week 2 of raw + thoughts on singleness

It never really hits home how truly “single” you are until you get this phone call.

You see, I used to do competitive ballroom dance back in college, and have been looking for a chance to continue. I put an inquiry in at a local ballroom studio about their “new member” package ($210 for only $75! 4 privates, and 2 group lessons! It sounded too good to be true). They responded in this manner.

“We are calling about your recent interest in our studio. Do you have a partner?”

I quickly answered the lady on the phone that I indeed, did not.

“Ah…” I could hear the hesitancy in her voice. She continued, flustered, “Well, it’s a great deal with a partner if you split it… “

I quickly interrupted, reassuring her that money was not an issue.

“Ohhhh, I’m sorry,” she said, in a consoling tone. “Unfortunately, we only have enough teachers for couples right now.” Her voice began to perk up, “But you can always contact us again!”

She sounded way more hopeful about my love life than I was.

Well then. That ended my ballroom dreams. I’ve signed up for yoga now.

Once upon a time, I could proclaim “Why are all the good girls still single?”

But alas, my best girlfriends are proof that this is no longer a true statement.

To be honest, I don’t know when it happened. Rather, it has been progressive: a few acquaintances started getting engaged, a few more older friends started getting married, and before I knew it, my best friends started dating.

And I can’t help but sometimes wonder - that by accelerating two years, have I suddenly missed a whole stage of life?

That by chasing my career, have I become one of the few single women in residency?

I know it’s not true, because there are plenty of successful women who also have families – but there are still moments when these thoughts come.

But one good thing I’ve noticed about the movement of time, is that my guy friends, whom once I would have snort out milk if you said they had a girlfriend – are slowly turning into men, into husbands. Who are learning to commit, to invest in a ring and a future.

I don’t know why, but I want to meet people in real life.

I think online dating is great. I really do. But maybe I’m still silly and old-fashioned and romantic but right now, it’s not the avenue I’m interested in pursuing. Does this mean I’m locking myself into this tiny mirage in the middle of the desert of Reading, PA?

Oh god, so help me now.

In other news, I cheated this week.

I ate 8 glorious jumbo shrimp and a delicious steamed lobster with a wonderful friend, followed by a glass of sangria in the evening without any regrets.

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i love seafood. in all its iphone 4 glory.

This week was much harder to stay raw. But overall, this experiment has made me realize how much more vegetables I can incorporate into my diet, and how I can easily eat healthier. (And that I can live without coffee and chocolate, though it’s less enjoyable.) Here’s to incorporating more salads in the future, but even more to the re-incorporation of meat!! Next up? Gluten free. ;)

Week 1 Raw Results

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A four session raw cooking course is $200. A 6 day juice cleanse from Blue Print is $400+. A 7 day yoga, detox retreat in Ecuador (not including flights) is approximately $1200.

A week ago, I would have purchased one of the options above.

And this was the true reason I wanted to try the raw food challenge; if I could prove to myself I could eat raw for a week, then I could not warrant spending over $1000 to be served it in an exotic location. (As much as I really really wanted to.)

After all, why seek the easy out and drop a lot of money on a single week or weekend of being healthy, when I could start enacting changes now? As it turns out, it’s much more cost effective and more beneficial in the long term.

So, the week is up and here’s how I fared:

  • Instead of skipping breakfast and powering through with a sugar filled latte, I eat three square meals a day. Breakfast is fruit, berries, and nuts. Lunch and dinner are as pictured. The first couple days were definitely difficult – but it highlighted an important theme: I was used to extremes of sweetness and saltiness on everything. Going without it suddenly made my salads taste bland, but over time, I’ve found myself savoring the freshness!
  • My biggest worry was that I would be hungry all the time. Instead, I find myself getting hungry right on time for the next meal! Before, I would overeat (and go to sleep feeling bloated…) but now I don’t, because it turns out, overeating spinach isn’t as fun as chocolate. Go figure.
  • Eating salads makes you savor your food because of the natural choking hazard of nuts. Points for mindful eating?
  • My only cheats were chewing gum and hard candy.
  • I’ve kind of fallen in love with my FItbit. My wrist feels naked without it! I’m also less active than what I thought. On an average work day – I walk about a mile, and have a consecutive activity time of 4 minutes total. (Sad.)
  • The best part was not having to think about what I was eating, and being able to eat as much as I needed. And yet, my scale dropped two pounds despite my (lack of) activity. Turns out abs are made in the kitchen, not the gym!

