One Year Later

 Its almost one year since I've written. I feel that I have now made peace or perhaps subsided with how things are. I've realized that anger and the subsequent sadness that had followed does not make for a very productive end nor does it change the circumstance. Despite knowing the truth I can and will continue to make changes where I can. The world does not need to harden me and that is what truly matters.

Guilt

 Its been a whole year since I've written. I have less than a year til I am done with the residency. I feel like my perspective has shifted since starting. From optimist to realist, or perhaps just a jaded burnout. These last two years have been an utter whirlwind. So much has happened and I feel empty. 

A reflection on the two years makes me want to both clam up and scream out. I know I need to remain mature and professional but the injustice pushes me to write. I am tired of shutting myself off, of not feeling, not speaking of how I truly think. I feel like a murderer. I did not go into this profession to kill, but rather to save. I am now a hypocrite. My values are completely misaligned.  I do not believe in what I preach nor do. These lives are just a cog in the machine and I alongside it all. The science is mainly pointless. Just hullabaloo that is hyped up. Don't get me wrong, occasionally there will be that miracle find. But for the most part, I wonder WHY! The inefficiency, the suffering, the lives. But people need jobs, capitalism doesn't end, the machine must keep on spinning, and I am in the middle of it now.

The Way We Get By

I know I'm supposed to be strong. Remain positive. But oh boy do the tears well up so easily and I'm not even sure why. Perhaps I'm tired. But I slept 16 hours this past Saturday. Perhaps I'm stressed. But I feel like all my care has disappeared. My heart feels heavy, maybe I'm overreacting. Maybe, I'll get over it. Maybe, maybe. One moment, one minute, one hour, one day at a time.

31.

Last Monday was my birthday. The questions that arose when faced with the passing of time made me take a step back and reflect. Is this what I want? How am I doing? Really? What do I want to keep and change?
This year has been intense. Starting my dream residency in beautiful San Diego. Creating a home. A new relationship. A wonderful relationship. Working with a new team and new species. So much learning. Not just medicine, but personally and professionally.
But is this what I want? Externally life may seem together, perhaps often precariously balanced. Internally I am still battling the same fights. Constantly fighting to improve my confidence and self-esteem. Never feeling good enough.

So how am I doing? Stressed, tired, anxious, sometimes depressed. But that internal fire to keep going has never burned out. Really? But really... sometimes I get overwhelmed and its all too much, especially during a pandemic and during a time of such turmoil. So then I seek solace and temporary relief in reflection, and then get right back to the grind.

And what do I want to keep? I want to keep my tenacity, my strength, resilience. And change? In the next year I would like to develop a habit for more pauses before action. Be less reflexive. Not allow my emotions to consume me. And take the time to value the good in my life such as family and friends.

Heres to another year spinning around this earth.

The Art of Science

My wildest dreams have come true. I was accepted to the position of my dreams in San Diego as a Laboratory Animal Medicine Resident. The first two months have been quite trying. But also incredibly fun. I love what I am doing but constantly worrying about my decisions. Medicine, like life, is not black and white. There is an art to it with an infinitesimal amount of variables to take into consideration. Sometimes what it comes down to is faith. There is great difficulty in this. When I do not achieve the expected result after hours of work, hope, and prayers for the best outcome I feel frustrated and crushed.

My faith is shaken. In myself, in medicine, in science, even in the process of effort.

"Eloi, eloi, lama sabashtthani" is a saying by Jesus at the ninth hour of the cross. It means "My God, my God, why hast thou forsaken me". It is an utterance of abandonment. Of hopelessness. These are common feelings when things don't go according to plan even when the best intentions were set. Its easy to lose motivation and to keep going at that point.

Residency will definitely push me to find enough inspiration to keep motivation to push on during difficult times, but not so much that I am perpetually burned. The reminder I willl set is that the faith is always there, sometimes I may just need to take a step back, re-charge, and continue on. 

75 Days Left.

What a journey this internship has been. It has pushed me to be more empathetic, be less reactive, and continued to make me more humble. But with each gain, did I lose something? Perhaps now I smile less, am more cynical, and am slightly more blatant. I have one more year of experience, one more year of laughs and tears, and one more year of wonderful friendships with new memories made.

But from that I tend to reflect on what else I could have done with that time. What if my journey had diverged else where? What if I had made other decisions? What if I wasn't where I am? What if I wasn't who I am doing what I am? All hypothetical. A mind game of looking back into the past. A reflection. The ripples have already dispersed.

I suppose this meditation is not on what was but where I am now. A reminder to come back to the present. A reminder to not live in the yesterday. To embrace the today and all that it brings.

