ANNOUNCEMENT: We are moving!!

Sorry blogger...you've been wonderful these past years, but wordpress just has so much more customizability and functionality, not to mention looks much more professional and aesthetically pleasing. Thankfully, it wasn't hard at all to transfer all my posts and I finally combined everyone in one blog, instead of keeping multiple :)

New site: 
http://untanglethechaos.wordpress.com/ 

See you there :)!

oh, science (and the public)

First off, my nerdy side continues to be in heaven here at the NIH. Second of all, I just posted up this article on fb yesterday with dismal opinions of the food in general, when I attended another talk today that presented this AMAZING article:

http://www.ncbi.nlm.nih.gov/pubmed/23193004

and then came across these lovely reviews of the article: 

Editorial by Brown et al. in the same journal

Commentary from sciencebasedmedicine.org

and public report by The Washington Post

As the conclusions in the abstract by Schoenfeld and Ioannidis report: 

"Associations with cancer risk or benefits have been claimed for most food ingredients. Many single studies highlight implausibly large effects, even though evidence is weak. Effect sizes shrink in meta-analyses."

From SBM:

"...there are lots of studies out there that claim to find a link, either for increased risk or a protective effect, between this food or that ingredient and cancer, but very few of them actually provide convincing support for their hypothesis. [HOWEVER], We must resist the temptation to go too far in the opposite direction and reflexively dismiss even the possibility of such risks as the ACSH is wont to do, most famously with pesticides and other chemicals." 

Bottom line:

"there are at least a few foods that are reliably linked to cancer. For instance, alcohol consumption is positively linked with several cancers, including pancreatic, esophageal, and head and neck cancers, among others. There’s evidence that eating lots of fruit and vegetables compared to meat can have protective effects against colorectal cancer and others, although the links are not strong, and processed meats like bacon have been linked to various cancers, although, again, the elevated risk is not huge. When you boil it all down, it’s probably far less important what individual foods one eats than that one eats a varied diet that is relatively low in red meat and high in vegetables and fruits and that one is not obese." 

From Brown et al:

"Important steps to improve the fidelity of research reporting include the following: Increased use and improvement of clinical trial and observational study registries; making raw data publicly available; making supporting documentation such as protocols, consent forms, and analytic plans publicly available; and mandating the publication of results from human (or animal) research supported by taxpayer funds. As Schoenfeld and Ioannidis  highlighted, comprehensive approaches to improve reporting of nutrient-disease outcomes could go a long way toward decreasing repeated sensational reports of the effects of foods on health. However, none of these debiasing solutions address the fundamental human need to perceive control over feared events. Although scientists may have ulterior motives for looking for nutrient-disease associations, the public is always the final audience. It is therefore imperative that we spend less time repeating weak correlations and invest the resources to vigorously investigate nutrient-cancer and other disease associations with stronger methodology, so that we give the public lightning rods instead of sending them up the bell tower." 

lesson from Dr. Fauci

1. When there is a will, there is a way
2. Keep an open mind, but the bottom line: ALWAYS have the final question in mind
3. Go with your gut
4. See number 1
5. Luck favors those who are prepared for it

pennies for thoughts...and memories

Lately, I've been encountering story after story of heartbreak and the consequences of imperfection--stories of illness in those close to those close to me, or even in those close to me. Stories of suffering, of sadness, of trial and fire. Stories of the realities of the human condition...and the dark side of it...

In the past year alone, I think I've had at least 4 friends lose their grandparents, 2 friends lose their parents, one friend lose one of their best friends, 2 friends with relatives with cancer, one friend who GOT cancer and one friend who is fighting hard, multiple friends with aunts/uncles/second relatives with cancer, and most dear to my heart, I've lost my own aunt. And then there's everything going on in Syria.

I've often said to these people that my prayers and condolences go out to you, but what I really mean to say is that every time I hear these stories, your stories, my heart breaks for the darkness and sadness we have to face in this world. It's a feeling that has come more frequently now then before, and I surprised myself when I put my finger on it; that the reason I was sad at random times was not for specific things (though they certainly played a part); but rather, for the world in general.

Part of it has to do with the fact that me and my peers are now at that age where our parents and grandparents are vulnerable to the elements of nature and aging; to diseases, ailments, cancer. My aunt's battle with cancer was both sudden, scary, and a reality check. Part of it has to do with the fact that I now have more than a thousand friends on facebook, and the internet has this power to broadcast all our life tragedies to the world (or, at least our connected friends) as they happen, versus pre-facebook times where grief was expressed privately, or only to those close in physical proximity. Or perhaps part of it is that after spending a year in medicine, my eyes are more open to the world of disease. I'm reading more about how humans live outside of our comfortable US. After spending only a week in Haiti but months learning about the burden of global health needs, my eyes are open to the extent of suffering that plagues mankind. After spending like 4 days at Urbana hearing the stories of missionaries, their struggles and their lives on the field, my heart asked to see things as God sees them. Maybe this is what it means.*

Because I grieve for the losses my friends have to deal with, but also for the unfairness of the world in general. I grieve for people who have to go before we feel it is their time. For young people who die in tragedy. Even more grievously is that the numbers of losses and illness in the lives of people around me are paltry to the numbers people attest to elsewhere in the world. So my heart also grieves for children who are scarred by poverty, trafficking, hunger, war, orphanage; their innocence torn from them. For people who have to live their lives in fear. For women who are at the mercy of their husbands, or families, without any ability to express themselves. For those who live under the bonds of censorship, oppression, violence. Yet my heart does swell with joy and emotion at the stories of determination and love that persist through these intense journeys, at the resilience of human nature, at the goodness of human nature too that can shine through. Not all hope is lost. My desire to travel, but to travel on the road less trodden, stems from a desire to hear more of these stories, to learn from these people, whose life and emotional strength is probably eons deeper than my own sheltered knowledge.

Finally, I grieve for the state that society (or at least our media) can display sometimes on the waves of development and luxury: of a blatant lack of tact, of a blatant idolatry of self and materialism, and of blatant refusal to better oneself--at times, promoting and celebrating irresponsibility, hedonism, self harm (*cough*popculture*cough*mileycyrus). Just because you have $$, freedom and a good life doesn't mean you have to spend it that way. What happened to active promotion of a desire to be better versions of ourselves...focusing time and energy on cultivating our ability to learn skills, be useful, think critically? The only thing a material and hedonistic society creates is a desire that is impossible to be satiated. I am so thankful to have (most) friends who continually strive to be better and inspire me. At the same time I think we all fall prey to many self-serving behaviors in some way, shape or form, and to varying extents. So I'm trying to get better, or at least less wasteful.

