A Secretly Learned Skill

One skill that most physicians are probably good at is compartmentalization. There's virtually no way that you can make it through residency and have a life as an Attending if you don't know how to compartmentalize. There's also no such thing as letting personal life affect your work. Take a day off because you're having a bad day? Ha, that's laughable. Or worse, take a day off because a close family member is in the hospital? Again, damn near impossible.

My whole life I've been extremely good at compartmentalizing feelings and this has gone to another level while as a resident. You learn to shove aside all your feelings while working. You put on a happy face in front of every parent and child. You answer question after question with a smile and then end with "Do you have any other questions?" It's a never ending cycle. You don't even know you're compartmentalizing until a specific trigger later brings out all the emotions you unknowingly kept behind a closed door.

This morning I woke up to a devastating text message from my dad. My grandma suffered from a major stroke and is now unable to move the entire left side of her body. Did I have time to call my dad and clarify what happened? No, because I had to dash to the hospital to preround and then round on my patients. Every rare free second I got, I texted my dad back to ask what happened, what was going on now, what was the next step. I texted my sister to talk about what happened, why things didn't go a certain way. All while furiously prerounding and jotting down numbers, labs, and coming up with plans for each patient. I rounded like a champ, kept up a smiling face while I explained the plan to parents sitting next to their child. I put in my first UVC line like a boss, no adjustments needed after the chest x-ray was taken to confirm proper placement. I had lunch with another physician and chatted like nothing was wrong. Grandma had a stroke? Well, at this moment in time, let's pretend that never happened.

You go about your daily life compartmentalizing every aspect of your life. Personal life goes into one box. Medicine goes into another box. Research, another box. Errands, another box. Social life is, but of course, yet another box.

I love my career with all my heart but I don't love learning to be very good at compartmentalizing. Things that should bother me, don't appear to bother me at all when I'm working. I'm happy to be at work, happy to be a doctor. Until that something or someone triggers my memory again and forces me to bring out what I had already separated into it's own special little box. Then the emotions begin. And when it starts, it floods. And there's nothing you can do about it except figure out how you're going to show up at work again the next day with that happy face, ready to preround, and round, and answer questions.

To a New Year

2016 was a whirlwind. I graduated from medical school and finally achieved my dream of becoming a Pediatrician, something that I've been working towards for the last 10 or more years. I traveled to new countries in Singapore and Malaysia and saw amazing sights and beautiful views. I finally let go of someone who previously meant a lot to me and decided that it was okay to move on and be happy without him. I matched into one of the best Children's Hospital Residency programs in the nation and with that, my eyes opened up to the struggles of both physicians and patients. 2016 was full of new experiences. No regrets.

For 2017, my new year's resolution is to be better at expressing my emotions. Too often I hide what I'm truly feeling and in the end, I hurt myself and I hurt others. I want to share more of myself from now on.

Happy New Years. To 2017.

Delicious food from Pingtung!

One of the best things about living in Pingtung is that the cost of food has not increased dramatically like in Taipei where a lot of food these days is actually quite comparable to the costs in the United States. Prices in Pingtung is usually half the cost of food in Taipei! Example, a grilled corn on the cob 烤玉米 costs NT40 ($1.25) in Pingtung whereas in Taipei, it costs NT100 ($3.10)!! And let me tell you, the corn doesn't taste any better in Taipei!

My southern Taiwan trips always include Pingtung, Kaohsiung, and Tainan (3 homes to some of the best food ever)

Here's a brief snapshot of some of the food I ate during my stay in Pingtung and Kaohsiung on this trip!

Mango is probably my favorite fruit in the whole world! Taiwan grows different varieties of mango and the one I ate above are green mangoes 青芒果. It is seasoned with a little bit of salt and it's good to eat! Crunchy, slightly sour, with a little bit of sweetness, it's the perfect in between meal snack.

No trip to Taiwan is complete without some very traditional 燒餅油條加豆漿 or "Fried dough wrapped in a clay oven roll dipped into soymilk". I honestly had no idea how to translate this into English so had to rely on a quick Google search. When we eat this in Pingtung, we don't go to the famous chain store called Yonghe. You have to get an order at your local food stall for freshness and authenticity!

