Super Star Blogs!

Why Do We Suffer: an intern’s story

Code Blue! My whole team took off running towards the 6th floor of the prison hospital. The adrenaline was pumping like no other time in my life and only intensified as we got closer to the room. And there we were… standing in front of the patient I had just pre-rounded on 20 minutes earlier. My heart sunk to the floor as nurses rushed in and out of the room. The world went mute and slowed down considerably as I tried to make sense of what was going on. My patient was as pale as a ghost from a massive hemorrhage.

That day was one of the worst days of my intern year. That night I questioned EVERYTHING. I questioned my competency, I questioned my career choice, I questioned God. Deep down I wondered why do we suffer? The emotional toll interns face is often overlooked and never talked about. You just kind of move on to the next case without fully internalizing things. Rarely are you asked to discuss your deep thoughts.

My patient was the same age as me. She had a family that loved her dearly. We got along very well in a very professional patient-doctor manner but at the same time I got the sense that we could have kicked it as friends under different circumstances. She had made mistakes in life that led her to prison at such a young age. She did not disclose her crime and I liked it that way since I never want to be biased in my care for a patient. The palpable irony here was the fact that this patient was a young, blond-headed, white lady while I was a young cocoa skinned, black male. We were outliers as she was nearly the only one who fit that description in the whole prison hospital and I was one of 2 black males in my entire residency program. If we were dressed in street clothes the world may have had different expectations for the two of us.  

Earlier that day…

That morning, like any other day, I walked into my patient’s room and greeted her. This was my first rotation as an intern in the prison hospital. My patient was all smiles and immediately stated, “I’m feeling much better.” We had been treating her over the past few weeks for anasarca or fluid overload secondary to nephrotic syndrome. She had a number of other medical issues including diabetes and hepatitis C. The patient had a renal (kidney) biopsy the week before and we were anticipating her results. The day before, the patient was with respiratory distress and calf pain. She was miserably in pain. I presented her that day on rounds informing my team of her shortness of breath, calf pain, tachycardia (fast heart rate), and hypercoagulable state. My attending looked at me with a grin and said, “So what does she have doctor?” I smiled back and said with all the confidence in the world, “Based on her high Well’s score, she has PE!”

Unfortunately, it was Saturday morning and scans were not readily accessible at that time. We were racing against the clock since a PE can strike suddenly. We walked by the patient’s room and my attending performed a physical exam teaching the medical students how to grade pitting edema, how to auscultate the lungs, and how to conduct the Homan’s sign for DVT. “Yep, I think you are correct. Let’s begin anticoagulation,” he said. In no time, the orders were entered and the patient was started on the IV heparin drip. 24 hours later, I was dripping in sweat performing chest compressions on her during the code. It turns out that the patient was suffering from a retroperitoneal bleed stemming from the renal biopsy performed a week or two earlier. We resuscitated her and she regained consciousness but only enough to get her to the ICU for a few days. The patient expired.

Asystole (flat line)

As I mentioned earlier, I really struggled with this case for some time. I believe every intern has that one case that sticks with them. It’s hard to move on. You think about the young life that was lost and all those who loved her. You wonder if you did the right thing. You become disgusted at the confidence you had behind your decisions. But somehow you have to keep going. There are more patients to treat (that’s if you are even worthy). Thank goodness I had a wonderful attending who recognized this was something I was struggling with. He pulled me aside and had a one-on-one meeting with me. We walked through the case step-by-step and he assured me that we took an evidenced-based approach to arrive at our decision. I thought back and agree that 9 out of 10 times I would make the same decision. Later that month, we presented this case at the monthly morbidity and mortality (M&M) conference. There was a consensus that this was ultimately the right decision despite the unfortunate outcome.

Looking back, I believe this case has made me a better physician. I know to carefully weigh all options when making a decision. I know not to be over confident in my decision and to humble myself enough to seek guidance from my colleagues when in doubt. I know that it is okay to say the words I am not comfortable with this plan of action. However, I continue to have many unanswered questions about life in general. A major one is why do so many suffer? As physicians and scientists we seek to understand everything around us but I take solace in the words of TD Jakes.

Have you faced difficult questions like this after the loss of a patient? 


Make sure to check out premed student, Curtis’ PreMed Voice podcast conversation about death. Dealing with Death  

Congratulations to Maria!  Student of the Week!

