Just finished up Family Medicine today with the NBME SHELF exam.  whee.  great fun.  so here are a collection entries I didn't get to finish up until today.

oh yeah, got the email address of that visiting student... at least I know she wasn't just humoring me these past three weeks, even if she was totally uninterested in hanging out...
 

Book review:  Quantum Rose (Nebula Award 2001)

My review:  To iterate what I posted earlier, some of the major themes that occurred to me included the Prime Directive deal, and the meaning of personal freedom in the context of leadership.  In the author's notes, she explains that the structure of the story, and many of its elements, purposely follow the excitation phases of electrons or something like that... obviously, I didn't read that too thoroughly because I got bored her exposition pretty quickly.  Novel idea... even fascinating, to some extent, to correlate a subatomic phenomenom with interpersonal relationships, but it's way too geeky for me to appreciate... overall, the story was pretty decent...  although, like the mystery reviewer, I got quite annoyed with the characters... too much 'linguistic cuddling'... made me want to puke sometimes.

Mystery reviewer:  "it started off rather...cheesy, but there were quite a lot of interesting ideas about language and culture that quite redeemed some of the other parts.  i thought the characters were interesting, though i think i got a bit annoyed at the main character at times.  i finished it a couple of weeks ago, so i'm forgetting what all my
thoughts were as i was reading and when i finished.  i was rather caught by the idea that not everything is perfect...that life is complicated.  i know its rather a well known fact by now, but sometimes this doesn't always reflect in sci-fi or fantasy (thus being fantastical...i suppose)."
 

Thought #1
With so many of my friends reflecting on their parents recently, the topic has rubbed off on me.  I spoke to my mum on the phone this past weekend and she informed me that my dad and her were taking out the family to dinner to celebrate my brother's engagement... where?  Black Angus.  I don't know about you, but it would have been kind of an anti-climax if I were in my brother's position.  I suppose this is a microcosm of a general struggle I have with my parents... and ultimately myself:  differentiating frugality (positive) and stinginess (negative).

I've always hated how cheap (it seemed) my dad was/is... if I bought something that he didn't approve of (basically anything not academic in nature) it was "a waste of money" and "stupid."  I remember collecting baseball cards as a kid and him frequently complaining about how I spent my allowance... as if there was anything of greater cultural or edifying value for an adolescent to buy!!!!  Even now, although my standard of living is substantially lower than my friends, he still reminds me that he thinks I'm a wasteful spender...

I realize that my parents grew up and lived in poverty most of their lives, even up to the mid-70's.  I know that living through the Communist revolution and escaping China was greater hardship than I could ever imagine.  I know that even in the states, my family struggled.  My mother tells me stories of how she had to sew clothes for my older brothers when they were young because they couldn't afford to buy clothing... and how my brothers suffered at school because of that.  My mum tells me of how my dad nearly committed suicide because of how distressed he was about providing for my mum and my two bro's.  Thank God he turned away from the train tracks that day...  Despite all this knowledge, I still react negatively to things like this -- that of all the great restaurants in the Bay Area, my dad's decided that Black Angus is the place to go to celebrate an engagement!  I know in my heart that my parents are generous to the greatest degree they know, but it is still difficult reconciling my feelings against my knowledge... and I feel guilt that I am still resentful of my dad and I worry that I will continue measure the worth of his actions by their appearance rather than their heart.

Not surprisingly this is one of the things I struggle with myself... knowing the difference between frugality and stinginess.  I really don't know that I can tell the difference in myself..... and another issue is how is true generosity manifested?  Clearly, it is not in the monetary or social worth of an object or action.  Biblical teaching affirms this as well.  But, generosity isn't defined by the market value of a particular object, generosity is certainly manifested through material things...  But, how can I tell?  in myself and others?  And, how about this question:  in what aspects of our lives is generosity truly warranted (ie doesn't become spoiling)?  Health care?  Tuition?  Clothing?  a house or apartment?  Food?  Leisure activities?  Because, clearly, between my dad, my mum, my eldest brother, my middle brother, and myself, we each have different ideas about what areas deserve a more free distribution of time and money and what areas can be sacrificed...
 

