dendritic arborization • I like that phrase

disordered thought processes

hidden in the seeming chaos is beautiful, elegant order—at least, I hope that's true.

maybe it's enough

posted on January 31st, 2014

I dreamt about a woman whom I’ve had unrequited feelings for. She was hugging me and telling me that we’d always be friends. In retrospect, it was probably for the best. As if it could’ve turned out any other way.


posted on January 17th, 2014

Well, that was disconcerting. As I was walking Pazzo back to my parents house, I saw a golden animal standing in the middle of the street far down the hill. It then darted to the sidewalk. Pazzo quickened his pace but didn’t bark or anything.

At first, I thought it was the neighbor’s dog, but my parents’ neighbor wasn’t out there, and I didn’t think the dog could’ve really gotten loose. After a moment’s confusion, I thought it kind of looked like Angel, except Angel has been dead for three months. I suppose it could’ve been a stray or even a coyote. Whatever it was, it was gone by the time Pazzo and I reached my parents’ house.

dying in the friend zone

posted on January 15th, 2014

How did people get over this? They obviously did. Every day someone fell in love with the wrong person and had to pack up all their fragile, misguided hopes and unwanted affection, and move on.

Josh Lanyon Perfect Day

Well, no, healthy people get over this. There are a lot of people who are not healthy. While, sure, a lot of these people who fail to get over such common mishaps are raging misogynist douchebags who think women owe them sexual favors just because they exist, some of us are really just failed human beings who never grew up, whose souls are just atrophying, decaying. Waiting for extinction.

And so you remember feeling what you thought was love, only now you’re wise enough to recognize that it’s nothing like love, it’s just a twisted, narcissistic simulacrum of love, and even then, you can’t help but think “That’s the last time I’m ever going to feel like that.” The last time you’re ever going to think that everything was going to be all right. The last time you’re going to hope.

She doesn’t owe you anything. You know that. You’ve known that for a long, long time. And yet, that corrupted feeling, that deranged emotion, is the best you can do. After that, it’s all distrust and avoidance and realizing you’re never going to actually fall in love, and that no one is ever going to love you, at least not in that way (whatever delusional way you imagine “that way” actually is.) Because you’re a failed human being that never grew up, and all you’ve got to look forward to is that last day when it finally stops hurting forever.

the law of equivalent exchange

posted on January 11th, 2014

The Law of Equivalent Exchange in “Full Metal Alchemist” is really just a reformulation of the First Law of Thermodynamics: matter or energy cannot be created or destroyed. Everything has a price. You cannot create something from nothing. This often leads to the facile interpretation that life is a zero sum game, where one person’s loss is another person’s gain, and vice-versa.

But the fact of the matter is that people are terrible at estimating the true value of things. For the longest time, no one really realized how much energy was locked up in the form of matter until a bored patent clerk figured out (through very convoluted means) that E=mc². Then there’s the whole idea of false vacuum and the energy contained in the vast interstitial space between atoms, even between subatomic particles. Given the general extravagance (some might even say “wastefulness”) of the universe, it actually seems likely that the universe is far more generous than any human being has ever imagined. Just because you can’t think of a use for something doesn’t mean it’s “nothing”. Chances are you’re grossly underestimating the worth of everything around you. There’s more in this universe than you can ever imagine, and you’d be surprised how much “nothing” can provide.

beginnings and endings

posted on October 31st, 2013

My sister picked up Angel in front of the Sav-On down the hill (long before CVS had bought it) when she was just a senior in high school Some kid was selling puppies for $10. It must have been sometime after Halloween, and we always used Halloween as his birthday (althogh we never really knew.) We wondered if she had taken him too soon from his mother. He fit on the palm of my hand, and he wouldn’t eat and we were certain he was going to die. But eventually he figured it out. For the longest time, he needed to be supervised, otherwise he wouldn’t finish his food.

I had just come home from a fruitless attempt at getting a job in the Bay Area. I had been crashing at my aunt-and-godfather’s place in Milpitas from May until August, when I drove back, defeated. I had failed to get into medical school that year, and at that point I really wasn’t sure what I wanted to do with my life. Those were dark times for me. Quite possibly the worst year of my life, even after all this time.

We already had a dog, a German Shepherd mix named Lucky, who was sweet and friendly to humans, but she hated other dogs. When my sister brought Angel into the yard, I was certain that Lucky would maul him. She sniffed at him dubiously, and it didn’t seem like she was happy with the new addition, but she left him alone, except when he got too close to her food dish. This got worse as Lucky got older and started losing her wits.

I was in the process of applying to med school again. I had ended up getting a few interviews, but none of the schools accepted me. My last hope was a post-baccalaureate masters program in the northern suburbs of Chicago. They told me I got in right after the 4th of July. I had three days to get there.

So for at least half of Angel’s life, I wasn’t really around much. I’d come back for summers (at least in the first few years) and holidays, and there was one 4th of July where he somehow managed to get himself trapped behind the A/C unit and I had to rescue him. My sister ended up going to San Diego for college, so he became my mom’s dog, and Lucky and Angel lived together in sometimes fraught coexistence.