Verdict: Hard at first, but worth the challenge! I liked it so much, I’m going to continue for one more week, before incorporating my favorite cooked foods (i.e. eggs, fish, and lentils) back into this diet. If I can do it, so can you! Give it a try, I challenge you. :)

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1 Week Raw Food Challenge

Who’s ready to join me? ;)

One thing I’ve noticed about my diet since starting residency is that:

  • Hospital cafeteria food has been officially renamed breakfast, lunch, and dinner. (True story. This is what happens when you literally live in the hospital.) This also means an unlimited buffet at each meal.
  • I consume A LOT of caffeine. I am almost never seen walking without a Grande in my hand. This means tons of ++sugar and ++milk. (This is also what happens when you have a 24 hour Starbucks in said hospital.)
  • I constantly snack on nutrition bars. They may be “healthy” but I can never just eat one. (Especially Kind bars – oh my goodness, so delicious.)
  • I also stress eat chocolate. Chocolate pretzels, chocolate chip cookies, dove chocolate bars, Hershey minis - these are always right in front of my fingertips and it is so incredibly hard not to indulge. Daily. At each meal. :P

The last two weeks of 14-16 hour days in inpatient medicine have been especially detrimental on my activity level. And for anyone who has ever tried to lose weight, I did not want to see my hard work be replaced by an intern year 15. (Helllls to the no.)

So, in an effort to motivate myself, I bought an activity tracker today! The Fitbit Flex. I couldn’t decide between this or the Jawbone Up24, so I’ll give this a two week whirl before seeing if I want to switch!

But it gave me an idea… what better way to track what a “fad” diet (since I’m already hopping on the Fitbit bandwangon heheh) and activity does, than 1 week of testing it on myself? =)

(The “juicing” detox diet, on the other hand, will be one I will never try! I love chewing too much.)

So, I’m starting tomorrow with eating only raw foods for the next seven days.  This means lots of salads and fruits and nuts, which is not too much of a switch; but the hard part will be cutting out my favorites of coffee, chocolate, dairy products, and protein bars.

Will I last a week without coffee? Or even chocolate? Will I even remember to wear the Fitbit? Eek!

Only one way to tell. Stay tuned for results in a week!

 

How to get into Residency (Part 1)

Congratulations on reaching fourth year!!

You are nearly at the finish line, at the foot of your MD degree, and your hard work is about to pay off. So don’t give up and don’t fret; the worst is almost over. You have just one more bridge to cross… and I promise that you can do it! You can and you will match.

I have been in your shoes, and I’ve struggled through similar anxieties that you may be facing. From debating which specialty to apply to, to worrying about not matching, to figuring out how to do the damn application, the list can go on! The ultimate reason I wanted to put this Q & A together is so you can avoid some of the pitfalls that I encountered, and can enjoy the ride (and many flights) that are coming your way.

Some background on my match stats (i.e. why you should and can read my advice): I matched into my number 1 transitional year program through the regular match, and into one of my top 5 ophthalmology programs through the early match. I’ve done not one, but two applications: the snail mail method of SF Match, and the electronic application of ERAS. (And I’ve been equally stumped by both at times.) I am also currently an intern and loving it. Honestly, I couldn’t have found a better place. But it took a tremendous struggle and work to get to where I am, and I don’t want you to face the same hurdles I did. Without further ado, let’s talk!

1. How do I pick a specialty? 

I am going to be very honest and practical with you. Don’t do something because you should do it, do it because you love and will enjoy it. Figure out what you value (is it money? having a life? becoming the top of your field?) and draw the line with what you’re willing to sacrifice to get there. Because the thing about medicine is it is a long and lifelong journey, and while you can switch between specialties, it is hard to do so later on. And yes, it is difficult to know these things as a medical student, so you have to make sure you are making the most educated decision you can.

