One of my favorite people sent me this quote today...so very true. 

“Destiny is a curious thing. It doesn’t always take us where we want to go, and many times ends up taking us to an unexpected place where we feel confused, lost, with no idea where to go next. These are complicated and painful moments that make us suffer and question who we are, along with what we want the most in our lives. But if we really make the effort to see these challenges as opportunities to find ourselves, we will understand that it was exactly what we needed to discover and strengthen our role on this planet.”
                                        [rickymartin]

peace

Source: Uploaded by user via Sherry on Pinterest

I needed this today.

Very exhausted.

More later....

What an amazing day!!!!

If my life was written as a book, (a ridiculous, crazy, emotional, weird, etc, book) Dec 14th 2011, this day, would no doubt be a very important page.

Today I found out that I will finally start my training in the field of emergency medicine at San Antonio Military Medical Center. It still sort of has not sunk in that this will actually happen in about 6 months. Although at the end of the day, I'm here, right now, exactly where I want to be, there have been times where I felt like I would never see this day.

Sure, it possibly sounds dramatic. But aside from the underlying blessings of my own health as well as the overall health of my family,  I've had days where I felt the opposite of blessed. Such days include the day when the Air Force revoked my medical school scholarship because I didn't actually get into a medical school in 2006 and proceeded to station me at Holloman, AFB in buttcrack, New Mexico to do fix airplanes. Also going down in the books as an equally "my life is ruined" day was the day when, after telling them I wanted to continue to pursue medicine, my own squadron commander and Air Force Headquarters ("The Man") told me, in not so many words, that now that I was a aircraft maintenance officer, going to medical school was not part of my life plan anymore and that I should proceed to accept the facts as a proud military officer.  Both of these epic days sprouted many other epic days that just made me really feel like my dreams were dwindling away with every day that passed.

It's pretty crazy to think back to those days and truly understand how I was able to look past all of the negative feelings of despair and not allow myself to be discouraged by the obstacles that, at the time, were everywhere I turned. I don't think I'll ever really know how I did that. I guess it's just one of those things that you don't really think about, you just do it. I remember like yesterday wishing and praying to God that if he would just help me get to this day, I'd never ask him for anything else. I remember so vividly the feelings that time was passing around me, taking my dreams of being an ER doctor with it.

That being said, it's still so surreal to me that I'm even typing this post right now. I've been fighting against everything and anything to get to this day that now that I'm here, I have a hard time actually believing it. I'm not implying that I've grown up living the life of hard knocks or anything silly like that. Simply that nothing in my life has ever come easy. I feel like i've spent my life struggling and fighting against to get here, to this day.  On the days like I talked about before (opposite of blessed days), there was nothing more that I wanted than to be finished fighting for "this life". But now that I look back, I feel like days when I felt like God or whoever had forgotten about me, were the days when I actually gained the most. It sounds all touchy-feely, I know. But no matter how many terrible days I have now, or how many times I think about how "tough" this life is right now, I look back at those days, remember how opposite of blessed I felt, and immediately realize that those were the some of the most influential days of my whole life. And without them, this amazing day, would not be nearly as meaningful.

So I love today. I love that I finally feel that some of my hardwork has paid off. But what I loved the most, was the feeling I got when I read my email telling me I was selected for Emergency medicine at SAMMC. I LITERALLY felt like the moment I read those words, the 200lbs, ever-powerful backpack of doubt and fear that I had been carrying around for a loooooooong time (even in my sleep, not just since last year) just disintegrated into thin air.

Overall, what an amazing day. I'm definitely going to bookmark this day and come back to it multiple times just so I know it actually happened.

Source: lifeslittlepresents.blogspot.com via Sasha on Pinterest

distractor post

It's match week!!!

I'm working furiously on Peru adventure planning to keep my mind off the match. I've narrowed down my flights, buying them this week!!! Hopefully booking an adventure tour that involves hiking the Inca trail..also this week! You would think all of these things would distract me from the match. (wrong) I have self diagnosed ADD so it's VERY easy for me to jump back and forth from thought to thought.

So very excited about this trip.

Other things to distract me this week: my cousin time I'm getting, the ever present ambulatory care, working out?, online xmas shopping, etc.

Ahh it's match week!!

ok, i'm done now, even this post can't distract me :(

Random thoughts...

•  As you can tell (or maybe not), I'm in the process of redesigning the blog! Actually, i'm not redesigning it, my cousin, the Xio part of XioKat is doing it for me :) Visit her blog and website, buy they're stuff, its awesome! I'm hoping redesigning= more posting, we'll see!

• Thanksgiving break was great. I got some much needed rest and time to see family. Sad that I'll be here for xmas, working, overnight, on my birthday, in the CCU, hell on earth. Wish me luck and prayers that I stay sane :)

• I don't even want to mention the upcoming (6 days) Air Force residency match that will determine my fate for the next few years. Lots of worst case scenarios going on in my head. I don't think its normal to be simultaneously looking for places to live in San Antonio, TX AND Okinawa...such is life. Bring it on AF!

• To celebrate and rebalance myself after this ridiculous match business, I'm planning on crossing an item off my bucket list very soon!!! Just sent in my leave paperwork to take an amazing trip with a very great friend to Cusco, Peru and hike the Andean mountains of the Urubamba valley up to the incredible Machu Picchu!! I can't even get over that I'm typing this because this has been a dream of mine, literally, FOREVER. Let's hope the AF comes through and I can overcome the mounds of computer training and jump through the obligatory hoops the silly AF requires me to do. Again, bring it on AF, your antics are  NOT getting in the way of this.  *side note: this trip will result in me having to do 4 months of wards straight upon my return, yes, i said 4, yes that's going to be insane. Who are we kidding though, it's Machu Picchu, it's worth it! And when do we ever get to travel like this? I'm doing it. :)

• I bought those silly five finger shoes. So far they're awesome but incredibly different and will take some getting used to. I ran today in them, maybe more than I should've. Feet are hurting now. I think if I can adapt my plantar fascia will like me again. Updates coming. 

• My cousin, from Colombia, is visiting me tomorrow for a little over a week! Very excited. She's a future doctor and awesome. 

