The Night Before Step 1

Less than 12 hours away from the 8 hour beast. I feel like the armor-clad protagonist facing the final villain with only one “revive” potion left. As I look back at the past two years (all the 25 miles *nod to Allison’s post*), I seriously can’t believe I’m finally here. There’s no way I’m really taking the Step 1 tomorrow. Right? My emotions cycle between fear, anxiety, confidence, anticipation, and back to fear. Deep breaths, Eunice. Deeeeeeeep breaths.

Now that I’ve done all I can to fit two years worth of information in my worn-out brain, all that is left to do is to leave the rest to God. Do I trust that God has everything in control? Do I trust that He has the best planned for me? Sometimes I sincerely question. And even now, I still have lingering worries about tomorrow and the rest of my future. Yet in spite of all my failures and mistakes in the past, He somehow always helps me back on my feet to try again. He somehow teaches me to be still, to listen, to be patient. I think I can trust Him to do it again this time.

A few of my classmates and I met together before the big test to talk about our fears, pray together, and encourage each other. We also crammed in a quick anatomy review sesh! Thank God for good friends who remind me of what’s really important and who see fun in everything. A passage we read was from Psalms 118:

The Lord is with me; I will not be afraid.
    What can mere mortals do to me?
The Lord is with me; he is my helper.
    I look in triumph on my enemies. [STEP 1!!]

13 I was pushed back and about to fall,
    but the Lord helped me.
14 The Lord is my strength and my defense;
    he has become my salvation.

25 Lord, save us!
    Lord, grant us success!

29 Give thanks to the Lord, for he is good;
    his love endures forever.

Pre-Step 1 – ready to be 3rd years!

See you on the other side of Step 1!

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.

Life in the Cracks

Everyone always tells you life’s a journey. I can’t begin to recount the number of times I’ve heard it likened to a path, a road, a process. Running a race. My nose wrinkled up a little bit yesterday morning when I had a similar thought. I’d always thought myself more creative than the safe, vanilla “life is a journey”-ers; but this time clichés got the best of me.

I hate waking up, but am in love with mornings. Days are one of the only occasions where I firmly believe that crust trumps filling; the beginning and end are so much more lively than the flat landscape of mid-noon. Sometimes I think my bias comes from missing the ocean; watching the waves come and go—finding a soft beauty and dynamic in the ebb and flow. The mixes of dark and light dancing into dusk and dawn remind me of the sea.

There’s something to be said for the mountains. Brave and jutting, imperfect and cragged, still not afraid to stand post above the skyline. I think the hills are my favorite—there’s something soft about hills; maybe it’s because they’re gold and dressed in tall grasses. Or that I’m fairly certain if one looked long enough they’d find a few hobbit homes tucked between their creases. Even valleys demand respect; low and unpretentious, the downhill slopes are protection. Always compared to hardship, heartbreak, and questions. How fitting then, that God would raise up walls around them on all sides to protect from the wind; valleys aren’t pits, they’re baskets.

I’m a super ADD runner. I rarely let my iPod make it through a song before I’ve queued the next. Sometimes I rip my ear buds out all together and let the tempo be my own. Either way, my mind is always going a thousand miles a minute. Sometimes I can corral my thoughts along the lines of whatever I’m listening to. Other times it revolts against the prodding and stubbornly insists to do its own thinking. There are a few constants to my runs, though. The first is that one of my shoelaces WILL come untied. Something about my footfalls is enough to unnerve even the bravest double-knots. The second is that I think about God. There’s some sort of weird synchrony between being outside and just running—letting yourself go without much purpose except not to stay still—and spirituality. The same rings true for lying down or siting in complete quiet. Maybe God likes morning and night and seashores best, too. The times where there is movement, and change, and rest all bundled into one. The third thing I cannot escape, besides running out of breath, is looking around. Sometimes I feel like I’m life’s spectator to a ping-pong match—my gaze darting around, displeased until it’s attempted to take it all in. Maybe that’s why I think about the mountains so much. And the hills. And hobbits. And the sea. And find myself agreeing with the kind of overused lines about journeying lives that should be found lining a tacky picture frame or bookmarks in the Christian bookstore.

