The thing that is hard is the hours. I do miss being at home with Wolfie and relaxing. I know it’ll get easier when I’m more used to the schedule and the such but compared to the extremely light schedule of 4th year this is quite the shock!

I had my first call and it was pretty rough. I’d say this has been the worst part so far. I fell asleep in the chair two times, suddenly woke up noticing that !!10 minutes went by!! and that was my rest for the call. It wasn’t hard to be awake so long, but I just wanted it to end so I could shower. I love to shower in the mornings and I feel all off if I don’t.

Overall though, it’s been good. It’s hard to move from the med student role where you don’t say much of a plan and you just are the information gather, to then formulating a plan while in the room. All in good time. I know this is what I want, and this is the way to get it, so this is the road I am on and that is that.

I did have a lovely surprise post call :) Flowers and Pie!!

The pie recipe is here. :)

Soft, beautiful… I just love pictures that to me come with a sensation.

There’s a beautiful rose garden here, and June is the time to go. :) The roses were looking a little tired but they were kind enough to be just as beautiful for me.

There’s a rose there called the chianti which has this amazing color. I just love it.

There was lots of purple

Being silly

This cool shot of a bee in mid flight

There were a lot more bees around this year than last year. They had a hive which was super cool. I hope that the bee population is recovering, they are very important critters!

The undersides of leaves were sticking out to me

A baby fern

Container gardens – this seems to be much more popular than before.

Or maybe I never noticed them before…

There was this odd thing

Which was made from natural materials, and it’s just mean to be as it is – not preserved or anything. So when it falls apart they’ll replace it with another sculpture. Interesting. You could walk around inside, it was a cool fort!

I found this very interesting article “Taking Time for the Self on the Path to Becoming a Doctor” in the NY Times that I’ve been circulating around, and even been sent to me :) Here’s a clip, and I hope you read the whole thing.

Over the next two weeks in hospitals and medical centers across the country, new medical school graduates will begin their internship. Among their many worries — moving to a new city, meeting new colleagues, adjusting to medical training — is a more profound, existential concern that had once plagued me.

Do I have to lose my self in order to become the doctor I want to be?

I learned the answer to that question partway through my internship. Not in the hospital but in the checkout line of a local grocery store.

The customer in front of me was an older woman — she wore a faux camel-hair coat and had hair dyed a matching color. I remember that she had wanted her groceries bagged in a particular fashion, but the sales clerk, a young woman with impossibly long pink acrylics, was perplexed by the woman’s demands.

I felt as if I had stepped into an avant-garde theatre production. Each time the young woman bagged the groceries, the older woman admonished her and asked her to go through the process yet again. The muscles of my jaw tightened with each round of bagging, and even though I was off for the day, all I could think was: I’ve got sick patients to take care of, I can’t wait for this!

Unable to bear it any longer, I stepped forward and bagged the woman’s groceries myself, shoving the plastic bags into her arms while resisting the urge to push her on her way. I imagined steam rising from my head as I ranted. But a part of me was as shocked as the people still standing in line. I had never lost my temper in a store, and I had never raised my voice in public. Now, a few months into internship and with a three-minute provocation, I had the capacity to act like a grizzly bear sprung loose from a trap.

I walked out of the store horrified. That night thinking back on the event, I grew more ashamed of my behavior. But I also realized that it was not the first time I had snapped. Over the previous months, I had thrown myself into my work and shunned everything I once enjoyed and nearly everyone I loved. I believed I needed to do so in order to become a surgeon.

But I had lost my self in the process, and the stress made me irritable. I was no longer the nonconfrontational person I once was.

I had, for example, raised my voice a couple of days earlier at a receptionist in the radiology department when she couldn’t schedule my patient for a CT scan. I had scolded a nurse who had had the misfortune of being the fifth person to page me as I scrambled to finish a procedure. And only a week prior, I had squabbled with my family after my mother innocently asked, “Why do you have to work so hard?”

Either way, some things recently have been harder without my Dad. The big one I had been writing about was graduation. My dad had a very zen like attitude about the pancreatic cancer and the ever shortening time he had left… but something that we all were upset about was the fact that he wouldn’t be at graduation. In medicine, you really learn that there are all sorts of possibilities, but it’s usually the middle road that end up happening. So at first when I learned that my Dad had metastatic lesions (the pancreatic cancer that had spread) in his liver, it didn’t necessarily mean he wouldn’t make it to graduation. It made it less likely than if he just had cancer that hadn’t spread, but didn’t necessarily rule it out. Then he had all this bleeding and was getting transfusions left and right from the tumor(s) and it was almost certain he would not make it to graduation.

I sure you can imagine him not being there was hard. I don’t like to make things a “you have to be in my shoes to know” but there’s something about not having someone like your parent at something so huge like a medical school graduation that you’ve been working years towards that is really, really difficult. It’s also hard to get some of those pitying looks, I’m a strong girl. I don’t need pity, I just want my Dad back for one more day of my life but some things aren’t meant to be.

There’s a coldplay song 42 with a line “Those who are dead are not dead / They’re just living in my head” I first heard this before any of the stuff with my Dad and thought it was an odd lyric. But then I heard it when my Dad was sick and it struck a chord that this is where my Dad would continue to be when he wasn’t here anymore. So I know my Dad wasn’t there on graduation, but I still have an idea of what he would say and his big smile! And that’s what I’ll continue to have for other moments of my life.

This father’s day I don’t have some silly card to give him, or some present. Maybe this year I could have gotten away from graduation from medical school as my present! joking :) I miss him a lot though, wish he could be there that first day I put my long coat on it with Dr. Goofy Girl, the first one in my family. Just not meant to be and I’ll just imagine his calling me an onesan – literally a big sister, but more meant as a grown up. And of course making that silly noise that Japanese people do when they are amazed – oooo! :)

• Orientation began this week for internship. Much of it is general orientation stuff, not the most exciting. What has been interesting however, is the focus on patient quality measures and their already huge impact on the delivery of healthcare (and it will only become greater as it is likely the quality measures are tied to amount of payment). So if you’ve been in the hospital and had a survey about your stay, those questions are more important than you’ll ever know!!
• I begin for real next week on Weds, and my first call is the following Friday. Scared, excited, nervous… :)
• I’m still very far from unpacked. I have a hard time keeping my apartment tidy to begin with and then all these half opened boxes, figuring out where to put things… it just needs to be done but not into it at all!!
• I’ve been reading a bit about this whole healthcare thing – and from my perspective it feels as though the priorities are off. I feel as though due to insurance and malpractice and general non-action physicians have been kind of put in a corner as far as how they deliver care. It just doesn’t work very well for delivering care that is compassionate – I think people have found ways to work within this framework, or do things that are outside of the box (micropractices) but I want a system where compassionate care is the standard. I want care where things aren’t just referred out (which costs more) because there isn’t the time. I want to be able to discuss with patients if a test is necessary because there is just so much over testing – and eventually there’s something that’s off. We’ve been told if you order enough tests, you’ll find something out of range. Doesn’t necessarily mean it’s nothing, but I would still rather have a real discussion of the necessity of the test instead of just ordering it to save time! But for now, I’ll hope for the best!!