My 4th year in med school, I did several months of outpatient rotations back in L.A. When I’d get back home, I’d take Angel for walks. Those were some of the happiest months of my life.

Residency took me to San Diego after my sister had moved to NYC for law school. Lucky died after Christmas that year. I got to see her a few days before she died. She had been sick for quite some time, but somehow my mom and dad were keeping her alive. She lived just past her 14th birthday. I thought about death a lot. That was also when I lost my first patient, at least, the first patient that I felt primarily responsible for, right on Christmas Eve. I had to tell his family why he had been put in the ICU after he coded, and why he was in a coma. They agreed to withdraw care. I felt like shit.

Residency was probably the hardest time of my life, but it was probably also one of the best. It didn’t end the way I wanted it to, and I returned back to L.A., once again defeated.

When I came back to live with my parents, my sister had left them another dog, Pazzo. Angel, much like Lucky, didn’t really get along with other dogs, and Angel was also kind of misanthropic and prone to biting, but he didn’t harass Pazzo too much. In fact, Pazzo was probably the only other dog Angel would play with, although he’d often take it too far, ending only when Pazzo would start yelping.

I moved out of my parent’s house just as Angel turned 13. He was still fairly active, but he wasn’t able to tolerate walking as much. I remember on one extended walk, he gave up as we climbed a hill and my dad had to pick him up in his car. My brother would try to walk him, but sometimes he’d trip over the curb and hit his head, so we stopped walking him.

He was still fairly active and able to jump right after he turned 14. Then I started noticing that his hind legs weren’t working as well. He’d started soiling himself. And the thing that kind of broke my heart is that he stopped being able to wag his tail. He’d still try to gallop and keep up with me, and he’d still patrol the yard and bark at passing strangers. But if Pazzo tried to play with him, he’d fall down. He’d have problems climbing over small steps. In the last few months he’d fall down a lot.

We knew it would probably be pretty soon. It looked like cord compression. So either one of his discs was squeezing on his spinal cord, or it was a tumor. Either way, it was surgery. It didn’t seem like a reasonable thing to do to a dog his age.

On my brother’s birthday, the Dodgers were losing to the Braves in Game 2. I came to my parents’ house to pick them up and take them to my brother’s birthday dinner. I went outside. Angel looked surprised to see me. In retrospect, I think he’d also been slowly going deaf and probably blind. And now he couldn’t get up. He struggled to do so, but his legs just wouldn’t let him.

After dinner, we went out for some drinks, but it was pretty somber. We planned to take him to be euthanized. I couldn’t sleep. I went to my parents’ house at 1 am to see how he was doing and he still couldn’t get up. I went home and still couldn’t sleep. In the morning I came back to see him and he wasn’t any better.

At work I looked up sites to figure out if we could get him euthanized at home. I pondered perhaps just extending his life, feeding him by hand, giving him water with a spoon. But that was no way for a dog to live.

I went home and tried to see if I could get him up so at least he could spend his last hours inside. If I carried his hind legs, he could plod forward with his forelegs, but if I let him go, his legs would give out and he’d fall.

I hadn’t eaten lunch and I was getting dizzy. Angel would try to get up, crawl forward a few inches, and then fall hard. This went for a while. I couldn’t handle seeing him suffer like that.

I went to get food.

It was a somewhat unseasonably warm day, well in the 80s. Santa Ana wind weather. A wildfire had broken out at the 2 and 134 interchange. I couldn’t eat in Eagle Rock because the music festival was happening and parking was horrendous. I ended up wandering aimlessly. One of the roads I tried to take had been closed off by cop cars, and police tape had been laid across. I guess it was a good day to die. Eventually I made my way near the hospital my mom used to work at, and I thought about those days more than a year ago when my dad had a brain bleed and we worried he would die.

My sister texted me. “I’m taking him.”

I met them at the vet. I volunteered to stay with him.

Naturally, he wouldn’t go out without a fight. He tried biting everyone who tried to handle him, even me when I tried to put a muzzle on him. After a while, though, he surrendered and lay breathing gently. I remember seeing his breath fog up the metal exam table. The vet had a hard time finding a vein, and after a few pokes, Angel started crying. That’s pretty much when I lost it. But eventually, they got one. The painkiller went in, and he relaxed. Then the rest of the solution went in. His hind legs relaxed and extended, and I imagined him going for one last run. Then his breathing stopped, and he was still, except for some residual twitching.

I tried not to totally lose my shit as I left the vet, and I failed miserably.

Maybe I’m projecting, but I sometimes think Pazzo misses Angel. Even though Angel was often quite mean to him, and he’d bite him, they still spent six years together. When Angel could still tolerate walking, I’d take them together, and they’d always race each other, dragging me along.

Now, if my parents leave Pazzo outside by himself, he’ll sometimes howl, something he never did when Angel was with him. Every time I’d bring him back from a walk, he’d peer into the backyard for a while, like he was expecting someone to meet him.

