Dabao@Dartmouth

"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?

Posted by at 3:24 PM | Permalink | Comments (0)

"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.

Posted by at 4:26 AM | Permalink | Comments (0)

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.

Posted by at 10:37 AM | Permalink | Comments (0)

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!

Posted by at 2:50 PM | Permalink | Comments (0)

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!

Posted by at 2:06 PM | Permalink | Comments (1)

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?!

Posted by at 2:15 PM | Permalink | Comments (1)

Whoo hoo, Bellagio with my fellow Dukies, wow, I can't believe its been 8 years . . . well, at least Darren's still shorter than me :)

Posted by at 2:41 AM | Permalink | Comments (0)

Some belated pics of our ridiculous 3000 mile drive out to Arizona from New Hampshire!

Cold Cold Cold West Virginia after a full night of driving through a blizzard in Pennsylvania, maybe it'll get better after these mountains

After a good night's sleep at Chateau le Roberts, off to Kentucky . . . Country ham anyone?

St. Louis, gateway to the west, yee ha, crossing the Mississippi

Largest cross in the Western Hemisphere, hmmm maybe this is where Karl Rove lives?

The Big Texan, home of the 72 oz steak in Amarillo TX, mmmm mmm here I come!

cow . . .

to steak . . .

yessirree, get 'n ma belly . . . I'm gonna eatcha

Ma? I don't think we're in Kansas no mo . . .

Epilogue: Anyway, we got in at midnight on the third day after 3 days of driving . . . exhausting but definitely an adventure

Posted by at 8:50 PM | Permalink | Comments (0)

Interestingly, according to the most recent Bill Clinton interview on CNN, he now says that he did NOT play the race card in South Carolina and that Iowa caused blacks to rally to Obama away from Hillary once people saw that he was electable and credible as a candidate.

He also made the point that the rules of the democratic election is to have a close race due to caucases etc compared to a republican race which he said if adopted the democratic rules would still have four candidates in the game.

One very interesting thing he said is that most democratic voters he talks to likes both candidates which actually goes against Hillary's argument that she is more electable because she can win the traditionally blue states like New York, CA, etc. According to Bill, Hillary's states would vote for Obama as the nominee anyway and his strength with independents and moderate republicans would ADD and not handicap his electability in the general election.

Anyway, it makes you wonder: What is this Clinton 'charisma' that allows him to convince, influence and suggest to you something that advantages his agenda even when you KNOW otherwise?

Posted by at 7:24 PM | Permalink | Comments (0)

Yá'át'ééh y'all! (hello in Navajo, you all in Texan)

Whhhheeeeeewwwwwww, Family medicine is just da bomb. 8-5 clinic, no call, fun patients, beautiful sunshine in Arizona, frybread, instant noodles and cable TV and maid service. Doesn't get much better than this. Hey, and I actually have time to write on my blog which is always a good sign.

So what am I up to these days? Well, it looks like my summer is all set which is always good. I am going to be in SF May/June for internal medicine to finish out my 3rd year of med school. Then I take step 2 of the US Medical Licensing Exam (three steps total before becoming a physician) in June/July along with doing geriatric medicine. I also set up an away elective in Oakland for emergency medicine at Alameda Highland Hospital which is considered one of the best ER programs in the country which is exciting and daunting at the same time. Then its off to Tuck and possibly a return to the cold hearted business world.

So what's the "differential diagnosis" for my career these days? A few thoughts that have come up
1) Emergency medicine + startup business - Finishing an ER residency in three years then working part time while starting up a business or helping Dan with one of his medical device ideas
Advantages: high cashflow, low risk, fun and exciting
Disadvantages: Something about just doing residency to work part time (even if it is for $250 bucks an hour) doesn't seem quite right to me.

2) Organizational Psychoanalysis - I've always loved analyzing people and myself, this would allow me to do psychoanalysis and work with organizations, two of my favorite things
Advantages: Can travel, make lots of money, the time flies by when I am talking with or about people, can consult as a psychoanalyst to CEOs
Disadvantages: Long training process (4yrs psychiatry residency + 2 yrs of psychoanalysis) and need to build up credibility, very narrow also, would not feel like a physician w/o some physiology involved

3) Build an industry, help the poor and make money doing it - For profit health care interventions at the base of the pyramid (serving those making less than $1/d)
Advantages: I would be excited and motivated about my job every day
Disadvantages: Although the point of building an industry providing public health through private means requires that one generate profits, I feel like it would be easier to make money doing something where the primary motivation was profits. It would certainly be risky and I am afraid the risks do not balance the rewards.

In the spirit of self-analysis and advice, I have gotten several snippets of truths around selecting a career that I have found very useful.
1) Dr. Coursin has always urged his kids to listen to their "quieter voices" in choosing a career in paths that may not lead to money or fame but could lead to happiness and personal expression.

2) Skip, Mark's uncle said to me that he thought I was "creative". Indeed I think I have always had a propensity for creativity whether it is in terms of business models, creative writing or creative analysis of a person or situation. Perhaps my quieter voice is one which resists conforming to a specialized career track and must look at all possibilities to accomplish a task before choosing one.

3) My dad told me that it is best to "widen the road you walk on" in terms of choosing a career such that you explore new possibilities even as you go down a career path and to maximize one's flexibility. I have always naturally resisted the social pressure to specialize and become an "expert" preferring instead to be a generalist, translator, bridge between disparate groups and knowledge areas. Why not continue to find a career that increases my flexibility rather than diminishes it?

4) Finally my bro told me the importance of cash generation + smart investing in wealth accumulation. In other words its not about maximizing your income so much as having some income and investing it in cash generating activities.

