Wrap up

This is it~ two-month rotation ends today. I still can't believe I'm heading back.

This morning I worked with a MS3 student from UCSF. Finally I got to see how med students behave here and the stark contrast with what I'm used to.

1. They are confident, nearly never back out. They step forward without indications.
   They seize every possible learning opportunity.
   compared with Taiwan, med students are always waiting for their cue. We do what we're asked or "allowed" to do. When I did Anes internship in VGHKS, I had to get approval from residents to intubate patients. Here, you just grab everything and start.
   
2. They are proactive. But I don't think I have problem with that.
3. It's interesting to see how they interact with attending. You don't have to be very polite here, to be honest. But I don't feel comfortable acting that way. You don't have to ask permit on everything. Feel free to walk out the room or whatever.
4. They are independent. It's students' responsibility to find opportunity. No one will care if you learn anything or not. It's cruel for newcomers but that's the way it is. The earlier you realize you're on your own, the better you fit in.
   

What I see and want to practice is their attitude. But how am I going to incorporate into hospital culture in Taiwan is an art. Smart and aggressive are not very good compliments in Asian society, whereas, in order to stand out in America you need to always act forward.

Hope I can do better in the future. Primary goal is to shorten my learning curve in each rotation!

[SHhhh] Secretly

Things are getting more interesting with me~

1. I met a nurse in OR, he came from Taiwan and really friendly.
   His salary is more than an attending doctor in Taiwan and he owns a house in Bay area!
   He suggested that I talked with my director about that anti-chaoyu issue.
   
2. I met an Anesthesia resident today. He's also from Taiwan. His father is an executive in Merck(something like that). He's also very friendly. 3 years ago, he joined國事部交換學生計畫 run by NYMU and had rotation in VGHTPE.
3. I started to chitchat with Filipino in the hospital. They are all very friendly and helpful.
   very fluent in English.
4. I secretly did LMA tiday. I also drew drugs from ampules and gave them through IV.
   I put in oral thermo and oral airway.
5. There's a Anes doctor from Burma. He's the sweetest guy in the hospital! Everybody loves him, including me.
   
6. Today is the first rainy day I have since arrival.
7. I got apple chicken sausage from safeway and it is 160Kcal/ea. I had two and many Ravioli for dinner. I won't be surprised if anyone calls me fatty.
8. On Thursday, I'll have farewell dinner with my roommates at north beach.
   On Friday, I'll probably have late night dessert with some new friends.
   In the weekend, hopefully I'll have a lot of food in Vegas.

I enjoy my stay. The best memory always comes from my friends.

[Crap] Anti-Chaoyu director

I was happy about today because it would be the last day I got to see
my anti-Taiwanese director.

An exit interview was scheduled for us to go through how I feel about
the rotation.

I paged him in the morning as a reminder.
well, not very surprising, he didn't remember anything.
"Oh~we have an interview? I have no idea what this is about."
"anyway, I'll call you back later. "
It was around 10am.
so I waited all the way till noon while I decided to get my lunch
rather than kept on waiting.
On the way out, I ran into him on the hallway chatting with someone.
good, he never bothered to give me a call even when he's having break.
I asked again when would be a good time for interview.
he said, not now but would let me know.

still no words, so I paged him again in the afternoon around 2pm.
he didn't return the page so I had to page again.
"I am really busy now, but probably couple minutes later I would be available"
that was 3 pm.
I decided to visit him in the OR to see how busy he was.
When I got to his room, good, there's a resident working inside.
what exactly was he busy with? Room 4 and 1/4?
I paged him again. Everyone in the clinic felt sorry for me.
I could have left at 2pm. Look what I was doing here!

finally the clock pointed to 5. It was the time for everyone to leave.
I paged him again.
after 10 minutes he called "sorry~ I won't be able to make it today"
((F*CK YOU!))
"you can page me on Wednesday to see if I'm available."
((Do you think I'm an idiot?))

so, I spent whole afternoon being a fool.
thank god I had good conversation with NP in the clinic.
or I'll kill him.

[Fun] Birthday Party

Today is another sunny day, but sadly I have no plans!!! I nearly finish all the points of interest listed in traveler's guide. Well, SF is not so big, you know.

