yesterday had lunch w/ a bunch of church family at one of our pastor's homes. of course, part of the conversation is dominated by dental questions. karen, a nicu nurse, mentioned that it is interesting to be so specialized, that my 40+ hours a week is consumed with problem solving and management with regards to teeth. just teeth. i thought about this and responded that i probably only think about teeth 15% of the time. the rest of the time is spent thinking about my patients' complex social issues, and the habit of having staff devotions each morning really helps me have eternity on my mind throughout the day.

today i did very little dentistry, but it was just as tiring as one of those days where it's just fillings and extractions all day long. today M came in with her son. J is the cutest and best-behaved. he had a rogue tattoo on his forearm. the tattoo was from bubble gum. (too much sugar!) anyway, he had a tooth abscess so we had to remove the tooth.

MEANWHILE, monin asked M about her teenage stepdaughter, N. N was supposed to come in january to have a crown delivered but didn't show up because she had run away from home. N is a commonly rebellious teenage girl, and her troubled relationship with step-mom, M, aggravates the situation. we've only seen them a few times. but within these few visits we've seen glimpses of dysfunction. having knowledge of how much dysfunction my own family has in the home compared to in public, i can only imagine the anger and frustration that N and M have toward one another.

-once M was upset that she had to stay in the waiting room while N was getting some fillings done. N is still a minor and needs a parent or guardian present to do any irreversible procedures. M broadcast to yoli that, "i don't understand why she needs a guardian present, if she's allowed to have sex!" whoa mama. N was in the waiting room amidst other patients who could hear this conversation clearly. this is all being said with a feisty spanish accent.

-when N did not show up for her crown appointment, monin spoke with M on the phone. she responded with, "i have no idea if she's going to show up. she's run away again and i have no idea where she is. i don't care anymore!"

-today, while we're doing a filling and extraction on J, M is pouring out her heart to us. poor J is getting his tooth pulled while listening to all this. "she's run away again. [...] i'm so upset that she was a straight-A student but decided to quit. who knows where she is and who she's hangin' with. i tried to tell her that if she is involved at the scene of a crime or is aware of her crowd doing bad things, the police will consider her an accomplice, so she'd better make better decisions. [...] she is currently dating another girl. and she's going to be 18 soon, so she can do whatever she wants, but i don't want her to bring her girlfriend into my home, where my children are - they are too young to see this. [...] she needs learn that things don't come for free, we work really hard to provide for the family. [...] i try to care for her, spend time with her and take her shopping. it's really hard to guide a child when her real mother isn't supportive and her father isn't disciplining her. [...] if she were my child i would pull her hair and give her a spank. but i can't do that because i'm her step-mother. [...] the bible says to take a rod to one's children. [...]"

-other things were said but my spanish comprehension couldn't keep up.

so i spent 45 minutes of my day processing this broken family saga.

and then i spent about 30 seconds thinking about how N is going months and months with a temporary crown in her mouth. and then another 90 seconds thinking about how maybe God let J have an abscessed tooth because He wanted M to come in and have a chance to vent her heart out to someone who would listen (monin did a better job at listening, since M's spanish is about 90 mph).

even though M is trying to be a good parent, there are so many circumstances and humanness that will cause her to fail at various moments. even though she does love and does care, she is unable to love and care perfectly. we might not all fall short this visibly, but we all fall short. and this is where grace needs to come in and do grace work. (versus human works).

she told us also that her medicaid was recently deactivated, so now she's not sure how to take care of herself, where to get care and how to get counseling, which she desires. i told her that she could continue coming to our clinic; however, without insurance she would have to pay on a sliding fee scale. i encouraged her to seek a church, and likely churches will have counseling resources. at the very least, she could talk to a pastor. (who hopefully has some counseling experience).

a thought that came to mind was that M does not have anyone in her life telling her that God loves her, or maybe that anyone loves her. whereas, i have multiple people, the Word hidden in my heart at a young age, and the Holy Spirit, telling me that Jesus loves and accepts me - multiple times a day .

God's challenge for me today is to share this good news in a sensitive way to all i encounter.

the liberty of doing things for Christ

-happy new year. still processing 2011. but glad 2012 is rolling along.