• Currently on an outpatient internal medicine clinic rotation. It's quite boring/annoying. I don't care about pulmonary function tests...or diabetes follow ups. I DO care about short days and weekends off. So no complaining here. :)

...that's enough random thoughts for now. 

Oh hey there Machu Picchu....

Sometimes I wish...

...that I was perfectly content with being a housewife and that I didn't care about the whole saving lives thing. I say this almost weekly, but really, who am I kidding?? With my domestic skills, I would make the world's most terrible housewife and my family would prob pay be to go back to work. It seems like it would make this life easier some days though. Until I realize cleaning and laundry stresses me out more than a crazy ER full of dying people. Maybe in another life.

...I was more girly. I've NEVER been an actual girly girl, as most of my friends have often told me. I've always been known as the tomboy of my family and I've actually gotten much better, thanks to my cousins :) I own actual high heels and dresses, several actually. This is an improvement from just a few years ago. I'm pretty content with my girlyness, or lack thereof. But sometimes, and by sometimes i mean once in a blue moon, I get the urge to wear dresses and high heels but then I quickly remember the trauma i have experienced from wearing high heels and my high heel PTSD comes back. Oh well, I'll stick with my flats out of respect for my feet, they do a lot for me as it is. :)

...I wasn't so stubborn. (this is not likely ever going to happen) Being stubborn isn't always a bad thing. It is part of the reason I've accomplished most things in my life. But sort of like the housewife thing, being less stubborn and more able to accept things I can't change would again, make this life A LOT easier lol. I guess it comes with the territory of being my mothers daughter. I never give up on anything. I often struggle with understanding that giving up isn't synonymous with walking away. Sometimes we just have to let things be and realize that, in my mom's own words, "cant save the world everyday." Let it be. Maybe a new tattoo idea?? ;)

...I had a longer attention span. My presumptive ADD sort of conflicts with my need to learn things for myself. I genuinely have to look up everything I'm taught, despite where/who I hear things from. Not in a distrusting way at all, I just always feel better reading things for myself straight from the source (i promise i'm not crazy controlling freak). I believe we should trust, but verify. That being said, I really have to work on my attention span. I go to read an article or a chapter to verify what I was just taught for example, and I can't make it through the 3rd page before thinking about what my next meal is going to be,   how far I'm going to run that day, or some other random non-important thought. I need to get a grip on this attention span thing...intern year is not the time to get distracted by every car that drives by lol. I feel like that dog from Up...sqquiirrll!!!!

ok I'm done now. There's many more things I could add to this list. Sadly, that last one is the limiting factor. Off to sleep.

This might actually be my wedding attire, one day, except red instead of purple... :) :)

Source: ninephotography.squarespace.com via Bix on Pinterest

I get to Starbucks before it opens :(

Not to be insensitive at all, but today I kept seeing facebook posts and even hearing people say "never forget".  And shamefully, I'll admit, I had no idea it was Sept 11th until I got home from work! :-/ Fail on my part as an active duty  military officer. In my defense, I didn't actually forget, I just never knew what day it was, seriously. Crazy what waking up before 4am daily,12 days straight without a day off, and extreme fatigue can do to you.  I live not by the actual date, but by how many days my patients have been in the ICU, I've been getting to starbucks before they open lately, and my attending has already told me to eat more for breakfast because my growling stomach during rounds is distracting... it's quite sad. lol

ANyway, MICU has been going well so far otherwise. One thing that I mentioned in my last post that has continued to be a theme of the month is death. Not because my we as a MICU team are bad doctors, but because it seem that this month we have been the terminal cancer service. In the past 2.5 weeks, i think only a 1 or 2 days have gone by where we didn't discharge a patient to heaven. Most were expected, a couple were not, and those were the rough ones, but not the roughest. THe roughest for me to get over are the ones that don't actual die. They stay "alive" but they're not actually living.  I don't dwell or let it really get to me to the point where I can't do my job, but I do have to admit that I am sensitive to this aspect of medicine, always have been. It's a good thing right? I feel like we live in a doctor culture, especially in the military, where we frown upon sensitivity. We are people, not robots no matter how tough we pretend to be. I bet even the big tough surgeons who puff their chests out all day long pretending to be big and bad get a little sad from time to time. lol  That being said about the daily death we have had this month, I have to say that there's a fine line between trying everything you can to preserve somebody's quality of life and keeping their heart beating until family can find the strength to say goodbye. I hope I don't have to ever make that decision for somebody I love. Either way, all I know is med school does a terrible job of introducing us what to do when you get the call "Mr/Mrs. X is just passed, come now, the family is very upset"....yikes!!!

Anyway, that's depressing. In happier news, next month I will have a life again! :) Things I'm planning on doing:

- Step 3 studying...only because I HAVE to
- Celebrating the fact that this crazy schedule that Tim and I have had due to studying for tests is over!
-Thursday night group rides with king william cycling group!
- uncover hidden treasures in san antonio/austin
- find places to hike/rock climb
- have groceries in my apt on a regular basis
- take lots of pictures...of everything
- cook...a lot
- stay awake past 9:30pm

On a side note: Since my mom recently welcomed a beautiful Chinese exchange student named Maggie, I decided that I'm going to visit her, my new sister, in China and I'm making this (climbing in China) happen soon...no matter what it takes!!  ;)

Source: onsight.com.au via Sasha on Pinterest

Welcome to the MICU....

I've been in the MICU for 1 week now and it's been great. By great, I mean that I'm learning a ton and I love the work. THe last 3 days, 3 patients died...rough. I pronounced my first death, did chest compressions twice already, and had to give some pretty tough advice about withdrawing care. Everyone has said that MICU is the busiest rotation and that I'll never have time to workout. So far, i've had the opposite experience. Everyday that I come home from being surrounded by death and dying, i feel compelled to run and exercise. Maybe that's just my way of feeling alive and shaking off the emotional weight of the day, but it's become necessary. (my love handles are also benefiting from this lol). Anyway, MICU is rough but amazing to say the least.

Tomorrow will be 1 yr since Tim and I went on our first date. Crazy. Crazy that he has continued to ask me on dates for a year. Crazy that he has continued to put up with me during this year of unknowns and moving and changing of plans. I'm pretty lucky in my opinion ;)

Thing's that I'm not used to yet...

