Sunday, August 27, 2006

Hospital Hostility or Hospitality

Ever since I embarked on this journey in the world of medicine, I have had the opportunity to observe countless different personalities, varying levels of authority, and numerous methods of dealing with difficult situations. I have found that certain subspecialties within the field of medicine seem to breed hostility, while other areas tend to cultivate kindness. Many times, I have encountered doctors who have reached the pinnacle of their professional training and yet have resorted to elementary ways (e.g. throwing fits and shouting obscenities) in dealing with stress.

The field of General Surgery is often pinpointed as an area of medicine in which physicians are rude, crass, obscene, and disrespectful. As a third-year medical student at a local county hospital, I remember being intimidated and aghast at some surgeons who barked orders at their scrub techs or pimped a fellow student until she nearly melted away in embarrassment. I always wondered, what possesses these people to lose their sense of chivalry and to let such uncouth habits loose in their work setting?

These are the conclusions that I reached (but as I am not a general surgeon you can take all my comments with a grain of salt):

1. Emergencies and urgencies and stress. Many times when people are faced with stressful situations, they tend to have a shorter fuse. The world of general surgery is constantly approached with difficult emergency situations in which things need to happen quickly (“STAT”). If the traumatic aortic rupture patient is not taken to the operating room NOW, he WILL die. In dealing with some of these crazy life and death situations, health care workers tend to regress back to a primitive paradigm of performance – they shout and scream for things to get done, they ignore the wife or husband at bedside who is brimming with questions, they have one focus in mind – to operate on the patient in order to save his life. By being bombarded with stressors on a day-to-day basis, physicians often forget how to take a step back from their emergent situation or how to ask for things in a nicer way or how to work on those relationship skills.

2. Lack of sleep. It is common knowledge that a person ideally needs eight hours of restful sleep to function at his or her maximum capacity. Surgeons are often sleep-deprived, being forced to awaken at ungodly hours in the middle of the night to repair a strangulated hernia or perforated appendix. Plus, surgery is the one rotation in which you have to get up at 4 am every morning, since surgeons have to round before they go into surgery.

3. Long and difficult residency. Of all the residency programs, general surgery has to be one of the most demanding. In order to become a general surgeon in the United States, one has to endure five years of residency after medical school. Deciding to specialize in vascular surgery or cardiothoracic surgery would add several years on top of that! By the time one finishes residency, surgeons have endured so much that they are often disheartened and cynical.

4. Food chain. During my third year of medical school, I noticed that there was an undeniable level of hierarchy in the hospital. I was obviously at the bottom of the totem pole, then the interns, then the residents, then the attending physicians. This food chain was especially evident during my General Surgery rotation, when the actual order in which we walked indicated who was at the top and who was at the bottom. Interestingly enough, when the attendings would give the residents a hard time, the residents would give the interns a hard time, and the students would get the brunt of it all.

5. Environment. The hostile attitude that is cultivated also dissipates into the other health care workers as well. Trauma bay nurses can be especially unfriendly. My first day on surgery call as a medical student, the intercom overhead announced, “Level A Trauma! Level A Trauma!” Our whole team ran down five flights of stairs to the ER, and my job was to record all the history, vital signs, and physical findings that the paramedics, residents, and nurses shouted out. Everything was chaos. I could barely hear what was going on. So I turned to a young nurse who was also documenting similar findings, and I asked her about the findings I had missed. Suddenly an older nurse began screaming at me, “This is YOUR JOB! You need to LISTEN and record this for YOURSELF! You ARE the medical student, aren’t you???!!!” I was so taken aback I could not even muster up a response. I simply stepped away and continued to record my findings. About half an hour later the younger nurse approached me and apologized for the way the older nurse had exploded. I said, “No, that’s okay. It’s just that it was my first day on call on surgery, and I wasn’t familiar with what I was supposed to do.” Ever since that moment, I knew that life inside a hospital was definitely different from life outside the hospital. Since then, I have encountered many unfriendly nurses and physicians, all experiences that have made me think and have led me to write this blog.

