In Uncategorized on July 13, 2014 by David

I started residency this past month, and while I can tell it is going to an enormously fun and growing experience, I want to put into words my fears. The more I can articulate it, the more I can mediate and avoid it! Residency will be a big part of my life, but I can’t help but think that there are both positives and negatives. Don’t worry – this is only one of a two part series (the second one will be the positives!).

I am afraid that I will get tired.

I am afraid that I won’t find passion in the work I do.

I am afraid of looking stupid.

I am afraid that I will work so hard that when I get breaks or vacations, I won’t know who to turn to hang out.

I am afraid that I will cut corners.

I am afraid that I won’t know who to turn to when I am suffering.

I am afraid that when I look into the mirror, I might see someone I don’t like.

I am afraid that I will lose sight of God.

I am afraid that I will forget how to talk about anything other than medicine.

I am afraid I will get callous.

I am afraid I will kill someone.

I am afraid I will take a patient’s death poorly.

I am afraid I will be lonely.

I am afraid I will be unable to relate to other people and that other people won’t be able to relate to me.

I am afraid that I am investing so much into something that might make me more unlovable.

I am afraid I will continue to step on the escalator to mindlessly apply for more fellowships, accolades, and projects without examining where I want to be in the next few years.

I am afraid I will be unhappy.





In Uncategorized on March 31, 2013 by David

Spend an hour writing each day.


My goal in March was to spend an hour writing each day.

Looking back, I rarely spent more than an hour writing each day – that goal was unattainable and overly ambitious. Like all goals, sometimes life would get in the way. I revised the goal to be to write everyday. It’s often the initial activation energy of starting to write, or being intentional about finding something to work on, that took the most effort. When I felt like I was in the mood to write, it became easier to keep going. Occasionally, when I had an interesting idea or a thought to complete, an hour or two would just fly by.

My writing was rather sloppy, in part because I felt like I was working towards a goal. I didn’t edit very much, even when I wasn’t satisfied with my writings. When I felt tired, I would just end the day with some train-of-thought, unstructured musing just so I can say that I fulfilled my obligation for the day. I answered questions on Quora to practice expositional writing, and also put in time to work on a manuscript. I need to be more disciplined next month.

March Writing Goal


19/31 = 61.2%

I will need to make up 12 days during next month. It’s a good thing I have some vacation next month – I wouldn’t be able to make up this goal and start on my next goal.

My goal next month is to read non-academic material continuously for 45 minutes each day.



Reflection on Surgery: Rotation 5

In Uncategorized on March 18, 2013 by David

Have you ever had the feeling that the whole world is a blur? When I walk home from the library after a long day studying, my feet often feel clumsy and I seem dazed, unable to take in what’s before me. As if my eyes became deconditioned from studying, everything feels blurry and surreal.  Everything is the same, but also strangely foreign – like opening your front door after getting back from vacation and seeing your keys and junk mail scattered across the kitchen counter. It’s like waking for a long nap – but I are still tired. There’s nothing inherently uncomfortable about this feeling, but it feels foreign. That’s how I felt after finishing surgery. Life feels foreign. As I took my car in for an oil change and did minor shopping this past weekend, my feet felt clumsy and I seemed dazed.


This was the first rotation that I did not feel joy. I did well on this rotation, but even that does not make me to see the rotation through rose tinted glasses.  I’ve always felt a masochistic joy in working hard, in willing to bear more pain and suffer to be prepared and shine when the opportunity arrived, but this time was different. Not that I shied away from hard work or that I didn’t learn a lot, but I did not feel appreciated. In fairness, my sense of helplessness, of lacking joy in my work, was more psychological and self-imposed than due to external factors or particular circumstances.

