WIPS

Quick check-in, as work as been insane. My boss is about to be my underling in less than 10 days. We are all a little stressed around here. P and I are trying for a baby, and we are going to visit the fertility doctor in 2 weeks. Hopefully, she will have more productive things to say than just "exercise, lose weight, and get on Metformin." I feel like the theme of the last few months has been "too much to do and so little time." My craft room is migrating, one skein and one bump of fiber at time, down to the living room, where most of the fiber activities happen. The craft room is where I make my cards, in the occasion that I have to make cards, and where most of the supplies are stored. But I feel like I have so little time with P, my husband, that I would rather craft in the living room, so that we can have a peaceful coexistence, ignoring each other but basking in each other's presence. Of course, this is also Advent season, and all of the boxes are flowing in from various fiber companies, and I am perplexed, as I have already forgotten what I ordered in June. I almost submitted another order for a Sweet Georgia advent, until my subconscious reminded me that I perhaps may have already purchased one. In terms of WIPS (and this is just what I am currently working on): 

 - Quaere fiber/queen city yarns socks for me (1 sock done, working on sock #2)

 - Lollipop yarn sock (probably for P, might be for father-in-law or my dad) - two-at-a-time sweet george gradient socks from a sock blank (both at the instep, about to get to the heel)

 - socks for me from souvenir yarn from Buffalo, NY, when P and I visited Niagara Falls in 2021 

- Sweater for P (Flax Sweater)- one sleeve down to decreases for the cuff. 

- Sweater for me, in fingering weight yarn- V neck tee (probably going to try to make this either a cardigan or a long-sleeved top) 

- Sweater for me, in fingering weight/handspun

 - handspun blanket I have so many WIPS stashed in the yarn room, that I need to start working on them.

 We cleared out a section of the room to move a 9-grid shelf, and I found more WIPS. Oy. I don't want to frog any of them, not yet. I just need to designate more time to knitting, I suppose, or at least be more mindful about what I buy and what I use. Hope everyone is doing well, and having a good start to their holiday season.

Return of the Knitting Mojo!

I've been working on socks here and there and started some sweaters, but all of the sudden this fall, after a certain nuptial event, I started wanted to make all of the things. Partially because I don't have to worry about the Boyfriend Sweater Curse, and partially because now I don't have to do wedding prep/planning anymore! I should get started on thank you notes... Between knitting for DH, replenishing my sock stash after the Unfortunate Great Apartment Flood of 2018, and knitting for my new baby cousin, I've got startitis. So here is the list of what I'm starting/knitting/finishing/working on: Socks for Peter, out of sock yarn that we picked up while we were on vacation in Buffalo, NY/Niagara Falls a Baby Sweater out of White Birth Fiber Arts (Wee Envelope, by Ysolda Teague), for my baby cousin Rex

Socks for me in Beyond the Pines Socks for Peter out of Quaere Fibres, Heirloom Carrots colorway (these were initially meant to be socks for me, but I ended up getting too large of a gauge, and they seem to fit Peter perfectly in the foot so far.)

Socks out of yarn I got for Christmas, in sweet georgia yarn, in a double knit sock blank

I am also starting a sweater for Peter in Fibra Natura LIMA yarn that I've had from Tuesday morning for a long time, and I'm knitting the Tin Can Knits Flax Sweater I also want to work on a couple of patterns for me: the Ripple Bralette and the Shelley Top. I'm trying to get as much done and clear the needles as much as possible, since Jan 1st will be the start of the ZK (Zombie Knitpocalypse) knitalong, and I want to participate as much as I can.

covid diaries 3/27/2020

I'm listening to a recording of the Cleveland Clinic Lerner school of medicine's daily town halls, which have been thoughtful and insightful. As residents, my co-resident were somehow inadvertently added to the call, which I appreciate to some degree. Although most of what they are discussing are medical school matters that do not pertain to me, I wish our GME would do something of the same. It is nice to have someone in charge, in a position of authority speak with confidence and knowledge (they were aware of all the recent drama with early graduations from Columbia, NYU and Einstein College of Medicine).


