Podcast with the Christian Medical Dental Association

I got a chance to do a podcast with the Christian Medical Dental Association talking about the challenges of medical training, particularly for the believer. Check it out and feel free to share your thoughts!

https://itunes.apple.com/us/podcast/pulse-13/id1226004273?i=1000394489503&mt=2

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Baby update! (with pictures)

Again life happened and the resolution to post regularly died a sad silent death. It’s been so long since I last posted I forgot my username and password. Time for a life update and another attempt to revitalize this blog!

To say that much has changed would be a huge understatement. Let’s see, some highlights since my last post in December (of 2016??):

  • Found out we were expecting in January.
  • Transitioned out of my teaching role at Harbor-UCLA to go full-time at the Children’s Clinic in May.
  • Decided with the new baby coming would not have enough time/energy/money/fill-in-the-blank to continue with seminary so ended my time at Talbot early with a certificate in Theology also in May.
  • Moved into a new home mid August
  • Closed escrow on our old place mid September

And the most wonderful highlight of 2017:

  • Welcomed baby Cody Jackson Tsai on September 21st at 12:18 am, coming in at 7 lbs, 4 oz and 18 inches.

The whole delivery was ridiculously fast. Priscilla went in because of some light bleeding. She didn’t really have any contractions, but we just wanted to be safe. Checked in around 6:30 pm, contractions started picking up and becoming regular, and made a little change by 8:30 pm so hospital decided to keep her. She was admitted around 9:30 pm and close to midnight the baby was ready to come out. 2 pushes later, enter baby Cody!

She progressed so fast that there was no time for an epidural. Her primary OB didn’t even make it (I was ready to jump in there, but thankfully there was a backup OB). That was basically Priscilla’s worst nightmare, but she pushed through it like a super champ (yes on the pun!). I’m so proud of her and amazed at her strength. The end result?

Well, at least a week later after he has been cleaned up, fattened up, and most of the jaundice had gone away. 1st days he looked like this:

2017, and particularly the last several months, has been a huge whirlwind of activity and it took finally being on paternity leave to have some space and time to reflect. And sadly, very shortly after Cody was born, Ansley caught Hand Foot Mouth Disease from daycare, and unselfishly shared it with me (we’ve been working on this).

Thankfully she bypassed the oral lesions and her hand and feet lesions didn’t hurt. Luckily, I caught the whole package deal. And I have to say these ulcers and blisters hurt like a motor scooter. As the lesions spread from my mouth to my hands and feet, making each bite and step excruciating, I couldn’t help but think of Job 2:7-8

So Satan went out from the presence of the Lord and afflicted Job with painful sores from the soles of his feet to the crown of his head. Then Job took a piece of broken pottery and scraped himself with it as he sat among the ashes.

Now obviously it’s not that bad but it has been quite miserable this past week. And as much as these lesions hurt, what has been so much harder has been not being able to hold my new baby and be with Priscilla in these early days. Sorry Priscilla that I haven’t been able to be there for you. And I know how painful it has been for you to have to turn Ansley away too.

Not to all of a sudden get too preachy, but I think through this I understand a little bit more of the immense suffering of hell. Whatever physical pain there may be, I suspect it will not compare to the emotional pain of being separated for all eternity from our heavenly Father, with whom we have been created for deep, intimate relationship.

I’m off the soapbox now. Thanks for reading and would so appreciate your prayers for Ansley and my recovery, and for Priscilla’s and Cody’s continued health. Please pray for my anxiety too as I know what doctors do to babies less than 28 days old with fevers.

Some more pictures!

Looking back, Ansley was probably the most contagious here…

“When Breath Becomes Air” Reflections

           I finally got chance to read Dr. Paul Kalanithi’s memoir “When Breath Becomes Air” over Christmas break. It really was a heavy punch in the gut, and it couldn’t have come at a better time. It was such a needed reminder of the brevity of life, the sacredness of the medical profession, and the immeasurable value of our human relationships, particularly those between physician and patient.
          Early in the book, Dr. Kalanithi asks the question, “If the unexamined life was not worth living, was the unlived life worth examining” (31)? In Dr. Kalanithi’s life is an example of both a profound reflection coupled with an active and intentional engagement of people, even at great personal cost.
          I was particularly challenged by his view of medicine, and of his patients. Regarding his work, he writes, “People often ask if it is a calling, and my answer is always yes. You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is” (151). He was referring to his field of neurosurgery, but I think this can be said of the medical profession as a whole. Sure the pay is substantial, whatever field you pursue, but the personal cost is steep, even after the training is done.
          And let’s not forget the enormity of assuming the care of a person. For Dr. Kalanithi, he was responsible for not just his patients’ physical health, but the entire weight of the whole of the individual. His call was to “protect life—and not merely life but another’s identity, it is perhaps not too much to say another’s soul…” (98). He understood that “all of medicine…trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most sacred, their most private” (49). It is a high calling , and a tremendous privilege to become a physician.
          What hit most poignantly was the stark contrast of the sense of purpose and urgency reflected in Dr.Kalanithi’s life, even before his cancer diagnosis, to where I am at now. Sadly I confess that 2016 has slowly drifted into a complacency where personal relationship (both with God and people) and my own personal calling have become obligations, and entertainment designed for rest and renewal has crossed into the realm of numbing escape. This was a much welcomed wake-up call.
          God, forgive me for mistaking physical presence with connection, thinking competency and efficiency was enough, and treating the sacred as ordinary. Grant me conviction and courage, by Your grace and through Your Spirit, to make 2017 different.
Be very careful, then, how you live-not as unwise but as wise, making the most of every opportunity, because the days are evil. Therefore do not be foolish, but understand what the Lord’s will is. Ephesians 5:15-17

