Tag Archives: education

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.

On Finding That Little Voice (for Ms.Lynne Aidikoff)

I came to America at age 9 not speaking a word of English. Liberal art classes were obviously my least favorite. All that the school system cared about was reading a passage and answering some stupid questions about main characters and plot. Needless to say, I didn’t thrive in school.

Then came the 6th grade, junior high. Ms.Lynne Aidikoff was my writing/history teacher. Somehow in all my grammatically incorrect assignments, she saw something worth reading. My dad had a meeting with her during the school year, she told him I can write (who knew?!). I received my first A in English since coming to America that year.

So I kept on writing, and reading so I can keep on writing. I wrote words that she loved which delivered my heart and my opinions. The type that was shamelessly honest and vulnerable. I wrote my way into UCLA, through upper division romantic lit classes in college, and then to medical school.

This year, during my residency interview, the program director remarked “I read 1000 essays this year, yours is the only one I remember.” I can’t help but think of Ms.Aidikoff and how her encouragements brought me here.

We’ve been in contact via facebook over the past few years. She left little comments and messages filled with proudness, joy, and always encouragement. I found out today that Ms. Aidikoff passed away recently. I wish I told her what an amazing adventure in literature, writing, and life she had sent me on. What unbelievable empowerment, release, and comfort writing has brought me in the darkest times of my life.

Looking back, I only realize now that she had given me the single greatest gift that a student can acquire in education, a voice.

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 

3 Lessons from Third Year of Medical School

I had a really amazing conversation with a resident lately after an attending made me cry. At the end of this conversation, I just really wished I knew these lessons ahead of time. So here they are, for the lovely medical doctors to be following this blog:

1.Confidence

You are not graded on how much you know, but on your confidence. There is no doubt that no matter how well read you are, there are a good 30% of answers you will not know. No matter what, say the wrong answers with confidence. Because if you sound shaky and scared, or hesitant, some residents/attendings will see it as “not knowing” anything at all. They won’t pimp you as much, they’ll start to ignore you or lose interest. Believe me, you need to make an impression to get that wonderful eval. If you don’t have a clue, start reasoning, such as “well, I think a person with hepato-renal syndrome will be hypertensive because…” The idea is not the right answer, but the reasoning and confidence that you deliver your reasoning that matters.

2.Mentors

You will not get along with every resident/attending. I was paired up with a fellow MS3 and we got along with every different people. Our knowledge shined in very different ways. When you find a resident/doctor that think like you, act like you, is the type of professional you’d like to be someday – grab them! A mentor will make a world of difference for you, not to mention you make a new friend in the field.

3.Perspective

This is the big one and the hardest. You will be evaluated subjectively on professionalism, knowledge, when most of it comes down to whether or not they like you and your baking. Constantly working for a “nice eval” or “honors” will burn you out. It also takes the fun out of learning. Instead, choose to see your work in a different light. If you love people, find gratification from the patients. If you love knowledge, choose to find joy in learning new things. Choose a stable aspect of your work that is not subjective and draw your energy from that. Believe me, no matter how spectacular a student you are, you will have horrible days where you feel like an absolute idiot.

For all the medical students, best of luck to you on your future career!!

USMLE Step I SCORES! AHHHHHH

Caption: the blue fish is my resident, the orange one is me, this was literally our faces as we opened the score report today at 12:15pm…oh the horrrorrr

Third year of med school has officially started today. But in reality, it actually started 2 weeks ago when I started my psychiatry rotation. So why did it “officially start today?” Because today I received my Step I score report…and I could NOT believe my score! I PASSED (most importantly), and I got a “happy” score (Thank You Jesus!).

This anxiety-ridden day started at midnight with multiple Facebook status updates and classmates telling me that apparently we are to receive our scores today. I just got off a 16 hour shift, and really wanted some sleep, but after all this updating chats about scores, I almost threw up. Last night was both the shortest and longest of my life. Then this morning I woke up, went back to the psych ward, and hoping that work would cheer me up (clinical medicine has made me so immensely happy about my life the last couple of weeks!). But I was so nervous that despite my lovely patients, I was about to jump out of my skin. Then at 10am, my rotation buddy told me that scores report notifications have been e-mailed, and behold, I got an e-mail! Oh the horror! What if I failed? I can’t cry on the psych ward! Quickly closed e-mail without checking the score.

Toward lunch time, my panic attacks have peaked. I couldn’t feel my hands, my heart was beating next to my thyroid, and my eyes got teary. I couldn’t eat so my resident (aka my boss) told me that we would check the score together. She then mentioned that the deans have paged the students who didn’t pass. I pulled out my little pager, and behold…3 missed pages! OMG! My heart skipped a beat, almost went into A-fib. I quickly scan the messages…none from the deans. Oh God, I was shaking now, and really wanted to pee all the sudden. We opened my e-mail, logged on to the NBME website, I’m about to type in my password….and emergency consult patient shows up (of course they would!). After a 15min chat, patient was diagnosed with anxiety and PTSD (I’m the only one who should be diagnosed with anxiety today). Patient leaves…we open the score report one section at a time…PASS…2##…9#.

I felt like bliss for the rest of the day, on cloud 9, utterly undeserving of God’s amazing grace, and of course for the first time in 2 weeks, I feel like an official third year medical student.

USMLE Step 1 Day 17

I have about 12 more days left before the big day. So, what have I learned so far?

The worst advice I’ve been told:

1.Memorize every word of First Aid (what crackheads)

2.You’ll burn out after 2 weeks (are you kidding? I’m peaking with motivation after 2 wks)

3.Buy groceries for the months (how big is your fridge darling?)

4.Pick a date and stick with it (ummm, take it when you’re most ready, I could use 1 more month if I could)

5.Study 15 hours a day (how long have you lasted on this one?)