PNR voting!!

I really like Meljean Brooks. and Nalini Singh. But have to say, Meljean hasn't gotten the publicity she deserves. This is also a shameless bid to win an ipad2 as well.

Where are you from?

I'd bristle whenever I heard that question. My answer was always a drawn out, Chicago IL, while I pointedly stared at the offenders and dared them to question me even further.

No.. (indulging smile) you know what I mean, where are you really from?

Making me admit my ethnicity was like pulling teeth. I prefer the direct, "What are you?" approach then the "Where are you from?" which implies that I'm still considered an outsider.

But, this year, I've stopped caring. Part of it was the boyfriend who's also Asian-American and who's never been bothered by the question himself. Most of it was that during interview season, my most hated phrase was the one question you could count on being asked by every applicant at least once.

I asked it myself more times than I could count. And ethnicity was the farthest from our minds. We wanted to know about which medical schools we were from and the places we called home. When we talked about programs, I was part of a new group, the American Medical Graduates. I was an "us" and the International Medical Graduates were the "them." And it felt good.

When I came home, I ran into an Asian-American MS2 on the streets. We started talking about food and he mentioned Chinatown.

Curious, I asked him, "Where are you from?" He look shocked. He spluttered. I could see his mind trying to wrap around the fact that another Asian-American, someone who should understand, was making him feel like he didn't belong.

I clarified, "I mean, are you like from California? Because Chicago's Asian food is pretty good, but Californian Asian food is probably a lot better."

I felt pretty good about myself. I had moved on. I was now just plain American and clearly this MS2 still had some ways to go before he could put together his fractured self-identity into something whole.

Then today, when I was purchasing the green book at the bookstore, the clerk asked me, "Where are you from?" I answered automatically, "Hometown, IL."

"haha no seriously, I mean, like where are you from?" I could literally hear the bubble burst. I felt like I was back at square one. But now that I think about, I've probably moved a few steps forward.

Since the Chinese Exclusion Act was repealed only in 1965, Asians are a new immigrant population. It might take a couple generations before we're considered an integral part of the whole. But, I have hope because while there are a lot of people who still consider me foreign, I've met a lot of other people who already consider me part of that whole. And when I automatically answered "Hometown, IL" instead of raising my hackles, I realized I considered myself part of that whole too.

Ohio State bitches!

oh my god. Is it 1130 yet???

Empathy is a joke.

The ability to truly understand another human being, whether in joys or ills, is humanly impossible. In fact, outside of our own close family and friends, other human beings are simply not real people.

My perspective on empathy changed when I became a patient myself a couple years back. Before undergoing a vascular Interventional Radiology procedure, I remember the fellow asked me if I wanted pain medications or not. Since she reassured me that there should be very little pain, I politely declined any analgesics. But when the fellow started to forcefully push the stiff catheter device into my arm, I had to stop the procedure. No pain?? This was fucking pain. Sharp, agonizing pain. I cried and I was embarrassed. and then I asked for some real pain meds.

The next time I went to IR again, I had a different fellow. I asked him to wait a few more seconds after numbing the catheter insertion site with lidocaine before proceeding. His impatience and frustration was obvious. Even though he "understood" the pain I would soon experience, finishing the procedure was a higher priority. I wasn't a real person to him. He waited a few more seconds than what was probably usual for him, and started anyway amidst my weak protests.

And then, I started to realize that the problem with empathy is not isolated to medical professionals and their patients. It's rampant, and it's everywhere. I've even blogged about it before.

Inability to empathize is why we can talk shit about each other. It's why we can conduct heinous acts of violence/racist crimes against each other. Because, even though we know that our victims are human beings, until we've been in their shoes, they are not real persons. We've all got a little antisocial personality disorder in us.

I've brought up my theories to friends/families and at first, there is reluctance to agree with me. People like to think of themselves as nice. That if they saw suffering of any sort, they would be able to relate and help in some way. But frankly, if we were able to empathize with the world, we would be frozen in terror and grief while we truly comprehended the effects of natural disasters and human tragedies.

Empathy really is a joke. And that's a good thing. It allows us to function when the rest of the world might be falling apart. Understanding the truth behind empathy can even make you a better sympathizer. People can tell when you're bullshitting, even if you can't yourself. But, when you realize your own limits, others start to appreciate that you do care, even if you still can't honestly relate.

And also, when more of us start to realize that it's so easy to hurt others because we view non family/friend peoples as objects instead of persons, the world might even become a better place.