1. This patient history:  22 yr old male with bilateral lower extremity below the knee amputations, right hand amputation, and blast injury to testicles and penis. (this kid is not a rarity sadly)

2. Being called doctor by above patient and him thanking ME for my service....are you serious??!!! I have done nothing compared to the sacrifice and decisions these kids make everyday. 

3. Realizing that I'm not a med student anymore and my signature actually means something now (mainly, I have a licensee to kill)

4. Waking up at 4am daily...and wanting to go to bed at 7pm

5. Being far away from Tim and seeing him once every 2 months :(

6. Knowing that my holidays will be spent in the hospital this year

7. Feeling like all I do is work and sleep

Source: None via Sasha on Pinterest

My path from A to B is quite similar to this. Doing my absolute best to enjoy this round about path that seems to be the theme of my life. :)

It's 7:22pm. Bedtime.

Deja Vu, I hate you.

So before I start this post, I want to note that I just read my previous post and i really don't even remember writing it! Totally serious. It was a good post, and I'm glad I wrote what I wrote, but I honestly don't recall writing it. This post on the other hand, I wouldn't mind forgetting...


Today was my day off. What did I do today?? Here's a list of the progression:
1. Got a hair cut
2. Spent way too long re-writing my CV while drinking Starbucks and people watching [ps-why does it feel like always have to re-do my CV but I never feel like I actually have done something awesome enough to make it better???]
3. Watched my new tv obsession, "I Shouldn't be Alive" on Animal Planet and got lost in my thoughts about how I would most likely die in each of the situations presented in the episode.
4. (Feeling guilty about watching tv): rode my bike to Mad Hatter's Coffee and started writing my new personal statement for this cycle of emergency medicine applications
5. Had a moment of horrible deja vu and despair about the fact that this whoooole drawn out process that is the military match AND civilian match is happening again :*(
6. (frustrated with my negativity) rode bike to eat away my stress with sushi and somebody who really inspires me [you know who you are]

I usually think deja vu is pretty cool, eerie, but still cool. I HATED the feeling I got today when it seemed like all my stress of the match, not knowing (again) what on earth I will be doing or where I will even be doing it, totally came rushing back. I've been telling myself for the past year now that everything happens for a reason and this is where I'm SUPPOSED to be right now. But i guess I just can't help but let the weight of everything, including the powerless feeling this process gives me, overwhelm me right now.  I know the right thing is to just relax and have faith that I'm doing everything, literally EVERYTHING, in my power to set myself up for matching in San Antonio this year. And I know the right thing to say is that, whatever happens will happen and things will work out for the best. I know that I can't plan everything (nor do I want to). And I know that I can't have back up plan B through Z when it comes to trying to end up in the same location with Tim.

It's almost painfully obvious that this is yet another lesson in faith and trust that it's all part of a plan. But I don't feel like any lessons today.  We're all entitled to have our days right? THe days when we feel like we're losing our grip on things we thought we had strong control over.  The days when we can resist what we know is truth only to be followed by a day of regrouping. I think today was my day to resist...and I successfully did that. Maybe tomorrow (i hope!!) is the day to regroup and move forward. .

PS-
I (not so?) ironically stumbled on this pin today...

Source: lilluna.com via Sasha on Pinterest

I love my job

It's 11:21pm, I'm home blogging instead of working on a case report that is due soon, and I love it. It's my day off today and honestly it hasn't really felt like a day off. Nights have been going relatively well. It is crazy busy and I feel like I'm running around like a pager carrying chicken that just had its head chopped that's trying to find it's way around a hospital. After the first night of getting lost, asking nurses how to do pretty much everything, and figuring a small amount of things on my own, I feel like I have the hang of things. By the hang of things, I mean that I know where  to find my patients in the hospital and can stumble my way through the calls I get from nurses. I haven't had anything too crazy happen just yet but last night was a close one. I came within a couple hours of having to pronounce somebody dead :(  I was pretty sure she was going to die last night but she (or somebody else) kept her with her family for a bit longer. I talked to her family and prepared them for the end that was very much in sight. It was really tough. As a medical student I've seen very sick people before, but never on my own. I was never the ONLY person that was in the room with a family and their dying loved one. I kept her comfortable and just let things play out. I'm not sure if she made it through the day today,  I guess I'll find out tomorrow.  It just made me really think about how fragile we all are. Here one day, and gone the next.

But overall its going well, I can't complain. I'm learning a lot and I think I'm actually getting to closer to the day when I actually FEEL like a real doctor. One thing I have noticed that I hadn't really thought about was the amount of young, drastically injured people coming to the hospital for rehab. I see them as i'm walking into work everyday. On a daily basis I see no less than 5 kids wheeling themselves and their newly amputated stump around the hospital. WHen I see them all I can think about is everything that landed them here. The process from being wounded in theatre to being able to wheel or crutch around a hospital on your lunch break form rehab. I  can't even begin to imagine the battles they fight everyday.  So it does make me sad to see so many young people like that. But it does make me re-evaluate things when I get frustrated and feel overworked or tired. I'm incredibly lucky and I can't forget that.

I think it's pretty amazing that I get to experience all of these things for a living and even better, get paid for it. The hours are long and it's a lot of sacrifice. But in no other career would I be able to actually make an impact on people and truly give back as much as I do. It's a special gift to be able to be here and good or bad, I wouldn't change it.

Night shift= no sweat...literally

I'm starting my 2 weeks of night shift tomorrow! Contrary to what my colleagues have expressed, I am very excited to start! This out of proportion happiness is probably due to the fact that I'm just so anxious to start being a doctor already, a real doctor. Not that 2 weeks on nights makes me a "real" doctor by any stretch of the imagination.  I just really want to get out of this holding pattern I've been in during these past 2 weeks of "research" block. (I mean really, how can I do research when I haven't even seen my first patient of my medical career???)