-'alejandro' is a little boy with severe autism. his mom is weary because she is home schooling him. he is unable to go to school because he is not yet potty trained at age 6. to his mom's surprise he let ada take his xrays. he also let me look in his mouth with a mirror only. a sharp-looking explorer he did not allow. cavities were found. there was no way he would let me drill his teeth. in this case i refer patients to a pediatric specialist, who can administer some type of sedative or anxiolytic. i was able to pray for alejandro and his mother. contrary to the way the world works, i felt soooo much freedom in being weak and incapable, when all i could do was pray for a patient in Christ's name. it is so burdensome to do things for results, to do things for the approval of others, or to do things for my own satisfaction. in the end i will be accountable to God alone. i want to do everything for Him. when i am surrendering control, He who holds the world in His hands is in control. when i am incompetent with my own strength, He who is all-powerful can work through me. and i am free.

friday around lunchtime we heard a patient next door moving some furniture and yelling violently. it lasted a few seconds. perhaps it was a child who didn't want to get vaccinated? we often hear crying children on our floor.

a while later we heard the patient again. this time everyone became silent to try to figure out what was going on. the yelling persisted longer. then we decided to peek down the hall to see what the commotion was.

i don't know any bad words in spanish. but monin told us that he was definitely cussing and also threatening to kill someone. people were paging security. and a couple male coworkers came down to offer help just in case he needed to be restrained. eventually the managers called the cops to take him to a crisis center.

speculation is that he was having anxiety/seizures, but also likely spiritual attack or demonic attack? the whole staff kinda stopped to pray for him. like laying hands style. hehe. micronesia flashback here...

we found out who this patient was. and i actually am very fond of him! he's always been chill with me and polite. when he was in prison, he got a bunch of tattoos, including half his face. including a spider web around his eye, and a skull/teeth/mandible, decorated with a baby cartoon red devil on his cheek. i wish someone would laser that piece off. maybe it was cool when he was 20. but 20-25 years later, i'm sure he regrets it.

the battle is real here.

ok this is gross.

one man's definition of love?
-i went to the front desk to make a copy of some forms and then i froze, mouth open, stared at a man in the waiting room popping his wife/girlfriend/sister/random stranger's zit on her temple. at first i thought, maybe he's giving a head massage. and then looking more closely i saw that he was indeed digitally draining her pimple.
blech!!!

so little did i know that this was my next patient.

he sat in the chair. and then told me about how much pain he's been having. then reached in his pocket and told me he was taking these pills to no avail, and showed me the bottle.

it was a bottle, labelled tramadol. but WAIT. the name on the label was cut off. totally not legal. anyway, no need to be indirect here, so i just directly asked him, "why is there no name on this bottle?!?!?!?!?" PORQUE?!!!!

his answer that the drugs belonged to his ex-girlfriend.

how is that a legitimate/relevant answer to my question? i'm not sure.

am i supposed to infer that his thought process was that he got a new girlfriend and perhaps she didn't want to see the ex's name anywhere, so she cut her name off the label? (kinda like the patient who turned his ex's name tattoo on his neck into some squiggly design? or the other patient who put a big black rectangle tattoo over his ex-wife's name tat on his arm?)

or... he had trouble getting over her, because her name just kept popping up everywhere, that he finally gave in and cut out her name.

anyway, at least we were eventually able to remove his rotting wisdom tooth, which smelled like rotting wisdom tooth.

had to look at a few pictures of puppies after that experience to feel better.

woke up late this morning. walked out of the apartment. realized that my outfit was pretty ridiculous, consisting of 5 different really bright colours, and wearing my new buggy-eyed sunglasses. it was too late to go back and make any modifications.

but then, i looked around me. and everyone else is wearing brighter colours, crazier prints, and crazier hair styles. that's philadelphia for you.

a news article for something that is not considered news

dear cyberspace,

yesterday our team at work found out that one of our patients stabbed his girlfriend to death on saturday. she was also one of our patients. we also saw their kids, ages 3, 2, and 1. we also see his grandmother and mother.

i can't find much information about the incident on the news, because sadly, violence like this in inner city north philadelphia are not considered "news". it happens way too often. "it" referring to "crazy s---". as much as i try to eliminate profanity from my vocab, the english language, as prolific as it is, simply cannot describe it better than "crazy s---".

calvin made the comment that if this happened in the suburbs, it would have been front page, filled with articles and memoriam regarding the victim, and how to help.

anyway, as a way to mourn and address my shock/vicarious trauma/grief, i'd like to write a little obit here.

--
Z.F. was a lovely young woman with a great smile. she always carried herself with gracefulness and dignity. she was the caring mother of three young children. she was a supportive girlfriend, daughter and grand-daughter. she was ambitious and wanted to advance in her career. she was organized, carrying around her huge weekly planner wherever she went.

i got to know Z during her several dental visits and as she also accompanied her family members. she never failed to be polite. she asked a lot of questions and also was open to sharing her life's stories.

she met her boyfriend/baby daddy a few years ago. she didn't like him at first, but he pursued with perseverance and finally won her over. he, K.R. seemed to depend on her a lot. whenever i worked on his teeth, she would hold his hand the entire time. K.R. was also always courteous, though more on the quiet side.