At some point during the call, they asked for students to record their insights and experiences, and it occurred to me that I have my own platform to be able to do that. This blog has seen my journey through residency training, learning to be a skilled knitter, and now, COVID19.


So, for my own edification and perhaps others, I will return to blogging my experiences again. (I had stopped due to boy drama and just the hectic nature of training.) It does feel good to record my experiences again, and be able to share my personal experience with others. (I suppose this is where legally I state that my experiences and opinions are my own and not reflective of my employers/overlords.)

Yesterday was the first day that I had an actual full schedule of patients. It was a bit hectic, but mostly soul-nourishing to be able to connect with my patients and help them. I still felt a bit limited, since I longed to reach out and be able to actually touch my patients, do OMT to help their pain, and comfort them, but I knew that keeping them safe was the best option at this time.

It felt good to reconnect my identity as a physician and do actual good work. In the last couple of weeks, there were so many things cancelled (board exams, conferences, trips), that it was good finally to have a schedule again, if only for a day.

Later in the day, I had a patient come in (the "essential visits" includes a clause for severe symptoms, and the patient had severe pain). We were able to do an injection for his shoulder, and I was glad we were able to help him. But it certainly made me nervous and anxious that I had to clean myself obsessively afterwards so that I didn't bring anything back with me to my apartment building. After seeing this picture of myself, I put hand sanitizer all around my neck and upper chest before I left for the day. While I don't suspect him to have COVID19, it was still a way to help me feel less exposed and hopefully prevent me from bringing more germs home.

My bosses are asking me if I would be willing to sign up for screening COVID patients or working in the inpatient wards if they need more people. I said yes. I want to help. But I am also terrified. It has been over a year since I've worked the inpatient wards. I don't want to mess anything up. I'm grateful that I've been doing boards studying, which has been helping me to refresh my memory, but I am still mostly an outpatient provider. I don't know how much good I will do, but I am willing to try. This is the life that I signed up for, to make a difference, one patient at a time, using my skills and knowledge. I am scared to catch COVID19. I am scared that I will transmit the disease to my loved ones or those that I don't know. I am scared that I will not be able to take care of patients to the best of my ability, or be a liability to my team. But I know that I can continue. I will do better than the average person on the street. I have been trained, these last 4 years, to do good, to work in many different high stress environments. This is my final exam. This is our collective exam, our graduating class of 2020. We came in epically, a group of fresh, wide-eyed, bushy-tailed interns, ready to tackle the challenges of residency. We bonded over late nights, challenging patients, the pager that  just.won't.stop.ringing, those 4AM calls about normal potassiums and sepsis alerts that were 6 hours old. We supported each other through patient deaths, injust blame, and our own personal lives: marriages, pregnancies, births,  illnesses, family member illnesses and deaths, and so much more. We've learned and grown up together, and transitioned into confident physicians.

I don't know what the future will hold. I don't know what the next day, week, or month may hold. But I know that I am resilient, agile, and strong. That is how I was trained. We'll see what the days ahead shall bring. 



Random Aside Bonus: Paying it Back

November has started, and with it, my month of Pediatric ER at one of the other community hospitals. It is one of the larger hospitals in the system, and one of the only hospitals with a pediatric ER. I was very nervous when I started, because I thought I wouldn't know anything, and be in the staff's way the entire time, but to my surprise, I have learned something in the last year and a half, and I find myself with at least half a clue about the assessment and plan of most patients. Sometimes, it is only one-fourth of a clue. Sometimes, especially on musculoskeletal issues, I know more than the attendings do.

Every shift seems to have a theme, and today's was psych day.  Every child seemed to come in with some sort of psychiatric complaint.  Each of the attendings and PAs had at least one psych case to deal with, and now it was my turn. The patient was in his late teens and had been brought to the ED by his frantic mother because his high school counselor stated that he had suicidal ideations. When I saw the patient initially, he refused to talk. Every question was a one-word answer. Finally, I politely asked his mother to step out of the room, and suddenly, the words started pouring out. His parents wanted him to pursue a field he hated, but they would be the ones paying his tuition. He didn't want to disappoint them, but he couldn't imagine a life stuck in middle management in a white collar job.
His peers at school hated him for being weird. His teachers didn't like him because he didn't pay attention. High school was "a prison" to which he was forced to endure on a daily basis 5 days out of the week. He wanted something more, something different, but there seemed to be no way out.

