September Update

Purple Rice Paddies
Purple Rice Paddies/Nikon FE2/Lomochrome Purple/Chau Doc/Vietnam

Hmong Mother
Hmong Mother/Nikon FE2/50mm/Kodak Portra 400/Sapa/Vietnam

Goal
Goal/Nikon FE2/24mm/Kodak Portra 400/Koh Samui/Thailand

Samui Palm

Samui Palm/Olympus XA/35mm/Kodak Ektar 100/Koh Samui/Thailand

My patient died. I couldn’t sleep the night I heard the news. Less than an hour after I had left work my patient went into cardiac arrest and died despite all attempts, drugs, and chest compressions, to keep her alive. I was not there for the code blue. I was getting into bed preparing for sleep and another long day at the hospital when I got the phone call.

At first, I thought it was a call to tell me that I hadn’t finished a note or a question regarding a patient I had admitted during the day. Rather, it was a notification of my patient’s passing. My co-resident, Jim, gave me the bad news. And, it sliced deep. I was so silent as he told me the order of events, how fast everything happened. The code and conversations with the Intensive Care Unit, everything that could have been done to save my patient was. Yet, it wasn’t enough.

I did everything I could and I couldn’t save her. The reality of that crushed me. I couldn’t breathe beneath my sadness and guilt.  I couldn’t sleep that night. My mind raced over her problem list, thinking of the hospital course, my choices as a physician, and my patient’s death. What could I have done better? Did I miss something? Was this all my fault?

I got a text from my senior resident. Call me if you need to she said. So I did. We talked it over. She reassured me that we did everything we could. That we, as physicians, aren’t Gods. That this woman, despite our skewed reality, was incredibly sick and complicated. And, while hindsight is 20/20, over the course of her time in the hospital our team did everything we could to take care of her. My senior reassured me, “Hunter, you did everything you could”.

After our phone call, I sat staring out my window at Chicago. I thought about my patient. My mind went over every interaction we shared. Meeting her on my morning rounds for the first time. The conversations about her life and her dreams. Cajoling her into drinking Golytetly and Ensure shakes. Her children and their accomplishments. After the first week she started to call me Smiley because she thought I had a beautiful smile.

Every morning when I came into her room to talk to her about her night and the plan for the day she smiled. She said that every morning when I came in with my big smile she couldn’t help but smile and feel at least a little bit better. She shared her pain and I gave her my reassurances that everything would be okay. She trusted me.

I made her feel safe and comfortable in the hospital. Hospitals are often lonely, scary, sterile places where love ones are far away. While she was in the hospital, I was her friend. I was her advocate.

When she was in surgery, I talked to her family and told them what was happening. I answered their questions and told them everything I could about their loved one. They called me Smiley. They trusted me.

And I realized, that my senior was right.

I did everything I could to save her.

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August Update, one month late

Hmong Farmer
Hmong Farmer/Olympus XA/Kodak Tri-X/Sapa/Vietnam

Saigon Life

Saigon Life/Nikon FE2/Kodak Tri-x/Saigon/Vietnam

Samui Fisherman

Samui Fisherman/Olympus XA/Kodak Tri-x/Koh Samui/Thailand

Marooned Boat in Halong Bay

Marooned Boat in Halong Bay/Nikon FE2/Kodak Tri-X/Ha Long Bay/Vietnam

My father was recently admitted to the hospital. I had just finished morning rounds and finally, after hours of discussing patients and formulating plans for the day, had a moment to use the bathroom. These bathroom breaks have become somewhat of a sacred moment, where I can gather my thoughts, take a deep breath, and most importantly empty my bladder. As soon as I entered the restroom, I get a phone call. Expecting a wrong number, I casually greet the caller and after confirming my identity the man tells me that my father has been in a bicycle accident. He was found unconscious in the of the road. Ambulance just arrived. My father heading to the hospital now.

 My blood ran cold. Everything stopped. My father, my best friend was hurt and I had no idea how bad or what happened. I was several states away just starting my day shift. I felt powerless. My medical training meant nothing in those moments as all I could do was tell the person looking at my father thank you for calling and hang up.

After many phone calls and phone tag I finally was able to rally my father’s closest friends to head to the emergency room at the hospital to give my father some company. After five years of medical training, all I knew to do was get people that cared about my father by his side. After all my efforts, I knew at least two people were headed to the hospital to take care of my father. I went back to work. I took care of my patients and as soon as I got out of the hospital I called my father.

