Archive for the ‘Goals’ Category


My Greatest Fear

In Goals,Medical Musings on March 7, 2012 by David

This past week, we had our last FPC session of the year. In our small group this past year, we have talked about a lot of the most important issues, like our experiences with death, that we don’t have time to talk about during the clinical curriculum. As we transition to the clinical curriculum,  we were asked “what is our biggest fear/worry as we start on the wards?”  It’s hard to imagine that almost two years have gone by, and I will soon be starting in the hospital. As I am about to start on the wards, my greatest fear is unintentional change.

During first year, in FPC one of my classmates talked about her older brother. Now a transplant surgeon, she recalled how he’s changed throughout the course of medical training. He was recently divorced and now just throws himself at his work, without much to his life outside of this. She still remembers him as the kind, gentle, and intelligent person he once was, but her heart breaks for the kind of person he has now become. When his parents are sick, he is a great resource – able to consult to chair of the GI department when they have a medical problem – but over his caring core is an abrasive shell. Being an attending surgeon, in command of surgical field, one comes to develop an expectation of how the people around you will treat you – and this expectation bleeds through into the other, more important, relationships. For better or worse, medicine is a very hierarchical culture. You can be treated poorly by the people above you, especially as people are busy, tired, end frazzled, unfortunately, this normalizes this kind of behavior when you advance, and can affect how you act in other aspects of your life.

That is my greatest fear. To one day, look into the mirror and not recognize the person I have become. Third year will most likely be a busy year, and be over in just a blink of an eye, and I don’t want to wake up next year and wonder how did I get where I am. As we grow older, no one intentionally becomes arrogant, aloof, cold, or impatient, yet these are adjectives that we find can too often describe adults. If we are being honest, these are traits that can especially describe physicians.  In medical school, we hear stores of surgeons throwing temper tantrums when the smallest of things go wrong. A rock’s natural tendency is to roll downhill –  to go with gravity and slide in the path of least resistance. It is just too easy be complacent and without intentional direction, to slip up.

And unfortunately, that is my natural tendency. I am arrogant, too confident in my achievements and accomplishments, even as in my heart I recognize that it not by my ability alone. I am impatient. The past two years, to my dismay, I have felt that my tendency is to be impatient. I am rushing for place to place to study.  I am too easily annoyed when I have to wait on others, yet ironically I am habitually late – making other people wait. Although I usually enjoy talking to people in passing, I find myself avoiding eye contact so I don’t waste time making small talk. As the next year to be even busier, I will need to consciously prioritize relationships and keeping up with people.

Ultimately, I think that my solution. To have meaningful change, I will need to prioritize and have goals. Next year will be the most challenging, the most tiring, and the most important year of my life so far. But in addition to all that, it will also be the best year of my life yet, the culmination of so much of what I have worked for so long. I will see, learn, and do so much in the next year. The next twelve months, as I study for the boards and then go off to the hospital, will be a stressful experience, but it is precisely this stress that is our impetus to improve, grow, and learn.

Originally written on 02/26/2012



Year In Review.

In Goals,Misc. on July 11, 2011 by David

It’s been a little more than a year since I came to San Francisco. I arrived June 10th of last year to start research. This past year has been the hardest year I have ever had. I had a difficult time adjusting to San Francisco, felt far from home and alone, and was not sure about my identity. I really enjoyed medical school and my new peers, but throughout the first year, I felt a sense of turmoil – a tension and conflict between who I am, who I seek to be, and how others perceive me.

Coming to medical school as an MD/PhD, I thought a joint degree would be an opportunity to delay choice. I both love medicine and science, and was not sure what I really wanted to what I ultimately wanted to pursue. I felt privileged to have this great opportunity, but for me there was the constant tension of the realization that to do something great, one would need to specialize and ultimately choose one passion. I hoped that over the course of eight years, I would be able to better understand myself and can reevaluate my choices and options. I thought a joint degree would give me more exposure to both science and medicine, and the tools to pursue both.

But having finished my first year in medical school, I have conclusion that a joint degree is not simply the sum of medicine and science training. It is something different – in the middle yet entirely distinct. It is not equal parts medicine and research, it is an intersection that can only be described as medical research that takes elements from both but also rejects characteristics of both. And with this training comes the implicit expectation that one would end up doing medical research, not medicine or research. Although not entirely explicit, I felt MSTPs had a subtle sense of disapproval for those who ultimately ended up in solely medicine or solely science, so many graduates end up in the twilight zone I’ve termed medical research.

For me, being MSTP felt like a source of constant conflict. When doing research, I dream about being back in school and in clinic. When bored in class, I daydream about what I could do with these idle hands back at the lab. There was a tension, partially driven by a sense of urgency in knowing that the training is so long and wondering why I am wasting time, but mainly driven by a sense of mistaken identity.

