Oh callouses my callouses...

Short, stubby, fingers.

Why can't you guys spread more easily?

Reach, strain, cramps...

Am I giving myself arthritis by doing this?

I have the worst possible hands for trying to learn the guitar.

At work I use size 6.5 gloves. They are frequently too small for some rooms to even stock them. Most docs look at me and wonder why I have such small hands.

I can barely get them to spread along the guitar neck...

Plus the steel strings. Oh those fine, hard, steel strings.

I wish my callouses would heal over faster so that I can keep practicing.

Why can't I get any better?

Fun Food Blog: Modern Club Teppanaki Restaurant

I always thought it was gone forever.

Probably more than 10 years ago, my old buddy Andy took me to this cozy little teppanaki restaurant on Dunbar to ty their Okonomiyaki, the only place in Vancouver to have these. For those who haven't tried it, Okonomiyaki is a version of the traditional Japanese "pancake" from Osaka, made with a mixture of cabbage and various veggies with various meats held together by a light egg batter and grilled on the hotplate. It's as much fun watching them make it as it is to eat it, and I guarantee your clothing will smell smoky afterwards. It unique and delicious. Somehow, I managed to forget both the name and location of the restaurant, and even though I've ventured around Dunbar numerous times, it never actually stood out enough for me to find it again. Eventually, I thought it had closed and forever left Vancouver and its lingering tastebugs...

Then a few weeks ago I spoke to an Uncle who knew that area well, and he told me that the place never left. I was so excited. I had to take my parents there. Finally!



We went on my birthday. It was as great as it was ten years ago. I'm not sure if the owners are the same, but their crafts was just as perfect. We tried two versions of the pancakes, one with grilled soba noodles and one without. I highly recommended getting one with mixed meats and prawns. As for the noodles, they are a nice touch but make it much more filling.

If you ever go, try to also try another version that they got, which is the pancake made not with cabbage but with green onions and mushrooms. We were too filled to try it, but it looked amazing.

I loved that this restaurant stayed open all these years. I hope that it will never close. It's the perfect setting for a nice interesting evening with unique food that you don't always get elsewhere. I love these little home-style restaurants. It's like travelling without having to pack your bags. Highly recommended.

On the other side of the table

Today I had the pleasure of being one of the interviewers for this year's candidates for family medicine residency for UBC. It's funny. I hardly felt qualified to interview these people. Firstly I never matched directly to this specialty. Secondly I think there are so many more truly devoted students out there who wish to be family doctors I felt odd that I play a part at deciding their career fates. Nonetheless, it sure was interesting being on the other side of the room being the one asking the, unfortunately, often ridiculously predictable questions. However, I love interviews, and I think it's a very precise art to perfect. From today, I've learn a couple of things that I think is true in interviews that I want to remember for when I go for interviews myself in the future. I thought I'll write them out to share. It might be helpful to some who is preparing for interviews. Others might disgree with me, but here's my take on some things to consider.

5 things I learned today when I was interviewing that might be useful to remember:

1. Make yourself memorable. I don't remember most of what each candidate said today in their answers, but I remember who made me felt they were truly passionate about something. If you think an answer is likely to be common (ie. choosing family medicine because diversity, get to do everything, continuity of care, blah...), then it's probably been said a thousand times. It does not pay to then say it one more time - it will only make me lose interest. Instead, make your answer personal. Tell me just one experience or event that shows me this job is right for you. It doesn't have to blow me away. It just has to be fresh, and I'll remember you.

2. Relax your body. I'll remember less about your words than how you look. And by that I don't mean your appearance, but instead your body language. I'll remember if you were a log, or if you were truly passionate about your answers. I'll remember if you lean forward suggesting that you were tense, or if you were too laid back as if you're so confident you didn't prepare yourself even just a little. I'll remember if you were so anxious you spoke a mile a minute, or if you were so slow that both of us almost fell asleep.

3. Be genuine but not forced. The best conversations are with people who are relaxed, genuine, and natural. Those mood makes almost everything click. If you're at ease, your interviewer is at ease, and all the better. I tend to remember, somewhat negatively, all those who were too pumped, too enthusiastic, too jittery, too confident, or too guarded.

4. Speak to be heard. Your answers are only valuable if they are digested by the interviewer. It's not enough simply to have said it out loud. If the interviewer doesn't look convinced, perhaps you need to take a different angle. The best candidates were the ones who engaged me in their answers. Often just by slowing down, letting the interviewer take in just part of the answer before going on, does wonders to maintain my attention.

5. You don't have to win me over. You just have to not mess it up. If you're plesant, natural, and genuinely identified that this job is right for you, then usually the feeling is pretty good on both sides. One or two candidates might have won me over, but more of them risked trying too hard and ended up looking worse. It's just like making a friend. If you felt like you've made a friend at the end of the interview, you've probably done pretty well.

Dis the season to be crying.

What is it about me and bad outcomes right before christmas time?

Three years ago, as a 4th year medical student in Toronto, I was part of a vascular surgery team that lost a patient on the operating table right before the joyous holiday season. The family was devastated. The surgeon, who looked so unflappable just hours before, looked so distraught I wondered if he could get over it dispite all his experience. I, naturally, wondered perpetually whether my involvement had any intricate ties to the bad outcome.

Last year, I was again on a medial team that had to deal with the tragic passing of a 1-day old newborn. It took me probably months to stop questioning every involvement I had with that case and I tried to learn from what lessons I developed from that experience to this day. That family, however, I'm sure, would be devastated for years to come.

