One challenge at a time...

It's only been a couple of weeks since returning to work from my short break, and already the intensity and the stress of working in the ER is hitting me.

It's been amazingly busy in the ER lately, at both hospitals where I work. I think that's the expected flow of things in the winter months, particularly at the new year, when doctors are often away, flu bug hits, and patients travel and pick up new diseases.

It's been disheartening and often very discouraging, when I'm already maxed out in my mental abilities, working non stop as fast as I can to move from one patient to the next, while making sure I take my appropriate time and attention with each patient to make them feel like they got their fair share of my care, and to make sure I don't make mistakes or overlook anything in the midst of all this chaos. But the waiting room keeps piling up, and I keep falling behind, and they keep coming. And keep coming. And coming...

This made me think of one of the more favorite movies I watched recently, Matt Damon's the Martian. In the movie Matt's character got stranded on Mars and had to engineer his way to survival and to a eventual unlikely rescue. He encountered endless bad breaks, each one seems insurmountable, but yet he motored through, created a solution, and lived on. Towards the end of the movie he became a professor and answered a question from a student of how he got through his predicament. His answer was, "just focus on solving one problem at a time."

When the world seems crumbling towards you, if you start looking at all of the problems that are coming, you will feel defeated, you will feel there is no way out.

One problem at a time. That's all you can focus on. That is the only solution. Do each problem justice, focus, treat it as the only problem of concern right now, deal with it fully, then move on. That is all you can do. That is the only way to hack away at it.

It's a difficult but high level task to master. As a ER physician, part of your job is to maintain control of your department and manage resources, beds, nursing efforts, and patient flow accordingly. Never must you lost touch with the current activities and demands of your department. It is much like a general in battle. You job is to maintain a pulse on all corners, and be the first to know what to do to keep the department afloat. Having said that, you never lose sight of your primarily obligations, and that is your patients, each and every one of them, when they are sitting before you. In that moment, you learn to shut it all out, even for 5 minutes, and make them feel like it's just you and them then. You give them all of your attention, you try to think of what it is best for them. You deal with their problem.

One problem at a time.

Yesterday I had a very difficult shift. Because I was sick. I couldn't sleep the night before. I woke up with chills and rigors and vomited and almost fainted during my morning shower. I thought about not going in but by that point it was impossible to get a last minute replacement on an early Saturday morning shift. I took 5 minutes to down some warm fluids and half a cup of greek yoguart. Then drove on to work. I thought about the day ahead of me. It felt taunting.

Then I remembered Matt Damon's Martian. One problem at a time. At this point, my first problem is getting to work on time, and arriving safely.

45 minutes later, I arrived at the parking lot of my hospital. I gave a sigh of relieve. First job done. I'm here. On time. I can do this.

I walked in, asked my nurse for an anti-emetic for myself, then picked up my first chart.

I got through the day. Focusing on one patient at a time. Luckily the department was manageable. And I think I did a good job with them all yesterday. I was so relieved when my shift was over. I was so exhausted. But I got through it. Thinking about the Martian.

Today I'm off. Just woke up from a 12-hour sleep. I'm feeling better. Hopefully this will past swiftly before my next shift tomorrow.

One problem at a time.

Anger. Hatred. Resentment. Belief systems.

All irrational mindsets that are deeply rooted in all this.

How we respond will further define this vicious cycle.

But how do we respond? As an international community. As nations. As communities. As individuals.

France has vocalized this was an act of war. Ironic since war is precisely what they want. Is war ever the answer? Or does war only creates more anger, hatred, resentment. And when has war not created a power vacumn that bred more evil?

But. Is diplomacy ever possible with irrational minds? You cannot argue against another's belief system. Especially when it is so deeply rooted that they are ready or seek, to die, from it. If perspectives are different, there is no meaningful conversations.

