First Few Weeks as a Med Student

James, First Year Medical Student“What is it like to be a medical student?” “What does a typical day look like?” “How do you balance between school and having a life?”–these are questions that I often wondered and asked when I was still a pre-med student. Unsurprisingly, I still cannot answer these questions myself at this point. In fact, sometimes I have to remind myself that I am already a medical student and I marvel at the thought that I will (almost certainly) become a physician in a couple of years. In the past three weeks, there have been times when I felt overwhelmed with what is expected of me and there have been times when I felt motivated by other students, doctors and patients. A fellow first-year student told me today that we are so fortunate to be here in medical school and I couldn’t agree more. For this reason, I will try my best to share some empowering as well as memorable moments from these past weeks.

Freshman Picnic: Entering A Christian Community

I have been in Loma Linda two times in my life. The first time was for the application interview and my girlfriend’s family brought me here. The second time is when I flew into Ontario International Airport the morning before orientation day. I was in a strange place and part of me felt excited to be independent. I pride myself on being independent at a young age since I lived away from my family about one third of my life. I was eager to explore the neighborhood around me, find out the best place to get groceries, and meet new friends.

Later that day, I went to school to try on my white coat and attended the freshman picnic. When the picnic started with a prayer, I felt a sense of peace and familiarity knowing that I am in a Seventh-Day Adventist community. It was a bit of a shock to me because I did not know that praying in an unfamiliar place with a large group of unfamiliar people actually gives me a sense of belonging. This feeling tells me that I am in a unique medical school and it is such a blessing to be spiritually connected to my peers and the faculty.

The White Coat Ceremony

During the first day of orientation, we were introduced to policies and other logistics in the student handbook as well as the numerous clubs and organizations on campus. Once again, I felt like I was back in college freshman year when I had to learn the structure of a curriculum, what was required to obtain a degree, and all the resources available to make the best out of my education.

When the day came to an end, I was excited about the White Coat Ceremony in the evening. I had already told my family that the ceremony would be online so they could watch it even when they were in Taiwan. I also told my girlfriend and my best friend who are in Washington about the live stream and I was really happy to receive texts from them saying that they were watching the ceremony.

As we lined up on the sides of the chapel and waited for our names to be called, I trembled from excitement and nervousness. I even reminded myself to walk really carefully so I wouldn’t trip on the stage! When Dr. Hadley helped me put on my coat, I struggled a little, but fortunately it did not take a significant amount of time. As I looked into the crowd, I started to wish that my family in Taiwan was looking at me on the live stream. Unfortunately, they had just moved into a new apartment and did not have internet available yet. When we returned to the stage to take the Physician’s Oath, parents started taking pictures of the students on stage and I started imagining the proud and smiling faces of each of my family members, grandparents, girlfriend, and best friend. When I saw parents and siblings waving and smiling at us, I felt like I was seeing my own family waving at me. It sounds strange but it’s true!

Symbolically, the White Coat Ceremony is the beginning of our medical professional. It helps us realize that we have chosen a career path that requires tremendous dedication and our utmost moral standards. As we all solemnly recited the oath, I felt our vigor and enthusiasm radiate across the entire chapel. Our voices said “This is the moment we have been waiting for. Starting now, we go from being cared for to taking care of others. Our hands will heal others and our words will guide the lives of many. We joyfully take on the responsibilities bestowed upon us and we will follow the example of our teachers. We will exemplify a Christ-like character in our practice and minister to all those around us with compassion and humility.”

Ward Experience: Patient-Centered Care

For the next two weeks, I spent the morning at Riverside County Region Medical Center shadowing an internal medicine team. I was amazed by how much 3rd year medical students know and how fast they learn in their rotations. They were given a number of patients that they were in charge of and they worked up the patients during pre-rounds. Part of me looks forward to the day when I am as knowledgeable and skilled as them but part of me also wonders how I will get there. Nonetheless, my partner first-year student and I tried to be as helpful as we could by grabbing charts, getting order forms, printing patient notes out, offering to help, and by staying out of the way.

Oftentimes, we could help with patients’ needs just by noticing their requests or asking them. One time, a patient wanted to have the nurse help him turn over to the other side because he was getting uncomfortable. After I spoke to a nurse, I went back and told the patient that a nurse should be coming soon. He was quite happy and thanked me for me. A small amount of gratitude such as that made me so ecstatic and I just can’t wait to do more for patients.

One assignment we had was to interview patients, listen to their feelings, and find out how their illnesses influenced them. My partner and I spoke with two patients and prayed for them. Ever since the interview, we always greeted them when we had a chance. Before we left, my partner gave one of the patients a small stuffed teddy bear in a praying posture because she said she likes to pray. She smiled was so brightly that it warmed both of our hearts.

