Smoking Cessation

I’ll be one of the first to admit that I tend to have absolutely no sympathy with smokers, judge them very harshly, and I’m just all around very rude and not understanding to them. I realized this was going to be a problem when I was shadowing in cardiothoracic surgery a few years ago because, well, there’s just a ton of patients I’ll get who will be smokers, and as their doctor, I can’t be nasty with them. So I always knew this would be difficult. Our first week in the pulm unit, we had a class on smoking cessation beginning with a patient presentation. I remember thinking that when they told us they’d bring in a smoker, I was very disgruntled, wondering what a smoker had to offer to a presentation when it’s really easy to find a smoker. What new information would this person provide?

Well, she was a quitter. And I guess that didn’t do much for me at first, but the more I listened to her talk, the more I realized how wrong I am/was about smokers. Granted, smoking is still terrible for your health. And you still should not start it. But I guess I always just approached the quitting part in a way that wasn’t conducive to anyone quitting at all, which makes me think back to a bunch of people I “defriended” because of their smoking habits. One of my classmates asked our patient what it feels like to try to quit, what a nicotine craving really is like, and she couldn’t really tell us except that she just wanted to smoke whenever she needed to cope with something stressful. I’m sure I’ve heard something like that before but this time my perspective changed. Maybe it’s because I’ve started to realize more of my own unhealthy coping mechanisms, but in that moment I suddenly felt a big burst of empathy for smokers (I know, I can’t believe I’m saying that too). It’s really hard when you’re in that moment to try to convince yourself out of your unhealthy habit — you know it’s irrational, you know it’s unhealthy, you know that in any other normal state of mind you wouldn’t want to do this, and yet you still do. I’ve struggled with my own demons for years, and it’s HARD. Even now, after seeing a psychiatrist and therapist, I still have my relapse days. And as we learned in psych, mine is based on neural circuits that I’ve ingrained since I was a child. So how different is that really from the smoker whose own neural pathway is also messed up, telling him/her to just get that burst of relief and calmness and happiness from the cigarette?

So I’m glad I actually had that interview in the end. Next week we’re supposed to practice motivational interviewing, something I was initially dreading because I didn’t think I could pull off acting sympathy. Well now I know I won’t have to because I really do get it, I think. And I’m glad that I’m learning more about what it feels like to be the patient (hah, as if I don’t have enough experience with that).

A Glimpse into Oncology

(NOTE: all identifying patient information is excluded and/or has been changed. also these are patients from different locations, different doctors, different departments, and different times in which I’ve seen them… I’m truly trying to minimize ability to identify them. If anyone thinks these are too personal, please tell me so I can remove it. Thanks!)

[1] We’re called up to the hospital because the doctor’s patient was recently admitted. First we look over her scans again. Although I have close to no experience reading images, even I can see the abundance of round balls in the brain that probably shouldn’t be there. It looks bad. Doctor sighs. The resident thinks she’s done for. Doctor agrees; the patient has at most two weeks left. We rush up to the room just to let her know that we’re here for her if she needs anything. She’s frail and old but she’s smiling. Does she know why she’s been hospitalized? Maybe she does, and maybe she’s made peace with it? Or is this a coping mechanism?

[2] A team of us load her onto the apparatus. The doctor and resident place the scary-looking metal devices into the patient. She’s on her last round of radiation for her cancer, and she’s clenching her teeth and gripping my hand. I don’t feel the pressure of her grasp because all I can think about is how brave she is and how much this must hurt. After, she’s crying. We tell her she’s so strong, and she’s so happy because she’s done for the foreseeable future.

[3] We walk into a cold room where a man is being strapped into a glass frame. He’s on harnesses and chains and velcro, and I can’t help but think that it looks oddly like someone in a Houdini water torture cell chamber. Still, he’s grinning. He’s about to get blasted with full-body radiation in preparation for a transplant that might save his life. I could see that being something to smile over.

[4] I see a survivor. He wears his hair long, perhaps proving his success and how he no longer needs chemo. He was diagnosed with his cancer decades ago. Genetic analysis showed that he had lost p53, a critical tumor suppressor gene that is implicated in many cancers. Doctor said, it didn’t look too great for him. He took his drugs and got his stem cell transplant. With the transplant, there’s risk for another blood disorder that could develop into cancer (myelodysplasia). They’ve been following up on him, but he’s well beyond the time frame in which post patients develop the side effect. Doctor thinks he’s “cured” (I hear that word is never used in oncology). It makes me wonder — when I’m ten years out from my disease remission, am I “cured” at last too? Or will I keep having to make routine visits to my nephrologist? When do we get “cured” from chronic diseases? (Is that even possible?)

