"Are you as peaceful as you appear to be?"

This question was asked of me yesterday night. It was the most loaded question I've been asked. Add in the fact that a complete stranger posed the query and you've got a Kirsten ruminating on it every free moment. 

First, a quick catch-up. Surgery went well in that I survived, got along well with everybody, and did what they needed me to do. Surgery did not go well in that I didn't get to spend nearly as much time in the OR as I wanted to. I was only able to assist on two cases. Both in the middle of the night during a call shift. As you may know, I love surgery, specifically being in the OR. It's a great way to shut off the personality part of my brain, and turn on the "mechanic" in me. In med school, I was told by surgeons and internists that I'd make a great surgeon because I can be cool-headed, calculated, and succinct. Of course, I was also told by family physicians and patients that I'd make a great family doc because I'm charming, disarming, and articulate. From all that, I figured that meant I'm adaptable to what individuals need and respond to best. Regardless, surgery was my second in line to family medicine. So my lack of OR time pissed me off, and I tactfully expressed my disappointment in my official evaluation of the service. The day after I submitted my eval, I received an email from my program coordinator asking if she could share my eval with faculty as it was definitive proof that the surgery service wasn't meeting the requirements of our residency. This was then followed up with a class meeting with our entire faculty to hash out what the future of the surgery rotation would be in our program. Who knew I could be such a shit stirrer? 

After surgery, we had a week-long conference where I was able to see old preceptors, learn new guidelines, and catch up on sleep. I had at least one night when I slept 12 hours solid. After the conference, I started an elective at a community health clinic that serves marginalized populations. Twice a week, I would work in the transgender clinic and the other days were a mix of general practice and addiction medicine. I chose this elective specifically to learn about transgender and addiction medicine and I was not disappointed. The doctors there are amazing, proficient, professional, and personable in a way that gains the trust of the patient which is so important given that you're serving someone who has been disregarded and stigmatized by the large majority (regardless of how liberal or progressive the Lower Mainland is).

Maybe it was due to being in the elective that when I was surprisingly asked to return to my old home church in North Delta to lead music at an event, that I felt inspired to recruit a team consisting of those disconnected from the church as well, the somewhat forgotten. It was also an opportunity to catch up with women whom I dearly love but haven't been able to see with any regularity. All were women that I'd played/sang with before, but never all of them together at the same time. Gathering for practice and the event was a wonderful experience that reminded me of how awesome they are as individuals, added with the joy of witnessing them discover the awesomeness in each other. I love my friends, but there are few things that make my heart warm as much as seeing a friend discover the greatness in my other friend. It reminds me of the time my Island family got to know Genny and how happy I was to see them appreciate the same things I love about her, and vice versa. These women have such full tender hearts that have embraced me in my vulnerable moments and their candor in return has always been unprovoked and therefore truly cherished. I cannot think of a time when I've had a conversation with any of them and been left in wanting or feeling like they were guarded. When we sat down after playing our last song at the end of an evening filled with belly, eye-watering laughs around our table, I shared a moment with one of my dear friends that consisted of a look of bittersweet recognition that our souls had been filled by this adventure but longed for it to last beyond that night. It's those moments when I wish I could throw off all my responsibilities and simply be with them, to rest and soak in the goodness and not worry about the rest of the world. But life is hard and full of "stuff" and we leave with the best intentions of carrying on some of the magic we had the privilege to create. 

The event officially ended and as I tore down the sound equipment, I took notice of an older woman with a labored gait winding her way through the emptying tables toward the stage where I was wrapping cords. She signaled toward me, and I made my way down the stairs to meet her on the floor. 

"Are you as peaceful as you appear to be?"
"Wow, that is a great question!"
"I ask because as I was watching you on stage tonight, you seemed so peaceful and it moved me." tears forming in her eyes "I appreciated what you said tonight and wanted to at least talk to you" (despite being recruited to just provide musical entertainment - I made some comments pertaining to God seeing our inherent worth and being redeemable as we are despite being so broken)

"Well thank you for the kind words. My name is Kirsten"

We exchanged names, she introduced me to her daughter, and then we hugged. 

Am I as peaceful as I appear to be? The short answer is no. The long answer is yes. In the narrow mind existence, I carry anxiety. Heck, the band spent 10 minutes in a private room deep breathing and praying away our nerves before the event started. Nerves not about our ability to sing or play well, but nerves about the people we'd see and the probing personal questions we'd face during the interactive times. I was nervous for myself and for my band mates. I was far from peaceful in preparing for this event. In the day to day of practicing medicine, when I'm faced with a problem I haven't got the slightest clue as to what's going on and the patients ask, I have to overcome an intense anxiety in order to muster the words "I don't know". I'm told it'll get easier, and patients will appreciate the honesty, but it feels like I have to summit a surprisingly high ego mountain every time. 

