The first life that slipped away

I saw someone die today

To be accurate, she died right under my hands as I was told to stop chest compression and she was pronounced dead.

A 14 year-old girl got hit by a bus as she was going to school.

I simply do not know how to react. I was about to break down when they were resuscitating her and realized that she might not make it – I saw her paper white feet when I first walked in and it hit me how bad things were. I guess seeing the big picture of her cut clothes, her blood-soaked head and her blank gaze brought on the gravity of the situation. But when I was doing the chest compression, as I looked back at forth between her face up close and the monitor, I was more worried than sad – probably because I was too occupied by the task at hand.

I left the trauma bay as the medical staff dispersed after she was pronounced dead. She was left on the stretcher, and I wish I had stayed to find out what happened to her after. Since the patient died, she was no longer a surgery patient and so we left, but who puts her away? Who informs her parents? Who takes her out of the trauma bay so that the next unfortunate human being can occupy that space? What happens to our patients after they are dead?

I did not cry after that red trauma – I went back to work with a heavy heart, but things went back to normal. As I was emailing my dad later in the day to wish him a happy father’s day, a tear drop trickled down my face, but no one saw it, and I did not know why I could only keep it together up until then. And even then, it was just a drop – seems so inadequate for what we lost, what I lost.

Later in the day she was on the local news. She was an honors student and had just parted with her mom shortly before she got hit by the bus to go to school. The bus driver has had traffic violations in the past and was nowhere to be found. Her family was crying.

I would never forget her face – her empty stare and blood-shot eyes, her left hand dangling off the stretcher gracing on my leg as I labored away to get her heart working. I would never forget her tiny little body and her cut bra straps, her paper-white feet and the blood weakly pulsating out of her nose as I looked at her for the last time before I walked away, her black straight hair in front of her forehead.

I found a news report of her online. I saw a picture of her prior to the trauma – I see the resemblance of the girl that I came to know, but the realities are so far apart that I don’t think I’ll be able to understand or imagine what she was like before today. To me, she will always be the girl we could not save - the girl that modern medicine could not save.

Written in October

I’m quite depressed…

Mostly because of the world and where it is heading of late…

The economy is in a slump worldwide, potentially because of the action of one man or the decisions of only one country, although I do hope that it takes more than one man for the world to collapse

Thailand is at a political impasse, because the supposedly-intelligent minority is so fixated on the hatred of one man that it is willing to undo years to democracy that my parents and our ancestors have fought for…

People seem to be meaner and ruder to each other, both on the national level and the personal level…

Why is it that human accomplishment is measured with a house and 2 cars, and why do the majority of us strive for such an arbitrary measure when they know it is unattainable for them?

Why is it that people pay tons of money to have a wedding, when that money can be put to better use, like paying for our children’s education, if not spent on others who need it more than we do?

Why must there be cakes at wedding? Why must brides wear white dresses? Why are wedding rings made of diamonds?

Because De Beers picked a random gem and said they are forever? Sounds like a lousy reason to allow for diamond-funded massacre in Africa.

Why are our decisions based on conformism, and not on reasons?

Why aren’t human life goals to help others, to help our own kind, to make a difference, to be missed when we are gone?

Aren’t these more sensible than wedding cakes?

What can we accomplish with making a million dollars before the age of 25? With living in a nice apartment on the Upper East Side? With a huge rock on the left ring finger?

With having a house and 2 cars?

The guy 2 doors down probably won’t even know we have it, and he definitely could not care less if it were gone.

This Christmas, I wish for a world where people are nicer to one another, because that would be the reasonable thing to do.

$700B blank check with a slap on the wrist

Supposedly, the politicians have reached a bailout plan that both parties can agree on. The bailout is still $700B but divided into small portions just so Paulson doesn't spend it all on a shopping spree. A lot of really smart people are supposedly watching over Paulson to make sure he doesn't mess up. CEOs of companies that participate in the bailout can't get more than $500,000 for salary (boo f-ing hoo), and since the government gets a stake in these companies, politicians automatically assume that taxpayers will benefit on the upside, even though as we have seen in history mostly the rich, who never really paid tax to begin with since all their taxes were cut, get benefit from the government when it gets lucky.

