month of months...

its been a month of months.

a couple of weeks ago, I received a call from the debt collectors. My dad has a $55000 credit card debt that went into default because the credit card company hadn't received any payments since June of last year. I can't really share any details about that since it's not resolved and the internet is like an open book. I'm dealing with debt collectors and they're really really good at making this difficult, I guess I'm not making it easy either. But I don't really know what the hell I'm doing. I just need to preserve what's left of our assets since that's what's keeping my dad in boarding care and day care.

Here's a little tutorial on how debt works. If you haven't paid your credit card bill in a while, it goes into default after which the credit card company will contract out a debt collection agency to call you and try to get as much money as they can from you. Typically, the client pays 10-30% of the total debt. If they can't get payment, the debt gets sold off to another collection agency, then another, and another. This supposedly goes on for a while. If they think they can't get money from you and also other factors I don't know of, they'll sell it to a law firm who specializes in getting money out of people. The law firm will then sue you for the debt. But, the burden of proving that you, the client actually racked up those charges is on the law firm. That means that they'll have to follow the paper trail of debt collectors back to the original bank and pull records and try to prove that every charge on there was made by you. This is a civil suit. If they win and there is a judgement against you, they can garnish your wages, confiscate your assets etc.

It's very scary. I'm still dealing with this right now, it's not over and it will take a while to resolve I think.

Additionally, my brother has an addiction problem. I've been trying to talk him into getting some help because he needs to, if not he can ruin his life and he won't be happy. I don't really know what I'm doing though. I'm talking to the school psychiatrist this week to ask for guidance. I want him to seek help and be able to stick with the program or therapy or whatever else it turns out to be.

Last week, my aunt collapsed. She has a patent foramen ovale, which means that there is a hole between her right and left hearts. Your heart is 2 pumps. The right side, pumps blood coming back from your body to be reoxygenated in your lungs. The left side, pumps blood coming back from your lungs to your body. When you're still in the womb, your lungs aren't fully developed and there is no oxygen to breathe anyway, you're bathed in amniotic fluid. So blood needs to bypass the lungs and there are two shunts; the first is within the heart itself, shunting blood from the right to the left; the second is a duct that connects the artery leading from the right heart to the lungs (pulmonary artery) and the left heart to the body (aorta). My aunt has a hole in the first shunt, the foramen ovale. This is supposed to close completely after birth, but in some cases it doesn't. People can live their entire lives without having symptoms, but I guess she was stressed enough that cardiac output decreased and she didn't get enough blood to her brain (this is my guess, I don't really know the exact details of her collapse).

She was worked up and the hole was small so the surgeons are not going to close it. The checked her out and everything seems good. A blessing in this month of months.

Last friday, my uncle died. He is the husband of my dad's sister. They live in Maryland. I don't know him very well, but I'm close with my aunt. He has diabetes, same as my dad. He suffered a stroke before same as my dad, he's the same age as my dad. The only difference is that he's in much worse health. It's been a tough weekend for me. I'm grieving much more than I expected. I'm also scared for my dad.

A few weeks ago, we found out that he had some blood in his stool, a positive fecal occult blood test. It means that there is bleeding somewhere in his GI tract, anywhere from the mouth to the anus. He was referred to the gastroenterologist for a colonoscopy. He ran some blood test to prepare for the colonoscopy. My dad has some anemia, there were abnormalities in his iron values. The doctor came up with a diagnosis of anemia of chronic disease. Chronic disease could mean a great many things. From kidney disease, colitis (inflammation of your colon), tumor, autoimmune stuff, anything that is chronic really. What happens is the chronic inflammatory process releases some molecules into your blood that makes your cells retain its iron stores so that your bone marrow can't use it to make new red blood cells. That's how you get anemia.

The anemia is an indication for an upper endoscopy, which is like sending a camera down your throat into your stomach, looking at structures along the way. The colonoscopy covers the other end. March 3rd is the big date. I don't know what to expect. I spent the day today learning about anemia of chronic disease. I still don't know what to expect. I just pray it's not bad news.