I am an ambitious person, and this is just another example of how my ambition is not healthy – it drained the joy from my work. I knew that this rotation was my chance to make the cutoff for AOA consideration and to qualify for a good MSPE – to that end I worked myself hard. I worked in a way that was in some ways excessive, which took away the joy from tasks that I honestly would have enjoyed. Surgery is actually really fun – being in the OR is very empowering and it is satisfying to tangibly help patients. I really enjoyed the ENT cases, and the resident was both willing to teach and extremely kind to me. Working my hands, learning tangible skills, and becoming a craftsman are all admirable things, but things that got overshadowed by my need to look good in front of others. My hands were clammy and slow when the attendings watched me tie knots.   I got to first assist on a really exciting neurosurgery case –doing almost half of the cranioplasty, but in the end, I did not feel that my personal reward/benefit balance was met. There were definite momentary highs, but the caveat was long periods of drudgery and excessive hierarchy.

During this rotation, honestly small injustices festered in my mind. I put on a mask of joyful work, but there were some residents where I did not respect and whose work ethic I felt put patients in harm. Rounds often lasted just a few minutes per patient, while the resident just ran through the motions, barely glancing at the patient and ignoring me while I rushed though my presentation. It did not feel like the surgery residents did not like being in the hospital outside of the OR – they rushed to finish notes on the floor and skim through patients to run to the OR.  In my hopes of pleasing everyone and upsetting no one, I did not speak up when I felt injustice. They are clearly talented in the OR, but I found the peri-operative care lacking. Even when it was time for feedback, I was timid and did not say what I wanted to say – that you made me feel small, unappreciated, and not part of the team. For the sake of my ambitions, I kept quiet at the bottom of the totem pole. This was particularly discouraging to me, as I once thought and still believe that “the measure of a man is a how many uncomfortable conversations he can initiate.”

In honesty, I am too ambitious for what I want in life – I need nothing more than a good family, good friends, and good community – but I want to be respected and appreciated. Although sometimes I can mask it, I am socially awkward, and subconsciously try make up for that by excelling at work. Although it’s not true, I unconsciously feel that if I throw myself at my work and excel at a craft, then at least people will respect me. I do not mean to work so hard, but when the rewards of studying one extra hour is so tangible compared to spending time reflecting or hanging out with friends, I take the easy choice out.

Going to the mechanic reminded me how awkward I feel when I am out of my natural habitat, speaking with someone I don’t know. Not that I did or say anything awkward, but I just felt so out of my element. When asking for the price to get my oil changed and waiting in the little lobby while people worked around me, I felt borderline autistic – extremely uncomfortable at making eye contact and at a loss about current events. When was the Super Bowl again? Was the 49ers playing? Did we win or lose? Was I on call that weekend? It was strange to watch the person work, but it was also uncomfortable to stare at my shoes. I know nothing has changed since I checked my phone a minute ago, but I can’t help but flip through my texts and facebook. I’ve honestly forgotten what to do when I have nothing to do.

It seems strange to think that I now feel more comfortable in clinic than having nothing to do and walking around a shopping complex. Part of it comes from predictability and having pre-defined expectations about what I should be doing, but after a year of having my actions continuously evaluated – I am done with that. Third year has been a tremendous experience – one that I am still trying to unravel, digest, and evaluate – but as I take a step back, I cannot forget that there’s a world past school.

I have a goal for every month this year. March’s goal is to be more introspective – to reflect about my past actions and my future goals –  and to write an hour a day. I’ll report back on my literary progress at the end of the month.


Ephesians 6:5-8

In Uncategorized on February 3, 2013 by David

5 Slaves, obey your earthly masters with respect and fear, and with sincerity of heart, just as you would obey Christ. 6 Obey them not only to win their favor when their eye is on you, but as slaves of Christ, doing the will of God from your heart. 7 Serve wholeheartedly, as if you were serving the Lord, not people, 8 because you know that the Lord will reward each one for whatever good they do, whether they are slave or free.

I remember talking with Jon Huang a few years back, when I went back to Houston for winter break as a first year medical student when he was a MS3, and he shared this passage with me. I was asking him what third year was like, and what kind of advice he had. I was still on the emotional high of starting medical school – everything was still new, just being in the hospital excited and terrified me – and I was confused when he shared with me from Ephesians.

Slave? What is this? I’ve never thought of myself that way. I’m smart. If I have a problem with something, I will ask questions and confront them head-on. I’m sincere, why would people be mean or unfair to me? Even I am not particularly impressed with someone, I haven’t really encountered any unfairness or anything that a frank discussion wouldn’t help overcome. I didn’t feel oppressed – it is a privilege to be here and learn.