Posted by at 1:04 AM | Permalink | Comments (0)

I've been thinking a lot about some career pearls I've gleaned over the last couple of weeks from a few of my preceptors. Dr. C told me as we were talking about the advice he gave to his son and daughter about finding their paths that he always wanted them to listen to "quieter voices" that might otherwise be drowned out by family or social pressures. Dr. H told a patient yesterday how much she loved OB and how to be a doctor today, you really have to love it because otherwise it is not worth the amount of work you do for the pay you get. And of course, my assumption and realization that I have always had a lot of interests, enjoy having lots of interests, being spontaneous and curious. So what job can give me all of that? Jeez, its definitely gonna be a challenge figuring out what I can AND what I can't do . . . can't wait to take it on!

Posted by at 4:20 PM | Permalink | Comments (0)

Lakers got Pau Gasol for basically nothing aka Kwame Brown and Javaris Crittenton, yyyyyeeeeeeeaaaaaaaaaa . . . the championship days are back!

Posted by at 6:57 PM | Permalink | Comments (0)

So its official: Barack won South Carolina today. What's interesting is a point that was brought up by Ian Lustick at the talk he gave here at Dartmouth last year entitled "Are we trapped in the War on Terror" in which I asked him if it was possible given the era of campaign finances and the American industrial-military complex he describes in his book for a candidate to win a presidency without "selling out" to special interests. He replied that in his view, it would not be possible. But yet this is exactly the choice that the Obama campaign claims Americans must make in this presidential campaign: the choice for change vs the "divisive politics of old".

The British newspaper the Independent makes a very interesting analysis that by ceding South Carolina (in fact, Hillary was seldom there in the last week and Bill even gave the concession speech tonight while Hillary campaigned in Tennessee), the Clintons are taking a page out of the Republican playbook which Bill described when I heard him speak last month here at Dartmouth as "making the other guy look so ugly that people will have to vote for you" and "dividing people". In essence, the article describes the Clinton's political calculus that despite the importance of subsegments of the Democratic party: blacks, hispanics, women, they know that the majority of Democrats are still white and that by catering to blacks and being rejected by them, they can actually galvanize the white democratic base as well as hispanics into shifting away from Barack even while blacks flock to him. Indeed, early polling by MSNBC in the states with lots of hispanic voters show Hillary favored 4 to 1 and looking at exit polling only 25% of whites supported obama compared to 36% for hillary and 40% for edwards. With Edwards likely fading out of the race, I'd be willing to bet that most of that 40% votes for Hillary with Edwards out of the mix.

In contrary to my article about picking Bill Clinton, I am thinking now that it was probably a good thing I didn't cast my vote the next day . . . he sure is one persuasive (and calculating) fella!

Posted by at 12:29 AM | Permalink | Comments (0)

No matter how hard he tries, Barack will never be like Bill

I just came back from a rally for Hillary that Bill Clinton did in the Dartmouth gymn. I did not get in (not at first anyway). Apparently due to some building fire code snafu, myself and another half or so of the 200+ people standing in line for half an hour in the cold to hear Clinton speak were not let in. Not only did Bill Clinton's staff continue to let people in as the original 100 left but also arranged for Bill to speak at a separate session at the Thayer dining hall for the people who did not get in at all. This is in contrast to both the rally I attended with Barack Obama (more flashy complete with Dartmouth acapella but short and without such concessions to include the motivated but unpunctual) and the talk on healthcare that I heard from Hillary Clinton herself when she came to DHMC (invite only without so much as a hello to those without an invitation who had to watch a closed circuit broadcast in a separate conference room). As I remember from watching him on TV and reading about him in the newspaper he was eloquent, friendly and brilliant.

Among the other things I learned are that economies with renewable energy are actually doing well Denmark along with 5 other countries that have met the Kyoto protocols. He argues that going green will not only help the planet but will be the most effective investment in jobs and industry creation that we could make as a nation. For example, we could reopen a mill in Berlin, NH making biofuels. Another interesting idea is that electric/hybrid cars may be the best intermediate green solution while we develop a hydrogen option. On international development, Bill Clinton pointed out that the world population is rising from today 6.5 billion to 9 billion in the next generation which will further the impending energy crisis and that educating the world's poor girls especially will reap dividends in the decreasing birth rate, increasing rate of contraception, delaying the age at which young girls marry etc.

On healthcare, Bill pointed out that the most effective healthcare systems in terms of outcomes are actually places like Japan, a mixed payor system rather than Canada which is a single payor system. He believes that healthcare reform has the backing of a majority of major corporations, physicians, labor unions as well as the public and that it has a reasonable chance of being passed because of this aligning of the stars.

On politics, Bill showed off again his uncanny ability to simplify, summarize and frame the issue: the Karl Rove game plan is to divide and paint the other guy as so ugly that no one will vote for him and that for the Democrats to win, it will have to unite the people whereas for the Republicans to win all it has to do is to divide the people.

Also, that Barack's platform of running as a candidate with 1 year of experience in the senate (which is a weakness spin-doctored into a strength which he calls "change") and a candidate with "good judgement" having supposedly been against Iraq from the start but who said in 2004 that he "agrees with the Bush position on Iraq"

(I couldn't find the exact quote but there is a good article from the Boston Globe analyzing his voting record on Iraq:
http://www.boston.com/news/nation/washington/articles/2007/03/20/obamas_record_shows_caution_nuance_on_iraq/
)

To the claim that Hillary is old news, Bill argues that Hillary is endorsed by the greatest number of both Republican and Democratic senators (10) and commands a great deal of respect in the Senate. He also used an effective anecdote that Magic Johnson said that the older he got, the less his vertical became and the slower he got but that he got better taking the pressure shots and that he believes the same is true in politics.

