Introduction: My Story

Is not this the kind of fasting I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke? Is it not to share your food with the hungry and to provide the poor wanderer with shelter—when you see the naked, to clothe him, and not to turn away from your own flesh and blood?

Isaiah 58:6-7

Calling

I was at the annual American Academy of Family Physicians conference in 2011. I had just finished my residency training at Harbor-UCLA and decided to stay on to do a faculty development fellowship to see if academia was something I wanted to pursue. Our department was at the conference recruiting and there, amidst that celebration of primary care, I reflected a bit on my own personal journey as a physician and how I ended up in this field.

At that time family medicine looked like a great choice, with primary care at the center of healthcare reform and all the buzz about Patient-Centered Medical Homes. It certainly was (and still is) an exciting time to be in primary care. But four years prior to that, making that decision as a fourth year medical student was more a step of faith, not in the future trend of medicine, but in what I thought was God’s calling.

To be honest, right up until the fourth year of medical school, I never thought about family medicine. Actually, I did have thoughts, but they were pretty negative. Wasn’t family medicine for those who weren’t smart enough to get into the specialty fields? After all, it is among the lowest paying fields, why would anyone choose that voluntarily?

And my scores were good enough. I didn’t study my butt off and love filling in Scantron bubbles for nothing. So it came as quite a shock to many when I made my decision. Particularly for my dad, being an anesthesiologist with many specialist friends whose kids were in medical school becoming specialists as well. During that time, it was like playing specialty roulette with him trying to sell me a different medical career each time we spoke, wanting to change my mind.

So why did I choose family medicine? Well, first off, in addition to being a large academic center, the medical school at UCSD operated a great system of student-run free clinics (much kudos to the many physicians who dedicated their careers to serve the uninsured of San Diego). It was through my involvement there, specifically through the street outreach van, that I was first exposed to the great need for primary care. We would drive all around San Diego offering basic services and trying to connect the homeless to care. And it was during this time my faith finally began to intersect with my professional life.

I had known I wanted to become a doctor way before I became a Christian in high school. Like I mentioned, my dad is an anesthesiologist and my mom was a nurse. Add bad asthma, frequent doctor visits, and a sprinkle of hospitalizations to the pot and you get a neurotic, determined pre-med as a result. It also helped that I liked science and had at least the bare minimum of social skills.

After I accepted Christ, nothing really changed in that regard. I went happily on my way to college at UCLA, majored in physiological science like a good little pre-med, and researched and volunteered my way into medical school. In medical school, I just looked for Christian things that I should do. So, I started volunteering at the free clinics, as well as going down to Mexico on weekend mission trips. I was a medical student who happened to be a Christian.

Then I met Dr. Nick Yphantides, a mentor who would change the trajectory of my medical career. Growing up, my heroes were Jackie Chan and my dad, and I quickly added Dr. Nick to that list. He was one of those superstar students who made medical school look like child’s play. He graduated high school and college early, and rumor has it he got top marks in every class and rotation in medical school.

This was a guy who could have done anything he wanted. But he was also a devoted Christian who loved the Lord, and was convicted by God to serve the indigent poor of San Diego. Because of that, he chose to go into primary care and spent the first decade of his career on the front lines serving exclusively patients without insurance.

In Dr. Nick I found a Christian who happened to be a doctor. He understood that God’s heart beats for the poor, oppressed, and marginalized. For Dr. Nick, medicine was simply a means in which to carry out that heart. As I spent time with him and saw that passion lived out, God began to put a similar conviction on my heart as well.[1]

Alongside these experiences, the Bible began to speak to me, opening my eyes to God’s desire for his people to care not just for the spiritually lost, but for the physically hurt as well. Passages like Matthew 25:31-46 about the sheep and the goats, and Isaiah 58 about true religious acts express very clearly God’s heart for those who are suffering physically, and for true believers to do something about it. One of the signs proving Jesus was the Messiah was that he healed the sick.

God challenged me to use medicine to carry out his heart for justice and mercy and, as I looked at the mess that is our healthcare system, there was plenty to do. I didn’t understand all the politics involved at the time (and I still don’t really), but I knew there were too many people suffering from complications of completely preventable diseases because of either a lack of insurance, or a lack of access to care even with insurance.

Who knows what our healthcare system will look like when this book gets published, but in 2012 there was something like fifty million Americans without health insurance. And it wasn’t just poor people. I was denied coverage because of my asthma, a pre-existing condition, and ended up with a thousand dollar-plus emergency room bill because I ran out of my maintenance inhalers. Even if we got a total revamp of our healthcare system expanding coverage, there will always be people without adequate access to primary care services.

And so for me, God put on my heart to use medicine to tangibly and practically obey that command to love those who are in need. While every medical field seeks to alleviate suffering, family medicine seemed like the obvious choice to provide the most basic care to those who needed it the most.

