As I type this, I have a Pomodoro timer running for 25 minutes to see if I can write a blog entry without getting distracted [not pick up my phone!].

For those of you who do not know, the Pomodoro Technique involves breaking up the work into time blocks. Currently I’m using a 25-minute time block, as a way to see how I feel about uninterrupted work for this amount of time, but hope to work my way up to 50-minute time blocks [wish me luck!].

It’s literally only been 5 minutes, and I’m itching to pick up my phone. Must. Resist.

This was all inspired by a podcast talking about this study on blocking mobile internet on smartphones. I was impressed by the results:

The intervention improved mental health, subjective well-being, and objectively measured ability to sustain attention; 91% of participants improved on at least one of these outcomes.

Noah Castelo, Kostadin Kushlev, Adrian F Ward, Michael Esterman, Peter B Reiner, Blocking mobile internet on smartphones improves sustained attention, mental health, and subjective well-being, PNAS Nexus, Volume 4, Issue 2, February 2025, pgaf017, https://doi.org/10.1093/pnasnexus/pgaf017

It makes sense that mental health, well-being and attention span were improved with the blocking of mobile internet. There’s a higher activation energy to picking up a larger device [like my laptop] and committing to doing work on it. Plus, the availability of social media applications on my laptop is much more limited; I have to open a browser and login to my social media site as opposed to being served up content on demand from a reflexive tapping of the icon on my phone.

I loved that the participants did other more interesting things out in the world with their extra time. I’d posit that this compounded their improved sense of well-being/mental health.

Those of you who have followed along for a while know that I’ve struggled with bouts of depression and anxiety. More recently, it has felt like my addiction to social media and the dopamine hits are preventing me from doing the things that I value. Like practicing writing this blog. Even content creation through more reels. My screen time last week on Instagram alone was > 7 hours and this week it is already > 8 hours [and the week isn’t even over yet!]. I don’t like seeing those numbers. I wonder how I would feel if I spent that time on other things.

Actually, I know I’d be more satisfied with more checkboxes on my to do list. Or even just dedicated time to read a book more intently. Maybe I’ll have more time to go to exercise classes and build some community outside of my house [Maybe. Introverted voice says, “WTF are you thinking? That sounds exhausting.”]

It seems like there are influencer “protocols” everywhere for everything. And everyone seems to be “-maxxing” stuff. So, I’m going to work on my own brainmaxxing protocol that I’ll share via my social media and expound a bit more on here.

Step 1 of my brainmaxxing protocol

Identification of the problem

The problem I’m identifying is that I’m spending more time on Instagram than I’d like to. Additionally, when I look at my pick ups, it’s a lot of reflexive tapping on Instagram than I’d like.

Goal 1: Less time spent on Instagram

Step 2 of my brainmaxxing protocol

Using a physical item to help me stay accountable. That’s where my Pomodoro timer comes in. Check out what my current status writing this blog entry looks like:

Goal 2: Trial 25-minute Pomodoro sessions for specific tasks like blog entries.

Wish me luck. Send focus energies my way! And check back to see my progress in future blog entries. [P.S. My 25-minute timer went off and I was just wrapping up the end of this entry. Amazing what little time it takes to actually get things done when your attention isn’t pulled in a million different directions!]

I feel like everyone’s talking about AI taking jobs. It seems like the tech world has been impacted by the AI boom with reductions in force. I’ve heard that those that managed to keep their jobs are using AI-generated code in place of an entry-level coder. They are AI-augmented workers. It’s crazy to think that when I was growing up, computer programmers/software engineers had the most stable job prospects. After all, we rely so heavily on computers and the software that runs on them!

Growing up in an immigrant household with a scarcity mindset, it was always on my mind that I wanted to select a stable career. One that would always have stable job prospects. The typical teaching was that doctors, lawyers, and engineers would always have work. I think that even in this day and age of AI, this continues to ring somewhat true.

I was having a conversation with someone about AI and it came up that we will still always need judges. We will always need a human to render decisions based on the rules that we’ve set forth. That’s a very human job. So there are avenues for lawyers.

And we will always have physical products that need engineers to be part of the design/creation/maintenance.

But anyway, I’m a doctor, so I’m going to speak on the field I practice in.