My agreement comes from looking down. Checking my shoelaces. Making sure I don’t step on cracks. Scouting for crackly leaves to tromp down on. It brings my vision back to my own two feet—rhythmically moving on the cold, hard grey. The metaphor of medical school—a path of flat monotony with little strips of breath, and change, and non-fluorescent outdoor, natural light shoved in between. Life lived in the cracks. I’ve never been so appreciative of the dirt and weeds and wildflowers that make their homes between the concrete slabs. Their beauty is lived by context; they are no more or less alive because of their placement, but their resolve to stay, to blossom between the rock, makes me smile.

Medical school is not an easy road. And I have a sneaking suspicion that things don’t get easier as the white coat adds more threads. This life is full of concrete slabs. But it curves around mountain faces and the backs of hills and into lowlands in the pit of God’s palm. Waves wash over this road, sometimes pounding, sometimes softly pooling around my ankles. This life is full of concrete slabs, but there are flowers in the cracks.

“Too many cooks spoil the broth”

Having gone half way across the country for my undergraduate education in Alabama, I thought that I had the whole “adjustment factor” under control.  It seemed like moving to California would not be much different, especially since I was transitioning from one Seventh-day Adventist school to another. I thought I knew what I was doing. So I decided to shrug off the old voices of wisdom who warned to “avoid distractions!”  But I quickly came to understand the saying “too many cooks spoil the broth.”

My pride was in thinking that it was okay to change all of the good study habits that I had developed in college (crazy right?).  Growing to care for all of my new classmates, professors, mentors, and various other students, I wanted to listen to their advice.  “Do such and such and you’ll be like John who was at the top of his class in ‘07’.”  After much critical analyses, I agreed that the advice was pretty exceptional.  Unfortunately, not all of it was exceptional for me.

So then it was one week before the exam hit.  My heart raced as I attempted to readjust my adjusted study habits back to what worked for me.  Mental roadblocks, long nights of study, knees worn out from prayers, phone calls from parents telling me to study more (and angry with myself knowing they were right!) encompassed the days before exams.  All of it reached an emotional climax on the weekend before Day One of the four day test week.

Fortunately, God pulled me through this one. However, as I looked back I realized that it could have been a lot less stressful. For me, the most valuable information learned was actually something that I already knew: Sometimes, the biggest hurdles in life are the ones that we set for ourselves.

When They Don’t Make It

I recently lost a patient.

Miss D was a healthy teenage girl who started feeling tired and having pain the week before. Urgent care had diagnosed her with an upper respiratory virus and muscle strain. Then she began to have altered mental status and was admitted to the hospital. When the infectious disease service was consulted she was in the intensive care unit, had stopped speaking, and didn’t respond to commands but looked around with wide eyes.

The last time I saw her she had neurological difficulty and was intubated on a ventilator. She died the following day.

The cause of death is still unknown.

I suppose I could tell you about all the interesting medical points on infection, exposures, diagnosis, treatment and epidemiology I learned from this case, but let’s save that for your infectious disease elective.

I just want to talk about what it feels like when patients, especially kids, don’t make it.

I’ve barely stuck my toe in the pool of experience I will have with this in my career, but it’s a reality of medicine we face all the time. We work with the sick and injured, and sometimes that means there’s nothing we can do to make them completely well again.

Much of our education is focused on,

“Here’s how you find the diagnosis.”

“Here’s how you treat this problem and that problem.”

Even “The prognosis for this disease is poor; these patients usually only live to X amount of years.”

And it seems unemotional.

In real life though, when you have talked to the patient and met the family and they’ve cried and asked you, “What are her chances of getting better?” and you’ve shared what you know and been hopeful everything would be all right, it just feels rough.

I’ve noticed that we may give the sadness a moment, but mostly we move on quickly and talk about the interesting medical points of the case. There are more patients to see, more notes to write, places to be and if we fall apart our living patients don’t get our best work.

Sometimes it may even look a little cold.

Here’s the truth though: every physician is a human, and no matter how he appears on the outside, he deals with patient death in a real and present way.

So I’m taking a minute today to say a prayer for Miss D, feel what I feel and be sad the way I need to. Then, we have a full clinic and more consults today, and we will all be putting on our doctor faces and doing our best, because we have to, and because we still love medicine.

Medicine is not always cheerful – sometimes it’s heart-wrenching – and that’s why acknowledging the experiences is so important.