Wow its been a while...

Sorry, its been a while since I've written. A lot has happened, a number of milestones and new events, and it sure has been busy. But alas, I can sit and write, and realize that I've already had this blog for 1 year!

First of all, Nicole graduated from PA school, and moved up with me in North Carolina permanently about 2 weeks ago. It sure is nice to have my wife living with me finally! She graduated with her second Masters's degree (her first was her public health degree from Johns Hopkins) with a perfect 4.0 from Emory's physician assistant program, and was offered a great job at UNC Hospital (where I work!). She'll be working with the GI docs that specialize in esophageal disorders, working in clinic and doing procedures. No overnight call, no weekends!! She will surely be my sugar mama! It will be exciting to have her in the same hospital, so that we could occasionally meet for lunch, etc!

Second, as soon as Nicole got up here, we got a new puppy! Her name is Sofie, and she is a catahoula leopard dog (with a little bit of lab mixed), which is the American version of an Australian shephard. She looks a little like our dog at home in Tampa, Fozzy, which is partly why I loved her so much.

The face of an angel!

Sofie in the mountains. It's cold, let me in!

Third, work has gotten better and better for me. Yep, as you can tell from me not writing for a while, I have been really busy. Since the ICU, which was a really good month for learning, I did a month on the pulmonary service which was extremely busy. Lots of people with lung disease, and this included teens and adults with cystic fibrosis, people with bad COPD and pneumonias, lung cancer, and people who were on ventilators who are extubated (taken off the ventilator) and transferred out of the ICU to us. I always carried between 7-12 patients, and at one time had 15 patients!! But this was the month that really gain some confidence, because if I got through that month with that many patients, I could handle anything. And sure enough, it was about this time I started getting more comfortable at being an intern. I'd start doing procedures myself, start needing less help while cross-covering overnight, and felt more comfortable seeing patients on my own. You start knowing that a patient with chest pain "needs an EKG, cardiac enzymes x 3, fasting lipid panels, hemoglobin A1C, thyroid tests, telemetry, started on an aspirin, statin, nitroglycerin, meds for high blood pressure, a beta-blocker if is pressure is ok, and consider a heparin drip." It all rolls off your tongue, and you don't realize that, damn, over the past 6 months this has become second nature.

After my pulmonary month, I did a month of geriatrics, which was a really good month. These old people are so cute, and many of them pretty fascinating. They have been all over the world, or have had interesting jobs or positions, and many of them are still living the good life in their assisted living homes. But also, we had many of the more somber cases of nursing home residents, who often get the nursing home sicknesses (pneumonia, urinary tract infections, diarrhea, etc), come to the hospital, get better, and then are sent back to the nursing home to get their next infection. I remember specifically, we had one nursing home resident who comes to us with failure to thrive, decreased appetite, nonspecific abdominal pain. Turns out he was a prominent faculty member of the UNC medical school. He has no wife, no kids, no family around. He had a fall a few months ago, and had to be put in a nursing home as he had no one to take care of him. But since his placement, he seemed to be profoundly depressed, and his memory got worse and he just didn't want to eat, or do anything. Other things can cause this presentation, this wasting away and anorexia and weight loss and abdominal pain, mainly cancer. But we did a big workup, and eventually found that really this was all from depression. Even his memory loss was from big time depression, which is called "pseudo-dementia." All his former friends and colleagues are associated at UNC, and there was no where else he wanted to be than among them at UNC. But he had no other reason to be hospitalized. We let him stay about a week longer than he should have, but eventually had to force him back to his nursing home, where he would spend Christmas and New Year's alone. That's the other side of these elderly patients. I hope that none of my family and friends have to be alone when they're old.

Lastly, Nicole, Sofie, and I spent our first Christmas in our own home, which was really great. Nicole's mom Barbara came down and joined us for the holidays, and we set up lights, got a tree, they put up stockings, and we had a great time. I got 5 days off for the holidays which was badly needed. We spend 2 of those days after Christmas over in the mountains, visiting Margot, George, and Stefan, friends of ours who were at the wedding. Stefan and Nicole were born the exact same day in the same hospital in Dallas, and lived on the same street! They have been friends since Day 0, and its pretty cool to see them still keeping in touch.

I'm now starting on cardiology at UNC, and it will be another busy but good month! And after that, another week of vacation, followed by 2 "easier" months, one of which I'll have no call or weekends!! Half way done with intern year!!!!!!!!!!!!!!

There's a lot more to catch up on, and more pictures to post, so as one of my new year's resolutions I'll try to keep up on this blog again. I wonder if anyone is still reading this after my lastest lull though...oh well! Happy holidays and happy new year!

the ICU

The intensive care unit is a very different place. The environment is good, the staff and nurses supportive, and all the doctors and residents who are on the MICU (medical intensive care unit) work really well as a team.

But the patients...they are so sick. Academic hospitals tend to have sicker patients than community hospitals. And patients in the ICU are the sickest of the sick. Here are some examples:

- 21 year old male who was binge drinking, past out drunk, vomited and then aspirated his vomitus. Found a few hours later by his brothers, and may have suffered severe lung injury as well as decreased oxygen to his body for hours.

- 70 year old male who had shortness of breath. His heart function turned out to be 1/6 of normal person.

- 45 year old female with metastatic breast cancer who was moaning, low blood pressure and high heart rate and fever. Symptoms were consistent with bad infection, and complicated by blood clots in all extremities. Died 2 hours after we transferred her to the ICU, from a heart attack.

- 60 year old male with shortness of breath and cough for 6 weeks. He was found to have lung cancer that occupied 50% of his lungs. We treated him with chemotherapy and helped him breathe with a breathing machine...but watched him slowly die, first by lungs failing, then with fever and infection, then dropping blood pressure, until finally his family stopped the suffering.

What I've learned is that, as much as we try to treat and save these patients, most of them will do what they'll do. If they are dying, no matter what we do most of them will still die. Medicine can only work its magic so far, until nature overpowers us.

We have saved people, too, though. The biggest thing we do for people is aggresively give antibiotics and fluids, and support their breathing if their lungs fail temporarily. The people who come in with raging infection that threatens to shut down all organs, we give them TONS of fluids, antibiotics, and hope that their body makes it through. And some do, and it really is a miracle.