I saw this patient, and in him, I saw 15-year-old me. I didn't fit in and I had few friends.My low self-esteem was reinforced by the fact that I was almost never invited to outings or gatherings.  I thought that my parents hated me and I hated them. I wanted to escape from parents' goals and aspirations, and I wanted to be a success without their input. High school was one of the most dreaded times of my life. And yet, ten years later, here I was. Face to face with the ghost of Christmas Past.

Today, I was able to tell this boy-man that he will be okay. That this agony will pass, and one day, he will be happy. That high school sucks, but it is better on the other side. I looked him in the eyes, as I wished some adult would have done with me, and told him that he was worthy and that he would eventually be able to become the person he wants to be. It won't be easy, but with enough hard work and determination, he will eventually escape from the darkness and depression and find his way to the light. Find people who will like him for who he is, and be amazed at the talents he brings.

 This patient was one of too many to count today that I saw during this shift, but it may be the one that matters most. The long nights of work and study, the anxiety of exams and practicals were all towards this goal. To reach people who really need it, and offer an hand towards recovery.

This is why I am a doctor.

September: Allergy/Immunology, Adventures in Research, and a Sick Day

Hey guys! This post took a really long time to write and polish, but I felt like it addressed some important issues. Sorry for the delay! October post coming up soon! 


It's late September. I'm at home taking the first sick day I can actually ever remember since middle school, and contemplating life. I've been such a go-getting, get things done person, that even on the days I feel bad, I get up and do the best I can. I don't want to inconvenience other people. I want to make sure I am getting my job done.

But this morning, as I coughed my way through eating breakfast and getting ready for the day, I realized that going to work was a really bad idea. For one, coughing hard enough to make myself dizzy and give myself nosebleeds was a really bad sign. For another, I could barely remember the phone number for our office (which usually I can rattle off the top of my head with no problem), and I just plain felt bad. It was time to stop.

 I felt absolute guilty for calling so last minute and canceling. I imagined my patients already there, waiting for me and not being able to see me. I imagined my poor coworker, having to see all of his patients and all of my patients. It would be insanity.

But I couldn't see straight enough to walk across my living room, much less walk down the stairs, drive to work, walk across the parking lot, into the building, up 5 flights of stairs, and into the madhouse that our clinic usually becomes. I just couldn't.

So, on a perfectly sunny Thursday, 15 minutes before I was supposed to start clinic, already dressed in my work clothes and white coat, I called in sick for the first time in my adult life. It was painful. It was guilt-ridden. It was glorious.

As residents, and especially as health care workers, we are told that our job is essential. We must show up to work every day, and we must do our job well. Do not be late. Do not take unnecessary time off. Do not inconvenience others. These mantras are ingrained into our minds as students, and continue for the rest of our lives. One of the popular medical blogs, KevinMD, has published several articles recounting this particular dilemma. It is inconvenient to our schedules, the patients, the medical staff, and our fellow residents and physicians if we have to call in sick. Many times, there are horror stories of physicians who were ill and were required to work as well as many examples of physicians who work through illnesses , whether their own, or those of their loved ones "by choice" as the alternative would be more inconvenient to their patients and coworkers.

In one of the above articles, the internal medicine physician whose children are ill mentions that the patient she discharged for bronchitis asked for a work note and "a few days off", and the physician was envious. I often thought the same thing when I saw my patients in the clinic, who have guaranteed vacation time, a regular 40 hour work week, and guaranteed sick days. But then again, we as medical professionals did enter into this strange dichotomy somewhat by choice. We wanted to become physicians, to help others with the knowledge and skill that we have attained after sacrificing our youth, energy, and sleep. But we are not always able to take care of ourselves.

After reading the countless horror stories of medical professionals forced to work, I am ever-so-grateful to our changing times and modern GME requirements. I am grateful to the culture of my program and the understanding program directors and GME coordinator, who all supported my decision to stay home, and called me to make sure I was okay. I was able to catch up on well-needed rest (after coughing all day), and was able to return to work the next day, still hoarse, but no longer dizzy.

