A few old posts

Here are a few old posts that I put on my iphone but haven’t uploaded

On Self Motivation 11/1/08

Lately, I’ve come to realize that the two times in my life where I have worked hardest and performed best were

1) in medicine where not working hard might kill someone

2) j&j where I followed an effective leader whose vision I shared, there was promise of high impact, prestige and to top it off I was compensated well

On Professional/Personal goals 11/3/08

New realization – goal is to be happy and the way to be happy is to be productive and this should be the goal Not productivity or networking or brand names for their own sake Eg maybe I want to be able to veg and do nothing sometimes and for that being an entrepreneur is not compatible perhaps I don’t want to be so passionate about something that I can’t sleep or have to be hypomanic and instead should just be employee #1 What makes me happy -social recognition & prestige -learning -mentoring/teaching -being excited about an opportunity not everyone else sees -being included (languages) -being comfortable -newness freshness -seeing what’s around the corner -self insight -connecting with people (talking to Paul and patients) -being appreciated/knowing I helped someone else -spontaneity -being part of something bigger (democracy in china)

I could never be the doctor patients want me to be Vc have not returned money Hedge fund quickly Two times to get in after Bschool and after Ceo

I need external motivators like threat of tests or embarrassment is it bc I’m not motivated or need to find what motivates me.

Do medicine for the right reason, being a better businessperson may not be one.

Christine’s observation 12/16/08

Christine said something quite interesting to me today. She observed that I really spoke about my time at jnj very fondly and that it’s rare to find a job you really like working with a great Boss for good pay. I told her two reasons it’s not totally ideal basedon geography and trajectory may be a bit slow but with great work life balance but that might be a cop out. Maybe it also lacks some prestige of working for a Mckinsey or the excitement of starting something new. In being a great balance of things maybe jnj just doesn’t have that sense of mystery and excitement that really gets me going?

Consulting for the summer 2/12/09

Finally got the “covetted” consulting job today but found myself wondering if that’s really what I want to do or not. Is it really a “positive” as in something I do because I love it? Or like Harold in white castle am I just lying to myself? So if not consulting then what really gets me up in the morning? Is it patients getting better? Is it the prospect of an exciting new business I’m building? Is it money? I guess looking back on the last few years I would say the general trend is that a few things really “activate” me and the rest is wanting to feel comfortable and safe. The things that have excited me tend to fall into a general pattern of being generally cool things that are innovative or clever and help people such as microfinance or things like my way village. The duration of the excitement varies and medicine has definitely been the most exciting of the bunch. It can definitely be enhanced by good management. In many ways JJDC was a sweet spot for me in terms of productive work that was interesting lucrative and helped people. The ability to also have ownership over it would be wonderful as well. The other factor here of course is prestige and feeling like I have to be better than others or in a position of strength, knowledge, insider, clubbyness.

Somehow I think the desire to work for Mck comes from this feeling of not being good enough. On the other hand the desire to be better and to excel also comes from this. So one question here becomes do I need to always have a boss? Someone to impress, someone to pat me on the back and tell me what a good job I am doing?

Yes and no, I guess I can get excited but not consistently, one reason I hedge all the time is because I keep looking for more interesting and prestigious things that are more clubby that can allow me to occupy that position of strength and give me that sense of confidence that I lack.

So who am I then? It seems that on both levels both in my personal life and professional life I am constantly seeking safety and sense of security both in terms of someone who can take care of me and who I can be a baby with as well as a job that at least on the surface can communicate to others what an impressive person I am.

So what now? Do I try to change all this? Understand it by getting a psychiatrist? Or do I just accept it and optimize who I am? Is there something I am missing here?

Crazy idea 3/5/09

I had a crazy idea today about drug compliance and starting a business which takes commonplace food and herbals habits and uses them to improve compliance with pharmaceuticals. Kind of like cough syrup or antibiotic lollipops for adults.

Been a while

Whew, its really been a while, way too much has gone on to update in a single blog so as I do with most things in my life . . . I’ll just put it off :)

For now, here’s some new pics of our BMS-DMS reunion in Boston this past weekend. We had a great time mostly eating and shopping (what else would a dozen med students do on their day off?). I learned how awesome the North End in Boston is. I think I’ll definitely be going there lots this summer when I’m there for my consulting internship.

Beautiful NH fall!