And all that was not even the biggest problem I have with this bailout. As some experts have said, the bubble broke a long time ago, since summer 2007, and since then Paulson and Bernanke (FED) have poured hundreds of BILLIONS of dollars into the market to encourage lending, WITHOUT SUCCESS. Somehow, I don't feel like this bailout will work either. And it won't be able to cover up the stench the drives investors away for very long, because this bailout addresses everything but the underlying hole in regulation that allowed this mess to happen in the first place. This is not the first time the finance world behaved irresponsibly and have the poor majority of America pay for it, and yet our government has not learned to prevent these calamities from happening. How long ago was Enron? Tyco? Worldcom? This bailout said NOTHING about coming down on predator lenders, about revising regulations on how securities should be rated, etc.

I think it is clear, as CNN reported (90 no: 1 yes), that most Americans oppose this bailout. True, the reported ratio was before the bailout was changed, but I, for one, still oppose this bailout even after all the extra conditions were added, because it doesn't fix the problem at its source and it is extremely expensive. Yet, supposedly this bailout will be passed tomorrow. I have sent many angry messages to congress even though I don't have a right to vote, and I don't know what to do at this point. I only wrote this note in the hope that you will entertain the point of view presented here and be cautious about what this bailout promises. And, of course, if you know a senator, I hope you will tell him/her to vote no.

The first presidential debate

First of all, I want to acknowledge that everyone is entitled to their own opinion on who won the debate. I don't think anyone has the authority to call it, and the only thing that really matters is which candidate, as a whole package, will win the election.

I felt like I was going into this debate biased, and I do feel that to the unknowing eye it may seem that McCain knows more about foreign policy, but I would definitely pick Obama as a leader in foreign policy. McCain may seem more confident and assertive to some, but to me he was rude - interrupting the moderator and Obama when it was not his turn. He was also condescending. Do you see the independent line dips down whenever McCain starts being derogatory? It's because it was rude and was not presidential-like. Imagine him saying that to other world leaders - how would they feel? I think Obama is definitely more suitable to be a leader, as shown by his character in the debate tonight. He was polite. He tried not to interrupt McCain until McCain got out of hand. He was humble enough to acknowledge someone when they are right, and even though McCain rudely repeated over and over again that "Obama doesn't understand," Obama never stooped to McCain's level. He was polite to McCain the whole debate. Even though such decency was not returned, Obama kept his integrity and never stooped to McCain's level. Now that is character.

McCain seemed stuck and stubborn like Bush and want to keep pouring resources into a war with a country that has nothing to do with us. The issue of the iraq war is just a stupid pride for McCain, who basically says I don't care what this war is all about, and even though we started it without a good reason, we have to keep plowing through to win it so we don't lose face. What Obama said is right - no mother should have to lose a son, no young man should be without a limb - enough is enough. We don't spend trillions of dollars and gazillion human limbs on stupid pride - we spend it for freedom, for safety, of the US and the world as a whole.

Many other points were touched on but basically experience is not everything. Experience can be provided to the president by advisors - that's what they are for. It is the judgment that matters, and I think Obama has way better judgment than McCain.

And threatening to not show up to the debate? It's like pulling out of a deal that both sides (along with the whole country) already agreed on. If McCain can't multitask and quit every time he's overwhelmed, he's not going to survive as a president.

And the cherry on top of a fantastic cake - Palin interview with Katie Couric: http://www.youtube.com/watch?v=Vbg6hF0nShQ

$700 billion blank check - the rich get away w/ it once again

I don't know the details of it, but I'm sure you guys have heard about the recent crashes of major banks due to irresponsible credit/loan issued to gain more returns for the CEOs when the economy was going well enough to conceal these practices. Now that the banks fall to pieces to reveal the greedy, irresponsible practices that go on, why is it that all the taxpayers in this country have to pay for all the money that a handful of people take, and why is it that these CEO bastards get to keep their riches after these banks declare bankruptcy?