Can anger ever be contained? Don't think so. Not when technologies and information exchange created a world with no boundaries. Not when the risk of lone wolf outliers further threatens the lack of predictability when they may not even adhere to the mandates of the central organization.  Not when the thread is irrational.

So how do we respond.

As usual, there probably is no single optimal answer.

There is likely some grounds for continued containment. To limit their resource. To limit proliferation of their extreme ideals. But to think they can be extinguished is likely naive.

There is likely some grounds for diplomacy, even if only to achieve an ongoing presence of international pressure against such thread. Form some form of unity. Better information sharing and security efforts could probably lead to, well, more security.

And there is probably grounds to continue to breed tolerance and compassion, to diffuse further anger, hatred, resentment. Continue to learn about our differences. Continue to find similarities.

At times like this, the natural reaction is an instantaneous radial aggressive angry response. It is probably better to carefully evaluate the options and potential implications. Answering anger with anger never works. When has that argument ever turned into a productive resolution?

This is an opportunity to grow closer as a people. Thread will always be among us. I see that all the time in my work. Most of it is unpredictable and irrational. Be vigilant. Form effective safety nets and protective mechanisms. Seek and diffuse potential threads. Show compassion and care.

And carry on.

Never sit on an opportunity to express myself or to show others what I am capable of.

Otherwise the next day days will just be filled with regrets of missed opportunities.

Don't have to be rude about. But also no need to be too polite. Maintain respect, but seize the chance if it's there for you.

Doors don't open by themselves.

Resist the urge to sit back especially in the midst of a downward spiraling mood.

Stand up and sing. Take the ball to the net and take the shot. Speak up. Call for the puck.

Nobody will thank you for being a bystanders.

Winners are not made that way.

Never sit on an opportunity to express myself. To show others what I am good at.

Otherwise, people will never know.

And what good is that?

I passed.

I didn't expect the results for perhaps another week. I was expecting the worse, actually. I wasn't a very pleasant exam. I didn't feel that it tested the knowledge and clinical skills we worked so hard to get. I was more flustered at whether I had interpreted their questions properly or whether I gave them the very answers their templates wanted me to give. I had never felt this poorly after an exam before. After the morning of the first part of the exam, I walked out feeling stunned. I'm sure I looked pale and ghostly. I wanted to cry. Christine kept asking me if I was ok. I didn't even care to look at her and answer her. I was sure I had failed it. I would be "the one" who failed it from our school in something like 10 years. After that terrible weekend, I was ready to accept the embarrassment, and had resolved to letting whatever happens happens. I'd be okay, I told myself. I have many options going forward. I'll just live with the shame for a  little while. Then it'll all be gone. And we'll live. Whatever happens.

So this morning when I saw my friends posting their happy news on facebook, I sat there, cereal in hand, wondering if this should be the moment that I meet my fate. I took a deep breath, thought to myself 'what the heck, might as well let it be', then opened the email link...

Whew. What a relief.

Is it joy? Is it excitement? Not really. It was very anti-climatic. I texted my family. Texted a few friends. Posted it on my facebook religiously as we are expected to do so with other major milestones of our lives. And waited for the congratulatory statements to flow in. Great. Now the world knows. I'm officially a certified Emergency Physician.

That last statement took some time for me to absorb. In fact that moment had hit me that morning when I prepared to leave for my flight to Toronto for my exam. Certified Emergency Physician. Seemed a tall order and actually took more a lot longer than expected to get here. I took many detours, many of which my own doing, for I had other ideas in life, other career paths at various points, other desire than medicine alone. But it's always been a floating target. I remember some of the most impressive teachers I've had when I was a medical student were Emergency Physician. As biased as it sounds, ER docs really are some of the most highly trained, knowledgable docs who really are expected to be able to do anything on the fly. Now in reality, they are really not that spectacular, and sometimes relies very heavily on good support from other colleagues and consultants. But from a skill set they are really the most comprehensive. When I was a medical student, I look to the core skill contents of the ER docs to be the set of skills that I must obtain to make a competent doctor. It took so many years to try to acquire those knowledge and skills, and I don't even feel I'm really there yet. But being board certified is a marker of at least getting there on the most basic level. It gives me a certain level of credibility, even though the exam itself really don't mean much of anything. But it's a symbol. There after many years of trying to get there, I think from a credentials point of view it means I have finally gotten here.

