The epilogue
The letters are opened, food has been eaten, dance floors have been trounced. Match day has come and gone.
It was an amazing experience. There was just so much excitement in the air, it was crazy! It was interesting to see how a few hours later... all of us were beat. Maybe it's because we are older now, but more likely it's because of how exciting match day was. I think our adrenal glands were completely done after pumping out gallons of adrenaline to keep up with the match day.
The sheer excitement was amazing and humbling at the same time. I can't believe I spent the last 4 years with these amazing people. Penn Med's match list for 2014 (as it is every year) is amazing. It was also so nice to see so many friends and families come out to support us. I know everyone things graduation is a big deal, but for medical students - it's all about match day. This is what we've worked very hard for over the last 4 years. Actually for many of us, this is something we've worked towards for almost 2 decades. So definitely the bigger deal.
It takes a while for the truth to sink in: I have my first job as a doctor. That's crazy. Personally, it's a bit disappointing that my first job as a doctor pays me less than my first job out of college (almost a decade ago). And I have way more loans. But that's just how medicine works (initially anyway). Besides - life isn't just about money. And medicine is so much more than just dollar signs.
Match day is a happy day. But it's not equally happy for everyone. Most students from Penn match in their top 3. Almost everyone matches in their top 5. Then there are those who do not. Now - matching itself is a great accomplishment. But it's easy to forget that when you have your hopes set high it's easy to get them (seemingly) "dashed". Much of life is about expectation management. Most of us didn't get here by aiming low. We aim high. Very high.
Unfortunately, when you aim that high and miss, the fall is pretty painful. Some people matched "not as well". At their 14th spot out of 14 programs on their list. On the other side of the country from their family and friends. In frigid temperatures. There is no doubt that they will still get amazing training and become amazing doctors. But it fell short of some personal, subjective criteria. And thus, some people are sad on match day. A sadness that is heightened because it stands next to the sheer, unconditional joy that the rest of the medical school feels (i.e. the ones that matched to their top choice). It isn't personal, but it's hard to not take it personally.
Personally? I wasn't very happy at match. I wasn't sad, but I wasn't jumping for joy either. Based on my match results, everyone around me was happy for me... except me.
I will start training at Cooper University for Emergency Medicine in Camden, NJ. Regardless of where you are in the US, you've heard of Camden. And that's the exact reason why it is an amazing place to train for Emergency Medicine. If you try to conjure an image of an emergency medicine doc, you are probably picturing the kind of doctor produced by Cooper (or from any place in the US that has quite a bit of trauma and violence - like Harlem, Baltimore, St. Louis, etc). Camden also has a surprisingly high amount of medically complex patients - again, great training for residents. Camden, in general, has a big focus on medical education and their residents do exceedingly well when they get jobs after residency. I also have a strong interest in higher level management of hospital systems - and Cooper has a specific track devoted to teaching this.
And it's in Jersey (across the river from Philadelphia). So it's obvious why my family (they live in Jersey) and my friends (who are mostly in Philly / Jersey / New York) are happy about this. My fiancee loves Philadelphia so she's happy about it.
So why wasn't I happy? Because of mismatched expectations. And focusing on the things that don't actually matter.
I hate cold weather. Always have. But I ended up living in Canada for a year. I went to Cornell for undergrad. I was in Philly for medical school and went through the polar vortex. I've tried to go to California every step of my life: undergrad (didn't get in), work (did get placed there, but got moved to Jersey soon after), med school (didn't get any interviews) and now residency. So when I said I wasn't as jump-for-joy happy about the rest of my classmates, it was for one reason only: I missed out on the California weather. Yes California is more expensive. Yes California's on the other side of the country from my family and friends. BUT OMG WEATHER!
This single-minded focus meant I shut out all other possibilities from my head. Even though my rank list was pretty split between California and Philly / Jersey, I only thought about California. I dreamed of getting up and walking outside without having to put on 3 layers of clothing. I had blinders on. I wasn't even thinking about "hey, what do I need to do to be a great doctor?" (now, this doesn't mean that California training programs are not awesome, I'm just saying I didn't think about that aspect as much). I wasn't thinking about "hey, what about all the other stuff that matters for the next three years, apart form the awesome weather?"
So, when I opened my letter and saw I wouldn't be in California... I didn't know how to handle that. I have to be in cold weather for another 3 years!? I have every intention of starting a family and putting down roots over the next few years... which meant this was it. I probably would never get to move to California again. And that made me very sad.
Did it matter that when I start a family I'd probably want to be close to my parents in Jersey? Nope!
I never claimed I was the smartest person in the room. And over the last few days, the objective parts of my brain have kicked in and said "Dude. Seriously?" To the point where I feel ashamed that I wasn't happier than I was on match day.
But that's the thing about being human: we aren't objective 100% of the time. We don't approach everything rationally. It's very easy to take for granted the things we have in life.
It takes a long time to realize that we were given what we need, not what we want.
How does that Rolling Stones song go? "You can't always get what you want. But if you try sometimes, you might find, you get what you need!"
The unofficial mantra of the match process is "trust the match."
I'm a believer.
Congratulations again to everyone at Penn Med and everyone throughout the US / world that matched. I truly hope that you matched where you needed to. And I cross my fingers that it lined up with what you wanted.
From my "now that's a funny story", to medical school challenges, to "wow, did that really just happen!?", to "so this is what residency is like" - you get to read it all. Well, the stuff that won't get me in trouble anyway... (Just to be clear: nothing on this site should be taken as any form of medical advice. It is not endorsed by any med school, and I have the utmost respect for the field of medicine and the patients I take care of)
![](http://2.bp.blogspot.com/-ZDAIICSubbA/UKWQR1B7oSI/AAAAAAAAALg/ch0vUtVqqbE/s760/Karthik_m_Cropped%2B2.jpg)
Tuesday, March 25, 2014
Friday, March 21, 2014
Match 2014 Episode 3: It's about time
This will be a short blog post.
