Personal statement

Ubuhlungu?

The little girl stared back at me, unblinking.

I tried again, knowing my South African Zulu accent was terrible. I said it another ten times as I pointed to her head, her heart, her stomach. Any pain? I smiled, trying to convey that I just wanted to help, that she could trust me. But instead, Thando continued to stare ahead, expressionless.

She hadn’t spoken to anyone for a whole week – none of her friends and no one in her family, not even the dog. And she had regressed, soiling her pants and bed sheets without warning. But why was she here at our HIV/AIDS mobile clinic? Her mother’s voice dropped to a whisper; she had a sinking feeling that Thando might have been raped. An uncle had just been diagnosed with AIDS, and there was an old wives’ tale that having sex with a virgin was the end-all, cure-all for HIV.

I sat there, aghast. Thando was only four years old.

When the visit was over, I gave Thando a Disney princess sticker, all too aware that nothing – not even the sparkliest, brightest, largest sticker – would be able to take away the hurt. I felt terrible. But what felt worse was sending her out the door, knowing there was nothing else we could do. Sure, we could treat the physical trauma she had endured and give her prophylactic drugs, but who would fix the emotional abuse?

Throughout the rest of my six-week stay in South Africa, I met many other HIV+ children, finding hope and drawing strength from their determination to not let this disease define them or affect the way they lived life. I had underestimated their ability to overcome what seemed like such a huge drawback to their lives. It was here that I realized that people are capable of so much more than we often give them credit for. And it was here that I found the strength to move forward and grow from my own personal loss.

Halfway through my second year of medical school, I found out that my grandfather’s cancer had recurred. I took many trips between Chicago and Taiwan, trying to assuage the guilt I felt at not recognizing the signs of his relapse earlier, but also trying to manage all of my obligations to school organizations and coursework. Yet, the delicate balance between my familial priorities and academic commitments eventually swayed in my family's favor and I took a leave of absence. I went back to Taiwan and was there when my grandfather finally succumbed to his disease, exactly two days before what would have been his 5-year remission anniversary. I was there for his funeral, to kiss him goodbye, and to tell him that he was my hero and will forever be my inspiration.

I went to South Africa after my grandfather passed away, wanting to channel my loss into something positive. I wanted to help out, give something to the community. What I didn’t expect was how South Africa ended up helping me, showing me how resilient the human spirit is. I came back to medical school renewed, and with a new sense of purpose, for it was in South Africa that I discovered my love for psychiatry. I found that I really enjoyed talking with patients, getting to the roots of their inner turmoil and finding that those roots were consequently related to their physical manifestations of illness. I loved the wide spectrum of experiences that each patient encounter became, never knowing exactly what to expect, but finding stability in knowing that I could be of help.

Our lives are shaped by the experiences we have, the experiences that we live through, and ultimately the experiences we survive. But to do so, we need others for support. I hope that by pursuing a residency in psychiatry, I will be better equipped to be that support for my patients, as they go through their tragic losses, their tenuous stresses, and their unthinkable traumas.

I want to help the Thandos of the world find their voices, for my Thando was the one who ultimately helped me rediscover mine. She showed me how to be determined, to be resilient, and lifted my voice from a mere whisper into a calling.

Perhaps perhaps perhaps

UPDATE: The official email from our deans, reminding us that scrambling is very much a possibility. Thank you Office of Medical Education for putting our fears to rest during this rather stressful time. All underlining and bolding is theirs.

Dear Class of 2011,Just a reminder for those of you participating in the NRMP. The Main Residency Match - Rank Order List Deadline is Wednesday, February 23, at 8:00 PM Central Time. There are no exceptions! Please do not leave entering your rank list until the last minute. Also, please make sure we have your current cell phone number in CAESAR. This is extremely important in case we need to get a hold of you. If you have any questions please do not hesitate to contact [any of the deans]. Thanks and have a terrific weekend.

---

I know I said I didn't want to talk about it. But let's talk about it. Because after all, I've been talking about it in half of the posts this month anyhow. Because I'm hypocritical. So let's talk.

Rank lists.

They're officially due next Wednesday. Our deans sent out an email yesterday telling us to get them in, and not to make any last-minute changes or decisions. Because those decisions tend to be rash, short-minded, emotional and essentially not good for life-changing matters.

I put in my rank list last weekend. Talked it over with the boyfriend and with family and close friends. Felt good about it. It was in and I was done. No more talking about it.

