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: What You Never Knew About Canadian Doctors Outside Canada

IMGImagine me, a single thirty year-old living in the bustling city of New York, out at a bar on a Saturday night.
“What do you do for a living?” – someone inevitably always asks.

Sometimes, for fun, I make up stories. I tell people that I specialize in cleaning elephant poo at the Bronx Zoo or something ludicrous like that. It is so much more interesting than just saying, “I’m a doctor.”

But when I do say that I am a doctor, people’s reaction is usually “Oh wow.” They think that I must live in luxury on the Upper East Side, drive a Mercedes-Benz or some other fancy vehicle, and travel to exotic lands every couple of months. They picture a doctor, noble and heroic, who goes to work every day and saves lives. Countless lives. They would imagine me shouting out a patient’s blood pressure, cutting them open, performing chest compressions, while pearls of sweat drip down my face, the sweat of hard work, of responsibility, of grandeur. Then the patient lives, wakes up, and thanks me with hugs and tears.

Well, all that is flattering, but none of it is true. I do not save lives every day. As a matter of fact, rarely, if ever, a single act performed by one person saves any lives. Granted, there are days that I intubate or resuscitate a patient, but without my presence, someone else would have taken on the same tasks. Moreover, the outcome of resuscitations is rarely favorable. On most days, I go to work, spend a lot of time in front of the computer reviewing charts and documenting, adjust some medications here and there, auscultate a few chests and backs, order some lab work, curse at the printer for being jammed again, document some more, and call it a day. I am not saying that these actions are not important – they are – but in a smaller, less valiant way than what the public imagines.

Most people also do not know that just because you are a doctor does not mean that you have a job. According to the 2013 report from Royal College of Physicians and Surgeons of Canada titled “Too Many, Too Few Doctors? What’s Really Behind Canada’s Unemployed Specialists,” one in six specialists cannot secure employment in Canada. Not that there is no need for specialists. Those with joint pain know how long the wait list is to see a rheumatologist. Cancer patients have experienced the anxiety in waiting to be evaluated by a radiology-oncologist.

Finding a job is even more difficult for International Medical Graduates (IMG) such as myself. Allow me to take you on a tour onto an IMG’s journey.

After repeatedly being placed on the wait list for Canadian medical schools, I decided not to wait any longer and pursued my medical education abroad, more specifically, at St. George’s University in Grenada. Without any kind of government subsidization, I searched for private loans and worked for a while to save up for the exorbitant tuition fee. After I obtained my medical degree, my initial plan was to return to Quebec, my home province where I would complete my residency. However, I found out that was impossible because Quebec requires all IMGs to have passed both exams of the Licentiate of Medical Council of Canada (LMCC) in order to qualify for residency application. Here is the paradox: one cannot register for the last part of the LMCC exam without having completed at least one year of residency. I gave up that option and eventually matched into a residency in Internal Medicine in New York. That was not easy either, as I was only allowed to pursue a specialty considered by Quebec to be “in need” in order to obtain the visa required to work in the U.S. From what I remember, the specialties considered to be “in need” by Quebec at that time were: Internal Medicine, Family Medicine, Oncology, Hematology, Rheumatology, Geriatrics, Plastic Surgery, Dermatology, and Anato-pathology. Most of these specialties also have a yearly quota, for example, Health Canada only allows four to five IMGs to pursue Rheumatology outside Canada.

Now I am almost at the end of my residency, and to my very pleasant surprise, I matched into a Pulmonary and Critical Care Medicine fellowship at Rutgers University in New Jersey. I did apply in Canada as well, however not in Quebec, because Quebec programs did not accept IMG applicants. Now comes the tricky part: I need Quebec’s endorsement and Canada’s permission to pursue the specialty that I am passionate about. Without Canada’s permission in the form of a letter called the Statement of Need, I cannot extend my visa and would not be allowed to stay and work in the U.S. Every October, Quebec and the rest of Canada come out with a list of medical specialties that they consider to be “in need.” If your chosen specialty does not appear on the list, your province or country will not issue that Statement of Need on your behalf. The result is you are without a visa.

Why not come back to Canada, you say? That was my original plan all along, but the length of training in Internal Medicine in the U.S. being two years shorter than in Canada, I cannot practice as a licensed internist in Canada unless I find an empty spot in the middle of a residency program. You can imagine how difficult that is, and the paperwork that is involved. So should I return to Quebec or Canada, you might find me working as an overqualified burger flipper.