The last gentleman I described above, the one with lung cancer, was one of the saddest cases. The wife finally decided to call all the family in, so that everyone could say their goodbyes. And then she gave the decision to withdraw support. He died 2 hours later. But they are only pronounced dead when a doctor says so.

I have never seen someone pronounced dead, and never learned how to do it in medical school or residency. It wasn't part of the training...and you don't study or prepare for it. But I was on call, and the nurse told me I was to pronounce Mr. S. I don't know how to describe walking into their room (not knowing what I'm supposed to do), with all of the family surrounding the bed. When I approach, they step aside to let me walk to the patient. And I do what I think I'm supposed to...I listen for a heart beat, feel for a pulse and a breath, and open his eyes and shine a light to see if his pupils react. Its very surreal, eerie, to be doing this to an already dead person, with the family watching me. I do these motions, and then simply say, 'okay', and nod with closure to the wife. I walk out with the nurse, and pronounce him: "Time of death, 7:50 pm." And I tell the nurse to ask his wife if she wouldn't mind answering some questions for me, whenever she is ready.

Its crazy. Mr. S was happy, jolly, eating when we first saw him. We knew he had cancer, and we saw that he needed oxygen by a face mask, but he was still alive and still talking with us. His wife was always there at his side. And we saw him slip away over the course of 2 weeks.

Afterward, I talked with his wife and 2 brothers, and we talked about his funeral home, if an autopsy was desired, if he is an organ donor. And then we reflected a little bit about him, how he didn't want to suffer, how it was hard to let him go. And they were thankful, I think, even though I barely knew him...I was just the doctor on call. It feels strange that I should be the one to give the final declaration that this person is gone.

I felt sad for the family, and a little numb that I just pronounced someone dead. I didn't quite know what to say to the family, or if I should've said more, or less, shown more emotion, or less. I felt like I was intruding into a emotional, very personal family meeting, and that it wasn't my place to say too much. Maybe they thought a doctor was coming in, performing the routine and doing his job, but I'll tell you it felt like a young, afraid, unsure man who just graduated from school had just put closure onto a huge chapter of this family’s life, and it didn’t feel natural to do so.

Our home

Just wanted to show you our home, now that its all furnished. Nicole's mom and dad gave us a lot of our furniture, and my mom and dad gave us a projector for our home theater! Come visit us anytime!

What have I been up to lately...

This past month has been an easier month. This is my "consult" month - where I get to work regular hours M-F, no overnight call, no weekends. I have been on the GI consult service, which is a specialty that I'm interested in. Its been good - we see people with GI bleeds, trouble swallowing, abdominal pain, diarrhea, liver and pancreas problems, and more. They have cool "toys" to play with, mainly the "scopes": colonoscopy and upper endoscopy. At first glance, yes, its sounds gross sticking a plastic hose up someone's ass - who would want to do that? But its kinda cool, like a video game. In one hand you have the controls, which feels like a complex airplane joystick. Your other hand is, well, sticking the plastic hose up someone's ass. There's not much poop, since the patient is supposed to take a strong laxative to clean out their colon before the procedure. And while you're in, you can look for any problems, use tools to remove polyps or get biopsies, and even in the stomach use things like lasers and rubber bands to stop bleeding. You can even get near the liver and pancreas and use ultrasound, or even xrays while you're in to remove gallstones or get biopsies.

I've also had a 2 week vacation this month, which quickly came and went. I had a fantastic time, going back to Atlanta to see some old friends and visit the old school. Got to hang with Ben at a Falcons game and played some tennis with him, and met up for dinner and drinks with my good med school friends Shveta, Dinesh, Dorothy, Mariano, Pei and Alice. Got to see Nicole's aunt Carey and her kids Warner and Kate and their cute golden retrievers, though it was sad to hang out there without Steve (Nicole's uncle who recently passed away).

Then I came back to North Carolina, where my parents visited Nicole and I for a long weekend. We went for some good dim-sum, showed them around the city and where I work, and they even outfitted our 'home theatre' with a new projector!

And then I went to Long Island with Nicole, to hang out with her mom and Francis out in their summer home. It is in Orient, the far eastern (not the "far east") part of Long Island, where its covered by miles of vineyards and fresh farmstands. The house, which is old and rustic with an outdoor shower, has a view of the bay, which is gorgeous. We ate and drank and just lounged around.

Nicole has worked the last 2 months up here in North Carolina, doing some elective rotations as part of her PA schooling. And she just finished a week of vacation as well, and is now back in Atlanta to finish up school. She graduates December 9, and will officially be a Physician Assistant by then, and my sugar momma. I'm sad she's not here... =(

Other cool updates --
- Jenny just found out she is pregnant! Jenny and Jeff, along with Tyler who's almost 3 is expecting their second!
- Amy just started at University of Florida and is loving it!
- I heard Bryan is trying out for American Idol. He's got the look, cuz he looks a lot like Clay Aiken



Alex and Sarah, our neighboring twins. Alex is an ER resident at UNC, and Sarah is a PhD grad from UF. We live in the same neighborhood, and yes, girls dig the Asians guys.

Nate and Amy with Nicole (note long stick for marshmallow). Amy is one of Nic's good friends from PA school, and Nate is Amy's soon-to-be-fiance.

Tyler (aka Wiggy!) So cute

Bachelor party 2006, starting off easy...

Me in the glider!

Nicole along the bay in Long Island.

Ben and Jen! Ben is fomer Braves' lawn boy, Atlanta Hawks administrator, sports agent, now successful real estate agent. Jen is a 6th grade teacher!

Musings

Hierarchy is a funny thing, and it exists everywhere. I am in Long Island, finishing up a 2 week vacation (which has recharged my batteries for more doctoring), and have had the fortunate opportunity to do some fun things this vacation, including going down to Atlanta to see some old classmates, having my parents come to North Carolina to visit Nicole and I, and heading out to the Eastern point of Long Island, where it is calm and quiet, surrounded by vineyards and farm stands.

Anyways, we visited Hobie, Nicole's mom's uncle. He is an avid flyer - he flies airplanes and gliders, and has been flying since the 1930's. He is one of the long-standing members of the Long Island Soaring Association, a group that flies mainly gliders. A "tow plane" pulls the glider a long, taking it up to around 3000 feet or more, and then releases it and the glider is free to fly and maneuver until it lands, usually in about 15 minutes at 3000 feet.