Between finding out that I did match on Monday to 11:30 am today (Friday), it's been mostly excitement. less anxiety. I think my fiancee is more anxious than I am. My family still doesn't understand the idea that I only match to one place (unlikely how medical school / undergrad admissions work).
So I went to bed at 2 am so I'd sleep in till 10:30. Unfortunately my fiancee woke me up with a call at 8am because she was super excited for me. No other way I'd rather wake up in the morning - it was cute to see how excited she was.
These are the times you realize how much love and support surrounds you - when everyone around you is way more excited than you are.
And man, this has been a long time coming. 4 years of hard work. A couple of decades of hard work before that. Making sure to dot my i's and cross my t's throughout my education career. Following the long road to my dream. And today - I get to hear about my first job as a doctor.
Let's do this. I have no idea where I want to be or what school I want to go to. Partly because I am shielding myself from disappointment.. but also because I would truly be happy to go to all the schools I listed on my rank list.
So, here goes everything!
Edit: The graduating class decided to give a gift certificate to Barb and Helene - two awesome rock starts at Suite 100 (our administration office) to thank them for all their help over the last 4 years. You guys definitely deserve it! And the standing ovation!
Edit 2: They've started calling names now. It's like a lightning round. Name after name - people run down, grab their envelopes and hurriedly open it. We are all screaming "whoo"s and "yeaaa"s. I don't think my voice will survive this day. Also, I don't think I can keep track of all of my friends who've gone up while still listening for my name. Man... the atmosphere is electric!!
Edit 3: I forgot to mention this. Each person who matched today brought in $1 to put into a pot. This would go to the person who's name got called last (people's names are pulled out randomly). A nice gesture!
Between finding out that I did match on Monday to 11:30 am today (Friday), it's been mostly excitement. less anxiety. I think my fiancee is more anxious than I am. My family still doesn't understand the idea that I only match to one place (unlikely how medical school / undergrad admissions work).
So I went to bed at 2 am so I'd sleep in till 10:30. Unfortunately my fiancee woke me up with a call at 8am because she was super excited for me. No other way I'd rather wake up in the morning - it was cute to see how excited she was.
These are the times you realize how much love and support surrounds you - when everyone around you is way more excited than you are.
And man, this has been a long time coming. 4 years of hard work. A couple of decades of hard work before that. Making sure to dot my i's and cross my t's throughout my education career. Following the long road to my dream. And today - I get to hear about my first job as a doctor.
Let's do this. I have no idea where I want to be or what school I want to go to. Partly because I am shielding myself from disappointment.. but also because I would truly be happy to go to all the schools I listed on my rank list.
So, here goes everything!
Edit: The graduating class decided to give a gift certificate to Barb and Helene - two awesome rock starts at Suite 100 (our administration office) to thank them for all their help over the last 4 years. You guys definitely deserve it! And the standing ovation!
Edit 2: They've started calling names now. It's like a lightning round. Name after name - people run down, grab their envelopes and hurriedly open it. We are all screaming "whoo"s and "yeaaa"s. I don't think my voice will survive this day. Also, I don't think I can keep track of all of my friends who've gone up while still listening for my name. Man... the atmosphere is electric!!
Edit 3: I forgot to mention this. Each person who matched today brought in $1 to put into a pot. This would go to the person who's name got called last (people's names are pulled out randomly). A nice gesture!
Monday, March 17, 2014
Match 2014 Episode 2: The middle chapter
11:58 am, Monday morning. I'm walking across the South Street Bridge onto campus. Officially, I'm walking to the administration office to pick up some paperwork for the VA (I'm planning to do a rotation there in April). Unofficially, I'm walking over as a backup: today is the day we find out if we matched or not. If we didn't match, we have to go through the "scramble" process (now called SOAP - see my previous post for more details) to find residencies with an open slot. To do that, it's recommended we be on campus between noon and 2 pm to meet with our advisors to help with the scramble process.
As I mentioned last time, this is the anxious phase for me: if I match, then the excitement will build. My plan last night was to play video games and watch TV till about 2 am so my body would sleep till 10:30 am. So I wouldn't have to nervously pace for too long before the NRMP emails went out. So I wouldn't have to look like this:
Back to the bridge: my phone decides to play "I got a feelin'" by the Black Eyed Peas, from their album The END (Energy never dies)
It's an oddly calm day on the bridge. It's also snowing pretty heavily given that it's mid/late March. It was like a scene out of a movie. And, out of nowhere, a large gust of wind hits me and swirls around. At this point I thought to myself "hmm, maybe this is a sign."
So I pull out my phone and there it was: a new email. In the little preview line you get with the notification I see this:
From: NRMP
Subject: Did I match?
Body: Congratulations! You have mat...
It's 12:01 pm and all I want to do is a happy dance on the bridge. Unfortunately it's icy and I'll probably break my neck if I tried. So I settle for a "YES" with a windmill of my arms and ended up in the following Rocky pose:
Friday can't come soon enough. I could end up here or, literally, on the other side of the continent.
4 days to go.
I predict there will be two more posts: the moments before the match - blogged "live" from Dunlop. And then a blog of the aftermath / the epilogue.
PS who is the first person I see in suite 100 as I get in? Helene of course. It was epic.