This year, as I jumped into third year, I worked harder than ever before. I woke up earlier, read more, and stayed later than I had ever before, all in the hopes of showing off and impressing the residents and attendings. I was not afraid of being scutted out – when other students complained about doing small tasks, I thought, what’s the big deal? It’s part of the hierarchy, and if I do more, maybe they’ll like me more and they would have more time to teach. I am trading work for learning. That’s just how it is. But still, what is this slave nonsense? I didn’t understand.

But 5 weeks into surgery, my resolve is starting to crack. This is the first time during third year when I feel like I can just do nothing right, and when there is injustice, there is no recourse. I felt invisible, forgotten when the team went to run the list and to eat breakfast together. There wasn’t anyone looking out for me, even as other students were afforded the opportunity to do more. Even as I broke eighty hours for two of the last five weeks, purposely choosing the most intense call schedule so I have more exposure, I feel like I have learned less than even on the light schedule of psychiatry.

If I am to be objective, this year has been a year of serving earthly masters. I strain so much to curry the favor of residents, chiefs, and attendings, that I have lost track of my purpose and my goals. Why am I here? What is the direction of my life? To be honest, I wasn’t bothered too much by it at the beginning of the year, when I felt like I was getting fair results for my hard work – but it only by grace that I am again reminded of my brokenness. My frustration stems from my brokenness, and my unwillness to set aside worldly ambitions. I am a slave to my brokenness, shackled by my pride and ambition.

For some reason, I was really reminded of this passage from Ephesians this morning, even though it wasn’t the topic of the sermon. I am reminded how my self-perceived strengths are my greatest weaknesses, and I am how distant, far from where I want to be.


Reflection on Neurology: Rotation 4A

In Uncategorized on November 17, 2012 by David

Neurology. Axons. Neurons. Cyclotron. Photons? Wontons.

Haha. OK. Neurology was fun. I really enjoy inpatient services, and this rotation was very similar to medicine – except instead of ABGs, I got to do LPs. 3! Haha. I like doing small procedures – my last one, I did the entire thing, start to finish, without any help. I really enjoy being the primary team – the hospitalist experience. It was more focused than the medicine rotation, so by the end of the rotation, I felt much more comfortable with the field. Our service was awesome – I got to see everything from West Nile disease to Creutzfeldt-Jacob (so rare!). The team was awesome – everyone was very passionate about teaching and I really felt included in taking care of the patients.

This year has been about growth, and while everything hasn’t gone exactly as I had planned and hoped, I am happy with the direction of my progress.  Compared to my first rotation, I was more comfortable formulating plans for my patients and trying to anticipate problems with prophylaxis and diet. It’s hard to believe it was only 6 months ago. Not much to say here today. I will relax before starting Psych on Monday. 


Reflection on Anesthesia: Rotation 3.2

In Uncategorized on October 16, 2012 by David

Anesthesia was great. I got to do more with my hands – more procedures, intubations, and IVs in two weeks than six months of the rest of the year. I think it was also really exciting to learn about physiology and to see the various types of surgeries people underwent – without having to scrub in and not be able to scratch your nose for 6 hours. The hours weren’t too bad – I worked really hard, but in general was still able to get in at 6 and finish by around 5. It’s actually quite nice to leave work and still have the sun out. I kind of missed that.

One thing I do miss was that it wasn’t as intellectual as internal medicine. You know what the patient is here for and you know what you need to do for the patient – I missed asking leading questions and coming up with crazy differentials. The people seem genuinely nice, had time to teach, and enjoyed their work. It seems really superficial, but I felt anesthesia was more like nursing than being a physician. It’s really important to get the logistics right – to intubate well, have good IV access, and
One of the resident’s described anesthesia as the best of all possible jobs, but perhaps not the best possible careers. As a job, anesthesia is almost unbeatable. Reasonably good hours, get to work with your hands, do things that clearly affect the patient, and make good money. It isn’t too stressful and you get to be quite good and comfortable with what you do. All the signs of a good job.

