Me & Yoo

From Bride to Bridesmaid

2007-10-28T23:35:00.000-07:00

Last week, Paul and I had the opportunity to be a part of my brother's wedding.

Yes, indeed, four months after Paul and I were married, James and Linda also tied the knot! It was a beautiful wedding, and I am so lucky to have gained a sweet and wonderful sister...

Chris Chu, Paul, and Ken Lim with my brother...

My mother-in-law came out from Hawaii to spend almost a week and a half with us before the wedding. She is so much fun to be around...

I got to see my little precious nieces again, Lizzy and Rachel...

Boy, am I wedding'd out! My poor parents are trying to catch their breath after this marathon of a year. At least they've married us off and can now move on with their lives.

Bangladesh Mission Trip

2007-10-28T22:15:00.000-07:00

Another reason that Paul and I were so busy (i.e. unable to post any blog entries) after we were married is that we were busy preparing for our mission trip to Bangladesh. From September 14 - 23, 2007, a team of 21 individuals from Loma Linda University (2 doctors, 2 dentists, 1 registered nurse, 1 licensed medical massage therapist, 2 nursing students, 9 dental students, 3 dental hygiene students, 1 pre-dental student) in conjunction with 40 local volunteers served the people of Bangladesh. Getting from Dhaka to Jalchatra was an interesting four hour experience. Never have I seen such a densely populated country. There were people everywhere!

The Bangladesh version of a schoolbus...

We had long days, which started at 7 am with worship and ended with an evening worship around 7 pm. As word spread that we were providing free dental and medical/eye care, the people of Bangladesh began to swarm to our little compound. The crowds were almost unmanageable. Our team saw nearly 2000 patients during our short stay there...

It was so hot and humid there that everyone's scrubs were drenched with sweat the entire week! It was literally like living in one big outdoor sauna...

The Dental School let us borrow some fancy equipment...

Thanks to the infamous beetle nut that was habitually chewed in that area of the world, many of the people's teeth looked like this...

Danny Morgan and Carlos Moretta were my flying buddies, since we had to fly in a day later than the rest of the team due to our work schedules...

I did basic eye care during my time there. Through an organization called PRVAIL, we had mass-ordered hundreds of reading glasses to distribute to those presbyopes in need. We also bought basic eye medications to distribute to the people. In about four days of work, I saw close to 400 patients! This would have been virtually impossible without the help of my two trusted translators, Peter and Babu.

This particular old man was sooo overjoyed to have this pair of glasses, donated by Sandra Shirley, one of my fellow church members...

This nun was a cutie...

This gentleman was essentially blind, but he insisted that these glasses helped him see more clearly!

I even had the opportunity to do minor surgery - two chalazion removals...

Near the end of our week, we took an outing on our "minivans" to a nearby forest. It was so surreal...

Snapshot of a local barber shop...

Sabbath afternoon we visited the local village children...

Each of us girls got a sari specially tailored for us...

Bangali couple?

Our awesome team...

Not only were we sad to say goodbye to Bangladesh, but the children shed tears as well...

Hawaii - Here We Come!

2007-10-28T21:47:00.000-07:00

We were fortunate to have a week off after the wedding to enjoy a honeymoon in Paul's motherland - Hawaii.

We went to the Big Island first, enjoying the beauty of nature there...

We stayed at the Hilton Waikoloa Village...

ATVing for the first time was quite a rush...

We had a few beautiful pit stops during our ATV ride...

Horseback riding was exhilarating (although Paul was quite sore after the long ride)...

We even got to go snorkeling with the fishies...

Our hotel room had beachfront access, which gave us opportunities to relax in the evenings on the hammock...

It was picture perfect there...

We even left our mark on the lava using white coral...

After a few days of bliss on the Big Island we returned to Oahu to join Paul's mother and church family for another wedding reception...

We've Tied the Knot!

2007-10-28T21:14:00.000-07:00

Four months after my last post, I have finally decided to take a step forth into the blogosphere again...now as a married woman. Amidst the craziness of being married and starting ophthalmology residency, time did not permit me to blog at my leisure. Nonetheless, tonight I made the determination to take a free moment to post pictures from our wedding. Paul and I were happily married on June 24, 2007. Here are a few pictures for your enjoyment. Many apologies for the delay!

Before the wedding...

Me, anxious to be married...

Ingrid's famous infrared shots...

My wonderful girlfriends...

Paul completely surprised me with his tears...

Our friends...

Our head table setup...

Cutting the cake...

The slipperiest piggy back ride ever...

Apologies

2007-06-21T16:19:00.000-07:00

Three days remaining before the big day! Things have been crazy...hence...the sparse blog entries. This update is a formal apology to my few faithful readers regarding my MIA status in the blogosphere. I promise to update this blog after the wedding and honeymoon are over. Please pray for us as Paul and I soon tie the knot! =)

Graduation Weekend

2007-05-28T11:14:00.000-07:00

About this time every year, Loma Linda University becomes a campus bustling with activity. The Class of 2007 from the Schools of Medicine, Pharmacy, and Dentistry were awarded their diplomas yesterday. The whole weekend, in fact, was a whirlwind of activity.

On Saturday morning, after hearing an inspiring sermon by Jason Shives, Paul and I attended the School of Medicine’s Baccalaureate service, where Amy Lee and Evelyn Law played a cello duet.

I have known Amy since our teenage years, and she has always been an outstanding musician. What a blessing that she agreed to share her music with us on our wedding day!

For lunch we went over to Eli and Susie’s house again for our weekly Sabbath potluck. This week the entire Shives clan as well as Eli’s family joined our group of friends.

Ken Lim’s parents even made their appearance. Dr. Lim showed us the “right” way to cut a pineapple.

Saturday night we headed down to San Diego for a huge birthday party for my niece, Taylin, who had just graduated from the eight grade. I didn't realize this would be more than just a family event. More than a hundred people showed up! My old church members from San Diego Korean SDA Church were all gathered there, and I was especially pleased to see Grace So, currently studying law at Georgetown University, and Andreia Kim, an aspiring physician’s assistant, doing her undergraduate studies at my alma mater – UCSD.

Of course, no event is complete without a doggie reunion.

Early Sunday morning, we rushed to attend the School of Medicine graduation.

Congratulations to A.G. (going into Psychiatry)...

and Sunik Oppa (Neurosurgery)...

Andy and Michelle Park (the newlyweds going into Family Practice and FP/Psychiatry, respectively)...

and Eli Kim (FP)...

can't forget to mention Miso Kim (advanced potty training -- upper division)...

and Jason Shives (FP)...

Sally and Aaron Sartin (FP/Preventive Medicine)...

and Ralph Clark (Preventive Medicine)...

and Marshall Ford (Ophthalmology)...

Afterwards, we had a feast at Eli’s house before rushing off to the School of Pharmacy graduation to celebrate with Annie Curnow.

We hung out for a few hours at Tim and Adrian’s house before finally heading to the School of Dentistry graduation in the evening, where my cousin DongWook earned his doctor of dental surgery. Here is a family photo with some of our cousins, uncles, and aunts.

I searched long and hard for my other "cousin," Erina, but could not find her amidst the multitude of people. Congratulations to her, too!!! =)

Other Dental graduates include Brian Chan...

Sarah Kim...

Melissa Lee...

Joe Chang...

Angela Kim...

and the extended Korean clan...

By the time we got to Bernard’s graduation dinner party, I was still stuffed from a whole weekend of eating. Nonetheless, I must say that my aunt had prepared quite a grand setup of fantastic food.

What a weekend. Once again, congratulations to all the graduates!!!

Update on Life

2007-05-22T13:44:00.000-07:00

Wedding planning has been incredibly busy, so I admit I have not been blogging on a regular basis. Eric visited the Southern California area a few weeks ago and promptly noted my lack of consistency in the blogosphere recently. So with this entry I hope to appease my few but faithful readers. Sometimes I wonder who actually reads these entries...if you are not shy please identify yourself! =)

On with snippets of my life:

1. Advent HOPE. At the turn of this new year, Paul and I started to attend a new church – Advent HOPE (AH). We have been so blessed by the environment, fellowship, and community we experience weekly, and we really feel God has really led us there. The great thing about this church is that amazing speakers are invited to come and share the Bread of Life every week, and all the sermons are posted on Audioverse. Since I attended a different church for the past few years, I made it a habit of downloading almost every sermon and listening to them on my nano ipod when I went to the gym; this helped encourage my spiritual growth. One new change is that Paul and I were recently elected to serve on the Executive Committee at AH – Paul in the position of Bible Committee and I as Secretary. I look forward to a powerful year as we have the privilege to serve on leadership.

In April, AH had an event called Mountain Church. Instead of attending a formal church service in a building, we drove up to the local mountains, hiked up to a pretty shaded area, and worshiped our Creator in the beauty of His nature. It was a good time. Everyone brought their dogs – even Lucy came!

Last weekend on Saturday evening before their end-of-the-year slideshow, we formed a prayer circle around those individuals who are making transitions in life (graduating, moving away for residency or additional schooling, etc.).

It struck me at that moment that Jason and Janelle and Eli & Susie (& Miso) will really be moving to Florida. Ana Gomez will be going to Kentucky. What a sad moment. I have appreciated their friendship, their leadership, and their enthusiasm for God. May they continue to be a light to those around them wherever they may be.

2. Aunt’s Birthday. Back in March 2007, my aunt had her 60th birthday party. In the Korean culture the 60th birthday marks a huge milestone, as many older generation Koreans lived at a time when the average life expectancy was quite low and they considered it almost a miracle to be alive at that age.

3. Joe and Grace’s Wedding. They tied the knot on April 23, 2007. Congratulations!

4. Forest Lawn. A few weeks ago, a group of us took an outing to a cemetery.

Yes, it was a cemetery. In fact, it is a beautiful cemetery in Glendale which houses two of the world’s largest paintings (The Crucifixion and The Resurrection by Jan Styka). It also houses Leonardo da Vinci’s Last Supper recreated in brilliant stained glass.

Exact replicas of Michelangelo’s greatest works (David, Moses, and La Pieta) are also found there. Here's David - I made some modest clothing for him.

This also happens to be where my grandparents were laid to rest.

5. Radiology. I have absolutely loved these last four weeks on Radiology. It is a very relaxing rotation, which has allowed me the leisure to plan this wedding as well as enjoy life. One of my attendings, Dr. Dang, is really an amazing person to work with. He is a heavy-set, good-natured, Vietnamese Neuroradiologist from Arkansas. I have picked his brain and requested that he teach me everything there is to know about CTs and MRIs of the head. It has been a very educational experience (when I actually show up to work, that is). =)

6. Facebook. Last month after receiving a friend request from my co-worker, Lanny, I joined Facebook, which seems to be an increasingly popular online network of acquaintances and friends – well, popular with the younger generation. Nonetheless, it has been interesting to be back in touch with people from my not-so-distant past. High school friends and college friends that I have not communicated with for 5 – 10 years have been “found.” These types of internet reunions are always interesting and somewhat amusing. Speaking of reunions, I believe I have a 10 year high school reunion coming up soon. I must be getting old.

7. Isabella. This past weekend, Peter Gregory and his family came out from New Mexico to visit. Isabella had a blast playing with Miso, perhaps to the mini maltese's dismay.

8. DongWook’s Wedding. Congratulations to my cousin on his marriage to Minju!

I had the opportunity to participate in their Pae Baek (traditional Korean ceremony), which was an entertaining experience.

9. Adrian’s Birthday. Finally, I had the privilege of celebrating Adrian’s 26th birthday with him.

I discovered that he has had a very interesting life up until now (he fled Pakistan at the age of 17 and has not seen his mother for the past 9 years). Happy birthday, Adrian!!!

Countdown

2007-05-16T00:33:00.000-07:00

What a strange feeling it is to be virtually finished with my internship year. Granted, I still have one more month remaining…but I only have these last, lovely rotations to complete – Radiology and Anesthesiology. It was strategic planning…I must admit, but I am grateful my program has allowed me such leisure. I feel very fortunate to be able to take two weeks of vacation right before my wedding. Another week after the wedding for a honeymoon is an added blessing.

According to my wedding website which has a built-in countdown system, I have 39 days remaining until the big day! As this day approaches, feelings of anticipation, excitement, and joy begin to well up within me. Paul and I have dated for over four years now (4 years, 3 months, and 21 days, to be exact). We have been engaged for 1 year and 3 months. We truly have been through thick and thin together, and it has been a crazy but wonderful ride. We have worked through our differences, reasoned with our parents, learned how to speak lovingly to one another at all times, understood what it means to care deeply for someone other than oneself, and grown together emotionally and spiritually. Never would I have imagined that someone so compatible with me could exist in this world. Never could I have conjured up in my dreams a more perfect companion.

The Lord answered my prayers for a godly life partner – someone who is like-minded and mission-minded. I feel overwhelmed by a sense of gratitude for this miraculous friendship. Perhaps I am a sentimentalist. Perhaps I am idealistic. Perhaps I am blinded by love. But whatever the case, I am grateful for the precious gift of Paul – my future husband.

Explorer: Inside North Korea

2007-04-29T11:33:00.000-07:00

Here are some clips of the National Geographic documentary on North Korea. My soul was stirred when I saw images of this communistic, isolated, poverty-stricken, brain-washed country. God-willing...one day I plan to serve there.

Part I

Part II

Drama on Internal Medicine

2007-04-27T00:06:00.000-07:00

Drama. This word encompasses what my Internal Medicine rotation has turned out to be. I cannot believe it, but today I officially completed my last call of internship. In fact, today marks the last day of my life that I will ever have to partake in an Internal Medicine rotation. This month has indeed been filled with drama. From turf wars between Emergency Medicine and Internal Medicine physicians regarding hospital admissions criteria to disgruntled family members of patients who threaten to pursue legal actions, this rotation has never lacked excitement.

Below I will share one episode in this fabric of drama.

One middle-aged gentleman whom we will call “John Doe” was intubated and admitted to the Intensive Care Unit a little over two weeks ago for a massive intracranial hemorrhagic stroke likely secondary to methamphetamine abuse and hypertension. His wife claimed to be completely unaware of her husband’s alleged substance abuse. After that initial meeting in the ED during which we admitted the patient, I had no contact with “Mrs. Doe” during Mr. Doe’s stay in the ICU. Once he was downgraded about a week ago to the telemetry floor and our team resumed care of the patient, I was introduced to the drama.