In the big picture existence, I am at peace and can confidently say I've been that way for years. I've always known I can hold my future with open hands while still tenaciously pursuing goals. I've said for a while that I know wherever I end up, it will be where God can use me the most and thus where I will be the most joyful. I do struggle with uncertain waiting periods and so admittedly, this year was incredibly reassuring that medicine is where I will most likely be. But should my career end tomorrow, I can move on knowing I didn't waste my time. I know I have dedicated a substantial amount of energy into people and being something good in their lives. People who I've mentored in church and now people through medicine. While the transition of focus is taking some time to get used to, given the necessity of sterility in medicine (can't evangelize due to ethical reasons), the conviction still remains. And yes, it has been a frustrating confusing process of trying to figure out how to maintain my integrity as a Christian in my residency, I'm happy that it's still something I've deemed worthy to work on. I know I've been stagnant in my faith and the motivation to dig into the Word is hard to come by, but I'm at peace knowing my foundation is solid and subsequently, so is my future.

A wake-up call

With a vacation followed by 4 weeks of "cushy" rotations, on paper, it would have been reasonable to expect a refreshed Kirsten typing this post. Unfortunately, life had some very different plans. I did escape to Whistler for a long weekend during my vacation so I had some thorough "me time". Then I started my elective at InspireHealth and life got busy.

InspireHealth is a non-profit supportive cancer care organization funded by donations and the BC Ministry of Health. Given that cancer is so prevalent, it was upsetting to realize that most people hadn't heard of InspireHealth. They are staffed with GPs, nutritionists, dieticians, exercise therapists, clinical counselors, and volunteers who are incredibly competent and empathetic in the best way possible. I attended their LIFE program as part of my orientation. It was incredibly humbling during the introductions to witness the vulnerabilities and anxieties of patients and their friends/family. By the time it was my turn, tears were rolling down my cheek as I expressed my sincere guilt of being there as an observer, hoping that I will learn something and not take their candor for granted. It was a two day orientation discussing overall health, practicing meditation and mindfulness (I had to mindfully eat a raisin and that was the most unique form of torture I've ever been through), learning about healthy eating, exercising, and communication. I was able to bond with these amazing people, exchange hugs, and dole out some witty one-liners to bring gut laughter and smiles to their faces. At the end of the 2-day orientation, many people expressed their gratitude that I was there so that I could understand their journey and be empathetic to other patients in my future practice. I hope I can be the family doctor they wish they had. 

Given the nature of the work, it was a very emotionally charged elective and on my 2nd full day of work, I got a call. Out of respect for involved parties' privacy, I'm going to be vague. What preceded the call were emails and texts of updates, itineraries, and prayer requests. What followed the call was a sleepless night of texts and calls back and forth for updates and coordinating efforts. I had to take the afternoon off work the next day as I was wiped, but also to attend to matters. After that, every day was work and texting for updates, and most free hours after work were spent with them or thinking about them. Altogether, the crisis lasted just over 4 weeks and I wore myself thin physically, mentally, emotionally. It seeped into everything. The tears came easy at work and the blessing is that I was working in a place where emotions were welcomed and without divulging my burdens, I was allowed to cry with cancer patients and have it be okay. It was a bit of a relief, but evidently not enough. One Thursday afternoon at my family clinic in North Van, I hoped the reprieve from cancer care would be good for the mind. Little did I know that I'd be proven wrong with my first patient, a woman with persistent back pain, whom I had absolutely no empathy for. I felt rage and restlessness brewing in me as I listened to her words but took no meaning from them. Aware of my rising heart rate and heat in my face, I quickly excused myself. My preceptor, who happened to be in the hallway outside the room, looked at me, and immediately took me to an empty room. 
"What's wrong?"
"I don't know...I can't seem to care the least bit for my patient. I know it's not her. It's me and I don't know what to do about it." 
I can't say I remember what happened the rest of the day. I know my preceptor finished the encounter with my patient, and I know I left a couple hours early without saying goodbye. I was so uncharacteristically me that day and it was the biggest wake-up call that my personal life can kill my professional life. 