But it was not an easy choice. As much as we want to say money doesn’t matter, a hundred thousand dollar per year salary differential in some cases really does a number on your personal convictions. On top of that, my dad is one of the biggest role models in my life, and to know that I chose something with which he didn’t agree was heart wrenching. It also didn’t help that there were attendings in other specialties who quite openly put down family medicine.

As the promises of this world tugged at my heart, I had to come back to the truth that Jesus is the Lord of my life, not me. I will go into more details in Chapter 1, but I had to remind myself that following Christ meant not just believing in Jesus for the forgiveness of sins to get into heaven, but being willing to obey whatever God was calling me to. God had been faithful in bringing me this far; I could continue to trust in him to step out in faith. By God’s grace and strength, I was able to follow through with my convictions.

Of course this is not to say that as a Christian you can’t be a radiologist, dermatologist, or whatever other specialty. By no means! There is a great need for Christians in every field, and God’s kingdom can be advanced whatever your specialty. But for me, to choose another field was to be disobedient to what I felt God calling me to. Subsequently, I chose the family medicine program at Harbor-UCLA because its mission statement aligned very nicely with mine: to train physicians to serve the medically underserved.

New Beginnings

My residency training at Harbor-UCLA was an amazing experience. There really isn’t a better place to train than at a county facility in my opinion. As a testament to the program’s dedication to raising up physicians to work with the underserved, I’m happy to say that, at the end of my time there, I still came out with the same convictions I had going into residency.

It wasn’t all roses and sunshine, though. Many times I doubted my decision to go into family medicine and, in particular, to care for the underserved. It didn’t take too long for my grand scheme of changing the world through the love of Christ in healthcare to run up against some harsh realities. Some days I wished I could go back to memorizing the Kreb cycle. It was going to take the support of my church community, fellow Christians in medicine, and my personal relationship with God to keep me on the path of God’s calling. I will unpack more of this wrestling throughout the book.

At the end of my residency, I decided to stay on for an extra year as chief and a faculty development fellow to explore academic medicine. To make a long story short, I discovered that I really enjoy teaching and working with the residents. I also saw how being in academics could be strategic in improving care for the underserved through research on care delivery. I even started the application process for becoming a faculty member, but at the end of that year, I decided to put that on hold as I felt God pulling me in yet another unexpected direction.

To be honest, when I was searching the job market near the end of my training, I had to again make the conscious decision to die to my own desires and ambitions. Even within family medicine there is a large salary discrepancy between private and federally funded community clinics. I remember sitting in on one job presentation by a large private organization, and it was so, so attractive. I could make almost forty percent more working for them compared to what the community clinics offered, and that was not even including the bonuses and other benefits. Suddenly, all these thoughts crossed my mind:

“Did God really call you to work with the poor?”

“Just do some volunteering when you have free time.”

“Think about how much money you can donate.”

Now, some of those thoughts weren’t necessarily bad. Sure you can do more ministry with more money. And obviously it’s not a sin to work for a private organization. But for me, again, I knew I would be betraying the conviction of providing care for the underserved that God had placed on my heart if I had pursued that job. So, I took a position in a community clinic organization in Long Beach working in their various sites, including their homeless clinic. I also picked up a couple of half days working as an attending at Harbor-UCLA teaching the residents to keep my foot in academics. And actually, between the two jobs, I decided to work only part-time.

Oh, by the way, at the end of residency in May of 2011, I got married to Priscilla, the girl of my dreams! I really did dream about her, and in both instances I told her I liked her and she rejected me. That story is in another book in the works (we’ll see how this one goes).

One important aspect of our relationship is our involvement in our church, South Bay Evangelical Christian Church.[2] It is the same church in which I was saved, way back in high school. I was involved in church activities throughout college, coming back almost every weekend to serve (and to see my mom). Being away for medical school was hard, but I was able to plug into ministry when I moved back for residency. Eventually I joined the leadership team and took on more responsibilities, including teaching and preaching.

During this time of figuring out our future direction, Priscilla and I were also praying about our involvement at church. Even though ministry was not on either of our radars while we were growing up, God was doing some funny things in arranging circumstances so that slowly we were getting more and more involved in church work. Since I was speaking from the pulpit, I wanted to take some seminary classes to help me do that more effectively (and make sure I wasn’t leading anyone astray). But with full time work, our present church involvement, and recently being married, we were already having a hard time balancing the commitments we had.

After much praying and talking with some of the elders, Priscilla and I decided yes (admittedly with some reluctance), ministry was something God gifted us for and was calling us to become more involved. We agreed I would work part-time in order to have time and energy to take some classes and assume more responsibilities at church. We committed our plan to God and he worked out the details, providing a part-time position with flexible hours, and opening the doors to seminary. I started classes at Talbot in the fall of 2012.

