[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!

[Fun] the wine country in California

Another sunny day in Bay area, so we decided to visit Wine country!
We actually stopped at Muir woods first to have a healthy forest walk, and then head to the wine country. As usual, I didn't do any homework before the trip. Everything would be random.

Sonoma was our first stop. It turned out to be a good choice because there are several famous wineries around. We visited Sebastiani (the largest one) and Buena Vista (the oldest one).
Wine tasting costs 5 dollars or more, depending on different selections. The fee is waved once you purchase any one bottle.
I remember I've seen Sebastiani somewhere, but Buena Vista is totally new for me.

I tried white wine first. Chardonnay is my favorite. It's fruity, refreshing, sweet but sometimes crisp. It goes well with light meal or alone.
Surprisingly, I had a great time tasting red wine today. I don't like red wine so much because it's too "alcohol" to me. But today in Buena Vista I actually felt smoky, nutty, strawberry, plum, and even the aftertaste of it. Amazing! just like when I have specialty coffee, I can feel different characters of coffee beans, and they are not just only caffeine drink.

If I have to choose, I'll recommend "Buena Vista" and suggest the 10-dollar tasting. It definitely worths the money, but I believe you'll get one bottle after tasting.

Wine is good, Scenery is good, probably food is good! It's just one hour drive from SF downtown. I envy the people here.

[Photos] Yosemite roadtrip

Yosemite fall - upper & lower fall

you can expect more water in summer, but now it's spring
there are trails leading to the waterfall, you can either take the easy one(to lower fall) or the strenuous one(to the upper fall).
I did the easy one and half the strenuous. both are fantastic!








Mirror Lake

serene beauty
nothing very spectacular, but I can sit here all day







Vernal Fall

the trail was closed for winter season, but we decided to take the chance.
I didn't climb up to the top, but my friend did (what a brave guy!)

But I had a good time sitting on the rock, listening to my matchbox20
it was pretty cold though...

[Fun] Roadtrip-Yosemite

一直待在SF downtown, 開始感覺悶了...
趁Radiology課程結束空檔拜訪Yosemite national park~在沒什麼計劃的情況下出發,也完全不知道可以期待什麼,總之就輕鬆玩,用力接近大自然

我從SF坐火車到距離3.5小時的南方城市Merced和從LA開車來的朋友會合~第一次搭美國火車,印象非常深刻! 美國火車走高級休閒路線, 火車網也沒有歐洲密集, 其實不是很方便的交通選擇, 但amtrak有搭配自己的接駁巴士, 對於沒有開車又想去熱門景點的人來說是可以善加利用的工具!

從Merced開車到公園大概要2小時多, 風景不錯,路況也很好~開起來(我想)相當舒服

我們住在el portal,在west entrance西方, 離公園車程大概20分鐘, 因為公園裡面的住宿不是太貴就是訂滿, 這次就沒辦法享受一睜開眼睛就看到瀑布的生活...
幸好開往園內的風景很好, 路上不至於太無聊囉~

這次是我長大有思考能力以來第一次造訪美國國家公園, 心得只有"數大便是美"可以形容!
美國景色是壯麗大器的, 跟歐洲精緻偶爾帶有滄桑的風景完全不同
在這裡心情會開闊, 思想會放鬆, 步調放慢, 讓人自然而然有休息的感覺

時間快的不可思議, 4天3夜結束, 現在我又坐在書桌前打著電腦, 好像沒有離開過一樣
每次旅行我都在思考到底要如何永遠記住眼前的感動...
但我發現yosemite留下的是情緒...看著照片,心裡是一份感動

[Fun] I can make you THIN @TLC

http://tlc.discovery.com/tv/make-you-thin/make-you-thin.html

TV show I happened to tune in last night...I can make you THIN
It was the first episode, pretty much like introduction and reassurance.
since he didn't try to sell anything, I finished the show.

some simple rules might be helpful:

1. when you feel hungry, EAT
2. eat the food you, WANT
3. eat, CONSCIOUSLY
4. when you are full, STOP

Let me follow the rules and see whether I can lose couple pounds.

