Jacky Lai

  The UNIVERSAL STUDIO JAPAN This is one of our major purpose to Japan.  We got up very early in the morning.  The breakfast was serving from 6am to 10am.  Quite delicious though, I was still a little bit disappointed because it was not entirely Japanese.  Anyway, we took JR to Universal City Station.  The station is located next to the harbor of Ferry Queen Mary in Osaka Bay.  We bought 3 tickets and rushed to the entry.  Astonishing, there were already hundreds of people waiting for entering.  We took a few picture of the most remarkable logo of the Universal Studio - the spining Earth in the Universe.  As I looked up, I saw something I was too afraid to try -  a rollercoaster   The three of us taking picture of the most famous logo in the movie industry   Spiderman Doc, now it's definitely not 88mph. Nice Turkey leg outside the Jurassic Park The Jurassic Park The Waterworld It's a lot of fun.  Definitely worthy!! We went to Osaka bay afterwards, but nothing special quite honestly.  Besides, my camera ran out of batteries.

To be, or not to be? That's the problem. The other day, I met one amazing girl, who is sort of my colleage.  She's very cute, very thoughtful, and I admit that she's some kind of girl that I like.  We were going pretty smoothly in the first two months.  She often gave me a phonecall at night, cuz she worked night at that time.  Kinda freaky though, i felt fine actually.  We knew each other better and better.  And then, things changed.  Something that really bothers me happened, and I knew it, or I saw it very very accidentally.  We both don't know how to face each other under such weird circumstence.  So we tried not to think about it and just let it go.  She asked me to go to their annual gathering, and undounbtedly her friends made lots of fun of us.  It's alright, doesn't really matter.  Two weeks later, we went hiking together.  That's the one day i knew something different from her.  I began to doubt her past.  But then i thought, if you really like someone, why should you doubt?  Isn't that more important to treasure what you have owned.  It's even more uncomfortable when it comes to the style of girls i like.  She recalled that i once said that the girl of my dream should be intellectural and musical, which by all means not kind of girl that she is.  But i said that it's not what she is that i like, is how we feel that i want.  Whatever, we had a great fun and went home happily.  On my birthday, she asked me out for lunch.  We met at Ikari Cafe, and my cellphone rang.  Shit, what a great timing.  I was not on duty, it was not my patient, but the chief resident just asked me to transfer the patient to ICU.  "I'm so sorry.  It's been so smooth all day long, and it's this moment they want me to be busy." i said.  "that's fine, i'll just wait." She knew it quite well, cuz i was always so "unlucky".  "So, my lucky star doesn't work today," i whined as i was transferring the patient.  An hour later, i finally had it done and returned to the Cafe.  She was still sitting there waiting.  " Damn, i was so sorry. I thought it would be quite fine, 'cuz everytime we have a date, i'd be so lucky!" "it's ok, happy birthday" "yeah, with you right here, i am really happy.  thanks!"  Shit, i missed a chance to tell her.  Then, I tried to ask her out for dinner two days later.  she refused, and i was confused.  In the weekend, i went to a temple to pray for a smooth ending of my internship.  I sent her a massage to see if she needs any extra-good luck.  She replied, and I noticed that she's having a big test in that weekend.  I prayed a little bit for her and wished her good luck.  Then, I received nothing from her anymore until two days ago, we met accidentally in the cafeteria.  Everything between us is just as usual.  Nothing seems to go wrong, but i just don't feel right. 