[5] I’m so impressed by how positive she is. She has papers with questions and appointments, and she’s so on top of her disease management. She’s also curious about her imaging and asks us to teach her about what’s going on. In a way, it reminds me of me. It also reminds me of previous patients I’ve seen; isn’t it so intriguing how some patients end up learning so much about their disease that they could almost be specialists in that field? I was so in awe of her energy that it took me by surprise when she asked about her eyesight. It had been growing worse since her treatment, and she wanted to know the prognosis. She wanted to go back to her normal life. I looked at the doctor. He told her it was unlikely she’d regain her vision. She started crying. In those few minutes I saw everything about what we’d been learning in the past few weeks about “breaking the bad news”. It makes me wonder what happens when you are at the crossroads of quality vs. sanctity of life. I can’t imagine ever losing my eyesight and how distraught I’d be. But when you’re fighting a disease as aggressive as cancer, there are casualties. When do you draw the line? I really don’t know what I’d do if I had to choose.

Wisdom from class

Ugh, I should really write my Berlin post. It feels like at this point, it’d be a waste, but I do have it all written out in my Moleskine, so the only thing that’s holding me back is pure lack of time (or perhaps laziness).

We’ve been learning about cancer this past week (and this coming week). Thankfully, I still think it’s a field I’m open to (as in I haven’t been grossly proven wrong, whereas with some other fields, I definitely feel a huge aversion to [esp. embryology… *shudder*]). Last Friday, we had this talk about end of life care. I thought it was going to be really depressing, boring (it was an out of class lecture), and/or stuff that I already knew. Somehow, it was a great lecture, probably the best of the ones we’ve had out of class and definitely better than some of the ones we get in class. The professor had this one GREAT quote that just shook me, which was “You cannot feel guilty about not being able to cure an incurable disease“. I don’t even know why this impacted me so much since I’m not doing any curing of any sort right now, but it just felt so revelatory that I had to share it here.

My favorite movie and my 10 truths

This isn’t the kind of post I’d usually put out in the public on my blog but I’m feeling carefree and on fall break, so here it is.

In 2008 when I was fresh out of the hospital, I read The Perks of Being a Wallflower by Stephen Chbosky. It was a book that my younger sister had raved about and I had read great reviews on, and it was short, so why not. I can’t remember exactly how I felt, but I know that when I read it, I learned things about myself and life, and I read the most beautiful and honest words, and I was willing to wait however long it took for the movie.

I finally got to see the movie last night (in all my excitement I didn’t realize it’s only out in limited release until October 5 but thankfully I was back in San Diego, which is just populated or artsy enough that they would play it there). It was funny, it was sad, it was hopeful. By far, the last scene just blew me away from the filming, the music, the scenery, and the emotions you feel behind those last words. It is, without a doubt, a movie that may be my favorite for years.

It’s hard to describe why I love the movie and book so much. The two people I saw the movie with clearly weren’t as moved by it as I was, which is okay. I think it’s because of what the story means to me. I wasn’t as awkward as Charlie but there was a time in high school too when I thought I was all alone, and then I met these incredibly fun seniors who made me feel like I belonged for the first time and helped me witness a life beyond books and studying. When they left, I was devastated but I knew that things would be okay for me now, and they were. The story reminds me of a time when I could dream big and I felt forever young and “infinite”. As stressful as my high school experience was, I think of those times with my friends as some of the happiest moments in my life, something I would relive. Probably the few moments in my life that I would relive include those years, the summer of 2003, and maybe my past year. To have a book/movie that brings me back to those times is more than I could ask for.

A few months leading up to med school, many people asked me if I was excited. I was, believe me, but at the same time, I felt some kind of dread. I realized that when I got sick in 2007 at the start of my senior year, the happy, carefree me was forced to grow into someone who could handle and adapt to what it meant to have a chronic disease. From then and on into college, my life was about getting and staying healthy and getting to my next step: med school. Most people say college is “the best time in your life” but I was robbed of that early. I guess that’s why it’s hard for others to understand why I pick HIGH SCHOOL as the time when I want to go back and live the best years of my life. Once I was on my train tracks to med school, I was going too fast to stop and see the ocean. So yeah, I like the reminder of high school.

