Greetings, readers. I guess this blog has become an annual project of sorts. We'll see if the more laid-back schedule of R4 year will give me more opportunities to write.

Which brings me to the most significant update since my last blog post: I'm an R4 now! The first few months started off with some great travel to California, Chicago, Hawaii, and Ann Arbor, to name a few destinations.

[1. Congrats to my newlywed Phi Psi brother, Sam! High high high! 2. Visiting Danny and Mary in Chicago! 3. A family vacation to the Aloha State. 4. A pilgrimage to The Big House with psychiatry classmates, three years in the making.]

The other important update is the fact that I'm one of the chief residents this year. My term is actually almost halfway over, which is mind-blowing (and something I didn't realize until writing this post). Part of the transition at the end of R3 year was attending various chief resident conferences that taught me to recognize my leadership strengths and pitfalls. The most enlightening part of being a chief, though, has been watching these areas of my personality play out in real life as I work with residents and faculty. The way these interactions have helped me grow in my personal and professional development has reminded me of what I think makes psychiatry unique among medical specialties.

At a psychodynamically-oriented program such as Wright State, we emphasize the healing power of the therapeutic alliance. In that sense, psychiatry shares the same one-way relationship with patients that other specialties do. The patient receives what the psychiatrist provides (namely empathy, an emotionally secure and predictable environment, etc.). However, psychodynamically-trained residents can also appreciate how a patient could have reciprocal effects on physicians. In the process of providing emotional support to patients, psychiatrists can grow emotionally as well. 

Sure, doctors in other specialties certainly have meaningful, sometimes life-changing interactions with their patients. I don't discount that fact at all. What I think sets psychiatry apart is that the experience of a psychiatrist benefiting from time with a patient (not just vice versa) is perhaps expected as part of the doctor-patient relationship; whether the process is a result of transference or counter-transference is less important to me than the fact that psychiatry patients impact psychiatrists more than we might imagine. When I recognize this process happening at my various clinics, it confirms I went into the right specialty and makes me hope I can transpose a similar process onto all of my professional interactions.

Yes, it's almost been seven months since my last post. My sincerest apologies. As I look back on previous posts, I realize this is the first one of R3 year, which is about halfway done by now. By this time last year, I had already written four posts about R2 year. Even though the blogging pace would eventually drop off to just two posts over the latter half of R2 year, I was curious about what might have changed this year.

For some insight, I reflected on a previous post, The Circle of Residency Life, where I tried to anticipate what R3 year might be like. Apparently at the time, I was concerned about doing semi-autonomous work without the immediate availability of attendings in the outpatient setting. Surprisingly, that has probably been the least worrisome aspect of being an R3. There have been only a couple of times where I had to urgently consult with an attending in real-time about a patient while the patient was in my office. For the most part, clinical decision-making has not been the issue. Instead, the focus of improvement for the remainder of R3 year will most likely be time-management (which was only a blurb of an afterthought last year), specifically improving my time-management while working in the office and living life outside of the office.

In terms of time-management in the office, keeping logistics running smoothly at clinics hasn't been too much of a problem. Rather, it's the effect that time-management might have on my clinical style. For the remainder of R3 year, I need to make sure that efficient interviewing/documenting doesn't get in the way of building rapport and establishing an emotional connection with patients (a common conundrum in all medical fields), a balance that I hope to achieve with the help of my various clinic supervisors.

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[What I imagine when I think of balancing efficiency with patient rapport.]

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Just as important this year has been learning how to manage my time outside of the office. The awesomeness of the R3 psychiatry schedule (with no work on the weekends or major holidays) still stands true. However, with great power comes great responsibility. As I reflect on why it's taken me so long to update my blog as an R3, I realize it was because I was still doing a lot of clinic work outside of the office during the early part of the year. I was spending a lot of time trying to chart-review patients and pre-writing notes ahead of time in an attempt to be efficient during office hours. In some clinics this strategy does pay off, but recently I've come to realize that this isn't always the case; some of these efforts were resulting in diminishing returns and not really saving me time. Thus, part of the change in time-management has been figuring out what patient information I need to know ahead of time and when I can Let It Go with other information, a change that has allowed life outside the office to settle down to the point where I can do things like update my blog.

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[Something else to do in my free time: watch "Frozen" and finally see what all the fuss is about.]

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Although I'm not necessarily "at a loss" for what to do as an R3, I think I'm still transitioning from certain habits developed after years of largely inpatient work. Fortunately, as one of my supervisors told me, all of the components of outpatient work are in my grasp; it's just a matter of learning how to wield them correctly, with both efficiency and empathy. If I continue to push myself to work outside my comfort zone (which involves limiting the amount of work I do outside the office), I can trust the process will yield results in the end.

