Tag Archives: medicine

Goodbye to Intern Year

I looked down at my iPhone as it marked mile 6…I know this is where magic happens. It’s when my legs stop hurting, when my lungs stop burning, and I am lost in the soft churn of the sunrise and the sound of the breeze.

I took up distance running during the busiest year of my residency in internal medicine. Something inside me signed up for marathons.

Maybe that something was anger – the day I heard my patient yelling at me after a 16 hour work day “I hate this hospital, and I deserve all your time!” I sat inside the facility room and cried, my dad was hospitalized and I didn’t have time to see him and just be a daughter. My dad deserves all my time.

Maybe it’s exhaustion – Obama care had brought so so many patients who had not seen a doctor in 20yrs, and in my 15min appointment, they have a list of 10 problems, and you just feel so so small and overwhelmed.

Maybe it’s the darkness – for a good 2 months of this past winter, I didn’t see the sun. My work started before the sunrise, and rolled well into the sunset. Living in darkness was isolating.

Maybe it’s the other things – that boy you loved that broke your heart but you walked bravely into another 14 hour work day, and all the friends you lost cause there’s no way they can understand why you can’t attend their wedding, their birthdays, and their worst days.

Maybe it’s grief – that day when you watch a daughter show her dad their childhood videos as he slips away. That day when a wife crawl into bed to hold her husband as he took his last breath. Or the family that finally overcame their resentment of each other, and unite at their parent’s death bed.

Maybe more times than not it’s pure joy – the day you watch someone wake up from a horrific illness, and know they’ll be alright. The day your patient made up a medical problem so they can have an appointment just to say you’re the best doctor they’ve ever had. And every single time you watch your patients leave the hospital safe and sound.

Back in high school, I ran for the races. Now I run for all the things in my life that I win and those that I can not. I run for those magical moments in time when everything feels wonderful and nothing hurts. At mile 6, I know that this run…it’s for me.

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For Mrs.S

 

I appreciate your candor and thoughtfulness…and lastly, I hope you’ll find a life of happiness.” 

Mrs.S passed away last night, and her family handed me a small white card with cherry blossoms (my absolute favorite), and those were her last words to me.

Mrs.S came in 2wks ago screaming in pain from metastatic ovarian cancer that she fought brilliantly for 10 years of her life, beating all the odds and statistics we love to throw at our patients. Her CT scan showed that more concerning than her shoulder pain, was her entire right chest was crushed by a gigantic tumor mass. The pulmonary doctor chuckled to me “she’s all yours, that’s the worst lung I’ve ever seen.” Mrs.S had almost no lung left. She went to Mexico to receive dendritic cell treatment, which did not work. It was clear on that night, she did not have much time on her side.

Over the next 2 weeks of my internal medicine rotation, I sat with her. There was no cure, there was no particular medical miracle I can offer her except pain control. She began to tell me the stories of her life. she met her husband at age 26, when he was 19. They spent a lifetime touring together as musicians, and they have no children. Some winters in Michigan, they would spend months indoors next to the fire together because it was painfully cold outside. They told stories and read novels to each other to pass time. They spent their 25th anniversary in the hospital over a liquid diet. She spoils her niece like crazy. She hated Spy Kids movies…we laughed over all these details of her life.

Then one day, sitting in the green armchair of the hospital room, she got serious. She looked at me and said she was afraid, not of death, but of leaving the love of her life all alone.

I looked at this woman who is more than a lifetime ahead of me in experience and age, standing less than a week from dying, being afraid for the pain this would cause her husband. As she spoke these words, her husband, working intently on his computer at the other corner of the room, came over. He told her that he had a lifetime of “happiness and love”, and he’ll be okay.

There are defining moments of our lives where everything we do just makes sense. As I watched a loving husband comfort the fears of his dying wife, I fell in love with internal medicine. There was no where else in the world I would rather be, nothing else I would rather do despite the months of indecision over my specialty options for residency applications this year.

And dear Mrs.S,

Your husband is busy driving across the country to take that trans-America trip you wished for. That’s how he chose that morning to celebrate your life.

As for me…I too, hope I’ll find a lifetime of happiness.

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 

USMLE Step 1 Day 5

Picture: Dr.Tao Le, the author of First Aid.

Step 1 Q: Why is Dr.Le bald?

