Foot in door vs. Foot in mouth

As some of you already know, I quit medical school about two months ago. I had one full year to go, which is an eternity when you despise something as much as I did medicine. It’s not about the hard work, it’s not about annoying patients, and it’s not about being in the hospital. What I hated was the science and knowledge of medicine. I simply did not care whether or not 2% of a specific subset of the population were prone to a disease that had a 30% chance of turning them into pumpkins. I don’t care about all the funny little proteins floating around in our bodies doing their jibber-jabber business. I don’t care about the 0.8% increase in the resistance to a particular antibiotic of a strain of bacteria in Baltimore found only in Oompa-Loompas addicted to cocaine. I don’t care about seeing little chocolate covered donuts under the microscope and knowing that there’s a 82% likelihood of the presence of a malignant vs. benign tumor. Whoopdy-freaking-doo. I just don’t care. So when people told me “why don’t you just become a radiologist,” they were completely missing the point.

One of the few things that I was truly passionate about (and proud of) in medical school was my position as the president of APAMSA, and our incredibly successful shirt sale fundraiser back in my 2nd year. Countless hours were poured over that project, and I loved every moment of it (I challenge any other club in a professional school to raise over $3,000 with one fundraiser). I also loved debating with a fellow medical student (who also disliked medicine) about ways to improve the daily operations of the hospital, and how much time and money could be saved from various practical changes. I loved reading a study from a particular consulting company accounting for the details of the rising costs of healthcare in America. I analyzed each and every one of those seemingly boring tables and graphs to make sure no details were lost.

Thinking back to college, I did the bare minimum amount of studying for my biology and chemistry classes. However, I remember entire days spent writing code for the extra credit portion of a computer science project, or the late night hours that flew by drawing little neat colorful graphs for the economics assignment due the following week. I was pretty dedicated, just not in certain subjects, and unfortunately I chose to further pursue one of these subjects.

It wasn’t until third year that I truly realized I was not meant to be a doctor. I have the utmost respect for most of my colleagues and other future doctors out there, because at times it is a truly noble and rewarding work (although half of them are in it for the wrong reasons). However, I knew medicine wasn’t for me. My path lies elsewhere, and I’m extremely happy to have come to this realization. Now, the wisdom versus folly of my decision won’t be determined until later in the future. If I am successful people will say “Epson had the courage and foresight to quit medical school and pursue his passions.” If I fail to succeed, then they will say “he was a quitter, and that’s why he hasn’t gotten anywhere in this world.” Such is the nature of hindsight, our never erring judgemental master.

It is a little ironic that I was able to make this decision partly due to a patient I had back at the VA (Veteran’s Administration) Hospital at the beginning of my 3rd year. The patient was a 70-something year old Vietnam veteran with an incredibly colorful history (long story short, he was the captain of some unit in the war, and he was a POW for a while). I spent about an hour just sitting in his room chatting with him, and before I left he said to me “just remember, if you don’t like where you are or what you’re doing, get on a bus and go somewhere else and do something else.” Call it dumb blind coincidence, call it fate, call it a nudge from God - whatever it was, it was exactly what I needed to hear. And so here we are, a little over a year later, in the aftermath of all that’s happened during the trying times of 2007 that led ultimately to my departure from medicine.

There’s nothing quite like parental disappointment. Due to some family issues, I opted to wait until last week to tell my parents the news. It would have been so much easier if they were angry and yelled at me. Instead, anxiety and defeat were what I got. I was already overwhelmingly burdened by my mom’s anxieties over the news, but I nearly broke in half when I heard my dad’s voice over the phone. It was a voice I had never heard from him, sounding not unlike a patient when they quit the fight and give in to the inevitability of their disease. It was the sound of defeat. It tore me to the core.

I know my parents will recover from the trauma of the news. Life will return to normal as it always does, even if the scars of the past linger on. I am now faced with the daunting task of moving on, of trying to stick my foot into the door of this hazy world of “business.” At times I am confident that there is a future for me, as people of my training, background, and ability must be in high demand out there, especially at such a transitional time in healthcare both in the US as well as in Asia. Yet at other times, I am bogged down by the fear of failure, of the reality that people will be hiring me for my potential and not for what I can already bring to the table. What company out there would be willing to take a risk on someone without any practical skills? Or worse, take a risk on a quitter, regardless of how smart he might or might not be?