He was hit by a deer. While bicycling through the outskirts of Nashville, a deer ran into him. My father flew from his bike and broke five bones: his right scapula, right clavicle, and 3 ribs. If he had not been wearing a helmet he would be dead. But, he is alive. Expected  to make a full recovery. Just a month of immobilization and slow physical therapy to bring him back to full strength.

My father’s freak accident served as an important and humbling reminder. Only two months into my residency and patients are becoming just names on the computer that require a sequence of clicks and notes typed to take care of them. That isn’t what medicine should be. These patients are people with families, friends, and loved ones who are just as stressed as I was when I heard the news about my father.

It’s hard though, as the more time I actually spend with my patients the less “work” I am actually doing. To get things done, I need to click, type, and sit at my computer and save my patients one progress note at a time. The brief moments I spend rounding on my patients is not enough, but if I am not working behind a computer all my patients suffer as nothing will get done. It’s the catch 22 of modern medicine and the electronic medical record because I DO CARE about my patients, but I can’t see them. I can’t get to know them beyond the initial HPI interview and the brief moments that encapsulate my morning rounds otherwise I will never be able to make it home.

My father though, taught me just how important it is that I take that extra few minutes to talk to my patients and get to know them better. To humanize them so that they don’t feel like they are on a conveyor belt in and out of the hospital as fast as possible. Which I think happens when 95% of residents’ days are spent typing and clicking and making phone calls, and typing some more. The patients behind the medical record can be lost. I understand why though; I am so busy trying to tread water. Order the correct medications, realize I ordered the wrong medication, reorder the medication, d, realize I calculated the incorrect doses, double check myself, triple check myself, and generally try to not kill my patients with my new doctoral powers. I just haven’t had the time to get to know my patients like I want to.

Despite it all, I won’t let my idealism die. As I’ve learned the system I’ve been able to spend more time with my patients and I know I will make a point of it to spend more time with my patients so that I can get to know them as more than just their chief complaint.

Residency is a process, and while I’ve had my trials and tribulation, I do feel that I am getting better at my job day by day. I love my job, so much more than words can depict. I am looking forward to tomorrow.

Refining My Passion

Atlanta Manta Atlanta Manta/Cannon T2i/Atlanta/Georgia College TreesCollege Trees/Cannon T2i/Chicago/Illinois

Migrant WorkersMigrant Workers/Olympus Pen FV/Fuji Superia 400/Guagnzhou/China

Red on Red
Red on Red/Panasonic Gx1/Boston/Massachusetts

When I started medical school I had vague ideas about what I wanted to do with my life. In medical school I discovered primary care and Family Medicine, the kind of doctor I have decided to become. I can’t wait to begin hearing my patients’ stories and understanding how they got into my office. I want to have my own go, using my own style to help people deal with managing their diseases. Forming authentic relationships with my patients so that they trust me and in turn I can use that trust to motivate my patients to make real changes in their lives. But, in these last five years of medical school I know I want to do more. I know I can do more. There are still countless areas to improve our healthcare system and the way we as healthcare professionals take care of our patients.

As a medical student I’ve become more and more familiar with our nation’s healthcare system and it’s simply not good enough. Despite the Affordable Care Act’s efforts, 33 million Americans still don’t have insurance. Furthermore, recent studies have found that only 51% of families can afford their deductibles. Also, consider that over 75% of American’s are living paycheck to paycheck with far too many financial responsibilities to even fathom an emergency savings. What good is health insurance if you can’t pay the deductible to use it?

But, insurance is complicated. Only one in seven really understand what they are looking at when they are deciding on a plan. People are inundated with complicated insurance plans with huge ranges of deductibles, premiums, and options of coverage. Disguised behind the ability to choose is a massive epidemic of poorly informed financial decisions. Behind the low premiums lie massive deductibles waiting to trounce the Americans that believe “that won’t happen to me” or “I’m healthy, I’m young, what could happen?” This is the problem. Picking our health insurance shouldn’t be a gamble. Americans shouldn’t be putting themselves and their families at risk of financial ruin. Americans deserve better than insurance companies leaching low premiums each month and then forcing American’s to put off care until they can “afford” it.

I won’t stand for it. Not anymore. I know now what I will dedicate myself towards. I will fight for better health coverage. Healthcare is a basic human right that everyone in this country, citizen and non-citizen, deserves. I will work through research and advocacy to change our nation’s healthcare system to one that every American citizen can rely on and be proud of; A healthcare system that is not the number one cause of personal bankruptcies in the country.

