Chapter 21

We must use time wisely and forever realize that the time is always ripe to do right.
-Nelson Mandela

366 days ago I set out to start this blog as a means of sharing my daily lessons. 

Quite unsuccessful as I only documented 20 of those lessons.

So I guess let me start off the year with the 21st lesson.

As I read everyone's post on Facebook of how awful or awesome 2013 was and how excited they are to apply last year's lessons to this year, I ask what's wrong with reflecting everyday?

There's something about starting anew on a Monday, on 1/1, next year. (For which I blame marketing tactics.) Making promises to ourselves that the next week or year will be better. But why not break it down even further? Why not make yourself better the next day, the next hour? Why can't we press that internal restart button spontaneously instead of a programmed start date? There's this fear of change mixed with procrastination to gain some time to rush to all our bad habits before turning a new leaf. Which is why I didn't really make any resolutions. I've been listening to my body whenever it desires to speak loudly. For my birthday and towards the end of this year,  I needed to genuinely make changes to my diet. I was unhappy with my energy levels, with the woman I saw in the mirror squeezing into her jeans. So what did I do? I made changes right then and there. Didn't need a new year's resolution, a new week, or a new year. Just good ole desire to change, setting some goals and dedicating the time and energy. Now to apply that same mindset to the other aspects of my life. 

We're living in an era where time somehow escapes us, where we feel like in the 24 hours we're blessed with, it's just not enough. By just driving around, the 1 second the light changes, people are quick to honk the horn. Pardon my 5 second lag, that is impeding you from rushing to your destination. I noticed I was no different when I went to Florida and my uncle was grilling some steaks. Five minutes passed and I'm upset that he's not done yet. My uncle shouted from outside, "Joa, this is not New York, everything is not done fast. You need to take it easy." Boy, did that shut me up and it stopped me in my track.

It took me back to the movie "Crank" where Statham's character is poisoned and needs to keep his adrenaline levels high so his life is on 2x speed. That's how I feel like I'm leading my life. If it's not photographed, I probably won't remember. I try to rush everything in one day and don't know how to relax. I feel like that's the product of the 2000s because I remember the 90s being pretty slow paced. Why do I bring this up? Not sure but it's been on my mind lately.

Lesson Learned: We need to live in the moment. These years are zipping by us and we don't realize it until it mid way or the end of the year. Seize the day, stop and restart if you need to. Every day is a new opportunity and use it as so.

Chapter 20

“Dreams do come true, if only we wish hard enough. 

You can have anything in life if you will sacrifice everything else for it.”  

~J.M. Barrie

Reynosa, Mexico.

A city directly across the border of Hidalgo, Texas.

The common point that linked seven teenage boys that otherwise were complete strangers to one another.

Some were from Ecuador, others from El Salvador and Guatemala.

Although their origins varied, their mission were the same: to reach the USA.

However for six of them, they only got as far as crossing the border. One actually made it all the way to the Northeast and was about to begin high school when "La Migra" aka U.S. Immigration and Customs Enforcement caught him and took him away from his family.

I was working the night shift in the ER when the attending said "They're sending another van load of the boys to get their XRays." Out of curiosity, I asked where are these boys coming from and why are they going to the ER just for XRays. It was explained to me that there's a safe haven organization not too far from the hospital that predominantly houses boys that have unsuccessfully crossed the border into the US and serves as a transition home during the family reunification process. Many of these young boys had positive PPDs (positive tuberculin skin test) so in order to rule out TB we had to do a history, physical exam and Chest XRay.

I was glad to have been in the ER that night because there weren't any Spanish speaking physicians around so I would be able to speak Spanish to the patients. However, serving as a translator exposed me to the saddest stories I've ever listened to.

One of the key questions to ask if suspecting tuberculosis is noticing any weight loss or if their clothes fit differently. One slim teen stated he was in the desert for 22 days with only one meal and he approximated about a 30 pound weight loss. Another teen couldn't begin to imagine how much weight he lost because he's never been this thin. Amongst the rest of the teens, similar stories repeated. The longer the journey, the less amount of food. This wasn't the response I was expecting.

Many didn't know what cities they were in. Some didn't know how many days they traveled since leaving their home but they all knew that Reynosa, Mexico was the last stop before crossing the desert into Texas.

I had to take a mental break.

I just had one of the most powerful experiences in my young medical career from simply listening.

My whole definition of sacrifice was shattered. Standing in front of me were living proof of corporal and mental sacrifices. Standing in front of me were young men who left their families behind, paid a stranger and blindly entrusted this person to lead them to "Los Estados Unidos", the land of opportunities. Standing in front of me were survivors of physiologic defiance when people otherwise die before reaching the U.S. because their dehydration was so severe that a clot went to their brain.  Standing in front of me were the most courageous young men I've ever met.

There I stood, a spoiled, gluttonous American who constantly complained of first world problems never questioning my next meal or expensive bottle of water. There I stood emotionally vulnerable because all I can offer was the native tongue my parents taught me to speak. There I stood wanting to give more of me and help these seven boys become the future of United States. There I stood rewriting my blueprint so when I do receive my M.D. degree I will be donating my time to immigrant health. There I stood.

