Alice Yi-Li Yeh's Blog

The Emotional Well

A year ago, I made the transition from the many hats I wore at Deaconess (pharmacy practice in adult/pediatrics, emergency medicine, and women's health) to a pediatric emergency medicine clinical position at a Level II Trauma Center. The transition has been a difficult one. The medication end was, believe it or not, the easy part; the hardest has been the constant emotional drain. There's a certain amount of empathy required when caring for sick children, moreover ones with whom you have no personal connection. This generosity is one of the things that I value most about each and every one of my teammates in the emergency department. Yes, teammates. While the medical hierarchy is certainly in place when it comes to decision making, there is a real sense of camaraderie that pervades the group, probably because of the nature of our work. Everything boils down to "for the kids."

With that said, there is no ready shut-off valve when the cases become hard. I don't remember my first adult code. I can remember every pediatric code that I've been in. I remember the accidents, the bad parenting decisions, and the non-accidental traumas, or NATs. Non-accidental trauma. It's a pretty phrase for what is, in reality, child abuse. When you work so hard to save lives, one of the most difficult things to fathom is an adult attacking their children, especially when I know women who would give anything to be a parent and can't for biological reasons.

Perhaps what makes these so memorable is that creeping sense of futility. Less than 10% of children who code make it to discharge. The reality is that we often sustain life just long enough for parents to say goodbye, or we leave them with the heartbreaking decision of whether or not to pull the plug. Sometimes, as in the case of hangings, the brain injury is severe enough that the most humane thing would be to let them go. And still we do our best to preserve life, because we believe that every life is precious.

Amongst all this is the difficulty in finding emotional support amongst family and friends who aren't in healthcare. Obviously details are kept mum due to HIPAA reasons, but what little you are able to share, such as "we lost three babies this week," seems to generate some variation of "Oh that sucks, I couldn't do what you do," or "Oh, I'm sorry, I'll pray for you," or my personal favorite, "Oh. Let's talk about something else." It's the equivalent of "That's nice, dearie" and a pat on the head. There's this unwillingness to just sit and share in the grief and the weightiness of life and death and the things that we can't control. I get it--it's a terrible feeling. As humans, we dislike pain, which is generally a good thing. What irks me is the misinterpretation of what it means to share a burden and help to carry a load. It isn't passing the ball to a higher power so that He can deal with it. It means allowing yourself to be uncomfortable so the other person isn't all alone. By all means, yes, pray, but do so together. Pray with them rather than for them. It's a subtle distinction, and it makes all the difference.

So what do you do when the emotional well runs dry? I recently came across an article in The New York Times indicating that awe is what inspires us to care for others. In the past year, I've sought out ballets, operas, orchestra concerts, art museums, and musicals. Glorious, transporting (if oftentimes expensive) reminders that there are wonders out there that are greater than ourselves. That the world still contains good things. My first thought upon reading the article was, "Oh, I've been self-medicating. Nice." Then I realized that I was taking care of myself because you can't rely on other people to take care of you, a realization that was as self-empowering as it was sad.

This post turned out to be a bit of a rambling jaunt through the jungle inside my head. It's currently an untamed mass of frustration, anger, hope, and weariness. So yes, maybe I tend to treat myself a little too often. Yes, I probably do have a baking problem. And no, I don't find your misguided quips about suicide particularly funny. I was in that mental space half a lifetime ago, but that's a blog post for another time. This one appears to be a plea for just a little sensitivity from those who work outside of healthcare towards those who do. Or towards people in general. I've heard it's good for you.

PetSafe Egg-Cersizer Meal Dispensing Cat Toy

After a visit to the veterinarian, it became clear that my kitty needed both diet and exercise. A minor, but useful, aid presented itself in the PetSafe Egg-Cersizer Meal Dispensing Cat Toy.

The Egg-Cersizer is, evidently, an egg-shaped toy that can be filled with food pellets. It consists of two halves. The top portion can be broken down into two parts: an outer layer with three quarter-sized, fixed openings, and an inner, movable layer with five openings. By adjusting the inner layer with the dial at the top, you change how much the openings in the two layers overlap. In other words, you can change up how a) how many openings you use at a time (max 3), and b) how large/small to make them. I started off using three openings at half-size, just to acclimate my cat to the new method of feeding. Once she got the hand of it, I adjusted it down to two openings, then one. After a month or so, I started using one opening at the smallest setting that will still allow pellets to come out.