Again, by the grace of God, I have a loving preceptor who is incredibly attentive. She emailed me the next day asking if I was okay (since I left while she was seeing a patient - I literally didn't say goodbye in any shape or form). I apologized and fessed up to the fact that I simply wasn't in the right frame of mind or being to be of any use, or anything positive. She was understanding and encouraged me to rest up as best as possible.

Now, the crisis is over. The dust has settled. And my "cushy" 4 weeks ends today. Tomorrow, I start my two-week Surgery rotation which has call every other day and a reputation to eat up IMGs with fury (they've already given one of our classmates a failing grade, meaning they'll need to repeat their Surgery rotation. The CMGs remain unscathed). I loved surgery in Chicago in med school, but I'm getting the impression that this will be very different. 

That being said, the timing of everything is uncanny. If this crisis had to happen, it happened at the right time and ended at the right time too. If I was in Surgery while all this was going on, I'd be fucked. So I'm very grateful for the timing. And with that gratitude is also the awareness that I have a lot to work on in terms of managing my personal life in a way that minimizes detrimental effects on my professional life. I had always thought of the opposite - that of my professional life potentially affecting my personal life in a negative way. Now having seen the terrifying reality of how much a liability my personal life can be to my patients, I have a responsibility to equip myself to avoid such catastrophes. I don't know if typing/talking about it helps enough. I think more needs to be done and I'm going to explore that as best as I can in the busyness of life. We'll see what I come up with.

And IM telling you

With Pediatric clinic in the rear view mirror, it was time to actually work in the hospital as part of the Internal Medicine (IM) team. And boy was the first week a rude awakening. I felt like a med student again - so completely inept to manage my patients, round efficiently on them, and give succinct handover. The plus side is that I'm on a great team consisting of a senior IM resident, an R1 IM, an R1 anesthesiology, myself, and three med students. R1s typically carry ~6 patients. The first days are always the hardest because all your patients are new to you and you're trying to catch up on their story so that you can properly manage them. In doing that, you don't take the time to think about what's actually going on with them or what differential diagnoses are still on the list to be ruled out. The med students only have 2-3 patients. So they have more time to read up and discuss all kinds of zebra diagnoses, which always makes for a great learning experience for all of us. Apparently, I was given a lot of hard cases, but I feel like the other R1's had equally complex patients but were just better equipped to handle them. 

The hours take some getting used to, especially after a couple months of relatively cushy hours. We have morning report at 7:30, but I always want to get to work at least 30 mins early to do a quick check on my patients. Then after morning report, time flies, you forget to eat and pee, and then it's 7pm wondering if your kidneys are ok, let alone your patients. The first two days I didn't leave until after 8. Friday was my first call shift. I got to work Friday at 7am and left shortly after noon on Saturday and got about 3 cumulative hours of sleep. Exhaustion is putting it mildly. 

As the weeks carried on, I got the hang of things and became more proficient at managing my patients. In my 4 weeks in IM, my most memorable patient was a 97 year old woman whom I had discharged after a week's admission. The day I discharged her, I happened to be on call that night. So it was an unfortunate surprise to be consulted on her back in the ER escorted by the executive director of the senior's facility she resides at. With complex patients like these, it's a trying task to discharge them without them bouncing back. You need to stabilize them medically and ensure supports are in place for their transition back home. If something doesn't get settled in time, you're increasing your risk for bounce back. In this case, we had organized home care three times a day and home OT/PT. One thing that was forgotten - calling the facility to let them know the patient would be returning and checking if it was ok. My job is to medically stabilize patients and get them out of the hospital promptly so as to reduce their exposure to hospital acquired infections. But as I said, for patients like her, there are so many other components that I have no part in that can completely derail my plan. I hadn't even dictated her discharge note by the time I re-admitted her in the ER. It resulted in a 4 day admission to coordinate 24 hour home support at her facility. The CNL (Clinical Nurse Leader) of her ward insisted that everything was in place and she could be discharged. Again, medically she was stable so I discharged her again. This time I dictated her and marked it as a priority in case she bounced back again. Low and behold, she was back in the ER the next morning. I nearly spent my entire day coordinating with her family doctor, her case worker, and our transition services team to ensure every last damn thing was in place, transport was arranged, and then I personally called her facility to say she was on her way back. My senior and attending told me I moved mountains that day. I'll take the win, even though it was battle. The next day, my attending told me he enjoyed reading the Part Three of her trilogy of discharge notes. I think it's because he knows exactly the tone that goes with the words on the page. 

