Burn and Rave

I’m a distance runner.  Put me out on path by icy patches of Lake Michigan in the middle of winter, and I’ll go.  My white puffs of frozen breath keep a regular pace for at least eight miles.  But not even eight minutes into an indoor fitness class on it’s last day and I am defeated, marching in place and gasping for air while the girl next to me, who’s braved the last 10 classes, keeps jumping and hopping.

This was my second time in a fitness class.  When I use the gym, paid for by a mandatory university fee, I usually get on the elliptical or the stationary bike in the weight room, but a couple weeks ago, after years of posting up the schedule of free group fitness classes in my room, I decided to trade my old routine for an aerobics routine.  I attended an hour of step kickboxing which was intense, but manageable since I’ve taught dance aerobics before and dabbled in tae-bo.  Enter 45 minutes of the Super Circuit class, just a few days ago.  I don’t what it means, but sure sounds fun.

PUSH-UP POSITION! SQUAT! JUMP! TWENTY MORE TIMES!

After five, my pace slowed and my legs struggled.  After ten, lactic acid was spewing into my legs and I decided it would be better to march in place than to collapse.

PUSH-UP POSITION! LOWER IN FIVE!

Before the instructor counted an emphatic “ONE!” my body was already pressed to the floor having already advanced “five.”  Ahh, feels good to rest.

HEY!  IF SHE CAN DO IT, SO CAN YOU!

Oops.  My instructor peered at me between the columns that held up my foot-high step and caught sight of my cheating strategy.  And I realized that she was wrong.  The other girl can do it, but I can’t because I haven’t been training with these muscle groups and exercises all semester long.  I also realized that the last day of a fitness class was the wrong time to join because apparently the intensity accumulates and I was a weak link here.  That was a couple days ago and today I’m still leaking lactic acid in my legs, in my arms, and in my abs.  Maybe I should stick to running outdoors until the classes resume next semester.  Yes.  I’ll start running when I recover and am not crying “ouch” to every little turn of my body.

My dreams of being a surgeon began to bud last November when no cardiologist I emailed responded, leaving me to turn to cardiothoracic surgeons. In the summer I completed an 8-week internship rotating with the cardiothoracic surgery service at UIH and confirmed that I enjoyed the technical aspect of procedures as well as the pathophysiology of the diseases. Watching the patients heal from open heart surgery was incredible and fulfilling. Now after 8 weeks on general surgery, my eyes opened up to the many other fascinating surgical specialties such as minimally invasive gastrointestinal surgeries (including bariatric gastric bypass), plastics and burn, pediatrics, and surgical endocrinology. I even think I would enjoy general surgery enough to be satisfied choosing it as a career if I do not want to go into a fellowship after 5 years of residency. I dream of being a surgeon and of cutting people open to fix them.  And I dream of being a wise surgeon who knows when not to put people under the scapel.

But all my dreams smattered to pieces as the surgery shelf exam karate-chopped my never-had-a-chance-bum. Now, I think I need to drag my books with me to Florida where I’ll be vacationing with my parents for a week and a half. I want to study them so that I’ll be ready when my school informs me that I need to re-take the exam. But what can I study? There is really nothing I can do to prepare for the test. More surgical knowledge would not have helped me. More real-world knowledge could confuse me. And the pursuit of more medical knowledge would never end. I’m really not sure what I could have done differently to prepare for the shelf. I think a monkey filling out the circles on the answer sheet would score just as well.

I can do nothing but wait, suffer, and endure. Perhaps there is a point to this mayhem afterall, because I know that life as a surgeon is difficult and busy. My life will suffer. However, if the results of the surgery shelf point me away from surgery, I may actually have a chance at a decent lifestyle perhaps as a cardiologist or a rheumatologist.

“At the end of my suffering there was a door.”  ~The Wild Iris by Louise Gluck

The reason why I wanted to go into medicine is multi-faceted, but one of the reasons is that I didn’t think I would have to worry about money. I just take care of people and get paid enough to feed my family and to help others. I neither had any intuitive financial sense, nor did I bother developing my economic intelligence through college courses. How wrong I was! There’s a lot that goes into being a physician…. paying off medical school debt, budgeting with a scant residency salary, and then as an attending there’s paying rent for office space, paying for a secretary and medical assistants and nurses, paying malpractice (weep), paying professional society fees, maximizing efficiency of office visits, and perhaps much much more that my naieve mind has not conceived.