I want to clarify that I am not sad in an intrinsic sense, as in I grieve so much I can't get up in the morning or see things through a pessimistic viewfinder. Nor is this sadness of pity. No, these thoughts come on and off through the course of a day; last a couple moments, then are replaced with the bustle of BAM, present life (i.e., the research I'm doing now, or my schedule for later today). I grieve in a sense that serves as a reminder and makes me emotional enough to want to do something about it...to want to play at least a small part in God's greater picture, to bring healing, to establish a skill set that will let me help others, and to remind myself that I have no, absolutely NO reason to EVER be dissatisfied with the life I am blessed with...no matter what comes. There is more to life than us! We are young; we have so much potential, we have so many resources...learn and get on it!

Let's all be reminded of that. Let's celebrate and be thankful in the life we do have, the lives we have been touched with, the memories shared, the experiences that shape our being, and really, everything.

As for me, thank you 姑姑 for teaching me some of that--what it truly means to feel grief, but also what it truly means to celebrate life. I can't believe it has almost been a year, but the lessons you have taught me and those around you live on. I love and miss you. I know that you are watching over us all, especially Uncle, S and N.

And thank you God for being my strength. I will praise You forever.
*1 Cor 12:25-26 and Romans 12:9-21

microbiome!

Probiotics lecture (on this study) Q&A:
Q: One could say mice have shared microbiomes because they eat each other's poop. Now in reference to humans, do you think there is an application?
A1: Well, I must reference the study on the microbiome of households with dogs that show increased homogeneity within these households vs non-dog households...
A2: There is a proposal that improper hand washing may play a role...heh heh

^__^' That's sort of gross. But also sort of fascinating.

For those unfamiliar with the microbiome, which has been BLOWING UP science news:
NYT: Say Hello to the 100 trillion bacteria that make up your microbiome

Nice collection of recent NPR articles

my people

"i heart you", said heart to the gut :P

You know that feeling when you meet people that totally just click with you? That you can be yourself around and not be judged, or be judged but still tolerated? That you might not even know that well yet, but you know you have so many things in common already, and totally hit it off?

Or when you just love the people you're surrounded with?

Reason #howeverhundred I'm so happy I chose medicine: my classmates and peers are some of the most amazing people I've ever met, or will ever meet, and though not everyone creates that same feeling felt above, there is a pretty darn high percentage of them that do. It is true that you may just meet some of your best friends in med school. 

Absolutely love the people I'm meeting, the people in my life, and the environment I'm in. Trust me, it wasn't always like this, and won't always be like this either. But man, does it feel good, and this moment deserves recognition in a post so that if I ever doubt or feel lonely, I am reminded that I really am not. Another reason I think this is possible is because I feel like I'm finally being honest with myself and who I am. Med school taught me the hard way that you can never please people, but hey, the lesson is learned. Also, I've been slowly coming out of my introvert shell--opening up a bit more, letting people in a bit more, being confident in who I am and getting away from the 'pleasing' mindset that has been in my head too long. It is amazingly liberating how good this feels. 

Thanks be to God for always being so amazing and providing :)  

dream

best. video. ever.

Utterly heartbreaking and powerful....wow.

afghani children of war-- a photo essay from the Atlantic

peace.

John 14:27  Peace I leave with you; my peace I give to you. Not as the world gives do I give to you. Let not your hearts be troubled, neither let them be afraid

John 16:33 I have said these things to you, that in me you may have peace. In the world you will have tribulation. But take heart; I have overcome the world.”

Philippians 4:4-9  Rejoice in the Lord always; again I will say, rejoice. Let your reasonableness be known to everyone. The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things. What you have learned and received and heard and seen in me--practice these things, and the God of peace will be with you.

God, for one of the rare moments in my life so far, I feel so small and lost. I am so thankful that it has been rare, for I know it is not true for everyone. The foundation you've blessed me with slowly threatens to be torn away, and Lord, you are the only one I know to turn to. So please, please Lord, have your way and please grant us the peace only found in you through it.

Here I am, down on my knees again
Surrendering all, surrendering all

Find me here, Lord as You draw me near
Desperate for You, Desperate for You

I surrender

Drench my soul, As mercy and grace unfold
I hunger and thirst, I hunger and thirst

With arms stretched wide, I know You hear my cry
Speak to me now, Speak to me now

I surrender
I surrender
I wanna know You more
I wanna know You more
[x2]

Like a rushing wind, Jesus breathe within
Lord have Your way, Lord have Your way in me

Like a mighty storm, Stir within my soul
Lord have Your way, Lord have Your way in me

IPV...a huge issue

Found this in one of my email drafts: I've been meaning to post it up, but wanted to write a bit more...but then other things got in the way. I think this alone speaks for itself:

from NEJM --

The U.S. Centers for Disease Control and Prevention (CDC) recently released a comprehensive report on the prevalence of sexual violence, stalking, and intimate-partner violence (IPV) in the United States.1 The report relays the alarming findings that 35.6% of women in this country are raped, assaulted, or stalked by intimate partners at some point during their lives, and approximately 6% experience these events in any given year. Men are also at risk for IPV victimization: 28.5% report having been victimized at some time during their lifetime, and 5% report victimization within the past year. But the forms and consequences of IPV experienced by women and men are not the same. Women are more than twice as likely as men to experience sexual coercion in their intimate relationships (17% vs. 8%) and are twice as likely to experience severe forms of physical assault by an intimate partner, such as being choked, hit with a fist, or kicked (24.3% vs. 13.8%). The most striking differences relate to the consequences: very few men (5.2%) report ever being fearful of their intimate partners, in contrast to 28.8% of women, and women are almost four times as likely as men to be injured by a partner (14.8% vs. 4.0%).

One THIRD of women. Aka, one in THREE. One in three women you will ever meet in your life either will have already experienced, or will experience, intimate partner violence.

if this was your mother, doc....

By HAIDER JAVED WARRAICH, M.D, from the NYT
 
I love this. Essentially:

Quote--

 "“Doc, give it to me straight. If this were your mother, what would you do?”

 While the patient-doctor interaction varies widely across cultures and continents, this question seems to be a universal constant...From a patient or family member’s perspective.... this question helps them make sense of the confusion, desolation and powerlessness that so often defines the hospital experience, which usually involves a full-on assault of numbers, jargon and ‘expert’ opinion... it makes sense that they would defer the choice to those who appear to know what they are doing. And by invoking the physician’s parent, they hope to humanize the physician and have a conversation with real stakes.

Yet I still find this question hard to answer. See...my answer to the question would be very different, as it would be for anyone, depending on which parent you asked me about.
  
So I have come to believe that the right answer to the question, “If this were your mother, doctor…” is: “Tell me more about your mother.” 

This response gives patients’ families the chance to think about their loved ones, about what they would value and what they would consider a good life, what they would think was worth fighting for if they were available to answer the question for themselves...It takes them away from a place where they feel solely responsible for the trajectory of their relative’s life to one where they simply communicate what the patient would want out of her life. We as physicians can then weigh in on whether it is reasonable to expect that to happen."

