Match Day!

The results of the match, the process in which medical students get hooked up with a residency program for the next x number of years, came out today. My congratulations go out to you all, whether or not you got into the top residency of your choice. And regardless of whether or not you matched your dream residency, or had to scramble, or even didn’t match this time around, surviving medical school is no minor accomplishment.

I never really understood how the match worked. This article was pretty helpful, and pretty amazing that the guys who came up with it won the Nobel Prize. I’m sure the algorithm is super sophisticated, but from our standpoint, it seems like we rank the top choices, the residency programs do like-wise, and we just sit back and wait…and pray… that we get matched into one of the programs we ranked. The hardest part of it I think is just how out of our hands this part of the process is. We can do all that we can to buff up our resume and maximize our chances, but still results can turn out that don’t quite make sense.

As Christians, it’s a great time to remember that while we may not be in control, God certainly is. Somehow God’s sovereignty is still at work despite what we do (and don’t do), and His hand is still over not just our successes, but our setbacks (at least setbacks from our perspective) as well. Reading through the book of Acts recently, I saw how God used even the not so good things to further His kingdom. Jesus in Acts 1:8 commissioned His disciples to bring the Gospel to Judea, Samaria, and to the ends of the world. They did a great job bringing it to Judea, with thousands of people being added to the church.

Then the persecution came, Christians were jailed, beaten, and even put to death. Why would God allow such badness to happen? Well, as a result the believers were scattered throughout the Roman Empire, fortunately bringing the Gospel with them. Perhaps the disciples would have been perfectly happy worshipping and fellowshipping in Jerusalem, and so God allowed the persecution to prompt them along.

Some of you are undoubtedly excited right now, praise the Lord! Others, though, not too excited about where they ended up. While it’s absolutely fine to be disappointed, the encouragement is to praise the Lord also. Perhaps God has prepared a good work for you to do that you may not have chosen on your own. Whatever happens, we know that we have a good God who gives good gifts to His children. While sometimes those gifts don’t come in the way we would like, we can trust that God will take care of those who call on His name.

So again, a hearty congrats to all. Enjoy your last break before residency!

And we know that for those who love God all things work together for good,for those who are called according to his purpose. Romans 8:28

Medical Training Advice: International Rotations

For those of you who are in medical sch0ol, an international rotation is a great idea if you can work it in your schedule (and if you can afford it). It’s an opportunity to see how healthcare is delivered elsewhere and just good in general to travel and see more of the world. The best time to do that is the summer between your first and second year (your last real summer) or during your 4th year. Even if you are just a first year, now is a good time to start thinking about this because it does take some planning.

Start exploring different options in your administrative office. Some schools already have partnerships in place with different hospitals/clinics, which make things like getting credit and scheduling much easier. The staff can usually get you in contact with other students who have gone before. Each school has their own policy and paperwork that is required.

Of course there are also many resources online. The international elective section here provides some good info if you are interested in family medicine. If you are planning to practice in California, I would highly recommend a medical Spanish immersion program that is part of the rotation. During my fourth year, some of us went through CACHAMSI, which is a program based out of Riobamba, Ecuador, which was an amazing experience.

It was a one month rotation and was structured for medical experiences in the morning (there were different sites like primary care in the rural setting and the ER in the local hospital) and Spanish didactics in the afternoon. We were each set up with a host family so it was a total immersion experience. The weekends were free for travel and exploration.

4th year of medical school is a great year, especially after your sub-internships and residency interviews. Plan ahead to make the most of it!

P.S. Don’t forget about vaccines and prophylaxis depending on where you go! International health insurance is not a bad idea either.

Here’ some pics! Fellow Travel buddies: Farshid, Charles, Regina

Picture 085 Picture 035a Picture 042 Picture 216 Regina SD Card #1 073 Picture 063

 

 

 

Medical Training Advice: Find a Mentor

Everyone needs a hero. If you read the free preview of my book, you know that one of the biggest influences on my medical career has been Dr. Nick Yphantides. If you don’t want to read the whole thing, here’s an excerpt:

After I accepted Christ… 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.