Wow, May has been quite a whirlwind of a month so far! I spent the first seven or so days of May at the annual meeting of the American Psychiatric Association, held in New York City this year. I not only learned a ton, but also caught up with friends from Michigan and Stanford and had a great time exploring all that the city had to offer. I found the Big Apple to be extremely accessible and look forward to visiting it again soon.

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[1. Started the first day of the conference by participating in my first Free Comic Book Day (the first Saturday of May, apparently)... 2. And ended the last day of the conference as a member of the Colbert Report studio audience!]

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The very next week I was in St. Louis with my mom and dad celebrating my younger brother's undergrad graduation from Washington University. I couldn't be prouder! (Fun fact: St. Louis is the birthplace of both toasted ravioli and gooey butter cake, both of which our family had the opportunity to sample during our stay.)

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[1. The view from the Gateway Arch (an obligatory tourist stop); 2. Me, my bro, and his college friends.]

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I arrived back in Dayton this past Saturday, and it was the following Sunday that inspired me to write this post. I was lucky enough to be finished with work at the hospital by 10 AM and was trying to think of what to do to make the most of my time. That was when I remembered that the Paul DeWolf Memorial Hero Run was being held in Ann Arbor that day. For those who might not know, Paul DeWolf was a friend of mine from medical school who was killed in Ann Arbor this past July. (I shared some thoughts in this post that I wrote a month after his death.) To make a long story short, remembering the run and finding out the run was scheduled to start at 2 PM inspired me to semi-impulsively spend twelve hours driving up to Ann Arbor, supporting my friends who had organized and were participating in the event, spending some time with M4s prior to their departure to residency programs across the country, and driving back to Dayton.

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[1. Reuniting the Phi Rho Sigma Class of 2012 at Paul's race]

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The inspiration for this post actually came when I was still in Dayton looking up the event's start time. I Googled "Paul's race" (before thinking of adding "DeWolf" to the search term), and what came up were a few Bible verses by the apostle Paul that make mention of "races." The verse in particular that stood out to me was a verse I believe was referenced during one of Paul's many memorial services:

I have fought the good fight, I have finished the race, I have kept the faith. (2 Timothy 4:7, ESV)

The concept of "finishing the race" stayed in my mind as I made the trip to Ann Arbor and I continued to ponder on its meaning this week. For Paul, his life's race was finished sooner than anyone would have guessed. It was finished sooner than anyone would have wanted...but I guess that's my point. As I watched all the participants run the course on Sunday, especially the recently graduated M4s, the message I wanted to convey was to be aware that the race of life can change at any moment. None of us knows exactly where the proverbial finish lines to our own races are. In fact, none of us knows what the course looks like in the first place. We might have started running on a track with organized lanes and numbers only to find out that the track changes into a cross-country path with hills and valleys. I would go so far as to say that there will be times when the event changes entirely, from running to swimming to skiing to climbing to biking to jumping, like some crazy triathlon/pentathlon where the component sports are unknown ahead of time and the time spent in each sport is unpredictable. We must be prepared to find ourselves in situations we never trained for. We must be prepared to face challenges we never knew would come our way. We must be willing to accept, even embrace, unanticipated changes in our preconceived life plans, not with disappointment but with an acknowledgment that we have completed the run and now it is time for the swim.

If you think about it, the road to becoming a doctor is well mapped out. For the most part, one must complete college, attend medical school, and graduate from a residency to become a fully licensed and board-certified physician, a journey that can take anywhere from eleven to fifteen or possibly even twenty years depending on what paths and detours one takes. Anywhere along the way, even after completing residency and starting our own practice, we might discover that the race we've been in is not the one that we thought was mapped out. If and when we come to that realization, our natural reaction might be to panic or become unsettled. What should reassure us, though, is the fact that we had successfully traveled down this current road despite using the wrong map. With the help of family, friends, and loved ones, we can always chart a new course. We might not know how the race will end, but we can know that we will finish it alongside the people we had met along the way.

Greetings from Ann Arbor! For the month of March, I returned to the inpatient psychiatry unit at the Dayton VA, which gave me the chance to use some vacation days to celebrate Match Day with friends in Michigan. Working at the VA has also given me the chance to reflect on my year as an R2 so far. There was a familiar poetic sense of homecoming returning to the VA for a month, similar to the sense of homecoming I had as a sub-I at the Ann Arbor VA (recounted in my post "Med School 360"). Inpatient psychiatry at the VA was my very first rotation as a brand-spanking new resident out of med school, and looking back at my previous retrospective post ("Another year older") I'm again struck by the progress I've made during my training. It's almost comical to read my thoughts and remember how I felt "at a loss" when carrying five or six patients on my second day as a resident, whereas now that patient load is all in a day's work. The most affirming part of returning to the VA was hearing the nursing staff comment on how noticeable my progress has been to them, staff whom I worked with as an R1.

