Iceland Day 6: West Iceland

On our last full day in Iceland, we made our way from Akureyri, the major city in the North, back towards Reykjavik. It was a long driving day, requiring a total of around 5-6 hours so we only really stopped at Hraunfossar, a waterfall on our way to Reykjavik. However the day was not without Iceland's usual breathtaking views. It was a bittersweet journey, knowing that the amazing views we saw were some of our last. A week is far too short a time to discover all of Iceland's treasures, but it was enough time for me to fall in love with this country, hard. All that kept me from tearing up, reliving the trip through these posts, was the promise that one day I'll come back. There's a magic about Iceland, in its untouched lands and endless beauty. Some of the experiences were so incredibly breathtaking that all the time in the world didn't seem like enough time to fully let the feeling sink in. It was an unforgettable trip and I cannot wait to return. Until next time.

On the road. 

This picture doesn't do this view justice. One of the most breathtaking moments on the trip. The clouds were breaking up, with patches of sunlight streaming onto a patchwork of fields and farmland. The backdrop is a chain of dark hills, enveloped in clouds. It's one of the few moments where the experience was almost religious; it is almost impossible to believe that a scene this magical and gorgeous wasn't made by some higher power.

A quick stop on the side of the road to stretch our legs. Of course everywhere in Iceland, even a random road stop results in a waterfall, a gurgling river, and a beautiful sight.

Hraunfossar is not the most popular tourist destination in Iceland but it was certainly not without its own beauty. This series of rivulets stems from water under the earth, coming from lava fields nearby. the little creeks appear from the rock itself, and end in a magnificent, roaring river.

Nearby is Barnafoss, a powerful, raging waterfall with a small and tasteful bridge of stone connecting the two sides.

Our last evening in Iceland, relaxing in our hotel's outdoor hot tub. It certainly doesn't compare to the natural hot springs, but it seemed fitting end our trip with water, enjoying the mountain view.

Iceland Day 5: East Iceland

The day started out terrifying. We were making our way from Hofn to Egilsstadir, which involved going up into the mountains. It was rainy and foggy, and we had to drive at a crawl for at least an hour in a thick mist that prevented our being able to see anything past a couple of feet around us. This means that we weren't sure if we were right next to a cliff edge or not, which was quite stressful. It didn't help that the road was gravel and not paved, making it for a stressful AND very bumpy ride. Eventually the clouds cleared and we made it to Fardagafoss, near the city of Egilsstadir. It isn't one of the so-called "must see" falls of Iceland, and it was more of an excuse to stretch our legs between Hofn and the Myvatn area where we were headed. However the falls were quite lovely, and I really enjoyed the view over Egilsstadir.

We got to Myvatn where we stopped for a dip at the Myvatn Nature Baths. Like the Blue Lagoon, it draws from the underground hot springs and was the perfect way to rest a tired body unused to hiking every day. It was not as fancy and touristy as the Blue Lagoon, but it had its merits. For one, it provided a nice view over the Myvatn area including Lake Myvatn and Hlidarfjall Mountain. It was also cheaper by a long shot, and did not require pre-booked tickets online.

We ended our day at Godafoss (waterfall of the Gods). I wish so much it had been sunny, because I'm sure Godafoss in the sun would be magnificent, accentuating every color, with a rainbow or two making an appearance. But it was regardless a thrilling and powerful waterfall to visit.

Hiking up to Fardagafoss, the view over Egilsstadir is beautiful.

Before reaching Fardagafoss, there is a second waterfall flowing into a gorge. Much of Iceland reminds me of Ithaca, which made the trip all the more special.

The handsome Fardagafoss. Apparently you can hike right up to the water, and there is a cave behind it. However we were short on time so we skipped that.

Dark clouds around Lake Myvatn as we were soaking in the Nature Baths.

On the top of Godafoss, you are able to make your way to right where the water actually falls. It's a quaint and fun little area to explore, forcing you so make use of the stepping stones all around the shallow waters.

The incredible power of Godafoss was undeniable, and it was thrilling to be so near something so majestic. 