There are many things I've learned during this rotation, but one thing that's become glaringly obvious to me is that my confidence is my saving grace, quite nearly to a fault. My demeanour and superior communication skills either disguise or provide the smoke and mirrors to distract from my knowledge gaps. In some ways, it's nice to know that I can charm the pants off anybody (just ask the switchboard lady who immediately changes tone and starts shooting the breeze with me as soon as I say "Hi, it's Dr. Yip..." even though we've never met in person). On the other side, I feel like I'm not meeting the mark in terms of clinical competence and I'm not being called out on it. I don't know if people don't notice, or they like me so much they don't want to confront me. But I have this sinking suspicion that my likability is preventing me from getting the reckoning I need. It's stressful to hear people say "Oh, you're an IMG? You must be pretty remarkable to match here." They're absolutely right. You typically do have to be remarkable academically to match into an IMG position in UBC. I am not being self-deprecating by suggesting I have the lowest test scores out of my entire class. They are woefully mediocre. I know people say that knowledge can be acquired over time and with practice, but social skills are harder to attain and that's why I matched. I have this wealth of what people want their family doc's personality to be, but I have this huge clinical ineptitude and it's really frustrating. 

I recently worked a weekend shift at my family clinic in North Van. My preceptor had two unmatched IMGs working that morning (much like how I worked in Steveston last year). Their job was to alternate observing me interacting with patients because I'm apparently this "amazing" resident per my preceptor. And all they're picking up on is my casual confidence with the patients. They talk about it in a context that seems so odd to me. They say (in broken English) "She is able to meet a patient and be their friend and gather history at the same time. I am nowhere near being able to do that. I have a long ways to go." Hearing this breaks my heart because they're talking about my personality which wasn't something I had to put a lot of work into, but rather came naturally through life experiences/passions, not to mention that English is my first language. It seems unfair to expect an IMG to be able to speak and develop rapport like I do, but it's entirely fair to expect me to be able to know the level of clinical medicine they do and I know that's where I have a long ways to go. The idea of coming out of this residency riding on the coattails of my charm terrifies me. Sure it's great to have a personable doctor, but I'd think you'd want a competent one more.

Thankfully, I was strategic about booking my vacations and am now officially on vacation for 1.5 weeks before I start a 2 week Family Med-Oncology elective. I'm looking forward to sleeping, reading, and working on building up knowledge and breaking down the anxiety of incompetence.

Not this time you filthy monsters!!

First off, I know the photos from past posts are missing. It was the unintentional result of changing my privacy settings. Given the clean slate and since this is a public blog, I'm going to limit the picture content. I have Facebook and Instagram which are only available to those whom I permit and that is where I will post pictures of colleagues.

I'm in a Pediatric clinic in Burnaby this month with Howard, a R1 (first year resident) from the St Paul's Canadian Medical Grad (CMG) class. We carpool when we work the same hours which happens half the time. Howard was raised in Vancouver but went to Western (Ontario) for med school. I'm 5 years older and he has a certain naivete to him. So Amanda and I view him as a little brother type who's still discovering the world.

Amanda and I are the only female CSAs (Canadians who Studied Abroad) in our class. There are 2 male CSAs and then the remaining 9 residents in our class are true international IMGs (International Medical Grads). Our class of 13 is diverse in age (26-50+ years old) and race (Indo-Canadian, Chinese-Canadian, Japanese, Russian, Iranian, Iraqi). Six of us have children. Eight have professionally practiced medicine prior to this residency. It's a mixed bag which makes it hard for us to connect. We're a very unique residency program in that we're the only program in Canada, let alone UBC, that separates the IMGs from the CMGs. All other programs integrate the two groups. The 4 of us CSAs are well aware of the fence we sit on, straddling CMG and IMG identities, but not fully belonging to either.

The Peds clinic I work at only accepts referral and follow-up appointments which I thought meant I'd be exposed to less germs because I wouldn't encounter acutely sick kids. I'm an idiot. Kids are filthy whether they're sick or not. Of course my immune system got overwhelmed during my dreaded 11-day stretch. But then the good Lord gave me an unexpected day of rest. For some reason, there were only two appointments booked for Day 9, so the preceptor had them re-booked because he wouldn't come into the office just to see two kids. I rested up, downed some DayQuil and Buckley's and was back in fighting form the next day. Thank you Jesus! Overall, I'm enjoying my time there and the kids seem to be taking well to me which has me feeling more confident about dealing with them in the future.

My Thursdays at the family clinic in North Van continue to be wonderful experiences. I've been especially enjoying the commute on the crowded bus/seabus listening to all the languages I'm surrounded by. It's music to my ears; a huge reason I love living in Vancouver. I've been able to practice my French and Spanish with some patients and I'm trying to learn some Farsi and Ukranian from my preceptors.