Then yesterday, again as we stepped into the month of December, I was again intimately involved with the sudden passing of who would have been a "previously healthy female" patient. She crashed right in our emerg, and a 30-minute code couldn't bring her back. The exact cause was still uncertain, but could well have been an aortic dissection which has the potential to kill rapidly. I was the resident on the case. I don't know if I couldn't have done anything differently to prevent her death. I will probably never know. The family may even refuse an autopsy. Nothing will bring her back, however.

I don't think I am a bad doctor. I try my best with every patient and try not to ever miss anything, although that is becoming increasingly difficult as I find myself struggling with being thorough, being thoughtful, and being time-efficient. I know I did not rush yesterday. I felt I mentally covered all angles. I could always have done better on my assessment and management. That always ring true with every single bad outcome you evaluate. There was always something more I should have, could have, would have done.

Nothing could ease how terrible I felt when I had to walk into the room full of shocked family and relatives and reharsh the events that led to their loved one's surprised passing. Most of them were too shocked for questions. I would have been too shocked to answer them.

Yet another family is ruined this christmas. I don't know if other trainees are involved with bad outcomes as much as I seem to have been. Or maybe I just talk about them more. I didn't cry this time around. I felt empty inside. The sad thing was this had happened quite early on my shift. I still had hours of emerg medicine to do. I took a washroom break, shooked off my nerves, and picked up the next chart. Thank goodness it wasn't another chest pain case. I couldn't handle two in a row.

After I came home, I logged on facebook, and saw postings from my friends about their otherwise "normal" days. I thought to myself. It would be nice if having a 'bad day at work' doesn't mean someone had just died on your watch. It would be nice to not have to worry about whether your next day could be 'another bad day'. It would be nice to just go, do your thing, and come home, and that any potential imperfections do not cost lives.

But then that's all about being a doctor, I guess.

With great power comes great responsibilities. Yeah I quote from Spiderman. But it's simple enough and it's true.

The Elephant In the Room

Hey look, there's the big elephant!

Oh yeah, I've seen it lurking around for some time now.

Great, yeah I find it quite annoying.

Turning chaos into something...

Another Thursday afternoon. Another battle.

I'm really not taking a liking to my new clinic...

It's chaotic. Period. My preceptor is chaotic. The setting is chaotic. The files are chaotic. The patients....

Well I guess the patients are always right.

... hardly...

Immediately after I showed up at the clinic, before I even put down my bag and my coat, Boss went, "oh, you're here. I didn't know you were coming. Here, see Eric over there".

... did I walked into an Emerg? Although it really felt that way.

And then of course the first patient was classic.

42 yo. Diabetic. Upper respiratory tract infection. Likely viral. Too late for Tamiflu. But not doing so well. Thought I would do a CXR to make sure no secondary infection.

"You want me to do an X-Ray??? I'm too tired to go!! Can't go today!!"

Ok. Do it tomorrow then. Go home and rest.

"What? There's nothing you can do for me now? I'm so ill!!"

No. It's viral. Go home and rest. Do the xray and if it's positive we'll talk. See me again in a few days to see how you're doing.

"Why did I come all the way here today? You can't do anything for me!!"

Great way to start the afternoon. Next time I'll remember the magic pill that everyone wants. Everyone just wants a quick fix.

Just another day in the battle field. Actually, it's a good training ground.

Patients come in all shapes and sizes.

They have all kinds of expectations and demands.

Some realistic. Some unreasonable.

But they all have to be met.

The trick in family medicine, and they don't teach you this in textbooks, is to somehow, in what little time you have, find a way to satisfy all your patients.

Make all of them leave happy. Leave satisfied. That it was worth it for them to have made the trip here, waited for you, and wasted almost an entire day for your opinion.

I have to make that opinion worthwhile, no matter how trivial it seems.

That is what I have to learn now.

Integrity

I remember when we first interviewed for medical school, one classic example of the type of questions you get asked during the interviews was this:

"Please define integrity."

What a bunch of crap. I thought at the time. How pretentious a question.

But today, while being bombarded by patients at my first day at my new family medicine preceptor's office, I understood why that question was asked.

You need integrity to do your job as a doctor.

After months at the educational-focused Oak Street Family Medicine clinic and two months in the leisurely Salmon Arm medical clinic, I started the last-leg of my family practice residency training at a busy semi-Asian high paced family practice office. Compared to what I had seen before, it was a gong-show.

Between an anxious Chinese Mom who kept asking about her son's cough and fever, two elderly chinese folks who kept telling me their histories into separate ears simultaneously, an over-zealous patient who kept asking me about every one of his blood test numbers, and a whole host of unhappy patients who had waited too long, felt too neglected, grumpy about the weather, and generally unimpressed about seeing a resident and not their beloved doctor, I had no time to think. Moreover, I knew nothing about each patient, the chart was all hand-written in what looked like foreign languages, and we were at least an hour behind.

I rushed. I omitted things. I cut corners to catch up.

And then I remembered, I cannot do this. I am their doctor today. They waited long but they endured to see a doctor. I must do due diligence to each one even if it means making others wait a little longer. I cannot be pressured by patients, by parents, by anyone to do any less of a job than I would in a more perfect setting. Yes it isn't ideal, but the medical care that they should get here should be no different than any other clinic I had been in.

Integrity is to hold your own in the presence of immense external or environmental pressure to do otherwise.

Today I finally learned it.