Category: Uncategorized

Overall it was a pretty tame rotation which is why I am lumping it together all in one post, and also because I kinda just saw it as a continuation of my ICU rotation as a Pulm/Crit super rotation (and not because I forgot/ got lazy). It was definitely slower paced on the ICU, but it allowed for a lot of time for learning and education and stuff, while still allowing me to get home before rush hour. I really enjoyed learning more about pulmonary physiology and tying it back to our basic physics. It reignited one of my many life goals of creating a science museum on exploratory body science. Anyways it seems like between the two services of ICU and pulmonary consult/ clinic, life as a PCCM attending seemed more chill than I expected, but that is also coming from a limited medical student lens. But the key phrase is “than I expected.” I still imagine it’s pretty demanding to get there in terms of the fellowship training, and the high likelihood of having to have call for the rest of my professional life. What I do like about Pulm/Crit is that you have the ability to specialize in a certain area while also still being more or less a generalist when on the ICU in terms of still needing to have a pretty robust knowledge of all of medicine. Then the next part of concern is if this is a career that would be compatible with my med-peds training and my family/ life goals. Lots to think about and looking forward to figuring thing out (or getting more confused during residency).

I switched things up this morning and decided to listen to Seth Godin’s Akimbo podcast on the way to work instead of the radio. He was talking about being “supple” and resilient in the face of change. One thing he said stood out to me this morning as a good reminder to keep in mind. He said:

“The world does change more slowly when you fight against it.”

Being at a place where there are a lot of change in my personal life coming in the next year, and there are a lot of technologies that are (or will) rapidly changing how we work, it’s important to think of how I can adapt and change with the change that is happening around me. Even though the extrinsic change that happens around us day to day feels inevitable, growing and changing myself is not as simple as waiting around for something to happen. It requires effort and work.

The them today was goals of care. I’ve talked about this a bit before on my internal medicine rotations and the Palliative Care attending that I had and the tips that he shared. Compared to IM though, these conversations are happening on a weekly if not daily basis in the ICU. It definitely makes me think a lot about how I would approach having these conversations with patients and families.

My attending this week offered an approach that I thought was pretty compelling. It was a pretty simple one in that in many of these cases we have done everything we can to help patients recover, and so her approach was to let patients know that, which I know seems basic and common, but she also stress the importance of explaining what improvement looks like to us from a medical perspective and what deterioration looks which I think is helpful in setting expectations with patients and their families. Being objective in these conversations does necessary have to mean being cold, and the objective aspects of a patients health or lack there of can be delivered with compassion and ultimately should help guide patients and their families to being at peace with whatever decisions they decide to make.

Coming back in from the weekend (thankfully they don’t make us go in on the weekends for ICU as a medical student) only one of my patients was still around while the other 2 were downgraded. Today I just picked up one of the patients who had been with us a while. And interesting, kind of mystery cases. He was initially brought to us in acute hypoxemic respiratory failure in the setting of a positive COVID test, though it sounds like initially they were thinking the pneumonia was secondary to an aspiration event as opposed to COVID because his imaging studies just did not look like COVID. So we had been treating him with antibiotics as well as completing a course of steroids for the COVID. He was looking a lot better from when I first saw him (on my first day of the rotation) but then this morning he took a turn and they had to re-intubate him, though we were not 100% sure why since we had been treating him for the most likely causes. Anyways I’m looking forward to digging into this case a bit more.

I was watching a video yesterday that was about brining white liberals and black conservatives to discuss different political issues, especially pertaining to race in America. The video was from a YouTube series called Middle Ground. I stumbled across it after watching a video of Ben Shapiro talking with Neil deGrasse Tyson about their thoughts on transgender issues, which I was honestly impressed by. It was a civil discussion with both expressing their thoughts in ways that were respectful, at least toward each other.

Back to the video I was talking about in the beginning; this channel looks like it does a lot of videos like this were it takes groups of people that they deem to be ironic and contradictory and have them debate each other. I can’t tell if these videos are good examples of political discourse or not. I think healthy debate is usually a good thing, but there were a lot of toxic things going on at least in this one video (primarily from a few individuals, and one in particular). I don’t think these videos capture the true spirit of a middle ground.

To me finding a middle ground is about finding shared values between two opposing parties and using that as the jumping off point for discourse. As opposed to starting at the point of contention and then have each side try to drag the other to their own way of thinking. If you take any two humans from anywhere in the world and ask them what values are at their core, I’d like believe more often than not there will be high amounts of overlap in the majority of cases. Where we differ as humans is in how we go about living those values, which is based on our lived experiences. That is where science can come in to show us what the aggregate of experiences tells us about the outcomes of those various practices in living out values. But science is not the be all end all. Just as in medicine, where there is standard of care and evidence based medicine, the science can be biased and the science cannot definitively tell us what is best for any individual case. It does however, create a place for us to start.