Unfortunately, this love of multiculturalism isn't shared to the extent I'd hoped it would be in our great nation or our southern neighbours. It's easy to pin this on Trump, but as Canadians, we were ignorant to the hate and prejudice that lives in our midst. Trump may have provided the confidence to vocalize their long-held views, but if one can influence another to evil, the same can be said for influencing toward good. I'm happy to see evil called out for what it is, because that's speaking the truth, but the moment I see evil met with violence, I get so frustrated. You lose your moral high ground, your integrity.

Integrity is so important to me. Nothing I say or do holds sway unless I have integrity. If I believe in the power of unconditional sacrificial love, I need to show that to others. But more importantly, when I show hatred or do something morally wrong, I need to own up to it and ensure I don't make the same mistake again. I try my best to understand other's opinions in a nonjudgmental way; to engage in discourse not arguments.

When it comes to my stance on multiculturalism, I first acknowledge that I am a forth generation Chinese-Canadian who grew up on the unceded territory of the Kwantlen, Katzie, and Tsawwassen nations, and have been settling on the unceded territory of the Musqueam, Squamish, and Tsleil-Waututh nations for most of my adult life. I recognize the crimes and injustices my country commits against the Indigenous nations in taking their land, committing genocide, and failing to provide them basic necessities like potable water and many social services that non-Indigenous citizens enjoy. I also call out my province's actions against Chinese, Japanese, and East Indian immigrants when we put a head tax on them, then an immigration ban, and recently made them the face of our most recent Foreign Buyers Tax (even though our government and trade industry were main proponents of foreign investment up until meddlesome millennials complained about their lack of material possessions while they wait for their parents to die so they can continue their lazy spoon-fed existence), put them in internment camps, and turned away the Komagata Maru. Despite these past and present grievances, I love my city, my province, and my country and am happy to call it home and represent its diversity which brought with it new education, art, innovation, and perhaps my favourite - food. 

I know that I am the face of Canada just as much, if not more (more if you're going by generations) than most of my white colleagues. Nonetheless, there's no denying I grew up being told "You're so white" as if it were a compliment analogous to "you're so Canadian". I can assure you, with every "you're so white" quip I get, the mirror reminds me that I'm so not. The complaints about the Chinese "stealing all the homes" and making the city unaffordable, followed quickly with "but I'm not talking about you or your family" remind me that I'm so not white (and that people don't understand how this city became unaffordable). Ladies and gentleman, the Chinese (not just the Yips) have been here for as long as Canada has been in existence. So you can't make an exception for just me and my family. This land was never "white" to begin with and neither was this country. You can tell me how your grandfather came from Europe and worked his ass off to get to where he is and provide for his family as if that's some kind of entitlement for you being able to buy a house in Vancouver, but I'll tell you how my great great grandfather came here well before your grandfather and had to work his ass off to provide for his 23 kids who had to work their asses off because prejudice was a bitch that wouldn't do fair business with Chinese people or let them get higher education, and then their kids had to work their asses off because we still didn't have the right to vote until 1947 (a few years before my parents were born). You want to talk about work? I'll show you generations of work, and I'm still busting my ass to this day because I'm motivated to care for this nation's inhabitants regardless of race, gender, creed or socioeconomic status. And if I settle in Vancouver for good, it's because I worked hard enough to afford it just like the generations before me. Don't you dare think our money materialized out of thin air or through unscrupulous means, that we ever had it easy, or use that faulty logic on any other family you haven't taken the time to know. 

I know where I've come from, how remarkable the journey before me was, how much progress has been made, how I've persevered in my life, and yet I'm still witnessing racism against me and others. It's a sad reality, but I still feel so lucky to confidently claim my Chinese-Canadian heritage, to bring awareness to the mosaic that this country's been claiming to be for decades (without seemingly understanding what that means e.g. this piece of garbage), to advocate for those who are new and working hard just like my great great grandfather. Who am I to say "you don't belong here"? I won the lottery by being born into the family I'm in, especially when you consider that over half the world's population lives in poverty. So yeah, I recognize the despicable history of my country, the fact that some of its citizens still hang onto outdated prejudices against folks like me and my family, but you're damn sure I'm committed to being a great Canadian, to make my life count by living the best way I know how - do justly, love mercy, walk humbly. They won't bring me down, not this time, or the next, or ever.

One month

One month of residency done. Two paychecks in. I've started using a budget sheet and scheduled a meeting with a financial advisor. It's nice to be able to develop a strategy to get out of my massive student debt. 

