FOLLOW DR. KO: WHEN LIFE GIVES YOU LEMONS

tequila copy 2“ When life gives you lemons, make lemonade,” or so goes a proverbial phrase. But when the lemons come at the most inopportune times, I say forget about the lemonade; I need to make tequila. And when excrement really hits the fan, I make that tequila extra añejo. Let’s just say that there has been a lot of tequila.

The past couple of months have definitely been very trying. Those who have read my previous blog entry know that I faced some pretty impossible scenario regarding my visa to stay in the U.S. to continue my medical training. But after obstinately knocking on every door I could think of, both literally and figuratively, including that of the Prime Minister of Health of Quebec, I was granted an extension on my visa, a lucky exception, allowing me to stay in the U.S. and start my fellowship in Pulmonary and Critical Care Medicine.  It was a much hoped-for and prayed-for triumph, followed by a summer not without its challenges.

It is hard to believe that I started writing this blog as I entered medical school, and this summer marked the end of my training as an internal medicine resident. At the end of residency, one can choose to practice independently as an attending physician, or continue further training in a sub-specialty in a fellowship. I signed up for another three years of training to be a lung and critical care specialists.  Call me nuts. But this means that in three years, I will work with patients afflicted with various pulmonary issues, as well as manage some of the sickest people in the Intensive Care Unit.

July is always a chaotic month for doctors. An old batch of trainees leave, and a new batch of wide-eyed incomers flood in. Add into the equation apartment hunting, car hunting, money scrambling, and oh, how can I forget, studying for one of the biggest exams of my life, the American Board of Internal Medicine, or the ABIM. Everything was on a tight and carefully thought-out schedule, all the while living out of cardboard boxes.

Unfortunately, or perhaps fortunately, depending on how you look at it, doctors are humans, too.  We have lives outside the hospital, we get sick, we get hungry and sleepy, we laugh, we cry, we make mistakes, we try to make lemonades when life gets sour, but sometimes we get overwhelmed by all the bitter lemons thrown at us.

Well, I eventually found an apartment and even managed to move by myself, hopping over fences while carrying heavy boxes.  I moved some money around (euphemism for ‘I borrowed’) and got a car so I can drive between the three different hospitals where I will be working.

Then I found that that I had failed the ABIM on my first try. Never having failed an exam in my life, it was to my surprise that I did not die from failing one exam.  I learned that a bad test score does not equate a failed career and that there are always second chances. So here I am, ready for the challenges and fun that the next three years will offer. Let me dust off that nasty feces that was thrown at me, and cheers!

Melody Ko, M.D.
Fellow, Pulmonary and Critical Care Medicine

FOLLOW DR. KO: Medical Mission to Haiti – Paul’s last days and a few highlights

It was one of those happy endings. Paul, albeit still frail, was now smiling, eating, and chatting with his family. When I first met him, as described in my last post, he couldn’t even breathe on his own. He had been lying listless in the Intensive Care Unit (ICU) bed for days, skin and bones, barely moving a muscle. It was New Year’s Day, and I couldn’t think of a better time to tell him that he was ready to be discharged home.
Paul was one of my first patients on a medical volunteer trip to Haiti earlier this year at Bernard-Mevs Hospital. Paul had been admitted to the ICU for acute respiratory failure secondary to an exacerbation of chronic obstructive pulmonary disease. I had made it my personal project to find him the best treatment regimen with the very limited resources we had. Often, especially at night, I was the only physician covering triage, the emergency room, the inpatient unit and the ICU, and I had only my pocket medicine book to rely on. That, and my own judgment.
It is pretty amazing how quickly a resident physician can grow when forced to think and act by herself without the usual close supervision of an attending, as is the usual case during residency. I remember my second night shift when, while all the volunteers went out to dinner, I was assigned to stay behind to woman the fort. With a mere one and a half years of experience in internal medicine under my belt, it was a tad daunting to be left in charge of the entire hospital. Lo and behold, an ambulance rolled in with blaring sirens, bringing in a young man who was in a motorcycle accident. Just as I was evaluating this patient, another ambulance pulled in, followed by another. Just like that, I was in the entrance of the hospital, surrounded by three ambulances and a crowd of spectators. Seeing as we had our hands full, the third ambulance was diverted to MSF (Médecins Sans Frontières) France which was about 15 minutes away.
As I gave instructions to stabilize the motorcycle accident victim’s neck with a neck collar to prevent worsening of potential cervical spine injury, I tried to gather some history about my second patient. “He has high blood pressure” was all that I could obtain from the paramedics. He was a transfer from another hospital, and apparently they couldn’t handle him so sent him to Bernard-Mevs. No one could tell me what his latest set of vital signs were, or what symptoms he had, so I jumped into the ambulance to take a look for myself.
The man did not respond when I called out or rubbed his sternum. He had no chest rise indicating air entry into his lungs. He wasn’t breathing, and he had no pulse. I immediately started chest compressions right there in the ambulance. A crowd of people gathered around, and one of the paramedics shouted out: “Doc, what do you want us to do?” It was then that I realized that I was the one in charge, and people were waiting for my orders.
We pulled the patient out and put him down on the ground in the driveway and tried to resuscitate him. I declared him dead after twenty minutes. Although the outcome was tragic, that experience gave me a confidence boost and taught me how to take control and be the leader of a healthcare team. Later that week I went on to run codes, manage patients in sepsis or severe infection, repaired lacerations, and made great friends along the way.
On the day of Paul’s discharge, his nephew and friend came to pick him up. They thanked me profusely and hung on to every word I said. “So is this going to happen again?” the friend asked. I told him that if Paul took his medications as instructed and quit smoking, the chances of having another one of these attacks would be decreased. I wasn’t sure what medications were available in Haiti, or how much they cost, so I told them to return to the hospital for another prescription if they could not find or afford those medications. They hugged me, and everyone was happy.
I left Bernard-Mevs Hospital the following day. Later, I found out that Paul came back to the hospital two days after his discharge, in respiratory distress. He ended up being intubated again, coded (lost his pulse), and died in the ER. I remembered the look of hope and trust on Paul’s nephew’s face whenever I spoke, and I could not help but feel like I had failed Paul and his family in some way, even though there wasn’t really much else I could have done.
At that point, I looked up to the sky. Two rainbows dashed across the heavens. It was beautiful. For some of us, life goes on.

Melody Ko

Blog authors are solely responsible for the content of the blogs listed in the directory. Neither the content of these blogs, nor the links to other web sites, are screened, approved, reviewed or endorsed by McGill University. The text and other material on these blogs are the opinion of the specific author and are not statements of advice, opinion, or information of McGill.