The time has finally come.

It’s been a long year since the previous match day, and I’ve certainly grown as a person and a doctor. This time, match day was not quite the same fanfare as it was last year. I was not afforded the opportunity to go participate in the envelope opening tradition: there are patients to be taken care of! As a result, I waited patiently as I started getting an influx of pictures and Facebook statuses of all my successful friends, matching at quality programs across the country. In the midst of this social media storm, I was also bombarded with text messages regarding my own long-awaited result. Alas, I have to wait until the hour after where the NRMP sends out an email, almost as disasterously cryptic as the first notification email. Instead of the suspense filled subject “Did I Match?”, it is now “Where Did I Match?”

I’m not going to lie. I was definitely nervous while opening the email, even though I already had a sense of where I was headed.

For my General Surgery Residency, I will remain and start anew at Ohio State University. In addition, my fiancée matched to the affiliated pediatrics program: Nationwide Children’s Hospital.

I will be repeating intern year, but this time as a categorical resident. This time, with more experience. This time, knowing the system. Some may say how rough or brutal it is to repeat intern year, but in all honesty, I am just happy that I am now categorical, and that after many years of being long distance, Becky and I can finally be back together in the same city.

It brings me great joy to see the many happy faces that are depicted on Match Day photos, but this feeling is mixed with a bittersweet aftertaste. After all, it is the harrowing, unspoken truth that there are those who do not get to revel in the same joy. It is these people who are left out of the photos and festivities, that we shouldn’t forget about. The Match is an extremely unforgiving process, and I am all too familiar with both sides of this coin. Many people who went through the SOAP/scramble process had reached out to me, and I hope that my experiences/advice have made that process that much more manageable. For those who need someone to talk to about this whole process, I will remain available. It is not easy to walk this road alone.

To those who have matched to their dream specialty and location, I celebrate with you. We’ve all worked hard to reach this spot, and it is definitely rewarding to feel like “it’s finally paid off.” To those who ended up with a less than ideal result, congratulations are still in order. Finishing medical school is no simple feat, and that MD will stick with you for the rest of your life. It is by no means a judgment on your character or worth, and you should not view yourself any less of a future physician. To those in a preliminary position: have no fear: my story is the perfect testament that it is not a dead end road, and that the assessment and plan must be KOKO, keep on keeping on.

Thank you all for the support throughout this whole process, I look forward to finishing the year with a huge sigh of relief.

God bless, Go Blue.

Being a surgery resident on call means you are often responsible for activated traumas that come through the emergency department. These can range from a little old lady who fell from sitting, but takes a blood-thinning medication and so thus has a head bleed, to a catastrophic motor vehicle accident or even aggravated assaults. Long story short, you can literally see anything and everything while on trauma call.

As physicians, there are always patient stories or encounters that will stick with you. This one story was literally so outlandish that I couldn’t make this up if I tried. Obviously patient names and other identifying circumstances have been edited per HIPAA.
—
It’s roughly 11pm. The night hasn’t been terrible; my pager has been ringing at a steady pace, but everyone was tucked in for the most part. A trauma activation is heard overhead. Trauma. Level 2. In 10 minutes. My pager soon follows suit and reminds me of the announced trauma. I make it down to the emergency room and the whiteboard in the trauma bay is blank. Usually, with enough preparation and a sufficient report, the trauma nurses are able to write down basic demographics to paint a picture for us before the trauma patient even arrives. This time, no such luck. When I asked the nurse if she had heard anything about the trauma, she shook her head and said that the report she got was painfully suboptimal, and that all she really took out of it was that it was an old lady coming from a nursing home with a neck fracture. A neck fracture? I jotted down a quick note to remind myself to have neurosurgery or orthopedics, whoever was on spine call that evening, notified.

The rest of the team assembles and we perform our usual sign-in and preparation. The trauma finally arrives, and the first thing that we notice is that she does not have a cervical collar on. For those not medically attuned, when there is any concern for a neck injury, a collar is placed to stabilize the neck, preventing potentially devastating spinal cord injuries. The EMS team gives their report, stating that the patient fell out of bed at a rehabilitation facility, not a nursing home, and was found to have a right femoral neck fracture. Okay, this makes a bit more sense; however, given that the patient fell and wasn’t able to tell us if she hit her head or not, we transferred the patient off from the EMS gurney and onto the trauma bay bed, and a cervical collar is quickly placed.

The woman was older, and all she could tell us was that she took a blood thinner, coumadin, but did not know why she took it. She was not sure about any medical problems or past surgeries. She did not complain about anything other than right hip and leg pain. Following ATLS protocol, we turned her, making sure to stabilize the right leg as we rolled. No spine tenderness. We find wound vac tubing with sponges over a fairly large, right gluteal incision that looks no more than a week or so out from surgery. Puzzling indeed.