However, there isn’t much room for advancement – anesthesia is not scalable. Anesthesia is rather mercenary – you are contracted by the hospital to provide a service, so there is limited incentive to provide better care or be more efficient. You aren’t the physician directly sought by the patient, so it is very much an ancillary role. You will be paid reasonably well, but there isn’t much room to go up, and there isn’t many paths that directly stem from your skill as an anesthesiologist. You have to be in the room, and a 10x anesthesiologist will not be 10x as efficient as an average anesthesiologist. As someone who is still young, ambitious, and foolish – it seems rather scary to me to have the same job for twenty years. I can’t imagine that I will have the same passions, priorities, and goals that I have now.

I think anesthesia would be a great career if I wanted to settle down, raise a family, and be able to spend a lot of time with my family. But it’s not a career to be hungry, take risks, and do ambitious things. I’m not quite where I am going to be. One thing that I realized after doing anesthesia is that it is possible to be physically comfortable, but mentally unsatisfied. I do not need golden handcuffs just yet – I am still hungry.


Time Lapse

In Uncategorized on October 7, 2012 by David

It’s strange to turn back and look at the distance traveled. It’s been five years since I graduated from high school, and it’s just uncanny to see both how much and how little people have changed. Last night was another brohaus party and it was fun to see so many of the TAMSters again.

In so many ways, people are the same. Paul is still loud and Deepyaman is still quiet. The mannerisms, the voices, and the laughs are still the same. Yet everyone has grown up – gotten more mature and more adult (almost, with Paul as an exception, lol, jk). It’s funny to see the same people who used to play ping pong now use the same balls to play beer pong. But that also shows more maturity – seeing everyone take care of that drunk girl shows responsibility that I could never have imagined five years ago. Ultimately, I think the people I met at TAMS are some of the kindest and most genu
ine people I have ever met.

It was fun to reminisce about past times – I feel like I’m going to become one of those old fogies who enjoy telling stories of past pranks and silly drama. Of when the seniors pulled the fire alarm before the junior’s biology tests or when someone went into our room and put yellow paint over Paul’s desk at night (I still have no idea who did that). It reminded me of so much I had forgotten – of politics in HOPE and silly girls. Guys played computer games and enjoyed TAMS – girls had drama and enjoyed TAMS less.

Seeing everyone made me a little introspective, wondering how I personally have changed. Talking to someone that I didn’t really know in high school, we somehow got to the topic of first impressions. She volunteered the fact that she thought I was arrogant – that she thought I seemed like a nice person back in high school, but after talking to me about careers and stuff for a while yesterday, she thought I was arrogant.

It’s amazing how sometimes the tiniest things stick with you – the whole day today, I couldn’t stop thinking about that. I do not want to want to become a prideful adult. If anything, that was my first and only resolution for third year – to be intentional about change and to remain humble. I think that stuck with me, in part, because I think it’s true. Insults that don’t reflect my true nature means nothing to me, but to hear something that echoes my own fears and worries was something that sticks with me. I too often am too proud of my accomplishments, even though I know I am where I am today due to a combination of serendipity and the support of those who took care of me.

I minimize the challenges that I have already overcome, although I still remember how excruciatingly difficult it is was to apply to medical school and how profoundly disappointed I was when I didn’t get into my goal school. I judge people based on where they went to school and made fun of caribbean medical schools, even though some of the people I most admire and wish to grow into came from humble beginnings. The comment stuck with me because it is true, and I am so very embarrassed. I acted in a way, if it was any other person doing that and I was an onlooker, I would say was arrogant.
I should be humble because I am here only because of grace, of tremendous serendipity, and of supportive family and friends.  I should be humble because the things that matter to me, things like my resume, papers, and projects are, in the long run, meaningless compared to the relationships I build and people I help. I should be humble because I should take credit for the things I do take credit for. I should be humble because whatever talents I have are overshadowed by the many shortcomings that I hide.

I remember when I was applying to medical school thinking that I should not go to a prestigious school, because that would make my head grow bigger, to the point of explosion, and that would outweigh any marginal benefit of better education. I hope I do not prove myself right. I will work on this.