Even now, finally doing what I want to do, sometimes I miss those days. I think I especially miss the carefree and spontaneity of it all. Anyone who has any idea who I am, especially my other med school classmates, know that I am an intensely hard worker who doesn’t really stop to breathe or have any sort of fun. It’s so hard for me to do that after what I went through; even to this day, there are some moments when I think I could lose it all if I were just to be hospitalized again. I want and need these reminders that at one point, I could live without a care in the world and I could do things at any hour of the day even if it wasn’t on my calendar and I could just take a random drive to nowhere with no plans and I could have fun.

In this video Sarah Kay talks about the spoken poetry form, which isn’t really something I’ve heard about before, but I think it’s close enough to Perks that I can attempt to link them. To me, one of the beauties of the book and the movie (less so the movie) is the prose; Charlie’s writing is simple yet honest, and in that way his letters sometimes sound like poems.

Anyway, Kay asks us to do this interesting assignment in which we come up with a list (and as an SJ, I love lists so this was right up my alley) of ten things we know to be true. Now you’d think that being in med school, I’d have a host of things that I “know” to be true, but I realized that a lot of things I’m just taught. For all I know, it could be a lie (probably not but it’s possible in a Brave New World way). So here are ten things that I personally know to be true. Also, this list was significantly harder to generate than I thought it would be:

1) When you’re tall, people automatically assume you’re older than you really are.

2) Renal diet meatballs taste better than off-diet meatballs.

3) It rains less in San Diego than it does in Charlottesville.

4) When a guy cheats on you and tells you he won’t ever again, he’s probably lying to you.

5) It will all be okay in the end.

6) Even the skinniest girls have something to gripe about with their bodies.

7) The easiest way to have a conversation with someone is to get the other person talking about himself/herself.

8) Any situation is only as awkward as you make or perceive it.

9) You can take hundreds of photos of the same scene with different settings but sometimes, you just can’t replicate the beauty of seeing it in person

10) Someone is always better than you, and someone is always worse than you.

Of a more personal nature: leaving

It wasn’t supposed to happen, that I’d not want to leave California. I was so determined to make it only a stepping stone for something bigger and better: med school. At one point in high school, I couldn’t wait to leave Virginia. I was tired of the “east coast mentality”, whatever. I wanted to behold what California dreamin’ meant. Somehow, when weird unexpected things happened, though, I got put here not by choice, and I couldn’t ever stop thinking about my California adventure as something forced on me. I still remember how determined my first year self was to not make friends. I wanted to be that weirdo who lived in her room or the library with the books. It was only a stepping stone to med school. We always knew I was going to come back.

I just didn’t think that in four years it’d be so hard to leave.

One of my great friends ES as of yesterday night committed to staying here for medical school. On some level, I held out in hope for her to pick her other option in NYC. On some level, I wanted it because I didn’t get that chance, but I also know now that even deeper down, I must’ve not wanted to leave her. I guess it was always obvious that she was going to stay, but it didn’t hit me until… well, she did pick to. I’m not ready to say goodbye. Last week, I had my last Words Alive meeting. I didn’t think I’d cry, but I did. It’s the beginning of the end. My friends I met only this past year in photography club — how was I stupid enough to stay away until now? Some other new people like JZ and my old friends like LN, ER, CR, CW…

How does timing work that we meet all these great people as we’re about to say goodbye?

Today I did many things I enjoy. I met some new people, hope, inspiration for the future. I went to eat lunch with ES, and I tried to be happy for her. I continued learning Beethoven’s Opus 13 Pathetique sonata. I thought about how the world is spinning very fast, and we can only hope we adapt to what life throws at us. I wondered how it was that when I left TJ I wasn’t sad at all — maybe it’s because I knew I’d keep those friends forever. Then why am I sad that I’m leaving UCSD? What does that mean? I thought about how funny it was that at one point I wanted to quit piano so badly, but my mom was right because she always is; that music, piano, this will always be there for me during the hard times. I lost my mind and soul and left this world for a little while when I read Haruki Murakami’s simple, calm, yet mind-triggering words. I found comfort in water. I realized that no matter how much I drag my camera around, I still never take “too many” photos.

So I guess some things never change.