Finalizing the secondary survey, we found that the right leg was notably shorter than the other, and that her hips were asymmetric. Moving aside for the chest and pelvic x-rays (since the rehab facility did not send any images with her), finally we had some imaging to better delineate what was going on:

(similar picture, not hers. Photo credit at the bottom)

Obviously “something” is wrong, so we call up Orthopedics to help direct further management. The Orthopedics resident comes down and upon hearing the brief history, his eyes widen. Wait. You’ve got to be kidding me. He goes through the orthopedic surgical case schedule; lo and behold, our trauma patient was on their OR table not quite 9 days prior. He explains, “This is what her hip should look like. It is a resection arthroplasty, or a Girdlestone procedure, a last ditch effort for those patients with unsalvageable femoral neck fractures.” It was later revealed that she had a remote history of a stroke that left her hemiplegic, unable to use that leg. She was bedbound at baseline, and so when she presented to Orthopedics with a femoral neck fracture, instead of a total hip arthroplasty or bipolar hemiarthroplasty, it was elected to proceed with the palliative Girdlestone procedure. The wound vac we saw, was what they had put on prior to discharging her 8 days ago.

Of course, as icing on top of the cake, the trauma nurse later called the facility back to get a better report. It turns out that the patient did not fall, but when the physical therapist tried to work with her leg earlier that day, she complained of increased hip and leg pain, and so an x-ray was done at the facility. Seeing what they saw, they called the ER. The rest, is history.

I, for one, was dumbfounded. This patient just got a multi-thousand dollar work-up for an “expected post-operative appearance”. This also highlights the importance of a good provider-to-provider handoff, in order to eliminate these kinds of medical misadventures. Upon confirming with Orthopedics that there was nothing further to be done on the poor woman, we passed on the message to the Emergency Medicine resident, so that she can return to her rehab center when transportation is arranged.

You’ve got to be kidding me.

—
Photo Credit (found via Google): http://1.bp.blogspot.com/-S1LE6N6m0dk/TwSJG87_2TI/AAAAAAAAJ68/GNi9IZdtoQw/s1600/Girdlestone.jpg

I’m starting to sound like a broken record; it seems I have to preface every post I make with an apology for how long it’s been since my last post. Perhaps a new year resolution would have been to be more reliable and intentional in posting here. Surgical residency surely makes life a lot busier than usual; however, it definitely provides a lot more interesting topics to write about.
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Picking up where we left off last, I have since started a general surgery residency at the Ohio State University Wexner Medical Center (OSUWMC), as a preliminary surgical intern. Now that I’ve been nearly two thirds of the way through this year, a few learning points really came to the forefront, upon reflection.

Being patient-centered takes an active (but worthwhile) effort.
As a medical student, it seemed incredibly easy to be patient centered. 45 minutes for a detailed history and physical along with a thoroughly exhaustive 14-point review of systems would make any patient feel like you were uncovering every little bit and piece of their illness. However, to which many of my fellow residents will attest, “Ain’t nobody got time for that.” What gives? It’s not so much that the moment you graduate medical school we all lose our sense of empathy or humanity (maybe). With the increased amount of responsibility (you have a legal MD now, after all), that time spent with an individual patient competes with all the other things that demand your attention. It becomes an increasingly stressful game of juggling, in which, if any aspect of a patient’s care is not done, it falls back to you. As a result, on the busier surgical services, patient-centered care becomes, unfortunately, more of an ideal than a reality. That being said, all is not lost. There are still many examples of attending physicians who take the time to explain the plan of care to patients and their families, but these are the same attendings who are seen spending longer hours at the hospital and putting in that extra effort for patient satisfaction. Those cynics in the crowd would say that much of this is related more for improving overall hospital ratings, as patient satisfaction is a metric by which we’re graded on as a hospital system. Ultimately, it doesn’t matter the motive of why you’re doing it, but that delivering patient-centered care is still doable and is something we should still strive for.

A sense of humor is absolutely essential.
When I was still in the early years of medical school, a more senior medical student at the time explained to me that our residency choices are not truly “informed” decisions. When I finally entered the wards third year, it became increasingly clear that she was right. The decision to pursue a specific medical field as a career ends up being based on a few months experience (at most). Because of this, the residents and attendings on service when you rotate through play a huge role in painting what that specialty is like. How enjoyable the service is becomes a factor of how well the team gels with one another. I’ve found that everyone ends up working better when there’s a little humor sprinkled into the otherwise long and stressful days. Even on an extremely busy service, I’ve found myself working more efficiently when I felt comfortable with the entire care team – mid-level providers, co-interns, senior and chief residents, even attendings. It could be said that each specialty has their own “personality” and as a result, their own “sense of humor.” Even in medical school, I felt that my sense of humor fit in the most with the surgical residents. It is reassuring that as a resident (at a different institution, no less), that the trend continues, further affirming my choice to continue pursuing surgery.