To the claim that the Clintons are a dynasty, Bill shared an anecdote that he actually tried to convince Hillary to leave him just after law school because he thought she was such a capable person and politician and didn't want to hold her back to which she replied "I won't ever run for political office, I'm interested in a bunch of other things"

And as always, he added a personal touch, something only he can do with that signature lowering and softening of his voice, somber glint of the eye conveying sincerity, genuineness and warmth. He told a story of a golf caddie he had who took him by the arm during a round of golf and told him that he was really not a caddie but the Captain of a NY regional fire department and that Hillary must win because of what she had done for all of the firefighters of NY. These brave men and women had breathed in the asbestos and benzenes produced by the demolished buildings and even as the federal government refused to pay for medical bills, even sending the EPA in to declare that this would not cause any health problems, Hillary as Senator proposed and passed legislation that ensured that these firefighters who subsequently developed health problems would have their hospital bills paid for. As he finished the story and described the tears streaming down his face, you could almost see his eyes glisten and hear his voice crack.

I think I've made up my mind . . . I'm voting for Bill Clinton for President

Posted by at 8:51 PM | Permalink | Comments (0)

Mom doing what she does best . . . mother

Mom's famous lion's head meatballs . . . mmmmm . . . I think I ate about 15 of em

Mom, Dad, bro and the new addition: Poki Hsu! :)

Mom and Poki: hey get back here and put on this hat

Sit still Poki!

"I said look at the camera dog!"

Cheers Mom and Dad!

Ulys and me trying to double team Poki into a good shot

Ulys and Kate, aren't they cute?

The Hsu men

MERRY XMAS EVERY ONE!

Posted by at 8:42 PM | Permalink | Comments (0)

In SF with my parents, my brother, his gfriend Kate and Poki (my bro's mini schnauser). Hope everyone is well and have a safe and wonderful Xmas

Posted by at 12:25 AM | Permalink | Comments (0)

. . . There must be the joy of doing something beautiful
- Dr. Venkataswamy, founder of Aravind Eye Hospital in India

This is an ophthalmologist who realized the vision to apply McDonald's model of efficiency to eye care by founding one of the most profitable eye hospitals in the world that restores vision to 1.4 million people a year. Its an amazing story from a book I am reading these days called "Fortune at the Bottom" by CK Prahalad which I highly recommend. It really debunks the idea that caring cannot also be profitable or that innovation in business models and high technology should be reserved for developed markets.

Posted by at 11:50 AM | Permalink | Comments (0)

You know that feeling in life when you watch something so amazing, you get goose bumps? Like an artist painting an image, a musician playing a sad song. Today, I saw something truly beautiful in medicine.

During our team meeting, my attending psychiatrist, Dr. C interviewed a patient. The patient, Fred was a small but intimidating guy who looked like his job as a logger suited him perfectly with the stocky build, coarse dark skin, dull grey eyes and a rugged black beard. The interview with Fred started pretty regularly, "how have you been sleeping? are you feeling safe?" but then Dr. C asked about what stopped him from hurting himself the last time, then asked about his family, his wife and child in California . . . After a few exchanges about his son, Fred paused for a minute and looked down. He looked choked up. "You got choked up for a minute there Fred, are you thinking about your son?" He nodded. "Do you miss him?" He nodded again. "You want to be a good father to him don't you?" Now there were tears in the corners of Fred's eyes. "I know how hard it is not to be with your son" Dr. C said. "I want you to know how much I appreciate your willingness to talk to us. Its not easy coming into a roomful of people and being able to show your emotions. Thank you Fred" And with that, the interview was over.

And just like that, the interview was over. No more than 10 minutes had elapsed. Not a pill nor shot had been administered, nor a drop of blood taken for a test, and yet the entire room fell silent as Fred walked out of the door and back onto the unit. For Fred, the healing process had begun . . . and I was getting goosebumps . . .

Posted by at 10:42 PM | Permalink | Comments (0)

Good to be back home!

Btw, www.millhouses.gr is like the best hotel I've stayed at

Posted by at 3:56 PM | Permalink | Comments (0)

Of course, a couple months late, pics of northern NH. Beautiful place . . . considering its in the boonies

So boonies here, they can't even spell Hillbilly right

On the border with Maine at sunset, its not the ocean but ain't it beautiful?

Mt Washington . . . I climbed that sucker . . . in my car :)

Gorham, not much there but at least its green and pretty.

Posted by at 2:05 PM | Permalink | Comments (0)

Just woke up from a fun night on Thursday my last call night on Surgery. Had a full day in the OR, still working on tying those knots under Dr. Liu's watchful eye. Made it to Dr Z's guest lecturer talk by Ross Jaffe, another one of those guys that one could perceive to "have it all". He's an MD/MBA, was an internist and founded Versant Ventures which now has $1B under management (with 11 other GPs, this means he probably pulls in $1mil a year in salary plus 2% carry so probably gets a payday of $50-70mil every 10 yrs). Dr. Jaffe said something that really resonated with me. He said that people ultimately get paid for 3 things 1) Skills 2) Analysis 3) Judgement of which judgement is the most important thing (and what he iterated to me that should be a reason for me to pursue residency instead of stopping at the intern year.

As I left with those words for my last call night at DHMC, I saw again how judgement makes a big difference in the ED. A 30yo guy who was partially ejected in an MVC came in with what turned out to be a really bad laceration in his spleen and was bleeding to death in his belly. We took him to the OR and as soon as we opened his fascia, he started gushing blood out of his abdomen. We ended up sucking 4L of blood out but fortunately found the lac in his splenic and short gastric arteries and tied them off (I hope he makes it). The other fortunate thing was that Dr. Burchard (one of the best teachers I've met here incidentally) was on call and was able to make the right judgement to take him to the OR immediately after the FAST scan (ultrasound) of his belly showed fluid for immediate exlap. In this age of testing and data overload, another physician may have wanted to waste precious minutes by taking him to CT scan risking the possibility that he would bleed out.

I guess the moral of the story is really that in an age where "evidence based medicine", hard sciences and technology seem to rule the day, the truth is that the soft squishy qualities like good judgement, common sense and deciphering what is important and relevant are MORE not less important.

