This Brave New World and the Meaning of Life

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It took about a week of classes before I came to an inconvenient realization: I actually have no idea how to study. I feel like the big-shot college quarterback that finally makes it to the NFL, only to get completely pummeled and humiliated in his first game against a professional defense. We all might have had great grades in college, but med school is on a completely different level. I think the intensive time commitment required for these classes is the most difficult thing for me.

Back in college, I lived the eclectic life of a typical small-liberal-arts-college hipster. Sure I would study, but that happened sporadically between tutoring, jazz piano, RAing, teaching labs, listening to music that nobody’s heard of, and sipping fair-trade coffee while debating english majors over the lingering effects of Portuguese colonialism on the migratory patterns of the European Gold Finch. Med school is different. In med school, you don’t do anything except med school. When med students encounter free time, we don’t know what to do with our lives. My classmates and I collectively had an existential crisis after we finished our first set of exams because we forgot that there was life beyond the books.

Christian wishes he had gone to dent school instead.

Christian wishes he had gone to dent school instead.

This lifestyle has taken a toll on my emotions as well. A few weeks ago I accidentally deleted two days worth of electronic flash cards and found myself crying harder than when I read “The Fault in Our Stars” this summer.

Fortunately, the medical school administration understands this syndrome well and plans an annual weekend retreat for students and professors following the first set of exams. I think they started doing this when the city of Loma Linda began to receive complaints of half-conscious first-years wondering aimlessly around the streets because they didn’t have the brain function left to find their way home.

Jonathan utilizes the sacred art of the 10 minute power nap during Cell lab.

Jonathan utilizes the sacred art of the 10 minute power nap during cell lab.

The retreat was wonderful. We drove several hours to the east, up into the hills and away from the Inland Empire’s smog. No cell service. No wi-fi. Just human fellowship, and it was beautiful. The most meaningful experience I had happened on Saturday afternoon when I joined about 10 of my friends around a piano and we just starting singing. Soon we had a cello and a guitar and we just sang random hymns for close to an hour. I’ve honestly never even liked hymns that much, but in that window of time, all my concerns about worship style melted away, right along with the stress of the previous weeks. When everything else is pushed aside and relationships become the focus of our lives- I think that is happiness.

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Later that evening was the legendary medical school talent show. I discovered a thriving subculture of musical talent in the form of medical school-themed parodies of popular songs (the genre is a cult favorite on YouTube). Indeed, at least half of the performances that night were popular songs with their lyrics adapted to fit the struggles of med school life. I realized that one of the best parts about being in med school is being able to complain about being in med school. I had the privilege to beat-box with an acapela group that sang a med-school adapted version of Pentatonix’s “Daft Punk Medly.”

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A Warning to the New Med Students

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I was flying back to California, and my third year of medical school awaited. The sunset lingered a little longer as I watched it from the cheaper wing seat on my flight west. I didn’t know how much the speed of the plane and speed of the earth’s rotation added up to the lengthening of the sunset’s colors, but just two weeks ago I had taken the monster of the test that was the Step 1 medical licensing exam, and even a brief summoning of whatever critical thinking I had left was the last thing I wanted. It was just nice to romanticize that my mini-summer break was holding on to me a little longer.

Medical school has been hard. Because of undergrad experiences, I figured the frantic cramming I did during finals week all-nighters would simply be a more frequent occurrence in medical school. It turned out that the first two years of medical school however, were when I got the most regular sleep, healthy food, and exercise that I had had for a long time. Mind you, the academic challenge was significant, but there was another kind of difficult learning to be done.

You see, I went to many different public schools since moving to America as a child, and held strongly to my Christian beliefs as I stood at each new lunch room and stared out at dozens of unknown faces. I like to say that my faith gave me roots and allowed me to branch out to meet and love all new and different kinds of people, many times over. I became confident in my faith, confident that having lived among secular lives for a long time had whipped me up into a mature and understanding Christian with most of the answers figured out. I fully expected Loma Linda to be a place where I would indulge in a sort of faith oasis, where I could sit back and be spiritually satiated while working hard on the doctor thing.