As I mentioned last time, this is the anxious phase for me: if I match, then the excitement will build. My plan last night was to play video games and watch TV till about 2 am so my body would sleep till 10:30 am. So I wouldn't have to nervously pace for too long before the NRMP emails went out. So I wouldn't have to look like this:
Back to the bridge: my phone decides to play "I got a feelin'" by the Black Eyed Peas, from their album The END (Energy never dies)
It's an oddly calm day on the bridge. It's also snowing pretty heavily given that it's mid/late March. It was like a scene out of a movie. And, out of nowhere, a large gust of wind hits me and swirls around. At this point I thought to myself "hmm, maybe this is a sign."
So I pull out my phone and there it was: a new email. In the little preview line you get with the notification I see this:
From: NRMP
Subject: Did I match?
Body: Congratulations! You have mat...
It's 12:01 pm and all I want to do is a happy dance on the bridge. Unfortunately it's icy and I'll probably break my neck if I tried. So I settle for a "YES" with a windmill of my arms and ended up in the following Rocky pose:
Complete with snow and hat and everything!
I am very happy and very excited to have made it this far. I cannot wait to see what happens on Friday. The last few days have been a roller-coaster ride, and I'm sure the next few days won't be any different. But I do like roller-coasters - and now all I have to do is enjoy the fun.
Friday can't come soon enough. I could end up here or, literally, on the other side of the continent.
4 days to go.
I predict there will be two more posts: the moments before the match - blogged "live" from Dunlop. And then a blog of the aftermath / the epilogue.
PS who is the first person I see in suite 100 as I get in? Helene of course. It was epic.
Saturday, March 15, 2014
Match 2014 Episode I (the prequel)
Hiyo!
Depending on where you're seeing this, you will likely see a mirrored copy of this blog post on either Penn Medicine's Match Day series, or on my personal blog site. A special thank you to Penn Med's dept of communications for helping me organize my thoughts into a three part series.
I have heard nothing back yet about where I stand in the match, and it's pretty nerve wracking. To bring you up to speed, here's the sequence of events in Match 2014 (I took this directly from the National Residency Match Program website).
It's hard to believe that just a few weeks ago I was looking through long spreadsheets with complex calculations trying to figure out how to rank the programs I was interested in. I had multiple categories: location, cost of living, "feel" of the program, future opportunities, future "settle down" potential, etc. I designed an awkward weighting for each of the categories. Then I plugged in hard values based on my interview day (and research from here for cost of living). All of this culminated in a final rank list. I compared this against a more subjective rank list I'd come up with (which had significant input from my fiancee). Funny enough, they were very similar (which probably means my subjective selection took into account all the objective categories in the excel calculator).
Finally, with my fiancee on the line, I clicked "Certify my rank order list" one final time. All of this happened a few days ahead of the Feb 26th deadline.
What now? ...We sit on our hands till Match day rolls around. In a way - this is good. There's nothing more (within reason) we can do to affect the outcome of the match process. So, every time I start dreaming (or nightmare-ing) about match day / week, it's easy enough to tell myself: "Well, I can't do anything about it, so I might as well just sit on my hands and watch some TV."
Problem is - how many people in the medical field do you know who are ok with sitting on their hands? In many cases (many more than medicine would like to accept) - doing less is better. But doctors have historically been horrible at doing less. Discussing whether or not doing less is more is a topic for another day - but suffice it to say that doctors, as a whole, prefer to do rather than not do. This makes it very hard for us as fledgling doctors to sit on our hands while a magical computer in the sky crunches numbers and decides our fates.
The best we can do is keep ourselves busy. On a personal level - I have a lot riding on this (as does everyone). This is my third career. I put quite a bit on the line by leaving the corporate pharmaceutical world after 5 years and entering medical school. It may be an oversimplification - but all your efforts over your 4(+) years in medical school boils down to this: the Match. It will determine where you'll end up for the next 3 or more years of your life. In some cases, it also determines what path you walk down - what kind of doctor you'll become. No pressure.
I'm lucky in a way: I was doing some clinical rotations for the past few weeks. I'm also directing, acting, dancing, collecting funds for and making ads for the medical school play we do every year. All of this keeps me busy by default. And there's all these TV shows I have to catch up on!
But patience has never been my strong suit. And limbo sucks.
NRMP hasn't been too helpful either. You find out on Monday if you matched, then on Friday you find out where you matched. The reason for this separation is the the back-up process built into the match called SOAP (Supplementary Offer and Acceptance Program). SOAP kicks in if you do not match in the first round of matching. Mind you, this is significantly better than the previous back-up process (affectionately referred to as "The Scramble") because SOAP is more computer-based. So, why is NRMP not being very helpful during our wait? They send us emails telling us about our eligibility for SOAP. When you open their emails, it takes a second or two for you two realize that NRMP is telling you nothing about whether you matched or not - they are just saying "hey, you have everything ready to participate in SOAP... just in case". Which is definitely nice of them to do! But for neurotic medical students, those few seconds of panic is quite painful.
So here I sit, waiting for Monday (2 days away) to find out if I matched. I am secretly happy that I'm eligible for SOAP (most people who go through the match process are) - just in case. I've thought through possible Plan Bs, Cs and Ds. I'm not sure what's worse - waiting till I find out if I matched, or waiting between Monday and Friday to find out where I matched. I'll report back on that.
The oddest thing? I'm not excited. I'm just nervous and anxious to get this over with. I'm hoping this changes after Monday - when I find out if I matched. After everything we've been through to get here, this should be a very exciting time for us. Here's hoping the excitement mounts soon and overshadows all this anxiety and nervousness.
I will end with one of my favorite images on the net:
- Karthik the-not-so-patient.
#PSOMMatch
Depending on where you're seeing this, you will likely see a mirrored copy of this blog post on either Penn Medicine's Match Day series, or on my personal blog site. A special thank you to Penn Med's dept of communications for helping me organize my thoughts into a three part series.
