Medicine: The Art vs. The Politics and The Business

So lately I find myself disappointed in a few things in my current field of study. I actually started this post about a month ago, but things have been so crazy with post-school year stuff that I haven't had a free moment. I am now down from 12-hour days to...you know, only 9- or 10-hour days. But when I came back to this post, I realized this stuff still upset me. So here it is:

I recently discovered that a local hospital, one of many like it in the country, refuses to have anything to do with abortion counseling. This not only affects medical students, but patients nationwide.
Now, I'm not saying a hospital shouldn't be able to decide whether or not it can conduct abortions. That is the hospital's and its parent organization's priority. But when the hospital refuses to train its medical students in this delicate matter, that doesn't seem right. Medical care these days is completely focused on being transparent, and making sure patients are well-informed so that they can give proper consent.  That means knowing all options and being able to assess them all as objectively as possible. Our patients trust us as doctors/future doctors to help them with these decisions, but we cannot do that if we are not familiar with the options!
Obviously abortion is a very controversial subject and doctors will differ in opinions regarding it. It's difficult to control how a doctor will feel about the procedure and how they will present it to a patient. It's even more difficult to predict how certain patients will react to the idea of abortion and whether or not they will be offended. That's why third-year medical students spend 6 weeks learning basic skills of how to help pregnant women and the babies they carry, and why those that choose to specialize in obstetrics and gynecology after they graduate spend four years in intense training and then a lifetime of working to become experts in the field.
The fact that these hospitals are leaving out this important and very relevant aspect of training/patient care means that the doctors trained there cannot serve patients as well as those trained elsewhere.

I'm not saying I'm pro-choice. I'm not saying what I feel on abortion because it doesn't matter. All that matters is that if a patient asks about the procedure, I need to be ready to discuss it with them. If I'm trained at the hospitals that I talk about in this post...I won't be ready, and unable to accept a patient's trust. And as idealistic as it sounds, I don't want to accept that.


I know there's not a whole lot that one blog post read by a handful of people can do (thank you for reading, by the way!) to change a massive hospital system. But another subject that really troubles me is a little more personal, and may be able to have a little more of an impact, and coincidentally also falls into the OB/GYN realm.
I am working in a doctor's office this summer and a week and a half ago, a patient came in, just a few years older than me, who had given birth over the weekend. The birth was fine, but the young mother was exhausted. Granted, the pain and suffering of labor leaves every mother exhausted (not that I know from experience, but I've seen it). However, this girl was really struggling after a couple of days at home, and developed violent stomach pains that sent her to the Emergency Room. She was unable to eat, so they gave her a nutritional IV and the pain subsided...but then they just sent her home. Didn't let her stick around to follow up and make sure she was okay, they just sort of shoved her out the door. She ended up in our office because the pain had her doubled over and she could barely walk, and between the pain and the new baby, she had not slept in days. A test showed that her hemoglobin level was a measly 7.8 (normal is 15). We all wondered, "Why did they let her leave the hospital?"
I work for a doctor who offers some less-widely-used treatments, so we gave her a couple of IVs of B12, Vitamin C, and other nutrition and mineral supplementation for an energy boost, and some pain management therapy. After just a few hours in our office, she felt a little better, though still weak. She came back the next day for another IV and looked amazingly better. She was able to walk and everything. It wasn't an instant cure - she became weak again, though less so, and needed to come back for more pain management and nutritional IV treatments. But they were helping.
Over this past weekend, the pain again became so severe that she had to go back to the ER. They finally investigated further and discovered that she had retained products of conception in her uterus - placental and/or fetal tissue (more so placental in this case, I assume, since her birth was otherwise normal) that are known to cause pain. She is going in for surgery to hopefully resolve the problem.

