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Dear all,

Hello all, I survived my first week of surgery! Although it was in the SICU, so it has been like medicine 2.0. But anyway, let’s get on with the show!

We had orientation on Monday, and learned surgical knots and sutures. The former seems like glorified shoelace tying to me…

My schedule for surgery is 3 weeks SICU, 2 weeks surgical oncology, then 1 week each of anesthesia, urology, and ENT. Then 2 weeks of Emergency medicine. Then I’ve given myself 3 weeks to focus on Step 2. AND THEN I’LL BE A FOURTH YEAR HOLY CRAP.




(If I’m not eaten alive on surgery first.)

On Tuesday, I began my rotation in the SICU. I’m with one of the most beautiful girls in the class for over half of surgery, so I’m always confused when people confuse the two of us. One of the interns went so far as to say, “It’s not fair that they sent us identical twins!”



The SICU is usually really busy, but this first week it was really slow. We had 3 patients on Tuesday, 4 on Wednesday and Thursday, but that bumped up to 8 on Friday (post-St. Patrick’s Day shenanigans), and then back down to 5 on Friday. It takes care of patients who have complications who need surgery or are post-surgery. Like, they’re hemodynamically unstable with low blood pressure, or need ventilation support, or – in one case – had to have a procedure aborted before closure, and thus their abdomen was just packed with gauze and then covered with more gauze, and kept on the floor until his blood pressure was stable enough to suture him closed. That was fun.

Otherwise, I have yet to scrub into a single surgery, and that’s fine with me, haha. The less OR time, the better…I’m perfectly happy rounding.

On Wednesday, I went out for bubble tea with Jas and Sarah, because I was long overdue for some girl talk. And just last night, I watched anime with Van, because pizza, hard cider, and Black Lagoon and Jin-Roh make for a fantastic evening.

But between those days it was…dun dun DUN! Match day for the class of 2016! Yay! Congrats to all my friends in the 4th year! As is tradition, they made a parody music video, which can be found here: https://www.youtube.com/watch?v=GAIohwJjXPE

I hope to participate in our class’s video. Probably not choreography and definitely not singing (HAHAHAHAHAHA NOPE NOPE NOPE), but I think I could lend a hand with lyrics. I’m pretty good at writing parodies. =P

But the best part of this video is Dr. Dhamoon shaking his head while saying, “Rounds can be forever.”

Because his head shaking was what I was thinking all yesterday, when I was on call. We had 6 patients, and a “substitute” attending since the one that we had had all week had to do an emergency surgery and was allowed to nap all morning. And this attending took, like, 4 hours to get through half of them. It was…tiring. Our net displacement the whole morning was maybe 5 meters.

When we FINALLY got through the list (BY 2 PM), I stood by the residents while they wrote their notes, and did practice questions on my phone. The intern paused typing and looked at me.

“You know, you can – ” she began. I waited for the two magic words “go home”. Instead, she said, “Sit in a chair.”




Then I went to the bathroom, and when I came out, all the residents were gone. I was kind of confused, but stayed in the area like a lost child. 45 minutes later, the senior comes back and scolds me for not joining the surgery they were in.


Well, I guess it was my fault for not asking the nurses where the residents went. Or being proactive and going to the OR myself. Whatever, at least I know now.

I was dismissed, and went home while humming “Shut up and Match with me” and wondering what fate awaits me in one year. But for now, let’s get through the next couple of months, haha.

Most Sincerely,
Annette Liem

~Sarcastic Quote of the Day~
Me (Chinese): Hey, have you seen Josephine (Korean)?
Patrick (Chinese): No, but I found Victoria (Chinese). Does that count?

Attending: He’s already on 2 broad spectrum antibiotics. Give him another and it’ll be like spitting in the ocean.

Me: So this anime is called "Danshi Koukousei no Nichijou" or "Daily Lives of High School Boys" -
Van: That is the most Annette anime I have ever heard of.
Dear all,

And Pediatrics is done-zo! Well, assuming I passed the shelf. Which, for a specialty that says it’s not about “tiny adults”, there were a whole lot of questions that were just general medicine…

Anyway. This week was pretty chill. We had the practical exam on Monday, but it was an adolescent (freshman hired from Syracuse University, probably) and her mother. Hard to take seriously.

We had a lot of “recap” classes, and before I knew it, it was Friday and exam time. That was a blur. I usually forget exams right away, though, so no surprise there…

The evening was fun, though! My roommate and I FINALLY were able to eat dinner together. Seriously, in the one year we’ve been living in the same apartment, this is the one weekend that neither of us had outstanding commitments or were going home. So yay! We went to Modern Malt downtown, which was recommended to me by two people on two different occasions. It’s pretty much like the name says: a modern twist on burger and shake diners of old. We both got burgers and shakes and after eating, rolled ourselves home with leftovers. So. Much. Food. And reasonably priced, too! Will definitely go there again.

Friday night and Saturday morning involved me crying while playing Fire Emblem. It took me that long to beat Chapter 10. And now I’m working on Chapter 11 and asking myself why exactly I find this game fun. Is it just because I’m a masochist and I secretly LIKE restarting chapters over and over again because RINKAH HAD A 80% CHANCE OF HITTING, BUT SHE MISSED, SO SUBAKI TOOK AN ARROW TO THE KNEE AND DIED. (That was probably my worst go at it…)

Since the weather was super nice Saturday afternoon, I decided to go for a walk downtown and enjoy the sunshine (before surgery starts and I’m deprived of sunlight for 8 weeks). But then I quickly realized there was a parade going on. And, you know, crowds and I don’t get along, so I spun around and walked back to my apartment to play more Fire Emblem.

But I didn’t just sit around playing video games all day. I went to a friend’s place to play board games, too! Then I watched anime! And today, I went grocery shopping! I should do laundry, too…and fill out away elective paperwork…and look at what stuff I need to bring for surgery orientation tomorrow…ugh. I think I’ll just play more Fire Emblem instead.

Sorry this one’s pretty short, but a girl’s got priorities! I lost an hour of game-time too, so I have to make up for it somehow. See you next week, for the start of the last (!!!) arc of third year!

Most Sincerely,
Annette Liem

~Sarcastic Quote of the Week~
Attending: It’s National Pancake Day! Free pancakes at IHOP!
Resident: *rolls eyes* It’s International Women’s Day, too.
Attending: So I can get a free woman?!
Dear all,

Well, it took four weeks, but I finally got sick from those meddling kids. Or it was from my attending, who had recently been sick with viral gastroenteritis. One of the two.

Anyway, before I go into those glorious details, lemme tell you about this week on outpatient pediatrics!

Actually there was nothing too interesting that happened! Except on Wednesday, we had some preventative medicine thing where I followed a nurse around for “lead visits”. And by that, I mean I came with her to the family of a child whose lead levels had recently risen, to try to figure out why.

First, we had a lecture on lead, and I learned that a brand of ginger candy I used to buy a lot during my time in Montréal has lead. I panicked and asked the social worker if that had anything to do with how derpy I am now. She said that as an adult, it probably wouldn’t do anything to me. I was already neurologically developed (LOL that’s questionable), plus the amount wasn’t that much. I would have to be eating an entire bag every day in order to have any ill effects. Also, as long as I had a good diet with vitamin C, which would bind the lead for its excretion, it would get pooped out anyway. Well, that’s good news. Still have to find a reason for my derpiness, though.

After the lecture, a nurse drove me to the child’s apartment while giving me a rundown of the young girl’s history. Dad wasn’t in the picture, mom was raising her on a minimum wage job. Her levels were initially 80 mcg/dL, which is WAY above the norm. (For the record, there is no “acceptable level of lead” as in we want the levels to be 0, but as that’s probably impossible for living in Syracuse, they set the normal to anything below 5.) With treatment it went down to 30, but now it was up to 40 again.

They lived in a pretty dilapidated building. The buzzers didn’t work so the nurse had to literally yell at the 2nd floor apartment to get the mom to hear us, and come down to unlock the door. She smelled of smoke, and when we got to her apartment, I saw the ashtray piled high with cigarettes. The window was open – which is why she was able to hear us – so I can only assume she was at least airing out the living room, which contained a small standard-definition TV, and an air mattress with two pillows and two blankets.

The kid was super playful, though. She kept bringing me her “treasures”, these little knickknacks that she kept in a cookie tin. I remembered having similar things in my own special box. They were nothing more than marbles or other small toys – I kept uncooked pasta in there at one point – but they were magical to me.

As I played with the kid, the mom confided in the nurse that she was being charged with petty larceny for stealing milk and bread from the corner store. My heart sank. She was just trying to feed her child. I wondered if my parents would do the same thing if they were in her position, or if they couldn’t get jobs as immigrants in the 80’s. But I had been raised in a single-family home with running water and heating, with my own bed, thanks to my hardworking, law-abiding parents. I’m not saying I had a good childhood because my parents are better people than this single mom, though. Just wondering how different our circumstances are.

We checked out the rest of the house, trying to find a new source of lead that could have made her levels rise. The mom told us she hadn’t gotten any new toys or anything, and the landlord swore up and down that this apartment did not have lead paint. So we left without figuring it out. W-what?! Really? After all that we’re just going to leave?!

Actually, it kind of made sense in a way. See, lead can be stored in our body tissue for years, and slowly leech out. So even though she did get chelation therapy, it wouldn’t have gotten the stuff in her bones and such. So, her levels could have risen from either new exposure OR it being released from her stores. So, they were just going to monitor her levels, and give her more chelation if it got too high.