6. Lack of God. It is my observation that when people are extremely busy, stressed, and sleep-deprived, they tend to forget about God. Personal devotional time is the first thing to go. Prayer time is limited to brief periods in the car or before meals. However, it is at this time when it is most necessary to have a strong relationship with God.

Of course I must at this point make the disclaimer that all of these generalizations do not apply to each and every General Surgeon out there. I have a few friends who are in general surgery residency who are among the sweetest, most mellow guys that I know (e.g. Jukes Namm, Geoffrey Lam). Nonetheless, I had to blog my thoughts simply because I have just finished a week of Trauma surgery, and I have been forced to think about all these points lately.

A few days ago, my co-intern Darin asked me with great consternation, “Are you okay? How has general surgery been treating you?” I automatically replied, “Oh, it’s been fine,…why?” He answered, “You just seem…different…more stressed or something. You always used to smile before, but now…you seem a lot more stressed.”

It was at that moment that it hit me. During the few days I had been exposed to the culture of general surgery – the fast-paced, uptight, down-to-business, no-nonsense culture – I had metamorphosed into a different person. I was no longer sweet, gentle, kind, caring, and understanding. Because of the stress of the rotation I had become uptight, no-nonsense, business-minded and short with patients, students, and fellow residents almost overnight! The reality hit me, and I was again taken aback – this time not because of the shock of someone yelling at me, but because I realized I had let my surroundings influence my character instead of letting God lead my life and consume my character completely.

I breathed a prayer of repentance to my Father, and I determined in my heart to steer clear of the temptation to follow the instincts of my carnal heart. Please pray for me – that I may keep my eyes focused on Him even during this trying rotation and that He can use me as a vessel to influence others for His Kingdom.

Friday, August 18, 2006

My Vacation is Over!

Have you ever tried planning a wedding? For those of you women who are married already, you know what I’m going through. For those of you who are still single, you have much to look forward to.

This past week was one of my four vacation weeks that are allotted to me as an intern. I pretty much spent the entire time planning out aspects of my wedding. It was insane. Here’s a taste:

Gathered information about stationery, flowers, decorations, dresses, budgets, etc. online
Looked at countless bridal magazines
Went shopping for a bridal gown
Went shopping for bridesmaids’ dresses
Met with J.Z.’s Party Charm regarding decoration price quotes
Met with J.Z.’s florist regarding flowers for the wedding
Met with Eden Hill Florist (in Los Angeles) regarding flowers
Talked with University Catering regarding the reception food
Planned and brainstormed with my cousin, Jennifer, regarding my wedding until the wee hours of the morning.

After the week of wedding planning, I was pooped. Sadly to say, my vacation – which really was not much of a vacation – ended yesterday. Today I committed my life to eight weeks of bondage to General Surgery. I am starting on the Trauma Surgery service. Today there were 5 traumas that came in – all motor vehicle accidents or motor vehicle-related accidents (e.g. 18 year old male who jumped out of the passenger seat of his car on the freeway while his mother was driving at 65 mph to take him to his psychiatric appointment). All the trauma victims suffered multiple abrasions, and one man required immediate surgery (he perforated his small bowel during the car crash, so the surgeons had to put him his intestines back together). Seeing so many crash victims reminds me again how fragile life is and how dangerous those highways can be. Don’t forget to wear your seatbelts and drive safely!!!

Saturday, August 12, 2006

Ho brah, we go grind den!

Tonight we had a nice gathering with the “Hawaiian crew.” Kenny Chang, an ophthalmologist who is friends with Paul, my fiancé, invited us over for a barbecue dinner. Laura, his fiancée, is a family medicine doctor in Riverside. Both Kenny and Laura are from Hawaii. Chris Chu and Ken Lim, also from Hawaii, joined us for dinner as well. Eduardo and I were the only ones with no Hawaiian connection. Nonetheless, it was a wonderful time.

Kenny cooked some mean dishes. I didn't know he could cook! =)

The stuffed tomatoes were a hit.