Iceland Day 4: Southeast Iceland

Today we first made the 2.5 hour drive to Svartifoss, a waterfall within Vatnajokull National Park. This place was clearly the place to be if you're into hiking. There were throngs of people camping there, with intense (in tents?) hiking gear, walking sticks, huge backpacks that tell you they mean business. Within the national park there are like a billion trails to explore, of all levels of difficulty. We chose to stick just to seeing Svartifoss, but on my next trip (cause I'm coming back, dammit!), this will definitely be a place that we could explore more. We had a lovely picnic lunch next to Svartifoss, sunning ourselves on the large rocks next to the river that Svartifoss turns into. My mom says that this was her favorite meal of the trip, eating in the sun, with the sounds and sights of Svartifoss right next to us.

Next we made our way to the Jokulsarlon Glacier Lagoon. This was by far one of the most unique experiences that Iceland has to offer. It is a lake that huge chunks of ice that break off the mountains end up. It gives the whole area this translucent blue glow, and the sight of these huge glaciers drifting peacefully in a lake is just mesmerizing. Also, we saw a sea lion!

This was one of many unique landscapes in Iceland. After a volcanic explosion, the resulting landscape is a moss covered lava field, devoid of any plant matter aside from a thick layer of soft moss. Very eerie but beautiful.

The view of a snow capped peaks, shrouded in clouds at Vatnajokull National Park.

On the hike up to Svartifoss, we are gifted with the view of a smaller, downstream waterfall: Hundafoss.

Svartifoss from a distance. I loved how from afar, most of these waterfalls were not all that impressive, but up close, once you get to know them, they become unique and memorable each in their own way.

The black basalt columns surrounding Svartifoss (black falls) gives this waterfall its unique flair.

The mesmerizing and peaceful glacier lagoon.

Iceland Day 3: South Iceland

On day 3, we started our road trip around the country in earnest. We first drove the 2.5 hours from Reykjavik to Seljalandsfoss. This is the only waterfall that we visited that allowed us to go behind it, which was a incredible (albeit drenching) experience. On the left of Seljalandsfoss was a smaller waterfall, Gljufrabui, hidden inside a cave. If I had to choose one favorite part of my trip to Iceland, this waterfall would be it. To get to the waterfall, you must make your way into the cave that is its home, stepping on rocks in the small creek leading to the waterfall. There is no manmade path, and the adventure of the shaky stepping stones leads you into a small enclosure where it is just you, the waterfall, and the light streaming down from above. It is a magical, peaceful, powerful, indescribable experience. It's spiritual, in a way, if nature makes you feel as at peace with yourself as it does for me.

Next we go to Skogafoss. What I loved about Skogafoss was its location. We were able to admire the waterfall from below, but you also were able to take the stairs to hike to the top of it (about 200 feet). Situated on the Skoga river, you could see the river it turns into, and follow its winding path across meadows and farmland all the way to the beach. It was breathtaking.

Finally we make our way to Reynisfjara Black Sand Beach. I wasn't able to take a picture of the drive there (since I was driving and as pretty as Iceland is, it wasn't worth dying for,) but the scenic drive was amazing. We went up and down through mountains, and you could see the landscape transform from green hills dotted with sheep to flat plains, interrupted with winding rivers from waterfalls, all ending in a black stripe of sand beach that ultimately lead to the blue ocean. I can honestly say that some of the best times I spent in Iceland was just driving, watching the landscape transform around me, being enveloped physically and mentally by the land and sea, and where I was. I literally would feel anxiety about not being able to capture well enough the gorgeousness of the scenery. I wanted every moment to never end, because it was just so damn beautiful.

Seljalandsfoss

Gljufrabui waterfall from outside the cave. You can see the rocks and creek you must brave to get into the cave.

One of my favorite pictures from the trip. My sister in the cave, staring up at the falls and the sky with wonder. It captures perfectly the magic you feel, the connection with nature.

We also climbed a cliff to view the falls better, but it was a treacherous and clearly terrifying ordeal.

