Mind's eye

When the fatigue stops me, I can't help but wonder...
Will this always be what it is?
Will it ever expand beyond this?
When will I have more time?
When will my energy overflow and the productivity abound?
How is it that some people do this on just 4 hours of sleep?
Is it legal to be that productive on so little sleep?
Where is it?
What is it?
What's the secret? And does the secret change with time and age?
Will it ever change?
And in the midst of my stream of consciousness,
somehow I lose my awareness.
I am covered by the serenity of sleep, left to do nothing more than to rest
and be still.
Somewhere weaved between moments of wakefulness and slumber
I am prayerful
that with morning, answers will rise to the surface of wonder
Clearing my mind and intentions
while creating space for something new.

Princess Serena

There you were, dancing in waves
Swirling and moving without a care
As if you didn't know your body was so frail
Wrought with sickness but yet still whole
Your spirit shone a light that was so bright
I could never forget it
I knew that soul
I saw that soul and cared for it before,
Admired its perfect beauty
Without knowing, you taught me so much
Gave a gift that could never be replaced
Etched your little self into my heart,
Like so many others I called patient
And though you didn't remember me
You once called me doctor
You didn't remember me
But I will always remember you
The perfect princess, the fighter
Who with years gone by
Still remains
A divine light

Wow! It's been a while! Renewing commitments, returning to my passion.

My lovely partner told me out of the blue when he picked me up for our first date over a year ago, "You are a Writer. I was entering your name into my address book today and for some reason I just entered, Khaliah the writer." I was a bit (actually very) taken aback by his eerie clairvoyance and even more so by his absolute declaration...self-assured, without any question, he knew this woman whom he really didn't know at all was a writer. Perhaps I was so affected by his statement because I never really thought of myself as that. I knew I loved to write, and I knew that for me personally, writing was a powerful outlet for self-study and reflection. But I never claimed to be a writer. I guess we tend to put a lot of weight into titles. And the act of announcing oneself as something carries responsibility. If I called myself a writer, well, that would mean that I had to be writing. Regularly. All the time. And there were so many things about myself and my life that I loved, but had lost, during my medical training.

Being a physician is amazing. There are few other fields that allow you to explore and internalize a body of knowledge the way that one does when studying medicine. And then to have the opportunity to put that knowledge to practice, while simultaneously building thought-provoking, life changing relationships with other human beings...it is amazing. The process of learning and practicing medicine is purely gorgeous. But getting to experience the richness of medicine, for me, meant sacrificing other things that I loved. It meant relinquishing some of the creative endeavors that felt so naturally a part of me, but that there just wasn't enough time for. In order to make space in my mind, my heart, and frankly- my schedule for the practice of medicine, I had to let those other parts of myself loose.

In retrospect, as I sit here now having completed residency, trying to put the pieces of myself back together, I recognize that my spirit suffered when I let go of those parts of myself that were so special. Like that part of me that was regularly nudged by the excitement of sitting down for an afternoon, working with beads and metal to make a really beautiful pair of earrings (that no one else in the world would have!). Or the side of me that could go crazy with a camera while traveling, capturing moments and faces that I would likely never see again. And the segment of my life, my being, that I treasured the most...the part that became so overwhelmed by the peace, comfort, and satisfaction that came from putting my words and thoughts down...letting them go to take on a life and meaning of there own. Usually, I could only begin to fathom the significance of my words once I re-read them and digested them, at a later time and place. At times over and over again. This process was so healing, so therapeutic.

But somehow, writing for me turned into a chore. I think this happened around the middle of second year of residency...when I started to count up all the unfinished manuscripts I had written, all of the poetry journals I had stacked up on my shelf with blank pages that needed to be filled, all of the days that had gone by since I last visited my blog to author a new post. I started feeling guilty about abandoning my passion. I felt guilty that at the end of a 13-hour day on the wards, I couldn't force myself to stay up twenty more minutes to start working on that reflection piece I was formulating in my head, or the poem that was inspired by a little girl I had cared for earlier that day. And my tendency is that when I feel guilty about something, I avoid it.