I now stand in front of a massive decision. Where will I go for my residency training? I will choose a program that will foster my enthusiasm and direct into a force of change and leadership. A program that will refine my passion and refine it so that I can work to better not only individual patient’s lives but our entire nation’s health and well being.

References:

Levy J. April 2015. In U.S., Uninsured Rate Dips to 11.9% in First Quarter. Gallup. [Date accessed: 11/18/15]. http://www.gallup.com/poll/182348/uninsured-rate-dips-first-quarter.aspx

Johnson A. June 2013. 76% of Americans are living paycheck-to-paycheck. CNN Money. [Date Access: 11/18/15].http://money.cnn.com/2013/06/24/pf/emergency-savings/

Dartagnan. March 2015. More And More Americans Can’t Afford “High Deductible” Health Insurance Plans. Daily Kos. [Date accessed: 11/18/15]. http://www.dailykos.com/story/2015/3/13/1370679/-More-And-More-Americans-Can-t-Afford-High-Deductible-Health-Insurance-Plans

Loewenstein G, Friedman JY, McGill B, et al. Consumers’ misunderstanding of health .insurance. Journal of Health Economics32 (2013) 850–862

A place to call home

273: Dali Sunrays

Dali Sunrays/273/Nikon FE2/Fujifilm 100/Dali/China

264/365: Breakfast Making

Breakfast Making/264/Nikon FE2/Kodak Gold 200/Shanghai/China

269: Tiger Leaping GorgeTiger Leaping Gorge/269/Nikon FE2/Kodak Portra 400/Tiger Leaping Gorge/China

252/365: Rice Paddies

Rice Paddies/252/Nikon FE2/Fujifilm 100/Dali/China

I have been in China for 320 days and I have just nine days left before I return to the Chicago. It’s amazing how fast this last year has flown by and a little scary at how fast these last few weeks have swept by within the blink of an eye. I will come back to America a different person, a medical student itching to graduate and start my residency. This time in China has pushed me to my limits, exposed me to many wonderful and life changing things, and has truly changed the way I look at the public health, world, and myself.

I began this journey well before I left medical school for China. My desire to travel to China that has been something dwelling in my heart  for many years. To spend a year abroad, to spend it in China has always been something I felt I needed to do before I died. It’s slowly built over time, since I left Vanderbilt for my short summer study abroad in Shanghai six years ago, this wish to travel to a foreign land and live. It started out as a dream to live and slowly transformed into a more meaningful mission to do public health research. With the encouragement of many special people in my life I went for it. I left the convenience, familiarity, and Internet freedom of the USA for the smog and Great firewall of China and there I found everything I wanted and more. I found myself. I found what really matters to me.

I realize now that while I’ve been a traveler my entire life, I’m the kind of traveler that likes to live. I don’t prefer the brief tastes of places, I’d rather savor the nooks and crannies that are often over looked when visiting a place for a short second. I’ve done that here in Beijing. I’ve made it a home for the last ten odd months, but now, I know it’s time to move on. While I’ve set up shop and made a life for myself here, but I know now that this isn’t my home. This isn’t where I am supposed to end up.

This journey has continued to build upon something deep inside me. My life has been an endless barrage of travel and transition, never in a place for an extended period of time. My time in China has shown me that I desire to finally find a place that I can settle down and put down roots. A place I can call my own. A way to finally answer one of the most difficult questions I am asked all the time: “Where are you from?”

It’s funny how such a simple question gets right to the root of one of my deepest struggles. Where am I from? Honestly, I really don’t know. I’ve lived in so many different and amazing places but what place has stuck with me? What place do I want to call home?

While this journey is ending, I know my next one is just beginning. That’s the funny thing about journeys; one ends and before you know it the next one begins. I am ready to take my next steps into an unknown future. I am finally prepared to answer one of my most existential questions.

My time in China has allowed me to discover that what I’ve always wanted in life has been in the States the entire time, in a city I was prepared to leave. A part of my life I previously thought I wanted to abandon.

I am ready and eager to return to Chicago. A place I think I can finally call home.