I felt like i had to document this here. I'm just not dealing with this very well. I was really feeling like I wouldn't be able to take anymore. I felt that after my aunt collapsed that there would be more to come and there was. I just don't want to make any prediction that will come true later. I'm a mess. Talking about it with friends helps, talking about it here helps more. I want to be able to remember this moment and come back here and know the details of what happened and see that this is a pretty bad time and my family and i got through it. Maybe it's a little messed up to want to remember the bad stuff, but i can't appreciate the good stuff without the bad.

Step 1 Board Exam scheduled...insert sense of impending doom

I just scheduled my step 1 date. It's going to be June 4th at 9AM. It lasts 8 hours, I'll be outta there by 5PM and asleep or drunk or comatose from food by 8PM.

I'll have exactly 5 weeks to study for it....I have no plan on how to do that yet.

Step 1 is probably the most important exam you'll ever take as a med student. For the most part, it determines the type of residency you'll get into, if you can get into something competitive like Dermatology or Radiation Oncology. Or it determines the location of your residency. It tests knowledge from the first 2 years of medical school. It's more memorization than it is thinking, or so I've heard.

So that's what's ahead of me right now

Nicaragua travel report - Day 2

The 2nd day we arranged for a guided kayak trip of the Isletas de Granada. Our tour guide was an Austrian expat who was named Fernando or Ferdinand or perhaps both, just in different countries. Anyway, we started our day with a hearty nicaraguan breakfast at a nice little cafe that would soon be our favorite breakfast place:



I picked the traditional Nicaraguan breakfast of huevos rancheros, let me tell you it was the best huevos rancheros I've ever had:


My mates picked various things, but the standout was the bacon and also this pineapple pancake with real pineapple bits built in, they were really good pancakes with a combination of a crisp surface and sweet fluffy insides:


They also had great coffee there, it was strong and was the best cup o joe I've ever had! We proceeded to the isletas, passing through the crowded beaches (it was a Sunday) of Granada. Our tour guide says the favorite past time of nicaraguense is to go to camp out at the beach over the weekend and have lots of sex, I don't doubt it!

On to the Isletas!



The isletas are basically small islands, some of them get completely submerged in the wet season while others are large enough to support houses and small communities. There was an isleta with a house built by two gay men from New York City:



We took a break on one of the isletas:


...where two of our mighty explorers professed their undying love for each other:


...over fresh coconut juice:



And our fearless misunderstood/sleazy? austrian guide:


We would save these coconut meat for some monkey feeding/drama later on:


The story is that, on a nearby isleta, many moons ago, some ingenious person took 6 or so monkeys to this isleta and let them loose. The isleta is the size of a football field, maybe smaller, surrounded by water and the monkeys can't swim. So they're pretty much trapped on the isleta. Thus is borned a tourist attraction. The monkeys survived all this time on food given by tourists who go by on tour boats. Tourists like us. Although typically they would just come on a motorized boat. Feeding the monkeys was a little complicated, we would have to paddle close and put coconut meat on the end of our paddles and reach over to the monkeys so they could pick the coconut off the paddles. We did this for quite a while and it was fun, until the monkeys got...violent. They were grabbing paddles left and right and they were charging us from land when we got too close, mind you they didn't dare get in the water. but it was scary nonetheless...I of course was not scared....although I did get yelled at by my boat mate who had extreme monkeyphobia...sorry no pictures, I was busy feeding monkeys...

So we continued on our way back home


Afterwards we had a nice lunch in town where we found another lunch time deal, tons of food for $3 or 60 cordobas:




...then we walked around the city where the girls got many catcalls for their sexy dresses....i didn't get any catcalls from the hot nicaraguan women...i guess they don't dig asian guys, they don't know what they're missing.