Worth the Cost, Introduction: My Story

If you are pursuing any career, not just medicine, an important thing you need to do is to find someone who has gone before that can mentor you. And especially if you want to do it for the Lord, you need to find someone who is living that out. Things can get really hard, and we need the experience of those who have gone before to follow after and a glimpse of faith lived out.

If you want to be inspired, here’s a cool video that shows a snapshot of Dr. Nick’s life.

Who in your life can you ask to mentor you in what you would like to do? Who in your life can you be a mentor for?

How to Cope

In my last post I talked about how difficult it is for those in medicine to repeatedly come face to face with human suffering. Whether it was the consequences of personal choices or due to unfortunate circumstances, the burden of caring for the sick can weigh heavily on the soul. It’s sad that even though medical training strives to raise up compassionate healers, people often come out jaded and cynical instead. Here are just a few things that have helped (and continue to help) me on the way.

1. Take a time-out

Medical training is such a hectic process, especially during your intern year. There is just so much to do you’ll be running around like a chicken with its head chopped off, rushing from floor to floor, patient room to patient room. Sometimes you just need to mentally check out for a moment. There was this place outside the hospital I would go to from time to time just to re-group. Even if you can’t escape the clinic or hospital, pausing for a minute before seeing the next patient can help to let your emotions catch up to your body so that you can be fully present.

2. Learn your patients’ names

It’s amazing how there are days I can’t remember a single name of the patients I saw that day. This might seem counter-intuitive, that the more you get to know a patient, the harder it will be emotionally  if things take a turn for the worse. But I think it is the dehumanizing of our patients that makes our jobs seem pointless and futile. Our patients become just another thing to fix, another obstacle asking of us our energy and time that is already so limited. But connecting with patients as people can help us celebrate with them the small victories even if there’s no ultimate cure.

3. Journal

Our experiences are meant to be processed, not buried away. I started my book project wanting to be helpful to others. After I finished writing, I found that there was something hugely therapeutic in revisiting my training experience and working through the lessons that I learned. If no one buys or reads the book, it would have played an important role in helping me articulate one of the hardest seasons of my life. You don’t need to write a book, but who knows, maybe one day your ramblings can turn into one.

4. Connect with others

This is along the lines of number 3. Medical school and residency were my loneliest times, even though their were plenty of people around. It’s hard to talk to others about our experiences because either we don’t want to be a burden, or we don’t think others will understand. The problem is that we are created as relational beings, so we do need others to help us process. Don’t forget your relationships, particularly your spouse. And sometimes professional help might be necessary. There’s no shame in this; some of the situations you’ll face will be intensely traumatic. There are resources available through your program so don’t be afraid to seek those out.

5. Keep the eternal perspective.

As high a calling it is to care for people’s physical body, we have to be reminded that there is a higher, spiritual reality. In the words of Dr. Cox from Scrubs, “Sooner or later, you’re going to realize that everything we do around here, everything is a stall. We’re just trying to keep the game going, that’s all. But, ultimately, it always ends up the same way.” The decay of our bodies and eventual death is inevitable, and while our job is to hold back the tide, our job as Christian physicians is, through our care of the physical, to point people to a deeper spiritual healing that we all need. This is where we need to remember God’s promises that He will one day make all things new.

This is just a short list of things I found helpful that I am still learning to do as I continue in my career as a physician. The road is a difficult one. My prayers go out to those who have embarked on this journey.

What has helped you from developing cynicism and becoming jaded?

 

 

 

 

Why God Doesn’t Just Heal Everyone

One of the most difficult things for me is seeing all the sick people in the hospital and wondering why God doesn’t cure people anymore. It’s tough.

This is a recent comment I got from a medical student. Thanks for your honesty, it certainly is tough. For me, it was especially tough seeing kids with terrible diseases. I remember being present at the still-born deliveries of twins and thinking, “God, how can you let stuff like this happen?” The question I was really asking was, “God, if you are good, why do you allow suffering to happen?” The follow-up to that question is, “God, if you are good and all-powerful, why don’t you do something about it?”