I love teaching.
One of the biggest reasons why I fell in love with surgery was because of how involved the residents were in teaching me about surgery, encouraging me to take on bigger roles in the care team, and constantly advocating for me to participate in the OR and bedside procedures. As a gesture of paying it forward, it has been very satisfying to teach the medical students as much as I can, involving them in the care of the patients they follow, and encouraging them to be in the OR and having them suture with me. It seems like the least that I can do, and even if these medical students with me don’t end up going into surgery, at least they can leave having some sort of appreciation for the crazy (fun) life that we lead. With how surgical education is dwindling in the standard medical school curriculum (prosection replacing dissection, limited surgical exposure except for those interested early), every little bit of encouragement will only bring more youthful enthusiasm to the field of surgery. I can only hope to impart my own excitement of joining surgery to those who rotate through.

Friends are essential.
Residency is stressful. Long hours, lives sometimes literally on the line; even the hardiest of physicians needs some reprieve. Both our physician and non-physician friends help us here. Our fellow physicians remind us that everyone goes through a similarly grueling process, and that we’re never alone this endeavor. I thank my co-residents for making the oft sought after resident camaraderie a reality. No one can quite understand what it takes to go through a surgical residency like someone in one. Our non-physician friends bring us back to the real world and validate us that what we’re doing is still worthwhile. I have my fiancée and friends (many of which are also physicians) to thank for their endless support, and keeping me grounded in everything that I do. At the end of the day, this should never be a solo journey.
—
As this preliminary year approaches its end, much like last year, I have the upcoming match to look forward towards. The interview process has been easier and harder at the same time. My interview answers were much smoother and calmer the second time through. Furthermore, having had a taste of surgical residency has only affirmed my desire to continue with surgery, but this comes with the increased stress associated with the gravity of my particular situation. My rank list is certified, and I wait for my second Match Day (March 18, 2016) for the finalized results. Stay tuned, for where Becky and I will be next year (hopefully together).

For those of you who read my previous post, undoubtedly there were a lot of emotions at play. Thank you to everyone who reached out, be it in person, electronically, telephonically, telepathically. Your support was instrumental in making sure I stayed strong and patient during the long wait.

It is only fair that I allow some closure on the situation, as I did leave a nasty cliffhanger as to what my plans were for the upcoming year.

Since writing the last post, I received a phone interview with Ohio State for literally one of the last preliminary residency spots left in the country (there were 3 remaining when they called; 2 of them were Ohio State’s). At the conclusion of the interview, they told me they had a few more calls to make, and the decision process would likely take a few days.

The wait continued. After a certain period of waiting, you become used to the feeling, and are dangerously toeing the line between trying not to be overly anxious and risk freaking out, and overcompensating, and being borderline apathetic. While this was happening, I continued to look into other options, should this all fall through. Research at Michigan. Research at outside institutions. Do I get a Masters? Do I commit 1 year or 2 years to research?

At long last, the wait is finally over. On Thursday, March 26, at 8:00pm exactly, I received an email from the Ohio State program director saying that he was excited to offer me a preliminary PGY1 position in their General Surgery program.

The first few minutes were completely silent. My mind, blank. I didn’t know what to think. I was simply in shock. I re-read the wording of the email to make sure I wasn’t crazy. After an 8 minute stupor, I replied stating that I am excited and definitely accepting his offer. After that, text messages and emails to my surgery mentors. My fiancee started dancing over the Skype screen when I told her. Phone call to Mom, who, through all this, has been hit much harder by worry and anxiety than me. Then text messages to those who have been patiently waiting and praying with me. It was all a blur. By the time I finally finished sending out thank you notes and updates; it was already midnight. Only then, did I finally breathe a huge sigh of relief.

Thank you all for bearing with me. Thanks for following me on this crazy journey. Thanks for riding this ridiculous roller coaster of emotion. I will have a job this coming year. I will still graduate with my class – the class of 2015.

The fight is far from over. There are no guarantees following the preliminary year. I will be applying again next year, but hopefully this whole process will be easier with the experiences that I’ve had already. It’s time to take this opportunity that God [through Ohio State] has given me, and time to prove all the others wrong for passing on me.

Finally,

Go Buc— [I still can’t do it. We’ll get there. Eventually. Maybe.]

Go Blue!

You work hard for four years (some may argue how hard you work M4 year, but we digress), and it culminates into one email the Monday before Match Day. Everyone hears about this nerve wracking email that comes in right at noon from the NRMP (National Resident Match Program) to tell you whether or not you matched. You get location and other details revealed to you on actual match day.

Whether by some sick and masochistic design or just trying to continue “the suspense”, the email arrives with the subject line “Did I Match?” and nothing else. Some people were lucky to have their email browser help them a bit, sneaking in the word “Congratulations” as the first word in the body of the email as a tip off. I clicked open the email, and read the words:

“We are sorry, you did not match to any position.”