On Tuesday, April 17th, Mr. Doe’s nurse paged me and asked me to speak with the wife on the phone. Apparently, she was very upset for a variety of reasons and had taken her complaints to top hospital administrators. I dutifully dialed the number and initiated the conversation with Mrs. Doe. She proceeded to lash out against everyone and everything that had to do with the care of her husband while at our facility. She expressed major dissatisfaction for the ignorance of residents caring for Mr. Doe, lamented the fact that no two individuals had given her the same prognosis about her patient (the neurosurgery resident had given her a glimmer of hope while other physicians more realistically spoke of the patient’s poor prognosis), bemoaned the stupidity of nurses who placed restraints on her husband’s left arm when he clearly had suffered a right-sided stroke and hemiparesis, complained that no one is listening to her wishes or giving her updates on her husband’s progress, and maliciously criticized the group of physicians who had supposedly accused her of being a methamphetamine user also.

After listening to her emotionally charged speech for almost forty-five minutes, it was all I could to keep myself from reacting to her verbal abuse. The carnal nature in me began to arise. After all, how could she make all these false accusations when we were doing the best that we could to treat her husband? How could she belittle my colleagues and in essence demean my co-residents who had done all in their power to help him to the best of their clinical judgment? Was it our fault that she did not have insurance and had to seek care at our county facility? If she wanted to pay out of pocket, she was welcome to take her husband to a private institution for a second opinion if she truly felt that we were not providing quality care.

As these thoughts were racing in my mind, I desperately breathed a prayer heavenward for help. It was only the Lord who sustained me, keeping me calm and collected, allowing me to continue apologizing on behalf of those who may have caused her bad experiences and keeping my voice from assuming the icy edge that I was so tempted to use. I reassured her that we did care and that we wanted to do our best to better the lines of communication; thus, we came to the conclusion that I would update her personally every few days on the status of her husband and call her with any new changes. I was so emotionally drained after this conversation that the distraction from having a terribly busy call later that night was a blessing in disguise.

On the morning of Thursday, April 19th, I came to work and realized that Mr. Doe’s mental status had decreased slightly after a severely hypertensive episode earlier that morning and that his pupils had become fixed and dilated. A head CT revealed that a new area of bleeding had occurred in the right midbrain area and that there was slight herniation of the brain downward. I called Mrs. Doe about this change and asked her to come in to discuss his code status. After a large meeting with Mrs. Doe, her sister, my senior resident, several hospital administrators, and patient advocates, she finally agreed to make the patient “DNR” (Do Not Resuscitate) – i.e. withhold heroic measures (chest compressions, intubation, or ACLS drugs).

On Sunday, April 22nd, I was exhausted post-call and about to go home when I remembered I had not touched bases with Mrs. Doe over the weekend. She happened to be at bedside at the time, so I was able to speak with her in person. During this conversation, she revealed that she had been unable to sleep, eat, concentrate; constantly crying at home; unable to go to work. She expressed more of her frustrations, but this time I could see more of the hurt in her heart. As God moved in my heart to feel compassion for this lady whose life was totally changed by this abrupt medical tragedy, I almost shed tears with her. I agreed to ask my team to request a Neurology consult, per the wife’s wishes. After our extended conversation, I felt nudged by the Spirit to ask her if she had any type of religious background. When she said she did, I asked if I could pray with her. She looked into my eyes and said, “I would really appreciate that.” Unexpectedly she extended her arms to embrace me, and I then proceeded to pray for the patient and his wife. I don't remember what I prayed...I don't even think that I said the most appropriate, comforting words, but God must have changed around my prayer to soften Mrs. Doe's heart. She expressed her gratitude profusely before I left. And that is what I would call another emotionally draining day at work.

Yesterday morning on April 25th I went to the hospital to face another overnight call. When I went to my usual post on the fourth floor of the hospital, there was something was strange about the room where Mr. Doe had been staying. The curtains were no longer halfway drawn as it had been in the past. The handmade sign on the outer door was a different one from the one that Mr. Doe’s room had had. When I peaked my head inside, sure enough there was another patient in the room. I immediately knew. Mr. Doe had passed away. I immediately felt shocked, then saddened. Then finally it dawned on me that I had been expecting this to happen all along and that my major concern was that Mrs. Doe was okay. Upon questioning the nurse, I found out that Mr. Doe had been transferred to the ICU the night before for a blood pressure in the 60s over 30s and that Mrs. Doe had reacted well to news of her husband’s death. She had spoken with the Neurologist the day prior and was by that time mentally prepared for him to pass away.

What an experience. For some reason Mr. Doe's death really impacted my life. I hope and pray that Mrs. Doe will be able to cope with this major loss in a positive way and that she will regain her strength in the Lord. And as I have admittedly become more calloused, desensitized, and cynical during this year of internship, I pray that God will work in my heart – that I may be more compassionate and empathetic, that I may treat and love everyone (including drug addicts) just as God loves them, and that I may be an effective witness for Him.

Dogs

2007-04-15T18:02:00.000-07:00

Perhaps it is contagious. Perhaps it is a trend. Nonetheless it seems that everyone is getting a dog. Eli and Susie have Miso. Ray and Alice have Lucy. Elisa and Michelle have Teddy. The Shives have Rudy. Hyun has Pommy. Henry has Brownie. Paul keeps telling me he wants us to get a dog when we get married. I keep telling him we should wait at least six months after our wedding date before embarking on such an adventure. There are several potential breeds of dogs on our wish list right now. One is a Labrador – loyal, faithful, gentle, and smart. I personally love Alaskan Huskies – known for their stamina, strength, and speed, but also gentle, playful, intelligent and mischevious. The most recent dog we fell in love with is one that we met at the Daffodil Park in Running Springs, California – a Shiba Inu – beautiful, lively, affectionate, and courageous. Isn't she gorgeous?

Camping at San Jacinto

2007-04-04T21:46:00.000-07:00

Question: Which mountain is known as the second highest peak in Southern California? Answer: Mount San Jacinto at 10,834 feet.

Two weeks ago a group of us ventured forth to Palm Springs on a slightly more challenging camping experience. Here are a few quick highlights:

Hiking to our campsite laden with our heavy backpacks...

Enjoying some tasty home-made cookin’...

Shivering in the cold (20-40 degrees Fahrenheit) without the warmth of a campfire...

Hiking in the part-dirt, part-snow trail to the peak of San Jacinto ...

Finding some interesting dug-out tree trunks...

Spending some good quality time with my soon-to-be husband...

What a wonderful and refreshing time it was to be out in nature and to really appreciate the wonders of God's creation. Our God, indeed, is an amazingly creative, artistic, and perfect God.

Engagement Photos!

2007-03-20T22:26:00.000-07:00

Ingrid Wahjudi, our wedding photographer, finally delivered our much-awaited engagement photos today. Here is one of them.

Camping at Yucaipa

2007-03-20T22:02:00.000-07:00

Due to wedding planning, blogging has been limited. Nonetheless, hope you enjoy the pictures from our recent excursion to Yucaipa Regional Park.

Just the girls

Ken and his girlfriend, Miso

Me and my honey

Desserts, please! Carob s'mores -- Paul's favorite!

The angelic Eli with his camera and flashlight creating some amazing special effects

Paul, keeping it simple

Reflecting on God's Word during our Sabbath morning devotion

Uncle Freddie

The family

Make-Up Fiasco

2007-03-01T10:01:00.001-08:00

Yesterday Paul and I took our engagement photos. I had made an appointment with a Korean salon in Riverside to do a trial run for my wedding hair and make-up. However, when they were through with me the result I saw in the mirror was terrifying. They had promised me a “natural” look; in fact, “earth tones” were their exact words. However, the dark shade of brown over my eyelids as well as the black smudges underneath my eyes were far from my natural look. It made me look absolutely scary. The inch-long fake eyelashes and glistening lipstick were an added effect to the whole picture. I did everything I could to keep myself from bursting into tears. The cosmetologists ooh’ed and aah’ed so much at their perfect work of art that I did not have the courage to tell them exactly what I thought. All I managed to squeak out was, “Isn’t the eyeliner a bit dark?”

They promptly responded, “Oh, although it may seem somewhat dark when you look closely at it, it’s perfect for pictures! Doesn’t it look fabulous?”

I hurriedly paid my fees and rushed out. When I arrived home I took some digital photos of my face in order to document this horrible experience I had before proceeding to erase all the evidence of the grossly overdone make-up. By the time we were supposed to meet our photographer for the photo shoot, most of the evidence had been destroyed. What a fiasco!

House Staff Officers

2007-02-08T22:00:00.000-08:00

House Staff Officer Dinner at BJ's Restauraunt

Back from Africa

2007-02-02T05:27:00.000-08:00

My trip to Zambia was so amazing! I don’t even know where to begin. I kept a daily journal during my time there, so I will post some of my journal excerpts below in this blog as I finish transcribing them into electronic format. I will also be intermittently adding some pictures from my trip. Stay tuned!

The Final Weekend

2007-01-27T23:20:00.000-08:00

After church today, we all went on a nice hike to Ruben’s (the optician's) village on the road towards Malawi. Then we headed to the Ang’s for dinner.

Todd really enjoyed the karaoke machine.

Yesterday was Todd’s 31st birthday, so we’ve managed to celebrate several times. Yesterday the Angs brought over a home-made cake.
Tomorrow we will have a joint birthday party at the Peduche’s for Todd and B-boy. It’s a weekend full of celebrations – before Todd and I have to say good-bye to Zambia. I can’t believe our time is coming to an end so quickly!

By the way, here is a photo of a hairy, scary tarantula that we found outside the Angs' house. Have I ever mentioned that I have arachnaphobia? Ewww!

Blessings in the Midst of Blackouts

2007-01-25T18:50:00.000-08:00

Another black out. Thursdays are our surgery days. We were just setting up to begin operating when the power went out again. There was not enough spare diesel to run the generator for all of our 10 scheduled cases, so we decided to wait it out. In the meantime, Mr. Limwanya entertained me with pictures from the various eye camps they had held in villages throughout the Eastern Province of Zambia. Although most of the pictures were faded or overexposed or underexposed, I could sense the joy and excitement of these once-blind patients who were granted the sight-restoring surgeries.

As we were enjoying the photos, Mr. Mwalle – the father of one of our patients (an 18 year old boy named Stephen) – came into the office to chat with Mr. Limwanya. He told us that he works closely with some non-governmental organizations abroad. He stated that he was quite impressed with the work we were doing at Mwami and wanted to assist us in finding outside donors.

The power outage being our excuse to occupy ourselves with something other than surgery, Chipo, Mr. Limwanya, and I began to brainstorm. We drafted a mission statement as well as a letter soliciting donations for our Eye Centre. We worked until 2 pm, at which point we broke for lunch, and then we finished the draft from 3:30 – 6:00 pm. I believe it was not by chance that Stephen required a lengthy stay at our hospital; I believe God intended to put us in contact with his father. Perhaps God also turned off the power so we would have the opportunity to hold this impromptu meeting. Whatever it is that God has planned for us, I am excited.

Just a side note: today I had my second hot shower during my stay in Africa! Yay! The hot water is fixed! What a luxury. =)

Kalichero Muleyi

2007-01-24T18:40:00.000-08:00

This morning I was supposed to meet Mr. Limwanya at 8 am. I waited…and waited. He is normally very prompt. However, it was 9:30 am by the time he finally arrived. Apparently, the Eye Centre landcruiser had gotten a flat tire this morning, so he had to change it out for the spare. I’m surprised that with the horrible condition of all the roads the tires in Zambia last as long as they do. Nonetheless, when we got to Chipata we stopped at the autoshop to repair the original tire and take off the spare again.

Finally we were on our way to Kalichero Muleyi. Wednesdays are always “outreach days.” We arrived at the clinic close to noon, and there were about fifty patients waiting outside for us. What a scene! After a prayer, we began to see patients. Mr. Limwanya and I split up the work so we could be more efficient – I saw close to twenty patients and he saw more than thirty. Although English is the national language in Zambia, many people in the remote villages only speak their tribal tongue. Since I did not know Nyanja, I often had to ask for translation. Nonetheless, we worked non-stop until 4 pm, at which point we broke for lunch. The clinic staff had prepared for us a delicious meal of nshima.

We headed back to Chipata with five patients whom we had scheduled for surgery tomorrow. One of the patients – a blind, older lady – felt nauseated and vomited all over herself on the ride home. Poor thing.
Anyways, Candice and Sarah -- the two girls from Walla Walla College -- are supposed to arrive tonight from Lusaka! They are both pre-med and commited to serving in Mwami for six months as student missionaries. I am looking forward to meeting them.

Wish List

2007-01-23T08:25:00.000-08:00

I have been asking Mr. Limwanya to provide me with a “wish list” of things that he would like to see happen at the Mwami Eye Centre. Some of the urgent needs include:

1. Another landcruiser vehicle: Frequent trips into the villages to bring pre-op and post-op patients to and from the hospital and crossing muddy streams and unpaved dirt roads require that they have rock solid transportation. Also, when they do “eye camps,” going into villages for 2-3 weeks at a time to do 80-100 surgeries, they need a large vehicle to take all their personnel, equipment, and other supplies. Currently have one good car which was donated by CBM (Christoffelblinden mission) about two years ago. However, that is not large enough for their purposes. They are in desperate need of another vehicle.

2. A teaching microscope and video/computer monitor for the operating microscope: For teaching purposes it is essential to be able to see what I going on during surgery or even on slit lamp exam during clinic visits. A teaching scope is an integral piece of equipment. A monitor would be a treat.

3. A slit lamp for the Chipata Adventist Clinic: Every Monday and Friday we go to “town” (Chipata) to see patients. However, we do not even have a slit lamp there!

4. Other equipment: an indirect ophthalmoscope, video camera, computer, vitrectomy unit, phacoemulsifier, auto-keratometer, A-scan, B-scan, etc.

5. Additional funding for staff training, staff salaries, expansion of facilities, additional eye camps, additional medications, and more intraocular lenses

I am convinced that God sent me here to Mwami for a reason. He closed doors for me in Lusaka, but opened wide the doors for me to come to Mwami. Even Mr. Limwanya mentioned that perhaps this is the beginning of an answer to his prayers. Although I personally do not have access to the finances necessary to fulfill these needs, I know God can provide a way to get these resources to Zambia. Somehow. Some way. I am excited about this mission field and what lies ahead. And I know that if I follow faithfully in God’s path He will show Himself to be our mighty, omnipotent Lord.

South Luangwa National Park

2007-01-21T08:35:00.000-08:00

Yesterday we had a wonderful day in the wildlife. After a full breakfast, we embarked on a self-guided safari with Chipo as our designated driver. From 8 am – 2 pm we explored the South Luangwa National Park. It was captivating to see so many animals in their natural habitat. We even witnessed an elephant defecating as it nonchalantly walked down the road.

Here are some photos of the wildlife we encountered:

from impalas...

to buffalo...

to elephants...

to giraffes...

to hippos...

to wild birds...

to lizards...

to zebras...

