Letting the Guilt Go

It's been a year since my grandma passed away. I used to think that it would be easier as time went by. In a way, it is easier. But in every idle moment, certain images still haunt me. Whenever i find the time to stop and think about all the things that have happened, whenever i find the time to reflect, all those painful memories come rushing back. A year has passed and i still feel as lonely. A year has passed and i still feel as guilty as i have been a year ago.

Every now and then our relatives would ask me if I dream about her. They are a superstitious lot, especially the old ones. They believe that dreams are one of the ways that those who have moved on to the afterlife communicate with those who are still living. I do not believe in such nonsense, but to answer their question--- yes, I dream about her. A lot. Not because she's communicating with me, but because she remains in my consciousness. And even at those times when i'm preoccupied i still think about her subconsciously. She's always present in my mind.

On most dreams, we are simply talking, as if she's still alive. And i remember waking up with a smile, and that warm feeling would quickly vanish once i realize that it was all a dream and she's long gone. Several times i dream of the last day she was alive, but i did things differently, things turned out well and i managed to save her life. Everything's fine, and i would wake up feeling so happy. And like most dreams about her, that great feeling that everything is all right with the world would disappear the moment i realize it was just a dream. All those dreams were so surreal, all those dreams were so vivid, i always thought that they were real instead of make believe. But that's just the way my life plays out. It gives me one fleeting moment of happiness, then in an instant it would take it all away and push me back into the darkness where it chooses to keep me.

I had several dreams about here which were so horrible that i wake up shaken and afraid. I never could remember what those dreams were about except for one, which was as vivid as it was disturbing. Again the last day of her life was being played out, but this time it was in an old, gothic, dilapidated hospital, the type of building you'd see in an old creature feature. Cobwebs abound, mysterious eyes shone in the dark, the floors would creak with every step--- stuff you'd usually see in those old horror movies. In this dream my grandpa was still alive, and we had to carry my grandma's body down to the morgue because in that hospital, it was the duty of the deceased patient's loved ones to bring the patient down. As we were carrying her i noticed that she wasn't that heavy. I remembered that i couldn't carry her on my own when she was still alive, but at that time i thought i could carry her easily. With faulty logic I just figured that's just how it is when a person dies, a lot of her weight would disappear. The morgue was filled with lighted candles, and there were a lot of coffins inside. I wanted to hug her for one last time so I pulled back the sheets that were covering her body, and it turned out all that was covered underneath was her spine connected to her head, her intestines, plus a big blob of blood. There wasn't any skin. Blood poured down on the sides of the stretcher, then my grandpa vomited. From out of nowhere my dad came out shouting at me, blaming me for something i could not understand. Then a little boy came out of the darkness, splashing about the pool of blood on the floor. He then reached for her intestines, then started nibbling on it. While he was chewing on her innards, he was looking at me and he was smiling. That was when i woke up.

My life as it is right now is in shambles. The fact that she's gone just makes things so much harder to bear. I never realized it back then, but she used to give me a reason, she used to give me a sense of direction. Now I don't know where i'm headed.I'm like a sailor out at sea, with no specific destination. I have always been lonely. I have always been angry. But not to the extent that i am now. Ever since she passed away all these negative feelings have been magnified. Oftentimes, i just feel like crying for no apparent reason. Not a day goes by when I don't lose my temper. Not a day goes by when i don't want to beat someone up. Whereas before i can easily keep my emotions in check and keep all the anger inside, nowadays i always feel the need to show it. For the past year i have provoked a lot of people into fighting me, just so i could release all the hate inside of me, but so far no one has been stupid enough to fight back. I've know what it's like to beat the hell out of someone who has done you wrong, and it felt so damn good, i have actually been craving for it. The satisfaction it brings is immeasurable. But the opportunity to release all this anger onto another person hasn't presented itself yet, so i have to be content with spending several hours in the gym. Some people think i've suddenly turned into an obsessive compulsive health nut. The truth is, i've been going to the gym frequently to release all this anger. Lifting all those weights and hitting that punching bag again and again is strangely satisfying. I just have to imagine that I'm hitting another person... someone i despise... someone who has done me wrong. And somehow, as i transfer all the pain onto an imaginary being, the pain i feel inside would go away, even for just a fleeting moment.

If she had told me that she was ready to die, maybe it would be easy to let go. But the very last time that i looked into her eyes, i knew that she still wanted to live. By the time that we've managed to get her inside my car, I already knew that i let her down. And with the way i'm living my life right now, i'm letting her down again and again and again. I know i can't let go of her memory, but her memory is entwined with such great feelings of loneliness and guilt, it makes the very act of living so damn difficult. It would be so easy to just give up, especially since i still have no apparent purpose, and i see no compelling reason. I know it's not the sane option, but giving up may be the only way of letting go of the guilt that's continuing to haunt me in this life.

