Blue Christmas

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As others have noted, I haven't posted on the blog for almost 6 months now, a long stretch even for me. Let's catch up to speed on what's been going since I moved to Virginia. Beware, it's a depressing (but realistic) read. Don't be fooled by the pictures, which were taken during brief shining moments over an overall gloomy last half of the year.

I moved to Richmond in late June, and I didn't secure an apartment until the week after I was due to start work. For the first week of my new job, I was living out of an Airbnb. Now the airbnb wasn't bad in itself, but I was living out of a suitcase and had no chance to settle in to new surroundings before I had to dive head first into work. One week after starting, I moved into my apartment. I left almost all my belongings in California except for about two suitcases of clothes, so I didn't start with much. The first few weeks were miserable, and although I didn't have any clinical responsibilities (in fact we were granted two weeks of orientation) all my spare time was spent trying to furnish and set up my apartment by myself.
 Orientation at the Virginia Museum of Fine Arts

 First year heme/onc fellows in 100 degree weather
Getting familiar with the neighborhood
E came to visit me in Richmond one of my first weekends!

Since my apartment was still mostly bare, I went home the first few weekends (a two hour drive each way) so I could study for my internal medicine boards and catch my breath from transition from the end of residency to the beginning of fellowship. Then, orientation ended and we were thrust head first into hematology/oncology fellowship, with full clinic schedules where we were the primary oncologists deciding a patient's course of treatment and writing their chemo. My first day of clinic I only had 3 patients, but then the next week I had 8, then the next week, 12 (I'm still averaging around 10-12 now). For a resident who was only used to seeing max 6 patients in a half day, seeing 12 oncology patients in a half day was mind blowing. And how was I supposed to know what to do for those patients? Good question, because nobody taught me anything.

And so I read. I have never read so much in my life as when I first started fellowship. "Basic" problems like MGUS, iron deficiency anemia, polycythemia vera, CLL which are bread and butter hematology/oncology (or will be in a few years) were completely foreign to me. How was I supposed to diagnose, interpret lab results (wtf is a kappa/lamda light chain, what is an M protein), and develop a treatment plan without ever treating a patient before? It was one thing to read about it in med school or residency, another thing to determine if this patient's cancer is under control or you need to start them on chemotherapy. In addition to our own clinics (we have one clinic at the VA and another at our university hospital), we would also be working with faculty specialists in GI, breast, lung, etc and writing notes for their patients in addition to our own patients. I would come home at 7pm, and then continue to write notes until 10 pm. Then I would read until midnight. And then repeat the next day. The first few weeks I was as overwhelmed as I ever was in my whole medical career. I felt like I was back in medical school, except I had to work a whole day, often until late, before studying late into the night. I spent many nights with tears in my eyes as I fell asleep, dreading waking up in the morning to have to start all over again.

The worst part was that it was unrelenting. I have clinic on Mondays and Thursdays, so I would need to start preparing for Monday clinic on Friday, and spend the entire day Sunday preparing and reading for my patients. Then spend Monday seeing the patients, and then writing the notes, then seeing patients in attending clinic and writing the notes for them. Tuesdays I had lecture until 6 pm, then I would start preparing for my VA clinic with 12 patients. On Wednesday night, I had a research course from 5 pm to 7 pm, and then went home to prepare some more. Then on Thursday, see my clinic patients and then spend the rest of the day writing notes for them. And then finally, Thursday night, I could take a breath. Before repeating it all again. In the first few weeks of fellowship, whatever time I had off I would also have to study for my internal medicine boards.
 Reunited with my intern bestie R on the East Coast in the midst of boards studying!
So glad to catch up at the Renn Fair in Maryland
I finally took my boards at the end of August, and then had one week off where I flew to Beijing for a few days to visit my grandfather and then to SF for a few days to visit my sister and friends there. I literally had no time off to recover, starting my first consult block the day after. A few weeks later, I had my first quarter year review with my boss, and I burst out crying. I just couldn't hold it together any longer.
Glimpses of happiness after boards
 Visiting my 97 year old grandpa 