I still wasn’t too happy, but we left after that. I got back to my nice apartment (paid for by my mother), microwaved some lunch (made for me by my mother), and ate in silence, grateful for everything I had.

The rest of the week passed by in a blur of well child visits and acute illnesses. The weekend came as a much needed reprieve…or so I thought.


I had felt off-and-on crappy during the week. I went to bed on Tuesday with body aches, but when my fever broke in the morning I felt well enough to do the lead thing and go to clinic. But on Saturday, after eating a pretty benign breakfast of peanut butter toast, I vomited. Uh, okay. That’s weird. I started to get a headache too, so I just decided to take it easy and do some Case Files while drinking ginger tea, which was hard because after each page I had more and more malaise.

A few hours later, after I took a shower and felt a little better, I decided I would nibble on some toast and see what happened. I immediately lost my appetite after just one bite. ONE BITE! Usually I can nom a piece of toast in ten seconds flat, but I had only gotten the tiniest corner piece before feeling sick. Five minutes later, I vomited it up, along with carrot chunks that came with a fishy aftertaste. Ugh, gross, that was my dinner from Friday! By now, I was convinced I had viral gastroenteritis. I remembered learning about it on Thursday; first comes the vomit, then comes the diarrhea. Fantastic. I threw the toast away, declared myself NPO, and took a nap, which lasted almost all of the afternoon. (I also warned my roommate, and Clorox’d the hell out of the toilet and sink.)

When I woke up, I vomited up more fishy-tasting tea. You know, ginger kind of burns on the way up…

My mom suggested Zofran. As much as I love stealing things (wait wasn’t I just talking about petty larceny a couple paragraphs up), I didn’t feel well enough to go to the hospital just for that.

My sister suggested Pedialyte to ensure I was hydrated. (In case it wasn’t obvious, she’s a pediatric nurse practitioner.) Like I have Pedialyte in my pantry…but I did walk down to the 2nd floor vending machines to buy Gatorade. That was all the physical activity I was capable of. I probably looked like crap in my red bathrobe, unbrushed hair, and Pikachu slippers, so luckily I didn’t run into anyone.

My sister advised no more than 1 sip every 10 minutes, so that’s what I did. I went to sleep early because I felt terrible (and also I kept dying in Fire Emblem), with my garbage pail right next to me in case I couldn’t make it to the toilet in time.

I woke up feeling a lot better. I dared to eat an orange for breakfast, and hey, no vomit (yet). That was about 2 hours ago. I haven’t had diarrhea, but that will probably come soon if it is viral gastroenteritis. If I feel up to it, I’ll eat ramen for lunch. Maybe start with broth first, then eat the noodles if I don’t vomit anymore…

Speaking of food, though, it could also have been food poisoning. I doubt it, since nothing is new, but I might have to clear out my side of the fridge just to be safe.

But for now, I’d better get as much work as I can get done now, before I’m sitting on the toilet for extended periods of time. I’ve got my shelf on Friday (eek!) and a write-up due tomorrow…

Most Sincerely,
Annette Liem

~Sarcastic Quote of the Week~
*text convo with Patrick*
Me: Just stay away from me if I end up going in on Monday.
Patrick: I always try to stay away from you…
Dear all,

Good morning, everyone! Happy almost-March! I finished my third week of pediatrics – meaning I’m only 2 weeks away from the exam. Yikes…that’s frightening. Anyway, let’s get on with it!

Monday and Tuesday were my last days inpatient. Huzzah! Of note there was a 3 year old girl with new onset hypothyroidism, when her only complaint was chronic constipation. No other signs or symptoms. I did research on it and apparently it’s very rare that that will be the only symptom; you’d have to test TSH and T4 in over 1000 constipated patients, racking up over $18,000, in order to find the one with hypothyroidism. But yet, that’s what Upstate does in any kid with constipation, and my attending and senior said this is the first time they’ve ever actually caught it.

On Wednesday morning, Patrick and I went to the newborn nursery to see three one-day-old babies and perform some screening tests. Mainly, the ones for congenital hip dysplasia (Hey, that’s what I had when I was born!) and checking for sacral dimples. When we were checking one young man’s, he started passing meconium, or “baby’s first stool”.


The attending said the one saving grace of meconium is that, since there’s no gut bacteria, it doesn’t smell. So hooray! We cleaned him up until all the green poop was gone, then I was given the pleasure of giving him a new diaper.


See, I’m the youngest of three. I didn’t babysit as a teenager. I played with dolls a little as a kid, but it was more like “okay so this is the princess and she’s going on an adventure la-ti-dah” stuff instead of playing House. So I had never even held a diaper before, let alone put it on a little squirming infant.

Although I put it on pretty easily. The attending came over to check my work, asking if we had checked the femoral pulses. Since we got distracted by the poop, we hadn’t. But then he noticed that I had put the diaper on backwards; the flaps are supposed to be brought to the front, not the back…


But you’re also not supposed to cover the umbilical cord (which doesn’t fall off for a 1-2 weeks), or else it gets “all grimy and gross” as per the attending. Good to know!

I did much better at burrito-wrapping them, though! I want someone to burrito-wrap me, too…

In the afternoon, we went to the outpatient clinic…which is conveniently right across the street from Geneva Tower. Hooray for going home for lunch! The clinic sees mostly underserved patients, so lots of refugees, people who can’t speak English, etc. But kids are kids no matter what country they come from. Wednesday afternoon was shadowing, but I was able to see patients one-on-one on Thursday!

For some reason, many mothers commented that I could get kids to smile when they usually don’t smile. It’s probably because my mental age is closer to a child than an adult, haha.

On Friday morning, Patrick and I went to the day care center that’s primarily used by Upstate students and staff. We were supposed to be checking developmental milestones…but I ended up just playing with them. Which, actually, is a great way to check developmental milestones.

The daycare is divided into newborns (6 weeks to 1 year), “minis” (1 to 2 years), toddlers (2 to 3 years), and then pre-K (3 to 4 years). I ended up reading to kids in the pre-K room, which was great, because books are awesome!

But then one girl sneezed in my mouth. Then laughed.

I hate kids. >_<

In the afternoon we had lectures, so no outpatient. That evening, I went out for hotpot for one friend’s birthday, and I came home very rotund! Man, I love hotpot…

My mom visited on Saturday (so that I could get groceries, since I’m carless), and she left this morning so I could continue my studies. Ughhhh…I’m averaging 60-70% on Qbanks. When I told Dr. Botash that at my feedback session, she told me I should study harder. ^_^’ Th-thanks, I thought that was pretty good for midway through the clerkship, but okay, I’ll try to do that.

In other news, I have been stuck on Chapter 5 of Fates. I thought I was ready for the “hard” difficulty! ;_; Maybe I’m not after all…well, a couple more tries won’t kill me. (But it WILL kill the virtual Kaze a whole bunch. Hahaha…oh well.) Also, Pokemon Sun/Moon is coming out in “holiday 2016”. Soooo…guess what I’ll be doing after I’m done interviews! Hiding in my room and not coming out until I beat the Elite 4. I wonder if this one is the edition that will finally combine all the regions into one super awesome game! If so…I might be playing until I’m a first year intern. =P

Well, that’s it for this week. I think I’ve deserved some lunch, then I’ll start “studying harder”. Whatever that means…see you next week!

Most Sincerely,
Annette Liem

~Sarcastic Quote of the Week~ (I missed last week and the week before that, but I’ve only two funny quotes so meh)
Attending: Even though Upstate does THIS, I want you to know THAT, not just for your exam, but so that you know what to do when you go to a NICE place for residency.

*conversation I have with myself every time I put makeup on*
Me: I look like an Asian prostitute.
Me: Those are the best kinds!
Me: O-of Asians or of prostitutes?
Me: Both!
(Note: Please don’t admit me to 4B…sexy-senpai isn’t on service there anyway.)
Dear everyone,

Good morning! This was a really off-week for me, for reasons that I’m not too sure about. It could be due to the fact that our attending and senior resident changed, and it gave more of an “OB/GYN” feel, since we were being ignored again…but still expected to stay until sign-out. So that’s over 12 hours in the hospital now. Not as bad as neurosurgery, mind, but still pretty bad because our senior ignored our texts asking if there’s anything that needs to be done. And apparently this is happening with the Red team as well (I’m on Blue team). So we pretty much end up studying for five hours, which is fine, but I’d rather be doing that from the comfort of my own dorm with tea at the ready instead of in a conference room with peanut butter and crackers that I pilfer from the nourishment center – ER I MEAN WHAT CRACKERS

Anywho, I’m getting better with doing physicals on babies. They’re not that scary after a while, haha. And actually kind of cute?

Although I faced my first anti-vaxxer this week. Luckily for the mother, the child in question didn’t get a preventable bacterial pneumonia; it’s probably viral in nature. But regardless, her smug look when she said she didn’t believe vaccines worked bothered me.

My internal monologue whenever someone brings up the anti-vaccine movement, whether they believe it causes autism or is just a government hoax, is that all physicians need their vaccines in order to get into medical school. Heck, we need them to get into undergrad! And most of us don’t have autism. We’re just a little weird. …Okay, I’m a little weird. I’m probably a bad example, actually. But that’s not the MMR’s fault.