I've also had a poignant sense of passing the torch these past couple of days. As an R1 at the VA, I worked with Luke Barton as the R2. I remember his words of encouragement and reassurance that, yes, somehow, magically I would find myself being able to handle more and more of a patient load. Neither of us knew how such a transformation would happen and to this day I still can't explain what exactly has changed over the past year and a half, but I've enjoyed providing the same perspective to the current R1 at the VA, Christine Molina. Attending Match Day in Ann Arbor has only strengthened that sense of passing the torch to a new generation. Maybe it's silly to think in such nostalgic terms when the current M4 class is only two years removed from me, but being invited to the ceremony was incredibly meaningful. I could participate in the excitement along with them, sharing bated breath and palpitations with everyone.

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[So proud of all of my Michigan med school M4 friends! So excited to have you join the ranks of physicians!]

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Now my focus is on my remaining years of residency training. Starting as an R3, I will be working semi-autonomously in outpatient clinics. The good news is my schedule will be awesome: outpatient clinics mean no work on weekends, major holidays, or (at least on base) snow days. The more daunting prospect is the semi-autonomous part. For my entire med school career and during my first two years of residency, my work followed a predictable pattern: I saw patients on my own, right after seeing the patient I discussed the case and my proposed plan with my attending, the attending offered some thoughts/suggestions/things I might have missed, which finalized the plan. As an R3, I will still see patients on my own and there will still be attendings available in the office if I have questions, but for the majority of cases I will be formulating my own plan, signing prescriptions, and sending patients off into the wild blue yonder without discussing the patient or my plan with an attending beforehand. Staffing patients with attendings happens after the patients are gone, a complete reversal of the work pattern I'm so used to. What's more, I will have to be more cognizant of my time-management skills in order to keep clinic appointments running on time.

I anticipate this drastic shift in my workflow will rekindle feelings of being "at a loss," similar to starting work as an R1. However, if history is any guide, I will somehow, magically find myself looking back and appreciating how comical it was for me to feel so daunted.

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[The Circle of Residency Life: baby Simba's face definitely mirrors my anticipation of being held over the cliff of R3 year, but maybe I should start growing out a mane in parallel with my own clinical transformation.]

On the cusp of another series of night shifts, I Googled for things to do in Cincinnati yesterday. What I found were not events in Cincinnati, but rather events in Newport, Kentucky, the town directly across the river from Cincy. Specifically, I found TUBACHRISTMAS playing at Newport on the Levee. Granted, tubas and euphoniums are no trombones, but I thought it would be nice to show support for fellow low-brass players. A few more clicks of the mouse, and I was ready to make a day of it.

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First up, breakfast. Culinary inspiration struck me the night before this trip: I have left over banana bread, why not make banana bread French toast?

[1. Work in progress; 2. Finished product.]

For the record, it was a very delicious way to start the day.

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Next up (after putzing around the house for a little bit), lunch. Turning to Yelp, I found this Newport gem: York St. Café.

[1. Unique atmosphere, including a collection of Elvis memorabilia and a pre-pubescent Justin Bieber vinyl record; 2. An absolutely delicious turkey, brie, and cinnamon apple sandwich with a cranberry mustard dipping sauce. It was a nice combo of sweet and savory.]

Overall, I would highly recommend this place for a meal. According to other Yelp reviewers, it can get really busy for dinner, but as you can see by my panorama shot, there weren't many other people at all when I ate there. (I think I was probably the first customer of the day.)

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Then it was on to Newport on the Levee. This was my first time visiting this shopping complex. Among the various stores and bars, there's the Newport Aquarium (ironically located directly across from a seafood restaurant called Mitchell's Fish Market). Both venues will have to be on my future to-do list.

I still had a couple of hours before the TUBACHRISTMAS performance, and so I thought to stop by the Newport Express Holiday Depot. 

[1. Outside the Newport Express Holiday Depot, admission just $5; 2. The centerpiece model train set (and centerpiece model train set conductor) greeting visitors at the entrance; 3. Per the sign on the wall, "August, 1944. George Patton's magnificent Third Army races through France. This one of a kind military train is designed and operated in honor of all our veterans; 4. A preview of the Lego magic that was to greet me; 5. Lego superhero menagerie, both DC and Marvel characters (as well as the random Star Wars character) in an action-packed scene. I particularly enjoyed seeing Spider-Man swinging toward Venom in the bell tower, and the custom-built Arkham Asylum; 6. Welcome to Studville! This picture does not give proper justice to the elaborate detail of the set; 7. Some close-ups of the various parts of Studville. A carnival with a fully-functional Ferris wheel and carousel, as well as a concert stage that lights up and plays "YMCA;" 8. Superheroes playing baseball (with Yoda at bat); 9. More Lego sports; 10. Meanwhile, in the Hall of Justice...DC comic rogues are being led to paddy-wagons while the Super Friends are being interviewed for TV; 11. Buttons that brought Studville to life; 12. Lego model train set (unfortunately no accompanying Lego model train set conductor); 13. An incredibly beautiful Lego model of the Cincinnati Music Hall; 14. The back of the Music Hall model; 15. A close-up of the auditorium in the Music Hall model, with Lego Hulk enjoying prime balcony seating; 16. Lego Coast Guard to the rescue!; 17. Lego fast-food, featuring Dunkin' Donuts, Taco Bell, KFC, and Pizza Hut.]

