I Lost My Friend of 12 Years/Best Friend of 7 Years, but Gained a Relationship with God and Became Closer to my Family

Disclaimer: this is a deeply personal post, much more than the previous one. Views are my own.

“Getting a corgi so you can attract all the ladies right?”
“Like I have time for that.”

“This sacrificing for medicine thing is no joke. Just turned down a hot date to study on a Saturday night.”

These are real quotes I heard in the past 24 hours from fellow medical students.

I didn’t get closure. I don’t know when I will. I am working on it.

We FaceTimed every day, catching each other up on our days. We had just seen each other the week before. Although we had a difficult conversation before parting, a joke was mentioned at the end. A week later, they want nothing to do with you because they found someone new. They want no contact because it’s not fair. Just like that, knowing someone since 5th grade means absolutely nothing. I am sentimental, sensitive, and loyal, so this shattered the depths of my core. Without going into all the details, our companionship did have a romantic plot for some time, but due to many external circumstances, slowly fizzled along with growing apart in different cities. I knew we were at different stages in life and wanted different things out of life, but I couldn’t stop my loyalty. Is it a death sentence to remain friends with your ex??? Maybe, I’m the only weird person, but life is too short. There should not be a limit as to how many people you can be kind to. I also would like to add I’m not some crazy person that would hold onto something relentlessly that isn’t reciprocated. All I’m asking is for relationships that grow apart: why can’t two people discuss a civil dissolution and go their merry ways while still remaining friends/acquaintances in the most general sense? I’m aware of the old adage of people entering and leaving your life for different reasons, but I was naive to believe this person would be my lifelong friend. If you look at my life, my dearest friends are those that I’ve known the longest. These are some life lessons I’ve learned recently:

  • People don’t have to be in every season of your life.
  • You’ll never change other people’s thoughts, attitudes, way of life. Accept what is and move on if it’s no longer giving you good energy and you’re no longer enhancing each other’s potential.
  • Even if you have the best intention, other people are not guaranteed to think like you do. I constantly think about how life is so short on this planet compared to eternity. This motivates me to relish in all of my relationships and connections to people and overall live with kindness for all people. I really do believe in the phrase “forgive, but never forget.”
  • Nothing is ever lost in life: memories were made, experiences were shared, lessons were learned. Take them with you and don’t make the same mistakes.
  • Always hold your family closer than friends (exceptions do exist, like when you have very unreasonable family members who always tear you down, but I sincerely hope this is not the case). It takes a lot to be estranged from family members as you share a blood line, but with friends and significant others, anything can break that bond within seconds no matter how long you’ve known them. Through my heartbreak, I’ve opened up to a lot of people and heard their stories. I can’t tell you how many times I’ve heard similar sentences, “married for 24 years, raised 4 wonderful children together, and divorced.” In my neighborhood, I am a part of a row of 3 houses that have single middle-aged women living independently after a divorce. The lifelong probability of a marriage ending in divorce in the U.S. is 40-50%. That’s about half of us! Here are interesting stats of some variables associated with divorce:
    • race/ethnicity
    • importance of religion to the couple
    • timing of the first birth of any children (before marriage, within 7 months, after 7 months, or never)
    • if one spouse has generalized anxiety disorder

This is not meant to be pessimistic, but realistic in the fact that anyone can have a change of heart. One of my prominent goals in life is to not experience divorce, so this little bit of research helped me prepare for the future.

  • Serendipitously, I became quick friends with an elderly gentleman at the gym I regularly workout at. He describes our friendship as if “we’ve known each other for years” when in reality, it’s only been a few months. Even with a 40+ year age difference, we’re able to talk about anything and everything. We know all about each other’s love lives. Something he shared stuck with me: “I wish I would have gotten divorced 5 years before we actually did.” Early on, they both knew trouble was brewing, but he really wanted to stay together for the kids, at least til they all graduated from high school. He shared that kids know when there’s something wrong. Sometimes, it’s not about holding on and being loyal, it’s about letting go. This reminds me that selecting the right person is so important, no matter how long it takes. Don’t rush and don’t settle.