Ugh, I’m gonna get off this soapbox…

On Friday, I picked up my preorder for Fire Emblem: Fates! Woo!!! I actually stood in line right behind two Japanese guys who were asking for it. (Why do they want the localized version? Seriously, just buy the Japanese version; it’s better.) But they didn’t reserve a copy in advance, so I got to feel their jealous looks on me when I proudly presented my receipt. Ohohohoho.

Of course I got the Special Edition that includes all three games (Birthright, Conquest, Revelations), an art book (which is fantastic), and a carrying case pouch. Oh, AND I got not one, not two, but THREE KEYCHAINS (that I didn’t know I would get, so that really made my day).

I played the first three chapters, and it’s different from earlier games because your weapons don’t have limited uses, but good points and bad points. Of course, so early in the game – before you actually start the diverged path – it doesn’t matter. You’re stuck with a Bronze Sword. Also, there are added weapons, like daggers (the butler Jakob uses those and YEAH I’M PRONOUNCING THAT SLIGHTLY DIFFERENTLY TO SOUND LIKE A CERTAIN PSYCH RESIDENT’S NAME) and shuriken (for the ninja!) and there’s a differentiation between katana and swords. Not entirely sure what it is, but it’s there.

On Friday, I also attended our school’s Lunar New Year celebration. This year I couldn’t participate in the umbrella dance due to my schedule, but next year I totally can, since I’ll be a senioritic fourth year who is done with her interviews!

Their dance was really good, as was the Cornell student dance. Plus, their outfits were gorgeous, haha. I probably wouldn’t be able to fit into them this year, actually…but I started running again this weekend, so hooray for me!

I also got lots of studying done, and yesterday I played some board games with friends to relax. Today I have MOAR studying to do, and I’ve got all the tea I could ever want a couple steps away, haha.

So I’d better get back to doing that. On Wednesday, I move to outpatient pediatrics (YESSS), which is right across the street from Geneva Tower (YESSSSS), and doesn’t start until 9 AM (YESSSSSSSSSSSSS), so needless to say, I’m excited~

See you next week!

Most Sincerely,
Annette Liem
Dear all,

(Disclaimer, I finished writing this on Sunday, but didn’t have time to post it, so meh.)

‘Sup everyone! I hope you’re having a great day! It’s Singles Awareness Day, or the day I give my Kawamura Takashi shrine its yearly homemade baked good. For 2016, he got a peanut butter cup filled cookie. He eats well, my husbando. =P

Anyway, onto the show. This week I began Pediatrics, and, talk about life goals, I haven’t gotten puked on (yet)!

For the first half of the five weeks, I’m on outpatient, and the entire time I’m with only one track-mate; he’s going to end up wanting to strangle me on the last day. We had orientation on Monday (which was a rude awakening for me; wait, I’m going to be graded on stuff I do again? Maaaaan….), which was followed by me sadly discovering that Yogurtland is closed, so free froyo day no longer matters. T___T And on Monday the weather was actually kind of warm (which is FREAKY for February, so I’m kind of glad the temperature is now -20 C please don’t kill me), so it would have been doubly as enjoyable.

Well, that’s okay, I ended up getting free food later in the week anyway.

On Tuesday, I was on the floors for the first time! Beginning at 6:30 AM with sign out, then continuing with 3.5 hours of “see your patient” time before rounds.

S-so, just walk into a patient room, right?

Man, it’s been a while since I’ve had unsupervised patient contact.

All right, I can do this.

The patient assigned to me was a 5 month old with bronchiolitis. After gowning up (this mask reminds me of my days in Japan, LOL), I got the history from the dad no problem, but the physical? Forget about it. I wasn’t really scared of him coughing on me, since I was protected (by mass-produced blue masks and yellow gowns of +100 immunity), but more like…this gelatinous glob (oh, he was like 150th percentile for weight) was moving around and wailing (which worsened his work of breathing; WHY ARE YOU CRYING WHEN YOU CAN’T EVEN INHALE PROPERLY), and he had so many things on him (okay, like one thing, an IV in his arm; STOP MOVING) and you know what I’m just going to read what the initial H&P note said and say it didn’t change.

I did manage to listen to his heart and lungs, which was pretty much it. He was done with me. He didn’t want me touching his belly, or tapping his knees, or heaven forbid checking his ears. I quickly left the room after my one minute flustered physical.

The senior resident was pretty kind about it. He gave me some tips for the next one, so I’ve been doing better since then. I’m still not a master, but I can at least get the kid still enough to do most of the physical. The entire week has pretty much been a whirlwind of learning. It’s hard to get back into “studying mode” but I’ve done some reading and am listening to lectures so I’m not totally sucking at life. Just sort of sucking.

Anyway, on Friday, I had bubble tea with friends followed by a birthday party…where I got drunk off of one can of Raz-Beer-Rita, which is 8% alcohol. Who gets drunk off 8% alcohol?! I literally had to lie down on the floor and close my eyes. But it tasted pretty good. Like, I’d have that again if someone offered it to me. (Just as long as they took full responsibility of me afterwards. Like driving me home and tucking me in.)

And thus, Annette became an alcoholic. CAGE me in a month, okay?

The next day I didn’t have a hangover, which was great because I had some serious studying to do. Plus, today I had call, and I just watched a movie with some awesome ladies to celebrate ABSOLUTELY NOTHING OTHER THAN OUR OWN AWESOMENESS. It was “How to be Single” and shut up.

I’m fine with my 2D men that’ll love me forever. (Especially the free otome games that don’t require you to pay for any routes.) >_<

And with that happy thought, I’m gonna head out. Love you all (in a totally platonic way).

Most Sincerely,
Annette Liem
Dear all,

(Note: That title is directly from Google Translate so I hope it's not incorrect.)

Hey there, this is my final newsletter in Japan. I’m writing it as the days go by so that I’ll be able to post it on Friday morning, right before I leave the dorm for good. So, here’s how I spent my last days here!

Sunday 日曜日 (nichiyoubi)
I ran for the first time in weeks! Man, I’m out of shape! And fat. Ugh, so fat. How many pounds did I gain?! I don’t want to know. T_T I’m not stepping on the scale in my room until I’ve run for at least a week…no, better make that two. Yeah, because that’s when I need to be able to fit into my Chinese New Year Umbrella Dance costume. Ahahahahahahahaha…ugh.

I also did laundry, and started packing for my return. That was…fun, I guess.

Then I took a walk around the city, and went to Wakura Onsen by train. I bathed in the waters that were supposed to make one’s skin beautiful. I’m not sure if it did anything since my skin is as dry as ever. Ah well. It was a nice bath regardless.

I also bought ingredients to make peanut butter and chocolate no bakes to use up the rest of my butter. But now I have leftover cocoa, haha. I’m bringing it back stateside.


I had to use chopsticks to stir the pot, a 400 mL yogurt container as a measuring cup (for ¼ cup cocoa, 3 cups oats, and ½ cup milk; luckily the sugar already came in a 500 mL bag), and the interior of three flattened milk cartons as wax paper. Also, I purchased the wrong type of sugar (it was this powdery white stuff that wasn’t confectioner’s sugar, instead of granulated sugar), and the only oats available were instant Quaker oats instead of my usual old-fashioned rolled oats. It was intense! But actually they turned out pretty okay, and I savored the rest of the Crunchy Skippy with my breakfast for the next couple of days. (In other news, I’m gonna have peanut butter and Rice Krispies as my breakfast of champions for the next couple of days.)

Monday 月曜日 (getsuyoubi)
Today was my “pre-test” day. Arai-sensei wanted to make sure that I actually knew what I was doing with the ultrasound machine and not just blindly swinging it here and there. Ahahaha…hm. But of course, as luck would have it, all the abnormal cases came that day.





Those were fun to figure out. It’s already confusing enough to use the ultrasound when the fetus is in a normal position, haha. But I’m getting the hang of it. The trick is to think logically and not panic. No one is dying (most of the time), and the baby won’t get a birth defect just because you’re temporarily pushing him from side to side.

Tuesday 火曜日 (kayoubi)
This day was memorable because it’s the first time I’ve ever actually been useful! See, it was near the end of the day in family medicine clinic, when all of a sudden, we hear of a patient who doesn’t speak Japanese, only English.


Yoshioka-sensei said that I should do his history and physical, with Miyasaka-sensei as my preceptor. Miyasaka-sensei’s English is very good, so I knew if I forgot to ask anything, she would jump in and ask herself.

When the patient had been roomed, Miyasaka-sensei opened the curtain.

Inside was a 24-year old Asian man, in no acute distress.

Miyasaka-sensei closed the curtain again and turned to the nurse, asking if it was the right room. The nurse said yes, he’s an English teacher for the high school.

In a blink of an eye, I realized that I made a huge career mistake.

I could have taught English in Japan without knowing Japanese?! And more importantly, I could have been surrounded by Japanese high schoolers (focusing on the males, obviously) for my entire adult life?!! Aughhhh…it’s not too late for me though…! I’m still young and I can still change career paths! But, well, I’m a little too lazy for that, so I’ll just stick with this “being a doctor” thing. Though if I really start studying Japanese seriously, I might be able to work in Japan one day too, nfufufufu…

Anyway, out of the “why is Annette such a pedophile” tangent, and back on track. The patient was a Korean-American from California, and he was a high school English teacher who had been teaching in Nanao City for a year and a half. He was here for new-onset non-bloody diarrhea and nausea after eating at kaki matsuri – crap.