This happens only in 1% of all pregnancies, so I admit that it would be hard to find that as the cause of her condition. But if she had been allowed to rest in the hospital just a little longer instead of being shoved out the door, they would have seen that there really was something wrong, and maybe the physicians could have investigated sooner so she would not have had to suffer for over a week when she should have been enjoying her new motherhood. I'm not blaming the doctors or the hospital. But this is what medicine has become, a business where the customer must be helped and then moved along, dismissed as soon as possible in order to keep new patients coming in. It can't be changed instantly, but I hope that I can remember this story in the future and try to remember that occasionally my patients need more than just to be shuffled through, treated, and streeted.

Things You'll Find On The Island, Part II

My good friend Rose recently posted an article from a Forbes author on her Facebook, and I quickly became a huge fan of the article and some of his other writing. Given how much I love writing about leadership, I felt I had to post these. They're better if you're fans of Star Wars and Star Trek, but still poignant. I may have to actually start watching Star Trek in order to better understand the anecdotal references.

Two different types of leaders:
Five Leadership Lessons From Jean-Luc Picard

Five Leadership Lessons From James T. Kirk

And for the organizations:
Five Leadership Mistakes of the Galactic Empire

Also, check out some of the new blogs I've added to "Other Islands You Should Visit." The A+M Blog stirs up some great friendly controversy, my good friend Aaron's blog is incredibly thought-provoking (lately, I've been contemplating Why I Blog and PS To Why I Blog...), his other Reinard Family blog is going to be a great look at the journey he and his family take in adopting their third child, and The Family Berzurcher is the insight into the amazing mind of my good friend, former bandmate, and all-around inspiration, Matt Zurcher, as he explores cinema, television, music, and more.

The Importance of Rounds 2 and 3

     So I was recently given the honor of presenting an award at the Pillars of Leadership Awards Ceremony at UB. It's basically a ceremony built to gather all of the award-winning leaders from organizations all around campus, and recognize them for their contributions to their organizations. I enjoy this ceremony, it's a great opportunity to interact with many other campus leaders. I am always inspired by these leaders - my fellow students - some of whom I don't see anymore except for at this ceremony, and I am happy to get the opportunity to talk to them about their latest endeavors.
     In one such conversation, a girl was discussing the decision she was facing in returning to one of her organizations for a third year in a row, and whether or not it would be worth her time and effort. She asked me about it because that was a decision I had faced with the Residence Hall Association as an undergrad. I advised her by asking the questions I was asked by my advisor back when I was in the same situation. She was grateful for my advice, but I wanted to expand on the points I'd made, in general just to organize my thoughts - part of why I blog. The questions are as follows:

1. What will I learn from this? Will it be good for me?
2. What impact can I leave directly on others by my involvement?
3. What impact can I leave on the organization? What difference can I make?

     The first question seems selfish, but it's a very important point. Even the most righteous and self-sacrificing leaders (at least, the ones who aren't divine) are human at the core, and thus have human emotions that need to be taken care of. If we live and die by those you lead, or those we are to care for, then that can wreak havoc on our minds, and drive us insane (see my previous blog post about holding on loosely). In addition, no matter at what age, a part of us needs to keep the attitude of "student leader." Every leadership opportunity is a learning experience, and we need to see it as such - when we stop learning from it, we need to re-evaluate our position and a) whether we're fulfilling its potential, and b) whether that position is still right for us. I say that knowing full well that I'm only 23 and haven't held any particular leadership position for longer than 5 years. But I'd like to try to keep that attitude throughout my life's work.
    The second question can be slightly selfish if you do it for the wrong reasons. We don't generally go into a position seeking to directly leave an impact on someone else. We don't plan to be someone's confidante if we aren't already, and we don't plan to directly influence someone by our actions. But it can happen, and we must make sure that our actions are such that when people notice them (and believe me, when returning to a position for the second or third time, people will notice), they make a positive impact on those around us, and inspire them to be better leaders by following our example. And this goes for all aspects of our lives. Everyone deserves to have fun, and there's no harm in going a bit nuts when the time is right - but we should strive to make decisions that we won't regret later, and that won't make others question our integrity.
     The third question is possibly the one we must think about the most before we choose to run for the position again. It sets goals for our next term. What do we want to change, and why? What do we  want to continue to do similarly, and why? And these must be fluid answers, for our goals are always changing. I'm not saying we should never be satisfied, because that often leads to miserable people. But our goals have to evolve with the times and be shaped by the events that transpire as we fulfill our leadership duties. These goals cannot be selfish. This is the part where we have to put our own personal stake aside and focus on what will make the organization better.