In the evening we had arranged to meet up with Ferdinando at a salsa place. Actually, he invited himself to our festivities, because zees is how zey do it in Austria ya!


The story is that, he was either trying to make friends (4 hot tamales in our group) or trying to get more business out of us because we said that we were interested in horseback riding the following day. He said he'd help us set something up for horseback riding before he parted earlier in the day, but later in the day we'd setup something through our hosts at the guest house, Alvaro and Meghan. So basically at the end of the night we told him we were good with our plans and he offered to drive us to the horse place for $10 each, which is highway robbery in Nicaragua. So thus ended our relationship vith zee Austrian. Misunderstood? Sleazy? You decide for yourselves, he was, however, knowledgeable about the isletas and the kayak trip was great I thought. Perhaps zees is just how zey do it in Nicaragua no?

The salsa place was great, we had some live music too:


Overall a great and memorable day that was!

Nicaragua travel report - Day 1

For Spring Break me and some friends decided to go to Nicaragua for a cheap vacation. Some background first: We were considering various other places at first, but then it was difficult to get people to commit because of cost issues. Nicaragua had become the poorest latin american country as of April 2009. Even Haiti was wealthier than Nicaragua (before earthquake, ahem)! To us that meant fun on the cheap! PERFECT! Just on that premise alone, we booked our $350 plane tickets to Managua. Later we would be freaked out by stories of kidnapping and literally highway robbery, as in they will rob you while you are driving on the highway and leave you destitute in the middle of nowhere, central america! So we were a little worried about safety, just the mere mention of Nicaragua, evokes images of revolucion and ak-47's in the hands of guerilla rebels and drug lords trafficking packets of cocaine in vagines and anuses. Seriously, this is what our families, or at least mine, said to me (maybe just a tad less dramatic). Fearful of airline cancellation fees, we set aside our panic and went ahead full steam planning our probable one way trip...

We had a couple goals in mind, we didn't want to spend our spring break week running around all over the country. We wanted rest and relaxation with a little bit of adventure. So we decided on two places, a colonial city called Granada for a few days and a volcanic island in the middle of central america's largest lake for a little middle of nowhere adventuring!

Fresh faced and naive, we boarded a train to NYC...


One thing that really sucks about Philadelphia air travel is that it's supposed to be a hub, but really it's not, it's like a large regional airport. Tickets to international destinations cost an arm, a leg and a mortgage on the house you would buy after you pay off your student debt. Traveling by bus 2 hrs north to NYC provides much cheaper access to the world!

The flight was uneventful except for the almost getting lost in Honduras because the itinerary forgot to mention that we would be randomly stopping in Honduras. Like dippy tourists, we got off and almost didn't make it back on the plane after we figured it out.

Upon arriving in Managua, we got conned into taking a $50 cab ride an hour south from Managua to Granada. Ok so we were going to take the Chicken Bus, see example below:


we were told that chicken buses are dangerous for gringos like us and that we should take the nice taxi. It was worth it I guess, we didn't start our day in Nicaragua by getting lost in Granada or Managua. It was a good warm up to Nicaragua

GRANADA, Home Away from Home!




It was warm, the city was beautiful, the guest house we stayed at was magnificent. The combination of almost 17 hrs of traveling and warmth and sun and finally being THERE made for a very happy first day in Granada. We had trouble deciding on a place to eat, thinking back now, we really should've just picked any place, you really have only one option for local food: rice, fried beans, fried meat, fresh veggies that's probably almost as dirty as a used petri dish. The food was good, not great, but it was good!

I think that first meal we gorged ourselves on the delicious local beer called Toña. They were cold and they were cheap! less than a dollar a bottle! We explored the market area a little before coming home to nap.







There was a lot of poverty there, we saw it first in the markets and also in the peripheral areas of the city. The nicer areas of Granada are in the city center around Parque Central. That is where the tourists congregate. As you go further away, you see the real granada, gone are the remodeled colonial homes around the city center, replaced with broken down colonial homes and dirty streets. There is a huge class divide according to our hosts, and there is a range of classes among the city, each class thinking they are better than the classes below them.

