Gene's Joint

Which way is home?

Long plane rides are great because of what you can’t do: you can’t read cuz the light is usually pointed at the wrong angle, you can’t sleep cuz the person next to you has smelly feet, you try to watch the movies but either the headphones don’t work right or you’re at such a weird angle that you end up seeing the back of the head of the guy in front better than the movie screen. So you just relax and think about stuff . . . on this flight, I thought about my new path in med/biz school and where it will take me.

I find that when it comes to defining my place in society, I am constantly striving for balance: between being a physician and a businessman, helping the less fortunate or selling out an making $$$, being American or Chinese or Japanese or Latin (yes, I’ve been mistaken for Chinese Peruvian). Despite all the career paths and all the social roleplaying I’ve tried or am trying, I have yet to find one that really suits me. Instead, I either try to do multipe things at once or more recently try to combine various disciplines together. Based on my track record to date, as a doctor, I will keep trying to make the untenable tenable: practice medicine while running a business on the side, help the impoverished while making enough money to buy lots of stuff, focus on my local community while being involved in international projects . . . I will try to do it all, and probably end up failing to do any one thing well.

The more I think about why I want to combine all of these things in the first place, the more I start to think about what really drives me. What I have been able to come up with so far is that most of all, I am afraid of “missing the bus”. I fear missing out on opportunities. Whether it is a new real estate investment, job opportunity or even a social activity, I always find myself wishing or hoping that I can contribute, become a useful contributor or be recognized as such. That’s why it is hard for me to make decisions without weighing all the possibilities. Its not that I want to be thorough but rather that I do not want to miss a good opportunity and come to regret it later. So I choose what I decide is the “correct balance” of my own interests, familial acceptability, social prestige and will still allow me the flexibility to not miss out on other opportunities.

When I think about it this way, my life thus far sounds petty and meaningless. It has worked for me thus far because I have been fortunate enough to be coddled by my parents, various mentors and employers I have met along the way. Through it all, I have yet to make a really tough decision that goes against everyone’s interests and my own but a one which defines who I am. For example, in my business school application essay, I describe my vision of a non-governmental medical clinic that provides both health care and financial services to the poor. Its interesting now as I train to become a doctor but doing something like this would go against everything I’ve been raised to believe about financial stability, providing for my family not to mention giving up the comforts of my life to date.

Is helping the underserved truly a vocation or is it just a passing interest? Would I really do it if the stakes became high and I could no longer balance the other forces in my life? When will I begin to choose my own path instead of letting the “right path” choose me?

Going going, back back, to Taipei Taipei . . .

Back in Taipei. Mom picked me up and took me straight to Din Tai Fung . . . best dumpling house ever (some pics if you want your mouth to water http://www.dintaifung.com.tw/eng/). Had some xie fen xiao long bao (crab meat dumplings) and some shrimp dumplings . . . mmm mmm. Gonna go shopping at the market for some materials and learn how to make lion’s head meatballs then maybe watch King Kong . . . man, this is the life, maybe there is a branch of medicine where I can do this all the time . . . :)

Overeducated here I come!

Just found out that I have been accepted to the MD/MBA program here at Dartmouth. What this means is that I am now spending 5 not 4 years of my life in Hanover (whoo hoo) and I will be taking one year off from the MD in 2008 to do the MBA. Crazy you say? I wonder that myself sometimes . . . then I look at the avg graduating salaries of Tuck students and surgeons . . . I wonder if I can hold down two jobs at once . . . hmmmm doctor by day . . .

10 hours until freedom

Its 10:50pm and I am in a hidden place on campus, studying immunology, hidden far far away from other med students and the distractions of this world.

In 10 short hours I will be walking out of Kellogg having finished the first set of quizzes of this new term a FREE MAN!!! (well for two weeks that is)

Then its a 6hr drive to New York and two weeks of VACATION BABY! :)

Impressions of Dermatology

Shadowed Dr. S today. Dr. S is the chief resident of Derm in a tertiary care center who ultimately wants to enter academic medicine. Over four hours I watched him examine a patient for premature male-pattern baldness, do a couple of new patients intakes, do a few procedures like removal of moles and possible melanomas, and got at taste of what it was like to dictate, write up notes and interact with attending physicians. In contrast with cardiology consults the day before where we were standing up most of the time, here we were sitting down with patients in rooms. Unlike in the wards or the ICU, the patients were ambulatory, most did not have dire conditions and no one was in any real distress. Throughout our session, the dermatologists role was one of counselor and diagnostician. Although I did see several procedures, none were very involved nor complex. Most diagnoses in derm did not involve complex pathophysiology although several were not straightforward. As in my previous experience shadowing in the pain clinic in SF, I heard the word “crazy” used to refer to several patients which I did not like.