A friend called in the morning and invited me to the birthday party of her classmate.
I didn't think before saying yes. How wonderful! an"American Party", even I knew none of her friends, I was excited.

It's a semi-formal party and it took place in a fabulous apartment in Mission owned by the birthday star(John). Average age of the guests is around 30. I was no doubt the youngest and I was wearing my Paul Frank Monkey T-shirt and Levis' Jeans.
American party is always with alcohol, so was today. There were Champagne, Punch and Rose. What's special was food and drink were served by the caterer. Just like in the movie, guests are busy talking and socializing while waiter serving snacks and alcohol. It felt so unreal, how many times in my life could I attend party like this? And there were so many friendly gay people present. I felt comfortable among them and I felt happy for them.

Food was also incredible today: polenta with glazed onion, endive with goat cheese & fig, roast beef sandwich, cheese plate, and crabcake. I couldn't stop appreciating John's elaboration and wonderful taste. Quite amazing that I never felt awkward for a second, even I just met him today.

I shall never forget today. Such a great experience. Hope I can have this kind of party when I turn 30 :-)

[Update] OR

Things are getting better, at least in this week.
But I still try to avoid my director. I haven't seen him for a week, which is great!

Tuesday and Thursday are OR day. It's all because of the stupid insurance, I am not allowed to do anything invasive. It actually depends on who I work with, like today, my resident let me do pre-oxygenation, OG tube and Oral/Nasal thermometer. But sometimes I can only watch.
To be honest, you never learn by watching, so even I was in OR for the past two weeks, I'm still kinda messy today.

There are more and more people chatting with me from this week. After three weeks in pre-op clinic, OR and ICU, I'm not a stranger anymore and I feel happy.
But when I just start to blend in, it's time to leave.

one more thing still bothers me is that I cannot "empathize" US patients.
Mt. Zion is a cancer hospital. Most of the surgeries are cancer related and patients usually are not doing good. But I don't feel anything after knowing their stories.

Quick note:
1) know the dose/concentration of each formula before medicating pt
2) skills of drawing drugs and opening ample (snap it)
3) second gas effect of N2O(Nitrous oxide): early wash in/out, less cardiosupression

[Update] pre-op clinic

Last Wednesday was the first time I saw patient in pre-op clinic, on my own.
I had no idea why I got so nervous when presenting to Attending.
the presentation was unorganized and of course imperfect.
anyway, first time is first time, don't push too hard right?

Today, I offered to see patient again. Attending was generous and brave. He even let me key in pre-op interview form and do patient pre-op instruction. Oh~ that's something, my language/knowledge level is capable for history taking but far away from giving instruction. Also, I'm not familiar with the system and everything. There's a good chance that I screw up.
well, right now, on reflection, I did make a few mistakes. I didn't check up patient's creatinine level and didn't measure her neck circumference.
Now I pray for successful surgeries tomorrow.

quick note:

1. for hyperthyroidism: take beta-blocker and anti-thyroidH(PTU/Methimazole) before surgery, avoid ketamine, etomidate for induction
2. don't forget to ask about dentures and moving teeth

I hope after today I'm still qualified for interviews on Wednesday.

[Fun] AT&T park- SF Giants vs. SD Prader

Baseball season is coming! I love baseball, especially with C.M.Wang playing! But in SF there's only Giants~ and it's not a very good team :P
anyway, I'm still happy I have the chance to watch baseball game in USA!!

again, the game started when people still finding their seats, very casual.
fast food, beer, souvenir everywhere, I wondered how many people actually focused on the game? never mind~

I had garlic fires yesterday. good when they're warm, even better with ketchup.

I hope one day I can watch C.M.Wang playing! It shall be Huge Fun!

