A Blog About An Asian Medical Student. Yes that's redundant.

Monday, December 29, 2008

QUOG: Breaker High is the Greatest Teen Drama Ever.

Started Ryan Gosling's career.

Who's with me!

- David

Sunday, December 21, 2008

David Poon and the Road to Medical School: Bedside Manner

I would make a phenomenal nurse.

I mean, I've already been a cheerleader. That means I have experience being the sole male on a team of sexy uniformed girls. Fantasy stuff in the making.

Cept Canadian nurses don't have that outfit those Chinese nurses have. They wear scrubs. I mean, yeah, they usually suggest that the chick is going to get covered in body fluids, but um... not in the hot sexy kind…

And uh, high school's the limit for the sexy cheerleaders, and um, well – retirement is the limit for the nurses.

Totally opposite of sexy.



I don't want to be a nurse anymore.

But I was making a point somewhere along the way.

I think I'm phenomenally good at holding a patient's hand and asking them about their life.

But for actual doctor work? Wow, am I ever shitty.

I've reached the point in my medical training where I am called an intern, which is essentially playing doctor. Not playing doctor like that one time with that girl in kindergarten when I almost (almost!) got to touch her tummy but then her mom came in and then I didn't get to touch her tummy. But playing doctor in the sense that you do everything a doctor would do, and then a real doctor (a 'preceptor') checks out what you did. Points are accumulated in the form of the preceptor telling me you did a good job, bonuses if the nurses like you, and you should (literally) score everytime you tell a girl "I helped save a life today." Of course, like any game, I always end up losing.

Currently, I'm working in the cardiology ward, the area in the hospital where we deal with heart patients. Given my premed dating life, I should know broken hearts pretty well. I should be getting straight As, heck, even triple As… just not in my patients. (Med humour… a AAA, or abdominal aortic aneurism is a medical condition).

Maybe I would be lookin’ pretty good on the wards if I wasn’t posted with arguably the best medical student in my class. My preceptor would ask us…

“What can you tell me about the patient’s heart, Smartest Medical Student?”

“Well you see you’ve got ST elevation in leads V1-2 suggesting a septal myocardial infarction probably caused by the coronary artery disease affecting his left anterior descending coronary artery that…”

“Wow, very good Smartest Medical Student. How about you David? What can you tell me about the patient’s heart.”

“Um… his girlfriend dumped him. So he’s in a lot of pain. I talked to him earlier, he’s sad. Also he likes the colour green.”

“…”

Yeah, I really dropped the ball at the hospital.

There was one patient who had to go for a heart imaging study, a MIBI (properly 2-methoxy isobutyl isonitrile), which sees how much blood getting to your heart when you’re physically active. To paraphrase…

“Hello, my name’s David, I’m the medical student is supposed to take care of you. Can you get into the wheelchair so we can go to the test?”

“No no, I can walk. And you’re so nice, you’ll let me right?”

“Um, yeah. I’m a nice guy.”

“Oh I like you.”

(5 minutes later)

“David?”

“Yes Dr. Preceptor who is evaluating me and has the power to say whether or not I’ll be a doctor?”

“Did you not put your patient in a wheelchair?”

“Um, no.”

“You realize she could have a heart attack from walking.”

“But, she said she could!”

“You realize you’re the doctor, right David. She’s not.”

Sigh, sometimes I wish I were a nurse. If the patient disagrees, I can just say ‘Doctors orders, if it were up to me, I’d let you eat that fried chicken.”

One of the common complaints against physicians is that they simply don’t care. An example is that they “always” interrupt the patient. I think the stat is something like the patient will speak for a grand maximum of 15 seconds before the doctor interrupts with another question. It's also the notorious number 1 reason doctors are sued. An inability to communicate becomes big trouble. I should know since every time I shop in Chinatown I get ripped off. Love you longtime my ass.

Me? I never do that. I care about what the patient says.

