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week 11: cardiology part 1!


Week 11: Cardiology part 1
Monday 3/18
Honestly was feeling nervous about today. The cramps were pretty awful starting first thing in the morning and I was too nauseous to eat. I didn’t get to work out because of the pain. Not a great way overall to start the day. Morning report was nice as usual and I managed to eat a banana, I met my intern right after who was really cool! He loves teaching and was always trying to slip in an explanation which was great. I was really cramping bad during rounds – I don’t know what I would have done without my lil hot hands pack tucked in my leggings all day. Also my senior is hilarious and is only scheduled to work because of some unfortunate circumstances but I can tell that she really wants me to have a great learning experience. We rounded until right about 12, most of it was sit rounds and we visited the new patients. I sensed that the cardiology team is much more focused on the heart problems and they leave thinking about the ~whole person~ to the medicine team. We had one patient who was my age with pretty advanced heart disease and that was a tough moment today.


Noon conference was just space for interns to debrief but I got myself a pupusa and some chips. My team told me to take the whole hour and usually I wouldn’t but today, a girl needed it. I was finally feeling a little hungry and up to eat, I managed to hold it down and take some meds which felt like a win! I went back to the team and not much was happening, we talked about expectations and goals and did some teaching. At afternoon didactics, Dr Wheeler tried to get me to present a patient case but I had made up my mind not to today. Christina was so kind and came by and gave me a hug before we started and it was a really sweet moment that I appreciated so much. It’s always so fun to work through cases with Dr Wheeler. Afterwards, we had some teaching with the attending! I didn’t quite grasp the nuance of pacemaker settings but it was a really helpful first pass. 

Later, Sam Lew emailed me some resources for folks who have lost things during street sweeps and contact info for someone who’s collecting stories of people who have had their stuff swept – I brought them both to a patient (who looked happy to see me when I popped by!) and that felt validating. I'm not sure how much it helped him but it made me feel like I could bring some outside knowledge in that potential improves patient care. Later, we visited the patient that I was going to pick up; she got really tired and wanted us to stop asking questions which was a bummer but we respected her wishes. I was having a tough time sorting through her case but it was helpful to talk it out with my intern. We went back to see her, she was having bad leg cramps, and I rubbed her feet and legs while we talked, and I could tell that she really appreciated it. That was probably one of the highlights of my day. I hope she gets some dinner and is feeling back to her usual self soon. I stayed until 8:15 and then got home around 8:40! Took a shower, made some dinner, and journaled. Mindy sent me the sweetest text out of the blue which was such a good way to end the day.


Tuesday 3/19

This morning wasn’t too bad. I forgot to swap scrubs last night so I walked into the hospital wearing leggings and a long sleeve shirt LOL and then put my scrubs on top. I read up on my patient and then went to visit her, I bumped into my intern Abhayjit and then hung out with him until rounds! I didn’t feel perfectly ready to present her case, I could have practiced it more and it was my first cardiology presentation, but overall I’d say it went well. Rounds went until 11:15 and then we had MDR at 11:30 so we just took a little coffee break which was fun. I had to change my pad a FEW times this morning because the bleeding was heavy whew. After MDR wrapped up, I went outside because the resident’s union was holding a demonstration (not a strike because they’re not allowed to!) for their demands over a fair contract and in solidarity of the strike happening at UCSF tomorrow. Noon conference was a great teaching about ventilator settings AND had burritos yum. I went to visit a patient after and ended up talking to her niece for a while about what school has been like. I definitely got turned around and my badge wouldn’t let me get out of the stairwell SOS but it was fine after I went down one more flight of stairs. I bumped into Alma Martinez on the way up, it’s always fun to see familiar faces around! We talked about the GBBO, and I told her about Queer Eye on Netflix. Abhayjit explained triple therapy to me before didactics, I only got to work with him for two days but he was so great at making time to teach! We had an hour session about HIV pharmacology which was super helpful because the meds are literally a different language. I finished up my note after that and there wasn’t much patient care to do, just some administrative tasks so I got dismissed early today!