Except, I keep looking at it. Because I stupidly screenshot my rank list to send to my parents. And that screenshot shows up every time my computer goes idle and starts displaying my five or so pictures still saved on my desktop. Now I'm wondering how much I'd rather go for prestige than location. For example: is Loma Linda really all that bad? Should I really be ranking it way below Mayo? Sure, Mayo has the name, but Loma Linda has sun and family and no snow. And then, if that's the case, maybe Loma Linda should be right up there with my other more academic Southern California programs? But is Loma Linda even going to rank me that highly, given that I didn't email them right after my interview with how I wanted to convert to Seventh Day Adventist-ism?

I don't know what to do anymore. Is making changes to my rank list this weekend considered to be last-minute? Should I just leave it the way it is?

I definitely need to move Mayo down on my list. Rochester, Minnesota! What was I thinking?

Permanent marker

ME

I had to flip a couple of coins, but my rank list is officially in.

MIKE

YAY!

ME

Yup, I have a certified ROL.

MIKE

Do you have a ROL dance?

ME

Haha, no. But I do have a ROL reflex that's awfully similar to the gag reflex...

Some like it hot

This is too cute.
Happy Valentine's Day, everyone.

Count it down

Ten days.

Might as well just start picking programs out of a hat.

Agh.

Waiting for the end

"Go tell him that we just need to put a drain into his stomach!" my senior resident barked at me, after the nurses paged him to say that the patient had refused to go down for the procedure. I hustled towards the door, toward the patient. "It's just a drain! It's not like it's a major surgery!!" he called out, exasperated that our patient was being difficult, "Use your psychiatry skills!!"

I went to go reason with him. After all, he was my patient. And he could be reasoned with. He was nice, pleasant, intelligent, and an all-around good person. Sure, he also had Stage IV gastric cancer, but that hadn't turned him into a curmudgeon by any means. Unfortunately, his cancer had metastasized, and now his belly was full of fluid, making it near impossible for him to do anything. We had planned for him to go down to IR to get a drain placed to remove this fluid, and hopefully decompress his stomach and bowels so that everything would start working again.

I was positive this was all just a giant misunderstanding.

I went to his room. Knocked. Pulled out my best Difficult Conversations face, and started to talk with him. Why didn't he want the drain? Had the nurses misunderstood? Was he worried about the procedure? Worried about pain? Would it help if I went with him?

He looked at me. If they put the tube in, would it get rid of his cancer? No. Probably not. If they put the tube in, was he still going to die of cancer? Yes, probably so. If they didn't put the tube in, how would that change any of the previous answers?

I looked at him, not quite knowing what to say. He had come to the hospital for intervention after all, right? That's the only reason why anyone comes to the hospital, I naively thought.  Yet, now he was here, and he wasn't getting anything. No food, no drain, no nothing. I tried to tell him that by placing the drain, we'd be able to feed him again. Steak? he asked. No, probably just clear liquids for now, but we'd advance his diet as soon as we saw how he tolerated it! Heck, he could be eating steak in a week!

I didn't think I was lying, just stretching the positive thinking aspect of things. But he saw right through me. Hahaha, he laughed. Steak in a week. Right.

He patted my hand, which had been resting on his bedrail. "I know I'm going to die," he said to me. "Do you realize that I'm going to die?"

I nodded, but couldn't make eye contact. He continued speaking, as I continued to look down at the hangnail on my index finger. "I'm going to die soon, child. And I'm good with that. It's God's will. It's my time. I've lived a good full fifty-four years."

The truth of the matter was, putting in the drain was only going to buy him a couple of weeks of eating. At most. And he, well, he realized that this was it. And he wanted to be at home, surrounded by friends, family, and his church choir buddies. They had made him some pretty amazing smoothies and soups the past couple of weeks. He'd just water it down some more once he got home, but he'd get the nutrients down. Somehow.

I went back to the team room, and told my resident that my patient didn't want the procedure. My resident - deeply unhappy that I hadn't done what I was told - ended up going to talk to my patient himself. I'll never know what happened during their conversation, but my patient went for the procedure two hours later, and came back to his room an hour after that, drain in place. Only to find that it wouldn't drain.

Turns out the "fluid" in his body was actually quite thick. So now IR wanted him to change out the tubing. And at that point, my patient completely refused everything. Everything but hospice. He just wanted to go home and drink his soup.