It's quite a pleasure to have a week off after these days.  Half an year has past, and I appretiate all the patients I've been taking care of.  The three of us have been waiting for this wonderful trip for a long time, and indeed, we had a great time. Dec. 17 Turn Off Your Cells and Let's Go!! 6AM, we packed up our packs and left for airport.  I've never been so excited.  I aint gonna hear by cellphone ringing for some annoying unpleasant complaints.  We're gonna take our time and enjoy our life. Boeing 777, EVA air flight BR2131 Taipei to Kansai Can't be more excited. Dr Lee, myself, and Dr. Chang 777 is surely a nice plane - all those entertainment stuffs and so on.  It's a quick flight from Taipei to Kansai, taking only about 2 hours.  As we finished our blunch, the flight began decending.  I'd like to say that our captain are really flying.  We landed smoothly and we're so thrilled to see everything different outside the window.  It's my second time to Kansai actually, so I'm quite familiar with this place.  Owe to "anti-terrorist" policy, our face and fingerprints were obtained while entering.  We grabbed our bags and went to Japan Rail Station to activate our JR passes. kansai Airport. 7-degree-celcius at that time JR Pass; that's how we save money on transportation JR Pass is a promotional product to facilitate tourism in Japan.  With a JR pass, you can ride almost all kind of transportation facilities including railways(this includes Shin-Kansen), buses, and ferry.  We took Haruka - Kansai airport express to Osaka.  It took us some 3~4 hours to find our hotel with our enormous backpack on our shoulders.  A little misunderstanding between the travel agency and ourselves.  We went to Osaka Tokyu Inn whereas our hotel is Esaka Tokyu Inn.  It took us 2,100 Yan to get there by taxi.  Well, at least the hotel is next to railroad station, that's a good news. Haruka - Kansai airport express   Our hotel room; the one in the picture is my classmate, Dr. Lee We quickly unloaded our baggage and went out for dinner.  There's a famous place in around Namba, Osaka.  We took the Osaka Loop line to JR-Namba station.  Then, we walked about 10~15 minutes.  It's easily recognizable, cuz there's a giant king crab hanging on the wall.  We can have all kinds of snacks and food there - Takoyaki, King crab, etc.  Man, it's really delicious! JR Namba station - underground King crab on the wall All kind of stuffs Oh, Gosh!! Mmmmmm........ Yummy!!! "something"yaki; It tastes like spaghetti folded with lasagna and lots of veges. Ahashiyaki; octupus stuffed in boiled eggs   But Le Ping.  Fried potato-salad! Fried shrimp and chicken; taste really good with cabbage beef-tendon stew After having these delicious dishes, we were finally on our way to hotel.  What a day!!  And tomorrow, our most important destination - Universal Studio Japan, WEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!

It's 16 out there but makes me feel like 6.  Every winter, every damn cold night, I'm all alone trembling in my own bed.  I don't wanna get up, 'cuz getting up means starting up; I don't wanna stay in, 'cuz staying in the bed alone only gets colder. 3 years ago, the most tragic thing struck my family; I do miss those days that my family had.  We used to stay up all night talking what's happening in school, what's happening at work; we used to make decent breakfast and enjoy "our" holiday morning; we used to get up early to watch baseball and boo the batter who bit up Tsao.  But every thing changed.  Tsao got hurt, and we're not able to do what w'all used to do ever, again.  Since then, I have grown from an extra-virgin medical student into a half-matured intern.  It's the bitterness that pushes me to grow, but I know, I know it so well, that it's the bitterness I don't need, i don't need it at all. No winter can be any colder; No supper can be any bitterer. Year after year, my heart may look so strong outside, but deep inside, it's so fragile.  It's such a burden, and i need a certain help.  I need someone that knows me so well, someone who i know so well that we could read each other's mind without a word.  Who is the one; when is the time; where is the place that I'm seeking for.