Hobie is very well respected, and you can see it in the way people greet him, ask him how his family is, how they say good morning. And Hobie doesn't ask for this, it just is. He's a sweet man, humble, assuming. But he has been around and seen it all.

Almost anyone can join the club. They pay a initiation fee, and they pay a small amount ($30 or so) for each flight, and the lessons are free. That's it!

But there is this unspoken hierarchy that everyone silently follows. I met some of the new members, younger guys. They seem to "know their place" - they do more of the labor of picking things up, they drive the older guys out to the airfield where the gliders are, they speak and act with reverance when around the senior guys. They step aside when the older guys walk by. Its a silent ritual of respect that they pay, and they do it in exchange for their tutelage, their education as new pilots.

We do a very similar ritual in medicine, and have a very similar hierarchy. The experienced, senior, wise physicians (chairmen, department chiefs, professors) are highly respected. Then beneath them are junior faculty and attendings, who have finished their training and we all respect, but they then step aside and defer to these elder, wiser attendings. And then there are fellows, who have finished residency but are training to specialize. Then their are residents, and then interns, then medical students.

As an intern, my job is to get things done. In exchange, I actively observe my residents' and attendings' decision-making process, and get to see the outcomes of these decisions. And the idea is that I learn enough that I will be making these decisions within a year. Just like a new pilot getting ready to fly on his own.

it's only been a month and a half...

since I last wrote. Damn, sorry about that guys. I did get swallowed into the "abyss", but I just started my vacation for 2 weeks! Which I badly needed...

So there was this patient of mine, a middle aged female, we'll call her Ms. M. She had liver disease, caused by hepatitis and by years of alcohol use. When you get "end stage liver disease", your liver scars up and shrivels up, and doesn't do its job of filtering all the blood coming from the digestive system. In fact, because its so scarred, blood may not even flow through it anymore. Instead, it may back up and pool up in the veins of the digestive system. These veins can get engorged and dilated, and can burst open and bleed, classically in the esophagus and stomach. The bleeds can be life threatening, so when someone has had a bleed like this, we treat her, and then try to prevent any future bleeding.

One of the ways we prevent future bleeds is through a procedure called TIPS (trans-jugular intrahepatic shunt). In other words, we decompress all that blood that is backed up behind the liver. We do this by creating a tunnel through the liver, so that the blood can go through the liver and back out to the heart. Its a temporary fix, until the patient can get a liver transplant. As you can imagine, the procedure is not without risks. The liver is a blood filter, so it sees a lot of blood. If you go poking around in the liver, it can bleed.

Well, Ms. M has cirrhosis of the liver, and was scheduled to get a TIPS procedure. I was her doctor. I usually schedule 1 am "bloodwork" for my patients, so that when I arrive to the hospital, her bloodwork is done and I can proceed with whatever needs to be done that day. Well at the time I was ordering bloodwork for the next day, I was finishing up an overnight shift, and was on my 30th hour, and forgot to order bloodwork on her for the next morning. She was going for her TIPS that day.

Ms M. got her TIPS that afternoon. She was returned to her room. The next morning I arrive, and find that she is in a lot of pain, right where her liver is located. She doesn't look good. Her blood pressure is okay, but her heart rate is a little high. I'm worried about her bleeding, but because her blood pressure is okay I planned on waiting until our morning rounds to tell my resident. I don't have any bloodwork, so I can't tell how much blood is in her.

30 minutes later, I hear "code blue, 3 West" over the hospital intercom, and 3 West is where Ms. M's room is. My stomach sinks, and our team runs down there, and sure enough, Ms. M has gone into cardiac arrest. We spend an hour doing CPR, giving her electric shocks and drugs to jumpstart her heart, but it doesn't look good. We end up getting a heart beat on maximal medications and 12 shocks, and she is transferred to the intensive care unit. Surely she suffered brain damage, and her body has shut down. Her husband withdrew care after 2 days, and she passed away.

I felt very responsible for her death, and carried this guilt over my head for a number of days. Sure, I didn't perform the procedure, but I damn well forgot to order that bloodwork. Maybe if I did order it, it would have shown her blood levels were critically low, and the intern-on-call would have been alerted and something could have been done to save her life. My bosses tell me, she was sick enough to begin...anyone who needs a TIPS is a sick person, and that we were trying to help her, we can't beat ourselves over our mistakes because they are 10 other patients that I need to provide my best care for. But it was hard to deal with this.

And this is how new doctors learn. We learn from our mistakes. But unfortunately, our mistakes can hurt patients. Most of the time they don't, but sometimes they do. And every intern, and every doctor, makes mistakes. I've certainly learned never to forget to order bloodwork before I leave. But there will be plenty more to come, since its just impossible to teach an intern all that needs to be known to care for patients before they are thrown into such situations. In medicine, we all aspire to be perfect, and patients certainly hope and sometimes expect us to be perfect, but we are human. We will make mistakes.

Medicine is unique in that our mistakes can directly harm others. Its really unsettling to me. Sometimes I wish I were fixing machines or computers or cars rather than humans...those are expendable. How does one deal with this responsibility, of trying to be as perfect as one can, knowing you never can, and that the fact you can't be perfect means you will hurt people?

I feel young

A picture of my glory days at Emory...


So I'm getting to know my co-intern on my team, and now we have med students, so I have a 3rd year med student working closely with me.

Turns out, I'm pretty much the youngest kid on our team.

My co-intern, Avi, is 33, married witha 5 week old son, and has spent 5 years working as a counselor for troubled adolescents. Not just troubled, but often gang members and other very challenging young adults. He's been punched and kicked, been in a facility where all the 'patients' rioted at one time against the staff, been inside the locked facility with threats of one of the patients having a firearm, and so on. He's seen and been through a lot and it gives him a ton of perspective. Now, he's a doctor in training and father in training, and he seems to be enjoying it all. His experience probably lends him so much perspective, because I feel like I'm busy enough just being a doctor in training that if I were a father too, I couldn't handle it!

Which makes me want to be someone who has perspective. Life is all about attitude, and to me developing that attitude has a lot to do with your perspective. I always wonder what I can do to get really good perspective. I want to travel a lot, to experience the 'have-nots', as well as the developed countries that live differently than we do in the US. To learn why people are the way they are. Why the US is so disliked. How people deal with life.

