Tag Archives: reflection

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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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.

My Baby Sis

My parents have shaped so much of who I am today. They’ve given me a safe home, and (like all awesome, competitive, A-type personality Asian parents) bought me some hobbies in art and music and dance. They’ve taught me the importance of education, to seize the best opportunities, and to take risks. Everyday, I become more deeply grateful that I come from a beautiful home. But, if there was one thing that I am the most grateful for, it’s the fact that my lovely parents gave me siblings.

Up until age 9, I seriously thought the world revolved around me. I had the full love and attention of everyone in the family..24/7. I would shed a tear, and the next moment, I would get whatever I screamed for. My grandpa once cooked 3 separate dishes for me…cause I wasn’t willing to eat any of them. I was…spoiled (ya think?!)

Then came my sister, a rotund 9lbs of boneless chub. My parents and grandparents busied themselves with the everyday activities of a newborn. When she cried, I got in trouble. When she learned to walk, she started keeping my stuff. When there was something yummy, she always got the last piece. And yet… I came to love her so so…so so much.

Because in the midst of the annoying crying, nagging, intrusion of privacy, unwanted touching and attention she brought to my life, my sister taught me to love more than anyone else in this world. She shaped the way I loved at the time in my life where everyday I was molding my heart and mind to the person I would become.

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From the sharing of things I didn’t want to share, she taught me about generosity and how I can give without expectations of anything in return. From those stubborn fights, she showed me that apologies aren’t here to prove who’s right, but to show us that relationships and forgiveness matter more than what we want to agree on. In exerting her carefree, social butterfly, “whatever” – personality, she taught me to accept and appreciate people simply for who they are despite how different our dreams, priorities, and lifestyle may be. From those hours of parental attention I did not receive, I learned to be introspective and to rely on myself to learn from my mistakes. Trying to live up to the unrealistic and incomprehensible amount of admiration she carried for me, I hold myself to a higher standard in everything that I do. This fall, when my “baby” sister went to college, and started partying, I learned what it feels like to wear my heart outside of my body.

Lizzy taught me so much about love, the type of love that I always hoped to give to the people I care about. When I see all the wonderful things that my parents have given me, I am most thankful for my darling baby sis. Because whether she knows it or not, she taught me how to deliver the single greatest experience of our human existence…unselfish love.

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 

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!!

Because Real People Die…

He’s a really sweet man, he has a family, and grandkids, and he’s lying there with his white hair and beard. On the first day of my inpatient medicine, he taught me how to do the heart exam on him. We saw him everyday, he was our cheerful patient, he will go home in a week. Then one morning, he looked a little sad, we talked and patted his shoulder, telling him to hang in there for us. So…it hurts, like hell, when you type his name into your computer the next morning and the computer pops up with the message “pt deceased at 1630, click ok to continue to records.” He went uroseptic, then shock, without a fever.

He wasn’t the only one to die, I’ve only been on medicine for a few wks, I’ve seen more death than I’ve bargained for.

Patient B has an 8cm cholangiocarcinoma, I stood there watching my attending break the news and watch his daughter’s world shatter in 5min. I watched her crawl into her father’s arms while he comforted her on how this is all “part of life.” How is his cancer part of life?

Patient C has ALS, he was walking and bouncing in July. In October, he can’t move anything. 1 finger means yes, 2 means no. Every morning we have the same question, “are you in pain?” He answers with 2 fingers. Until 2 mornings ago, we spoke with him about “how hospital may not be the best place for him.” Tears came out of his eyes, I’ve never seen a frozen face cry before, and we cried together. The pain is deeper than anything I’ve ever known.

They wrap their bodies in an American flag and we see families say their last good-byes. I once wrote about how much I wanted to be a doctor for the “people.” People is something I was rarely hesitant to open up to, to reciprocate, to let in. Now, I can tell you, I keep a wall between my patients and I. A wall so I can survive medicine, and they can get objective care.