Posted by at 1:33 PM | Permalink | Comments (0)

Malcolm Gladwell's Blink talks about a couple of states of mind. Positive override vs negative override. Positive Override is where you are generally happy and anything negative is just a fluke that you roll with and Negative is the opposite where you are generally miserable and anything good that happens is just a temporary run of dumb luck that probably will go away.

Today I find myself DEFINITELY in positive override! I won't overanalyze but I think its a combination of things most important of which is that I am REALLY loving it at Dartmouth these days especially after being back from my "away" rotation at Children's Hospital of Orange County in California and seeing what it is like in the real world of medicine where interns are too busy to learn and told to spend LESS time with patients to be more efficient and doctors generally are rewarded for efficiency, not critical thought or patient care. The management and rewards system there is definitely messed up!

Contrast that with Dartmouth where we spent a whole day on talking and reflecting about Death and Dying with our Associate Dean who happens to be a practicing oncologist trained at MGH with 30+ years of experience talking with patients. And today got to watch Hillary Clinton come to DHMC and give an excellent talk on healthcare (btw, I think she won my confidence today for candidate most informed and capable on improving healthcare in this country). Then proceeded to interview a former drug user who has turned her life around as part of our substance abuse discussion today. Btw, I think I am going to be really good at psychiatry.

Anyway, besides that, I am really happy to be around my classmates and friends who love and support me. Just found out that one (and probably another one) of my classmates is sticking around for an extra year and will probably be graduating with Jane and I which will be great!

Today I feel like I am learning, growing as a person and feeling very happy with my life and relationships. Its a great feeling!

Hope everyone else is doing well too!

Posted by at 2:35 AM | Permalink | Comments (0)

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.

Posted by at 9:21 PM | Permalink | Comments (0)

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) :)

Posted by at 10:36 PM | Permalink | Comments (0)

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.

Posted by at 9:20 PM | Permalink | Comments (0)

Just got back from a Sonny Rollins concert. Seriously, one of the best parts of being here are the $5 concerts with legends like this man.

Its special. I want to be doing something I love at 77.

Anyway, its amazing how good music can really help you let go of the day to day stresses and worries and remind you of the real good stuff. For me, it really comes down to freedom and belonging. Freedom, like walking along Ocean Beach from the bottom of the alphabet up toward the tip of Golden Gate park and going along PCH to the Sutro baths to watch the sunset. Belonging that feeling of camraderie of being out with the guys driving on the highway with the windows down on a cool summer day. Damn I love the ocean.

Note to self: figure out how to get closer to the ocean! :)

Posted by at 11:04 PM | Permalink | Comments (0)

I feel like I'm in such a rut lately. The second year of med school is finally winding down but I feel like I've been so bored, boxed in, confined for the last two years that I've become downright boring . . . and really bored

So much so that the only things that seem to offer me some kind of escape tend to be thinking about the future, about my career, about taking care of patients, etc etc etc

Its at times like these that its good to get some perspective. Dr. Payson, the "godfather" of the MD/MBA program here at Dartmouth had some great advice. He said that in the end, allow yourself to be opportunistic and take what comes to you. In other words, though we may all think that we can plan and plan our careers to maximize our productivity, time, happiness, Norm's message is quite the contrary: don't plan

He's the second person (along with Prof Michael Chu, another person who I want to emulate) who has had great societal and personal success in life, a happy home life, successful career, does philanthropic work, etc. Like Prof Chu, Dr. Payson's career as turnaround guru in the insurance industry and a big time private equity zonk was not something he mapped out but rather stumbled into and became good at because he liked it. In fact, he started his career as a family doc in the Indian Health Service in Arizona before joining the first group practice which he later became CEO of and sold before starting a successful HMO and then turning around a major insurance company in Oxford health and selling that. Its interesting to hear him say now that despite all of his success in business and all the impact that he has had to insurance companies, doctors and patients that he doesn't think there is anything one could do that has the same emotional impact as helping a patient especially one from a vulnerable population. So as to the questions of what do I want to do with my career, my degree, my life (questions I get asked and ask myself all the time), in the end, I think I'm gonna just do what I feel like.

As Norm says, no matter how much you plan, its very unlikely that you'll map your way into being uber-rich but if you follow your passions, you have a good chance of living a happier life.

Posted by at 6:54 PM | Permalink | Comments (0)

Lately, I've been talking with Jane and others about the idea of being simply satisfied with your life vs being truly happy. The latter obviously more important one always seems so elusive and as I think about what I really enjoy doing I think it really all comes back to talking with people in a time of need. For example, I recently I had a long talk with a friend about a major career change. It was a difficult decision that had major consequences on his personal and professional direction and somehow counseling him, establishing the relationship, listening and offering good advice all was really fun for me. So much so that the two hours we spent together literally "flew by" and I found myself having to run to my next meeting and almost getting late.

Anyway, this all makes me think that perhaps counseling and mentoring folks is my "happy place". Developing a relationship, working toward a goal with someone. The problem is that somehow this all sounds a lot like psychiatry, resolving unresolved conflicts, listening to people, cognitive behavioral therapy and the like. The only problem there is that psychiatry is the antithesis of all the symbols of prestige and power that I have surrounded myself with my whole life even if it would fulfill the side of me that wants to help people. So maybe I should just be a psychiatrist after I have had a successful business career and satisfied my business ego? Counseling and motivating CEOs as my patients, hmmmm . . .