So for the last three years, I've avoided something that I love so much. And all the while the love grew stronger and stronger, and the guilt associated with the abandonment became more powerful. It is only recently, in reconnecting with all parts of my self (mind, body, and spirit), that I have come to recognize that nothing is more important than love when it comes to my writing. Nothing is more important than how I feel when I am able to make the time to write, when I am able to simply be in the moment and forget about the guilt, focusing instead on the art and craft of this powerful form of self-expression.

So after a year and a half, I return to my blog in efforts of breathing life back into this very treasured part of myself. The part of myself that will continue to tell stories, and continue to find meaning in putting my words and thoughts down.

I have so much gratitude that I am, and always will be, a writer.

Changes

Has it really been almost three months since I made my last post??? This is crazy! (lol). I love that I have my blog though, this medium through which (when I do have the time), I can stop for a moment, pause, and reflect. There have been so many things that have transpired over the last several months that have made me think, "I would love to write about this on my blog." But what has stopped me has been the inability to stop (smile)...for long enough to get some of it out.

Just this past Friday I was given the most amazing gift in the world (or at least if feels that way to me, at this point in my life)...a three day weekend! No travel plans, no immediate deadlines, no expectations. So I've been able to slow down for a little bit. I thought it would be the perfect time for me to get back in the saddle and write some. It's a much welcomed change.

Speaking of change, we're entered into a new year since I last posted. Though I'm so thankful for the course my life has taken and can honestly say that each year has brought its own incredible occurrences, the thought of 2009 makes me particularly emotional. I just went to hear President-elect Barak Obama speak at the War Memorial in downtown Baltimore yesterday, and watched through tears as he talked about the road he has traveled to the White House. Though he will be faced with many challenges while in office that in present may seem insurmountable, I have undeniable faith that our country and world will see better times under his leadership. The foundation of hope he has created for us motivates me to take the work that I do both here in Baltimore and in other parts of the world to another level...in 2009 and beyond.

As hard as I work (especially in the face of some of the challenges that came up in 2008), I've realized that I have to take responsibility for shaping the direction in which all areas of my life will move, not just my career. I'm turning 30 this year!! This realization is incredibly exciting, but also very sobering. I have spent so much of my life training, learning, and striving to get to the next step in this process of becoming a doctor. There is definitely part of me that has come to acknowledge that I've lost some parts of myself in this process. I've sacrificed a lot of the fun and spontaniety of the 20's to walk this road. And though I have no regrets, as I enter my 30's, I am going to do so with a degree of consciousness that I didn't have for the last 10 years. There are a number of women in my life whom I respect and admire greatly whom I have talked with recently about the 30's, and they all say the same thing, "My thirties were the best years of my life." This year, I am committing myself to living the best years of my life as fully as possible, with eyes wide open.

Having said that, I've already identified some changes that I'm going to make in this new year, yet haven't yet stopped to write them down. But writing things down has always helped me to bring my thoughts to life and put them to action. So hear it goes!

Changes and ambitions for 2009
1. Be seen!! I'm going to make an effort to step out more this year, both locally and in some other locales I've been dying to visit. Possible trips this year: Europe, Miami (can you believe I still haven't been??!), Chicago, and the usual must have at least every 6-12 months or will die trip to Cali :-)

2. Nurture thy family. I brought in the New Year with my family this year, and there is no other way I would have rather spent it. It set the tone for some of the changes I'd like to make in months to come. More quality time (even if its as simple as more phone calls) with those who love me best, mom, dad, and Nai.

3. You have a feminine side...let it out! So this is my mom's nagging voice in my ear, "remember that you are a beautiful young woman and you have to let your femininity out sometime!!" Okay mom, I hear you, and I agree. I will make more time to play at Sephora and Vicki's Secret, and of course to doll myself up when I step out now and again.

