Tag: journal

Broken Ribs But Not Broken Spirit

My own Popo and I. Last pic together. 2022.

I woke up at 3 am thinking about the 93-year old lady whom I discharged the evening prior, wondering if she’s doing okay.

Popo G (‘Popo’ means grandmother in Chinese) has a blue cap on her head, covering her face, shielding her from the bright fluorescent light of the exam room in the ER. Her family brought her to the ER because she’s been complaining of right-sided back pain since she fell off her bed the day before. She stares at me blankly when I greet her in her native tongue, Cantonese. Her daughter at bedside tells me she’s very hard of hearing, which explains her lack of reaction. In hindsight, I wonder if her stoned expression and subdued manner was because of the oxycodone she was given earlier. As I get to learn more about her later, her personality is nothing like this calm, subdued woman sitting in front of me, and she is able to hear me and others well enough to yell back with full strength. At that moment though, that isn’t what happens. I try hard to communicate with her, both yelling next to her ears, as well as using the tele interpreter on max volume, but all she does is stare at us with a blank expression. It’s as if there is a 6-inch fiberglass wall surrounding her, blocking out all sounds. All she says to us is, “I’m deaf!”

Popo G’s fall resulted in three consecutive rib fractures on the right side. Thankfully, there is no pneumothorax or flail chest, and nothing else was broken or ruptured. She was referred to me for an admission, mainly for pain control, and a physical therapy consult to ensure she’s safe enough to be discharged home, or if not, to go to a rehab for a short stay. It’s a straightforward enough case, and I admitted Popo after my failed attempt to communicate with her. I never thought that 3 hours later, I’d suffer the wrath from her for the plan to admit her to the hospital without her permission.

I get a message from her nurse Q, who informs me that “patient is threatening to jump out of the window if we try to keep her in the hospital”. I’m surprised by this, given that no matter how loud I yelled next to her ears earlier, she didn’t seem to respond or acknowledge that she heard me. How is it then, that she’s now able to express such threat? Q says they use the help of the tele interpreter to communicate with her. I’m intrigued, and I have to see for myself, this drastic transformation of character from hours ago. When I get to the bedside, this thin-framed but not-frail nonagenarian is sitting at the edge of the chair next to her bed, with her two daughters and a son-in-law at bedside, the tele interpreter, and her nurse next to them. Popo G seems to be in a fight-or-flight mode, or maybe just in a fight mode, and when our eyes meet, I feel the burn all the way through my eyes into the back of my skull. I’m both intimidated and amused at the same time. She reminds me of my own grandma.

What happens after is a long multi-way conversation and negotiation between this sprightly woman, her grandson who is a psychiatry resident out-of-state (on the phone), her family at bedside, the tele interpreter, the nurse, and myself. Popo wants to go home; she insists that the pain is nothing unbearable; she’s never been sick her whole life – and she reminds us she’s been around for almost a century – why are we trying to keep her in the hospital now, and how dare we make that decision for her without her permission! Family members seem to be okay with whatever decision I make for her, which aggravates Popo even more. Grandson says if I think Popo is safe for discharge, he’s okay with that, to which I tell him, to the extent of her three non-displaced fractures without other complications, she’s stable for discharge. That said, as is for any elderly patient who lives alone, there will always be some safety concerns given their high fall risk. Nurse Q on the other hand feels patient should stay, because she hasn’t been evaluated by PT, and thus is very unsafe to be sent home just like this. She adds that patient may need to be evaluated by psych given her threats to jump out of the window.

While it’s not wrong that there are some risks in sending nonagenarians like Popo G home after a fall, the risk of recurrent falls won’t change or abate whether we send her home today or the next day. In this case, she’s able to ambulate independently, her internal organs are intact, she tells us her pain is tolerable. She’s also shown us that she won’t give in without putting up a fight if we insist to keep her. First, there’s the question of whether it’s ethical to keep her against her wishes. One cannot assume the lack of decision-making capacity just because a person is old. Old in age does not equate senility. Even if we manage to convince her to stay, are we sure we’re helping her and won’t cause more harm to her? How many times have we seen unnecessary admissions for benign diagnoses such as constipation or simple urinary tract infection in elderly that was supposed to be kept overnight observation that turned into a long drawn out admission due to hospital-related complications?! Lastly, the threat that Popo G verbalizes? Should we take it seriously verbatim or is it her way of expressing her anger and frustration for having her freedom of choice taken away from her? Here is a woman who feels she’s about to lose her dignity and independence the moment she allows us to keep her in the hospital. She’s making her last pitch to fight for her freedom.

After discussion with her family, I ask her daughters to take turn sleeping over at Popo G’s house for the next few days just to keep a watch on her, which they gladly agree to do. The son-in-law will also work on lowering her bed and get her a walker in case she needs it. I send her home with some pain meds in case she truly is in pain and needs it, but emphasize to her the side effects, and to use it with caution. I tell them what to look out for, and to come back to the hospital if she has any new symptoms or worsening pain. Everyone seems to be happy and agreeable to the plan, everyone except Nurse Q. From the corner of my eye, I saw her slight dismay, and her sarcastic manner when speaking to me tells me she’s not at all convinced this is the right course of action. Too bad, I thought to self, I can’t please everyone.

