Category: Uncategorized

A family member of 2 of my patients (twins) told me about an unfortunate experience they had during their admission. A staff member of the hospital, threatened not to perform their duty because the family member and one of the nurses were speaking to each other in Spanish. This was pretty shocking and upsetting for me to hear, and I can only imagine how it must have affected this family member. Our hospital serves a diverse community, but with a large majority of that population being Spanish-speaking, so the fact that someone in who works here can carry that kind of attitude in their heart made my heart sink.

I just sat for a while and listened to what this woman had to say, as she was understandably angry and shaken. What surprised me though was the good things she had to say about this hospital besides this isolated event. That, at least prior to this incident, she felt this hospital genuinely cared about the community and the patients that came through our doors. And how she trusted this hospital to see her and her family members as people, not just as patients. It was affirming to hear that many of the reason I wanted to stay here for residency, are ways the people in the community view this hospital. It was a good reminder to always do right by our community in the face of emboldening bigotry, and actively fight against it.

These were the words if my attending today. Of course, here he was talking about the literal heart in the context of cardiorenal syndrome (specifically type 4, which is technically more of a renocardiac syndrome), but it kinda hit me hard on a figurative heart level. Recently (but also chronically) I feel like I put off doing things that move me in the direction I want to go with my career, my relationships, and my life in general, often for the sake of more transient things. And over time, that “lost” time weighs on me more and more as the dreams I had for myself become more distant, and that hurts my heart a bit, ya know?

Don’t get me wrong, I’m very happy with my life overall right now. I love the work that I do and I feel lucky to have so many good and fulfilling personal and professional relationships, there’s just a part of me that feels like I could and should be doing more, not sure for myself, but for the people I care about and for my community (locally and globally). But if I keep holding off on working towards the things that I think I have to offer this world, I may well go into acute heart failure which as we know requires some diuresis (of like ideas, as in I need to do the things [or maybe forget about some] so that they don’t just build up inside me).

Now that we’re a couple weeks out from it, I wanted so share some of the thoughts I had following the night of the election:

Words can’t fully capture how I feel right now, so these are just words. I’m angry, sad, disheartened, disgusted, appalled, furious.

I’ve been hearing a lot of talk and seeing a lot of posts on social media about people no longer wanting to associate with anyone who voted for him. First of all I want to acknowledge that this is a valid sentiment for any individual who feels this way because yesterday the majority¹ of our country essentially invalidated multiple marginalized and vulnerable populations (and some that have been disregarded regardless of yesterday’s outcome), which includes a lot of people who I hold dear.

Another part of me thinks the solution to the situation we are in cannot be to further isolate into our echo chambers. This is not meant to shame any one who has decided that they no longer want any part of the population that has in invalidated their existence, you have every right to do whatever needs to be done to protect yourself and your wellbeing, and no one should be telling you how to feel or how to act in this moment. For myself, who has the privilege of being a cis-hetero-man, a US citizen, educated, from an upper middle class family with all the opportunities in the world afforded to me by the work put in by my immigrant family (some of whom are supporters of his), I feel like I can’t step away. I owe it to all the people I hold love for — my family members, my patients, and everyone else out there who are going to suffer because of the direction our country may head in these coming four years — to fight the affliction of heart and mind that has seemingly taken hold in so many people.

Despite what the election results show, I (perhaps naively) choose not to believe that all those people are hateful, idiotic, misogynistic, sexist, xenophobic, transphobic individuals. It’s possible that a large number of them may be one or multiple of those, but they are also people with their own priorities who were made promises through cult rhetoric of a better life for themselves and for their loved ones.

Something is missing. I ask myself, How can intelligent people, people who I have at least at one time called my friend, support a man who represents so much hatred and idiocy? There has to be as disconnect. Maybe not… perhaps every single one of those supports are themselves representative all those things. But if so, then where do we go from there? Because based on how this country elects presidents (i.e. the electoral college), leaving both sides fester in their own bubbles will not turn out well for progressive ideals, as we’ve seen. And something tells me that process is not going anywhere soon — call it a hunch.

It’s so easy nowadays to shut off and shut out beliefs and perspectives that differ from out own. Algorithms, socials media, likes, and follows all exacerbate this, if they are not indeed the root cause.² Unlike, unfollow, report; sure it makes us feel better because then we no longer have to see it, but rarely will that stop it from existing, and those who do resonate with that content will find it and come together, free of any dissenting thoughts thus hardening their beliefs, and making it inconceivable that anyone else of sound mind would think differently.

The change we need comes in culture shifts, not in elections in and of themselves. Culture shifts come through changes in believes and values. Those changes can only come when you are challenged by beliefs and values that differ from your own. It comes from not demonizing other people for having a different world view or having different lived experiences. It comes from finding common ground, as difficult as it may be. It comes speaking up, but perhaps more importantly, from listening. It comes from being disruptive for the sake of change, as well as being open to change.

I could have done more, even if it wouldn’t have changed the outcome of this election. I failed to speak up in casuals conversations for fear of embarrassment, retribution, or not being knowledgeable enough to back up my beliefs. I stayed in my comfort zones only engaging in spaces where I knew my ideals would be validated. These are things that need to change, even if they are coming woefully late. I anticipate that 9.5/10 times doing any of this work will leave me frustrated, hopeless, angry, and desperate, but the alternative is equivalent to me personally giving up and choosing to live with my privilege relatively unscathed, which beyond complicity, would be an injustice and waste.

Again all of this is just words. Words that are basically meaningless in light of what is at stake, and in the absence of action.

I know not all the people who read this will share my perspective. If you are one of them I want to hear your thoughts. I can promise to come into the conversation with an open heart and an open mind, and I hope you can do the same.

¹Which might not be quite true anymore, but that doesn’t change the outcome.
²The roots cause is human nature, these technologies just feed off of and augment it.

It’s crazy the difference 2 people make in the workflow of our team. Then again it’s also crazy how easily the rest of the team is able to pick of the slack. Today also was pretty busy because we were down 2 people (it was their day off), but busy is good, it makes the day go by faster and I get to see more interesting stuff. That said there are definitely task that I don’t look forward to, or times when I don’t want to be perceived doing the things I need to do (talking to patient, calling consults) it in almost all cases I have either a senior or someone else right next to me whether they are actively engaged in my conversation or not. Anyways overall, this has been a pretty nice way to transition into this new role in the hospital. I get a lot of model examples of what the work should look like and can easily determine whether or not I am meeting a certain standard, while also being in a safe space for mistakes and stupid questions, because here lots of people have my back.

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.