Silicon Power 64GB Firma ZN F80 USB 2.0 Flash Drive

After my last *free* flash drive died an unfortunate death of causes unknown, I began using Dropbox as my main means of accessing files on the go. Recently, however, I had to give a presentation at another facility and was paranoid enough to want copies in multiple places and wasn't quite sure that a hospital computer would have an SD card reader. Thus, the need for a new flash drive.

My requirements were space, so that I could store all of my reference articles; ease of use, since nothing is more annoying than something easily lost or stuck in the USB port; and aesthetics, as I like pretty things. After an inappropriately long time scouring Amazon, I finally came across the Silicon Power 64 GB Firma ZN F80 USB 2.0 Flash Drive.

This product is the winner of multiple awards, and it was quickly evident why. First off, it's small. After years of clunky, chunky flash drives, I was surprised by one measuring less than two inches or so in length. Next, it doesn't require a cap. I've lost more covers to things over my lifetime than I care to consider, so this was a definite plus. Users on Amazon swear that it is actually waterproof, as stated. One mentions sending it through multiple washer cycles. I like it too much to test that theory, but I'll take their word for it. The circle on top is easy to thread through a key chain, or in my case, a carabiner. No messing with needle-size openings and embroidery thread here. The same opening makes for a convenient grip when removing from USB ports.
 
As someone who hates dealing with instruction manuals and set-up guides, I was glad to find that all I had to do with this flash drive was plug it into the port, let the driver install itself, and then save away. (Note: an internet connection will be necessary so that your OS can find the drivers for the self-install.) The saving process is incredibly fast, enough so that I could work on my Powerpoint directly from the drive without any noticeable lag time as I (compulsively) saved. One less thing to store on the desktop. The 64 GB storage is also pretty amazing, especially when the price tag is in the neighborhood of thirty-four dollars, plus free shipping if you have Amazon Prime. Not too shabby.

Lastly, this drive really is fingerprint- and scratch-proof. I had it in my pocket with keys, and it still looks like new. No fingerprints, either, which is remarkable since I had my grubby paws all over it as I worked on my presentation between flight delays, multiple airports/layovers, and a brief train ride. Color me impressed.

All in all, the Silicon Power 64 GB Firma ZN F80 USB 2.0 Flash Drive was absolutely a worthwhile, durable purchase. It gave me one less thing to stress about in the midst of a hellish travel day. Just make sure you keep it attached to something, or it may get lost.

Travelogue: Thailand, Day 4

This marked the beginning of typical tourist behavior. After all of the transportation issues getting to Hua Hin, I was reasonably nervous about taking the train and river boat to go sightseeing. After breakfast, I slapped on a brave face and stepped out.

Riding the river boat express was surprisingly interesting. First off, it was a different way to travel, though the water was dirty enough that I felt no desire whatsoever to go wading. Secondly, it revealed the strange juxtaposition of dilapidated houses made of metal sheets and fancy international hotels. Both abutted the waterfront, thought the latter had more formalized piers. While announcements on the boat were made in English by loudspeaker, it was difficult to understand what the guide was saying, and I had to rely upon signs at the piers again to figure out where we were / how much farther we had to go. In the end, I got off by Wat Pho when I meant to disembark by the Palace. Whoops.

Wat Pho
The reclining Buddha has to be the largest golden statute that I've ever seen. Even its toes were inlaid with mother of pearl! Guests had to put on green robes if their clothes revealed too much skin, and everyone had to take off their shoes to enter.



While the giant Buddha is the main draw for tourists, there is actually a lot more to see at Wat Pho. If seemed like the more that I walked around, the more that I discovered to admire and examine. Not bad for THB 100 entrance fee...they even give you a free bottle of water!



Eventually, I managed to see everything I could want...or rather, I lost interest. It happens. At that point, I decided to walk the two miles to the National Museum, taking a detour through a university campus to see their view of the water. After attending college on a stereotypical (but of course, very lovely) Ivy League campus, it was incredibly different to see Thai-style academic buildings. As jarring as it was, that's probably what they think when they visit the States, so there you are.

National Musuem
This was my original goal when I set out for the day. Despite the small size of the campus, there's actually a good amount of artifacts stored. The Naga featured prominently in pieces of balustrades and other stoneworks set out for display, though some of them were rather worn :( After a lap outside examining those and a few carriages and cannons, I ventured inside for more protected pieces.

I'm pretty sure my eyes started to go after a while from all of the gold. From chariots to funeral urns, it seemed like everything was covered in it, at least in the first building that I entered. The workmanship was amazing, though!