Course I end up listening about their Mom’s knitting for Christmas for about an hour, but hey, I can study medicine some other time. No rush, not like they’re going to die.

Oh wait…

Bedside manner is a term used to describe a healthcare provider's ability to speak, relate, and communicate to patients. It comes from, I assume, the fact that doctors, nurses, pharmacists, and nutritionists typically speak with hospitalized patients at the bedside. The best bedside manner is likely a physician who makes the patient feel comfortable, understood, and human.

So really, the physician is like a friend who takes care of you.

Except we’re taught to keep a boundary between our patients and ourselves, called “professionalism” officially, but really personal distancing in practice. Probably has something to do with preventing us sleeping with patients, but if Grey’s Anatomy has taught us anything, it’s that the hospital is very much a burlesque house. I think we’ve all seen pretty terse, almost cold physicians who seem to only want to spend the bare minimum amount of time with the patient. Family physician billing codes actually reward doctors who see the most patients, not spend the most time with them. But really, why can’t we be our patient’s friends, why can’t we spend more time with them, what’s wrong with a little chit chat?

Why can’t we care about the person, not just the disease?



I saw someone die today.

It was a revelation.

Not only because it was the first person I had seen whose TOD (Time Of Death) was called before my eyes, though that was pretty important too.

Not only because it was the first time I had gone to a “code” (officially “Code Blue”, when someone’s heart stops, aka “cardiac arrest”) though that was pretty important too.

And not only because it was the first time I did chest compressions, and saw the patient’s unable to breathe, move, or close his eyes, though that was really important too.

It was because I saw how calm everyone was. One physician even pulled out his iPhone to show something to a colleague. A man’s life was in danger, and everyone seemed so… relaxed.

To summarize what happens when a code is called, first an announcement is made in the hospital. So “Code Blue, 5G4, Code Blue 5 Golf 4” s announced, where suddenly the closest available physicians, nurses, and emergency responders go quickly to the room. Students like myself are allowed too. Something affectionately called the ‘crash cart’ is brought in, that has medications, syringes, a defibrillator (that awesome machine that you see on TV that someone yells “CLEAR” before heroically electrocuting a heart back to life), among other tools. Cardiopulmonary resuscitation (CPR) is typically administered, which is that other TV friendly motion where you heroically press down repeatedly on a person’s chest to get blood flowing though the body.

Until today, I’d never done CPR on a real person. We have to keep a certain rhythm, which we taught was exactly that of the aptly named ‘Staying Alive” by the Bee Gees. Which (don’t tell anyone) I was singing in my head while doing CPR. It was actually really cool.

Until I looked at the patient’s face. The man’s face. A person’s face.

Head tilted, eye visible, open, empty, alone.

Under my hands.

Lifeless.

There’s a character on ‘Crime Scene Investigation (CSI): Miami,’ one of my favourite TV shows, who is what is called a forensic pathologist. This is essentially an MD who specializes in the laboratory examinations of the body, to assess criminal causes of harm. ‘Alex’ has a habit of saying something to the likes of…

“Oh Horatio, the victim was so young… so young… why do they die so young... young and innocent. (touches dead teenager’s face) The young are so beautiful, even when they die… which is sad… because they’re young…”

… effectively bleeding her proverbial heart out so much that she contaminates the entire damn crime scene. And for those who don’t watch ‘CSI: Miami,’ Lieutenant Horatio Caine is the main character, and the television equivalent of me – tortured complex inside, macho cool with the sniper aim awesome on the outside. On that note, anyone questioning my choice in TV shows should remember my taste for Latin women.

Actually, on that note, anyone questioning my sniper aim should see me on a date… I can show you.

But that kind of heartfelt compassion from a doctor is probably just on TV. Now, in the real world, my Mommy is the most compassionate doctor I have ever known. Admittedly, I’m biased cause I love her like a mother, but she honestly wholeheartedly feels for the patient with an empathy I can only admire. As a family doc, she earns money by the number of patients she has seen, not how long she has spent with them. Yet, I’ve seen her hold a patient’s hand for what seem like hours, comforting, listening, and most importantly caring. While professionalism standards today have effectively nullified this concept, she had always considered her patients her friends, more than just her billing codes. Yet even she scoffs at the character Alex, saying “I cannot stand her. So fake.”