And our “barbecue” was modified to meet some of our vegetarian needs (vegetables on skewers!). =)

I suppose that since I am now engaged to someone from Hawaii I needed to be initiated into the Hawaiian culture. It’s amazing that during my entire lifetime prior to meeting Paul I knew nothing about “Pidgin,” the local slant on English that they use in Hawaii. =) For those of you who are as ignorant as I was about Pidgin, I encourage you to listen and even attempt to pronounce some of these words on this entertaining website:

After some research on this above-mentioned site you may be able to accurately decipher the title of this blog entry. Enjoy! =)

Sunday, August 06, 2006

Surf's Up!

Ahhh, another wonderful weekend! Janet and Julie, two of my church friends, invited me to join them for a surfing lesson today. Although I am very fond of land activities, I have always been somewhat wary of water sports since childhood. Swimming is one of those things that I never felt comfortable doing as a child because of the fact that I hated wearing a bathing suit. Consequently, although I learned how to swim, I never practiced the sport nor did I develop a passion for it. However, after learning how to snowboard during high school I was always intrigued by the world of surfing. That fascination prompted me to give surfing a try today.

So Julie, Janet, and I ventured out to Bolsa Chica State Beach in Orange County (Huntington Beach). We took a quick photo before we departed from Janet’s pad in Tustin Ranch.

At the site, we were given a wetsuit and a surf board. Our surfing lesson lasted one hour, and then we were given one more hour to practice what we had learned. The name of the surf school that provides these lessons is Corky Caroll - They were very nice, and I thought the lesson was quite good. Here is a quick summary of what our instructor taught us:

- Beach safety
- The three ways to approach a wave:
1. Paddle-through: paddle through the wave
2. Up-and-over: arms locked straight ahead, trunk upright while feet on either side of board for balance
3. Turtle: roll over the side of board into water, turn board upside down over you, then turn board back over after the wave passes

- The four things to think about while paddling out:
1. Water line = line where water forms a line near nose of board
2. Feet together to prevent drag
3. Shoulders back
4. Paddle with smooth strokes one arm at a time with palms cupped at all times

- How to go from a paddling position to standing up on the board.

Although we did not catch and ride many waves (I think I stood up only once and had some partial stands on other attempts), we had a blast! =) After our time in the ocean, we had lunch at the Tustin Marketplace at a delicious Corner Bakery Café. I think Janet really enjoyed her lunch. =) Mmmmm...

Wednesday, August 02, 2006


Yesterday (8/1/06) I watched and participated in an enucleation for the first time in my life. It was pretty crazy. =) Here’s the story. A middle-aged man who is completely blind in his right eye was having severe pain in that eye and wanted it removed, so he was scheduled for an enucleation.

Here is a picture diagramming the steps in an enucleation:

Let me explain in layman’s terms what my senior ophthalmology resident did, as it was slightly different from the enucleation pictured above.

The attachment of the conjunctiva was carefully cut from the globe of the eye. Then, all four rectus muscles were isolated and removed from their attachments the eyeball. After that the cornea was cut out and all the intraocular contents were removed (all the fluid inside the eye came gushing out, then he removed the iris, ciliary body, retina, etc.). The optic nerve was severed, and the ophthalmic artery was subsequently cauterized. At this point the eyeball was freed from the eye socket and now looked like an empty white bag with just the scleral shell remaining. It was thoroughly cleaned out and soaked in an antibiotic solution (Ancef). The shell was flipped inside out, placed like a finger puppet on the tip of the resident's thumb, and cleaned out even more thoroughly with absolute alcohol. Finally, a silicone ball was popped inside the shell, which was then closed up with some strong suture. The combination of the sceral shell and silicone ball (making up the new eyeball) was placed back in the orbit, the extraocular muscles were reattached to it, and the conjunctiva was sewn back together over the eyeball. The eyelids were also sewn together temporarily to prevent the eyeball from popping back out.

This was truly a fascinating case. I even got to scrub in at the very end, so that was fun. =) Eyes are amazing. I am very thankful I have two of them. =)