I bet the ignorance of many would be tempered if they travelled and saw something other than through their own experience.

My medical student, Will, is 30, married for 6 years, and did his PhD before starting medical school. Its so funny how med students treat me, like their so respectful and say hi and how are you every day like we're so much above them. I was just a student 3 months ago. But I used to do the same too, treat our residents with respect. Its weird being on the receiving side!

I have a lot of growing up to do - world experience, spirituality, philosphically, as well as with my relationships with Nicole, family and friends, and with my medical career. I feel lucky though, that I am surrounded by just neat and brililant people. All of my friends and family have never ceased to amaze me.

Alan

2 weeks done!

Well I just finished my first 2 weeks of internship, and things have gotten a lot smoother. I've got the hang of the computer system, getting around, knowing what to do, so things are getting more efficient and more manageable.

There is the phenomenon of the "white cloud" and the "black cloud". The white cloud is where you don't get too many patients, your patients don't stay for too long, and therefore the amount of patients you take care of at any one time is less. On the converse, if you have a "black cloud" hanging over you, you're carrying 10-12 patients, and they always seem to stay a long time, so that every 4th night you keep getting more patients, and none are really ever leaving.

I'm fortunate enough to have the white cloud over my head right now, as I have only 3 patients (I had more as a student), but my poor teammate and fellow intern has 11, and its been this way for the last week. I'm probably jinx-ing myself right now by talking about this, but I guess I'm trying to say its not so bad right now. I'm on call tomorrow night, so I'll get up to 6 more, but the hope is that they are not too sick so they don't have to stay in the hospital so long.

There is a hierarchy in medicine. The "attending" physician is the boss, the one responsible for all the decisions. Then there is the "resident", who is in the 2nd or 3rd year of residency, who has experience and reports to the attending. And then the "intern", who is in the 1st year of residency and does a lot of the day-to-day work, while the resident and attending make the important decisions. And then the medical students, who are there to learn the basics of medicine. Usually, the intern is the one to see the patient every single day, and gather all the data. Thus, they actually are the ones that know the patient the best.

I have this one patient, a 19 year old girl who is very sick with Lupus (where the body attacks itself) and TTP (where the body attacks your platelets, making you at risk for heavy bleeding). Her lupus has caused her kidneys to shut down, which has caused her to retain too much fluid, and caused her blood pressure to skyrocket. No matter how many blood pressure meds we gave her, her pressure was still too high. She need to go on dialysis, a machine that acts like artificial kidneys, so it will take away extra fluids and toxins in the body. The "attending" kidney specialist was trying to convince her and her mom that she needed this. However, the attending walks up to me, and tells me that the mother would like to talk to me about dialysis. Huh????????? Me?????? Turns out she trusts my decision more than the kidney expert. So crazy.....and the kidney expert was standing right beside me, so I was pretty nervous to give my opinion with him there. Anyways, she really did need dialysis, so I told her so, and she said, okay, do it. Shows how much influence us "interns" really have, whether we realize it or not. We're the faces they see each day, and just that simple fact of us going in and asking them how they are doing, each morning, seems to make us their doctors. Pretty cool.

Mom, dad, Jenny, Jeff, Amy, and Tyler are all on family vacation in Orlando. Wish I could be with them!!

Nicole is up here with me, and has started her pediatrics rotation in Raleigh. I think she forgot how much she likes working with kids, and is having a really great time. Apparently on Monday there will be a bunch of kids from Belarus coming into their clinic. These are kids who have suffered the effects of the Chernobyl nuclear meltdown in Russia in the 80's. I'll let you know what she finds, should be really fascinating (and sad).

How is everyone doing??

Alan

Yes I am busy but I will continue to post!

Well, I just finished my first week of internship. It was A LOT of hard work, but I think it will get easier. I probably put in about 100 hours of work, and today is my first day off in 8 days. But, working that hard makes these days off sooooooooooo nice.

So far, the thing that has left the biggest impression on me are the patients. I'm on the oncology (cancer) service, and I take care of patients with cancer. Most of them are already diagnosed, and are coming in for scheduled chemo, or some other problem related to their cancer. Some are new diagnoses - people who came in sick, and we suspect that they do have cancer.

One patient I had was a 22 year old girl who has Hodgkin's lymphoma. She had probably been sick for a year or two before being diagnosed. They live out in the boonies of North Carolina, with thick southern accents. Her mom and and her husband were with her. She was admitted to us because she was having pretty bad nausea and vomiting, and couldn't eat or drink. So we gave her some IV fluids and strong nausea medicine, and she responded great and was able to eat the Wendy's her family brought her. I gave them a prescription so they could continue the medicine, but when they were being discharged I could tell she was quiet and sad. The family said they couldn't afford the medicine; if they bought it they couldn't make their house payment. Then this opened the floodgates, of her not wanting to be sick anymore, wondering if its worth all this treatment and being nauseous, that perhaps she could go on without chemo and asked if she would survive without it. At that point, I intervened and sat down and talked with all of them, about their options (the social worker could probably work something out with the meds). I asked if things would be different if she could get her chemo, but not be nauseous, and she said she'd like that a lot, so we determined the most important thing for her was to be able to get the medicine, so that she could carry on. Because we had a plan now, she felt relieved I think.

I felt good about this, and it was one of the things I could do...the complicated medicine, I don't know right now, but as doctors a lot of times the patient doesn't need anything complicated. Just a plan and some reassurance to get them through tough times.

I was proud of myself, but not necessarily for intervening like this. It was because I had been on hour 28 of my 30 hour shift, and I had so many things I had to get done before I left work, and my first thought was that sitting there talking to her was taking up all my time, preventing my from writing progress notes and doing all the little things that are necessary from day to day. But about 30 seconds into the conversation, I realized I should listen to her.

The other very challenging part of residency is this thing called "cross-cover". I stay overnight every 4th night. When I'm there, 3 other interns can leave at 5pm or so, and I watch their patients. And when I'm not there at night, one of the 3 others is there to watch over my patients. You can imagine that when I'm there, I'm watching over all these patients that are very sick, yet I don't even know them. And if something happens to them, my job is to help them get through the night. So, for example, when a patient who is on chemotherapy (and the chemotherapy has weakened their immune system) gets a fever, their blood pressure drops, their heart races, it is very serious because that infection can kill them in hours. So when I get the call from the nurse that patient X is indeed having a "neutropenic fever", I have to immediately run studies on him and order antibiotics, IV fluids, and anything else they need. And then I watch him/her, and pray they make it. No wonder we don't get any sleep.