Halfway through our morning on Chichele Drive our landcruiser got stuck in the soft mud. We ended up taking about 45 minutes to extricate the vehicle.

More than a few times during our daytime safari my heart pumped with adrenaline – especially when we were entrapped between two sets of elephants, and also when we were surrounded by an entire herd of buffalo (>100 animals in this particular herd) which was crossing the street. It was amusing to watch them all just stare at us as we stared at them.

We returned to our lodge for a short lunch break, then we headed out again on our night safari – from 4 to 8 pm. This time we were in a real safari car, the kind with no covered roof, making us feel very vulnerable to any animals that might come our way. The safari car was especially built for these extreme outdoor situations and we were literally able to forge through roads completely covered with water. It was a bumpy ride for us in the back row, but terribly exciting and adventurous at the same time.

We spotted many more hippos grazing outside the water. We even spotted a hyena. My only regret is that we were never able to find the wildcats, neither the lions nor the leopards. But at least now I can say I have come to the heart of Africa.

The Morula Lodge

2007-01-19T22:10:00.000-08:00

Here I am sitting beneath a mosquito net in the middle of a game park here in South Luangwa, Zambia. Dr. Verna Peduche (an Ob/Gyn), her husband Gemini, her two kids Beth and “B-boy,” Chipo (our fearless driver), Todd, and I made the decision to venture forth to the game park despite the fact that we are in Rainy Season. Chipo is from the Luangwa area, so we visited his grandmother earlier today on the way to the game park.

The first half of the way from Chipata to Luangwa was smooth sailing – the dirt roads were graded so we were literally flying down the road. The second half of the trip was another story althogether. We encountered even more potholes here than in Mwami! Fortunately it had not rained all day, so the roads were not completely flooded. About 1 km from our lodge, however, we encountered a “lake” crossing our path. “No, No! NO!” counseled Todd nervously, “We can NOT go through there.” At that moment on the right side of the road there was a sign pointing down another path that read out as if in warning, “Crocodile Lake.” The road was low-lying, and the surrounding water from the Luangwa River had literally flooded over the road. About a good 10 meter stretch was completely underwater, and there was no way to know how deep the water was or how muddy the underlying dirt would be. If we got stuck, there was a possibility that we could end up as bait for the crocodiles or even the hippopotamuses (or is it “hippopotami”?) that like to congregate in these waters. Chipo bravely forged ahead in our Eye Centre Landcruiser. We almost got stuck, but by the grace of God we arrived safely at the Morula Lodge. “Only in Africa.”

At the Lodge, we were delighted to encounter about a dozen monkeys just lounging around or playfully jumping atop one another. The Luangwa River flows right beside our site, and hippos can be spotted frequently from shore. There are about 8 to 10 chalets scattered around the campus. It is a beautiful, serene spot in the middle of the heart of Africa (locals often say that Zambia is the “real Africa”). The best part about this is that we are getting a huge discount on the lodge (since we’re with a local Zambian and also because it is Rainy Season when business is really low) – it only costs about 25,000 kwacha per person per night (about $6/night). That sure beats the exorbitant prices tourist-loving luxurious lodges like the Chichele Lodge, which can cost $500 for a one night stay.
As soon as we arrived at the Morula Lodge, we immediately prepared food and sat down to a surprisingly exquisite candlelight dinner under a wooden gazebo-like outdoor dining area. Afterwards, we gathered in my room for a short evening worship. The Peduche family is staying in one chalet, and Todd, Chipo, and I are in another. Our chalet has two rooms, so I get one room all to myself since I am the only girl. What a wonderful experience this is going to be. This is the first real safari of my life, and I am excited to see some amazing wildlife tomorrow.

Operating in the Bush

2007-01-18T21:50:00.000-08:00

Today was surgery day. We ended up doing 10 cases – five cataracts, two trabeculectomies, and three pterygium removals.

Mr. Limwanya actually let me get behind the microscope and do some basic, preliminary portions of the surgeries – clamping the superior rectus muscle, making an incision in the conjunctiva, removing the pterygium. Although I was only taking baby steps behind the operating scope, it was my first time actually “operating” on the eye, and it was so awesome! Of course, the power went out twice during our day, meaning that we had to sit and wait for the generator to kick in. Nonetheless, we were able to finish our surgeries successfully.

On surgery days, nshima is served. It is quite a tasty dish, made from ground maize or cassava. It is a true Zambian staple. In fact, the local people say that if they have not eaten nshima, they have not yet eaten. Reminds me of how Koreans need their rice. I had nshima today for the first time in my life; it was served with a green vegetable called rape. Mmmm….

Clinic in the Bush

2007-01-17T23:00:00.000-08:00

Chanjowe is a very rural town fifty kilometers east of Mwami. It’s in the bush. Every Wednesday, Mr. Limwanya and the Eye Team goes on "outreach" to the rural villages, and the Chanjowe Health Post happened to be our destination today. We were quite busy, as we saw 56 patients from 10 am – 2:30 pm. From presbyopia to allergic conjunctivitis to senile mature catracts to post-operative follow-ups to corneal ulcers to optic neuropathy to retinal detachment to glaucoma – all examined and diagnosed with the naked eye, a flashlight, and an ophthalmoscope.

The toilet was an interesting experience – I had never before gone in a triangular hole surrounded by elevated foot markings.

When we returned to the Mwami Eye Centre, more patients were waiting for us. We have eight surgeries planned for tomorrow – four from today’s excursion and four from prior clinic appointments.

The Angs had us over for dinner again. Once again the power lines were malfunctioning – but only halfway this time – we were running on dim lights at 110 volts. Very strange. As we always say…”Only in Africa.”

Congenital Cataracts

2007-01-16T21:00:00.000-08:00

Another day has passed. The morning began with a six year-old girl with congenital cataracts on whom we performed bilateral cataract extractions. She required general anesthesia, so we took her to the main hospital OR for the surgery. She did surprisingly well. (Addendum: a few days later, she was running around playing with her friends – happy about her newfound vision but unable to comprehend the true magnitude and life-long impact of that sight-saving operation).

The baby that was delivered this morning breathed her last few breaths tonight. When we checked up on her at the end of the day, she was still in respiratory distress, bradycardic (heart rate in the sixties), and very limp. May God be with her mother and grandmother who will be grieving the death of this newborn baby.

It is hard to believe I’ve been in Africa only one week; for some reason it feels like I’ve been here much longer. And while a part of me wishes I could stay longer to serve in Zambia and get to know these people, another part of me is counting down the days until I can return to my family, my fiancé, a warm shower, my own bed, and even my hospital (despite its flaws, it is a wonderful hospital with modern equipment, accessible resources, a relatively efficient system, and new facilities – all worth millions of dollars that most third-world countries would not even dream of).

Each day that I am here I realize that there is still so much for me to learn before I return to Africa as a missionary. Firstly, I need to learn ophthalmology – not just ophthalmology as practiced in the U.S., but also “bush ophthalmology,” including extracapsular cataract extractions, examination and treatment of eye conditions in HIV/AIDS patients, etc. Perhaps I can also learn to do corneal transplants. I do not know if there is even a single corneal specialist in entire country of Zambia, which has a population of about 12 million people and of which only 12 are ophthalmologists.

Next, I need to learn how to bake bread. “Shoprite” is a supermarket where one can find food/supplies easily, but what it is really known for is its tasty bread. One loaf of bread costs about 1700 kwacha, equivalent to about $0.40, depending on the exchange rate for the day (it was approximately 4200 kwacha per dollar when I left Zambia). Interestingly, however, the people always cue for bread as they wait for it to be made in the oven. Instead of a straight line, however, there is consistently a large mob of people crowding around the bakery counter frantically grabbing loaves as they are distributed. It is an interesting sight. If I could learn how to bake bread, however, there would be no need to participate in the madness of waiting for Shoprite bread.

Other things that I have to learn before I return to Africa include: how to cut hair, how to grow my own fruits and vegetables, how to cook tasty meals with limited ingredients (maize, cassava, flour, potatoes, onions, and garlic), how to drive stick-shift, and how to speak Nyanja (the tribal language commonly spoken in the Eastern Province of Zambia).

Here’s a quick lesson in Nyanja:
Muli bwanji = How are you? (Morning greeting)
Machoma bwanji = How have you been? (Afternoon greeting)
Zikomo = Thank you.
Penya cu mwamba = Look up.
Penya panzi = Look down.
Penya cu manja = Look to the right.
Penya cu mazere = Look to the left.
Tika dye = Let's go eat.

Déjà Vu

2007-01-16T05:00:00.000-08:00

Déjà vu. That is what I experienced today. Another newborn baby desperately needed resuscitation. At three am I was rudely awakened from a deep slumber by a knocking sound on my window and what seemed like a man’s voice. Half asleep and alarmed by the strange noise, I timidly called out, “Yes?” This last week for three nights in a row there had been houses in our immediate vicinity that were known to have gotten robbed, so Todd and I were especially paranoid about having an unwanted visitor. “Yes?” I said again, this time a little more loudly. No one responded to my call, so I simply laid my head back down on my pillow, wondering if I had dreamt up the entire scene. However, five minutes later, I heard a distinct, urgent knocking on my window and voice saying, “Doctor, a c-section! The patient is waiting!” I then realized that Dr. Ang was on call and that the watchman had come to awaken us to join him for en emergency c-section. By that time, Todd had awakened to see what was going on. He and I quickly got dressed and walked over to the hospital. The night was dark, but the clouds had cleared, so the stars were unbelievably bright and beautiful.

Todd scrubbed in with Dr. Ang, and I posted myself by the “crib” (a metal tray on wheels covered with a thin sheet) as I reminisced back on my days on Newborn Nursery calls during my Pediatrics rotation. The mother was dark-skinned, petite, and very tired. The c-section was called for PROM (premature rupture of membrane), polyhydramnios (too much amniotic fluid), and fetal distress. When the baby was removed from the mother’s womb, it was limp and blue. Flashbacks of my experience with difficult babies on Pediatrics came rushing back. We bulb suctioned and deleed the baby and gave her oxygen by nasal cannula, but the baby remained limp, did not cry, did not even breathe. I felt for her pulse her umbilical cord, and it was less than sixty. We started to administer positive pressure oxygen, and I began two-finger chest compressions on her. Apgars at 1 and 5 minutes were a pathetic 1 and 1. After extensive resuscitation and some dextrose into the umbilical vein, the baby began to take a few, feeble, faltering breaths. Nonetheless, it was not enough. The anesthetist intubated the baby, and we continued to bag her. By about 30 minutes, she was finally able to sustain her heart rate greater than 100, breathe spontaneously, and her color had improved slightly. I had never prayed so hard for a baby before, and God seemed to answer our prayers as we desperately fought for life. Thank God for his deliverance!

Yesterday, I went to the Chipata Adventist Clinica again with the Eye Team. It was pouring rain (it had rained for twelve hours straight through the night), and we suspected the clinic would be slow. Nonetheless, we had a great turnout with many interesting cases – several severe corneal ulcers, a bad case of herpes zoster ophthalmicus, uveitis, glaucoma, diabetic retinopathy, foreign body, a few manual refractions, etc. I had never before seen such a severe case of herpes zoster ophthalmicus (the re-emerging chicken pox virus that affects the V1 branch of Cranial Nerve V on one side, often affecting the ipsilateral eye) – it covered her entire left forehead and eyelid area with contagious blisters, and it had only begun 5 days ago. Many of these severe cases can occur with immunocompromised states, so we encouraged her to get testing.

Herpes zoster ophthalmicus:

Corneal ulcer:

One mother came in with complaints that her one year-old son had been tearing for the last few days, right eye greater than left. We assumed it could be allergic conjunctivitis. We projected that it would be difficult to invert his lids, but we attempted it anyway. Lo and behold, a 2 mm black foreign body was embedded in his upper eyelid. We successfully removed it and at the same time learned an important lesson: ALWAYS invert the eyelids if you suspect anything fishy might be going on.

Indian Zambians

2007-01-14T20:45:00.000-08:00

Today I met Moosa. His mother is African. His father is Indian. They never married, and Moosa was raised solly by his mother for the first twenty-six years of his life. Then, his mother suddenly passed away while Moosa was in Lusaka studying at the university there. It was at that time two years ago that Moosa finally sought out his father, who lives in Chipata. His father is a medical doctor by training, who turned to business when his own father, a businessman (as most Indian Zambians are), passed away and needed someone to take over the lucrative family business. Now, Moosa’s father has moved on to the farming industry – to be precise, the tobacco farming industry. Moosa’s father eventually married two women – the first is of Indian heritage, the second is African. They are both legally married to Moosa’s father. Their two families do not ever interact; in fact, they live in separate houses on opposite sides of Chipata. Moosa was at the Katuta lodge, a sort of park or resort area on the outskirts of Chipata, with his three half-brothers, the sons of his father’s second (African) wife.

Polygamy is still prevalent in Zambia. In the Eastern Province where I was staying, those men who choose to live polygamous lives will have only two or perhaps three wives. In the Southern Province, however, the Tongan tribe is known for the great number of wives the men often have – six, eight, even ten women – depending on your wealth and status.

Moosa told me of his life adventures – he studied Arabic in Libya and completed a two-year diploma there. Originally, he had wanted to study science and become a physician or an engineer, but the scholarship funding promised him did not arrive on time and he was essentially forced to withdraw from the university. He plans to study public administration in Uganda so he can return to Zambia to help his people. It was refreshing to meet Moosa, a 29 year-old Zambian who has experienced many life struggles yet who is ambitiously aspiring to better himself and his people.

After spending the entire day at the Katuta Lodge, Todd and I accompanied Dr. Ang while he made some house calls. Both families we visited were Indian patients of Dr. Ang’s. Initially, it was surprising for me to see how many Indians have settled in Zambia, but now I have realized that this is the reality in Zambia. Since the late 1800s and early 1900s the Indians colonized the area and set up business. Today, it is the Indian population that owns almost every business on the streets of Chipata. Hence, they are quite well-to-do. I found that these Indians were also very kind, hospitable, and generous.

By the end of the day, Todd and I were tired. Nonetheless, we still had to make the 30 km trip from town to Mwami. Today, the trip took more than an hour because of the heavy rains from the day, which had eroded the dirt road and created an even bumpier ride back to Mwami. I really would like to speak with the Chief about paving the roads around Mwami – this is ridiculous!

Here are pictures from the beautiful Katuta Lodge:

Chipata Adventist Clinic

2007-01-12T19:35:00.000-08:00

Another exhausting day! But finally the Sabbath is here. This morning was Day #4 to endure a cold shower. It is actually not too bad. Although it is currently the “Rainy Season” the weather is always between 60 – 80 degrees Fahrenheit. A cold shower anywhere else in the world would be absolute torture, but here in Zambia it is quite refreshing. Every Friday and Monday mornings, the entire staff at Mwami Adventist Hospital meets together for morning worship. After some beautiful a capella singing (Africans can really sing with soul), a short message was given by the hospital chaplain.