In the evening we wanted more comidas tipicas, which are your local Nicaraguan food. A friend and I shared the following, which costs $13 total


Note that that is a very large plate and that everything is fried. We were then treated to a show by flame twirlers



We closed out the evening with a light stroll around the city center and called it a night:


stay tuned for kayaking the mysterious isletas of granada, uncovered from its watery berth once every 12 moons

breakfast burritos

Back in late February, we had our Block 3 midblock exams. Me and a friend studied like madpeople. I made these delicious filling breakfast burritos:


They were easy to make, but I think I forgot how to so here's the recipe to the best of my memory:

* 3 eggs scrambled with a little bit of white pepper powder, the oil from chiu chow chili oil, a quarter of a red onion, pinch of salt
* 1/3 of spam can, cut into bite sized pieces and browned until crispy
* 1/2 cup of medium soft cheese (I used cheddar once and swiss another time)
* Ketchup to taste
* Sriracha to taste
* 1/2 lemon, squeezed over eggs & cheese for some "liquidity", add before adding spam to maintain crispness of spam bits
* Tortillas, toasted, browned however way you prefer.
* makes 2 burritos

Optionally, you could add a dollop of sour cream and/or guacamole for more "wetness" to the burrito.

the finished product:

Clinic update

Had clinic tonight, we set up a triage to screen for diabetes among our patient population. One of the first years, a good friend of mine tested a patient with a random non-fasting blood glucose of 135 last week. The threshold to see the diabetes nurse was 140. His gut told him to take the patient to the nurse anyway, nurse orders him to come back fasting the following week. Today, the patient came back (fasting blood glucose is diagnostic for diabetes), and the blood glucose is 300. A first year did this, he pretty much saved the patient from untold problems down the road had it not been caught.

Although it is not a place to teach students, we have setup a program that has so far been fruitful and I'm so proud of my classmates who undertook this project. We're making a difference in the lives of people!

Other updates, the clinic has gotten volunteer ophthalmologists providing services. Unfortunately, we've lost support from Drexel's affiliated hospital to do free lab work. Right now we are not doing blood testing for our patients. I'm looking into point of care devices to do blood testing and some grants to pay for it. I have the whole summer to figure it out since I'll be sticking around here to work at the clinic. It's part of a paid summer program offered by Drexel.

life update

Dear friends and family,

I apologize for not posting in the past 2 months. I have been on a soul searching journey these past 2 months. I believe I have come to a resolution that I am satisfied with.

I have been failing classes at school and I have kept this from even my closest friends at school. I will have to remediate most classes this summer. I do not think it is responsible of me to continue to waste money and time to become a mediocre physician, let alone the consequences of my actions as a physician. I have therefore decided to leave medical school to do pursue another adventure.

That adventure was a subject of much consternation. I found my answer, however, in Nicaragua. I saw farmers growing tobacco, mangoes and rice. The kind of life they led appealed to me. I had grown to love Nicaragua in the short time I was there. Therefore, I have decided to pursue my love and my passion and move to Nicaragua to become a farmer. In the past month I have begun to take agricultural courses at the local college. This is the reason I have been absent from my regular group of friends as well as my classes. I believe I am ready to go out on my own and grow fields of produce.

I have plans to grow mangoes, tobacco for cigars in the dry season and rice and beans in the wet season. I will finish out the year and I will depart immediately in June. I will of course move my father with me as I think he will like the tropical climate as it resembles the land of our birth, Indonesia. It will not be an easy life, but life is an ever changing landscape and each new turn brings different adventures and challenges. I believe we are on the cusp of something great for myself and my father and I hope you can respect and support my decision. Thank you for all of your support in this failed endeavor, I will hopefully see my aspirations bear fruit in Nicaragua.


Sincerely,

HS