Don’t be afraid to ask people about their lifestyles, about the bread and butter they see, and what they like and dislike most about their specialty! There will be no perfect specialty, just one you are willing to make yours. One of the reasons I picked ophthalmology was because the residents were the happiest I knew and seemed to regret it the least. (Though looking back, it may have just been partially the Wills Eye effect, haha.) 

To help with selecting a specialty, you first have to figure out if you want to play an active role or supportive role for your patients. The supportive roles are specialties like radiology, pathology, anesthesiology. While you affect the care and diagnosis of the patient – you will not be the primary caretaker, so if developing patient relationships is very important to you, these specialties may not be for you.

The active roles can be further divided into medicine and surgery or both. This depends on whether you prefer to work in primary care, or in the acute setting (hospital/ER/surgery), or with your hands. It is also said that internal medicine is for those who can never decide – you can continue to sub-specialize until you find an area you like.

2. What if I’m stuck between two specialties? How do I pick where to apply to? 

The two most important factors that will play into your decision making are these: location and lifestyle. When I started medical school, I fully believed that I could live and breathe medicine, that I could spend my entire life in the hospital and it would be all I needed. However, it was only when third year rolled around, that I realized – there is much more to life than just work. There are friendships and relationships and family and hobbies that are just as important.

So depending on your personality, you have to think about what you want in a future career. Will it be in research and academia? Or outpatient, or both? Usually the specialties that offer the better lifestyles and flexibility, are the ROAD(E) specialties or in primary care. (Of course, after you are an attending, you will be able to dictate your schedule. However, the years of training should also be accounted for.)

On the flip side, location is also very important. Do you have a significant other, family, or friends you want to stay close to? Or prefer to live in the city or the country? If you decide to pursue a competitive specialty and are an average applicant for that specialty, be aware that you may have or may not have to sacrifice location.

In summary:

  • if you have a specialty you would regret not pursuing – go for that specialty. If you feel that your stats are perhaps not high enough, discuss with your adviser about ways to maximize your chances, such as taking a year off and building your resume. If you really fall far, you may want to consider applying to a backup field at the same time, depending on how you feel about not matching.
  • If you like two specialties equally, but one provides a better work-life balance - go for the one with the better lifestyle. Of course, this is my personal opinion, but from my experience, being able to maintain a good work-life balance is crucial to overall happiness.

3. Okay, I’ve decided want to sub-specialize. How do I pick between a transitional year or preliminary year program? What is the difference? 

First, the difference between preliminary and transitional years is this: a prelim year tends to contain more medicine months (i.e. in the ICU, CCU, inpatient floors) whereas a transitional year tends to be more similar to fourth year (i.e. few inpatient months with more elective time.) But just because a program is a prelim program does not mean it may be harder than a TY program! Some prelims programs are structured to be easier than some TY programs – so make sure to do your research (SDN is a great resource, and PA has some great programs to apply to!)

All I will say on the topic of deciding between the two is this: you will spend the rest of your life learning and working in your sub-specialty. In this intern year – do you want to work as hard as a medicine intern even if you are not going into medicine or would you rather learn at your own pace, and have the freedom to delve into specialties you may never be able to in the future? There is no right or wrong answer – just one that fits you.

This leads to my next point: I wish I had spent more time on selecting prelim/transitional year programs on my ERAS application. I selected programs based off of location, without much research, and applied to WAY too many. For example, half my list were California programs (hey, one can dream); however, the majority of my interviews came from regional hospitals close to my location. Had I known, I would have applied to fewer locations further away. I also applied to way too many preliminary programs as back up, and ended up canceling all but one, after realizing they didn’t offer what I was looking for.

Tip: These programs offer frequent interview dates. I recommend scheduling them (if you can) after your advanced specialty interviews; this way, you can have an idea of where you many end up, and cancel interviews accordingly.

Tip: You do not need to go to every interview! If you can match into your advanced specialty, you will absolutely match into a prelim or TY program. I ended up going to 8 transitional/prelim interviews, and found it was more than enough.

Tip: Contact programs you are going to be in the area for! For example, if you are interviewing in Boston for an advanced specialty, contact the program director of the prelim/TY program and see if you can squeeze in an interview before or after! They may have spots available and it is always worth a shot.