 So I know nights is going to kick my butt in more ways than one but I'm actually very ready to start learning the real things that doctors do. I'm ready (I say that now) for the 3am call about a patient who is having chest pain and needs help. I'm ready to frantically run my little intern feet down the hall to a code and immediately realize that every ounce of medical knowledge I thought I had suddenly disappeared and I have absolutely no business being part of a code, much less running one! I feel like I'm ready for all of these things! Oh and just for the record, ready does not mean prepared. I'm fully aware of how unprepared I am to manage the needs of every and any medicine patient in the hospital at night. But I do think that it's more important to be ready than prepared in certain situations. For things like crazy night shifts and running codes that not only take you out of your comfort zone, but destroy any last memory you even had of feelings of comfort, there is no amount of time that could prepare you adequately. I have this feeling, and I've been told, that it's just one of those things that you have to go through to fully understand. I guess it's like the whole "you had to be there" jokes. Except I highly doubt I'll be laughing, maybe, who knows.

The things that I'm putting in the "bright side" category about night shift:
       -no waiting at the BAMC gate for 3x the amount of time it took you to actually drive there
       -no extra people (i.e. interns, visitors, random people that just get in the way) around to worry about
       -the lack of extra people will decrease the number of people that see me screw up!
       -The cooler temperatures during which I will be leaving. No sweating on the walk to the car, yes!!
       -The "learning experiences" I will get...*nervous laugh*

...and that's all I can think of right now. This list surely decrease starting tomorrow as I'm sure I will only see fewer bright sides (literally) after my first night shift.

Off to continue my quest to stay awake as long as I can and sleep all day tomorrow. (so far I'm failing miserably!)

I hate Blues...

Today was Monday...It's "Air Force Blues" day where we're required to wear the dreaded uncomfortable blue uniform.  I felt a little on the blue side today for a few reasons.  I guess I was just following the blues day theme.

I start night float on Friday. I'm pretty excited to finally start working and get out of this holding pattern/psuedo research block i've been in. I'm also pretty scared that I'm going to be so overwhelmed and not know what i'm doing. I'm not going to be alone, but even with help there, i hate feeling like/being an utterly clueless doctor. It's going to be busy, no sleep, and crazy.  Wish my patients luck!

Short post today (see paragraph 1). I'm off to visit a friend and eat some yummy Filipino food. That surely will mark the end of Air Force Blues day. (i hope)

Source: None via Marybeth on Pinterest

The chase has...continued!!!

Weekend with Tim!

I was one of the lucky ones to have start residency on a non-inpatient rotation. Not only is my first couple of weeks non-inpatient...it's actually a non-patient rotation...RESEARCH! :-D  At first, I was bummed out that the huge build-up to internship felt a bit anti-climactic. My first real day of being a doctor didn't even require me to come into work! However, I am NOT complaining at all. It was a blessing that I was able to have the weekend off because my Tim was able to visit me! He arrived Friday night and we had a great weekend. I showed him around downtown San Antonio and King William. We spent most of the weekend on bikes making plans to live here in our own cute King William house. It was nice and I'm excited to see what the future holds <3. We rode around town, did Crossfit with some fellow interns (which totally kicked out butts!!) in their home crossfit gym (CROSSFIT EMESIS) they made, cooked ourselves a fantastic dinner, and just relaxed. It was a weekend that we both needed to put things in perspective again.

Now that the weekend is over I'm looking forward to really getting a study/workout regimen started. I have lots to do in these next 5 months and a lot is at stake. Residency, Boards, EM applications, fitness goals will for sure keep me busy and hopefully make the time without Tim go by fast! 

Pics from the weekend...

Our vehicles!

                                           Post-thai dessert: Tres leches cupcake and cheesecake

Dinner my Teem made for me!

Pioneer building in King William

Admiring homes in King William historic District

Dancing at a beer garden on First Friday <3

Source: 1.bp.blogspot.com via Sasha on Pinterest

Sometimes we fall off...In my case, it happens a lot...just have to remember to check the breaks and keep the wheels turning <3

Home is where my bike is...

I'm approaching my final week of residency orientation! It has been somewhat of a long 2 weeks full of paperwork, endless power points, safety briefings, and trying to re-adjust to being back in the Air Force. In-processing, the military word for checking in and starting at a new duty station, has pretty much been a painful experience for me. Mostly because something got lost in translation (i.e. my SSN-which is kind of a big deal) and made virtually every form I was supposed to have, every system that I had to have set turn out incorrect. Long story short, I had to do everything at least twice to fix the error in my SSN.  BUT...it's ok, it all worked out and I got a 2 week lesson in patience :)

In other news, I'm getting settled! I LOOOOOOOOOOVE my apt..well...with the exception of the elephant wearing high heels that lives above me. It has gotten better over the past week. However, the first week I was certain the upstairs neighbor was practicing her runway walk promptly at 3am daily!!! Aside from that, the apt/loft is amazing. It's the nicest place I've ever lived in and it makes me feel like a real adult...scary. Not only is the place awesome, the location is great. King William is a very unique historic district with a great soul. There are several galleries, independently owned shops and restaurants and just a general alternative. It's not your run of the mill suburbia and that's what I love about it! Probably the best thing I like about this location is that I can (and do) ride my bike pretty much anywhere. Downtown is a 5 min ride, King William is 1 block over from where I live. In phoenix, i really only rode my bike with groups and when I was specifically training for races. I forgot how much I loved just riding my bike places, no real training goal in mind. For example, i rode my bike to get my hair cut last week after a very very long day of orientation. It felt so nice, other than the little fall I had, to ride a bit and "unwind" after work! Overall, in just a few short weeks, San Antonio has brought me back to my bike and makes me feel at home. I'd say that's a good sign! 

So now that I have one week until I start and am more or less settled, life is better :) The interns and residents have been really nice and helpful so far. I know it's going to be a tough year in so many ways, but I can honestly say I'm excited and grateful. 1 year ago I was in San Antonio ironically. During that time I can remember feeling like I belonged here and praying that I would match here. Well..I did! (sort of...more on this later)This year, I'm here, and praying that I STAY here. I guess we'll find out soon enough. I mean, who would be more perfect for SAUSHEC (pronounced: SAW-SHEK), than Sasha! (prounounced SAW-SHA) I mean really...can it be more obvious that this is where I'm supposed to be!? ;) 

Here are some pics from the past couple of weeks!