Since the only time I’ve ever heard her say that was the last time I brought an Asian girl home (zing!), I admit this surprised me. The Alex character took the time out of her day to lament over the patient, talking about the cruelty, the indignity, and the horror of death. In the show, this tortured sentiment eventually led her to leave her job and medical career with the CSIs.

I saw someone die today.

It was a revelation.

Not because I cared, though that’s important that I do.

It’s because I’m still affected by it.

After the code ended, and the patients TOD was called, the emergency team wheeled the crash cart out of the room, and got straight to the debriefing and paperwork. My friend, talking about the excitement and detail of the events with a colleague, turns to me and says “Well, time to get back to work!”

Me? I reflected on what I saw.

The time of death was well before 17:00, when I was supposed to leave the wards, but I ended up leaving about 2 hours later, well after my preceptor and buddy finished up. Why? Because I had to catch up on my paperwork, physical exams, and seeing patients. The number of mistakes I made after the code ended was ridiculous, I’m surprised I didn’t cause one myself.

Wait a sec – sorry, I should mention that my last hurrah was that, by the end of my day, one of my patients I was attending to went into atrial fibrillation (‘afib’). That means a part of her heart stopped moving. Didn’t get to the point where she needed a code to be called, but certainly something I didn’t see coming. Certainly something I should have seen coming.

And I would have, if I wasn’t so damn busy spending my time caring.

Someone I knew very well during my premed days once said something very offhand, and very profound to me.

“David, do you want a doctor who’s a good leader, a nice guy, or do you want someone who knows what they’re doing.”

Of course there are many out there who do both with tact, grace, and humility. But in the end…

… the human body itself is unaffected whether or not a physician knows someone’s favourite colour, the bands they listen to, or how long it is given a hug. Independent of how much, or how little, small talk is had before the physical exam, the body lives, or the body dies. It is the doctor’s role to move that course one way or another. The disease remains unchanged if the patient is hated or loved.

The patient will not care if you said “hello,” as long as you prevent them from telling their families “goodbye.”

The emotional detachment between the patient and physician is likely deeply rooted in the basic medical principle that you would never treat your family members. At first, it seems ridiculous, as one would think, “Who better to treat someone that I love than myself? I care about them the most!”

And then you realize you don’t want them to be hurt. You withhold the scalpel. You don’t want to see them vomit, you stop the meds. You want to be nice, you let them take the stairs instead of the wheelchair.

Suddenly, you’ve stopped providing care. You just care too much to give it.

Of course there are happy mediums, and of course care and treatment do not always have to be dogmatically opposite. But chest compressions famously break peoples’ ribs, cancers stop with amputations, and a doctor must remain emotionally unattached before they too are dragged six feet under. A physician is of absolutely no use to a patient sulking, remorseful, and despondent. When a doctor didn’t ask what you studied at school, he or she was simply too busy diagnosing your disease.

I was a bit of a mess after the code. I actually ended up losing a patient’s file, when I remembered that I had actually brought it with me to the emergency, leaving it on a chair before I started chest compressions.

I went back to the room.

The body was still there.

Head tilted, eye visible, open, empty, alone.

He was dead.

And I got out of the room quick, when I saw a woman talking with some of the staff. She was about to cry as she began walking towards the room I just left. I stopped in my tracks. Would I tell her that her loved one wasn’t alone as he was surrounded by staff? Should I mention that the school trains their doctors to have at least 30 seconds of small talk before beginning asking their patient’s medical questions? I’m sure someone visited his room to sing Christmas Carols, that’s gotta count for something.

He was dead.

I didn’t say a word.