Mom wasn’t even home when I called, but dad and I chatted for a while. We talked about match day and I was saying how I didn’t like the idea of it. Dad reminded me that mom didn’t even get to match, no programs wanted to interview her during the year! And then there’s the added layer that foreign medical graduates were really just offered residencies that required them to commit to YEARS of service in underserved rural areas that are downright hostile sometimes to brown people. The indignity of what my mom had to go through instead of “matching” – at the time (and still today!) my mom was an incredibly well-trained, meticulous doctor who had already completed one residency and who had a vast knowledge base that American medical trainees just couldn’t compare to. But aside from being clinically excellent, mom is inordinately kind, warm, and thoughtful, she treats people so well, she’s a creative leader who comes up with effective solutions. She’s the person who gets there early and stays late, never complains about the workload, makes time for that one extra phone call with a family. If she didn’t have the IMG label, residency programs would have fought over her. International medical graduates have it really tough, there’s so much uncertainty and unfairness, you’re given so little and expected to do so much in return. Our conversation made me reflect on no matter how stressful my match day is, it’ll still be better than my mom’s experience. Framed like that, match day will be just fine. I’ll end up where I end up, and I’m the kind of student who tries to learn from every opportunity so I’ll get trained well. Residency is a finite amount of time. And looking forward, it feels like I have no control where I’ll end up but that’s just not true, students get to rank their list for a reason. I hope my match day two years from now is a good experience for my parents, one they can feel proud of. I hope I get to keep making them feel like all the indignity they’ve dealt with and sacrifices they’ve made is worth it because everything they’ve worked tirelessly to give us I’ll have made the most of.

With my lil snippet of extra time today, I decided to read a few more chapters of Unmarriagable by Soniah Kamal. Instead, I couldn’t PUT IT DOWN and ended up finishing the book ugh when I was trying to savor it! It’s a spin on the classic pride and prejudice story, but it was so refreshing to see a South Asian cast reclaim the trope. I liked that it was fun and light but ALSO had important social commentary and touched on urgent issues like the ways in which women are pressured to get married still! In addition to the traditional layers of critiquing patriarchy and class hierarchy, there was a really nuanced discussion of colonization too which brought race and ethnicity into the fold. I loved it. I want more books like it. Earlier today, I had been thinking about how I was raised speaking English, our colonizer’s language, at the expense of the language of my ancestors -- and the book addressed that. There’s one passage I keep reading over and over again. I’ve realized that I’ve looked for reflections of myself in the arts of others my whole life, and that there’s something so validating, so magical, so joyful about seeing my family, my story, my background, ME in art created by the south Asian diaspora. I grew up watching Bollywood which was a mixed bag and I probably should make more of an effort to get back into it, but that always felt like the INDIAN experience, one that I can’t really relate to! I’m most drawn to work by folks from the “third culture” or South Asians who grew up outside of the motherland – no matter where they ended up, there’s something about their work that just resonates so deeply with me. Riz Ahmed’s music, Mindy Kaling’s romantic comedies, Padma Lakshmi’s writing and advocacy, Hasan Minhaj’s talk show, Alok Vaid Menon’s poetry and cultural critique, those are few that come to mind immediately but the list is so long. Sometimes I feel a little self-conscious or question my need to surround myself with South Asian voices, maybe it’s to fill in the gap I still feel from my childhood growing up without it, maybe it’s a hunger that doesn’t ever go away, maybe it’s just the human need to see myself reflected in the world. It’s interesting to be in healthcare where there are objectively a disproportionate amount of South Asians but even being around these people, it’s the hospital and we have patient care to take care of, my identity feels clunky (like ooo it’s awkward that there’s three Indian providers on this one team and no UIM folks yikes). But I feel there’s an entire world of art made by folks like me, FOR folks like me. I want more of it. And I want to contribute to it one day. One day!


Wednesday 3/20

Driving to MB this morning was so sweet. We got to drop Smrithi off to Parn and pick up Ryan and then we saw Hallen and she wished us a wonderful day! Such a great way to start the day off. The drive was fun and we got there with some margin. The lectures varied but I was mostly able to pay attention and got some great takeaways. We ate lunch, went on a lil stroll to Spark to fries for Aish, had a lil bit to just soak in this beautiful sun that was NOWHERE TO BE FOUND earlier this morning. Afternoon didactics were about the nuances of renal physiology which I need to work at just a little bit more! We got boba before driving back and then was home around 4:45, not bad.