One month of residency done. Hours of bike riding in. My pants tell me my thighs, ass, and lower back are getting bigger while I will them to get their act together because I hate shopping. It's nice to have a healthy body.

One month of residency done. Many new acquaintances in. My closest classmate is Amanda who is from Richmond and also went to a Caribbean med school (the only other female Canadian who studied abroad in our class of 13). It's nice to have a confidante to text with daily.

One month of residency done. Ten days at the North Vancouver family med clinic in . My preceptor loves me, some patients have asked if I am accepting patients, and the MOAs (Medical Office Assistants - they are not just secretaries) were surprised this was my first month of residency because my confidence made them think I was at least a 2nd year. It's nice to have an ego boost before the grind really starts kicking in.

One month of residency done. All Wednesday night dinners with Grandma in. I'm happy I've still been able to make these dinners happen, even though I know that won't be the case soon. It's nice to have that routine with her and I hope to continue to prioritize seeing her weekly (my apartment is a 10 minute walk away from hers).

One month of residency done. Zero small group meetings and three Sunday services in. My church tells me I'm missed and I miss them too. It's nice to maintain connections as best I can, but I will need to find a small group that meets on a different day as Thursdays will always be out of the running. It's also nice to be able to tithe financially again.

One month of residency done. Two new movies, one new album, and a handful of catch-up dates in. My schedule allowed me to see The Big Sick (with Deen) and Spider-man (with Kurtis), give the new HAIM album a solid thumbs up, and consume much food with other lovely people. I was even able to take in Canada Day festivities and see one of my favourite local bands Hey Ocean! in concert followed by Sam Roberts. It's nice to still have a social life and keep up my hobbies and interests.

One month of residency done. Next month is Pediatric clinic in Burnaby, with Thursdays at my family med clinic in North Van. I have an 11-day span without a day off, and that should be interesting. It's nice that I won't have to work nights or be on call for the month. 

One month of residency done. I'm looking forward to developing a routine, to meeting more people, to learning and solidifying skills, to maintaining my integrity and continuing to live life confidently.

One month of residency done. I still find myself surprised that I'm here with each reminder that I've made it despite the odds being against me. I hope to never take this gift for granted.

 

Resiliency, Wellness, and what happens when you have none

We've completed orientation and today marks our first official day of residency, as July 1st has marked the occasion for decades. For all the Canadian IMGs, orientation was a redundant 2 weeks of being constantly told that it's okay to say "I don't know" and to ask questions and to take care of yourself throughout residency. It's a cultural mentality we're familiar with in Canada. I'm sure some IMGs appreciated knowing they're supported in that aspect of their lives and it's encouraging to see UBC be a leader in terms of providing many resources for residents to develop resilience and cultivate overall wellness. 

Unfortunately, residents (and med students) have some awful stats when it comes to depression, anxiety, and suicide. In some ways, it's to be expected given the rigor and pressure that comes with the "noble" profession. The truth is we're human and some of us aren't able to cope well, or we think we should be mentally stronger than the average person. If everything works as expected, your colleagues will look out for you, help you get the help you need, and you heal. If everything works as intended, your destructive path is stopped because there's a community of people supporting you all along the way. In the end, you learn life skills to help you function and recognize when you're not at your best. But everything doesn't always work out the way we want, or there are decisions made that make the difference between helping a colleague find healing and removing that colleague entirely from the supportive community.

As excited as I am to start my residency, it was beyond heartbreaking to learn that a Ross grad was the gunman in the fatal shooting that took place at Bronx-Lebanon Hospital yesterday. I was at Bronx-Leb in Oct 2015 for my Family Med Sub-internship. Both hospitals I worked at in New York City (Bronx-Leb and Brookdale) are in low socioeconomic status areas, where every orientation involves an active shooter safety video. We weren't shocked by the videos because we knew we were in a high crime zone. What's shocking about this shooting is that it was a doctor; someone who at some point in his life served to preserve and respect the dignity of human life. This is very rare. So this hurts for all of us physicians, all IMGs, all Rossies - the entire medical community. My heart goes to the colleagues I have there, especially to the Ross residents and students who were present during the shooting. (Note: I will not give names or say if I know any involved persons because that is not important. This is personal regardless of how many people I know.)

Over the next few days, news outlets will try their best to inform the public as to who this doctor is, which in most cases results in outcry against many things. After that, they'll probably cover gun control, hospital security, immigrants who fail to "assimilate", whether IMGs are good for the country, and perhaps a brief glaze over mental health. He will be painted as a troubled man. "Disgruntled" will be used multiple times. How people/companies react to this portrayal is where the harm/benefit factor really comes in for me. 