YES. Totally using this.

asian parent quotes #2

Me: Hey parents, so it turns out I'll need a car in MD for this year
Parents: Hmm alright. Use the van for now.
Me: Will you guys be ok? (we didn't have enough cars for everyone to drive to work, so my parents were going to carpool in the meantime o_O) Do you think it's time I bought my own car?
Parents: Just keep the van for now. We'll figure something out.

2 weeks later:
Mom: So...should I get the Tesla?
Me: WHAT?!
Mom: just kidding!

1 more week later:
Parents: We got an electric car! (Ford Focus!) It drives so well!
Me: So...what about the van?
Parents: The van is now yours. Enjoying the new ride :)

To put this in context, I now drive around a 2002 Toyota Sienna...total soccer mom status without the company ^__^' Gotta love my family. Don't get me wrong, I'm happy to have ANY vehicle to drive. But its sort of funny :P

photos within photos

THIS:
75-captivating-looking-into-the-past-pictures

So cool!

Also, quite pleased I actually got my butt out the door and on this trail! Went the opposite direction from the original plan, but it was a nice run regardless (click to expand)

update: didn't think it was possible, but woke up still with a runner's/endorphin high! definitely need to do this more often! :)

“Do not go where the path may lead, go instead where there is no path and leave a trail.” – Ralph Waldo Emerson

a life we've chosen

...and you BET I'm honored to be in it. Medicine definitely has it's dark and humbling side, as exposed by this article: To-being-doctors-to-be by Mrigank. However, as physicians, we have the incredible honor of seeing what our bodies can...and can't do...face to face. Mrigank's entry was too beautiful and so eloquently written, I had to repost.

Quote:

"We who began our adult lives spending alternate days with corpses... Who spend the prime of our youth in the grime of wards. Who have already witnessed a lifetime’s share of deaths. Who learn about depression but fail to recognise it in ourselves...We who are hunted and haunted by questions that have no answers. Who feel guilty when we know less than we should. Who fear that we will never be good enough...
We who cannot ever abandon logic. Who are rational but must allow for prejudices. Who have no choice but to listen...
We who will never tell you any of this.
We who really need to step back and appreciate ourselves."

realities of science

So much goes into how you phrase things, how data is cherry picked, how bias plays a role...it goes back to that quote: "Luck happens when preparation meets opportunity", or some similar variation. Or, you could even say it is analogous to "Beauty is in the eye of the beholder." Just replace beauty with evidence, haha.

Lesson? (I think my dad for encouraging this in me): NEVER take things at face value. ALWAYS be critical. PRIMARY sources are paramount.

Case in point:

As reviewed by the NYT. A hugely popular book, considered the vegan bible by many
Trusty ol' Wikipedia's article <--I say this very tongue-in-cheek-ly, but I do like the ease of wikipedia to at least put things in a general context :P

Some more links on the China Study:

A Google Books Preview
More detail from the author
Amazon link -- look at those rave reviews!

 Sounds awesome right? But then...

Critical Review from Science Based Medicine (from a group of physicians)

In summary, Dr. Hall's conclusions:

"It would be wonderful if we could prevent cancer and all those other diseases by avoiding animal protein. It would have the extra added benefit to the environment of increasing the productivity of agricultural land and reducing the greenhouse effects of gassy cows. I look forward to future well-designed studies investigating the effects of very low protein and animal-protein-free diets. Meanwhile, The China Study makes a good case, but the case isn’t quite good enough"

 Another criticism, THOUGH to be fair, from also a questionable, very biased source. Quote: (one of the commentators on the SBM link:

"Weston A Price is deemed a questionable dentist and the Weston A Price Foundation is deemed a questionable resource of health information by Quackwatch.

Their agenda is to propagate, among other things, the claim that a high-fat diet with plenty of full-fat, pastured-fed muscle and organ meats and lots and lots of raw, full-fat dairy will produce optimal health and cure many chronic diseases.

Keeping their agenda in mind, it’s no wonder that they have an article vociferously arguing against the China Study, which purports the same outcome as their advocated diet, but in a somewhat diametrical manner."

However, I stand by the SBM Critical Review, because it does seem to come from a less-biased source.Still, just look at all the contradictions within contradictions! Basically, again, PRIMARY SOURCES. I am at fault for not citing primary sources in my criticism articles, but then again they are meant to just prove a point that information can be skewed so many ways.

PS: From my limited 10 minutes spent reading this, the reports from SBM seem reasonable. However, I have not actually LOOKED for a criticism of this site so I'll just put this here to look back on later
http://www.sciencebasedmedicine.org/

Review:

nerdiness cont. :)

Ok this is really true testament of my science dorkiness--I am seriously in love with the things people are doing at the NIH! So many crazy talented people, so much AWESOME science being conducted...absolutely amazing.

Had the opportunity to meet with Dr. Dunbar today and if I could clone myself, I would TOTALLY work with her (or maybe Dr. Childs). Both are incredible mentors; both are extremely brilliant; both do stuff that can use ALL my research experience and makes things come in full circle...how cool would that be!? I think in the future, once I get a computational background and learn programming and more vigorous statistics this year, I want to take another year and do research with them. Extremely, extremely awesome projects they both have going on, particularly this paper.

Tracking HPSC's with confocal microscopy!! :D

Sadly, I can only work with one person this year :( Or can I?

No, that would be suicide. Ok Sharon, lets focus here.

A good reminder to do a future post: the lure of academia vs the pull of the heart

the vitamin/antioxidant paradox

source

Wish this came out before I started interviewing with mentors...at least 3 of them work on this and I had no idea! Also, fascinating read about the rise and fall of Dr. Linus Pauling

From the Atlantic: The Vitamin Myth

In other news:
Mom: Wow, the people in your lab are international? You should get to know them so when you travel, you can live with them!

LOL. <3 you mom. Too bad I won't be working with them BUT God is so good...working with my dream mentor!!! super excited for this year :D!

and the search continues...

source

"Finding a mentor is a lot like dating...you wouldn't respond to a super long message from a stranger, right?"   -P

Haha...these past two weeks have proven that statement to be a very accurate analogy. Like my methods towards dating, in my search for a mentor:

1. I'm open. I'm willing to listen and give people chances
2. Chemistry is important. Sounds weird putting it in this context, but it really is. Also, the 'chemistry' in the lab also is important...get it? HAHA sorry too tempting to pass up ;)
3. Future prospects matter...a little bit. Though less in dating than here. Or is it vice versa ???
4. Connections are vital--they make or break who you might be able to meet, and can open so many doors!!
5. I'm still too nice. Need to be more effective at communication. Need to be FIRM when I do NOT want to work with someone. No but's...you can't have everything!
6. I like knowing everything about a person, so in a mentor search pubmed, the NIH website and the interwebs is basically the 'fb' of each investigator.  haha
7. First impressions are very important.
8. At the end of the day, you just need to take a leap of faith and COMMIT!!