With the way things are going, many of these practices will continue, because the CEOs know they get to keep all the profits and never have to pay for the losses.

Many people say bad economy only affects the financial sector - laypeople like us aren't really involved with what goes on in wall street or the fed. Well, this is exactly why what Bush does or what the fed decides to do affect all of us directly. If you haven't noticed the upgoing prices of commodities, this is another example of why we are all in this together, and practices like this need be to be stopped.

I wish I knew how to influence changes in this regard. If anyone know what we can do to stop this from happening, please let me know!

A social experiment

An unstoppable train is coming down the track, which splits into two. One track leads to 3 kids, while the other lead to 1 adult man. The train, at default, will head to the track with 3 kids and run them over, killing all of them.

There is a switch that can change the track of the unstoppable train. If someone pushes the switch, the train will instead run over the 1 adult man, saving the 3 children.

The unstoppable train, obviously, cannot be stopped. The 3 kids and the adult man cannot leave the tracks. No matter what happens to the switch, either group of people have to die.

You are at the switch...what would you do?

Things to keep in mind: Doing nothing to the switch is a type of action, in which you choose to kill 3 kids instead of the adult man

Personally, I would not touch the switch. I know I am making a choice of killing the 3 kids by doing nothing when I could have saved them.

If you have seen Batman *spoiler alert*, near the end of the movie, the Joker was doing a social experiment, in which he told people on two different boats that there were bombs on both boats. They both have a switch that will activate bombs on the other boat. If they blow up the other boat, they get to live. One boat was filled with criminals - the other boat was filled with the good citizens of Gotham.

In the movie, one person on both boats had the switch in their hands. The argument was made that the boats filled with criminals are worth less than the boats filled with good citizens, and the criminal boat should be sacrificed. But in the end, no one on either boat had the heart to push the switch that would kill hundreds of people.

And that is why I would not touch the switch in this train track scenario either. Shooting someone in the head and letting someone starve to death are both evil, but I do think that they are different levels of evil, as shown by the Batman example - no one could do it because they felt it was wrong, even though by not pushing the switch, they are murdering their boat-mates. There is a difference in pushing the bad fortune onto someone else instead of letting the bad fortune take its course.

Hippocrates said, "First do no harm." Why is it that doctors who didn't stop to help dying victims from a car crash do not get arrested, while the ones that poisoned patients with cyanide do?

If you answer that you would push the switch so that the 3 kids could live, imagine yourself on one of the Gotham boats, would you really push the switch?

A good economist

Pauline Chen wrote a recent article in the NYTimes titled "Medical student burnout and challenge to patient care" which can be accessed here: http://www.nytimes.com/2008/10/31/health/chen10-30.html?_r=1&partner=rssnyt&emc=rss&oref=slogin

In a nutshell, she cited many studies that show medical students are burnt out, while a smaller but significant percentage considered suicide in the past year. Apparently, many of the reactions were to stop crying like a baby and suck it up, like hundreds of people who went to law school, business school, and other schools that potentially require hard work and perseverance.

One thing they don't understand is that the burnout is barely from the long hours, the lack of sleep, the constant need to proof ourselves and to not get yelled at. I think the most significant cause of the burnout is really the nature of our job - it is the fact that everyday, even as a medical student, you could potentially kill a human being or save a life. And at any moment, you could watch someone die right in front of your eyes and there is nothing you can do about it. I have watched people die and it is taxing. It is difficult to watch life slip away, and it is that much harder to have the patient's family looking at you for what they want to hear and not being able to pacify them. Many times they want to hear that it is time to pull the plug, because the fight is too taxing for them. Other times, they want us to tell them why it was their loved ones who died, and no lesson can prepare you to deliver these answers. How do you learn to tell someone that it is time to end the life of their loved ones?

From those in the medical profession, some of the reactions were to stop crying like a baby and suck it up, like hundreds of doctors have before us, but I fear they only survived because they desensitized themselves. They simply stopped crying when people die.