1. Tell us a little bit about yourself. My name is Maria and I am applying for medical school this cycle. I’m originally from Colombia and moved to the US about ten years ago.  Many years ago, back when I lived in Colombia, I started my career in architecture, and then worked for a few years in the field. I recently -about two years ago- decided to switch careers to fulfill my dream of becoming a doctor.  As an older applicant, I’ve had many life experiences and after all I’ve been through, I’m extremely happy I decided to do this.

2. Who was your favorite teacher in school and how did he or she impact you  Dr. Ely; my chemistry professor. She helped me through a real struggle with general chemistry, and she was so amazing as a professor and as a person! She helped me overcome certain fear I had toward chemistry.  Last Fall, she endorsed me to become a chemistry tutor with the University’s athletic department, and a teaching assistant with the chemistry department.

3. When did you first decide you wanted to become a doctor and why?  I remember being very young when I first told my mom I would become a doctor. That idea was always in my head.

Growing up, my dad always spoke of my grandfather, who suffered from Parkinson’s, and he would tell the story about how his dad would go to the market, and my dad, a teenager then, would get a call saying that his dad fell down in the middle of the street and couldn’t get up (due to the muscle stiffness associated with Parkinson’s). My grandfather spent his last few years suffering from this painful disease.

I wanted to know more about it, and wanted to find a way to help people with the disease. I was always scared my dad would get it, and I remember thinking that if he ever did, I would be there to “save” him. Luckily, my dad is in his mid-60s, and is very healthy 🙂

4. What area of medicine are you interested in? Although I know this could change with the experience that medical school will bring, I have always liked surgery, emergency medicine, and pediatrics.  I think I’m excited about those three fields because for the past couple of years, I’ve had volunteer and shadowing experiences in these three fields mainly. We will see what the future brings.

5. What’s the coolest experience you’ve had so far on your premedical journey?  I shadowed surgeons in the operating room, and those were extreme adrenaline-producing opportunities for me.

I’m also a Spanish-English interpreter for a local pediatrics clinic for low income Hispanic families. It feels so amazing to help those children and their families, as I feel I can truly connect with them thanks to my Hispanic background.

6. What is your favorite book?  I’m a fan of self-help books and meditation. I’ve always been interested in how other people face their challenges in life and how they become better people after those experiences.

My favorite book is The Seven Spiritual Laws of Success, as I feel that Deepak Chopra outlines some of the most basic principles to live a spiritual and successful life.

7. Tell us one thing interesting about you that most people don’t know.  I’ve played the piano since I was eight. I try to practice when I have time off, which is scarce nowadays.  Something else -but most people do know- is that I’m married and we have a 7 month old baby girl. She’s our miracle 🙂

8. If you couldn’t be a doctor, what would you want to do?  I won’t take no for an answer. I would wait and continue to pursue my dream. I’ve had many life experiences and I am convinced I was born to be a doctor.

9. What has been your biggest obstacle as a premed and how did you (or are you) overcome it?  I don’t see many things as obstacles, but instead, as learning situations which guide my path.  One of the most challenging situations for me was that, since I was pregnant during the Fall 2017 semester, I had to take two Incomplete grades to then fulfill the final exams during the Spring 2019, which was a time with very little to no sleep for me as a new mom.

Being a mom is the most rewarding thing ever. However, it’s been a little more challenging than I thought to complete my prerequisites while being a first-time mom: time-wise and effort-wise. Thankfully, my mom and my husband have been crucial in this journey.

10. What do you like most about Diverse Medicine?  Studying for the MCAT has been a marathon, and I feel that between the networking opportunities, the podcasts and other people’s shared experiences on Diverse Medicine, I’ve learned a lot and my journey has been more fun.

If I wasn’t a doctor…..

Fill in the blank: If I wasn’t going to be a doctor, I’d be a ____________.

A couple weeks ago, I got invited to be a guest on the Today Show. One of their producers asked me to send in some childhood pictures so I reached out to my mother. As I flipped through the old photos, pleasant memories returned and she told me stories about various pics. When we got to my preschool graduation, she laughed and said, “That day, all the other kids said they wanted to be firemen and police officers. When you got on stage, you said you wanted to be a doctor. Everyone started clapping for you.”

I have absolutely no recollection of this and didn’t even know I wanted to be a doctor at the age of 4. Well, in reality, I was probably just making something up (I really wasn’t set on medicine until college). The truth is, I always wanted to be an NBA player, but height isn’t one of my God given gifts. As mom told me stories, I got to thinking, what would life be like if I wasn’t a doctor. Would I be happy? That then led me to think about all of you on DiverseMedicine.com. I’m sure these questions surface in your minds from time to time.