While I did finally figure out how to do my taxes, I’m not off to much of a good start. I had been writing articles for the school newspaper’s health section and was surprised when I got paid for them, not much, but still something I’m quite grateful to receive. The checks were inconveniently located in a campus a few miles away, and my schedule was always inconveniently full. I kept asking to get the checks via mail, but it took 6 months for the checks to be sent to my house. I did examine the checks to see if there was a deadline set for me to deposit them, but no such warning was apparent, unlike my checks from college that gave me ninety days.

I took my time and soon it was another six months before I finally made an effort to deposit them at the bank.  Apparently they expire after six months.  That’s almost $200 that expired.  Ooops.  My lack of aggression in financial matters seems to have caught up with me.   I hoped that my smooth communication skills might be able to save me.

I emailed the newspaper accountant apologizing for allowing the checks to expire and asking for the amount to be renewed and re-sent to me.  Afterall, I did make a sporadic effort to have the checks routed to my house.  I expected the worst, but two weeks later, the accountant worked his magic and I got both a $190 check and a very important lesson in financial responsibility.

When I was leaving the hospital today, a patient as his family and friends were standing outside, maybe waiting for a ride. As I walked by, I caught a segment of their conversation:

“This hospital is WORTHless and every who works in it is WORTHless too.”

I glared back wanting to give this fool a few pieces of my mind, but I held back my tongue. I looked away and just kept walking. My first reaction was that I felt really hurt. I work non-stop running from one patient room to another, from one building to another, to serve the healthcare of the patients in this hospital. I know it’s not glamorous. I am aware this is an inner city health facility operating on a limited budget. Many of the patients get free or government-sponsored healthc aid. I was mad at these fools who were demanding the best for free by just standing around and spitting out angry words. They are so blind.

I work with the doctors in this hospital, and even though the equipment might not always be the best, I know the doctors and the employees are the best. They are smart, talented, and caring. I was angry that these fools couldn’t and wouldn’t recognize that. They just cry out “give me give me give me” “and never say thank you.

But then I remembered the patients who did say thank you, and who did smile and show their appreciation. And then I realized what it meant to give and not expect anything in return.

Every day I’m in the hospital, I’m giving my all. Not just for a good grade, but also for the patient’s health care. I want the patients to recover, get better, and have their questions answered. The attendings and residents are very busy helping many patients, so if there is any part of the patient care that I can help with to make their jobs easier and to give them time to help other patients, then I am there to dig in 100%. I always will and I am starting to not expect any acknowledgement in return. Afterall, I’m just doing my share and I’m very happy to do so. When patients show gratitude, that’s a bonus of satisfaction. When they mouth off and have an attitude, they just don’t know. It’s all worthwhile to me.

With a two-week semi-vacation, I had time to catch my favorite TV show Law and Order.  A girl was kidnapped because her online avatar from a computer game called Another Youniverse resembed the former victim of a child molester.  Knowing that Law and Order story lines are thinly disguised real life head lines, I searched for the computer game.  It’s called Second Life.  It seems very intriguing to enter into a fantasy land where you can choose whatever name you want, whatever looks you want, and whatever activities you want.  I even thought about signing up to try it out.  Then I remembered that I don’t even have enough time to keep up with all my real world friends and finish all my real world tasks, much less have time for fantasy friends and hobbies.  Now, instead of dreaming about a neat, spotless home, I’m going to take baby steps and go clean my bathroom to make it beautiful.  Then dishes, and then work on my research project.  Instead of clicking through various body types for an custom avatar, I’m going to do some situps to custom tone my abs.  And as for fantasy…. I’ve always wanted to have time for piano and guitar, so might as well add that to my list.  And then there’s rock climbing.  In the computer game, I might have embarked on scaling Mt Rushmore, but I think for this week I’ll settle for the wall in my gym.  To me, that’s living the life, the real life… that makes your back sore after cleaning and makes your legs ache after a good climb.

when i first started medical school, i was convinced emergency medicine was the field for me, mainly attracted by the complaint of chest pain.  then i started to really like the heart in physiology and pathology classes, so by the beginning of my second year, i thought that cardiology might be for me.  that quickly chanced to cardiothoracic surgery.  i absolutely loved the operating room and watching the heart beat and stop as it went on bypass, and then resume activity at the end of the case.  i watched many cases in my free time and even got a scholarship to do an internship in cardiothoracic surgery as my first rotation in third year, approved by all my deans to count as a fourth year elective.  but as the title of the blog goes, some thing has changed.