The staff saw how distraught I was, asked me how I was doing. I muttered something before I went back to work. I wasn’t really thinking, and that’s going to show when the staff go read my work later on.

I’d like to think that I hounoured the man who passed away today by keeping him in my thoughts. But instead of letting his memory inspire, I’ve let it impede. And by no means do I want to diminish the value of life, but I will see many, many more deaths in my career, with far more exposure to the person than the 20 minutes I saw the man today.

I guess in short, I gotta brush it off. Shit happens. Who cares?

Before he left today, my colleague stopped by, watching me franticly play catch up on paperwork, sitting in some hall writing away. After making sure the patients he was treating were stable, he asked me how I was doing, told me I could call him if I needed to.

In the end, he let me know that he cared.

And that’s when it mattered.

That’s a revelation.

- David

David Poon and the Road to Medical School: I'm NOT A PREMED

The quickest, most accurate way to ascertain if a particular science student (in his or her undergrad) is a premed is by asking,

"Are you a premed?"

If the answer is something like, "Well, I considered medicine for awhile but am looking to finish my physiology degree and do research in peripheral nerve stimulation."

... this person is NOT going to apply to medicine.

If the answer is something like, "I am NOT A PREMED."

... this person is a premed.

This blanket, reflex-like, sanctimonious rejection of the slightest possibility is the cardinal sign of a premed. Counter intuitive obviously. But in my opinion, SUPER EFFECTIVE.

As I discussed in my above linked 'Premeds' chapter of the Road to Medical School, it takes quite a bit of courage to label yourself as someone who admits to wanting to be something else. If this label persists, it becomes part of your identity, and should you not become what you want to be (in this case Medical Student) then you're lost part of your identity. This is made all the worse because others (your friends, loved ones) had seen that as part of you too. At best they have to see you in a different light - at worst they pity you for never having fulfilled your dream.

I'm reminded of my premed days the most strongly than I ever have since my med interviews two years ago.

Some of you have been faithfully following the POON blog during my decent into madness. I've been live updating:

http://www.facebook.com/note.php?note_id=46649360827&id=120408269&index=1

To chronicle some of it. I feel a little better when I'm typing out my thoughts.

But the one thing I haven't wrote out, the reason for my apparent breakdown, is not going to make it onto the web. I'll know by tomorrow if I'm going to say anything about it. I'll give you a hint - this happened about last year around my sister's super sweet 16th birthday party.

Why not talk Poon?

Because I'm afraid. Like every good premed (sorry, "NOT A PREMED) I have come to a point where nervously admitting that I have dreams means nervously admitting that they can be broken. In my most personal moments, I can handle it. But, real or not, I cannot handle:

"Oh, I'm so sorry David."

Don't be. Please. My mistakes are my own. It is incredibly difficult to admit inadequacies, but to be pitied for them (conscious or not, misunderstood or not, sincerely or not) is something I cannot do.

I believe we all have that gravitational feeling, the moment once we learn something that we could feel in our hands leave our possibilities. I had to explain once to someone very close to me that this feeling almost never leaves me. It's a dullness in the gut, a persistent void holding me in. It's just getting worse over the next couple hours.

Hope is not the same as dreaming. Hope is essentially something you wish would occur, well outside of your control.

"I hope to win the lottery"

A dream however is something that you believe (keyword believe) is within your control.

"That's my dream house! Someday I'll earn the money to buy it."

Don't dictionary me to death. That's how I interpret those words.

Failures happen regardless of effort. It is ignored by the complacent, but it destroys the dreamers. Much talk is made of persistence, determination (I have built my entire academic career on these principles). But failure is very much a concept made by the dreamer - one doesn't fail unless there are expectations. And who expects more than the dreamer who actually believes?

Last year my sister's birthday was beautiful. I ruined alot of it because of my own deficiencies in the aforementioned, unspoken topic these series of notes are based upon. But she was beautiful, it was beautiful, it had all the future in the world.

She makes a wish and blows out the candles.

