I made it driving all the way from Nevada to New Hampshire! So far everything is awesome. Weather is exciting, I love my new job at Dartmouth-Hitchcock, and the people here take “fantastic” to a whole new level. You will actually get a few doctoring stories from me this year, as my free time prospects are quite good and I’m finding that radiology is much more “doctor-like” than previously anticipated (to my surprise, I will be sporting a white coat, pager, and likely even a stethoscope.)

I’m learning a thing or two about moisture and real weather. This week, we had beautiful sunny days in the 70-80s, punctuated by an electrical fire on the freeway, flash flood warning, violent thunderstorms, and brief power outages. (In Reno, we had four seasons, but it was just the demo version.) The little Christmas village on the welcome sign is promising. Having lived in Montreal before, I understand the concept of snow, but it’s the New England houses that I believe will make it a magical winter when the time inevitably comes.

I’m also discovering a sense of camaraderie that never existed in larger cities. One of my colleagues who lives in my apartment complex asked me if I needed anything, and I half-jokingly mentioned a vacuum before my stuff arrives, which he told me I could pick up anytime. Well, I didn’t go get it, but this morning I found it left on my doorstep with a note saying he’ll get it back sometime next week and wishing me luck with my move! It totally made my day to have such thoughtful friends in this very trusting neighborhood! (Out west, people are generally friendly but things have totally been stolen from our garage when we left the door open unattended.)

If you’re thinking about moving to New Hampshire for any reason at all,  stay tuned for updates about life here from a west-coaster perspective.

Creation of Adam


A couple years ago we took a tour of the Vatican museums, learning about the history and politics behind the significant works of the Renaissance period. In those few hours, I gained a whole new perspective and appreciation for Art.

Unlike their modern-day counterparts who sell toilet seats for a million dollars, Renaissance artists thought deeply about religion and science and existence, and they used their art to depict their journey in the search for Truth. From learning about the works of Michelangelo and Rafael and their contemporaries, I got a sense of artist as scientist and philosopher. For the first time, I understood the importance of their work as so much more than pretty pictures. I was so impressed with their level of insight into the eternal truths that so many people still struggle with today.

Like everything else in Rome, the Sistine Chapel is massive. But unlike what I imagined from decades of media influence, the Creation of Adam painting itself is tiny and is just one of many, many paintings covering the ceiling and walls of that room. I had thought that the fingertips of God and Adam touching, portraying the instantaneous existence of man out of nothing, would cover the entire ceiling. Instead, the painting contains much more elaborate meaning. God has his other arm around a woman who is making eye contact with Adam. Surrounding them is a group of children. They are all reaching to Adam from inside a shadow in the shape of a womb. This, what God had in store for Adam and what He had planned as the creation of man, is infinitely more sophisticated and true than mere instantaneous existence from nothing!

The ceiling decoration consists of nine scenes from Genesis, telling the story of humankind from the separation of light and darkness to the fall of Adam to the great flood to the birth of Christ, depicting the need for the Atonement. Michelangelo read and reread the Old Testament during the four years of work he put into this, drawing inspiration from the scriptures rather than established tradition. A total of 343 people were painted, allowing Michelangelo to show off his skill in recreating the human body in a huge variety of poses, and revolutionizing Western art with a set of models for all other artists ever since. To boot, he was actually a sculptor who considered painting to be beneath him.

I was equally fascinated by the logistics. Until I personally stood so small under those grandiose ceilings, it never dawned on me how much of a pain and danger it would have been to clamber up those great heights and not only forget my fear of imminent death but proceed to engage in an intellectually-demanding activity. Michelangelo fashioned his own scaffold, a platform hanging from holes near the ceiling, rather than built up from the floor, for a tremendous savings in timber. He painted standing upright with neck craned upwards all day. He described these horrid conditions in a clever sonnet, summing up his feelings in the final line, “foul I fare and painting is my shame.”

Dragon Fighting



After having been a princess all my life, I decided to take up sword-fighting! Or, more precisely, Historical European Martial Arts (HEMA).

Did you know that this was a thing? There are currently thousands of people around the world who have taken to reviving the art of historical fencing, using the manuals left by the masters of the 14th and 15th centuries. The modern iteration of the art is a couple of decades old, and people are starting to become quite decent at it. There are groups practicing in just about every major city. Our group in Reno meets twice a week.

Now, why would a doctor be interested in wielding a sword? For me it’s because, at its core, sword-fighting is a mind game. Mind games are ideally won by smarty-pants like doctors.

I’ve been at this for about six months. Previously, I’d watched my husband pursuing the art for the whole nine years I’ve known him. He’s taught groups in Reno and Vegas, practiced with others all over the west coast, and even trained in Scotland for a year. I had been dragged to practice occasionally, but I was never really interested in swords before… I don’t know, I guess I don’t have a tolerance for standing around holding a sword while someone explains stuff for several minutes at a time. My idea of a workout is sprinting on a treadmill while listening to lectures or memorizing flashcards—a doctor’s got to use her time effectively.