The Memory Remains

I did it out of boredom. I didn't have anything to do this afternoon, so i thought i might as well clean up my room. All my things were in such disarray when i got back and i never bothered fixing things up. i just didn't feel like doing anything. Part of it was laziness. But it's mostly because I didn't really care. It took me about an hour. I finished much sooner than i expected, so i figured I'd go clean up my grandma's room as well because no one else would bother to do it. Although we weren't planning to get rid of most of her stuff in the near future, I thought it would be wise to start sorting all of her things. Truth be told her room has a lot of junk stored in every corner, it would take days to sort everything--- from those that we could keep, to those that we would donate, and to those things that were unsalvageable. And besides, the room was in such a sad state of disarray, i figured it wouldn't hurt if i restored a bit of order. After all, i stay in that room often. It wouldn't hurt to make it look as if someone still uses that room.

I finally cleared her bed of all those papers, envelopes, and photo albums. Now i have a great deal of real estate whenever i would sleep on her bed. I placed all of those clothes that remained outside for some weird reason inside her closet. I noticed a lot of those clothes had holes in them, yet she still uses them. I used to wonder why she kept wearing the same set of clothes whenever we went out. I used to think that those were her favorites. But I guess the real reason was she didn't have a lot of nice clothes. When i opened the closet, there were the those clothes, the same ones i kept seeing in pictures taken from the past couple of years... all five of them. I saw that one pair of shoes that she always wore, and they were really worn out. I opened one of her drawers and saw a lot of my old socks, the ones i used to wear in college. I remember setting them aside to be thrown out because they were already worn out and too loose. Yet there they were, inside her drawer. All along i thought I had gotten rid of them. Apparently she still used them at night whenever her feet got cold. We always had the luxury of wearing the nicest clothes, of having things of great quality... thanks to her. Yet she never availed of such luxuries even though she had the means. Rather than using her money to buy her own luxuries, she'd rather spend all that for the things that we wanted to have.

God, i wonder when this stage of grief would end. Every time i think i'm already over it, that overwhelming sense of sadness comes crashing back in. I wish these tears would stop flowing already. I'm so fuckin' tired of crying.

No Reason

On my way home this evening, i passed by a church and there were several people outside giving away flyers. They were wishing everyone happy holidays. And they were inviting everyone to a seminar of sorts. I threw the flyer away when i passed by a garbage can. But a part of the slogan stayed in my head. Three simple words.

Are you happy?

Honestly, I'm not. And while i was on the subway, i tried to think of those times in my life wherein i felt genuinely happy. The type of happiness that makes one feel warm inside, not the type of surreal and artificial happiness that alcohol brings. I tried to think of those times wherein I could say that I really felt happy... and I couldn't think of any. And now that I'm back at the apartment, i still can't think of much.

When I was given my first car, I guess I was happy then. I could go places. I could do things that i could never do before. And it gave me a certain amount of freedom. it was the shallow type of happiness that material things give you, but i was happy nevertheless.

When i first learned how to surf. And the many instances after that. The feeling you get as you ride the waves is indescribable. If I have to give it a word, it's nothing short of exhilarating. You wouldn't mind swimming back in again and again even when your shoulders become sore from all the paddling. It's temporary, and it's also shallow... but it's still happiness nevertheless.

When I first learned how to play the guitar. Even when all the songs that I knew how to play are those songs in the tutorial, i felt as if I've made some great accomplishment. It's something that I wanted to learn for so many years, and to finally learn how to play gave me a great sense of fulfillment--- and that made me happy.

When I saw one of my favorite bands perform live for the very first time--- i felt that I was in heaven. For years I've just listened to them on the radio, on my CD and MP3 players... and on that day, there they were, merely a few feet in front of me. To watch them perform with such gusto was surreal, and to share that experience with a few thousand others who share the same interest with you stimulated my senses in so many ways. That level of happiness was indescribable to me because that feeling wasn't familiar. It was such a great feeling, yet it felt so out of place.

Those times when I gave a few bucks to those beggars on the streets, and when they respond with such huge and genuine smiles, with wide eyed awe as if you've given them a small fortune even when what you've given them won't even last for a day. When they say thank you with all of their hearts, and you can clearly see how grateful they are, and you would be grateful yourself because you are so much better off--- during those times i felt all warm inside. i felt happy. Some sort of acknowledgment that I have made a difference in their lives, no matter how small and insignificant--- that makes me happy. Too bad only a few of them respond that way.

