Photo on the left: Yes, that's me! No one has been able to pry me away from cars since.

A follow-up to the blog post from November 7. I went to go see the young patient on Friday that I had cared for in that story.

Despite starting off already dead, and all that had happened, this person was neurologically intact. We ended up talking briefly about this person's first twelve hours in the hospital. Without going into too much detail, it was interesting to see this person wearing a cross around their neck. We ended up talking about God, how everything that night played out in this person's favor, and how the surgeons, anesthesiologist, nurses, RT's, and blood bank workers worked so hard and well on this person. Really and truly, had everything not fallen perfectly into place that night, this person would have stayed dead. Sometimes we are very lucky and God gives us the a second chance at life. I really do believe that without God's grace, this person would not have been so lucky.

Sometimes negative events happen in my life, and I wonder to myself, why? There is so much uncertainty when it is going on, but when the smoke clears and the dust settles, things seem so much more clear. Admittedly, I was initially dissapointed that I was put on call that night, after all, I had just written an exam during the day. Now, I realize that God gave me the most significant experience thus far in residency.

Everything that happened around the time of that rotation benefited me. I was no longer dating anyone (yet again), which freed up some time for me to read about things that ended up helping that night. One of the senior anesthesia residents was a schooling me on the ICU, but was very kind and taught me a ton of stuff that I used that night. I ended up doing a ton of procedures before that night, some of which I had struggled with. But all that experience allowed me do all sorts of procedures that night with speed and accuracy when others were unsuccessful, and gave me the knowledge and decisiveness to remain in control of the situation.

In the end, I feel as though I was given series of challenges, some of which I had struggled with, some of which seriously annoyed me, and some of which really made me ask why? When all those challenges and seeming curses were all added up, it prepared me for the final struggle that night. The reward is so clear now, and it was so worthwhile. A young person now has a second chance at life, and I get to live on in my own little life knowing that God let me make a critical difference.

On a slightly more random note, I just mailed off 52 Christmas cards. All written, sealed, labeled, and stamped in a mad rush in 2 hours. Think of it as my personal touch this Christmas. ;)

The title of yesterday's post is from the lyrics of the Queen song, "Bohemian Rhapsody". I actually did not mean that I felt like that, I was trying to be a little abstract.

The first half of the this blog is a bit sullen, but the second half is non-crappy, or more crappy depending on how you look at it.

You know, recently, as in the past year, I cannot help but to feel that I have changed a lot. I think I have gotten smarter and more confident with medicine, yet at the same time, I think I have become more uncertain and lost in the real world. Reading through my old blog posts from say five years ago, I think I was a lot goofier and nonchalant about things, and really those were the happiest days of my life.

It's always so much fun for me to read through my old blog entries and think, "what the heck was I thinking". Part of it has to do with being too obsessed with work now. Part of it has to do with a fragmentation of my social circle. Part of it has to do with hanging out with a lot of bitter and stressed people at work. It seems like some of the residents in my program are unhappy, spiteful, or just plain angry all the time. The problem is like a bad case of scabies that it rubs off on you when you spend too much time with them. Don't get me wrong, I love my coworkers, they're wonderful at heart. However so many of them seem so broken and I need to avoid becoming like them.

I was at work today and one of my colleagues got angry at me over misunderstanding. This person ended up freaking out at me in front of the entire nursing station. The nurses and unit clerks threw their support behind me, which made me feel all warm and fuzzy inside. I ended up just talking things through with the other resident, kind words to diffuse the situation, and things were okay afterwards. A kind word turns away wrath. I really dislike conflict. I wonder when some of my coworkers get so frustrated, that if it is really just the tip of the iceberg. That there is really a big pot of angry stress that has been ready to boil over for some time and all I need to do is poke the stove in the wrong way and they will just boil over and scald me. Since I have a rather oblivious demeanor, and combined with the fact that I have things pretty good, I often have no concept of what others go through.

One of the grad students I used to work with would always say "spiteful people are ugly" whenever she got a little riled by someone who wanted to take out their life's problems on her. Then she would just smile, get all cheery, and move on. And she was right, she always had a great smile and wonderful demeanor, she never looked bitter or resentful or ugly.

So onwards, let's talk about colonoscopy.

Just to be clear about things colonoscopy is a complicated process. The day before your date, you drink four liters of bowel prep called "go lytely" to completely clean out your gastrointestinal tract. In reality, the solution should be called "go so heavily, go profusely, and go constantly". If the "bowel cleansing" solutions health food stores hawk is like a pellet gun, medical bowel prep is an atom bomb exploding into your toilet.