But I think we should cry every time our patients die, because for a while we took care of these people and we knew part of their life stories. We should cry because we should never forget the impact on the family and relatives when our patients are gone - nothing should ever minimize the enormity of a human life.

For a bad day at work in other professions, you might cost your company 10 million dollars. A bad day at work as a doctor, someone dies. I guess for some, one is not necessarily worse than the other, depending on how much a human's life is worth, but to me, a human life is priceless, and that's why I can never be a good economist.

Sweets and Lemons

After shadowing a few doctors around, I definitely have my own opinions of bad doctors and the better ones, and sometimes I wonder if the patients would agree with me. For me, I have my own opinions of which doctors connect to patients in meaningful ways, and the patients surely have theirs. Since we are all humans, I hope that after trying my best to put myself in their shoes, the patients and I would agree on who cares and who only pretends to. I can tell, to some extent, which ones know their shit and which ones are just making stuff up, but unfortunately the patients mostly cannot.

But people relations and knowledge do not a doctor make. It's the craft of weaving the two together that does, and the glue, in my humble opinion, is confidence. To the unknowing eyes of patients, confidence seems to be everything, and it should be everywhere. Because patients cannot tell when doctors make stuff up, they look for correlations, and the sure-fire correlation with knowledge, in the patient psyche, is confidence. If a doctor acts like he knows something, he probably does. If he is soft-spoken, flustered, confused-looking, he is probably a lemon.

But from my observation, the correlation is, unfortunately, hardly reliable. Many doctors are solid on their medical knowledge but are regrettably un-confident, while the confident-appearing ones are sometimes just shooting in the dark. Both are bad doctors, but not to everyone. The former are bad doctors in the patients' eyes, while the latter are worse doctors from an insider's point of view. The former may do harm, while the latter are just ineffective. It's like choosing between...Hilary Clinton and Sarah Palin, except both of them were so bad I don't know if Clinton is necessarily worse per se.

Either way, it is simply sad that good doctors don't shine, while the bad ones successfully send patients to the wrong test over and over again, and it all hinges on confidence. It is the glue that make candies sticky...

While the lacking lemons go sour...

The First Death

Today, I experienced the first death of my medical career

I first met her on a Wednesday afternoon. She was a sweet 81 year old lady, and she has survived many things that would have killed others of her condition in an instant - she survived a left lung collapse and was talking without much effort with just one working lung. Her X-ray shows infiltration that whites out her entire left lung. We were consulted because of a left facial - it turns out whatever signs the doctors thought were neurological, were really physical, and she recuperated without residual neurological symptoms the next day. She seems to be doing fine after that, hanging out in the hospital because her sons would not make a decision about what they want to do with her. She was instantly our favorite, because she was so sweet and funny, even when she was sick. Every time we do a Babinski on her, she would exclaim "Ooh!" and looked around at us, as if to say, "Wow, did you guys feel that?". She would ask all of us where we are originally from, and she would say she loved us because we were the only people who came to visit her. She was from Armenia, and she seems like one of those tough old ladies from another unfamiliar land, where everything is tougher than our cushy American life. For a while, I believed that whatever neurological symptoms might have come upon her were gone for good.

A few weeks later, she had a seizure and was intubated in the RICU. I was worried, and our team went to see her as soon as we heard. I was relieved to see that she was conscious and seemed exactly like she was but with a tube coming out of her mouth. One day later, she was extubated and was back to normal. We visited her every day after that, and she seemed to be back to her usual sweet self. Now, if an old, 81 year old lady with one working lung can survive an extubation without a scratch, the last thing that could happen to her in my optimistic heart, was death.

Today is the last day of my neuro rotation. I was exhilarated since I just finished the shelf exam and, therefore, my first rotation. I was also happily surprised to run into my favorite neuro resident, when she told me the bad news that my patient has expired, and because she is not our patient, we do not know why she passed. I was shocked, but I did not cry. I was really in disbelief, because of all the patients I had at Elmhurst, she was not one of the people I thought would pass away, definitely not this soon. What sets her apart is the fact that she was such a resilient woman in our eyes, and because she was so sweet, death does not really have a place for her in my hopeful opinion.