That, uh. That’s the same festival I went to on Saturday, isn’t it?

Oh, but you went on Sunday? We’re good, then.

*stares at stomach*

But you know, some diarrhea would be kind of good, too. I still haven’t had a decent bowel movement since my first weekend here. After I wake up (IN MY OWN BED!) on Saturday, I’m going to buy some Dulcolax suppositories and…yeah, you get my drift.

It sounded like your everyday viral gastroenteritis, so Miyasaka-sensei prescribed some probiotics and metoclopramide PRN for nausea. And I was able to write a note! (In English. On a Japanese keyboard. Which has a spacebar smaller than the enter key.) Man, I felt so boss! And the patient looked relieved to be able to speak with someone who responds in fluent English. (Although, to be honest, the first thing I said to him was, “Good eveni – *looks at clock* – afternoon!” But that’s something I would do in America anyway, so never mind.)

I went home feeling very proud of my accomplishment, as if my entire trip was for the purpose of helping ONE guy manage a clinic visit in a foreign country.

But you’re on your own next time, man.

Wednesday 水曜日 (suiyoubi)
GUESS WHAT GUYS?! I PASSED THE ULTRASOUND EXAM! I now know how to measure biparietal diameter, femur length, and abdominal circumference! These are all going to be very helpful…as a psychiatrist…if one of my patients is ever pregnant and trusts ONLY ME with her unborn child. Hey, it could happen. XD

There was also an emergency: postpartum hemorrhage after a cesarean section, losing 3000 cc of blood. Yeah, you read correctly. 3 LITRES. That’s kind of a lot. Especially here, where Arai-sensei says their blood bank is nowhere close to enough should a mass emergency take place. I told him how our school runs regular blood drives, and he was pretty impressed.

Luckily, the patient was AB+, and they had plenty of that in store, and plus Takata-sensei and Ogawa-sensei (new resident) worked fast so they were able to stop the hemorrhage and place a Bakri balloon to combat the uterine atony.

Oh, and the baby was totally okay.

After a long a grueling day, it was time for my goodbye party, 焼肉 (yakiniku/grilled meat) style!

*cue TeniPuri song called “Yakiniku”…if you don’t know it, look it up*

I wish we had this type of BBQ in Syracuse instead of Dinosaur BBQ…don’t get me wrong, meat is life, but I think grilling the meat yourself is so much more fun. And healthier. Then again, Yasuda-sensei was grilling it all for us, and we were sloshing the meat in some type of shoyu and dipping it in fancy salt. B-but I mean, it was still most definitely healthier than Dinosaur BBQ! And tastier too! Who knew that diaphragm (ハラミ/harami) could be so tender and delicious? Mmmm…

After the yakiniku party, we went to the Monterey Jazz café again, because Japanese doctors like to drink, and being the only sober person (aside from Miyata-niisan, who was the designated driver…again) is super fun. =D Although I did enjoy the bourbon-infused chocolates and pineapple soaked in brandy. I’m actually impressed, since I usually don’t like any alcohol in my food…

I got back at, like, 12:30 in the morning (Miyata-niisan drove everyone home because he’s too nice and people take advantage of him for that), took a shower, and slept at 1 AM, and I hit the snooze button until I felt refreshed…at 7 AM.

Thursday 木曜日 (mokuyoubi)
Six hours of sleep? Really? That’s what I’m running on? And somehow doing fine!

It was my last day studying Kampo with Takatou-sensei. I’m leaving with a memoir written by her (in Japanese, so I’d better study up), and giving her my e-mail address (for her son). The kampo stuff is definitely going to help me in the future, so I hope that the second thing bears fruit as well…fingers crossed! (Then I can have a Kampo teacher for life as my mother-in-law! Woo-hoo! Guess I’ll be refreshing my e-mail a million times from now on, hahaha.)

In the evening, I had to pack. My biggest problem was finding a way to fit all my snacks without putting them in danger of getting crushed. Because broken Pocky is sad Pocky (but still delicious). And while I had gotten some room from giving away presents (Rockwell prints), it was only so much room. And I am nowhere as good a packer as my mother.

But the snacks fit!

And I’m heading home.

Friday 金曜日 (kinyoubi)
So, that’s that! I’m making a final stop at the hospital for a teleconference with Dr. Bailey. I’m not presenting though; Miyata-niisan is. I was going to make a powerpoint about the differences between Japan and America in terms of medicine, but Arai-sensei said he’d prefer it if I wrote an essay. So that he can publish it…? And of course I still want to make a powerpoint about my experiences, because everyone wants this exchange to continue from my pioneering adventure, so in the future, students can get credit for it. Not just students though; I think residents could also learn a thing or two about how medicine differs. Just so get a broader worldview, you know?

But if this program doesn’t continue, that’s fine by me. That means I’ll get a monopoly on visiting Nanao City. It’s all mine forever! Mwahahaha!

Anyway, thanks for following my adventures in Japan. I hope you had some fun; I’m sorry for all the poop jokes. And if you didn’t, well, you clearly have no sense of humor because poop jokes are hilarious! I won’t bore you with my travel details (Hey, remember that time I vomited all over myself during landing? How old was I? Oh yeah…23 years old.) so my next newsletter update will likely be after my first week of Pediatrics is over.

…Man. I have to be graded again, dang it. Things are going to COUNT again. And I won’t even have a car to run to Wegmans for a study break, double dang it. (Oh yeah, guys, I’m replacing Quincy with another car. Not sure what kind yet. My dad wants me to get a normal car like a Honda Civic. Can you guys picture me driving something that’s NOT a toy car? Because I can’t.) Luckily I’m on-campus for all of Pediatrics, so that’s not a problem. You know what is a problem? I won’t have a car to pick up Fire Emblem: Fates when it releases on February 19th. Which means I have to beg a friend to drive me to the mall for the sole purpose of buying a game I won’t have time to play until summer (maybe). That, or take the bus. Hm, I’d rather beg a friend. At least then I can pay them back in baked goods.

Plus side of this, I get to actually bake stuff again. Can’t wait to pop banana bread in the oven again!

*stares at stomach*

Uh, maybe let’s go running for a year before we go crazy…

Signing off from Japan for the last time in the foreseeable future,
Annette Liem/アンネット リーム/ 餡子

Receipts (レシト / reshito)
Butter (バタ/bataa): 307 yen (forgot to add this last time)
Peanut butter (ピーナッツバター/piinattsubataa): 591 yen
Oatmeal (オートミール/ootomiiru): 648 yen
Cocoa powder (ココアパウダ/kokoapauda): 307 yen
Caramel latte Pocky (キャラメルラテポッキー/kyaramerurate pokkii): 170 yen
Curry bread (カレーパン/karee pan): 400 yen
Milk (牛乳/gyuunyuu): 118 yen
Wakatama-kun bag (わかたまくんバッグ/wakatama kun baggu): 4000 yen (the mascot of the Wakama City onsen)
Pretz (プレッツ/purettsu): 98 yen
Walnut cake (クルミのケー/kurumi no keeki): 398 yen
Quattro cookies (クアトロクッキ/kuatoro kukkii): 100 yen
Chocolate almonds (チョコアーモンド/choko aamondo): 268 yen
Mushroom/bamboo chocolate (きのこたけのこチョコ/kinoko takenoko choko): 268 yen (they’re not mushrooms and bamboo shoots literally covered in chocolate, they’re chocolate snacks in the shape of mushrooms and bamboo…that apparently there was a fake war over because they were made by the same company, released within months of each other, and taste pretty identical…I like them both okay?!)

Dear all,

Hey there! Didja miss me? It’s been a while. Anyway, let’s get started!

Monday 月曜日 (getsuyoubi)
On Monday, after taking a shower that I desperately needed, then freezing my butt off in my below zero room, I called Arai-sensei who said I should take the morning off to recuperate from the trip. Fair enough. I mean, I did end up sleeping on a train overnight, and not even with a nice bed. So I spent the morning making Rice Krispy Treats for the evening party, and fixing my air conditioner. I literally unplugged it and plugged it back in, and hot air blew out of it again. Ah, simple things work like a charm.

I went in in the afternoon to see some GYN patients and do more ultrasounds. I’m getting better! Then for one reason or another, I was ushered to scrub in for an ovarian torsion due to a dermoid cyst. Whoa, what?!

Seriously though, the thing was huge. Dermoid cysts, or teratomas, are benign or malignant ovarian germ cell tumors thought to be created by meiosis I or II failure. They become huge blobs of ecto, meso, and endoderm and thus look like random pieces of tissue and sometimes teeth. This poor woman had her entire right ovary taken over by the tumor, which had grown until it was 3-4 inches in diameter. After it was removed and cut into for pathology, I saw it was a huge wad of hair with bits of tissue. It was really incredible!

After being responsible for retracting for three hours, it was time for the resident party! Free sushi and yakitori! Woo hoo!

And either people were being polite about my Rice Krispies, or they actually liked them! Yay. It was weird not baking sweets, though. Like, if I don’t get flour on my shirt or have my hands smell like butter for a full day, it feels like something is off, haha.

Tuesday 火曜日 (kayoubi)
On Tuesday I was in the family medicine clinic with Miyata-sensei (the dentist-turned-doctor), a second year resident. He’s really cool in my opinion. I admire people who go back to school after having a profession. You know, people like my mom and sister. It shows dedication and character. I’m pretty sure I’d just give up instead, haha. I’m kind of lazy like that.