Like I said, maybe I’m just projecting.

“If you don’t have much soul left and you know it, you still got soul.” — Charles Bukowski

This post about a medical student wondering what the hell happened to her empathy got me thinking about the times that probably messed me up really bad, but I’ve just been suppressing it and trying to act like a normal human being.

Probably the worst thing I’ve ever witnessed was an 8 month old baby actively dying of cancer. I was only cross-covering but I spent a lot of time in that room standing dumb and feeling utterly helpless, just listening to that little baby struggle to breathe while we gave him a ton of morphine. I had nothing to tell his parents that they haven’t heard in the endless days of their ordeal. I’m sure they didn’t expect anything from a cross-covering resident, anyway. I don’t remember much of the rest of those 30 hours. In the morning, the attending thanked me, and I felt like asking “for what?” I drove home and remember crying myself to sleep. It wasn’t like wracking sobs or heartrending wailing. I just lay down face down on my pillow and the tears just kind of leaked out before I finally passed out from exhaustion.

Probably the worst thing I have ever done was lose my shit at a dad who accused me of poisoning his son who had been actively dying inside the hospital for weeks, and I just couldn’t take it anymore. My intern was going nuts trying to figure out how to give him phosphorus in his TPN without totally sclerosing his veins because his serum phosphate level was absurdly low, and after a while of struggling with the calculations on no sleep, I couldn’t help but think “Does it really matter if he has a phosphate of 0.9 mg/dl? He’s dying!” Well, we figured something out anyway, but the dad lashed out at us, because there wasn’t any damn thing anyone could do. A nurse had to calm me down, and I got my shit together and apologized. The kid died on my weekend off. I remember signing him out to the cross-covering resident, warning them that the kid was circling the drain and would probably end up in the unit. They called a code probably about four hours after I left the hospital, and the kid did indeed end up in the unit, and the resus was a disaster, and he lingered for a a long while before he died.

So, yeah, holding on to your empathy can be tough. You still have to try, though, because being a heartless bastard actually makes everything even harder. Given how long and how much effort it takes to become a physician, inevitably a lot of your identity ends up based on your profession. And if your success in your profession depends on giving a shit about other people, if you stop giving a shit about other people, you inevitably stop giving a shit about yourself, and from there, it’s a downward spiral into realizing how worthless all the sacrifices you made to get where you are have been, and now you’ve pretty much got nothing left to live for.

how i hate the night

posted on October 21st, 2013

I wonder how long it will take me to be able to go to sleep without second-guessing the decision to euthanize the family dog and without needing antihistamines and/or alcohol.

the kick

posted on October 11th, 2013

I dreamt Angel had gotten out through the gate somehow. I asked him “What are you doing out here? How did you get through the gate?” Then my brain went “Oh, I’m dreaming” and I immediately got booted out of that level of the dream.

silver linings

posted on October 11th, 2013

At least Angel doesn’t have to be cold anymore.


posted on October 8th, 2013

I’m totally getting the auditory hallucination thing that I’ve read some pet owners get.

Sometimes I think I hear his tags jingling, or his claws clattering on the hardwood floor.

Last night I thought I heard him howling in the darkness.

The more I think about it, the more I realize that, yeah, it was definitely the right thing. He would’ve suffered worse otherwise. But it still hurts a lot.

some say because it's over

posted on October 6th, 2013

When my cousin died all of the sudden without warning about seven years ago just after we started reconnecting, I listened to this song a lot.

Some say because it’s over
we should be sad, but that’s not true
‘cause death may seem something nasty
but it belongs to me and you

Don’t try to avoid your destiny
Accept this kiss with dignity
In this embrace you’ll find relief
Get rid of all your grief

Some say because it’s over, we should be…
Some say because it’s over, we should be…
Some say because it’s over, we should be…
Some say because it’s over, we should be free!

I think I want this song played at my funeral.

who's going to watch you die

posted on October 6th, 2013

I think the worst part about watching death–even just the death of an ill-tempered and anxious dog who lived a long life of almost 15 years, who had deteriorated to the point where he couldn’t even stand up to take a drink of water or even to move out of his own filth–is that you know for a fact it’s going to happen again and again, unless you happen to go first.

I have seen a lot of people die under my care. And the deaths of friends younger than me have been difficult to bear even though I did not witness their final moments. And I dread it more and more, even knowing that’s just what the future holds.


posted on October 6th, 2013

I am so tired but I can’t sleep. Wonderful.

life. don't talk to me about life.

posted on October 5th, 2013

I’m sitting here in the dark, totally drunk, recounting my failures and losses. There are a lot of places where it went totally wrong, but I find myself lingering on one of the milestones that I choose to remember. A. I loved you in my fashion. But that is neither here nor there.

Having to put down my dog has somehow made me truly realize just how empty and lonely the rest of my life has been.

it's all bullshit

posted on October 5th, 2013

I could be coping better. This is not going well at all.

I am so lonely right now.