Moving into the Buddhist relics, I was caught between a rock and a hard place. On the one hand, I'm morally opposed to the use of elephant ivory for human purposes. On the other, one has to acknowledge the skill that went into carving out these tusks. I'm still slack-jawed looking at the pictures.



The day ended with dinner at noodle cart. My wallet was basically empty as I settled down on the dirty plastic stool and ate noodles and bean sprouts made by a vendor who was definitely not wearing plastic gloves. Oh, the horror. It's interesting how my standards for sanitation drop precipitously whenever I travel to Asia. The meat's been sitting out in 90+ degree weather, and the vegetables were handled by unwashed hands, but so be it. My stomach was full and happy, and all's well that ends well. For the equivalent of $1 USD, dinner outdid a burger from McDonald's any day. :)

Overall, I'd say the day was reasonably productive. Not as jam-packed as many another tourist's, but it was a reasonable pace, rather than the stressful "go go go" that often occurs on foreign vacations. Thank goodness.

Travelogue: Thailand, Days 2 - 3

Originally, I expected to write a single entry for each day, but after ending Day 2 with an experience that was awful, yet character-building in retrospect, I had to temper it a little with an outstanding third day.

Most of the morning of Day 2 centered around settling into a new environment. Breakfast at the hotel was great. Then, I ventured out into the streets and realized what I probably should have done for breakfast, mostly from a cultural and cost-saving standpoint:



Moving on...like New York, Bangkok seems to have an awful lot of scavenging birds. And then you notice where the rice came from...



These same temples are placed within half a block from both Christmas trees and culturally correct Ronald McDonalds. I was a little confused, but shrugged and accepted it after taking a few pictures that probably pegged me as "tourist" even from far away. Camera aside, people kept assuming I was Thai and greeted me accordingly. Awkward.



After a rather yummy lunch at Erawan Tea Room, I made a series of mistakes that essentially destroyed the remainder of my day. For one, I chose to save the equivalent of $1 USD and walked to the MRT station to Hualamphong Train Station. By the time that I finally found the station and boarded the subway, I was a hot, sweaty, flustered mess. This proved to be unfortunate when I chose to take the train staff's word for it that my train was at 1535, instead of 1515 as stated online, and 1510 as stated on my ticket. After chatting 2 hours with a backpacker from New Zealand as I waited for my (presumably late) train, I boarded only to find that instead of the express, I was on a regular train that would take twice the time to arrive at Hua Hin. Since seats are assigned, I was essentially bounced from train car to train car until I was finally dumped in an open bench in the lowest class train car, which was what I had chosen to pay for. The lesson has been learned: at a certain point, saving money isn't necessarily worth it. The benches were essentially wood wrapped in broken vinyl, the light made me think of horror films, and the open window, with its tilted metal shade, let in more than one mosquito along with its lovely, contacts-drying breeze. Without any overhead announcements, I sat for six anxiety-ridden hours, terrified of falling asleep and missing my stop. At each train station, I had to stick my head out the window to catch sight of the one station sign that may or may not be anywhere near my train car.

By the time that I arrived at my bare-bones hotel room, I was about two incidents short of a panic attack. Looking back, I suppose that it was good to experience cheap travel firsthand, and to discover that such mistakes can happen and I'll still be alive, healthy, and safe at the end of the day. In any case, I forewent the night market across the street and settled in for a rough night's sleep on a mattress with very palpable springs. In the morning, I woke up and discovered that I forgot to pack a breakfast and an extra shirt.

You may recall at this point the hour-long, sweaty walk and six hour train ride from the day before. Smelling my shirt, I certainly did. With an hour to my scheduled pick-up time, I decided to wash it out with hand soap in the sink. After the water finally ran clear, I proceeded to wring the shirt out until my fingers hurt, then rolled it up in a towel and stomped on it in order to pull out whatever liquid I could. After that, I swung the shirt around and around in the air like a maniac until it was only reasonably damp, at which point I decided "screw it" and put it on. I then inhaled a random candy bar sitting in the bottom of my bag.

After checking out, I sat in the hotel lobby for over an hour, waiting for the ride that never came. The lady at the front desk of the hotel tried both numbers that I gave her twice, only to find a busy signal with each attempt. At this point, I was starting to regret this whole venture. In another ten minutes, I tried again and finally got through. As it turned out, the driver had gone to the wrong hotel, and it would take 20 minutes or so for someone to get me. Fabulous.