I hope and pray that this fear does not paralyze me in the coming weeks as I begin seriously searching for a definitive start to this new beginning. Exciting times lie ahead, although like I often say, excitement isn’t necessarily always a good thing. Regardless of what happens, I’m glad I made this choice. It was the right choice, even if hindsight disagrees.

Homer: "If You don’t like your job, you don’t strike. You go in every day and do it really half-assed. That’s the American way."

Two Crackheads

I think I've finally reached the peak of selling out to the fad of pop-culture pseudo-rebellion.  I'm currently sitting on a plane typing this entry on my new Macbook Pro, listening to MC Solaar (French rapper) on my Ipod nano, and wearing a moderately fitted t-shirt with the Ghostbusters logo proudly displayed on the front.  Somehow I've managed to become the antithesis of a conservative capitalist pig - not that I ever considered myself as such, but I definitely have my right-sided leanings.  The only thing keeping me from turning completely into a snooty coffee-shop-stalking buret-wearing poetry-spewing guitar-strumming imaginary-rebellious yuppie hippie is the fact I'm on my way to go skiing at Lake Tahoe.  Not snowboarding.  Skiing.  The one that old rich white men prefer.  I keeps it real like that.

So anyway, let's talk about relationships.

Now I must first give credit to where it's due.  The core of the ideas I am about to present are not my own.  Instead they came from a certain friend of mine, who we will call S. Kang to protect his identity from you online predators.  Actually, that's too obvious, we'll call him Sam K. instead.  Only someone from an engineering background such as his can take something like relationships, with its infinite shades of gray, and turn it into a distinctively concrete, very concise, and surprisingly logical bullet form list.  Perhaps this simplicity is where this theory derives its strength.

To begin, I must first stress what this list is NOT.  This is not a list of everything that goes into a successful relationship.  Instead, this is a list of three things that MUST go into EVERY successful relationship.  If you still do not understand this concept, let me put it another way.  Just as there are many different types of cakes out there, there are many different types of relationships.  However, all cakes have in common certain ingredients, like eggs, flour, water, and sugar.  Depending on the scenario and personal preference, however, cakes may or may not have chocolate chips, fruit, whip cream, etc.  We're here to talk about the eggs and flour of a relationship.  (Yes I realize there are ice cream cakes and cheesecakes.  Stop breaking my delicious dessert based analogies you bastard.)

As a second disclaimer, this entry is not simply limited to romantic relationships.  The list applies to all human friendships.  Since friendships are at the core of any relationship, be it professional, romantic, or between friends (duh), it translates pretty well to all manifestations of social bonds.

Without further ado, here are the three elements vital to any relationship: Fun, Respect, and Trust.  Now you may be thinking to yourself "that's so obvious Epson, you're an idiot for thinking this is somehow profound!"  Is it really though?  Let's analyze each in further detail.

First we have "Fun."  This one is pretty straightforward.  Two people must be able to have fun in order to enjoy each other's company.  This incorporates things such as sense of humor, similar interests, and that sense of "chemistry" that's so hard to describe with words but everyone has experienced as some point (kind of like asking you to describe what "salty" tastes like).  When you have fun with someone, time disappears.  Three hour phone conversations feel like they only lasted 15 minutes, and you can barely recall what topics were covered but you know you had a lot to say about whatever it was you talked about.  You can joke about the stupidest things and still somehow entertain (or be entertained).  You can go play basketball or hit some balls at the driving range, eat some fast food, and wait two hours in line to watch the latest superhero blockbuster movie on opening day.  I don't really need to explain further what having fun is like.  You just know.