The working environment here is really great. All of the doctors and nurses and my fellow classmates are really nice, and really helpful, and their computer system is very good, which makes work a lot easier, at least when I finally master it.

I have to say, this past week I have worked the hardest I've ever worked in my life. I knew residency was hard, but man NOTHING prepares you for your first day of residency. You really learn on the fly. There were moments when I thought, "what the hell am I doing here, why did I choose this career, am I cut out for this???!!" That never happened in med school, but it sure as heck happens here. But, it will get better, and each day got better last week for me.

Nicole just arrived today from Atlanta. She'll be staying here for 2 months doing rotations up here, so I am so glad she's finally joined me. We'll be doing some things to our new house - getting a new lawn mower, putting up blinds, working on the lawn, organizing, etc - as well as exploring the area. At least, whenever I have time.

Write back with your thoughts or questions about this whole crazy thing!

I miss all you guys,
Alan

Anticipation

Hey everyone,

Well, we’ve just about finished orientation at UNC, and I’m about to start my first real workday, my first day of residency as a doctor. Of course, with my luck, I get assigned to be on overnight call my very first night. That means I work Saturday, my first day. Then I work all through Saturday night. Then I work until Sunday at 1pm. Then I can leave and go home and sleep.

Yep, 30 straight hours. However, that’s not what I’m even scared of. What scares me is that I have no idea what I’m doing. Sure, I have some fundamental medical knowledge from medical school. But I’m starting with oncology (cancer patients). Many of them are in the hospital, very sick. I will inherit probably 5-8 patients from the previous intern when I start. But, since I’m the intern on call at night, I will be covering 3 other interns’ patients that night while they go home after 5pm. So I will have possibly 20-25 patients, who I don’t even know, who I have to care for that night. This is in addition to the new admissions. Any night you’re on call, you get up to 6 more patients who become yours throughout their hospital stay. This will add to the 5-8 patients I’ve already inherited. And they are ALL cancer patients. AND, I have no idea what I’m doing. How to order things, who to call for x, y, and z.

Can you tell that I’m up against a lot?!

It gets better…a few months later I’ll know my way around the hospital, the logistics, the computer system, and be better at patient care. But now, I’m a brand new doctor.

Anyways, I've met almost all of my classmates, my colleagues. They are fantastic, and from different cities all around the country. We have former carpenters, AP English teachers, world travelers (over 30 countries), college tennis players, and even another former pole vaulter and former high school pole vault coach! Its maybe 60/40 men, however I'm the only Asian, and there are no black people in my class. So strange! And many of the girls are Indian or Middle Eastern. Anyways, they are all very nice, many of them attached, a good bit with children. Makes me feel young. I'm really looking forward to getting to know them, and this year will be tough and be a bonding experience for all of us.

If you can, avoid going to hospitals in July! Just kidding...sort of.

=)

Wedding pictures

Hey everyone, just wanted to direct you to a website with our wedding pictures. Also a slideshow on it. The slideshow doesn't work on Mac, only PC.

http://www.charliepappas.com/alannicole/show_wedding.html

=) Alan

Steve Burns

I regret to say that Steve Burns, Nicole's uncle, died in a car crash this past Sunday. He, his wife Carey, and their 2 babies lived in Atlanta, and Nicole and I were very close to them, frequently going to their house for dinner or to walk the dogs or to hang out. It is so terrible to have lost him so suddenly. I feel so sad for Carey, and Warner (2 yrs) and Kate (6 mths), who are left behind. Sarah and I will be driving to Atlanta tomorrow, to meet up with Nicole, to attend his funeral. He was such a good person, so nice and caring, a great dad, and never deserved anything like this.

One especially shitty part is that Steve had been diagnosed with appendiceal cancer about a year ago. He went through chemotherapy, which was really tough, and finally just recently finished chemo and was starting to get better. And then this happened.

This has made me step back, and realize that life is so short. Can you imagine if, in a second, you lost your spouse? Or your mom? Or your child? One second here, the next, gone. Steve told Carey he was running to the store to get something, and then, he's gone.

It really shows you that you shouldn't worry about the little things, and you shouldn't get upset about the little things, because it all doesn't really matter. I shouldn't get upset at Nicole for some petty mistake...because what if those were the last words I ever got to say to her?

It's upsetting that it takes something of this magnitude to give me perspective. And even worse, I admit that even in the course of this week, I at times even forget the perspective, and revert back to letting small things bother me. I need to remind myself that LIFE REALLY IS SHORT. Enjoy it, seize it, relax, and love the people most important to you.

Steve was a lawyer, a partner in a neighborhood burrito joint, a husband and father, an animal lover, an uncle and mentor, and a wonderful person. We will miss him dearly.

Alan

Almost done, and yet just beginning

Hey everyone! It's been a long while since I've updated the blog, sorry about that. The craziness is almost done...and yet just beginning. Just to recap what the last few weeks have been like for us...

May 6 - got married!
May 7-11 - closed on house, did house and lawn work
May 12-15 - graduation weekend
May 15 - I officially became a doctor!
May 16-23 - Honeymoon in St. Lucia!
May 25 - Amy graduates from Hillsborough!
May 28 - Mintz and Kitner get married in Dallas
May 29 - finally back in Atlanta, and now cleaning and packing our apartment
June 9 - moving day - to North Carolina

So finally this is the first breather Nicole and I have gotten, yet right now we are in the midst of packing for the move. Well, well, let me tell you about our wedding!! Everyone who is reading this was probably there, but hey, I'll just highlight it... We had 140 of our closest friends and family join us at the Atlanta History Center. The ceremony was outside at the Swan House, and the reception was at the Ballroom. It really was fantastic!

We had a great time, loved seeing everyone, and partied it up! The band was awesome, and played the best music. Tyler was jamming to Sugar Pie, Honey Bunch at the end of the night! Bryan played his piece which was very sweet, and then encored with the band with all the ladies drooling over him (Reeves!). We were so fortunate, since it rained Friday and Sunday, but it was beautiful on Saturday.