     I'm not really trying to educate you about leadership here - instead, I hope you use this post and these questions to help you focus your thoughts regarding your current leadership position. Thinking these things out and clearly defining the answers to these questions (and thus defining our goals for the position) is what will make us better leaders.

How Eighties Rock May Help Me Become A Better Doc

It's a Monday evening, and I should be studying the intricacies of the gastrointestinal system. A couple weeks ago was the last of 6-week period where my classmates and I endured an exam every week. At first it wasn't too bad, but it quickly burned us out

Recently I have had a lot of conversations about the stress of medical school, and the career that follows. One of the first things we were told during orientation week last semester was that it is possible and, in fact, important to maintain some sort of existence outside of our studies. That was an encouraging message, but as we progressed through classes, it became more and more difficult. And even I, a guy who once prided himself on being optimistic and maintaing a positive outlook (see my September blog entries), have become very cynical, and more prone to fits of frustrated anger. I was just getting through material to pass the next exam, and even seeing patients was just a "let's-get-through-this-and-get-out-of-here" experience.

And it was between exams five and six earlier this semester that a friend of mine pointed me towards a very insightful TEDTalk she had recently found.

At timestamp 5:45 is where it got especially real for us. We realized how much it resonated with us - yes, grades are obviously important, and the mental anguish brought on by medical school is a necessary evil. But your brain in a positive state is 31% more productive than at negative/neutral/stressed?! Doctors are 19% more efficient and accurate?!

In another conversation, a friend of mine told me she wasn't sure if she could handle being a doctor because she would be hopelessly devoted to her patients to the point of burnout, and if she tried to take care of herself, she would feel that she was inadequate in caring for her patients. On the radio later came the .38 Special song, "Hold On Loosely." Go YouTube it, because it's a great song. But the chorus, which inspired me on this subject, goes like this:

"Just hold on loosely/
and don't let go/
if you cling too tightly/
you're gonna lose control./
Your baby needs someone to believe in/
and a whole lot of space to breathe in."

I've been told by numerous doctors (both on TV and in real life) that we cannot live and die by our patients alone. We have to do our very best to care for them, but at the end of the day, we have to make sure we keep our own well-being in mind as well. Our career, "our baby" in the case of "Hold On Loosely," can't be clung to so tightly that no room is left for us. Doctors who stop caring about their own happiness end up burning out quickly, and like Dr. Achor discusses, they are scientifically proven to be worse at their jobs.

So I'm trying to turn my negativity streak around, because like Dr. Achor, I feel truly blessed to be where I am now, slaving away in medical school. So I'm trying to see more of the good in the world, and trying to find a happiness in my work, even as I spend long hours studying. [Edit: Along the same lines, I gave up swearing for Lent. So much harder than I thought it would be.] Easier said than done, but I need all the brain productivity I can get. :)