There will be people who say, "He never should have been hired in the first place! That would have prevented this whole thing!". These are typically the same people who support the knee-jerk reaction to terminate employees after they've committed a certain offense. A non-fatal example would be the firing of Ian Power and his producer from CKNW following an interview where Power made racially insensitive comments. Many were in favour of the radio network's swift decision. Interestingly enough, the interviewee, Denise Balkissoon, who was on the receiving end of Mr. Power's comments thought the network handled the situation poorly. She would have preferred that Power and his producer go through a cultural sensitivity seminar to educate and help them re-evaluate their views regarding multiculturalism and subsequently be able to communicate the importance of that process through their jobs. She didn't want them to be fired. She wanted to have productive conversations with them so that understanding and growth could be had. She wanted healing. Instead, you're left with two people with deep wounds not only by being cut from the company, but now with the stigma from the reasons why and not having that opportunity to reconcile. Will they actually change their views or just keep quiet about their views at future jobs and harbour bitter resentment? 

It's this area where the strategy veers way off course. We stress resiliency and wellness and say we're here to support you through everything...unless you're caught doing/saying something racist or sexist or some other outward manifestation of inner thought processes deemed inappropriate. Am I the only one seeing the disconnect here? How can we say we'll help you address depression, anxiety, and other mental health issues, but then show you the door with other thought/mental processes/issues. It sends a mixed message. Imagine that that happened to you. Would it not feel like the rug has been taken out from underneath you by the same people who are there to help you find your footing in the first place? How could you not be angry and distrusting? I admit that some people may never change despite how many times you try to help them, but they're an exception. 

I don't know what interventions, if any, took place with the intent to help this doctor develop professionalism during med school or his time at Bronx-Leb. From what I've read and interviews I've seen, people are quick to label him as "crazy" and "belligerent". Most telling is a quote provided by law enforcement who say the doctor yelled "Why didn't you help me when I was getting in trouble?" at another doctor whom he then tried to shoot. A literal cry for help. He knew he needed help, and knew he didn't get it. The powers that be thought they were reducing harm by cutting him off from the Bronx-Leb community. How tragic that it ultimately resulted in multiple deaths, critical and stable victims, and thousands of emotionally wounded. 

This speaks to influence and the magnitude it has for good or bad. We're quick to think little of ourselves in terms of having an influence. We think only the great or the horrible can leave a legacy - just the extremes, not the in-betweens. Well tell your bruised ego to fuck off. You don't have to aim for the stars when you're being purposeful in life. Sometimes you just have to be there and that's enough. Maybe you'll impact thousands or hundreds or dozens or a handful, it doesn't matter. It's not zero, and it's not a competition. Be something good in this world not for the reputation, but because you want be something good in this world. It's as simple as that. Showing love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self-control from a simple smile, or a text, or not saying anything - you have no idea what level of influence it'll have. Don't focus on that. Just think of the good you want to do, and then act on it.

Welcome to The Ross-ident Years

Yup, I'm back. Some asked if I'd ever return. Part of me felt that chapter of documenting my life was over. Much like my breaks in med school, I stopped blogging and reconnected through in person dates. Because I had the luxury of time, there were large gaps between catching up with people resulting in relaxed relationships which took some getting used to (given the history of cramming dates during breaks and being heavily involved in people's lives through volunteering prior med school). It's nice to be able to say that I love people but don't need to see them every week or month even if I'm able to. So this is what normal adult friendships are like? The extra "me time" has been wonderful.

In my free time I got back into music, playing drums, guitar, bass, and I read a lot of books. Some mixed non-fiction (e.g. The Vagina Monologues, Persepolis), but mostly medically related non-fiction. I've come to enjoy Atul Gawande and recommend "Being Mortal", "Complications", and "Better". The latter affirmed my decision to return to the blog. In his afterword, Gawande recommends Writing as one of things to do to be "better". One reason being that it allows you to step back from the mental and physical fatigue of practicing medicine

So I'm back, but make no promises with regard to regular posting. It will happen when I want to. It will be less about the day-to-day life and more about processing thoughts and experiences during residency. 

Oh right, I matched into UBC's Family Med Program at St. Paul's Hospital. Back in med school, I said that matching back home in the Lower Mainland would be the ultimate dream, but matching anywhere in Canada would be like winning the lottery. It's crazy to realize I matched into a program I thought was the furthest thing from possible.