This is one of my favorite after meal sweet desserts! Dou Hua 豆花, loosely translated to sweet tofu pudding, can be mixed with so many different toppings. The most common ones are peanut, tapioca pearls - like this one, and jelly pieces. The tofu can also be flavored like strawberry or chocolate, but the original flavor seen above is by far my favorite! Once you pick your tofu flavor and toppings, it is then topped with a sweet and light ginger sugar syrup which can be cold or hot depending on the season. Since it's summer, I got a cup of cold dou hua with pearls!

THIS is the ULTIMATE Taiwanese snack. Popcorn chicken or Xian Su Ji 鹹酥雞. This is from a local favorite night market stall of my cousin's and once I had my first taste during a previous visit to Pingtung, I was hooked too. This stall lets you combine chicken with several other fry-able items depending on what you're in the mood for. We always add pig's blood 豬血糕 (sounds gross I know but it's SO SO good) and tempura 甜不辣 to our chicken. What's great about this stall is that they fry your order right in front of you with some green onions and season it perfectly!! The result is HOT, CRISPY chicken + HOT, CRISPY anything else you chose to add to it. 

Teppanyaki or Tie Ban Shou 鐵板燒 is a popular meal in Taiwan during lunch or dinner. We went to a newly opened Teppanyaki restaurant in Pingtung where my skirt steak with noodles lunch costs a grand total of NT120 (only $4!!). Not only that but the restaurant also provides unlimited cold black tea, corn soup, crispy bread, and ice cream for dessert. So worth it!

Mille crepe cakes are my favorite cakes that aren't ice cream based. My cousin took me to a cafe in Kaohsiung where they are known for their mille crepe cakes! I was shocked after one bite because the cakes here are made unbelievably well, nearly comparable to the famous Lady M. I also had a direct comparison because I had Lady M on my trip to Singapore about 1 week after I tried this cafe! While Lady M only has two flavors of mille crepe cakes, green tea and original, this cafe also includes other flavors like black sesame (above), chestnut, and strawberry. Each slice only costs NT120 ($4!!) compared to $9-$10 at Lady M! 

I had another ridiculously good dinner at this restaurant which specializes in fried pork cutlets. I never know why but the fried pork cutlets in Taiwan always tastes a gazillion times better than in the U.S. The way they bread and fry the pork is super different to make it so delicious here. I added daikon over my meat for some added zing. Served alongside the main dish were rice, 蒸蛋, miso soup and the dessert seen below!  

 

Dessert included an apple vinegar smoothie which was so refreshing and black sesame ice cream!

After we came back from the bridge in my last post, we had lunch at a soup dumpling place (not called Din Tai Feng). We grabbed a couple of light snacks while we waited for the main meal to arrive. Seen above are cold noodles, tofu bites, broccoli, green beans, and taro.

This familiar dish is something that most everyone likes. Shao mai 燒賣 is a Hong Kong based dim sum dish made from delicate dumpling wrappers stuffed with pork and shrimp on the inside. This particular one also had a little bit of a ham topping on the top.

My favorite soup dumplings Xiao Long Bao 小籠包! These are not AS good as Din Tai Feng but were really very good still and had plenty of hot soup inside which is so gratifying to drink with the rest of the soup dumpling.

A zoomed in shot of a perfect little soup dumpling sitting in a bath of soy sauce and vinegar. MMM MMM DELICIOUS!

And my ULTIMATE dessert in the hot summers of Taiwan....MANGO SNOW SHAVED ICE topped with CONDENSED MILK. The mangoes from Taiwan are the sweetest, juiciest mangoes that I have ever eaten and the snow shaved ice is literally the finest, softest shaved ice ever. Of course, no shaved ice is complete without condensed milk, basically pure saturated fat so super unhealthy, but it's okay every once in awhile! (or so I tell myself...)