I have heard nothing back yet about where I stand in the match, and it's pretty nerve wracking. To bring you up to speed, here's the sequence of events in Match 2014 (I took this directly from the National Residency Match Program website).
It's hard to believe that just a few weeks ago I was looking through long spreadsheets with complex calculations trying to figure out how to rank the programs I was interested in. I had multiple categories: location, cost of living, "feel" of the program, future opportunities, future "settle down" potential, etc. I designed an awkward weighting for each of the categories. Then I plugged in hard values based on my interview day (and research from here for cost of living). All of this culminated in a final rank list. I compared this against a more subjective rank list I'd come up with (which had significant input from my fiancee). Funny enough, they were very similar (which probably means my subjective selection took into account all the objective categories in the excel calculator).
Finally, with my fiancee on the line, I clicked "Certify my rank order list" one final time. All of this happened a few days ahead of the Feb 26th deadline.
What now? ...We sit on our hands till Match day rolls around. In a way - this is good. There's nothing more (within reason) we can do to affect the outcome of the match process. So, every time I start dreaming (or nightmare-ing) about match day / week, it's easy enough to tell myself: "Well, I can't do anything about it, so I might as well just sit on my hands and watch some TV."
Problem is - how many people in the medical field do you know who are ok with sitting on their hands? In many cases (many more than medicine would like to accept) - doing less is better. But doctors have historically been horrible at doing less. Discussing whether or not doing less is more is a topic for another day - but suffice it to say that doctors, as a whole, prefer to do rather than not do. This makes it very hard for us as fledgling doctors to sit on our hands while a magical computer in the sky crunches numbers and decides our fates.
The best we can do is keep ourselves busy. On a personal level - I have a lot riding on this (as does everyone). This is my third career. I put quite a bit on the line by leaving the corporate pharmaceutical world after 5 years and entering medical school. It may be an oversimplification - but all your efforts over your 4(+) years in medical school boils down to this: the Match. It will determine where you'll end up for the next 3 or more years of your life. In some cases, it also determines what path you walk down - what kind of doctor you'll become. No pressure.
I'm lucky in a way: I was doing some clinical rotations for the past few weeks. I'm also directing, acting, dancing, collecting funds for and making ads for the medical school play we do every year. All of this keeps me busy by default. And there's all these TV shows I have to catch up on!
But patience has never been my strong suit. And limbo sucks.
NRMP hasn't been too helpful either. You find out on Monday if you matched, then on Friday you find out where you matched. The reason for this separation is the the back-up process built into the match called SOAP (Supplementary Offer and Acceptance Program). SOAP kicks in if you do not match in the first round of matching. Mind you, this is significantly better than the previous back-up process (affectionately referred to as "The Scramble") because SOAP is more computer-based. So, why is NRMP not being very helpful during our wait? They send us emails telling us about our eligibility for SOAP. When you open their emails, it takes a second or two for you two realize that NRMP is telling you nothing about whether you matched or not - they are just saying "hey, you have everything ready to participate in SOAP... just in case". Which is definitely nice of them to do! But for neurotic medical students, those few seconds of panic is quite painful.
So here I sit, waiting for Monday (2 days away) to find out if I matched. I am secretly happy that I'm eligible for SOAP (most people who go through the match process are) - just in case. I've thought through possible Plan Bs, Cs and Ds. I'm not sure what's worse - waiting till I find out if I matched, or waiting between Monday and Friday to find out where I matched. I'll report back on that.
The oddest thing? I'm not excited. I'm just nervous and anxious to get this over with. I'm hoping this changes after Monday - when I find out if I matched. After everything we've been through to get here, this should be a very exciting time for us. Here's hoping the excitement mounts soon and overshadows all this anxiety and nervousness.
I will end with one of my favorite images on the net:
- Karthik the-not-so-patient.
#PSOMMatch
Sunday, February 2, 2014
What gets under your skin?
Oh hello there!
Looks my last post was in June 2013. That's about 7 months ago. Yowza. Even for me... that's pretty bad. Oddly, compared to my first 3 years in medical school, I've been the most "free" over the last 7 months. Starting my fourth year has been an interesting transition. I don't go to class and I'm not going to the hospital for clinic work either. But it's odd. Because of the two research projects I'm working on, plus applying for residency programs, plus flying around for interviews... I still don't get why I didn't have time to write more on my blog.
Oh well.
Also a shout out to my new found readers: hello MS1s (for posterity sake: class of 2018)! I'm very happy and honored you guys stop by to read my blog! Sorry it's not nearly as posh as a blog should be.
So, what's up for today's topic? Empathy!
A popular question asked on the interview trail (for residency) is "What kind of patients get under your skin?" Now of course, this question actually has nothing to do with the question itself. The actual question they are asking is "Do you have insight into what bothers you, and what actions have you taken to deal with it?". I mean, it would be great if they actually asked the question they intend rather than beating around the bush. But maybe that's also part of the "test" - can you read between the lines. But I digress (as always). I strongly believe that all questions are best answered honestly. Even when others are trying to play games - such as interviewers are (I'm not blaming them - that's a topic for another day).
So I thought about. What kind of patients bother me.
That's an easy answer for me: the patients who don't take responsibility for themselves. Take (a completely hypothetical, but not unrealistic, example): a very obese patient, with type 2 diabetes, comes in with uncontrolled sugar levels. Maybe even HHNK! For those interested in medicine: most patients with type 2 diabetes don't actually go into DKA. They tend to go into HHNK because, unlikely patients with type 1 diabetes - an autoimmune destruction of insulin secreting cells in the pancreas (at least, that's what we think it is) - type 2 diabetics tend to secrete just enough insulin to prevent florid DKA.
