“do not let my emotional change affect the treatment plan for my child”

i knew i did not want to do pediatrics because it’s commonly cited as “veterinarian medicine” – that is, the children below a certain age cannot tell you what they want and you’re often dealing more with the parents than anything. but rule number one of peds is to address the parent’s concerns always because this will really dictate how the visit and the relationship is going to go.

this particular parent’s child has been in the hospital for almost a month now. a wound dehiscence lead to an infection, now with a wound vac and biweekly changes and multiple abscesses leading to multiple drains.. all in the setting of a crohn’s flare and significant malnutrition.

to see your child in so much pain is hard. how does one not take her emotions into account? how does one not give a tad bit more propofol to keep him adequately sedated while changing his wound vac and taking out his drains? how does one not stand next to his bed and hold his hand in yours on one side and his moms in the other? how does her mental fatigue and anguish not push your harder to make sure all bases are covered and no stone left unturned?

i let your emotional affect my plan mom, because it teaches me that beyond the tubes, drains, lines, lies your son.
your emotions is what cements the humanity in medicine.

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12 year old girl history of crohns presents with cachexia and malnourishment and RLQ pain, now pending surgery for persistent abscess and multiple fistular communications.

hospital day 22.
TPN on full blast.
i can trace her veins under her pale skin
her pelvic girdle looks like a porcelain bowl
delicate with coating of subcutaneous fat
anorexia? no
more poverty and excruciating pain that overrides ghrelin
socio circumstances that ruin nature’s work of art
leaving a beautiful masterpiece in ruins

surgery is not as fragile as her body
the hands inside cavities, pus, bile
there is no surgery if there is no blood
intestines clinging to abdominal wall like cobwebs on forgotten homes
you darling, are not a memory however.
i see you despite your fear of what’s to come
and fear of what’s at home
the irony in “there is nothing to be scared of”
is the nothingness that made up fridge everyday
and i will make sure that your soul is replenished
with suckers, popsicles, and lollipops
because we were made for this.

the resilience of children is amazing. pediatrics inpatient. a presumed cdiff diagnosis (one positive cdiff diagnosis, treated with abx, recurrent diarrhea) quarantined a 8 year old boy to his room for 5 days – two negative pcrs later and there’s this smells like cdiff looks like cdiff rumor that continues to keep him isolated and touched through gloves on yellow gowned staff.

freedom? “i’m outta here!” as he did 14 laps around the floor, attached to fluids and antibiotics on a pole but damn if that will will slow him down. road runner indeed. he attacks the santa figure and says he has skinny legs like santa. pops his head over the counter and waves to the nurses. comes up to my room window and pushes his face on it.

freedom. unchained. showing the world magic tricks. the world needs more freedom.

stubborn goats

With frustration, I learn to practice acceptance and compromise.

Context:
I chose medicine not for fame and fortune. Sure it crossed my mind several times that it would be a financially secure career path, but only in the setting of a strong desire to take care of my parents when they are older. Anything above that is cherry on top.

So when I meet/work/come across people that blatantly tell me that their primary goal in medicine is having power and influence through the development of specialized knowledge, it is jarring. I understand the important of legacy…after all, I work with patients on a daily basis in which when their health turns south, hospice talks can consist of what we desire to leave behind. However, when this goal is combined with domineering phrases and minirants about how having knowledge puts you at an advantage over others, it’s a bit uncomfortable to me. I think it’s just worrisome to me to think of physicians (or soon to be physicians) that seem to crave the power dynamics of the medical world. I’ve never been one to back down from an argument but I also know when to step back to try and understand where someone is coming from. That’s just who they are.

Nonetheless, stubbornness is different than perseverance and I hope that people realize that the beauty of medicine is that you will never know everything and you’ll always be learning. And that’s why I love it.

cyclic thoughts in primary care clinic

A repeat patient in clinic reminded me of how much I enjoy continuity. That sense of familiarity that comes with seeing a person, getting to know what their issues are, and then seeing your recommendations take effect. Not only do we touch base on health concerns, but life events too. Did you end up enrolling in those math classes? Are you still staying with your friends? I enjoy learning the details of a person’s life that makes them who they are. My initial draw into medicine was for the stories.

However, the back of my mind rings with frustration. I am given half an hour with my patients, more than most primary care clinics offer to their physicians. The VA system is generous that way. 30 minutes to combed through health problems lists long, yet each one so important. But there’s an understanding that this is “med student” clinic. The exception rather than the norm. In the real world, I’d be working with 10/15/20 minute time slots and piles of insurance forms. How realistic is my experience here? How cynical have I gotten…

“Internal medicine is intellectual masturbation”, one of my physician mentors told me today.

A crude but accurate terminology that lets me reflect on why Internal Medicine has been such a fascinating specialty to me. My inpatient internal medicine experience can be sold as the “core” of medicine easily. Patient gets really sick, they go to the hospital where if they get admitted, they see a team that closely manages their care, they get better (finger’s crossed), and then they leave. The doctors that help them in the hospital that they see the most? Internists. But when a person thinks of medicine at it’s root, is it the internist we think of? Or the family physicians that are reliable, dependable, and….there through thick and thin. Front line of defense. Right?

I struggle with where my passions lies and as I go through with third year, I am utterly swayed by every specialty I come across. I loved loved loved surgery. The operations! The technical skill! I loved loved loved internal medicine. The complexity! The management and detective work!

Now what?
Who am I?
What do I do?

As I continue learning medicine, I guess I’ll learn more about myself.

I’m writing my personal statement for Surgery and I wrote this paragraph. I took it out because I’m already in medicine and should be focused on why surgery instead but I thought it’d be a good post here for future’s sake 🙂

Act I. During college, I wanted a career that was not only highly dynamic and intellectually challenging, but also allowed me to serve every population I came across. I harbored an innate desire to reach across cultural barriers and build trust with someone whilst working toward a common goal: their health. This most likely developed from my upbringing. As a child of immigrant parents, I understand the complexity of cross-cultural care and the barriers that often arise between patient and physician. I knew I could make a difference with my cultural and bilingual background. Medicine ended up being a field that satisfied my thirst for knowledge, my dedication to service, and my love for the intricacies of the human body.