Unfortunately though, unlike in dating, a 'date' or meeting that doesn't end up working out doesn't mean a new friend...that's a whole area of lost connections. Yikes.

 These past two weeks have been initially stressful, because I was in a rush to identify a mentor or at least get SOME leads...but while I would really like to identify a mentor soon (so I can start working!! and also stop wasting people's time) I actually sort of enjoy this process. It is a lot like attending mini-seminars at an umbrella of a 'conference' of my research interests...it is very awesome learning about each individual team's work, questions, and variations in methodology! I've learned so much in this past week...particularly because the people I talk with are so brilliant and accomplished, and have so much experience ;__; I wish I could work with everyone (maybe that's not impossible? hmm...particularly if I do microbiome stuff?? (reality check...no))

Need to remember proper etiquette in my correspondence during this time. Particularly:

-Just like in medicine, each person you talk with is an individual who demands your individual attention, and frankly doesn't know nor could care less about the many other people you are in correspondence with. So, RESPECT. Respond to emails in a time manner, because their time is just as important as yours. 

-Take the time to craft a well thought out, well executed email. These people, again, are at the top of their field, have years of experience, and are (amazingly) willing to give you their time! Though you are no where near their level, respect!!

-Calling someone by their first name still does NOT make them your peer. Need to get used to this. It took me a year and a half to finally get on terms with calling K by his first name, just because it was so hard for me to give him the respect I thought he deserved as my mentor otherwise. But EVERYONE does it in research. ^__^' OK FINE, first name basis it is, but KEEP THAT RESPECT

-At the same time, don't discount yourself. I feel almost inferior compared to the brilliance of the people here, but apparently I guess getting into the program counts for something huh? And apparently people are impressed my CV, which IS who I am, so I guess all this hard work does pay off?

I am really blessed to be accepted to a program that does recognize hard work paying off. Again, am so fortunate to have this amazing opportunity.

Also, while this is technically a 'year off' from med school, it is NOT a 'year off'. Made that mistake my first summer...not going to let something as incredible as this go to waste. Already my schedule is booked for the weekend and summers...hopefully things will calm down later this year ^__^'

is it worth it?

 

NYT: On Tests in Medical Practice

Notable:

 "[Research for quality control] takes a research culture that promotes a healthy skepticism toward standard medical practice. That requires physician researchers who know what standard practice is, have the imagination to question it and the skills to study it. These doctors need training that’s not yet part of any medical school curriculum; they need mentoring of senior researchers; and they need some assurance that investigating accepted treatments can be a viable option, instead of career suicide"

"...The administrative demands of clinical care, on one side, and the competition for research funding on the other, make it increasingly difficult for researchers to see patients. They become isolated from standard practice, and their ability to study it diminishes. Clinicians who are well positioned to study these issues are increasingly directed toward enhancing productivity...instead of questions about whether the practices are warranted in the first place."

[Unless we do something], we can continue to argue about who pays for what — without knowing what’s worth paying for." 

After all,

15 year old finds cheap test for pancreatic cancer

dude, this guy. no words. such an inspiration!!!




also according to this article "it will take at least another 10 years to get it into the clinic" <-- 10+15 = 25. TWENTY FIVE, with a patent for a cheap, effective way of detecting pancreatic/ovarian/lung cancer. what are we doing with our lives?! D

Cancer in China

source

Awesome article, confirming all my mom's comments about cancer care in China:

NYT: As Cancer Rates Rise in China, Trust Remains Low

Notable quote:

“Our Western physicians take difficult cases as challenges, whereas Chinese physicians first assess risk to themselves and hesitate in helping patients.” 

“Hospitals are reluctant to have patients die on their premises. Lack of hospices for dying patients” is a problem, the authors wrote.

Original article: Practicing Western Oncology in Shanghai, China: One Group’s Experience, from the Journal of Oncology Practice

Also relevant: China's Cancer Village Phenomenon

Hillsong - Scandal of Grace

Oh to be like you
Give all I have just to know you,
Jesus there's no one beside you, 
Forever the hope in my heart.

God, let this be my prayer for this next year. Missing my philly MCO family today. Now I know what M was talking about when she said we were spoiled in Philly. Tenth, TCN and MCO were such blessings, with such amazing people. God, you have always been so good to me, and JCF and MCO were perfect for sculpting me at the right times these past 3 years. Let those stay as a strong foundation for whatever may come this year. I'm ready :)

star struck *_*

Oh my goodness...so the science dork in me is DYING here!!! First of all, my tutor at the NIH discovered freaking fibronectin (and is a total beast at everything else. But we'll just leave it there for now haha). Second of all, Dr. Fraumeni of THE Li-Fraumeni syndrome (which as a refresher, is an autosomal dominant hereditary disorder characterized by mutations in the p53 tumor suppressor gene that--for nonmedical people--strongly predisposes people to cancer at a young age) is not only STILL AT the NIH, but is also a tutor for one of the (SUPER LUCKY) students here. Ahh!!!!

It's going to take a while for me to get used to this. Thank you so much Lord for this amazing opportunity <3 My science dorkiness is in full swing hahaha.

In other news, this is currently on repeat:

 

Thanks to C for the share :))

not immune

Today, more than ever, I realized what it feels like to be wrestling with darkness.

I had a conversation recently with a friend, about my path and position so far in faith. We talked about what it really means to walk with God, and she brought up a point that she had observed, validating what her pastor had mentioned: that the stronger we grow in faith, the harsher, the more powerful and more testing our trials become. In our present world, we are not immune from the temptations, the attacks, the manipulations of the devil. As a combination of Satan trying to fight back, and of God giving us challenges that he knows we can eventually  handle, with a bit of roughing, it can be argued that it is NECESSARY to go through these hard times to make us grow stronger. It really struck a cord with me, because maybe if I analyzed things that way, it would appear as if my internal battles and struggles this past year were rooted there. I'm not going to lie...I loved this past year. However, there were times it was EXTREMELY hard to stay motivated. At times, I did feel like I lost all control-- and the weak person I was, I fell completely into the apathy, the damage, and the temptations. I am ashamed to look back on the damage that is done and come to terms with the fact that now I have to face the consequences. I did not prioritize God enough; I did not pray enough, I did not serve my community enough. And no, it is not guilt due to lack of works, but rather an 'outflow' or 'lack of flow' that I blame completely on not prioritizing my relationship with Him enough. I am 100% confident in my faith and where I stand, but that doesn't mean I should go on my own merry path. My work should not be, or ever be, an object of worship. Who says I am important at all? God is a jealous God, and again, I see God humbling me in order to bring me back to Him.