Made in God’s Image

It’s been one of those weeks…

Two patient deaths, a patient stabbed right outside of clinic, and the regularly scheduled patients still waiting to be seen. And it’s only Wednesday.

Today I spent some time talking to the daughter of one of the deceased patients who called from out of town. They had been estranged for some time so she had many questions, particularly about how he looked before he passed. Apparently his body had decomposed too much for her to see, so all she had was my general description. My heart was heavy after that call.

Talking to her reminded me that this patient was not just another homeless man, another name on my schedule, or another disease to treat. But he was someone’s father, someone’s son, someone’s friend.

It’s so easy to lose track of the person in the endless list of patients that need to be seen. I’m ashamed to admit that there have been days where I can’t remember a single patient name, but I can tell you their diagnoses and treatment plan.

It’s been a tough week. But it’s been a good reminder that each person has intrinsic worth. That was God’s design, making each person in His image. God help me to see and treat each patient that way.

To my patients who passed away…

Sorry for the super long no update. Life has been busy (but good!). Having a child really does change your life…

I found out this week that another patient I had gotten to know pretty well at the homeless clinic passed away. They say the average life expectancy of the homeless is around 50 years old. Sadly, I have found that to be true.

Some of these deaths were pretty expected, but this last one caught me completely off guard. I had just seen him a couple weeks ago, and I expected to see him in a couple of weeks for his monthly narcotic prescriptions (and usually some brand new complaint).

It has been hard finding the space and time to mourn. After finding out through an inbox message the very first thing in the morning, I had a full panel of patients waiting to be seen.

Medical school and residency didn’t teach me all that much about coping with patient death, and I have found that it has been much easier to just set it aside and forge ahead. After all, there are still living patients who need my immediate attention.

This morning as I took my daughter out for a walk, I realized something that made me sad; I am beginning to forget. I was thinking about the patients that I had gotten to know who have passed, and even now I can’t remember some of the names.

Well Bob (fictitious name), I don’t want to forget you. Here’s to your memory. I’ll try to do this for the patients I have gotten to know, but we’ll see how it goes. Hopefully it wouldn’t be too frequent.

Bob, I have to admit that I did not look forward to our appointments. Narcotic management is one of my least favorite things, and you certainly made it difficult. For the longest time it felt like a wrestling match of sorts, you always pushing for more and me trying to hold my ground. I confess that there were times I gave in because it was too much to deal with and I had too many patients waiting.

I’m happy to say that it has turned into much more of a partnership this past year. But still, I would always want to get out of the room as fast as I could because there was always “one more thing.”

You were a tough guy, and you have endured much. And you certainly looked the part: big, perpetual scowl, multiple tattoos. Yet you showed me a side of you that very few have seen, even shedding some tears. Thank you for that privilege.

Thank you for sharing with me one of your favorite Bible verses the last time I was with you, Proverbs 3:5-6. That’s one of my favorites too, so hopefully I will never forget about you.

I didn’t know I will never see you again (this side of eternity, anyway). Thank you for the reminder that tomorrow is never guaranteed, that no matter how difficult the patient encounter, that might be my last so I need to be present completely instead of already having one foot out the door.

I do hope to see you again one day. May you rest in peace.

“Trust in the Lord with all your heart
    and lean not on your own understanding;
  in all your ways submit to him,
    and he will make your paths straight.” Proverbs 3:5-6

Question from the Reader: Was it Worth it?

This past semester the book was used by a pre-health class at Point Loma, and the students submitted questions as part of their assignment. I got a copy of that list, and they were great questions! I’m going to try to answer a question every couple of weeks, so here’s the first! 

“Looking back on your journey into medicine, what aspect of medicine made it “worth it” (worth the time, money, energy, many hours of studying, etc.) to pursue for you, and how has your view shifted (or remained the same) today?”