Thought #2
At WWKnight, even though it's family practice, I still have seen my share of sad stuff:  pts who have recently lost spouses, pts victimized by domestic violence, kids whose parents refuse to have immunized...  I still react fairly strongly emotionally to these things.  I still have a strong sense of empathy and social justice.  But, I wonder how long that will last before I simply get desensitized by it all.
 

Thought #3
Children are an economic liability.  A sad fact in the realm of social justice.  Poverty and low SES are perpeturated by high birth rates.  Look at Africa.  Look at your local inner-city.  Take the 20 yo couple I saw in the clinic -- the woman/girl with her second pregnancy, and the both of them working at Wendy's.  Or the medical and psycho-social train wreck of a 25 yo single mom with three kids I saw yesterday.  What kind of quality of life do you they will be able to afford?  What opportunities will they have in the future?  I have a hard time believing that answers to either of these questions are encouraging.  It's sad to see people dooming themselves to a life of poverty for them and their children...
 

Thought #4
One of the most ill-advised comments I've heard recently:  On the Today show last week, when Williard Scott was doing the weather and found out there was a group of high schoolers on a college-search filed trip to New York, he said, "This is your country, too."  Um, yeah.  I was rolling my eyes with the woman who was chauffering the trip.  So, the USA belongs to fat, ignorant white people, huh?  Okay.  Got it.
 

Thought #5
Biloxi, MO has installed continuous surveillance cameras in all the rooms of their schools.  Hmmm... sound familiar?  Like Minority Report?  Or "The Eye"?  Or even 1984?
 

Thought #6
Okay, getting all these asian/chinese/oriental comments are really getting on my nerves.  Went to a Bible study today... one woman asked me if I knew Andy Lee who used to go to her church... note -- he is the only Asian of all the MCO students who go there... and then one guy busts out with 'oriental' and 'chinese baptists' and how asians end up in med schools around the country b/c it's so tough in CA.... I really tried to be patient... I tried pointing out that it's not just asians, but ALL californians that have to apply out of state for med school... he didn't get the point.  Holy s***....  I don't know how to talk to people like that... I swear I want to yell at them, "Are you a f***ing idiot?!  Don't you realize that I'm not the same f***ing cookie-cutter asian you seem to believe we all are... and that every asian in the whole f***ing country isn't my cousin or best friend just because I happen to have similiar color hair and skin?!"  Yeah, that probably ruined a perfectly decent Bible study.
 

August 10, 2003

L -- if it wasn't nasty enough... you bastard... ha

Tomorrow starts my last week of family medicine... thank goodness, sometimes I feel like bashing my head against the walls I'm so bored.  Good grief, I was super-excited when my resident asked if I wanted to dictate... you know you've hit bottom when you're jumping at the chance to do scut-work.  pitiful.

I've realized over the past couple weeks that I'm running around with a chip on my shoulder.  I really, really want to do well this year... it's affected me to the point that I've been trying to study like a fiend... and been ducking out on outings early... so sad.  partially because I want to get into a good program and not have to settle for somewhere like... Peoria... and partially b/c I feel like I need to prove something to myself after a troubling 2nd year...  Whether this is a healthy attitude or not, I figure I might as well take advantage of the motivation while I have it.

I did make time to go to the annual Toledo Rib-Off..... lots of tasty ribs.... lots of BMI-challenged people... lots of mullets... ha ha

Final thoughts on this rotation:
Family Medicine -- I can appreciate its qualities, but I think I'd go insane
Pediatrics -- It'd be great if I didn't have to talk to the parents
OB/Gyn -- no
 

August 6, 2003

More 'firsts'...
a) first abnormal breast exam... likely fibroadenoma..........  not mine!  a pt's!
b) first rejection of the year?  you decide:  asked a visiting student who's rotating at WWKnight with me if she wanted to go grab some dinner after clinic hours.  She said she had to head back to her school straight away b/c she has lecture all-day Thurs + Fri and is in a friend's wedding this weekend.  convenient excuse or unfortunate coincidence?
c) first major problem with Quantum Rose. although I said I've enjoyed the romantic storyline, the occasional, playful bantering between the two characters does get a bit nauseating after a while...
d) first IRB approved or rejected research project.  Who knows?  They gave me a deadline yesterday less than a week's warning for some pithy, poorly communicated deficiencies in my application.  Obviously, I've heard no response to either my not-so-polite request for an extension or to my submission of materials Monday.  The IRB is a big pain in the a**.  You would think one of their goals would be to encourage students to engage in independent research projects instead of stifling them.

