Wrestling With a Patient


image credit from jesuslivesinmyheart.tumblr.com


“Lord, I pray that you would help me see my patients the way you see them.” This is a prayer that I prayed from time to time during my junior year. Just recently, I have been reminded of this prayer by a friend and it turned out to be tremendously helpful in processing one of my more difficult patient encounters.

A patient with a genetic disease presented to the ED with pain, which is a fairly common symptom of her disease. She frequently visits the ED requesting IV analgesics and would attempt to leave with IVs in place. This time, she did the same thing again. There was concern that she may be addicted to opiates and intended to keep her IV for drug administration, so I went to her bedside and tried to understand her thoughts. After I listened to her thoughts, I explained the causes of her pain, the need to learn ways to manage and prevent pain, and the importance of following up with her primary physician. She became less guarded and tearfully shared that she felt no one really cared about her. She eventually agreed to have her IV taken out and go to follow up visits. With satisfaction, I gave the attending the good news and brought back the discharge papers. However, the patient changed her mind and refused to have her IV taken out again. She insisted that her pain is not better and if she was not going to get IV morphine, she would re-admit herself or go to a different ED. I explained we could not give her what she requested and she could not keep her IV, so she said she was going to pull out the IV herself. She had an external jugular IV placed because she was a hard stick, so out of concern for an air embolus, albeit most likely harmless in this situation, I recommended that she lay down. However, she refused to lay down, and would not let me place gauze over the IV site. She shoved my hands away every time I tried to place gauze over her IV and we were essentially wrestling back and forth for minutes. Right before the IV tip was pulled out, I was able to put gauze over it and tape it in place.

As I reflected upon this encounter at home, I realized that I really cared about this patient and wanted the best for her. I felt disappointed that she did not take my well-intentioned advice that was meant to help her. Then I realized how heartbroken God must feel when His children whom he cares and loves deeply disobey His commands that were meant for their good. I was not angry at her, but sad that she was too fixated on what she wanted in that moment and could not see a better alternative. Perhaps in many ways, I am like her in God’s eyes. I have desires that I am fixated on. I also have disobeyed God despite His wholehearted intention for me to do what is righteous. I have broken God’s heart many times. Despite my ways, God is gracious to those who repent and promises eternal life, delivery from sins, and refuge for the broken.

This patient encounter started out disheartening but I definitely learned from it. Now, if I see the same patient again in the ED for another pain crisis, my prayer would be “Lord, I pray that you would help me to treat this patient with the same kind of grace and forgiveness that you demonstrated to me.”

4 Things I Wish I Knew Before 1st Year

Just a few tidbits that I learned on my way to being 1/4th Doctor…

  • Don’t underestimate the difficulty of medical school.
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Late night group date with histology

Medical students said that it’s hard. Teachers and mentors warned that it’s hard. Yet with foolish pride, I still thought, it can’t be that hard. I thought hard would be late nights and weekends in the library. Later I realized that hard was catching a cold four times in a year and losing weight without exercise. Hard was failing an exam and doubting whether I would pass the next one. Hard was missing my sister’s school performances and my friends’ graduations. Hard was seeing my classmates struggling too and not knowing what to do. Of course, my experience is not everyone’s experience, but it doesn’t undermine the fact that I would ask God countless times for strength just to make it to the end of the day. I wish that I had better prepared myself mentally and emotionally for the task ahead of me and truly understood the sacrifices that I would have to make.

  • Find rocks for strength as well as cushions for comfort.
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A few of my many cushions!

My family has always kept me grounded and accountable. They remind me that I am strong and capable and lend support when needed. These rocks were essential in driving me forward and upward, and I wish I had utilized them more and sooner. Sometimes, though, rocks were not what I needed. I needed people who would hug me after a long day, grab giant meals and sweets after exams, listen patiently as I ranted and cried, and assure me that my worth doesn’t come from numbers and comments. Finding and calling on that kind of support earlier instead of (again) foolishly thinking I can do medical school without much help would’ve helped a lot.

  • Ask for help.

Though similar to the previous item, this one deserves to stand on its own. There are times to vent to family or friends. And then there are times to speak to a professional. After doing poorly on an exam, I knew I had to do something different. Though I felt embarrassed, I set an appointment with Dr. Lamberton through the School of Medicine’s Student Affairs office. I never thought that I would sit in front of a dean to talk about a low score. But after that meeting, I was glad I went. I realized staff and faculty members are truly there to encourage and offer tangible support. Over the course of first year, the Student Affairs office has been indispensable to my success in medical school. They set up tutors (take advantage early!) and have many connections and resources. I wish I knew earlier that it’s okay and normal to ask for help.

  • Connect with something greater than myself.
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Friday night music and Bible study

This one I had been doing before medical school but it was easy to stop doing it once classes picked up. When drowning in my own struggles, I looked inwardly and focused on rescuing myself. Soon there wasn’t time to spend in the Word or to give to others. But the more I focused on myself, the more anxious and helpless I felt. I found volunteering to be refreshing because it reminded me of the bigger picture–that there is a world out there that needs help too. Though sometimes I didn’t feel like it, I went regularly to Bible studies and worship services so that I could at least spend that time reflecting on a God who cared and whose character I wanted. I wish I had taken more time to do things that weren’t just about me and my studies.