At about 8:30 am, Mr. Limwanya and a van full of people headed off to the Adventist Clinic in Chipata, about 30 kilometres away from Mwami. A heavy rain had fallen last night so the roads were in incredibly horrible condition. As I rocked back and forth in my seat up front on the left (Zambia was colonized by the British until October 24, 1964, so according to the British way Zambians also drive on the left side of the road and have their drivers’ seat on the right), I was reminded of the rocky ride called Indiana Jones at Disneyland.

When we arrived at the clinic, we proceeded to say patients. There was no slit lamp available, so diagnoses were arrived at by using a flashlight and direct ophthalmoscopy. Mr. Limwanya said he had no access to an indirect ophthalmoscope, but the budget allowed recent approval for one to be purchased next year. Refractions were all performed using a case of trial spectacles and lenses. Intraocular pressures were obtained using a Schioetz tonometer.

I also spent some time with Ruben, the optician, who actually made the glasses while patients waited. Using a large standard lens, Ruben took pre-made frames chosen by the patient and traced the shape of the frame onto the standard lens. He then chipped away portions of the lens with a crude metal mini wrench-like apparatus. Then, using a spinning wheel, he proceeded to grin the perimeter of the lens until it was smooth. Finally, comparing the lens to the shape of the selected frames, he proceeded to match the two perfectly. I was perfectly amazed at his skill and at the relative simplicity of making spectacles in less than one hour.

After clinic – which was only a half-day clinic due to the upcoming Sabbath – we ran errands (went grocery shopping, checked email, etc.). When I got back to Mwami, it was already time for vespers. After vespers, I ate dinner and I’m now finally winding down. What a day!

"Bush Opthalmology"

2007-01-11T21:10:00.000-08:00

Today I was welcomed into the world of bush medicine – and more specifically bush ophthalmology. In a small town called Mwami where surrounding villagers are very poor, there exists a fully functioning mission hospital called Mwami Adventist Hospital. This morning, Dr. Ang gave us a tour of the facility.

The pediatric ward, the largest ward of the hospital, was filled primarily with PMC (protein malnutrition) cases. As we walked into the unit, the charge nurse there cheerfully greeted us. “How is everything?” inquired Dr. Ang. “Oh, everything’s fine,” he replied. Almost as an afterthought, he added, “Besides the fact that two children died last night of PMC, everything is fine.” We entered a room where six malnutritioned children sat, accompanied by their concerned mothers. Signs of kwashiokor included a distended abdomen, edematous extremities, desquamating skin, anemia, and lethargy. Several of the children looked quite sickly. “This one looks infected,” commented Dr. Ang. The “infection” was in reference to the all-too-prevalent HIV/AIDS epidemic so rampant in sub-Saharan Africa, particularly in Zambia.

Statistics show that one in every four Zambians (especially women) in urban settings is infected – and 16% nationwide. This figure is likely grossly underestimated due to the taboo nature of the disease, denial, refusal to undergo testing, etc. Having heard these statistics in the comfort of the United States is so different from encountering the actual individuals here who are suffering the consequences of this deadly disease. One of the contributing factors to the spread of AIDS is the promiscuity and prevalence of prostitution in the cities. Driving around Lusaka at night, I remember we would hear cat calls from almost every street corner – from street walkers dressed up in hip-hugging outfits. Edward Martin – a tall, African-American bachelor – told me, “It’s difficult to be a single male out here. Sometimes I have to be very direct with the women who approach me. I definitely need a wife.” He mentioned that many Africans believe the myth that if an HIV-infected individual were to have sex with a virgin, he would automatically or miraculously be cured from his disease. Hence, there are an increasing number of rapes that have occurred at local elementary schools, sometimes by HIV-infected male school teachers. This news definitely saddens me.

Continuing on with my tour of the hospital, the other pediatric beds were filled with malaria patients, orthopedic fractures, etc. One boy had been in a coma for two days, but regained consciousness by the time with sam him this morning. His malaria smear was positive (2+), and he had presented to the hospital with seizures. Todd commented, “In the U.S. that boy would have been in the PICU – intubated and monitored closely. This is wild.” I agreed; this indeed was wild.

We continued to tour the male and female ward, the Ob/gyn ward, the HIV/AIDS clinic. Afterwards, Dr. Ang took us to the Eye Care Centre, about a ten minute walk away from the main hospital. Spending the day with Mr. Limwanya, the cataract surgeon, was a fantastic, eye-opening experience (no pun intended)!

There are two main buildings to the Eye Hospital – the first houses the reception area, a diagnostic room, a female ward, and a male ward; the second holds the operating theatre and the accountant’s office. There were about ten patients lined up, awaiting surgeries. Mr. Limwanya had brought these patients from a village 50 kilometres away. This morning’s line-up in pre-op clinic included: a presumed squamous cell carcinoma of the conjunctiva, several senile mature cataracts, a painful blind eye (s/p trauma two years prior), two glaucoma patients needing trabeculectomies, one pseudoexfolation syndrome case, a pterygium, and a six-year old female with congenital cataracts. After assessing their vision and examining them with the slit lamp we prepared to go into the operating theatre.

In the OR, Mr Limwanya and his assistant proceeded to set up everything – they assembled the operating microscope onto an old rickety operating table. The sterile linens and instruments were laid out methodically. A purple-tinted alcohol solution was poured out into the stainless steel basins.

Two autoclaving machines were conveniently situated near the entrance of the OR – both of which were used repeatedly to sterilize instruments immediately after each case so they could be used for subsequent patients.
The resources were indeed limited. The venue was primitive. There was no phacoemulsifier. There was no bovie for cautery. Instead, we used “fire” – a small bottle of fuel with a wick, lit with a match – to heat up a small metal tool, which was lightly touched to the bleeding vessels in the conjunctiva. Irrigation and aspiration was done manually with a bottle of normal saline hung from a metal stand with the tubing attached to a special cannula and syringe. The capsulorrhexis was performed with the “can opener” method. The lens was dislodged by hydrodissection and manually removed. Although in a primitive setting, the sight-saving surgeries were performed successfully and in a timely fashion. It was quite incredible.

Zambia, You-Tubed!

2007-01-11T08:00:00.000-08:00

Here are some video clips from Zambia:

1. African Lawnmowers. In Zambia, the ground is too uneven to use a lawnmower. And the grass grows too high too fast, especially during the rainy season. Thus, the Zambians are forced to "slash." Here is an example of a local Zambian slashing away at the grass.

2. Bumpy Dirt Road. The road conditions around Mwami are horrible. I really don’t know how patients even manage to make their way to the Mwami Adventist Hospital. Here is a clip of me on my way back to Mwami from Chipata. It did not rain too heavily this day, so the road isn’t too bad. After heavy rains, however, it gets pretty crazy.

3. Zambians Love to Sing. Here is a special song performed at one of our morning worship sessions. The Zambians are able to harmonize beautifully – they really have a gift.

Safe In Lusaka

2007-01-08T23:45:00.000-08:00

After a two days’ journey to the continent of Africa, I find myself in the city of Lusaka. I still cannot believe I’m halfway across the world. On the flight over here, I met some interesting individuals. On the first leg of the flight from LAX to Washington, D.C., I sat beside an intriguing graphic designer named Derek, who does art for Adidas Kids T-shirts and Wrangler jeans. Derek also has his own T-shirt label – “Manifest.” The second leg of my flight was a 14 hour trip from D.C. to Johannesburg, South Africa. During that flight I met a man named David Woods who claimed to be going to Maputo, Mozambique on a mission trip to build 1000 churches. “I’m with Marantha Workers. We’re going to build Seventh-day Adventist churches.” I replied, “I’m Seventh-day Adventist, too.” What a small world! The last leg of my journey was a flight from Johannesburg to Lusaka, Zambia. I sat beside an older, retired lady from Indiana. She was a teacher by profession and was going to a small town for three months to teach 11th/12th grade Biology/Chemistry at a Wesleyan mission high school.

Finally, we landed in Lusaka. As I was getting my visa at the Immigration Office, I noted a tall, Caucasian male who was getting his visa at the window next to me was headed to Chipata, Zambia. It turns out Todd Templeman, and ER/IM 5th year resident at University of Illinois, Chicago, was going to be spending time with Dr. Ang at Mwami Adventist Hospital, too! Edward Martin, executive director of Adventist Health International’s Zambia projects, picked both of us up from the airport and took us to our respective lodging – Todd to the Holiday Inn and myself to the Lusaka Eye Hospital. I am thrilled to be here, and I can’t wait to see what God has in store for me.

I Love Snow

2006-12-28T18:09:00.000-08:00

Ahhh...what a luxury to get away from the hospital for a day and spend a few hours breathing in the crisp air at Big Bear. Here's evidence of my co-intern, Sonia, ditching work for a day on her Anesthesia rotation to come snowboarding with me!

Quick Plug for Vegetarianism

2006-12-26T08:16:00.000-08:00

Check out this article:
http://news.yahoo.com/s/hsn/20061215/hl_hsn/kidswithhighiqsgrowuptobevegetarians

In the Emergency Department

2006-12-24T17:41:00.000-08:00

Working in the Emergency Department of a county hospital, I have had my share of varied and interesting experiences. Some of the situations I see are amusing, but most of my cases are quite sad and heartbreaking. I have been working the night shift for the last few days, and without fail the middle of the night is often the time when the most bizarre cases present to the ED. Here are some cases from last night:

One gentleman came in after getting a huge mag-lite flashlight stuck in his rectum.

The X-ray of the pelvis was quite remarkable.

He was taken to the Operating Room for removal by the surgery team.

Photos courtesy of Dr. Lanny Hsu. Cell phone cameras often come in quite handy.

A middle-aged lady with history of multiple sclerosis was brought in by ambulance for vomiting. Her entire body reeked of a foul stench, and she was found covered in her own stool as her diaper had not been changed in quite some time. She also had a foley catheter in place, which was incredibly dirty and filled with purple urine. The paramedics relayed that her house was in the same filthy condition.

There is actually a syndrome called “Purple Urine Bag Syndrome.” It is a rare syndrome associated with alkaline urine and some urinary tract infections, and it is more frequently observed in chronically catheterized and constipated women. You can read more about this here.

A middle-aged obese man came altered after overusing street drugs and began to have respiratory distress in the ED. The respiratory therapists began to bag the patient. As he was unable to maintain his airway, the decision was made to intubate him. My senior residents perceived that I was looking on with eager eyes, and he invited me to participate in the intubation. I happily jumped at the opportunity. After an initial failed attempt to open the mouth and sweep the enormous tongue, I realized he was going to need some sedation and paralysis. We halted the intubation attempt for a few seconds while he was given 20 mg of etomidate and 100 mg of succinylcholine. After that, his mouth was much easier to open, but his tongue kept interfering with my view of his vocal cords. His short, stout neck did not help matters. My senior was forced to intervene and after a few futile attempts he finally asked for a gum elastic bougie.

He advanced the bougie through the trachea, then threaded the tracheal tube over the bougie. Good breath sounds were appreciated and the CO2 monitor turned from purple to yellow, indicating that the intubation was successful. He later told me that was the most difficult intubation he had ever done, and that I should not feel disappointed that I could not get it. I was grateful that he was considerate enough to let me try.

The University of Virginia has a quick review on how to intubate.

A 45 year-old male with no significant past medical history came in with a two-day history of blurry vision and generalized weakness, polyuria, and polydypsia. His blood sugar was found to be 577. He denied ever being diagnosed with diabetes or having any family history of diabetes. He did admit to using methamphetamine and drinking 5 or 6 cans of soda per day. His anion gap was only 10, so he was not in diabetic ketoacidosis. We simply treated him with subcutaneous insulin and sent him home on oral diabetic medications with a follow-up appointment with a family practice physician. I made it a point to come by before his discharge to encourage him to stop “shooting up” and to educate him about dietary reforms that he could make to prevent complications of diabetes later on. He admitted that one of his New Year’s resolutions was to stop using speed and to get a job. I told him that with God all things are possible and that it was within His power to help him with his terrible addiction. His eyes were bright, and I could see that hope rested in his heart.

Through my limited experience in dealing with patients over the last few years in my medical training, I have realized the gravity of our condition – the hold that sin has on our lives and on our health. The laws of temperance with regard to our appetite and base passions have been shamelessly broken. During this holiday season and as we approach a New Year, may we resolve to surrender our lives daily to Christ and claim freedom from the bondage of sin that he so freely promises. May we resolve to live healthy and pure lives. May we resolve to recommit our minds to the study of His Word and His will for our lives. May we resolve to fight sickness and poverty not simply for the sake of fighting sickness and poverty but for the spiritual transformation that accompanies the battle. Amen.

Footprints

2006-12-08T10:46:00.000-08:00

What an encouragement to know our Lord is always with us.
For more, visit Dong Haeng.

A Bayside Experience

2006-12-05T07:45:00.000-08:00

Highlights from my weekend in Northern California:

Visiting my brother, James, and seeing his new pad in Santa Rosa.

Bumping into Cherie Leng at Sacramento Central SDA Church.

Playing music with Eric, James, and Cherie – all proficient musicians - after having a nice Sabbath lunch at Rachel and Eric Nelson’s place.

Visiting my cousins, Grace and Eddie, and their four beautiful children.

Playing with Rachel and Lizzy, the two youngest and most flexible children.

Going to San Ramon to visit my friend, Nyein, whose sister, Ayemi, was also visiting her this weekend.

Attending a church called GRX (Great Exchange Covenant Church) with Nyein.

Going to the 37th Annual Bay Area Fungus Fair at the Oakland Museum of California.

Zambia, Here I Come!

2006-11-30T17:52:00.000-08:00

It’s true! It’s true! I finally heard from Dr. Ang! Today, I received word from the missionary doctor and medical director at Mwami Adventist Hospital out in Zambia, Africa, stating that I am welcome to come to Zambia for a mission elective in January. Dr. Ronilo Ang is an anesthesiologist/surgeon, and he has been a missionary in Zambia for 12 years! He also happens to be the uncle of Liz, a friend of mine who is a nurse at the hospital where I work.

Quiz Question #1: Where is Zambia?
Answer: In South Central Africa.