Today I really regretted taking Claritin-D.

For most of my life, I have suffered from a nonrelenting case of allergic rhinitis. I have never been able to breathe through my nose. My sense of smell was shot and my sense of taste wasn't far behind. I remember as a kid being ridiculed when I brought my nasal spray to school in my lunch box. My mom also used to mercilessly tease me by asking me what I thought about her soups and when my answers were always a disappointingly, "I don't know," she'd scoff in my face and say, "Why did I even ask? You could eat dog $%@# and it would still taste the same!" (obvious exaggeration)

At the same time, there were some benefits. Whenever we went camping, I could tolerate outhouses for longer. During anatomy, I could dissect into the GI system without blinking an eye. When I visited a neighbor's house in Paraguay and they offered pig skin soup with the bristle still attached, I chewed the furry mess and was honestly able to say that it was a good meal.

But then I discovered Claritin-D and my world changed. I could breathe! I could smell! I could taste! It was amazing. It was a miracle. Did you know that flowers actually smell sweet? All this time, I never understood why people would stuff their noses in bouquets and sigh in bliss. Now I know. I became addicted to experiencing the world through my missing fifth sense. I gladly endured the daily pseudoephedrine inspired headaches and palpitations. I looked forward to the withdrawal fatigues and depression because I knew that the next day would be filled with exciting and wonderful fragrances.

But little by little, I've started to wonder if my new olfactory world may have some draw backs. The streets of Chicago have become more pungent than I remember. and the subways and buses are definitely more aromatic.

And today, after performing my first real drainage of an abscess pilonidal style, I discovered the smell of bodily fluids. and it stinks. At first, cleaning the abscess out was satisfying. There's nothing like squeezing out the badness from the skin and knowing that the patient was going to feel a lot better afterwards. But then it hit me. The smell. The disgusting, putrid smell of anaerobes gone wild. It was horrifying. I gagged a little into my mouth. While I kept a straight face and kept expressing the badness now with a completely new dimension of badness, I thought longingly back to the days where I could have remained blissfully ignorant of the foul odors that now surrounded me.

But then I ended my shift and came back home. And realized I still really loved breathing. And maybe the world didn't smell quite as bad as I thought. Now all I have to figure out is how to obtain a 30-day supply of my heavily regulated miracle drug without a prescription before I leave the country in two weeks. all in a perfectly legal way. i promise.

If you died, do you want us to bring you back?

Yesterday was my first day on the trauma team at the ED. Around 8 am, we received a call that a 60-something year old man had had a witnessed cardiac arrest and the ambulance was already on its way.

We gathered in trauma bay 1 for the arrival and I started shivering. It was freezing and the adrenaline was pumping. This was my first real code. As we waited, our attending took us through different diagnoses, how the code would set up, who would do what, etc. My student partner and I looked at her with hopeful expressions. Yes! we were assigned to chest compressions.

The ambulance pulled into the bay and soon the EMT's quickly walked in and rolled the patient into the room. They weren't doing chest compressions. I blinked. I expected to see someone sitting on top of the patient, precariously balanced on the gurney, giving him frantic chest compressions and shouting, "Come on, damn it! Come back to us!!" Was the patient already gone?

We shoved the overweight white male onto the table. and it was momentary chaos. the patient wasn't all the way onto the table. no one knew how to detach the EMT's ambu bag to check his airway. the iv's were going in. chest pads were being placed. we still couldn't see the airway. then my resident yelled out,

Start chest compressions!

We formed an organized line and got to work. Someone joked that maybe tonight we would break the 96 minute record set in Minnesota where someone actually made it.

My turn was quickly up. I stepped up on the stool and put my right hand over my left with my elbows locked and started singing staying alive in my head. It was hard. Really hard. My arms and abs were burning and my calves were cramping. I had to tap out at a shameful 1 minute.

I couldn't believe I was so weak. The dummies were always so easy to resuscitate. Were my weak compressions killing the patient?

While waiting for my turn again, I hesitantly reached out and touched the patient's skin. He was warm. I was hopeful. Maybe we were breathing and pumping enough blood to keep him going.

My partner got him into VFib after the 4th cycle of CPR. We all cheered and shocked him a couple times. He went back into asystole. With each cycle, I was getting more and more confident of my chest compressive abilities. I was lasting the full 2 minutes. My compressions were fast enough and hard enough. But the patient kept getting cooler and cooler.