What I’ve learned in China

231/365: Xinjiang Cowboy SilhouetteXinjiang Cowboy/231/Nikon FE2/Expired Fuji Velvia 50/Xianjiang/China

232/365: Chicago Crossing Chicago Crossing/232/Yashica Electro 35 gsn/Kodak Tri-x 400/Chicago/IL

236/365: Hutong Construction Hutong Construction/236/Yashica Electro 35 gsn/Ilford HP5+/Beijing/China

239/365: My Prayers Smoldering My Prayers Smoldering/239/Olympus PEN FV/Kodak Tri-x 400/Guangzhou/China

In the last 9 months I’ve learned so much. I’ve learned how to approach public health research, how to address missteps and mistakes with poise and a positive attitude. I have started the process of defining my dreams and am ready to start my fourth year of medical school. I know what I will talk about in residency interviews. I’ve discovered confidence I didn’t think I possessed. I uncovered and refined my passions. I have gained a greater understanding of my motivations and what I need in order to continue to grow as a person. Most importantly I’ve learned what I love most in my life: Jennifer An.

I’ve been so self-obsessed with chasing prestige and what I imagined others to think would be important for my career that I glossed over other aspects of my life that I knew deep down were the most important. It was a battle of my heart and my mind and for the longest time I let my mind prevail. I justified my mind’s victory over my heart’s desires with career aspirations and countless petty excuses that I now realize are meaningless. I’ve been terrified of commitment and that next crucial step in a relationship where you plunge everything you have into making something take root and thrive. But, if I get another chance, I won’t let fear stop me anymore from loving the one that matters most to me.

It is interesting how one day things just click. How clarity can just set in at a moment’s notice. How a problem that has been staring me in the face for months becomes instantly clearer. How suddenly my vague dream of working in public health has manifested itself into an ideal future with Jen by my side. Before coming to China I believed that global health is where I was needed, that those problems were not only more relevant, but easier to address. That may be true. I used to think that domestic public health problems were too difficult and full of bureaucracy to change. But, China put into perspective what I could and wanted to do with my life. It reminded me the reason I applied and chose to attend Rush in the first place. Rush and Cook County Hospital are institutions trying to make change for underserved and hurting populations throughout Chicago. I’ve had mentors that battle daily in the trenches trying care for and to produce research that can make meaningful change for vulnerable populations in Chicago. I’ve worked in the hospital that was responsible for making it illegal to turn down a patient at the ED, no matter their ability to pay. I’ve lived in a city that has sat at the cornerstone of public health change. I know Jen also wants to continue to change those disparities for the better. That our career pursuits and passions don’t have to diverge but can instead converge. That with our powers combined we could help further transform a city that is suffering and dying due healthcare accessibility and a myriad of other problems. The potential of that future together excites me. It would not be a sacrifice to match in Chicago with Jen, but a dream come true.

There are still too many variables to know what will happen when I get back to Chicago. I’ve made mistakes and sometimes an apology just doesn’t cut it anymore. But, I am excited to return and start carving a direction. I am only in the infancy of my career and my life and I hope things go the way I want. I know now though that no matter what I will be successful and happy. It’s funny, by finally following my heart I think I’ve arrived at a potential future that my mind could never have  conceived, a much better dream than I could have ever imagined before China.  During my time in Beijing, I’ve learned that I want to spend the rest of my life working to love every second of it and to make my family’s, friends’, patients’, and hopefully Jen’s lives better.

Validation

210/365: Guangzhou Rain CoupletGuangzhou Rain Couplet/210/Olympus PEN FV/38mm/Lucky B&W100/Guangzhou/China

218/365: Gobi Cowboys
Gobi Cowboys/218/Nikon FE2/Kodak Ektar 100/Gobi Desert/Gansu/China

213/365:Macau streets
Macau Streets/213/Olympus PEN FV/Kodak Gold 200/Macau/China

219/365: OblivionOblivion/219/Yashica Electro GSN/Kodak Tri-x 400/Chicago/IL

When I was accepted into the Fogarty I knew I would change, that I would grow. I knew I would become a much more accomplished clinical scientist and that I would learn a lot about myself and who I want to become. I didn’t anticipate the wild ride it would be. I didn’t foresee such massive increases in my self-confidence and clarity in what I want in life.

I’ve needed this year. It’s cost me a lot; my friends have matched together, their next stage in life decided. And, here I sit unsure what will happen in a year. I still have so many questions regarding my future and direction. I’ve put distance between my friends/family and myself that no amount of gchat, skype credit, or facetime can change. I pushed away the person that matters most to me. Despite these challenges and tribulations, I know that this year was necessary for my self-growth, for me to be a much better physician, and to be the best human being I can be.