This is a hard one. I think the best answer I’ve heard was from a sermon by John Piper who said that suffering and tragedies ought to remind us of our initial rebellion against God.  It is a reminder that the world as it is was not the way it was created, but what we see now are consequences of our sin against God. I mentioned this in a previous post that because of Adam and Eve’s sin, not only was our relationship with God broken, but the whole natural order was corrupted (Romans 8:19-21).  That means diseases (as well as natural disasters) are as much a result of sin as all the terrible things that people do to one another.

But knowing that suffering is ultimately the result of our separation from God, while true, isn’t very helpful when we come face-to-face with the ugly realities of this world.  We can kill ourselves asking the why’s but, often times, God doesn’t give us the answers.  Instead He says, “Look to my Son.”

I don’t think we’ll ever figure that out why God created the world knowing all the suffering that was going to result. But, somehow because of His love, it was worth it to create despite knowing that we would fall into sin.  But God didn’t just create and run away.  No, God was here. God entered into this world of suffering and sin in the person of Jesus, the incarnate Son.

When Jesus came into this world, yes He did heal the sick and make the lame walk.  He even raised the dead.  But there were multitudes that were not healed and even more who remained dead.  God was here at one time, but He was not here to end all suffering.  God was here, shared in our brokenness and suffering, and died on the cross to meet our ultimate need: to be reconciled with our creator God. Jesus’ healings and other miracles merely backed up His divinity and His ability to forgive our sins.

The story doesn’t end there. Not only was God here, but God is also near: Jesus is going to return.  While He didn’t come the first time to end all sickness, poverty and natural disasters, when He returns, that’s exactly what He will do.

I don’t want to minimize the sufferings we encounter because the pain we experience is real. We should care. God cares. While we may be angry with God, without God there is no good answer for the problem of suffering. Without God, tragedies ultimately have no meaning; they just happen. But we have a God who took on the ultimate suffering, bearing the burden of our sins on the cross.

So back to the question, why doesn’t God just cure everyone?  He actually still does heal (worthwhile read), but miraculous healings are the exception rather than the rule because there’s a spiritual reality that our sufferings point us to. More often, God uses ordinary people to be his hands and feet in order to love someone in their time of suffering to help them see their ultimate need for God, pointing them to Christ.

For future healers, this is not an easy calling to battle against the consequences of sin. In my next post I’ll write about some ways to process through these difficult experiences. For starters, let us remember the words of Revelation 21:4-5 that one day God “will wipe every tear from their eyes.  There will be no more death or mourning or crying or pain, for the old order of things has passed away.  He who was seated on the throne said, ‘I am making everything new!’  Then he said, ‘Write this down, for these words are trustworthy and true.’” 

For those of you in the medical field (or any field for that matter), how do you deal with the suffering that you see? Please feel free to comment.

Adapted from a previous post in response to the Sandy Hook shooting

3/30/13 Found this video that has some good insights

 

 

Medical Training Advice: How to Prepare for Residency

Congratulations to all who matched into residency! For those who don’t know, last Friday was Match Day where everyone who got accepted into a residency program found out where. During your fourth year of medical school, you apply to residency programs in your field of interest. After your interviews (hopefully you get some), you then submit a list of the programs in order of preference. The residency programs also rank all the students they would like to accept and by some magical (and complicated) formula, you are “matched” with a residency program based on the respective rankings.

Where you match is where you have to go, unless you decide to take the year off and try again the next year. It’s a bit of a lottery so it’s quite nerve wrecking. During match day there’s usually some sort of ceremony where all the envelopes with the match results are laid out with your name on it and it’s a royal rumble affair to get your envelope. Some schools have students individually come up to get their results (extra torture). Usually there’s a lot of rejoicing, but there’s also disappointment for those who don’t get their top choices. But regardless of where you match, it’s a huge achievement so my congratulations again.

People ask what they should study or if they should do really hard rotations near the end of medical school in order to prepare for residency. To that, I reply with a resounding NO. There definitely is preparation to do, but not in medical knowledge. That’s what the 1st three and a half years of medical school was for. Medical school is hard, no doubt about it. Residency, though, is on a whole other level. You need to establish and re-establish some life-lines.