So now what? Well it really doesn't change anything. I've already started working in the ED since July. All this means is that I don't have to face the embarrassing possibility of having to tell my department that I had failed the exam and they have to reschedule all my shifts. As for what it means for my future, I haven't decided that either. I'm still trying to find a comfortable balance in where I'd like to work, what type of practice I want to be in, whether I want to keep some clinics going, and what else in my life I want to be thriving for going forward.

But one thing is more clear. I want to get back to my own life a little bit. After years of pondering my medical career, and a year of intense studying and residency work, I feel like I've really left myself behind. Sometimes when I come back to my empty apartment after a series of shifts, I'm not really sure what I want to do with my time anymore. All my hobbies had been set aside. My natural curiosity in anything other than medicine has been smothered. It's so easy to go from day to day just carrying out my work and errands in a robotic manner. My soul hasn't grew much the last few years. I haven't evolved much as a person. I've been lacking a lot in time for self-reflection.

Which is why I'm back here, on my blog. My last entry was almost 5 years ago, about the time when I first finished my Family Medicine residency. I'm not even sure if I'd be publishing my blog online at this moment. But I wanted to write. Writing makes me self reflects. Writing triggers my emotional self and allows me to dig back into my values a little bit. Writing makes me feel more in touch with myself again. It brings my world back to me, through my own eyes, my own mind. Keeps me in control a little better in a life (and now a career) with very fast moving parts.

Hope I can keep this up. Hope this keeps me up.

Newleaf. Now officially Newleaf, CCFP (EM).

Enough already.

Enough already.

All these years I've learned to view life with a critical eye. It's served me well. I'm great at identifying problem areas that can often lead to solutions. But when it's my own life, I'm been identifying too many problems and haven't yet discovered too many solutions...

Perhaps being naturally critical is becoming a major downfall. I have yet to learn to count my blessings and enjoy life a little.

I should be glad. I should be thankful.

If I learn to just stay positive in life, I might find there to be not as many issues that require fixing, or that, even if I choose to fix so many issues, they can be fixed more enjoyably.

I am rather glad, actually, of what I have become. I just need to learn to be prouder.

I'm mighty thankful to be in a job where my natural curiosities carries me through my tasks. I'm forced to read and learn things I would happily enjoy learning anyways. I get to be extremely practical in my work. My knowledge applies to all my surroundings. I have worked for years for a set of skills that has enabled me to handle almost any health question with an approach. And I am mightily thankful to have achieved that.

I am thankful my work doesn't kill me. I have a rather routine schedule, extreme flexibility, and can choose to work as hard or as little as I feel like. I make enjoy to make life comfortable, and enough to allow myself to be generous to the people around me whom I am so indebted to.

I am fortunate have so much opportunities to spend quality time with family at an age when we are all young enough to enjoy each others' craziness. Trips, home rennovations, goofing around. I'm lucky my work has not taken me away from them, allowing me to cherish every moment of every day with them.

I should feel good about what lies ahead. I am in a lucky position that allows me to give as much of myself as I wish into my career. There will be opportunities for furthering career aspirations, and I already have a great job to fall back on. It doesn't matter which decision were correct, or which future decisions is the best. All options have the positives and negatives, but I will always hold the control in the kind of work I wish to do. Finding the positives in whatever I am doing will always yield a happier process. And as we all already know, the secret to happiness is to enjoy the process of life, not the destination.

Acceptance, Arrival, and Perseveration

I've inherited a lot of good things from my parents, one of which is the spirit of persistence and the believe that, with enough will and creativity, one can always find ways to get what he wants in the end.

