Continuity

Before coming to medical school, I was actively involved in an after-school mentoring program called Healthy Asian Youth. There was where I believe I first discovered a love for mentoring and teaching, and this has been something I have strived to maintain and continue as a medical student. One thing in particular that I have been able to assist with is demystifying part of the process of applying to and interviewing for medical school. During my time as a medical student, I have been asked to help high school students prepare to interview for BS/MD programs and undergraduates preparing for MD program interviews. To date, they have been successful at their goals and it humbles me to know that I played an important role for them.

As an undergraduate at Ohio State, I was involved as a volunteer in various organizations. At that time, I picked up on a concept that has remained central to my growth and personality to date:

“You can never pay back, so you should always try to pay forward” – Coach Woody Hayes

I was able to succeed as an applicant to medical school in large part due to the assistance of more senior students and mentors who were able to help me avoid pitfalls, meet deadlines and clarify the process for me. As I reflect on this, approaching the end of medical school I can’t help but realize the honest truth of this quote – I am not sure how I could express my gratitude for their help, but only to make sure their advice goes immortalized in my own practice and that I promote through my actions, words and intention.

This really began to manifest as a MS4, where on my surgical sub-internship I would routinely take time to help MS3s and even MS2s on shadowing or similar programs navigate the hospital, the EMR and teach informally to them while walking around. In particular, I had a surgery shelf powerpoint that I would try and go through with the students, as retrospective experience told me that it covered high-yield points and allowed me to recall intricate details about test questions that were key. Given that my sub-internships were also very early on in the clerkships for these students, I can only hope that I was helpful.

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I continued to do this while on my away rotation as well, knowing that as a MS4 I was constantly a role model and source of advice to the students. Questions about lifestyle, how to schedule Step 2, which services to work on and how to study were just some of the things I fielded. Something I have learned during my time as a medical student has been to not underestimate the value of experience, whether it is me passing down my own or reaching out to others to learn of theirs. I only see this continuing as a resident and eventually attending, as so much of medicine is this informal process of learning. I am eager to continue my role as learner but also to begin wading into the waters of being a teacher and educator, paying it forward as my career unfolds.

Systems-Based Practice:

  • Identify and utilize professional role models as a means of growth and accept the responsibility of acting as a role model and teaching and training others.

Going into medical school, I found it difficult to imagine that I could uphold all of these responsibilities – yet, at the same time I realized I was entering what was considered a noble profession, one that many in the general populace look up to, admire and hold in esteem. In starting out, I would say much of the nuts and bolts of this was fostered in Longitudinal Group, where I found myself really getting to know a group of complete strangers, who grew to become some of my closest classmates. It was one thing to know to be empathetic and to behave like a professional, but there was much to be practiced. Part of my growth was facilitated by the nurturing and welcoming environment, and part of it was also being able to work with good people. Some excerpts from near the end of second year really did help cement examples my growth:

“Yang has a demeanor that makes it clear that I would want him to be my doctor. He is empathetic but professional, and understands the material well, and works hard to stay on top of things.”

“Yang is very well rounded with everything going for him. He is super smart, interacts well with patients, and has a great sense of humor. Your patients are going to love you once they get to know you!”

With all of this, I realized that I had come a long way – it felt very familiar and comfortable to interview patients, to get to know them. However, it was less the endpoint and more the process of going to LG on a regular basis and becoming invested in these clinical skills that are going to serve me for the rest of my professional lifetime.

My development of clinical skills and focus on patient care continued into third year. One instance in particular was a pediatrics patient, who was 6 or 7 years old. She had been transferred from outside of Columbus and what family she had here was few and far between when it came to visiting. Early during her stay, she was found to have been attempting to climb out of her bed and had a near-fall. Following this, it was determined that her bed railings needed to be up for her protection.