  Alex Rodriguez, hitting some 50 homers and 150 RBIs in the season despite providing the Yankees less than 3 RBIs in the playoffs, decided to opt out his contract at the end of the season.  His agent $cott Bora$ said to the reporters that it ain't gonna be any negotiation unless Cashman brings in 35mil a year.  Just what Micheal Kay used to say after A-rod batting - "See Ya!!"  A-rod have won two MVPs in his career but none of them helped his team to go deeper in the playoff, not to mention that the Rangers didn't even make the playoff with his first MVP.  Take a look at big Pappy and Manny - how invencible they are in the playoff!!  And look how you did, A-rod!?  Consider the following scenario - tied game, botton of the eighth, 1 out, men on 2nd and 3rd, B. Abreu at bat, A-Rod on deck, and you are the pitching couch.  Option A, get a left-hander to face Abreu; Option B, let's just walk Abreu and face A-Rod, a double play or a strikeout are both desirable.  11 out of 10 couches will definitely choose B.  Now, let's complicate this case by changing the batters, D. Ortiz at bat and Manny on deck.  Option A, get a left-hander to face D. Ortiz; Option B, walk Big pappy and face Manny; Option C, safe your bullpen for the next game.  You're not gonna see any idiot to pick B.  It's for sure that A-Rod is some one-of-the-kind, but he aint worth of 35mil.  Besides, 35mil is almost the team-cap of the Marlins in the last year.  Waiving Joe Torre and signing Giradi may be a controversial move, but setting A-rod free by not moving into the auction is really brilliant.  Can't wait NOT to see you, A-Rod!! Oh, and I'm so glad to see A-Rod hit 3 GIDP in a row against my favorite Wang next year. So, what's going on in the West Cost? Rockies excellent performance in the playoffs!? NO!  I'm talking about the place where all the 'Drama' born - Hollywood.  Kobe Bryant have been openly complaining about his boss and teammates, making all Lakers fans very uncomfortable.  Where he's gonna be?  The only move the manager did in this Summer is release Smush Parker and sign with the rookies.  No J. O'neal, not even a ripple of K. Garnet.  All the Boos in the opening night at Staple Center are definitely not what K. Bryant thinks of as the beginning of his season.  And the way they play against the Rockets - God, it looks like there are three teams in the court, Lakers, Rockets, and Kobe.  But the next game, Lakers @ Pheonix, it seems that they finally put themselves together.  With the team playing so well lately, Kobe Bryant would possibly be the last one to ask for a trade.

  My surgical internship started in September.  It is so obvious that I might have a very difficult September for my Blog remained silent in the past two months.  I began the course with General surgery, which is the toughest course in surgery.  The house officer is one of my uncles classmates, who is a very respectable professor.  He is always enthusiastic in teaching and cautious about managing his patients.  And I began to learn how to take care of 24 patients without burning myself out.  As days went by, I finally knew the keypoint in taking care of surgical patients.   Following the general surgery, traumatic surgery is one of the courses that I shall never forget.  There, I took care of 25~30 patients, which not only broke the regulation of upper limit of intern loading, but also set up a new record of caring amounts of our class.  Patients in this field all come from emergent department.  As a matter of fact, traumatic surgery is a relay of ER and Home.  About half of our patients suffer from gall stones, whereas half of the other half have acute appendicitis.  The rest of our patients show a great variability in this field.  We have liver abscess, hemothorax, pneumothorax, acute pancreatitis, pancreatic cancer, psychoses, and even pregnant patients.  "Thanks" to the variability of our patients, I have to read a lot more to know how to handle these patients so different.  To be quite honest, it aint easy at all.  First of all, "25~30" is already killing me.  How could I memorize every single patient in detail with a 3-page-patient-list?  Moreover, as our house officer so busy replying consultation sheets from ER, and the resident stuck in the OR, I am the only one who can access the ward.  Fortunately, I was pretty confident with my previous training, making it looks easy taking care of all these patients.  In the second week, two surgical clerks joined our team, and I began to realize why senior residents are sick of supervising these youngsters.  Our resident don't even have much time to talk with me, and with my work almost overloading, I seldom have time to teach them something.  As a matter of fact, our house officer's ward round is the only time I counld teach them without being bothered my nurses.  Leading them towards the bedside, the house officer will make a brief introduction of the patient.  And I tell them what our planning gonna be and the indication of surgery.  At this time, the house officer will give them some little pop-quizes that they seldom respond correctly, exactly how I looked like last year.  It is so interesting how internship helps in the maturation of a doctor.  Seeing them anxious, nervous, and not knowing what to answer, I slowly, patiently told them the answer and began to think, "when did I learn those things?"  I didn't recall "touching" my textbook recently;  I was a straight C student in the past six years.  But why? Why did I know all the answers?  Actually, it's pretty simple.  In my clerkship, I only took care of no more than 3 patients at the same time.  i.e., I would learn no more than 3 common diseases in each course.  I had to ask for the opportunities to perform some invasive procedures: inserting Foley cath, N-G tube, artery puncture, central line.  For an intern, these are the procedures that we could find no chance to avoid.  That's the major difference of a clerk and an intern, and that's why I always want those kids to learn more by doing. 