Roaming Around Pingtung Part 2

One of the recent new attractions in Pingtung is the Liu Li Diao Qiao 琉璃吊橋 loosely translated to the Glass Bridge. It opened in December 2015 in the Sandimen area of Pingtung and since its opening it has been met with an overload of people flooding the bridge on weekends. The bridge has a glass surface and is now Taiwan's longest suspension bridge! It's located 15 stories up from the ground and spans across the Ailiao River below. The bridge has a maximum capacity of holding 100 people at once and when it initially opened, visitors were allowed to go back and forth on the bridge. However, because there were so many visitors, now they only allow you to walk one way across the bridge and you have to take a bus that drives you back to the parking lot on the other side of the mountain where you started.

After making one trip up Sandimen mountain on a weekend and seeing the LONG line of people waiting for the bus, we knew that there must still be a ton of people waiting to get on the bridge on the other side of the mountain. It was incredibly hot that day so even though I really wanted to go on the bridge, I knew I would melt waiting under the sun. But of course I still wanted to go so my cousin was nice enough to take a day off work and drive us up the mountain so that we could walk across the bridge! It was the best decision ever to go on a weekday because even though there were still a number of people trickling across the bridge, it was nothing like the crowds on the weekends. We parked and got our tickets in less than 5 minutes and were on the bridge quickly! Despite the sun, heat, and sweat, I had a ton of fun on the bridge!

The beginning of the bridge walk

Family pic. Photo cred to my cousin! You can see him right behind me in the picture above!

There's not that much underneath the bridge, mostly a small stream with mud and cement surrounding it

Hats off to making it to the other side of the bridge under the HOT sun. I rewarded myself with a cold watermelon juice once I made it across!

Roaming Around Pingtung Part 1

Pingtung County is a place where I have so many memories. It's a place where I spent many months while growing up. Pingtung is located in southern Taiwan and encompasses the southern tip of the country. In recent years it's become much more of a tourist attraction not only because of the Kenting Area but also because people are now finally realizing the amazing views and scenery that Pingtung has to offer with its beautiful hills and luscious green mountains. I've been fortunate enough to travel around Pingtung a lot ever since I was young because of how familiar my cousins and family are with the region. On top if of all, I've been super lucky to eat all the great food from Pingtung and enjoy how cheap everything is here compared to the country's capital of Taipei where prices are now often inflated 2-3 times.

Egg crepe with corn 玉米蛋餅 - This is pretty much my go to Taiwanese breakfast. It's so simple to make but for some reason, you just can't buy and make it as well in the United States. The crepe is crispy on the outside and so chewy!  

Welcoming 2016 at Pingtung City Zhongshan Park 屏東市中山公園

For lunch, we drove up Sandimen Mountain 三地門 and ate at Ju Gao Restaurant 巨高風味餐廳. The restaurant is located at the highest peak of the mountain and everyone eats outdoors so that you can enjoy the green scenery while eating. Today was pretty hazy so we weren't able to see very far!

One of my favorite dishes at the restaurant is called 五更腸旺 Wu Geng Chang Wang. The sauce is made from a combination of garlic, chilies, ginger, pickled cabbage and probably a bunch of other things and the main ingredients are actually large intestine and duck blood. It understandably sounds crazy but it's super delicious over rice!

We also went to a Coffee & Chocolate Farm in Neipu 內舖, Pingtung 屏東. It's location is pretty remote, in the countryside near National Pingtung University of Science & Technology or 屏科 for short.

The seating area of the cafe is outdoors and you can see the large cocoa fruits that are being harvested. At first I thought that it was just for decoration because it's so colorful but it turned out to be real!

AMAZING, delicious semi-sweet dark chocolate truffles made in house!!

My cutie niece having a lot of fun rearranging the bears on the forks

My cutie nephew loves taking pictures on our phones!

Dried pineapple fruit plus super flavorful and aromatic cocoa tea, both also made in house!

Pre-Residency Trip to Taiwan!

After finishing up my last rotation ever as a medical student, I flew back to Taiwan for a quick trip. Lucky for me, my parents are always up for upgrading our plane tickets if at all possible, especially for a long 13 to 14 hour plane ride as is the case from SF to Taipei.

On the menu....

Can't forget the ice cream on board!

It's pretty crazy how my energy level is these days especially when I look back and remember that I used to be able to not sleep the entire overnight plane ride to Taiwan, land at 5 to 6 am local time, and then have enough energy to last the entire day in Taiwan before going to bed at 9 pm. That's me not sleeping for 36 to 48 hours!! Oh, those were the good middle school and high school days. Now, that's certainly not the case anymore. As soon as I finished eating the late night dinner, I completely zonked out for nearly 7 hours.

