Going to Greece and maybe Mexico

Good news, Jane and I are going to Greece, Athens and Santorini in 2 weeks! whoo hoo

http://millhouses.gr/Photos.asp

Now arranging a Mexico trip with my parents

A great day in surgery

My last day on the trauma service has turned out to be what you could say is one of the best days any physician could ask for. It started with patient C (a kickboxer who got rhabdomyolysis – where his muscles broke down and put him into multiple organ failure including a failing heart) whose tests showed he was finally stabilizing after almost a week of acute resuscitative efforts, he’s a long way from “stable” but doing a lot better than when he came in.
Then the shocking highlight of my day when a woman came in literally having had her hair caught in a mail sorting machine and being scalped and me and my resident spent a good 20 mins washing clots from under a loose hanging scalp and wrapping up her head while she was fully conscious talking to us.
There was the 2AM trauma case of a guy whose tractor flipped over onto his leg followed by the highlight, a 16yo who killed a horse by ramming into it with his ATV with a intracranial bleed who we took into the OR and evacuated. I ACTUALLY GOT TO CLIP OFF PIECES OF HIS SKULL with a bone cutter. I think we saved his life, he went from appearing to be dead on a ventilator to breathing on his own after the surgery. I hope he does well.

Finally eating breakfast with my residents who all complimented me on the good job I did. Definitely a sense of satisfaction and even a little pride. In particular Josh, my chief resident and someone I really look up to as a physician told me “you are one of the best medical students I have worked with”. All in all, a great learning experience

On a brighter note . . .

I think if surgery/critical care were a lifestyle specialty where I could be in California and travel to Asia occasionally, I’d TOTALLY do it. Its exciting, challenging, multifaceted and you really do get to say to yourself at the end of the day that you saved lives (Not true in most specialties).

My fallback plans are Anesthesia (where I would definitely get to do critical care but its also a specialty that appreciates and values good lifestyle), Urology, where everyone seems happy and the surgeries are cool. Medicine is looking more and more miserable and kinda painfully esoteric compared to the practicalities of surgery.

Liking surgery . . . or do i?

Last day (and night) on trauma surgery. My highlight today was talking to my patient Mr. T and his wife B, he was in a motorcycle crash that very nearly killed him and he was basically comatose last week, this week he is really recovering except for some minimal depression from being in the hospital. I gave him a pep talk, they talked about how nice it was to have me and complimented me, it felt very good to have played the role of the good doctor with the excellent bed side manner.

But that’s just it, in the end I think I’m a relativist. Its not that I have a “passion” for medicine. Its more that I feel very comfortable playing the role of the caring doctor. Do I really care about the patients? I dunno. I check up on them a lot, I hope they get better. But I am also really really glad to be outside the hospital and I groan at the thought of sacrificing the hours of my youth away at the hospital as a “resident”. Nonetheless, I think I empathize with patients, and to some extent that must mean taht somewhere deep down, I really do know a little what its like to be alone in a strange place. But on the other hand, I really do enjoy the compliments I get from patients, the compliments I get from my residents or attendings (my teachers). Those things also make me feel smart and with it. The added benefit of surgery too is that its almost exclusively an old boys club where you get to feel like one of the guys. That too is a role that I like to play.

So the real question that I have been asking myself for the last 3 years is, do I like playing the role of the compassionate physician at the beside who sacrifices his time and energy for the good of his patients or would I rather play the role of the coldhearted business person who doesn’t really help people but has time and money to spend on the material things in life?

Either way, I think shakespeare was right, life really is just a stage.

Notes on surgery

The last three weeks have been like a roller coaster, downhill at a 100mph one minute, then crawling up to the top for another drop. In Trauma surgery, its an amazing thing to be able to say that I helped save someone’s life. But the sacrifice to one’s own life is equally profound. In the last three weeks, I’ve spent less time outside the hospital than inside, slept an average of 5 hrs a night for 14 days straight without a break and have felt at times completely exhausted, mentally and physically. I don’t think I’ve used my cell phone at all except to call my girlfriend to get dinner after leaving the hospital. I’ve even questioned at several instances whether or not I even want to do my intern year at all.

The bright spots are the days when I can really talk to families of my patients in the ICU, watch the kidney of a 22yo suicide victim being fused with the arteries of a 38yo diabetic recipient or the day that one of my patients who fell off a bike and had emergent surgery to repair a bleed into her neck finally left the hospital.

Sleeping for 15 hours after being up for 35. Man, I can believe I’m paying tuition for this!

First Post-call day!

Man, what a weird last 48hrs. It started two nights ago with my resident Kamran text paging me to bring my toothbrush. Started yesterday morning at 6:50am, had a full day at Children’s Hospital of Orange County (in Cali baby!) including my first presentation at morning rounds. Then spent the rest of the afternoon kinda bored just reading and doing a progress note. Did figure out a cool problem of a kid with superinfected eczema who probably had Wiskott Aldrich syndrome (a rare immune deficiency disease) posed by Dr. A, one of the ID docs at the hospital (one of those senior docs everyone is afraid of but respects b/c he is a really smart but intense guy). Around 8pm got to do my first admit, a 7mo old girl who had lost her developmental milestones and had gone from being a happy cooing, feeding baby to one that was always crying and wouldn’t feed. Still not sure what is wrong with this one although likely something bad like a neurological disorder or metabolic deficiency. Then made my first diagnosis of a little 15mo old with Myasthenia Gravis, made more likely by approval from my senior residents at rounds and my intern who credited me! Got 5 hrs of sleep and then rounded on my patient in the morning wrote my first admit and progress notes which were included in her chart and then came home around 2pm excited at having done all these firsts only to crash literally sleeping on the floor with the TV on missing two phone calls. I just woke up, its 5pm and has been 36hrs since I started my first call day.