Truth be told, I never felt truly comfortable in the role of MSTP. They are big shoes to fill. I never liked it when there were jokes about MSTPs being smart. In fact, I actively disagree. I think MDs are no different from MSTPs in terms of ability, just a different in interests and background. I squirm when singled out as an MSTP, because with the title comes expectations. An expectation that I enjoy all kinds of science and all types of research, when in fact developmental biology and other vast fields of science bore me to death. An expectation that I don’t enjoy the “touchy-feely” stuff, although like science, there are aspects I really like. The conflict has struck at the very heart of me – ultimately, this past year, I was not sure who I am and what my identity was.

Conversely, If there is anything I am sure about, it is that one needs to focus to succeed. To have too many fingers in too many projects, one will surely fail at them all. Throughout both high school and college, I always got myself involved into many projects, many interests, and many activities. I had a hard time distinguishing “many” from “too many”. Although I was fortunate to never crumple under the weight of too many responsibilities – things always worked out, I see now that this is a sign of immaturity. It is a sign that I do not know what I am truly called to do. I reminded of a good quote – “beware the barrenness of a busy life”. Despite the constant pressure to be busy and productive, I will take the next month to be still, to be calm, and rest before I start again.

I have decided that life is too short to live by other people’s expectations. There is a quote that really stuck with me – “The measure of a person is a how many uncomfortable conversations he or she can initiate.” In fact, I am glad that I had a difficult year. I had the opportunity to grow as a person and more realistically solidify my self-identity and expectations for the future. The discomfort is only a sign of growth.

I look forward to living for myself again.



In Christian,Goals on July 1, 2011 by David

This week, Google came out with Google Plus (Google+) in an effort to challenge Facebook’s dominance in the social sphere. As people spend more time online interacting with other people they know in real life, the social internet has an increasingly important role in our collective consciousness. One of the main critiques of Facebook, one that Google seeks to distinguish itself, is the unwieldiness of having one all encompassing online identity.

The premise is that people act differently in different situations and with different people. You might send nerdy starcraft videos to your high school friends, share awesome pictures of surgery with your medical school classmates, and be professional with your professors, bosses, and co-workers. At its heart, I think the premise is true – our actions are products of both our environment and something internal – a fluid dynamic ‘identity’. Both in real life and online, our identity is in a state of flux, and our actions change based on our mood, social norms, and expectations.

But ultimately, what is my identity? Identity is supposed to be something that is inherent in oneself – that is constant across situations and expectations. In church, the pastor is going over a series seeking to define identity, in particular, what it means to have an identity in Christ. What is common to me? What is the whole of me, that is true regardless where I am and who I am with?

Outside of Christ, people seek identity in three main areas. They define themselves by what they do, what they have, and what they desire.

What I do: I am a medical student. I am one who has worked hard for many years for the privilege of treating people in need. I am one who has stretched oneself, and continues to stretch oneself to fit in this conforming standard of one who is compassionate, professional, intelligent, and authoritative. Ignoring Christ, I am one who is prideful – feeling that spark of pride when I wear white coat and can answer someone’s question. As a medical student, I am selfish with my time – in service, in relationships, and in many other things I am always nagging by this sense of “let’s make sure I’m not wasting my time”, “how can this help my career”, and “should I be studying now? Is this activity worth my time?”. Despite the best motivations, my career in medicine is not Christ centered, and despite my best attempts, I cannot put to death my worldly ambitions.

What I have: I am an Asian American. I come from an upper middle class household, with a strong nuclear family. I love my parents, my sister, with the fullness of my heart. Yet because of this, I am not willing to accept Christ. In Mark 10:37: it is written, “He who loves father or mother more than me is not worthy of me; anyone who loves son or daughter more than me is not worthy of me.” After reflection and contemplation, I think even in the here and now, that has not changed. I do not love the rest of the world, any of it or all of it, or even God, with the fervor with which I love my parents and sister.I love them because they have loved me unconditionally. My parents would love me regardless of what I do and who I become. I love my family because they have taken care of me when I am weak, when I am broken, and when I am distraught. When I feel abandoned, tired, alone, or isolated, I know that I am only as far as I am from my family. I do not feel the same love for Christ as I do for my parents and sister. Jesus’s love has never been as real to me as the tangible love that I feel from my parents and sister. Anything anyone can say about God and why they love God, is true, infinitely more true, for my love of my family.

What I desire: My desires are selfish. I desire a girlfriend. I want someone to celebrate my victories with me, and someone with whom to share my defeats. I want someone who share my ambitions, but also someone who does something completely different that I can appreciate. To be honest, I don’t know what I want.

To be perfectly honest, in many ways, I rage against this idea of Christian identity. In the things I do and the things I prioritize, I very much want to live for myself. For me, is Christ my identity – at the core of my being – or is it just a Circle – just a shell that I put on and off when I am in certain environments?