In addition to enjoying the model trains and Lego sets, I learned about the Ohio Kentucky Indiana Lego Users Group (the group responsible for all the Lego models featured at the Newport Express Holiday Depot) and entered their raffle for a Lego Ewok Village (drawing is on New Year's Day, fingers crossed!).

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The cost of admission included a free 1-hour game card from GameWorks (which I promptly used up). Finally it was on to the main attraction: TUBACHRISTMAS! A 45-minute free concert, filled with rumbling harmonies.

[1. The beginning...; 2. ...and end of TUBACHRISTMAS, with a sampling of "Deck the Halls."]

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It was a rainy day, with flood warnings throughout various parts of Ohio, but well worth the trip!

Looking back at the past few months, I've had the pleasure of doing quite a bit of traveling, everything from cross-country flights to simple afternoon visits to Cincinnati. Like any good Asian, I tried taking plenty of pictures and was also excited to figure out the panorama feature on my iPhone. Here's a summary of what to expect below:

• Boston (September)
• Ohio Renaissance Festival (September)
• Stanford 5th Reunion (October)
• Afternoon drive to Cincinnati (October)

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Boston

Walked the freedom trail with Steph before we attended a wedding. Along the trail, we found many references that certain friends of ours could appreciate, and even met a lady from Ann Arbor who played "The Victors" for us on a replica of Ben Franklin's glass harmonica! (I unfortunately did not have the sense to record a video of the performance.)

[1. Massachusetts State House, a.k.a. big shiny building; 2. For Dr. Daron Watts (psychiatry residency classmate and Commander in the Coast Guard); 3. Paul Revere's grave (kind of an important guy); 4. Samuel Adams's grave (also an important guy who I think was known for his beer); 5. A Benjamin Franklin statue; 6. A history lesson on political mascots; 7. For Dr. Brandon Smith; 8. Steph outside the Old State House and the site of the Boston Massacre; 9. A Samuel Adams statue; 10. Quick stop at Mike's Pastry shop; 11. My first attempt at a panoramic shot (with subsequent weird people-distortions); 12. Nomnomnomnomnom; 13. A Paul Revere statue (fun fact: the statue was purposely positioned with the horse facing the historically-incorrect direction in order to prevent congregants of the church across the street from being greeted with the horse's rear-end at the end of services; also, totally did not catch the tour guides inadvertent[?] photo bomb); 14. A panoramic of our lodging for the weekend, courtesy of Airbnb.]

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Ohio Renaissance Festival

My first ever visit to days of yore. Steph and I enjoyed bouts of jousting, a magic show, and pirates trying to perform Shakespeare. I've already marked my calendar for next year's festival!

[1. A glass craftsman making a butterfly; 2. Giant turkey leg noms; 3. Parade of villagers; 4. Our jouster, Sir Robert (not of the House Baratheon, unfortunately); 5. Real-life, unscripted jousting contest (alas, Sir Robert was not fated to win); 6. A human chess game (that was scripted); 7. The end of a long day of whimsical adventure.]

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Stanford 5th Reunion

I'm going to phone this one in and direct readers to my Facebook albums for most of the photos: Day 1, Day 2, and Day 3. However, there were highlights from the weekend.

• Day 1: touring Stanford Stadium, attending "LSJUMB 101" to kick off the 50th-year celebration of the modern Stanford Band, Dinner on the Quad.
• Day 2: LSJUMB 50th Reunion field rehearsal, Phi Kappa Psi homecoming dinner, LSJUMB Bandquet
• Day 3: Gameday with the Band, night in downtown Palo Alto

[Day 1: 1. Tour of Stanford Stadium; 2. Panoramic shot of Stanford Stadium from the lower deck; 3. Proudly showing off the open-ceiling design of the bathrooms; 4. Underneath the HD scoreboard; 5. Making our way to the press box; 6. My first (and hoping it's not my last) time sitting in a cushioned press box seat; 7. The view from the press box; 8. Go Card!; 9. Showing off the pre-modern Stanford Band uniform, which would subsequently lead to a demonstration of the high-step marching style of the pre-modern Stanford Band; 10. Recounting the history of the Tree (the official Band mascot and the unofficial university mascot); 11. Pics from the unveiling of the first Tree; 12. The second-ever Tree costume (because the first one had apparently been burned or similarly unceremoniously disposed of); 13. Recounting "The Play" of 1982 and how THE KNEE WAS DOWN; 14. And of course, an appearance by the LSJUMB; 15. Phi Psi roommates reunite at Dinner on the Quad.]