Now that I am done with my training and have been in working for a few years, I can say that the realities of medical practice is definitely much different than what I expected as a pre-med, and even as a medical student. To answer the second part of your question first, the two major frustrations I have encountered as a physician are the 1) the brokenness of the medical system impacting the type of care I can provide, and 2) the non-medical nature, or components, of complaints I get from patients. 

As for 1), the sad reality is that medicine in the US is a commodity, and healthcare a business. Of course there should be appropriate checks in how doctors should practice, but unfortunately, it really comes down to maximizing profit which means seeing as many patients as you can. In the underserved community clinics where I work, there is less of that, but then there’s the problem of less resources available. And now with the expanded healthcare coverage, which is great for my patient population, even underserved community clinics are pushing to see more and more patients since they can finally be reimbursed for the care they provide. So, in the 15 minute time slots, doctors really only have a fraction of that time for direct patient care if they don’t want to stay after hours to finish all my charting and other admin work. 

Not only is the system broken, 2) the nature of healthcare has changed too with primary care being mostly about chronic disease management. The most common conditions I see are diabetes, hypertension, and high cholesterol with all its complications. Sadly, these are largely preventable diseases and largely related to lifestyle choices. While people want to feel better, they don’t want to change the way they live (sometimes they can’t change because of socio-economic factors like no access to affordable healthy foods or safe places to exercise). There’s nothing quite as defeating as spending extra time counseling patients and coming up with a game plan to find out at the next return visit that things are worse. Going into medicine, I thought I was going to come in and change everyone’s lives, impacting them like Jesus did. But even in Jesus’ time, there were people who didn’t really care for true healing, but just wanted the miracles.  

So real-life practice is not what I expected going into medicine. But, as frustrating and infuriating (at times) medical practice can be, I will say that it has been and still is worth all that it took to get to where I am. And that is because I constantly come back to the realization that my pursuit of medicine would not be just about my own fulfilment, but about God’s kingdom. If me being in medicine was simply about being happy that I get to help people and make a good living, then no this would not have been worth it.

Without the kingdom perspective, I would have burned out long ago (and I haven’t even been practicing that long!). You don’t have to search very hard to find articles about physician dissatisfaction and doctors leaving medicine. But with God and His kingdom purposes in the picture, I still see that being in medicine is so strategic in pointing people to the realities of heaven where there is no sickness, death, and suffering. 

It may not happen with every patient, and may even happen very far and few in between, but if we are open, God does arrange for divine appointments where we can have more than just physical impact. This looks different for each patient, and for each specialty, but the opportunities are there if we have the sensitivity to the Holy Spirit, and the courage to act on those promptings. And the really cool part is that we don’t have to try to love people in our own strength. As long as we are abiding in Christ and receiving from Him, God will continue to strengthens us for His kingdom work.

Medicine opens up so many doors to be used by God in powerful ways. My prayer is that as you continue in this path, you would make choices to put God first starting now so that when you are done with your training, medicine can still be about Him, rather than just about yourself. 

 

SD visit!

Wow sorry for not updating for so long. I have a pretty good excuse though, it was March Madness. Just kidding, I didn’t even watch a single game entirely. Incidently, I was third in my church bracket. Not bad for just picking randomly.

Life has been very much different since the new year! It has been so much fun being a dad. That’s because Priscilla is doing most of the work =P. Since I am back at work now, she let’s me sleep through the night. It is crazy how fast she is growing up. Here’s a fairly recent picture, and one of my favorites!

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Absolutely adorable. We’ve been so bless, she’s done so well. Just this week she went on her first overnight trip! I got invited to speak to a pre-health class at Point Loma University so we made a family trip out of it. No melt-downs or anything, she was quite the trooper. It is crazy how much we have to pack though just for one night.

It was a really fun trip. We got to spend time with some old church friends, as well as with Dr Nick, which is always an encouragement.  The day of the talk Priscilla and I enjoyed brunch at the Mission Restuarant in PB (can’t believe I never been there before), and then exercised the spiritual discipline of bargain shopping at the Carlsbad outlets.

Speaking for the pre-health class was such a privilege as well. It was so good to be with these students whose heart for patients has not been hardened by the trials of training and the frustrations of the realities of patient care. Even though I was supposed to be ministering to them, I was blessed and encouraged by them. I needed to be reminded of convictions God placed on my heart when I was in their shoes, and that I need God’s spirit to start softening my heart up again to love.

So, to the pre-health class, thank you. I will be praying for you as you continue to seek God’s calling for you. And if that happens to be medicine, I pray that God would strengthen and guard your heart as you go through your training and beyond. Dr. Choung and Dr. Buzzell, you are doing a great work. May God persevere and bring to completion the work that has been started!

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