  Being an intern for a month or so, I start to recognize how my life's gonna be in the rest of my life.  I am now in the department of Physical Medication and Rehabilitation, know as PM&R.  It's a subspecialty that began during the 2nd World War and Vietnam.  While facing a resource shortage, "recycling" is always the first principle of resolution.  That's the original concept of rehabilitation - menpower recycling.  Since it takes too much time to "produce" a well-trained warrior, it'll be much easier to re-use wounded soldiers than to train new recruits.  Thus, medics selected those who weren't badly injured and designed a program to restore their capibility of fighting.  In a hospital, rehabilitation program is designed to restore the capibility of daily life activity for those who suffered from neurological events.  Because our patients have been strictly selected, we usually wouldn't have emergent medical issues.  Thus, duty day here is relatively easy, or to be more precise, boring, quite different from what I had in neurology ward.  But seeing them putting themselves together and trying to walk on their own again is quite a privilege.  We can't see such progress anywhere else. 
  Since I definitely need a great re-energizing, I'm thinking of starting a "weekly series" - "Jacky's Weekly Journal Review."  There're already tons of "NEJM weekly summary" or stuffs like that in my mailbox, but honestly I pay very little attention on those.  And I guess that it might be helpful to catch up with the latest updates in the journals if I wrote a weekly review by myself.  Besids, I definitely need more practice in English, 'cuz I found myself easily getting stuck while "utilizing" this language.

    Ok, I'm a Laker's fan for sure, and i do like Kobe Bryant.  But it doesn't mean that i will tolerate whatever Kobe does.  He's been whining about too much duty and too little help, for what, two years?  Since he threw Shaq away, Los Angeles has become the city of KB.  No one cares how Lackey's doing; No one notices that the Ducks won Stanley Cup.  All media now focus only on where Kobe might go.  I'd like to say that KB is lucky enough to have his teammates.  As a matter of fact, the players on this team are good enough to return to glory but the team aint ready.  Kobe Bryant is indeed invincible, but the Lakers are as fragile as a piece of paper.  No actual "teamwork" we could see on this team.  And evidently Phil Jackson aint facilitator of the team chemistry.  He could be a good philosophor, but he's not a fine pusher.  He didn't push Kobe to think, to learn how to be a team leader.  He didn't push Lamar to find his feet.  Two franchise player playing their own basketball are very unlikely to bring Los Angeles the Championship.  Maybe Kobe is right, start the trade and re-order the roaster might be a better way to replay "the show time".  But who will be the skeleton of the brandnew Kobe-free Lakers?  In my own opinion, Jordon Farmar and Luke Walton.  Try to acquire Kevin Garnett and place Kobe on the eastern conference with a multi.  With Garnett joining and the big guys preserved, it'll be very easy to freeze opponents' scoreboard and win by attacking their paint.  It's the easiest way to win ball games - do more dirty jobs.