Here's something odd -- I dreamt about one of my old roommates last night... this was a guy I considered him one of my best friends through college, before he dropped off the face of the planet.  We were traveling separately, but met up while following the Tour de France.  Can't remember specifics... just vague impressions... like I was worried about his personal well-being... strange.
 

August 4, 2003

Um, you may want to skip this sentence if you're squeemish -- today was significant b/c I did my first Pap smear.  uh, I'm not particularly thrilled about it, but it's one of those 'firsts' that are somewhat important, I guess.......

Current Rotation: Family Med at  WWKnight at Toledo Hospital
Best thing about this rotation:  lots of teaching, pretty laid back attendings and residents, got a couple DO's too -- neat to see their work, good free lunches
Worst thing about this rotation:  it's still family medicine
Current Attending MD: Bodi, Kergen, Lewis, Matus, Roby
Current Resident MD: Beirise, Bodie, Murphy
How I know my attending loves me:
    Me:  "... and she denies costo-vertebral tenderness..."
    Dr. Lewis:  "I love it when you talk dirty."
How I know I'm in med school:  I realized that I'm playing the game already...  B/c I want to go into Emergency Med and it's pretty darn competitive, I REALLY need to do well during clinicals since my grades slipped 2nd year due to, in large part, external circumstances.  So, I've realized that I'm actually trying pretty hard to be enthusiastic, ask intelligent questions (who knows if I'm getting anywhere with that), try not to look *too* foolish, be social with people, make zebra diagnoses (peroneal nerve causalgia -- I told the Dr. Matus to tell me if my shot in the dark is right)........  I have mixed feelings about all this.  It's really not my personality to try to be visible and suck up.  I'm much more used to passive learning, Asian self-deprication (think I spelled that wrong), and general introversion.  But, at the same time, I kind of have to reverse my social and academic tendencies and do these things (to a reasonable degree).  Talking with Melissa, she told me that she was pretty uncomfortable with playing the game as well, but then realized that it's really nothing that we can avoid if we really want to be successful... it continues through med school with residents and attendings... through residency with chief residents and attendings... through our jobs with attendings of greater seniority and clout... etc etc...  Oh well.  Guess I'm getting resigned to it...

Biggest gripe:  I still haven't had the motivation to go yard-sale searching for a dining room set.
Best thing to happen to me recently:  Foodtown, a local grocery chain, closed -- so one of their stores (that wasn't acquired by a competitor) sold everything for 50% off.  I was too late to get tp, detergent, or contact lens cleaner, but was able to stock up on survival food... ie frozen food, granola bars, ensure, etc

Next meaningful leisure activity:  Huh?
Current Bible study topic: Still Romans 12... Brian's hiking and climbing Mt. Whitney for the next week and a half.
Current books I'm reading:  Quantum Rose (Ch22),  Grace Unknown (still haven't started)
My opinion:  QR -- the pleasant surprise has continued..  One of the primary themes is essentially the Star Trek Primary Directive of noninterference.  Overall, it's been an entertaining read.  And, I'll admit, I've enjoyed the romantic storyline... so sad.  I suppose there really is a bit of Freddy Hill in me... so sad, so sad...
Deepest thought recently:  Although I will encounter stupid people doing stupid things to themselves (see July 30 entry) in all areas of medicine, the difference will be the inherent dynamics of our patient-physician relationship.  Specifically, in emergency medicine, my relationships will generally be brief and transient (besides the frequent-flyers).  My responsibility to those patients, as well, will be brief and transient... In contrast, to be in family medicine, I would have long-term relationships with my patients, that will also have a certain degree of personal relation...  When I try to imagine beating dead horses and watching patients I've known for 10+ years do the same stupid stuff despite my efforts... I think I'd feel like throwing myself (or the patient) out the window.....  While I recognize and appreciate the importance and unique influence of family physicians, I just don't think I have the patience and motivation to be one...
 