Anyway. So there's this hypothetical patient sitting on his/her bed... with a box of fried chicken wings (that's right, right? I'm vegetarian so I may have gotten the description wrong). And they say "I'm really good about taking my medications and eating right! This isn't my fault."
With the picture I painted, there are multiple issues in play: socioeconomic factors that may limit food options available, or if they can actually fill their prescriptions. Literacy issues or education issues which may prevent them from properly following doctor's orders. It's never one thing that causes health problems (or any real problems in our world) - if it was, problems would be significantly easier to fix. But let's focus on the point at hand: "It's not my fault".
That gets under my skin. I don't expect people to be perfect. On the flip side, I also don't expect people to beat themselves over their heads for not being perfect. I think the issue is with me: I come from an immigrant family and the common denominator for many immigrant families is the idea of pulling yourself up by your bootstraps. No excuses.
No excuses.
Coming from a "take responsibility" environment means when I see patients, who have the power to help themselves (and thus have a much larger impact in their own health than any pill ever could), say "this isn't my fault" - the primitive parts of my brain get slightly fired up.
Now, will any of this actually affect my care for patients? I hope not!
Why? Because I realize when this happens (thank you frontal lobe!) that I'm making this about me. And it's not about me. It's not about how I was raised. It's about the patient who's in front of me. It doesn't matter what my opinion is on their statement "it's not my fault." It is my job to tell them "you can help us make you better - here's how." And you better believe I'm going to try having that conversation with my patient - because it's the right thing to do. For them. Not because of how I feel about their "it's not my fault." I'll also get to work on hanging some saline bags to combat their HHNK while slowly getting their sugar levels down (again med people: recall that you can't just hit them with insulin to reduce their glucose levels! They'll become hypo-osmolar when the glucose disappears!).
But it still irks me. So, I say my serenity prayer:
"God, grant me the serenity to accept the things I cannot change,
I'm not Christian, but it definitely helps me quite a bit. Whether you want to interpret it as me thinking I cannot change the patient's view of their perceived helplessness, or that I cannot change how my brain reacts to the patient's statement - that's up to you.
If you've read my older posts, you'll know my post about why "blaming" people is a bad idea. That's very different from the view I present here (or so I tell myself). This isn't about me "blaming" these patients. This is about me getting irked that so many people do not take responsibility for their actions. Which, unfortunately, builds a divide. You may think me callous or "not as awesome as a doctor". Which is fine, I know I'm not perfect. But I'm trying to better. Everyone has their buttons, and I know this is mine. Hopefully I'll grow and be better about this issue.
Ok. Wall of text done. I didn't even have any pictures this time around. Sigh. I'll do better next time! For now, I leave you with these closing thoughts:
Although I live by the saying "Forgive many things in others; nothing in yourself" - Ausonius,
Looks my last post was in June 2013. That's about 7 months ago. Yowza. Even for me... that's pretty bad. Oddly, compared to my first 3 years in medical school, I've been the most "free" over the last 7 months. Starting my fourth year has been an interesting transition. I don't go to class and I'm not going to the hospital for clinic work either. But it's odd. Because of the two research projects I'm working on, plus applying for residency programs, plus flying around for interviews... I still don't get why I didn't have time to write more on my blog.
Oh well.
Also a shout out to my new found readers: hello MS1s (for posterity sake: class of 2018)! I'm very happy and honored you guys stop by to read my blog! Sorry it's not nearly as posh as a blog should be.
So, what's up for today's topic? Empathy!
A popular question asked on the interview trail (for residency) is "What kind of patients get under your skin?" Now of course, this question actually has nothing to do with the question itself. The actual question they are asking is "Do you have insight into what bothers you, and what actions have you taken to deal with it?". I mean, it would be great if they actually asked the question they intend rather than beating around the bush. But maybe that's also part of the "test" - can you read between the lines. But I digress (as always). I strongly believe that all questions are best answered honestly. Even when others are trying to play games - such as interviewers are (I'm not blaming them - that's a topic for another day).
So I thought about. What kind of patients bother me.
That's an easy answer for me: the patients who don't take responsibility for themselves. Take (a completely hypothetical, but not unrealistic, example): a very obese patient, with type 2 diabetes, comes in with uncontrolled sugar levels. Maybe even HHNK! For those interested in medicine: most patients with type 2 diabetes don't actually go into DKA. They tend to go into HHNK because, unlikely patients with type 1 diabetes - an autoimmune destruction of insulin secreting cells in the pancreas (at least, that's what we think it is) - type 2 diabetics tend to secrete just enough insulin to prevent florid DKA.
Anyway. So there's this hypothetical patient sitting on his/her bed... with a box of fried chicken wings (that's right, right? I'm vegetarian so I may have gotten the description wrong). And they say "I'm really good about taking my medications and eating right! This isn't my fault."
With the picture I painted, there are multiple issues in play: socioeconomic factors that may limit food options available, or if they can actually fill their prescriptions. Literacy issues or education issues which may prevent them from properly following doctor's orders. It's never one thing that causes health problems (or any real problems in our world) - if it was, problems would be significantly easier to fix. But let's focus on the point at hand: "It's not my fault".
That gets under my skin. I don't expect people to be perfect. On the flip side, I also don't expect people to beat themselves over their heads for not being perfect. I think the issue is with me: I come from an immigrant family and the common denominator for many immigrant families is the idea of pulling yourself up by your bootstraps. No excuses.
No excuses.
Coming from a "take responsibility" environment means when I see patients, who have the power to help themselves (and thus have a much larger impact in their own health than any pill ever could), say "this isn't my fault" - the primitive parts of my brain get slightly fired up.