Tip: Follow up with the program you are most interested in. Program directors like it when the people they like want to come. Instant points.

Inside the Doctor Life

“Wherever the art of Medicine is loved, there is also a love of Humanity.

Yesterday, we pronounced a death. A patient who wanted to die on her own terms, on hospice. Her wispy breath, extinguished silently, only to be met by the clamor of sobs in a room filled with sadness,

Today, we brought back a life. The rapid compressions on her chest, the shocks from the defibrillator, and rapid oxygen from the intubation tube slowly, but surely coaxing back her soft, sweet pulse.

On the hospital floor…

To my right, is a twenty year old struggling to fight disease and addiction. Her short life, marred by drugs, was being cut even shorter by the giant of the autoimmune deficiency syndrome attempting to consume her. But family was there, armed for the battle with her.

To my left, is a centerarian, face marked by wisdom and of years lived, questioning, always questioning why she was still alive, why she was the only one left. No family, no close relatives; everyone was gone, as was rapidly deteriorating, her mind.

Behind me, is a patient with a pre-renal acute kidney injury. No significant past medical history combined with youth, translated to an easy, smooth recovery. Only saline, and adequate hydration, was necessary.

Ahead of me, is a patient with a simple complaint – abdominal pain. Yet, a complicated history combined with advanced age, necessitated a full work up that revealed metastatic cancer. Only time would be his medicine, and would give him his final peace.

//

This sampling of patients above, are just examples of the ones I see every day. I’ve had to learn to collect my emotions, and be able to move forward to the next patient and concentrate on them, despite what may have just occurred in the room next door. I’ve been learning to give orders, listen to my seniors, collaborate with consultants, and most of all – manage my patients.

And it is not easy.

There have been days when I’ve come home exhausted and utterly, emotionally spent. And then there are days when the stress and the work accumulates up so much during the day, because I want to do well for my patients, do well for my team, not let anyone down, try to be a superhero, but am meeting so much resistance and coordination and the disease won’t listen!! – that I can feel the hot tears threaten to build – and my deep breaths  and counting begin.

But then there are the moments that make this profession so incredibly worth it.

I gave out a hug today. It meant a lot me. It represented a goodbye, a battle well fought, but a war just beginning, and a discharge well deserved. An I’ll see you later, but not here.

And sometimes these moments can feel far and few in between. But we live for them – we remember them – we keep them, so that when things do get hard, we have them.

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Also, too many conditions that I see in the hospital are preventable.

If every person knew how much they mattered to someone else, knew how much they were loved, and would continue to be loved – how much better care would they take of themselves? 

Would they still take the drugs that provided the quick fix, the fast high? Would they still be non compliant, skip appointments or would they begin to eat healthy, exercise? There are so many scenarios.

And it just breaks my heart. Every. Single. Time.

This is why when I feel like I am running out of juice, I am running out of love, I am running out of patience – I remember who gave me my life, who blessed me with health and this job. Suddenly, I realize I owe so much more than what I give out. And that’s why I’m here… I’m going to continue to pour out love, because it doesn’t come from just me.

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Terminal.

What would you do when the one you love most has a terminal illness?

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While going through my drafts today, I came across this piece I wrote as a third year medical student. I don’t share stories as often as I would like, but since starting residency, I’m grateful I recorded this down. I’m once again, reminded that all my patients have unique stories. They are more than their disease; they are daughters and wives, husbands and sons. And it is my responsibility, as a physician, to care for them to the best of my ability.

//

“They says it’s suicide.” 

“You think? Well, I heard she was found down on the floor with empty pill bottles around her…”

“Oh her poor soul!”

My ears perked as I slowly made my way around the nursing station that, this morning, was filled with commotion and whispers about the patient I was about to see. I knew the basics: a woman in her mid fifties had been found unconscious in her home, brought into the ER by a concerned husband (not unusual)… and was now sitting behind the door of the room across from me. I was to screen for depression and the possibility of a suicide attempt.

I took a deep breath. If the first week of psychiatry had taught me anything – it was this: anything was possible.

And true to form, what I discovered was so different than what I was expecting.