Like the rest of us, she doesn't say what she wished for.

- David

David Poon and the Road to Medical School: Disordered Thought

Firstly, last weekend I got to have a wonderful time singing karaoke.

I know, you're thinking, 'Obviously cause you're Asian.'

Hah hah, real original.

Living in an international residence, there were only THREE orientals. The rest a mix of sombreros and hijabs. I naturally had to give into my unhealthy pop star infatuation and turn up the Enrique.

Enrique Iglesias, for the heathen of you who don't know him, is the musical equivalent of raw, unbridled sexy passion.

Really, the Latino version of me.

I naturally give my heartfelt, heartachingly, hearty rendition of 'Escape' which brought tears to the eyes of no less than 7 people in room, and breaking the wineglasses of about double that, where a girl approaches me...

"David, that was amazing!"

"Hi, um, who are you."

After finding out that she studies medicine, I thought I finally found a friend in my profession at a residence overpopulated by students that say "I study arts because" as if to justify their existence to a world that simply never questioned it. She is an international medical student from Holland, so I was sure that we had much to learn from one another.

I thought I'd share the good news with her:

"I study medicine too!!"

"Hah hah, you're so funny!"

"Um... no, seriously."

"Hah... hah... what?"

"I'm in my third year of medical school. I know some of the people at the department you're doing research in. (Gastroenterology)"


"... they let people like you in?"

"Shitty eh?"

(get it? Shitty?? Cause she researches Gastro)

After that brief exchange, my favourite Korean Boy Band gets on air, for which I naturally am compelled to get onstage to perform.

Again, for the heathen of you, Korean Boy Bands are the only acceptably attractive Asians you will find in popular culture. Everyone else is too cross eyed or simply too much of a comedy icon to be considered anything else.

This performance only further exacerbated my image of an exceedingly beautiful voice of an angel, far too brilliant for mere medical school.

...

Fine. It was a ballad of my trademark high pitched, prepubescent cracking voice. But it was awesome.

...

So once I finished, I continued my discussion with the girl.

"So um, why can't you believe I'm in medical school?"

"Hah, you're funny."

"No, really. Hey you, ethnic kid I know across the room."

"Si senor?"

"Am I in medical school?

"Si si, medicino si."

"Proof enough?

Turns out her perception of us Canadian medical students was that we were geeks. But I, wasn't.

^-_-^

Readers, mark down the one moment in history where David Poon was NOT considered a geek.

Also, mark down the one moment in history where David Poon was LIKED for not being a geek.

Truly Holland is a remarkable place. Apparently me knowing every word to 'Larger than Life' squealing Enrique louder than a gay Mexican, and dancing like a Korean being tasered makes me not geeky.

In Canada, it makes me a virgin.

My sister and I were at a family reunion of sorts about 2 years ago. I was at a table meeting cousins for the first time in my life. My well dressed relative mentioned to the other people that I, Mr. Tie Fell Into the Curry, was also in his medical school class.

One cousin asks my sister,

"Is he really in medical school?"

"Yes."

"..."

"Something wrong?"

"That guy. The one who's putting tonic water on his tie."

"Yep."

"In medicine?"

"Serious."

"Your brother!!? THAT GUY IS IN MEDICINE!?!?!?!"

"That guy is, but don't call him my brother so loud, you'll embarrass me..."

NOTE: Starting here I go back into 'Crazy Poon Writing Out his Unfiltered Thoughts Mode." I'm ranting just to relieve some stress.

Secondly, you know, every once in awhile (in between complaining about blood and needles and talking about how much med is the worst profession) someone, for reasons either sympathetic or (more commonly) self righteous, ask me

"Poon, what's your problem with medicine?"

Medicine is an easy way out. From my experience as an Asian kid born of two doctors, it was essentially expected that I go to medical school. Everything else, was simply an 'interest' or hobby.

Think about many of us, premed and med student alike. It's as if we only know one thing, one skill, can talk about one topic. Place a few of us in a room and within minutes the topic falls to seemingly the one thing most important to us.