July 30, 2003

Sometimes my days at clinic have certain themes, such as "look,-lots-of-leg-edema--day", "everyone's-got-some-peripheral-nerve-injury--day", "good-grief-why-does-everyone-who-has-hypertension-and-diabetes-have-to-get-checked-up-on-the-same-day--day", etc.  Today was "STD-pregnancy--day."  We saw a 21 year-old girl who didn't know she was pregnant until the 9th week.  Saw a 24 yo who contracted Trichomonas and Gardenella from her boyfriend of 4 months (although the Trich seemed pretty happy floating around on the wet-prep).  The most disturbing was a 12 yo girl who came in with her 20 yo sister, with the express consent of their mother, to inquiry about and get contraceptives.

As much as I realized that I would be in a position to counsel, support, and treat persons with different moral values than mine, it was still unnerving to be in the position of helping a 12 yo KID get contraceptives...  I have no illusions about the sexual permissiveness of our culture, however, it still stunk of irresponsibility and stupidity.  And, it was perhaps more disturbing to realize that I, in the position of the resident physician I was following, would have made the same recommendations and been willing to prescribe those contraceptives and, thus, condone to a certain degree social behavior that I disapprove of in a moral terms as well as from a medical standpoint.  At this point in my life, personally, it comes down to this:  I would rather strongly encourage and take measures to ensure that my patients protect themselves and their potential fetuses from the repercussions of their sexual behavior than totally shun them, and thus, allow even more severe consequences (eg abortion, child neglect or abandonment, HIV) to occur from their likely inevitable life choices.

The personal admonishment of this experience is this:  As a future father, it is essential that I actively teach and train my children to know the emotional, physical, and spiritual consequences of sexual intercourse, to cherish and protect their sexuality, to have high personal self-esteem, and to be proactive in self-protection and seeking advice.  But, of the most critical importance is to teach my son(s) to be respectful of women.  Since men, typically, just do not understand or have to deal with the gravest consequences of intercourse and are often the direct cause of many of these consequences, it is of even greater importance that I teach my son(s) to make wise choices and take his responsibility as a male most seriously... <sigh> quite a weighty and difficult task...  In the future, I hope and pray that I do my best in this aspect of my blessed duty as a father.
 
 

July 27, 2003

This afternoon my family and I found out that my brother Terence proposed to his girlfriend Elaine yesterday afternoon.  Oh, and she said 'yes'.  ha ha   Cheers to you from Toledo!  See, even Lance Armstrong is toasting you!
  1)  that's how I feel... Lewis after losing to Brazil  2) Convey's winning goal against Costa Rica

July 26, 2003

On Thursday, the US lost its semifinal CONCACAF Gold Cup (North, Central, and South American yearly version of the World Cup) match to Brazil... Up 1-0 leading to the 86th minute, the US yielded the tying goal... and 10 minutes into overtime, gave up the winning goal on a penalty shot.  I only saw highlights on SportsCenter (if only I had Univision!) -- Keller, the US goalkeeper, made a lot of great saves... and, he nearly stopped the first goal, even though he had fallen to the ground after stopping the initial shot and was the only white shirt surrounded by a pack of 3-4 Brazilian players.  On the penalty shot, he just guessed wrong... c'est la vie.  The US won the 3rd place match 3-2 against Costa Rica today, though.

Lance Armstrong won the last time trial today of the Tour de France.  His only competition, Jan Ulrich, could have made it really close, but wiped out on a turn which, in turn, wiped out (ha ha  corny play on words) any chance of him making up the 60-some seconds he was behind.  He will be only the second person, besides Miguel Indurain, to win the Tour FIVE years in a row.  If he wins next year, he will be the ONLY person to have won the Tour six times.  He is already arguably the greatest cyclist in history, the argument may be over next year.  CBS will have Tour highlights Sunday at 200pm ET.