Before your procedure, a nurse gives you some medication to make you a little sleepy (and forgetful), then tucks you into the fetal position. The doctors mutter some stuff to you. Then you have a ten foot long cold black fiber-optic tentacle with various Borg-like gadgets built in lubed up and shoved into pooper to assimilate you from inside-out. The gastroenterologist then starts to advance the monstrosity, known as an endoscope up through your large bowel all while watching it on television. The camera view of this is really quite exhilarating. It is like driving in the Formula One Monaco Grand Prix. The curvy segments of the rectum and sigmoid colon are driving by Massenet, the Casino, and then hitting the challenging turns at Mirabeau Haute, the Grand Hotel Hairpin, Mirabeau Bas, and then Portier. Then you hit the wide open straightaway of the tunnel; also know as the descending colon. Slow down when you hit the splenic flexure and make a left turn to go by the swimming pool of the transverse colon. Make another turn at the hepatic flexure, and then you're onto final straightaway of the ascending colon towards your checkered flag of victory at the ileo-cecal valve. During all this, resistance is futile as all of your individuality and uniqueness is being sucked into the vacuum port of the endoscope.

When you are done getting your colonoscopy, you are carted out to the recovery room. But your memory is all blur because of the drugs, kind of like an alien abduction that you signed a consent form for.

They say colonoscopy is like playing a videogame, and I really like playing video games. That being said, I am not sure if can play videogames as my main job for the rest of my life.

Thursdays are my favorite day of the week. The reasons, though fickle, are a plenty.

First, is that we have our "academic half day". This means that I get to disappear from my usual activities at the hospital to go for teaching. It literally is a half day away from work every week, so that I can be a slacker.

Second, Thursday is the satisfying harbinger for Friday. I do not need to explain why Friday equals good.

Third, my brain cells enter a state of stagnation. The Japanese edition of Shounen Jump makes it way onto the internet, so I get to read Naruto and Bleach. Then I usually end up downloading my favorite television shows that evening.

Finally I get paid every other Thursday.

So speaking of getting paid, I have found that I have become rather obsessed with money recently. Well, fine I kind have always been obsessed with money. Namely, I am very cheap and stingy. However, recently, the problem has become worse. I started moving my money into a higher interest rate savings account, and have also started investing in stocks. Calculating things out, I can make a few extra paychecks worth of money each year from savings interest and stock growth. Investments generally continue to grow, and as I put more money into them, the growth increases more so.

Here is a where things start to bewilder and confuse me a little. Early on in the game, where my initial investment is small on a grand scheme of things, the term "a penny saved is a penny earned" is really significant. Say I have money left over this month and I want to buy a digital camera for $500. My thought process will come up with one or more of these lines of reasoning: 1) spending that money is like spending the money I made on stock recently and/or 2) that money could be used to fuel my savings or stocks and/or 3) it is easier to save money earned than to make money via investing. Damn my misery stereotypical Chinese upbringing.

Whereas most people try to save a portion of their paychecks, I usually end up hoarding about 50% of it immediately into savings, then try to be stingy and squirrel away as much of it on top of that as possible. I feel like a flea ridden packrat that can't stop storing shiny coins up. Once I reach a set goal, I shift the stash into stock, to further fuel the growth. When I buy groceries, I try to buy as bulk and cheap as possible, and I avoid expensive or frivolous foods. The only time I really do break out and spend money is on dates, because meeting the right girl is the biggest investment of all, which is a whole other conundrum to deal with.

So what is bothering me really, is that I feel I cannot afford a lot of fun or luxury purchases. In reality I actually can, but I always feel compelled to save up as much as possible and to protect my investments. When all is said and done, once I get married and am done paying for a mortgage I think I will a stress a little less about it. Or maybe I need to start worrying about putting kids through university and retirement. Okay fine, its official, I think I am crazy. I feel like I am the only person my age that plans for the future like this. I wonder if this is genetic, at least that way I can blame my parents for this.

This summer, one of the attending intensive care physicians came to teach us about managing patients in extremis. He told us, that when someone is dying, they do not need an intern, a resident, or an attending doctor. He told us that they need a physician who can make the right decisions, act quickly, and is capable.

I have seen doctors panic and not know what to do in emergencies. I have seen people do procedures improperly and hurt patients when under pressure. I have seen some of the smartest residents unable to manage emergencies, because despite knowing what to do and all the theory, they were unable to perform on a practical level. Granted these are more exceptions than the norm. I did not want to become one of them.

That being said, on a raw brainpower level, I am fairly certain that I am one of the dumbest residents in our program. If there is ever the scritch-scritch sound of knuckles dragging along carpet, you can expect to see me lumbering around with hunched posture, hairy back, my uni-brow furrowed, and drool oozing from my gaping-slack-jawed-pie-hole. I am a moron. This makes working hard and getting lots of practice all the more important for me.

