Mile 13624: Final Push

Above: Team "Kentucky Fried" takes one final shot. December 2010.

PUUSSHHH!!!!

Being on call has become a routine for me. Every fifth day during my rotation, my partner and I end up staying 24 hours at the hospital "on call" in the Labor & Delivery Ward. We're responsible for admitting patients in labor, writing their history & physicals and to observe / assist with deliveries. Sounds hectic, but yet over the 6 1/2 calls I have had over the last 6 weeks, there was none more busy than my final day. However, that doesn't mean that the night was tiring beyond measure, as I found the pace of this call exhilarating. I found myself in synchronization with three other nurses saying "push!" to get a mom to finish her delivery and even was treated to a "fourthmeal" along with the nursing staff underneath our attending doctor's tab.

I'll be honest, a quarter pound burger along with a frozen non-alcoholic lemonade sits pretty well when being on call.

However, even after not having busy calls, that night was our "test" to see how much we learned through the deliveries that we had over the calls in the past weeks. And that's something both my partner and I both noticed: we learned a lot simply by observation (and much more than we give our eyes credit for). With the help of our attendings and our past memory, we were able to position the baby's head on its exit from the vaginal canal, deliver placentas, and even coach the mom through her contractions.

I'll admit that it is really invigorating and exciting to do the coaching. I've always seen it on telemagazines and on TV shows, but when actually doing it, it feels quite different. Coaching seems to be one of the most important parts of delivery, as I see how good coaching can result in much more efficient pushing and quick delivery of the baby.

Okay... 10 seconds... Let's go!.... Come on back into it, take a deep breath, give me 10 more seconds... you can do it!

I really loved the OB portion of my rotation. There's always some type of joy associated with delivery, and it brings a type of doctoring where instead of dealing with something that holds back our own lives (the loss of health), OB most of the time brings happiness and its not just to the mother but to the baby's family. This was best seen midday, when one of the nurses yanked my partner and I out of the nursing station simply to do "rounds" consisting of delivering a muffin-top birthday cake and 2 glasses of "fake champagne" (aka sparkling grape juice) to each mom with a newborn that day and singing "Happy Birthday" to each new baby boy and girl. We did 9 newborns that day, and it felt very rewarding.

Even in a world where malpractice could be scary, I can definitely see the light that OBGYN doctors see that motivates them to do their work everyday.

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Forgive me for not writing for the last month. I'll admit the hectic schedule of OB has held back my ability to stop and think and write. However, I was able to see a side of my OBGYN rotation that is more applicable to anyone in every field, and I'm thankful to have an attending that was inspirational as the one I had to show me it. More on that in the next entry.

Mile 3288: Shortie - Nature & Nurture

Above: Jason Alexander as 2nd most popular motivational speaker in the USA, from the short-lived ABC series Bob Patterson in 2001.

"MOST OF US ARE
FAR FROM OUR POTENTIAL."
Dr. Angela Duckworth at the University of Pennsylvania

Folks, its been a busy week at the new clinic I'm at. So here's a quick shortie, and you'll get a full update on what's going on very soon.

The sacrifices that we make to go to medical school are large (both for U.S. and Caribbean students). For many of us, the sacrifices include a long time in school and being piled in debt that is miles high. For others, the sacrifices are greater, either from the demands of moving from place to place, and even trying to support a family during the demanding time schedule of school. Some of us have been more successful at balancing the plates than others.

One thing I've always wondered in such a demanding & competitive environment is whether or not there really is an advantage of background when going through medical school? Is the person who comes from a lineage of doctors going to be more successful from the student who comes from a farm-based community in Iowa who wanted to become a doctor to exit the world of agriculture? I know of many successful doctors who have come from families where mom, dad, or more relatives came from the medical field.

What truly determines our success, the drive or where we come from? One of my Facebook friends, Frank, posted a link to a New York Times article saying that motivation actually outweighs nature and nurture (background) in the long run. It's been a debate that has been going on for centuries. Some scientists are saying that genetics are not related to how well someone does in their own field. Others say that challenging environments make people better at their field by generating motivation. And finally, we still have people out there saying that families of people good in a field will foster future generations also good in that field.

After going through my Leadership Certificate training at the Illinois Leadership Center at the University of Illinois, I still believe it is truly up to the person to make themselves the "cream of the crop." And it is for this I want to somehow become involved in teaching, because I have always wanted to empower others to reach their potential; many people at the U of I have motivated me to make it this far, even as I'm not from a family of doctors. From my experiences, I think its a good combination of the right environment and self-motivation that can make someone the best that they can be. Talent isn't necessarily inherited.

I encourage you to read the cited article below to learn more.