During the pre-rounds, I also saw a medical student on our team chat with his patient and I was able to see the patient in a completely different light. She usually seemed unwilling to talk because of her discomfort. However, in the pre-rounds, the medical student joked around and laughed with the patient and I found that she is actually quite humorous. She jokingly complained about things and swore in front of us, which I find very amusing. The medical student demonstrated that physicians can definitely ease the discomfort of patients and make sure their thoughts are heard. It also helps with their cooperation. I learned a lot from the Blue (ninja) team and have added a few more people to my list of role model physicians.

Special thanks to members of the Blue Team: Dr. Chitsazan, Dr. Lewis, Vu, Kenley, Genoveva, Juan, Tiffany, Marly, and Stewart.

Medical Strategic Network Practicum: Power of Listening

On the Friday of the second week, I attended the Medical Strategic Network practicum and I was able to begin learning how to practice whole person by listening to the spiritual well-being of two patients. As I sat in a dim room on the bedside of a patient, listening to him talk about his faith, I felt the light shining on him grew brighter and warmer. I noticed the times when his eyes grew misty and his voice seemed to almost choke up. Here is a man whose faith has carried him through difficult times and given him strength when he thought he would not make it. He expressed graciousness and thankfulness to God, and I realized that he was my teacher and I was his pupil. As I sat with him, he taught me the importance of having faith despite the circumstances, the power of being listened to, and the need for me to be humble and listen to what he had to say. It was an incredible experience and the deepest conversation I have had with a person who I do not know anything about. This speaks to the unique privilege that health care providers have and the incredible effect it has on people when we truly listen to thoughts that are otherwise never told to complete strangers.

Gross Anatomy: Bodies With Stories

Just this week, actual classes have started and the gross anatomy class has always been something that I had looked forward to early this summer. When it came time for anatomy lab, we were showed something during the orientation that always came up in my mind every time I see our cadaver. We were shown letters written by the donors and one of it read:

“I want you to know that am making my final gift to mankind and leaving it to you to ensure it is delivered. Please know that the bones, muscle, the tubes, cords, and organs within me did know love, pain, hardship, and joy. My eyes have seen the beauty of this world and my feet have crossed only a small portion of its mountains and streams. My hands both gentle and strong have tried to impart comfort to the world. I revel in the memories my mind has stored and I wish I would have used my lips to smile at a stranger or a loved one a bit more often…”

Upon reading this letter, I felt sad, as if I was the donor and the hands that I used to touch my loved ones and my feet that took me to places are to be reduced to cold anatomical terms. During the lab when I studied the muscles in the suboccipital region, I spent a few seconds each looking at the arms that are still slightly pink, her shoulder that is freckled and aged, and her scalp that was shaved. I remembered that she once was alive and her body still holds her life story. She is not just a cadaver, but a teacher who has dedicated herself in a way more than all my other teachers had and I am very grateful for that.

There are a lot of thoughts to be shared because being a “student physician” requires me to see people and lives so differently. This level of involvement is unprecedented, personally, and it makes me constantly evaluate myself and think about the kind of physician I want to be. So, after being a Loma Linda medical student for three weeks, I have felt a wide spectrum of emotions from admiration and enthusiasm to feeling overwhelmed and insignificant. As far as I can tell, each of these emotions is going to feel more intense down the road! But for now, first week of classes, check!

Hugs and Other Highlights from 2 Weeks on Pediatrics

Paige, Second Year Medical Student

At the end of our first year, all of us “soon to be second years” flooded the hospital wards for 4 weeks of clinical experience.  My top choice for this experience was Pediatrics (no surprise there).  I was absolutely elated to hear that I would be spending my first 2 weeks of clinical rotations on the Pediatric Gastroenterology team in the children’s hospital.

Although I was delighted to finally get some clinical experience in the specialty of medicine that I have had my heart set on joining for my entire life, I was also terrified that I might not actually enjoy pediatric medicine as much as I hoped.  However, all of those fears were immediately subdued as soon as I set foot onto the pediatric wards.  There is something unique about pediatricians; they are fun loving, down to earth, caring, and passionate advocates for their patients.  The team that I was with made me feel right at home and allowed me to use the minimal skills that I had learned during first year to work as a valued part of the patient care team.  I was able to pre-round with the third year student that I was shadowing and perform history and physical exams each morning.  During rounds, our attending would ask us basic science questions that were applicable to our patients and would give us research articles pertaining to the diseases and treatments that we were discussing.  It was absolutely amazing to be able to take an active role in patient care for the first time!