We had finished rounding on her one day when I noticed that not all of her railings were up – only three out of the four. I took the initiative to bring up the last one. As we left the room my attending noticed this and as it turns out, there is a policy in place at Nationwide Children’s that only a maximum of three out of the four railings can be up, as having the child completely closed in increases the chances that they will attempt to climb over as opposed to getting out of bed in a normal fashion, putting them at more risk for an injury. My attending still recognized my initiative and intentions and wrote about it in my evaluation:

“I was impressed with Yang’s concern for his patient’s well being. As an example – he was the only one to put up one of his patient’s bed rails amongst the entire rounding team as we left the room after examining the patient. He was interested in learning and performing well. He was an active member of the team and interacted well with everyone.”

It was somewhat embarrassing to be instantly corrected by my attending about this when it happened. However, he quickly reassured me that he greatly appreciated my concern for the patient and understood why I did what I did. It became a learning opportunity for the entire team as this policy was a subtle but important point when it came to patient care. More importantly, even though I made a mistake, it was for a reason where I committed myself to patient care and the well-being of somebody else, embodying many of the principles expected of me and my classmates.

“We are what we repeatedly do. Excellence, then is not an act but a habit.” – Aristotle

Truly, I hope to be able to repeatedly be compassionate, to consider the patient and to make a habit of good patient care and my daily interactions. Nothing would please me more than to know that I am giving my all to my patients and serving as a role model to those around me.

Professionalism:

  • Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice and a commitment to excellence in all professional and personal responsibilities.

Eat Your Pancakes

Going into medical school, I had heard many things about the difficulty of it. Whether people equated it to drinking from a firehose, eating stacks of pancakes, or some other analogy, it certainly did not disappoint. I knew early on that my study habits during undergraduate years would not be adequate or organized enough to keep up with medical school.

Knowing this, I came in and hit the ground running. Instead of haphazardly organizing my notes in one big folder and casually flipping through powerpoints (as in undergrad), I completely revamped my studying. I moved everything to the computer, where I took notes in word documents organized in a weekly file, and would on a daily basis turn these notes into Anki flash cards to be constantly reviewing topics from the beginnings of the blocks, in order to not fall behind. I honestly credit a large part of my success and sanity during this early period to my systematic and organized method.

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This was a huge shift from my previous methods and one that I am particularly proud of – it worked to help me survive preclinical years and provided me with a solid foundation as I hit the wards. Things began to make sense. It was systematic, regimented and so modular that I could customize and modify every aspect of my learning.

However, I quickly found that the wards were an entirely different beast. Pre-set answers and truisms gave way to clinical subtlety and the benefit of experience. I recall certain situations during my surgical sub-internships – for instance, we had a patient, a 22 year-old female who suffered a ruptured appendicitis. She underwent surgery and I in my inexperience suggested that she would be able to be discharged 1-2 days following surgery. Not having taken care of a patient in this situation prior to this, I was summarily told I was wrong, and taught that patients who suffer from a perforated appendicitis tend to develop a severe ileus and a prolonged stay. That patient ended up requiring a nasogastric tube placed and stayed in the hospital for 10 days. I saw firsthand the benefit of experience in predicting this course and how it was not something I would have been able to learn with my numerous flash cards. It is always humbling to realize how much there is to continue to learn and exciting to know how much more expertise can be gained by learning in the present and being observant and reflective.

With all of this, what I’ve learned to date is just the beginning. As new developments, therapies, diagnostic modalities and such arise there is still more learning to be done. And as with any other profession, there is experiential learning to be done as there is always such subtlety to patient presentations and the truism that “the patient is not a textbook”. However, I have also grown to appreciate the fact that basic science underpins so much of medical practice, still – I often find myself reminding myself of basic mechanisms because it truly does help me understand the patient presentation, their course and how to expect complications of their stay. Being able to integrate these two aspects of medicine – clinical and basic science will continue to serve me well and I am eager to see how my experiences will allow me to grow and reach a point where I can integrate all of my knowledge in an effective manner.

Medical Knowledge:

  • Demonstrate a broad working knowledge of the fundamental science, principles, and processes basic to the practice of medicine and apply this knowledge in a judicious and consistent manner to prevent common health problems and achieve effective and safe patient care.