God, I am so sorry. Message taken.

To be completely honest, this year was a very dark year for me, and I really believe part of it was due to my lack of commitment to my relationship with Christ. Lack of sleep, lack of exercise and lack of eating well threw my whole life balance into wack, and I felt like I needed to prioritize eating, sleeping and pleasing other people in order to do well. I worried about trivial things. I worried about what other people thought. I worried about my future--my profession, my future spouse, my plans. I stopped caring about other people--to a scary point. But like God says:

 Is not life more than food, and the body more than clothes? ²⁶ Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? ²⁷ Can any one of you by worrying add a single hour to your life? [...]
 ³¹ So do not worry, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ ³² For the pagans run after all these things, and your heavenly Father knows that you need them. ³³ But seek first his kingdom and his righteousness, and all these things will be given to you as well. ³⁴ Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own. - Matthew 6:25-34

In the past, I could get away with just using that doctrine occasionally. But at this point in my walk, I can't just be nonchalant about my faith. I can't just be lukewarm, because I'm NOT lukewarm. My mind is in one place, but I am still not pursuing a life always pleasing to Christ. I feel like God is trying to help me to get there...I just have to stop resisting!

A huge thing I struggle with also is not opening up to people. Secondary to my Chinese-instilled-fear of saving face, denial, and fear of burdening people, I try to escape from the reality that I am in a very very bad place at the moment, and need help from others. I feel like my fears are unreasonable because people in our lives are in our lives for a reason, and no one is meant to be alone. Yet I still feel bad about burdening other people; whether people will still take me seriously...:/

Sometimes I wonder whether there is something intrinsically wrong. The state of mind I was in before the end of 3rd year scared me, and made me  personally worried for the people I would eventually take responsibility for, because I simply was not prepared. I was only partial about my learning this year and feel horrible about it...what am I doing?! Instead, I prioritized feelings, temptations, ephemeral, stupid things. Part of the reason I am taking a year off is to try to get my life back together, to know medicine WELL, and re-start the path I started 4 years ago...this time on the right track. A couple quotes I've heard recently that have resonated:

"If you smell crap wherever you go, look under your own shoe"
"Practice does NOT make perfect. Perfect practice makes perfect" <--SO true.

I know what I am capable of, with the gifts God has blessed me with, but I also know that I am far from it at the moment. I need to stop asking for easy, fast results and take things one step at a time. As my dad keeps telling me--this is not a sprint; its a marathon. You're in it for the long haul, so please, keep the bigger picture in mind.

Which brings me to this: GOALS FOR THIS YEAR
1. find a significant other (isn't that crazy that that was on my list before? no longer.) instead, prioritize quiet times, prayer, and my walk with Christ.
2. get back into shape. in fact, get into the BEST shape of my life, not just for my previous number 1, but for my actualy number 1: because my body is a temple; i've abused it enough. enough is enough.
3. review medicine, again, not for myself, for my career, but to glorify God.

God, I'm giving this up to you. 

DONE WITH 3RD YEAR!!!!

It goes without saying that this year has been insane, from ridic hours to ridic cases, but the ability to experience the nitty gritty of medicine made this year my favorite year yet. Even more awesome was having the honor of working with amazing classmates, incredible residents, brilliant attendings and finally, merciful patients (haha)! The lessons learned this year were unmatchable.

Will definitely miss clinical medicine for a year, but in the meantime, time to get ready for the NIH ;D

(more to come later...now to pack!)

it's all relative

I CANNOT believe it is already June 10th!! Where did is all the time going!? I feel like I started pediatrics, blinked, and now it's almost over. Which freaks me out because there is a lot of administrative stuff I need to do before I start my year off. Namely:

-de-register as a medical student and submit all my forms, which I'm still trying to figure out
-coordinate stuff at the NIH
-study for my peds shelf at some point, since that is next week >__<
-say goodbye to everyone (this might not happen)

-email all my rec writers
-meet with GM and KS


Time needs to slow down o_O I took a day off of work today and I still didn't get everything I wanted to get done. Yikes.

asian parent quotes #1

I think I'm going to start a new sub series, just because some of these things are too good to not post.

parents: Hey, when are you planning to move down to MD?
me: I was thinking June 22nd?
parents: Hmm...can you move any earlier, like the 20th? or later, like in July?
me: No, my lease ends June 28th :(
parents: alright we'll hire you a moving company, since we won't be in town to help you move out. we're going to northern europe for three weeks!
me: ;__;


Haha my parents definitely deserve it though...they have been such good parents and deserve to finally enjoy life and empty nesting...while still supporting my tuition ^__^' Can't wait until the day when I can finally pay them back <3

wanderlust #2

Favorites from the National Geographic Photo Contest, 2012:

Village and islands in background in Gásadalur, Faroe Islands

Baobab forest in Avenue du Baobab, Morandava, Madagascar.

Buddist temple in Bagan, Myanmar (Burma)

Japanese maple tree in the Portland Japanese Gardens, OR

More winners

also Some choices from this year's contest

Looking at these photos makes me want to cry. Because I want to be in those places SO badly. In reference to my previous entries, I have SUCH a wanderlust...to the point where I really want to run away and explore the world for a year. Too bad reality is that I am stuck until I finish my career. Or am I? What is stopping me?

-logic

-lack of money

-safety

-money

But why should I do it now?
Reasons from this guy (from previous post)
-i'm young
-no ties down.
-no job that demands things out of me 360 days a year (*cough* residency)
-clearly, i am currently miserable haha

Just putting this here too:
Pictures of the Szechuan Earthquake 5 years later

wanderlust

currently drooling over pictures from 4th years traveling, like this from my friend in Nepal:

sigh

TRUTH: Why you should travel while young
Also: Living with less

life is what you make of it.

Because it's late and I'm tired, just going to do a quick jot down again before I forget:

-Got to catch up with an old friend this past weekend and we ended up spending like 30 min debating insurance companies vs physicians HAHA. It was actually very refreshing to hear her side...and made me realize how easily convinced I can become if I don't force myself to play the devil's advocate. Later on, I realized I DID agree more with her standpoint than my previous position. Within reason, of course ;) But again...goes to show I really need to be more widely read. More sometime later about the changing face of 'primary care' and family physicians.

-There was a (gorgeous) patient today who accurately (and a bit arrogantly...but not unreasonably) stated he was probably the healthiest patient I'd ever see. And he was quite accurate. Basically this guy has a family history of longevity (and no disease haha), is a physical trainer for a living and is EXTREMELY strict with his diet. He googles everything to make sure his body is in its best possible condition. He takes curcumin because it's been shown to help prevent nerve damage.

Did I mention he was extremely attractive? Man...made ME feel bad about myself o_O haha but I guess I should use it as inspiration huh? ^__^'

gratefulness

Just going to do a bulleted recap because this week was full of so many things...!

