Saturday, July 29, 2006

Hiking at Palos Verdes

This afternoon, Paul and I decided to join the Advent HOPE Sabbath School group for a hike at the Palos Verdes Estates Beach. It was quite a long drive out there from Loma Linda, but the weather was perfect and it was absolutely gorgeous.

Some of us ventured forth to hike down the steeper side of the cliff to the shore. Fortunately, there was a rope to keep us from falling.

Down on the shore we took some nice photos, and I got to spend time with Eli and Susie's baby, Miso. =)

After we spent some time looking at seashells and skipping rocks, we gathered together for a small sundown worship before heading home.

What a blessing it was to be out in God’s nature once again, to soak in the wonder and grandeur of His creation. It was nice to fellowship with the Advent HOPE group as well. Although I attend the Riverside Korean SDA Church, my heart is very much with the Advent HOPE congregation. One of my favourite websites is, where you can download and listen to many inspiring sermons that are preached weekly at Advent HOPE. =)

Thursday, July 27, 2006


Words cannot express how happy I am that I chose to go into Ophthalmology. Tomorrow marks the end of my first week of a three week Ophthalmology elective. Seeing patients in the eye clinic is a total joy to me. Even looking into the eyes of grumpy old men at the Veteran’s Hospital has been exhilarating. *laugh* Watching cataract surgeries, glaucoma surgeries, plastic surgery cases, and other minor procedures this week has been fascinating. The complexity of the eye and the intricacies of each step of the evaluation, diagnostic, and treatment process is a joy for me to learn about. Yesterday, I spent 3 hours at the library just reading through the first few chapters of Kanski’s Clinical Ophthalmology, and it was so enjoyable for me. =) I especially like my rotation right now because my days are mostly 8 am - 5 pm days with evenings and weekends free. Oh yes, life is good (I needed this break before I get roughed up in General Surgery next month). =) I know that God must have led me into this field of eyes. It was completely providential, and I thank God for helping me find a field that fits perfectly with my character, talents/strengths, and future goals.

Sunday, July 23, 2006

Enjoying God's Nature

I had a wonderful weekend. It was my first full weekend off since I started residency (since I am done with my month on MICU and now starting an elective in ophthalmology). So my fiancé, Paul, and I decided to go up into God’s nature. On Saturday afternoon (7/22/06), we made the 45-minute journey up to the local San Bernardino mountains – to Forest Falls. It was about 30-40 degrees Fahrenheit cooler up there than it was down in Loma Linda. The heat in Loma Linda has been killing me. To look on the bright side of things, at least the 119 degree weather is not exacerbated by humidity.

Today (7/23/06), Paul took me out on a surprise date. He drove me to the Mount San Jacinto State Park out in Palm Springs. It was really beautiful out there. I had never been there before! We took the aerial tram up to the mountain area. Here's the view that we had from the tram.

And at the 8000 feet altitude, we again were able to escape from the sizzling heat. We were able to hike along some nice paths, and we took our handy-dandy tripod along so we could capture some Kodak moments without having to infringe upon the time of other passers-by. Here are some shots of our adventure. =)

Wednesday, July 19, 2006

The Case of the Central Arterial Line

Yesterday, I had another central line disaster. A 52 year old Hispanic patient was admitted to the ICU Monday for respiratory failure secondary to terminal interstitial lung disease. Her blood pressures began to drop later that night, so yesterday we decided to place a central line in her. I attempted the first few sticks in trying to find the subclavian vein, and my senior took over soon after. Because this lady was volume depleted and she had significant scarring attributable to her pulmonary fibrosis, she was a difficult patient to get a central line in. My senior poked around several times, but when we got a flush of blood back we noticed that it was bright red and pulsating very vigorously. We had entered into the subclavian artery! After several tries and a new central line kit, we finally got a central line in place. The blood looked a darker red, and it was not pulsating with each heartbeat, so we assumed we were in the correct place. We sutured in the line, and got a STAT portable chest x-ray.

About 15 minutes later, I took a look at the x-ray, and from my limited experience I thought the line was in the right spot. I called the on-call senior just to make sure, and he confirmed that the position of the line was fine. I wrote the order, “OK to use central line.” But then suddenly the nurse handed me the phone and stated that a radiologist wanted to speak with me. He asked, “Are you taking care of a patient named >>>? Did you see any arterial pulsations when you put in the line?” He proceeded to tell me that he thought the central line was in the artery and not the vein. “Unless this is an anomaly to the venous structure, I think you are in the artery.” So we got an arterial blood gas on the blood from the central line just to confirm, and the respiratory therapist said he thought the blood was indeed arterial. By that time, it was already 8 pm, and I was supposed to go home by 7 pm. Unfortunately I had to punt the task of removing the central arterial line and placing another central venous line to the poor team on call. They ended up putting in another central venous line. Today when I asked my senior about it he told me that the first line had been in the right place after all and that the anatomy looked different simply because the patient was all scarred down from her pulmonary fibrotic disease!