A million thoughts race through your head at that very moment. Time slows down. You feel every single one of your heartbeats, despite how tachycardic you are. First, a wave of disappointment hits you. Disappointed that you won’t be joining the vast majority of your classmates in saying that you matched. Disappointed that your week leading up to Match Day will no longer be smooth sailing. Disappointed in yourself for not being “good enough to match.” What compounds this sinking feeling is that in the age of social media, all your classmates post their happy statuses about locking down a highly sought-after residency spot in the country. As happy as you are for your classmates, colleagues and friends, there is that nagging black mark in your mind. Second, you realize that time is of the essence and that a lot needs to happen very quickly. In the regular match, you had an interview season that spanned 3 nearly 4 months (varying per specialty). In the SOAP (Supplemental Offer and Acceptance Program), all of that happens within 48-72 hours.

What has been an interesting observation in the last week, was as people slowly found the courage to ask the M4s regarding whether or not they matched, especially at a school such as Michigan, the expected response is something along the lines of, “Yes, I’m so happy/relieved, but I’ll find out where on Friday.” This was the script that everyone who asked me expected the dialogue to go. Unabashed, I told them “No, I did not.” Given my personality, the first response was a unanimous “You’re joking right? That’s a terrible joke if it is.” Once they realized that I was serious, the tone became immediately apologetic and sympathetic.

In all honesty, the sympathy was somewhat of a double edged sword. Undeniably, all their “sorry it happened to you” and “you don’t deserve this” lines made me feel like a victim and that was just adding to how uncomfortable the whole process already was. That being said, I truly appreciated everyone’s kind words, support and prayers. It is the support from those close to me who have really kept me going strong and thinking clear minded through all of this.

Our chair of surgery, who has been a great mentor to me, once told me in the context of clinical care that “What makes a great surgeon is not necessarily how few complications he/she has; rather, it is how he/she faces those complications that makes the surgeon great.” Many people have commented on how calm I have been through the whole process, and how they’re impressed with how I’ve handled the whole situation. I view this, in concept and in practice, like a surgical complication. Being frustrated/angry/sad/scared may be appropriate reactions, but they don’t help the patient (me) with the current situation. Rather, I’ve spent my time looking through unfilled programs, keeping my phone charged and always with me, and reminding myself that I am not the first person to not match, I am not the only person to not match, nor will I be the last person to not match.

All in all, this whole process has been exhausting from multiple fronts—mentally, emotionally, physically. I know God has an overarching plan for me, whether I can see it immediately unfold is moot. I trust in what He has in store for me. One of my surgical mentors, who has been absolutely amazing in terms of going to bat for me, and walking me through this process, said it best: “As much as this sucks, don’t let this define you in a negative way. That being said, you should be angry. You should take it as a chip on your shoulder, and use it as a learning opportunity so that it never happens again.”

5 rounds of SOAP, an immense number of hours waiting, with nothing to show for it. After the SOAP process is done, there is a scramble, where all schools who did not participate in the SOAP and schools who did not fill after the 5 rounds become available for emails of interest with your application files. It then reverts back to a mind-numbing waiting game, for program directors to contact you regarding your application and whether or not they are interested in offering you a position. This whole process has a dynamic page that program directors update as positions get filled. What happens now? Only time will tell. I wait, even now, for a phone call that tells me they want me as a preliminary resident next year.

To my wonderful classmates/colleagues/friends: Congratulations, you all deserve the joy and pleasure of matching at the top programs in the country. I couldn’t be happier for all of you.

To the Michigan Department of Surgery: Thank you for all your unwavering support, sorry I couldn’t have been a more stellar candidate to have this process go smoother.

To everyone who has sent me prayers, luck, feelings of good will and/or good vibrations: I can’t thank you guys enough. Again, your support has kept me keeping on through these tough times. You guys are the best.

Finally,

Go Blue!

The current status of medical care in the United States is not one of which I would typically speak very enthusiastically or fondly. This would seem strange coming from someone who will very soon join the ranks of newly minted MDs to join the physician workforce. What has been studied and subsequently revealed is that the health care provided in “the best country in the world” is not equally the best in the world. Medical care expenditures continue to skyrocket exponentially, while our clinical outcomes end up ranking somewhere in the 20s.

Why the discrepancy? It has been noted before that in America, there is a sense of entitlement in terms of “getting a full work up”. I feel that this consumeristic approach to health care is the heart of the problem. A patient who receives a full slew of tests, only to receive a bad diagnosis. Unhappy with the result, they go somewhere else for a second or third opinion, where another array of tests are then ordered, commonly resulting in the same end diagnosis. The bottom line is, “more tests are not necessarily better”. This poses two problems: first, the obvious fiscal irresponsibility of ordering tests that have been done before, secondary to not trusting lab values from “an outside hospital”. Second, nothing we do in medicine is without risks. Even the simplest, most routine tests have risks and these must be balanced with what my attending doctors have taught me to inquire, “Does this change management?”