Adventures in Research

To graduate from residency, I am required to complete two research projects, one of which must be a quality improvement project. As I am in the second year of the four year residency, it was time to start getting my feet wet. Our hospital, and the programs associated, are not known for its medical research culture. In fact, our first day of orientation as interns, we were advised by the grants coordinator (the closest thing we had to a research coordinator), that we were better off  "tagging on to someone else's research" than starting our own, and "just get your name on a paper" so that we could "get it done and over with." It was quite discouraging. As we are a community-based hospital, I knew that we weren't going to be in research mecca, but it would have been nice to have a little bit more guidance. Thank goodness, I am on Allergy/Immunology this month, and the program director there was starting a module-based program to educate osteopathic physicians on medical research. Thus, my afternoons and nights have been filled with watching research videos and taking copious notes, and plotting for research. It has been tedious, and difficult, and my knitting has suffered, but hopefully worth everything in the end.

Allergy and Immunology
Allergy and immunology has been the most interesting month so far. It is such a sub-specialty field that I felt quite out of my depth when I first arrived. All of the patients we were seeing were patients that I had only read about in my textbooks and told that "most likely, you will never see one of these patients in person". But Di-George, Common Variable Immunodeficiency, B-Cell Lymphoma, were patients that the fellows no longer even batted an eyelash at. They were the "run-of-the-mill" patients. It was bizarre. Gradually, though, I learned what they were looking for, and how I could contribute. The physicians were great at diagnosis, but awful at doing osteopathic exams on their patients. Every chance I had, I would treat the patients with OMT, which increased the reimbursement that the physicians could charge for.

<Knitting content>
There isn't much knitting content this month, as I was gearing up towards getting my IRB completed and because I was getting ready for my friend Liz's wedding. I did finish up some baby sweaters in preparation for my friend Laura's twins. I will be carpooling with Laura on the way to New York, so I wanted to give them something.

That's quite a bit more exposition than normal, but hopefully more knitting content next post! Spoiler: I am going to Rhinebeck!

August: Pediatrics, FDM, and knitting!

It's August! I'm officially a second year for a month! Hallelujah!

Really, though, not much has changed. I still rotate every month through different rotations. I still see clinic patients (though now, I see them every 40 minutes instead of every hour, and I 'm in a constant struggle to get faster), and I have to take house call every 6th week.

This month, I was in outpatient pediatrics, with a community provider's office that was recently acquired by the mega-conglomerate. The physicians in the office were mostly transitioned but occasionally struggled with some of the transitions that were now enforced with the new management. It was definitely an interesting process to watch. With my transition away from hospital/residency medicine to outpatient, community-based medicine, it was a bit difficult at first to revert back to a shadowing role. I was no longer the main decision maker in the process, and for much of the rotation, I didn't feel like I even had much of a voice at all. I did not want to anger or embarrass the physician I was rotating with, so I often had to spend more time with my mouth shut and staring at the floor if I did not agree with the physician's conclusions. Most of the time, though, it was fascinating to see how his management different drastically from that of our "in the trenches" comprehensive care we provide to our patients.

The physician's patient population were a mix of white suburban, well-to-do families with money to spare on summer trips (Myrtle Beach, Hilton Head, etc), who were mostly here for well-child exams,  juxtapositioned with young ethnic mothers on Medicaid with new babies in tow for newborn exams. It was boring and fascinatin
g at the same time. I had a good time learning from the first week or so, but the monotony of the same questions (5 fruits and veggies a day? 4 servings of dairy? less than 2 hours of TV?), and the stark contrast to my own patient population ( mostly urban, elderly African Americans) seemed to mock the necessity of this rotation. At the same time, I was fascinated by how the physician I was following maintained his relationship with his patients. Sometimes, he was a father, scolding them for not doing this or that. Sometimes, he was a guidance counselor, gently shepherding the lost sheep towards his goal. Sometimes, he just nodded, disapproval in his eyes, and used his "you are an idiot but I am going to be nice to you" voice in order to avoid conflict. There is so much psychology to be learned in the art of clinical medicine. I may not have learned as much pediatrics as I would have liked during this visit, but I certainly have gained insight into the nuanced skills necessary to gain the respect of patients and keep them coming back.