Source: The New York Times

First Lecture of 2010

Above: The best of all pictures from Randy Pausch's Update Page featuring his daughter, Chloe.

DID YOU CATCH THE
HEAD FAKE?

I'm really looking forward to the year 2010. As I enter the new decade, it was welcomed by my mom and dad, my best friend Neal and his wife (who were in town visiting), and of course, James Taylor. Okay, I'll explain the latter.

It usually spend New Year's with my family (which has come to mean a lot to me), as I was never into all that celebrating/partying/yackety-smackety. I honestly think that the moment that the clock strikes 12 simply means that the calendar turns to another day. What's more important to me is seeing how the new year can mean something that +1 on the calendar but more what can I do with that year. So, I avoided anything on TV regarding countdowns (even the NYC ball drop) until the last 2 minutes of the Chicago countdown. After flipping through channels, I thought that James Taylor singing his hit songs on acoustic guitar on PBS would be perfect for a toned down night.

Taylor's One Man Band DVD is highly recommended, btw.

However, the next day on YouTube, I found a video that unexpectedly set my new year on the right note. It was a lecture given by Randy Pausch, formerly a professor at Carnegie Mellon University.

The video I found was described as his "Last Lecture," which was an academic tradition at Carnegie Mellon University that was to be given as if it was the person's final one... ever. For Pausch, it truly was. Although Pausch was championing his pancreatic cancer (he was outliving his original expectation to live 3-6 months), Pausch knew that at a point he was going to lose the battle (it had already spread to other organs). Yet, in front of a standing room crowd, Pausch proved that he was still much stronger than much of crowd by demonstrating his pushup skills (alternating between 1- and 2-handed versions). His "accidental celebrity" status (as he termed it) all started with a lecture that has attracted 10 million plus views on YouTube. In it, Pausch spoke about his dreams.

... and not just achieving them. How we make them come true. Who helped us along the way. How the dream came true even though it wasn't they way one imagined. The effort needed to achieve them. How grateful we need to be for what we can get...

In the talk he gives, called "Really Achieving Your Childhood Dreams," he tells the audience about how he wanted to play in the NFL, meet Captain Kirk, and even become a Disney imagineer (something I also have wondered about doing), and how the dreams had came true, but not in the way he had originally expected. Yet to Pausch, the outcomes were quite satisfying. I never expected to stay on board for his 1.25 hour long lecture, but his humor and personality caught my attention and grabbed my curiousity.

Just by watching the video, I knew that Pausch was a man that really wanted to live life to the fullest, and for knowing that he wouldn't be in the world much longer, I salute the man for having the strength to make the best of what remaining life he had. He used his efforts to improve awarness of Pancreatic Cancer and even coming back to Carnegie Mellon again to share more of his lessons with the graduating class of 2008. Pausch passed away that year, 22 months after his original diagnosis of pancreatic cancer, leaving behind his wife and family. Although his life had ended, he went on to motivate his family and millions of others. He was featured on news outlets such as Good Morning America, Time magazine, and CBS Sunday Morning. He also wrote a book called The Last Lecture which eventually went to become a New York Times Bestseller.

After watching and learning about the Carnegie Mellon professor, I ended up making one of my objectives this year to work even harder towards my dreams... the dream of not just becoming a doctor, but to hopefully to turn out to be a great one.

Randy, thanks for making me learn a lot from my first lecture of 2010. Here's to you.

DO YOUR HOMEWORK: Watch the lecture. It might be just what you need to start the New Year. When you get a chance to watch his video, watch out for the "head fakes" (aka deeper messages) in his lecture and see if you can figure out what they are before he tells you what they are at the end of the video (I'll give you a hint, there's two). I know you'll get a few of those "Aha" moments when you learn what they are. Just trust me.

Blue Collar, Blue Scrubs

Above: Michael Collins, author of the 2009 book Blue Collar, Blue Scrubs.

"BELIEVE IN
THE SYSTEM."

I needed some inspiration... but we'll get to that in a second.

Two weeks ago. Just past nine in the morning, central standard time, I'm walking up to my standard desk at a local library, and oddly enough, a plastic placard was standing on it. I knew it wasn't there yesterday, but my mind was eerily perplexed why of all desks, my desk, had to have a placard on it. After laying down my bookbag on the floor, my eyes zipped right to the title heading the advertisement.

"A Night with Dr. Michael J. Collins, M.D."

Doctor coming to speak? At first I thought, meh. Well, I kept reading the mysterious placard for more... It was then I learned he was a construction worker, then turned medical student, then turned Mayo Clinic resident, into a distinguished orthopedic surgeon. He was there to promote his new book, Blue Collar Blue Scrubs, a story about his experiences before and during medical school, a transition from working in construction to medicine.