Specifically, I am an anesthesiologist and an ICU physician. When I was deciding whether or not to do a fellowship after my anesthesiology residency, I actually opted for critical care medicine because I thought it was an insurance policy for if anesthesiologists were to become obsolete. One thing you should know about the field of anesthesia is that we’ve seen a lot of ups and downs over the last few decades. There was a time where anesthesiologists struggled to find work which then set the stage for a huge shortage of anesthesiologists so the pendulum swung dramatically the other way and people were being paid crazy salaries.

Currently, I believe we are in a bubble in the anesthesia market. The job market is so hot. There are some really nice salaries being offered. People have been jumping ship from groups because groups down the street are poaching them with more money for less work. Why would you pass up that offer?! But history tends to repeat itself so I am skeptical that the demand for anesthesia services will remain this high.

Either way, you came here to read a rant about how my job [the anesthesiologist part; maybe I’ll tackle the ICU part at a later date] is AI-proof. Apparently this Forbes list agrees with me. (The author should have investigated the difference between a nurse anesthetist and an anesthesiologist since CRNAs were #1 and we were #11 on this list. I’ll interpret this as because the training pathway to become an anesthesiologist is longer and more expensive, it fell lower on the list.) (Also of note, 7 out of the 20 on that list are medically-related so I guess those of us in medicine picked wisely!)

So… let’s get into it:

These are the reasons that anesthesiologists and those of us that are also critical care trained are protected, for now:

• Real-time decisions with life or death consequences
• Procedures
• Liability/regulatory limitations
• Interdisciplinary coordination
• Human touch
• Cost

The areas where I want AI/technology to help us:

• Preoperative assessments
• Early alert warning systems
• Drug dosing and delivery systems

Real-time decisions with life or death consequences

Everyone loves to compare the practice of anesthesia with being a pilot. There are critical times in a flight that a pilot’s decision making could profoundly impact the trajectory of the airplane… the same thing goes for anesthesia providers. These critical portions of an anesthetic are typically induction [like takeoff – the process of anesthetizing/sending someone to “sleep”] and emergence [landing the plane – turning off the anesthetic and waking them up]. Procedural portions [intubation – placement of a breathing tube or device, arterial lines, central lines, epidurals/spinals, regional blocks, etc] of our practice can also have complications/consequences and thus are critical.

Sometimes unexpected reactions/complications happen related to the anesthetic. Patients can have anaphylaxis to our medications – having personally cared for a patient who had anaphylaxis before, it has major hemodynamic consequence and high risk of mortality [death] if not immediately managed. Luckily, the operating room is literally one of the safest places to experience this medication complication because we are well-equipped and well-versed with the treatment of this entity.

The other critical times are related to surgical factors. Sometimes we can anticipate major blood loss AND hemodynamic swings [like an open aortic repair… we know a patient will bleed and experience swings in blood pressure with clamping and unclamping]. Other times, a surgical complication can occur and it’s a surprise.

While the surgeons I work with typically are excellent communicators, they’re also PERFORMING SURGERY. So if something isn’t going smoothly, they often get hyper-focused on fixing the problem. One skill I learned in training and during my practice is being attuned to the signs [suction, tense voices, request for more surgical clips/ties in rapid succession, etc] that I need to be on high alert.

Either way, the operating room is an extraordinary dynamic environment. AI can work well with non-time sensitive medicine. Outpatient clinics. As scribes. When learning about a specific diagnosis or trying to generate a differential diagnosis. Radiology images. But at this point in AI technology, there isn’t a robot that can “read the room” and respond.

Procedures

While we are not surgeons… as I mentioned above, a big part of our work still involves procedures. What kind of procedures?

• Procedures anesthesia providers routinely perform:
  • Peripheral IV (PIV) access
  • Intubations
  • Arterial lines
  • Epidurals
  • Spinals
  • Peripheral nerve blocks
  • Central lines
  • Pulmonary artery catheters
  • (With additional training) Transesophageal echocardiograms (TEE)

While there are certainly robots that can be created to perform some of these tasks, there’s also a reason why you have yet to see one employed in the hospital. Patients are unique. They have unique anatomy. Robots/algorithms do better when they are given a set of instructions. Literal instructions.

A great example of how technology may augment, but does not replace humans… the “vein finder.” I once was on a pediatric anesthesia rotation and we had a cute baby with no veins (for those of you with cute babies, the more “prosperous” – in Chinese culture the chubby babies – your child is, the harder it is for us to find a vein!). We used a vein finder device and placed a catheter… in an artery. Since we’re human, we did not inject medications through this vessel (which is dangerous)… we identified that it drew back too easily and tested our hypothesis that it was an artery rather than a vein (hooked up the catheter to a pressure bag and confirmed a systemic pressure). So… it’s a good thing that a robot didn’t just cannulate whatever vessel there was and use it as this could have caused harm to the patient (e.g. embolic events, limb ischemia, etc).