This brings me to Ms. C. I met Ms. C in the medical procedures unit, ready to undergo a bronchoscopy. This is a routine, fairly benign procedure that involves using a fiber-optic camera to directly look at the airways. Ms. C had a nodule that had been fairly steady on imaging surveillance, but needed to get definitive pathology, as this would affect the potential treatment of her overarching medical issues. Because this nodule had an airway that ran nearby, the plan was to use CT-guided biopsy technique, also known as super-Dimensional bronchoscopy and biopsy. This uses computer algorithms using the patient’s recent CT scans to map out a path to the nodule, reachable through the airways alone.

The procedure went as planned, having obtained 5 biopsy samples of the nodule in question. From there, things took a turn to the unexpected. Ms. C had been coughing sporadically throughout the procedure, which is not uncommon: having the fiber-optic camera in the airway can irritate it, resulting in coughing. She suddenly started coughing out high volumes of blood. Jumping into action, my attending quickly pulling the bronchoscope back to look for the source of bleeding. Throughout the entire airway tract, we failed to see any bleeding, even in the nostrils, where epistaxis [fancy word for nosebleed] was something that could be expected. Ms. C continued to cough up large volumes of blood, and sensing that she was quickly decompensating, a code was called and started.

Within a few short minutes, the room that only had 5 people in it, was suddenly packed to the brim, with various physicians now calling out orders and running through the ACLS [advanced cardiovascular life support] protocol. An airway was quickly obtained, impressively done by one of the anesthesia residents, who, because of the continued hemoptysis, had to essentially intubate blindly. A quick look through the tube with the scope confirmed proper placement. Meanwhile, doctors were lined up to cycle through chest compressions, while another team was attempting to get an arterial line started. Despite our interventions, Ms. C transitioned from sinus bradycardia to PEA [pulse electrical activity], to asystole. After 35 minutes of cycling between boluses of epinephrine, continued chest compressions, and pulse checks, the physician running the code called time of death. The room got eerily silent.

 

A lone voice said, “I’m sorry. Thank you everyone for your help.”

 

And just like that, the room emptied.

A few days later, I ran into my attending in clinic, and the biopsy results showed only granulomas. This is a sign of chronic inflammation that would slowly resolve on its own, or stay indolent. It had not changed for years, and it would most certainly not have changed in the future. Of course, there is a degree of 20/20 hindsight, but this would definitely fall under the realm of “unnecessary testing.”

This whole experience has been very eye-opening in terms of placing things into perspective. As a doctor, it is very easy to type in the name of the test you want into the electronic medical record, and think nothing further of it. Through it all, the lesson will always stick with me to think before I order any procedure or test, making sure that the risks the patient have to go through are worth the information you will get back. “What will you do with this information, and will it change management?”

Rest in peace, Ms. C.

It has certainly been an embarrassingly long amount of time since the last post on here, and I chuckle to myself as I look at previous posts. I had originally promised myself that I would try to chronicle my adventures during M3 year, but that obviously did not work out quite how I imagined it. Needless to say, this would be that post that attempts to summarize what I went through.

—

In all honesty, I wouldn’t have properly told you about my 3rd year without describing the very first patient I took care of in the inpatient wards. I was at the Veterans Affairs hospital, starting my 2nd month of internal medicine, having not had any exposure to working in the hospital yet. I was oriented to the team room, hospital beds, and my computer station. I was then given a name and registration number by my senior resident. I looked in the medical records for what he came in for: 3 week history of fatigue and pallor, concerning for cancer. Woo. I knew asthma, chest pain, reflux, diabetes, hypertension and maybe gallstones. Nothing like starting with a heavy hitter. I took a deep breath and went to put a face to the name and number scribbled on my paper.

He was an older gentleman, sitting on the side of his hospital bed, fully changed into the standard issue inpatient hospital gown. As I walked in, he turns to face me and greets me, “Morning Doc, the name’s Dave. What’s yours?”

“Steve, I’m a third year medical student and I’ll be a part of your care while you’re here.”

“Sounds great, when do we start?”

We laughed; I could tell that this was the beginning of good friendship. I had picked up other patients, who came in, stayed for a couple days, and then left. Dave stayed put; his diagnosis was leukemia, which required an extensive regimen of chemotherapy. For the month, I reported overnight events, vital signs, lab values, and an assessment/plan that was reduced to what day of chemotherapy he was on. I learned from Dave every day: about leukemia treatment, about possible complications, about antibiotic choices, but most importantly, about how to be a doctor. Despite me stressing to him that I was a medical student, he continued calling me his doctor. I would check in on him in the afternoons, always “tucking my patients in” before I went home for the day. The only contagious thing in his room was his positive attitude. After a month, it was time for me to move to the next service. The week before, I had told Dave and he joked with me, comparing his chemotherapy schedule with my service schedule, and went ahead to wager with me on “who would get out of this hospital first.” Naturally, we both bet on ourselves. Ironically enough, on my last day, Dave was in remission and healthy enough to discharge. I shook hands with him, and said to him, “Alright, we’ll call it a draw. Take care, my friend.” His reply has stayed with me.