[Day 2: 1. A line of LSJUMB Old Fartz eagerly waiting to check in for reunion; 2. Field rehearsal; 3. Panoramic shot of half of Phi Kappa Psi homecoming dinner, with the other half of the house to the left of the photo!; 4. Sophomore year Phi Psi composite!; 5. Methline (a.k.a. members of the Stanford Band who were Class of 2008) at Bandquet, 5 years older and (theoretically) 5 years wiser.]

[Day 3: 1. The rehearsal hall in the Band Shak before the wee morning hour field rehearsal; 2. Group photo after field rehearsal! (I think I'm somewhere in the top right corner...); 3. Rallying the football team at The Walk; 4. Starting to cadence down the street and into the stadium!; 5. Made it into the stadium; 6. Kickoff...; 7. ...and victory! (With a game in between); 8. "Play with your feet!"; 9. Band post-game rallying into the late hours of the night; 10. Catching up with old friends before flying out the next morning (and yes, I did have friends of other ethnicities, not just South Asian).]

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Afternoon drive to Cincinnati

It was a Friday and I was scheduled to start a series of three night shifts that weekend. Heck if I'm going to let that stop me from doing something fun. A quick search on Yelp for lunch ideas with a quick search for "Things to do in Cincinnati" on Google and I was off!

[1. Court Street Marketplace, home to Le's Pho and Sandwiches; 2. Beef pho with Vietnamese iced coffee; 3. A quick jaunt through Washington Park; 4. A great shot of the Cincinnati Music Hall (placed on future to-do list); 5. Carew Tower, with access to its 49th-floor observation deck for only $2; 6. North side of Cincy; 7. East side of Cincy; 8. South side of Cincy (with Kentucky across the river); 9. West side of Cincy; 10. Something else to place on my future to-do list; 11. Vertical panoramic shot of Carew Tower, all 49 stories; 12. A sampling of the great collection of building art in Cincy; 13. Apparently, Cincinnati was named after an ancient Roman, Cincinnatus. (Learn something new everyday.)]

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Can't wait to see what the next few months have in store!

First the big news: after 16 weeks of inpatient psychiatry at the VA, 4 weeks of child and adolescent psychiatry, 4 weeks of emergency medicine, 12 weeks of internal medicine, 4 weeks of a substance abuse rotation, 4 weeks of urgent care psychiatry, and 8 weeks of neurology, I graduated from first year of residency.

[What? R1 LUKE is evolving!]

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[Congratulations! Your R1 LUKE evolved into R2 LUKE!]

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In writing this post, I figured I should have some big insights after intern year. For help, I looked to my favorite medical show, Scrubs (rest in peace), specifically the episode about J.D.'s last day as an intern: http://www.youtube.com/watch?v=QXMopZ4i7pk (Scrubs - Season 1, Episode 24). The episode had some typical intern-coming-of-age lessons such as the need to remain compassionate in the face of increasing cynicism as a resident. What stands out for me, though, is the ending where Dr. Cox's ex-wife goes out of her way to expose various secrets that the characters had. (Hidden romantic feelings, previous hook-ups, professional back-stabbings.)

Fortunately my year didn't end as awkwardly as the episode did, but I think the scene highlights an important aspect of intern year: the development of relationships. Each of the secrets that was exposed involved a relationship between the characters that had been cultivated over the season. Though it has happened throughout my life, connecting with others has taken a special significance during intern year. As funny as it might sound, intern year was when I started truly living on my own (dorm and Phi Kappa Psi fraternity house in college, condo roommates followed by Phi Rho Sigma in medical school). The transition from living in a house with twenty-five friends to living by myself in an apartment was striking. No longer could I rely solely on proximity to connect with others.

I believe this fact is what motivated me to go out of my way to make relationships this year. Ever since undergrad I've been notorious for being a listserv spammer, but I feel that this year my emails to others took on more significance as I looked for company to join me in exploring Dayton's culinary and entertainment scene. Being selected as the 2013-2014 Resident Social Chair was the most visible culmination of these efforts, but they don't stop at simply finding people to hang out with. Some of the most meaningful moments this year involved mingling friend groups (most notably when I had a big dinner gathering of high school, college, and med school friends in San Francisco during the APA Annual Meeting) or helping people to network with others (e.g. med student friends with friends in residency). Here's to hoping the trend continues!