When I ran into another student on my team later on who also liked our patient very much, I ran over to relay the news and simply broke down as the words came out of my mouth. I sobbed like a little girl with a broken toy. It was unexpected and uncontrollable. The 5 stages of grief ran through me, as I skipped from bargaining to acceptance. I rationalized that it is better for her to finally leave the hospital, but with her beautiful spirit, I do not really know if she really is better off. I know the world has definitely lost one of its good citizens, and that is a big loss in today's world.

I don't know what I would do if I actually saw her die - I really don't know, but I guess that's the journey that every doctor has to go through. It is the growth that we as doctors have to experience and come to terms with it ourselves. No one can really hold our hands through it, because as hundreds of our doctor friends hugged us with sympathy, the death does not go away until we have learned to accept it.

Going to die in jail...

Hospitals are really jails in disguise.

It's unbelievable how many of my patients are in 4-point restraint, all for a variety of reasons.

One of them is a mentally retarded young man whose childhood is ravaged by constant seizures - he pulls out his NG tube twice a day because he hates them, but the tube is the only way to reliably feed and medicate him. Hence, everyday is a game of perseverence, to see who will give up first - the doctors putting the NG tubes in or the kid pulling the tubes out. There are many other things wrong with this case, but it is beyond the scope of our topic today. We'll call him Mr. G and we'll come back to him another day.

Another is altered and his only instinct is to leave the hospital (isn't it funny how no one wants to stay in the hospital and be healed?). And so he is restrained. I was walking past his room when he flagged me down, asking for help to get up off the bed. I innocently went to the nurse and asked for assistance, when she told me the patient doesn't know what he's doing and there is no way he's getting off that bed.

Another man is a true disaster of 4-point restraint. He was a young vibrant man when he came in with encephalopathy. He then went into a coma and is now slowly coming out of it. The disastrous part is that he is not conscious enough to voice his desire in an understandable way, but he is conscious enough to try and escape from his bed. So what do we do? We sedate him, to prevent him from leaving in his half-altered condition, but also to delay him from ever gaining his full consciousness. And thus everyday we set him back from recovery with Haldol, so that the nurses and the doctors are not bothered. I wonder if he will ever get out alive.

Many times I hear people begging and screaming for water...and the screams go unnoticed. As a medical student, I have to bother the scary nurses for permission to provide screaming patients with water, because some of them may be NPO, and some attending surgeons may literally kill me if I set back their scheduled surgeries with drops of water. But NPO is really a euphemism for starvation, and it is a brutal penalty. Many times patients are held on NPO for many days as the surgery date keeps getting rescheduled at the convenience of surgeons and at the mercy of hospital politics. It really is a form of torture.

Many hospital prisoners are allowed to execute themselves. How? We leave old, frail patients alone in their room, and as they get up, they are bound to fall, hit their head, and never move again. I can't count the number of patients whose plugs are being pulled this week - some of their deahts will be a direct result of hospital negligence and lack of fall precaution when one should have been instated.

So what do we get when we add 4-point restraint, torture, mind/behavioral control with sedation, and execution together?

We get a US hospital. There is one right where you live. And once you agree to enter, you'd better hold on to your consciousness. If you become altered, you may never get to leave ever again. If you don't listen to them, they will restrain you. If you try to escape, they will quiet you with sedation, and you'll never live to tell anyone what happened to you.

I would never want to be in a US hospital, not as a doctor and definitely not as a patient.

Too tired to write about everything...

But I just want to document this episode for myself in the future, so that I do not lose sight of what medicine is and should be.

Today I fed someone his whole dinner because the guy was disabled enough that it is difficult for him to eat by himself, but he was not disabled enough to require someone to help feed him. He was stuck in this limbo that makes it really excruciating to watch him eat on his own. The funny thing is I don't think I've done anything remotely close to healing until today. As a medical student, I'm useless and mostly counter-productive in the medical system - it only tolerates me because without me there will be no future doctors. The most I can do is to call people for follow-up and look up labs by taking twice as much time as a resident would.