He left the next day, with my well wishes. But as he left the floor, I couldn't help but be struck by the fact that he was leaving us with a non-usable drain, that he hadn't wanted, because he didn't want to meet God with a line sticking out his stomach.

We want to fix everyone who comes into the hospital. It's why we do what we do. We want to make people better. So when it comes to the point where nothing else can be done, we start coming up with things that could be done. We want to say that we tried everything, that we did everything. But sometimes, the best thing is to do nothing.

It's a hard lesson to learn, and some of us refuse to ever learn it.

Hold it against me

Let me just start by saying that I love kids. I really truly do. I mean, I thought I was going to do pediatrics for the longest time, all the way up until the end of my actual pediatrics clerkship. But even now, I fully intend to do a child fellowship after I finish my psychiatry residency. Because I love kids.

Because, I think they're all super cute, with very unique personalities and adorable gap-toothed smiles and giggles.

So, as you can probably tell, I'm going on the defensive about how much I love kids, because I'm about to completely rant about how some kids are total brats. And it amazes me how terrible parenting can be. Seriously.

A couple of interviews ago, I was on my way back to Chicago, sleep-deprived and headache raging. I bought a coffee from Starbucks and some tater tots from Wendy's, and settled down into one of those really comfortable leather chairs that Southwest has. I placed my coffee and Wendy's bag on the table, and I snuggled into my chair, hoping to get in some shut-eye before boarding started. I could hear children giggling around me, but given how tired I was, it was all white noise to me, and I quickly fell asleep.

No more than ten minutes later, the flight attendant came on over the loudspeaker, announcing how the whole boarding situation would work. Preboards first but only if you had one of those blue preboard sleeves. Then the A boarding group. Then family boarding. And then the B group. So on and so forth.

I sat up to grab my coffee. That's when I saw her.

She was super cute. Huge eyes. Missing her front two teeth. Adorable pink barrettes holding up her pigtails. And her hand? In my Wendy's bag.

She had eaten my tater tots.

And her grubby little kid hands were still in my bag for more.

I just stared at her, not quite believing what I was seeing, trying to figure out how to tell a stranger's child that what she was doing was wrong, so wrong! And unsafe! Didn't her mother teach her to never take candy from strangers? Granted, in this situation, she took without asking, so maybe that wasn't part of the lesson plan. And yes, I have also been taught not to leave a drink unattended, but it was morning, and this was the airport, not the bar, but fine, I see your point about how I'm not the best at heeding lessons either.

I probably would have just fumed silently, but then her mother/aunt/caretaker looked over, and cooed, "isn't she cute?" completely oblivious to what her child was actually doing.

I sort of just snapped. "Um, she's very cute, but I would think she's cuter if her hands weren't on my food and she hadn't just eaten half of my breakfast. Shouldn't you be keeping a better eye on your kids?"

I stalked off, glad that my section was being called to board, amazed at my gumption, and feeling just a tiny bit like an ogre who hates kids. But seriously! Who does that?

So I guess that means that I love kids conditionally. As long as they stay away from my tots.

Blue suede shoes

ME

You know, there's a new trend with mini-dresses. But I have to wear them as shirts, because they don't quite cover my butt.

LEE-ARNG

Would you rather be short?

ME

Yes. Oh my goodness, yes. Shoes are cuter with heels. Everything's cuter when it's smaller! If you're tall, you cannot be cute. You can be elegant, and well, that just doesn't apply to me. At all.

LEE-ARNG

Just wear those flat ballerina shoes. Those are cute.

ME

Eh, I wear flats all the time. They're not so cute when they come in size BIGFOOT.

LEE-ARNG

Pff...I bet a lot of girls would love to be your height. So poop on you.

ME

Poop on you? What are we, five?

LEE-ARNG

I always end my arguments on the most cogent point. Which is usually "poop on you."

SNOMG

Title courtesy of Mike Chan. As in OMG OMG OMG SNOW! OMG!!! SNOMG!

It's gonna be the new "pwn" or "zomg" -- granted, I still don't know what those words mean, but my little sister uses them a lot, and well, she's supposedly pretty hip. Or at least she used to be. Per the high school yearbook staff.

The Northwestern Intercampus Shuttle -
deserted on LSD, and apparently full of snow!

Today, I was lazy and stayed inside where it was warm and comfortable. I was also one of only maybe five or so non-gunners on my clerkship who decided to take full advantage of the official snow day, and not go to class. Seriously, gunner classmates, we never ever get snow days. Why would you waste such a precious gift from the deans by going to a clerkship where you do nothing for five hours, as you watch the clock and wait for your resident to send you home?