Reaching Out

A significant activity of mine was my Community Health project – briefly, it was an educational activity where I and a group of classmates created an original curriculum driven towards educating lower-income children at the Central Community House. The curriculum in particular was driven towards educating the children about health and wellness. Though the children were young (kindergarten, first grade), we believed it was imperative to provide a comprehensive approach. This consisted of mental health/self-empowerment, exercise, relationships/sharing, hygiene, nutrition, and a brief primer on anatomy.

The video above in particular was one portion of the curriculum I was individually responsible for. In addition to this, I borrowed a mold of my one of my roommates’ teeth and with a short lecture I was able to provide a brief introduction to the importance of dental hygiene.

Before this, I had pretty much no experience interacting with kids as young as this. Especially when it came to teaching something like healthy habits. However, it was very refreshing to see their viewpoints and knowledge base and have a personal hand in helping them improve their lifestyles.

This project culminated in a poster presentation. Initially, our impact was only encapsulated in the kids’ behavior but in the long run, we wanted to see how the parents perceived the impact as well. While we did not have an objective measurement survey for this, we did host a parents’ night following the 8-week curriculum. The results were encouraging, as many parents described their children doing things like pointing out healthier food options, wanting to play and exercise more and in general exhibiting better behavior.

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Honestly, our group was floored that in such a short time (approximately 1 hour a week teaching these children) we could have such an immediate impact. It felt incredibly meaningful to have the chance to play a positive role in the lives of these kids, many of whom come from single-parent, low-income homes where it can be difficult to live a normal life. Being able to present the impact was just a cherry on top.

At the end of the day, experiences like this served to help me sharpen my skills when it comes to analyzing information, distilling it into important points and distribute it in a relevant and comprehensive way. Whether it was implementing our curriculum and making it digestible to children or creating a poster highlighting our success, there were many opportunities for growth. I was also able to work with a very different set of the population than I was usually acquainted with, and this has helped to enrich my own learning and sense of patients, which will only continue to help me as I encounter the diversity of patients in practice as a resident and eventual attending.

Interpersonal Communication:

  • Effectively prepare and deliver educational materials to individuals and groups.

Personal Records

Balance. A finicky word to manage in medical school, yet it has been central to my success and motivation to this point, and something I see as I move forward. Going into medical school, I knew that there were certain things I would not want to lose – one of these being my love of fitness, powerlifting and maintaining hobbies and interests outside of medicine.

Studying was a chore, certainly but it was made better by knowing I had an outlet for my stress. Looking forward to going to the gym or a run got me through many of my days, even as I progressed from the books to the wards. I recall especially not feeling like I could manage the time to do so during my UPRSN ring, not feeling that it was really possible to do so. I did not go to the gym for 3 months or so, and felt terrible for it. In retrospect, I realized that it was possible – I just had to continue to refine my efficiency and time balance in order to find time to go. I became better at studying for the wards, making the most of free time in general and also being more flexible about how much time I wanted to spend in the gym. It was never going to be the ideal 5-6x a week for 60+ minutes each time (as during M1/M2 year), but it would certainly be better than not going at all. I was unhappy because I was so inflexible and simple-minded in how I wanted to do things.

The video here is of me at my current strength – a warmup set of 5 reps of 315 pounds on the deadlift. It has taken me years to get here, and though there have been hiccups along the way, progress is just that – progress.

The importance of this balance is something I have found cannot be understated. I often hear many residents and medical students lament their unhealthy lifestyles. And I can sympathize. Having been there before, it is incredibly hard to make time for it. But I have found that if one deems it important to their life and overall wellness, it will all be worth it.

The photo below is me and my now-girlfriend post-Columbus half marathon approximately two years ago. In keeping with my theme of reducing inflexibility, fitness and stress relief need not be just weightlifting – running can work as well, not to mention the multitude of other activities I enjoy: cooking, baking, listening to music, reading, etc.

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More than that, having the determination and habits to maintain this has allowed me to develop a determined personality when it comes to progress, improvement and most importantly personal wellness. I have seen wellness personified in many different ways – residents and attendings all speak of the various ways they unwind. Whether it is running, cooking, binge-watching Netflix, or reading I see how their faces light up when they can enjoy their lives outside of a hectic work schedule.