The outside/inside of my complex: South End Lofts 

Waiting for a red light in Downtown :) (I'm an eternal tourist)

Houston St. and St. Mary's- sitting at a starbucks 

"Beauty...it rubs against one's tongue

it hangs there hurting one. insisting on its own existence

finally it gets so one cannot stand the pain

then one must have beauty extracted..." 

- this was something i saw on a ride home recently...it's pretty interesting, still trying to figure it out

My trainer!! (and makeshift riser lol) I love it! Now I just need a new bike for riding around town :) 

 Messy and a work in progress...but it's a start

<3

Something I just realized...

I need to re-do my collage above for it's annoying me. I'm not sure why. Maybe it's because some of the pics of Tim and I are stretched awkwardly and we look like fatsos.

Nothing interesting to speak of tonight. Just miss Tim a lot. I get to see him on July 1st!!! So that's great news and the countdown has begun! <3

Orientation starts tomorrow!! (gulp!)

Tomorrow the Air Force will attempt to orient, in 3 weeks, on how to be a doctor...yikes! I'm sure it's going to be a lot of briefings and trying to stay awake while they try to explain things that should only take a few minutes, in 3 hours. Nonetheless, I'm happy to get started! I'll let you know how it goes! In the meantime, this is me:

Fast forward 4 months!

In my last post, I was in a different country. And now, now only am I back in the USA, I am calling a NEW state, TX, home. LOTS has happened (i always say that) in these past 4 months, here is a list: 

- Was blown away by my awesome seester's BFA show and her work--> she is incredibly talented and I really admire her creativity and how she's following her passion.

- Graduated from medical school--> Was so happy to have my family and Tim come all the way to Kirksville, MO to share this special day. We didn't go to pricey dinner or have a crazy party. But we did spend time together, and that is more valuable to me than anything in this world.

- Became a Captain in the Air Force--> I can really get used to being called Capt Ramirez ;) 

- Saw my little brother graduate high school--> I'm so proud of him! He has grown up to be such a good boy/man but he will always be my little brown boy. 

- Went to Puerto Rico with my family and my Tim :) --> Beautiful place with my favorite people in the entire world. 

- Moved from Phoenix to San Antonio, away from Tim :( --> A very bittersweet day for us. But I know the greatest things in life are not always the easiest and everything happens for a reason. Hopefully this will make our relationship stronger than ever. 

- Started to process of planting my feet in Texas :) --> This is sort of a work in progress. I already know I love San Antonio from being here several times before. Moving in to my new place next week will be the next step. I'm so excited to design my place and explore and really make San Antonio my new home!

So, HUGE milestones going on and as always, it feels overwhelming, exciting, scary, and crazy all at the same time. It's tough to describe how it feels to be here, at this point in my life. One one hand, it's a feeling of relief and accomplishment, of, "wow, I'm DONE. I finished 20 years of school!" It is an accomplishment that is surreal still. On the other hand, I feel like things are only just beginning! It's sort of like a long, yet amazing, introduction to, what I hope will be, an equally incredible and fabulous story! 

The excitement I have for this next step and all of the steps to come is also tough to describe. It's almost like this is the moment everyone was talking about when they ask, "what do you want to do when you grow-up?" I'm grown up, it's happening right now (somewhat), but my answer to that question seems like it went from doctor, to doctor + a million other things! I have so many things I want to do in life and now that my introduction has been written, I can finally start the real story. 

Here are some of my favorite pics from the past few months :) More posts to come soon!  

3 days left in Colombia :(

My month in Bogota is coming to an end and I´m torn. Part of me really wants to stay and experience more, but the other part of me can´t wait to get home! I turned in my white coat today, the hospital gave me one to use, and I´m basically done working´now. The past couple of days I was getting REALLY tired of kids with gastroenteritis, so I think its safe to say I was ready to be done lol. All in all, im happy that I got to coem here and learn in a different system. Fundacion Santa Fe is actualy only a very very small picture of what the medicine in Colombia is really like though. It very much resembles the US in terms of EMR, medical resources available, etc. If i could do it again, after already experiencing FSFB, I would want to do EM in a not so nice hopsital in town that gets trauma or at a rual health center in one of the surrounding small towns. But that´s def later, once I have a few years of being a doctor under my belt lol. Maybe one day... :)

Anyway, now that Im almost gone, I´m starting to think about where I want to visit next. I know craziness (intern year) is going to start soon in June and I wont really have anytime, but I´ve decided that I want to always have travel plans in the works. If not now, then when will I ever do it? Its all too easy to say theres no time. ANyway, I would love to come back to Bogota with Tim and show him how amazing it is. I also have really been wanting to go to Brazil lately. My cousin was there for 6 months and, although I already have been wanting ot go for a looooong time, the way he talks about it is just making me want to go even more. Also, #78 on my list of 200 things I have to do before I turn 50 is: learn Portuges!!

In other news, now that i only have a few days left, ALL of my aunts want me to see them. Theres too many aunts and family and not enough time :( I have gotten to see a good fair share of family though since ive been here and Im happy about that. Everytime I come to Colombia I meet more cousins and I love that. I dont think you can ever have too much family, even if they are somewhat crazy or weird lol.

what else...Ive met some pretty awesome people here at the hospital too. I think I work pretty hard, but Im constantly amazed by how hard the med students work here. They are brilliant and juggle school, research, traffic, and life in Bogota (which can be tough at times). I can honestly say, they work MUCH harder to be doctors than most american students do.

ok, now Im off to make the bes tof my last 3 days here!

Week #2 in Bogota!

Time is really flying! I cant believe its already the end of my second week in Bogota! I feel like I just got here. This week was good. I am mastering the flow of the ED and learning the different quirks of the different docs/nurses (i.e. some like notes in a certain format, some don´t let me write notes, some want me to do everything, and some nurses get offended if I put a pulse ox on a kid without asking them to do it, very ridiculous, I know). Im also mastering the art of gaining weight! I´m not dieting while Im here but I have been trying, and failing miserably, to eat small portions and work out. Its not that I eat all the time (almost), but the food here is very heavy. Lunch always is some sort of meat with rice, potatoes, some other carbs, etc. I know its not the best, but I cant resist it!! ALso, if you dont clean your huge plate of food here, ive noticed tha tpeople look at you weird, like you are wasting good food. Im trying not to think about it and enjoy everything here, but I feel like a lard. I havent worked out in 2 weeks and that makes me feel more tired! Its sort of like the lady from the movie eat, pray, love, who has to buy herself some "big lady pants" after 4 months in italy. Im almost to the big lady pants point in only 2 weeks!! yikes!