Lesson Learned: Many of our goals and sacrifices may seem like leaps of faith but we should try not to question our current position/situation as it may be a part of the grand scheme. We know where we started from and what we want the end result to be but what builds our character is the journey in between.

Chapter 19

For humanism also appeals to man as man. It seeks to liberate the universal qualities of human nature from narrow limitations of blood and soil and class and to create a common language and a common culture in which men can realize their common humanity.

-Christopher Dawson

“Andrew is vomiting!” yells the mother of one of our SICU patients. Before I ran to get the attention of the senior resident, I paused a millisecond because something was so different with that statement. It wasn’t the voice of Andrew’s mother, as I’ve heard it in daily conversations for the past two months. It wasn’t the fact that was he was vomiting for he’s had fluctuant health.  Throughout the day I gave it some thought and finally came to the conclusion that it was the fact she referred to her son by his first name. For 8 weeks, my surgery team has either referred to the patient by his bed number, the procedure that was performed on him or informally by his last name, military style. This small instance of humanism warranted reflection.

Since the beginning of my medical school career, we've been lectured on the principles of humanism in medicine, its importance in the patient's care and just in case we forgot, they gave us a nice pin during our white coat ceremonies that served as friendly reminder. However, something happens in transition in which we lose that touch. I caught myself slipping while I was on surgery.  The redundancy of our days in addition to long, dragging hours mixed in with the interesting personalities of the patients, I found myself becoming a grumpy robot. I'm typically a cheerful person but by the end of the rotation I was a cynical, grim, jaded student questioning my career choice. I guess that's the natural process for anyone that pursues something they love, sometimes you just fall out of love until you're reminded why you fell in love in the first place.

There's a blog post circulating on the Facebook walls of medical students and residents that highlights the nonglorious aspects of what it really is to be a physician in the United States, beyond the six figure salary. Oftentimes physicians are scrutinized for their lack of empathy and it's evident to the patients. I don't think it's fair that we blame our long work hours for our missteps. Just like it's not fair to yell at your child if you had a crappy day at work. I think the same applies in medicine. Our patients are more than just a disease, a surgical procedure, a collection of pill bottles. They're humans with feelings and emotions just like the people taking care of them. Before stepping in the door seeking your service, they were mere strangers. In just a matter of minutes, you know their entire personal history. And to think that despite this privilege, medical professionals forget that healing patients is a delicate process. 

Andrew's mother reminded me that for us that septic patient is still her son. Her cries of hurt, anxiety, and hope reminded me why I fell in love with medicine.

Lesson Learned: As generic and obvious as it may seem, everyone should be treated with fairness and respect. Whether on the train, your local McDonald's, gasoline station or your doctor's office, be courteous and polite because your simple, kind gestures can go a long way.

Chapter 18

The young always have the same problem
 - how to rebel and conform at the same time.  
They have now solved this by defying their parents and copying one another.  

~Quentin Crisp

I am genuinely baffled with present day teenagers.  

I'm not even a decade older than most but it seems like there's this generation gap that keeps widening and I need to watch my step.

Last weekend I had a conversation with my cousin about how "grown" our teenagers look. Gone are the days where a clean, young face is appreciated.  Or that awkward pubescent transition phase where a girl's body is becoming a woman's body, unsure about what to wear without overexposing so the clothes fit just right but not too tight.

Now I can't even guess who 30 or who's 15. 

Every woman looks the same to me ...... except the geezers with failed attempts of Botox.

I went to buy a Lotto ticket last week and the clerk asked me my age. I replied "24" and he still had his doubts and asked for my ID. He gave my ID one long stare and calculated my age. My ID was returned with a "God bless you." At that time, my eyeliner has worn out, I had a bright green North Face bookbag and my energy levels were on E, so I probably looked underage. 

It's amusing that at some point in our lives we wish to look younger but when we have that youth, we rush to look older and do the things older people do. All for what? Some bragging rights? 

Today I was reading the news about Courtney Stodden, the "teen bride" of Doug Hutchison. She's barely 18 and with all the makeup she has on, on any given day she looks like she's going on 30. Who made it okay or even acceptable for someone her age to look like that? I was literally shaking my head in disapproval as I was clicking through her photo gallery.

Besides looks, the behavior and manners of these teenagers leave us hopeless for the future. 

I saw the video of Penelope Soto, a teen attending a hearing for possession of Xanax. The fact that was she was abusing Xanax warrants another discussion but her erratic answers to the judge sentencing her was just surreal. No fear of authority whatsoever and for that her defiance and sassy remarks earned her 30 days in county jail. 

Not only would I have been scared for my life to even fathom the reaction my mom would have if I called from jail but to add insult to the injury and say I disrespected a judge?! 

Where did that gut wrenching trepidation go?

All these unanswered questions presents as a unique challenge not only to society but to myself.

I've had failed attempts at mentoring the youth and that bothers me. I want to make an impact, I want to show these teenagers their potentials.