“Sounds good, buddy. Don’t be a stranger. Keep doing what you did for me for all your other patients, you’ll be great.”

—

Over the course of the past year, I did some pretty incredible things: I caught/delivered babies and handed them to their moms, cut a person’s sternum open to access the chest, watched an organ procurement and heart transplant, performed a mastectomy, held and examined a 27 week old premature newborn, the list goes on. I have had plenty of amazing patients, each of them teaching me a little piece of what it meant to become a doctor. Throughout all this, I kept in touch with Dave and his wife; they were just as thrilled, watching me progress. Sometimes my friends ask me if I would still do it if I had go through this year again. My answer is absolutely yes. Third year may be difficult at times: intellectually, mentally, and emotionally, but I wouldn’t have it any other way.

Dave continues to do well, he has since stayed in remission. One time when Dave was in town and we were catching up over lunch, I asked him if he was ever worried that a clueless medical student was “in charge of his care”, he laughed and said, “You always sounded like a winner buddy. Nothing I can’t handle.”

—

Now, I sit here as a freshly promoted M4. I’ll have to channel that same energy and attitude that Dave showed me, as I pick up additional responsibilities and try to meet the higher expectations that have been placed on me. One day, in the midst of a busy surgery service, I hope to be like Dave.

“Nothing I can’t handle.”

 

***Addendum: Yes, in accordance with HIPAA, patient names have been changed.***

Second week, second installment. This time, the theme is: high school.

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It’s early. Too early. Why on earth the principal called a school assembly that required you to be awake and alert at 8am…the inhumanity. We sit there awkwardly, talking to our friends, talking about how smart it was for one of our friends to bring a McDonald’s McCafe on the commute over. The speaker, an old man, stood patiently with his microphone for us to settle in and quiet down. As soon as he spoke, his heavy Polish accent resonated through the auditorium. He starts off asking a critical question: “What does it take for someone to succeed?” We’ve all heard this talk before. It’s been said how opportunity often limits the potential and effectiveness of education, but how much is attributed to personal effort? Just as often are there stories of kids not being able to pursue their dream because of lack of resources, are there uplifting stories of how a kid who had to drop out of school to support a struggling family, only to self-learn their way into entrepreneurship. What this guy did now, was totally different. He then followed up this discussion with another question: “How many of you like grades?” The crowd chuckles, and the crowd stays still. He smiles and continues, “Good. because grading sounds effective in theory, but is ultimately only degrading.” He’s certainly working the crowd here, right? Wrong. Grading takes out the creative process to learning, forcing people to learn in one manner: quick memorization, banking on youthful short term memory, then purging anything that we deem “totally not important.” This guy promotes self-discovery, self-driven, goal-oriented learning. His parting words were: “Tap into the human’s natural ability to learn, and learn a curriculum as parts of a greater end goal.” As he wraps up his talk, we file out and hardly any time seems to have passed.

—-

The worst part of going to a large high school was easily the general squeeze during the “passing time” given in-between classes. The hallways are clearly way too small to handle the bulk flow of bodies up and down stairs. Everyone forgets whatever manners they could have learned up to their teenage years. What adds to the experience is gossip storm that happens as groups of people shuffle behind the person in front of them. This brings up what a class counselor once told me and a few other advisees. Your brand, is what people say about you, when you’re not in the room.” Isn’t that just gossip, then? No. Your brand, is more of a social front that people put up, and it can be tweaked to create more meaningful interactions. She goes on to explain: “We could give more control to other people, letting their opinions influence our decisions, in which we may be shown new directions and ways to approach problems. We can also give less control to people, with more direction and less wavering over a multitude of options, it is easier to get things done. Finally, we must realize that many things are ultimately out of our control, in which the best response is to smile at the serendipity of the situation, and welcome it with open arms.” The momentary lapse into deep introspection was interrupted when I was shoved from behind. “GET MOVING.” I grumble and head on to my first class.

—-

I walk in and sit down. Psychology 100. What was I drinking/smoking when I signed up for this class? Oh, I remember. It was the only class that fit into this time slot and still gave me an open hour after “lunch time” so that I got a long lunch every day. Priorities, right? The teacher starts as soon as the bell rings. A food for thought question: “Why is it that when someone has a mental illness, they don’t get the same sympathy as if they had any other illness?” Mental illness is readily apparent and a very real problem. In fact, a psychologist, who admits that she herself has a mental illness, recently released a study/theory that our minds are really maladaptive: back in the stone age, our stresses, mainly sabre-tooth tigers and such, would spike our cortisol and adrenaline, and we’d respond with two actions: either run away from it, or kill it. Either way, those hormone levels would go down afterward. Now, our stresses are still present, but last I checked, we couldn’t run away from the IRS, or kill the police officer that gave us that ticket. The bell rings. I’m outta here.