What’s beauty without my mug on the picture? ;)

Me n my buddy Dave from a rock

Great Day

I don’t know where this feeling came from or what its all about but I am feeling GREAT and want to capture it! Maybe it all started when I met Dr. Bob Arnot who is
a TV Physician who does a lot of interesting reporting in the middle east and africa on humanitarian disasters and such. He’s also a war junkie who can’t
wait for the bombs to start falling so he can get embedded with the troops. Anyway he had a simple piece of advice for me that he called the Biology of Success, “Design your day so that you build in things that make you happy”. He gave the example of going for a bike ride in the New England Fall and having a nice breakfast at Lou’s. After that, he says, my day is already a success and anything else that happens is just topping. Ever since I’ve been riding a growing wave of endorphins. I think what has made me happy the last couple of days have been talking to interesting people and learning a few pointers that made me think. Besides Dr. Bob, I’ve gotten to meet with Shumeet Banerji the CEO of Booz & Co who just came and Peter Volanakis the COO of Corning both of whom had some great business lessons. On top of that, the last couple of days I’ve been going to the gymn and working out then shooting hoops which I haven’t done in forever. It feels great to have a basketball in my hands. Finally, I had dinner with Jane and Dave at Yama’s, great food, good friends and ice cream. Its so good I’m not even thinking about the great board scores I got nor all the accounting homework that I haven’t done yet.

Its like the little good things start feeling great, you feel thankful for everything and the bad things just fall off you. Its a mixture of excitement, joy
contentment, adventure, freshness and joy. I am loving it!

Ramblings on my day off

“Pluots pluots . . . Super dulce” a mexican accented voice

Man, I love having weekdays off

I’m sitting in Cafe Spritzers in Alameda after a breakfast of samosas and pluots (cross between apricots and plums and damn good and juicy) that I got from the Webster St Farmer’s market. Tomorrow is my last day of emergency med at highland hospital. I think I’ve done well there and the training has definitely been a trial by fire but certainly made me a stronger better trained physician. Its certainly not going to be an easy road ahead. Part of me really longs for the idyllic worlds of places like CPMC and DHMC where the patient’s send you wine, thank you for your help and tell you how great a doc you are. But there is something about medicine that I’ve realized, maybe it shouldn’t be easy. Thinking about doing emergency medicine seems like a really really long hill to climb. Its no wonder so many Highland residents finish residency and then do 6 shifts a month, they are simply burned out and need time to recoup, reflect. Sure you learn how to save lives but at what cost? My thinking now has turned from do I like/love emergency medicine enough to can I even make it through this residency? Yet the skills are quite amazing. I talked for about an hour with an old Chinese gentleman during a medical code yesterday AS HE WAS DYING in front of me. He was having a severe heart attack. We had to shock him 4 times and gave him thrombolysis (clot breaking medication) to save his life. Twice I had to start CPR because we couldn’t find a pulse. Both to distract him from the pain and to assess his mental status, I talked with him about the Beijing olympics, about his family, his grandchildren and what he had for dinner that day every minute reassuring him that everything was going to be okay. Ultimately we were able to transfer him to a hospital in Oakland with a catheterization lab where the cardiologists can mechanically image and make sure the blood is flowing to this man’s heart and on the way I heard he began to reperfuse his myocardium. We saved his life. A few hand slaps and sighs of relief later with the residents, my shift ended and I was satisfied that we did the right thing for this man by giving him risky but life saving medication. But as I left the hospital that day, I felt something was missing. Where was that buzz of excitement that I had from saving my kickboxer patient with the rhabdomyolysis? Or the sense of purpose that I felt after giving my Chinese patient bad news about his lung cancer? I was so tired I just wanted to go home . . . to finish this month and relax . . . I know by my the evaluations and compliments I’ve received from patient’s and supervisors that I can play the role well . . . be polite, listen to the patient . . . but is this the kind of doctor I want for myself?

A nice story

“If there is anyone on board who has any medical training, please ring the call button”