This was the best meal from my entire trip. Lunch at Hotel Anna, a tiny, nondescript farmhouse restaurant that served 3 dishes only. This was the lamb with potato cake. The lamb was the most tender and flavorful lamb I have ever had. It was warm, the salty gravy perfectly accentuated the gamey taste, and the skin was crisp. The potato cake it came with was hearty and tasty. The restaurant itself was very representative of the average Icelandic farm: quaint, small, cozy, humble, and welcoming.

Skogafoss, welcoming us with a rainbow and many tourists.

Reynisfjara black sand beach.

On the beach were these very unique basalt rock columns, that resulted in this formation after the rock was interrupted by molten lava. A fascinating and beautiful pattern that Iceland is known for.

Iceland Day 2: The Golden Circle

The Golden Circle is a series of landmarks near Reykjavik, comprised of Thingvellir National Park, the Geysir hot springs, and Gulfoss. It is a great introduction to the cultural and environmental history of Iceland. It took roughly 8 hours total, though the driving time from start to finish is only around 2 hours.

Thingvellir National Park, where the Norse settlers held Parliament since 800 AD and discuss the future of the country

 Thingvellir Park is home to two tectonic plates still drifting away, allowing you to walk between America and Eurasia.

It's also gorgeous with its greenery and rocky landscape, and incredibly tranquil and therapeutic just being there.

Next stop: Geysir! You can see the multitude of small hot springs all over the park.

This is Strokkur in the middle of an eruption. It goes off without fail every 8-10 minutes. I managed to be startled every time, despite staying for 3 eruptions.

Last stop: Gulfoss. It means "Golden Falls", and certainly set the waterfall bar high as our first major waterfall in Iceland.

Gulfoss from above. Words cannot describe the power and beauty of this waterfall, and this country.

Iceland Day 1: Reykjavik

We took the first day to tour the capital city, Reykjavik, and the Blue Lagoon. Little did we know, Reykjavik was the first and last major city we would explore. Iceland as a whole is so untouched, undeveloped and comprised of raw and undisturbed nature, that its capital city probably hosts the majority of the country's population. It's a quaint, typical European city with small but comfortable and cozy buildings, littered with cafes and small restaurants.

Our hotel here had the BEST breakfasts. Whole grain bread, fresh tomatoes and cucumbers, hard boiled eggs, sharp cheese, and salty salami. Also, Iceland butter is the best I've ever had. Wholesome, incredibly creamy and flavorful, and so smooth.
I can't believe it's butter! (And not Icelandic crack.)

Reykjavik is right by the ocean, and we were blessed with a sunny day. The air was a little chilly but crisp and fresh, and the salty breeze was a nice welcome.

The Sun Voyager sculpture, an ode to the sun.

Hallgrimskirkja church, designed to mimic the basalt lava columns of Iceland's cliffs.

At the Blue Lagoon. We enjoyed the complimentary face masks, and the mineral-rich waters actually did wonders for my calloused feet.

The waters were deliciously warm, which contrasted nicely with Iceland's consist 50 degrees F. 

We ended the day with a delicious dinner at the Lava restaurant at the Blue Lagoon. Here is my INCREDIBLY tender steak with hearty mushroom sauce and crisp french fries. Also pictured is a very modern and delicious Hollandaise foam.

The happiest place on earth: Iceland.

I can't remember when it was that I first started obsessing about Iceland. After learning about the Northern Lights in high school, I know that I always wanted to see them. And maybe later in college, I started seeing amazing landscapes pop up on some photography blogs, and Iceland with its thousands of waterfalls and endless varieties of landscapes drew me in. This summer, at the risk of sounding dramatic, my dreams came true. I spent a glorious, wondrous week in Iceland that was way too short. I'm going to make a series of posts, one for each day we spent in this beautiful, breathtaking country.

Loose associations:
Iceland is more beautiful in person than any photograph can convey. The fresh, crisp air, the endless, winding roads, and the untouched, raw beauty of the land. The hospitality of the people. The constantly changing landscapes from irregular, moss covered rocks like the surface of the moon, to bleak and barren black sand reminiscent of Mordor, to gently rolling hillsides with rivers winding their way to the sea. Off-white sheep dotting the craggy cliffs. Icelandic horses with their wild manes and gentle eyes. Waterfalls everywhere, surrounded by people, isolated from any living thing, small and big, roaring and trickling, an inconsistent constant of the land, always so beautiful, each one unique.