I had a long call with Michelle about Tate Society, it’s so sweet to still be involved with one of my favorite groups from college. It sounds like the members are asking tough questions and trying to hold the group accountable to values that matter like representation and equity. It was a great conversation, and Tate stuff just makes me so happy.

I wrote a lil poem (idk if I'd call it a poem but it wasn't prose that's for sure) about my parents today and sent it to them - it's hard to express how much I love and cherish and admire and appreciate them but it felt really nice to give them something tangible today.


Thursday 3/21

Today was such a satisfying day. I had a great workout (despite missing 3 days of working out because of my period ugh) and didn’t hit much traffic on the drive in.

I was planning to pre-round on my patient this morning but she got transferred overnight and my senior was super apologetic but honestly was happy that she’s one step closer to getting the surgery she needs!! The rest of our patients were pretty much chillin and there wasn’t much to do, made me grateful that we do q4 call days because that means tomorrow we get a new crop of patients yay! I read up one of our guys and on thoracentesis procedures and then went up to see Liat do one! The pulm team came in and took over, they walked us through the steps and we pulled out 1500 cc of fluid from this woman’s lungs, HOW do people have so much in that tiny pleural space?? It was not a very satisfying patient procedure, she was an older woman who was just 100% done with us, she barely talked to the interpreter and didn’t respond to our overtures of warmth and support during the procedure. That might have been one of the hardest patient encounters yet, feeling like we’re hurting someone and not being sure that they understand why and not feeling any sort of connection. She was stoic to us but I could see discomfort and pain on her face, I couldn’t tell if she was someone who suffers quietly by nature or who stands her ground but didn’t feel up for it in another language. Sometimes the best way to honor others dignity is giving them space and not inserting ourselves into their moment. I hope she started breathing better soon.

We went up to rounds, one patient had a complete heart block and a question came up. I thought I knew the answer so I just went for it - in a room full of residents and a fellow and an attending, maybe I should have been a little more cautious. Turns out I was right - and it felt like validation for all the times I thought I knew the answer but wasn't 100% sure and didn't speak up and regretted it later because I was right. We left for intern report after and also noon conference was about POCUS which I love and want to get better at!!

The afternoon was awesome. We saw an echo and got to follow through the chambers and valves with expert commentary from Rohit the fellow and Dr. Win, our attending. We also saw a cardioversion – a patient with atrial flutter was shocked back into sinus rhythm. That might have been the most satisfying part. I also know now to grab paper towels as soon as they’re done with the ultrasound probe to help them wipe off the gel and it makes me feel helpful. I asked one question about amiodarone vs the other anti-arryhmthnics and Dr. Win and Rohit said it was a tough question and apparently I had tapped into some longstanding controversy without realizing how important the question was, that was fun. Rohit invited us to ask more questions and encouraged us to stay with him for a pacemaker check. This was the second patient today that made me really wish I spoke Spanish. 

In other reflections, my hair looked good today which is always nice. When I got home, I was pretty productive for a few hours and then I went on a run to the beach which was a smidge colder than anticipated but felt really nice to be outdoors and WALK and run and blow off some extra energy. Phone call with mom was sweet. The MUNI worked out perfectly on the way back, I took a shower and ate dinner and now should go to bed soon


Friday 3/22

This morning was a lil frustrating because I got there for morning conference at 7:30 but forgot it was intern orientation so I didn’t need to be there until 9. I did some Uworld questions which was productive. Rounds are always a lil dry, esp when I don’t know any of the patients but I tried to listen and think about clinical reasoning. Dr Win asked if I had a patient but long story short, I didn’t have anyone to present on, it was nice of him to ask me. We did a bit of bedside teaching but had to return for MDR. I went to noon conference which had my favorite tofu sandwiches and a fun outpatient case (syphilis!!), then there wasn’t much to do before didactics. 