[Fun] Matchbox20 concert @ San Jose

昨天跟在Berkeley唸書的朋友一起去matchbox20 concert, 只有一個爽字形容!!
果然不能一個人去聽演唱會~ 太孤單了!!
matchbox20是我一直很喜歡的團體, 曲風多樣和比較有深度的歌詞 (不過在演唱會歌詞實在不是重點哪) 於是就把生平第一場美國演唱會獻給他們~~

美國演唱會流程真的很不一樣...
6:00進場 7:00開唱, 前半個小時是暖場小團表演, 可惜我不喜歡昨天的暖場團, 太吵了 :P
休息15分鐘後特別嘉賓出場~~ 昨天特別嘉賓是Alanis Morissette!!!! GOSH~我超愛她!!!
雖然之前就知道Alanis會出現, 但聽到她聲音還是好開心好開心阿~~~~

Alanis唱了將近30分鐘, 把熱門曲都唱完了(害我一度以為來錯場) 光這部份就讓人大呼賺到...
接下來long break 15分鐘, 演唱會主人matchbox20才出現(出場方式好可愛~~~)
跟台灣演唱會流程完全不同, 大開眼界^^

Matchbox20的現場功力實在太強大!!! 聽完演唱會心中只有賺到跟感動可以形容
有機會要來美國聽演唱會喔!!!!

[Fun] Coastal trail & dinner

Since I was completely amazed by the beautiful Golden Gate bridge yesterday, I decided to have this close-up bridge walk today.
It was actually an accident. Originally, I planned to take bus 28 directly heading to the vista point(where all tourists go), but I ended up taking bus 29 and got off in the middle of nowhere.
I had to walk to get to the bridge. It was a beautiful accident, cause it got me the chance to visit one lovely nude beach and a less crowded "vista point" for the bridge.
Can't help saying I was so lucky to have 2 consecutive sunny weekends!

The whole coastal walk, from Baker beach to Golden gate bridge visitor center took almost 2 hours. It's not easy due to stairs and slopes, but it definitely worth the time. Strongly recommended!

As for tonight, I had dinner with Taiwanese students from UCSF at a Caribbean restaurant on Haight st. Food was good, it's actually fusion style (What exactly the Caribbean eat?). I had only one glass of wine but now I am feeling dizzy and everything seems to be spinning. I shall never drink alcohol when dining out.

Great weekend!

[life] My window

6:30 in the morning, view from my window in SF
do you see the pinkish sky?



Dusk!
I live in the west part of SF, sunset district, which means I can watch the sun setting almost everyday.
I never know I can praise the sun rising and setting this much.
I can fall in love with SF just for them.

[Fun] waterfront of SF

這週繼續當觀光客

Now is Cable Car time! 舊金山一共有3條cable car line: Powell-Hyde, Powell-Mason, California
前面兩條因為觀光客很多,假日通常要排隊10分鐘左右
第三條則是橫貫downtown,終點在Ferry building
Powell St.上有名的cable car turn-around,就是只能單向前進的cable car駛進一個圓形轉盤, 藉由人力幫他轉向, 是個著名的觀光景點!
( 我今天忘記帶相機出門T-T真是非常令人難過)





Powell-Hyde line終點是 North-Point, 路途中會經過有名的Lombard St. 也會經過很多個上坡下坡, 好可惜下坡時cable car不會像雲霄飛車一樣衝下去喔~ 那樣一定很好玩 :P
今天天氣很好! 可以看到Golden Gate Bridge的全貌囉~ 聽說有些人來都碰到霧鎖大橋, 我真是非常幸運!!
我好喜歡好喜歡好喜歡Golden Gate Bridge喔~~~應該是說我喜歡任何一座橋!!