[Scent] Jean-Claude

Jean-Claude 是目前Hermes專屬首席調香師, 著名的尼羅河系列以及最新推出的恆河系列都是出自於他,連Bvlgari的綠茶也是Jean-Claude的作品之一!
amazingly, those are all my beloved fragrance! I must be a huge fans~

今天晃進Barney's NY(是家貴族百貨公司,想找特別的品牌進來沒錯)沒想太多,就往香水專櫃走去
看到L'artisan Perfumeur, 目前在台灣漸漸紅起來的品牌, 既然有full collection當然不能錯過!
沒想到Jean-Claude幫這品牌設計了一款香水: Bois Farine (wood flour), 源自於他某次到熱帶島嶼的旅遊經驗
阿~ Jean-Claude的創作很多都是源自旅遊經驗,最近Hermes的香水也是在旅遊中誕生
果然旅遊會帶給人很多啟發:~

先說說今天這款: Bois Farine
真是不便宜50ml/95USD, 100ml/135USD...看到價錢就卻步了
前味是神奇的"nutty flavor"有點像almond butter,對於期待"香水"的人應該是不倫不類的東西, 但對於習慣Jean-Claude的人來說,心情反而雀躍, 不知道又有什麼驚喜 :D
我拿了試香卡離開~
回到家果然被幽幽飄來的woody scent吸引, 綜合檀香和沉穩花香,讓人忍不住一直握著紙卡深深吸氣~帶來撫慰心情的感覺
味道有點像Hermes essence Vetiver tonka的後味, 幾乎是一模一樣, 除卻bois farine多了一點花香
同樣是剛開始不怎麼吸引人, 但卻越來越令人著迷

下次再去聞聞the different company的香水
真開心San Francisco居然有厲害香水大集合^^

[Life] today

I need to write something just for today.

I had a very nice conversation with my Brazilian roommate last night. I am surprised we actually bear so much resemblance. She is a special friend.

Today is Costco day. I met three new friends and had a decent lunch in Japantown.
I made myself Ribeye steak for dinner, really nice! with a glass of Zinfandel, perfect and drunk again.

I forgot to write one particular thing for Yosemite trip. When we were on the way to south park entrance, we nearly hit a deer! How wonderful, A Deer! thank god we didn't ran over it, or it would be a crime I guess.

[Mood] passive?

今天被指派到ICU見習, 一如往常, 我不知道自己要幹嘛
這感覺很差, 沒有目標的一天, 也沒有人把我當成團隊的一份子

那位假裝自己不會講中文的director看我怯怯的站在他後面, 就叫我review某位病人的data向他報告
他的確就是台灣人, 跟之前遇到的外國attending完全不同風格, 非常harsh, 也不會在你回答問題時用鼓勵的方式引導,反而一副等你答錯的樣子...
跟他相處讓我感到非常灰心
所以今天直接問他: what do you expect me to do for this rotation?
他也說不上來, 總之不能有patient contact的前提下, 我想回答這問題很難吧

在ICU不做procedure真的沒啥用處
在刀房不做procedure更是無聊
現在只好把目標轉移到prepare clinic,看能不能爭取到接病人的機會

我對自己的英文太沒信心了...

[medicine] Any better?

Today I worked in OR, finally got the chance to see how Anesthesia functioning..
Honestly, I'm sort of disappointed...

the first surgery I went was hepatectomy due to colon cancer mets. there's supposed to be plenty blood loss, so CVC, A-line and two IV lines were given.
The patient also had epidural catheter for pain management.

total preparing time was almost 1.5hr, including 20 mins of epidural catheter placing, 20 mins induction/intubation, 20 mins CVC and patient position/monitor.
I was surprised preparation took so long. For example CVP, they needed ultrasound guiding and time to think what's next. If I weren't have trouble with insurance, I'd really like to try my "Taiwanese way".

the second surgery was TAH+BSO+partial cyctectomy on a patient with urachal CA.
I didn't get involved in induction though, but it's really bloody when I stepped in.

What really impressed me today were better equipment and medication.
In surgery, they don't use prolene for skin closure but staples, which saves time.
They have better epidural kit, better sterile CVC kit and even IV catheter.
Disposable ET stylet, latex-free gloves(GREAT! I am allergic to latex), fog-proof masks, better 3-M tapes...... certainly safer working environment.
However I don't see better skills or better arrangement to go with those equipments. I think of my Anes residents in VGHKS when watching sono guide CVC placement here.

I hope my rotation will get better after this week. I need to overcome my communicating fear though and try to think everything in English.
My director is actually Taiwanese but he never talks to me or shows any concern. Anyway, that's his issue.

well, make the most use of everyday~ it costs money!