But I learned more about Japanese medical training. I knew medical school was 6 years and one could go straight out of high school, but the first four years of that is deskwork. Then the last two years are clinical experiences, like our third year rotations. However, it’s rare for students to have any very-hands-on training with patients. As in, they wouldn’t be able to give injections, and they definitely wouldn’t be able to make an incision during surgery or even suture the site closed.

And Arai-sensei told me that most students don’t really get meaningful patient contact at all, because they’re too busy studying for the tons of exams in 4th and 6th year, then the National Medical Licensing Board Exam in February. Hey, they only have one national exam? Lucky; we have 3! *pout* Of course, I guess their entrance exams and overall classes are harder, but still…

Anyway, after graduating, they have two years of training as interns. This is where they get to actually take care of patients. So it actually ends up being more like our 3rd and 4th year, because they get to choose their own curriculum and do rounds and, like, touch patients and stuff. Hm, that sounds dirty. But you get the picture. Then, after two years of intern training, they have their residency, which varies in length.

So, in summary, going to medical school straight out of high school in Japan is about the same length as having undergraduate school then medical school in America, because of the two-year Japanese trainee period. Guess staying in America was okay too, haha.

Unless Trump is elected president.


In the afternoon I was dumped on Iwata-sensei, another resident. There was a lot of Google Translate used, haha. But there weren’t many patients, because many patients actually cancelled their appointments on account of weather.

Wednesday 水曜日 (suiyoubi)
Nothing spectacular happened in the hospital on Wednesday, but I did end up watching the Ano Hana movie that served as the year-after epilogue for the series. As expected, I cried, but I think it could have been better. Half of it was flashbacks, so I felt a little cheated. (Also, I’ve had this question for a while, but are Poppo’s parents okay with him basically being a high school dropout and traveling the world on a minimum wage salary? Like, does he contact them at all? Where does he live when he’s not in the Secret Base? I only wonder because he’s my favorite character. I mean, he has sideburns, and I’ve noticed that I have a thing for anime guys with long eyelashes. Man, I’m weird. Sideburns and long eyelashes don’t work on real life guys at all. Ugh. I’m going to be single my entire life. Man, this tangent got depressing fast. Time to change the topic.)

Thursday 木曜日 (mokuyoubi)
More Kampo! Oh gods there’s so much to know, I’m never going to remember all this. I should focus on the basics.

Like looking on the bottom of the tongue to see if the veins have any blockages. And feeling the pulse to see if it’s strong or thread. And tapping on the tummy to look for excess water (probably ascites and the fluid wave).

There was also a case of a patient with textbook white coat hypertension. She even had a notebook logging her home pressures (highest being 130/88) and her at-appointment pressures (that day’s was 190/110). It also didn’t help that she was a nurse who was overly concerned with her health. Yoshioka-sensei had seen her last week and said she didn’t need any treatment. But she was requesting Kampo help, so Kampo help is what she got. Takatou-sensei told me that what she prescribed was pretty safe and with a mild anxiolytic effect. I guess this type of Kampo is okay too, haha.

Takatou-sensei also offered some solace into my lack of a love life. She studied in Omaha, Nebraska for 9 years, and in the last two years her boyfriend of 7 years broke up with her…then when she got back to Japan, she married a new beau at 35, and has been living extremely happily. So I’ve got hope!

After lunch, she took me to the 6th floor of the hospital. See, I’ve been really curious about it for the longest time. On the ground floor map, it states it’s the “Keiju Innovation Lab” (in English) but every time I go up there, their glass doors are locked. Except for one time they were miraculously unlocked and I needed to use the bathroom. (That was also a horror manga waiting to happen: protagonist finds a mysterious research lab is open for the first time, then gets magical powers. No wait, that sounds more like a mahou shoujo theme. Man, that’d be cool. But alas, after doing my business, the rest of the doors in the dark hallway were locked, so I was forced to return to the lower floor.)

She pulled some strings and got the doors unlocked for me. Man, Takatou-sensei is awesome. It was actually her first time being there too, haha. The guide took us to the door furthest from the entrance, and led us into a conference room that was brightly colored like an elementary school cafeteria. It was super cute. And in a room connected to that was the main attraction: a simulation center with two mannequins named Philip and Catharine. They had computers hooked up to them so you could practice listening to different types of heart murmurs. They had wrists with a palpable pulse, and abdominal organs to palpate. They had eyes with pupils that would constrict or dilate to light. They had freaking reflexes. It completely blew me away.

Though to be fair, I haven’t seen Upstate’s simulation center in its fullest yet. We might have something even cooler. But I was really impressed with Philip and Catharine and the fact that they let an outsider play with their expensive dolls for a while.

In the evening, there was a resident party! Again! But this time, the only female resident was preparing the food at her apartment. It was a nabe party~

I also tried a sip of super strong Okinawan sake. The single drop burned its way down my throat, and I still felt it during the walk back to my place. No Asian flush from that, though, which surprised me.

Friday (金曜日・kinyoubi)
In the morning, I had to give a presentation to the MCEF team and Dr. Bailey (via Skype). It was on pregnancy and skin-related changes, a topic given to me by Arai-sensei. I learned a lot while researching for it, actually, so I’m glad I did it. Next week I think I have to give another presentation on the differences between American and Japanese medicine that I’ve noticed. That’ll be pretty darn long…

Afterwards, it was GYN clinic with Takata-sensei, and my afternoon was free so I studied more Kampo. My mother is going to buy me a different Kampo textbook (since Kampo doesn’t really change, it doesn’t matter what edition it is), so hooray for having a supportive mother who wants me to learn alternative medicine to take care of her, haha.

In the evening, there was a goodbye party for Miho. That’s right, now I’m lonely. T_T It was a party with the MCEF doctors, so Yoshioka-sensei, Miyata-sensei, Arai-sensei, Takatou-sensei, Takata-sensei, and Miyasaki-sensei (another resident) were in attendance. We went to ICOU, a popular café/restaurant that serves organic food. I went there with the secretaries in my first weekend here for pancakes. There were tons of different foods served, and of course the sensei ordered lots of alcohol. I ordered off the (katakana) non-alcoholic menu, so I could retain my position of sober scribe.

And many fun things happened that I don’t know if the sensei will remember.

Firstly, they started talking about how worried they were about “Miyata-kun” never getting married at 40-something. Then Takatou-sensei brought up how I have a sister 13 years my senior. Everyone got really excited, and Miyata-sensei pretty embarrassed…so I started calling him Miyata-niisan, to everyone’s amusement.

This was almost immediately followed up with Takatou-sensei saying, “Annette, please date my son as soon as possible!” Not really a sentence I’m used to hearing…of course, if her son isn’t interested, there isn’t much I can do about that, haha. Plus there’s the fact that I’m leaving Japan for who knows how long in, like, a week. That’s probably the bigger issue here.

Nevertheless, it didn’t stop Arai-sensei from leaning back in his seat and pointing his wine glass at Miyata-niisan and me, and loudly claiming, “Ah, spring has come!”

A little later, we created (or rather, I announced) my “Japanese name”, which I had been thinking about my entire stay. Since “Annette” means “little Ann(e)”, plus my mother’s name is Anna, I decided on “餡子/Anko”, which means “child of An.” It also means sweet red bean paste, which is why all the sensei burst out laughing when I suggested it. But after I explained my reasoning, it was met with applause. So I guess my maid persona is Momo-chan no more, but Anko-chan! Also, my surname “Liem” was originally “/Lin” in Chinese, which means forest. The kanji “” also exists in Japanese, pronounced “Hayashi” but also as “Rin” in certain situations. So from now on, my Japanese name will be 餡子/Rin Anko. よろしくお願いします/yoroshiku onegaishimasu/nice to meet you.

After I was stuffed with delicious food, half the sensei left so Arai-sensei, Takata-sensei, and Miyata-niisan (I don’t think I’m allowed to call him this at the hospital) took Miho and me to the most popular bar in Nanao: a room with 6 stools and a flat-screen TV. The bartender has the same face as Miyata-niisan, so I called him “Master-niisan,” since in Japan, bartenders are called “Master” because they are in charge of alcohol. They own you, man. You are nothing without them.

Of course, I stuck to oolong tea because I’m a loser, haha.

We were able to request songs to lay on the flat screen, so I indulged and asked for two Japanese songs for me to pseudo-karaoke (by mouthing the words into my glass of tea). I also learned a lot of Japanese singers (and promptly forgot their names, except for Miho’s favorite Fukuyama Masaharu, who is SO イケメン/ikemen/handsome, with a voice like honey).

Sidenote, Japan is the only place I ever will bar hop, haha. And even then, I’ll only stay out until a little past midnight. Mostly because…

Saturday (土曜日・douyoubi)
After I went to bed at 1 PM, and woke up at 9 AM, I had to quickly prepare for かき祭 (kaki matsuri/oyster festival). Miyasaki-sensei and Miyamoto-sensei (a different hospital sensei) were treating Miho (and me, who kind of forced an invitation), and GUYS GUYS GUYS IT WAS A REALLY AWESOME FESTIVAL.