Many procedural specialties are somewhat protected for now because of the unique characteristics of most human bodies. While we mostly have similar organ configurations, the patient that arrives with situs inversus (organs are on the opposite side of the body) may confuse the algorithm. It probably could be trained to figure out what to do next, but one thing that is uniquely human is our creativity and ability to create a new solution or apply a unique approach to problems that arise in real time. While AI is “smarter” than a human, I would argue that it is not more creative than a human. It is only able to generate what already exists in its training model.

Also, procedures taken over completely by AI would require the use of robotics to actually do the physical action. As we’ve seen time and time again, it is extraordinarily difficult to get robots to do complex tasks. At this point, automation of warehouses and supply chain things are where there’s growth in the robotics arena, but medical procedures probably will take a bit longer to see actual autonomous devices.

With an increasing use of minimally invasive techniques, there certainly exists an opportunity to train AI to augment human decision making for the best. We will need to conduct studies to really dive deeper into how AI-augmented care impacts decision making and whether it will actually improve outcomes or lead clinicians astray (i.e. if AI is hallucinating, will the human be able to detect the error and correct it or will it lead a human to doubt oneself?).

Liability/regulatory limitations

Let’s say in the future we have an AI anesthesia robot administering medications and managing an anesthetic. If the robot makes a mistake/hallucinates and a patient is harmed, who is responsible? The company? The hospital that decided to get AI robots to replace human anesthesiologists? Who do we sue?

This kind of ties into some of the regulatory limitations. It’s hard to predict in this current political climate how regulations may change. AI companies are looking to make money, so it makes the most sense to tap into the fields where there is minimal red tape, and potential for revenue generation and huge growth exists. I’d argue that with how much regulatory red tape there is in medical licensing and the litigious landscape of American medicine, most companies are not incentivized to tackle replacing physicians performing technical skills or fields that require quick action in response to a changing patient situation.

The specialities that are ripe for AI right now are those with static findings/datasets that a model can be trained on like radiology and pathology.

The other challenge that arises is that studies need to be done to demonstrate that the AI anesthesiologist is better/cheaper than a human. There are a lot of components to anesthesia that make it hard to break down into

Interdisciplinary coordination

The operating room often feels like controlled chaos. There are a lot of people that need to be part of an operation to make it happen. There continues to be work done to ensure that we have systems in place maintain patient safety, but the reality is, when there are unexpected complications or challenges that arise with equipment, there is a lot of coordination and teamwork necessary to manage these types of situations. AI requires a dataset to train from so that it can make a “judgment” and “decision” on what to do next. The issue is that while there are certainly common things that can go awry when working in the operating room, there are also a lot of things that are unique that we face in the operating room that are hard to train a computer with. One example is that in order for certain operations to occur, it requires specialized equipment that also needs to be sterilized and checked for sterility. Often there are new devices that our device representatives know well enough to guide a physician on use. While one could say that all of these “jobs” can be replaced by a robot, I’d argue that robots aren’t anywhere near as cost effective (see below) as our current system of humans. One potential benefit of a robot in the operating room might be that it’s feelings won’t get hurt (Maybe? Do our AI chatbots have feelings and sentience? Probably not, but with how good chatbots have gotten at mimicking emotion, it certainly can seem that way.)

Human touch

Admittedly, it is heart-warming to read about the ElliQ robot companion that was designed for older adults. There’s a real loneliness crises among older adults (and probably younger adults post-pandemic). Loneliness is associated with cognitive decline, so if this device provides companionship for our older adults, why not use it as a way to also combat cognitive decline/dementia?

That being said, most people don’t get surgery/procedures everyday. For most people, this is one of the most vulnerable moments in their lives. If society gets to a point where humans have AI robot companions, I could see that helping in the perioperative setting with calming anxiety and providing company. Currently, I do think most patients would feel more reassured by knowing there is a human caring for them and that human connection/trust is vital to the surgical journey.

It’ll be interesting to see how this evolves over time. More people are falling in love with their AI chatbot so…maybe the time is nearer than I thought for humans to accept robots caring for them.

