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

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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!

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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!

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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