Saturday, July 14, 2007

a day at the va spa

my attending went away for the weekend and so the chief of ID at the Ann Arbor VA covered for her yesterday. the chief of id is my kinda pseudo-advisor and i had some email conversations with her while i was still on my fogarty in Thailand and then later talked to her in person at the VA. she is hugely famous and is one of the world's most foremost experts on fungal and yeast infections. for medical people out there, let's just say that when i went to read about a patient i had with Candida parapsilosis, Dr. K. was the author of the Up-to-Date article "Overview of yeast infections." i was trying to explain how crazy that is to Chris, to have your attending be the primary author on numerous Up-To-Date articles in the field that you're hopefully going to go into. anyway, she's a big deal, but really down-to-earth and into teaching and giving good advice. basically, she would be a woman version of a nice dr. cox (on scrubs) but dr. kelso's age. i just got the feeling that that was a terrible analogy, but im free-writing, so i'm going to keep it anyway.

in any case, yesterday was pretty slow. i got one consult for a patient who had Bacteroides fragilis growing out of his blood cultures but E. coli in his urine, and we were asked about the source of his infection and on recommendations for treatment. i learned a lot with my senior resident (who was also interested) and hopefully made a good impression. i was surprised that i i didnt feel as intimidated as i thought i would and also was psyched to learn a few things on rounds, which always includes a trip to the microbiology lab, where i smelled some S. mutans on a plate. There was a vote on whether the S.mutans smelled like butterscotch or butter popcorn and I voted for popcorn (it ended up being a tie). who knew micro lab could be so fun?

later, we went to change a dressing on a wound. i went to help get supplies and had tape to keep the dressing in place (which i can never tear). dr. k. watched me struggle with the tape briefly and then took it from me and ripped a piece off without a problem. her advice to me: "you have to be bold!" the patient's wife (who was learning how to do the dressing) interjected that she always had a problem with the sticky tape so i didn't feel so bad. granted, i still am decades younger than either party though. note to self: practice tape-ripping skills for further ID work.

after rounds, i went to work on my note. during that time, i got excited since i received an email from an administrator at Johns Hopkins saying that the Fogarty International Center funds from their center would pay for me to go back and spend a month at Dr. Cynthia's clinic in Mae Sot, on the Thai-Burmese border. this means that i will return to Thailand twice this year, once as a OC Hubert/CDC Foundation scholar and once with Fogarty. I'll be spending about a month in Thailand each time and be based in two different places (Nonthaburi, outside Bangkok, for the CDC, and Mae Sot/Chiang Mai for the Fogarty). Maybe fourth year will turn out to be more like my "year off" than I originally thought. :)

in any case, this email got me really excited. when i went to leave for the day, i stopped by Dr. K's office and told her about it and the projects i was going to be working on in thailand. we talked about how medical education was changing at michigan (some medico-legal officer doesnt think student notes should be allowed in the medical record anymore?!) & the differences between thailand and the us. i brought up that the Fogarty Center had solicited a piece about "the need for patient education and health literacy in the health care system, drawing from your experiences in Northern Thailand" after reading my article in The New Physician. i was kinda offended although i'm not totally sure why, but i feel defensive about people just being like "can you comment on the plight of the poor?" or the sentiment of "please draw from your exotic experience and perspective as a first-world person working in the third world." it's not like people in the US don't need health literacy too, although i don't think the woman who emailed me was implying that they didn't.

i ended up writing the article, which i posted on my friend's health-care related blog, cure this!. it will also be published in the July issue of Global Health Matters (the Fogarty newsletter), but decided to compare my experiences in the US and Thai health care systems instead of just focusing on Thailand's shortcomings. Dr. K. and I talked about this for awhile, and i was really struck by a comment she made when I noted that my close friend (and ID fellow) would see a ton of patients in clinic and not really have a ton of time to talk to them or write the best ever notes in the chart, but she was still providing good medical care. Dr. K corrected me - "excellent medical care" and noted that Thailand's health care system may not be perfect, but the docs over there were truly saving lives.

as i prepared to leave, she said that she was excited for me to return to Thailand and advised me to take malaria prophylaxis, adding, "You should go back - it's a privilege to be in a place where you can really practice medicine."

i sometimes wonder if mentors know how much students look up to them, and how a little comment can really go a long way.