Cost

As I type this up in 2026, I’d say that human labor is probably still cheaper than an AI-powered anesthesiologist or ICU doctor. There are certainly things that AI will be “cheaper” in being able to do (administrative things, coding, summarizing, etc) but the reality is that the physical labor, critical thinking, and variety of skills required in order to provide anesthesia and attend to an ICU are not replaceable by a single robot. There are many pieces of what I do in my work that could be augmented or even done by AI (like my pre-op job – more on that below), but the combination of all of the things would cost a lot more money than I cost at this time. Maybe someday the cost of the technology will be less than a human, but for now, it seems like we’re safe.

Areas of anesthesia that AI can/will influence/impact

The areas of anesthesia where I think AI makes sense:

• Preoperative assessments
• Early alert warning systems
• Drug dosing and delivery systems

My leadership role is in the realm of pre-operative evaluation – reviewing a patient that is scheduled for surgery and assessing whether they are optimized or not to proceed. This area is absolutely an area where I WANT AI to come and help summarize the incredibly bloated medical record. Now, the technology is only as good as the data that’s fed into it, so I anticipate that humans will still need to validate the summaries that are generated and review the citations (links to the original note that it extracted information from) that it includes. One recent example of where summarizing a patient’s chart could be erroneous without a human: I saw in a single note that reported that the patient had a specialized device implanted, but then noticed that there was no evidence of the device in the patient’s imaging. So I called the patient and it turns out that the patient’s partner, not the patient, had this device implanted. We will never know whether this was a scribing error or a human error with note entry… but this is an example of how human judgment, instinct, validation, and oversight will still be necessary in this realm.

Another area in the anesthesia realm that I think AI could really make a positive impact on patient care is with early alert warning systems. The anesthesia record is ripe with data that, if analyzed, could really create prediction models for early signals for adverse events. The most common reason for hypotension in our world is unanticipated bleeding or under-resuscitation during a case. I believe that AI should be applied to analyzing the dataset of anesthetics to be able to provide a warning indicator for when a patient may be at risk (e.g., analysis of arterial line pulse pressure as an early indicator for hemorrhage). Now… this requires a high index of suspicion from the anesthesia team to place invasive monitoring like an arterial line, so we (humans) still need to stick around for a bit. And we still need a human to respond to the warning system.

One of my colleagues is working on a device to provide suggested dosing and to also optimal evidence-based recommendations for maximum dosing of local anesthetics (which can lead to a dangerous complication called LAST if over-dosed). Using AI technology for decision support is another area that I’d welcome a computer that’s programmed with good evidence/data to make suggestions for optimal dosing. In our world of anesthesia, we administer a lot of medications… some medications should be dosed by actual body weight others ideal body weight and sometimes we should use adjusted body weight. Training helps us learn which one is which, but with new medications that get added to the market and new studies on optimal dosing, it’d be amazing to leverage AI to incorporate this information in a way that is easy for the user to apply to a patient. Truly using evidence-based, precision medicine would be an ideal end goal!

Target-controlled infusion anesthesia delivery systems already exist in the market. Although these devices are more widely used in Europe, there are limitations to the technology and there are guidelines surrounding their use cautioning around its application to patients outside of the studied in the patient model (i.e., healthy, non-obese patients). This is a great example of a technology that attempted to automate an anesthetic… but looking at the error margin that exists (the devices’ mean estimated concentration of the anesthetic could be 25% from the actual) and the fact that the vast majority of my patients do not fall within the validated model (I don’t take care of healthy, non-obese patients frequently), make me rather skeptical of its applicability to my personal practice. That being said, these devices certainly are a ripe area for exploration and application of AI models. However, these systems would make more sense in an ICU setting first rather than in the operating room where there will be more dynamic changes to the patient’s status depending on the surgery and potential complications of the surgery.

If you grew up in a low- to middle-class household or maybe just an Asian/immigrant household, you probably had some exposure to the scarcity mindset. I am thankful for my family’s super-frugal philosophy because it allowed me to be financially comfortable today. I am education-debt-free. I am working a lucrative career. Life is good.

But… the scarcity mindset has its downside. It means that there are some weird things I struggle to spend money on. It’s irrational. One example: I have a hard time taking Ubers/Lyfts when there is a train station/bus and my ability to use my own two legs. Once, I was out late and I didn’t feel safe while I was waiting at the platform of a train station so I walked 30+ minutes home instead of just taking a < 10 minute ride in a rideshare. In my mind, this was being frugal. Totally reasonable. [It was irrational. I can admit this now.]

