The dogs are crazy.

Hello. It's been a long time as I often come home way too tired to want to do anything but crash. And then on top of it, we were stupid enough to get puppies about 1 month ago. They're incredibly cute, but incredibly annoying too. I can't wait till they grow up and do not want to pee everywhere. I keep telling myself they'll be so much more fun then.

Anyway, things here have been ok. It's so hard to explain what being an intern is like. The worst times are the times when I am on overnight call, and I am expected to answer questions for patients from 5 teams, which usually is something like 45 patients. It doesn't sound like a lot, but when the pager goes off, sometimes two or three pages at the same time, and all night long, it sure feels overwhelming. I hate being called to do death pronouncements, esp. I do that for the whole hospital except the ICU when I am on overnight call. Those nights, I'm so scared that people are going to die because I'm so painfully inexperienced. At the same time, I tell myself over and over that it's God and not me that is control of life and death, and there's actually very little I can do to harm a patient. Truth is, most of my pages are over silly things, like someone needs tylenol or someone needs a sleeping pill or someone needs food. That, I can do. But the calls that come about someone having a seizure or someone not able to breathe or someone's heart rate is 150--that really worries me. I'm never really alone, my senior is always there but no one wants to wake up their senior and admit they can't do something unless it's truly an emergency, so we all just blunder along and hope our mistakes are reversible in the morning.

At the same time, I've been struck by how much more I am able to love people, in my position. When I came back from Africa, everyone wondered if I would be able to apply the work I did there to my patients here in the US. It seems easy to serve those who are so poor, and to serve those in a country where it's ok to pray with your patient. Here, it's not. Yet, the need is different but just as great. I do have my own clinic, which is mostly underserved patients, so I definitely see the poor people here in the US. But in addition, even the "non-poor" people in the US have great needs. We have so much technology, so many advances, people think we should be able to cure everything and help everything. In general, we don't really know how to deal with suffering. It's frustrating for the patient, that they can't have their problems totally alleviated. It's frustrating for me, that I can't help them as much as I want to. And so many people seem to come from non-ideal situations---families that are dysfunctional, people who are lonely, people who have drug addictions, people who have incurable, long-time diseases which are just inevitably getting worse. I find these people need kindness and love more than anything else we do. And that's mostly all I tried to do in Africa, too.

My senior resident today told me that in time, everyone starts to distance themselves from their patients, putting a barrier between us and them, not caring as much if you connect or not, because you have to or you go crazy. I hope that isn't true for me. I hope I always will strive to make my patient feel I am connecting with them and listening to them. I don't feel like I'm very good at it at the moment, because somehow my days end up being so tied up by paperwork writing orders and talking to other doctors and running around going to conferences, I end up talking to my patients for at most 20 minutes a day. It's pathetic. But I just pray all the time that God is working through me somehow, and that's all I can do. I hope the long hours won't make me bitter. I hope someday the pretending to know what I'm doing will become I actually know what I'm doing. But we'll see.

It's finally raining here in Portland, this is the first week it's rained since we got here. Our grapes are in full season so Frank is making grape jelly like mad, the dogs are constantly wet and muddy, and the mountains have disappeared. But still, we had three months of straight sun and beautiful weather so I can't complain. I'd better go read some articles now, but I hope you are all well. I miss everyone.