My absolute favorite memory from those incredible two weeks occurred one morning while I was pre-rounding with my third year medical student.  We went to see a young boy with Down’s syndrome who had been admitted the night before for an infection of his G-tube site.  My third year let me run pre-rounds on our patients that morning so it was my job to take the lead on seeing this patient, performing a physical exam, and discussing his history with him and his care providers.  I walked in and excitedly said, “Good morning James*! How are you?”  Without any hesitation whatsoever he immediately gave me a huge grin and held out his arms for a big hug.  Although I’m sure that he would have reached out and hugged just about anyone because of his extremely jubilant and friendly disposition, in that moment, I felt like I was on top of the world. Getting to see James was the highlight of every day that he was on our service.  Each morning was always the same; we would walk in and say, “Good morning James!” and he would respond with excited smiles and affectionate hugs.   James showed me, beyond a shadow of a doubt, that pediatrics is the field for me!

*This patient’s name has been changed to protect confidentiality*

I feel so blessed to have had the experiences that I had during my time on the pediatrics ward.  It was incredible to realize just how much we had learned during our first year and how far we had come in terms of being able to understand medicine since the two weeks of clinical experience that we had at the beginning of the school year.  Moreover, these two weeks showed me that pediatrics was in fact everything that I hoped and dreamed it would be, and reinvigorated me with even more passion to pursue a career in pediatric medicine.

Special thanks to the members of Pediatrics Team D for making my time on the ward exceptional

Dr. Yanni – Attending Physician

Dr. Tan – Resident Physician

Dr. Hersch –Resident Physician

Dr. Tsukimoto – Resident Physician

Sharon Wirawan – MS3

Greg Johnson – MS3

Sara Aney – MS3

Humble Pie

Maybe it was the white coat I was wearing, the inexplicably long strides I was taking, or the fact that he had his eyes glued to me as soon as I walked through the door, but everything felt so official. Unnatural. Completely the opposite of what I was expecting.

Up until the moment I walked in the room, I had delusions of walking in, being greeted with a wonderful smile, and having an absolutely engaging, perhaps even cathartic conversation with the patient. We would laugh and joke about our age difference, I thought, and share pithy sentiments about how much we both miss home. Unfortunately, it seems that I didn’t anticipate that people stuck in an hospital, especially those who have been there for a long time 1) are not, by no fault of their own, jolly folk, and 2) see a white coat and anticipate being poked and prodded or exhibited to an audience, not expectant of a whimsical conversation about the universality of life’s travails.

It was in this rather unsettled atmosphere that I attempted to introduce myself.

“What?” Of course he was hard of hearing. I was certainly off to an auspicious start.

“Hello sir, I’m a first year medical student, and I was wondering if I could speak to you as a part of an assignment. We have been asked to…”

“Are you here about taking me somewhere else?”

Hmm? That was unexpected. Apparently the doc had told him that morning that he would be going to stay in some sort of care facility before he could finally get home, and like any other normal person, he was distraught. Eventually, with all the enunciation I could muster and the loudest voice I dared to use, I was able to introduce myself properly and convince him that I wanted nothing more than to talk to him. To my relief, his shoulders relaxed, his facial expression changed to what could be optimistically regarded as “resigned,” and I, on cue, grabbed a chair, sat down, and began trying to fulfill the goals of my first assignment––to “connect” and “listen”––in earnest.

Though the conversation had not started in the most ideal way, I was unfazed. I began to implement everything I knew about trying to be a good listener––I leaned forward slightly, made eye contact, deftly changed the subject when I felt it had run its course and spoke softly and infrequently. I offered my condolences for his unfortunate situation, and tried to commiserate with him about the unique homeness of home. However, despite my efforts, the conversation gradually waned, and fifteen minutes after I had walked in so stridently, I excused myself and walked out, far humbler and a little confused.

It’s been a few weeks since that encounter, and I think I now have a better idea as to what happened. It would be easy to blame the fact that he had received disheartening news a few hours prior, that he had trouble hearing what I was saying, or that the rather stilted start to our conversation was too disadvantageous to overcome. I could say that it was understandable because I was four days away from my first patient interview class, and therefore I wasn’t armed with the full arsenal of interview tactics. However, it’s pretty obvious to me now that it wasn’t at all that I didn’t have enough techniques to unleash on him; instead, it was something beyond them.

To be sure, I’ll have practice and internalize the various aspects of the medical interview endlessly to be an effective clinician; there is no substitute for sheer effort and repetition, especially in trying to cover the vast scope of a proper patient history without seeming robotic and unnatural. However, knowing our physical diagnosis notes cold is not an end in itself. Rather, it is only to ensure that a lack of knowledge does not impede our true goal––to be able to express real empathy.

It’s really hard to be able to express empathy if we’re struggling to remember what we’re supposed to do after the social history; in turn, without real empathy behind our words, our efforts will appear less genuine at best and utterly forced at worst. With enough practice, maybe I would have been able to use my patient interview techniques in an organic and natural way, and as a consequence make him feel genuinely cared about. It would definitely have helped me avoid so many cliches (“there’s no place like home”) or be generally less awkward (“it’s not home, but it’s better than the hospital, right?” I’m still dying a little inside after that one).