Amazing! I think part of medicine is that you get tortured so much with lack of sleep, scut-work, getting yelled at that the littlest things, a small complement from a senior, getting thanked by a patient or learning about a new diagnosis literally makes your day. This is a new way of finding happiness by lowering ones expectations to the point that just getting by is enough. You also become so efficient with your time that you can even manage your free time more effectively.
Still not sure if I want this life but surprisingly after 36 hours I am still feeling pretty good about myself! :)

I PASSED STEP 1!

Only got around the mean but hey, that means I still passed! Whoo hoo!
Of course, my roommate gets 2 standard devs above the mean but oh well . . .

This is the life . . .

Man, 3rd year is awesome. Finally you feel like you are learning and DOING something useful with your life. Plus I started with outpatient pediatrics which means I get put up at a nice little lodge (paid for by DMS) overlooking the beautiful white mountains of NH. I’m sure I will have to pay for it later when surgery starts (next block) but so far its nice to get out at 4pm and have time to swim in the pool, do some online cases and SLEEP. Anyway, two more weeks of vacation and then its going going . . . back back . . . to cali cali

Views from the hotel

The good ole Town & Country Motor Inn

DONE

Its day three of freedom after taking Step 1 of the US Medical Licensing Exam. The way it works is that in order to become a licensed physician, you have to take and pass three killer exams called steps 1,2,3 respectively. I just spent 8 hours of my life taking Step 1 this past Sunday.

Anyway, I am ECSTATIC that I am finally done with the lecture based, sit on your ass portion of med school and going on to the learn on your feet bedside portion of my training. Thats really what it is I have found, training. Its pretty amazing amount of information that they cram into your head, even if most of it leaves again the day after the exam.

For example, got CPR recertified today and took the course. Compared to the last CPR course I took 3 years ago, it was amazing to know and be able to have a map of the human body in my head as the instructor talked about positions, techniques etc and know precisely the physiological bases of respiration and circulation.

Anyway, so it is on to pediatrics starting on Monday. Gonna be working in the Neonatal nursery (. . . awwww . . .) which should be pretty great. Then its off to the white mountains for a pediatrics outpatient experience before going going back back to Cali Cali in late July to work at the Children’s Hospital in Orange County. I can’t wait to be a real person again.

Medicine – great job, no room for imagination

So finally after two years of painful examinations and sitting in the classroom, my schedule is finally my own . . . sort of . . . Board exams which are coming up in June are around the corner and there is STILL that sense of something hanging over you, something foreboding, another test, another milestone ahead that we must reach, whether its by running, walking or crawling . . .

Its easy to buy into the myth of the “promised land” in medicine. It is easy to admire those urologists, dermatologists, anesthesiologists, radiologists with their tidy little salaries and the “perks” that they have to do what they “love” and ONLY work 60-70hrs a week. After all, if one were to be paying $50k a year in tuition, it BETTER be for something right?

Yet as I sit here procrastinating in the library, I came across an article about Al Gore and the freedom he has now that he is not in politics to be on the board of a private equity company, give presentations about global warming, advising Apple and Google on their business strategy and as usual it reminded me of all the other things in life one misses out on when one enters this profession, or should I say this priesthood that is medicine. In fact, as you look at the average life of a physician, the objective really is to have a stable, well paying, prestigious and interesting job around which the rest of your life is supposed to orbit. When I compare this to the life I would choose to live if I were not in med school, it lacks the spontaneity, the imagination that I think defines who I am. I want to be able to fly to Nice for Cannes and connect what I learn about human nature there to setting up a agricultural project in Burundi, visit my familiy and friends in Taiwan and Japan on the way back to the states for a business meeting while finishing a few interesting books and eating some good meals along the way.

What is the problem with medicine? Its not just the hours in medicine that really prevents physicians from living a life like this, its the culture which replaces the room for imagination and creativity with patriarchy. Ever since the first day of orientation, my life has been planned out, circumbscribed, and micromanaged for me. You are expected to respect a hierarchy. There is an attending physician and below him (sorry ladies, most physicians in positions of authority are still male) a resident and below them an intern then there is the medical student who gets all giddy when they get to do ANYTHING of significance. Within this culture, it is no wonder people are leaving medicine. I heard recently from Dr. B that 3-4% of medical students in the country enter medical school with NO INTENTION of practicing medicine. In fact, I would argue that once training is over, that number is doubled. Take our graduating class of MD/MBA students at DMS this year. 4 out of 6 are going into consulting or banking and to be honest, if some of the other DMSers that did not have exposure to Tuck and the possibility of doing anything OTHER than medicine were properly exposed, I could see 20% or more of the graduating class going into a non medical profession. I think the reason is clear, the cult that exists in medicine really turns away the most imaginative and entrepreneurial individuals that enter medicine. How does this impact patient care? Well it has certainly narrowed the role of physicians to one of being bystanders. I would argue that most of the profound decisions and innovations occur outside of the purview and even peripheral vision of physicians.

Things like new drug or new device discovery, health management and organization building, health care policy, things that really impact the way health care works is done by non full time clinicians (the business execs, consultants, entrepreneurs and inventors may have MD behind their name but generally do not practice medicine). THEY make the real important decisions in medicine, NOT physicians who are mere bystanders in the process

Wow what a rant, I guess procrastinating is really getting to me . . . . anyway better continue this another time before I fail boards.