But that all changed when my husband came to a deep understanding of the art and revamped his curriculum for beginning students. All of a sudden I had a really good teacher, and as I started to study, I realized that the same skills I’d picked up in medical school applied to fencing.

Contrary to what movies would have you believe, sword-fighting is much more sophisticated than whacking people with a stick of metal. It boils down to the intellectual task of understanding the principles of Physics and Geometry. (Sound familiar? It’s the same reason that I chose Radiology as a career.) To successfully implement these principles, one must not only train the body, but must also train the mind. It’s a matter of critical reasoning, of correctly assessing the situation and remembering the algorithm for the best response, and especially of doing all of this faster than the opponent. As an intern in Internal Medicine right now, “critical reasoning” and “algorithms” just about sum up what I do in the hospital every day! And as more and more people figure this out and incorporate the thinking game into their HEMA practice, the art will only become more intriguing.

Plus, swords are really photogenic.





As many of you know, last week I graduated from medical school AND officially released my book, Tales of an Ugly Docling. The book is a collection of stories and essays about my experiences working as a medical student in clinical settings, much like the posts I make on my blog. All of the proceeds from sales of physical copies of the book will be donated to medical charities worldwide.

The Kindle version of the book is currently FREE on Amazon (from 5/20 to 5/24)! I am doing this as a “graduation gift” from me to all of you! Please take advantage of this promotion: download the book, rate it, review it, and spread the word!

Also to promote my book, I have a new WordPress site and blog at http://www.uglydocling.com. In the future, I will be posting my medical stories in the new Ugly Docling blog, and I will repurpose Nervous Impulses for things I do outside of medicine, such as traveling, cooking, photography, and music. I encourage you to follow my new blog to continue reading about my adventures in residency and beyond.

I want to thank everyone who has followed me through my journey in medical school over the past four years. The thoughtful feedback and support have really pushed me to continue writing, and the whole experience has made medicine so much more meaningful for me! Let’s have many more adventures together in the coming years!

I’ve decided that every week between now and when I start working as an intern in July, I’m going to try something I’ve never tried before. With graduation on the way and having completed both my clinical rotations and my book, I haven’t been writing a lot about medicine lately. And that clears up a whole ton of time to take on new hobbies! Not the least of my reasons for doing this is that I really, deeply believe in constantly showing myself new facets of life that I suck at.

Two weeks ago, I went snorkeling in Puerto Rico. When we signed up for this, I clarified with my husband, “So in cartoons, when they sneak around underwater and look out through a tube… is that what snorkeling is?” I’ve always been a terrible swimmer, so naturally, I have the floaties to thank for my life.

Last week, I broke out my new camera and made my debut in portrait photography. Not only do I now totally understand why people keep taking unflattering photos of me, but I can also now take my revenge. (Shown here are my husband in his historical fencing gear, my sister before Prom, and my other sister with her date.)



This week, I took up golfing. It is pretty much obligatory for a doctor to play golf, and my family consists entirely of competitive golfers. On day 1, my average drive was an impressive 10 yards. On day 2, my average drive increased to 100 yards. I was SUPER excited for day 3, but I’m sorry to say I did not average 1000 yards.

Of course, now I’m looking for other fun things to add to my list! I will consider all plausible suggestions that comply with my moral standards. =]

Ugly Docling cover copy


Tales of an Ugly Docling, my book of essays about medical school, will be officially released on May 16th (2 weeks from today)! The Artist in Residence program, which funded the materials for the project, will be hosting an artist reception/book signing that day 4-6pm at Sierra Arts in Reno, Nevada.

Not in the Reno area? Most of my readers aren’t, but you guys have really been a huge support in making this happen. So for you, I will be releasing my book on Kindle FREE for the first week! Just as a way of saying thanks for being awesome.

(Note that 100% of the proceeds of the book will be donated to medical charities worldwide, so more people will benefit if you also order a physical copy through my website,www.uglydocling.com)

Ugly Docling cover copy

An update on my upcoming book… Here is my first draft of the cover! I made it with a combination of pencil drawing, scanning, Paint, XnView, and Photoshop (on a Mac and a PC). I’m not too much of an artist, and I’m kind of indecisive about the kerning aspect, so feel free to give me any feedback on how to make this better!

I wondered for a whole year what I was going to title my book, and suddenly, “The Ugly Docling” came to mind. I think it’s fitting on many levels.

For one, the Ugly Duckling is the story of a nerd kid who grows up to be a doctor (or engineer, or astronaut, or member of any profession that draws from the smart kid pool.)