The second element is Respect.  Any relationship, be it a good friend, a significant other, or a coworker, must have respect.  To list a few components, you must respect the person's intelligence, wisdom, moral/ethical fiber, generosity, patience, dedication, character, and passion.  Now not all of these are necessary, but they all contribute to an overall sense of respect for someone, and the more of these elements that are present, the stronger the respect becomes.  In essence, there must be qualities in the other individual that you admire, and these qualities must be greater than the person's shortcomings.  I'm not suggesting you must idolize the person, but think of it this way - you cannot date or be very close friends with someone who is, in your opinion, dumb as a rock, a pathologic liar, or stingy like Scrooge McDuck.  A hippie tree hugger will probably not be best friends with an investment banker, because the two simply would not have respect for each other's outlooks on life.

These first two components remind me of a Chris Rock standup routine, where he astutely points out when a relationship simply won't work.  I believe it goes something like this:

"That's right.  If you born-again, your woman gotta be born-again too.  If you a crackhead, your woman gotta be a crackhead too.  Or the sh*t won't work!  You can't be like 'I'm going to church, where you going?'  'Hit the pipe!"  That relationship aint going nowhere!  Two crackheads can stay together forever."

Anyway, the last item on the list is Trust.  Some of this overlaps with respect, but at the core Trust is a very different thing.  Trust is when you can tear down your own defenses and really open up to a person, because you know the person will not hurt you when you are vulnerable.  Trust is when you can place a piece of your own welfare in someone else's hands, and know that they will not end up stabbing you in the back.  It is knowing the person isn't selfish enough to put their own interests ahead of your relationship with them.  It is knowing the other person is dependable, that they will be there when you are down, and will abide by that oh-so-important social code of conduct that binds us all.  Trust is knowing and respecting the other person's moral and ethical character enough to know they will do the right thing when the time comes, when faced with a difficult personal decision, when mutual interests conflict, when doing the right thing means making a personal sacrifice.  To willingly make sacrifices for a relationship, that is the utmost sign of a truly strong bond.

Think about all your current and past friendships and relationships.  How many of them meet all three criteria?  Think about that person who you SHOULD enjoy hanging out with but end up checking your watch every 10 minutes when you're with them.  Think about that coworker who you chill with at work but don't really care to show him or her to your other close friends.  Think back to that friend you always hung out with who would chirp about "bro's before ho's" and then backstabbed you or another mutual friend.  Think about that really hot date you had where you just wanted to bang your head against a brick wall everytime they opened their mouth, even though you know they are a nice down-to-earth person.  It's not so easy building a strong relationship is it?

I maintain, then, that all successful, deep, meaningful relationships must include all three of the above elements.  Notice how I avoided using the word love.  That word has come to mean so many different things to so many different people that trying to address it in an absolute sense would be biting off way more than I could chew.  I hope and pray for all of you to have at least one relationship in your life that possesses all three of these qualities.  Those are the relationships that will last, the ones that will make you a better person, and the ones that will bring you the most happy memories.

Mr. Burns: "I'll keep it short and sweet - Family, Religion, Friendship.  These are the three demons you must slay if you wish to succeed in business."

2008 Smells Like Ice Cream

It's amazing how one single year can bring about so many changes, but here we are, 5 days into 2008, and I'm still dazed just thinking about 2007.  To say I'm happy that 2007 is over is like saying Michael Moore is only slightly overweight - meaning that it is the understatement of the century.  I am f'ing ecstatic that 2007 is over.  I'm not going to recount all that has happened in the previous 365 days of my life - that is not the purpose of this blog.  Strangely, I don't really know what the purpose of this blog is...

So looking ahead to this new year, the logical first question that comes to mind is "what is your new years resolution?"  I must confess that my resolution is sort of a cop-out one, but it's my resolution so I can do whatever I want.  Quoting Russell Peters, my resolution is "be a man, do the right thing."  Vague, yes, but if correctly applied it's strangely powerful (and mildly amusing if imitated in a fobby accent).  There's a lot of pride and ego standing between me and "doing the right thing," but here's to trying.  For starters, I began this new year right by not drinking on new years eve (or day).  I refused to bring in this joyous occasion inebriated and not in full possession of what remains of my faculties.

I can't divulge certain details of some of the changes to come this year just yet on a public online blog, perhaps in a couple months when things settle down after the proverbial  doodoo hits the fan I'll share the details with you three loyal readers.  I was taught that a  paragraph needs at least 3 sentences, so it seems I'm still short one more.  I wonder if that first sentence was a run-on...