I am elated. I have been trying for a few months now to get the signatures of approval from an attending physician in Africa so that I can move on with the process of getting approval from my own institution. Things had not been working my way, especially in these last three weeks, as I had been repeatedly attempting to go to the Lusaka Eye Hospital site in the capital city. All my plans were thwarted, however, and I was fast approaching the deadline in which my paperwork needed to be submitted. I began to pray for God’s will to be done. Then, I heard word from Dr. Ang, who immediately responded positively to my inquiry about rotating with him during my elective month in January. After several days of correspondence, I realized that this may be God’s will for me instead. Hopefully, my hospital will give me approval to embark on this four-week adventure to Mwami. Nonetheless, I am going to start working on getting my malaria prophylaxis, immunizations, plane tickets, and visa. I have a lot of work to do! But praise God,…I think I’m on my way! =)

Quiz Question #2: Where is Mwami?
Answer: Close to Chipata.

By the way, I have officially begun my long-awaited week of vacation. This weekend I will spend some time in Northern California to visit my brother, James, and my friend, Nyein. The rest of the week will be dedicated to wedding planning. Wish me luck!

My Night on Pediatrics

2006-11-26T04:07:00.000-08:00

My heart is still pumping. It’s about 4 in the morning, and I just finished in helping resuscitate a baby.

I had fallen asleep in the call room at around 2 am after examining six newborns that were born back to back through the night. At about 3 am, I was rudely interrupted by my “baby pager” obnoxiously beeping away. The voice on the other end screamed into my pager, “Please come to Room 14 for prolonged decels. Room 14 for prolonged decels.” I crawled out of bed and rushed to the room. No supplies were set up, so the NICU nurse, Respiratory Therapist (RT), and I quickly assembled the equipment.

Newborn resuscitation bags/face mask/oxygen tubing – check
Delee/connection tubing for suction – check
Bulb suction – check
Scissors – check
Endotracheal tubes/stylets x2 – check
Laryngoscope handle and blade – check
Meconium aspirator – check

As we were working on the neonatal supplies, the Ob/Gyn resident was attempting to deliver the baby. The laboring mother was a 40 year old Hispanic G4P3 (interpretation for all you non-medical people: Gravida 4 = has had a total of four pregnancies, irregardless of whether they were carried to term; Para 3 = has had 3 viable births) whose last baby was born about 11 years earlier. All of a sudden, the baby’s head was seen to be out of the birth canal, but it was stuck! A nuchal cord was present (umbilical cord wrapped around the neck), which was essentially choking the newborn and preventing the body from coming out. Everyone seemed to go into a panic. The Ob/Gyn resident began shouting at the mother, “Push! Push! Empuja!” Two delivery nurses jumped onto chairs and began pushing down on the mother’s uterus. The resident was pulling on the baby's head with all her might. The laboring mother’s husband and sister were frantically encouraging her to push. I watched helplessly in the background and silently offered up a prayer to heaven for the mother and baby, that all would go well.

After what seemed like an eternity, the baby was extracted! It was a girl! The Ob/Gyn resident quickly clamped the cord and brought the baby to the infant warmer where I was standing. I had never seen such a miserable looking baby. She laid completely apneic, blue from her head to her toes, as floppy as could be. The RT tried to intubate the baby. The nurse tried to stimulate the baby. I listened for her heart rate. Greater than 100! Those were the only 2 points she earned on her 1 minute Apgars. The intubation attempt failed the first time, so we decided to simply bag the baby. We vigorously cleaned off the baby with warm blankets, trying to stimulate her to cry, and suctioned out her nose and mouth. In the middle of our resuscitation efforts, the aunt cried out, “Is she okay? Why isn’t she crying?”

“We’re working on it,” was all I could say.

After what seemed like another eternity (perhaps about 30 seconds after we started the oxygen), the baby finally began to cry. I realized that everyone in the room must have been holding their breaths, because at that moment I heard the strange sound of a collective exhalation.

We delee’d the baby (suctioned out her mouth/stomach), percussed her back, and continued to bulb suction her mouth and nose. Fortunately the baby did well after that, receiving a final Apgar score of 9 (out of 10). Her color was now a pinkish hue, her tone was good, and her cry/respirations were vigorous. As I left the room, I breathed a prayer of thanks to our Lord for saving the life of yet another baby. It was a close call. My heart is still pumping.

My Little Chapel

2006-11-24T19:33:00.000-08:00

Four nights ago one of my fellow residents, Pat, introduced me to a special spot that has now become my favorite place in the entire hospital – the chapel. Although I am at a county hospital not affiliated with any religious group, there is a chapel available for anyone who wishes to pray and meditate. It is a cozy rectangular room near the main entrance of the hospital. It is simply furnished with six or eight short pews, a small podium at the front, a table filled with artificial flowers, a Book of Prayers (a journal available to anyone who wishes to write down their thoughts and prayers regarding life and their loved one in the hospital), and a beautiful stained glass window depicting Jesus with a flock of sheep. However, to me the most coveted object inside this chapel is a small organ that sits in the corner.

When Pat led me to the chapel and I spied the organ, I thought to myself, “Does it still work? Is it locked up?” To my amazement, I discovered that it was a fully functioning instrument! There were a few hymnals lying around, so I proceeded to play hymn after hymn. As it was the middle of the night, however, (I have been on Pediatric Night Float this entire week of Thanksgiving) I made sure that the volume was turned low. Nonetheless, it was wonderful! For some reason, that night during those few hours I was in the chapel all the babies refrained from being born into this world so that I could have a short period of respite.

Each subsequent night this week, I have had the opportunity to sneak down to the chapel alone to pray and play the organ and sing hymns. It has been a wonderful reprieve from the duties of work and residency. I am delighted to have discovered this haven, and I look forward to many more visits in the future.

The Memorial Service

2006-11-15T22:14:00.000-08:00

Mr. Won Koo Lee, My Late Uncle

Today we held a memorial service for my Uncle at our church. Perhaps some of you have never attended a Korean funeral. I have attended many weddings in my short lifetime, but I have not frequented many funeral services. Floral arrangements such as the ones pictured below seem to be a big part of the Korean tradition after the death of a loved one. The service itself was well thought out and meaningful. It was also a nice time to reunite with other family members and friends. The highlight of the evening was to see my estranged cousin and uncle, whom I have not seen in close to 15 or 20 years.

Some of my extended family

Translation: Uncle, may you rest in peace until Christ's second coming. From James "Hyun-Uk" and Janie "Hea-Ryung" Lee.

More flowers. . .

And even more flowers. . .

Tribute to My Uncle

2006-11-12T11:55:00.000-08:00

Three hours ago, my uncle breathed his last breath of life. He was the eldest brother of my father. He has been gravely ill for the last few months – frequenting the hospital wards and the intensive care unit, going through the discomfort of intubation and extubation, suffering multiple paracenteses for his ascites, even going through a period of hepatic encephalopathy when his ammonia level was through the roof.

But now he is finally at rest. He is in a state that the Bible repeatedly refers to as “sleep” (Acts 13:36; Acts 7:59-60; John 11:11-14; 2 Kings 14:29; Job 14:10-15; Daniel 12:2), awaiting the soon return of Jesus Christ. Apparently, the nurses called my niece, Joanne, at seven o’clock this morning to let her know that her grandfather was not doing well. She and her family rushed over to the hospital, and it was about that time that he was pronounced dead.

As soon as my family was notified, we drove out to the hospital as well. My brother is back in town for a wedding this weekend (he recently transplanted to Santa Rosa, California, for a new job), so he was able to join us. Fortunately, today was my day off from work so I was able to go as well. However, my father could not come, as he has recently been afflicted with a bad case of the shingles and has been bedridden secondary to severe pain.

Upon arrival at the hospital, I found my uncle lying motionless in bed, wearing a light hospital gown and covered up to his neck with a simple hospital sheet. His mouth was partially open, and his eyes were closed. His skin was pale, and smattered with purpura due to his coagulopathic state. He was cold to touch. I checked for a pulse, but I could not palpate one. I resisted the urge to reach for a stethoscope or check for a corneal reflex or perform a cold calorics test. I took in a deep breath and simply accepted the fact that he was indeed dead.

I embraced my niece and hugged my other cousins and aunts and uncles as they trickled into the room. Pretty soon, our church pastor and a few church elders entered. They performed a simple but meaningful worship service, dedicating my uncle to the Lord and praying for him and his family. Despite the mourning there was a deep sense of community and unity. Without exchanging many words we all understood one another’s grief and yearned to comfort one another.

The strange thing about dealing with death of a loved one is that suddenly we come face to face with our own mortality. When life is smooth, when finances are stable, when wars are only in faraway lands like Iraq or Sudan, we forget about our own finiteness. Our own mortality. We get swept away in the pace of life and forget to reflect on the things of true import.

Life is a gift. It is a time allotted to each individual. For some it may last 76 years. For others the gift may last only 26. Some may choose to squander the life given to them – taking part in activities that only hurt them and others around them. Others choose to live a life of dignity, integrity, and purity – taking part in activities that only uplift themselves and others around them. May we celebrate life while we still have the breath to celebrate. May we appreciate one another while they are still alive. May we learn to love and be loved. May we comfort those who are in despair. And most importantly, may we live lives that are pleasing in the sight of God, that peace and joy may abound.

I look forward to that day when “God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away.” Revelation 21:4. I look forward to the day when I shall see my uncle in heaven. Please say a silent prayer for my uncle and his immediate family, that they may take heart and be comforted by the Holy Spirit.

The Case of the Internal Jugular Line

2006-10-29T20:51:00.000-08:00

Last week, I received a page. It was not an ordinary page – not like the other million and one pages that I normally receive from nurses asking for Tylenol or from my students giving me an update on their patients. The extension that appeared on the tiny LCD screen of my Motorola pager indicated that somebody was paging me from the sixth floor, where all the offices of the administrators and attending physicians are housed. My heart skipped a beat. I braced myself and dialed the extension.

“This is Dr. Lee, I was paged,” was my automatic greeting. I immediately recognized the voice of one of my attendings from General Surgery. At that moment, a myriad thoughts flashed quickly through my mind: “I’m on Pediatrics now . . . Why is he calling me? Did I do something wrong? Am I in trouble? Did I violate my work hours by going over eighty hours per week? What could he possibly want?”

He began the conversation by firing a series of questions at me. With his characteristic southern drawl, he asked, “First, I just wanna ask you, were you on call for Trauma on September 29?”

I replied, “If my name was on the schedule for that day, then, yes, I was on call for Trauma on September 29.”

Without skipping a beat he asked, “Then, the next thing I wanna ask you is, do you remember if there was anything special or different about that day? I ask because there was a particular progress note with only my signature on it by the student’s note, but there was no intern or senior resident signature. Do you remember if on that particular day the senior resident was not present or if I happened to round with just the students or if there was anything else unusual about that day?”

I answered, “I honestly do not remember if there was anything unusual. I do know that a resident does not always sign the progress notes, but that does not necessarily mean that we were not present.”

He then asked, “And the next thing I wanna ask you is, do you remember a lady with an arm amputation and a C2 fracture?”

I replied, “There were actually several arm amputations that I took care of on Trauma Surgery that month, so can’t for sure say that I remember that lady in particular.”

My attending proceeded to tell me, “Well, the problem is that that patient died. And she was apparently discharged with a central line still in her neck. And she was also discharged after being on IV morphine here in the hospital without being switched over to oral medications. ” He continued, “Do residents on the SICU generally let you know when they are downgrading a patient to the floor if there is a central line in place in that patient?”

I answered, “No, they don’t.”

“Or are you aware of a policy somewhere stating that that piece of information should be relayed?”

“No, sir, I am not aware of such a policy.”

“And aren’t patients usually converted over from IV morphine to oral pain medications to see if they can tolerate it before they are discharged home?

“Yes, they are.”

The attending continued, “I am not in any way trying to say that you are at fault or did anything wrong in this case. I am simply trying to get a better understanding of what happened on that day. If you think of anything or have any more information after you take a look at the chart, call extension 01055. Anything you think of might be helpful in this situation.”

I replied, “Thank you for informing me of this situation. I will try to review my personal records as well as the chart to see if I can think of anything.”

“Thank you, Dr. Lee. Bye.”

Thoroughly confused and somewhat taken aback, I hung up the phone. A few days later, as I reviewed the chart and spoke with the administrative assistant who was investigating the case, I realized what had happened. The patient had been recently downgraded from the SICU to the Trauma service a few days before her discharge, and she still had an IJ line (central line in the internal jugular vein) in place under her C-collar (neck brace) at the time. My co-intern was assigned to this patient, but on that Friday, September 29, a new intern came on service and inherited the patient that day. She was discharged with her IJ line still in place. Later that evening at a motel, her husband noticed that she had something dangling from her neck, and so he brought her back to the hospital. At that time, it seems that they asked for some oral medications, and someone apparently prescribed her MS Contin in a dose that was three times what she had been taking at home for chronic pain. The mystery lies in who prescribed the MS Contin; the handwriting is clearly different from that on the discharge paperwork, and there is no documentation anywhere in the chart of anyone having given it to the patient. My question: could the night float intern have prescribed that when the couple returned to the hospital for the IJ removal? Only time will tell.

Anyways, after her discharge (I do not know how long afterwards), the patient subsequently went into respiratory failure. At first it was feared that it may have been a complication of having been given too large a dose of narcotics. Although the cause of death remains unknown, administrative secretary stated that the respiratory distress clinically fit the picture of a pulmonary embolism. The patient was taken to a nearby hospital, where she eventually died. And now the disgruntled husband is planning to sue.

What a disaster. Every surgeon's nightmare. I am just thankful that I was not the one who wrote those discharge orders (or any orders on the patient during her hospital stay, for that matter). I would just as soon stay out of trouble with the law this early in my medical career.

And I have learned my lesson always to check for central lines before I discharge my patients home.

My Friend Nyein

2006-10-22T17:42:00.000-07:00

Today, I had a wonderful time hanging out with my friend, Nyein. Nyein is a Burmese girl that I met during my freshman year at UCSD. She is currently working up in Northern California. Thoughtful and sweet as she is, she made it a point to fly down just for the day to visit and celebrate my birthday with me (I turn twenty-seven tomorrow!). Not only is she thoughtful, she is also beautiful (inside and out), intelligent, articulate, and loyal. I also respect her for her faith – that she was able to make a commitment to believe in Christ during her undergraduate years despite the strong cultural pressures of her Buddhist upbringing. She is a joy to be around, and I appreciate her friendship. I am privileged to have her as one of my bridesmaids in the upcoming wedding. Here are some snapshots that we took today. My poor technologically challenged self had a hard time figuring out how to set the self timer button, so we took pictures the old-fashioned way, extending our arms out as far as we could. hee hee. Try to guess who's holding the camera in each picture. ;)

Jukes and Aileen Tie the Knot!