As much as I cringe with the thought of it, it excites me even more to want to pursue adolescent medicine.  To have a teenager come to your medical office speaks volumes. There's something wrong in which can't be pushed aside any longer. This is the point in which their veil of indestructibility comes down and their vulnerability shows. 

Lesson Learned: As adults, we question whose fault it is that our teens have become this way. This game of pointing fingers needs to rapidly end. It takes a tribe to raise a child. It's all our social responsibility to steer the youth in the right direction or we're doing a disservice to our future.  

Chapter 17

Habit is habit and not to be flung out of the window by any man,

but coaxed downstairs a step at a time.

~Mark Twain

Ever since my classmate told me about Vegetarian's Paradise on West 4th Street, I haven't stopped going. During my 4th attempt of vegetarianism, I tried this place out and their soy nuggets are to die for.

I haven't returned to being a vegetarian but I'm currently on Day 15 of the Simple Green Smoothies challenge. Everyday I drink some leafy green with fruit concoction so I would be able to get my servings of fruits and vegetables. It actually tastes better than what it sounds. This is something I want to carry over beyond the 30 days because I feel great. I also ran two miles before going to the hospital. The whole day I was euphoric because my energy levels were so high and my soul just felt rejuvenated.

I realized that I've always tried drastic measures to lose weight compromising the foods I love to eat and imposing strict guidelines. It shouldn't be like that. I need to learn how to take small steps in the right direction whether its in my weight loss goals, career goals, savings plan, whatever. It's just more realistic.

Lesson Learned: Slowly changing the direction of a ship over time is safer than changing its direction right before you hit an iceberg. It's better to have gradual results panned out over a long time than drastic changes in which you're susceptible to relapse.

Chapter 16

Love overcomes hate. Love has no color
Love has no orientation. All is love.
~Adam Lambert

I had a very interesting conversation with the resident I'm shadowing: our significant others. She asked "Does your family like him?".

That question often makes me cringe while I go through a number of emotions.

My response: "I guess. It's hard to tell because he's Black." She then asks "But aren't there Black people in Dominican Republic?" The million dollar question.

I come from a culture where a racist dictator brainwashed the people of the country for decades that black is ugly. However, I will not solely blame him for the ignorance because people can choose to surpass that. There's a saying that "everyone has Black behind their ears" which means essentially every Dominican has SOME Black in them. We're a country that began with indigenous natives that were colonized by Spaniards that brought in African slaves. Our people are a color spectrum, which is a beautiful thing.

I've been in my relationship for close to seven years. However, to my family the first two years never existed. Yup, I hid my relationship for two years.

I was afraid of the "consequences" of coming out. No one else in my family had dated a Black person and the Dominicans I know don't hide the fact that they don't like Black people. Forget the fact that he comes from a great family and finished grad school, his skin color was of utmost importance. So I was stuck. It wasn't fair to him that I have him hidden but I didn't want to be the "black sheep".

To me biracial couples are one of the greatest products of living in the U.S. Here you are, in a heterogenous country where you can meet the love of your life whose ancestry is halfway around the globe. You don't need to understand their culture or speak their language, all you need is love. Families should be content that you have found a person that loves you for who you are. Despite all the animosity and racist remarks (i.e. going to have little monkey children, better know how to braid hair, I was such a good daughter until this, etc) Aundrée has stuck it out with me because he believes in our love and I can never be more appreciative.

Lesson Learned: Shatter the blinds of ignorance. Don't be afraid to confront people and stand up for what you believe in. Love goes deeper than a hue.

Chapter 15

In times of great stress or adversity, it's always best to keep busy, 

to plow your anger and your energy into something positive.  

~Lee Iacocca

Something is off and I have no idea what. 

I've been in the ophthalmology clinic for two weeks and it's a pretty relaxed environment. However, I've been feeling this looming stress recently.

So I did what I usually do when I'm stressed: clean. I clean when my anxiety and stress levels are super high. My roommates pointed it out to me some time ago. I would snap at them the day before an exam because they failed to do their chores. Shortly after I take the exam, I would go back to the apartment and got my clean on.

I usually prep myself by playing some bachata and letting the Ajax sit in the bathtub. I scrub every tile and scrutinize every crevice. Once I'm done, I stand at the doorway and admire my work of art. Today, I also wanted to clean my room so I repeated the same procedure. There's something about a clean environment that just feels like a breath of fresh air. 

Speaking of fresh air, yesterday I was really unhappy with how my body felt. I told myself I would go running at 630 am. Let's just say waking up at 730 am felt amazing. However, I wanted to follow through with the promise I made myself. After cleaning my room, I went for a run by the FDR Drive just to clear my mind and get rid of this unknown source of stress.

According to my Nike Run app, today was my longest and farthest run. I also realized I pushed myself to stop as little as possible. Those 2.6 miles went by like nothing and I feel really good (well not entirely because my knees are aching).

Lesson Learned: Often times we carry this unforeseen load of stress that can be triggered by so many different aspects of our lives. As long as we are be able unload the stress and channel that energy into something productive there's nothing wrong with a little bit of "healthy" stress.