One Month In

Each day I look at my failures, my mistakes, my difficulties and I feel regression. However, in the sum of things, there is progress. It is good to take a step back and observe the overarching direction, to see whether your efforts are going to fruition or if you need to reassess and try a different approach. It is never too late to turn things in a different direction since progress is not linear. Progress to me has always been intuitive, it has melded to whatever life throws at me at that moment. This last week was certainly difficult with the addition of added stressors. Some of which I chose to take on, so that is somewhat a downfall of mine. Taking on too much while expecting not to crumble. But with a step back, a breath, some time to myself, a moment to re-assess I know that it will all be ok. 

[Stelvio Pass, Swiss -> Italy]

Perfectly Broken

The Japanese have a method of repair which is termed kintsugi or wabi sabi.  The metaphor of this philosophy is quite beautiful. When an object is broken, say a plate or bowl, it is subsequently fixed with gold. The original object is made stronger. The imperfections are not hidden, they are highlighted and they are what make that object unique.

Such is resilience and such is life. Lately, I've been a bit harsh on myself with comparing to how things were or how I wish they could be. However, resilience means not giving up and pushing on despite setbacks and so-called imperfections. I am made more valuable by being broken, over and over again.

A Dance in The Theatre

The room is illuminated by two surgical lights emanating a cool blue tinge to the patient on the table. Ribs retracted, the slow, steady hum of the bypass machine in the background accentuated by the steady heart rate beeps. "Pressure?!" bellows the primary surgeon before the cardioplegic solution is pumped into coronary circulation causing arrest.

The procedure starts, four sets of eyes follow as a cut is made into the fleshy red tissue. The device is placed into the designated valve and slowly the incision is sutured. A small pucker remains on the ivy leaf shaped left auricle. As the heart starts returning from arrest it squirms and quivers, like a bag of worms. Fibrillation.

"Paddles!! Charge to 150!" bellows the surgeon as all hands leave the table. Thud. "Charge to 200!" Thud. All eyes are on the fleshy organ that has now developed mild bruising. Will it beat with all this damage? Resilience triumphs today as it cardioconverts back into rhythm and returns to its bright red color. It happily jumps inside the chest, and returns to its role as life giver when bypass is removed.

This momentous surgery may be a procedure to some, however for me, as with most things, it had a deeper meaning. This is something that I aspire to, but am I ready? To hold the fragility of life in my hands, to walk on the tightrope between life and death. Something that I am so intimately aware of but am still petrified and confused by.

I am not sure I am ever meant to understand. Perhaps, instead, I should be content with the dancing in my own ribcage.

Love

"Where there is love, nothing is too much trouble, and there is always time"

One of my absolute favorite quotes.

Think

Do you know who you are?
Do you know what has happened to you?
Do you want to live this way?

"All it takes is one person, one patient, one moment to change your life forever.

It can change your perspective, color of your thinking.
One moment that forces you to rethink everything you know."

As the end of this month approaches, I am forced to re-evaluate my perspective. It was a month of harrowing surgeries that made me think differently about medicine and patient care. Everything from a huge thymoma on a sweet tail-wagging Labrador (pre- and post- op) to a hemangiosarcoma that had no saving.

It was both beautiful and weary. Now I am off to a "safer" side of medicine, one where there are fewer feelings involved and one where I can comfortably run off to recuperate in.

This month also beat me up in other ways. I am still waiting for a response to the residency but I am not quite so sure anymore. I honestly thought I was the best fit for the position and the strongest candidate. Rejection sucks and I am not used to it. I really hope two months of cardiothoracic surgery will take my mind off of it and allow me to find my place again.

I feel lost and out of control right now. Definitely not in the happiest place but as usual I know all things come and they go. I am thankful I have my health, family (close as they may be), and that my dog is healthy!

Onwards

The end of this year is fast approaching and it has been a year of adventure, growth, and change. I hope that the next year will continue as such. I am looking forward to all that it continues to bring. Cautious optimism.

While it is good to look forward to things, there is always the joy of the journey.  While in Australia I got extremely homesick and started yearning coming back to California. This depleted the pleasure of the moment and thankfully I was able to realize that. All it took was a conscious change in attitude, a reframing of the mind, so to speak. This can be done in any circumstance where there is suffering. Realize that you are suffering. Source out a why behind the suffering. There may often not even be a why behind the suffering, but the validation alone is often enough. Then change your perspective.

If you cannot change the circumstance, you can change how you think about it.

Dangerous Love

This past weekend has been spent surrounded by very inspiring individuals. Makers, do-ers, discoverers, searchers. And yet all so humble. I suppose that is what drives the medical profession, or scientists in general. We are usually never satisfied.