*sigh* That’s two for two in disastrous events in placing a central line. Hopefully I will have more luck in the future. =)

For more information on placing central venous lines, visit these websites:

Quick update on my Code Blue patient. On Monday (7/17/06) I had the opportunity to catch the tail end of the autopsy on my patient who passed away three days ago. The pathologist who was performing the autopsy said he was disappointed to find that there was nothing discovered grossly during the autopsy – no tumors or obvious masses, no significant lymphadenopathy, no organ anomalies. All he found was the cervical lymph nodes that had already been biopsied, an enlarged, soft spleen and hemorrhagic bowel. Everything else was unremarkable. So this case is still a big mystery. Why exactly did the patient pass away? What triggered her to go into DIC? Did she have cancer or an infection? Perhaps no one will really know. I suppose we will just have to wait and see what the final biopsy and pathology reports show.

I will keep you updated.

Sunday, July 16, 2006

Code Blue

One of my very sick patients passed away today. It all started on Friday afternoon, when I was notified that I was going to get a transfer from another medicine team. They told me about a 36 year old Hispanic female who was admitted about a week and a half ago for generalized weakness and fevers. She was neutropenic, and apparently her primary care physician in Los Angeles had already worked her up, and she had already had a left cervical lymph node biopsy done that seemed highly suggestive of lymphoma. She was apparently becoming coagulopathic and her liver enzymes were elevated. A coag panel on Friday showed that she was in full-blown DIC (disseminated intravascular coagulopathy), so that is why she was being transferred to the ICU. The oncologist told me that he had done a bone marrow biopsy that day, and he said he highly doubted that the diagnosis was leukemia or lymphoma. He suggested getting infectious disease on board to figure out if there was some infectious etiology for her sudden decompensation.

When I got back into the hospital the following morning (Saturday), I heard word from the on-call team that the night was quite eventful. Her blood pressures were plummeting, so a central line was placed and she was requiring multiple pressors. She went into respiratory failure, so she was intubated. She received many transfusions of packed red blood cells, platelets, fresh frozen plasma. We gave her multiple units of cryoprecipitate and more blood transfusions throughout the day. She was bleeding everywhere – vaginally, from her central line site, from the biopsy site, and from her stomach. Her hemoglobin went from 10 to 4. Nonetheless, she remained alive all through Saturday, and she was still breathing when I went in to work this morning.

Today she was still requiring multiple pressors to keep her pressures up. I ordered more blood for her. She was still on dobutamine, levophed, and neosynephrine drips. I finally got an infectious disease consult, and the experienced physician stated that although sepsis could be a possibility, the DIC was probably not caused by an infection alone. He was convinced that there was some sort of malignancy that was the culprit.

Suddenly, at 2:00 pm, I received a page, and an overhead intercom voice announced “Code Blue, Two South; Code Blue, Two South.” I knew it was my patient. She had become bradycardic, and she was now pulseless. My senior was not present (today was his day off), so my co-intern and I were in charge of running the code. One of the nurses told me to find the patient’s husband, explain the situation, and let him know that at any time he could call off the code. So I left my co-intern to continue running the code as I rushed off to find the husband. I saw him come into the ICU, he looked dumbfounded. I explained what was going on – how we were doing all that we could to sustain her, but that by continuing the code we were prolonging her suffering. I invited him to come into the patient’s room, which was now jam-packed with nurses, respiratory therapists, the on-call medicine team, other residents, and medical students. By this time, one of the senior medical students was doing chest compressions. The husband continued to look on, seeing his wife deteriorate in front of his eyes. After about 5 minutes from the time the husband entered the room until finally spoke – which seemed like an eternity – he threw up his hands in the air and said, “Okay, let’s stop.” Twelve minutes total had passed since the code had begun, and the patient was declared dead. The patient’s husband began weeping, a strange cry that was lacking in physical tears but full of agony, as he held the hand of his beloved, deceased wife.

We allowed the extended family to come visit with the patient. After about 30 minutes, I went back in to speak with the patient’s husband about having an autopsy performed on the patient. I told him that he could accept this free service if he still desired to figure out the cause of his wife’s death. After an extensive conversation, he agreed to have the autopsy performed.