To the first years starting classes in a few days, I wish you only the very best! If I can make it, I know that you definitely can too.

From Homeschooling to Loma Linda

I’m now a second year med student, and I am excited to finally contribute to the blog I read so much during my college years. Whether it was reading for information about Loma Linda and its MD program, perusing for an interesting and funny story, or simply looking for inspiration that I would one day get here, this blog has been one of my favorite sites to visit for the past few years. This is my first timer as a regular blogger, and I hope you’re as excited as I am for this continuing journey in medicine.

 

I’m the oldest of 10 home-schooled children. Normally, when people hear this, their mouth drops and they say “How did your Mom do it?”, “your poor Mom”, or “your Mom must be amazing.” Actually, she always wanted a big family. My Dad wanted at least 2 boys and 2 girls, and it just so happened that they had me first, then 5 girls, followed by the second boy. With 7 children already, they asked “What’s a few more?” and had 3 more boys to round out 10 children even divided between boys and girls.

Family photoMy family

Living in a large family has its share of fun and responsibilities. I really enjoy having so many siblings to do things together with. Whether playing a game of soccer, playing music together, or planning a mission trip, we have lots of people to get things done. There is always someone to play or chat with. Growing up, we all obviously had lots of responsibilities to help keep our family and school running smoothly. We all have to help watch little ones, wash laundry and dishes, and help teach our younger siblings. One of the reasons I really enjoy teaching (and may possible pursue academic medicine) is that I have been helping teach my siblings since I was 8. In our home-school, when you complete a grade level, you should be proficient enough at the grade level to teach it to a younger sibling. This has really helped reinforce the learning both for the older and younger sibling.

HomeschoolingThis is what homeschooling looks like!

For high school, I mostly taught myself out of textbooks as we use Rod and Staff curriculum along with Apologia for high school science and Saxon (back then) for math. My dad was my math and science tutor and my mom helped me a lot with English. I finished our homeschool curriculum at 16 when I passed the California High School Proficiency Examination (CHSPE). I then enrolled at Fullerton College for the next 2 years before I transferred to California State University Fullerton where I graduated last year with a degree in biology. During college, I was able to go on several summer medical mission trips to Honduras and Mexico. I had read a lot of missionary biographies growing up and was already thinking about pursuing medicine since high school. Mission trips really confirmed for me that medicine was what God wanted me to go into.  I was able to see God using health professionals to heal and touch people’s lives (for a story, check out this link https://mercertohonduras.wordpress.com/) and I saw medical missions as something I wanted to continue in my career.

 

As my parents and I began looking at medical schools to apply to, we found out about Loma Linda. I really was drawn to the mission of the school and its many opportunities for medical service. Reading the blog, I was impressed by the Christian environment of the school and the balanced lives of the students during medical school. I have been to every Loma Linda University open house since 2012, and each time I visited, I would count down the number of years left till I could apply and join this amazing school of medicine. I am happy to be here and would not rather be anywhere else, although a few months before matriculating at Loma Linda, UCLA school of medicine, a top 20 medical school that I had applied to as a back-up, offered me a scholarship on top of cheaper in-state tuition to go there. Although going to UCLA for 4 years would have been significantly cheaper than Loma Linda, I felt that God still wanted me to go to Loma Linda. I realized that there are things such as a school’s environment, mission, and character that are more important than money and prestige. Loma Linda has been a dream come true, and I am looking forward to the journey ahead!

DSC_2420Made it here to the school of my dreams!

Our second year starts in 11 days. Here’s to the last few days of break!

Lessons of the Clinical Year (MS-3)

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Some time in freshman year, we were told that our patients are our teachers. It made a lot of sense, especially in the context of anatomy class where we studied the human body through working with cadavers. Somewhere along sophomore year, buried under review books and lecture material, I slowly forgot that valuable perspective. Now, more than midway through junior year, I am noticing a new appreciation for my patients as teachers. I have pieced together several valuable patient encounters that left special impressions. Here is what my patients have taught me:

You can find strength in places you expect the least

In my hand is a list of children’s names. Next to their names are words such as ‘depression’, ’suicidal ideation’, ‘sexual abuse by uncle’, or ‘physical abuse’. However, in front of me is a group of beautiful children sitting quietly in a circle. One is saying that he wants to be a professional football player and get drafted to Missouri University. Another wants to be a video game designer. In a different occasion, these children are laughing while playing Pictionary. It’s heartbreaking to think about how much pain and sorrow each one of these young children have gone through and yet, they laugh, joke, and behave almost like a regular group of children. They carry such dark pasts with them while at the same time, demonstrate so much hope and potential. Their resiliency is absolutely amazing to me.