The only gripe was the caterer. Their food was great, but their service at the tables was a bit too aggresive. They would always take full drinks off the table, take food away before we had a chance to eat it, and even took our chopstick favors away! Otherwise, it was an extraordinary wedding. Our wedding planner did a great job, the cake was awesome, and Bridgette our officiant was simply fantastic. Quite an expensive wedding... I can't believe how much we spent, but we had an awesome time from beginning to end.

My beautiful bride Nicole is now my wife, Nicole Cheng! She is such a wonderful woman and person, and we're looking forward to our new life together!

My vows to Nicole:
Nicole, you make me want to be a better person, a better man, and in my eyes you are beautiful and perfect, and you make me want to be the husband of your dreams.
I promise, for now and ever, that I will love you, deeply, tenderly, and completely.
I promise to always communicate with you, and always be open to change.
I promise to support you, and respect you, as my wife and my best friend.
I will always be committed to you, for from this point on, you are the most important person in my life. I love you.

(I find out later that at the reception, my dad nudges my mom and says she's the most important person in his life....very good dad, very good!)

We should be getting pictures next week, so when we get them I'll post a link to them on Shutterfly. See some prelim pics here, of the rehearsal, rehearsal dinner, and wedding. (courtesy of Jeannie and Robert)

http://share.shutterfly.com/action/welcome?sid=8AbNWbFwzauHIQ

------------------------------------------------

Okay, after that was my graduation. A surreal moment, as I finally became an MD. I'm now Dr. Cheng! Its so crazy, but its pretty neat. Graduation day is always built up with anticipation and then fizzes as everyone walks across the stage one by one, but the people don't let anyone cheer until after everyone walks. But, I have now taken the Hippocratic Oath, and will begin to fulfill my mission to reduce suffering and do no harm!

-------------------------------------------------

HONEYMOON!!!!!!!!!!!!!!!!!

Us with the Pitons in the background. We rented a Jeep for a day and explored the island. Behind us is the town of Soufriere, about 10 minutes from our resort.

Nicole chilling in one of the plunge pools at the Spa. The Spa was elevated, and had a breathtaking view of the bay and the Pitons. We got massages in outdoor cabanas, overlooking this view!

The bay and the beach that the resort is set upon. The boats are water taxis to take you to excursions or other parts of the islands. We lounged under the little huts on the beach. The water is crystal clear and full of fish and life!!

Us at Ladera, a different resort set even higher. This view is from their bar. Amazing.

This is from the helicopter that took us from the airport to the hotel. You can see the 2 Pitons, and the beach is in between the two. Oprah says seeing the Pitons is one of the 5 things you need to do in your life!

Oh man, it was absolutely awesome. We went to St. Lucia, an island in the Eastern Caribbean. We chose it because its an island that has mountains, lush rainforest, beautiful beaches - a really neat combination. We stayed at the Jalousie Plantation resort (www.jalousieplantation.com). We actually booked it through LuxuryLink (www.luxurylink.com), which has great auctions for vacation packages.

It was probably the most beautiful place I have ever seen in the world. Our resort lies between two mountains, right on the beach. These two mountains, the Pitons, overlook the Caribbean Sea. The resort has individual villas, and each villa has its own plunge pool. It also has a spa set up the mountain a bit, and a quiet, private beach. Each beach has little huts, and you are given a flag to raise anytime you want a waiter to come! Everyone in St. Lucia is so friendly. The island's chief exports are bananas, though they produce a lot of local spices and fruits. They even have 'soursop', a white flesh fruit that apparently is "natural Viagra". Tasted good!

See our pictures of our honeymoon:

http://share.shutterfly.com/action/welcome?sid=8AbNWbFwzauHEg

Our honeymoon was very romantic, and we could not have asked for a better time!

--------------------------------------

After the honeymoon, we went to Tampa for Amy's graduation. We had a great time, and we are very proud of our little sister. She is graduating from the IB program of Hillsborough High, where she was the drum major of the band, and is going on to University of Florida pursuing aerospace or mechanical engineering. I'm sure she'll have a great time, and learn to grow up and be on your own a bit!

Then we were off to Dallas for Mark Mintz and Jen Kitner's wedding. They are the last of Nicole's group of friends from her Emory class to have gotten married. Now we are all married, its the popular thing to do! Congratulations to them!

Jason and Amy Rice
Mike and Beth Hatfield
Alex and Sarah Ho
Alan and Nicole Cheng
Mark Mintz and Jen Kitner

Perdido, Labor Day 2007, here we come!

Okay, thats enough for now. I really hate packing, but then again its exciting to be actually getting a house.

Doctor Cheng

We did it!

WE ARE MARRIED! The wedding was awesome! Thanks to everyone who came to be a part of it. I will give more details later, but I'm in NC and we're closing on the house tomorrow morning, and I am butt tired. Hope everyone had fun!

Love,
Alan and Nicole

My feet smell...

Moving on...

Well, as you know by now our wedding is only days away! It's exciting, and yet I don't know if everyone goes through this, but I'm almost tired of talking about it. I know when the events happen, they'll be fun and it'll be great to see all our friends and family. But damn, I've been doing wedding planning for the last month and a half, and I can't wait for it to be over!!! There's so many "tasks" and "errands" that I just want to stop thinking about it.

However, now that I've vented, we're in good shape for the wedding, and really there's not much else to do. So hopefully, the hard parts are behind us and now we can just enjoy the company. I hear the wedding day, for the couple, flies by so fast, and before you know it it feels like only 10 minutes have passed, and tens of thousands of dollars are gone. Well, its a good excuse to get everyone together and party, so thats what we'll do.

The forecast is calling for 30% rain. Our wedding ceremony is outside, so we are all praying for good weather this Saturday. If not, we have an indoor backup, but its not as nice as the outside gardens. I'll post some pictures after the wedding, but I don't want to spoil it for you right now.

I want to give a quick shout out to the groomsmen:

Andy Krueger - best man. Met in high school, and we talk about girls a lot.

Ben Yin - groomsman. Met in college at Emory, and he is my go-to guy for sports and video games.
Bryan Edwards - groomsman. Met in high school, through Andy, and have been co-track stars toegether.
Chad Smith - groomsman. Met in college at Emory, and we talk about religion and Jackass.
Alex Ho - groomsman. Met in college at Emory, through Nicole and her web of friends, and we talk about doctor stuff.
Jeff Holcombe - groomsman. My brother in law, we talk about Cheng family tradition. Chee.