Overall, dermatology as a specialty seems to be characterized very much by choice rather than necessity from both the patient’s and the practitioner’s standpoint. Most patients that come into dermatology seem to have a choice of whether or not to go to a dermatologist. Hair loss, while traumatic, is not life threatening. The top three most common cases with the notable exception of skin cancer are acne, skin infections, mole removals, all non-life threatening. The physcian though is allowed a choice to some extent. Most dermatologists are in private practice (I was informed that DHMC actually does not keep any dermatologists on staff – too expensive) and have the choice to work more or less (make a lot of money or a lot more).

Yet the hours are great, the environment is generally upbeat, people are attractive and nice. I have yet to learn whether this difference between cardiology and derm is more due to the difference between outpatient and inpatient medicine or if the symptoms I saw were just specific to derm. What I take away from these two days of derm and cardiology is the lesson that shadowing experiences can be highly variable and that I should hold off judgement until I have seen a good sampling of interactions and get more direct experience in a field. Yet if I had to choose after today what I would be just based on what I have seen thus far, I’d choose to be a cardiologist.

Impressions of Cardiology

Shadowed Dr. A in Cardiology consultation today. Rounded with two residents and the attending cardiologist for about 3.5 hours, saw several patients in both the wards and the ICU. The cases were exciting and the pathophysiology was complex. For instance, saw one patient who had non-small cell lung carcinoma that had caused fluid to accumulate in his pericardium (called tampinade) which was restricting his cardiac output. The treatment

I saw several really positive things about cardiology which I liked:
First, the attending was an EXCELLENT doctor, perhaps one of the best that I have seen in action. He genuinely cared about his patients and his students, even noticing and changing minute details that would help the patient feel more comfortable while receiving care (such as allowing a patient to use an innocuous nebulizer because she thought it helped her breathe better). Second, I liked the intellectualism and problem-solving. I liked the applicability of it all, that the concepts in physiology we learn in class were really used to diagnose and model what was going on in someone else’s chest and body! I also liked the importance and meaningfulness of it all. The cardiologist or internist is like the brain and the mouth of medicine. Without their diagnosis, achieved through careful observation, reasoning and testing, there is no telling what kind of heart treatment or surgery to give. There is the opportunity and risk of making decisions that have a high impact on a patient’s well being. Innovation in technology have made “seeing” the heart much more easy although diagnosis remains a real challeng. There is the opportunity to deliver very important news in a very simple way to a patient or a patient’s family which itself is an interesting and fascinating prospect.

Overall, I was very intrigued by this experience and it makes me want to seek more in the way of examining speciallties closer to internal medicine.

Xmas break itinerary

My holiday travel itinerary, lemme know if anyone will be overlapping with me.

12/18 arrive in Taipei
12/21 Taipei-Shanghai
12/25 Shanghai-Cambodia
12/30 return to Taipei
1/3 depart for US

Happy Holidays all!

To the joys of cubicle-dom

In the last three hours, I reviewed two weeks of biochemistry, reviewed a business plan for a fuel cell company, set up meetings for a book publishing company in China, finished a budget for a clinic in Burundi and collated names for a gift exchange I’m organizing. All in the name of productivity.

Somehow in the midst of thinking about what specialty I want to do, memorizing detailed biochemical pathways, writing outlines to organize elusive physiology concepts and digging around in cadavers to find obscure arteries and nerves, it is refreshing to feel productive writing emails, reading business plans and advising entrepreneurs. Business concepts seem to come so much more naturally to me than being a med student.

I like multitasking. When life seems too simple, I complicating the heck out of it. I like feeling like I am a part of a thousand different things, relationships, opportunities at once. I like networking. The thought of finding suitable business partner for people, doing favors for someone else so that they may someday help me. I like believing that friends can be business partners and I love making introductions that work. Most of all, I like the thought of being a part of something that is being created. I like starting new things, meeting new people, brainstorming new ideas.
As I build a new life around being a med student, learn new knowledge and meet new people headed in a wholly new direction, I am reminded on days like this what I liked most about business, working in a cubicle, cranking out emails and making phone calls . . . Is it more important to spend little effort, “feel” important and make a small difference to society or to spend lots of effort and actually accomplish something really meaningful for other people??

Well, here I am, pencil in hand with a laptop on my lap and a stack of notes on my desk putting in a lot of effort. Isn’t life crazy?

Passed first term Med school!

P=MD and I am 1/12 a doctor! Hoo-ray!

Lakers lose 96-93

Kobe scores 43 and the Lakers lose . . . thats just ggggrreeeeaaaat