On the flight to Iceland, we had some foreshadowing. 

On kids.

It's been a whirlwind of a month and I've loved psych more and more with each day. I never believed the doctors at the interest group dinners who were like "Just go on rotations, cause once you fall in love with something, you'll know it." Well it happened, and I guess they were right, with all their experience or whatever.

I've especially come to love adolescent psychiatry. There are some kids, yes, that are difficult cases but they are almost always a product of their environment. Sometimes it's a sad, sad environment with stories that suffocate me and make my chest hurt with their tragedy. Like the 15 year old girl who grew up with a mother with schizophrenia, and was repeatedly raped by her mother's continuous conveyor belt of deadbeat boyfriends. She told us that two years ago, she got pregnant from her mother's boyfriend, carried the baby to term, gave birth secretly at home and then her mother "threw it away." Hearing that story, my heart broke into many pieces that still haven't fit back together quite the same as before. The girl ended up going to a more long term facility. But then there's the kid who came in two months ago, floridly manic, leaping from table to chair to bed to table, rattling off Eminem lyrics for no reason, picking fights with kids without even knowing why. After months of tweaking drugs, and an extensive (but ultimately negative) neurology workup, the anti-psychotics and mood stabilizers kicked in and he went home to a loving, concerned, but ever supportive family. There are happy stories in psych too, that give me hope for these kids, which by default give me hope for the future.

What draws me most to adolescents is how sometimes I see myself in them. I've felt their hurts before, I've sat in their chairs listening to the same lecture that I heard not too long ago myself. I saw myself in the cynical emo kid who found all his classmates achingly shallow and dull. I saw myself in his consciously "stick it to the man", "go against the flow", opposite of mainstream attitude. He was exploring his gender identity and wanted to cross dress, but his parents wouldn't let him due to their living in a white, conservative, small area where he would almost certainly be a negative target for both kids and teachers at school. He also struggled with these struggles themselves; he felt like a burden to his family and friends. He said he "leeched from their happiness, but never added to his own in the process." He told me when I asked if he was happy or unhappy that "happiness is an unsustainable state of mind" and he brings people down. He should major in philosophy in college. His parents were also supportive, telling him they loved him but that sometimes the world isn't fair, accepting or easy sometimes. They compromised by letting him cross dress on weekends, and at the upcoming Comic Con. He was the splitting image of his mother, both with striking, bright blue eyes and a very distinct smile. He's a kid I don't see coming back to the hospital, a kid who will use this experience to learn, grow, and go to far away places where he can be a she if he/she wants.

Today I had a family meeting with a mother I was afraid to meet. Her daughter threw herself into traffic after a counseling session last week in a suicide attempt and was brought to the hospital. Their history is a difficult one, as the mother has HIV and is in end stage kidney failure and waiting for a new kidney. She is an African American single mom who has had serious health issues all her life. Her daughter, this bright, bubbly, though very dramatic 14 year old girl stole my heart despite my best attempts for her not to. During our first interview, she cracked jokes, playfully called me "Ms. Crystal", and asked the resident where he got his shoes. She told me about her difficult life, how she was raised half the time by a family friend while her mom was in and out of the hospital, how when she lived with her dad he "beat her and burned her." She was also raped by the family friend's husband two years ago, after which she felt so alone and confused that she started seeing an imaginary friend who has been with her ever since. My heart went out to this poor girl and her tumultuous upbringing, bouncing around homes, never a stable life.