By this time, the husband was calm and collected. His stage of mourning was over, at least for the moment. He proceeded to tell both the nurse and me how much he appreciated what we had done for his wife. He understood that we did everything in our power to keep her alive. He then turned to me, clutched my hand in his, and proceeded to tell me that he appreciated me, what I had done, and that as I grew older I would gain more wisdom and learn how to help people all the more. Tears began to well up in my eyes as he was thanking and building others up during his most difficult time of life. He gave the nurse a hug and thanked her repeatedly for all she had done for his family. It was a very emotional time for us all. It took all of my energy to keep from breaking down in front of him, but somehow I managed to blink the tears away.

I know that this will be a difficult few weeks for the patient’s husband, as well as for the two children that she has left behind. For any of you who may be reading this blog, although you do not know this patient, I ask that you take a second to breath a prayer up to heaven for this family.

Dear Lord,

Strengthen this family. Allow the husband – and especially the children – to cling to you for support during this difficult time. May you be real to them. May they grow in faith. And may the patient rest peacefully in her grave until You come again to receive her unto Yourself.

In Jesus’ Name I Pray,


Thursday, July 13, 2006

The Truth About 9/11?

Today is my day off of work! What a relief! I have not had a day off in twelve days, and my poor body is worn out. Today I slept in until 8:30 am! It was absolutely beautiful not to have to drag my body out of bed this morning. =) Later in the morning while checking my email, I saw that I had received a forward with this link:
Since it is my day off, I took the time to watch this 82 minute documentary. I must say that it was quite interesting. If you have the time, feel free to watch it for yourself.

Sunday, July 09, 2006

Freddie, the Country Boy

Fred sings to Jane at their wedding reception. He confesses that he is a country boy from the South, and he does quite a number to demonstrate that. =)

(Sorry it's sideways, computer illiteracy prevents me from knowing how to edit it so it shows up right-side up.)

Jane and Fred's Wedding

So today (7/9/06) I attended another beautiful wedding – that of Drs. Jane and Fred Lee. It was out at Newport Beach at the Marriot Hotel. A gorgeous outdoor wedding and an indoor hotel reception. =) I am so sentimental at weddings. I must admit that I shed tears several times throughout the ceremony and even during the reception. I am so happy for Jane and Fred. I have seen their friendship sprout, grow, and blossom into a God-centered relationship. Jane is one of the sweetest, most tender-hearted individuals I know. She is so giving, loving, and caring. "Freddie" is also a wonderful man of God, ever smiling and welcoming to anyone who enters into his sphere of influence. I will miss both of them dearly while they are serving the underprivileged as missionaries at a Seventh-day Adventist Dental Clinic in Trinidad. May God bless their new family.

Paul, Freddie, Jane, and me

Sunday, July 02, 2006

My First Week of Internship

So I have finished my first week of work as a brand new intern on the Medical ICU floor. Wow! I must say that it was a tiring and eventful week. Here are some snippets.

My first day of work was Saturday (6/24/06). On weekends, there are no “rounds,” so my co-intern and I basically took care of patients, wrote progress notes, and tried to do our best to keep our critically ill patients alive.

On Sunday, I managed to experience my first code blue as an intern. My senior resident was not around to run the code, so my co-intern and I were left to fend for ourselves. Fortunately another senior resident was available to help us out.

Later that day, my senior resident told me to hold a “family meeting” with members of the family of a critically ill patient. She had suffered from a massive left cerebral artery stroke, which caused significant edema in the cerebral cortex, causing a 1.7 cm midline shift. The patient was minimally responsive and had quite a poor prognosis. I had only met that patient that very morning, as that patient had been transferred to our hospital from another facility the day before. Now I was now being expected to tell the family about all that I knew about the patient, her condition, and her prognosis. I braced myself for the encounter, and I breathed a prayer to heaven that He would give me the right words to say. A security officer led me to the conference room, and he warned me that there were a lot of family members in there. I was shocked to find that there were more than 30 individuals packed into one small room – the entire family of the elderly Hispanic lady. I proceeded to talk to them about what I knew…and about what I didn’t yet know. I answered their questions as best as I could, and I let them know that at this point we could not give them a definite prognosis. Although I did not have all the answers, I did my best to clarify what our plans were. At the end I asked them if they had any faith background, and when they shared that they were Catholic I asked if they would like for me to offer a word of prayer for them and their loved one. They agreed. After the prayer, I left the room, and the nurse later reported to me that the mood changed one hundred and eighty degrees after we prayed. Before the prayer, they were tense and stressed and angry with the other hospital that failed to give their loved one the appropriate timely treatment that they had expected. After the prayer, they were reconciling with one another and hugging each other. I just thank God that He gave me that opportunity to pray with that family at that critical moment of their lives.