Ans: Dr.Le is bald due to late effects of DHT

For those who are not in medicine, the USMLE step 1 is the first step of the medical licensing exam that all med students have to take. Students in US take it at the end of their 2nd year of med school. My test day will be on 6/24 (breathe….). It kinda, sorta determines what range of specialties you can potentially get into. It’s a really important test, like the MCAT for med school, or the SAT for college. But unlike those 2 tests, the stuff on the USMLE exams are actually important fundamentals for patient diagnosis and care.

My Step 1 prep has officially started and I am 5 out of 31 days in my schedule. So what does a typical day look like for me?

8am-12:30pm study

1:30pm-3:30pm study

3:50pm – 6:30pm study

6:50pm-8pm study

9pm-11pm study

During this 11 hour study period, I mainly have a one way love affair with my First Aid book, click through about 140 UWorld Questions, drink mountain dew (36mg caffeine/8oz) to stay pumped.

Of course, I have my daily workout squeezed in there. I went home to mommy in LA, mainly for the food (she took me to have Pho tonight). There’s nothing like home cooked meals for board studying.

Reflections on the First 2 Years of Medical School

“Every new beginning comes from some other old beginning’s end.” –Closing Time, Semisonic 

9/9/2009 First day of med school

5/20/2011 Last day of second year

The second year of medical school ended last Friday and marked the conclusion of our preclinical years. I’m so happy and proud for all of my classmates. We’ve come so far from that first day under the warm San Diego sun when we put on our little white coats and took pictures with our overjoyed parents. We were so full of hope and ambition for the next 4 years. And, in a blink, 2 years have gone by. We’ve completed over 60 exams, we drank gallons of coffee, we’ve slept in the library, missed important outside events, pulled our all nighters, shed our tears, and shared our laughs.

In behavioral science, we learned to see the patient and not the disease, always. In clinical medicine, we listened and diagnosed aortic stenosis for the first time. In free clinic, we spent time healing the homeless and those who can not afford healthcare because our world does not see the relief from suffering as a fundamental human right.

As I look back on these 2 years, I learned some important lessons:

1.I can learn much more from failure than from success

2.I am not defined by my career or my achievements

3.I am defined by how I embrace, accept, and overcome my failures

4.The most important attributes to have as a physician is humility and compassion

5.To always do right by the patient no matter what

6.Your friends and family will get you through anything

7.Take the challenges one day at a time

I can’t help but miss the last 700 days, days that I once wished so much to pass by quickly. As we begin our 3rd year as clinical students, we no longer sit in a classroom of 120 students. We no longer chat and waste time before exams. We no longer take pictures of each other falling asleep in lecture.

We will now work on separate teams with real responsibilities to real patients. We are finally introduced to real medicine. I am scared of the new set of challenges and responsibilities, but most of all, I am excited!

In the words of Semisonic’s song closing time – “every new beginning comes from some other old beginning’s end.”

Goodbye preclinical years, and thank you for the ways you’ve helped me grow. And Ms3, here I come =)

Grey’s Anatomy vs Medical School Reality

Season 1, episode 4 “No Man’s Land”

http://www.hulu.com/watch/159394/greys-anatomy-no-mans-land

 

Shows like Grey’s Anatomy usually never capture the gist of just how much work and work…and work there is to being a doctor in training. For starters, in the last 3 days, I’ve slept maybe a total of 10 hours. It’s the last leg of the preclinical years for me. One more final down today, the biggest one on Wednesday covering 6 months of detailed microbiology. One last one on Friday and the Step I prep will start officially on Sunday. Med school is not sexy, it’s not cool, it’s not a dress up game, it’s hard and stressful. I took 5 finals last quarter with a fever, strep throat, scratched esophagus (what?!), influenza A (who gets strep and flu all at once?!). The hardest part of the first 2 years…seeing the purpose behind the book work. I signed up to be a doctor so I can have a chance to heal people, I didn’t sign up to memorize and regurgitate 65 exams in 700 days. But last night, at the end of my studying, I watched an episode of Grey’s anatomy. In this episode, a nurse says to Christina (a surgical resident) in her dying breath to think of medicine “as a hazing experience.” I paused the video and a weird feeling came over me. For the first time in 2 years, I saw the incomprehensible and inhumane amount and context of work explained in 1 sentence. It’s called “hazing.” The system works you hard, and it strips you of your arrogance, and all the stuff you’re used to because you graduated top of your class up until this point. This hazing builds humility, and a small cover of numbness so you don’t emotionally lose it when it matters. But then, I have an immense sense of peace…because the best thing about hazing? It’s very short compared to the rewards, and once you earn the ability to be a physician, I hear it’s going to be absolutely amazing.