One problem was that after being in the hospital for three days, her mother never visited once. She told me that her mother would tell her she'd visit, but then she wouldn't. Her mother told the doctors that "she's just seeking attention" and she refused to visit. I was appalled, and so sympathetic toward this girl who just wanted to know if her mom cared. And when her mother met with us today, her first words were "My daughter did this to herself, and I'm just about done with her." My first reaction was fury and judgment. This girl needs you!, I wanted to say. She's hurting, she's confused, she needs guidance, but mostly she needs support from you!
Then she broke down. She explained that they're financially struggling, that she hopes to get a kidney by June but needs to keep her stress/blood pressure low for that to happen. She just moved into an unfurnished house with no refrigerator but she just bought a microwave and is working on getting it furnished. She is looking for a job but it's hard to find one that will accommodate her need for dialysis twice a week. She's working on pressing charges against the man who raped her daughter. She dabbed at her eyes as she explained how everything she does, she does for her kids, and her daughter doesn't understand that she has to meet her half way. That her daughter doesn't come talk to her civilly with her problems, but instead does these dramatic, self injurious gestures to garner attention and sympathy all the time. "I have a son to think about, and he's getting neglected because I'm always dealing with her." And as we spoke for close to two hours, with her son sitting alone in the hallway waiting area, I understood her frustration, her deep love for her kids, and her guilt for not being able to provide more. I also understood why she did what she did. "I didn't come on purpose," she explained, "I cannot enable this behavior. I would do anything for my kids, but she needs to understand that her actions bear consequences, and I won't tolerate this behavior. I'm almost at my limit as it is." And I heard her, I believed her.

When we brought her daughter in, the first thing she did was squeal, "Mommy!" and jump into her mother's lap, hugging her for a long time. But as we talked more, she slowly shut down. "Talk to me!", her mother would plead. "Be open with me!" The patient stated that she was worried that her mother's health was failing, and what would she do if she died? The mother reassured her that she wasn't dying. The patient brought up how whenever she talks about her feelings, it always ends up in an argument. The mother responded that it doesn't have to be that way, but that her mother would not sugar coat things, or treat her with comforting sympathetic nothings if that wasn't how she really felt. "The real world out there doesn't care about your feelings. I do, and I'm here right now, and I'll be here legally at least till you're 18, and probably even after. But I'm going to tell you like it is, even if you may not like it." Throughout this, the patient nodded but became silent, making less and less eye contact, and eventually left the room without a word. We were confused, and I felt that there was something missing.

I followed her and asked her what happened. She told me that she was mad that her mother lied to her, told her she'd visit but she didn't. She told me that her mother often doesn't let her finish her thought before interrupting her and jumping in. When she tries to get her to stop and listen, her mother "thinks I'm being smart with her" and it escalates into an argument. She is also struggling with the conflicting feelings that 1) she doesn't want to be a burden to her mother in this difficult time, but 2) she needs her mother's support and that means to be a burden to some extent. Her mother sends conflicting messages like "my health is fragile so do your best to help me and not cause trouble", but "always be open with me with your thoughts, good and bad ones." I can see how she's struggling, how to behave with her mother's best interests in mind, and when to listen to her own needs. It sounded like she would bottle up her own needs in order to help her mother until she wouldn't anymore, and it all just explodes and her mother sees her as a volatile, dramatic, unpredictable and immature child. Her mother reminded me of my own mother. There are times when I just need support, I need to vent, I need a sympathetic shoulder to lean on. However these strong, independent women, in their need to raise strong, independent daughters have trouble playing into this role. "I'm the only one who will tell you the harsh truth," my mother would tell me, "if you want fluffy support and nice words, you have friends for that." It's frustrating, and I totally get it. But we can't change who they are, we can't demand emotional resources that they don't really have/aren't willing to give. We have to live with what we've got, and coming to terms with the fact that your mother isn't a soft, downy comforter but more like a solid, hard floor is a difficult journey that I, myself am still navigating.

I convinced the patient to return and tell her mother what she just told me. I prodded her to explain how she was mad that her mother lied about visiting, and her mother apologized, saying she didn't mean for it to hurt her, she just needed her to understand that this is not OK. The patient also explained how she didn't feel heard, (granted she was interrupted twice during this exchange so I see where she's coming from), and we agreed it's something her mother can work on. At the end, it was a positive meeting, and we will be referring them to services that provides in-home family therapy.