Clearly I should buy new shoes but some inner voice of mine is reminding me that these are still functional. They mostly cover my feet. They mostly protect me from the bodily fluids that I’m exposed to in the operating room and ICU. They are still comfortable to walk around in. They will just end up in a landfill so I might as well keep wearing them!

Where the scarcity mindset gets tricky is when it creeps into other areas of life. I’ve seen it seep into my perspective on dating/relationships; there were moments in the last couple of years where the scarcity mindset kept me in a relationship or seeing someone that I didn’t really like, but felt like I should keep trying at it. Kind of like my shoes. They are functional so why would I trade them in for something better? There probably isn’t anything better!

[Actually, I believe there is often a better “fit” when it comes to relationships. It’s important to have alignment on the big life values. The best thing about being at this stage in my life: I am incredibly fulfilled by my work, family, and friends. The bar should be high. A life partner should be a value add to your life.]

I’m now in the process of evolving from a scarcity mindset to one of abundance. It feels lighter to live life this way. From a financial standpoint, this has looked like spending money on purchases I value [e.g., vacations/experiences, higher quality clothing that I look/feel good in, items that bring ease into my life]. I also recognize that lifestyle creep is a real thing, so I try to be mindful about that without resorting back to complete scarcity. I’m proud of how far I’ve come in the last few years… I no longer believe that these purchases will rob me of my financial stability. [For those of you wondering about my work shoes situation, I bought some Brooks shoes but I just haven’t brought them to work yet to break them in.]

From a life standpoint, I have started to see abundance everywhere. There are abundant opportunities at work for making a difference in patient care. There are individuals I am lucky to have the opportunity to connect with on a deeper level. There is the incredible feeling of unconditional love that my chihuahua, Minnie, shares with me each day.

In dating, just a year ago, I think I was giving off seriously desperate energy. I believed that quality partners were scarce. But as of late, I’ve connected with some incredible humans. And more and more seem to show up randomly, when I least expect it. Even if these connections don’t work out as life partners, I am enjoying the opportunity to meet new people and get to know them. I still feel sad and lonely sometimes… but don’t we all?

Those of you who know me in real life know that I have always looked for silver linings in everything. I feel that this is my true nature and that the dark years [i.e., premedical, residency, some of fellowship, a bit as an attending] were not a good representation of my true character. My true character has always been to believe positive intent in everyone. There is an abundance of goodness all around, if you just look for it. [Plus, gratitude interventions have a proven track record of helping mood.]

[Do I sound woo woo or what!? At least there’s some research to support it!]

Let’s get this out of the way: I am happy, satisfied, grateful, etc, etc for this beautiful life I get to live. I have the best job, the best friends, the best dog, and the best family. 10/10 would recommend this life.

But I’m missing the romantic partner. Heh. The other things in my life, I can somewhat control. Finding another human who chooses to put up with my quirks, finds me attractive enough to want to make babies [and of course, vice versa], and is a kind soul that I want to throw my mountains of my love at… this annoying thing… is not in my control.

So, like any human being that is starved for connection, I get sad sometimes. Like really deep dark well of sadness kind of sad. We all seem to be fluent in therapy speak these days, so yeah, there’s some sort of childhood wound that’s mostly scabbed over in the last decade or so but still rears its ugly head sometimes. I guess I have been known to pick at scabs.

Being out of medical training has helped lessen the sadness. The loneliness is lessened by the unconditional love of my dog, and strengthening of my friendships. I was always been terrible about reaching out when I was in a dark place. I appreciate my friends in residency who could pick up on the signs of my sadness and reach out to check in. But now, I’m in a place where I will actually reach out to people and let them know that I need their support. So that’s good. *pats self on back*

There is a real weight that is lifted when you’re done with residency/fellowship [do not recommend critical care fellowship in the midst of a global pandemic…] AND you’ve found a nice stride in your clinical work. Not everyone will experience this luxury that I have, which is why I have to preface this whole entry with being appreciative.

But let’s just dive right in. It sucks to feel alone in your mid-30s when you’re surrounded by your favorite people who have partners and babies [the human kind, not the fur kind]. Who have the proverbial white picket fence [or are hiring someone to build one]. Who have challenges in their marriage but are doing the work with a therapist to work things out because they realize that their partner is worth it. Who are in relationships and building something incredible together. I am happy for my friends but the constant reminder of what I’m lacking when it’s staring me in the face can make a person crazy.