First, some logistical issues to address: Posterous unfortunately is shutting down (http://blog.posterous.com/thanks-from-posterous), hence the move to Posthaven. Theoretically I could have written this post sooner, but like all good residents I procrastinated, in this case with importing my previous posts. Anyways, the import is now complete so I have no more excuse to hold off on writing.

To understand this post, some background info is needed. For those who don't know, I was baptized into Christianity on June 10, 2012. (That entire testimony and my continuing walk with Christ is probably more appropriate for a separate blog in and of itself, but I digress.) For a bit more than a year now, part of my Christian life has included listening to Christian rock, specifically K-LOVE. This was a genre of music that I was previously indifferent to, if not mildly annoyed with. I can't really explain why. Maybe the lyrics sounded too cheesy. There was also the amusingly cynical view that South Park expressed in their Christian Rock Hard episode, questioning the purity of Christian artists' motives. Whatever it might have been, for a while whenever I heard "Jesus," "Lord," or "God" in the lyrics on the radio I would scan for a different channel. I can't say when exactly I started tolerating Christian rock or when I started actually enjoying it, but I can say that now it is what I listen to in my car almost all the time. I'll occasionally switch to NPR for news updates, or to a classic rock or pop station if K-LOVE is out of reception, but this is rare. What I've come to appreciate is how Christian rock is like prayer in music form. Lyrics praising God's plan to redeem the world through Jesus's death and resurrection; lyrics trying to describe the indescribable amount of love Jesus had to have had for every human past, present, and future in order to willingly go to the cross; lyrics explaining the reassuring implications of God's grace; all of these concepts I sort of understood on a cerebral level through reading Christian literature, but putting these messages to music has helped me understand these concepts at a heart level as well.

Which brings me to the main thread of this post. (Note: there is a lot of musing on religion, but there are also thoughts in the end on how these musings apply to medicine.)

Although I was raised in a household that believed in God, I never went to church services growing up, so a lot of my growth as a Christian has been simply learning about the traditions that many believers know like the back of their hands. One of these traditions is Maundy Thursday, the evening service on the Thursday prior to Good Friday that commemorates the Last Supper and the night that Jesus was betrayed. This year was the first year I went to a Maundy Thursday service. That night, I drove to church with K-LOVE playing, parked my car, and went in for the service. The program included Scripture readings, hymns, and explanations of the significance of Maundy Thursday. I remember the atmosphere being more subdued than usual, but not necessarily somber. Everything seemed to be fairly straightforward until the account of Jesus's trial was read (I believe it was the account in Mark 15).

I distinctly remember following along in the Bible with the reader at the pulpit when she came to the verse where Pontius Pilate asks the gathered crowd what they want done with Jesus. The verse was read ("Then what shall I do with the man you call the King of the Jews?") and I was expecting the next verse ("Crucify him.") to follow shortly...but instead there was silence.

And then I realized the reader at the pulpit was trying to hold back tears.

After a few seconds, she read in a quivering voice, "Crucify Him."

Pilate asks what Jesus has done to deserve this sentence. And again the reader had to collect herself before reading again, "Crucify Him."

In a similarly halting manner, she continued on to recount the abuse Jesus suffered, the crown of thorns on His head, the beating and taunting he endured.

I can't remember if she went on to read the account of the crucifixion, but at the end of the service the congregation was asked to make their way out silently. Getting into the car, I turned the key with the expectation that I would drive back with K-LOVE on the radio like usual...but it didn't feel right. At that moment, I needed silence. So I turned off the music and there it was again, like those few seconds during the reading.

Silence.

The original intent of this post was to photo-document my adventures during Columbus Day in October. I thought (and still think) that the idea of "exploring" Dayton on Columbus Day was a clever play on words during the holiday. With an entire day of freedom, I plotted out a few goals to structure my time, namely breakfast at Butter Cafe, lunch at Smokin' BBQ, and dinner/trivia night at The Pub. How I would arrive at each goal, though, was up in the air, an adventure waiting to happen.

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[An overview of my travels (all on foot) through Dayton on Columbus Day, courtesy of Google Maps]

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Like any good Asian, I took a lot of pictures as I wandered the streets of Dayton, but trying to post them all with individual commentary proved to be too tedious and made the post look too cluttered. There were some particularly nice shots that I wanted to share though.

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[E: Pausing in the middle of the street and looking back north up Main St.]

[F: A beautiful shot of the rising sun amongst clouds over Route 35.]

[G: There was something tragic(?)/ironic(?) about seeing a Salvation Army store boarded up. This was the first time on my journey that I realized how blind I've been during the hustle and bustle of residency. I've passed this building countless times, driving to and from work/errands/social gatherings, and never noticed it until I took the time on Columbus Day to slow down my life and simply walk down the street.]

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[K: A post-breakfast walk through Woodland Cemetary and Arboretum, with stops at the grave of the Wright Brothers and a view of the Dayton cityscape. There was also a pretty cool Civil War portion of the cemetary.]