As far as our house...nope, we haven't closed yet.. We were supposed to close April 28th, but the seller needed time for some repairs, so he asked to push closing back to May 8. Fine by me - means I don't have to move in til later, so I don't have to start paying til later. May 8, however, is 2 days after the wedding. 2 days! 2 days after Nicole and I get married, we get the keys to our house! Very exciting. Nicole has informed me that I am supposed to carry her into her new house as a newlywed.

After the wedding we will spend about 5 days working on the house - painting and lawn work. Then we come back, and I graduate! Which is another crazy step in my life...walking across the stage with a diploma that says I'm a doctor!

Speaking of which, I just got my schedule for my intern year at UNC. For medical buffs, you'll find it interesting...for others, plus/minus.

July - Hematology/Oncology (solid cancers)*
August - General Medicine*
September - Gastroenterology
October - Intensive Care Unit*
November - Pulmonology (lungs)*
December - Geriatrics (old people)*
January - Cardiology (heart)*
February - Urgent Care/Walk in Clinic
March - ER
April - Nephrology (kidneys)*
May - Infectious Disease*
June - General Medicine at Wake County Hospital*

* = overnight call every 4th night

I have 3 different vacations:
Aug 29-Sep 11
Dec 23-27
Jan 30-Feb 5

So...I start off with what I think is one of the hardest rotations. Cancer patients. They are sick, and there are a lot of issues to deal with. I'm sure it will be a challenging time, and I hope I do a good job.

And in other news:

- Chad just returned from a 1 1/2 year study abroad in South Africa!

- Scanlon is about to graduate from grad school at Georgia Tech

- Andy bought 'Guitar Hero' for x-box after experiencing the pimpness at the bachelor party

- Nicole is hot

Wedding is 2 weeks away!

Hey everyone....

I think its down to the wire for the wedding. We pretty much have a close head count - about 140 people. Less than we thought, mainly because a lot of faraway family and friends have decided not to come. We were thinking 150-175! Its too bad they can't make it, they will miss a heck of a partay!

I just bought some cool manly tools today. Some person was selling all their lawn stuff cuz they were moving, so I went to check it out. Came home with a gas edger, hedge trimmer, weedwacker, shovel, rake, hoe (not the lavender donkey kind), and a seed spreader, all 1-2 years old. All for $235! Sweet, the edger itself cost about $250... Now I can be a man and take care of my own lawn. All I need is a lawn mower and a blower, and I'm all set.

Otherwise, I'm just spending these days finishing details for the wedding and the house. Man, you never really know how much detail goes into a wedding until you actually dive in. What type of bags do we want to give guests when they arrive to the hotel? Do we want white linens or ivory? Should the boutineers be calla lilies or roses? There sure are a lot of decisions to make. But besides these little details, the wedding is pretty much set. We have a band, so I hope you all are coming ready to party and dance!

As far as the house, we've decided that there are some things that need early attention. Oh, we are supposed to close on our house April 28th! Which means we'll get the keys in our hand right then! However, there are a couple of repairs to be made, and we won't close until their made, so it might delay it. But anyways, we know that we want to paint some of the rooms, get a fridge and a washer/dryer, and work on the lawn. We'll have about 3 weeks for all this, while Nicole may have 1 or 2 to help me.

A couple more pictures:

Feeling kind of rusty on the medical school stuff. I haven't really had any medical responsibilities since the end of February, so my skills are getting rough. Its the last time I'm going to have a real vacation though. Once July 1 rolls around, no more playtime for me!

Residency will be a shock to the system for me. All residents work really hard their first year, and UNC is no exception. It averages out to about 80 hours / week. We have what we call q4 call. This means every 4th night, you have to stay up and work overnight. So lets say Monday, Tuesday, and Wednesday are normal work days, about 6am-5pm. However, on Wednesday, I have to continue working all night, often with maybe an hour of sleep, and then continue working a normal Thursday morning. Then at noon on Thursday, we go home (after about 30 hours of working). We sleep or catch up on things we need to do at home, and then come back Friday for another round of work. We get about 1 day off per week, thats it! I have to do this routine for 10 months out of 12. The other 2 months are more "normal months", such as 8am-5pm no weekend work.

Crazy! Its the rite of passage that all doctors go through, except that it was even harder 20 years ago. Now residency is considered much easier! Ha!

Other news -
- My dad's birthday is today! Happy birthday dad-dee! The big 5-7. He doesn't seem that old to me though...
- This is Nicole's last week of work before a month off to have our wedding and honeymoon!
- Amy, my little sister, has decided that she's going to University of Florida for college, for an engineering degree. I think mechanical or aerospace. Whoa!

Later,
Alan

Now that I have recovered...

I shall write about the fun and frolic that happened last weekend. Yes, yes, I had the time-honored tradition of the bachelor party. And Nicole had her bachelorette party.

We decided to do a whole weekend extravaganza, since we had a couples shower planned for that weekend. Rather than having everyone travel again for a bachelor/bachelorette party, we decided to do it all in one weekend.

The couples shower on Saturday was awesome, and we had a great time. Thanks to the bridesmaides for putting it on! We got all kinds of gifts in the form of kitchen and garden tools. Also, everyone shared their "fondest memories" of Nicole and I...it was touching, and somewhat embarrasing! I love how one of the guys shared the fact that I "wet my pants" freshman year. Who was it that shared that? Scanlon? But really, Nicole and I had a really great time, and we are so fortunate to have such good friends and family.