Certain life things are just easier when you have a partner. I’ve been going through the process to freeze my eggs. And you know what you need when you freeze your eggs? A responsible adult to pick you up after your anesthetic [during the egg retrieval process, patients typically get sedation with propofol]. When you’re a single lady with bada** professional friends, it’s hard to ask them to rearrange their lives to pick you up on a random morning. I want to just tell the clinic that the anesthesiologist is my responsible adult. They’re my colleague. I’ll just sit in my office at work until I’m recovered. Promise! As long as I don’t get any midazolam!

[Doctors make the worst patients.]

I want the security of knowing that someone else cares that I am alive at the end of each day. That there’s another human being that will open their arms to me and wrap me in a warm embrace when I’m having a tough day. I want to know that I can ask things of a partner and they want to be there for me. I want to know that someone cares enough about me to try to make life better/easier [Snow storm? Someone who loves me enough to drive me to work!].

Prior to this current season of my life, I was a serial monogamist. I had a serious relationship in high school. Then college into medical school. Then residency. And now… this is the longest period of my life that I’ve been single. When I look back at my serious relationships, I can’t help but wonder, did I f-up and fumble something that would have been good for me long term?

[The answer is no. None of those relationships should have worked out, BUT, only in retrospect can I appreciate what characteristics I took for granted. Like, really took for granted.]

The thought that I’m most scared of when I’m in this dark place: what if I never find another relationship?

When I reflect on this single season in my life, what scares me is that I haven’t grown close to any potential partner in years. It is not for lack of trying. Ask my friends – I’ve been on dates. A lot of dates. I meet people. I make time to date. I try to give people a couple of chances to make an impression on me. But nothing has stuck. Nothing recently has felt like a good connection with aligned values that could actually go somewhere.

What is going on?! I am not that picky. I believe there are suitable men out there for me. I make the effort to meet people. But nothing is sticking.

I think that there are a lot of people on the apps that are purely seeking validation. And a lot of people out there that are just not willing to put in any effort [not prioritizing dating and finding a partner, probably].

No one has offered a set up – I’m open to them! Promise!

Anyway, there is a real catharsis with writing down these thoughts. I am loving the DMs I’ve gotten from people who are in the same boat as me [Hi! Keep sending me messages!]. Even though I’m scared that there may be a universe where I will never find someone to call my partner, I do believe in my heart that it’s possible for me. That it will happen. Someday. [#manifesting]

I recently posted a reel on my instagram about how I experience seasonal affective disorder (SAD) annually in the winter and how I try to manage it. One thing that I mentioned on the reel is that I will take fluoxetine (Prozac) for a short course to help me through the season.

Let’s back it up to almost 5 years ago when I was going through a major breakup. Like… we lived together. We survived most of residency together. We sort of endured the COVID pandemic together [I think that the pandemic ultimately was what accelerated the realization that we were not a good fit for each other]. And I was facing the most challenging exam of my career: anesthesia oral boards.

There was a day that I was scheduled for an afternoon operating room shift and I spent the entire morning crying. I could not stop the tears from flowing. I could not stop my mind from feeling horribly sad and despondent. You’d think that eventually your body would run out of the salty water that pours out of your eyes. But apparently my body saw no end to it and I somehow had to go to work and study for this high-stakes exam?!

That was the day I realized I needed to do something. I had to overcome the voice inside that represented my upbringing and its resistance to psychiatric ailments and the medications used to treat them. There was no way that I was going to be able to focus on studying and figure out how to live post-breakup without a little help.

So I made a virtual urgent care appointment with an internist and explained to her that I had an acute life stressor and I needed an antidepressant to help me through this period. I also made it very clear that I needed an antidepressant that would not make me gain weight or lose my libido because… well, I was single now. And I wanted to look hot for dates. And I want the ability to get aroused by potential future partners.

The internist recommended Prozac and I said, “sign me up”!

I’ve always been extremely sensitive to any medication I’ve taken. The dose she started me on was the “lowest” dose but it was still incredibly stimulating. I’m so sensitive to medications that literally the day I picked up the medication and took my first dose, I could feel a difference. I felt like a person again that wasn’t weighed down by heartache and the reality that I was going into my 30s as a single woman [if you don’t know me… I’ve wanted that whole nuclear family thing for my whole life; I want kids and I thought I’d have them by this point in my life].