  Intership differs greatly from clerkship that interns are functioning staffs for nurses, whereas clerks are just bunch of nonfunctioning foreign bodies.  My very first minute as a neurologic intern, i was asked to re-insert a N-G tube for a hemiplegic patient.  It's not quite a problem for me actually, 'cuz i've done such procedure several times during my clerkship.  Two hours later, the resident asked me to collect arterial blood for gas analysis.  Puncturing artery needs some fine techniques.  First of all, the vessel wound be engorged by tension, which means that the practitioner can only depend upon arterial pulsation.  Secondly, blood gas analysis needs strictly the arterial blood, as being an important indicator to patients respiratory and metabolic status.  I'm so glad that i've succeeded in my first four arterial blood collection, thanks to a paralyzed patient that is totally unable to resist my practice. As a matter of fact, aggressiveness during my clerkship makes the transformation of a clerk to an intern rather easy for me.  Besides, i'm very pleased with my job.  It definitly aint well paid, averaging no more than 58 NT/hour, less than 2 USD for an hour, but i'm ok with it.  It's the satisfaction what i'm seeking for, not salary.
  My first duty was a holiday-duty.  The ward was crowded that night, so we didn't have any new admitted patient.  But there was a very critical patient in our team.  He is a case of large MCA territory infarction, or severe stroke, and his family has been adviced to receive intubation.  They denied and signed the DNR permitment.  That night, i had a very bad feelings that something might go wrong.  My cellphone didn't ring for nearly four hours making me more suspicious for what's gonna happen in the next few hours.  As i was about to fall asleep "again", it rang and the nurse was speaking with anxiety. "7A-16A, shortness of breathe, unconscious!!" I jumped off the bed and rushed toward bedside.  On the way, i ordered a blood gas analysis, biochemistry panel, and electrocardiograph STAT.  When i arrived, nurses were busy maintaining his respiration.  Without any sign of hemodynamic changes, i collected a syringe of arterial blood and finished ECG.  After we stablized the patient, the duty supervisor arrived and decided to repeat CT scan at once.  It resulted in hemorrhagic transformation with aggravating brain swelling.  For most neurologists, this aint a good sign, not only for prognosis, but also too life-threatening.  We used as much mannitol as we could, and amazingly he woke up a few days before i left and spoke to me just like nothing happened.  This is some case to memorize.  As a begining of my career, this "is" a wonderful experience.
  Speaking of career, "office romance" is one of the issues that we definitely will encounter someday.  During these days in Keelung, I did have someone that came "closer" to me.  Not that we have anything unusual, it's just that one of her patients belonged to our team was very uncooperative, so I helped her out alot.  Since she's an young and unexperienced nurse, it is inevitible for her to have lots of problems.  Whenever she had a problem, she turned to me, and I never let her down.  Curiously, everytime i was delayed for lunch, she'd be the one left in the conference room (where we have our lunch and dinner).  A rumor between us started to spread, and our colleagues began to make fun of us, e.g., when i finished my lunch and left for my patients, some nurses would say, "what so hurry, Dr. Lai? Just stay for 'a while'!"; when i was busy doing my chart work, some would say, "c'mon, lunch time.  You have plenty of time to do it, someone's waiting for you inside."  I began to feel a little bit annoying and awkward, especially when we're chating.  I would like to say that this kinda relationship is not what i would prefer.  No room for error, no time for conflict.  It's too much pressure for this situation.  On the last day, she asked me if i would like to have dinner with her, it was the first time i turned her down.  No one needs this aggravation.  And last night, my roommates and i concluded that being single is one of the benefits to get through our internship smoothly, but we'd have to face some even more disturbing problems.  it'll be better to have a girlfriend rather than to be the topic what they're talking about.

    Internship is the ending of my college life.  Look back on the past six years, the most regretful and joyful memory is the tabletennis room.  Half of my college life is tabletennis, and half of the other half is baseball.  Pretty dreadful, isn't it!?  A guy who spent most of his time playing sports will be handling medical emergencies in 3 days.  Things're gonna be fine.  At least, i spent the rest of my time studying with a very efficient way.  If you ask me what i wanna do most but didn't do, it'd be gals.  I dunno, maybe i wasn't born with that part of the brain.  I got nervous talking to gals. When it came up to me, i just screwed it up.  If I took them as guys, i am pretty easy with 'em, but not when i took them as girls.  That's possibly why i had bunch of friends but quite without a girlfriend.  Well, i can't really blame my inarticulacy with girls.  See, I had a really bad image since the "greeting-camp" for the nasty role i played in the show.  I like math, and i'm good at it.  But calculus didn't help me re-establish my personal image.  Still, i was known as a horny, nasty asshole like Stifler.  Personal image aside, Chang-Geng University is so far away from civilization.  It's definately isolated.  My only chances to see someone out of this school are bridge contests and Med-Cup.  From 3rd grade to 6th grade, we're all locked up in the classroom and labratory.  Less and less outdoor activity restricted our circle of life to expand.  Besides, I don't want my life fool of medical issues, making myself more difficult to find the right one.  Most of my classmates said that i am too picky.  In my opinion, being picky is the right thing to do.  I can't imagine how i gonna live with if i don't really have an ideal one.  This one have to be perfect.
   Alright, it's enough for gals.  Let's say something about my internship.  I wasn't lucky in the lottery making my draft position very crappy.  Most people want their course to start with internal medicine, or at least have internal medicine in the first half, because it helps establish a better knowledge base to face the complaints.  But patients are more troublesome in internal medicine, as for me, i would rather be better experienced before i handle patients so complicated.  Moreover, i have an easy minor course, which means that i could have a happy summer vacation.  Glad that i passed the ACLS in the pre-intern training course, making me more confident to face medical emergencies.  By now, i'm not only glad to have my clerkship done but also excited to take the real one.

