Tag Archives: thoughts

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.

A Beautiful Morning

Hello 2013! You’re a big year for me:

1.matching for residency (internal medicine) 3/15

2.graduating from UCSD 6/2 

Skyline <3

San Diego, California

Both of these I consider life defining events, and in-between all these things will be getting Step 2 CS results, submitting my research paper, ICU rotation, and figuring out my residency rank list which I set out to do this week. As I’m wrapping up my interview season, I’m becoming more and more certain of which geographic region I want to be, but more confused which program will be the perfect fit for me. Everything I set out on excel to measure how well a residency program will fit my personality has been trampled by my ultimate gut instinct preferences (which strangely, is the exact opposite of the excel score sheet).

photo (5)

French toast 🙂

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Blackberry pancakes 🙂

So, I decided to spend the morning with friends, having a yummy breakfast, and…taking my own new year resolutions to heart…see the ocean, and taste some goodies (so amazing!)

The view is incredible! (Pacific Beach)

The view is incredible! (Pacific Beach)

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.