I got through oral boards. I started dating. And eventually I recognized that the medication was starting to have more side effects than benefits. Or maybe through time, and therapy, and journaling, I was finally able to get over the acute stressor of the breakup.

For me, the side effects included: lack of appetite [which… I actually enjoyed since it was a great way to lose weight and feel confident in my single hood], GI distress, diminished libido, and a total lack of ability to cry.

It’s like we came full circle! I started Prozac because I couldn’t stop crying and now suddenly I’m complaining because the tears won’t come?! Make up your mind!

One thing that I have always been proud of is my ability to be empathetic and caring. My ability to feel emotion. Strongly. I’ve always equated crying with catharsis. I think that I am a better intensivist because I feel the emotions surrounding tough medical situations so strongly.

In my life I’ve been prone to depression/sadness. I fought through waves of very dark times. But as I’ve grown older, I’ve started to realize that the feeling happiness and joy seem exist because of the contrast to the sadness and despair I’ve felt before. I think I needed to experience the struggle into order to appreciate the sweetness of when life delivers good things.

So when taking Prozac meant I was numb to feeling and emotion… I decided this was too much. I weaned off of it [I believe it was during the spring/summer] and could feel like me again. Life was steady. Life was good.

But each winter would roll around and I would start to descend into a darker place again. Or I’d find that my anxiety would act up. One thing that I was amazed about while I was on my first course of Prozac was how well it quieted my anxiety.

A few years ago, I decided, why not go on a short course of Prozac for my winter seasonal affective disorder? Turns out, this is a relatively effective approach for me and has gotten me through a number of very dark winters in New England.

I was inspired to write this today because I wondered if this season would be different. I wondered if I would be able to get through winter without the Prozac. I’ve made it pretty far into the season and haven’t felt like I am incapable of living life. It’s almost halfway through January and I cannot say that I’ve needed to curl up into a ball and cry my eyes out. Life feels steady. Work feels manageable. Dating feels mostly fun [sort of… more on that in the future].

But it hit me that the last few days I’ve noticed time passing in a weird way. It’s both moving too fast but also too slow. I’ve sat down and felt like I needed a fast forward option. I needed a 2x for this part of life. And I didn’t like that. Life is so short. It’s precious. Every moment is meant to be savored as best as it can. And I hated that I didn’t have the ability to do that.

So… this year will be a new experiment. Prozac PRN [as needed]. I pulled the trigger today because my monkey mind was raging. This time, it was crippling anxiety and the inability to just take action that led me to restarting.

More to come!

[P.S. This is not medical advice. None of this blog is ever meant to be medical advice.]

When I started blogging here on the internet in 2011, it felt like I was writing to no one. I was an early adopter of online journaling – I used Xanga and LiveJournal and loved playing with designing on those platforms and also sharing all of my angsty thoughts on the internet. Anyway, fast forward to 2011, I am about to start at a brand new medical school, I am working as an engineer, and I am also about to start a long-distance relationship. I thought, why not document this journey and also why not share about this crazy adventure I am embarking on?!

I loved [still love!] the community I built. It was small. It was cozy. There were really nice comments. I felt like this was all I needed to keep writing and sharing. At some point, my study plans made it higher up in the internet search ranks so people were appreciative of my musings there. Everyone was so uplifting and positive and nice.

Now… people are just not nice. The internet has changed.

This is the excuse I am telling myself, at least.

There’s probably a combination of things. I find that I very easily can hit a writer’s block if I’m weighed down by work and life. When emotions are running around… I just cannot seem to use words [words are hard]. What are words when your brain is going a million miles per hour spiraling on life things?!

Also the mean comments [mostly on TikTok for the minute I tried that and a couple on YouTube because people are weird about anesthesia providers]. WTF happened to civility?! I am a human. I have feelings. I am delicate flower/snowflake on the inside and saying mean things really can linger and weigh me down.

But lately… maybe the other stuff/noise has finally settled and I feel more clear. The stream of creativity is slowly opening up again and I am excited about the prospect of writing and sharing with you. I maybe even started drafting a memoir[!!!].

And maybe I grew some thicker skin and care a bit less [or internalize a bit less] the negative chatter. As long as the positive, uplifting, friendly conversation continues to dominate, I think I’ll continue to show up. And honestly, it doesn’t all need to be positive… constructive comments/feedback are taken to heart and also appreciated.