It wasn’t like Gion matsuri (祇園祭) that I went to before where I was dressed all pretty in a yukata. Actually, you wouldn’t want to wear a yukata for two reasons. Firstly, it’s winter, fool. Secondly, the entire point of the festival is to eat oysters that you GRILL YOURSELF ON THE HUGE GRILLS SET UP IN THE CENTER OF THE AREA. You can also buy other seafood and some meat to grill as well. Some people were SUPER SMART and brought their own marshmallows to eat for dessert instead of lining up for crepes.

And the oysters were freaking HUGE. And freaking DELICIOUS. As was the Noto beef. And the sea cucumbers (ナマ/namako). And now, almost 6 hours after eating, I’m still ridiculously full. I think I’ll sleep early tonight…tomorrow I have to do laundry. “OTL

Most Sincerely,
Annette Liem

Receipts (レシト / reshito)

There were so many freaking parties that I didn’t buy any food. Plus I’m leaving soon (and Miho gave me bread) so I’ll keep my purchases to a minimum.
Dear everyone,

Hey there! I’m currently writing this from the Shinkansen going from Fukushima to Oomiya. Then I have to change to the one going to Kanazawa, then I have five minutes to get to the express train to Nanao City. But since people said it’s snowing in the Kanazawa area, there might be delays. Of course, they also said it would snow a lot in Fukushima, and we got, like, less than an inch. I was so disappointed. It’s not like I LOVE snow or anything, it’s just that I expect a certain amount at certain times of the year.

Anyway, let’s get on with the newsletter, shall we?

Friday (金曜日・kinyoubi)
After a short day (basically, removing the gauze from the colposcopy patient), I had an hour to kill before going to the station. From Nanao, Arai-sensei and I began a long and tiring journey. Nanao to Kanazawa was about an hour, then Kanazawa to Oomiya took 2 hours, then Oomiya to Fukushima took another 1 hour, plus waiting time meant we traveled from 10:20 to almost 4. It was SO tiring sitting on my butt. And since I didn’t want to look like a loser in front of my sensei, I couldn’t even play anything on my 3DS. So instead, I slept a lot, drooling all over my Upstate class jacket in the process. Representing my school like a boss.

As we left Nanao’s vicinity, it began legitimately snowing. I commented on how pretty it was, but Arai-sensei said he was worried how much would await us at Fukushima. And when exited Fukushima station, he glared icily at what lay at our feet. I did too, but for a different reason.

When someone says, “there’s going to be a lot of snow”, as an Upstate New Yorker, I expect at least 6 inches from a non-Upstater, and 3 feet from an Upstater. What I stepped in was barely enough to cover my soles. Still, the television show playing in the hotel lobby warned its watchers that there were many accidents around Japan. (Meanwhile, in Hokkaido, they got many meters and are like, “well, guess we’ll make nabe for dinner” LOL.)

The hotel we were staying at was called the Celecton. Initially, I thought it was a misspelling of “Selection”, but apparently the “cele” stands for “celebrity”, “elect” for “select”, and “ton” for “a ton of money” that I didn’t have to pay! Hooray for hospitals including “bring Americans to conferences” into their budgets!

Arai-sensei gave me an hour to play before we had to go to a faculty meeting. Right next to the hotel was a department store where I immediately bought snacks (you know, so I can complain about Japan making me fat) and spent money on capsule machine (more specifically, a “surprise Gintama toy” machine. I got what appeared to be trading cards and a mini clear file that I probably will neither use nor give away. Hooray excessive spending!

The faculty meeting was for the instructors and assistants of the ALSO conference, which stands for “Advanced Life Support in Obstetrics”. The entire thing would be in Japanese, but Arai-sensei gave me a copy of the English syllabus to study. I should have told Akito-san to take my place; she would have learned a lot more than me. And not been as awkward as me. And went out to the bars after the two (TWO!) dinner parties instead of going to sleep at 11 like a loser. (Ha, just wait until Saturday evening.)

Saturday (土曜日・douyoubi)
The conference started at 8 AM sharp on Saturday morning. After getting free breakfast, I basically sat at the back and read Arai-sensei’s handouts while following along with the Japanese instructors. The first icebreaker was actually pretty amusing, though: it outlined the teamwork involved in emergencies.

Each group of 5 people was given three sheets of paper, a gluestick, and a pair of scissors. Their goal was to make as long a paper chain as possible. Then, they did the same thing, but each person could only use one of their hands. Lastly, they did the same thing, but also could not talk to each other. It was funny to watch some teams come up with brilliant strategies (adding to the chain from both ends), work together (two people held the paper for a third to cut), and scream at each other with their eyes.

Other than lectures, there were also practicals, which I was allowed to participate in. I was taught how to use a vacuum suction to assist in vaginal delivery, what to do in shoulder dystocia (it’s more than McRobert’s maneuver), how to safely deliver a frank breech vaginally, and basic BLS training on pregnant women.

Which brings up an important difference: BLS training is not mandatory for medical students or even residents. Only a handful of students get trained upon entry, but they usually wait until residency. Even then, not all residents do it either. Arai-sensei told me the only reason he recertifies is so that he’s able to teach the ALSO courses each month (MONTH!).

After that day’s lectures, which lasted until almost 7 (SO, LIKE 10+ HOURS OF STRAIGHT LECTURES BECAUSE THERE WAS EVEN ONE DURING LUNCH; the bento was delicious, though), there were more dinner parties, but I skipped out on the second one and ended up curled up in my blankets at 9 PM to study what I had learned.

Sunday (日曜日・nichiyoubi)
Again, we started at 8 AM sharp. We started the day with radio exercises (which are a thing on Sunday mornings in Japan) to get our bodies moving, then dove into reading fetal monitoring strips. HEY, I CAN DO THIS.

After lunch, Arai-sensei pulled me away from the group and said I was free to return to Nanao, since it was only study time until the exam the others would take. He had prepurchased tickets (which again, I didn’t have to pay for – woo!) that left two hours later. So, I had two hours to kill in the Fukushima station department store!

It was much bigger than Nanao City’s department store. I clung to my wallet, keeping an eye out for any cute clothes. See, my favorite clothes are now dresses that look like they’re actually a shirt and a skirt. I still only have two party shoes though (one pair of flats, one pair of heels, both black), three if you count my work clogs (also black). I’ve still got a ways to go, haha. Anyway, so I was looking for anything like that, and I encountered a couple stores that had them…and immediately ran away. Was it the price? No, not really. Was it the size? Nah, I didn’t gain THAT much weight. It was more of the customer service. See, when I’m in America, whenever a “sales associate” comes up to me with a smile asking if I need anything, I usually leave, not because I’m annoyed but because I’m scared of social interaction. Just leave me to browse, dammit! No, I don’t need help! Yes, I’m aware that you’re having a sale! But things are still overpriced because my level of “normal” is the TJMaxx clearance rack!

In Japan, it’s a million times worse because they are constantly saying, “いっらしゃいませ!” or “welcome!” every time you pass by, when you enter, when you walk around inside, even if you’re the only person in the store. It’s courtesy, it’s what they’re trained to do, and I know that, but it still makes me uncomfortable. Stop being polite! I’m not used to this much attention! Just ignore me, like everyone else does! “OTL

Finally, there was one store that had cute clothes AND didn’t scare me away! And I bought one blouse to go with leggings I already own. I browsed each floor until I reached the 5th one. Oh boy! I thought, I’m doing so well with not spending money!

*spots an Animate store*


So for those who don’t know and can’t guess from the name and context, Animate is an anime merchandise store. And also one of the two stores I spent half my yen at during my last trip (the other was Kotobukia). Like a moth to a flame, I walked into the store as if in a trance. I wasn’t looking for anything specific, and in fact was trying my best not to look very hard, in case I found something I really wanted. I ended up spending less than 1000 yen, so my wallet is still healthy! My obsession isn’t, though. =P

Finally, it was about time for me to get on the Shinkansen, but first I stopped by the huge arcade they had on the first floor. There was a Project Diva contest going on, with someone cosplaying and competing as Hatsune Miku and I AM KICKING MYSELF FOR NOT GETTING A PICTURE but he (yes, HE) was really good! And had better legs than me, ugh. I need to start running again. And not eat so much.

*eats some more edamame chips*

Oh, I also bought ingredients for rice crispy treats while I was at Fukushima station, because for whatever reason there’s a grocery store there. See, there’s going to be a party among the residents tomorrow (WHY ARE THERE SO MANY EFFING PARTIES), and Akito-san and I are invited, and since the location is the hospital, I figured I could make them a “traditional American dessert”. Since I have no oven, and peanut butter for no-bakes is unbelievably expensive (I AM NOT SPENDING 700 YEN ON A CUP OF SKIPPY), I figured the easiest thing to make was Rice Krispie Treats. I had to buy the ingredients then, because Dontaku closes at 9, and I am not making it back until a little before that, and walking to my apartment will take several minutes. So once I get to my apartment, I can make the treats and put them in foil tins I also bought there, because it’s Valentine’s time, and thanks Japan, I really need reminders that I don’t have a boyfriend and probably won’t get one any time soon. But it’s cool, bro. It’s not like I’ll die alone. I’ll at least have my dog to attend my funeral.

Just kidding. I wouldn’t do that.

I won’t die before my dog.