During my two months on ICU, I managed as many of the sickest patients as possible. I did as many procedures as possible. I wanted to develop my skills. I wanted to be ready for when a patient truly needed help, and when other doctors needed assistance, that I would have something to offer.

Last Sunday, after I wrote my general licensing exam, I returned immediately on call for the intensive care unit. I thought that since it was my last night on ICU call that perhaps it would be quiet. I did my usual routine, mixed up my favorite three emergency blood pressure raising medications, tossed them in my pocket and hoped for a quiet night. I bought a bag of chips, sat down at the ICU desk, and got ready to check my email. *Beep Beep Beep*. My pager went off.

It was a page to a hospital extension, followed by the numbers "911". I picked up the phone, poked the keypad, and one of the RT's picked up the phone. "We need you in resuscitation now." Then she hung up. I hobbled down to the emergency department as quickly as I could and hoped in my walnut-sized brain that I would be able to make a difference.

I arrived in the resuscitation room, and there was a trauma patient there who looked dead already. Well, technically the patient was dead, but the other doctors downstairs managed to bring the patient back to the point where there was a pulse in the neck. The doctors and nurses were trying to give the patient blood and fluids, but only had one small intravenous to run it through. There were nurses trying on both arms to start IV's, and some of the doctors were already trying to put central lines in. The patient had bled so much that most of their veins had all but collapsed. There was no femoral pulse, but anatomically I knew where to go, and by the grace of God I hit the femoral vein immediately. I placed a second central line immediately thereafter, and again, by the grace of God, I hit that vein immediately. We gave the patient large amounts of blood products and fluids, I used up most of my blood pressure medications, but we got a blood pressure back on the patient. I felt all warm and fuzzy inside. There were five central line attempts by various people and I was 2 for 2 on my attempts, the patient was alive, and I felt I made a difference. We were off to the operating room. Just before leaving, one of the emergency nurses pre-mixed a fresh supply of some of my medications and put them in my pocket. I felt so flattered that she did that without me even asking, and it was a double score that she was a cutey.

We got the patient to the operating room and the surgeons went to work. Thank God for surgeons and anesthesiologists. The surgeons did as much damage control as they could. They even called in another surgery consultant to help in the operating room. The anesthesiologist worked hard to stay ahead of the blood loss and to keep the patient as physiologically normal as possible. Unfortunately the patient went into DIC (disseminated intravascular coagulation) and started to bleed uncontrollably from everywhere. The surgeons were standing in a pool a blood, their gowns were splattered, and the bottoms of their pant legs were soaked in red. The surgeons did their best, but could not do more, and we needed to transfer the patient to the ICU. The patient's belly was still gaping wide open, and the patient was still bleeding profusely.

We transferred the patient into the intensive care unit. Their body temperature was low, their blood acidemic, and I could see the blood oozing out of every hole in the patients skin from all the intravenous attempts and around the central lines I had placed. That and there was the patient's still open belly with all the internal organs staring back at me.

My attending physician gave me some sage advice to get started, and off I went. We transfused blood and fluids as quickly as possible. Every time we needed to pause and switch to a new bag of blood or fluid, the patient's blood pressure would drop. Three nurses, three RT's, and myself spent the next hours working nonstop to keep the patient alive. It was such a great team on that night, and everyone worked really well together.

We kept suctioning the patient's bed, because a large pool of blood would keep re-accumulating. The bleeding slowed and in morning, the surgeons took the patient back to the operating room. Several operations later, the patient is still alive now.

Two days later after that night, I heard from the blood laboratory that in managing that patient, I broke the transfusion record. The number they gave me was 79 units of red blood cells and 201 units of blood products total - in less than twelve hours. The average person has 12-13 units of blood cells in their body.

I sit back now and feel all warm and fuzzy that the patient made it through it. I definitely could not have done it without all the nurses, RT's, surgeons and anesthesiologist, blood lab workers, everyone who donates blood, my wise attending physician, and God's grace. It was the grande finale of my ICU rotation. The last big test. The decisive battle. And it could not have ended any better.

So thus a new month and a new rotation have begun. My two month stint on the intensive care unit is over, and it feels a little strange. I miss doing procedures, I miss the need to be quick and decisive, and I miss running the show in emergencies.

Today I stopped by the intensive care unit to see do some consults on patients, and ending up spending some time chatting with the nurses, fellows, and consultants. Despite being only one week out of the ICU, I already felt nostalgic about things. It felt like home.