My whole life I’ve needed outside validation. I’ve reveled the thrills of adding another succulent line to my CV and felt the terror of continuing to feel obligated to top my past accomplishments. I can’t be a failure. I can’t settle. I have to be the best. At least that’s what I used to think. Though it’s a trap that’s easy to fall into again. I’ve started to realize that the metric system I employed most of my life to measure my self-worth was based on what others thought of me. Not what I thought of myself. Happiness was based on what I thought others believed to be important and not what I valued.

Coming to this epiphany really lifted a burden I didn’t know I carried. I’ve been so terrified of disappointing everyone else that I forgot that I shouldn’t disappoint myself. Not that those things don’t sometimes coincide, but sometimes I find these two views clash. When they do, for some reason, I think everyone else is right and I must be mistaken. Ironically, I am the one that was wrong all along. I don’t need to worry about what others think of my life and my accomplishments as long as I find my own happiness.  With this in my mind now I am approaching things with a new resolve. I will do what makes me happy and what I deem to define me. I will not hunt the validation of others. I am proud of myself. I already see this new view beginning to change my priorities and dreams, but I know this will lead to new adventures full of infinitely more passion, satisfaction, and love.

Letting Go

153/365: Ice ShadowIce Shadow/153/Nikon D7000/Hou Hai/Beijing/China

195/365: Ditan Men KouDitan Men Kou/195/Nikon FE2/50mm/Ilford Delta 3200/Ditan Park/Beijing/China

110/365 Jiu Zhai Gou LakesJiu Zhai Gou Lakes/110/Nikon D7000/Jiu Zhai Gou/Sichuan/China

109/365: Jiu Zhai Gou Falls 1Jiu Zhai Gou Falls 1/109/Nikon D7000/Jiu Zhai Gou/Sichuan/China

200/365: goodbye

goodbye/200/Nikon FE2/Fuji Superia 400/50mm/Wukesong Camera Market/Beijing/China

This last week I was in Guangzhou with John, a fellow Fogarty Scholar working in Guangzhou. It’d been eight months since I’ve last seen and met the man, and it was an amazing experience getting to know and glimpse a tiny picture of his life in the Pearl River Delta. In our hours of conversations though he asked me a tough question: what has been my greatest struggle while in China?

Thinking about this now and investing a little more thought into identifying my greatest struggle I believe it has to be learning to let go. I’ve found that one of the hardest things for me to do is to relinquish control and let things flow naturally. I need to solve things instantly, I need to have the answer now, and I need results now. I must have instant satisfaction. I fear that without this control my anxiety will strangle me and leave me unable to operate or breathe.

But, ironically, I find that the more I try to exercise control over uncontrollable situations I feel even more stressed, more strained, and unable to sleep. I have found myself paralyzed by this inability to solve certain challenges or dealing with the frustrations of countless attempts to take control with no progress.

China has taught me about my limits and to accept them. To understand when I’ve done everything I can in a situation and relax. In the last two weeks, I’ve encountered so many challenges that revolve around this necessity to let go, move forward, and stop stagnation. From IRB nightmares right before the initiation of my study, to the death of my computer, and trying to move on from a past love. Constantly fretting over these and other issues, I couldn’t live the way I wanted to live. My mind felt like it was racing from crisis to crisis, with little more I could do to alter the problem. I had to let go. I knew if I couldn’t, I wouldn’t be able to continue to function. I let forces continue on their way, and as it stands now, my self-perceived crises are either resolved or resolving. My study is complete with IRB approval. Preliminary results are showing very interesting findings, consistent with many of my initial hypotheses. My dead computer is being revived by the Geniuses’ Magic at the Apple store at no charge and with a backup I can begin to rebuild. And, while I am not fully over Jennifer, things are getting better slowly as I find my own independence.

The last 9 days in Guangzhou were nothing but spectacular. You couldn’t plan a better trip. I didn’t have anything prepared when I arrived in Guangzhou. My study was an outstanding success with 105 women recruited. I went to Macau and ate seven or eight of the most amazing egg tarts from different shops around the peninsula. I had lunch with an old friend in Hong Kong, someone I thought I’d never see again. Bought 3 rare unique rolls of 135 film at the biggest film collection store in the world, FilMe. Got a hilariously awkward life story that I will tell people for the rest of my life at a 24hr spa in Shenzhen. And, most of all I met and made wonderful friends that I won’t ever forget and I hope to see one day in the future. It was an exercise in focusing on the present, and I loved every second.

Thanks again John. Check out his excellent blog full of wonderful photography here!