-Finally feel like I'm connecting with my preceptor (ugh...after weeks of me feeling like an idiot around him). First of all, on Friday, after completely missing the PMH and assessment on a patient, decided to try to redeem myself by going the extra mile. For the next two patients, I spent a bit of extra time, but 1. printed out patient information and lots of educational stuff for a patient 2. got called a sweetheart by another. My preceptor actually smiled :)! 

Second, he finally agrees with and is using my A/P's with patients (!!)

Also this week, made another preceptor very happy, did patient advocation for another, and requested to see another patient in the office on a return visit. My lab-stalking paid off :)

So this next week is the last week to make an impression. After receiving a disappointing grade in Medicine (which really upset me...definitely going to try to argue it in 2 weeks :/) I really want to do well in Family. About 3 weeks ago, the chances looked pretty dismal...the physicians in the practice are so smart and amazing, it is hard to please them. But here's fingers crossed for the last two days...my hopes still should not be that high, but it's worth a try right? sigh.

-Met up with a guy on Tuesday for the first time and it TOTALLY felt like I was talking to someone at job interview or something o_O I need to work on my flirting LOL. But in all seriousness...you know how all the guys lament being that 'nice-guy' friend? I'm pretty sure I'm a female equivalent to many of my guy friends T__T

I also realized I am so lucky to be surrounded by such amazingly smart, clever, compassionate people in medical school. Where else do you find such incredible people? I love my class, the classes below me, and the classes above me. That also makes it hard to find that right person because my standards are pretty high o_O

-Got called not once, but TWICE by classmates for advice about the management of  conditions in people close to them. That really surprised me because at this time of year, I still don't feel as competent as I should be. Yet both times I had the right A/P gut-wise...just wasn't as confident ^__^' Will hopefully try to work on that in the next couple months.

And did I mention the week before, diagnosed a new murmur in a patient! Note to self: follow up on her echo! 

going with your gut

source

Great article on the all too easy, all too often assumptions we can make as physicians, and the consequences: Afraid to Speak Up to Medical Power (from the NYTimes), based off this NEJM submission

Noteable excerpt (on sending a patient to surgery who clearly wasn't well):

"We realize that, each of us unsure, we gained confidence from the perceived assurance and expertise of the other. We unearth the other specialists who participated in the patient's care...The general internist bowed to the others, and the surgeon was approached as the next service provider in line. Tragically, no one person looked beyond the effusion to the whole patient. Although he saw myriad specialists in his last week of life, he died lacking holistic care"

Conclusion:

"...In a profession abounding with experts, no one person's expertise can always count for more. Although certain technical skills may be specialty-specific, there's a much broader range of skills on which no group has a monopoly. There's no chain of command in using gut instinct, showing concern for the whole patient, avoiding harm, or curtailing futile care. We must recognize that debate is healthy and that without open communication, we fill the space by guessing at each other's motives."

Lesson? Speak up and go with your gut. If all else fails, at least you'll learn something.

And again, more reasons to count blessings

Boston marathon coverage from NY Daily News

Working in the medical profession, particularly in acute-care settings, has definitely changed my perspective of natural disasters and the recovery from devastation. Every time I head about explosions, disasters, bombings, etc, my mind has learned to reflexively think about the emergency/disaster medical teams that must mobilize so quickly and try to save as many people as possible. I can only imagine the chaos amidst fear and confusion and trying to be the face of calm, trying to think straight during those times so you can prevent more destruction...man...

Part of me wants to be in on the action, to be there to help, save people, and protect lives. After all, that's what I'm being trained to do now, isn't it? However, it's a fine balance between getting to do a lot and also sacrificing my own personal safety (I tend to disregard that a lot...heh).

My friend posted up this story from WWII as similar to this story from this week about a fortunate man who escaped TWO destructive events very narrowly. I read Hiroshima by John Hersey back in high school, but I think at the time I was not experienced enough to appreciate the devastation that was caused by the atomic bombs. I did not understand fear or human pain. Part of it was because I feel like as humans, we want to avoid feeling pain. We want to avoid causing ourselves more emotional stress than is necessary, so we block those feelings and distance ourselves.

3rd year has taught me that pain will come, and HAS to come, to grow us. And I no longer run from pain--I embrace it (more on this later). I am thankful for the experiences in my life so far because they have slowly opened my eyes to depth of pain people can suffer and the strength of human resilience. Look at the people in war torn countries right NOW...they go through bombings and attacks everyday. Referencing back to my previous post we are SO lucky to be in a country that is LARGELY safe. Safety is NEVER guarenteed, but with Christ, PEACE is. <3

counting blessings

The incredible and wonderful acts of kindness people performed after the events in Boston today were incredibly touching, but even more so because it brought such a contrast to the stories I hear from refugees who find their new homes here in the US everyday. I am SO incredibly thankful we are in a country where there is an ABUNDANCE of helpers...a gift many places in the world do not have. 

A patient the other day came in as a new patient; we soon found out he was a refugee. After having been imprisoned multiple times for speaking out against the government, finally forced to flee his country because of persecution, with nothing but the shoes on his feet and the clothes on his back, he went into a neighboring country with no contacts, no friends, no helpers. Through pure resilience, a wary heart and the kindness of a handful of strangers, he made it through. However, he left his then-infant son back in his country, and has not talked to him in more than a decade. If he ever gets to meet his son, his son will have already become a grown man... without his father.

How many of us would have made it through without the abundance, the COMFORT, that comes from knowing we are in MULTIPLE good hands? Such is a luxury we take for granted here in the US, where generosity is welcome, praised, and encouraged.

It is not the case in other places.  

Again and again, I am reminded of what a blessing Urbana was for me. As one of the speakers said: 
'Our problem, the reason we are so unhappy and disatisfied in our first world lives is because we have given ourselves a sense of ENTITLEMENT. As mere mortals, we are not entitled to ANYTHING. But we have such a merciful God who is willing to bless us with gifts...and we can combat our dissatisfaction with being thankful everyday for the things He has given us.

Tonight, my prayers go out to Boston, both the victims and the helpers. God, please calm their hearts, show them how good you are, and give wisdom to those who are still helping. But also, my prayers go out to those suffering in the dark places, who have learned to deal with this kind of thing as commonplace. There is so much sin in this world. God, more than anything, comfort them.
----

inspiration #?

I like to post links to people I admire, so I have a reference later on for who I might want to emulate.

Example:
Dr. Fagenholz
Spent "[first 3 years doing general surgery residency. then next 2 years] he was a research fellow...studying the epidemiology of surgical diseases such as pancreatitis and burn injury as well as the physiology of hypoxia and high altitude illness.  His high altitude work led him to Nepal where he performed field work in the Khumbu Valley and met his wife Alice, an emergency medicine physician.  Dr. Fagenholz then returned ...completing his residency in General Surgery....