I’ve always wondered what happens after you hear the broadcast. Today I got to find out. K was a 32yo gentleman who I met in the rear galley of a 737 headed to San Francisco from Boston. He was in great health, in fact he was a former professional basketball player. K had just come from a reception in which he ate some seafood and creamy bisque soups that he normally wouldn’t have eaten but then felt fine and boarded the flight. Halfway through, he began feeling nauseous. He stood up hoping the feeling would go away but the nausea got worse and he eventually had to make several trips to the bathroom to throw up. It was at this point that the overhead broadcast went out. At the time, I was engrossed in my new iphone playing a game while listening to a korean pop song. Two physicians were already attending to K when I first saw him in the rear galley. He was a tall guy, probably about 6’5″ with a muscular build looking pretty sick to his stomach and sweating from the retching. I brought the doctors my stethoscope thinking it was the least I could do while reprimanding myself for feeling so self important as thought I could add anything of value as a medical student. “Its probably a gastroenteritis . . .” I overheard one of them saying in a well-practiced outside-of-the-patient’s room tone of voice. “Yea, you’re probably right, I have some meclizine in my bag, do you think we should give him some?” . . .” I heard the other one say. “Naaah, he doesn’t need it.”
They took my stethoscope, listened for a moment then handed it back to me without looking or acknowledging my presence . . . “Just like on rounds . . .” I thought to myself. So sheepishly, I decided that there was really not much more I could add at this point, after all two full fledged physicians were already attending to K and what else could I the lowly medical student hope to offer him that they could not? So I shrugged and headed back to my seat. Luckily, I among the 30lbs of books I had with me was a quick read Emergency Medicine handbook that had a short chapter on nausea and vomiting. It explained that the usual presentation of “just a gastroenteritis” was vomiting AND diarrhea and that the two most commonly missed or dismissed surgical emergencies were bowel obstructions and appendicitis. In a young guy like K, certainly these were possibilities as well right? I convinced myself that I really ought to check on him again in a few minutes. By the time I made my way over and introduced myself, the other two docs had returned to their seats allowing me to examine him alone. I found out he had some LUQ pain which he said started before he threw up, that he did not throw up any bile or blood or stomach contents but that he was not passing gas or stool. He also said he was starting to feel light headed when he stood up. I examined him, felt his pulse which was strong, slow and regular. He belly was soft not rigid and I could only elicit tenderness near the border between his ribs and stomach. He did not have any headache or trauma, no recent alcohol or NSAIDs, had not been sick or feel warm and did not have sickle cell or any other spleen trauma. We were about an hour and a half into the flight and he had been back and forth to the bathroom, didn’t have any pain or swelling in his legs so I did not suspect a clot that had formed in his legs which traveled to his lungs. He had no family history or medical illnesses besides some mild asthma. Without even thinking about it, I had ruled out a series of life threatening causes for his pain and vomiting and had even gotten to know more of K’s story. He had played basketball in Europe for a few years, but decided to get his master’s in education because he had some bad experiences as a student growing up and wanted to change things. He had taught for a few years and risen up to become principal of a charter school near Sacramento whose student body was comprised of mostly kids from households living under the poverty line. K had finished a second Master’s in Institutional Leadership at Harvard which he did as a correspondence program while working 80hrs a week as a principal, substitute teacher, basketball coach and mentor for his students. We chatted about this and other topics as I monitored his pulse and watched him as he continued to rush to the bathroom every few minutes. In between the rushes, we had a fascinating discussing about the pros and cons of affirmative action, the problems facing public funding for schools or healthcare and how to change a culture of despair into a culture of confidence and resilience. During one of these lulls, K and I shared thoughts about passion for one’s work. It was then that he told me that he could tell I was passionate about medicine to which I responded that I was really tired and stressed by training and sometimes wondered if I could really handle the tough lifestyle sacrifices in medicine. K then told me something that I never thought of before. He said that passion is really about following through, persisting and taking the time and care to make sure something gets done. “You know you are really passionate about steak because when you crave it, you go out and buy some meat, grill it up and get that steak on your plate”.
“If you weren’t passionate, you wouldn’t be back here, you would be at your seat, playing video games or reading a book, you wouldn’t be spending all this time talking with me”

I never thought of it that way but when I think about it medicine is really the only thing I have ever done which I can really say I put 100% of my effort into over such a sustained period of time (5 years if you could my post bacc studies). And still I think about the planning, the anxiety of doing a good job, staying late to make sure a patient’s labs are reported, rounding on the patient one last time before the shift ends, coming in early to check on someone and spending an additional 5 minutes with a patient to listen to their story before rounds. These are not things that typically characterize me.

And then I realized that doing whats right and not whats convenient is what medicine is all about. But it has its perks. K told me about the story of a student who “made it” and I could feel the passion in his voice when he talked about how great it felt to know that this person would be the first in their family to go to college then pass that work ethic and resilience onto their kids and so one for the next generations. Perhaps all of my thoughts and schemes of finding the perfect dream job focusing on what this person has and that person has and wouldn’t it be nice to have is misplaced. Perhaps what I should really focus on is not what others have that I want but on what I have that others do not. Perhaps being great is not just about securing a fancy sounding title or degree or maximizing your potential earnings but about using your skills and your passions to follow through, build relationships and make a difference in someone else’s life.

