Tag Archives: doctor

What Medical School Forgot to Teach Me

My adorable grandparents, who raised me for almost a decade of my life <3

My adorable grandparents, who raised me for almost a decade of my life ❤

My 89 yr old grandpa, with a history of type 2 diabetes, very well controlled, spiked a blood sugar in the 500s (normal is in the 100s) on a Monday in February. He was a little more fatigued than usual, and my mom called me for advice. I was concerned about any infections. His primary care doctor ordered 2 doses of insulin that day.

Day 2, he appeared sicker and sugars remained high. I talked to his doctor’s office asking  very nicely for an infectious workup which includes blood work and cultures, chest xray, and urine studies. The nurse on the phone sounded younger than my sister, and did not know what hyperglycemia meant. The doctor ordered only one part of the labs that evening – a blood culture, and told his nursing home there was no need for a chest xray to assess for pneumonia.

Day 3, the results have returned and the nursing home said they were unable to reach the doctor.

Day 4 AM, my grandpa was in septic shock from aspiration pneumonia, and was admitted to the ICU. He never fully regained consciousness.

My mom called me, and I drove home to LA. The doctor’s excuse for 4 days of delay in care was “he’s old…I don’t want to be aggressive.” He offered no apologies. For the first time in my life, I cried because I was furious. I kept thinking of what my neurosurgery chief once told me “one day, you will know that your job as a good doctor is to protect your patients against the morons in the hospital” and his other advice “the worst prognosis is a nice patient with a nice family.”

I spent my time in the ICU since Valentine’s day. He became vent dependent meaning he needed a machine to breathe, he got tuberculosis (when he tested negative all his life), he got a feeding tube and then had a massive stomach bleed, and finally DIC, a condition indicating severe illness. He also assumed decerebrate posturing, indicating possible stroke, a likely complication of his severe shock. In between all these episodes were his doctors telling us to take him off of life support, a conversation they never fail to deliver when they somehow forget to discuss any other test results or procedures conducted.

My grandpa is on comfort care now, meaning there is no more treatments or blood draws. He gets a morphine drip and some IV. He is dying, paralyzed, and semi-conscious due to gross medical negligence. 

I thought of how much medical school failed to prepare and discuss with me: 

-How our treatment can hurt as much as it can save a life.

-How machines and medications and procedures can prolong not the living, but the dying process. 

-How the consequences of our inaction and negligence, ignorance and fatigue is real. 

-How not to sue another physician, a doctor who’s negligent at the end of his career at 65yrs old, who makes a very humble living as a primary care doctor in a country in gross shortage of primary care physicians. 

-How to act as a family consult with medical knowledge, and objectively decide to terminate treatment for someone I love deeply. 

-How to deal with my mistrust and anger toward members of healthcare when I myself am a physician. 

-How to advocate firmly for the correct course of care when it’s in disagreement with another physician. 

-How important it is to encourage patients and their families to be vocal, and strong advocates irregardless of how stupid it sounds. 

-How important it is for physicians to apologize in times of error, not because of policy or fear of lawsuits, but because the patient and their family deserves it. 

In 2 months, I will become a full time internal medicine doctor. I thought of all the families who have yet to come under my care, and all the things that can go wrong. I didn’t know…4 years ago…when I first began medical school, what tremendous responsibilities this lifetime was going to entail.

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Match Day 2013: Dreams Do Come True

(Match Day: every year, medical students across the country will open an envelope on 3/15 to find out where they will go for the next 4-10 years of their training in their chosen specialties. The hospital and student preferences/selections are determined by a computer algorithm after 3-4 months of grueling cross the country interviews for desired candidacy.)

Match Day!

Match Day!

26 years ago, my mom loved me enough to leave me in China with my amazing and loving grandparents. She came to America alone to pursue an education and a future for me. She wanted to bring me to a place where any of my dreams can have a chance. I came to America 9 years later.