2006-10-18T19:36:00.000-07:00

The news you have all been waiting for. *Drum roll* I’m done with General Surgery! Last week on Thursday was my last official day. One thing I am sure of is that I will not miss waking up at 4 am every morning. Now that the weather has gotten much chillier in the early morning hours, I appreciate the fact that I can stay in bed until 5 or even 5:30 am! =)

Pediatrics has been fun so far. On Monday morning I started Newborn Nursery. My job is to assess and admit every baby born to the hospital (that is, if the baby does not go to the Neonatal Intensive Care Unit). We carry around a little pager akin to the infamous Trauma pager from Surgery. Every time there is a C-section or a crash delivery with complications (meconium or shoulder dystocia, etc.), the obnoxious pager goes off. *BEEP BEEP BEEP BEEP BEEP BEEP BEEP* “Crash C-section in OR 1! Crash C-section in OR 1.” I jump every time the pager rings (a result of PTSD from my Trauma days), but the workload is not too bad. It seems that in the last two days, however, there has been an overwhelmingly large number of babies. In fact, there were so many admits last night that the white board we use to keep track of all our babies could not even hold each individual, so we had to resort to pen and paper for the extra babies. Today, rounds seemed to last an eternity; we had to see 35 newborns (anywhere from 1-3 days old)! Why this sudden explosion in census? Counting back the days, I realize that this must be a product of New Year’s or Valentine’s Day.

Speaking of love . . . last Sunday (October 15, 2006), my friends Jukes Namm and Aileen Vitangcol were married! It was an intimate wedding at an exclusive estate in Palos Verdes overlooking the Pacific Ocean. Watching Jukes hold back his tears of joy triggered tears in even the manliest of men.

I participated in a string quartet with Leslie Kim (violin), my brother James (viola), and a girl named Joo (cello), who is doing her Master’s in music at USC.

Jukes and Aileen, being showered with petals after the wedding

Paul and me, exploring the estate grounds

For more pictures of the wedding, check out Renato's blog

Paul in Honduras

2006-10-02T19:50:00.000-07:00

Ahhh…I’m back on Trauma Surgery again. Coming off of night float, it’s good to be able to sleep at night and work during the day. I have just two weeks left on this surgery rotation, and I will forever be done!!! Trauma seems like a vacation now. I only had 17 patients on my list this morning. Since I split those patients with one other intern, I only end up seeing about 8 or 9 patients each morning. That sure beats juggling 26! =)

During my week of night float, Paul and Ken were in Honduras on a Dental mission trip. I sooo wanted to tag along, but unfortunately I was stuck here taking care of my patients. Here are some photos of Paul on his trip.

Paul with the orphans

Getting drenched under a huge waterfall

Exploring the ancient ruins

Paul and Ken seemed to have had a wonderful time on the trip. They were able to serve the needy with their skills in Dentistry, and they were able to see a little of the natural beauty that Honduras had to offer. Oh, the joys of medical missions! One thing in this life that I am sure of is that I am called to the medical mission field. Ever since my high school years, I felt called to serve overseas. Currently, Paul and I are seriously praying about going to Africa after we finish our training here in the United States. That should be an adventure.

This past weekend I had the privilege of going to church for the first time in several weeks. It is unfortunate that my internship schedule prevents me from getting Saturdays off. During my two months on General Surgery I was only scheduled to have a grand total of two Sabbaths off! Nevertheless, I have learned to appreciate and cherish the Sabbath so much more now that I rarely get to go to church. This Friday evening I went straight from work to the "Freedom from Fear"evangelistic series with Pastor Randy Skeete. I felt so blessed to listen to a convicting sermon and to sit amongst fellow believers. On Saturday morning I went to church, and then I spent the rest of the afternoon hanging out with Paul. We listened to another sermon online before having dinner. Afterwards, we attended the final meeting of the evangelistic series. Although I went to bed a little later than I would have liked (it was so difficult to get out of bed at 4 am the next morning), I was thoroughly blessed to have had such a spiritually rejuvenating weekend. The Lord knows I surely needed it. =)

Apostasy

2006-09-21T08:02:00.000-07:00

Somewhat amusing and yet at the same time very disturbing.

"Then if any man shall say unto you, Lo, here is Christ, or there; believe it not. For there shall arise false Christs, and false prophets, and shall shew great signs and wonders; insomuch that, if it were possible, they shall decieve the very elect."
Matthew 24:23-24

More Thoughts on Internship

2006-09-17T17:13:00.000-07:00

I am still baffled when I think about the internship program I am currently involved with. The General Surgery service truly is insane.

At the end of last week, I was the sole intern for a team that was taking care of TWENTY-SIX patients. What a disservice to the patients I was responsible for, let alone a crazy time for me.

Because of the new “eighty-hour work week” rule that is imposed upon all residents, the General Surgery department at my hospital has decided to crack down on anyone who defies the rule. They are essentially in danger of being closed down, or at least put on probation, because a disgruntled resident recently submitted an anonymous letter to the AOA (American Osteopathic Association) stating in so many words that the surgery residents were being overworked. Now the AOA is keeping a close eye my institution, which is why my chief resident sat all the new interns down at the beginning of our rotation and told us that we MUST work less than 80 hours per week. There were some new rules instituted to help us comply with that concept, one of those being that we are not allowed to come into work before 5 am.

Nonetheless, that poses a problem when I have to see 26 patients before rounds. At 5 am when I walk in the door, I go immediately to the fifth floor. I hide my bag in a certain cupboard of a certain conference room. Then I log on to a computer to check my patient list. I always gasp in horror when I see all the new patients that were added overnight. Then I proceed to rearrange their room numbers. I then spend some time assigning patients to my six students (I have 3 medical students and 3 PA students), making sure that no student has more than a maximum of 4 patients. Finally I go through and check the vitals signs on all 26 of my patients, making sure that none of them were hypotensive or tachycardic or febrile through the night. I check any new labs that I had not checked from the day before (but the AM labs are never ready by then, so I do not even bother to check for those). I make notes of who needs to be replaced with magnesium or who needs another set of AM labs. During that time, the night float person will usually call me to sign out. He spends about 5 minutes telling me about the issues overnight and any new patients that were admitted to our service. I also juggle answering questions from my students and the nurses about their specific patients.

By the time I finish with all of this it is already 6 or 6:15 am! If we are supposed to round at 7 am, I essentially have 45 minutes to see each of my 26 patients. They are usually all spread out over seven or eight units (5100, 5200, 5300, 4100, 4200, 4300, 3100, and 3300), not including the recovery room or the ER. Let’s do the math. If I spend about 30 seconds walking from one room to another and looking for that patient’s chart (which is impossible to do, especially closer to 7 am when the nurse’s change of shift occurs), I spend about 13 minutes simply in transit. Subtracting 13 from 45, I get 32 minutes to take care of 26 patients. Thirty-two minutes divided by 26 patients gives me an average of 1 minute and 13 seconds to look at each patient’s chart, talk to the nurse for that patient, talk to and examine the patient.

Needless to say, that is simply impossible. But that’s how crazy my life is this month.

Two days ago, I started night float. My hours are now 6 pm to 7 am. Friday night was quite busy. My pager never stopped going off. I received about 10 General Surgery consults and one major trauma activation. Fortunately I had two great students, Lisa and Nathan, helping me the entire time. Saturday night was slow until midnight. Then suddenly we had an onslaught of trauma alerts. From midnight until 6 am, there were about 7 or 8 traumas that came in back-to-back. All of the patients were intoxicated with alcohol. Most of them suffered bone fractures. One lady ended up passing away after a severe motor vehicle accident. What a night!

When I got home, I was exhausted. At 9 am I went straight to bed, and I woke up at 4 pm. It feels weird to be sleeping in the middle of the day, but I’m sure I’ll get used to it. By the time my body is adjusted, I’ll be back on the day shift again (This Friday I switch again). Although night float is busy, it is certainly a welcome relief from the insanity of working days. Oh, the joys of general surgery. . . =)

Erina and Ron

2006-09-11T20:45:00.000-07:00

It has been a few weeks since my "cousin" and dear friend, Erina Lee, got married to Ron Im. I just wanted to post some pictures in their honor. The wedding was in Pasadena, California, on Sunday, August 27, 2006. I was so happy to have the day off work so I could attend the beautiful wedding.

Me, Erina, Ron, my brother James, and my fiance Paul

Ron and Erina with my parents

Congratulations to you both, and here's to a happy marriage!

Strep Throat

2006-09-05T18:36:00.000-07:00

Absolute madness. That is what I would call this past weekend. Most of you who live in reality outside of the hospital bubble had a long weekend. For me, it was one of longest weekends of my life. Here is why.

Thursday, August 31, 2006. I started to feel sick. Malaise, headaches, body aches, fevers and chills, sore throat. I worked from 5 am until 6:30 pm that day, and by the time I was ready to go home I felt horrible. I did not eat dinner and went straight to bed, hoping that I could sleep off whatever illness I had begun to contract.

Friday, September 1, 2006. I awakened to my usual cell phone alarm ring at 4 am. I still felt terrible. My headache and sore throat were worse, and after taking a quick peak in the mirror I knew my tonsils were inflamed, erythematous, bulging. I popped some Tylenols into my system before I headed off to work. I continued to get fevers and chills throughout the day. Since I was switching services and starting General Surgery Team #1, I had the additional stressor of trying to figure out who each patient was and what we were supposed to do for him/her. In addition, I had five new students, three of whom bailed out on me (went to the operating room or clinic or lecture) so I was left to fend for myself with my limited knowledge of the patients during rounds. On our “short days” or “non-call days” the rule is that I am supposed to go home at 12 pm. Needless to say, that never happens. There was so much work to do that I went home at 4:30 pm, and I felt absolutely miserable.

When I took a look into the mirror again, I diagnosed myself with strep throat. I decided to start myself on oral antibiotics. I was too tired to go to the urgent care center for a rapid strep test or a prescription, so I just took some amoxicillin that we had lying around the house. This time I decided to choose nutrition over sleep, so I ate some pureed food for dinner before going to bed. My tonsils were so inflamed that every bite was sooo painful to swallow.

Believe it or not, this is what my throat looked like. Look at that white exudate. Yuck!!!

Saturday, September 2, 2006. Crazy weekend days. Our two General Surgery #1 and #2 Teams are combined into one huge team on weekends or holidays, and so the senior resident rounds with me on all the surgery patients. We had about 30 patients total on our lists, but only two students to help me write notes. I ended up writing about 13 progress notes by myself that morning. Consults started coming in one by one – and pretty soon we had about 8 consults by the end of our shift. We didn’t start rounding until about 11:30 am, and we didn’t finish rounds until nearly 4 pm! Imagine 11 straight hours of running around like mad, not stopping to drink or eat anything! After rounds, my students and I grabbed a quick “lunch.” And then we had a little less than 2 hours to finish all the floor work. It was insane. Although I was supposed to leave at 6 pm, I left at 8 pm. Fortunately, I had more energy on Saturday than I had had on days prior. Perhaps the antibiotics were kicking in. But, more likely, God was helping me (I know my fiancé was fervently praying for me). All I know is that I’m thankful He got me through that crazy day.

Sunday, September 3, 2006. I had the day off. Just got my hair trimmed and went out to eat with my dear friend, Kar-Yee. Physically had time to recuperate from my illness. Feeling sooo much better.

Monday, September 4, 2006. Another crazy “weekend” day (since it was a holiday). This time, I had to write notes single-handedly on 15 patients, as there were about 40 patients on the combined General Surgery #1 & #2 Teams today. I would have had to write more, but fortunately I had two students and a second year surgery resident helping with the rest of the notes. After that madness was over, we again had the mad rounds. We didn’t start until 12 pm, and we were interrupted with surgery cases in between, so we again finished rounding at 4 pm! Between then and 6 pm, I discharged about 10 patients and took care of floor work for the others. It was so crazy. In order to get everything done, I did not even take a lunch break that day. I just made sure I had a nice dinner later (a vegan pizza that Ken Lim baked). Mmmm...

Despite the insanity of my weekend, I see how God has led through this experience. He sustained me when there was no way I could have had the energy to lift a finger to get any work done. He reminded me that I must lean fully upon His strength at all times. I was forced to pray for help, and He answered my feeble cry. I serve a great God, and I hope and pray that you have all experienced the peace that overcomes you when He is in control of your life. Hooray that another week on surgery is over! Just 6 more weeks to go! =)

Hospital Hostility or Hospitality

2006-08-27T10:19:00.000-07:00

Ever since I embarked on this journey in the world of medicine, I have had the opportunity to observe countless different personalities, varying levels of authority, and numerous methods of dealing with difficult situations. I have found that certain subspecialties within the field of medicine seem to breed hostility, while other areas tend to cultivate kindness. Many times, I have encountered doctors who have reached the pinnacle of their professional training and yet have resorted to elementary ways (e.g. throwing fits and shouting obscenities) in dealing with stress.

The field of General Surgery is often pinpointed as an area of medicine in which physicians are rude, crass, obscene, and disrespectful. As a third-year medical student at a local county hospital, I remember being intimidated and aghast at some surgeons who barked orders at their scrub techs or pimped a fellow student until she nearly melted away in embarrassment. I always wondered, what possesses these people to lose their sense of chivalry and to let such uncouth habits loose in their work setting?

These are the conclusions that I reached (but as I am not a general surgeon you can take all my comments with a grain of salt):

1. Emergencies and urgencies and stress. Many times when people are faced with stressful situations, they tend to have a shorter fuse. The world of general surgery is constantly approached with difficult emergency situations in which things need to happen quickly (“STAT”). If the traumatic aortic rupture patient is not taken to the operating room NOW, he WILL die. In dealing with some of these crazy life and death situations, health care workers tend to regress back to a primitive paradigm of performance – they shout and scream for things to get done, they ignore the wife or husband at bedside who is brimming with questions, they have one focus in mind – to operate on the patient in order to save his life. By being bombarded with stressors on a day-to-day basis, physicians often forget how to take a step back from their emergent situation or how to ask for things in a nicer way or how to work on those relationship skills.

2. Lack of sleep. It is common knowledge that a person ideally needs eight hours of restful sleep to function at his or her maximum capacity. Surgeons are often sleep-deprived, being forced to awaken at ungodly hours in the middle of the night to repair a strangulated hernia or perforated appendix. Plus, surgery is the one rotation in which you have to get up at 4 am every morning, since surgeons have to round before they go into surgery.

3. Long and difficult residency. Of all the residency programs, general surgery has to be one of the most demanding. In order to become a general surgeon in the United States, one has to endure five years of residency after medical school. Deciding to specialize in vascular surgery or cardiothoracic surgery would add several years on top of that! By the time one finishes residency, surgeons have endured so much that they are often disheartened and cynical.