And on that happy note, I’m done this week’s newsletter. Since I began, I changed to the Fukushima-Kanazawa train. I might take a nap now, and hopefully not oversleep and miss my stop. Hm, that’s something that would happen to me…

Most Sincerely,
Annette Liem

Receipts (レシト / reshito)
Chocolate-covered corn (チョココーン・choko koon): 108 yen
Edamame chips (枝豆チップ・edamame chippu): 108 yen
Matcha pretzels (抹茶プレ・maccha pure): 108 yen (these were really tasty and a good Pocky knock-off!)
Fruit candy (フルーツ飴ちゃん・furuutsu amechan): 216 yen
Ginger and honey candy (生姜はちみつ飴ちゃん・shouga hachimitsu amechan): 170 yen
Chocolate milk candy (チョコレートミルク飴ちゃん・chokoreeto miruku amechan): 194 yen (I LIKE JAPANESE CANDY, OKAY)
Gintama toys (銀魂おもちゃ・gintama omocha): 400 yen
Salad (サラダ・sarada): 228 yen
“Special” melon bread (特別なメロンパン・tokubetsu na meron pan): 173 yen (I didn’t taste anything too different, so I can only assume tomorrow I’ll wake up with magical powers)
Mineral water (天然水・tennen mizu): 110 yen
Blouse (ブラウス・burausu): 2280 yen
Onepunch Man strap (ワンパンマンストラップ・wanpanman sutorappu): 540 yen
Onepunch Man manga (ワンパンマン短歌本・wanpanman tankabon): 432 yen
Marshmallows (マシュマロ・mashumaro): 482 yen
Rice Krispies (ライスクリスピー・raisu kurisupii): 647 yen
Valentine cake foil (バレンタインケーキアルミホイル・barentain keeki arumihoiru): 237 yen

Today you learned lots of katakana. XD

Addendum (追加したもの / tsuika shita mono)


I made it to Kanazawa in one piece, but due to the snowstorm in the area, most trains were stopped, including mine to Nanao City. A very kind train conductor told me what was happening in broken English, and I had a limited wifi connection so I could translate most of it. I waited for an hour or so, then lost the connection (because the convenience store closed LOL), but then the conductors herded us stray lambs into a train that wasn’t in service. I’m currently sitting in that train, typing furiously, because THIS IS SOMETHING OUT OF A HORROR MANGA.

Think about it guys. I’ll set the scene.

A handful of strangers (actually, there are probably two dozen of us, and we range in age from elderly obaa-chan and ojii-chan to young high school students) are stuck on a train overnight due to a snowstorm. Suddenly, the radio picks up a distress signal that the snowstorm is heralding something much more sinister, and is headed in our direction! The train conductors tell us to stay on the train while they check out the scenario. Then we hear screaming, so some reckless high schoolers run out and witness THINGS attacking/killing/eating the conductors. One of them escapes and tells the rest of the passengers that we need to get away. Most of the elderly can’t run away and tell us young folk to leave while we can. With tears in our eyes, we escape to within Kanazawa station as they are attacked.

The station is only temporarily safe; all the stores are closed for the night, but as we run to the station hotel, we see others fleeing, screaming that there are monsters. We escape above ground to see the entire city in ruins, with monsters of various shapes and sizes. Dead bodies litter the ground, and I break down and fall to my knees, crying, crying, oh gods I’m going to die here.

Oh hey, the conductors are giving us free riceballs (おにぎり・onigiri), sandwiches, and bottles of tea! And a rescue sheet to keep myself warm. XD But they have the heat blaring already, so I’m actually really hot. XD

Anyway, I should probably conserve battery. I won’t know when I’ll be able to post this. No one may ever be able to read this. But if anyone does, I want you to know I lived without regrets. Mother, father, I’m sorry for leaving first.

Now to eat this onigiri while it’s still warm. =P

Most Sincerely,
Annette Liem

Addendum (追加したもの / tsuika shita mono) 2
So, I slept on a defunct train for a whole 4 hours. Woke up looking like crap. We weren’t attacked by man-eating monsters, though, so that’s a plus. Also, all of us looked like crap, so I wasn’t alone in my crappiness.

Afterwards, around 5 or so, they got us on buses to our respective stations. When we finally left Kanazawa station, I could see it was legitimately snowing. There was at least a foot of freshly fallen snow, and piles over 10 feet that had been built by plows. The bus ride which should take, like, an hour, took almost three due to car accidents and dangerous conditions, but no monsters! Because being on a bus driving around a secluded mountain pass is also a recipe for a horror manga.

I arrived in Nanao City around 8 AM, and began my trek to my apartment building. I clambered over snowbanks and trudged knee-deep in white fluffy stuff. I was wearing my dress pants, but since I had kind of slept in them, I was totally okay in getting them even dirtier. Finally, I arrived in my apartment, only to realize the heat wasn’t working. I can totally see my own breath. But that’s fine. After I take a shower, I’m going to the hospital to work.

I hope the hot water still works. O_o

Gonna stop now, as my fingers are currently experiencing the first stages of frostbite.

Most Sincerely,
Annette Liem
Dear everyone,

Uwah, long week plagued by sickness for half of it! I probably did catch something from Arai-sensei’s daughter, but it’s clearing up. Tomorrow I leave for Fukushima for an ALSO (Advanced Life Support in Obstetrics) conference, and my expenses are being paid for by the hospital. I guess working for a hospital isn’t THAT bad, haha.

Monday 月曜日(getsuyoubi)
I woke up with a headache, a sore throat with cough, and a running nose, which improved slightly after a shower. And I got another shower on the way to the hospital, since I didn’t have an umbrella after the one Arai-sensei lent me broke…

I grabbed a mask at the hospital before heading to the family medicine clinic! Yay! I was with Yoshioka-sensei, who translated interesting things I couldn’t quite figure out, but I could follow easily when patients pointed out specific parts of their body with a pained expression…

See, the family medicine clinic (and Kampo clinic) are attached to Laurel Heights, a senior citizen assisted living facility (which is directly across the street from the hospital), making it very easy for them to get access health care. And with Japan’s National Health Insurance (which by the way doesn’t cover injuries from intentional fighting or being drunk LOL), the copay for medications is 30%, regardless of price (which, according to Yoshioka-sensei, is about the same as in America, for the most part). Yay for healthy old people!

But not everyone I saw was old, haha, it was just easier to figure out that they were just there for their aches and pains. The younger people came in with coughs and colds and headaches and random rashes out of nowhere. So…pretty much the same in America, haha. However, a lot of the medications are different. I’m not talking Kampo-type remedies (which were also prescribed to those who asked for it, but Yoshioka-sensei said he doesn’t use them that much because he’s not properly trained in it), brands that a swift Epocrates search showed were either discontinued or no longer legally acquired in the US, despite having the same mechanism. Some of them didn’t even show up on Epocrates, so I had to turn to Google to learn that they’re pretty much Japan-exclusive, even though the generic drug is the same as what we learn in pharmacology.

Also, screening is SO different here. I mentioned the pap smears and vaginal ultrasounds every 1-2 years being a bit excessive for me, right? Well elsewhere, they don’t seem to be excessive enough. Colonoscopies are not routinely recommended (unless there’s a family history). Instead, they start with fecal occult blood tests at 40 years every 5 years. HPV testing only if a pap smear is abnormal. Vaccines not routinely given. Mammograms every year instead of every other year, so that’s more common, but you get my drift…and that’s not even talking about the lack of bloodwork for diabetes. Then again, I guess it’s the prevalence of it all.

Lunch was chicken stir fry, miso soup, pumpkin, and orange slices for dessert. It’s like they knew I was sick! Also, the flat-screen in the dining area was playing some Japanese drama…I am affectionately referring to it as “Feudal Era Downton Abbey,” or FEDA.

FEDA Edith has such bad luck.

I’m kidding.

I was doing the thing where you adlib random things.

Adlib FEDA Edith has such bad luck.

After a long day (stayed in the hospital until 8 for a conference that Takata-sensei translated for me…that still went way over my head), I left the hospital into the pitch-black night, thankful because there were no raindrops falling on my head.

But then the sky briefly turned white.

A few seconds later, a rumble of thunder.

My fellow sidewalk travelers and I looked up with trepidation, and hurried on our ways. Then the rain came, slight at first, then eventually becoming heavier and creating giant puddles for me to leap over, not that it made an ounce of difference in the state of my trousers.

I made it to my dorm safely, but I still had a problem: I needed to buy food, and the grocery store would close in less than an hour (small city means things close at 9). So, mustering up my running leg power (which has diminished significantly since I don’t run every day anymore because of sucky weather and no access to a treadmill), I raced to the grocery store across the street and tried not to breathe too heavily as I made a beeline for the reduced price produce.

Other than my usual staples of fruit, milk, bread, and snacks, I also got some prune juice because I was feeling constipated and wanted to return to my normal BM schedule ASAP. (Unfortunately, it hasn’t been helping that much; someone could probably mistake me for a woman in her second trimester by now. “OTL But don’t worry guys, I’m not pregnant! Side note: I hate having my period when traveling.)

I added an umbrella to my cart, because I was not risking any snacks getting wet. Now fully equipped with a tote bag over my right shoulder, and a collapsible umbrella in my left, I walked outside…only to see that it was no longer raining. Sigh. Oh well.

I went to sleep almost immediately after putting all my groceries away. Since I had pushed my bed directly under the heater (which everyone calls the “air conditioner”, which was initially confusing because to me, “air conditioner” means “machine that blasts cold air out”…but this one put either hot or cold out air depending on your needs, so I supposed “air conditioner” is the better term!) I was slightly warmer. Only slightly.