到了Fisherman's Wharf不免俗就要來吃海鮮~ 因為最近我快沒錢了...... 所以不能吃螃蟹.....我好想吃螃蟹喔......(怨念)
吃不起螃蟹只好吃clam chowder in bread bowl(哀這東西Costco也可以吃到)
SF有名的sour dough就是這家在pier39的boudin~ 生意好的不得了! 不過clam chowder就是那樣, 我覺得麵包比較好吃
10年前跟家人到SF就有在pier 39吃螃蟹 T-T 超好吃的呀!!!!!!





接下來到了東邊的Bay Bridge, 相較之下這座橋就比較理性^^但還是一樣好漂亮! 我照樣也幸運的看見了橋的全貌~



最後來一張美國常常可以見到的街頭表演吧! ferry building (其實這是個高級菜市場,裡面有好吃的oyster bar!!!)前面廣場常常會有活動, 今天是一群小朋友即興演出打擊樂! 阿~ 這才是周末應該要做的事情阿! 在台灣為什麼我都呆在家呢?

[Med] visiting student day2

上課第二天, 昨天是 orientation + physics of radiology + introduction to vascular anatomy
班上有2個台灣人(Wenli & me), 兩個德國人, 1個哈佛人, 5個UCSF學生(3個華人) 所以班上總共有5個華人!!! amazing
但班上的華人同學似乎對兩個台灣人沒啥興趣 :~ 但兩位德國人非常可愛!! lucky to have them :-)

我們在這邊的角色是clerk, 生活目的就是上課和玩, 每天的課程從早上9點開始,通常下午4點就會結束! 老師看天氣好還會提早放人... 哈哈~ 美國學生都這麼輕鬆還是這裡例外?

這裡的PACS系統比榮總簡潔許多, 但沒機會常常用, 無法比較兩者好壞

今天上chest x-ray...教授非常注意heart size, pulmonary edema, Kerley ABC line, Line&tube...
看了30多個CXR, 到後來都頭痛了@@
由昨天病人的CXR database 看來 , UCSF medical center的病人還不是普通爛, 光IABP就看到3個
有2條central line的病人也不少...我想這裡的ICU應該很厲害!

下午上brain MRI, 哀, 從來沒搞懂過~ 加上要把brain anatomy, lesion site, possible disease用英文表示就有些困難 :( 我發現教授也比較不會點外籍學生起來問問題...我想這就是現在要克服的地方! 就knowledge來說, 台灣醫學訓練出來(只要你好好學)不會比國外差! 只要克服語言,我覺得一點問題都沒有

阿~ 每天都好早放學喔...要好好唸書還是當個觀光客呢~~~

[Fun] weekend walk

趁週末在舊金山市區走走~ 要去的地方太多了...我能夠通通玩完嗎?
要很會搭公車才行~

星期六先去了Union square & Information center, Union square 是逛街的好地方
你可以把所有要買的東西買齊~ 當然是花原價...對一個已經去過outlet發現東西可以多便宜的人來說,真是看的心都痛 :P
downtown 就是那樣~ 沒啥好期待的



今天(Sunday)天氣照樣好好好~ 室友們約好一起去郊外走走!
隨意走到mission區的公園, 很多人在曬太陽玩球溜狗
到mission就要來個burrito! 可惜這東西對我來說太重口味,不太能適應...份量超大, 可以兩人吃或當兩餐!











這是從我房間看出去的日落 :-) Gorgeous!
我住的區叫做sunset, 就是在說這裡天天可以看到sunset唷!!

[Fun] Los angeles

I had a great time in LA. partly because I lived with a good family friend in a very nice district. Their hospitality made everything wonderful!

I only spent 5 days in LA. I should've stayed longer to see more.

During these five days(less than five), I visited UCLA, Santa monica, Pasadena, dessert hill and had a Ferrari drive! Ferrari is wonderful! Not many people can get a ride in their lifetime. I was lucky :-) There was going to be a Harley ride too, but canceled due to limited time.

You can't live in LA without a car. But the traffic heading in town is terrible. This was my second visit to LA but still not able to visit downtown area. It's alright! I'll definitely go back in the future. I start to consider moving here after this visit. But first of all, I need to marry an American or find a job here.