4. Define my style. I've always loved fashion, and I love the attention and respect that a confident, well dressed woman commands. And many women I know have defined their personal style in their 30's. This year I'm going to work on my wardrobe...so more budgeting for sample-sale shopping trips to NY! (smile)

5. Get my hustle on! I thank God for and am excited by some of the financial moves and decisions I've been able to make in the last 1-2 years. But in order to afford much of the above :-), I'd like to come up with some creative, low-stress, and fun ways to make a little extra money on the side in '09.

These ambitions are definitely a change from my standard. And I feel really good acknowledging that. And of course, the usual New Year's resolutions apply: I will continue to put my best foot and efforts forward in my career, I will work more on getting to the gym and eating well, I will take care of my friendships, I will pray more and try to always remember to turn to God in both good times and bad. Oh, and of course, I will post more often to my blog :-)

Looking forward to all the joy, success, and change that 2009 will bring!

No rest for the weary

Perhaps the toughest thing about residency is the infringement it makes on your personal time. No matter if you've had a restful weekend off, whenever you go back to the grind it just seems to inevitably suck the life out of you. And that restful weekend off subsequently seems so far in the distance.
No number of weekends off, 9-hour shifts (so much better than 24 hour ones), or other short breaks away from the hospital can eliminate the fatigue that I feel when I'm done with a crazy shift in the ED. And without fail, it always seems to be that I can't get out on time. I get trapped! And there goes another hour of my personal time. There goes the 7 hours-of-sleep night rest in exchange for the 5 and 1/2 hour one.
Right now, I'm sick of the trade offs.

Sometimes the love is not enough to buffer disappointments

I love my work as a pediatrician-in-training. Every time that I look at the faces of one of my little patients, participate in their dreams of what the want to be when they grow up, or hold the hand of their parents as we talk through difficult news related to their child's health, I feel that there's no other job that I'd rather be doing. However, there definitely are times where that love is challenged...when things happen that make me feel frustrated and challenge my faith in our sometimes flawed judgment as human beings.

The other afternoon, I was working on the urgent care side of our pediatric emergency department. One of our nurses came and told me about a three year old child waiting in triage who had accidentally ingested bleach. There was subsequently a buzz of conversation between several staff members regarding the sequence of events that lead up to the child's presentation to the ED. About fourty-five minutes prior, a call had come over our box from an EMT who was in route with the child and was seeking support with management. The EMT informed all health care providers who had received the call(including my attending) that the patient had climbed up on a book shelf and reached a bowl of bleach that had been left there by an adult in the household. After having ingesting a small amount of the bleach, the child began vomited profusely, at which point his mother found him, realized what he had did, and called 911. In arriving to the scene to assess the child, the EMT found an alert and well-appearing, yet shaken-up three year old. He wondered if the child needed to be brought into an emergency room to be assessed, or if the situation could be managed at home, with the assistance of poison control. The poison control expert who participated in the conference call agreed, as did my attending, that bleach ingestions (particularly those that are of small volume) can typically be managed very easily at home with ingestion of water and frequent phone calls from poison control to the household to check in on the status of the patient. Yet apparently, when this child's mother had been informed of this recommendation that came from experienced health care providers who have taken care of many children with ingestions, she still insisted that the EMT bring her child to the ED to be evaluated. So alas, forty-five minutes later, here was the child in our ED, and I was the one who was to evaluate him.

I feel very strongly about the role parents play as advocates for their children and their children's health. It is my job to help parents see to it that their children are well and recover from their illnesses as smoothly and painlessly as possible. So when I encounter a parent who insists that certain things are provided for their child, I am eager to listen and respond. In fact, the role of working in concert with parents as an advocate for their children is perhaps the aspect of my job that I take the most pride in. So as I went in to see this patient, I felt that I was going to do everything I could to make sure that this child, who's mother was clearly very concerned about his well-being, was evaluated thoroughly. I talked with the mother about what had happened that lead up to her son ingesting the bleach, and she seemed very fuzzy on the details. "Um, I mean, I think he just got up there and got into something he shouldn't have. I don't know how he got up there, he just did." I asked where she had been when the ingestion took place and she responded defensively, "I was taking care of something else in the house at the time."