Z.F. passed away at age 24 on saturday, stabbed to death after a domestic argument. K.R., age 23, confessed to the stabbing and is currently being prosecuted for murder. L.N.F., Q.N.F, and L.D.R. are reportedly staying with extended family in delaware.

----
some thanks/lessons learned:

-during lunch after we found out, our team paused and prayed for the family. it's awesome to work in a place where in times of crisis, we can stop and remember our Lord, asking him for strength and peace. i might not see these patients ever again, but i was reminded that our ministry to patients does not just happen when they are in the dental chair, but it happens remotely through our prayers as well.

-i've never really had to deal with such gory news with anyone that i've met face-to-face, and i admit that i was approaching a moment of hysteria. i didn't know why because, after all, i'm just their dentist. and i was only their dentist for about 4 months. my boss reminded me that it must be a hard and heavy news to deal with because i cared for them. yes, i did care for them. and i do care for the family. this is what it's like to be in a helping profession, to encounter thousands of people over a lifetime and rejoice/suffer alongside others. i suppose i could choose to be a dentist that doesn't care. but i'm trying hard not to turn into a dental robot. sometimes my dentistry fails, to my dismay and the only thing that carries me through is my care. i'm so thankful for so many senior doctors at esperanza (i'm the youngest practitioner so far at this time), who exemplify christ's care in our practice.

-after my meltdown in march, i did a few sessions of counseling. my therapist, who is familiar with my organization, informed me that the majority of people who work in my org suffer from vicarious trauma. my inner hypochondriac was excited to receive a diagnosis! i could see that a year and a half of working in the inner city brought a cumulative sum of second-hand, third-hand vicarious trauma. but this was the first time i experience first-hand vicarious trauma. now i can relate better to the traumatized. i've graduated to the next level of empathy. and i've graduated to the next level of casting heavier burdens on christ. 1 peter 5:10.

-so i've shared the story with various people in my philly community life over the past couple days. i've encountered several different reactions. it inspires interesting conversation about death. how does culture affect our response to death? what has shaped my perspective on death?

-recently i've been receiving news of friends' babies born. i'm so happy for new life that enters the world, amidst other lives are ending.

--------
on shock:

-when taina first heard the news from zoraida, she wept. when i heard the news from taina, i yelped. i felt the need to sit down. i almost wanted to vomit or cry. but i could do neither. i imagined what it might have been during the crime. it just seemed so surreal. gun violence someone distances a murderer from their victim. it also happens more quickly. but to think about stabbing. where there is resistance. there is conscious pain. there is a killer who is just overtaken by madness and anger. madness. the state of mind of reckless madness. during the kensington strangler deal, i read up on a little about the psychology of serial killers, how they like to have a relationship with their victims. this is probably this case of where love goes mad. K.R. obviously couldn't live without Z.F. like, most kids hold their mama's hands when i give them injections, and sometimes when i extract teeth. but, holding baby's mama's hands even when i'm just checking for decay? i can deal with PDA (lived in france for a year!), but it's not like i can say that i enjoy it, especially in my dental chair. anyway, i suppose there was definitely some remorse since he did confess after all. "what have i done? i can't live without her. damn."

-everyone has a deep story. everyone is broken. everyone is in need of grace. i know i'm just as capable of snapping. it's only God's grace that i haven't done anything with such horrendous consequences to this day.

-of course people may seem nice if i only see them every other week. who knows what goes on in the home behind closed doors.

--------
a prayer:

-on christ the solid rock i stand, all other ground is sinking sand.
-urban life is definitely a lot more stressful than college town serenity where i spent all of my educative years. dental school was possibly the hardest thing i've been through. but, the brokenness and poverty of an inner city neighbourhood usher in a spiritual battle that is wearing on the body, mind and soul. Lord, sustain us. thank you that you are bigger than all these strongholds. thank you that you have already conquered death and sin and fallen-ness.
-please redeem and restore this ugly situation. redeem and restore K.R.'s soul. redeem and restore the kids' souls.
-our life on earth is but a flicker. help me to invest in eternal things and to live for you and your kingdom alone.
amen.

since i've been trying to go outside and walk around during lunch these days, i'm seeing a lot more reality kensington.

wed went to see dexter across the street. we've been working at the same corner all these months and never knew. so it was fun seeing the pharmacy and meeting all the feisty women he works with. they all told their boss about me and now i gotta go again to meet him and be neighbourly. apparently they gotta lock down the place real well at night because there was a break-in in the past where someone DRILLED A TUNNEL through the wall from the back alley to steal drugs.