Looking back always gives us the most complete perspective. Though I probably would not have paid attention, a bigger warning should be considered for the incoming freshmen: studying the science of medicine while taking religious courses on ethics and human suffering could be a catalyst for major spiritual upheaval.

Let me explain. If you too were brought up in a deeply religious Christian setting, or even many kinds of traditional religious settings, you are also aware of a certain kind of mindset, one that is afraid to look at the unholy for too long because of what I’ll call the exposure effect: your subconscious shapes you and before you know it, you too will be jetting off to France with someone you just met because you watched a little too many episodes of The Bachelorette, or you too will be using heroin if you hang out with the fringe of your college social circles. We all know there is a certain amount of truth to that fear, and so here I stand, telling you to beware of the dangers of medical school.

You’ll see that if you spend most of your waking hours practicing the rational rhythms of science and rational thought, you will be at a significantly higher risk of applying such skills to your ethical and spiritual questions. Maybe your previous life, like mine, allowed you to keep your religion and my academia separate, but such is no more! You see, endless days of studying and complete dedication to medical science resulted in break times that became filled with philosophy and religiously-inclined talks with friends. That’s how I found myself going to a professor at the end of an ethics class and asking where I could find a similar church or bible study group. After all, a school that has a building full of science-appreciating religion professors must have some sort of meeting space where the messy subjects are tackled. It turns out that that very building where our science classes take place during the week turns into a weekend full of PhDs of history, ethics, religion, psychology, anthropology, and any other “-ology” you would need. This building that brings us all anxiety and fear as we fail to know everything turns into a space of free exploration guided by minds filled with expertise in other parts of the human experience.

I won’t bother to tell you the conclusions I have come to; I like to save that for those long dinners or late-night bonfire musings. All I can say is that Loma Linda has allowed my first two years of medical school to make some sense. I have been able to finally bring my mind and spiritual heart closer to synchrony, and it has made all the difference.

As my window became dark, only lit up by the subdued stars above and tired city lights below, I made a new decision: I wanted the sun to set faster, and third year to begin sooner. If first and second year were any indication, I wanted to see what improved version of myself that these clinical years would bring. So far, third year has been an interesting ride. It has included being splattered on the face with some unsightly patient bodily fluids, but then also partaking in important conversations of end-of-life decisions with patients’ families. While it’s too soon to tell, I’m at least wise enough to know I will be changed in significant ways, and I welcome it all with open arms (all while wearing as much protective equipment as possible).

PSR SM Retreat

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Just over an hour away, we rounded the mountain curve to find Pine Springs Ranch before us with teepees, covered wagons, cabins, and a cozy lodge. It was time for the School of Medicine annual retreat.

It was a time for celebration. First and second year students had just conquered their first rounds of tests.

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It was a time for fellowship. Third and fourth year students were able to see friends from different tracks.

It was a time for relaxation. Students, faculty, and family took a break from the books or wards or both to play Frisbee, go on nature hikes, or take much-needed naps.

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It was a time of fun, laughter, and amazement. The talent show consisted of medicalish comedy, a Capella Pentatonics, and acrobatics that-although they didn’t need it-made you glad there were so many doctors in the room.

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And, it was a time to rejuvenate spiritually and remember why we chose medicine. In Sabbath school, students recapped their summer trips of healing ministry in Chad, Thailand, Nigeria, and other areas of the world.

Overall, the weekend was a time of memorable moments.

The Other Side of the Curtain

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On Friday, August 1, my dad was admitted to Loma Linda University Medical Center on Unit 9300. Hospitalizations such as this had been somewhat of a routine since his initial diagnosis of Stage IV metastatic colon cancer four and half years ago. However, this hospitalization was different for many reasons. For one, his body was beginning to show signs of giving up the battle that he had been fighting so valiantly for so long. The previous day, he had been told that the myelodysplasia that had resulted from continuously stimulating his bone marrow to produce more white blood cells, platelets, and red blood cells had progressed to full-blown leukemia. He was requiring several platelet and RBC transfusions each week and he was admitted to hospital this time for uncontrolled bleeding requiring platelet transfusion and unexplained spiking fevers. Despite the seemingly more and more grim prognosis, we remained hopeful that dad would pull through this just as he had with his many previous hospitalizations.