In other news, walking home has been awesome this week! I figured out a faster, although initially more dangerous, route home. By more dangerous I mean I have to cross 2 really busy streets and a railroad track, and then its all sidewalks. Everyday to cross the initial 2 busy streets people (including me, but I let them go first so if anybody gets hit its them) have to sort of step right out in front of cars hoping they will stop. Nobody has gotten hit since ive been here, so Im assuming that tactic is pretty much the norm and cars are used to it by now. Nonetheless, i still get a little scared. After that though, the rest of the walk is side streets that take me through the mall and straight home. There are lots of cute stores on the walk home that Ive stopped in. Theres one, Inkata Design Store, that I really love. There are stores all over Bogota and theyre awesome! THey also have a really awesome outdoors store on the way home that I have yet to stop in because Im waiting until I have time to shop and buy things :) Ive also tried almost every coffee place (which is probably about 15) on the way home. The biggest coffee store here by far is Juan Valdez. Its the equivalent to our Starbucks, only better and they sell clothes! Its funny because at home, pretty much nobody would be caught dead wearing starbucks sweatshirts or jackets. But here, everyone wears clothes from juan valdez and its def in style!

THis weekend was super fun. I hung out with my cousins, went out one night, and explored the downtown area of Bogota. Some people say the "Centro" (downtown) is really dirty and ugly but I thought it was awesome! There are lots of homeless people around thats foro sure, but what downtown doesnt have those? The only difference between these homeless people is that they have no problems walking right up to you while youre sittin goutside having coffee, telling you a crazy story and asking you for money. THey will literally sit down with you until you give them money. After the 5th one, it gets really annoying. But the downtown is really artsy and down to earth, I loved it. Full of museums and really cultural places. I prefer that waaay more than ritzy parts of Bogota. I went with my cousin Mauricio, we were both sort of hung over from the night before lol. We called it the hangover trip!

I got a little sad today because I realized that there is soooo much more I want to do and see in Bogota and I only have 2 weeks left! I want to take a bike tour, go to more places with my cousins, go into the mountains. I know I wont be able to do it all while im here this time. :(  I wish I didnt have to work M-F and I could have more time to be on vacation! But I guess Im technically here for school. I have a feeling though that Im going to keep coming to Colombia for a looong time. Everytime I come here I want to come back more and more. Just have to make time for it somehow once I start working.

ANway, it was a great weekend. More posts to come...

First week realizations

My mid morning snack today :)


So Ive been here for 1 week now and everyday I´m getting a little more comfortable! I´m finally seeing my own patients and its awesome! I spent the first 2 days more or less shadowing the docs and "interns". I was really frustrated at first because I wanted to have the same productivity and initiative that I usually have but I didnt really feel comfortable´presenting a patient with the proper medical terms, nor did i even have the slightest idea of how to use the computer system. I didn´t really get an orientation or at least a "this is how things work" talk lol. I showed up, everyone said hello and welcome, and i was just ready to go :) Im getting the hang of everything though, even the crazy confusing program they use for notes lol. I made myself a little template of the proper ways to present a patient and write a progress note, without sounding like a gringa (aka white girl) Also, its tough to understand people because they speak SOOOOOO FAST!!! I can understand 99% of spanish but when they speak so fast I just stand there like, "ummmm.....huh???" But its going really well overall.

After 3 days of taking an hour to catch a taxi, fighting wiht people over taxis, getting ripped off by taxi drivers (they like to drive in circles to charge me more because they know im not from here and have no idea where im going), and getting lost in said taxis (here you have to tell most of them exactly where to go, the address isnt really enough for the ones ive been in), I decided to walk home everyday! :)  My family told me it was pretty far but when I walked it a couple fo days ago its pretty close! Its only about a 25 minute walk at a godo pace...but it takes 40 mins for me because I take pictures of everything. Its even nicer for me because I dont mind walking through the city and I can stop and get coffe, shop, etc on the way home.

I was talking with a couple of the interns today about the differences in their school vs. ours. I´ll try to explain. They go to high school, and go straight into medical school. The medical school is 6 years, the first couple being classroom oriented, and the last years are rotating in hospitals. Then they do 1 year of internship, which also consists of rotating through all of the specialties. After internship, everyone who wants to practice medicine in Colombia MUST do 1 year of rural medicine in a small town. This is required to get liscensed in Colombia. After that year is when they can apply for residency here. SO, eventhough they dont do college, it ends up being pretty much the same amount of time spent to become a doctor, excluding residency. One huge difference here is that they have to pay for internship and residency themselves! So basically, they dont get paid until they become attendings...i found this crazy at first.  How on earth do they pay for school and residency without ever getting any type of salary or anything?? There are some ways to get loans but basically, you have to have money to become a doctor plain and simple. When I first heard this I thought: In the U.S, NOBODY (well not me anyway) would be a doctor if we had to pay our own way through med school PLUS residency!!  The difference is this: the cost of their entire training, including residency, comes out to be approximately between $80-90K. That is less than HALF of what med school costs for us!! SO, in actuality, its not that bad. I just cant imagine working for a hospital, with intern hours and the 36 hr shifts they pull here (and in the US, despite new rules limiting hours) and not gettign paid. It seems like the hospital is totally taking advantage of the interns and residents, its crazy. But that's the system. Some people love it and stay, and some get leave to the U.S or other countries.

Here are some more random things I found to be really interesting:

- Metronidazole and other heavy anti-parasitic meds are given out like water here! A parent can actually call a pediatricians office and say, "my kid has belly ache and diarrhea"...and they will give you Metronidazole without even seeing the kid. Reason: Amoebiasis is rampant here! In fact, tons of people walking around here have E. dispar (the asymptomatic amoeba). Its so common that people just go to a parmacy and by metronidazole and abendazole and use them at the first sign of a stomach ache. I just thought that was pretty interesting.