I've hung out with Engineering and Business students a far bit, and it always astounds me how long it takes for them to reach that school related bottom of the conversation barrel. But us?

"Med med med med" (or for the premed), "getting in getting in getting in."

Maybe I am alone in this, but this line of thinking, focusing on one subject, allowed me to eschew a real challenge of life - decision. The arduous process of getting in completely blinded me to the opportunities that choice allows in such a country as Canada.

I'm reading up on Craig Kielburger, a 26 year old Order of Canada member who started 'Free the Children' when he was 12. His record at such a young age astounds me, and allows me to put my life into context.

I am not so arrogant to believe that I could ever be as good as this man. But I do honestly think I should have expanded my horizons beyond simply medical school. And one could argue I had all the opportunity to do that. I know. Stupidly, I followed a seemingly one lane Road to Medical School.

I could have taken a detour, I know, I cold have driven off road. But the 'getting in' mentality allows for one thing - becoming a medical student as quickly as possible.

I rarely talk about my accomplishments, but a quick look at my resume would typically alert readers to my rather diverse interest, from my business team at the UofA, to my amateur debating career, to my FABULOUS time as a high school cheerleader. I have been involved with an international business organization for 3 years, founding my own team 2 years ago, competing nationally as the only medical student team president in the country (perhaps even North America).

My business colleagues, they get funding to compete in Toronto with me. I don't even get excused absences.

This year, a professor announced to my class that 'Medicine sucks the creativity out of you."

That was one lecture in med I truly could relate to.

The culture of the MD is such that you must want it so much that the sacrifices you made to 'get in' are no longer a problem. That means you no longer miss what you've lost, because you neglect it as part of who you are. But that portion of your soul that no longer has time for your hobbies? Easy - fill it with medicine.

Look, I know there are many successful MDs who do other things than just medicine. Vincent Lam wrote a Giller winning novel, and two doctors started Bioware, the company that makes the phenomenal Mass Effect video game. I went to see Dr. Lam talk, and he does less and less medicine as his book becomes a TV series and he continues his amazing writing career. Dr. Muzyka and Dr. Zeschuk no longer practice at all, busy now as Vice Presidents of Electronic Arts, one of the largest video game publishers in the industry.

The correlation I see is that these men found greatness once they left the boundaries imposed on them by a hierarchical, rigid, self regulated system placed upon those in the medical community today.

I had a wonderful opportunity to speak personally with Dr. "BEST VIDEO GAME EVER" and I asked him what was the point of getting his MD. He said that maybe some of his analytical thinking, thought processing skills had helped him. And certainly working the emergency room to pay for his company in the first, unprofitable years helped keep Bioware afloat.

At Dr. Lam's talk, I will always remember him telling us: "Two careers." That was good enough for a doctor.

Every time I bring up my business interests, I am either greeted with sheer disdain (followed by quick, unyielding, unwanted remarks about "two tier health care") or the aggravating, more typical "But you're in medicine!"

Recently, a preceptor told me I cold talk about personal stuff with him. I told him about my various interests, and why the faculty gave me a day off from clinic duties. Later on, he told me that on my evaluation, he is going to write he is concerned I may be doing too much.

Why must medicine be so self contained, so self regulated to the point that it must be seen as sacred, to be kept untainted by anything else?

I have made it less and less a secret that my goals now include getting a law degree. Most people think I'm joking when I tell them that. Maybe for the above reasons.

I've met a few lawyer/doctor combos. I get a pretty standard answer:

"As a lawyer, the MD is invaluable knowledge. But as a doctor, that knowledge in law isn't very useful"

But why isn't it? Why aren't expanded interests a hallmark of a great doctor, instead of a sign of an unfocused one.

I'm not saying my thoughts are perfect - I realize they are flaws. But I'm so often told I shouldn't even be in medicine.

Maybe I shouldn't.

But why not?

- David