I hope by writing and sharing, I can gain some closure. I often think about how my experiences can help my future patients. As doctors, we need to remember we are humans and remind patients we are too. An activity I recently did to cope with loss is: writing down all the reasons why this was meant to happen and then on the back of the page, specific qualities of life you wish for in the future. Keep it somewhere you can access when you need to. Spirituality has also helped me cope tremendously. My family had roots in Buddhism, but I didn’t grow up with a religion. I’m not sure where this will take me in the future, but I have found comfort in developing a relationship with God, praying, knowing that He has a plan for our lives, and listening to Christian music instead of mainstream radio. Another relationship I gained is a closer one with my family, particularly my mom. We’ve had our ups and downs, and still do, but this is the most honest relationship we’ve had in our entire lives. Due to external consequences, that individual and I did not open up to our families about the relationship. As teenagers and young adults, we blindly believed love is all we need. This was not healthy, toxic even. After I told my mom everything after 7 years, I vowed to live honestly and authentically, especially with family. If someone doesn’t appreciate honesty and authenticity or if I find myself doing something that violates these values, I know I don’t have to force a relationship with that person or continue doing that activity. I can’t wait to finally live freely and without fear. In the Asian culture, respecting and caring for our elders into their old age is extremely valued. It can be hard growing up in the US where this is not valued. It’s an ongoing internal conflict for me. The current cultural notion is: we’re young, we should be building our own lives, move far away, have 5-minute surface conversations on the phone with one’s parents, they don’t need to know the important thoughts and activities of your life, visit them only during major holidays because being away from your friends is so boring. Years pass and the next time you really become close with your parents again are when they’re nearing death in a hospital room. Yes, we should all be independent adults chasing our dreams, building a life worth living, taking as many trips as we can, and having fun as 20-something-year-olds. I don’t disagree with that, but I also know life can flash in front of your eyes. Years quickly pass, your parents get older, health problems arise with age, and when you finally realize you should have cared and spent more time with them before they pass, it might be too late. Looking at the grand scheme of life, we have a lot of time to live without our parents if that’s what you’re looking forward to, upwards of 40 years. Imagine stepping into your parent’s shoes. The best situation would be to still have your significant other grow old with you, but what if you were divorced or widowed in old age? Would you want at least one of your children you raised to care about you or be sent to some arbitrary nursing home instead? I’m not advocating to live in your parent’s basement or constantly worry about them and put them first before the important things in your life, but a healthy balance must exist between independently building your vibrant future while also remaining close to your family, especially those that sacrificed so much to raise you to be the successful adult you are now. I am happy to return to my true values and know that one of my purposes in life is to care for my single mother. Never change your values for anyone. I can only hope that my future significant other respects me for who I am, values and all.

Sample some of the songs that have helped me get through tough times:

  • Stars Go Dim – You are Loved
  • Danny Gokey – Tell Your Heart to Beat Again
  • Matisyahu – Live Like a Warrior (Richello Remix)
  • Chris Tomlin – Impossible Things
  • Axwell – On My Way
  • Mandisa – Unfinished
  • Lauren Daigle – First
  • Matthew West – Mended
  • Bobby Mcferrin – Don’t Worry Be Happy

There were a whole host of reasons for my situation, but I cannot leave out the fact that medical school played a part. We have to say “no” to hanging out on weekends with friends, going to birthday parties, family functions, weddings, vacations. We need to plan around major exams. We only have one summer between 1st and 2nd year. We always have things to study seven days a week, 24 hours a day. Lifelong learning is a cornerstone to being a physician. Sometimes, friends and family don’t understand this. I’m creating an ongoing list here to resolve this sacrificial dilemma and think about it in a more positive light:

  1. My faculty mentor told me “you can have it all – all of your priorities”. Know what your priorities are. Write them down. Your studies should be #1 or #2 on your list. If you make time to do what’s most important to you (say the top 5 things), you can have it all.
  2. Treat medical school like a 8-5pm job. Work relentlessly hard Monday-Friday during those hours to get things done. There’s always going to be more, but if you had a good week, don’t feel bad about taking one day during the weekend off to enjoy your #2-5 priorities.
  3. Share with your friends and family what you do and what interesting facts you’re learning about in the human body.