On Monday, I failed to make it to Morning Report. We are supposed to attend these daily morning meetings at 8:30 am with the department of internal medicine. However, there were so many patients to look after that I could not make it to the meeting. One of the senior residents basically chewed me and my co-intern out for not showing up. We apologized and told him we would try to make it to the other meetings. So far, I have only made it to one Morning Report. I realize that I am at risk of failing this rotation if I do not attend 70% of these meetings, but it would have been impossible for me to attend these meetings and take care of all my patients, as our service was overloaded with an extremely large number of complicated patients.

Later that day, I heard some fabulous news. We were getting medical students! I had thought that we would be without medical students for a whole week! But that news totally made my day.

I tried to get my long white coat from the linen department. The shipment was not coming in until Wednesday. I got so tired of carrying a million and one things in my single left breast pocket in my scrubs, so I decided to go down and try to check out a loaner white coat. However, there were no loaners available in my size (34). I finally decided that a large lab coat would be better than no white coat. So on Tuesday, I went down to get whatever I could fish for. They had a size 42 for me. I rolled up my sleeves three times, and I was essentially “swimming” in my coat,…but at least I had somewhere to put my handy dandy pocket reference guides.

On Tuesday I attempted to do a central line. Interestingly in all my years in medical school I had never had the opportunity to place one before. One of the senior residents who was guiding me through it yelled at me for making a wrong move. *sigh* That was quite the disaster. Nonetheless, we ended up getting the central line in successfully after all, and the patient did quite well afterwards.

On Thursday, I attempted to do a lumbar puncture. Another transitional year resident was attempting to guide me through it. Somehow, she managed to show me an incorrect position for where to place the needle. We were way too low in the spine. After several attempts on my part, and after several attempts on her part, we finally called over one of the senior ER residents to help out. He got it after only one try. The poor patient was in tears by that time. *sigh* That was another disaster, but I suppose this is all part of the learning process.

After counting up my hours, I realized that in six days I worked a grand total of 89 hours this week. If I continue down this path, I will be in violation of the ACGME requirements for an 80 hour work week. But at least the worst is over. I now have learned how the charts work, how to get labs and radiology images on the computers, how to phone in for the radiologists’ reports, how to transfer patients, how to make patients "DNR," etc. In one week I have learned how to manage fever, cough, nausea, vomiting, gas, sore throats, hypocalcemia, hypomagnesemia, hypophosphatemia, hypokalcemia, acute coronary syndrome, diabetic ketoacidosis, gastrointestinal bleeding, septic shock, pneumonia, acute pancreatits, and alcohol withdrawal.

Today (7/2/06), I witnessed my first “terminal wean.” An 85 year old Caucasian male, who had been admitted for a massive cerebral hemorrhage, was essentially being supported on the ventilator. He had a very poor prognosis, and the family was made aware of the situation. The entire family finally made the decision to make him a “DNR,” (Do Not Resuscitate). So today, for the first time in my life, I watched a patient pass away before my very eyes. The nurse made the patient comfortable with a morphine and versed drip. Then, I watched the respiratory therapist take out the endotracheal tube and detach the ventilator from the patient. After a few minutes, the patient’s lips began to turn blue, and his face turned an eerie ash-white hue. The monitors were turned off inside the patient’s room, where a few family members insisted on watching their loved one pass away, but the monitor outside in the nurse’s station remained turned on.

After a few minutes, I stepped outside to take a look at what was transpiring on the monitor. It took a total of 10 minutes for the patient’s heart to stop beating. It was a weird feeling to watch the monitor portray a “countdown” of the patient’s oxygen saturation – which went from 100% to 99% to 98%...all the way down to 0 – and to see the heartbeat become an asystolic line. The family was happy that their loved one was able to pass away comfortably, without showing any signs of gasping for breath or pain or discomfort.

I must say that this experience was a strange one. It made me remember that life is so fragile. At any moment in our lives, we must be ready to have our breath taken away. We must be right with the Lord at all times. We must reconsecrate ourselves to Him at every moment. For it is a sure thing that our lives here on earth will come to an end. But if we lay up our treasures in heaven, we can look forward to an life of everlasting joy with our loving God in heaven.

What a week. I’m pooped. I will write some more of my adventures as an intern some other time. Good night!