—-

Wonderful. I totally forgot that after psychology, I had speech class. What a disaster of a class. The teacher never taught us anything really important, and we’d just have to give really awkward presentations in front of the rest of the class, to prove that we could speak. Well, today was one of those days. Luckily, I didn’t have to go today. It was Rachel’s turn today. Now Rachel is one of prettiest girls in our grade, and everyone agreed. What was even more attractive about Rachel, though, was that she was smart too (even if she didn’t act too smart, fearing she’d be called a nerd…typical). She confidently goes up to give her speech, and opens with this line: “Talk nerdy to me.” The class is in an uproar: how many times do you hear a pretty girl tell you that? Talk about Big Bang Theory…but I digress. She gives us the equation (yes, we can tell she’s actually nerdy/smart): [Science – (Jargon + Bullets)]/Relevance * Passion = Understanding. Outside of the clever use of nerdy terminology to make her point, it honed in on some key points. People are interested fascinated by what the cutting edge of technology brings, but it is not always readily accessible to everyone outside of that field. Bring us the science, don’t dumb it down, you don’t need the fancy jargon nor the barrage of bullet points, tell us how it applies to us, and show us how cool you think it is. Those simple steps, make for better communication, ad let us appreciate all the “nerdy” things you do. Man, someone should have taught me that sooner, then maybe I could have talked nerdy to pretty girls…

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Ah, after lunch I have my biggest blowoff high school class: Art & Design. It’s usually we walk in, doodle for 53 minutes, and walk out having learned nothing. We generally explore different mediums, so we really don’t know what to expect when we walk into the class each day. This time, we broke off into groups of 3, and each group of three got a tablet, and we were to explore the art we could create using a tablet. Technology and art have always seemed to be on opposite ends of the spectrum. When asked about why the art teacher decided on this medium, he gave us an unusual, but well constructed answer. “Technology creates possibilities, design creates answers, art creates questions, and leadership creates action.” Through these four interlinked steps, we can link technology and leadership to create not just what is “old” or “new” but what is “good.” It combines the innovation of technology with the flexibility and creativity of art and design. My art teacher jokes, “If you say you don’t get what this artwork is saying, it’s doing it’s job. It’s to create questions, after all.”

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We get to the last class of the day. Doesn’t help that it’s world history, right? We’re in the middle of the renaissance period, talking about prominent people; no discussion of the renaissance is complete without mention of Leonardo da Vinci. We have been following a History Channel documentary on how there were many da Vinci pieces of artwork that had gone missing, and hence there was an extensive usage of grant funding for people to investigate these pieces of artwork and try to pinpoint their whereabouts. One guy’s work focused on using medical technology in an unconventional way to help in this process. Having come from Art and Design the hour prior, I thought it was too much a coincidence. He uses x-rays among other instruments to determine original paints, scope through refurnished brick walls, and most importantly, discover the true, sometimes secretive stories behind many of these paintings. This guy gave a demonstration of some of his findings, and they were truly remarkable; to think that some of these sketches and original da Vinci works were not seen by human eyes since the 1500s…that’s some serious perspective. This guy focused on how we shouldn’t accept everything for what it is at face value, and we should keep an ever-inquisitive mind, and a matching heart of discovery. In this fashion, we can all have a little Leonardo in us.

This is the start of interesting installment of information tidbits made available via the ever popular TED talks. My goal for this was originally a private, personal one; however, after some encouragement and talk with some buddies, I’ve decided that it was good to share some of the principles that I’ve learned per week. On average, I’ll be aiming for 5-6 TED talks per week, getting an eclectic mix of topics, to broaden the range of interests. Each week, I will attempt to connect the talks through a central theme, while still leaving them in their own native vignette format. The common theme to this week of TED talks is: speech. Without further ado, it’s time for a little TEDTalking.

***

We come up to an artist, one who specializes in working with space, working with communication, and modalities that involve large numbers of people. The project that she wanted to share with us in this talk was that she took a broken down house in a neighborhood, and changed an entire side of the house to a living size chalkboard. The chalkboard had the line: “Before I die, I want to _________” written over and over, across the entire length. As people passed by, they wrote in their answers, and the final product was a memorial-esque piece that highlighted the goals, the hopes, and the dreams of the community. It took something that was sore-looking in the neighborhood, and transformed it to a public forum where the community can share thoughts.