Whoa, I thought. Mind you, at this point I've been days into studying for the boards. The books were starting to get to me... I needed some inspiration to kick me back into gear.

So, I signed up.

Last night. As usual, things never go as expected. I always thought 15 minutes to my library would be just enough time to get there (it usually takes me five). Unfortunately, storms in the area, and an accident down the road, almost made me tardy for something I was really excited to go to. However, as soon as I got into the library's meeting room, dripping wet from a failed dry-dash across the parking lot, something surprised me about the audience.

Not a single med student.

In fact, I probably was the only patron under probably about the age of forty in the room. I sat in the back row, and patiently waited for Dr. Collins to make his entrance, starting to wonder if this was going to be a presentation that would be exactly tailored to me. I have material to study, my time is quite a commodity right now.

It turned out to be a well-spent 45 minutes in that room. My eyes were glazing up, watching him as he read a few passages about his experiences from transitioning from construction work into medicine, and then as he lived a life that... well was quite similar to one that I'm leading right now. Here's a few highlights & quotes:

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He said: "It's easy to fall into something and just drift along."
It's so true. Collins was referring to him choosing to go into construction initially, and enjoying it. See, it wasn't until he had an "epiphany" wondering how he could do something useful and good with his life that he started thinking about the medical field. To me, I saw this quote as referring to my tendency to believe its just easy to pass exams, and be satisified with just passing. I'm just drifting along medical school... but to improve, there's gotta be a challenge: the academic challenge to get out of the rut of just passing.

"Who wants a 25 year old beer guzzler in their medical school?"
Collins was referring to his doubts about getting into medical school when the idea came along. He overcame that doubt to get on the track of where he is now. Quite, quite impressive.

"Work isn't painful, it's rewarding."
So true... us med students gotta remember what we're here for, and it'll remind us that the work that we put toward it is all worthwhile.

"If you love enough and care enough, can't we get through the obstacles that get in our way?"
Sometimes I end up thinking like this if things don't work out. However, I'm glad that I'm not the only one pulling up those doubts sometimes. With the rigor of medical school, its hard to see sometimes when the obstacles end, and it goes back to one of the themes of Collins' book: Hard work results in accomplishments.

"Believe in the system."
During the question and answer session, I raised my hand. Upon his eye contact, signalling that I could ask my question, words came flying out of my mouth... "Understanding that a humanitarian drive called you toward medicine, when you were in the first years of medical school, faced with the loads of scientific and non-human seeming information, how did you get through it all?" After a deep pause, Collins said he didn't like the first years of medical school and compared it to a kid in the library carrying 30 books in his hands (so true). But he said that believing in medical education carrying students through is what got him through. I'm thinking about finally putting some trust into it too, even though it may be hard at times to do so.

"There is nothing like medicine."
The man's interest in medicine resonated in his voice when he said this to the crowd.

"Keep the faith."
I got a second chance to shoot another question at Collins. This time I asked, "Looking back on your experience years later, if you had one piece of advice to give a medical student, what would it be?" I felt a drop of sweat plop against my skin after the question, as one of the ladies in the audience told someone next to them, "He must be a medical student." When I heard that, I'll admit that I kind of laughed under my breath. However, again, with a deep pause, Collins replied back to me that simple quote. He then said, "As medical students, you come in idealistic... as residents, you might come out cynical." True, medical school can do so much to the students that are in it (I think I see some cynics already :P).

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At the end of all this, I can see some of you saying... Yeah, anyone can say any of that. True, but with these quotes coming from someone who broke through the obstacle of a non-scientific background to become a distinguished physician... to me, it means so much more. I'm now ready to hit my notepads and books once again.

I'm looking forward to reading Dr. Collins' Blue Collar Blue Scrubs... but for now, I gotta believe in the system.

The Inquisition

Above: The San Juan, Puerto Rico skyline from the Best Western Hotel & "Casino."

WHY EXACTLY DID YOU GO

TO MEDICAL SCHOOL?

There's no doubt about it... the human race is a curious one. We always are finding ourselves asking questions for a multitude of reasons, either philosophically or scientifically. I don't think I can come up with a time that A) we're not ever asking ourselves a question or B) can't ever come up with one. However, one of the most intriguing things about being inquisitive is there are questions that I ask myself over... and over... and over again... such as:

Why do I want to become a doctor?

No, I'm not going to take this entry to try to rewrite the essay question that I answered (multiple times) as I was applying to medical school. For many people, that's one of the first times that they truly start asking themselves that question... why they are entering this niche in life. However, as an inquisitive human myself, I have to say that I've asked this question many times as I've sat down with books when I was studying. And I'll admit that the answer hasn't been exactly the same each time I've asked...