One taxi ride later, and I finally arrived at what would end up being the highlight of my whole trip: the wildlife rescue centre. Here be rescued primates, cats, bears, birds, and of course, elephants.



It seems that Thailand's sense of wildlife protection is pretty shoddy, as the government doesn't particularly care about the non-native species that many have taken on as pets. Not shown are a monkey shaped more like a chihuahua thanks to the tiny cage in which it was housed; a young male elephant resigned to a lifetime of celibacy as the rescued females are all old with bad backs that would not support being mounted (thank you, elephant-riding tourists and illegal logging industry); and a gibbon left on her lonesome after her mate and baby were taken on a government raid. The staff provided a very thorough tour and know each of the animals and how they were rescued. I met two lovely couples from England and Germany during lunch, and together we walked with one of the elephants, bribing it along with fruit, and gave it a standing shower. After a quick visit to the other elephants on the compound, along with a first-hand view of monkey feeding time, they left and I received the rest of the tour that I had missed from one of the long-term volunteers. Three hours later, I was back at the Holiday Inn Bangkok.

Perhaps it would be prosaic to call this two-day venture "life-changing", but I can't think of another phrase to truly describe it. Others, including "horrified", "heartbroken", and "appalled" don't quite cover the more life affirming aspects of spending a day surrounded by those who seek to rescue these creatures and, if possible, rehabilitate them so that they can rejoin their wild counterparts. It's shocking how the tourism industry can really wreck local ecosystems and hurt animals, and seeing it in person makes me want to be more responsible as a traveler. My stomach turns as I realize that these atrocities are occurring in places besides Thailand, and we're likely feeding into them without realizing that they're even occurring. Time to hit the books, I suppose.

Travelogue: Thailand, Day 1

As a new resolution involving adulthood and independence, I've decided to start taking international trips on my own. The first was intended to be a visit to Machu Picchu, but with the arrangement of a friend's wedding in Thailand, those plans were put on hold. And so, I submitted myself to what amounts to 7 days in a foreign land, with 30 hours of travel each way.

It's telling how long it's been since I've traveled to a country besides Canada. First off, the movie selection has improved drastically, which is critically important on 13.5 and 6.5 hour flights. I managed to work my way through most of the animated features on my "to watch" list, along with other random movies such as Man of Steel. If I'm staying up >24 hours in hopes of preempting jet lag, at least I should make good use of my time, right? Well no, not really. With USB and standard wall outlets on the back of each seat, actual productivity is also an option. My jaw dropped when I realized that I could review Thai phrases off my phone without sucking the battery dry. Oh, happy days.

Over the course of said super long flights, I was able to meet other single female travelers, which took a great load off my mind. To be honest, the thought arranging activities, managing money, and coming up with worst-case-scenario contingency plans, I managed to work my way up to the panic that hits Type A people when they realize that the "best laid schemes o' mice an' men gang aft a-gley." So there we go. The woman beside me for the longest leg swapped travel tips that she had gleaned from her own research. These ultimately turned out to be helpful when my taxicab driver required prompting to turn on his meter.

As a sidenote, the food options at Tokyo Narita Airport is pretty fantastic. Too bad my body was convinced that it was 2 am and felt like it had recently been run over by something heavy.

The hotel was perhaps a surprise. I walked in the door to discover that one corner of the restroom is formed by a combination of window and wooden blinds. Granted, my friend will not be joining me until later this week, but it just seems a little odd, unless you're working under the idea that visitors are couples or singles and really won't care. For now, I suppose I'll enjoy the sight of a vacant hotel room as I stand under the rain shower head...right. Really, the shower and the bed were the highlight of my day. While the latter is heavenly soft, to be honest, I could probably have slept on a wooden bench and been fine, if only because I could finally stretch out. It's the little things in life =)

Speaking of little things, internet at this hotel costs 200 THB/2 hours, so I suppose this will have to be cut short. More to come!

Lennox Double Scarf

New scarf pattern posted! The inspiration for this pattern came from the DIY Braided Scarf on Life Like Honey.

A sophisticated twist on the infinity scarf, Lennox Double Scarf features a wide band seamlessly joined to a thick braid. It may be worn long or doubled over for extra warmth.