Did you know heart burn, acid reflux, and GERD are talking about the same thing? This is when stomach acid used to digest our food leaks backwards into our esophagus that connects our mouth to our stomach. The best treatment to try first for this is lifestyle modification, not medication.

  • Eat more plant-based protein (beans, broccoli, spinach) to improve the strength of the sphincter/door between the stomach and esophagus.
  • Avoid dietary fat, caffeine, chocolate, mints, herbs/spices eaten after meals, alcohol, estrogen and progesterone (birth control pills).
  • Lose weight and eat smaller meals, so the stomach doesn’t extend too much.
  • Avoid eating before laying down and elevate the head of your bed 4-6 inches (sleeping on pillows won’t work, you have to physically place blocks under the head of your bed to raise it).

Both men and women 50 years and older are recommended to get colon cancer screening. Colon cancer is 70% lifestyle related. Want to know how to prevent colon cancer in old age?

  • Eat less processed meats (lunch meats, bacon, sausage, etc.)
  • Eat less red meat
  • Eat more vegetables and other fiber-rich foods

The link between a meat-heavy and vegetable-sparse diet to colon cancer is as strong as the link between smoking and lung cancer.

3/4 of all adults and 90% of adults from African and Asian descent will experience lactose intolerance. This means that you don’t have the functioning enzyme to break down the lactose in dairy products. The lactose travels further down your gut and gets chewed up by bacteria. As a result of bacterial digestion, carbon metabolites, hydrogen, and carbon dioxide are produced. This is why you have bloating, diarrhea, and dehydration after eating dairy products if you’re lactose intolerant.

Take your significant other to medical functions or a night out with your classmates. When you involve your loved ones, they become a part of the journey rather than a carry-on baggage you lug around. However, if sharing your new way of life isn’t working and you feel dragged down and stressed by this person, it might be time to let go. We’ve had 3 relationships break up in our medical school class shortly after starting school, but we also have 2 students starting families while in medical school (albeit the wives are not the students). It can be done, but it requires deep understanding, patience, and strong communication from both people. I recently read a wonderful article about how a wife survived family life while her husband was in residency. It helped me gain a lot of insight into how to work on a relationship and what kind of understanding must exist on this journey: http://www.kevinmd.com/blog/2014/11/wish-knew-advice-spouses-doctors-residents.html

Thanks for reading. I pray we all live the life we’ve always wanted.

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~lntan

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Day 15 (Saturday, May 17): Adventures in Mysore + Life Musing

Woke up around 6:45am. Walked down to breakfast around 7:10am. Adam, Drew and Paul were the only ones there when Lindsey and I arrived. I hugged Adam because it’s his birthday! The dining area was immaculate and mostly white in color. Breakfast was buffet style and featured American food! There were an assortment of around 15 dishes, bread, an omelet station, pastries, fruit juice, cereal, milk, coffee and tea. I was craving cereal from yesterday’s noodle dessert that tasted like Frosted Flakes, so I had that along with potatoes, pancake, turkey sausage and a cup of tea.

IMG_0899First stop: Traveled to the top of a mountain to visit the Sri Chamundeshwari Hindu temple.

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Our driver asked if we were all Christian. He told us he’s Muslim. I greeted him with “assalamualaikum” (May peace be upon you) and he responded “Wa ‘Alaikum Assalaam” (May peace be upon you too).

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When we approached the golden temple, little brown blobs were moving around and they turned out to be dozens of monkeys.

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Second stop: Christian church. We explored the congregation area and the basement.

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IMG_1316Third stop: Silk scarf store. I believe the scarves were around 1000 rupees. I didn’t buy any, but quite a few people did.

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While driving, saw an area where a plethora of white sheets were hanging. I don’t remember who told us this, but this is their method to wash and dry hospital sheets.

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Fourth stop: Women’s Health Research Institute.

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After a brief introduction by three ladies, we received a tour of the facility. Most of us quickly realized that mostly women worked here, so someone asked if any men do. They said “yes”. The three guys work as the driver and food coordinators.

We met an intern from the US that’s studying TB at the institute. There is a $500 administration fee to ensure the interns are serious and not just here for vacation. We toured the kitchen for the interns. Before leaving, a group of us talked to the US intern. He’s from California and took a year off after graduating from UC Berkeley with a public health major. He will be attending Yale Medical School in the Fall. He was here for 6 months. Fun fact: he learned to drive a vespa here.