Coming to Ross is no joke. I've heard about the specific discrimination that some med students have in the states for med schools that say it's a "beach" of a time when you go to a caribbean school. I'll be honest with you: it isn't. I can go for pages about how the program does have the rigor of a US School, and sometimes how the school can sometimes catch me off guard with policy & administration changes.

It's the loads of sacrifices that I have to make that add to my weight.

- I'm thousands of miles away from home, mom & dad, my friends.

- I don't have a car to drive around.

- Living in a developing country, and not having the "amenities" and "distractions" present in the developed world.

- And I had to give up some of my favorite things in life: including the super slurpee that I'm craving for right now.

And that's when the self-inquisition sets in. For the economists: it all comes back to a game of costs and benefits on myself. I'll start questioning whether or not being away from the comforts and cares I had in life is worth it for the long and winding road. I've also pep talked my friends into rethinking that big Why? question. Some of the answers that truly worry me about getting into medicine (especially if its the only reason) include the following:

I really want to care about people.

I am doing this for my mom and dad, to make them happy.

It's a great field with great job security & benefits.

And every time I read those answers... I say those can be some ways to get involved in medicine, at least for the short run. But where's the self-drive in those answers, what's going to keep people passionate about what they do everyday... to strive even more and to be happy with working hard.

I sometimes think that the commonly heard 40 year-old depressed doctor comes from the wrong rationale behind going to medical school. I keep hearing quotes - and also keep forgetting where they've been coming from - that sound like, "You can't take care of other people, until you take care of yourself." I believe that a person needs to empower themselves with a rationale for their own self-benefit to succeed at what they do. And that's where I draw the line between primary and secondary self-drive (my lingo for motivation).

1) Secondary Self-Drive

Let's start with the more concerning of the two. I'll admit that job security and benefits is a self-drive, but I would call that more of a secondary. I'm thinking secondary in terms of going through a physical outlet to achieve that "final satisifaction" for what you do. It's not a direct hit. For instance, in job security, the road to getting to getting that happiness and satisfaction looks like this:

Medicine => Secure Job => Satisfaction

Let's say that A) you don't get into the match... satisfaction isn't going to set in.

Let's say that B) you get to the secure job... you've already accomplished it... so what's new that's driving you?

It all goes back to if that secondary self-drive is removed... how can one make it to the goal of satisfaction with the loss of that driving factor? It's good to have secondary self-drives, but it needs a backbone:

2) Primary Self-Drive

I honestly believe that a primary self-drive is what actually will drive me to being successful at what I do and keep me motivated. A primary self-drive looks like this: I'm in medicine because I really am motivated to learn more about how our lungs work and potentially improve the prognosis of patients who develop lung cancer. And bam...

Medicine => Satisfiaction.

Take a look at the direct link back to the subject topic - the academic world of medicine - and how there's a pure interest in what this person would be getting into - the subject topic & improving the situation. There's a reason for looking into those books and to strive further than any man has done before. It can be applied to any situation... i.e. going to a bar for the ambience.

It's tough to define... but think of it this way: name a way you wouldn't satisfy the example above... the only way is if you never find the answer to the problem. BUT!... Remember, how I said we're a curious group of people? Unless you're not human... you'll be satisfied & content with what you do.

Okay, so the rationale is done primarily & secondarily... finally keep in mind of one big hole...

3) The Black Hole of Vagueness

I think that one of the greatest things that I learned at my Alma Mater (the University of Illinois at Urbana-Champaign) is that a goal in life needs to be defined well. It's great to define your self-drive, but don't forget about defining the ways or coming up with a game plan to go about it (i.e. doing medical research, reading up on journal articles, etc. etc.). A game plan is crucial to laying out what needs to be done so one doesn't fall off track that the drive has them on. So with realizing the answer to this big Why? question, make up a game plan to make it happen.

And when I look at it all, for being successful and being happy with what I do, which is the way I define satisfaction, there are going to be primary and secondary self-drives that motivate me. However, in the end, but it will always come back to what you're truly passionate about... the primary self-drive about what the field you're in or what you're doing.

So next time you have a friend who's about to join into medicine or even just entering college, tell them that its okay to be selfish. Because if there is a self-will, there's a way to travel down a successful and may I say, enjoyable road. And yes, you'll still be able to take care of that humanitarian side of you, just remember to take care of yourself first. No matter what field you're participate in with life, it's a good thing to just remind yourself of why you got into that field in the first place. Perhaps you'll realize that all the sacrifices you made were worth it.

Ahhh.... Curiosity is such a beautiful thing. :D Yet, it is so, so complex.

I bet you're curious now... why exactly am I becoming a doctor? You're probably tired of reading... so I'll be telling you soon enough...