I tried to remain neutral, asking questions matter-of-factly, according to the script that many of us pediatric residents have likely compiled in our heads for use in instances when children are victims of accidents at home. Though the vast majority of the time incidents like this one simply occur secondary to oversight, the fact of the matter is that in these cases, the child advocates in us have to think about the possibility of abuse or neglect. As much as we want to support parents and believe they want the best for their children, we first and foremost have to protect our patients. Part of being a good resident is compiling the best differential diagnosis that you can and in this instance, abuse and neglect have to remain on the differential. Despite knowing this, I didn't want that reality to affect my interaction with this mother. I proceeded calmly through the interview and examined the little boy (who was rambunctious and healthy-appearing). At the end of it all, I put all the pieces of the history and physical together and concluded that the ingestion was most likely just do to "an accident", and was already planning in my mind the conversation I would have with mom prior to discharge about safety in the home.

While I was in with the family, Poison Control had called to recommend that the child be observed in the pediatric emergency room for approximately one hour and mentioned that if he had no nausea or vomiting after ingesting a given quantity of water, he could be discharged home. When I explained this to the mother and informed her that we were going to check toxicology screens on the child (just to be thorough in our evaluation), she seemed very resistant and said, "he looks fine, why do you all need to watch him that long?"

If I were in a cartoon-drawing at that point in time, I'm sure there would have been a bubble with a question mark inside floating over my head. At that point, I realized that my patient's mother may have perceived us as being on different pages.

"Didn't you want to come here to make sure that your child was okay?", I thought to myself. "Isn't that the reason you insisted that he be brought here by ambulance despite the fact that you were told that he would be okay to follow-up with poison control at home?" I pushed the perhaps somewhat judgmental thoughts to the back of my mind and responded to the mom's inquiry by explaining that the hour of time would give us the opportunity to make sure that her son would not run into any problems that we may not be able to foresee if we didn't observe him and also would allow us to get the results of the toxicology screening back (just in case there was something else in the cleaning solution that the child had ingested none of us were aware of, which might change our management). After the explanation, she agreed to stay, seemingly without any reluctance. Meanwhile, despite Spongebob being on the TV in the examination room, my little patient kept saying, "I want to go home, I want to go home (understandably, why would any three year old want to spend his afternoon in the emergency department)!" He perked right up when I told him I would look for a toy to keep him entertained while we waited. "I want a fire-truck!" So there I went, in search for a fire-truck for my patient.

I was excited to find the exact thing my little patient had requested in our Child Life toy cabinet. I brought it back to him, and went about taking care of some matters for a few other patients. About five minutes later I noticed the patient and his mother had their coats on and were walking toward the front door. I asked the mother, "Where are you going? You aren't planning on leaving are you? He hasn't had enough to drink yet and it hasn't been an hour."

She replied, "No, no, I'm just going out front to look for my daughter. We'll be right back."

Several more minutes went by and as I carried on with the work up of a patient who was in a motor-vehicle accident, I paused and wondered, "Did they really leave?" I went and asked the nurse that was working with me if he had seen the boy and his mom and he said no. When I explained to him what I thought had happened, he went out and inquired with security about whether or not they knew anything. Five minutes later our security guard came back and told us that several people had confirmed they saw the two leaving the building together.