I learned from this whole ordeal so many things. I learned that a patient will only ever paint one picture of a person, and to never make judgments until you sit down and talk with the other party yourself. I learned that communication is still always so, so important. It's the first step to say to your daughter, "be open with me, I'm here for you." But it's harder with a teenage daughter to stop, shut up, listen to all her thoughts and feelings. Feeling like you are heard and respected is almost as important as actually being heard and respected. I learned that mothers with older daughters have a tough time too. Your kids are your kids, you still tell them what to do and want to teach and prepare them for the world. But you need them now, they can be your confidante and support as well, and it's a weird change in dynamic. I think this patient and her mother have a long road ahead, learning to communicate and facing their difficult social situation. But I felt so much better that I wasn't really meeting with an apathetic, abandoning mother, but a brave woman struggling with the difficult hand she's been dealt. I think they'll be OK, and I felt like I made a difference, showing the patient what it's like to have this first conversation where her side is heard, but there wasn't a fight. I showed her that she doesn't have to shut down, that her mother can work with her. I love psych even more after this experience, and I can't wait to help more kids figure out this confusing and scary journey that is growing up.

Hello. It's Me.

God I haven't written on this is so long, and I was pleasantly surprised to be greeted with pictures of such delicious food when I came back on this! I completely forgot it was a keto blog for a short while. But this post won't be keto, though I suspect come March, there might be some of that resurfacing.

Today I'm writing about a patient. I have recently decided to pursue psychiatry (possibly child/adolescent) as a career. It was a stressful career shift for me since I was hardcore neuro for the longest time. But it hasn't come as a surprise; I was always kind of humanistic and psych minded.

I've been following a patient for a few days now. In medspeak, she is a 55 year old Vietnamese female with a past medical history of bipolar disorder, currently not on medications who presented to the hospital with an acute manic episode with psychotic features. She was put on 1 mg Risperdal (an antipsychotic) and is showing clinical improvement. In humanspeak, she's literally the cutest little Asian lady ever. She doesn't speak much English but somehow we communicate our feelings pretty well for the most part. She extremely friendly and trusting, though also rather childlike. I met her the first day and spoke to her through the translator (the most tedious experience where we both talk to a distant third party through two telephone lines on the wall.) She told me about how she came to the hospital with shortness of breath, how she has heart problems, and headaches. These were all logical issues. But she also said that the headaches were from how her brother beat her head with a stick decades ago, and that sometimes her hand talks to her. In the notes from the ER and from collateral information from her brother, she had been sleepless for days and was breaking all the dishes in the kitchen, which was actually why she was brought to the hospital. So you see, it's hard to know what's real and what's not with psych patients. I kind of saw her as another psychotic patient who was sweet but not altogether with it, and did not think too much of it.

The next day I found her coloring at a table. She smiled this toothy, smile with unbridled pleasure. She was tracing her hand onto countless pages of a notebook. She took my hands as I asked her about her sleep (of which she got none, according to the night nurses), and she traced them onto paper. I don't normally touch the patients as a rule of thumb, but her lack of hesitation regarding physical contact didn't worry me. She start coloring in my hands and she named off the colors: green, blue, yellow, red. I asked her which color was her favorite: yellow. I asked her if she had breakfast: no good breakfast, I love eggrolls. She told me that her family ran a Vietnamese restaurant on Bailey avenue (that I actually have been two a handful of times), that she helped make noodles there. She told me how much she loved candy. After finishing coloring, she tore out the paper and gave me the picture of my hand, as a gift. I thanked her profusely and noticed that I didn't see her as this crazy, psychotic patient. I saw her as a woman with an illness, an immigrant hospitalized for a reason she didn't know, surrounded by people using a language she didn't speak, yet she connected with me, shared with me her interests and created a bond with me. I started feeling protective of this woman twice my age. She reminded me of my parents: immigrants never completely feeling like they belonged, but toughing out the current situation and adapting to whatever comes. I felt a special softness for her in my heart as I took my gift to the conference room and showed it off to my residents and attending.