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It was during breakfast at Butter Cafe that I started cultivating the thought behind this post. You see, I used to be an avid Foursquare user when it first came out. The thought of racking up purely symbolic points against other friends was enough motivation for me to "check in" at even the most mundane locations. After receiving a few purely symbolic badges, the novelty of the game soon wore off. In hindsight, I think the purely symbolic nature of Foursquare points just wasn't worth the effort it took to maintain my place on the ever-changing leaderboard. However, during Columbus Day, I opened up my Foursquare app and on a whim tapped the "Explore" button for the first time. This was a new feature that was introduced a few updates ago, and one that I simply hadn't paid much attention to until that day while I was sipping my hot cup of coffee, waiting for my delicious Bacon, Avacodo & Tomato Omelette.

Turns out, that decision helped add to my itinerary that day! Through Foursquare's "Explore" feature I found a section specifically dedicated to tourist-y sites (How appropriate!), which led me to find the Stewart Street Bridge. Not only that, on my way to visit the bridge I discovered Dayton's Vietnam Veterans Memorial Park, and from the park I discovered the Point of Peace. 

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This string of happy surprises has led to a change in attitude. Other possible titles for this post might have been "Meta-Exploration" and "Explorations in Exploring." This is because on Columbus Day, I learned to explore for exploration's sake. I learned to forget about collecting artificial points and simply enjoy the journey. Since that marathon of a day, I've come to enjoy walking whenever I can. If anything, the freedom of movement that comes with being a pedestrian gives me the chance to see streets I might not otherwise commute on, and from a perspective I might not otherwise appreciate. Just today, for example, walking to get dinner from the Oregon District led me to the Dayton courthouse plaza, and on a whim deciding to take out my Thai 9 udon soup and sushi to Riverscape helped me stumble across the Riverscape Metropark Ice Rink (which I didn't even know existed).

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[Christmas tree and ice skating. December has arrived.]

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I'm hoping to extend this spirit of exploration into my academic life also. I'm halfway done with my Emergency Medicine block, and have three more Internal Medicine blocks left. Although I would obviously prefer to be working psychiatry cases, having a spirit of exploration has helped me get the most out of these Internal Medicine months. (At the same time, assessing patients with acute mental status change and seeing what I think was my first case of serotonin syndrome has kept the rotation relevant.) Even if it isn't related to psychiatry, knowledge is still knowledge, and I've come to appreciate learning for learning's sake, in the hopes that happy surprises keep coming my way.

On that note, explore away!

All in all, not a bad way to live the domestic life, if I do say so myself. Now if you'll excuse me, dinner beckons.

Usually I associate the phrase "Another year older" with birthdays. In this case though, it came to mind during this past Fourth of July, and not necessarily because it was America's birthday.

Yes, I've been delinquent in keeping this blog updated. There's been quite a lot of happenings, the most significant one being my graduation from med school! No less significant, though, being my birthday in April as well as my imminent transition to Dayton. In fact, since my last post, I have found a sweet apartment in downtown Dayton and the Air Force has moved a majority of my household goods from my room. (I am literally living out of a suitcase since my clothes drawers are on their way to Ohio.)

• Getting the residency application process going. Turned in the first part of my military application and had my first set of interviews.
• Lots of good food options. Of course, there was the dining hall on base and the cafeteria at the medical center, but off base my favorites were The Pub, Thai 9, Dublin Pub, and the Fox & Hound. (Fox & Hound, especially, for their weekly Thursday military appreciation nights.)
• Claudia coming to visit! Specifically watching Harry Potter 7.2 and Captain America together.

1. Don't forget where I came from as a medical student. Don't forget what it feels like to be a medical student.
2. Take time to teach while doing hospital work, even if teaching doesn't come in the form of sit-down talks. Some of the most helpful teaching I've encountered came from residents explaining their trains of thought as they reviewed a chart or put in orders, i.e. explaining why they were doing what they were doing.
3. Peace and love. Peace and love.

• Tutoring math for underclassmen when I was a senior in high school.
• Being trombone section leader in the LSJUMB, helping "my frosh" navigate the Stanford Band culture.
• Being president of my fraternity, trying to set a good example for how to lead others who looked up to me.
• As a fourth-year medical student, passing down insight gathered over the course of medical school, specifically helping pre-meds in college with the application process and providing advice for med students interested in going into psych.

[Renewal (and sunshine) finally in Ann Arbor]

In the end, the trip was an amazing success. This year was the single biggest year ever in terms of number of patients treated. The final numbers over the course of 5 days were as follows: 500 patients seen in clinic, 58 surgeries, and 16 in-office procedures.

A big travel day back home.

[Photo 1, 2: a last look outside the window of my hotel room.]