dexter showed me a bottle of 500 endocet, which costs them about 45$. each pill can sell on the street for $5 each. meaning one could potentially make 2500$ for the bottle.

this is why we do not carry narcotics at esperanza. too much liability.

today i didn't have any food. went to turner's to maybe bring some baked goods to the pharmacy girls as a neighbourly gesture. and since i knew boss jimmy would be there. but marvin was out. i guess he just opens and closes as he pleases. he needs to get air conditioning.

finally, i decided to buy some produce - they were so nice there! $1.50 for a bag of peaches. not too shabby!

on my way there i ran into O. i haven't decided what i should do when i see patients on the street/in the subway. since a lot of people might not want to publicize who is their dentist/that they see a dentist. whatever hipaa rules and stuff. hipaa with dentistry is a little weird. lots of people tell me their dental stories alllll the time and are very open about what goes one w/ their teeth, telling the whole world and all. it's a little different than say, seeing a psychiatrist. or seeing an oncologist. or a plastic surgeon. or other more sensitive issues. however, we are all bound by the same privacy laws. anyway, so O saw me and made eye contact, so i thought, what the heck. i waved really dramatically, then was hoping for the euro bisou rather than a handshake coz who knows what he's touching on the street. but too late, he extended for a handshake and saw that i was extending my cheek so gave me a bisou anyway. then he exclaims to his friend (as they are both smoking on the corner), "hola! das my dentist! where you going?"
and i have no idea why i do this, but i tend to imitate the way people speak. and in this case sounded like a spanish fob. and replied, "i'm hohngry! going to get food!" then skipped away.

O is a recovering drug addict and who knows if he was in a gang. but he knows the streets. he's older now, so kinda retired from a lot of la vida loca. and of course looks older than he is coz of the drugs/smoking.

in contrast to this rather peaceful stroll amidst the urban heat and humidity, right after the produce station i went to walgreens to look for snacks. it seemed crowded but i could imagine a lot of the people were lingering in the store to witness lots of hullabaloo.

security guard was talking in a raised voice with this dude in handcuffs right when i walked in.
"YOU WOULD MUCH RATHER DEAL WIT ME, THAN DEAL WIT DA COPS OUT THERE."
"but i didn't steal anything."
"YOU'RE A PROFESSIONAL AND TELLING ME ALL THE SAME STORIES. BUT YOU'RE NOT A PROFESSIONAL, COZ YOU GOT CAUGHT. I'M WATCHING YOU! I SAW EVERYTHING! I'M JUST DOING MY JOB."
"i didn't take anything out of the store."
"YOU KNOW WHAT MY PROTOCOL IS, IF YOU'RE PUTTING THINGS IN YOUR SHIRT AND TRYING TO LEAVE THE STORE. I'VE DONE THIS, LIKE, SIX HAHNDRED TIMES."
then they went back and forth so the entire store could hear.
well, mainly the security guard wanted to flash his badge and feel like he had some power, in a city where, as a minority, he's kinda disempowered in a lot of ways. and who knows what his home life is like. anyway, i'm glad he's doing his job and catching shoplifters. but, the flamboyant display of words was a bit unnecessary and disheartening.

meanwhile, there were two semi-older men trying to return a phone card (where he had already scratched the covering off the pin number). he swore it was unused and that there is no printed notice that it cannot be returned. a younger man in line was trying to translate/reiterate/mediate between the men and the manager. the manager didn't give them much time, frankly told them the no-return policy and walked away. the younger man tried explain what the manager said. the older men were so frustrated, they stormed out the door yelling, "WHERE'S HIS F****** CAR, I'M GONNA THROW A F****** BRICK AT IT!"
the manager was minding his own business when the security guard and cashier were trying to tell him, "they just said they was gonna throw a brick at your car."
manager walks towards the door to take a look.
cashier: "YOU BETTA NOT GO OUT THERE AND LOOK AT YOUR CAR, OTHERWISE THEY KNOW WHICH ONE IS YOURS!"

i was gonna narrate everything else here, but time is short and i don't want to give glory to all the profanity that i heard over the span of 4 minutes paying for my snacks, then walking out through the parking lot, and across the street.

so much is happening on one corner, every single day. can't keep track of it all!

in my mind, i want to be a good citizen and be helpful. but it's moments like these that make me want to just mind my bidness and keep to myself. very typical asian-american thing to do. i guess there's a fine balance between wanting to serve versus wanting to be a hero. i always imagine these scenarios where i would go crazy on vigilantism. and i'm thankful that i have yet to encounter some scenarios and have not done anything foolish (street-wise). God is protecting me here!