Posted by at 12:47 AM | Permalink | Comments (0)

Great day today starting off with talking to my mom last night, getting breakfast in bed this morning (fries and a breakfast sandwich), classes and then a lunch at Lou's (eggs las migas and chocolate bday cake mmmmm) with a bunch of good classmates, following Jane and her cronies around Hanover shopping while I caught up with my bro and my friend Dan on the phone, then went to an admissions committee meeting and got a nice surprise from Lisa who baked me a cake in celebration . . . topped off with a visit from Rachel and a nice gossipy talk about our classmates . . . what a great day

Posted by at 1:46 AM | Permalink | Comments (0)

It just occurred to me thinking again about my last few meetings with Prof Chu and the idea that instead of preaching behavioral changes for the sake of health, mental sanity, prolonging life or other seemingly far away risks with uncertain consequences, the goal of changing someones health maintenance behavior really ties in very well with culture, social image, fashion. Its amazing how willing we all are to change our behavior, even enduring pain (such as by putting on high heeled shoes) to look fashionable, attractive to the opposite sex etc. Well, why can't we channel this insatiable urge to look "cool" in front of our peers or "fit in" toward a beneficial health consequence? In my own case, I think to the time I was trying to fit in during high school and ended up learning how to read Chinese characters by singing KTV. Every week, I would buy the latest CDs and bring them home to play them and memorize the characters and every weekend, when my friends and I would go singing, the boys would croon their newest tunes in front of the ladies. It was silly and in any other context, I would not be caught dead trying to sing nor did I have any desire to really learn how to read Chinese at the time, but somehow the incredible need to fit in and be cool and the unquenchable teenage sex drive I had really made "studying" Chinese an imperative part of my life.

So this is really the fundamental idea behind commercializable health interventions, the idea that people don't change their health behavior for the sake of good health but they might really take to the idea that good health is not just healthy but can be fashionable, sexy or cool too.

Case in point: the explosion of this DMS alum founded website: http://www.grassrootsoccer.org/

Posted by at 12:03 AM | Permalink | Comments (0)

Just heard from Dr. N that we might be setting up a deal with a hospital in San Fran to add more clerkship sites for 3rd year! Sweeeet

That is, IF I pass my boards in June

Posted by at 12:01 AM | Permalink | Comments (0)

So I met with Prof Chu again, the HBS professor I have been meeting with who made a few very convincing points about health prevention and economic decision making. The interesting thing is that human beings can be both extremely rational yet also extremely irrational. Rational when for example, deciding between planting cassava and potatoes as a farmer in Burundi and irrational when making health prevention decisions. For instance, we are very irrational in changing our behavior when the doctor tells us that we shouldn't eat that fifteenth donut because of pre-diabetes and hypertension. Yet we are also irrational when for example women decide to wear high heeled shoes which kill your feet but are "fashionable". Is there a way that our irrationalities could actually cancel one another out in a productive, health improving way? Prof Chu's belief is that it can in a sustainable way. His current project between HBS and Harvard School of Public Health is trying to figure out some projects that would do exactly this.

Posted by at 12:45 AM | Permalink | Comments (0)

It seems to me that I like to think a lot about what I want to do with my life . . . that's all well and good but like I told Dr. Comi (one of my fav profs today), the MD will make me a better businessman, the MBA will make me a better doctor and the combination will make me a better person.

Maybe what I should do instead of trying to figure out what narrow specialty I want to do is to remain as flexible and open to new things and new experiences as I have always been. I have always trying to combine stuff US and China, business and medicine, economics and literature when what I have always really valued most is flexibility, the ability to shop around, have options, try new things, change course, dabble, sample. As I start to enter 3rd year of med school with new opportunities and increasing pressure on finding new things to do, I think I will try to stick with what a friend of mine who is in his sixties and very well established once told me, "I still don't know what I want to do when I grow up".

Posted by at 10:45 PM | Permalink | Comments (1)

So apparently ruminating literally means swallowing and then bringing your food back up during a meal and chewing on it some more. As you guys might have heard, we have had a storm recently (here's a pic of the Hopkins Center at Dartmouth which is our student center where we have performances - $5 bucks for Wynton Marsalis last year baby!) Anyway, as usual, whenever I have time off I end up thinking about the career. I honestly dunno if its ambition anymore or insecurity but here are my current thoughts about potential career paths and their inadequacies.

In general, I still haven't found the perfect career. This may be because I am really looking for a career in which I can have it all: be able to do something that is interesting and constantly stimulating, honorable and worthy of respect, get paid handsomely, while having free time to do things I like (travel, interact with diff cultures) and to raise a family and finally something where I can feel like I am having a social impact. That said, here are some of my recent thoughts on potential career tracks and their potential shortcomings.

1) Venture capital - its cushy, you get paid handsomely, you get to feed your ego (once you have raised that billion dollar fund), its very stimulating and you get to interact with all kinds of experts, lots of excuses to travel and meet new people

drawbacks: you really don't get a sense that you are making any kind of social impact although this is a great profession to make enough money and have the time to do philanthropy on the side. You also pretend that you are starting businesses more than you actually are although I am not sure just how much I want to "get my hands dirty" as an entrepreneur these days.

2) Working for McKinsey in one of their more entrepreneurial practices (like Beijing) - very prestigious, you don't get paid that well but its a stepping stone into bigger and better things, the networking is phenomenal (for example, there are 5 McKinsey projects apparently studying the Iraq rebuild strategy), they give you weekends off which is pretty cool, you travel a lot, its very international

drawbacks: its really not very entrepreneurial and can be very academic and rigid, seems like its more of a stepping stone than a long term career for me. Again a big drawback is that you don't really get to feel much of a social impact in your work although I guess there are pro-bono projects you can do (e.g. Gates Foundation is a client of McKinseys as well as several African governments)

3a) Neurosurgery - my latest fad specialty in medicine, you get to put your hands in people's brains! How cool is that? ;) This may be nothing or it may be something but its very prestigious and we have really only hit the tip of the iceberg in terms of what we can already and will be able to do in applied neurobiology in the next decade. Already there are experiments being done that are making people walk and talk again, curing people with tremors (I have seen this myself, its literally miracle work). You really really get to help people, it is prestigious, well paying, very secure.

drawbacks: apparently you can sacrifice your life for this specialty very easily and in some places that is even expected, 7 years of residency, hard to have a family life, you are on call the rest of your life, working with very sick patients

3b) Interventional Neuroradiology - you do minimally invasive neurosurgeries basically by going through blood vessels and doing microprocedures on people, this may be to neurosurgery what balloon angioplasty and stents have been to heart surgery. This is a happy medium in many senses, there is cutting edge work being done also in this field, there is tons of potential AND you get a life, only problem is that it is VERY competitive to get into any of these programs and still a long residency process if you include the fellowship time (6 years total)

3c) Emergency Room Doc - its shift work, you work a couple of days a week and then take the rest of the time off, its very intense extremely challenging exciting and you really get to help people. You are paid well, the residency is short (3 years) and the people you help are really the people most in need and it is very financially challenging to be in ER medicine (most ER depts in the US do not do research, don't get as much grant funding and take in all the sick uninsured people so they are cost centers to the administration).

drawbacks: this may be a happy medium within the constraints of medicine. You still have to do residency you still have to stay local mostly.