I was about to type up a note in the afternoon, when I heard from the speakers: "rapid response on 5/3. rapid response." I stopped, confused. That's my floor and zone; I guess I should check it out? As I walked toward the patients rooms I saw a crowd of people staring down at someone on the floor. It took a solid minute before I registered that the woman laying on the floor was my patient, my sweet Vietnamese lady who hours before was coloring happily next to me. Her vitals were stable and it was unclear as to why she seemed to lose consciousness. Apparently she was walking down the hall when she felt her knees give out, and she clutched onto a nurse, who lowered her onto the floor. After a minute or so of unresponsiveness, she opened her eyes. They put her in a wheelchair and took her to the ER to be evaluated. In the ER she sat, expressionless in her chair as people took her temperature, asked her what happened, how she felt. I tried to explain that she didn't speak much English, but the ER is no coddling environment. At some point she reached out and took my hand. She clutched it close to her chest, making no eye contact, and my heart nearly broke in half. How afraid was she, waking up on the floor to unfamiliar faces looming above her, bombarding her with questions she couldn't understand, taking her to a place she didn't know, connecting her with leads to some strange machine? I clutched her hand back, and told her it would be OK, trying somehow to show her that she at least had me on her side. When we were finally left in the room with just us and a social worker, she seemed more calm. She told us that her head hurt and her chest hurt. She said she was thirsty. And she said she wanted to go home. We held her hand and chatted, asked for Tylenol, got her water. She told us that her brother used to work in a casino, and was good at blackjack and poker. She and the social worker gave each other head massages. People came in and out, connecting her to the monitor, getting an EKG, chest Xray (now there's a rational use of resources). She remained stoic, cooperating with each instruction the best she could as I desperately tried to explain what they were for. She said she was hungry and they brought her a packet of graham crackers and a sandwich. She waved the sandwich away ("no good") but opened the crackers and ate one. She handed the packet to me. "There's still one left", I told her, showing her. She nodded and smiled, closing my fingers over it, motioning for me to eat it. My heart swelled as I insisted on giving it back to her. "You eat it!" I laughed. "I have food at home, this is for you!" I could not get over how this woman was trying to feed me, thinking of my wellbeing when she is going through this stressful ordeal. Who she was as a person never shone through to me as clear as it did then. She wasn't a bipolar with psychotic features who had a possible syncopal episode, awaiting further evaluation. She was my patient, sweet and caring, resilient and strong, yet so vulnerable. I stayed with them for maybe another extra hour, long after when I normally go home. Yet I left with an immense sense of guilt. She had no family with her, no one to speak her language, and one of her only advocates is leaving.

As I drove home I kept telling myself "work stays and work." It's not the first time I've gotten too invested in a patient and had it affect my mood and thoughts long after the event. I wonder about her even now. Is she scared? Asleep? Cold? Can she communicate what she needs well enough? Why did she have that fainting episode anyway? Was it neurogenic or psychogenic? Aside from her being a genuinely sweet and adorable lady, I always feel a special tenderness towards middle aged Asian people because I'm so strongly reminded of my parents. Her silent cooperation and hesitance to ask for help makes me feel even more fiercely protective of her. But if it gets to the point where I"m losing sleep over her, worrying about her care, is it too much? Obviously it's good to care about your patients, but where do you draw the line? I guess it's something that comes with experience, learning to leave work at work, to balance your emotions between getting invested and caring enough, but also maintaining a professional distance.

I've only followed her for two days yet somehow she has taught me so much. How to never judge who a patient is, regardless of how disorganized they may present. That who someone is lies in the actions and behavior as much as in what they say. That each patient deserves an advocate, someone who truly holds their best interests at heart, preferably at a personal level, not just a professional one. That I still need to learn how to toe the line between being an involved and empathetic doctor, yet maintain a distance from which I won't get sucked in and overwhelmed. It's an emotional journey for me with certain patients, and I do believe that it's a good thing. And though today has been difficult, I think it has solidified my choice in psychiatry. This is where my heart lies, where I am drawn. I want to be the voice for patients who can't organize their thoughts well enough to speak what I want to say. I want to help patients find themselves when they are lost. I want to help them navigate this twisting, confusing, frustrating, terrifying system. I think I'll be good at helping them; but I need to learn somehow to help me too.