I Could Seriously Go For Some Ice Cream After Writing This Post

    Whenever the subject of celebrity crushes comes up, two names always get mentioned when you converse with me. Jennifer Aniston, the lovely Rachel from Friends - America's sweetheart, and Demi Moore, the stripper fighting for her daughter's custody in Striptease, and one of the few women who actually look better than her husband when they are both bald. One thing they have in common is that they both look better now, in their 40s (42 and 49, respectively), than they did in their 20s. Granted, they both have personal trainers and rigorous routines and I think Demi's daily food intake consists of little more than an orange (I know she ate a burger recently at a photo shoot, but it's funnier to say it that way), but it definitely pays off for them. They're gorgeous.
    And the nice thing is, for the most part they've been good celebrities. They don't party too hard, they keep it fun but fairly modest. They've both had divorces from actors I like and have gotten involved with guys I'm not a fan of (I love John Mayer's music - it's unfortunate he's a douche; I've never liked Ashton Kutcher, whatever). But recent events have put one certifiably over the other...
    Demi Moore was recently sent to the hospital. I really hope she's okay, I wish harm on no one. But rumor has it that she was sent to the hospital after doing "Whip-Its" or "whippets." Have you all heard about this? Apparently you snort the nitrous oxide out of a can of whipped cream, and you end up with a full can of whipped cream that doesn't work (for the parents that want to make sure their kids aren't addicts).
    This is the stupidest idea I've ever heard. Are people so desperate to get high that they've tainted the sanctity of whipped cream? Doesn't whipped cream give you enough joy as it is? I mean...why wouldn't you just eat it, and get a natural high? I mean, if you really want to alter your mental state, they make alcohol-infused whipped cream (the chocolate variety is delicious) (I can't even imagine what snorting that would do to you).
    I feel like Demi would have someone in her life telling her that this is a bad idea. Heck, if you don't have anyone in your life that would tell you this is a bad idea...go find some new friends. And stop being stupid. I myself am immensely thankful for the friends I have. When I first found out about this incident, I was with a great group of people, and I am confident that Nikhil, Zach, Peter, Christina, and many others would definitely stop me from doing something as dumb as "whippets." Nushin is probably already doing them and I need to hold an intervention (to all readers, I'm sorry, Nikhil was having nightmares because I hadn't mentioned him in a blog post, and he and the others are very important in my life).
    Again, I wish Demi a swift recovery, and hope that people will see her as an example and use their whipped cream properly.
    And to Demi or Jennifer - if either of you would like to debate the merits or faults of this decision, please don't hesitate to contact me. I'll be waiting.

Things You'll Find on the Island, Or A Series of Links

I know lately I've been trying the "incorporate a lesson into my blog posts" thing, but that's really not why I started this blog. I kind of wanted to just put my musings and scattered thoughts somewhere. I have amazing friends who I can talk to about anything, but I can't always be random-tangenting into topics I want to discuss. Though once in a while, I do that...

Anyway, I wanted to write today just about some things that give me joy. At this point in the semester, we're taking exams every Monday for the first six weeks. So Monday nights I take a little time off. :)

Most people who know me and talk to me for more than 5 minutes, or sit in my car for more than 60 seconds, get to know that I love jazz. All jazz. Big band, small group, electric, acoustic, modern, classic, fusion, and more. One of my least favorite varieties is vocal jazz. Don't get me wrong, I've played with some amazing vocalists. If you're ever in the Minnesota area, or just want to hear an amazing voice, check out my old friend Laura Ellen. She's one of the best. Lately, I've been giving an immense amount of iPod time to a vocalist or two that I heard on Jazz.FM, my favorite radio station. Canadian vocalist Shannon Butcher was played the one day, singing what might be the happiest song I've ever heard. I later downloaded her latest album on iTunes, and it's fantastic. From the first track "Joy In My Heart," (seriously, I think singing it too much might make me poop butterflies) to the cover of Bryan Adams' "Run To You," and all the other tracks, it's great. Tight rhythm section, fun tunes, and to top it all off, she has a lovely voice.

Words With Friends. I know it's clichéd, but I just started playing it a couple weeks ago. And it's amazing. At first it was taking up too much of my life, and I was afraid my studies would slip. But I've downregulated my time spent there to just once a day or every other day, so it's a nice distraction without keeping me away from studying too much. I like that it stimulates me to get creative. Though I swear some of those words are fake. I mean, what the heck is "zeks"?