Religion has always been one of those mysteriously foreign things to me, strangely familiar yet always just out of reach.  But over the last year this foreigner has managed to provide much comfort in my times of need, and if nothing else I've learned to be a better person for it.  I'm pretty sure the Christian path parallels my "doing the right thing" path, so really if the two are so closely related why not learn more about this thing known as Faith?  I've already taken one lesson from the Bible, that whole "turning the other cheek" business, and applied it to my own life.  I've got many cheeks to turn (4 to be exact!) so what's the harm in turning just one? Some of you have already heard that stupid joke before, but I like it so I'm gonna keep kicking the dead horse.  So here's to spiritual growth, may you stay strong and true in my life.  Of course when I write that I have this mental image of me raising a glass of champagne and toasting a crowded room - I guess it doesn't work quite as well online.  Use your imagination people.

On a closely related topic, the new Rambo movie looks awesome.  With a catch phrase like "Heroes don't die, they reload" I think we're finally going to have a ridiculously awesome action movie like the good ol' days (remember the first Lethal Weapon or Terminator 2?)  And I don't know how Stallone does it, the man must be a robot sent from the future, because no human being can be his age (the man was born a year after World War II ended!) and still be such a badass.  Brain, I'm shutting you off, because it's gonna be a good time and I don't want you ruining this movie for me.

This year should be a good one for movies - a few that come to mind: Batman Dark Knight, Wall-E, 10,000BC, Ironman, the next Harry Potter, the new Narnia movie, and that movie where Adam Sandler plays an Israeli secret agent turned hair stylist.  I might even throw in Hancock (Will Smith rogue super hero movie) into that list, but Big Willy Style is pretty hit or miss when it comes to movies so I'll reserve judgement there.

The hour grows late, so I must go goof around elsewhere now.  Til next time.

Homer: I'm like that guy who single-handedly built the rocket and flew to the moon.  What was his name?  Apollo Creed?

What is the greatest problem facing healthcare?

Recently this question of great magnitude was posed to me, and being neither up to date with current political perspectives nor well informed on the subject (a state I will remedy in the near future), I was at a loss for a response. Being a medical student only affords one with a minimal microscopic perspective on the issue, and asking me for my opinion on the subject is akin to asking a lowly foot soldier his thoughts on how to end the war in Iraq. After much contemplation, I decided to take a step back and tackle the problem from a more theoretical and philosophical approach. What follows may seem like the rantings and ravings of an uninformed man who loves to hear himself talk, and while that may not be too far from the truth, I maintain there is yet some shard of relevance and truth in the verbal diarrhea to come.

The biggest problem facing healthcare is its rising cost. Now, that may not seem like a very insightful or profound statement, so let us try and break it down into smaller, more palatable chocolate chip pieces. And for the record, when I use the word “cost,” I am referring to all of healthcare as an overarching entity, including private insurance organizations, government programs and assistance, individual out of pocket expenses, and any monetary expenditure related to medical care. We can go on a liberal tirade about the black-hearted HMO’s and their passion for high profit margins and baby seal clubbings, but that would not be completely relevant to the discussion, as private insurance company profits are not at the core of the rising costs problem.

At a superficial glance, it is obvious that there is a lot of money and resources simply falling through the cracks, not reaching the consumer (the consumer in this case is the sick patient seeking medical care.) These dollars are being drained by inefficiencies in our lumbering dinosaur of a medical system, inefficiencies like unnecessary middlemen, poor communication, overlapping services provided, imbalance in regional supply vs. demand, and so forth. Thus there is significant room for streamlining and maximizing efficiency to help cut a moderate percentage of current healthcare costs. However, I believe there is a greater more fundamental problem, one that the short term bandage solution of maximizing efficiency will not be able to cure, a plague that claims the majority of responsibility for our rising costs. Who is this evil mastermind?