In addition to his travel to Nepal, Dr. Fagenholz has also worked with Partners in Health performing and teaching surgery at Butaro Hospital in Rwanda (http://www.pih.org/pages/butaro-hospital) and is currently invovled in international surgical development through the Program in Global Surgery and Social Change at Harvard Medical School (http://ghsm.hms.harvard.edu/uploads/pdf/global_surgery_3.pdf).


This guy is AWESOME!! His story ignites more frustrations on whether oncology should really be the field I want to pursue if I want to go into international work (though, there definitely is a hole there. which means lots of new research upcoming on prevention and cost juggling!). OB/GYN?? EM???? probs not surgery, though so cool!! :)

reasons why NYC is awesome

Did I ever mention the sax and cello are my favorite instruments ever? If you can play either, you definitely have a piece of my heart ;)

so this is the outpatient side...!

Having done very little outpatient work during 3rd year so far (except for like 3 days on OB/GYN), it has come to my attention that as a student, you are much busier in the outpatient than inpatient setting. This is because:

1) Patients in the hospital are not going anywhere, nor do you need to wait for them, so you really can see them whenever you are able. Basically, you can manage your time. If you really wanted, you could spend an hour on one patient. On the contrary, in clinic, you have a set schedule, so once you're done with one patient, another one is waiting for you, and your time is limited. I had more time on the floors to use the bathroom than I had in clinic today.

2) On the floors, you were assigned certain patients out of a whole list of patients. In the office, you see EVERYONE (or at least, every other o_O).

3) If each patient's visit goes a bit longer than is scheduled, you are no ddoubt going to be 'late'. There is no real concept of 'late' on the floors. I had enough time to think and formulate a plan on the wards...that definitely did not happen today.

However, my school's family medicine department is PHENOMENAL. Sometimes I feel like the physicians there know loads more than the hospitalists, because their knowledge is 1) broader in scope and 2) more applicable and realistic. Most people are healthy but need checkups. Also, it is usually a PCP that sees a patient's first presenting signs of any illness. I know this might not hold true for all family medicine departments, but props! :)

The Medscape report I posted about in the previous entry comments on how PCP's are the physicians who most complain about underpayment. After today, I couldn't agree more. Specialists have their job almost handed to them--usually the HPI is already taken, you order some tests that only you can order but don't compensate you back THAT much...you have one area where only so many things can go wrong...on the contrary, the PCP does a lot of the heavy lifting. Honestly, I feel like specialists who get paid the big bucks like cards and GI do so because of their procedures. But family medicine doctors do procedures too! In big academic centers and cities, primary care doctors are grossly underrated. They are THE doctors, THE lifeline, in low resource/rural settings.

 I dunno...this is only my first day on family medicine and already I am both overwhelmed and in awe. It doesn't help that my preceptor has high expectations. Did I mention I'm working directly with an attending?? (but who happens to only be like...in his early 30s?!)

With this year off, if I choose to do onc, I'll be...25 when I graduate medical school. 28 when I finish IM. 31 when I finish my onc fellowship. I keep forgetting that fellows are pretty much attendings. But for those who only have like 3-4 years of residency training, and them WHAM you're an attending--i.e. EM, peds, family med, hospitalists or IM generalists, PM&R, OB/Gyn, neuro, ophtho...basically most things if you don't specialize...some of my medical school CLASSMATES are older than some of the newer attendings. That blows my mind. Especially since 30 is like the new 20s.

That, and I feel like I have friends who range from 23-31. So technically I could be peers with an attending o__O

#candleswithoutapowerouttage

I am fortunate to have family medicine and pediatrics to end my 3rd year...two rotations that are supposedly less time-intensive than all the other clerkships. Therefore, let this be a testament that in the next (and last!) 3 months, I will make it a priority to:

1) Write at least 3 times a week, because there are so many stories still untold, many memories needing reflection, and I want to capture them before they disappear into the abyssmal space that is my 'life' in the midst of my medical training
2) Take care of myself both in food and exercise, because now I can't really blame my schedule or the weather on my lack of activity :P
3) Study for step 2!!!

Random note:
Yesterday, I decided to be completely spontaneous and 'study' by candlelight. It wasn't exactly an attempt to be eco-friendly, since I was studying on my laptop (haha the irony), but there is something about the flickering of the small flame and the orangy-glow you get from the candle that creates such a calming ambiance.

My desk last night :)

I swear, I study normally 98% of the time! But honestly, who wants to be normal that long? I love unique people because I truly believe they add spice to life. And I fully embrace my weirdness :)

To add to my bucket list:
[ ] spend a night with someone (friend, family, future significant other?) only by candlelight, and talk until the candles burn completely out :)

on the 'deceptive income of physicians'

"Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher."

Source: http://benbrownmd.wordpress.com/

Not that this affected my decision to do medicine in the first place (I truly and completely love what I do, and would totally do it for free if I didn't have to worry about anything), but this article from Dr. Ben Brown is definitely a good one to show those people who complain doctors make too much :P

Also, interesting stats about physician compensation and satisfaction in 2012: from Medscape

I'm going to try to write more often now, regardless of how coherent it is. I realize a large reason I sometimes find myself struggling to find words is that I'm not using them as much as I would like. No practicing, no fluidity. Lets try to change that, shall we? :)

teachers

Source

I realized I have a really soft spot for really smart, dorky people who are good TEACHERS. And by good teachers, I mean people who can challenge you to think on your own, but not in a way that is condescending or intimidating. People are smart and who love to share their knowledge with you in a way that breaks it down, is very understandable, and doesn't discriminate based on background knowledge. People who give you a chance to show your abilities. When they teach, they teach to everyone, because everyone should have a fair chance to learn (especially as a team!). They are willing to tolerate mistakes as long as you learn from them. And what enables them to be good teachers is that above all, they don't brag. They are HUMBLE, and that humility shines through.

Sigh. Hopefully one day I can be like that

relevant

on work life balance: from the NYTimes 

on end of life care: how doctors die

a typical day in the ER...

52yr old male comes into ED complaining of extreme left lower extremity pain, shooting from his left lower back to his left foot, going on for the past 3 weeks. The pain is described as '10/10', throbbing in nature, persists through walking and at rest and 'is unbearable'--it keeps the patient from sleeping and has made him depressed. No appreciable weakness or numbness in any extremities. The patient has tried taking oxycodone 30mg every 4 hours, with minimal benefit. Of note, the patient tried cocaine yesterday in hopes of alleviating the pain--that also did not help.