While watching the commercial for this new movie, halfway through I thought to myself...this movie can only be called "Man On A Ledge." Anything else...and I will be severely disappointed.

I defy you to listen to this song and not get it immediately stuck in your head. Special thanks to my good friend and mentor, Aaron, for that. Sorry for putting herpes on your Facebook wall.

And for yet another musical thought - dubstep. I know most people like to jam out and dance to dubstep, but I can't get enough when I'm studying. My friend Eric turned me on to The Glitch Mob and since then, that station on Pandora has been my study soundtrack for most of medical school thus far. And from there, I found the group Emancipator. Like chill stuff? Check out their page, download the free stuff. Then go pay for the album. As one decidedly amateur reviewer so eloquently put it, “Um, it’s really pretty, but like with SICK beats.”

As I write this post, I realize that I'm sounding a little like my sister Jocelin's writing. She and I have a very chicken-and-egg thing going on where we act a lot alike, but sometimes even we're unsure which one of us started a particular behavioral quirk. But she's a pretty cool person, weirdo that she is. ;)

So that's some stuff that I've been digging lately. Hopefully you enjoy it too, and we can talk about it.

Also, can anyone recommend a good beard trimmer?

Renew, Rejuvenate, Recycle

Happy New Year!


Well, so much for keeping up steady posting during school.
I'll say this, I can't really blame myself. One of my classmates said it best on the morning of our last final when he said, "This semester...felt like it was a year long." And it certainly did. Since my last post, we flew at the speed of light through an array of somewhat interrelated subjects through the insanity that was Fundamentals I and II. Learned skills of how to deal with difficult patients suffering from physical as well as emotional pain in Clinical Practice of Medicine. Felt like doctors as we fulfilled our assignments of talking to patients in the real world with our preceptors ensuring our progress. And of course, the dreaded yet amazing tour de force that was anatomy. But we made it through, and without too much damage. Over a quick hurdle of biostatistics that our exhausted minds only barely absorbed, and then into the sweet freedom of winter break to renew our mental strength and capacity for next semester.

But as exhausting as the semester was - reducing some of us to tears, some to fits of fried laughter, and some to numbness - I and most of my classmates would not have had it any other way. We were exactly where we wanted to be. And it's worth the craziness.
But that's not what I'm writing about today. I find myself thinking about how, in addition to rejuvenating my brain, this winter break has been a major time of renewal for me.
I renewed my connections with my extended family over Christmas weekend. I have a big extended family - 29 first cousins! (I'll pause a moment while you gasp.) I absolutely love it. Since they range from ages 5 to 30-something, I relate to some of them better than others, but it's always a happy moment when I can see any of them, usually because a significant amount of time passes between such occasions. It's great to catch up with them. I have older cousins who have forged a path into the medical field (we're Indian, big surprise) who now tell me war stories of their time in medical school, and give me advice on where to go from here. I also have younger cousins who look to me for guidance - at least, they would if I saw them more, to my regret. But more than that, we just have a good time in each other's company - watching movies, trading stories, talking about how silly or wise our parents are, and (in my family's case) playing the couch game (I'll explain later). Being with them is always awesome, and one of my goals for the future is to see them more, or at least keep in touch better.


I also renewed my connection with the house in which I grew up. We just had all of our hardwood floors redone, and there are few things that make you see a room more differently than taking all the furniture (and everything associated with that furniture) out of it. "Were those walls always pink?" "Where did this rug come from?" "Oh, that's where I lost that shirt!"