In no other aspect of life do we as Americans have an innate expectation for deserving “the best.” If you made $50k per year and demanded to drive a Ferrari, people would think you were insane. If you made that much money and demanded to live in a mansion with a 100ft yacht, people would know you were insane. Yet if you made that much money and one day got cancer, you would expect to be guaranteed the best available healthcare. We as Americans feel obligated, and perhaps rightfully so (an ethical debate reserved for another day), to the best healthcare regardless of the cost. And therein is the dichotomy - only in healthcare do we expect and receive the best. If an MRI shows even a marginal advantage over traditional Xrays for confirming a diagnosis, the patient will receive the costly MRI. If surgery is the indicated treatment for a disease never will the patient only be given medications and sent home. If the man earning $50k per year requires procedures and hospital stays costing over $200k, he will receive the necessary care. We find it so ethically and politically incorrect to set financial limitations when providing for the sick, and yet as a society we have a finite financial capacity. But it gets worse.

To compound the issue, technology will only serve to drive costs even higher. Healthcare cost was not an issue back in the days when leeches and holy water were mainstays of therapy. When MRI machines were not available, people did not have that high cost alternative as a management option. As technology advances further, the “standard of care” will continue to rise because we are all, afterall, deserving of the very best care. If in the future reliable artificial organs were invented and everyone currently on an organ transplant waiting list could be fitted with new livers and kidneys, can you begin to imagine the spike in associated healthcare costs?

To make matters worse, the United States is even more susceptible to rises in healthcare costs because we are at the forefront in medical technological advances. Not only do we deserve the best, but we must also be the best. The Da Vinci Surgical System, which costs $1.5 to $2 million per unit for hardware and installation alone, was invented here in the US in 1999. We were the first to implement and utilize this expensive new technology, and by extension incur the associated high costs. A large number of major hospitals across the country own one of these systems now, showing its pervasive (and expensive) penetration into our medical system. In comparison, there are exactly three Da Vinci Systems in all of Taiwan, and I would wager probably not many more than that in all of Africa. As you can see, it’s an expensive endeavor to stay ahead of the curve.

Unlike Alanis Morissette’s misuse of the word “ironic,” there is some real irony in the rising cost of healthcare. As medical technologies improve, people will survive once fatal diseases and live longer. Americans will have more time to subject their bodies to unhealthy practices like smoking, drinking, drugs, and chocolate chip cookies. Longer life expectancies without healthier lifestyles will naturally result in more medical care. When people used to die at the average age of 35, healthcare costs were not an issue. Now that people are living well into their 80’s and 90’s, we are beginning to see more and more expensive acute and chronic diseases emerge in our elderly population. It’s like microphone feedback static, the cycle keeps magnifying itself indefinitely, until you blow out a speaker. Isn’t it ironic, don’t you think, that the more diseases we cure the worse our economic burdens become.

So we are guaranteed the best, the best continues to get better, and we continue to require more of the best. Yet we as a society are not able to increase our overall productivity to compensate for this increased expenditure. The elderly population that we have managed to keep alive, while bountiful in elderly wisdom and delicious home-baked chocolate chip cookies, are not capable of maintaining a minimal level of productivity for society. If we as a country are limited to a certain percentage growth in GDP every year, and medical costs in the country continues to grow at twice the rate (these are hypothetical values) then naturally there will be a growing deficit. Even if we manage to maximize the efficiency in the system, eventually down the line, unless some unforeseen increase in economic productivity occurs, we will run out of money. We as a society will no longer be able to sustain our demands for the very best.

I am in no way suggesting some sort of senior citizen genocide, nor am I suggesting we shift to a completely capitalistic system of healthcare (ie: the Asian grocery store system – you touch you buy! Cash only!) I am simply pointing out a trend, albeit from a somewhat conservative perspective. Yet part of me knows the dangers of focusing solely on economic concerns, since reality and ideality are in such conflict when human lives are at stake. Watching patients wither away in the hospital, you can’t help but forget "all about the Benjamins" and focus solely on improving their health by whatever means necessary. In the operating room, you don’t see a homeless man with no money addicted to cocaine and alcohol, you see multiple fractures and a ruptured spleen in a human being who got hit by a bus. So perhaps the biggest problem facing American healthcare is also the biggest strength of our healthcare, because at the end of the day, we still care enough to give and be given the best.

In the beginning...

I created this blog. And it was good.