What’s crazy is that I totally thought I was being empathetic, but I didn’t realize that I wasn’t really until now. It seems that the shock of finding out how little I know about nearly everything is a pretty ubiquitous experience among us medical school rookies. But that’s another post altogether; for now, I’m just going to have to work up a healthy appetite for humble pie.

Where I Belong

The main reason I chose to blog this year is that I wanted my experiences to serve as an inspiration to those who are currently in the process of applying to medical school.  When I was in the process of going through the pre-med courses in undergrad and working on my application, I would read the LLUSM student blog regularly to remind myself of my ultimate goal.  It inspired me, challenged me to take a deeper look at my faith, and taught me a bit about what to expect in the future years.  Most importantly, reading the blog solidified my already strong desire to attend Loma Linda University because the stories the bloggers shared made it seem like a place where I would fit right in.  Now that I have experienced my first 2 weeks of orientation to medicine at LLUSM I can honestly say that I have found the place where I belong and I couldn’t be happier!  For all of you pre-med students out there who are reading this and looking to be inspired, all I can say is it’s worth the hard work and this school is even more incredible than you could ever imagine.

These past 2 weeks of orientation have included SO much!  We started off with a few days of basic orientation to policies and procedures, we received our white coats, we got a taste of what medicine is like on the wards, we had several incredible worship services, we took a personality test that taught us about how our personality best matches up with study techniques, we had a panel of physicians from all of the various specialties tell us about their fields, we had dinner at a faculty member’s home, and we had A LOT of fun!!!!!!

I feel so incredibly blessed to be in a place that gives first-year medical students these two weeks to spend time on the inpatient wards of hospitals and see what awesome things we have to look forward to after our two years of bookwork.  Even though I didn’t know much about any of the cases that our internal medicine team had on its service, the third year medical students on our team and the residents took the time to teach us as much as they could.  I learned that the proper presentation of the patient follows the SOAP acronym (Subjective Objective Assessment Plan).  I even got to practice presenting several patients using the SOAP method with my third year.  We also had the chance to interview a patient and gain a much deeper understanding of what it’s like for them to be in the hospital.  This interview taught me so much about what it means to be a doctor who can see a patient as a whole person instead of just a list of symptoms.

Remember how I mentioned all the fun?  Well, after these 2 weeks of med school I can honestly say that I am in LOVE with my classmates!  We have been spending time together almost every evening going ballroom dancing, playing volleyball at Drayson Center, going to the beach, having game nights and movie nights, going to church together, and having our own mini vespers.  It seems like I’ve known these people forever and yet we’ve only just met.  It’s the people in our life that make it worthwhile and I couldn’t feel more blessed to have made these new friendships.

If you can’t already tell how much I love this school, then let me just clarify…coming to Loma Linda University is the best decision I have ever made.  If you are a pre-med student looking for a school where whole person care is a priority, where faith and science are fused seamlessly into a first-rate medical curriculum, where each class begins with the acknowledgement of God’s guiding hand, and where the people are genuinely kind, loving, and Christ-centered, then look no further because Loma Linda University lives up to its mission of training doctors who want to continue the healing and teaching ministry of Jesus Christ.

Party Rockers!

I placed my white coat on the hanger where it’ll probably be for the next eight to nine months. The ward experience was amazing. I was at Riverside County Regional Medical Center (RCRMC) internal medicine on the yellow team. Our team name was Party Rockers which, if you add a professional connotation, described our group pretty well. Our party of 10-12 included an attending, residents, an intern, a PA, occasional pharmacist, third-years, and four of us wide-eyed first-years.

Speaking for myself, during the first few days, I felt like I was in a foreign country I had only read about in a few books. I picked out a few of the words and had some idea of the culture, but mostly, I was just lost. I walked in more than one circle trying to find my way from green ICU to purple ICU. And if you thought texting had a lot of acronyms, the med field definitely trumps. “The 59 y/o F with h/o DM2 and HTN p/w AKI, CKD, and GERD…” For those like myself who aren’t fluent in doctor, it’s not an LOL situation.

With only two weeks of exposure, I definitely should not take charge of your health care, but with the help of my team, I did learn a lot. Everyone, especially LLUSM graduates and our third-years, took time out of their busy schedules to show us interesting patient cases, keep us involved with questions, and answer our questions. They taught and gave us the opportunity to examine patients on our own, present to the attending, and write our first medical prescriptions.

I also learned by simply observing. Our team was composed of compassionate health care providers that connected and brought hope to our patients. My third-year often had patients asking specifically for him. The ward experience changed my perspective of medicine–in a good way. I’m excited and ready to face the upcoming hours of book work, so I can help my patients in the future and not be as lost during wards at the end of the year, especially since I won’t have the excuse of being a brand new medical student.