Interns in lab study various topics such as:
– Malaria and helminthes infections in pregnant women
– Joint Indo-US study of lactobacillus and its phages in bacterial vaginosis
– UTI
– Vit D deficiency in women with BV
– Dengue virus IgG ELISA

Research:

Lab
– Molecular epidemiology of bacterial vaginosis. Amsel’s criteria for diagnosing bacterial vaginosis (must meet 3 of 4):

1. Thin homogenous vaginal discharge.
2. Vaginal pH higher than 4.5.
3. Postive whiff test for amine with KOH prep.
4. Clue cells on saline wet prep

Lactobacillus research funded by NHI. Lactobacillus in vagina and urine testing. Post-test counseling and post-natal care (PNC).

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– Evaluation of rapid diagnostic tests
– Antibiotic resistance
– Community acquired resistant UTI
– STI

Community
– Maternal child health projects
– Women’s reproductive health
– Cancer prevention
– Immunization and children health camp

Clinic
– Longitudinal cohort studies on bacterial vaginosis, reproductive tract infections, cervical cancer screening, STI/HIV prevention.
– Obtain HIV blood from mother. Identify positive or negative. Counseling available.

How they build more awareness about their services to the community:
Collect list of pregnant woman from Anganwadi teacher. Go door-to-door (service at their doorstep). This makes it easier to motivate people to come to the mobile clinic in the subsequent days.

2nd day- Education for general public. Awareness program for blood pressure, diabetes, cancer, HIV. Pregnant women. Immunizations. Birth. Flip chart pictures and power points. Family planning.

3rd– Medical camp. Self-help group. Bring women to clinic. HIV stigma very high. ASHA linked to village. Mobile clinic. Given a place to set up like a school. General check-up. Consent. Antenatal exam. Blood draw, serum separation, blood grouping.

– They do not provide treatment, but focus on education, research, detection and counseling.

– The institute is linked to the government.

– Post-natal care follow-ups last up to one year.

– Serve rural areas. Have capacity to serve 144 villages, but currently it’s 82 villages.

– HIV in pregnant woman is decreasing.

– Highest cancer rate in India is cervical.

PAP smear requires a lot of trained workers and is typically administered by private doctors. The rural population needs sustainable tests -> VIA (Mysore is pioneering this) – visual inspection. Treated by cryotherapy and LEEP.

I asked the question “for young girls, is it common to provide preventative vaccinations for cervical cancer like Gardasil?” They talked about how expensive it is – $6000-7000, which is a challenge. Currently, it is not on the required immunization chart. Targets ages 9-30 years old. Research is currently working on a cost-effective approach to preventing cervical cancer. This is also a public policy issue. They need large interest groups to support the vaccinations.

Parliamentary is mostly men. Advocating for women is a constant struggle.

Saving Children Improving Lives (SCIL) is a successful strategy for increasing uptake of HIV/PMTCT services among rural pregnant women. Provision of conditional cash transfers to women’s microeconomic self-help group members to refer pregnant women for antenatal care and HIV testing.

Prerana women’s health initiative. Objectives: provide sexual and reproductive healthcare; physical, mental and family health; conduct research to provide evidence-based care and treatment.

Project Chaitanya: increase awareness and education around the prevention of cervical cancer.

Primary prevention: 1) Creating a peer educator model in rural villages by giving training and awareness about HPV, cervical cancer and vaccination.
2) HPV- Vaccine acceptability study by parents

Secondary prevention: collaboration with prevention international: No cervical cancer (PINCC) from the US –increase screening capacity of developing countries to screen women for precancerous lesions using simple methods

Train health providers in performing simple procedure like cryotherapy and LEEP on detection of precancerous condition.

Current cervical cancer screening program is on Friday (special clinic day only for VIA screening). IMG_0970The ladies were so hospitable in that they provided us delicious snacks during their presentation: samosa, chex-mix like dish, pretzel-shaped dessert and mango juice (I apologize for not knowing some of the technical names for the food).