Monday, July 09, 2007

i am an immigrant in a country of immigrants

i started id consults today. besides myself, my team consists of another 4th year med student who was originally in my class, a third-year in her last month of internal medicine residency, a fellow from Romania, and the attending. dr kauffman introduced me to my attending (dr malani) last month and i met with her to talk about possible research projects a few weeks ago. besides having a common interest in id, we also discovered that i lived in the house across the street from her childhood home until i was eight years old. the world is small, and the island i grew up on is even smaller. in any case, we decided that i was going to work on writing a review of HIV care in the elderly patient with her and another fellow & plan on publishing it in a geriatric journal. im super excited about it and think ill learn a lot! yay for side projects :)

back to id consults and my team. i think the first couple days on a team are always interesting because you're getting to know people because you're sitting in small rooms with them. of course you're talking about patients part of the time, but (if you have social skills) you're probably talking about life-outside-the-hospital for most of the other time while writing notes, waiting for phone calls, or just doing busy work. as a team of almost all women, the subject of families (and children) inevitably came up early on. all of us are married except the guy on my team, so we talked about husbands and husband's jobs and whatnot. i also found out that my resident went to a liberal arts college and did post-bac at bryn mawr (yay tri-co). she noted that she thought we (as michigan med students) had to work way harder (and learned more) than she did during med school but that it probably didnt matter in the long run. i told this to post-call liz today and she confirmed the widely-believed rumor that michigan med does totally prepare you for internship, so at least i know the q4 is worth it :).

in the afternoon, i got a chance to bond with the fellow who just started at u of m last week. she is originally from romania, where she completed medical school and trained in id. she admitted she was nervous about starting (arent we all, regardless of what stage of training we find ourselves at at any moment in time). we talked about our backgrounds. she talked about moving to america six years ago when her father was approved for a green card and the decision on whether to leave her career and her husband's career (as well as their homeland and life) behind. in the end, they decided to try it for their children who were six and two at the time. she vividly remembers taking her son to first grade in october, when they arrived in america. he did not speak a word of english, and the first day of school he asked his mom "what should i do if i have to go to the bathroom?" talk about resourcefulness and resilience. when she told this story, she was proud of him and proud of his struggles. they all struggled at the beginning, working jobs that paid less than $8 an hr - a big change from their professional lives back at home. eventually, she started studying, got into a residency, and matched into id at u of m. her eyes lit up when she talked about it, saying that she suffered from a lot of inferiority issues as a international medical graduate, didn't think she would get in to an IM residency in the US, much less fellowship. getting into michigan was a "cherry on the top", in her own words. i felt privileged to hear her story and to work with her. it reminded me of how lucky i am to be educated in this country and of the opportunities i have. she also gave me the opportunity to share my story with her.

i am second generation thai-american. i am the daughter of immigrants. i grew up in an almost exclusively white neighborhood on an island and was one of two or three asians in my graduating class.

i wanted to be white for a long time (i didn't really talk about this part with my fellow though). i was frustrated that my parents had rules that my friends didn't, like family dinner everyday with no tv and talking about everyone's lives. i had the same curfew from 9th grade-12th grade until i threw a fit my senior year and got it extended to 1 am (but if i was out, i still had to call to check in). even now, as a married woman and almost-doctor, i still try to call my parents everyday.

identity was a hard thing for me to figure out and was definitely a learning and growing process throughout my young adult life. my parents were always supportive and adamant about being not-american (which they equated with being white). sometimes, it was okay to be american because it was good to blend in and win at their games (academic ones, of course). i distinctly remember my mom saying, 'if another kid in your class gets 95%, you have to do better than that because you are asian (and your work won't count as much).' she thought it was also important that we were able to succeed in an all-white environment since she figured that was what our workplace would look like in the future. interesting message, but one that stuck with me for a long time - fit in, but remember, we are not like them.

i spent a lot of my adolescence fighting with my parents who were raising me 'thai' which meant no going out after darkness and no boyfriends (for girls). obviously i rebelled against all these rules, but i have to give it to my parents for trying. in retrospect, i can say it was okay to be raised 'thai' (and many thai people, including all the nurses i worked with at the repro health clinic in Chiang Mai, approved).

