Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

” Not because they are easy, but because they are hard..”

“We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”  John F. Kennedy at Rice University on Sept 12, 1962.


Why choose medicine (or any profession in health care) if the work and preparation for that work is so hard? I asked myself why I spent hours in chemistry, physics and biology lab when my friends who were business and marketing majors were spending their weekends enjoying the club scene and knew the latest shows on the telly? Why was I putting in the hours making sure that my organic chemistry lab reports were accurate and complete? Why did I choose to study advanced applied differential equations, multivariate calculus and higher algebra (math minor) when I could have stopped with integral calculus? In short, why did I deliberately choose a rigorous college education in math and science where I demanded only the highest performance from myself when I could have taken a far easier route? The answer for me was pretty simple, “I had to know how things worked” and setting a hard goal energizes me and my skills.

Yes, my majors in undergraduate were considered difficult by some people but they were sheer heaven for me. Every minute that I spent in lab and applying math theories was not a chore but a pleasure. I had always loved to “figure things out” and I had parents who challenged me (and my siblings) to always do our best work no matter how many hours the job would take. From undergraduate to graduate school (I was a research scientist before medical school), I could focus in on a problem and see many alternative methods to solve that problem. I wanted to explain mathematically, how energy from a laser was transmitted via a heavy mineral acid matrix to a delicate protein in order for that protein to become ionized. I wanted to understand the mathematical model for that phenomenon and others. Fortunately for me, science allowed me to go where my mind could take me and then some.

So what does that mean in terms of medicine? This means that all of my previous studies from primary school to secondary school to undergraduate university to graduate university and medical school are all aimed at understanding why and figuring out how things work especially the human disease phenomenon. One simply has to have a grasp of the whole picture and the whole person in order to have a strong perspective as to how to best help that patient. Medicine is not like business in that one can take a “shortcut” and still get to goal. Medicine is like preparing for a marathon or to lose 100 pounds in that one has to see the long-term goal, work constantly and consistently at a high level and one has to remain vigilant or the goal slips away. This doesn’t mean that the path toward the goal isn’t pleasant because the journey is great fun but the most enjoyment comes when one sees how building upon a knowledge base and application of that knowledge base actually solves a problem for a patient.

I remember spending hours as a third-year medical student in the anatomy lab as I was perfecting my suture techniques. I sutured the skin of cadavers much to the chagrin of the first-year medical students who had spent hours removing or dissecting that skin. I would come into the lab before my surgical rotation started (I was there at 3AM); practiced my suturing and tying techniques and was off (smelling of formaldehyde) to write my morning notes before rounds. Yes, it was “hard” to get up on a cold and snowy morning when it was dark outside and head to a cold anatomy lab with cold steel tanks all around. No, I didn’t “have to” get up early and practice my suturing and tying but after I knew that I wanted to be a surgeon, I knew that I had to put in the time and hone my skills.

When I was in the hospital on overnight call, I went to the library and read about my patients’ problems. I refreshed my knowledge of pathology, I reviewed every medication that they were on and I made notes of how the disease process should progress. Was this easy? No, it was far easier to grab a nap because the Trauma pager would be going off practically continuously after 9 PM and I would be in the emergency department almost constantly until 5AM when it was time for pre-rounding. I learned to cat nap on call (sleep no more than 20 minutes), read when I was exhausted (putting my feet up was better than sleeping for hours and hone in on a surgical procedure while the rest of the world slept. Was it easy? No but I had set a long-term goal for myself and I was determined to get the job done with the same work ethic that my parents instilled from day one.

Conquering Hard Goals

Excellence becomes a habit if it is practiced on a hourly basis. This was the first thing that my parents instilled in me. When self-doubt creeps in and procrastination begins, remember that you can turn around your thinking in the next instant. Why is it so easy to NOT do something well when it is just as easy to DO that something well? There is always more than one way to do anything and any method that one chooses that brings about excellent results that are safe and ethical  is the method to accomplish something. In one’s academics, there is little time to spend on “thinking” about how inferior/superior you are in relation to one’s peers if one is constantly striving toward a long term goal of consistent excellent performance. This doesn’t mean that one wastes time on being “anal” or a “perfectionist” because these two traits carried to an extreme waste too much energy. Consistent excellence means building upon a foundation and linking prior knowledge to present knowledge to setting the foundation for future knowledge.

Sometimes one needs to get a different perspective. If you are finding that you are “spinning your wheels” on a task that seems insurmountable, break that task into more manageable pieces and tackle each one in turn until the whole task is done. Again, if you have 100 pounds to lose, you have to lose that weight one pound at a time. You can’t spend time hating the process (takes away from time that could be better spent working toward the goal) and you can’t afford to indulge in self-pity “Why is it so hard for me and so easy for everyone else?”. In short, your goals and challenges are unique to you and trust me on this one, everyone has goals and challeges that you may or may not be able to see or appreciate. You are no lesser or no greater than any person around you but you can make better or worse decisions as to how you will handle your challenges and goals.