Right now I am frustrated at myself with my lack of motivation and inspiration. With my lack of purpose. It feels pointless and frustrating to live like this. A life with purpose is everything. Find purpose and you have everything. Purpose can always change. But to live without it is meaningless. It is a waste.

I know that I will find purpose again, however, right now I am in limbo. I know that I should be studying for the NAVLE, which I am. But that is purpose in itself. There is no passion behind it. Purpose should be self-driven. You cannot help but think about it. You cannot help but obsess about it. I want to find that something again. My dangerous love, where are you??

Want

For some reason, lately I've been seeing wanting as weakness. To want something too much puts excessive expectation into the matter. Hope for a job, a relationship, or any other result can often lead to disappointment. But harboring too much non-attachment is also no way to live. A balance should be sought and letting go should be practiced. However establishing and adjusting that balanced tightrope walk can be truly difficult. When do you know when to let go or when to hold on a little more? When does wanting something become harmful instead of uplifting?

Breathe

Ah to breathe again is a blessing. I am trying to cleanse myself from the misdeeds of the summer, from all that was seen, from all that was lost. A time to process, meditate and let the dust settle before life sends me on another run. I see now how life comes in waves. At moments they engulf me to the point where I feel that I cannot swim and will surely drown. However it always settles, and I come up for more air. Right now I am trying to cherish the peace and quiet but I know before long the madness will start again. These peaceful moments remind me how there is more to life besides accomplishment. They remind me how there is beauty in simplicity and joy in absolutely nothing.

Surgery

"Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures."

The month long internal medicine rotation once again reaffirmed that I am not meant for clinical practice. My place is in the OR where there is peace and I can hear myself think. I see so many parallels between surgery and life. How you win some and how you lose some. How nothing is perfect in a surgery, but a life will go on. Unless if it doesn't. But then again, death is just part of life. Life is filled with decisions, so just make them or live with the regret of not making them. We are all going to die, so make the best of it, with each surgery, with each day. And remember to breathe... 

This was my first time seeing a thoracotomy, a perfect preparation for the cardiothoracic surgeries up in Davis in February. Also my first hemilaminectomies, which I got to see several times and became comfortable with. Neuro should be very interesting in Vancouver in October. Very much looking forward to meeting the neurosurgeon up there! 

With all that is lined up, I am excited but also saddened that I am back to being my lonely self. There was a moment, a glimpse of partnership, but then it faded. Soon enough this wound will fade into a scar, and so it goes.

Heartbreak

This is for when you feel torment inside. For when your heart is ripped from your rib cage. Sit and feel the tears welling up in your eyes. The pain will pass, it always does. No, life is not fair, but it is beautiful. This will make you stronger and after you heal, you will approach life with zeal again. I know right now it feels like the end. But look at it like a new beginning. Feel, feel, feel. Don't run from the tornado brewing inside. It will settle. Just breathe and take it moment by moment.

Inbetween

Pathology is defined as the study of disease usually based on the analysis of tissues, organs or the body. So essentially it is the study of disease based on the dead. A very morbid topic and one not many would want to tackle. However I feel that it is a necessary subject area since life and death are so finely intertwined.

Disease is what often causes death. Sometimes it can be acute but in the modern age and when looking at humans it is often chronic. When a diagnosis is beseeched upon someone we are often at a loss. However we often forget that we are always dying. So much so that we forget to live. Our lives can often be lost in meaningless drivel, spent doing useless tasks that have little purpose.

However meaning can be found in the littlest of things. In fact sometimes its the littlest of actions that have the biggest consequences. Seek meaning in what you do. Do not let your life become diseased. Make the most of it because before you know, it may be over.

Potential Butterfly

These dreams keep haunting me
Mistakes, lost potential
I wake up gasping for air
Grasping at what could have been

Each moment slips by
Time which will never return
A stream, silver drops going by
Gliding through my hand

With each loss
A piece of me is torn off
Taken from my inner depth
Yet I do this to myself?

These masochistic tendencies
Leave me tangled between emotions
I end up in a corner as a curled cocoon
But will I emerge as a butterfly?

Sleepless

Patience, patience...
It will come together in due time.
Then it will all fall apart.
This is the way.

Let the anxiety flow through you.
Express that energy in selfless deeds.
Think outside yourself.
When you focus on the suffering of others,
yours will minimize in comparison.

Fill your heart with passion.
Embrace emotions.
They will take you from the greatest highs,
To the worst lows.
Just feel, you do not have to react.

Remember to love
Cherish what you hold dear
and do not forget your values.
Ask yourself,
"Is this the life I want to live?"