as an adult (it's weird that i am no longer considered to be in the 'youth' category, although 26 is the cusp), i am proud to be the daughter of immigrants. i think my parents demonstrated incredible strength and recognize their sacrifices to give us the lives that they didn't have. i think it is super awesome to come from two worlds, to be thai, to be asian, to be american. i feel like being the daughter of immigrants gives me an unique perspective on language, culture, and struggle. chris and i have talked about our children and how they will be third generation, and that i am sometimes sad that they will not be children of immigrants. i used to think that so much was lost from generation to generation, and sometimes i feel that is still true, but i think a lot is gained too. my parents wouldn't speak out or protest at a rally, but they do donate money to causes (like MSF, or Doctors Without Borders) that they think are cool. i do both, and i try to actively pursue social justice in my life and career (hopefully my kids do too!) with privilege comes a lot of power, and im trying my best to use my privilege to do good in the world. i think it's working so far :)

at my fellow said, 'i came here for my children - if they are ok, i will thank god and know that i made the right decision. i have no regrets." i said, "i think my parents feel the same way and i think your children will be good and make you proud." when i left, she said "thank you for sharing your experiences with me." i smiled and said, "thank YOU!" i think it is really brave for people to share their stories and be honest and admit to their insecurities with others, especially at the first meeting.

it was nice to have that conversation to set the tone for the month, and to remind myself that i do make my parents proud in both traditional (yay my kid is going to be a doctor and my life is complete!) and non-traditional (what is this social justice you're always talking about?) ways. i tried to re-enact this whole conversation with my mom tonight (in the middle of writing this blog entry) but she was watching a korean soap opera (i could hear the music in the background) so she didn't contribute much to the conversation. go figure.

Monday, July 02, 2007

US Social Forum and my identity politics

a good friend and past amsa pres was supposed to speak at the US Social Forum in Atlanta about access to essential meds and pharmfree but couldnt make it at the last minute. i was chosen to go in his stead. i didnt really have any background about the US Social Forum at all and tried to hurriedly make plans to get myself down there and find a place to stay. it was pretty stressful. my last-minute ticket cost almost $500 and none of my friends or contacts could offer me a place to stay. i ended up splitting a hotel room downtown with a college student my age from DePaul in Chicago whose class was centered around the US Social Forum. The trip overall cost over $800 for me, but i was able to use my savvy fundraising skills and get most of it covered through IPHU & Global REACH at Michigan. i am thankful for those who support students to attend conferences like these because they really give you a chance to ground yourself in what you're doing. at the same time, my experiences at the USSF really pushed me to go beyond my limits in thinking about not only my identity as a woman of color, but also about the politics that inform my work and my life.

it has been a long time since i've been to a non-health related - or even non-academic -conference. although amsa is awesome and has really helped me provide me with a community of like-minded peers throughout my medical school experience, i was reminded in not-so-subtle ways during the USSF that being a future physician made me part of an elite community. i was no longer a 'college student' or a 'community organizer.' i was not 'youth'. sometimes, i was a representative of the 'broken health care system' or 'the medical establishment.' comments on the first day of the IPHU (International People's Health University) brought back vivid memories of me not feeling XXXXX enough in college. Not Asian enough, not poor enough, not radical enough. i felt frustrated because i didn't like the way i was being judged. i am working hard in the best ways i know how to fight for health care and social justice. med school has not been an easy road for me, but sometimes i need to be reminded that my life has been one of extreme privilege. i struggled with that fact in college for a long time. feeling guilty and not knowing how legitimate i could be in fights for social justice. discounting my parents' struggles because i was angry and felt like i didnt have any of my own to share. growing up and realizing how insulting that was to my parents who worked around the clock to give me all of those things that they never even knew existed in rural Thailand. appreciating them for sending me to Swarthmore, where i began defining social justice for myself, and being okay with bearing their hopes and dreams while still trying to figure out the ways in which i wanted to infuse and live my own life, but not totally ready to believe that my life was partially theirs too.

