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.

Coma: A Pause Between Life and Death

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There was a flurry of activity surrounding his body – buzzing sounds, blinking lights, hands flying in and out of view. There was shouting. There was a panic. Then there was a silence. The noises and commotion had not stopped, but the patient’s heart did. An eerie, ringing silence muffled the background noise––death was knocking. The stillness that comes from the awe of gazing upon the grandeur of death’s door was broken by a team of physicians who came crashing into view. They fought to save his life. And after seven minutes, the enemy of longevity, death, retreated. The man’s pulse returned; the physicians had saved his heart. However, they were not able to save his mind. His brain had spent too much time without oxygen, and the anoxic brain injury bell toll rang. He was standing on the edge of a coma.

Twenty-four hours later, the man showed little signs of improvement. Repeated testing of his brain-stem function gave little signs for hope. He wouldn’t speak, open his eyes, or move his limbs. He was estranged from his sons, so they debated over the phone from different cities about keeping him on a ventilator or taking him off. This man who once had hopes and dreams was now alone, trapped inside his mind. And then, the next morning, his niece showed up at the entrance to his room.

Hearing her uncle’s story, and seeing his condition brought tears to her eyes. As we explained the circumstances and discussed the expectedly extended trajectory of his recovery, she grabbed his hand gently and looking at us with watery eyes said she knew he would get better. He was showing minimal signs of recovery, but she had found reason to believe in spite of what she saw. And though it was touching to hear, it seemed as if time did not agree with her.

Days went by and the man did not improve. His sons could not come to an agreement on what to do with him and his niece could not relinquish her optimism. Every morning she sat at his side, his hands clasped in hers, whispering words of encouragement. It was something worth marveling at, really––seeing hope thrive like a single flower in such a barren valley of despair.

It was a privilege to witness such courage, and an even greater privilege to see her courage rewarded. The next day the man began to twitch when his nail beds were pressed. The following day his eyes opened. The day after that he began to turn his head when his name was called, and the day after that he began show responses to simple instructions like “raise your eyebrows” or “turn your head”. Within days his breathing apparatus was removed, and he was beginning to form words again.

The next morning when I examined him, he had taken leaps and bounds overnight. With effort, he was able to follow almost all my instructions, displaying remarkable gains. He was forming sentences and it seemed as if he was the most aware he had been since I first saw him. He was possibly more aware than he would have liked to be. With the return of his cognition came the full realization of his condition––he could barely move the lower portions of his body. When I asked him to raise his legs or move his feet, he was still having significant trouble. As his mind grappled with the reality that he still could not move his limbs at will, he looked at me with a pain expression and tears started running across his face.

I didn’t know what to say. I wasn’t expecting him to cry. But his aged face stayed focused on my confused one. “Don’t lose hope.” I fumbled. “It may take some time, but you can do this.” I was at a loss for words and that was all I could scramble for. I grabbed his arm with intention, “Whatever you do, don’t give up.” He slowly nodded. He was being prayed for.

When rounding with the attending and team three hours later, I found the man was sitting up in bed seconds away from practicing walking with a physical therapist. My jaw was scraping against the floor. What is this power that moves over human life? What is the source of this hope, this courage, this strength that mankind shows in times of sorrow and duress? Who can reach into the depths of a man’s mind and lead him back to his loved ones safely? How could someone stand so close to the brink of death, and so quickly find his way back to life? Was this man’s entire recovery simply attesting to the magic of medicine? Or had I glimpsed into the eyes of a miracle? Was this the heart of the ministry of healing?

The room was lighted with smiles and laughter. The man was moving. He was speaking intelligibly. And what else would be some of his first words other than a quip against the US president? I smiled and thought of these words, “By prayer the sick have been encouraged to believe that God will look with compassion upon them. A ray of light penetrates to the hopeless soul, and becomes a savor of life unto life.” (EGW, Adv. Review and Herald, 1900).

My Waiting Game

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One Day. Ever since beginning medical school, “Match Day” felt like more a myth than reality, an elusive goal that never seemed to get any closer. And now finally, FINALLY, it’s only one short day away. We haven’t graduated yet, but for the first time, we are being told all our efforts are worthy of being a doctor. After all the time we put into the books, the clinics, the call nights… someone out there wants us to be a doctor! Match Day is the realization of a dream. Only. One. More. Day.

Keep Calm

Ok, boring stuff first (skip ahead if you want to read about my experience!): this is how “The Match” works! A big part of the 4th year of medical school is dedicated to finding a job. Graduating from medical school is not enough to practice medicine in the United States; one still needs to complete additional training after graduation to become certified in a specialty. This process begins when 4th year students submit applications in September to residency programs of his or her choice. The next few months are a blur of interviewing, trying to impress programs all while searching for the perfect place to train.

Next comes the tricky part. Each applicant makes a preference list of where they would like to work for residency, the “rank list.” Likewise, each program makes a list of applicants, ranking the interviewees in the order of its preference. All these lists are thrown into a huge algorithm, and when the switch is thrown, it tries to match each applicant as high up on his or her rank list as it possibly can.

So for example, lets say my rank list has 3 programs: Awesome is at the top of my rank list, followed by programs Spectacular, then Fantastic. If Awesome still has one open spot left when the computer reaches my rank list, it will put me there tentatively. If the algorithm later finds another applicant who is higher up than me on program Awesome’s list (boo!), because there are no more spots left, I will get bumped out in favor of that other applicant. The algorithm will then try to put me in Spectacular. This process continues until I am permanently put in a program, or the algorithm has exhausted my list of potential programs. Because of that possibility, applicants typically have a lot more than 3 programs ranked!

Hard Work

Ranking Programs Is Hard Work!

Back to my story. In my last blog post, I was finishing up interviews and ready to start creating my rank list. That was a whole lot harder than I thought it would be! Fortunately, that was because I liked most of the programs at which I interviewed, and not because I hated them all. It was a nice problem to have! I knew where my first two or three programs would fall on the list, but after that, it was pretty tricky.

After submitting my rank list toward the end of February, there was nothing I could do but wait. And it’s been the hardest waiting game I’ve ever had to play! I’ll be 100% candid with you, this whole process of applying for residency has been pretty stressful. Emergency medicine has a firm grasp on my heart, but it’s a tough specialty to get into. And even though it’s where I know I belong, lingering doubts about my application kept trying to get me down: Are my grades good enough? Did I say anything dumb during interviews? Is my repeat year of medical school going to hold me back? How do I stack up next to other applicants?

The Monday before Match Day, all applicants are sent an email letting them know if they matched or not. Those that don’t match usually have to try for a spot in any remaining programs that didn’t fill up (which usually means having to change specialties). Needless to say, this past Sunday night was a long one for me. I tried sleeping, but about two hours before the expected email arrived, I just couldn’t keep my eyes shut anymore. I rolled over in bed to see my wife, wide awake.

“You can’t sleep either?” to which she replied with an anxious, “Is it time yet?!” Those two hours crawled ever so slowly, and I was reminded of being an elementary student, staring at the clock and watching the seconds tick down to the end of a Friday afternoon. But then it happened. At exactly 8:56 AM, my phone gave off it’s recognizable notification ding, and this is what I saw:

Matched!

Next thing I know, my wife is sobbing, I’m doing this crazy happy dance, and my son is squealing with delight. I did it!! I’m going to be a Doctor of Emergency Medicine! So now here I am, with one day left to go, a guaranteed match in hand,but no clue where I’m headed. Tomorrow (Friday) at 9 AM, my classmates & I will gather in a big celebration to find out the results of the Match… To be continued…

class of 2015 GalaThe Class of 2015, Ready to Match!