4) Working for or running an NGO building social justice in places like Burundi or doing barefoot doctor work in China

drawback: no $$, no real prestige although lots of self respect, tough life but you get to travel and meet a lot of needy people and build the things we take for granted here. I think ultimately I might be better suited to directing an NGO from the board as a philanthropist though.

Posted by at 7:25 AM | Permalink | Comments (0)

the cold cold cold farm

8 hours of class yesterday, 7 today . . . boards in 6 months . . . wait, why did I leave VC for this again?

Posted by at 11:41 AM | Permalink | Comments (0)

Merry Xmas 2006 everyone from Addis Ababa, Ethiopia (well, the airport internet cafe anyway)!

Posted by at 4:06 PM | Permalink | Comments (0)

Probably the best thing about being in an academic setting is the opportunity to exchange ideas with extremely thoughtful and accomplished people like MC. MC is a professor at HBS, general partner at a Latin American VC firm that he founded, on the board of Accion a very successful microfinance organization and a member of the Board of Trustees of Dartmouth College. By some external measures of success, he's got it all, a supportive and healthy family life, financial security (he had a lot of success in his career at KKR), social impact (Accion is one of the leading firms in providing financial services to the poor), academic advancement in his field of social entrepreneurship which he teaches about and researches at HBS. Today I had the opportunity to sit down with him and talk about his story, career advice and making money by helping the poor.

It was one of those memorable discussions where you are in the right place both physically and developmentally to really engage and benefit from a discussion with another person who has been through and experienced some of the things you want to experience.

MC started his career at Dartmouth in the 60s at a time of social change and revolution where governments were changed and the idea of government debated. After graduation he did not know what he wanted to do but knew firmly that he DID NOT want to paricipate in business which he believed at the time to be the source of social ills. He would tell his business friends that someday they would be up against the firing squad. Upon returning to Latin America and joining in the political opposition there he was given some words of advice by a friend who managed a part of what is today Unilever's business in Latin America: "If you truly believe that business is the enemy, why not learn about the beast from within? And oh btw, I need a purchasing manager for my business here. From then on MC embarked on a successful career in business which took him to HBS for business school, BCG for consulting, and KKR doing leveraged buyouts. In the meantime he continued to tell himself that someday he was going to help cure the social ills of the world as he set out to do when he was younger. At some point, the same friend "Scott" from Unilever made him aware of an opportunity to be on the board of Accion International whose mission was to provide financial services to the poor. This became an opportunity which he began to learn fit in with both his beliefs of addressing social inequities and his skills and experience from the financial world. So at some point he had a choice to make - continue making a boatload of money doing very interesting things at KKR or taking a large paycut and being the person he has always said he wanted to be. Ultimately he decided on the latter because he realized if he did not, he would always be the person who "just talked about curing social ills" and would never actually do it. He realized that making such decisions will DEFINE who you are.

MC's view is that there are no moral compasses or even social compasses by which you should judge whether a career choice is a good or a bad one, rather a given opportunity is simply the right one for you or not the right one for you. Simply the feeling you get when you walk into the door will tell you whether all the components are there that you hope to achieve. Analyze with your mind, choose with your heart. Don't spend your career building a resume only to one day get hit by a car crossing the street ("what's your tombstone gonna say? he never did what he wanted but he sure built a damn fine resume!")

This was all extremely wonderful for me to hear about from someone who has been through it and made difficult choices but in the end was able to have his cake and eat it too. The key takeaway for me really was in how all of this came about without planning but with a crossing the stream by sensing the rocks approach. In that way, I also feel that in my past experiences I've learned more and more about what fits me and what will fascinate and challenge me for the future. For example, at JJDC this summer getting paid well, building a resume, doing interesting and important stuff with brilliant people was fabulous but the missing piece was the social impact of my work. In much the same way, seeing patients as I understand it so far in medical school is socially useful, personally gratifying but lacks a wider social impact and the intellectual challenges of creativity, initiative and risk that I love so much about entrepreneurship and venture capital.

In the course of talking about careers, I also learned a lot from MC about microfinance and social entrepreneurship that I would like to touch on briefly here. First, the now validated evidence that YOU CAN MAKE MONEY BY HELPING POOR PEOPLE is something that he has demonstrated through his career and success with Accion and this is one of my most fundamental beliefs or hopes about what I can do with my life and career. Second, MC pointed out that microfinance is NOT for everyone, you do not want to loan money to someone who does not have sufficient caloric intake to work. "The only thing worse than being desperately poor is desperately poor with DEBT". Rather you want to provide microfinance to those who are already delivering the 6 bottles of oil every day and by allowing them through access to working capital to decrease their costs increase their supply and efficiency to lower the price of oil for everyone in that community, including the starving person.