The patient stayed in asystole. My attending turned to all of us and asked, does anyone have any more ideas? we silently shook our heads. ..Does anyone have any objections? We shook our heads again. Time of death, 8:59 am.

The patient wasn't coming back. I snapped off my gloves. Poor guy, he probably never had a chance. He'd been popping nitrates all weekend. He had a history of congestive heart failure. He probably wouldn't have made it even if the ambulance was right there when he collapsed. But at least we did something. We didn't save him, but we tried. and I actually helped.

We left the room to get our coats and I saw a quiet older woman with a strained, pale face staring at us while we filed out. I froze. It was the coworker who had called 911. Did she know? How could she not know? She was sitting right outside.

I kept staring at her. Slow seconds passed. One of the attendings came out and bent down with a hand on her shoulder.

"I'm sorry"

She started crying. Large wailing cries of grief and denial. And I suddenly realized, this man is really dead. He's not coming back. We didn't accomplish anything. He was dead dead.

My attending took us students aside to help us sort our feelings. She was crying a little herself. We talked about the morbid excitement and feeling of accomplishment. Feeling the patient getting cooler and his face get more purple. The moment when you realize the patient wasn't coming back. The moment you realize that this patient was an actual person when you witness the grief from a friend/loved one/coworker. And then my attending took it farther and started talking about code status. She said you have to be honest.

It's not, if your heart stops, do you want us to do everything we can to help you? It's, if you die. if nature takes its course, and if you DIE. do you want us to bring you back? Don't fool yourself. The patient had been dead for 30 minutes before he arrived. He was not alive. He was not barely alive. He was dead. And we tried our best to resuscitate a dead man for another 30-40 minutes. He had been dead, and he stayed dead.

I'll never forget looking into an unresponsive face with eyes barely open that looked like he could wake up any moment. I'll never forget staring at the coworker in her chair, anxiously following our exits with denial in her eyes. I'll always remember this. Feeling like a hero. And a patient who was still dead.

Until society looks down on men who choose careers over families, more women than men will choose families over careers.

Women are different from men. There is no doubt that we are biologically different. And biology plays a large role in how we act.

Since women are the only gender that can get pregnant, naturally one can conclude that women should be the primary caretaker of their children.

I argue that women choose to be stay at home moms because society praises them for it. When I had to choose my medical specialty, I noticed that more females than males were discussing the conflicts between careers and families. In fact, I know of several female students who intentionally chose their medical specialty because they wanted to have a family. But why do women still have to choose between success in their careers and success in their families in the 21st century??

Obviously, the fact that fertility decreases dramatically after women turn 35 years old plays a huge part in our decision making. But, assuming the average age difference between married couples is 2 years, I would also assume a large proportion of single male students should also be worrying about having enough time to raise their children.

But they don't. Because society does not expect them to spend more than a couple hours each evening with their kids. Men work. Women raise kids. In fact, society looks down on females who choose careers over families. They are portrayed as the lonely workaholics who have little to show for their lives except for their careers.

If our culture looked down on males who choose careers over families, if we start calling all males who choose to pursue a highly competitive career Mr. Scrooges, men would spend more time with their families. And women could finally have equal opportunities for success.

I strongly believe that an equal proportion of genders/ethnicities/etc should be in an equal proportion of non-physically dominated successful positions such as ceo's/presidents/thursday night comedy stars/etc. That means an equal number of men should be able to become stay at home dads. An equal number of men should be expected to pursue careers that are more family friendly. And an equal number of men and women should be able to pursue careers that are less family freindly.

Women can succeed in formally considered "male-only" roles. Just look at physicians. 50 years ago, there were no women in the profession. Now each class is made up of 50% women. And surprisingly enough, the world has not ended. I would even argue that doctors have benefited from having another perspective since half of our patient population is incidentally female.

In fact, I really wish dads were expected/given the opportunity to spend as much time with their kids as moms. I love our moms. They are strong, wonderful women. But, who knows, maybe having a stronger dad perspective since half our children are males would benefit us in some way. At the least, I'm pretty sure the world won't end.

lady gaga's new music video.

cool.

it started off.. different.. but with potential for quirky fun. and then, see above.

i went through obgyn, but i'm still not okay with that whole birthing of good/evil graphicness. i know there's lots of references that are going over my head and it was probably well thought out and all that. seriously though, not what i want to see first thing in the morning.