The other aspect that made this hospitalization different from all the rest was the fact that I had just begun my 3rd year of medical school and had completed a rotation on this unit just a few weeks prior during my time on the Gynecological Oncology service. Moreover, many of classmates were now rotating through the halls of 9300 and were even responsible for rounding on my father each day while on their Internal Medicine rotations. Each day I would dodge glances from residents, attending physicians, and students that may recognize me as I entered the hospital as a visitor instead of as a medical student. For months, I had been the one in the white coat standing on the outside of the curtain, now I was the sitting at a bedside on the inside of the curtain experiencing the same sights, sounds, places, people, and decisions but from an entirely new perspective.

As time progressed, it became apparent that my dad’s condition was in fact much worse than we had imagined and that we may be faced with saying goodbye sooner than we had hoped. We made the decision to take my dad home on Hospice on Friday, August 8 and merely three days later he passed away peacefully surrounded by family on Monday, August 11.

I tell this story of my dad’s illness and my experiences that went along with it because this is medical student blog. And whether I liked it or not, I was a medical student and a patient’s family member at the same time throughout this process. Moreover, I tell this story because so many of the subsequent events that occurred speak such volumes regarding what Loma Linda University is all about and how I can now personally attest to the fact that Loma Linda holds true to its mission “To Make Man Whole” when surveyed from both sides of the curtain.

 

The Patient Side of the Curtain

There is nothing more meaningful to a patient and family members sitting in a hospital than being treated by a team of people who truly care. Doctors Howard, Moore, and Wei were 3 such physicians who stuck out in my mind as physicians who truly emulate the mission of Loma Linda to treat the whole person. Dr. Howard was my dad’s personal oncologist and he took several evenings of his own time after clinic to come and visit us in the hospital. He spent hours with us discussing our options and ensuring that we knew that we would be taken care of until the very end. Dr. Moore has mastered the art of comforting patients and caring for patients during the end of life as a palliative care specialist. She worked with our family for several days to ensure that we could take our dad home on hospice so that he could be comfortable during his final days. Dr. Wei is a Senior Resident on the internal medicine service who took the time to pray with our family several times during our hospital visit. Perhaps the most touching moment of all for me was when he and his entire team visited our family during the memorial service and expressed his condolences for our loss.

At a certain point in the progression of my dad’s illness, we knew that he would likely succumb to the cumulative toll that his disease had taken on his body. These physicians never lost sight of the fact that there is always something more that a medical team can do to ensure the wholeness of their patients and families. They dedicated their time, prayers, and support until the very end of my dad’s life and then extended their love to us as a family after his passing. I cannot think of three more compassionate, dedicated, and Christ-like physicians and I am so grateful for everything that they did for our family.

 

The Medical Student Side of the Curtain

As I’ve mentioned in previous blogs, medical school is hard. Adding on the additional stress of a situation such as this was, at times, unbearable. Prior to this hospitalization I had not shared the reality of my dad’s illness with more than a few of my closest classmates and friends, I didn’t want to burden them with my problems. However, now that I knew so many people in the hospital because of my clinical rotations and because of the severity of my father’s illness, I finally opened up to my classmates and the School of Medicine Dean’s Office about my situation. The response that I received was amazing to say the least.

I have never in my life felt more completely surrounded by support and love. The Dean’s Office ensured me that I could take as much time as I needed away from school to work things out with my family. My classmates sent me Bible verses, encouraging words, and offered prayers for my family seemingly continuously. Several of my classmates provided a moving special music during the memorial service and many classmates and members of the Dean’s Office attended the service in order to support me through this difficult time. My family and I were completely astounded by the tremendous out-pouring of support that we received from the School of Medicine during this time and I can only say that I am so incredibly blessed to be in a place that cares for its students in such a profound way.