At that moment, a number of motions flooded me. I felt confused, angry, frustrated, and worried. Why would someone bring their child to be seen at the hospital and then decide that they didn't want to wait to make sure everything was okay? Why didn't this mom see us as being on the same page in wanting what was best for her child? And what if something positive came back on her child's toxicology screen, and we had trouble getting in touch with her to advise her appropriately? There was a part of me that felt her actions were somewhat selfish and unwise. As I turned those feelings over in my mind, another series of questions came up for me. As the EMT was explaining to her that her child could be safely managed at home, why didn't she stop and think that the resources of that ambulance ride could have been used to transport another child to the emergency room who may have been somewhere else on the edge of life, in respiratory distress or cardiac arrest? Did she even know the number to poison control to follow-up if her son started to have new symptoms at home? Had she asked any questions about how to prevent similar accidents in the future? I put my head down on my desk and sighed. Inside, I knew he would be just fine and that if something else went wrong at home, she would find a way to get him back to the ED. I acknowledged to myself that sometimes it just sucks when you are trying your best for your patients and their parents and you feel as though your efforts are overlooked. I lifted my head and went to finish up things with my other patient who was awaiting care.

And then my heart sunk when I walked by the little boy's empty room, and realized that not only had he and his mother left, but they had left with the fire truck.

Sushi Love!

"What is she doing eating sushi in China?!!", you might ask. Well, I just had perhaps one of the most incredible dining experiences of my life, so much so that I had to try to put the experience down in text.

Cheri and I have been having such a blast zipping around Beijing. One of the highlights of this trip (as I've mentioned in previous posts) has been the food. We decided to treat ourselves to fancy dinners on our last two nights here. This evening, we dined at Yotsuba, a traditional-style Japanese restaurant that is known locally as a "gem" within the city. We arrived to find locals dining with their shoes off at low seated sushi bars and private rooms, enjoying the peaceful ambiance while eating at their own pace. We then sat down to two and a half hours of a leisurely experience that can be described only as self-indulgent(but well-deserved) decadence.

We started with warm sake and green tea (which prepared our palates beautifully for the sushi love that was to come), and then moved on to perfectly prepared, flavor crab-miso soup. Our second appetizer course included a beautifully arranged plate of steamed okra with tempura flakes, cherry tomatoes, and a marinated sea-snail accented with sea salt. We also enjoyed wasabi flavored octopus salad and ginko nuts, which neither of us had previously tried. The ginkgo nut is the hard-shelled kernel of the fruit of the maidenhair tree, one of the earth's most ancient plants; it is thought to bring good fortune to those who eat it (we were feeling lucky tonight- :-)). I would describe the ginko nuts as little nuggets of joy in a pistacio-like shell. So yummy!!

There was a beautiful, "seasoned and experienced" Taiwanese couple (who live in the neighborhood of the restaurant and, as we learned in conversation, dine there on a weekly basis) who sat beside us at the sushi bar. They mistook us for foreign-locals that were dining out after work (and we happily accepted the compliment). We asked them for their recommendations on what to order, and they said that we couldn't leave without trying the unagi. But of course! Unagi is one of our favorites!

The absolute highlight of the meal was the fish...that is, ahem, flown in daily from Japan. We had a sampling of shrimp, fatty salmon, roe, flat-fish, and tuna sushi...each piece unfolded in our mouth like pure treasures. I welcomed the surprise of the fresh and flavorful quality of each and every bite. Our entree experience was rounded out by the finest yellow-tail sashimi and unagi sushi I have ever had in my life. To be honest, there are no words for what the unagi was. Pure buttery, rich, savory and sweet goodness (that's a shot, but still doesn't do it justice).

One of Cheri and I's Bay area traditions was to visit our favorite San Francisco sushi restaurant together, "Sushi Zone." Tonight was sushi zone to the 10th power. Absolutely oustanding. And what made it all the more special is that we shared in it together...close girlfriends, celebrating the end of two wonderful weeks of travel together, as well as our accomplishment of making this trip happen. How awesome...eating some of the finest sushi on EARTH with one of my finest friends. I guess we truly are big girls now, taking the world by storm, and loving every moment of it.

Here's to Sushi love, to travel, and to best friends.

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