YouTube is an arena that I had fun with during the pandemic and I want to keep doing. I realized as I got back into recording this video and a future one that maybe I should figure out a more sustainable way to do this stuff because while the idea generation and the recording maybe take around an hour’s worth of time, the editing process does take longer. I enjoy it [most of the time], but it’s certainly a lower barrier to write these entries compared to the video content.

For a while, I hid my dating life. Maybe it’s something about how I couldn’t erase Mike from my life when that ended because he was so fundamental to this blog and my online identity. And I didn’t want to repeat being “attached” to another person who may or may not be my forever person. But now I feel like I missed out on early thoughts from my last few relationships. By memorializing my past love, I am also able to memorialize the feelings [the really good ones that are quickly forgotten]. Doesn’t everyone love a reminder of the giddy/dizzying feeling of early love? Of early excitement? Of fantasies of how a romance could unfold and a beautiful life painted in the synapses of the mind?

Anyway, I digress. I’m back, I think. And I’m really excited[!!!]

Back when I was an impressionable premedical student, my research mentor sat me down after I shared plans to leave his lab and said, “You won’t become a doctor.” He then explained that he would not be adding me to his lab alumni page on his website and that he would not write a letter of recommendation on my behalf to medical school.

I remember feeling totally crushed by this statement. But it didn’t stop me from achieving my goal/dream of becoming a physician.

Sometimes we encounter haters that don’t believe in your goals and dreams. When you encounter these individuals, I go over 4 ways to overcome them:

1. First ask yourself: Is there a grain of truth to what they said?
2. Find a lot of mentors and sponsors
3. Consider whether a pivot is necessary
4. Keep hustling, working hard, excelling

The anesthesia market is HOT right now so many anesthesia residents are going straight into practice without fellowship. Even though I initially dual applied for cardiac and ICU fellowships [more on this in the video], I recognized that I was making a $1 million dollar decision to pursue an extra year of training that didn’t align with my long-term career goals… so I dropped the cardiac fellowship part.

Everyone’s decision is unique to their current situation and career goals. Sometimes your situation changes. Sometimes your career goals change. That’s all ok. I decided that ICU fellowship was the right path for me and 5 years into practice, I am still happy with this decision.

In this video I go over:
– Why it might *not* make sense to do fellowship
– Scenarios where fellowship *should* be pursued
– Returning to fellowship after being an attending
– The potential “insurance” policy of doing a fellowship

Internship/residency were HARD. There were some REALLY low moments and some really tough scenarios that you face for the first time as a doctor-in-training. The hours are long and the work is tough. So… when I got an email that asked me to record a video about how I survived residency, it took me a little bit to reflect upon the experience and come up with 4 concrete things:

1. Mindset: I went into training with the mindset that internship/residency are TEMPORARY/finite and that the purpose was to advance to my goal of being the best possible physician I could be.

2. A strong support system: Both at work [to be able to vent, process new experiences/challenges, not feel alone] and outside of work [great to take your mind off of medicine].

3. Living close to the hospital/work: Not everyone is going to have this luxury. Some people will need to go to multiple sites for training. I go over in the video that during internship I had to drive 30-40 minutes each way and after a 36 hour shift… I don’t even remember driving home. That was scary. When I moved to Boston, I abandoned my car and made it essential that work was in walking distance. Also, my residency offered an Uber/Lyft reimbursement for post-call… I definitely used that.

4. Enjoying time outside of the hospital to the fullest: Even though the hours are long and the vacation is limited, there are weekends that exist and every once in a while you get out early [depending on the rotation]. I definitely took advantage of this time when I could and saw friends, celebrated milestones, went on weekend trips… I basically lived life to the fullest outside of the hospital. It gave me energy to go back in for the long, tiring days. And seeing what we see during residency makes you appreciate the little things.

There’s a stereotype that anesthesiologists are hiding behind the drapes trading stocks or doing sudoku puzzles, but that’s certainly not the reality of my job! I think it’s so important to share what the reality of the job is like and one reality of being an anesthesiologist is that it can be physically and mentally exhausting. Here are some of the reasons that contribute to this:

1. Covering multiple ORs w/sick patients 
2. Having to take call 
3. Unpredictability/feeling like there’s no control of your schedule 

I cover these three things in my newest Youtube video!