Third, MC's take on the current impasse in helping the poor is in health care DELIVERY. The treatments (such as vitamin A for blindness) are available often for pennies but the challenge is how to deliver these interventions to the poor? He has also learned that no organization for profit or not can succeed without four elements: SCALE, PERMANENCE, IMPACT and EFFICIENCY. For example, he is currently working on a joint project between HBS and Harvard School of Public Health called Antaries that aims to identify commercial interventions using the 80/20 rule where interventions can be rethought and redesigned from being "public goods" provided by government or NGOs to private goods that the private sector can validate and model and mass market to the poor. It involves rethinking of the poor as "end users" instead of the doctor-disease-patient centric approach in medicine or disease impact on society perspective of public health. For example, instead of treating iron-deficient anemics in low income communities with government mandated policies to distribute bad tasting pills through underresourced clinics or schools, how does one make a good tasting soda supplemented with iron and market it (say with Shakira advertising it) to the kids in these communities as great tasting and oh btw it will improve your health rather than the other way around. Ironically, the current soft drink makers that do similar things tout the "health benefits" of drinks rather than focus on making it a great product first.

Another example is paint that has anti-malarial insecticide in it which people would buy because 1) its a great color and has great protective properties 2) is affordable 3) will keep more mosquitoes away. This would help replace malaria nets which are hard to use and uncomfortable and potentially not useful for people to use. It would be distributed not by enthusiastic NGOs or inefficient governments but by the private sector who sees one organization being successful at it and that organization spawns an industry wide adoption of similar products and concepts. Like microfinance, success in a few leading organizations will catalyze an entire industry of profit seeking companies that because they are seeking profit delivery advertently or inadvertently a social good.

Another example is of drug stores that contract out the sales of condoms to peers and thereby allow young people to earn money by selling condoms that are cheaper than the competition. It is a superior product, sold in a more effective way that reaches more people.

Mexican "minute clinics" where you charge 2 dollars a visit for a no-wait consultation with a doctor and meds that are 30% cheaper than at the hospital which the poor prefer to no-cost 12hr waits at hospitals for "free healthcare".

MC was quick to point out from his prior experiences that the key to success of Bancosol in Bolivia which is a commercial entity that provides financial services to low income community was a first mover advantage, scale and STRONG management which drives increasing cost efficiencies despite price competition. This example has spawned hundreds of similar banks throughout latin america.

Personal notes: MC has 1 son working for a NY law firm and lives in Boston. I will keep him updated on my career both in terms of the MD/MBA and my experience in Burundi this winter. I think documenting these rituals in Burundi and finding opportunities for commercial ventures is one of my goals for the upcoming trip to Burundi.

Posted by at 2:00 AM | Permalink | Comments (1)

Good evening! Thank you all for coming. My name is Eugene Hsu and I am a second year MD/MBA student in the DMS/Tuck joint degree program. When I was asked to speak at this event several weeks ago, my grandmother had just passed away after a decade of progressive mental deterioration from a massive stroke that paralyzed one side of her body. Today marks the fifth week since her passing which in Chinese culture is a day for remembrance by the sons, daughters and grandsons of the departed. In this spirit, I would like to share a story with you about my family and what your contribution means to us.

When I was growing up, I often wondered why my parents never really expressed their feelings and emotions the same way other parents did. When I would do well on a test or win a spelling bee, they might cook a nice dinner or ruffle my hair a little but they never told me the words “I’m proud of you”. Years later as an adult, I watched my father care for my grandparents as they became ill. My father would take days off work to fix the toilet at their house, my mother would cook grandpa’s favorite crab dish for Chinese New Year’s, and both of my parents would work extra hours to afford my grandparent’s medical care. And not once did I ever hear my parents utter the words “I love you mom and dad” nor my grandparents say the words “I’m proud of you”. All my life, my family has taught me that emotions like love, respect and pride are spoken loudest through self-sacrifice and service to one’s elders.

My grandparents’ lives represent the finest example of self-sacrifice. In the 1940s, they escaped the Japanese invasion of China, leaving their elders behind to give their children a better life in Taiwan. My grandparent’s spent their best years raising three sons and working to pay for their college educations. After the youngest son, my father, finished a graduate engineering program in the United States and married my mother, my grandfather and grandmother officially retired, planning to return to China to reconnect with family and to travel to all of the places they had wanted to go before the war. This is when my grandmother had her first stroke. She had had heart disease for many years that was left untreated because she did not have access to health insurance and did not want to burden the family with her illness. Ironically, after her stroke and paralysis, my grandfather would spend his retirement funds paying for her medical bills and then the remaining 10 years of his life caring for her day and night. Last year, as he was dying from heart failure, I was able to visit grandpa and tell him that I had started my first year at Dartmouth Medical School. He responded by saying, “finally, our family will produce a doctor”.

I realize how fortunate I am to be here tonight, the result of many sacrifices that my grandparents and parents have made for my life and education. With my MD/MBA, I hope to one day bridge the chasm that exists today between the business and clinical medicine and provide not only the best medical care for patients but the most affordable and accessible care. In doing so, I understand that while I may never fully repay the sacrifices of those that have come before me, I will forever be inspired by their example when I serve others as a physician and as a person.

I wanted to share my story with you because I want you to know how much your contributions mean to my family, my classmates and me. For us, the scholarships you provide represent pride in this institution, respect for the profession of medicine and love for the patients we care for in the future. Yours is the most significant of contributions to the training of future doctors and your generosity speaks loudest of all. Thank you.

Posted by at 11:52 PM | Permalink | Comments (2)

My grandmother passed away today at 9/15 12:15am Shanghai time (12:15pm 9/14 EST). After hearing the voice mail in which my dad spoke in a soft, calm voice about the time she passed away and how he was going to Shanghai, I came home and immediately called my family. Those I could reach, my dad, uncle and brother all had the same reaction "yea . . . I heard she passed away. . . " and proceed to talk about logistics for traveling to Shanghai for the funeral. I made sure to ask the same question each time "how are you doing?" which did not really ever yield
the answer I was looking for. I wanted to know how they felt inside, if they were hurt, sad, relieved, missed her. It was the same when my grandpa passed away. I saw my dad cry for the first time ever but it was when I passed his room on the way to the bathroom that morning and he quickly wiped the tears away and prepared himself for that day of funeral arrangements.