When I've helped several patients get well and they thank me sincerely and genuinely... even if they do not give me anything material in return, their gratitude made me feel happy. Even if their cases proved to be difficult, even when treating them involved so much work, all those hardships disappear in an instant when you see that you have helped them get well and they express their gratitude in return. Too bad only a few patients were that way. I'm aware that simply knowing that you have helped should be enough, but when people make you feel appreciated makes that much of a difference. Most say thanks in a very mechanical manner, as if they were required to do it, or as if they were only doing it out of habit. You could feel their lack of sincerity. Some are indifferent, some wouldn't say thanks at all. And there are a few who act as if you owe them a favor for allowing themselves to be treated by you, and some shout out expletives in return. Such patients amplify all your frustrations, and they make you wonder why you even chose to be a doctor in the first place.

When the plane landed in Seattle about a year ago. I felt genuinely happy. That was the first time that I travelled alone, and I felt as if i was about to undertake a huge adventure. And I had a great outlook in life then. There was so much potential. I was about to make my dreams a reality. Back then, it all seemed possible. Back then, it seemed that all was within arms reach. So early in the game i was a fool to believe in the ideal. I was ignorant, i was foolish, but i was happy.

Two months before my grandma passed away, i remember that one instance when we were talking in her room. We were smiling, we were laughing, talking about random stuff, talking about nothing... I was happy then... at least for a few minutes. Because after a while I wondered why we didn't do that often... just sitting in front of the TV and talking. I tried to think of the last time i've had a meaningful conversation with her, and I realized I had none. All those years, though I was always in close proximity, though I talked to her everyday... those conversations were all shallow and perfunctory. When it came to meaningful conversation, the type of conversation that would get to you, the type of conversation that affects your whole being, the type of conversation that you'd remember for a long time and cherish for an entire lifetime... i realized that we had none. Amidst the happiness that i was feeling that time, i realized something very depressing.

Happiness is essential to all human beings. We need happiness to continue living because it takes our minds off the negative, it distracts us from all the pain. When happiness evades us, we see all the darkness underneath, we see the pain of reality, we lose our shield from all the misery. Happiness gives us reason to live until the next day, it makes us look forward to tomorrow, it gives us the inspiration and strength to keep fighting. Happiness fools us into believing that there's still so much to live for even when there is none, it keeps us from giving up and letting go.

But when all happiness is gone, when nothing can mask the reality anymore--- what happens to the man who discovers that there's nothing there to live for?

I know the answer to that question. I've known the answer for a long time now. I just choose not to say it out loud.... not yet, anyway. But I will when all is certain and final. I will, when there's no more turning back. There are things that are better left in silence when there are still lingering doubts... but when all doubts are gone, i will have to decide. Things will fall into place in due time.

For now, I'm just waiting for a sign.

Thunderstorms

I used to think that i was over this phase...

I used to think that it was just a phase, something that i had to go through, until it's over and done with...

after so many years, it rears its ugly head once again...

Ever since I got home I've been in a state of depression. Either I'm pissed off about something, or i just feel so lonely for no apparent reason. That is my baseline.

I've been that way for years... my emotions just fluctuate every now and then, but these fluctuations never veer far from the baseline.

But since I got back i've felt so much worse. The fact that i'm not doing much work has given me time to reflect on the things i've done and haven't done for the past couple of years, and my realizations have been so depressing.

And with the recent death of my grandfather, together with the feelings of guilt that came along with it... it has led me to an even deeper state of depression.

During dinner, I began to notice things... and i began to look at my family with disdain. How my grandmother's bad traits have been showing. How my mother appears to be some sort of a user. How my brother doesn't give a f*ck about anything at all. How everyone could act so happy, just like that, as if nothing has happened, as if nothing has changed. And of course, how my father can piss me off with such ease as always.

At the dinner table i remained quite. I felt as if i was about to burst. I kept playing with my food, just as I did when I was a kid whenever I didn't feel like eating... while they went about with their idle conversation.

i just want to go away. i just want this stage in my life to end. If i stay here for long, I will surely go crazy.

And that's when I thought about doing something drastic. That's when I thought about the things that filled my thoughts those many years ago. back when I wanted an easy way out. Back when I would let irrational thoughts cloud all logical thinking.

But I knew all i had to do was take a drink. Calm down and take one drink. It always pulls me away from my state of melancholia, albeit temporarily. I just fear that the day might come when I'll grow tired of such temporary relief...

Because as of now, i'm so tired of my life as it is.