Size: n/a
Gauge: 1” = 7 stitches

Materials: US 4 circular or double point needles cable needle 2 stitch holders 2 skeins Plymouth Sakkie yarn in stone (or any sock or fingering weight yarn)

Purchase Pattern in Ravelry Purchase Scarf on Etsy

Frozen Cake Batter Custard

For Memorial Day, my cousins and I decided to try a hand at homemade cake batter ice cream. The final result was, as one of them put it, "better than Ted Drewes", but not necessarily cost-effective given the ingredients, effort, and equipment involved. While some basic ingredient costs are unavoidable, the cake batter mix is somewhat negotiable. I'm on a quest to cut back on processed foods in my diet anyhow, and so, I decided to see if making the custard completely from scratch would save anything. Here's the final cost breakdown per quart:

Commercial Cost:$10 (estimated)Semi-Homemade Cost:$3.75Homemade Cost:$3.25
The final conclusion is that making the cake batter mix from scratch doesn't save very much over its semi-homemade counterpart. With that said, it's one less item to purchase and one less "bulk" bag to keep in the pantry until you find a way to use it up. You also get to escape all of the preservatives that keep the commercial mixes stable at room temperature. Don't ask me about the calorie count; I get an anxiety attack just thinking about it.

Of note, there is the potential for the cost to drop even further with cheaper ingredients. I chose to use cage-free eggs and organic milk and butter since the regular stuff makes my skin itch.

Here's the final recipe.:

Frozen Cake Batter Custard
Prep Time: 10 minutes
Cook Time: 20 minutes
Total Time: 10 hours

Ingredients:
Cake Batter Mix2 tablespoons granulated sugar1/2 cup all purpose flour1 tablespoon cornstarch1 pinch salt1 teaspoon baking powder3 tablespoons butter, cubed
CustardCake Batter Mix1/2 cup granulated sugar2 egg yolks2 cups heavy whipping cream1 cup milk1 teaspoon vanilla extract
Directions:Combine all cake batter mix ingredients in a food processor. Process until mixture resembles fine crumbs.Whisk egg yolks and 1/2 cup sugar together until yolks start to lighten.Pour all ingredients into a 3 quart saucepan. Whisk until smooth.Heat custard, whisking constantly, until temperature reaches 160 degrees Fahrenheit. At this temperature, the batter should thicken and become smooth. DO NOT BOIL.Remove from heat and cool to room temperature.Refrigerate for at least two hours until custard is cold.Pour the chilled custard into your ice cream maker and follow the instructions for your machine.Freeze in refrigerator for at least four hours.
Makes 8 servings.

DIY Foaming Hand Soap

I recently made the conversion over to foaming hand soap from the usual gel formulation. It spreads easier; it washes off better; and the five year old in me loves the bubbles. An article that I read months ago said something about it being better for your pipes as well. Unfortunately, each pump pulls out a greater volume — try both dispensers and you'll see. Why does this matter? Cost.

I'm a little obsessed with eco-friendly products and conservation, so two of my favorite product lines are Method and Seventh Generation. Method has a wide array of scents and colors, but 1 litre of gel hand wash costs the same amount as the foaming solution, and both are significantly costlier than, say, Softsoap. This presents a good place to cut a few corners.

西瓜牛奶 (Watermelon Milk)

Summertime supermarkets have watermelon in abundance, a fruit that my mind associates with the watermelon milk that I drank aplenty in Taiwan. Now, one of the toughest parts about living in the Midwest is the difficulty in obtaining so-called "ethnic" foods (#firstworldproblems, I know). Anyway, I was chopping up watermelon today and decided that if I can't buy it, I might as well make my own. Added bonus: watermelon is currently dirt cheap.


Watermelon Milk
1.5 lb (~680 g) seedless watermelon flesh (approximately 1/8 of a large watermelon)
1 cup milk

Makes 2 servings

Step One: Cube the watermelon flesh and place in blender with milk. I chose to use 2%, though whole milk would probably have been more effective. I wouldn't use skim milk, as it would throw off the mouth feel; you want the final product to be a little creamy.


Step Two: Blend. I used the "liquefy" setting, though you could probably get away with puree. As you can see, the blended product is a little foamy, which leads us into Step Three.


Step Three: Strain with a fine sieve. I set mine over the same bowl that I used for collecting watermelon, mostly because I hate washing extra dishes. This step isn't absolutely necessary, but straining produces a cleaner product. Someone more creative than I am could probably think of a good use for the watermelon foam; as for me, it's headed straight for the sink.


Step Four: Pour into glasses and enjoy! (Note: Variations include using almond milk or soy milk instead of regular moo juice. If your watermelon is ripe, you shouldn't need any extra sugar.)