A cool little travel pack

Sleep time...

After I woke up I decided to watch Spectre 007 on my tv screen (another big and positive change to flying) followed up by another 1 hour nap. Spectre was good although I wouldn't say it's one of the better James Bond movies. After waking up, I watched Big Hero 6 while eating the morning breakfast meal. Practically everyone had told me that Big Hero 6 was a really good movie and so many little kids have seen it that I felt that it was about time to catch up with the times and watch it for myself. I must say...I teared up quite a few times during the movie, basically because of Tadashi!! Anyway, solid cartoon movie and one of the better recent ones!

Finally, after eating and another 40 minute nap, we arrived! Even though I slept close to 9 hours on a 13 hour flight, I still felt exhausted!! Seriously getting old, sigh.

Spotted the giant Taiwanese flag as the plane was pulling in

Welcome to Taiwan!

We left Taoyuan International Airport and took a quick bus ride to the Taoyuan High Speed Rail Station where I grabbed some 7-eleven food. Taiwan is known for its amazing convenience store food and atmosphere. Whether its 7-eleven, Family Mart, OK, or Hi-Life, all the convenience stores here never let me down. An interesting fact is that Taiwan has the world's highest density of convenience stores per person, with a rough estimate of 1 store per 2,500 people. It's pretty common to see multiple convenience stores on one corner of the street here.

A korean BBQ + kimchi onigiri (NT28) and garlic spicy cold noodles (NT39) from 7-eleven translates to just about $2 in American money and a very, very full Evie. Solid food.

Once the high speed rail train arrived, we took it all the way to the last stop, 左營 Zuoying, which is in 高雄Kaohsiung. My cousin picked us up and we drove back home to 屏東Pingdong! All this and it wasn't even noon yet!

Rotation #7 Diamond Headache Clinic

During the past two weeks I finished the last of M4 year with a short rotation at the Diamond Headache Clinic. The clinic treats many patients whose headaches are refractory. Many of them have already been seen by several doctors including going through their primary doctors then various neurologists before arriving at the clinic here in Chicago. A good number of patients that I saw travel from all over the United States, some even from other countries to be treated here. Many patients make multiple trips to Chicago every year to be seen. Not only is there a clinic but the Attendings here can directly admit their patients to the Headache Unit which takes up the entire 9th floor at St. Joseph's Hospital.

There are several different types of primary headache diagnosis. The four that I saw the most included 1) Migraines 2) Clusters 3) Tension and 4) New daily persistent headaches. Although the age range of patients that come to the clinic is incredibly wide, I was mostly interested in those in the younger age group. Most of those in this group, between the ages of 11-24, were newly diagnosed with new daily persistent headaches which is commonly caused by EBV, the Epstein Barr virus.

What I found so amazing was that patients had suffered from headaches for so long prior to presenting here and with their debilitating headaches, there were often a multitude of psychiatric diagnosis that were associated. The most common were depression and anxiety, but a couple of patients also had bipolar, chronic fatigue syndrome, fibromyalgia, and various other pain syndromes. It's no wonder that most patients, especially those that were over 40, were on over ten different medications including antidepressants, antianxiolytics, antipsychotics, antiseizure meds, antiinflammatories, and about 3-4 different pain meds. This does not even include medications most older patients were taking for relatively common diseases such as hypertension, hyperlipidemia, and diabetes. The amount of medication management required for these patients is a complete art alone and it was crazy to watch my Attendings run through the list for each patient on every visit.

Those with chronic headaches tended to also have depression as a diagnosis as well and it reminded me how interrelated neurology, pain management, and psychiatry truly is. It's so connected that it's difficult to treat one without dipping into the realm of the other two.

On a side note, recently, I also had an interesting conversation with my sister regarding euthanasia and physician assisted suicide. Then I happened to run across a video posted by the Economist on YouTube. It's a short documentary called 24 & Ready To Die and it explores euthanasia in Belgium which has one of the world's most liberal physician assisted suicide programs. Very very touching and an extremely well done video.