I've lived that spirit for much my adult life and opened my doors to my future.

And then I take that spirit many steps too far, and all my doors are closing because of it.

My perseverance has became a stubbornness, one that I had not learned to shake for many years.

I have yet to learn, that in many facets of life, one does not always get what he wants.

And that is often harder if one does not even know what he wants.

I refuse to settle, but by doing so I also refuse to settle my dreams.

I let them evolve, let them transform according to my day to day inclinations, until they lose their original form and I start to wonder when I will recognize them again.

I refuse to accept my new found reality, because I felt I am still searching for my bearings. But I kept switching targets.

Arrival. I have not yet felt I have arrived at the place I set out to go so many years ago when I set on this long and trying pursuit.

Arrival cannot happen if I keep changing the destinations.

Does one ever arrive? Does arrival mean settling for the reality, when reality rarely matches the dreams.

Or is it simply acceptance. Accept one's place in this world, where I am now and what I have destined to become, and accept it with pride for what it stands for and embrace.

I have not yet learned to accept. I question what I am capable of, if I only keep pushing.

But by refusing to accept, and not feeling I have arrived have left me empty inside. I am slowly wasting away my youth, my opportunities, my time.

Instead I forget to celebrate what I have been given. The knowledge. The responsibilities. The securities. The possibilities.

And instead I tend to focus on my envies. I perseverates, on my many brief moments of envies that would take hold of me for days, and I let them sway my intentions.

I live my life by trying to cherish little moments, but it is these moments that are eating me up. I let them dominate my thoughts. I let them question who I am. I let them change my course.

I have not learned the concept of "make the most of my current situations". Instead, I keep trying to redefine my situation.

What is most important to me today? What shall I embrace? A good friend once reminded me to ask myself.

I kinda know the answer, but I'm not sure which are my true values, and which are my aspirations generated by moments of envy.

Stop looking for my arrival.

Accept what I have been given. It's impossible to know if past decisions were right or wrong.

Make the most of my situation. Accept that some options may not exist.

Remember my blessings.

Is this a sabbatical?

On a curvy little side road, onto a stretch of modest old houses situated behind the popular hiking destinations, the Chiefs, I found the address to the place I were to stay in for the next two weeks while I embark on some extra Emergency Medicine training here in Squamish.

Greeting me was an early-40-something Asian women with various tattoos and crocked teeth, but with a certain native American appeal crossed with the new-age organic-food-eating microwave-hating lifestyle. She works as a mountain-biking and white-water kayaking instructor, and has recently rebuild her own home from the foundation upwards and is the in midst of picking up a new B&B career by herself. Her room was beautifully cozy on the inside, but needs a lot of work on the outside (she has the only unpaved driveway on the street). Inside, she has a brand new gormet kitchen with stainless steel appliances but no microwave. The living room has stacks and stacks of DVDs but no cable. She used to live in the city, including growing up in Kerrisdale and then spending time in Kits followed by Commerical area. But eventually she found it too appealing to live the simple outdoor life here in Squamish and hasn't been back for years.

I tucked back out to hit the town for some necessities. Then moved my stuff in, took a nice shower in her new bathroom, and settled at the table with my macbook and some warm comfort food that my Mom has prepared earlier today (reheating it was tricky). I look around, I guess this is what I need. After months of studying for exams and then working lots and then fuzzing over the rennovations of the new house, it's good to be tucked into a quiet place somewhere and just focus on less things. Here, I need to learn some new skills in Emergency Medicine to allow me to practice confidently in the rural. I can practice a little guitar and go bike riding. I can reconnect with some friends whom I've been neglecting with all the life distractions. I can pick up a book and try to read again.

It'll be nice. Of course I'm only here for 2 weeks this time, plus I plan to go back this weekend. So all this simplicity wouldn't last very long.