In 7th grade, Mr.Honda had a farm of chickens, rabbits (with countless bunnies), and a classroom iguana. I fell in love with biology the day he made us plant vegetable gardens on the back alley of Paul Revere Middle School. I touched a giant potato bug, screamed and almost threw up (please google potato bug).

At 13, I remember calling 911 and a random lady drove by and stopped to hug me while I panicked in front of my house. Later that night, I stood in the corner and watched some Kaiser critical care doctors save and stabilize my grandma. My prayers for more time with her were answered. I thought it would be “cool” if I became a Kaiser doctor one day.

At 17, I was jumping with my little sister on my bed after opening my UCLA acceptance e-mail, I was going to my dream college.

On my 19th birthday, I listened when Annie told me that my best friend and roomie, Karen, passed away from cardiac arrest, 4 hrs after I told her no one dies from coughing, 8 hrs after watching her laugh over my bday dinner. Her mom came to clean up her room, and I will never forget the face of a mom who had just lost their child. In that place of guilt, and pain, I chose to become a doctor…selfishly hoping I will never be that helpless again.

4yrs ago, I was in Washington DC on my Georgetown interview when I received the call that I was accepted to my dream medical school UCSD.

On 3/15/2013, I opened an envelope on match day that realized a lifetime of little hopes and once impossibly long term dreams. I will be starting my life as an internal medicine resident physician at Kaiser Permanente.

Every doctor tells me I will never forget my match day. I thought of my amazing family who gave me the love, and support to pursue dreams that are often so out of anyone’s control, and so distant. My friends whose crazy shenanigans, and advice allowed me to survive the last 4 grueling years with sanity and fun. My incredible teachers who taught me to be passionate and perfectionist with my education.

And lastly, God, for giving me the beautiful and truly wonderfully blessed life that I do not deserve.

Perspective

I’m looking up at the operating room light, it’s so bright it hurts. It’s hour 18 of my day. I’ve been working since 4am, and now it’s close to 11pm. My neurosurgeon attending is telling me that the surgery will take at least another hour. I’m so tired, and sleepy. In my mind, I go over the things that are not perfect in my life. I start thinking about the rec letters that need to be done, the residency apps, not having enough honors in my third year, maybe I won’t get into my top 3 choices for residency, maybe I picked the wrong career. In my daze and exhaustion, I went over all my inadequacies, and my insecurities.

Then I stopped. There on the OR table is my patient. She is 20yrs old, a college student, riding her bike at 7am that morning. I wondered what she was thinking about, the dreams that she had, if her morning always started off with lots of hope, or a list of things to do. I wondered what she was thinking about as a trolley slammed into her, and threw her off her bike. 2hrs later, she woke up, unable to move anything below her shoulder, but knowing everything. She looked so scared with all those tubes, all the doctors. Her parents are there in the next hour, asking us questions, questions that we don’t want to answer. “can she move again?” “is she going to die?” “why aren’t you guys doing her surgery damn it!”

Medical school teaches us all about science. So technically, she has a complete spinal cord transection at C5. She will be a quadriplegic from now on, if she’s lucky, she’ll breathe on her own. Literature says she has 9yrs more to live with this type of injury, there’s no hope for recovery. She’ll eventually die from an infection, ulcers, or pneumonia. Surgery will stabilize her spine, but will not change her paralysis.

It’s 11:30pm, I’m standing over the table thinking about the imperfections of my life. Yet, my patient will never walk again, write again, breathe on her own again. She will never ride her bike again. Chances are, she will never get married, have a family. She will never get to travel, or use her education. All of this is gone, because of a 2 second impact, a little fracture of that vertebrae.

It’s all about perspective, it’s close to midnight, and I am grateful for my life. For the fact that today, I can breathe, and eat, and walk, and think, and love. Today, I have the ability to still give my all and make a little difference in this world.

Today is a beautiful day and

“we are the lucky ones” Rent