Anyways, I think my priorities are in order. Warmth, sleep, food. Wash, rinse, repeat.

Go check out Jean's blog, because she was far more adventurous than me and actually ventured out into the crazy weather. Weather so crazy, people started making up new words to describe the craziness. Snowsquall. Sleetercane. Etc.

My favorite's still gotta be thundersnow, though.

Also impressive? How well Chicago cleaned up after everything. I mean we went from this:

Yes, this would be Lake Shore Drive
disguised as a parking lot of deserted cars.

to this:

Just kidding. I wish Chicago had magically transformed into a sunny paradise. But all jokes and pictures of California's PCH aside, I was impressed with how well the city took care of itself. Seriously, streets were clear, sidewalks were plowed. No one died. Even though all the news were catastrophizing that this blizzard was going to the be the biggest one ever seen, and "life-threatening" and so on and so forth. The world is gonna end, people. Just not today, and not in Chicago.

Nicely done, Chicago maintenance people. Nicely done indeed.

Hope you all are staying warm, whether it be in balmy California or still-stuck-in-the-snow Wisconsin.

Lock up your children

THUNDERSNOW.

It's thunder + lightning + tons of snow.

And it's very wet. And cold. And windy. Very windy.

HIDE YOUR KIDS. HIDE YOUR WIFE. AND HIDE YOUR HUSBAND.

Just kidding. Rachel and I ventured out, and we made it back with feet and toes intact! Even with only our flip flops and scrubs to defend us against the forces of nature.

We might also be idiots, because it's sixty minutes later, and my feet are still frozen.

Grenade

Con: figuring out my rank list is giving me a stress ulcer.
Pro: at least I'm finally losing my interview weight gain, thanks to the accompanying food aversion.

For the past couple of weeks, I've been doing a lot of that whole pros and cons thing.

Whoever decided on the match process was a glutton for disappointment. Seriously. It's not like all of us can go to our first choice program. Yet, here we are, trying to determine the rank order of programs where we feel like we could be happy. As though we all have an equal chance at #1.

Trying to figure out where I want to be in just a mere five or six months is a complicated process of checks and balances. One place has a great location, another has better psychotherapy training. One program might be the highest ranked, but is full of married people. One program has the best of both worlds, but I'm sadly still minus one book deal. This program has a world-class addictions unit, but also has one OCD-afflicted residency director. And so on and so forth.

It all boils down to figuring out what I value more. Training? Location? Celebrities? Proximity to decent sushi?

So I came up with a random point system. Ten points for close proximity to the boyfriend. Two points for good psychotherapy. Minus two points for traffic. Plus two points for sushi. Minus two points for corn fields. Not ever having to drive for the rest of my adult life equals three points. Not ever having to learn how to drive for the rest of my adult life equals two points. Et cetera and repeat ad nauseum.

Then I started making the list. But by making that list, I am clearly delineating that there is one program that is better than all the others, one program that will make me so ecstatically happy come Match Day. And conversely, there is one program that I'm hoping I won't end up at, but going there would be better than scrambling into South Dakota.*

And at the end of the day, when I look at my list, I want to vomit. Because there are some programs that I would give whole limbs to train at. Legs, arms, kneecaps, eyeballs, whatever you want! But I know there's a good chance that I won't end up matching at those places, no matter how many arms and legs I might promise them. There's a chance I might end up scrambling into a program I've never even been to, never even heard of. There's a chance that maybe this will all blow up in my face. A pretty good chance that this will all blow up in my face.

All this uncertainty sucks. And it's causing my stress ulcer to go into acidic production overdrive. Someone tell me why we can't apply for residency the way most people apply for jobs? With job offers and all that wonderful sense of security and certainty? Because with the Match, unless you're one of the lucky few that does match at their top-ranked program, it's just another lesson in disappointment.

And well, if all the years in medical school have taught me nothing else, it's taught me this: I am not one of the lucky ones. I do not live a semi-charmed kind of life. And if things can go wrong, they will.

I am absolutely dreading Match Day. So if we could just agree to avoid the topic all-together, I'd be much obliged.

---
*No offense to those South Dakotans. There's actually only one psych program in South Dakota, and I hear it's actually quite good, and competitive. For a South Dakotan. But still, very competitive!