You may not become the best doctor in the world, or this country, this state or city. Hell, you may not even be the best doctor on your street, at your hospital or clinic, or the best doctor on a hospital floor or in a room at a given time.
But when a patient comes to you, scared the headaches, the chest pains, whatever they’ve been having for months might be something worse, at that moment, YOU are their best chance for survival. You are that patient’s best hope, and proving yourself worthy of that responsibility is the only title you should ever care about winning.
A practicing physician for 40 years, and one who still hasn’t lost sight of what truly matters in this profession: the patients.
While preparing for my next patient I read in her previous note that she “..is a Vietnamese immigrant who works at a nail salon.” I stifled a laugh as I recalled Dat Phan’s comedy bit on the Vietnamese taking over the U.S. one foot at a time. I mentally scolded myself as I tried to dismiss my racist stereotype. Yet, you cannot deny that this is one stereotype that frequently plays true.
She smiled as I entered the room, remaining patient as I fumbled with the pronunciation of her name. After exchanging pleasantries we discussed her reasons for coming in: a lingering cold and a skin lesion. I noted that she had missed multiple appointments prior to this, failing to get follow up labs from over a year ago. She blamed this on her busy schedule, caring for two children and working full-time. For providers the chronically busy patient can seem as frustrating as the chronically sick patient.
Next we proceeded into her exam. The stigmata for bacterial infection were conspicuously absent. I described my findings to her, watching her mood deflate slightly when I explained that antibiotics would not help. I continued to work my way down her body in a systematic exam, explaining as I went. As I came to her hands I winced. The skin was thickened, dried, and cracked. My hands began to hurt in sympathy.
“Tell me about your hands,” I said.
She responded in deeply accented English that her hands became like this after working with the nail chemicals all day.
“And do you like this job?” I asked.
“I hate it,” she responded. I continued to inquire why, if she hated her job and it hurt her skin in such a terrible way, she did not seek other employment.
“In my country I was a nurse. But here I would have to start schooling over. It would take twice as long because I would first have to take English classes.” She continued to explain that when coming over, many Vietnamese people worked in nail salons because that is where other Vietnamese people worked. In other words, it was one of the few places they could get a foot in the door as untrained workers who barely spoke discernible English. Suddenly the Dat Phan comedy bit seemed a lot less funny.
“Why come to the U.S.?” I asked. “If you were a nurse in Vietnam, why immigrate to a place with few job opportunities.”
Her answer? She makes more here as a nail technician than a nurse in Vietnam, meaning she can send money to her family at home. And being here gives her two teenage children a better opportunity for employment as they grow up. In short, this woman gave up a job she enjoyed, to work in conditions she hates, in order for her family to have opportunities she never could.
Long after I wrote her note and sent her on her way, my Vietnamese patient lingered in my mind. Interestingly, the more I thought the more I realized she did fit into a stereotype, although I had placed her in the wrong one. Perhaps it is partially true to think that many Vietnamese immigrants are nail technicians. But I think the better way to look at immigrants, in all flavors, is with the lens of selfless hope they often bring with them, rather than the employment circumstances they often find themselves in. She, like the most tremendous among us, gave up her life goals in order to propel her family into a new socioeconomic class. That to me doesn’t fit the image the media promotes for immigrants, but rather the image I think of when I see working class mothers struggling for their family’s sake. And I think that stereotype, an example of the best that people have to offer, is a stereotype I can live with.
In less than two months I will graduate. It is a surreal experience. Just the other day I corrected a patient who referred to me as doctor, and it struck me that soon I won’t have to do that. Somehow I made it. And if I can, you can.
Medical school is a crucible; one I almost never made it to. Eight years ago I was working a job I hated in order to fund my outrageous partying habit. Through a series of life events I found myself facing a crossroad, asking “what am I was going to do that will make some difference in the world?” It was then that I found medicine.
No one thought I was serious when I said I would quit my job and go back to school. I wasn’t even sure of my sincerity. But I did it. Soon the late nights at the bar were replaced by late nights in the library. Alcohol was replaced with coffee and energy drinks. I practically moved into a local coffee shop.