While I do realize that as residency begins, time will only become more difficult to manage and balance may have to shift a bit. But in the end, residency is finite and I believe that my interests are things that can, for the most part be sustained decades down the road. Indeed, taking time to promote this balance within my life and identifying the things that make me happy has been a trial and error process, but a worthwhile one and will continue to serve me well down the road.

Practice-Based and Lifelong Learning:

  • Identify one’s own strengths, weaknesses, and limits; a) seek performance feedback, b) maintain an appropriate balance of personal and professional commitments, and c) seek help and advice when needed.

Facing the Odds

The moment I met CM, I could not imagine the road our fates would take. She was a not uncommon multi-problem hospital patient, transferred from an outside hospital to Ohio State in order to stabilize her. A strange hepatic abscess underlined her new-onset atrial fibrillation, CHF exacerbation and multitude of other hospital issues. One of the things I remember most prominently about her was her lability – she was frequently tearful and worried about her hospital course, and we did our best to reassure her on a regular basis that her course was moving in the right direction. She was stabilized and I was able to learn much from her as my rotation wound down.

Never in the wildest imagination of anybody would the next events unfold. I was on my surgical sub-internship, when a consult came up and it was CM. She was ill – much more sick than the last time I saw her. A raging C. diff infection had taken root and rendered her septic and the only solution for her was an emergent total colectomy. She survived the operation, only to continue to bleed in the ICU, requiring an emergent bedside exploratory laparotomy. After this, it was felt by her family that being kept clinging to life on machines was not in alignment with her wishes and care was withdrawn. And like that, she was gone.

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The content of this encounter became a central theme of my personal statement for residency. I will never forget CM – as long as I live, as long as I practice, she will have left an indelible mark on my experience. To have lived through both sides of her medical/surgical coin, to have been what was likely one of the only people on my surgical team to know her voice and her personality and to know that I was there for some of her last moments is both haunting and humbling. It is a lesson I will carry with me as I progress through residency and eventual practice as an attending: to never forget the humanity of the patients I work with. At one point, she was reduced to to her C. diff infection and all I can remember is the violaceous hues of her bowel. At other points, I remember her husband driving through the night from West Virginia to be with her during my initial encounter with her, her tearfulness and her optimism.

There is something so unique and intimate that a physician is somebody who will be there for a patient’s final moments. Whether it is palliative care, emergent surgery, critical care or even a family physician seeing multiple generations of a family. And though the physician is at the center of the encounters, there are always many moving parts: nurses, various therapists, social workers, family members, patient care workers, and beyond.

PB was another patient I had the privilege of knowing. He was my health coaching patient for my first two years – a gentle retired civil engineer who was suffering from newly diagnosed Parkinson’s disease. In getting to know him, I found that during his lifetime, he had traveled to all fifty states and been to five of the seven continents. We spoke at length about China and France, two places intimately tied to my own self. I learned about his profession and career as a civil engineer and his struggles as he learned to navigate the internet and figure out e-mail.

Before him, I had never seen a tremor first hand nor had I seen dementia to the degree that I saw in him. Despite all this, he remained positive and I enjoyed visiting him. His goals were to palliate his symptoms, remain active and live his life as best he could. As I began third year rotations and saw more on the gradient of this debilitating disease, I realize how functional PB was and grew to appreciate even more what an honor it was to help him.

In such a short time, I have seen both ends of the spectrum of dying in medicine. From CM’s emergent surgery and clinical deterioration to PB’s slow, relentless disease I have seen and participated in so much of the patient’s experience. Reflecting on moments such as this help to ground and remind me why I chose medicine. Yet, I know this is only the beginning of my foray into a lifelong commitment to patient care and if my experiences thus far are any indication, it will be an interesting and fulfilling journey. Along the way, I know I will continue to meet more memorable patients and I can only remind myself to reflect on them, their humanity and continue to integrate this learning into my practice.

Patient Care:

  • Approach the care of patients as a cooperative endeavor; integrating patients’ concerns and ensuring health care needs are addressed.