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“Why does everyone keep asking me about the car crash?? Like I said, the other car ran into me!” She howled, as she pulled her hands close to her eyes, covering her face.

“I’m sorry, ma’am but I have to ask…” I trailed off. We had heard from the husband that she had been in a car accident a week prior, and had told him that there was another driver who ran into her car on the highway. A few days later, he received a police report that detailed an entirely different story. She had ran her own car into a tree, and flipped it over.

I tried an alternate approach.

“Tell me about your family.”

//

I soon learned about her family: her grown children and their different personalities and careers, their own families, and her increasing grandchildren. Through her words, I could sense her dedication to her loved ones.

But we too quickly reached the present, to the current change in events.

Suffering from poorly controlled diabetes, she had a complicated leg amputation earlier this year. She lost her job soon after, and had been slowly losing her sight. Now, she was practically blind. On top of that, during this hospital admission, we discovered she had suffered a stroke as well.

And then, there was… her husband.

“My first marriage, oh – it was so young and stupid. We stayed together ten years before I was able to leave him. I was 17 when I got married, you know? Too young, too naive to know anything. But Jorge, this marriage… it was for all the right reasons. We married for love…” her voice cracked, “but it’s been too short! Only two years…”

“What do you mean?” I whispered, captured by her story.

“He… he was just diagnosed with terminal cancer. They found it too late. He has… about a month. I don’t know. Maybe shorter?” She broke down sobbing. “I don’t know what I’m going to do without him. I can’t be without him. I’d have nothing.”

“Would you hurt yourself if he were gone?” It almost felt cruel to ask. (But in psychiatry, you see, this is the number one question we had to ask to rule out suicide.)

“No.” she shook her head vehemently, “I have my family, and I have to be there for them.”

//

After her interview concluded, we diagnosed her with natural bereavement, which is to say – it is normal to grieve. Sadness is part of the human condition – if we try to treat it, and make it go away; what is there left of us?

Too often, in medicine, we over diagnose. We ask questions and we speak, but we forget to listen. Sure, we hear the words, but we don’t understand. Instead, we respond by placing our own judgement and interpretation onto the patient, forgetting to look and listen.

Today, I don’t know what became of that patient, or of her husband. But I am thankful for these special hours I was able to spend listening to her.

If I were to write a book on dating…

It would go something like this.

For sh*ts and giggles; a satire. 

Chapter one: Why Looking for Mr. Right is like Looking for the Right Bra. (Or Jeans.)

Does he boost your assets and make you look good? Or does he diminish your worth? Is he too tight, too controlling? Or is he just not the right fit? Is he going to last or is he just there for eye candy? So many questions, not enough VS personnel.

Chapter two: Size matters.

Who your potentials are depends on the size of your pool. Even in the smallest fish tank, a guppy may seem appealing. But put him in an ocean – does he still stand the test? If not satisfied, then expand your pool. (Why else is online dating so popular… make the world your oyster.)

Chapter three: It all comes down to go-fish.

Forget poker, this game is all about fishing. When a guy isn’t serious, he’ll catch a shiny pretty fish to show around and then toss back. But when he is – then he’s looking for a trophy fish. Be that trophy fish.

On the flip side, if you want to catch him – you must always throw some bait. If he doesn’t bite, he’s not interested. (Fish ALWAYS bite something they like.) If so, move on. There are always more fish around.

Chapter four: Sometimes, you have to set sail.

Is he a sailor? And you only walk on land? Are you an introvert? He an extrovert? Do you love music, and he loves racing? Sometimes, you have lower your guard and try something new. You never know what you can discover when you decide to step foot on the boat; perhaps that treasure map was right – x really marks the spot.

Chapter five: To park well, park early.

My mother once told me, men are like parking spots. The best ones in the front? Well, they go fast, and they go first. There’s this thing about being too picky – in the end, you’re left in the back of the lot because no other spot was “good enough.” Tough luck.

Chapter six: The Golden Rule.

To be respected, you must first learn to respect yourself. Have confidence, be honest, and be straightforward. Don’t give excuses; sometimes when there is no chemistry – there is no chemistry. But when there is, don’t be afraid to go after it. Good luck. ;)