Priscilla also started looking for a job that would allow her to be at church consistently and be available for our different summer activities. Previously she was working the 3 p.m.-11 p.m. shift and every other weekend at Harbor-UCLA. (Did I mention she’s a nurse?) That schedule precluded her from regular church attendance, and the work was emotionally and physically exhausting, leaving little to invest in ministry. Not too long after we made the decision, God provided a school nurse position that not only freed up her weekends and summers, but was more in line with Priscilla’s heart to do public health. That was a huge answer to prayer in our minds; undoubtedly God’s sovereign hand at work as the other nurses who interviewed for the same position were more qualified and experienced. This provision served as an additional confirmation that this was the right decision to make.

Again, this wasn’t an easy decision, and was actually scarier than choosing to go into family medicine. When we met with our church elder who supervises the English ministry, he said something along the lines of, “If you pursue ministry, I can only promise you heartbreak and suffering.” Not that he was jaded and burnt out from church service, but he understood how difficult it is to provide soul care. This is another career that shouldn’t be entered into lightly (perhaps someone should write a book about this too!). And even with our church involvement thus far we had experienced to a small extent what Paul said in 2 Corinthians 11:28, “Besides everything else, I face daily the pressure of my concern for all the churches.”

But we had also experienced the joys and fruits of ministry. I’m scared to even think about how I would have turned out without my church investing in me, and I saw how God was using this ministry to shape and impact the next generation. And so, despite our many fears and doubts, we decided to take a step forward knowing that we couldn’t see ourselves not involved in church ministry. I left out some details which will hopefully be filled in as you read, particularly in Chapter 10.

You can imagine my parents were not big fans of this decision. My dad had all these plans for me after residency, now that I had become real doctor supposedly making real doctor money. He wanted us to buy a house with him so we could get more tax deductions, save up so that our kids would be taken care of, and on and on. Not that he’s a greedy person, but he wanted to make sure his son was taken care of, and I appreciate him for that. But for me it was such a striking contrast between building up God’s kingdom versus spending all my energy trying to build up my own.

Now, for all the fun I poke at the stereotypical Asian parents, I have to say my parents have been unexpectedly supportive. They are not believers, but once they realized my faith was genuine and not just a phase, they gave me the freedom to pursue it. I love my parents and appreciate all they have done for me. If they had not helped majorly with my school debt, I wouldn’t be as free to serve the Lord. But without Christ, my post-medical school decisions have been foolishness, not just in the eyes of the world, but in their eyes as well.

After all, in the world’s thinking, why would you go into one of the lowest paying fields in the first place? Why would you then take on a lower paying position, work less hours so that you are making even less, and on top of that pay tuition to do something you aren’t being paid to do? Why would you put your career on hold for something that’s not going to do anything for you professionally in the future?

As I write this, I’m involved in patient care of the underserved, teaching residents, attending seminary, and preaching at my church. It definitely is not at all what I had envisioned when I entered medical school, and it might seem like I’m a bit confused in terms of my purpose in life. And maybe I am. But if you think about it, wasn’t this kind of what Jesus went around doing? Matthew 4:23 says, “Jesus went throughout Galilee, teaching in their synagogues, preaching the good news of the kingdom, and healing every disease and sickness among the people.” I just want to be like Jesus.

*

I am not sure what the future will look like, especially if little Jacks and Priscillas come into the picture. At the rate I’m taking classes, it will take me six years to finish this two year MA program. Maybe I’ll only be able to take one or two years of classes and have to call it quits. Perhaps I’ll love it so much I’ll take ten years and get the full MDiv. Maybe God will grow our church and I’ll end up in full-time ministry. Or maybe the ministry will fizzle out and I’ll focus mostly on patient care, who knows. I’m not very used to living with such uncertainty, but there has been such an intimacy with God that I haven’t experienced in a long while.

One of the first classes I took at Talbot inspired me to write this book. I was challenged to pray about the unique experiences God had brought me through, and in particular my journey in medicine thus far, and how I can integrate my faith to help others navigate their choices in obedience to the Scriptures and the promptings of the Holy Spirit. What started as a reflection project turned into a book idea, and somehow miraculously turned into a book. So I do not write this because I am an expert, or even consider myself an author. This is all a result of the promptings of the Holy Spirit and God’s grace in my life.

To all the parents who have asked me to talk to their kids and to the equally neurotic, determined pre-med students who wonder if they should pursue medicine, I offer this book. It is a compilation of my personal experiences, previous reflections in my blog and sermons, and my interactions with others on the medical path. I tried my best to give credit where credit is due, but I’m pretty new at this. Please let me know if I left something out or something is not cited properly.

If you are thinking this is too much to read, don’t worry, this didn’t turn out to be a very long book. (I was tempted to use 1.5 spacing to make it look longer.) But if you aren’t willing to put in some work, then you, my friend, should probably not pursue the eleven-plus post-high school years that is the journey of medicine. And that’s just the training.

I had very different ideas of medicine way back before embarking on this journey. I wish medical school spent more time teaching about what real life practice would be like. Instead of asking “How do I get into medical school?” you ought to figure out first if you really want to get there.