FDM: Fascial Distortion Model
To some in the osteopathic world, FDM is the epitome of everything they railed against. It uses excessive force to achieve its goal. Its modalities cause patients pain while they are utilized, and patients will be sore, bruised, and limp home with a packet of ice and strict instructions not to use heating pads.At the same time, it is one of the best modalities for treating weird spots that are nagging, painful, and just won't resolve. In spite of my reservations, I attended the weekend course for FDM, and found it to be immensely helpful.

Other life news

I got to go home for a few days at the end of July/early August because my brother was on break. It was so nice to go home, get to eat good Chinese food again, and to see my family!
-> Vegas, as usual, the only place where ringing slot machines are the soundtrack to your arrival

I also visited my friends Marlie and Al in mid-August, and played with their dog and the dog they were petsitting

Knitting content: 

I'm finally finishing up my sweaters! I participated in the sweater knit along hosted by the Grocery Girls, and it was so much fun that I decided I wanted to finish up some of the other sweaters in my queue. I am still working on finishing the button band on my Calligraphy Cardigan, which I am making wider than the pattern calls for because it seemed to be more flattering for my body shape.

I finally finished my Drachenfels shawl, which I bought the yarn for in early November last year when I was in Grand Rapids, Michigan for an audition rotation. Through the last year, it's been a nice reminder of that crazy time, the wonderful people at Michigan Fibre Studio, and the crazy chain-smoking AirBNB that I lived in while I auditioned.

In addition, since I've been at the pediatrician's office, I've been knitting at lunch and during my downtime. It has been helpful to keep me from going crazy with the monotony of the day. I've been knitting on socks as well as on my Bifrost scarf from Infinite Twist

I bought yarn for a Faded shawl, but I haven't decided which one to make yet. Yes, I have also succumbed to the faded trend by Andrea Mowry. It is just so tempting! 

On the plus side, I did discover a really nice restaurant next to the office which offers "express lunch", which means they give you soup, salad, and a sandwich for a set price, brought to the table within 10 minutes of you sitting down, or it is free. It has been so nice to have that resource so that I don't have to resort to the fast food restaurants down the street.

All the ramblings I can think of at the moment. ~Z

It's May!

As I started this month, I thought a lot about countdowns. The countdown to my vacations. The countdown to the end of Intern year. And the countdown to finishing this ridiculously hard and yet, at then end of it, extremely educational stretch of 13 days without break. I know that many of my friends and fellow residents have worked much more than that, and maybe I am making a bigger deal of it than it needs to be, but it is actually spelled out in our duty hours requirements that we should only work 80 hours per week (I worked 83) and that we should be relieved to have mandatory day off every 6 days that we work. But reality and requirements are not often the same thing, and reality was that someone needed to be on call and work night shifts and weekends while my fellow residents took care of babies, attended weddings, worked on their marriages, and attended conferences. I cover for them, just as they will cover for me when I go to China to see my grandmother, and take care of her in the precious time that we have together.

I'm back on internal medicine this month, which means managed insanity. Insane schedules, insane work hours, and insanely noncompliant patients. While I completely understand autonomy for the patient, I am also somewhat perplexed sometimes why patients who refuse all medical care come to the ER and want to be admitted to the hospital. There are cheaper ways of obtaining 3 meals a day and an air conditioned room with crappy television service.

Knitting has been interesting, as I start working on the Fairy Hill Shawl!

I'm excitedly waiting for my beads to arrive. I have the perfect yarn that I bought at Stitches Midwest 2016 last summer, from Dramatic Knits, in their Cherry Blossom Colorway. It screams spring in the most polite manner, and will be elegantly paired with citron colored beads. It will be the perfect thing to work on during the long plane rides, though at the same time, perhaps sleep deprivation is leading me to insanity, as the thought of hundreds of tiny beads scattering throughout a trans-Pacific airliner jet when we hit turbulence sickens me to my stomach.  Stayed tuned!