I’ve been a misfit since elementary school. First it was because I was an immigrant, had an odd name, wore different clothes, and didn’t speak the language. But even after I grew accustomed to American culture, I still struggled with being a nerd. I tried so often to dumb myself down so I could be accepted by other kids. I wanted people to know that I was a musician, a poet, and a tennis player, but I would be mortified if anyone found out that I was in MathCounts or Academic Olympics. And though I spent way too much time trying, I never had nice hair. For me, this one was tough; high school is all about the hair.

Fast forward to medical school: Everybody is a smartypants. Everybody is charismatic. Everybody has nice hair. Well, almost. When we tell people that we are going to be doctors, they react with kind words of admiration, appreciation, and respect. (And then they show us skin lesions for diagnosis.) Yet, when I found my old MathCounts roster and pointed out that a couple of my classmates were on it, they were mortified. It really is bittersweet to look back on those years. But hey, let’s face it: doctors don’t just pop out of thin air; they were Mathletes when they were little! Nobody makes fun of a doctor. So why are American kids taught to make fun of nerds? I consider this book to be a big hug for my young self—and for nerd kids everywhere. Nerd kids: It gets better!

But my personal Ugly Duckling story continued even after I met up with the other swans in medical school.

Perhaps because of our common unspoken background as nerds, the culture in medical school is reversed. We admire and compliment each other for knowing the right answer at the right time. We fear being laughed at when we act ignorant or incompetent. Some may brag about how they never study, but they are either lying or willfully endangering lives and mocking the practice of medicine, and the rest of us know in our hearts that we would never refer our own patients to those individuals.

It was in this culture that I realized I may still be a misfit. Yes, of course I have studied my tail off, and of course I want other students to think of me as being a stellar student. But to the degree that I still have gaps in my knowledge, I question my doctoring skills. When I get an answer wrong, I question if all my classmates are smarter than me, if I can be a good doctor, if other doctors will want to refer their patients to me. For the first couple of years, I focused so much on test scores as measures of my doctoring skills. But then, when the exams were over and I was thrown into the real world of hospitals and clinics, I was humbled to learn so many things that were never taught in the medical classroom. These are the things that I felt moved to write about.

I’m ready to let the word out that I am publishing a book this year, thanks to the Artist in Residence program*. The book will be a collection of essays that document the adventures and insights of a medical student, much like the posts I make on G+ and my blog. As part of the graduation festivities, there will be an art show at the Sierra Arts Gallery in Reno on May 16th, where I will have my reading and book signing event. The proceeds of this event will be donated to medical charities locally and world-wide.

Right now I am in need of suggestions for medical charities to benefit. I have been a long-time fan of Doctors Without Borders, and recently heard about Child’s Play (which provides toys to children’s hospitals around the country). I also want to recognize my readers by letting them suggest any medically-related charitable organizations or causes that are close to their hearts. Please post any suggestions in the comments, and include an explanation of why the charity is important to you.

Please feel free to spread the word! I’m very excited about this project, and hope that my messages (and the funds they generate) will reach many people in need.

*The Artist in Residence program is a collaboration of the University of Nevada School of Medicine, Sierra Arts Gallery, and the Healing Arts Foundation at Renown Hospital. Every year, they give awards to graduating medical students for pursuing artistic endeavors related to medicine. It is funded by generous donors in the Reno community.

Have you ever had a doctor break down and cry with you as you received bad news? Sometimes I have to work really hard not to be that doctor.

Each day in Oncology clinic, I see all the stages of grief. Everyone battles cancer completely differently, and I get to experience it all as one giant roller coaster.

One minute an old woman comes in after her last round of chemo left her hospitalized. She absolutely insists on taking another round. Her doctors hesitate to give her more chemo and radiation than she could tolerate, yet she refuses to go to the grave without having pulled out all the guns. The defiance in her eyes is contagious. I want to shout, “Yeah!! Go get ’em!”

Next thing we see a young man whose cancer had no business interrupting the course of a well-plotted life. He’s already nauseated just worrying over how the treatments will affect his family. He and his wife raise a slew of questions, exploring every crevice of every possibility. Our uncertainty makes them visibly uneasy: Curing cancer is a numbers game, from our perspective. But for each individual patient, we either achieve a cure or we do not—and the side effects are definitely not worth it for a not-cure. I wonder if he might talk himself out of getting any treatment at all.

Then we get a happily oblivious patient, a guy with brain tumors so far gone that he no longer has the capacity to understand his own plight. We try to explain that he needs to take his chemo pills diligently. He smiles pleasantly and agrees, indicating that he clearly won’t do anything of the sort. While this is truly terrifying to me, part of me also thinks that perhaps, for a cancer patient, he is in the best of all worlds.