Mini epiphany about work

I’ve realized that the most fulfilling work one can do is work in which you get to invest your own creativity and personality. Work in which one’s own ideas, skills or emotions are invested is the most fulfilling and rewarding. The example that I recall ironically is in the one summer in med school when I did business stuff and came up with a research project and presentation on Asian investment opportunities for J&J which was both personal and creative for me. Similarly, is there a field in medicine where one really adds creative energy instead of just following the care maps? Interestingly enough, primary care, psychiatry and plastic surgery are the areas where I’ve seen the most of that rather than the excitement and “life saving” fields like Emergency medicine, critical care or trauma surgery.

The ability to inspire . . .

I just watched Barack Obama’s 2004 Democratic Convention speech and realized something. Leadership, true leadership is rooted in the ability to inspire. Its not just being the smartest person in the room or the tallest, best looking person with the deepest voice. It is about finding that inner truth about oneself and being confident and human enough to share it with everyone that defines the true meaning of leadership. Somewhere in transit, that inner confidence strikes a chord in another person, another person, and yet another person and inspiration happens. Leadership happens because no matter what you say, that connection, trust and bond you have just created will allow others to stop and listen to what you have to say and give you the benefit of doubt that your vision is consistent with their values. And so leadership happens.

I think Barack really understands on a human level this connection that can happen in a big crowd or with one person, one at a time. Its this ability, this quality of inspiring others even when he is criticized (including by myself several times in conversation) that he is too abstract or too dreamy that will attract those around him to believe in his vision and put in the work to achieve that vision. Having seen the fruits of leadership in several institutions now, the leader not only sets the vision, but creates a culture within their organization within which the work of achieving that vision happens. Whether its in a residency program who attracts the right kinds of residents and lets them be their friendly, caring selves or a business that attracts the brightest but also most competitive individuals that do not like to work together, it is ultimately the leadership who sets the cultural tone for the organization and inspires others to either work for the common good or work for themselves. I believe that I’ve underestimated this quality, this ability to inspire the best in others that Barack possesses which is so vital to leadership. I’ve become so mired in memorizing molecular minutia in medical school that perhaps I’ve lost the perspective that its seeing the big picture that may matter most in the end. Vote for Barack Obama in November!

Grass is greener . . .

I was just talking to my bro the other day about where we each are in our careers/lives and where we want to go. As an entrepreneur, he’s feelin’ the pains of the economic recession pretty hard on his business and thinking about going into the recession proof health care industry whereas I am three years into my health care “experiment” in which I would get a sense of whether I loved being a doctor enough to give up doing business. Its funny because both of us are looking at the greener grass and wanting to be there. Myself, missing the excitement of a big transaction or the “pie in the sky” while Uly wanting a simple non-stressful office based practice that pays a steady annuity with good health benefits down the road. The story is not quite so clear cut in the sense that both of us are ultimately want both. Some sense of stability punctuated by periods of excitement and risk taking. Ultimately, I think we will both have a little bit of both.

All of this does give me pause as to whether I am glorifying that other world of business too much in my mind and forgetting the downsides of uncertainty and frustration that come with risk taking. We’ll see what happens . . . Admitted Students Weekend at Tuck is next week!

30th Bday pics

Thank you to everyone who called, emailed and wished me a happy bday. I had a great time yesterday, sleeping in, going to Page, visiting Antelope Canyon (where they filmed Broken Arrow), hanging out on the beach at Lake Powell and eating a nice bday dinner (mexican fried tilapia with octopus and shrimp). No bday cake but Mark got me something even better – bday PIE!

Anyway, here are some pics from my bday. Thanks everyone!

Antelope Canyon, its really just a crack in the ground . . . but its actually pretty durn deep!

30yo . . . but I don’t look one day over 20 do I? I got carded like 10 X in vegas!

Pretty pics of the canyon from inside

Wow, this canyon’s pretty deep!

Yet more pretty pics

Me and the pretty canyon

Its kinda purple colored without direct sunlight

This one looks like a tapestry . . . wow, I used a big word on my bday

They say there is a Navajo face somewhere in the canyon, is this it?

More prettiness

For some reason, this one reminds me of a birth canal

Yin and yang, with sunlight and without

Leaving the canyon

Lone Rock Beach, the water was cold . . . brrrrr

Me and Mark at Fiesta Mexicana after a nice bday dinner

Of course, what’s a birthday without some bday cake . . . I mean pie at the end?!