Now, will any of this actually affect my care for patients? I hope not!
Why? Because I realize when this happens (thank you frontal lobe!) that I'm making this about me. And it's not about me. It's not about how I was raised. It's about the patient who's in front of me. It doesn't matter what my opinion is on their statement "it's not my fault." It is my job to tell them "you can help us make you better - here's how." And you better believe I'm going to try having that conversation with my patient - because it's the right thing to do. For them. Not because of how I feel about their "it's not my fault." I'll also get to work on hanging some saline bags to combat their HHNK while slowly getting their sugar levels down (again med people: recall that you can't just hit them with insulin to reduce their glucose levels! They'll become hypo-osmolar when the glucose disappears!).
But it still irks me. So, I say my serenity prayer:
"God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And wisdom to know the difference."I'm not Christian, but it definitely helps me quite a bit. Whether you want to interpret it as me thinking I cannot change the patient's view of their perceived helplessness, or that I cannot change how my brain reacts to the patient's statement - that's up to you.
If you've read my older posts, you'll know my post about why "blaming" people is a bad idea. That's very different from the view I present here (or so I tell myself). This isn't about me "blaming" these patients. This is about me getting irked that so many people do not take responsibility for their actions. Which, unfortunately, builds a divide. You may think me callous or "not as awesome as a doctor". Which is fine, I know I'm not perfect. But I'm trying to better. Everyone has their buttons, and I know this is mine. Hopefully I'll grow and be better about this issue.
Ok. Wall of text done. I didn't even have any pictures this time around. Sigh. I'll do better next time! For now, I leave you with these closing thoughts:
Although I live by the saying "Forgive many things in others; nothing in yourself" - Ausonius,
PS - I start classes tomorrow! Actually class! In a lecture hall and everything! I haven't done this in... years. And this month of February might be the last structured set of classes I take (unless I decide to do an MBA or a JD or something down the line).
- Karthik out.
Sunday, June 9, 2013
Surviving, achieving and living
Well. It's been a while since my last post - shocking! (not)
So what have I survived since the last post? I officially finished all of my required clinical rotations (in med speak - I'm done with third year!). It's an odd time at Penn Med because this is the second semester of my third year, yet my "courses" now are equivalent to what 4th years take - the first 2 years are compressed to a year and a half = the clinical years get an extra 6 months.
I did a month of Radiation oncology (omg lazors), and a month of Ophthalmology (eye balls are awesome - seriously).
Took 2 months off to study for and take the USMLE (US Medical Licensing Exam) Step 1. The old saying is - you take 2 months of step 1, 2 weeks for step 2 and a #2 pencil for step 3. That saying is a slight exaggeration, but that's how it tends to go: the later tests are far more clinically focused - so you've probably seen it / taken care of a patient who had it.
Then came my sub I in Emergency Medicine. Sub I = Sub Internship. The first year of any residency is called / considered your intern year. A subi is a month where you show you're capable of filling the shoes of an intern when it comes to taking care of patients.
What have I achieved since the last post? I did well on Step 1 and I've decided to pursue Emergency medicine. A pretty big decision! Then again, if I've learned anything from my life - it's that I should be prepared to be surprised. I usually have a plan and a goal I'm working towards, but I almost always end up doing something radically different. So we'll see where this road leads.
And now? Now I'm living. I am still taking electives, but it isn't a crazy marathon sprint (yes, that's what third year is). I get to stop and smell the roses (less metaphorically put: visit friends outside of medical school, say hi to my parents in person for a change). It's frightening to realize that I'll be an MD in just under a year. It's also a scary personal realization that most of what I'll learn in medical school (like 90%) I've already learned. When I look back, there's no doubt that I've learned an immense amount of information. The reason I'm scared is because my 3 years of medical school have taught me how much more there is to learn. And there's a ton of it yet to learn...
Looking back at my third year, I started to carefully think about what the three words: surviving, achieving and living mean. Obviously they mean different things to different people. Asking a kid who goes to Princeton what his/her definition of surviving is will get you a different answer than someone from the war-torn Congo. Putting all of that aside, and throwing in my own personal philosophy into the mix, I think these are 3 completely different mind sets. But they get mixed up quite often - especially in the Asian / Jewish / immigrant culture.
I can't speak to the Jewish culture but I know from an Asian and immigrant background that survival was our foundation. Our parents (or our parents' parents) had to work their butts off just to get by. Some of them got lucky and ended up with the ability to give you way more opportunity than they (or anyone else) had.
And don't kid yourself. The world isn't fair. They got lucky.
There is something to be said for making your own luck. There's a saying that goes: "I don't know what can guarantee you success, but I know what can guarantee failure - and that's not trying". Ok, even that may not be true because some people are just so damn lucky that they don't fail despite not trying. But let's leave those people out for a minute.
Putting all of that together - our parents/family push us to try very hard. I am lucky enough to not be in the "survival" situation they were in. I don't have to worry about making enough money to put food on a plate. Or worry that we won't have electricity tomorrow. With the way medical costs are going, I may have to worry if I can pay for my medical care - but that's a digression for another day.
Our families take what they know (survival) and channel it into something that is more situation appropriate: achievement. If you aren't achieving, you've failed. And in the survival world, failure is not an option. Thus the push to achieve. All. The. Time. It's a pain in the butt, but it works: Asians and immigrants are increasing their presence in top schools.
But here's the problem with all of that: what about living? Many Asians and immigrants will tell you all they've seen their family do is work hard. They aren't sure if they've ever lived. Now, let's not start arguing about what it is to "live" - there are more opinions on that than every discussion above that I've shelved combined.