The rest of my shift went by uneventfully, I got home and went to bed. Didn’t think much of it after Popo G and her family left. And so, it comes as a surprise to myself when I jolted up in the middle of the night thinking about this incident. Somehow Nurse Q’s response bothered me. I find myself wondering whether I did right by my patient. Have I been careless to send Popo home? Will she be okay at home? What if she suffers another fall, and this time break another bone? Should I have made sure she stayed the night and have physical therapy evaluate her before sending her home?

No matter how I think about this, I still arrive at the same decision. I just regret that I wasn’t able to convince the nurse to be onboard with the decision. I hope Popo G heals well from her rib fractures, and that she lives a long, long life without any fall or hospital encounter. I know she will be alright. Her sassiness and feisty self will keep her going for a long time.

As I drift back to sleep, I think of my own grandma. How I wish she was around a little longer.

The End of a Chapter

The days are long, but the years are short. I was just here three years ago; thought I was going to be around for a few more years, yet life has other plans for me. In less than a month, I’ll be moving on to a different city, for a different job.

Honestly didn’t expect to be leaving this place so soon. A part of me feels a little wistful; another part of me needs to get out to save myself. I’ve tried to talk myself out of it, telling myself that I need to stick to what I initially chose, that persevering is good. That this is grit, I have the will to power on, things will get better, and I will eventually look back and be glad that I stuck around. But at which point do we know that persisting is no longer ‘grit’, and that it is time to move on?

There is no right answer, but I think this is the right time for me to move on. I’ll be taking a break from primary care, and will return to practicing hospital medicine, at least for now. I will miss my patients, some of whom have grown on me so much that it saddens me so much to say goodbye. But, it is what it is. Everything comes to an end eventually. I’m just thankful we’ve had all this time together.

Not all is lost. I’ve learned a lot from my patients, and gained a handful of good friends along the way. And I’m sure I’ll be back to this place to visit. That’s all for now. Off to start packing!

A cute little breakfast spot in Dover-Foxcroft, ME- Peace, Love & Waffles.

2023 Year End Reflections

Sometimes life has a way of surprising you, throwing you rotten lemons at the speed of light, that you don’t even realize you got hit. This one hit me hard. For a while, the pain was so intense I almost lost sight of the big picture. I thought about whether to write about it here, but decided now is not the time to share. Perhaps one day, when the pain and trauma has subsided enough for me to talk and joke about it, I will write more.

What is the big picture, though? We, mere humans, Homo sapiens, this insignificant species in the ever-expanding universe (or multiverse)–what are we doing? We wake up, go to work, consume, excrete, sleep, repeat. Some days I do wonder if any of what we do matters at all. But such thoughts are too depressing, so I try not to go there. Yet these days, I find myself thinking a lot about existential questions as such: Is this all there is? What is there to look forward to?

Perhaps because I’m reaching midlife, I find myself pondering all these midlife questions. Am I in what they call “a midlife crisis”? A crisis doesn’t have to be an imminent situation; it could mean “a turning point”. I think… this is where I’m at- at life’s intersection, trying to decide how to move forward, when ahead of me seems to be a thick fog that refuses to lift.

This year started off great. Was able to go home for a few weeks, spend some quality family time together, visited relatives, some of whom I haven’t seen in years. I celebrated CNY back home- the first since 2015. The following months went by so quickly: I got to see my bestie at a conference, visited a dear friend in NC, have a friend visit me in Maine. I then visited another BFF for a short weekend trip for her child’s birthday, had a reunion with a childhood BFF and her family, spent thanksgiving with my adopted family, sat for and passed the obesity medicine’s board exam. All in all a great year- I can’t complain. All good, except for the above said ‘incident’.

As I work to maneuver life and get past this fog, I hang on to the few things I know. I know I’m quite lucky; and I’m immensely thankful for all that I have- fairly good health, family and friends who will be there for me, the ability to think, work, and help people through my job. The acute awareness that none of this is guaranteed, and that any of it can dissipate at any moment, is not lost on me. And so on this Christmas, I pray for peace, love, and that the ongoing wars will end. I pray for more kindness, decency, honesty, generosity, and tolerance amongst each other.

Here’s hoping that 2024 will be a good year for all. Merry Christmas, and Happy New Year!