[Photo 3, 4: crates and luggage being packed.]

[Photo 5, 6: Alex and Paul...with the mountain of bags looming behind them.]

[Photo 7: a full bus.]

[Photo 8: checking in at the airport.]

[Photo 9: brunch at Wendy's in the San Pedro Sula airport, decked out for Mother's Day.]

[Photo 10: waiting to board our flight.]

[Photo 11: layover in Atlanta for dinner. Panda Express chow mein, Golden Treasure Shrimp, String Bean Chicken, and Black Pepper Chicken with a raspberry iced tea.]

[Photo 12: boarding our flight to Detroit. Almost home!]

[Photo 13: picking up our stuff at DTW...almost there...]

[Photo 14: ¡el fin! Home safe and sound!]

For yesterday's Devotional, we mixed it up a bit by having Alex lead some hymn singing (Come, Thou Fount; and In Christ Alone). In terms of the hospital, yesterday was my day in the pre-op area and my overnight call.

[Photo 1: the sign outside the hospital. In for a long day.]

Pre-op consisted of starting lots of IVs. In between patients, I had a chance to read C.S. Lewis's "The Screwtape Letters." My pre-op shift ended around 2 PM, at which point I was able to go back to the hotel for a bit before my overnight call. After a two-hour nap, email time, and dinner, it was time to return to the hospital.

For the most part, last night went pretty smoothly. There were some late surgeries, with the last patient arriving in recovery at around 9 PM. However, all the patients admitted to the hospital (turned out to be four in all) were fairly stable. The nurse who was on call with me, Michelle, was gracious enough to let me get a few hours of sleep while she monitored vital signs overnight.

[Photo 2, 3, 4: the hospital at night.]

[Photo 5: taking care of the last two patients to arrive in recovery.]

This morning, it was simply a matter of getting some quick vital signs before the surgeons arrived, eating the boxed breakfasts that our colleagues brought for us, and heading back to the hotel to have the rest of the day off.

[Photo 6: clinic starting to pick up in the morning.]

[Photo 7: standing outside the front of Hospital Suizo.]

It promised to be a busy day at the hospital. The original plan was to only have clinic and no surgeries because we'll be leaving tomorrow, but the group ended up scheduling in surgeries for today in order to accommodate all the patients that needed to be treated.

As for me, though, I went back to the room to nap before getting an all-American lunch at Pizza Hut.

[Photo 8: the movie that was playing at the Pizza Hut, featuring Jackie Chan!]

The rest of the day consisted of emails, other computer tasks, and gift-shopping. I had plenty of limpera (Honduran money) to bring back some genuine Honduran coffee, postcards, and keychains.

[Photo 9: before going gift-shopping, a special coconut cookie...with a bite taken out of it.]

[Photo 10: the souvenir shop, El Buen Amigo.]

[Photo 11: chilling in a hammock.]

Tonight was also the end-of-the-trip banquet. It was a night of good food, good company, toasts to all the folks who made the trip possible, and overall merriment.

[Photo 12: the med students at the hotel, before the dinner.]

[Photo 13: our banquet table.]

[Photo 14: Alex, me, and Josh.]

[Photo 15: Alex busting out the tunes.]

Tomorrow is a big travel day. See you all back in the States soon!

Fixed my post about Day 5. Have at it: http://lukeli.posterous.com/la-ceiba-mission-day-5

Today's morning run was probably the most humid this week. After returning to the hotel, showering, and coming down to breakfast, we found out why: there was a torrential downpour, the first time it has rained on this trip that repeat participants could remember.

[Photo 1: raindrops falling to the ground.]

Fortunately, the weather cleared up by the end of breakfast, and we were off to start the day.

And what a day it was! I started the day learning how to do a tonsillectomy, and then took out a tonsil all by myself. The surgeon I was working with, Dr. Fung, said he was impressed that it took me all of two minutes. He commented something along the lines of "Good hands for a future psychiatrist."

[Photo 2: the fruits of my labor. I think the tonsil I took out is the one at the top of the photo.]

Literally right after the tonsils were removed, we were informed that our OR needed to be used for a C-section! We turned over the room as quickly as possible. Members of our team were drafted to assist with anesthesia and with the surgery itself.

[Photo 3: crib, ready for the newborn.]

[Photo 4: Dr. Fung (left), first assist on the C-section with the Honduran Ob/Gyn.]

[Photo 5: ¡hola!]

[Photo 6: yes, turns out pediatricians do the same newborn exam in Honduras.]

[Photo 7: a coy smile from our youngest patient.]

[Photo 8: new Facebook photo. Count it.]

After that bit of excitement, I took part in a thyroid resection and septoplasty.

[Photo 9: a thyroid.]

Overall, it was quite a satisfying day. Tomorrow, I'll be in pre-op starting IVs, and then spending the night on call.