it can be'.I was of course, thrilled but humbled. And I thanked her.I shook her hands and then she took me back to the room with all the other candidates. Then, she shook my hands again. She was so so pleasant. I saw that everyone there had smiles on their faces... Kean Kwoh left a LOUD voice message and I didn't know who it was. Then I phoned him up and he said he drove here from Purdue for his visa and then, we met up and he drove me to CHinatown where we had AI Ping's favourite Mango Bubble Tea at Joy Yee (apparently very famous =)). And I bought Tong Yuen - Glutinous Rice Ball with Sesame Filling and some ginger...I came home, made tong yuen. David thought it was a bit spicy (that was what the guys said the other time!! -.-) I love ginger though !! ;)Then, we met up with Brian at Cheesacake Factory and had dinner and cheesecake =)Then, we went back to Brian's crib which was absolutely beautiful and his room is H.U.G.E! With a breathtaking view of Lake Michigan as well! Hung out for a bit then came back home... =)It's been a long day today. Tomorrow am there's another interview again.I told David and Brian that if I decide to work in CHicago, I'll have two friends there already whom I'll come and find to hang out with ;) !
her
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1:27 PM;;
Tuesday, December 09, 2008
I've been in Chicago for 2 days now =)David's been really accommodating as well, and really helpful.Thanks so much to both Max and Crispin for looking up their Chicago friends to help me out =)It's really very nice of all of them. 1st day in CHicago-terribly C.O.L.D. I was wearing five layers and came home needing 15 minutes before the pain from the cold was relieved from my fingers. My toes were numb. I now understand why David says 'he's lazy'... With cold like that, and an apartment that's cosy and comfy- I wouldn't leave the comforts and the warmth of the indoors either. I'd just kick back with a cup of hot chocolate and nice music in the background, chilling out on his couch and watching the view of Lake Michigan on his vast sheer glass window. I was taken to Wow Baos. It was pretty good actually. Enough fillings :) Though I wish the baos were double in size ;)Then, we went to Millenium Park where I forced David to take pictures with me with 'the bean' - correctly known as the Cloud Gate :) He was so uncomfortable, saying that he's from Chicago... and obviously feeling shy at having to take pictures with the bean since he's been here for 2 years - nevertheless, he obliged LOL. I forced la... ;)I did touristy stuff today.By myself. I actually impressed myself by doing that solo. Usually I'd never do such a thing, exploring and taking photos by myself... But I slapped on very thick skin and got other tourists and security guards to help take pictures of me with touristy landmarks :) And managed to get home by myself too. I remembered my way home! David was being obnoxious when he said he kept on checking his handphone for messages and missed calls to see if I got lost anywhere or not -.-PRe-interview dinner tonight. Met some people. More Chinese here than in my other interviews.Tomorrow I have to be up by 6am. INterview's at 7 ish am.=)Then, we're having dinner at Backstage Bistro with Brian and girlfriend. And then, we're heading for dessert at Signature Lounge up in the John Hancock BUilding where there's a whole view of Chicago from the observatory :)And we're making tong yuen :) *muahahahaha*And I'm going to try the CHicago HOT DOG =)Then, I am going back to NYC, just on time for Hau Jia's company's Christmas party!And staying with my colleague for a couple of days - since I have to move out by this weekend -.-
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her ALIBIS
1:35 PM;;
Sunday, December 07, 2008
Friends far and wide know that I love company.
And detest being alone.
And cooped up in four walls. Unless it's darn cold outside ;) And I'm being a lazy bum :)
Just the other day, a friend called me up because he wanted to talk to someone.
He spilled out how he felt. And I told him this, something I always remind myself time after time- and something I tell everyone whom I meet who I think should know:
'You've got to be your own pom-pom. You're your own cheerleader. You have to be your own best friend'
People can backstab. People can manipulate you. People can be harsh and mean and hurtful.
Ultimately, you'll have to protect yourself and stand on your own two feet.
Not many people are sincerely nice. Not many will stay with you when you're in trouble. Not many can keep your trust, as you soon realize with time.
You learn to be tough. Independent.
I remember learning this the hard way.
I used to be so nice. And naive. And I got played out. Manipulated by friends. Backstabbed. We were all in competition then.
Then I cried a few times. Cried at the thought of your own friends doing this to you. Cried at how harsh the world can be when all you've done is try your very best to help people along the way.
Then I reminded myself to toughen up and hardened myself in a way.
But then, I realize you lose a part of the real you when you harden yourself too much. The part that's actually a strength; a positive personal attribute. Nice people don't always get played out. You just have to smarten up.
I didn't like the "hard" me- which was present for a short while when I was much much younger. It was, in retrospect I realize, a coping mechanism to protect myself from getting hurt again.
And then I became myself again- I opened up. The same ol' me with the same ol' heart that I have, realising that that's a big part of who and what I am. That's the reason for so many of the things I choose to do and the reason why I am in this line.
In my heart lies my strength, and I find that's why I form great connections and rapport with my patients.
I don't think having a heart and giving too much is a flaw. I feel it's humanizing. And the world needs more of it, anyway - *lol* sounds so extremely noble... *aiyor* I can feel my hair-raising already ;)Personally, I've found a good balance in knowing when to draw the line.
As long as nothing is being taken away from you and as long as you set boundaries so that people don't take advantage of that, then it's really alright.
her
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her ALIBIS
3:55 PM;;
My mouth sometimes gets me into trouble. Thankfully, it's not too often that I don't process what I say before I think.
Though I really should learn to bite my tongue -.-
I've had my fair share of learning. Do undo others as you would have others do unto you.
We girls have had this conversation a gazillion times. But I swear I can never bring myself to making the first move or letting anyone know in the slightest hint that I have a slight small crush on them (if ever I do). A guy friend was so confused at that, exclaiming 'So how are we supposed to know then if you like us?'.
I think it's just me la. When I get shy, then you know. But now that I'm *older* and am conscious of that, I usually try and keep that in check.
But if a guy doesn't take the first initiative to ask me out, then there's no chance that we'll be going out. I might drop hints and give him ample opportunity to try and ask me out, but if he doesn't get the hint, then that's really it.
And most girls are like that, that's why you guys just really should go for it and give it shot. This is what I have to say to those guys who say they cannot get girls. You MUST MAKE the first move!
"Don't miss me too much" ;) I said.
'I'll cry myself to sleep every night' was the reply.
...and I laughed.
'It'll be an all boys' team. It'll be so much more fun!... Then, we can round in our underwears'
I laughed at the lameness. *hehe* I know it won't be half as fun without me in the team, since I'm the loudmouth. The biggest talker. With the loudest voice. And the cheekiest one.
The team was so nice. They all wished me the best of luck for my interviews in Chicago next week.
My birthday is 2 days before our last day in nephrology. We promised to celebrate ;) when I get back. And, when I'm back from Chicago, we're going to MOMA. Finally! =) And we're going to head to Williamsburg for some night fun after work ;)
I've promised a few friends at work to meet up. It's getting difficult trying to meet up since nephrology hours are a bit hard to juggle around since almost every night I'm home later than 7pm.
Lauren- dinner.
Dory- dinner.
Simon-MOMA. Mojitos.
Carmela-Drinks/dinner.
Steve-weekend lunch.
Don't watch Australia. I'm not kidding.
I'm leaving for Chicago on Sunday am. Thanks to Max, who hooked me up with his friend, so that I have a place to bunk in at for the next 4 nights =)
her
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12:46 AM;;