Pray with patients when you sense the Holy Spirit working in you

A man was seen in clinic for a referral for an adenoma found on a colonoscopy more than a year ago. He had been referred to a surgeon in the past who wanted to do a repeat colonoscopy. On the day of colonoscopy, he found out the procedure was cancelled by his insurance because this surgeon was not covered by his insurance policy. Frustratingly, the insurance went back and forth for a year before he could have another appointment to address this tumor. Fortunately, the surgical oncologist I was working with was comfortable with attempting to remove the tumor through colonoscopy first and is having a colonoscopy scheduled right away. I was happy for the patient and I felt the Holy Spirit bidding me to pray for this man. So right as the visit ended, I asked for his religious background, got permission, and held his and his wife’s hands as I prayed for a smooth procedure as well as praising God for progress in this uncertain stage of his illness. The second I finished praying, this man stood up and hugged me firmly. I was taken back by surprise by his hug and seeing his wife tear up. I realized there was a reason I felt I should pray for them. The prayer really addressed their burden and worry for the past year since his diagnosis but nothing was done about it. It was a huge weight lifted off of their hearts and I was blessed by their joy.

Prayer is powerful for the patient, but sometimes even more so for the physician

A man in his 70s is laying in bed, looking sullen and depressed. His cirrhosis has caused him to have ascites and pitting edema up to his thighs. He is so fluid over-loaded that he is seeping serous fluid from a small scratch on his flank, soaking his bed sheet. Every morning, he greets me with a gloomy undertone. Maybe it’s because his renal failure keeps worsening and he started on hemodialysis. Or it could be that his new cellulitis at his IV site is too painful. He had been in the hospital even before I joined the medicine team. Just a few days before I was leaving for Christmas break, he commented that I fortunately do not have to be here anymore. Upon hearing that, I knew he was feeling bitter about his long admission and deteriorating health. I felt my chest tighten up because I felt a lot of sympathy for him and I felt like I was not doing anything for this man.

For the rest of the day, I felt gloomy to the point of being depressed just thinking about how this man will spend Christmas holiday in bed while the rest of the world is celebrating. I decided to write him a Christmas card and I gave it to him on my last day. I also prayed with him, asked God to heal him, give him peace, and to help all of his providers to take good care of him with the hopes that he feels cared for and encouraged. After I finished praying for him, he appeared comforted and more cheerful, but I was on the verge of tears. After I bid him farewell, I hid myself in the closest bathroom for a few minutes and allowed tears to pour down my face. I do not fully understand my emotions at that time. There’s been times when prayers moved my patients to tears or immense joy, but I have never been brought to tears by my patients. Perhaps the Holy Spirit was moving in me and I truly empathized with him. Perhaps I was unconsciously saying farewell to someone who had become a friend and I knew I won’t see him again. Whatever it was, I truly hope that the Holy Spirit touched him on that day, comforted him, and sparked an interest in Christ. As for me, I learned that when I pray with patients, I experience the satisfaction and fulfillment of knowing I had done everything I can to take care of a patient’s physical and spiritual wellbeing.

Change is possible no matter what

“I take full responsibility for cheating on you 7 years ago”, he said genuinely as he read his letter to his wife to the other men sitting in a circle. As he continued to read a list of things he takes full responsibility for, his voice started to choke slightly and had to pause a little. I have heard love letters, confessions of love, and even wedding proposals, but so few are done so honestly and genuinely that you would not think he’s exaggerating or making things up to sound good. On the addiction & chemical dependency unit, there are many individuals struggling to quit substance abuse and relapses. It is difficult for me to break certain bad habits in my life, and I can’t imagine how difficult it must be to quit addictive substances and remain clean in the face of temptation for the rest of life. However, it is also in drug addicts that I also find the most spiritually passionate Christians. Romans 5:20 reads, “but where sin increased, graced abounded all the more.” The more wrong a person has done in his life and desires to change, the more he appreciates forgiveness. As I listen to this man’s letter, I realize that I, too, have many areas for growth and a need for forgiveness.

There are so many special patient encounters in the clinical years and I feel these are what give meaning to the practice of medicine. Yes, there is much value in practicing evidence-based medicine and in ongoing break-through research. I do not want to minimize the intellectual aspect of medicine as that is absolutely necessary. At the same time, I am reminded of 1 Corinthians 13:2, “If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have faith that can move mountains, but do not have love, I am nothing.” A physician with perfect knowledge but no expression of compassion and kindness to his patients is missing out on some of the best parts of medicine. There’s so much emotional healing and sense of fulfillment in holding patients’ hands, praying with them, getting to know them, and encouraging them. This applies to any aspect of life as well, but being in medicine is a very convenient position to do this. I hope all Loma Linda students will try praying for their patients at least once during their training. We are made with a yearning to be loved, to be cared about, and nothing makes us happier than being in a loving relationship with others. I am truly glad that I will be able to care for patients for the rest of my life and I thank God for this unique environment here at Loma Linda.