Most doctors would think feeding a patient is a nurse's job, and the nurses are too burnt out and exhausted to sit down and patiently feed him. But I think as so-called "healers", we should be forced to engage in these types of activities that immediately and directly help the patients - most of the medicines and the procedures we prescribe to cure people probably make them sicker than when they walk through the door, so who's to say that these acts of kindness and caring cannot heal better than CT scans and metformin?

I think this whole education process makes us lose sight of what healing really is. Radiologists look at pictures of people's brains and claim that they are healing people without ever speaking to them or touching them - now what kind of healing is that? Other doctors walk in and out of patients' rooms, order tests that cover their organs and disregard other health problems smoldering in other parts of the body - now what kind of healers heal only one organ and not the whole person? The more I think about it, the more I am convinced that nurses or home-aids, who interact with patients directly everday, giving them medicine and wiping their foreheads when they spike a fever, are the true healers in our army of medical personnel.

The guy told me he has never had it this good (us feeding him with patience) and he really appreciates our help. I don't know if I should jump for joy because I made someone happy, or cry because this guy doesn't get the high standard of care he deserves everyday

The Battle for My Soul

Today I concluded my first week of third year, and today is definitely the most intense day I've ever had so far. I think it is because all the human drama that has been building up all throughout this week ended with the epiphany of modern medicine in its ugliest and truest form - when the exhausted ER residents can no longer be bothered with politeness, and when the lavish lobby and colorful gift shops are stripped off to show the dirty, cop-ridden ER of Elmhurst.

I will just head straight to the epiphany - I will not yet bother with subtle things throughout the week that represent the uncorrected remainings of bad medicine, the complicated mistakes that patients rarely see.

Our Neuro consult team got called down to the ER today to see this old Korean lady who had diarrhea and lethargy prior to admission. She then became unarousable by her daughter, who promptly called 911. We arrived to find a frail, white-haired lady tugged away in the corner of the cramped ER ward, manned by her daughter. The interpreter service is unavailable in the ER, as there is no phone anywhere near the beds. We proceeded through our neuro exam awkwardly - maybe because the daughter could only speak minimal English, or maybe because the patient was a bit altered. We left with some promising exam results, but a part of me felt uneasy for reasons I could not pinpoint. In hindsight, I was probably bothered by the fact that we could not get an interpreter when one was warranted, and that the patients appear neglected, even though none of them asked our hoard of doctors for help. I think it's the way they looked at us, as if they need help but they knew that we could not help them - not because we do not want to, but because the system taught us to only relay the information to the overworked ER doctors and continue on our merry way - because that is how things are.

It did not hit me until we returned a moment later to perform further neuro exam. The lady was alone, agitated and was determined to climb out of bed, unaware of the chaos around her, nor of the overworked nurse who roughly stripped EKG pads from her chest in order to move her to another spot. It seems that when this patient became altered and confused, the inner instinct that remains at her core tells her to go home. We approached her, and as the other doctors tried in vain to talk to her, I said hi in Korean. My heart leapt when she immediately turned to me - then she started gesturing that the IV in her hand is paining her. I could not say anything else in Korean, so I gestured to her that she should wait until we found a staff who can interpret. A Korean cop came to interpret for a while, but that did not do much good since the lady seemed too confused to even understand her language. In the midst of this attempt at adjunct interpretation, her son came to the scene. We then told him to ask her a simple neuro exam question:

Doctor: "Can you ask her if she knows who we are?"

The son followed instructions, and reported that she answered no. He then engaged in a back and forth conversation with his mom, as the doctors observed and waited patiently for the findings. After a while, he paused, coping with everything that just happened, then uttered in a quiet disbelief...