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Fifth stop: Mysore palace tour. A headphone-guided version was available, but we just did a walk-through. We followed masses of people in the maze-like tour through rooms filled with replicas, paintings, photographs, memorabilia, trinkets and statues. Cameras were not allowed inside. Not sure how exactly long it took, but I would guess around 30 minutes.

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Sixth stop: Café Aramane for lunch. Our group opted to sit in the air-conditioned room because the restaurant environment was smoky and humid. I sat with Nikki and Xhonela, and we shared two platters (one North Indian and the other South Indian).

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Seventh stop: A quaint art gallery with a lot of ancient paintings. Dr. Raj informed us that a lot of the paintings correlate with stories in the Hindu religion. A couple of us observed that exposed breasts were a theme in many of the artworks, and I think Taniqua bravely asked Dr. Raj what that was all about. He informed us that sari’s back then did not include a blouse because blouses are a western invention.

Eighth stop: Pantaloon store at the mall. The department store was so large that we didn’t have time to peruse the other stores in the mall. I was looking for some Indian-styled shirts/blouses, but didn’t come across any that was a good fit. I found a light blue and white patterned scarf for 249 rupees though!

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Headed back to hotel for an hour. Lindsey and I decided to chill in the lobby and asked for the hotel’s wifi password. My phone was extremely slow, so I eventually gave up on accessing the internet.

Ninth stop: Returned to the Mysore Palace to watch the light show. There was a story line behind the light show, but we could only guess what was happening because we didn’t know the local language, Kannada. A few minutes before the show ended, it started raining. Fortunately, as we were walking back to the entrance, we had the opportunity to see the palace all lit up in golden lights. Such a majestic sight.

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We walked about 10 minutes back to the hotel, which was quite an adventure. Imagine a group of 20 students crossing a wide and busy Indian-style intersection at night. Not to worry – we all survived! Haha. I got an adrenaline rush from the experience.

We had some time to kill before dinner, so several of us played “Would you Rather?” in the lobby using a question bank from the internet. The one question that struck a cord with me was “would you rather have a bell ring every time you are aroused? or feel a sharp pain in your side whenever someone says your name?” I was surprised that everyone agreed on the sharp pain, but I would choose otherwise (I didn’t get to voice my thoughts at the time). I’m going on a tangent/a little TMI, but life’s too short to live dishonestly with oneself or to be afraid to tell someone how you feel. I read this relevant quote a couple weeks ago:

IMG_5926I think this message can go beyond a romantic context (I know. I know. The question above used the word “aroused” but forget about that for a second). You can let your family and friends know that you love and care about them. We often take for granted the people we see frequently, so it’s never foolish to remind them of their value in your life. In the case of romantic relationships, if the love isn’t reciprocated, at least you tried and won’t have any regrets. Living with honesty and openness and welcoming candid conversations is extremely liberating. This is what it feels like to be human. I am working on this myself. #gettingoffthesoapbox

Multi-cuisine dinner buffet. We all sang for Adam’s birthday.

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For dessert, I was tempted to try some fruit because I was missing it in my diet, so I ate five small pieces of the assorted pineapple, watermelon and papaya. Ice cream is my weakness, so of course I had some for dessert also. The flavors were vanilla, mango and chocolate. I even went up for seconds.

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The concierge encouraged us to go to the discotech club right outside the hotel.

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As a collective group, we decided to check it out. We only had to walk one minute to see a couple men dressed in black shirts stamping people’s hands with the words “the room” in purple ink. We walked down the stairs to approach a coconut door.

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On the other side of the door was a neon green lit up path that led to the dance floor equipped with a disco ball and everything.

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There were “no smoking” signs plastered on the walls, which was nice. Techno music permeated the room. We stood relishing the sights and sounds for about ten minutes. We went back to our rooms in the hotel. Coincidentally, our room was one of the closest to the club, so Lindsey and I could hear the pulsating beats of the music well into the night, but it didn’t bother me. I showered, packed and went to bed. Stomach wasn’t feeling too well during the night. Suspected it was the fruit. I’m not sure if I mentioned why we shouldn’t eat raw vegetables and fruits here, but it’s because of the water and the different bacteria in it that our stomach might not be used to if we didn’t grow up in the country.