Gene's Joint

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! :)

From the top of Mt. Washington to the Block at Orange

I am such a city kid. Just spent the day walking around with Jane at the local mall here in Orange County, CA. Its not a great mall even but just walking around, buying churros from the food court, seeing what movies were playing and people watching was so much more comfortable and fun than being at top of whats considered one of the finest sites in the Northeast, Mt Washington where I was last week before I left Gorham, NH. Definitely tells me I will be coming back to Cali one day.

Not much has changed except everything

Crazy, just saw Nacho who went to Taipei American School with me for the first time since graduation in 1996. Its been 11 years! It was great to see him but just amazing to me how time can really stand still for 10 years. Its crazy how you can have an intense shared experience like going to high school with someone then lead totally different and mutually exclusive lives and when you see that person again, it can be just the same as it was before. Anyway, cheers Nacho to your kid and life in the suburbs.

Oh yea, it was good to see Monica and Max too (but I’ve seen you guys more recently than 10 years) :)

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.

Wenda Gu’s studio in Shanghai

In case I forget it, apparently Wenda’s studio is in the emerging “modern art center” in China. The address

101 Ground Floor Building 3
50 Moganshan Rd
Shanghai, China
t 8621 62996293

Contemporary Chinese Art?

Pretty funny. I went to an opening of Wenda Gu’s Exhibit (www.wendagu.com) at the Hood museum today. Basically this guy who calls himself one of the original contemporary artists to come out of China (was even banned by the Chinese government) took Tang poems and translated them to English, retranslated them into Chinese again except incorrectly so the strokes were backwards and extra radicals added etc. The point is that in the process of “bridging cultures” nothing can be precisely interpretted and authenticity is lost/created/recreated. Not particularly creative in my mind and not as interesting as actually talking to the artist who was pretty vague about modernity, postmodernity and culture but lucid about markets, which markets are more developed for art, who his leading competitors are and how many studios he had. He even compared himself to Walmart saying that his production base is in China (low cost and better craftsmanship) and his “creative center” in New York.

What was funny to me was that while his art was contemporary, the business of buying and selling is as ancient a tradition and as authentically Chinese as can be.

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.

I DID A SKIN CLOSURE ALL BY MYSELF!!!

Whoo hooo!
After 8 hours of watching surgery, I got to DO some today! Well, just a taste anyway by way of skin closure. I shadowed a urologist and got to watch a cystectomy and histerectomy/oophorectomy today (basically we took out a woman’s bladder, uterus and both ovaries because of bladder cancer).
I figure that if I want to do surgery, urology would be the one. You get to see patients in clinic 4 days out of the week and be in the OR 1-2 a week which is just fine with me. Very few emergencies, you can take home call and whats more is that urologists are in high demand these days. Sort of just like anesthesia but on the surgery side. Similar to anesthesiologists, the people are just much more laid back and happy. Dr. B who I shadowed says that he wants to keep doing it until he is 70. The surgeries are interesting and highly diverse and flexible.

The downside of course is that its a surgical specialty although with a relatively short training period (5-6 years). Also interestingly it is one of the specialties projected to have the greatest shortage in upcoming years yet urologists are very conservative about expanding slots for residencies. Talking to Dr. Birhle there are at least a couple of reasons one of which is the opening up and closing down of some bad programs (UVM, Tufts were mentioned) and hesitancy to open up any new slots unless they are “good” ones and also that there was a little fall out from the late 1990s when some docs thought they were just gonna retire and then ended up going back into practice when the bubble burst.

Anyway, what bothers me about urology is that I don’t know how motivated I would be in the long run in doing some surgical specialty since I am not really the fall in love with surgery at first sight kinda person. For example, I didn’t love anatomy all that much (and was surprised how much surgery is really just like anatomy lab, lots of dissecting, clamping, finding structures) and don’t really get that urge to do things when I am watching. On the other hand, when I finally did get to suture up a patient, I LOVED IT. So I guess I am trying to sort out how much of that excitement was just from getting to do something (which med students don’t really get to do) and how much is actually something I could see myself doing for 20-30yrs!

Its probably all a moot point anyway since I won’t get high enough board scores to qualify anyway.