I think living is the opposite of achieving. Ever heard of delayed gratification? In the classic experiments, you'd get the rewards, even delayed, within a reasonable timeframe. Now - we are expected to delay gratification for years, or maybe even a decade (*cough* medical training *cough*). Where does it end? When do you get to live?
I think what people who are in my situation forget (and I'm in my situation because of dumb luck - more on that in a bit) is why we work so hard. Why our families worked so hard / push us so hard. It's so we can have what they didn't. So we can have a better life. Living. Sadly, I think people often miss the forest for the trees. Achievements are easy-to-measure milestones. We are quick to count off the number of trophies in a case or the number of extra letters after a person's name. We are quick to see the size of a house and the number of cars and do an approximate net worth calculation. What we aren't as quick to see is how well they've lived, what they've sacrificed to get here, and are they happy. These are very, very difficult things because they are not quantitative like the things I mentioned before.
So, what's my point? Don't lose the forest. I'm lucky enough (like many of my peers) to have the opportunity to live your life while trying to achieve - why? Because this isn't about survival for us. Not like it was for our immigrant/Asian parents. It isn't an OR condition - you CAN have both. It's about maintaining balance. Or so I tell myself.
Now, from this spawn 2 arguments:
1. Can you really achieve to your fullest potential if you are "wasting" some of your time / energy / whatever on something else (like this "living" I speak of)? If you take it as a zero-sum game, then probably not. You can't possibly give something 100% (or 110% if you are a "good Asian") if you're doing stuff like stopping and smelling the roses. If you take it from a perspective of self-actualization, then... maybe: the fact that you are living / doing things that directly make you happy can make you better/more efficient = your output per time unit invested improves.
2. What the hell leads to achieving anyway?
I'll probably make a blog post about both 1. and 2. at some point. But I will put in a small blurb about #2 - mainly because I said I would earlier.
I agree with Ben Bernanke's talk: for those of us lucky enough to be here and to have achieved this much - it's exactly that. Luck. I could've just as easily been born into a family that wouldn't have ever left the slums of India. Would I still have found my way to Cornell, Columbia and then University of Pennsylvania? Probably not. Is that to say my hard work didn't play any role in the outcome? No, that's silly too. But, more often than not, I tend to think that luck and just plain showing up are what lead to outcomes rather than your hard work (and keep in mind, any innate aptitudes you have are also innate to you because of luck). Even if hard work contributes only 5% to the overall scheme - I'm still going to work hard.
Why? Because that's the only thing I have control over. And I'm a control freak. Well, for the stuff I can control anyway. For the rest of it - meh. At least I know I tried!
- K Dawg out.
So what have I survived since the last post? I officially finished all of my required clinical rotations (in med speak - I'm done with third year!). It's an odd time at Penn Med because this is the second semester of my third year, yet my "courses" now are equivalent to what 4th years take - the first 2 years are compressed to a year and a half = the clinical years get an extra 6 months.
I did a month of Radiation oncology (omg lazors), and a month of Ophthalmology (eye balls are awesome - seriously).
Took 2 months off to study for and take the USMLE (US Medical Licensing Exam) Step 1. The old saying is - you take 2 months of step 1, 2 weeks for step 2 and a #2 pencil for step 3. That saying is a slight exaggeration, but that's how it tends to go: the later tests are far more clinically focused - so you've probably seen it / taken care of a patient who had it.
Then came my sub I in Emergency Medicine. Sub I = Sub Internship. The first year of any residency is called / considered your intern year. A subi is a month where you show you're capable of filling the shoes of an intern when it comes to taking care of patients.
What have I achieved since the last post? I did well on Step 1 and I've decided to pursue Emergency medicine. A pretty big decision! Then again, if I've learned anything from my life - it's that I should be prepared to be surprised. I usually have a plan and a goal I'm working towards, but I almost always end up doing something radically different. So we'll see where this road leads.
And now? Now I'm living. I am still taking electives, but it isn't a crazy marathon sprint (yes, that's what third year is). I get to stop and smell the roses (less metaphorically put: visit friends outside of medical school, say hi to my parents in person for a change). It's frightening to realize that I'll be an MD in just under a year. It's also a scary personal realization that most of what I'll learn in medical school (like 90%) I've already learned. When I look back, there's no doubt that I've learned an immense amount of information. The reason I'm scared is because my 3 years of medical school have taught me how much more there is to learn. And there's a ton of it yet to learn...
Looking back at my third year, I started to carefully think about what the three words: surviving, achieving and living mean. Obviously they mean different things to different people. Asking a kid who goes to Princeton what his/her definition of surviving is will get you a different answer than someone from the war-torn Congo. Putting all of that aside, and throwing in my own personal philosophy into the mix, I think these are 3 completely different mind sets. But they get mixed up quite often - especially in the Asian / Jewish / immigrant culture.
I can't speak to the Jewish culture but I know from an Asian and immigrant background that survival was our foundation. Our parents (or our parents' parents) had to work their butts off just to get by. Some of them got lucky and ended up with the ability to give you way more opportunity than they (or anyone else) had.
And don't kid yourself. The world isn't fair. They got lucky.
There is something to be said for making your own luck. There's a saying that goes: "I don't know what can guarantee you success, but I know what can guarantee failure - and that's not trying". Ok, even that may not be true because some people are just so damn lucky that they don't fail despite not trying. But let's leave those people out for a minute.
Putting all of that together - our parents/family push us to try very hard. I am lucky enough to not be in the "survival" situation they were in. I don't have to worry about making enough money to put food on a plate. Or worry that we won't have electricity tomorrow. With the way medical costs are going, I may have to worry if I can pay for my medical care - but that's a digression for another day.