4. Food chain. During my third year of medical school, I noticed that there was an undeniable level of hierarchy in the hospital. I was obviously at the bottom of the totem pole, then the interns, then the residents, then the attending physicians. This food chain was especially evident during my General Surgery rotation, when the actual order in which we walked indicated who was at the top and who was at the bottom. Interestingly enough, when the attendings would give the residents a hard time, the residents would give the interns a hard time, and the students would get the brunt of it all.

5. Environment. The hostile attitude that is cultivated also dissipates into the other health care workers as well. Trauma bay nurses can be especially unfriendly. My first day on surgery call as a medical student, the intercom overhead announced, “Level A Trauma! Level A Trauma!” Our whole team ran down five flights of stairs to the ER, and my job was to record all the history, vital signs, and physical findings that the paramedics, residents, and nurses shouted out. Everything was chaos. I could barely hear what was going on. So I turned to a young nurse who was also documenting similar findings, and I asked her about the findings I had missed. Suddenly an older nurse began screaming at me, “This is YOUR JOB! You need to LISTEN and record this for YOURSELF! You ARE the medical student, aren’t you???!!!” I was so taken aback I could not even muster up a response. I simply stepped away and continued to record my findings. About half an hour later the younger nurse approached me and apologized for the way the older nurse had exploded. I said, “No, that’s okay. It’s just that it was my first day on call on surgery, and I wasn’t familiar with what I was supposed to do.” Ever since that moment, I knew that life inside a hospital was definitely different from life outside the hospital. Since then, I have encountered many unfriendly nurses and physicians, all experiences that have made me think and have led me to write this blog.

6. Lack of God. It is my observation that when people are extremely busy, stressed, and sleep-deprived, they tend to forget about God. Personal devotional time is the first thing to go. Prayer time is limited to brief periods in the car or before meals. However, it is at this time when it is most necessary to have a strong relationship with God.

Of course I must at this point make the disclaimer that all of these generalizations do not apply to each and every General Surgeon out there. I have a few friends who are in general surgery residency who are among the sweetest, most mellow guys that I know (e.g. Jukes Namm, Geoffrey Lam). Nonetheless, I had to blog my thoughts simply because I have just finished a week of Trauma surgery, and I have been forced to think about all these points lately.

A few days ago, my co-intern Darin asked me with great consternation, “Are you okay? How has general surgery been treating you?” I automatically replied, “Oh, it’s been fine,…why?” He answered, “You just seem…different…more stressed or something. You always used to smile before, but now…you seem a lot more stressed.”

It was at that moment that it hit me. During the few days I had been exposed to the culture of general surgery – the fast-paced, uptight, down-to-business, no-nonsense culture – I had metamorphosed into a different person. I was no longer sweet, gentle, kind, caring, and understanding. Because of the stress of the rotation I had become uptight, no-nonsense, business-minded and short with patients, students, and fellow residents almost overnight! The reality hit me, and I was again taken aback – this time not because of the shock of someone yelling at me, but because I realized I had let my surroundings influence my character instead of letting God lead my life and consume my character completely.

I breathed a prayer of repentance to my Father, and I determined in my heart to steer clear of the temptation to follow the instincts of my carnal heart. Please pray for me – that I may keep my eyes focused on Him even during this trying rotation and that He can use me as a vessel to influence others for His Kingdom.

My Vacation is Over!

2006-08-18T17:57:00.000-07:00

Have you ever tried planning a wedding? For those of you women who are married already, you know what I’m going through. For those of you who are still single, you have much to look forward to.

This past week was one of my four vacation weeks that are allotted to me as an intern. I pretty much spent the entire time planning out aspects of my wedding. It was insane. Here’s a taste:

Gathered information about stationery, flowers, decorations, dresses, budgets, etc. online
Looked at countless bridal magazines
Went shopping for a bridal gown
Went shopping for bridesmaids’ dresses
Met with J.Z.’s Party Charm regarding decoration price quotes
Met with J.Z.’s florist regarding flowers for the wedding
Met with Eden Hill Florist (in Los Angeles) regarding flowers
Talked with University Catering regarding the reception food
Planned and brainstormed with my cousin, Jennifer, regarding my wedding until the wee hours of the morning.

After the week of wedding planning, I was pooped. Sadly to say, my vacation – which really was not much of a vacation – ended yesterday. Today I committed my life to eight weeks of bondage to General Surgery. I am starting on the Trauma Surgery service. Today there were 5 traumas that came in – all motor vehicle accidents or motor vehicle-related accidents (e.g. 18 year old male who jumped out of the passenger seat of his car on the freeway while his mother was driving at 65 mph to take him to his psychiatric appointment). All the trauma victims suffered multiple abrasions, and one man required immediate surgery (he perforated his small bowel during the car crash, so the surgeons had to put him his intestines back together). Seeing so many crash victims reminds me again how fragile life is and how dangerous those highways can be. Don’t forget to wear your seatbelts and drive safely!!!

Ho brah, we go grind den!

2006-08-12T23:10:00.000-07:00

Tonight we had a nice gathering with the “Hawaiian crew.” Kenny Chang, an ophthalmologist who is friends with Paul, my fiancé, invited us over for a barbecue dinner. Laura, his fiancée, is a family medicine doctor in Riverside. Both Kenny and Laura are from Hawaii. Chris Chu and Ken Lim, also from Hawaii, joined us for dinner as well. Eduardo and I were the only ones with no Hawaiian connection. Nonetheless, it was a wonderful time.

Kenny cooked some mean dishes. I didn't know he could cook! =)

The stuffed tomatoes were a hit.

And our “barbecue” was modified to meet some of our vegetarian needs (vegetables on skewers!). =)

I suppose that since I am now engaged to someone from Hawaii I needed to be initiated into the Hawaiian culture. It’s amazing that during my entire lifetime prior to meeting Paul I knew nothing about “Pidgin,” the local slant on English that they use in Hawaii. =) For those of you who are as ignorant as I was about Pidgin, I encourage you to listen and even attempt to pronounce some of these words on this entertaining website:

http://www.extreme-hawaii.com/pidgin/vocab/.

After some research on this above-mentioned site you may be able to accurately decipher the title of this blog entry. Enjoy! =)

Surf's Up!

2006-08-06T19:19:00.000-07:00

Ahhh, another wonderful weekend! Janet and Julie, two of my church friends, invited me to join them for a surfing lesson today. Although I am very fond of land activities, I have always been somewhat wary of water sports since childhood. Swimming is one of those things that I never felt comfortable doing as a child because of the fact that I hated wearing a bathing suit. Consequently, although I learned how to swim, I never practiced the sport nor did I develop a passion for it. However, after learning how to snowboard during high school I was always intrigued by the world of surfing. That fascination prompted me to give surfing a try today.

So Julie, Janet, and I ventured out to Bolsa Chica State Beach in Orange County (Huntington Beach). We took a quick photo before we departed from Janet’s pad in Tustin Ranch.

At the site, we were given a wetsuit and a surf board. Our surfing lesson lasted one hour, and then we were given one more hour to practice what we had learned. The name of the surf school that provides these lessons is Corky Caroll - http://www.surfschool.net/huntington/. They were very nice, and I thought the lesson was quite good. Here is a quick summary of what our instructor taught us:

- Beach safety
- The three ways to approach a wave:
1. Paddle-through: paddle through the wave
2. Up-and-over: arms locked straight ahead, trunk upright while feet on either side of board for balance
3. Turtle: roll over the side of board into water, turn board upside down over you, then turn board back over after the wave passes

- The four things to think about while paddling out:
1. Water line = line where water forms a line near nose of board
2. Feet together to prevent drag
3. Shoulders back
4. Paddle with smooth strokes one arm at a time with palms cupped at all times

- How to go from a paddling position to standing up on the board.

Although we did not catch and ride many waves (I think I stood up only once and had some partial stands on other attempts), we had a blast! =) After our time in the ocean, we had lunch at the Tustin Marketplace at a delicious Corner Bakery Café. I think Janet really enjoyed her lunch. =) Mmmmm...

Enucleation

2006-08-02T21:02:00.000-07:00

Yesterday (8/1/06) I watched and participated in an enucleation for the first time in my life. It was pretty crazy. =) Here’s the story. A middle-aged man who is completely blind in his right eye was having severe pain in that eye and wanted it removed, so he was scheduled for an enucleation.

Here is a picture diagramming the steps in an enucleation:

Let me explain in layman’s terms what my senior ophthalmology resident did, as it was slightly different from the enucleation pictured above.

The attachment of the conjunctiva was carefully cut from the globe of the eye. Then, all four rectus muscles were isolated and removed from their attachments the eyeball. After that the cornea was cut out and all the intraocular contents were removed (all the fluid inside the eye came gushing out, then he removed the iris, ciliary body, retina, etc.). The optic nerve was severed, and the ophthalmic artery was subsequently cauterized. At this point the eyeball was freed from the eye socket and now looked like an empty white bag with just the scleral shell remaining. It was thoroughly cleaned out and soaked in an antibiotic solution (Ancef). The shell was flipped inside out, placed like a finger puppet on the tip of the resident's thumb, and cleaned out even more thoroughly with absolute alcohol. Finally, a silicone ball was popped inside the shell, which was then closed up with some strong suture. The combination of the sceral shell and silicone ball (making up the new eyeball) was placed back in the orbit, the extraocular muscles were reattached to it, and the conjunctiva was sewn back together over the eyeball. The eyelids were also sewn together temporarily to prevent the eyeball from popping back out.

This was truly a fascinating case. I even got to scrub in at the very end, so that was fun. =) Eyes are amazing. I am very thankful I have two of them. =)

Hiking at Palos Verdes

2006-07-29T23:37:00.000-07:00

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 http://audioverse.org, where you can download and listen to many inspiring sermons that are preached weekly at Advent HOPE. =)

iConsult

2006-07-27T21:41:00.000-07:00

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.

Enjoying God's Nature

2006-07-23T21:51:00.000-07:00

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. =)

The Case of the Central Arterial Line

2006-07-19T11:00:00.000-07:00

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:

http://www.emedu.org/invas/subc.htm
http://note3.blogspot.com/2004/02/central-line-placement-procedure-guide.html
http://apps.med.buffalo.edu/procedures/centralvenous.asp?p=6
http://en.wikipedia.org/wiki/Central_venous_catheter
http://clinicalcases.blogspot.com/2004/02/complications-of-central-line.html

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.

Code Blue

2006-07-16T20:59:00.000-07:00

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,

Amen.

The Truth About 9/11?

2006-07-13T09:50:00.000-07:00

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:
http://www.loosechange911.com/
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.

Freddie, the Country Boy

2006-07-09T21:52:00.000-07:00

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,...my computer illiteracy prevents me from knowing how to edit it so it shows up right-side up.)

Jane and Fred's Wedding

2006-07-09T21:16:00.000-07:00

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

My First Week of Internship

2006-07-02T21:30:00.000-07:00

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!

Meet the Residents

2006-06-22T21:54:00.000-07:00

I realized that I needed to go out to dinner a few times before my social life was completely and utterly demolished (i.e. the start of internship).

Here is Viki, Sunnie, Monica, and me (and Tracie) – my old team on Internal Medicine at Riverside County Regional Medical Center. =) Two nights ago we all decided to go out to eat at a Korean restaurant in San Bernardino to celebrate Sunnie’s and Viki’s completion from a grueling preliminary medicine year.

Viki and Sunnie were my superstar interns! Viki will be going on to Ophthalmology, and Sunnie will be moving up to Northern California to complete a residency in Anesthesiology.

Tonight all of the new residents were invited over to the house of an attending physician (Dr. Raval’s) for dinner. It has been fun to get to know the other residents. Here is a picture of some of my fellow incoming interns.

Me, Uma, Darin, Sonia, and Socrates

The Most Frightening Countdown of My Life

2006-06-21T23:50:00.000-07:00

The countdown has begun! It is difficult to believe that in about 54 hours I will be starting my first day of work as an intern on the Medical Intensive Care Unit. I have spent the last two weeks sitting in a cold conference room of a large county hospital, freezing to death indoors while outside the weather has been over 100 degrees Fahrenheit.

What did I do and what all have I learned? Wow…there was so much thrown at us that I don’t know where to begin. Talk about information overload. Here is a quick run-down on what I did and learned during these last two weeks:

ACLS (Advanced Cardiac Life Support): how to save a dying adult
PALS (Pediatric Advanced Life Support): how to save a dying kid
NRP (Newborn Resuscitation Provider): how to save a dying baby
How to treat our patients with respect
How to manage assaultive behavior (e.g. how to get out of a headlock or a simple arm hold; how to appropriately pin a combative patient to a wall, etc.)
What dental and medical insurance to sign up for
What vision insurance is available to me (I get a free vision exam and up to $85 for a frame)
How to wear our ID badges
What the dress code is at the hospital (e.g. the need to cover all my tattoos with long sleeves or dark nylons, to refrain from wearing any type of denim or jeans, etc.)
What rights I have as a member of the staff at my hospital (e.g. not to participate in the termination of pregnancy, not to participate in organ procurement, etc.)
Where to park (in “physician parking” – finally!)
How to report bloodborne pathogen exposures
How to handle organ donations
What features make our hospital seismically resistant (i.e. it is built to withstand an 8.3 magnitude earthquake!)
What ancillary services are offered at our hospital
HIPAA regulations
How to use the new program for doctors to order all medications online, a trial program which is scheduled to go live in October 2006
How to use the online PACS (radiology) system
How to look up labs and reports online
How to log all of our procedures and hours online (per ACGME requirements, we cannot work more than 80 hours per week, averaged over 4 weeks; and we are prohibited from being in the hospital more than 30 hours at a time)
What electives I can take (I plan to do ophthalmology, anesthesiology, radiology, rheumatology, and hopefully a mission elective at an eye clinic in Africa)
Received a walking tour through the hospital
Received a box full of business cards with my name on it
Received a personalized stamp with my name and "M.D" after it
Met my Program Director
Met with my senior resident
Met with an outgoing intern, who reviewed everything I need to know before I start MICU
Met all my fellow interns, who for the most part seem like good people

All and all, it has been quite an exhausting two weeks. Ready or not, I am prepared for take-off. Tomorrow I will receive my white coat (finally a LONG white coat!). Friday I will shadow the current (outgoing) interns on MICU. Then Saturday (6/24/06) is my first official day of work. Anyone who is reading this (if anyone does actually read these irrelevant, incoherent, uninteresting entries in their entirety)...please pray for me! =)

Riding our Bikes at Newport Beach

2006-06-21T23:28:00.000-07:00

6/13/06

By chance, we bumped into my brother, James, at Newport Beach, who took this video shot of us while he roller bladed past us.