When I got accepted into medical school, I went out and bought a custom dog tag (that was the thing to do during my college days) that had the caduceus symbol and read “My Passion.” At that time, I truly believed that medicine was my destiny and perhaps I wouldn’t be happy if I wasn’t a doctor. Many of my friends had that same mindset. We ate, breathed, and slept the premed life. This was good, and maybe necessary to achieve the goals which so many of us now have. But when I ask myself that oh so famous question, “If I wasn’t a doctor, I’d be a …”, I have absolutely no trouble answering it.

If I wasn’t a doctor, I’d be a social entrepreneur. My true passion is to help others live up to their full potential. That’s exactly what a social entrepreneur does. They focus on providing services/solutions for others (typically marginalized communities) to the ultimate good of society.

So why does this matter? Why am I telling you what I’d do if I wasn’t a doctor? Because I want you to understand that who you are and your life’s mission is not linked to your career. There are few things I find more satisfying that walking into an ICU and helping a patient go from deathly ill to walking out of the hospital. It’s extremely gratifying and I love that feeling. However, it’s important to understand why I love it. It’s not necessarily because of the medial aspects. Those just make me really really like it. But I LOVE it because I helped a patient live up to their potential in a unique way that not many people can do.

I’ve heard people say there’s no other job in the world they could do. I don’t find that to be a thoughtful statement. I challenge you all to spend some time thinking about this question. Find at least 2 other careers which you’d be happy doing. This will force you to truly evaluate why you love the field of medicine. What is the driving force behind your passion?

So my question to you is, if you weren’t a doctor, what would you be?

Social Identity vs. Self-Identity on Race, Violence & Medicine

Stereotype bias, imposter syndrome, and authenticity. What does it all really mean?

The interplay of social versus self-identity informs our daily interactions. Kamilah Collins, an equity and inclusion consultant, explains how malalignment of these two identities can impact you as an individual, and impair organizational dynamics.

Listen to the episode at https://brianwilliamsmd.com/blog/2019/kamilah-collins-social-versus-self-identitiy

5 Things I Wish I Knew in My 20s

My 20’s blew by faster than any other decade. This was a time completely saturated with school, school and more school. I enjoyed the years but now that I look back, there are 5 major areas I wish I had optimized as a premed, medical student, resident and fellow. Some of these things would have saved me a lot of stress and money (literally thousands). I’m sure many of you can benefit from some of my mistakes.

1. Don’t Chase Love

I know… this can be very hard for many young adults to appreciate. I don’t want to be the bearer if bad news but the truth is, love can get us all to do some very stupid stuff. At the time, it all sounds like a great idea. I cannot emphasize how important choosing the right spouse is. As a “soon”-to-be high income earner, you do not want to spend your life with the wrong person. Don’t select your school primarily based on someone who is not worth it. I have also witnessed so many med students put all their eggs in one basket and get so heartbroken that they struggle in medical school. A few weeks into medical school, one of my classmates dropped out because she missed her boyfriend. I observed a few divorces while students were in medical school. These things happen more than you would think. All that said, if you have a solid partner, your don’t mess that up. They should be understanding of your career and what it takes to reach your goal. They should not be a hinder to your goals.

Dating in Medical School Blog

2. Learn About Finances

Please, please, please don’t make the same costly mistakes that I am now trying to correct. As a medical doctor (or any high income earner) there will be leeches coming after you from every angle. I guarantee you that at some point during your training, there will be financial advisors knocking at your door. They may host a nice big dinner for you and other trainees. The herd mentality will be in full force with many of your peers attending events for the free food and being sold products. It will all sound good and you will feel pressured to buy now especially since premiums will be higher if you wait to buy. While some financial advisors have your best interest in mind others will just see dollar signs. You may want to make sure you have a fiduciary advisor working with and for you. It is also easy to borrow, borrow, borrow without having a solid strategy to pay off your loans. I implore you take the time to learn about finances starting now or at least while in medical school. A great book to consider reading is “The White Coat Investor”. You may also consider subscribing to their podcast. I am not an expert in finances and so do your self a favor by learning these things early before someone takes advantage of you.