- They RARELY use CT scans in the ED. We've had at least 5 kids this week who 100% wouldve had CT scans in the U.S. to confirm appendicitis. They use ultrasound in 95% of cases in the ED. The only times they do CTs are when the surgeons demand it. Which surprisingly, itsnt very often. BUT, its possibly a good thing in peds since CTs are waaaay over used in the US and ultrasound saves the kid the radiation.

- There is one day every 3 months whare cars are prohibited and only taxis, busses, and handicap cars are allwed on the road. There a really big emphasis placed on improving the air quality, the environment, and healthy lifestyle. So, that one day every 3 months is very cool because everyone either walks, rides a bike, or takes taxi/bus. My cousin said that just 4 days per year of eliminating cars has improved the air quality by something like 20%. As cool as it sounds, I doubt the states could ever do that because its so big and spread out. Bogota is big, but everything is fairly close.

- New mom´s are give 3 MONTHS of maternity leave. I think thats pretty awesome.

Ok well, more stories to come soon!

Heres a picture

Just an Idea of the traffic here...

This is only mildly exaggerated...

First day!

So today was my first day and I think it was an overall success! I'm pretty sure I stick out like a sore thumb american, but I think I held my own. The morning started off with me not being able to find. Apparently I'm not the only one who pays for taxi's to go to work in the morning. Instead I had to flag down one of the taxis driving probably 70 mph (not kidding) on the street in front of the house. I had no idea how to get to where I needed to go so I really was praying that my taxi driver knew the address and could get me remotely close. The ride was rather interesting as the whole way there, which wasn't very long thank goodness, the driver wouldn't stop talking to me about how his wife just left him for a younger man and that he kissed her feet and she still laughed at him! Seriously, you can't make this stuff up. So as he's telling me about his wife and her new bf I quickly see that I'm close enough and ask to get out please! It was an interesting ride.

I got to the education building and after the mandatory purse check (this is required to enter any building here) I sat down with about 15 other med students and new residents starting rotations at the hospital. Talk about being intimidated! So after waiting in the group for about 30 mins I realized I needed to be in a different place since I'm an international student with totally different paperwork lol. Nevertheless, I figured it out and they sent me to the hospital to make the usual rounds: ID badge and White Coat. Here they don't allow me to wear my ATSU short white coat, they require us to wear the hospital emblem and a long white coat :) I feel special. Maybe its a preview of what it will be like a in few months! ANyway, I miraculously found my way to the ID badges. I did however, get so lost looking for the place where I collect the white coat (which btw is in a small grey seemingly abandoned trailer in the back of the hospital parking lot!). I'm pretty sure I ended up OFF of the hospital grounds, don't ask me how.  BUT I got everything and finally made it down to the ED before noon.

THe doc I'm with is amazingly nice and awesome. She teaches a lot and has asked me to teach her as well. She wants to learn english so she'll ask me how we say common diseases. My first patient of the day was great, it actually gave me some confidence since I was pretty nervous about the whole spanish thing.  I saw a little guy who's mom said she was feeding him, he rolled on his arm weird and since then he hasn't moved it.  She let me examine him and I was pretty sure it was a Nursemaid's elbow, it was pretty obvious.  The doc consulted orthopedics (which is a common thing here for anything even remotely related to orthopedics) and he found nothing and did nothing. SO, mom came back down and the doc let me fix it! It's no big procedure or anything, but it was nice of her to let me do that on my first day. Baby felt better within 10 minutes and everybody was happy, yay first patient!

The only other really exciting/frustrating part of the day was the trauma that came in. The kid was about 9 yrs old and he ran into a volleyball net and flung himself backwards and hit his head on the concrete at school. According to his mom he was fine for an hour and then started to drool and slurr his words, pretty scary.  Side note: in the midst of the say, one of the other attendings (also very awesome) assumed that I was a 3rd year Peds resident, something clearly got lost in translation lol. SO, we're at this trauma and she says "go ahead start, I'll be right there"......ummm....WHAT?! Luckily my initial attending had already gotten there and everything was fine. BUt i seriously, in less than 2 seconds, panicked and started sweating through my clothes lol. Anyway, everything was going on and I knew what I had to be doing to help, but I was so oooo frustrated! I could barely understand what the doc was calling out because she was talking so fast! Also, traumas seem to be run differently here, so I was a little lost. But the most frustrating thing was that I just couldn't get my words out fast enough. I think in english, so it takes me a second to think about it all in english and get it out in spanish. Everything was fine, he got taken to CT (which btw i had no idea is called TAC) and he ended up being fine. But i was really so frustrated that I felt like a total idiot standing there in the trauma bay. I felt helpless and like everything I know is useless if I can't get it out the way I need to. I know it was only my first day, but I hated that feeling so much. I am getting the hang of it and training my ear to the Bogota accent. That feeling is another huge reason why I came here. I need to practice! The spanish I speak in Phx with the mexican people is VERY different than here. Anyway, that was my excitement for the day.

A list of some things that are different here that I think are worth mentioning:

- Med students wear long white coats
- nobody does undergrad, they go straight from high school to medical school (6 yrs)
- you actually have to pay for residency, you don't get paid
- nurses are called "jefe"  (translation: boss) by everyone
- EVERYONE takes a full hour for lunch, even the ED attendings! (this I'm NOT used to)
- White coats are NOT allowed to be worn outside f the hospital
- Parents (for the most part) are very educated about what to do when their baby has a cold (waaaay more than in the US!)
- The docs aren't terrified of getting sued by everybody that walks in the door


More stories tomorrow and more will be added to the above list! :)

[BOGOTA]

I'm in Bogota! After spending most of my 3rd year of medical school setting up this international rotation in Peds EM in Bogota, Colombia, I'm finally here! I don't even want to count how many awkward conversations I had with the department of education of the hospital where I'm rotating (Fundacion Santa Fe de Bogota). Trying to ask them if they would take me as a student, explaining exactly the documents I needed, translating said documents to english and vice versa, and apologizing for the infinite number of requirements from my university was extremely frustrating. Also, it's somewhat annoying when your own university doesn't even believe you'll ever be able to set something up in such a "dangerous" place. Nevertheless, I'M HERE! My rotation starts tomorrow, yikes! I've been in Bogota for just a day now and I'm getting more and more excited to start. I have some hesitations that make me nervous, mainly because of my spanish. I do speak fluent spanish, but my medical spanish isn't perfect. Living in AZ i've had so much practice and I've come a long way, but for me, it's still not good enough. I know (i hope) everyone will be very helpful no matter what, but i can't help but be a little nervous!