And then I reconnected with Richard Marx. Not in person, I've never met the guy, though I'd like to some day. I know what you're thinking now - "Who's Richard Marx?" Check out his songwriting and production discography and you're bound to recognize one-third to one-half of the names. Richard Marx's self-titled album was the first music I ever owned - my father handed the audio cassette to me, I slapped it into my Walkman, and that was that. My cousins will tell you how I used to listen to that tape almost obsessively, and in retrospect I was pretty ridiculous. But I just found something relevant in his music, something spoke to me. In addition to writing songs for other artists, he's put out several albums of his own over the last 23 years, and just recently released "Stories to Tell," a compilation album with acoustic and electric re-recordings of songs he wrote for himself and for others. And on top of that, he actually replied to one of my Tweets! I reacted quite calmly on Twitter, simply re-Tweeting it, but I was definitely doing a little dance when I saw it.

And finally...I know most avid readers like myself use their downtime to get into amazing new series like "The Hunger Games" or great biographies or instant classics or the next Tom Clancy or John Grisham book. Me? I chose to use this time to reconnect with The Animorphs. Mostly due to the fact that my friend Juliana keeps insisting that I should finish them, and I like the satisfaction of finishing a series. So I picked up where I left off at book 19 and am continuing all the way through #54.

All of these renewals had something in common: there was some level of change involved in my experience. Many of my cousins, the ones who watched over me and influenced me in my childhood, have children of their own now, all in the age range of 1-7. The last time I was in that full of a house for Christmas, surrounded by running children...I was one of the running children. I love kids, I always have. And it's interesting to see the other side of these interactions - to be the one watching over them as they have adventures by the couches, the monster that they need to fight, or the airplane to help them fly into the next room. It's no preparation for actually raising children, but it does make me look forward to the idea...but not for a while.

Meanwhile, inside the house, our living room, dining room, my parents' bedroom, and all the kids rooms look radically different. Partially because with Robin now being the principle child of the house and me only visiting on major holidays, my parents moved her into my old room and me into her smaller one. That's different. But just the feel of the rooms is different now. They're cleaner, for sure, but the shiner floors and some new furniture bring a new essence to them. It's unfamiliar, but it's like a rebirth. Like I'm exploring the rooms for the first time, in a new leather cockpit and new shiny wood and glass control panels and a much cleaner interior. Though, for those of you that have seen my living room before...the giant picture of Jesus is still in the same place. :)

Richard Marx's latest album has a disc of reworked versions of his classic hits, as well as recordings of some of the songs he's written for other artists. I was always Backstreet Boys over N*Sync, but I really enjoy Marx's versions of "This I Promise You." Marx spent most of the '90s in the Adult Contemporary section, but he's brought out more of his modern rock side in the 2000s, returning to his roots but adapting to the times. And I love artists that do that. (Side note on comebacks and adapations: While I agree that Madonna could make a very successful comeback, who thought it was a good idea to have her do the Super Bowl halftime show? I don't wish unemployment on anyone, but I kinda hope that person was fired.)

And the Animorphs? Well, in middle school - the last time I picked these books up - they were just entertaining books. But now, in my 20s, I see much more in the books. I mean, I hate eisegesis as much as the next guy, so I'll try to avoid that. But in addition to seeing how much K.A. Applegate influenced my own writing, I was astonished to see the depth in the stories. The middle school kid heroes of the series have aged greatly in the course of 30 books. Applegate has effectively captured the battle-ravaged minds of warriors who have seen death, betrayal, and genocide, and combined it with the angst and insecurity of the entry into adolescence. And then she condensed all these enough that middle school readers could understand. Take that, Stephenie Meyer. If you'd like to join Juliana and me in discussing and debating these books, let me know. :)

I used to be very big on tradition and lack of change. While I still struggle with it a little bit, I realized a few years ago that change can be an amazing thing. Sure, some traditions are good, and when something's being done right, there's no need to change it for change's sake. But one has to be able to adapt to change when it does come. All of these renewals I've experienced have only helped to reinforce that. Whether it's sharing new life experiences and the joy of children, or breathing new life into an old room, or giving an old song new life, or finishing the story of the battle to save the Earth, or just renewing yourself for the next round of medical school, there is no problem with revisiting the old. But don't be afraid to look at it differently, since there's a good chance you'll find something amazing in it.