Its strange that I am entering a profession in which we value empathy, compassion, emotional expression and yet I come from a family that does not express in words what we feel inside. Instead, I think my family is more comfortable with actions, doing something to show non-verbally that we care. The same way my brother and parents flew in from California and Taiwan to help me move into and start medical school. The same way, we all met in Shanghai earlier this year to send off my grandfather. While part of me wishes we could express ourselves verbally the way I hear many of my fellow mainstream American families do it "I love you, I miss you, etc", I know it is just not the way my family does things. But that doesn't mean we can't try to verbalize some things a bit more.

One thing I want to do is to record for myself some of Grandma's stories so that I can know her better and that way she can be a living memory for me to carry with me in my life. I realize that although Grandma had the good fortune of living to age 91, we did not have the benefit of enjoying her stories or sharing thoughts and experiences with her in the final years. I personally don't recall much interaction with her at all. The one thing I do remember was when Yeh Yeh and her lived with us in Arcadia and she found out I was taking piano lessons but wasn't practicing. I think that really got the "teacher" in her fired up and she took it upon herself to force me to practice. Anyway, I remember her sitting with me in front of the piano watching me play to make sure I practiced. I can still remember her stern gaze, the disciplinarian tone of her voice. "Bao Bao, practice!" she would say. Unfortunately, this was the only clear memory I have of her before she became sick. On the other hand, it might be because of her that I am able to force myself to study in med school! Thanks Grandma! :)

Posted by at 8:48 PM | Permalink | Comments (1)

Chris and Pauling's wedding!

Hong Kong = too many Chinese people

But the food is pretty good - try the roasted goose, its DE-lish!

And sunset is pretty nice - especially on the cruise boats

Ray's Wedding in Oregon with Janet and Caesar

Bride and groom, awwwwww

Eugene with his new friends at J&J!

Dave and Eugene go to White Castle!

We are excited to eat the burgers Harold and Kumar ate

That is until the shit hits our stomachs . . . uuuuuugggghhhhh

Back at Dartmouth, Back in Boston!
There must be something wrong with my camera, my stomach is NOT that big!

Posted by at 7:06 PM | Permalink | Comments (0)

Today I found a piece of paper on which I scribbled one of my last conversations with Grandpa last year That day, I asked him about his father and mother (my great grandfather and grandmother). He described great grandpa as "yi dian yi hua" meaning that he was straightforward and that he was "hen zhe xing" meaning that he had a warm heart referring to his work for the YMCA (for which he actually traveled to the US). Great Grandma was more difficult to describe for Yeh Yeh. "I guess you could say she was very 'lao shi' Yeh Yeh finally said smiling out of the corners of his mouth. Then after a few minutes of silence, he let out a deep sigh and commented out of the blue that grandma "hen ke lian" (is very pitiful) referring to my grandmother's paralysis.

I asked one final question that day, "Yeh Yeh, do you ever regret leaving great grandma and grandpa in China?" (Grandpa never saw his parents again after he left Shanghai for Taiwan). At this, yeh yeh chuckled and said to me "why would I have any regrets?" I've worked hard to put all of my children to college.

Yet I could not help but think to myself as I helped Yeh Yeh across the room through the doorway to the kitchen where we would share one of our last meals together, "did Yeh Yeh ever get lonely in the months and years between visits by my father or me eating by himself?"

Posted by at 7:19 PM | Permalink | Comments (0)

I finally gave my presentation today, the sum of probably over 150 hours of hard work, staying up late at night, going home in the afternoons for 2-3 hr naps and then waking up to stay up through the next working day . . . all to create a 30 min presentation on Asian investment opportunities for a roomful of 15 people, many whom I met for the first time.

It was well received! Not only did I get a round of applause but I had people coming up to me afterwards talking to me (a lowly intern) and telling me to keep in touch with them. It was fun!

I guess I am trying to capture between yawns just why this feels so good so that I can hopefully feel more of it. I guess its a combination of exceeding my own expectations, bringing out the best in myself and delivering. That last word means a lot to me these days because it takes some imagination to be able to "envision" a goal but to actually execute it and overcome ones fears along the way . . . that's a different matter altogether.

The critical thing is that I feel a sense of accomplishment, a sense that I did a good job in something I set my mind to. I didn't need to do this in order to complete my job, it was totally my own initiative to ask for this research project, work as hard as I did and deliver the results at the end.

Of course, it helps that Dave and Ashish, both people I respect and admire (and am even intimidated by to some extent) complimented me as well as all of my mentors here supporting me along the way. Today I feel really fortunate to have met these wonderful people, proud to have done some hard work and surprised at myself in a good way that I was able to deliver the way I did. Best of all, this was REALLY FUN!!

Posted by at 6:38 PM | Permalink | Comments (0)

At least I'm getting paid to be here.

One thing I've realized this summer working and living by myself. I really miss being a kid. Yup, I look at the aspects of my character: I like people who mentor me, I like lounging around eating what I want, traveling where I want to, absorbing things, wide-eyed like a child. I don't have a very long attention span at all. I like reading books and watching movies about a boy and his father, the good ones always make me cry . . . (btw, good book - Kite Runner, good movie - Together) yup, I am like the living embodiment of the Toys R Us line, "I don't wanna grow up, I'm a TRU kid . . ."

I guess there's nothing wrong with that. In fact, I think this probably is the root of what makes me a good listener, good learner, polite, curious, always forward-looking. In fact, maybe that's one of the reasons I like venture capital so much. We talk here at JNJ a lot about the "Future of Medicine" or future of healthcare where things like stem cells can cure diseases like diabetes or where we can prevent cavities by ADDING good oral bacteria to outcompete the bad. Just thinking about these things give me good bumps . . . like when I was a kid and used to imagine what it would be like to be like a comic book superhero

Anyway, enough reminiscing . . . I have a very "grown up" deadline coming up!