Internal Monologue

This space that has once given me solace, suddenly feels so foreign. It’s been too long since I wrote here. As the year comes to an end, I thought I’d drop by. (Even my choice of words reflect that- I’m ‘dropping by’ to this virtual space that once felt like home to me. Leave a place long enough, and it stops feeling like home… at least initially.) Anyway, I found a number of drafts that were never seen to completion. They were mostly stories about work, emotions that ICU patients and incidences stirred up. Stories of dissatisfaction and disappointment. Angst, anger too. Looking back, I think I didn’t post them for fear of repercussion. A part of me didn’t want to hold back anything if I were to write about them; yet another part of me, the part that ultimately won, was scared. Scared that if those people read it, they might know it’s about them, and would hate on me or react in ways I’m not ready for. Perhaps one day, I’d go back and clean up those drafts, and share them at some point. Today I just wanted to revisit and just… be here.

This year felt long and short at the same time. Anything pre-Covid felt so distant, like it’s been eons since that ‘normalcy’. We graduated from residency, and some of my closest friends left to start their new jobs and new lives elsewhere. Some people whom I thought were friends turned out to not be so. That was something I couldn’t get over. How many minutes and days have I spent (wasted) dwelling on the why…?! I wish I knew. Alas, I’d never find out. It took a long time to get out of the mind trap, and I think I’m finally over it (maybe?!). Sometimes you just have to let go. And so this year, amongst all the lessons I’ve learned, the biggest one is to let go. This theme keeps reoccurring, and I think to some extent, I’ll always find it hard to let go, and will never get used to, but it is something we all have to do. In life, if you care enough, you’d feel hurt. Not caring isn’t the answer; learning how to deal with it, is.

That’s all for now. I came here wanting to talk/write about something else. Ended up being sentimental/nonsensical. Blergh. Till the next time!

Kopi-C Peng With Love

I lied. I said I’ll write more, but so many things happened since my last post, and I couldn’t muster enough energy to put my thoughts and emotions into words. Or maybe I just didn’t want to. Words elude me when sadness overwhelms, and all I want to do is just to run and hide.

I dreamed of a 20-foot  Sandman who was chasing me everywhere. No matter how far I run, he’d still get to me. Friends and family tried to protect me by allowing me to build secret passageways underneath their living quarters, and eventually I managed to create a maze of an underground passage that led me to somewhere ‘safe’ where I didn’t think he’d thought to look for me. That morning when he came for me, I ran and ran until I got there, and there it was– a small poorly vented underground room that was once a prisoner’s cell long ago and had now been abandoned. The self in my dream was quite smug for finally outrunning Sandman, but that smugness lasted about 2 seconds- I remembered, then and there, that while I was tucked away safely in this cell, Sandman would still be looking, and I knew how relentless he could be. What would happen (or rather, had happened) to those people who partook in hiding me?! Sandman didn’t look like a compassionate thing that would allow any accomplice to get away. I knew then, that I was responsible for that, and there was nothing I could do about it. It’s too late; I had blood on my hands. There was no such thing as safety; sooner or later Sandman would get me. I couldn’t stop crying, and all I want to do was to undo everything. But there was no chance for that- I woke up, covered in tears and snot.

Such a morbid dream; so much to unpack from that stream of subconsciousness. Grandma passed away four months and a week ago, and I’m still coming to terms with it. Early on, my mind kept replaying all the memories I had with her, and I couldn’t help but think that I’d never have the chance to create more memories with her anymore. I selfishly wanted more time with her. I was going to go home for Chinese New Year next year! Why now? Why so soon?! Then it hit me- how hypocritical I was, for saying I wanted more time with her. How was I going to do that when I’m all the way here in another country thousands of miles away?! Going home once every few years does not cut it. Just like that, my anger on whoever it was from the Otherworld who took her away from me, and my regret, turned into guilt. And guilt–is the worst feeling of all. The early days just after her passing were filled with spurts of lacrimation fest, of which faucet I had almost no control over (at least I could stop self from doing that when around people).

It got better over time. Work kept me busy, so I didn’t have to think about it too much, or at all. The daily hum-drum became a soothing balm, and if work wasn’t enough to tire me out, there’s always the endless TV shows that I could turn to to numb me up.  I was doing quite a good job at that until about a month ago. It was just another day not unlike any other, except I incidentally found out about a dear friend’s tragic and unexpected demise. To say I was in shock was an understatement. How could a seemingly healthy person just suddenly be dead? I just saw him a little over a year ago and had a great catch-up session after 8 years of not seeing each other. I have questions, but none of which would ever be answered. They probably didn’t matter anyway.

Death has a way of reaching inside and squeezing the life out of you, figuratively (and perhaps also literally). I was deeply shaken, and for the first time in months, I saw how I was not-living. I thought I was doing fine after Grandma passed away, but in truth I sealed off a part of me, and was going through the motions of living without really doing so. Grandma wouldn’t have wanted me to live like this, nor my friend. This was a wake-up call; I have to do better. So here I am, writing about this, cherishing all the memories I’ve had with them, and letting all the emotions wash over me. Tonight, I’ll sip on Kopi-C Peng – Grandma’s favorite beverage – and just, feel. Sandman will always be after me (us), whether I like it or not. If it’s futile to run away, why not just live every day like it’s the last?