So I went shopping yesterday -- spurred by the realization that I diid not have a single belt that matched my Florsheim shoes!!!!  Quite appalling, actually, that I would allow such a fashion faux pas to persist... I found a belt, only to be faced by a new frustration -- I really wanted a yellow tie, but couldn't find any that I liked AND were within my meager budget.  Truly, these are the trials in life that either build our character or sink us into despair.  ha ha

Current Rotation: To start at WWKnight on Monday
How I know I'm in med school:  When asked whether my ties could be "fun" or should be "conservative" as a medical student by a salesperson at Tinkor's (kind of a Men's Wearhouse I suppose), I replied:  "Well, would you rather your doctor be 'fun' or 'conservative'?"  ah, so sad.

Biggest gripe:  Couldn't go to the Glasgow Celtic v Boca Juniors exhibition soccer match in Cleveland yesterday.  stinker.
Best thing to happen to me recently:  My A/C still works after a month!  It almost redeems my opinion of it after all the car problems I've had this past year.

Next meaningful leisure activity:  Went to a Toledo Mud Hens' (Detroit's AAA baseball affiliate) game tonight with a bunch of random people from church.
Current Bible study topic: Romans 12
My opinion:  12:1 is much more meaningful now that I better understand the "God's mercy" that Paul spent 11 chapters expounding upon.
Current books I'm reading:  Every Man's Battle (almost done), Grace Unknown (haven't started), Quantum Rose (CH6)
My opinion:  QR -- although my masculinity was threatenned by the PINK ROSE on the cover and the endorsement by the ROMANTIC READER magazine on the inside cover, I've been pleasantly surprised by this Nebula Award Winner (2000 I think).  The prose is good.  The dialogue and action is fluid.  I've been most impressed with the portrayal of a society's understanding of artifacts from a much more technologically sophisticated society.
Deepest thought recently: Although MATT 5:23-24 and ROM 12:18 have admonished me, I've sometimes wondered why I ever bothered considering reconciliation with my ex...  even after over a year and a half.  If nothing else, it's at least been a clear illustration of the foolishness-wisdom concept (1COR 1:18-25 not a precise application, though).  Furthermore, reflecting on broken relationships, my fall-out with my former roommate comes to mind as well.  That makes me wonder how much offense and hurt in relationships is simply due to 1) misunderstanding due to personal or cultural differences, 2) selfishness and pride, and 3) ineffective communication.  But, to ease any worry that I still dwell inappropriately on these things, I've "closed the books" on both of these relationships after doing my best to live out those Scriptural principles.
Political thought of the day:  No guesses on how this Iraq thing will turn out, even with getting Saddam's sons.  How long do you think the American public can stomach losing 1-2 of its boys each day?  I gave up predicting these things when I was dead wrong about Afganistan -- I thought Afg was going to be the security headache that Iraq has become.  I can hardly believe I'm saying this, but to some extent, I hope Bush is reelected so that US foreign policy will at least remain idealologically consistent.  It's certainly better than Clinton's seemingly haphazard foreign policy.
 
 

July 23, 2003

Tyler Hamilton won Stage 16 of the Tour de France this afternoon.  Lance Armstrong will win his 5th straight Tour and is one of the greatest athletes of our time.  But, Tyler Hamilton (currently 5th in the standings) deserves laud for racing the ENTIRE (minus the 1st stage) 2003 Tour de France with a compound fracture of his right collarbone.  Racing in sharp, sheering shoulder pain for up to 6 hours each day for nearly a MONTH!  Absolutely amazing... although his 2-3 hour massage after each stage must be nice.  ha ha

How do I have time to write about random stuff like this?  I just finished about 2 1/2 hours of work on a research project and need a freakin' break!  ugg!
 