this weekend, i went to go visit my friends in philadelphia.  friends i grew up with, aunties and uncles i looked up to for advice, and kids that i taught in church.  i realized how sheltered i have been in my last three years of medical school.  i have forgotten how enjoyable it is to take life easy - chat with the people i care about and listen to their stories, observe how they’ve changed, talk to them about future plans, hopes, and dreams.  i think that if i do surgery, i will be able to make enough time for my immediate family - kids, husband, parents.  but i’m not going to have time to keep in touch with my larger family circle - the people i care about.  i could care about them from afar, think about them, but i want to show them that i care about them through my actions - calls, cards, and visits.  that takes time.  time i won’t have as a surgeon.  but maybe time i’ll have as an emergency physician.  plus, the training is much much shorter.  as of right now, i think i would much rather sacrifice my ego and a fancy career.  i think i’d like to forego the privilege of watching and working on a beating heart so that i’ll have time to hug and listen to the hearts of my family and friends.

My neighbor’s daughter and another neighbor’s niece were playing together and they stopped to chit chat with me as I pulled in from biking and started to pump my tires.  Nicknames, Disney movies, birthdays… then they ask me my age.  And then they ask me if I’m married.  I’m not.  So the seven year old niece decides to give me some dating advice by telling me about an episode from a dating show and then concluding,

“So you need to find a man who loves you for who you are, and not some big-headed jerk.” 

I laughed so hard, that moment was definitely the highlight of my day, next to biking next to the park and smelling the fresh scent of trees.  Kids say the funniest things, and they often contain the undiluted truth. 

I am perfecting my philosophy of working hard and playing hard.  Having committed myself to a career as a physician, it really doesn’t matter what specialty I choose, the work will be demanding especially during my youth (my twenties and early thirties) as I slave away in residency for less than minimum wage per hour.  In order to stay competitive, please my superiors, read textbooks and articles, and deliver carefully and logically thought out care to patients, I have to work hard - long hours, little sleep, and constant action.  In order to stay sane, however, I will have to play hard as well.

Every moment I have free, I am going to do something I enjoy.  I will not hesitate to go to my favorite coffee shop (Caffe de Luca) or to go running or to take my bike downtown to ride by the lake.  I will not hesitate to watch movies with my friends or to fly away for the weekend when the plane ticket price is right.   No pondering the pros and cons, no cautious planning, I’ll save that for patient care.  But for my social life, I just go.  

Of course then there’s the mature side of life that I have to squeeze in between working hard and playing hard as well.  That’s eating well, helping my family to cook and clean, and spending time being with and keeping in touch with my family and friends - which is part of the playing, but I wouldn’t exactly consider such activities playing hard.

I wouldn’t consider this keeping life balanced on a tight rope, but more like bouncing between two parts of life by teeter-tottering on the seasaw.  At work, work’s all up, and play is down.  At play, work is down and play is revved up all the way!

The attending surgeon says jump.  I say how high.

My instructions from him for this weekend was to go play.  I said okay.

Even though I want to maximize my time at the hospital to maximize my learning experience, I am also learning to balance the work life and the family life.  I kind of had a wake up call when I didn’t see my dad or grandparents for two days despite the fact that we live together.  I left before they woke up.  They weren’t home by the time I went to sleep.  I realized that I need to rearrange my schedule a little.  Next Tuesday will be the ultimate test.  There’s a cardiac catheterization conference at the same time as a Ravinia concert that my family is going to.  Even though I enjoy going to the conferences to learn and to impress my cardiac surgeon attendings and mentors, I am going to turn down the conference this time.  At least that’s the plan.  I need to increase the amount of time I spend with my family.  

My route to the hospital is just straight down two roads.  No big deal right?  No more than 2 miles.  I can run five no problem now, and I’ve run way more in the past.  Biking two miles is a piece of cake! 

Nope.  I stand radically corrected.  The lactic acid really builds up on my legs.  I’m so happy when I get to a red light and when I stop, I’m gasping for air.

So I suck at biking, but I’m really looking forward to getting better.  I even mounted a lock bracket on my bike today so that I don’t have to carry the heavy lock in my bag.  (Today I almost fell over as my bag shifted on my back, putting my center of gravity very off center.)

I also wear a helmet.  Almost forgot that in the OR locker room today.  Had to go back and get it, bc it’s just totally uncool to not be protected like that.  And I am so cool that I was so happy to see an arrow on the inside of the helmet bc I couldn’t figure out which way was front and back.  Learn some thing new everyday.