-__-'

chemo

On the treatment of diffuse large cell lymphoma:
"Other regimens are now considered only for patients whose condition relapses and who are not candidates for high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) for diffuse large cell lymphoma. They include the following:

• ICE - Ifosfamide, carboplatin, etoposide
• ProMACE-MOPP - Prednisone, methotrexate, leucovorin calcium, doxorubicin, cyclophosphamide, etoposide, mechlorethamine, vincristine, procarbazine, prednisone
• MACOP-B - Methotrexate, doxorubicin, cyclophosphamide, vincristine, bleomycin, prednisone, leucovorin calcium, trimethoprim/sulfamethoxazole DS, ketoconazole
• ProMACE-CytaBOM - Prednisone, doxorubicin, cyclophosphamide, etoposide, cytarabine, bleomycin, vincristine, methotrexate, leucovorin calcium, concomitant trimethoprim/sulfamethoxazole DS"

And I thought HAART was bad. Do I still want to go into onc? xD

surrendering it all

This past winter break, I made the decision to spend 5 days in St. Louis at the InterVarsity Urbana conference. The conference was mostly for undergraduates, but there were a significant number of seminars that were catered towards to-be medical professionals. Additionally, there were numerous seminars that aimed to help people be better evangelizers, be better neighbors, and just be better Christians in general. Thought I was a bit skeptical about going beforehand (I've never been to something of this caliber and knew sometimes emotions can speak larger than reality), and I was spending a significant portion of my only vacation during 3rd year at the conference, I went with faith. In all the leaps of faith God has teased me with this past year, God has never failed. So I went with an open heart, open to the lessons He wanted to teach me, open to whatever God had planned for me at Urbana.

And oh, did God have things planned for me.

I know people say this over and over again, but God seriously does work in incredible and powerful ways. Part of what makes Urbana so awesome lies in the incredible sense of community and power you feel, with over ten thousand people in once place, all with the same passion, calling and willingness to follow God. To have more than ten thousand people be able to testify to God's goodness, to His persistence, and to His answers to prayer...To have hundreds of people who have gone the narrow road, who have taken up their cross, and who have followed Jesus without turning back...To have those hundreds of people speak SO joyously and passionately about God's provision and his ability to literally move mountains for these missionaries...Oh, it is an amazing testament to how God is SO good. At the conference, more than ever before, I realized how great a DISSERVICE we do to ourselves, our own dreams by thinking they are too SMALL. NOTHING, NOTHING is too small for God to do, if it is in His will, and if the ultimate goal is to glorify Him.

I realized at the conference I was really at fault for falling short in faith. I was not asking God for ENOUGH. God WANTS every one of our requests. And oh, can He provide!

To be honest, I think this was the first time I felt, tangibly FELT, the Holy Spirit moving in me, making physical, tangible changes. As someone whose grown up in the church, there have been times in my life where I wonder where I can continue to grow in my walk with Christ, since I've known him for all my life, right? WRONG. Also, I've always thought I had good faith. WRONG. Thankfully God in His great mercy forgives my arrogance and continues to remind me how much further there is to go, but how patient He is in helping me down that road.

For example, I remember always reading Romans 12:1-2--

"Therefore, I urge you, brothers and sisters, in view of God’s mercy, to offer your bodies as a living sacrifice, holy and pleasing to God—this is your true and proper worship. Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will."

--And my reaction was always, "Yea, yea of course God. I'm transformed. Of course I'll sacrifice for you." When really, I was not there at all. I've heard stories about people who have reached this point already and admired them, but I still held onto the comforts of this world. I still held onto my own opinions. I still wasn't quite ready to surrender. I never had enough faith.

Until now.

It wasn't a 'one moment you're one person; another moment you're not', but at some point during Urbana, I think God wanted it to be time for me to make a commitment to Him. Not to what I though His plan was, but first and formost to HIM, and to be willing to be transformed, not just partially but completely. By slowly stripping me of minor material possessions and my desire to make plans, God gave me very clear signs about what it TRULY means to live out Romans 12:2.

Mind you, things like 'the willingness to surrender your life' are not easy to swallow (which is why it took me so long to get here in the first place). Also, it wasn't like God was giving me this awesome clear next-5 year plan for my life. God didn't reveal to me a residency, or a place he wanted me to go. No, God wasn't clear about my future at all. And just because I didn't have hesitation about surrendering to God, didn't mean I didn't have FEAR. But God was clear about one thing: HE WAS HERE. He is with me. And He's not going to tell me everything at once, but He's going to give me baby steps. All I have to do is obey.
The first step was clear: I needed to pray more.

When I was at the exhibition hall at Urbana, I met up with a missionary who had worked with one of my good friends. I had entered the hall in search of a project, but was praying God would give me guidance. God brought me to this missionary's booth, and instead of providing me with an opportunity, the missionary provided me with a challenge:

"S, you sound genuine. But before you go forward, you need to ask yourself this: Do you want to go to **** because YOU want to, or is God truly calling YOU to go?"

That was like a slap in the face. I was speechless. The missionary was so right. How much of my desire to 'sacrifice myself' for God was MY doing, and how much of it was truly me following God??
That humbling experience would haunt me for the next month. I realized how little I knew about what God wanted me to do, and how helpless I felt because I didn't know. It was terrifying. I was utterly broken by how far I felt from God at that point because I felt so lost. I also knew this wasn't just an emotional reaction to a stimulus because the feeling persisted after the conference. In fact, Urbana was the spark; the realization of my shortcoming. The realization of my paltry sacrifice; to only partially commit for so long!?...it was a realization that brought me to my knees in humility. I spent many moments this past month literally in tears, because I was so scared. I was so torn between the sacrifices God was calling me, SO STRONGLY, to do, and how scary it was to fully and completely obey. But I knew that was what God wanted me to do, and that He knew I was at a point where I could take that leap of faith--to commit to a lifetime of faith.
And so, with many tears, I did.

Did I mention how good God is?

This past month, for as many tears I've cried, God has reminded me of His grace. In places I thought I'd never see him work, God has opened doors. In fact, more so than I had ever imagined, when God's first command was to pray and I finally obeyed without hesitation, God started answering ridiculously quickly. My old self kept trying to hold back, but with each new leap of faith, each tear was dried away with feelings of utter joy. This, THIS was what I was missing out on and THIS was what it meant to be God's servant, to be walking hand in hand with God. It feels amazing.

Words cannot explain how much of a blessing Urbana was for me. How much of a blessing the people God's put in my life have been for me, to have slowly built me up to this point. (Special thanks to J, A, C, D, and J for being amazing examples!). How much joy and comfort I now have because my confidence is solely, and ONLY, in the Lord. Again, this doesn't mean that I don't have worries. But now, those worries are lifted to God, and suddenly, I have confidence. On the floors, I not only see patients through eyes of compassion; I see them through eyes of Jesus. When the sins of this world tug at my heart, I give those burdens to Him.

I am sharing this with all of you guys so you can keep me accountable. And so whenever I am in those dark and scary places (which, believe me, are many in the medical world), I can look back on this entry and remember that in all things, God is good.


Amen :)