Beijing--> SF --> straight to Stonemill Matcha 

 Reunited with E back in SF! 
Never happier than in Cali
Thankfully, my boss was very understanding and listened intently, trying to brainstorm ideas to help me in whatever way he could. But honestly, there was nothing he could do. For the next two months, things got worse before they got better.
 Charlie warming up my bed while I'm on call

 Fancy pho 
Solo adventuring on my one day off a week
 Pumpkin carving and Ghostbusters on call 

 Half of my pictures are of fall foliage

 Sunset river run 
From September through November, I was on Bone Marrow Transplant (BMT), which I knew absolutely nothing about before I entered fellowship. We didn't have BMT at CPMC as it's usually only performed at large academic centers as it's so specialized, so I felt even more likely a medical student when I started. Plus, I was suddenly on call Monday, Wednesday, and Friday nights so had to answer pages and put in orders for everything from fever to prescribing patients medications after they were discharged to taking transfers from other hospitals (Literally the first day I walked in, there were 2 admissions at 5 pm and I was in charge of admitting the patients and being on call without knowing anything about transplant or the sick patients on the service). During my two months of BMT, I also had to work 6 days a week, and so never had a full weekend off until Thanksgiving weekend (I worked Thanksgiving day and on Friday). Last weekend, I worked the whole weekend. And so this weekend, I'm finally off. How's that for a life update?
 Hosted Thanksgiving for all the working fellows at my place
Thankful I didn't have to spend Thanksgiving alone 
Most blogs and articles out in the blogosphere are notoriously upbeat and positive, and even if there is a solemn tone they always end on a positive note. I'm even guilty of that myself. However, I'm not going to sugar coat it: these past 6 months have been the worst of my life.

In my last post I voiced my trepidation at moving to a whole new city/coast but was excited about the road ahead. However, I now know what it feels like to have all of your fears come true as I've truly been miserable and feel like my soul is dead inside. I've tried to dull the loneliness by watching a lot of trashy TV so I don't have to sit alone with my thoughts, but this is the first time in my life if I've wondered if medicine is the right path for me.

As I've moved through college, medical school, and residency I've always been one of the fortunate ones who never questioned her path to being a doctor. I've always been quick to pick things up, a fast learner, and efficient at my job so I never had to take too much work home (in fact, in residency I rarely worked from home to the chagrin of my friends and roommates). I had a vibrant social life in San Francisco, a comforting home life with my roommates, and a whole city at my feet to explore. The first day I came to Richmond, it all got turned upset down, and I've been treading water trying to figure out how to get it back.

By now, my friends and family have been tired of hearing of my struggles and hardships and I'm sure they wished I could just snap out of it. I try to tell my new friends and colleagues about how much I miss my old life, but I just don't think they understand how happy I was and how good I had it, so I've stopped talking about it as well. Which just leaves me to wallow in my own sorrows alone.

My knowledge base has grown though. And I am learning more. I know how to do a bone marrow biopsy, infuse intrathecal chemo, even infuse chemo through an omaya. I've written multiple regimens of chemotherapy. I now how what a bone marrow transplant entails, and know how to take care of some of the transplant patients. I know how to take care of some basic cancers. But there's still so much more, I've only scratched the surface of what hematology/oncology entails. And so this upcoming holiday season will be a Blue Christmas for me. However, there's a saying that goes "diamonds are formed under pressure" so hopefully I will grow from what has been a soul-crushing experience these past few months. Thankfully, I am taking a week off to go to Mexico with my family for some R&R (which now has another connotation for me as it means relapsed/refractory in hematology speak lol) this Christmas, however I am really hoping for some better times ahead. After Christmas, I'll have finished one-sixth of my fellowship, and I'm literally counting down the days until I can graduate!

 Surprise blizzard in the beginning of December

Sunrise views on the way to work


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