3. Pick up Healthy Habits

I hate to tell you this but that six pack will not always be there. The habits you pick up in medical school may stick with you. Life always gets in the way. I understand it is very difficult to find the time to prepare meals, to go for a run, or to get that 7-8 hours of sleep. But think about it… if you can’t do it, then how can you expect it from your patients? As physicians, whether you like it or not, your patients will likely judge you on your physique. They will ask you for personal advice. I literally had a patient tell me they no longer see their PCP because they could tell he wasn’t following his own advice to them. Set the example for your patients, your children, and your community. Check out my previous blog post on health eating as a premed.

Eating Wise as a Premed

4. Keep in Touch

Don’t forget to call your mom. Med school, residency, and fellowship can consume your life. I always joke with folks that my 20’s felt like I was locked up in jail for a decade. I lost track of trends and events. Now this was probably before most of you were even born but I always joke with folks that coming out of med school I felt like Fly Guy coming out of prison from the movie, “I’m Gonna Git You Sucka” (YouTube it). More than keeping up with the trends, it is important not to miss out on important events if at all possible. This doesn’t mean you have to buy a ticket and fly across the country for every event but it’s good to text a friend who just had a baby or FaceTime your little niece on her big recital day. Take the time to communicate with loved ones because tomorrow is not promised. Cherish every moment with your grandparents and gather as much family history from them while they are still here and coherent. A simple phone call can make someone’s day and that someone just may be you.

5. Soak it all in

Breathe… You are young. You have so much life and opportunity sitting in front of you. These may be some of the best years of your life. You will probably form lifelong friendships, find love, start a family or grow your family, purchase your first car or home, and begin carving your pathway into society. Your 20’s and 30’s are awesome. enjoy them. While training, learn as much as you can. Take on zebra cases you may not see for another 20 years. Learn procedures best performed in academic centers. Have lunch with one of the attending physicians considered a guru in that field and pick their brain on how medicine has changed over the decades. Do something that challenges you. Take on a new hobby. Your training years are difficult at times but always think back to your premed years when you were working so hard to get accepted to medical school. This is what the blood, sweat and tears were for and many others wish they could be in your shoes. It truly is an honor and blessing to be here. Soak it all in!

The Final Chapter

Week 52 of  the PreMed Mondays book covers my best wishes for you.  We’ve been walking this journey together for the past 1 year!  Can you believe that!  We’ve covered my entire book!  This has been one of my most special projects.  So many of you have reached out and sent me messages.  Each one of them has been VERY special and I am appreciative of your kind words.   PreMed Mondays is NOT over, this is just the last episode that goes exactly with my book.  The show will go on (…I think).  

Click HERE to register for our next webinar with Yale School of Medicine’s Linda Jackson.  

Premeds, find affordable services designed to help you get accepted into medical school at www.PreHealthMarket.com

 

Medicine and the Humanities

How would you like to increase your levels of wisdom, empathy, self-efficacy, emotional appraisal, and spatial skills while decreasing your intolerance of ambiguity, physical fatigue, emotional exhaustion, and cognitive weariness? Who wouldn’t want to play this game, right? According to a 2018 study, exposure to humanities such as literature, music, theater, and visual arts provides these benefits.

But medicine is all about scientific information and knowledge, right? Isn’t it about data-driven decision making? In the current climate of meaningful use and clinical documentation improvement requirements, is there room for anything besides data in the practice of medicine?

The answer is that multiple studies confirm the benefits of incorporating the arts and humanities into the practice of medicine, not only to benefit patients (music therapy, anyone?), but for the good of the providers as well. We don’t have to be doctors, though, to recognize that the same principles apply to us as scribes when it comes to our own empathy and emotional wellbeing.

If you’d like to increase your observational skills, study art. To listen better and improve communication, listen to music. To better empathize, dance or write a poem, or both. To collaborate better, perform in an ensemble. To avoid burnout, take a sculpting class. Both the arts and medicine build on a foundational level of skill built up over practice, and then they take on layers of artistic interpretation to bring about astonishing results. Get started layering now!

(Similarly, the physical and emotional benefits of exercise in the practice of medicine are well-documented and worthy of a separate article at another time.)

If you’re interested in reading more about medicine and the arts, check out these links:

https://link.springer.com/article/10.1007%2Fs11606-017-4275-8

https://www.aaojournal.org/article/S0161-6420(17)31708-6/fulltext

https://hms.harvard.edu/news/arts-and-medicine?fbclid=IwAR0D-HyhzlM_wxfo73cjnc6QFsyatzPdOfPk2FScW3FuQDVNbehvxl5I2Xg

http://test.medicalmusical.com/

https://mh.bmj.com/content/26/1/3#ref-7 

(Anne Bean is a Scribe Training Administrator with AQuity Solutions and plays violin with a local string quartet.)