Friday night was the chill night of the weekend. Just to name the highlights:
- Andy and Ben made the food: hamburgers, bratwurst, hot dogs, beans, chocolate and key lime pie...yum!
- We played the guitar game on xbox (Bryan stunk)
- We played the karaoke game on PS2 (Bryan was great, and Jeff was booted off after 20 seconds of singing "My Ben Yin Love aka My Endless Love"). Alan loves Michelle Branch!
- We played poker til 3am

Saturday night was the par-tay night!! We had rooms reserved at the InterContinental, where we were supposed to return, but more on that later. I have to say, it was an awesome party night! Now this blog is to remain decent and censored, but lets just say we had a great time.
- Dinner at Dantana's...where Danny Kim kicks off the night by flirting with the hostess...the man has no shame, and I love it!
- Out to Lava Lounge...its about 10:30 pm, and its still a major sausage fest. Danny Kim again kicks it off at the bar by flirting with "Sienna". Now this girl Sienna is a hoochie! She's there by herself, wearing a white dress that barely covers her thighs. And later I find out she's an ER resident at Emory! We do a little dancing, and she moves on to the 40 and above crowd. Also, some EtOH was imbibed there. Then it was time to leave for the
- (I will be writing in subsitute words and pig latin here). Lavender donkey. I sit on the bouncer's throne and check ID's. We go in, and the place is crazy packed! I sit down in a chair by the bar, taking it all in, as the rest of the guys huddle together and come up with a plan for me. The rest .................................. is history! Stogies, melons, rumps, and cantilysay adclay irlsgay ancingday ontinuslycay llay erovay emay...quite the experience!
- However, after we left the lavender donkey we were all supposed to meet at R. Thomas with the girls to hang out, eat, and continue the night, but Iay asway ootay runkday danay omitedvay noay hetay ottedpay lantspay. It was the end of a really great night. Sorry about that.

I was actually pretty functional the next morning, though I just seemed to be tired for the next 2 days. But all the memories of having some of my best friends with me doing guy things, I'll never forget.

Find the absurd statement:

As I was looking up how to obtain our marriage license, I came across this information.
Your mission? Find the absolutely absurd fact about getting married in Georgia.

Applying for a Marriage License in Georgia
Marriage License Laws

Requirements may vary as each county in Georgia can have their own requirements based on the Judge in that area.

Residency Requirement: Do not have to be a resident of Georgia. However, if not a resident, you must apply in the county where the marriage is to be performed.

Identification Requirement: Two valid forms of id such as drivers license, birth certificate, U. S. passport, Armed Forces ID card, or Resident Alien ID card. Applicants will also be asked to fill out a brief form.

Pre-marital Education: Cobb County offers a free Marital Workshop called FOCUS ON FOREVER. It is a skill-based non-religious workshop designed to address issues concerning communication and listening skills, anger management, and financial planning. Contact the Cobb County Superior Court for more information.

Previous Marriage: If divorced within six months, you will need to show a copy of your divorce decree.
Some counties, including Glynn County, require a final divorce decree no matter how long you have been divorced. You can obtain a copy of your final divorce decree from the Superior Court in the county in which you filed for divorce.

Waiting Period: There is no waiting period for getting married in Georgia.

Fees: It costs approximately $26.00+ to get married in Georgia. Some counties will only accept cash.

Other Tests: As of July 1, 2003, blood tests are no longer required in Georgia.

Common Law Marriages: Yes.

Proxy Marriages: No.

Under 18: If you are 16 or 17 years old, you may apply if accompanied by both parents who have given written consent. If the bride is pregnant, no parental consent is required if you submit a statement from a Georgia licensed physician certifying that the bride is pregnant. If underage applicants already have a child, they should present a certified copy of the birth certificate for the child at the time of application. If parental consent is not required, the court will notify parents or guardians that you have been issued a marriage license. There is an additional fee of $1.00 per letter.

Cousin Marriages: Yes.

Same Sex Marriages: No. In November, 2004, voters passed a constitutional amendment banning same sex marriage. More Information

Officiants: Licensed or ordained ministers, clergymen, or pastors of recognized religious societies, and justices of the peace.

Chinese wedding

Courtesy of Bryan. Thanks man, thanks a lot.

Chinese Newlyweds:
A Chinese couple gets married - and she's a virgin. Truth be told, he is not too experienced either. On the wedding night, she cowers under the sheets as her husband undresses. He climbs in next to her and tries to be reassuring "My darring" he says, "I know dis yo firss time and you berry frighten. I pomise you, I give you anyting you want, I do anyting - juss anyting you want.. Whatchou want?" he says, trying to sound experienced, which he hopes will impress his virgin bride. A thoughtful silence follows as he waits patiently (and eagerly) for her request. She eventually replies shyly and unsure, "I want to try somethin I have heard about. numbaa 69". More thoughtful silence, this time from him. Eventually, in a puzzled tone he queries... "You want... Chicken wiff Broccori?"

We are homeowners!

I'm sorry that I've taken a break from blogging, but I am back, and I'd like you to know that Nicole and I have a house!!

Well, actually, I should say we are under contract...but we're going to have a house! We just came back from househunting in North Carolina, and saw the two houses we liked the most. They're in the same neighborhood, and actually very similar houses. We put an offer down on the first one, but someone beat us to it. That house was on the market for less than 24 hours! Then we put an offer down on the second house...the house that was in the previous blog. The big, pretty, 2 story blue one. After some negotiating, we have agreed on terms, and now by the end of April it will be ours! Nicole and I can't believe it!

Here are some pictures:


House is on the end of a cul-de-sac, off to the side. Great street, lots of nice houses on the street. The neighborhood is a great neighborhood too, good variety.

This is the entrance/foyer. The stairs are at the entrance, and the wood floors go back into the kitchen.

This is the family room/living room on the 1st floor, just to the right of the foyer. Gas log fireplace.

This is the kitchen. Very big and lots of cabinets and countertop space. No fridge =(. Gas range for Nicole to cook! =)

This is the breakfast area, viewing from the kitchen. The door opens out onto the deck.

The deck. Nice and big.

The backyard lawn is probably one of the reasons the house didn't sell as fast. Its naaaaaaaaasty!

Upstairs, there are 3 bedrooms and then this bonus room. Its pretty big, could use it for whatever. Taking suggestions on what we should do with it!

Master bedroom with trey ceiling.

Master bathroom with jacuzzi tub (ahhhhhh)

Master bath with 2 sinks (very important to the survival of the marriage!)

We are extremely fortunate to be able to buy a house like this. If we were in Atlanta, this house inside the city would be only in our dreams. But in Durham, this price of this house is really reasonable!

We'll probably paint some of the rooms to warm it up, and do some lawn work, add blinds and some appliances...but otherwise its in great shape.

Nicole and I have realized how extremely fortunate we are in all aspects of our lives...our families who have been so supportive, our relationship, our friends, and our education. Both of our parents have worked so hard to carve out their place in the world, out of scratch, and we recognize how much we have gained from their hard work and success. We really do have a good life, and it wouldn't be without any of you, our friends and family.

Let me know what you think!

Alan