Gene's Joint

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?

Emergency Med reflections

Been a busy couple of weeks. Professionally, its the middle of the hump right now and emergency medicine has definitely been a roller coaster, if nothing else. Part of me likes the excitement, there are definitely lots more procedures and you really do feel like your doing real medicine. Real world patients, you really do get to learn how to save lives, a little bit of ICU, a little bit of OBGyn, a little bit of peds, a little bit of anesthesia and a little surgery as well as a whole boatload of medicine problems. I do think I miss the safety and security of a structured and slower paced environment like an internal medicine at CPMC. During my shift I always feel like I’m frenetically running around and treading water just to stay afloat. But as Jane said, I will definitely give it till the end of my rotation and having a little patience before really weighing in on it. On the other hand, I do really like it when I am complimented and my confidence level goes up a bit.But man am I tired after doing these shifts.

Right now I think Emergency Medicine would be ideal from a career point of view, higher pay, less hours in the hospital, very interesting and exciting which would allow me to do VC or be an entrepreneur while still supporting myself.

On the other hand, I just like hospital medicine more: a little slower paced but not outpatient, more time and opportunity to think through differentials and read up on diseases. And I kind of like the academic environment and the people are more to my liking, more thinkers than doers. And you have time to think in a less hectic setting where there are still acute things. And you still have the opportunity to do outpatient later on in life. I will definitely say that being in the clinic is definitely a lot more chill than having to go to the hospital every day. It just makes me feel a little inadequate though to think that you really won’t be very proficient with procedures compared to ED with internal medicine. And the pay is almost half that of EM which is unfortunate and I really don’t think the culture is quite there of moonlighting etc.

Maybe all this rumination eventually comes down to that last line.

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.

A good day in outpatient medicine

Its been a while and I need to catch up on blog entries (Not that my life is so exciting between studying for boards and being cooped up in the hospital).

Anyway, ongoing thoughts about outpatient medicine. I’m on my last day with Dr. H here in Claremont and its really been surprisingly good. There is a side of outpatient medicine that is attractive: getting to really know your patients and also being the first line to pick up really bad things when they could otherwise go unnoticed. One of the highlights during this rotation was finding a woman with a large retroperitoneal abscess likely either from a ruptured appendicitis or a appendiceal tumor who came in because she was just feeling lousy and looked kinda crappy and had some diffuse aches and pains and a tender belly and some pale eyelids. We got a stat white blood cell count which showed that she had 20,000 white cells (normal is less than 10k) and was anemic with a hemoglobin of 12, scanned her belly and found the abscess. She got the abscess drained and put on IV antibiotics. We probably prevented a life threatening blood infection in her and probably saved her life. In some ways it was kind of like the emergency which WE found and upgraded rather than the patient defined emergencies for which they go to the ER on their own initiative. Either way, you’re really saving a life which is very meaningful. A very different twist on Emergency medicine!

Of course my preceptor (this funny German guy who is VERY German, always on time, uber efficient, the ultimate task master who expects things to be done 10 minutes ago whose idea of fun is to rent a smart car instead of a taxi from the airport) think I ought to go into primary care because “its more important”.

Great day in Medicine!

Man, what a great day. It started as normal, actually a little later than normal because I got out of bed late which made me preround on my patient late which subsequently made me late to morning report. As I sheepishly slinked into my seat, I beat myself up in my mind for being late, what would my program director think of this guy that’s always late? I thought to myself. Gave a nice presentation on Cdiff colitis with my team and then retired to the doc’s lounge to “read” and just sit around. Then around 1-2 got a page from the GME office that I had a package. It turns out that one of my patients, a sweet old lady who had a TIA and some hyperlipidemia owns a vineyard down in Carmel and actually SENT ME A BOTTLE OF CABERNET from the vineyard with a little card directed to “Dr. Eugene Hsu”. After celebrating a bit and telling my senior resident M about it, I happened to ask M to fill out a little evaluation card for me to give back to Dartmouth. On it, I didn’t expect to find a comment about how one of my patients actually said to M that she wanted me as her primary care doctor. It was literally one of the best compliments I have ever received in my life! It really made me feel good about myself better than any compliment, score on a test or feedback in med school. Then to top things off, at the end of the day around 6-7pm, I still hadn’t admitted any patients despite lolling around all day and I decided to “stick around for one more patient” despite my senior resident telling me I could leave and that “it wasn’t worth it” to see this last patient. It turns out this patient had some lower abdominal pain associated with filling of her bladder and needed to go constantly ever 10 minutes to relieve the pain and I was able to come up with a diagnosis (interstitial cystitis) that fit her clinical findings PERFECTLY and presented the perfect assessment and plan to my attending who agreed with me and told me the H+P was “great”. It all went so well, I felt so confident and on top of my game. Anyway, I left the hospital whistling and singing. Later, J told me that this was a lesson in faith, patience, interdependence. Whatever it was, for the first time in a while I think I know what I’m doing . . . and I’m doing it WELL!

Excited!

Wow, its amazing, I just had dinner with my buddy Dan who is an MD/MBA and inventor of medical devices. Man, that stuff is so exciting. It makes me excited just thinking about doing that stuff. Anyway, hopefully I can work on that stuff when I get to Tuck . . . can’t wait, can’t wait, can’t wait