"She does not know who I am"

I looked away to hold my tears. In that lonely chaos, I did not know if I should feel sorry for the old lady who had no idea what was becoming of her, or for the son who learned for the first time that he has lost his mother, the personality and the memories that make her his mother and not a few pounds of flesh. Looking back at her stretcher as we were leaving the ER, I can see myself standing in the shoes of her son - standing, because there are no chairs for family members in the ER - guarding the fleeting remaining of a stroked out loved one, waiting in the nerve-wrecking anticipation that one of the many armies of doctors will eventually come with a solution and not more questions. In the midst of arguing nurses and scary cops, the helplessness around that ER ward was overwhelming -everyone from all walks of life came to this ER and had no choice but to submit to the mercy of the medical system - one that is broken, overworked and unkind.

The scary part for me was that I wanted to cry, but it would have been inappropriate to cry then. So for the rest of the day, I held up the tears in their fort, waiting for the opportune moment to "feel". In order to appear composed and appropriate in the eyes of colleagues and patients, my soul became a numb existence - a functional machine with no sympathy. There are two paths towards MD - the path that is art and the path without art. The path without art numbs us from the human drama that is life and death, so that we can function. It is the opposite of art, where you give up your soul to emotions and feelings in order to create. The path that is art teaches us that medicine is barely a science - it is an art - the art of calming down the agitated, the art of delivering bad news, the art of following our instincts instead of impersonal numbers in the NEJM that may not apply to the human flesh sitting in our office.

And until I hang my white coat, everyday is a battle for my soul.

The Calm Before the Storm

There is not a more fitting title to this entry - I feel curiously calm, even though the storm is in sight. On Monday, I will depart the realm of being a second year medical student, where mistakes can be forgiven, to the real world as a third-year medical student in which my actions have consequences, both insignificant and dire. My decisions may not dictate life or death, but they can make a big difference in non-obvious ways. I can only pray that my bright-eyed, optimistic attitude will stay with me when I pop out the other end of the third-year tunnel, and that I will remember that my duty is to serve others - this is not an egoistic game of puzzles in which I race to the one, correct diagnosis, the way House does. No, this is not about the doctors - it is about the patients. It is about what they want, what they need, what they become, and there is never one, correct diagnosis. Health is a complicated interplay of factors that can never be handled through a single diagnosis, and I again pray that I will be as thorough as I hope to be. My biggest fear is that the monster that is the medical system will strip from me the passion, the patience, and the kindness, all of which are vulnerable to fatigue and competition. I feel it slipping away as we speak - part of it became casualties to the gruelling board studying and various events of second year. One thing I can hold on to is the exciting curiosity to learn and excel at neurology, my first rotation. I believe in hard work and the gift of intelligence given by my genes+environment - the power of the two combined should overcome any obstacles, and there will be no excuses to fail.

I can only hope that this entry will keep me grounded and focused until the journey through this black hole comes to an end. Do you remember those exercises in high school, where you write a letter to yourself 10 years in the future? This is one of those letters, and I hope it reminds me of me, before the transformation - good or bad transformation.

Entries after this one, hopefully many, will record encounters throughout this journey, life-changing or petty.

Insure your pet's health...

So I was browsing facebook today only to be bombarded yet again by advertisements, this time for Health Insurance...for pets. I am completely speechless, in the way that I don't know if I should jump for joy or start screaming.

I learned in school that insurance is a good thing - we spread risk among a group of risk averse people and everyone's happier - most of all the health insurance companies. Fine, I can live with that. But now that health insurance is unobtainable to most people in this country, I don't know how I feel about the fact that dogs and cats and some parrots on the UES will have a better health insurance than millions of Americans. Some people from PETA will come after me and say, "Why should we lower our standards for pets just because our government can't get it together for humans? Just because some people can't get health insurance, it shouldn't stop animals from getting one".

Well, the problem is that the money that will go towards paying for these pet health insurance is a result of discrimination, unequal playing field, and economic exploitation of humans around the world (think rich pharma CEOs testing drugs on children in Africa) that results in disgusting wealth disparity that we see across countries today. If someone is rich enough to insure the health of their pets, doesn't it disturb you that they won't pay to help people whom they exploited to get a health insurance?

In 2006, Americans spent $15.2 billion on pet food - how many health insurance (for humans) can we buy with that money?