July 22, 2003

Today was my last day with Dr. Figy (yes it's only tuesday ha ha).  He's taking a vacation starting a couple hours ago.  So....... my one take-home lesson from spending time with Dr. Figy is that no matter how unflattering my opinion of a patient may be, it is truly possible to treat them with dignity and respect... Dr. Figy complained about a lot of his patients, but he, seemingly, gave away none of his true feelings about the patient while seeing them. He was stern with some patients, to be sure, but never, ever appeared to be condescending.  QUITE impressive.  It's still a formidable goal considering the cynical culture of medicine and my interest in emergency medicine, but it gives some hope.

well... here goes five straight days of studying my butt off... gotta get in the time before I start at WWKnight (Toledo Hosp's family pract clinic) next week.  whee!
 

July 21, 2003

Without going into details inappropriate for a publically accessible website, I "closed the books" regarding my relationship with my ex in a tangible way.  Who knows what will come of these events?  Maybe nothing, which wouldn't be so bad.  Hopefully, God will bless the both of us through my grudgingly performed act of obedience to Him.

How I know my doc loves me:  "Don't even _think_ about going in to see [insert patient name].  She'll eat you up and spit you out."  "I'll see [insert patient name].  I wouldn't make you see [name].  I'm not that cruel."
pics from my last fun trip for a while... Machu Picchu, Peru

July 19, 2003

Like always, I'm stealing good ideas from other people.  So, thanks to Lucas and Dorothy for inspiring me by envy.  I doubt I will be able to match Lucas' wit or the depth and meaningfulness of Dorothy's thoughts, but I figure this is a good way to keep people updated on my life as it quickly becomes emersed into the life-sucking bog of med school rotations... the 80+ hr work weeks are soon to come!

Current Rotation:  Family Medicine (7/7 to 8/15)
Best thing about this rotation:  working 6 days during my first 3 weeks -- woo-hoo!  hey, don't blame me that we have lectures Fridays, my doc has Weds off, and we had two days of orientation.
Worst thing about this rotation:  Family med is pretty darn boring... same old stuff all the time.  Besides that, unless you run your own private practice, you really can't practice family medicine like it should be (eg My doc has 15 min, AT MOST, to spend per patient).
Current Attending MD:  Dr. Rex Figy
Funniest thing about my attending:  besides his generally amusing sarcasm and grumbling, he took a 12-hr ER shift _just_ to avoid a party his wife was hosting.  ha ha
How I know I'm in med school:  My choices for activities Sat night are 1) studying and 2) shadowing Dr. Figy as he works a shift at St. Luke's ER

Biggest gripe:  being repeatedly mistaken for one of my maybe half-dozen Asian American classmates by patients and OTHER STUDENTS!  three times in the last two weeks.  come on, guys!  I know there's like two billion East Asians in the world, but it's really not THAT tough to tell us apart... sheesh.  So far, I've been mistaken for Mike Chan, Andy Peng, and Andy Lee.  If you knew them, you'd know I look NOTHING like any of them........ good grief.
Best thing to happen to me recently:  got the A/C in my car to work for the first time in the 5 years I've had it

Next meaningful leisure activity:  None.  Wasn't able to get tics to either the Glasgow Celtic v Boca Juniors exhibition match in cleveland or the Womens' World Cup matches in columbus. What a stinker.
Current Bible study topic:  Romans 11
My opinion:  pretty difficult
Current books I'm reading:  Every Man's Battle Ch11 (Arterburn and Stoeker), Grace Unknown (Sproul), Quantum Rose (Asaro)
My opinion:  EMB -- impressed by the frank testimonies of the authors.  unimpressed by the largely unoriginal reasoning and postulations.  good and friendly use of social psychology and behavior modification.  most directly applicable to married men.
Deepest thought recently:  The development of our complexity and maturity of thought in specific disciplines (eg theology and medicine) mimics, although imprecisely, the process of cognitive development in children.  Aristotle's theory of cognitive development (if I remember correctly) describes a progression from concrete (facts, forget the term) to abstract (dialectic) to persuasion (rhetoric).  Many martial arts apply similiar principles by teaching forms first before applying them and finally, integration and improvisation.
Political thought of the day:  Tony Blair is an exceptionally gifted statesman and politician.  It's too bad this Iraq thing will probably destroy the rest of his career.