i remember a conversation i had with a friend, rafael, in college. i was in my i-will-not-go-to-med-school and my-parents-cant-make-me stage of my pre-med career, and he was really adamant about me taking agency and doing what i wanted with my own life. "Screw your parents!" he said. "It's your own life; you're the one living it!" "What would your parents do if you didn't do what they wanted? Disown you?" i had never thought of things to that extreme but just knew that i really felt guilty disappointing my parents in any way. i also felt like i had a big responsibility to prove to them that everything they had done for me was worth it (my mom was never hard-pressed to compare our family to others to prove how committed she was to us). looking back on my childhood (and even at my life now), i have to give it to them though. i had every lesson - ballet, TaeKwonDo, ice skating, roller skating, swimming, piano, and more - that my mom thought would make me a well-rounded person. i went to summer school or camp as soon as i was old enough. my parents' lives were consumed by working at their family practice to save up money for lessons, for school, for medical school. their dreams were a big thing to carry. sometimes, i think they still are, but ive learned many things over the years that have made it a little easier.

i had dinner with a friend and family physician, anjali, where we shared stories of our second-generation histories, stories of how our parents had shaped our lives and stories of how they could be the most supportive people in the world or how they could crush the fragile (independent) identity you thought you had built for yourself. anjali asked if my parents had been supportive of my 'years off' (particularly this last one). i think so, i said, but i prepped them for a long time so they knew it was coming. i have learned to use their language and to frame my decisions in terms of things they value and understand. in college, my parents valued getting into medical school, and now, they value getting into residency. i frame almost everything i do into these contexts and they're okay with it. i've also had a decent track record so far, so i think they've learned to trust me (although they were a little shaky about the whole majoring-in-Chinese thing and organizing in Philadephia's Chinatown in college). i often talk about karma with my parents as well. good karma through my actions is good karma for my parents. to me, it also means that im using my privilege to try and make a difference while i have the chance to do so. i wake up everyday and think about how lucky i am. i hope that i am living up to my past lives and my past karma as well, and pouring water and not salt into the mix. (see analogy from a Buddhist monk in the entry.)

back to identity politics. after being totally overwhelmed by the number of workshops offered at the USSF (about a hundred for each time slot), i decided to center my didactic experience around asian-american issues, attending workshops set up by NAPAWF (National APA Women's Forum) and CAAAV (Coalition Against Anti-Asian Violence). i contributed to the IPHU and to conversations about health care access by presenting about what is going on with Thailand and Abbott, but did not go to any other health-focused workshops after that. i heard amazing presentations from groups like the Asian Pacific Environmental Network, the Bus Riders Union, DRUM (Desis Rising Up and Moving), the Chinese Progressive Alliance, and the API Women and Family Safety Center. i participated in discussions about trafficking, heard stories from workers in sweatshops, and was excited to see and be around tons of progressive APA youth. i felt the need to move to california to be a part of these movements, this organizing. i remembered what it felt like to be comfortable in a room where everyone looked like me. i realized that my days of asian-american organizing were not over, that it was silly to think that i had grown up and moved beyond identity politics because i had already figured out how to be proud of being Asian-American. i finally thought about immigration and diversity and about a lot of things that were coming down around me and how this connected to our struggle as a people and to many other struggles as well. i remembered the moments i had become excited about going to medical school when i saw that health care was a basic right that people needed and i thought that as a doctor (like Dr Siu in Philadelphia) i could provide that. not having health care came up over and over again when people were sharing their stories. all of this resonated with me, and a part of me came alive again.

throughout the four days i spent in Atlanta, i had long conversations with people i cared about and met some new friends as well. i thought about priorities, about what i want out of a residency program, about what kind of community i want to be a part of and how i could build that. i shared my perspectives and my stories and made commitments to help people process where they were going and what they were doing whenever i could. i was happy to come home and didn't feel guilty about it. i thought a lot about how i could be a part of the asian-american movement while being in the midwest. i thought about how, when one of the organizers of the workshop got people to stand up in groups and cheer when he called out where they were from, he didn't know to call out after saying "California" and "NYC" and how the Midwest and South and Northeast just all got lumped together. i briefly felt not Asian enough, but then thought about the necessity of representing my own community that was not based in LA or the Bay Area. i reminded myself not to be ashamed of being, as F.Omar Telan refers to himself as, suburban fabulous.

i briefly shared some of my thoughts with chris when i got home pretty late at night and tried (unsuccessfully) to re-enact the CAAAV workshop with all the different speakers sharing their stories in different Asian languages. before we went to bed, i told chris that i maybe wanted to move to california. he smiled.