—–

We quickly move to a psychologist who stresses the importance of body language, not simply vocal. The mind and body work in a collaborative effort to present the person that is you, me and anyone else. The traditional thought is that people use their mind to change what their body does. However, there is more and more evidence that the body can influence what the mind thinks and processes. It was shown that people who “power pose”, or assume a natural position showcasing dominance, tend to do better in stressful occasions and end up actually feeling more dominant and in control of situations. The measure of increased testosterone and decreased cortisol highlights increased aggressive/assertive behavior along with decreased stress response hormones. Brain over brawn was something that many people may have heard before, but this might just pinpoint how important it is to having both. Power posing may be feigning dominance for the time being, but in other words, “keep faking it until you become it.”

—-

There have been many cases of which people misunderstand an author’s original message and intent. One of the most polarizing, well-known, consequential examples of this would be the Bible. We find ourselves learning from a comedian, in an effort to create a longitudinal social commentary, decided to pursue a year-long project: living out the Bible to the letter. The message, albeit riddled with funny moments such as him trying to “stone all adulterers”, was surprising. Deeply embedded behind the satire and biting comedy, one thing ran clear in his experience: when you thought nice thoughts and did nice things, you became a nicer person, and not only at the surface level. Sound like déjà vu? You can only fake being a kind-hearted person before you started truly becoming one. I guess his final point on the topic is a good one to hang your hat on: “Don’t take the Bible literally.”

—-

We find ourselves sitting in front of a violinist. As he plays his solo piece, we feel the music speaking to us. It conjures up feelings, thoughts and words that we did not have prior. He focuses on how music brings out the speech that we know or didn’t know we had. People who have lesions or strokes to Broca’s area have an impaired ability to produce speech, connect a chain of words together into a coherent sentence. However, once paired with music or a little ditty that they knew before the accident, these patients can oftentimes sing out their favorite phrases, seemingly unhindered by their impairment. This is due to different parts of the brain working, bypassing the area of normal speech production, and moving straight into musical recollection. The violinist (also part doctor, now more apparent) shows us the power of music and the application of using music to help in speech therapy, which may (soon) be applied to other branches of medicine in which people suffer from incurable, debilitating neurological diseases.

—-

Across the stage, a choreographer stands into the light, and begins with an embodiment of what the shape, orientation and color of the “TED” erected behind him meant to him. Completely separate from verbal or musical thought, this was physical thinking. As he brought out two of his assistants to re-enact his thought processes, we saw how not only did his directions speak to his dancers, but also how the dancers interpreted the physical motions of the other, the original movement of the choreographer, and working with the anatomical boundaries and limitations offered. Physical thinking was not a truly separate entity; rather, it was an application of the creative process. Its three-part mantra broken down into: occupying space, avoidance of space, and manipulation of surroundings is something that can be used to assess many things outside of dance. As dance speaks to different people in different ways, the process with which we use to craft our own identity remains universal.

—-

Our last stop is in an art gallery. The curator walks up to us, and leads us into a room, filled with tapestry. Enormous time-consuming works of art that depict everything ranging from a normal Sunday afternoon to a deity smiting mortals. The colors vivid and the images overwhelming. As we work our way through the gallery, a concern is brought up, “why is this relevant?” The curator chuckles and points to the inquirer’s iPhone. “Why is this relevant?” He continues the tour, commenting that everything was contemporary at some point in time. We shouldn’t be so blinded by the barrier that is “academic art history” and experience the narrative of the art, how the artists wanted to speak to us individually. The curator shows us the direction to the last segment of the gallery, and asks “If that is all, I hope you enjoyed your time at the Met. Good day.” Sometimes it is good to detach oneself from the jargon and identify something for exactly what it is. “After all, it’s not a bacchanal, it’s an orgy.”

It’s definitely been a while, especially for everyone who has followed us as we’ve written about the whole medical school application process. As Pham and I get busier and busier, it becomes apparent that the time commitment to your studies while in the preclinical years is no joke.

However, it would simply be wasteful and unfortunate if Pham and I stopped blogging altogether and let this site collect dust. To that end, I’m going to add a little bit of eclectic reading to the mix. A personal project that I’ve been working on (it’s fairly recent, let me assure you), is to watch a TED talk daily, from Monday to Friday, and then write up a summary synopsis of what I learned from these talks over the weekend.

Originally this was to serve as a mental exercise, to live out a meaningful phrase that was told to me, “Learn for the pure enjoyment of new knowledge, and not as a chore.” However, following a few requests from close friends who wanted to hear about some of the quirky, inspiring, and informative stuff I’ve been accruing, I’ve decided that I will be posting up the weekly summary of these 5 TED talks as a post here.

I’ll continue to update any kinds of meaningful medical school experiences, as well as address any questions that may be left on the blog or on any older post, so by no means is the focus of this blog shifting. Rather, I’d think of it as “adding something new to the docket” (it’s election year, after all).

This week marks the first week that the project was underway, and seeing as it is Thursday, I do have 4 TED talks down. Sometime either Saturday or Sunday, I post up the brief summaries of what I took out of these TED talks, and an overall reflection of lessons learned from the week.

Cheers,

Steve