To My Sister

In Goals on September 14, 2010 by David

Hi Jessica,

As I start medical school here in San Francisco, I have been excited to meet interesting new people. In a class of 149 people, the UCSF medical class has a broad range of experiences, ideas, and backgrounds represented – and yet there are a few commonalities that seem to describe everyone. As I take time to reflect back on how I got to where I am, I want to take some time to share with you a few of the key decisions and habits that I see as being common to my class and other interesting and successful people.

In talking with my classmates, the first thing that struck me was how common it was to have people who went to the same high school meet up again in medical school. Often, there were people who went to the same middle and high schools and then different colleges or universities, but end up back together at UCSF. For example, here at UCSF we have only a few people from Texas (3 or 4 at most), but I have a high school friend from TAMS who is also in my class. More than just random chance, I think that there is something essential about the growing up process that happens at about middle school and high school – and this vital factor is necessary, maybe even sufficient for future success.

What I am trying to say is that going to the best college is not really that important. It’s too late to change an average person to an exceptional person. Don’t think that growing up happens in set intervals and in quick sprints. Don’t think that by getting into Harvard, you will become a super genius or be set for life. Don’t think that you will turn 18 and suddenly start thinking like an adult. You are gradually, day by day, changing and growing into the person you will be forever. Growing up does not happen quickly, but rather by pushing yourself in different areas, slowly and gradually. Day by day, you cannot tell that there is change and it is only when you take a step back and look far back when you will be amazed by how far you have gone. That said, it is important to have good goals. Goals and direction that is worthy of your time, because that is your most precious resource.

You might not think it now, but time is the most important thing we have and it is the most fleeting and precious. You cannot save it or store it, and everyone only has so much. The only way to capture it is to make good use of it through worthwhile goals. I’ve previously emailed you Paul Graham’s high school speech (it’s one of my favorite speeches), but I just wanted to reiterate how much I agree with it. The biggest regret I have (that everyone has) is how much time I wasted in high school. Unfortunately, it’s natural to waste time – to surf the web, watch mindless TV, and think about trivial things, but that’s what makes environment and friends so much more important. (Remember the start of my email, where I wondered why many people at UCSF went to the same high schools, and even the same friend groups?)

Of the things that are in your control, environment and friends are the most important. When we talked about applying to St. Johns, you mentioned that you didn’t know if you wanted to go because you were afraid that you would have to leave your friends right now – yet to me, this seems like one of its greatest advantages. You see, I think it is vitally important to be part of a community that cherishes and enjoys learning – and this is something that I don’t know if I see at your current school or with your current group of friends. Sometimes, our worse influences are our best friends. Friends, for better or worse, reinforce what we think is important and what we spend our time thinking about.

You see, if we were the same age and I was back in middle school, I don’t know if we would be friends. When I was in eighth grade, I was fat, selfish, nerdy, and never took care of how I looked. I had a lot of growing up to do when it comes to learning how to be humble, how to be a good friend, and how to play well with others. Fortunately, these are all really important areas that you are good at, and I am glad to see that you have many friends and care about them so much. But in addition to these flaws, I had my strong points. Because I was unpopular, I was not shallow. I could understand what it was like to be an outsider, and to this day I try really hard to include people who I see aren’t fully engaged in group activities. I had a passion for learning, and to this day I love the activities I got involved in at that age. Little did I know speech and debate or computer science could be important, but even as I continue to the path of a doctor, I am impressed by how vital and helpful they are. These are two traits that I think are absolutely important in growing as a person – yet I am I worried that these might be areas that you are struggling with.

You are pretty (or at least you think you are) and you are popular (or at least you think you are), but I want to ask you if you think that these are worthwhile goals. When you are my age or even older, do you think you will care about these things? It might be a waste of time for me to tell you that such attention to how you look don’t matter, but I will say that every time I hear mom describe how much time it takes you to get ready for school in the morning, it makes me a little sad on the inside. You might ignore me when tell you that popularity is not that important, but I want to unequivocally (state absolutely) say that it is not OK to try to pretend to be more popular by making fun of or disrespecting others who you think are less pretty, more awkward, or in any other way is an easy target. (I am reminded of how you treat Byron.) We will not be remembered by how cool we are, but by how we treat both our friends and our acquaintances. Good friends will spur us on to be more creative, to do greater things, and to try our hardest. Given how important your next few years are, a change in environment might be good for you.

Everyone is different and unique – we all need to walk our own paths – so I do not ask you to be as nerdy or studious as I was when I was your age. Science is an acquired taste, and we all need to acquire our own interests and passions. But I would like to ask you to remember that:  You are gradually, day by day, changing and growing into the person you will be forever. Choose goals that are worthy of your time. That’s an important responsibility, but one that you should take with joy and excitement. Life is beautiful, diverse, and interesting. However, all that requires that you open your eyes, think critically, and stay curious.


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