Our families take what they know (survival) and channel it into something that is more situation appropriate: achievement. If you aren't achieving, you've failed. And in the survival world, failure is not an option. Thus the push to achieve. All. The. Time. It's a pain in the butt, but it works: Asians and immigrants are increasing their presence in top schools.
But here's the problem with all of that: what about living? Many Asians and immigrants will tell you all they've seen their family do is work hard. They aren't sure if they've ever lived. Now, let's not start arguing about what it is to "live" - there are more opinions on that than every discussion above that I've shelved combined.
I think living is the opposite of achieving. Ever heard of delayed gratification? In the classic experiments, you'd get the rewards, even delayed, within a reasonable timeframe. Now - we are expected to delay gratification for years, or maybe even a decade (*cough* medical training *cough*). Where does it end? When do you get to live?
I think what people who are in my situation forget (and I'm in my situation because of dumb luck - more on that in a bit) is why we work so hard. Why our families worked so hard / push us so hard. It's so we can have what they didn't. So we can have a better life. Living. Sadly, I think people often miss the forest for the trees. Achievements are easy-to-measure milestones. We are quick to count off the number of trophies in a case or the number of extra letters after a person's name. We are quick to see the size of a house and the number of cars and do an approximate net worth calculation. What we aren't as quick to see is how well they've lived, what they've sacrificed to get here, and are they happy. These are very, very difficult things because they are not quantitative like the things I mentioned before.
So, what's my point? Don't lose the forest. I'm lucky enough (like many of my peers) to have the opportunity to live your life while trying to achieve - why? Because this isn't about survival for us. Not like it was for our immigrant/Asian parents. It isn't an OR condition - you CAN have both. It's about maintaining balance. Or so I tell myself.
Now, from this spawn 2 arguments:
1. Can you really achieve to your fullest potential if you are "wasting" some of your time / energy / whatever on something else (like this "living" I speak of)? If you take it as a zero-sum game, then probably not. You can't possibly give something 100% (or 110% if you are a "good Asian") if you're doing stuff like stopping and smelling the roses. If you take it from a perspective of self-actualization, then... maybe: the fact that you are living / doing things that directly make you happy can make you better/more efficient = your output per time unit invested improves.
2. What the hell leads to achieving anyway?
I'll probably make a blog post about both 1. and 2. at some point. But I will put in a small blurb about #2 - mainly because I said I would earlier.
I agree with Ben Bernanke's talk: for those of us lucky enough to be here and to have achieved this much - it's exactly that. Luck. I could've just as easily been born into a family that wouldn't have ever left the slums of India. Would I still have found my way to Cornell, Columbia and then University of Pennsylvania? Probably not. Is that to say my hard work didn't play any role in the outcome? No, that's silly too. But, more often than not, I tend to think that luck and just plain showing up are what lead to outcomes rather than your hard work (and keep in mind, any innate aptitudes you have are also innate to you because of luck). Even if hard work contributes only 5% to the overall scheme - I'm still going to work hard.
Why? Because that's the only thing I have control over. And I'm a control freak. Well, for the stuff I can control anyway. For the rest of it - meh. At least I know I tried!
- K Dawg out.
Thursday, November 15, 2012
Death and all of his friends
Hmm. I just realized that quite a few of my posts are related to death (or dying). I don't mean to be doom-and-gloomy. Seriously I don't. I hope when people read through my posts they realize I'm trying to encourage people to live their lives to the fullest, or help someone else do so. Why? Because (as I mentioned in an older post) - only one thing is truly guaranteed in life: death. So if you've got a limited amount of time - do something worth talking about. If not, at least do something fun. So on your death bed you can say "damn, what a ride". So that life was worth it in the face of all the suffering, obstacles, and annoying people you had to deal with.
Today's post is based off a video posted by the class of 2015 at Penn med. It'll likely bring tears to your eyes:
My Last Days: Meet Christopher Aiff
This is a great, well made video, but what I wanted to highlight were the Christopher Aliff's words at the end:
"When we devote our energy and time to trivial matters and choose to stress over things that are ultimately insignificant, from that point we perpetuate our own sadness and we lose sight of the things that really make us happy. And rationalize our way out of doing really amazing things."
I don't presume to know anything about Christopher, but it seems the general population doesn't seem to think about things like this till the end of their life. As the (14th) Dali Lama once said (paraphrased):
"Man [...] sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present [...] he lives as if he is never going to die, and then dies having never really lived"
It saddens me greatly, but this is very true.
So what's my take home point? Besides being doom-and-gloomy?
Today's post is based off a video posted by the class of 2015 at Penn med. It'll likely bring tears to your eyes:
My Last Days: Meet Christopher Aiff
This is a great, well made video, but what I wanted to highlight were the Christopher Aliff's words at the end:
"When we devote our energy and time to trivial matters and choose to stress over things that are ultimately insignificant, from that point we perpetuate our own sadness and we lose sight of the things that really make us happy. And rationalize our way out of doing really amazing things."
I don't presume to know anything about Christopher, but it seems the general population doesn't seem to think about things like this till the end of their life. As the (14th) Dali Lama once said (paraphrased):
"Man [...] sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present [...] he lives as if he is never going to die, and then dies having never really lived"
It saddens me greatly, but this is very true.
So what's my take home point? Besides being doom-and-gloomy?
"Dying doesn’t need to be a bad thing – it is in fact a necessary
thing. I want to be remembered as someone who did their best." - Christopher Aliff.
I intend to do my best, and be able to say "Damn. What a ride" when it's my time. But, for now, I'll be nursing my R knee's patellofemoral pain syndrome (the most commonly diagnosed knee pain! And you thought I was going to do a post without any medical context whatsoever..) while practicing my dance routine(s).
All in the spirit of procrastinating homework assignments for school.
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