(Reprinted from June 2019 Vital Signs, AQuity Solutions Scribing Services Newsletter)

Potential Transfer to the University of Maryland, College Park 

Hello everyone,

I would like to inform you that, there is a good chance I will leave The Ohio State University for the University of Maryland. Out of state tuition accumulation after year one will be insane. I don’t want to go to medical school with a lot of debt from undergrad. There were a few times in the academic year, I felt unwelcomed on campus. I envision myself being a physician-scientist (MD-PhD or DO-PhD) and having many degrees. Including assets. A huge amount of debt will complicate my future. As a black male, that is one of the many challenges I have to face in the United States. UMD is a large PWI like OSU. The difference will be, the in-state tuition, home field advantage, and I know people on campus already. It is a very familiar environment. It will be a different experience, racism and discrimination will always exist on some level. To be a world renown physician-scientist, that is something I have to overcome. These were thoughts I had for several weeks now and I have pondered them very deeply. I am grateful for the bonds I have created at The Ohio State University. It will be something I will remember for the rest of life. I have also created a Twitter moment that has many tweets, videos, and pictures throughout my first year at The Ohio State University. Since we met, my life has changed a lot. I know I want to revolutionize the field of medicine with my interests in cybersecurity, quantum mechanics, natural medicine, alternative medicine, integrative medicine, quantum computing, artificial intelligence, mathematics, neuroscience, data analytics, medical physics, and spirituality. Moreover, I have received an opportunity to apply for the University of Kentucky Medical Education Development Summer Program (UKMED). Currently, I am a tutor for Grade Potential Tutoring. I tutor biology, chemistry, consumer computer software, pre-algebra, algebra 1, geometry, algebra 2, and pre-calculus. Furthermore, I have applied for 6 opportunities at Johns Hopkins. Last month, I have also won an award, premedical student of the week from Diverse Medicine. I am determined to become a great physician.

Ohio State Twitter Moment: https://twitter.com/i/moments/1133811796626812928

Sincerely,

Shiraz Robinson II

5 Reasons Why It’s Worth The Wait!

Week 51 of  the PreMed Mondays book covers 5 why the field of medicine is worth the wait.  To become a doctor, you have to put in decades of work!  It’s a tough road with plenty of sacrifices.  You’ll have ups and downs that make you question why you’re pursuing this career.  DON’T QUIT!  It’s worth the wait!  Here are 5 reasons why!

Click HERE to register for our next webinar with Yale School of Medicine’s Linda Jackson.  

Premeds, find affordable services designed to help you get accepted into medical school at www.PreHealthMarket.com

Who is on your team?

Any person who sets out to accomplish a challenge knows that having the right support system is critical to success. Therefore, it should not be surprising that preparing for a career in the health professions similarly requires the right support.

The Diverse Medicine Recruitment Center is one (excellent) tool for online guidance, support, and mentoring. In addition, I also recommend having an onsite faculty advisor at your institution. These are professors, upperclassmen students, or counselors who have a track record of successfully guiding applicants to entry in a professional program. A campus advisor can help with information such as: which sections of a class will be more beneficial; which professors are more likely to prepare a student for higher MCAT and other entry exams; and if there are benefits to any specific order to take pre-requisite classes to best prepare for applications and testing.

Another part of your support system is fellow students. Some students prefer to study alone, others in pairs or a study group. Students can help in more ways then simply study partners. Even if you tend to study by yourself, there are many benefits to networking (outside of study time) with other students at the same level you are. Other students will be able to share information they have learned from their own mentors; they may have access to study materials you do not have; and they may also have information on campus resources, clubs, or other organizations that can help you achieve your goals. Conversely, if you surround yourself with underachieving and unmotivated classmates, they may hinder your academic goals.

Last, but definitely not least, a third part of your support system consists of people and activities which serve to maintain your mental health. This includes date nights with your significant other; outings with your platonic friends; regular exercise; listening to music; getting periodic massages (massage schools have low cost massages!); attending religious services; or anything else that spiritually, mentally, and emotionally uplifts you. If your mind and body are in the ideal condition, you will be more likely to succeed academically and professionally.

Let’s keep this conversation going: in the comments, please include who else is in your personal support system; who has, or is, helping you to achieve your goals?

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