One of the residents had a family member who was in the ED today but doesn’t have health insurance, another resident mentioned losing a family friend to suicide recently, and I was drained from keeping up with the HB481 updates but it’s good perspective that life just doesn’t stop happening when you’re working and that everyone around us is carrying their own troubles. Didactics were nice, I always enjoy learning from Margaret Wheeler. The afternoon stretched on, people kept signing out and the conference room was empty soon. There wasn’t much to help with but I couldn’t just leave because it was call day and I hadn’t picked up a patient yet. And my phone was dying. It was a difficult afternoon, and I would have rather picked up a patient and worked through a case rather than sit around. But it’s good to have learned that. And I got some quality time with the amazing women of team 3. Dr Win came by around 5:30 and told me to leave, I hesitated at first but took the hint quick and slipped out.

Another thing I jotted down during the day – Jenn who's my new intern really pays attention to the little details, she made sure our patient’s curtain was completely closed before we moved their gown to ultrasound their heart and she made sure I could see when we were all gathered around the little screen. It’s so reassuring to see interns still remember the little things and shows me that I can be that intern too!


Saturday 3/23
We only got one patient overnight who was getting discharged today so I still couldn’t pick up anyone! It’s easier to get distracted and zone out during rounds when I don’t have a patient to feel engaged with BUT I tried to be extra intentional and listen carefully and ask good questions especially since weekends are made for teaching without the interruption of didactics or MDR. I accidentally sat next to the attending which ended up being great for teaching, he quizzed me along the way and I got to ask some clarification questions. We started visiting patients and a CT surgeon joined us – he was SO nice and really made his patients feel so cared for. 

My intern dismissed me fairly early in the day, but I wanted to stay for team lunch. Right after, Lulu who was covering for another resident today mentioned a consult, I was kind of ready to go but I stayed and I'm so glad I did – the guy had a pretty bad tumble but he was so nice, he said it meant a lot to have such a good team taking care of him. Lulu had another consult but both her and Dr. Win encouraged me to peel off so I left the hospital around 1, but when I was driving back from grocery shopping, I did feel like I had left prematurely. I didn’t think I would ever regret leaving early but I was a little bit today. Good to know for next time I’m at the same fork in the road.

But grocery shopping and meal prepping and taking a nice long nap were sooo nice and I still have a WHOLE DAY left of the weekend! Precious.

Later in the afternoon, I checked in with some sweet MS1 friends who invited me over to their pregame tonight. It was SO GOOD to see them, and I had sweet individual conversations with lots of people. One heart to heart that really stuck with me was about validation and how chasing tangibles like titles and authorships just aren’t what we find satisfying and how it’s hard to carve out our own vision of the kinds of doctors and people we wanna be! We ended up at a birthday party that Smrithi was still at (I thought she would have been long gone), was so good to just hang with her and our wild MS1 friends. Some MS1s had mentioned that they were keeping up the blog which was just really really sweet - I don't really imagine people reading this but it's nice to hear that others are enjoying what I have to share. The end of the night ended up a smidge messy and it took like 20 minutes to say our goodbyes (lol so brown and so typical) but I managed to be in bed by 2 which wasn’t BAD. Such a good night, sure filled up my cup to see so many familiar faces who are all living their best H&S lives!


Sunday 2/24

Waking up today was a little hard, I would have stayed in bed all morning if Smrithi hadn’t come collected me. So glad she woke up and got me moving for the day, I got my laundry and washed my hair and collected my things and was ready to go in like 20 min! We got to Home cafĂ© and worked for a while – I had my first coffee in a while and I’m glad I brought some snacks. I could have been more productive but I definitely checked off a number items from my to do list which felt good. 

I also booked flight and hotel stuff for MIAMI – so excited that this is happening!!! Later today, I had a REALLY sweet phone call with one of my favorite people in this world, Isha <3 <3 she’s one of those people that I think about every day and it just did me so good to check in!!! Aww ugh I just love catching up with her, there’s so much I want to say but I also love listening to everything she says so we could really talk forever. It was so good to talk to mom and dad who were just in ATHENS eating at THE GRIT aka my fav restaurant in this world honestly after Jaaie’s Tate induction which just sounded so presh ugh NSSA!

At some point today, I had this moment where I just realized that I love where I’m at. I love that I’m working hard and learning so much and in medical school, I’m proud of how I treat others and how I try to be present in all that I do. I’m excited about upcoming travels and I’m grateful for all the friendships. I just feel really at peace and grounded going into this new week. Curious to see what's in store! 

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