I missed a few days, partially because by the time I’ve been getting home I’m usually too exhausted or have other things to work on in the limited time I have before I go to bed in order to get at least 6 hours of sleep. On my previous IM rotation almost a year ago I was scheduled for 12 hour shifts, but only would really be there for about 8-9 hours because my residents would usually let me go once I’ve finished my notes. This rotation, the expectations are a bit different and rightfully so given that I’m now a 4th year. It’s not a bad thing, and I’m grateful for the opportunity to be able to continue getting closer to resident work level.

Today I was discharging all the patients I was following. One of the them was one I had since I started on the medicine service. The other 2 were new ones I just picked up yesterday, a atypical vertigo picture and a COPD exacerbation secondary to pneumonia. The COPD patient actually decompensated a little bit during the day so we ended up keeping him. What is kinda cool about medicine is that no matter how many times you see similar conditions there’s always something to learn or to brush up on. Each day I feel like I’m able to improve upon something or there’s some opportunity to do some additional research. I also like being able to sit at the table with people who are smarter than me and listen to their approach to different medical problems and to learn from them.

Right now I’m kinda in the process of really trying to figure out where in medicine I want to end up. We just wrapped up 3rd year this past Friday and tomorrow is the start of 4th year. I completed all my core rotations and at no point in the last 10 months did have that “aha” moment that people always talk about. I feel like my problem is that I have an tendency to tolerate, or dare I say enjoy, whatever I am doing. There was nothing I absolutely hated (that doesn’t mean I didn’t rule anything out), but also there wasn’t anything that I 100% fell in love with, and I’m not sure such a thing exists.

I’ve spoken to a few advisers in the specialties I’m interested in which has been helpful. I have also spoken to family members and friends, and while I’ve very much appreciated everyone’s input, it’s hard to know who to trust. I feel like no one I’ve talked to fully understands me as person nor due that fully understand my my values or my philosophy towards medicine. Many of the doctors I’ve spoken to, including those within my family, seem to have come to medicine from a slightly (or more than slightly) different angle from me with their own set of values. The metrics are different, but often in conversation we speak as if they are the same. What is a downside of a particular specialty for one person, may actually be a bonus to me and visa versa. Then to make it even worse, just because a particular thing matters to me now, doesn’t mean it will matter to me 10+ years down the road.

At the end of the day, I will eventually have to make a decision based on whatever information I’ve obtained by that time and then live with that decision. I just have to remember that regardless of what happens, my satisfaction and contentment with life is based on so much more than the outcome of what currently feels like the biggest decision of my life.

In 2023 we have the solution to boredom. We’ve actually had it for a while now and it comes in the form of these tiny rectangles we keep in our pocket. The moment boredom rears its ugly head we have the perfect weapon to ward it off. Not a single minute of our time need be wasted sitting idle when we can fill it with videos of people dancing at work or of people showing the silly things they did at Disneyland or of 5 tips for making yourself rich TODAY.

No more wasting our time with useless mind wandering and daydreaming when our attention can be continuously captivated by an endless stream of catchy and misleading headlines, targeted ads, and controversial content. We can check our emails, be entertained, catch up on the news, connect with friends, make business connections, or love connections (or both?) all without taking our eyes off our screens. It’s called productivity and productivity how we keep up in this world lest we fall behind into cultural irrelevance.

There’s no need to reflect, there’s no time to pause because we already have notifications piling up that we need to attend to and trends we need to participate in. Boredom and idleness are problems of the past, and in this day and age we finally have the space and the tools to be focused on what’s really important.

We’ve all been there. After hearing the phone buzz after that risky text; after being told the results for the exam you didn’t feel great about have been released; after lifting the cup from over a cockroach you think you trapped, there’s a fear of finding out what the outcome is. Our minds have a tendency to perseverate on the worst possible outcome (or at least mine does), regardless of the true likelihood of that outcome. And as they say ignorance is bliss.

I feel like I used to be really good at combatting that fear; at telling myself and believing that knowing is better than living in that dark, but as I’ve become less confident in myself I’ve found that fear starting to win more battles (even though in most cases I end of needing to confront reality at some point, and usually it being fine). I’ve been slipping. I want to go back to that mindset, and part of that involves taking back control of my competence and identity.

I came across this term, FOFO somewhere but I can’t remember where so I apologize to whoever inspired this thought, and thank you, and I definitely do not take credit for coming up with it.

I started to get into rock climbing about 5 months ago and recently it has been the only physical activity I’ve been engaged on a consistent basis recently. I been taking it pretty slow, trying to nail down easier climbs, improve my strength and endurance, and develop my climbing IQ before jumping into higher level climbs. What I’ve enjoyed about climbing is that each one is a puzzle, and as you move to more difficult climbs it doesn’t just get more physically demanding, but it also requires you to think more critically and creatively, and just like with mental puzzles, even when you get it wrong the first time something about it has you coming back to try it again to figure it out. There is not just one way to do any particular climb, but there usually is a “best” or “lowest effort” way. The freedom to fail and to try things out and work slowly is something I’ve missed since being back in school, so it’s been nice to have this as an outlet.