   Ok, for most Yankees' Fans, this is undoubtedly the greatest news after Pain out of the season for his elbow.  Just one day after Wang nearly achieved his first career perfect game, Roger Clemens showed up and announced his coming back to Bronx.  With Wang healthy and dominant on the mound, we can see a nasty rotation of the Yankees - Moose, Andy Pettitte, Rocket, Wanger, and someone to be named.  4 out of 5 in this rotation are propably future hall of famer, and they still have couple of rising stars in the minors.  But the problem is Aging.  Mo is now struggling to save Yankees' games.  Moose is very effective, but questionable to complete the season.  Roger will not be back til June.  How far can this rotation go?  There's no exact answer.  4 years ago, when Carl Pavano signed with the Yankees (39.95M/4yrs), no one expected a 4-year-disabled contract.  In the past 4 years, he went in and out the disable list because of bunch of ridiculous reasons, such as fractured thomb in a car crash, sprained ankle and wrist in his bathtub, and broken heart with his girl friend.  Meanwhile, Roger did a fantastic job in Houston and won his 7th Cy Young Award in 2004.  Recording only 7 wins last year though, he still showed his invulnarability on the mound.  With Yankees huge run support, Roger is very likely to win some 13 to 18 games by the end of this season.  28 mil contract means just one thing, the World Series Title.  Roger is the missing piece of Steinbrener's puzzle.  He is brought out of Texas to fit in the frame.

    The other day, my friend and I found a new karting place beside Da Jung shopping mall.  It's a great news for us since the karting in TaiMall was shut down.  We used to go karting in Shin Dien and TaiMall before the company went bankrupcy.  Any place otherwise is either too far or too expensive.  And in February, other karting-mania came up with this place and we decided to give it a shut.  We didn't have a chance til last week we finally gathered several friends to go for the trial.
    The circuit is actually part of a parking lot.  We can still see some remains.  The track is pretty rough, but they do have decent rental karts.  Speed track is about 120 meters long in between two high-speed curves.  3 complex hairpins are pretty challenging and critical to lap time.  As soon as we left the pit lane, comes the speed track.  Push the throttle all the way to the first curve and brake hard to enter a left'n'right-hairpin complex.  Then, there's 40 meters for acceleration coursed smoothly to the right and followed by a right'n'left-hairpin complex.  Push carefully to escape the 2nd complex and stir violently with throttle half-opened to pass the last right'n'left complex.  As we pass by the entrance of the pit lane, we hit the timer and the speed track is right in front of us again.  My friend Brian and I made 32 sec flat in our first trial.  Track record of the day was set by us, approximately 0.2 sec under.  As a trial, i would say that is very successful.
     After the first trial, we went to that place again yesterday.  It's the Employee's Day, so we've been charged 250NT for 10 mins.  Marshals were paving the last hairpin complex and we saw lots of crust at the apex of every hairpin.  Kinda worried though, we got dressed and chose our kart.  Engine sounded just the same, but tires were totally different.  Thanks to the rough surface of the track, the tires must have been scratched off and lost, say 60% of grip.  We could hardly control the kart in and out every curve.  Brian even spun several times during the race.  Driving very aggressive though, my record was 1 sec up compared with last time, whereas Brian was 3 sec up.  We tried to figure it out, but the marshals told up that it aint easy to make a sharp improvement on a day like that.  Apex too slippery, tires unchanged.  Too many disadvantages for us to cut record.  Anyway, rental karts are just for fun, ain't it?
    Karting aside, it is the cinemax that matters.  SBC, Star-Bridge-Cinemax, is on the fourth floor of the mall.  The first time here, we saw "Wild Hogs" after karting.  It's about 4 middle-aged bikers with very frustrating lives and looking for a way to restore their fountain of youth.  The four of us talked much about this movie.  We love to drive; we love the excitement; We love to push the throttle and listen to the roar of the engine.  We are very likely to spend our first 100 throusand to buy our own kart and rent a spot in a professional circuit like the RKS.  Are we likely to loose our fountain of youth by the age of 40?  Our lives so miserable?  Wow!!