What are life-lines? These are the things most important to you that renew you, encourage you, and support you. These are things that will give you the strength to get up again after being beat-down, sleep deprived, and emotionally trashed, and do it again and again. These are probably things you have neglected because of all the studying and rotations during 3rd year. First and foremost are your relationships.

The most important is your relationship with God, and it really is time to reconnect with Him and build into your routine the basic spiritual disciplines. If you didn’t have time during medical school to read your Bible and pray, then anticipate not having much of a relationship with God in residency. You have to be very intentional about carving time out for God, and if you are in the habit of doing that when you do have time, you’ll build up the discipline to do that when life gets busy.

Now is a good time to start scoping out churches where you will be training. Hopefully you took into consideration the church community in your ranking process. If you don’t have a church home, it might be a good idea to find a church with different services so that you can go if you are on call on Sundays or post-call. Fellowship with God and other believers is going to be key in reviving your soul and reminding you of why God called you into medicine.

Next is your relationship with your significant other, especially your spouse. They will be your number one fan, but they also will be affected by the difficulties of residency. The long hours and the emotional drain will cause big strains so it’d be wise to strengthen your marriage prior and continue to tend to your relationships during the process. This is a huge topic just by itself, you can read this article for more on the subject. Of course your relationship with your family and friends are important so make an effort to build up your encouragement base before the craziness starts. You’ll need all the support you can get.

Lastly, I’ll just mention you need to connect again with the activities that give you joy, whether it’s a sport, hobby, or special routines. Medicine isn’t just about caring for others, you have to care for yourself first. Again, residency will be hard. There will be times when you can’t do all that you want to do (or know you should do). Hopefully by building up the support and habits now, you can not just survive residency, but thrive.

What are your life-lines?

 

 

Medical Training Advice: How Do I Decide What Specialty to Go Into?

Here’s the first of the posts I want to do to address commonly asked questions I get about the medical process. If I collect enough of these, I’ll make a separate FAQ section. Enjoy and thanks for reading!

How Do I Decide What Specialty to Go Into?

After your decision about Christ and your spouse, this is probably the next most important decision you will make. Well, maybe the decision to have a kid is somewhere up there too. This is a question I get pretty often, but unfortunately there’s not a one-size-fits-all answer.

Besides going through rotations with an open mind and heart to get the most out of each experience, the best advice that I received is to talk to as many physicians as you can about their daily practice. You might love certain things about a specialty, but you might come across those diseases or procedures once in a blue moon. It might seem cool to be a surgeon, but are you ok with taking out gallstones and appendices the majority of the time? Find out what the bread and butter is in each field and ask if you can see yourself doing that day in and day out.

Having said that, you can do a lot with medicine with a little creativity, flexibility, and perhaps a willingness to sacrifice some monetary compensation. I didn’t want to do patient care everyday so I split my time up between my clinic in Long Beach seeing patients and Harbor-UCLA doing some teaching. If salary is a big deal, here’s a general idea of how much physicians can make in different fields.

If you are wondering what field would be best to serve the Lord with, that one is easy: any field. The question is what do you want to do to serve the Lord.  Do you want to serve the Lord overseas or in a rural area? Then a surgical field, obstetrics (or family medicine with emphasis on high risk OB) would be super helpful.  Realize, though, that certain specialties are more volume dependent so you might not be as free to do ministry work in order to keep your skills up (even more of a concern with residency work-hour restrictions).

But you can really do anything and be used by God to impact his kingdom. There’s a tremendous need for medical education to train up native physicians so even if you are a super sub-specialty, you can meet  needs overseas. Of course, specialty services are much needed for those without insurance or access to care. And not to mention the day-to-day ministry opportunities that you have with your patients, whatever field you re in. The moment they step into the office and particularly the hospital, they become more aware of their mortality and more open to thinking of things of eternal consequences.

If you are interested in how I chose to go into family medicine, check out the free preview.

If there are particular questions you would like to see addressed, please leave me a message or email me at jacktsai@unfailingspring.com.