The tearful patient really gets to me. Someone had given her false hopes about her prognosis, so then it became our job to set the record straight. The doctor apologizes profusely. The patient retreats into heaves and sobs as she begins to mourn her own death all over again. In her mind, we have just killed her. I hand her a box of tissues—inadequate for the gravity of the situation. Yet she smiles briefly as she takes the box from me. We continue the conversation as she empties the box. Pagers ring, and we silence them without answering. Occasionally I stare at the ceiling so the tears won’t crash down.

Where in my medical training was I supposed to learn how to let a patient die? How do I tell the dark news, and then, how do I react? Do I grieve the disease, or do I fight it? What does the patient need to hear? Is it inappropriate to laugh with them? To cry? Is it unprofessional to admit that the cancer, in beating the patient, is also beating the doctors?

What is a good doctor?

This year, I spent Christmas Eve in the ER… as a patient.

1:00 pm. After signing all the paperwork and explaining my situation, my husband and I were asked to find a seat and wait for my name to be called. The waiting room was pretty empty. Before we’d even agreed on where to sit, my name was called.

They took my vitals, and saw that I was not going to die. When asked again, I stuck to my story.

“Fast service!” My husband commented.

“That was just triage,” I told him. “The real waiting begins now.”

“But at least they got you through triage fast!”

“Umm, I’ve already triaged myself. That’s why I’m here in the first place.”

1:20. We made our way back to the waiting room. A lady was sobbing loudly. A man was pacing frantically and occasionally moaning in agony. A volunteer was apologetically offering blankets. I opened a textbook and got to work.

3:30. I’d reviewed the textbook chapters pertaining to my condition, decided on the course of action I would take as the ER physician, and also made several attempts to set a new record for Fruit Ninja. About a dozen other people had since arrived and been called in. I went up to the triage desk again.

A couple was yelling at the triage nurse and threatening never to come back again. When the nurse finished dealing with them, she turned to me with a very exasperated look and asked, “Can I help you?”

I tried a different approach. With a smile and a casual tone, I said, “I just wanted to get a rough idea of where I am on the list.”

She scanned for my name. “You are at the top! I have you on the fast track, but there aren’t very many beds turning around.“

“Wow, really? I’ve been here for two hours.”

“You will probably be the next person called,” she reassured. Then, on second thought, she added, “But we also get heart attacks and strokes.” Of course, I knew all too well.

4:30. After several more people fast-tracked past me, I was brought into a room in the pediatrics ER, which I knew served as overflow for when the main ER was full. It was freezing, and I had to change from my winter clothes into a thin gown. I was given one small blanket, which quickly lost its heat. I huddled into the blanket and asked my husband to pile on several extra sheets from the cabinet. After pressing all the levers, I gave up trying to raise the back of the bed, so I stayed lying flat, bundled, craning my neck to watch the TV in the corner of the room.

5:30. The doctor came in to make his initial evaluation. He laughed when he saw me, but was kind enough to bring several more hot blankets. He asked me again what happened. As a courtesy, he listened to my heart and lungs. He told me the list of tests he wanted to run, instructed me not to eat or drink anything in case I had to go for surgery, and then disappeared for another hour.

6:40. The nurse finally came back to put in an IV and draw my blood. A really sick baby had arrived just after me, and the doctor had been too busy to write orders for any of my tests.

7:00. My husband wondered out loud how much longer we might be there. It had been six hours, and we were just gathering the first, most basic of the studies. The nurse said, best case scenario, another three hours. I knew that I wouldn’t be staying overnight or going for surgery, but that it would be late evening before all the tests were collected. I asked him to call home and tell the family not to wait on us for Christmas Eve dinner.

So this is probably a typical ER day for any given patient: boring, exhausting, uncomfortable, and inefficient. And I might add that those IVs are ridiculously itchy! I can only imagine that patients without medical degrees must find it excruciatingly frustrating to wait, wonder, and suffer. Most of the patients probably don’t know what’s going on, what’s being suspected or tested for, how serious it is, or even whether or not they are going to die.

I’ve worked these shifts, and I’ve treated patients like me. It’s notinefficient from the other side of the door. I know those ER docs are running around frantically on a day like this, constantly seeing new patients, doing procedures, running codes, writing notes and entering orders, calling consultants, following up on results, reassessing, reassuring. In fact, I have never seen an ER doc take a lunch or dinner break no matter which shift they were working.

How frustrating that there should be such a difference between what the patient experiences and what the doctor experiences! I feel slightly embarrassed by it, almost like I need to apologize. I’m sure it’s hard to see your doctors as real human beings when they’re running in and out and making you wait for hours in between. It’s really hard to convey just how much work there is to be done, how much there is to think of, between those hectic runs into the patient room. I don’t know how we can close this gap. But at the very least, I want to say this, in case no one else ever does: Your doctors care a lot about your well-being and work really hard for you, even when it doesn’t seem like it.