The Art of Riding a Bike

2006-06-14T13:55:00.000-07:00

The old adage is true indeed! One never does forget how to ride a bike! =) I believe the last time I rode a standard bicycle was back in elementary or junior high school. It had been about fifteen years since I had last ridden one. Although I always knew I could still ride a bike, I never had the occasion to prove it to myself.

Until yesterday.

Jenny Park recently graduated from the School of Pharmacy and she will be moving up to Washington state next week, so we wanted to have a Girls’ Day Out at the beach before she left. So yesterday (6/13/06) Jenny, Susie Kim, Lynn Park, and I made our way to Newport Beach. We rented four Easy Rider bicycles from a local beach vendor at $9 per “beach hour” (which is equivalent to about an hour and a half), and we rode up and down the sidewalk parallel to the beach. It was a gorgeous day out, and the sea gulls were soaring overhead (luckily, we were not made easy targets due to our high pedaling speed). I must say we had a great time!

Miso, Susie’s miniature maltese, also came along with us, and she enjoyed her time at the beach immensely as she rode along with us in a little basket hanging on Susie’s bicycle handlebars.

More Marriage

2006-06-12T20:33:00.000-07:00

Yesterday (6/11/06), I had the privilege of attending another wedding – the lovely union of two of my Riverside Korean SDA Church members, Andrew John and Cindy Nam. Cindy looked absolutely gorgeous, and...well...I suppose Andrew looked all right as well. =)

Their wedding was held at the Los Angeles Arboretum, a picturesque outdoor venue for a charming wedding.

Although I personally hate playing music for outdoor weddings (there are just too many variables in the great outdoors such as moody microphone systems, distracting airborne animals that make terrible squawking noises, loud vehicles vrooming by), this particular wedding went relatively smoothly. Congratulations, Cindy and Andrew! Enjoy your honeymoon!

Love and Marriage - Part One

2006-06-05T12:51:00.000-07:00

Love must be in the air. It is a strange phenomenon. An astute observation was recently made that “everyone” seems to be getting married or engaged! This seems to be an unusually busy summer wedding season. Or maybe it’s just that we’re getting old. For example, yesterday (6/4/06) there were five different weddings or bridal showers that were going on. Unfortunately, I could not attend all five events. I only made it to one – the beautiful marriage of Erwin Gonzalez and Cheryl Paw in Glendale, California.

Erwin is a fellow musician (a violist) and friend of mine who has come through for me whenever I was in a bind. He was always so willing to play in my string quartet whenever I got a call for a wedding gig. He did kind things for me such as playing at a concert with our newly formed Loma Linda University Symphony Orchestra when we were desperately in need of a violist. He even donated his time last year to play at Arrowhead Regional Medical Center for an annual tea party for breast cancer survivors. Playing for his wedding was a privilege and the least I could do for him. Last week on Monday (5/29/06) two of my classmates (also new MDs) Andrea Kuntaraf and Patrick Crane were married. Here is a photo of their wedding.

Weddings are always so beautiful. I always end up fighting back tears (sometimes successfully, usually unsuccessfully) at every wedding….I often think that I am much too sentimental for my own good.

Love and Marriage - Part Two

2006-06-05T12:50:00.001-07:00

Perhaps as we are on the topic of love and marriage, I will take this opportunity to share my own personal story of my engagement. Some of you may already know the story, but others may be interested to know the details of what happened.

It was the month of February 2006, and a friend of mine, Susie Kim, suggested that we have a Girls’ Day Out sometime in the next few weeks. I was in my fourth year of medical school in the middle of a rotation – my sub-internship in Internal Medicine – at a notoriously busy hospital in Riverside County. So I checked my trusted PDA – a refurbished Tungsten E Palm that I had purchased on eBay two years earlier – and finally found a good post-call day, the 19th of February, in which to hang out with “the girls.” We decided to go shopping and then to have dinner at the Mission Inn, an elegant and historic landmark hotel in Riverside established in 1902. As February 19 coincided with another friend’s (Kar-Yee Yung’s) birthday, I simply assumed that the dinner would be a surprise celebration for her. I waited with eager anticipation for that day. I even called my friend and classmate, Eunice Lee, to see if she was going to be able to join us for shopping, but she said that she could just meet us for dinner.

Sunday, the 19th of February came, and I was finally excused by my interns (Viki Hsu and Sunnie Lee) and released from the bondage of the hospital. We had finished rounding somewhat earlier than anticipated, because our patient census was quite low (I tend to be a “white cloud” on call days, I am told). So I gave my boyfriend, Paul Yoo, a call and asked him if he wanted to hang out for a little bit before I went to meet the girls. To my disappointment, he told me that he was really immersed in his studies at that moment and that it was not the best time to meet. I had always tried to be supportive and protective of his study time, as Dental School has not been a “walk in the park” for Paul, so I told him that I understood and that we could meet up the following day on my day off.

A few hours later I went to Susie’s house to meet the girls. I had assumed that there would be many girls coming out with us, but to my surprise it ended up just being Susie, Kar-Yee, and me. We spent some time shopping at Ontario Mills, and my only significant purchase was an arm band iPod holder, which I needed because I was training for the Los Angeles Marathon (March 19, 2006). We were supposed to meet the others for dinner at 5 o’clock in the evening, but we were already running behind (funny how time flies when one is shopping). I could hear Susie talking on the phone with her husband, Eli, telling him we would be arriving soon.

When we got to the Mission Inn, Susie began a full on sprint toward the building in her ever-stylish heels. Kar-Yee and I worked to keep up with her as she weaved through the Spanish style architecture and up four flights of narrow spiral stairways to the roof of the building. Fortunately for me, I was in the best shape I had ever been because of my months of training for the marathon; otherwise, I probably would have experienced a syncopal episode with all the exertion and excitement. The entire time Susie was leading Kar-Yee and me through the Mission Inn, she was secretively talking to her husband Eli on the phone. She was acting quite suspicious, and I thought to myself, “Susie is making this WAY too obvious…Kar-Yee is going to figure out that we are planning a surprise birthday party for her!” When we were finally on the roof, in the corner of my eye I saw two familiar faces – those of Eli and Paul!!! They were bent over behind some stone structures, and it looked like they were lighting some candles (Kar-Yee’s birthday cake, I assumed). I instinctively waved at them, happy to have finally found them after the work-out of sprinting up the staircases, but then I realized that perhaps they were still working on the surprise. I halted my voice in the middle of my “Hi,” and quickly put my hand down. Had Kar-Yee seen them? I thought to myself, “Man, I really messed it up this time!”

Susie awkwardly suggested, “Ummm…why don’t we…take pictures together here on this side of the roof?” It was obvious that she was stalling for time! After the photos, we decided to investigate the bell tower that was on the roof. I had a strong desire to explore and see if we could climb up to the top of the tower. But then I realized that Paul and Eli were probably still there on that side of the roof! I looked carefully at Susie, understanding that she would probably give me “the look” if she wanted to give the boys a little more time to prepare, but she eagerly joined in and said, “Yeah, let’s go check out that tower!” Relieved, I began to walk toward the tower.

Suddenly, I sensed that Susie and Kar-Yee were no longer walking next to me. I looked back and noticed that they had fallen behind and were watching me. Confused, I beckoned for them to come with me. They motioned with their hands for me to continue on. I noticed that there was a picturesque hallway, covered with vines overhead, leading to the tower, and I also noticed a few rose petals on the ground at the entrance of the outdoor hallway. Still thinking that this was part of Kar-Yee’s surprise party, I looked back again and asked Kar to come instead. They insisted that I walk forward alone.

Then, I realized what was happening. I saw Paul standing at the end of the short hallway, which was covered with red rose petals and lined with candles along the side. He was standing there with a single rose in his hand. My heart started to pound as I walked toward him. He proceeded to get down on his knee, clasp my hands in his, and say, “It is not good for Man to be alone,…” Everything was a blur after that; I honestly do not remember the rest of the speech. My sentimentalism took ahold of me once again, and tears began to well up in my eyes. Paul gave me the long-stemmed red rose and placed my engagement watch on my left wrist. He proceeded to ask me if I would spend the rest of my life with him, but I was so overwhelmed with emotion that I was speechless. He must have asked me a second time, and I finally was able to nod and say, “Yes.” This entire time, Eli was attempting to capture the moment on video with his digital camera, but it was difficult in the dark as the sun had already set some time earlier. Susie and Kar-Yee snapped away with their digital cameras, and then we headed down to the restaurant below to meet the others for dinner. Many of our friends came out to join us at dinner and celebrate our new engagement with us at the Mission Inn. It truly was a memorable and beautiful experience.

Paul celebrating his victory

Paul and Janie, newly engaged

More Graduation Photos

2006-05-31T14:33:00.000-07:00

As more photos come in from various people who took snapshots throughout the weekend, I feel compelled to post a few more favorites.

Paul and me in front of the LLU Medical Center

James Lee, D.D.S., with lots of girls

Group of happy dental school graduates:

Cindy, James, Fred, Hye Ryeon, Jane, and Tyler

Janie Lee = M.D.

2006-05-30T23:28:00.000-07:00

The much-anticipated Graduation weekend has finally come and gone. One of the highlights, besides that of receiving my diploma on Sunday, was becoming a celebrity overnight. Well, perhaps I did not quite become a celebrity, but I must admit that somehow my photograph was published in the esteemed local newspaper, The Press Enterprise! Yes, it is difficult to believe. If you want proof, you can take a look at the article online with your own two eyes:
ttp://www.pe.com/localnews/inland/stories/PE_News_Local_H_lomau29.dea8f7f.html
Here’s the full story. All of my classmates and I were lined up and impatiently waiting outside at 8:00 am on Sunday morning (5/28/06), waiting for our procession and the graduation ceremony to begin. Suddenly, my friends Helen Lee and Eunice Lee (we were standing in alphabetical order) noticed that a strange man with a large camera and an even larger lens was voraciously snapping photos of us. Uncertain as to what we should do, Helen and I instinctively posed and timidly smiled at the foreign camera that was looming in front of us. The man behind the black device abruptly looked up at us and stated, “One hint…if you want your photo in the newspaper, don’t look at the camera!” He proceeded to take out a pen and paper and asked us to jot down our name, age, and hometown. He told us that there would be a few graduates that he would be following and taking photos of throughout the day, and he hoped that our photo would make it on the front page of the newspaper.

I thought nothing more of it, until the ceremony was over and we were marching out. Suddenly, the photographer jumped out of nowhere and began to take dozens of photos of me. By this time, I was thoroughly covered in leis and an inflatable tube in the shape of a yellow duck. I could hear him mumbling to himself, “I love it! I love it!” I assume, in reference to the duck. Needless to say, a picture of the duck was successfully published in the “Local” section of The Press Enterprise.

Here is a picture of that famous Duck, along with his friend, Froggy!

Other than that, Graduation Day was an exhausting one. My School of Medicine Graduation went from 8:30 – 11:00 am, then we had a lunch party at my house from 12:00 – 2:00 pm, then I went to the School of Pharmacy Graduation until 3:00 pm, then I attended my brother’s School of Dentistry Graduation from 5:00 – 7:30 pm, and finally we had a dinner party at my house from 8:00 – 11:30 pm. That was what I would call a full day.

Although I was tired, I was happy for the chance to spend time with family and friends. And I cannot complain about the many gifts that people generously gave, including monetary ones (Korean family members really know how to give cash)! I was especially touched that my friend, Nyein, drove all the way down from the Bay area to attend my graduation! It was very nice to see her and to introduce her to my fiancé, Paul. She is the only one out of the seven girls who will be my bridesmaids who had never met Paul. Fortunately, she liked him and gave me her stamp of approval for me to marry him.
I was also extremely grateful for my cousin Curtis (shown on left), who was my unofficial photographer for the day. He is a sweet, talented, wonderful man (a very eligible bachelor who knows how to cook well) who gave of himself all day to take the 200+ quality photographs of my graduation.

I am especially thankful to my parents, who were so supportive and active in making that graduation day a success. They hosted both the lunch and dinner parties. They faithfully attended both graduations and ran back and forth to make sure that everything ran smoothly. My dad took his usual post as the unofficial videographer. I attribute my successful completion of medical school and all that I am today to to the love and support of God as well as my parents. I love you, Mom & Dad!

In conclusion, I must say that this weekend was successful in that I was officially granted the title "M.D.," deemed so by Loma Linda University. I have proof...the diploma is in my hands!

It is a bit strange to think that I am now a physician. I feel too ill-prepared, too unworthy, too naïve and inexperienced to be called a real doctor. This truly is the beginning of a new era in my life.

The Proposal

2006-05-30T23:10:00.000-07:00

If the video does not display properly
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James Sarasua proposes to Tara at our Senior Banquet (5/25/06)!

Graduation Weekend has Officially Begun

2006-05-26T22:42:00.000-07:00

Last night (5/25/06) was our "Senior Banquet." One of my classmates, James Sarasua, took advantage of that opportunity to propose to his girlfriend, Tara. If I can ever figure out how to post videos on this Blogger site, I will show you a short clip of the proposal. =)

Above is a picture of me with Kar-Yee, Kar-Wai, Eunice, and Yuri, before eating the delicious Chinese food provided by University Catering at the Wong Kerlee Conference Room (which is where I plan to have my wedding reception on June 24, 2007). =)

Tonight (5/26/07) was the School of Medicine's "Hooding Ceremony," during which loved ones participated in "hooding" each graduating senior. Mom and Dad hooded me. =) It was a meaningful and lovely ceremony. Here are some more photos of the event.

Saying Good-bye to Student-hood

2006-05-24T01:10:00.000-07:00

Yesterday I worked my final shift on my Emergency Medicine rotation, and I was filled with mixed emotions - joy, sadness, excitement, regret, anticipation, fear, amusement, and hesitation. As I reflect upon my last day of work as a medical student, I realize that I am now stepping out of a role that I proudly held for twenty-one of my years of life - that of a "student" - and timidly tip-toeing into another role that I will carry for the rest of my life as a "physician." Graduation Day for the School of Medicine at Loma Linda University (Sunday, May 28, 2006) is rapidly approaching, and I have a hunch that life will be very different as I enter into residency. Nonetheless, I know that the Lord will be by my side as I face sleepless nights and trying moments, for He has been by my side from the beginning.

With these words I initiate my first weblog entry. I have been contemplating starting a blog for a few months now - having been inspired by countless friends who have faithfully burned the midnight oil to keep their web journals and blogs updated - but I never had the courage to do it for fear that I would squander away my precious time posting thoughts and pictures. Nonetheless, I have finally made the decision to begin, although I am unsure what will come of this newfound interest. Feel free to stay posted for more of Janie's thoughts to come, although I will provide no guarantees on the quality, quantity, or frequency of these entries. Ciao. =)