The First Obstacle

Down in the dumps. So f*ckin' depressed. That was how I felt when I received the results of my USMLE step 1. I know, I should be happy that I passed, but I just can't help but feel depressed. A long time friend pointed out that it must be because of my bruised ego. As someone who was viewed as a genius/ nerd a decade ago, getting a below average score is a major downer. Fine. My ego was bruised. It wasn't just bruised. It was crushed. But that's not the reason why I'm feeling depressed. I feel sad because for a fleeting moment I thought I really had the chance of getting into the program that I really wanted. Yeah, it was probably a long shot, but I still had that chance. And just like that, as quick as a blink... the chance was gone.

What exactly am I talking about, you ask? If you manage to read my blog from the very beginning, you'd come to the impression that I'm sort of a morbid creature. I get high with the sight of blood and guts. I get that adrenaline rush when I encounter emergency situations. The most obvious clues would be my entries from the year '07, when i was blatantly ranting about the residency program that I was in. I didn't want to be a doctor in the first place. But here i am now, it would be really impractical to make a sudden and drastic career shift. So if I had to choose a program to specialize in, it had to be something I enjoyed doing. Every incision I make gets me high. Successfully doing an operation, no matter how simple it is, gives me a great deal of satisfaction, a remarkable sense of accomplishment. In order to lessen the bitter taste that this profession leaves in my mouth, to make everything easier to bear... if I had to choose a residency program, it has to be surgery.

When one of my close friends told me I had a shot two months ago, as long as I get an above average score, I was extremely happy. I knew how hard it is for a foreign medical graduate to get into surgery in the US. One needs to have a lot of credentials. US clinical experience. Published research works. Recommendation letters from renowned American Physicians. Exemplary grades in Med school. Exceptionally high scores in the USMLEs. Most of which i don't have, but I still had a chance because my friend has relatives on "the inside", and they could help me out. I just had to get high scores on my MLEs. And when I got my score, that dream vanished instantly.

It's not a big deal really. Crap, I know this would sound selfish, but my main reason for wanting to train in the US is money. Yeah, I know the medical profession is service oriented, and financial matters should not be at the forefront... but I'm just so tired of getting such a paltry some for all my efforts. All those years spent in med school, with all those lavish expenses, those sleepless nights, the mental torture... all for what? For a job that offers salaries that can barely support a single person? Don't get me wrong, I like serving others, I like to help out. But how can I continue helping others when I can barely support myself? So yeah, financial gain is my primary purpose. If that's my primary purpose, then it shouldn't matter which residency program I get into, right? But is it so wrong to dream? To wish that i could get into that certain program that could make this whole profession I'm in a little easier to swallow?

Now reluctantly, I'm exploring other options. First is family medicine. They say it's the easiest program for foreign medical graduates to get into because it's the least competitive. Most American medical graduates choose other specialties, and I can't blame them. Because family practice, deals with primary care, they get the huge patient loads. Schedules can become hectic. On the upside, that means more cash. Plus, the option to take up Sports Medicine as fellowship makes the program attractive to me. And---! I heard that doing minor surgical procedures is part of the program, and sometimes family medicine residents even do major operations when no surgeons are available. i can do something I like, although it would be mixed with rotations that i hate, like obstetrics and gynecology. Yuk. The only problem is, the option to go back to my home country after residency is still an option for me... depending on how things go. In this country, other physicians look down on family physicians and emergency medicine physicians... the "jack of all trades, master of none" stigma... add the fact that family medicine is not a lucrative practice at all back here.

So... option number two would be internal medicine. Since med school i hated this subject matter. Even during clerkship and internship I hated rotating in this department, and now, every time i go on duty at the emergency room, I cringe whenever i have to handle medical cases. I'm also more hot headed when dealing with these patients. It just isn't my thing. At times, I even feel like a fish out of water when I encounter such patients. I know I can learn eventually, but when it comes to this subject matter, I have no urge to learn at all. Would the promise of hefty salaries be enough to make me last for years in a program that I absolutely detest? One upside would be a better private practice back home if ever I decide to go back. And there would be none of that family medicine stigma. And I could take up gastroenterology or pulmonology for fellowship, the two subspecialties that piqued my interest back in med school. But I just can't stomach the other subspecialties. Just thinking about those three years during residency where I have to go through those other subspecialties nauseates me.

The other residency programs are not for me. I just can't see myself as a pediatrician, an obstetrician, a gynecologist, a radiologist, an anesthesiologist... i just can't. So it's a toss up between family medicine and internal medicine... I don't really like both, so it's going to be difficult weighing the pros and cons, which program would be easier to stomach. Man, I hate choosing between two evils. But as they say, beggars can't be choosers. I'm in no position to be choosy.

But it's not over yet, is it? That's just one step, there are three more to go. Maybe if i get a better score on the next one, I might still have that chance again. It's a long shot, but maybe there's still a chance that I won't be spending everyday in residency drenched in utter misery.



Hey, the last time I checked, everyone is still free to dream.