My last 2 weeks have been spent on the Internal Medicine team at LLUMC; the same team that took care of my dad during his final hospitalization. I now stand, once again, on the outside of the curtain, knowing numbers, lab values, and diagnoses but only catching small glimpses into the private lives of my patients who anxiously await any news about their health and well-being. During my first week on this service, I was faced once again with the painful realities of some of the experiences that my family went through. I’ve been a part of a team who diagnosed a man with advanced cancer and watched as his world and his family’s world came crashing to a sudden halt as those words escaped our attending physician’s lips. I’ve held back tears watching patients struggle through illness, treatment, and even death. I’ve been shaken to my core by these experiences, been pushed to the limits of my emotional and mental capacity, and have been left wishing that there was something more that I could do to ease my patients suffering and my own.

And yet, as difficult as this all has been, these challenges and raw emotions have been a blessing because they have taught me so much. I have a whole new understanding of what it means to stand on both sides of a hospital curtain. I have had the opportunity to be comforted and be the comforter. I’ve had the chance to be the one who is prayed for and to be the one who is praying. And through it all, I’ve seen the hope, assurance, and peace that only a faith in God can bring during the most difficult moments that we face in this life.

 

I pray that you’ve never had to experience both sides of a hospital curtain, but the chances are that many of you reading this blog have already been or will be faced with that reality. I hope that from the patient side you will be able to experience the same healing and wholeness that I was able to appreciate from the team that cared for my dad. And I hope that from the physician side you will never forget the power that you have to bring your patients hope and point them toward the greatest physician of all.

 

My dad's photo in the halls of LLUMC as a part of the "I Am" campaign

My dad’s photo in the halls of LLUMC as a part of the “I Am” campaign

Family Medicine Wards

Adam K., First Year Medical Student

As I sit down to write this post, my head is spinning with new anatomical terms. For some reason “external occipital protuberance” is stuck in my mind and my mental voice continues to chant all those syllables. When I try to sleep, I think of transverse foramen and sternocleidomastoids. It’s bizarre, but that’s med school.

The first week of classes has been a brutal initiation, with anatomy composing the bulk of the suffering. Nothing is too complicated; it’s just the sheer volume. You thought you were ready for this, but after the first lecture you realized that you were NOT, and that the overwhelmed, my-head-is-on-fire feeling that you can’t shake is probably not going to leave anytime soon. It’s tough, it’s draining, but I absolutely love it.

One thing keeping me focused through all this, and something that I am very glad is part of the Loma Linda curriculum, is the ward experience we had in the two weeks prior to the start of classes. The goal of wards is simply to expose you to a (possibly new) discipline, see how a medical team works, and experience some patient interaction before the blitz of textbook material begins. My previous experience was mainly in pathology, with a little urology sprinkled in there somewhere, so when I discovered I was assigned to a family medicine inpatient ward, I had no idea what to expect.

The family medicine team consisted of another first year med student, two interns, two residents, an attending physician, and myself. The second week we switched attendings, and added a fourth year med student and another intern. I could tell right away that I was going to get along with them. They were earnest, had a great sense of humor, and worked well with each other. The first day we spent the first ten minutes of rounds discussing our favorite restaurants in the area. The next day, recent vacations.

The family medicine team

The family medicine team

At about 9 AM every morning, the team would go through rounds, either at the table in the call room, or walking rounds in the ward. One thing that surprised me was the amount of interrupting concern. The phones were constantly ringing with different patient issues. Typically we had about a dozen patients in the ward, and after going through each in detail, the whole team would visit the patients.

I won’t go into detail about most of the things I soaked up in those two weeks (including my newfound love of family medicine—a later post, perhaps), but I do want to discuss the Love Rounds. Each Thursday afternoon, the family medicine team visits a patient to talk with them about their personal and spiritual life. The woman we visited was a regular patient with diverse medical issues, and someone the team thought they knew fairly well. In the course of a forty-minute conversation, we learned the source of her anxiety (the traumatic death of her father and the fear that she would die and leave her kids behind), her earnest but unformed belief in God, and other personal details. It was amazing to see the more intimate side of medicine. The intern in charge of her care said his eyes were opened and that he now understood her situation much better.

That’s what this is about, taking care of the whole person, and as my mind burns with anatomy, I can remember that there is a higher purpose to what we are doing.