During undergrad there were times I struggled. One particular day, while stressed out and on the verge of giving up, an advisor told me I might want to reconsider med school if I could not handle the stress of undergrad. A year later, I was criticized for accepting admission to my state school because I “wasn’t aiming high enough.” And when I inquired about getting an MPH in medical school I was told by multiple sources that I would not be able to handle two degrees in 4 years (most programs require you take a year off, which I did not want to do).
This May, after 4 years of medical school, I will graduate with my MD and my MPH. I have multiple journal publications. I have held positions on national committees in organized medicine. That’s not bad for a guy who “wasn’t aiming high enough.”
I am not a role model for anyone nor am I here to speak of my successes; I am just a guy that survived the experience. At every step of my journey there have been people who have tried to temper my goals with their doses of “reality.” Each time, those predictions have proven to be false. I want to share with you, the med students and pre-med students who read my blog, that you are the master of your future. I am proof that you can make it when everyone around you suggests you can’t.
Your life is just that, your life. You cannot let anyone or anything else dictate where it is headed. Maybe you had a rough past. Maybe your parents say you can’t make it. Maybe your scores don’t seem high enough. But what ever you want to do, you can do it. The world abounds with stories of individuals overcoming odds.
My point is this: I, an ordinary and unexceptional person, made it to, and through, medical school. I promise you, if I can do it then almost anyone can. Talent only gets you so far. If you have the drive, the passion, and the work ethic then you can do whatever you set your mind to. No matter who says you can’t, you can.
how to be an awesome med student (and your intern’s best friend)
students are a precious commodity in the intern world. A good medical student
makes it a lot easier to get through the day and get all the jobs done. But it’s
a fine line between being a clingy medical student and a helpful medical
student, and one that’s difficult to work out. So, this is my wish list for all
my future medical students – do this and I’ll be indebted to you for life.
for our number and give us yours. I’m always happy to be texted by a keen
medical student who wants to put in lines and take blood and clerk patients. If
you let me know you’re free, I’ll let you know how you can help. Just don’t page me. Interns are perpetually
one page away from a nervous breakdown.
carry files on ward rounds. I know that you’re not a human bookshelf, but there
are a lot of files and I only have two hands. Any help here is greatly appreciated,
and extra points if you volunteer to write notes. It lets me give my hand and
my pen a break!
to love the list. The patient list is the most important thing an intern has,
and we need our medical students to value this. Whether it’s writing down jobs
on the list, helping us type it up, or keeping track of the registrar’s list
(he or she will inevitably misplace it), your contribution is noted and
questions. Interns are fresh out of medical school and know a lot of things. Most
of the time, we’re happy to answer (and it makes us feel like we might actually
be semi-competent doctors!). Just pick your moment – over coffee is good.
During a code blue is not so good.
to do practical things. An IVC resite can take half an hour. If you volunteer
to put a new drip in (or even put an IDC in!), we will be forever grateful. I’m
even happy to supervise whilst you do it – it gives me a moment to sort through
my pages and even delete a few).
that you’re going to be an intern soon – and internship means paperwork. The
more you can help us with our paperwork, the better prepared you will be for
your internship, and the more likely we are to pay you in coffee.
the interns are busy, ask us for patients to clerk. I love it when medical
students show an interest in my patients and in learning – do this, and I will
always listen to you present your findings. It’s a good skill to learn, and it
shows that you’re keen to be a part of the team.
I know this
sounds demanding, but spending time on the wards with your intern not only
prepares you to be a junior doctor, it gives you a lot of hands-on experience
that you can’t get from your physiology textbook. And the more time you spend
on the wards, the greater your chances of being rewarded with coffee.
Strict old anatomy prof: How was your weekend? What did you do for Valentine’s Day?
Me: Studying. Nothing particularly special.
Anatomy prof: Ohhh… No boyfriend? You know, other people would say, “oh that is a shame,” but why should it be? WHEN YOU ARE A SURGEON, YOU CAN MARRY THAT LEONARDO DICAPRIO OR WHATEVER HIS NAME IS AND HE WILL WANT TO DIE FOR YOU, BUT HE WILL NOT DIE BECAUSE YOU WILL BE A FANTASTIC SURGEON. *slaps me on the back and marches off*