A couple people have asked me why I decided to come to Colombia, a place I've already visited several times in my life. Why not try for India or Africa (which I WILL do in my life guaranteed) or just someplace new????? The truth is that yes, I've visited Colombia before, but this is different than just visiting. It has always been a dream of mine to do medicine in different countries and really immerse myself in the country/culture. I chose Colombia because it seemed like the most natural place to start. Although I've been here several times, I have to say that I still feel like a stranger here. There are so many subtle cultural differences that, when put together, really make it a different world. I love that. I've always said that you never really know people until you've seen them when they're sick. Granted, I'm doing peds EM, but working here for a month in a hospital is going to give me a completely different experience that I've ever had here, I know that for a fact. The intention is not to go see the "pretty" things (although I can't skip some tourist things), but I just want feel the culture from a different perspective. I also want to see how medicine is practiced in general here. Based on the cultural differences alone, it should be interesting to see the differences in the ER alone.

I went to visit the hospital today just to look around and I loved it. I'll post pictures once I get more comfortable and know when and where it's ok to use my big camera like a tourist. It's in a cool, very business oriented part of the city. I have to take a taxi to and from everyday. It's cheaper since it's not far and just easier than taking a bus or walking.

I'm still not entirely sure what to expect or how tomorrow will go. My main goals for the first day are to just make a good first impression and not look like a total idiot. I'll let you know how it goes! :)

Residency post!

When I talk about my match results (residency), i’ve had lots of people look at me with the “why is she so happy? I thought she wanted ER”- type of look. Anybody that knows me even remotely well knows how committed to emergency medicine I am. So, I understand the confusion going through my friends’ heads. The truth is that I was upset, quite upset when I first found out that once again, (flashback to not getting into med school first time around) it didn’t work out the way I planned and really really wanted it to...big surprise. I think I put so much weight on matching to EM this year because of how tough it was for me to fight my way out of a path that wasn’t in my plan (maintenance officer at Holloman AFB) in the first place and get back on track with my original plan for medical school! The LAST thing I wanted was to have to give myself the same daily pep-talk that I did when I found out I was doing the opposite of my dream in, what seemed like at the time, the worst place on earth lol. Everyday I would tell myself, “it’s not what you wanted, but it’s just an alternative route to get to where you want to be and no matter what, you’ll be better for it. Never give up”...blah. So I took not matching to EM pretty tough at first. 

Oh and also, in my own defense, just to put things in perspective for non-medical students. Being in med school, surrounded by hundreds of other type A personalities that make not matching seem worse than dying a fiery death, tends to make the mere thought of doing something other than what you want totally UNTHINKABLE! For some reason, it’s equivalent to failing. So, we can graduate medical school and be in the top 1% of people but in our minds we’ve failed lol. Dramatic? Yes. Ridiculous? Absolutely. But that’s how we crazy medical students often think. And actually, that sort of thinking is what has actually brought us this far. But anyway, not trying to defend my craziness with this post.

 So all that being said, my sadness over the match lasted only a day or so. I quickly realized, possibly because I’ve done this before, that all is not lost, not even close. Just because I didn’t match this year (to EM), doesn’t mean I’m never going to match into EM. Internal medicine is not something I would have chosen (obviously), but it is still a great year of experience that I can get under my belt. I’m in no way changing my mind about EM. Some friends in my same position have had a change of heart and decided to continue with the specialty they were given, and I’m happy for them if they’re happy. I’ve even had someone in a position of leadership in my school “politely” tell me that i should switch to a less competitive specialty so I have a better chance of matching again. (really?!?!?!) And honestly, that would make my life a lot more simple and maybe slightly more predictable. Fortunately (or unfortunately), it seems that it’s my plight in life to take the more difficult path. No regrets though, I wouldn’t want it any other way. I’m actually very excited to start intern year in internal medicine. I know it will only help me be a better ER doc in the long run. I’m trying really hard to look at from the perspective that I am still doing what I love! I'm still going to be an ER doctor that's for sure, but I know I'm going to love just being an intern. Sometimes I get so caught up in working towards what that “final goal” that I forget that life is happening right now. Sure I want to be an ER doctor that's very clear. But I'm not going to dwell what I did or didn't match into this year and not make the best of the opportunities the next year brings. I'm still going to be a doctor in an awesome internal medicine slot learning at a very sought after location. It's very cliche but very true, "Life is what happens when you're busy making other plans..." I highly doubt I'll ever be able to stop planning, but rather than looking at this match as a failure or short fall, I'm looking at it more as a previously overlooked opportunity and stepping stone to the next thing (ER next year!)  :) 

I'm extremely excited, very scared, and totally ready to start! I love the city, love the people there already, and can't wait to make it my home. And you already know that I'm going to find my way into that ED every chance I get!! 

So that's my story and the long version of what I tell people when they give me the awkward stare when asking me about the match. 

Updates :)

It's funny that I've started my last few entries with something like: "it's crazy how long it has been since my last entry..." Well, to continue my theme, it's been 3 months! Actually, it feels like longer than that to me. Big things have happened since the last post! Just to name a few: I matched to a PGY-1 spot in Internal Medicine (see below) at San Antonio Military Medical Center :) , I got approved for my international rotation in Bogota at Fundacion Santa Fe de Bogota University Hospital (for which I leave tomorrow!!!), and I started a great relationship with an awesomely understanding and extremely sweet man that makes me very happy! So needles to say, things have been going very well for me.

Rather than try to post one looooong update post, I'm going to post a couple of long overdue posts after this one :)