Tuesday 火曜日(kayoubi)
Tuesday morning I had to hit the ground running: as soon as I walked in, I was called to the labor/delivery ward where a woman was having her second degree laceration repaired. Ouch. Lots of blood. So much blood. Augh. But the baby was safe. And by itself, chilling/crying under the heating lamps. That shocked me a little, since during my rotation, if the baby was stable and the mom needed sutures, the nurse would swaddle the little one and present it to the mom as a distraction from the needle. Takata-sensei explained that the mom got an epidural so didn’t “need a distraction”, but still, I figured a little mother/baby bonding time during the waiting period wouldn’t hurt.

Had the afternoon with Yoshioka-sensei again. There was an old man with probable dementia with hallucinations (Alzheimer’s VS lewy body) who just seemed lonely, so Yoshioka-sensei spent some time talking with him, asking if he was eating well, talking about books they liked to read. The patient also lived at Laurel Heights, and after the patient left, Yoshioka-sensei told me his family doesn’t visit very often anymore, as with many of his other patients, so he tries to make time to talk with them so they can cheer up a bit more. Most of the time they are depressed (especially here, where there isn’t much sunshine OH MY GODS, I JUST REALIZED I’M IN JAPANESE SYRACUSE), but they don’t want medications for it. This hospital also doesn’t have a psychiatrist (or a psych ward), and since this is Japan, people are uncomfortable with the thought of having a psychiatric illness.

Then we got into a discussion about that stigma, and how Yoshioka-sensei can manage most stable depressed, schizophrenic, bipolar patients, but if they had a manic episode or psychotic break, he has to either refer them to the closest hospital with a psych ward (1 hour by train, then more travel time for probably 2 hours), or just not treat them if the patient doesn’t want help. He can’t force them into the psych ward (I neglected to ask him if the rule about non-voluntary admission for suicide is the same), and if they’re functioning members of society there isn’t much “wrong with them” other than the fact that they maybe think their neighbor is poisoning their water supply. I wish there was a psychiatrist I could speak with to get their opinion though, since Yoshioka-sensei did say he’s uncomfortable with prescribing most psych medications (not much different from American docs). I know there’s a psychologist though; maybe I can ask Arai-sensei if I can speak with him for a day.

Anyway, the rest of the day was fun! And there was a party at night: sushi at 蛇之目寿司 (Janomesushi) with the residents and Akito-san (fellow med student)! Apparently, the place is so famous, that people from around Japan come to Nanao City just to eat there, and reservations are for 2-3 months in advance. Their specialty is omakase-style, meaning patrons pay a fee (for us, 3500 yen per person), and the chef makes an entire menu up, starting with light fare then going towards heavier ones. It’s usually cheaper than ordering a la carte, and since this is Nanao City, the quality of the fish was superb. I don’t remember everything I ate, but it was good.

Though, I have to say, the residents here aren’t as social with me as the ones in Hirakata-shi were. It might be that their English isn’t as good, so I was mainly communicating through Akito-san and another female doctor (who, by the way, were the only girls at the dinner), and they didn’t ask that many questions. Thus, most of the dinner was me watching Japanese commercials on the television mounted in the corner.

After sushi, some of the residents were still hungry (although I was probably around 25 weeks gestation), so some of them brought Akito-san and I to an oden place run by a happy-go-lucky obaa-chan.

I didn’t eat that much, but as the residents drank more, they started practicing their English more, until it was past midnight and I really wanted to sleep. And also get a suppository.

Wednesday 水曜日(suiyoubi)
Wednesday was pretty standard, without anything too interesting, except that I learned that the resident room ha wifi. I don’t know how it took me two weeks to make this astonishing discovery, but I was lamenting the fact that I had no data in Japan to Akito-san, and she gave me a puzzled expression and pointed out a router hidden in the corner. But Arai-sensei said there was no wifi! Regardless, Cuyler 2.0 now can access the internet. And so can Switch! After lunch (skipped on account of constipation reaching critical gas – HA SEE WHAT I DID THERE – but seriously, at this rate, I might need to do a self-fecal disimpaction), I had the afternoon off but “on call”, so I quickly ran home, grabbed my laptop, and came back to work on the presentation that is the entire reason I came here in the first place. The title of my Powerpoint? “Well, THAT’S Different: A comparison between Japanese and American medicine”. Yes, I’m a horrible person.

In the evening, we had suturing training! And you know, I think I finally figured out how to do three knots! I don’t remember the names, haha. But they were really good! I think I can probably be useful in surgery now. TAKE THAT, DR. KRISHNAMURTHY

I was all set to go home, but Akito-san said we were taking a taxi to a nomikai (飲み会/drinking party) with Takata-sensei, the midwives, Yoshioka-sensei, and Yasuda-sensei.





Although I knew this from last time, doctors in Japan really know how to party. If American docs did this, they’d probably get fired. Or get “mistreatment buttoned” for sexual harassment. Or both! Uh. Yeah.

The food was all delicious, of course. Sushi, nabemono (鍋物 / hot pot), French fries (wtf), and alcohol! Lots of alcohol. Akito-san introduced me to plum wine (梅酒 / umeshu) which literally tastes like juice. I can’t taste any alcohol at all! I drank the entire cup but restrained myself for asking for another, since my Asian flush was settling in and I really didn’t want to make a fool of myself in front of so many important people.

But if I can find this in America, watch out guys. I’m likely going to become an alcoholic. You should probably CAGE me in about 4 months, so I can get back on track for Step 2 studying.

We also played a drinking game when we had to use a stopwatch to get as close to a random number as possible. I got 3rd place somehow! (Maybe because I was sober, haha; unfair advantage, I guess.) I won two pairs of socks and a bath ball that I’ll likely give away as a present because I don’t take baths. Uh. That sounds wrong, but you know what I mean.

A very drunk Yasuda-sensei dragged four of us to 2 more restaurants (a yakitori place and a Korean place), even though I had progressed to feeling my food baby kick every 5 minutes. Really should get a fetal heart monitor on this thing.

I’m glad Akito-san was there though, because he was getting very flirty with her and mostly left me alone to mull over my green tea (and watch Nishikori on the television) with Takata-sensei and dentist-turned-doctor-whose-name-I-don’t-know. We got home BEFORE midnight that day, but I still slept in until 30 minutes before I needed to leave. I really should do that more often, haha.

Thursday 木曜日(mokuyoubi)
This morning I had Kampo medicine with Takatou-sensei. She lent me a book (in English!) that explains many of the concepts. However, I can’t seem to find it on Amazon.com or anywhere else, so I’m going to read this from cover to cover ASAP and take very detailed notes because hot damn, this stuff is interesting. And confusing. And dear gods it will take me a lifetime to learn. Challenge accepted.

In the afternoon, one of the secretaries from the first weekend interviewed me with her coworkers. Apparently it’s on their Facebook page. I’m kind of afraid to look at it, haha. I picked a bad day to wear glasses…then there was a colposcopy I assisted on, and I got to go home early, with no party! Thank gods. There’s only so much fun with other people I can take in a week. I just went grocery shopping for dinner (I bought some premade udon and cooked them with some vegetables), and soon I’ll go take a shower and sleep early for once. As I said earlier, tomorrow I am going to Fukushima for an ALSO (Advanced Life Support for Obstetricians) conference. It’ll be away from the radiation, and I have no idea how the conference will go. I just know that it’s being paid for, and I’m probably going to be expected to make a presentation on it. Man…

Oh well. That’s all for this week. I will hopefully be able to write when I get back from Fukushima on Sunday. See you next time!

Most Sincerely,
Annette Liem

Receipts (レシト / reshito)
Oranges, 5 (オレンジ/ orenji) – 316 yen
Pears, 2 (/ nashi) – 198 yen
Prune juice (プルーンスジュ―ス/ puruunsu jyuusu) – 478 yen
Milk (牛乳 / gyuunyuu) – 118 yen (everyone ought to remember this one by now!)
Pokemon tissues (ポケモンポケットティッシュ / Pokemon pokketo teisshu) – 128 yen
Mitsuba cider candy (三ツ矢サイダーキャンディ / mitsuba saidaa kyandei) – 158 yen
Chocolate (チョコ / choko) – 278 yen (this one too!)
Valentine strawberry Pocky (つぶつぶポッキーハート / tsubutsubu pokkii haato) – 128 yen (from me, to me; actually “tsubutsubu” means “pebbly” as in there are specks of things in the Pocky, and the “haato” means that the stick is shaped in a heart…it’s cute)
Tsubu anpan (つぶあんパン) – 138 yen (again, tsubu means pebbly, as in the anko beans are mashed like crunchy peanut butter instead of creamjy peanut butter)
Tea (お茶 / ocha) – 198 yen
Hand cream (ハンヅクリーム / hanzu kuriimu) – 248 yen
Umbrella ( / kasa) – 598 yen
Pantyliners, 12 (パンティライナ/ panteirainaa) – 974 yen (how I envy you girls with light flows…I needed the heavy overnight pack)
Lemonade (レモネード / remoneedo) – 160 yen
Hot milk tea (ホットミルクティ / hotto miruku teii) – 130 yen
Yogurt water (ヨーグルト/ yoguruto mizu) – 120 yen
Udon (うどん / udon) – 288 yen
Vegetables (野菜 / yasai) – 108 yen
Spicy crackers (辛いせんべい / karai sembei) – 108 yen
Shichimi (七味 / shichimi) – 98 yen (it’s a chili powder)


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