Last summer while gearing up for the residency application cycle, I had the strangest but surest feeling God didn't want me to apply to any American programs. It goes against all reason given how insanely competitive Canada is compared to the USA for IMGs. It seemed very Gideon-esque to eliminate >100 applications with one decision. I wasn't on any sort of spiritual pilgrimage or fasting, but I was regularly voicing my anxieties about my future in medicine to God and a select few prayer warriors in my life. There were no signs, just a feeling that Canada was it. So in faith, I didn't register for the NRMP (USA residency cycle). I was at peace or a nervous wreck depending on the way the wind blew. 

I submitted applications to all 43 eligible Canadian family med programs (I'm ineligible for Alberta and Quebec). At the CCFP conference, I spoke with the University of Manitoba Family Med's rep. She took down my info and said she'd look out for my application. Unfortunately, due to one of my references not uploading their letter in time (despite giving them 2 months notice and regular reminders), my UoM applications were rejected. Ontario decided their cutoff for exam scores would be raised higher than the scores I got, so I was out of the running there too. That left me with UBC, Saskatchewan, and Dalhousie (24 applications total) with the latter two having only 13 spots between them vs. 52 at UBC (which had >1000 applicants). As Christmas neared, I hadn't received any interview offers and wondered if I'd have time to register and apply for the States, but held off. Then at 1pm Dec 20th, I received an email from UBC offering me an interview. I was alone at home and immediately started bawling. As strange as it sounds, I felt like I had just matched into UBC even though all I had was an interview offer at that point. The relief of having your blind faith affirmed after a series of losses is simply indescribable.

The interview at the end of January went well. My confidence was at an all-time high, but Match Day is March 1st, and confidence has a funny way of disappearing over the course of 30 days. I began doubting how high I'd be ranked by the programs. I felt I didn't compare well to the other IMGs I saw at interview day. I convinced myself that matching wasn't going to happen, but I also couldn't wrap my mind around not matching as if something was blocking me from imagining that very real possibility. On Feb 28th, I wrote down all my anxieties and thoughts onto a card and mailed it to China to a woman who thoroughly understands how this whole process has been for me mentally. It was therapeutic to send that card, knowing that by the time it arrived, we'd already know the end of the story. 

March 1st was an odd day. Erin and Jesse were staying over because their flight to Prince Rupert was cancelled due to inclement weather. Dad's car broke down the day before meaning he needed the car I normally use. So I had many distractions. Nonetheless, I was up every hour until I decided I'd stop trying to sleep and patiently wait until 9am when the Match results would be posted.

I didn't cry or run to Erin's room to wake her. I just sat in bed, looked at the screen, and breathed. Then I called Deen because she was expecting a call either way. Cool as a cucumber, I told her the good news and she was ecstatic. In thanking her for all her steady-headed support, I choked up and we cried over the phone. After that, I went about procuring a car. Took the bus down to my aunt's work, picked up her car, and casually told her I matched. Drove home where Erin was finally out of bed, and told her and Jesse I matched then took them out to Jethro's. Left a message with my parent's receptionist since neither was available, then went about notifying everybody else.

Between then and now, I moved out of my parents' to a place biking distance from all major Vancouver hospitals. It's beyond glorious to have my own space. I've been involved at Trinity Baptist Church for nearly a year in the worship ministry (tech, playing, and leading) and small groups, enjoying the church family I have there. Health wise, I decided to concentrate on my shoulders and back muscles while eating a bit better (oatmeal with fruit for breakfast, no added sugar; at least one vegetarian dinner a week). My abs have taken kindly to the changes (I know, you were very worried). The rest of my body looks forward to all the cycling I'll be doing in my daily commute.

In summary, life is good. It's a huge relief to be where I am right now - to have my passions and decision to pursue medicine come to fruition. Of course I know I'm still a long ways away from being able to settle someplace and plant roots, which has been the yearning of my heart for some time. After my 2-year residency, I need to do a 2 year Return of Service practicing family medicine in an under served/rural area in BC (which I look forward to). I know I'll be meeting many more people through residency - relationships I'm already praying about and hoping I can be purposeful in them regardless of how long we're around each other. I also recognize the unique position I'm in, in that I'm still committed to maintaining my friendships at home as I was when I was away, except I'm physically home now and will need to find an appropriate balance. However, I think this year off has prepared me for that, which I'm very thankful for. 

So there you have it. I've just finished my first day of orientation and I'm feeling really excited about what's in store and what God wants to reveal to me in this chapter of my life. Welcome to the Ross-ident years.