Look from a different perspective

I have been fortunate enough to have spent some quality time looking at the world from the cockpit of my small plane. When I need to put a problem or goal into perspective, I head “up top” and look at the wonders of the world below. When I fly in a commercial airliner, the world below is much smaller at 37,000 feet (on a clear day), than at 3,000 to 6,000  feet where I can mentally interact with things below. The people below are not insignificant at that altitude and the world below becomes more than just the day in and day out tasks of getting things done. In short, find something (for me, it’s flying) that can take you out of your world for a short period of time and help you refocus. For me, flying takes focus and concentration but the pay off is worth the effort. It’s a challenge for a person who thrives on challenge.


You can see the goal (the runway) down there and you can take the steps to line up and get down there to that runway. Flying for me, is a metaphor for meeting the challenges that I encounter on a daily basis. Again, I learned to fly not because it was easy but because it was a hard challenge” that it “serves to organize and measure the best of (my )energies and skills ” and it allows me to accept, willingly, other challenges (not postpone them) that I meet in life.


14 December, 2013 - Posted by | organization, relaxation


  1. I just started my residency in critical care in my country and am already feeling overwhelmed, extremely stressed with the sheer amount I need to learn. From learning interpretation of ABGs and other investigations to re-learning a lot of diseases. I was wondering if you could advice me on how you would approach learning when you are in such a program but didnt build up good knowledge base in undergrad years.

    Comment by Tina | 8 September, 2014 | Reply

    • To Tina:
      You make a list of things that you need to master and check them off as you go. As you review items, then add them to your list of things that are done. After you have mastered 4 or 5 things, then review those things before moving on. You keep repeating the cycle until you have everything completed. Don’t try to sit and do everything at once but prioritize what you need to learn first, second, third etc. Many students get so overwhelmed with the volume of materials, that they try to do everything in one sitting. Make a schedule of what you expect to master and reward your self when you have completed your schedule. Don’t schedule too much or too little as each of those situations can be problematic. Finally, take at least 10 minutes out of every study hour and relax (walk around, go outside and get a breath of fresh air). Turn off the computer/telly/phone so that you are not distracted. You can turn those things back on during your break. Any task that seems overwhelming can be broken down into manageable sections.

      Comment by drnjbmd | 8 September, 2014 | Reply

  2. Indulging into self-pity… that was what I had been feeling these days. I am first year medical student in South Korea. Unlike USA medical college, in Korea it consists of 6 year, 2 years of premed + 4 years of learning and practicing medicine. For me, I’m not sure that I’m doing right feeling like losing “big picture.” I’m really afraid to be stupid doctor like parrot. I know how important it is “to think” and be scientific but I can not find the way. Each day tons of manual and knowledge are accumulated and exams for every one or two weeks, I feel suffocated not because they are exhausting because they make me guilty. I know you can’t actually help me. Because it is a matter of intelligence and learning and thinking which is totally rested upon myself. Sometimes I think competent scientists and physicians are the ones who are born to be so. I really want to feel the enjoyment of knowing how and getting my perspective on the world. But it makes me sad when time just flies without gain. Do you have any suggestion?

    Comment by BC | 2 April, 2014 | Reply

    • To BC:
      There is nothing “intelligent” about mastery of medicine. The key is organization so that you can learn. You can’t afford to let yourself be intimidated by the volume. Divide and conquer but organize first and take frequent breaks. I used to set a timer for 50 minutes and then 10 minute break. When I finished my break, set timer for 50 minutes. Don’t just sit and stare at a page but have a purpose for what you want to learn. You don’t have to be able to recite back word for word but you should be able to summarize. Try the timer strategy and go from there. Good luck

      Comment by drnjbmd | 2 April, 2014 | Reply

  3. Hello. my name is Brian, an undergraduate graduating this year. I have been reading your posts on sdn and was wondering how did you study for your mcat? (hope you dont me asking)

    Comment by brian | 17 January, 2014 | Reply

    • To Brian:
      I was a graduate student in Biochemistry/Molecular Biology when I took the MCAT. My actual study was to prepare for my comprehensive exams for my graduate program. It turns out that my coursework and comprehensive prep was more than adequate for me. I did work one of the retired MCAT exams (available from AAMC website for purchase) so that I was totally familiar with how the test is constructed. Good luck.

      Comment by drnjbmd | 17 January, 2014 | Reply

  4. Great post ! I have read a lot of ur older posts ..and you give great advice. I was wondering whether retrospectively you ever felt that being so strict with your schedule you missed out on having fun ? Or were you able to achieve a good work life balance ? Do you ever feel that you should have taken it easy ? And have u ever felt that surgery as a career choice has been very hectic ?

    Comment by charoo iyer | 16 January, 2014 | Reply

    • To Charoo Iyer,
      If you love what you do, it isn’t work. Surgery, or medicine for that matter, has never been work for me. I love and thrive on challenges and sought a vocation that gives me those challenges on a daily basis. I certainly believe that an individual has to figure out what works and what doesn’t work for themselves. Too many people look outside for approval of their lives and life choices when one should actually look from within. The only person who has to approve what I do and decide for myself is me. In short, I have great fun every day and can’t remember a day when I haven’t had great fun.

      Comment by drnjbmd | 16 January, 2014 | Reply

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