Confused? That is ok. This is indeed a very complex and confusing process that my peers and I learn as we go along.

A Quebecois SGU classmate and friend of mine just matched into Rheumatology in NJ for which Health Canada had alloted five spots by this year. He waited with trepidation to see if he would be one of those five, and luckily he was. Another Canadian classmate of mine, also from Quebec, finished Neurology and wished to continue his training in Neurocritical Care but was not “allowed,” so now he is doing a fellowship in Epilepsy at Yale University. Prestigious position, no doubt, but not what he really loves.

Why are there only five spots allotted to Canadian IMGs who wish to train in Rheumatology abroad? It cannot be a question of funding because the Canadian government is not involved in our training in the U.S. And if Canada has not contributed a single penny to our medical education and training, why does the government restrict what we can or cannot practice? These are questions that we ask ourselves again and again because we do not know who would have the answers, if there is any answer at all.

As for myself, those who know me know how much I love critical care and appreciate pulmonology (respirology in Canada). After all these years of trial and tribulation, to finally arrive where I want to be is a truly rewarding feeling. I am now in the process of working things out, but as of this moment, a piece of paper stands between me and my chosen career.

Next time somebody asks me what I do for a living, saying that I work in the zoo might not be as far-fetched as it sounds.


Melody Ko


Last Monday was the long awaited day! The Match! That’s when med students find out where they will be spending the next couple of years; if they match! If not, it’s a long year before another chance comes around. Monday came. Phew! I found out I matched. But it would not be until Friday that we would find out exactly where we would be heading.

The night before the final result, I could not sleep and went to the gym at 11 P.M., and then again at 4 A.M. to relieve my stress. If only I would work out like that everyday, I would look like a super model. Yeah, sure.


Friday March 16th, at 1 P.M., I opened my email gingerly, as if afraid of shattering something fragile, but also with great hope and cautious optimism. And there it was: I matched into a position as an Internal Medicine resident at Lincoln Medical Center in New York City. At that moment, what was shattered was not my computer; it was my dream of becoming an Emergency Medicine physician.

I stared at my computer screen for a while, at first confused, then my heart started to sink. I knew that Emergency Medicine is quite competitive, especially for foreign grads; Program Directors have told me “We like you but we’ll take an American grad before a foreign grad, so let’s see what happens,” which is frustrating, but I guess understandable. But I also thought that I had a pretty good shot at it. After all, I received high praise during my Emergency Medicine rotations, and I thought my interviews went well, although that could just be my hopeful perception.

Maybe I let myself hope too highly, but I had already let myself imagine working in an Emergency Department, running happily in the chaos, coming to patients during their most dire needs, resuscitating one patient while another shouts in the background demanding Percocet. I also envisioned taking my skills on international humanitarian missions. Just thinking about it brings a smile to my face.

There were tears, cries, phone calls, and consolations.
“At least you matched! Some people didn’t!”
“It’s just because you’re Canadian, not because of your abilities!”
“Everything happens for a reason!”
“Emergency Medicine is not good for women anyway, it’s too stressful!”
“You’ll still get to be a doctor!”

Despite people’s best intentions, some of their efforts to console made me feel worse. And although irrational, I was still heartbroken and my lacrimal glands very much active. But I also know that most of them are right. What is not broken is my will to be a physician, to heal, and to comfort. As I sit here and ponder the future, I’m starting to think that Internal is really the heart of medicine. In no other specialty are you as likely to see such a diversity and complexity of ailments.  And I’ll get plenty of intellectual stimulation. So I will dry my tears, end the self-pity, keep my chin up, and be the best that I can be. Who knows? I might even be glad in the future.

Guess what? This summer one journey ends, and another begins. I’ll finally be a doctor! Internal Medicine, here I come. With enthusiasm.


FOLLOW DR. KO: Almost There, And Yet Still So Far Away!

In less than a month, I will be done with medical school and school altogether. At last!  When I tell people about this, I am inevitably asked how I feel, whether I am excited. I am not sure how to put all my emotions and chaotic thoughts into words, but I will give it my best shot.

Disbelief. From being a curious and inquisitive child interested in science and the human body, to the fateful day I made up my mind to pursue a career in medicine while riding on a bus in Cuba, to now, stethoscope around my neck, white coat hanging on my shoulders, fingers tingling from being so close to touching that diploma. It has been a long, long road, and I really cannot believe that I am almost there.

Anxiety. I’m almost there, but where is that exactly? I have just created my Rank Order List, a list whereby I rank the residency programs for which I have interviewed in order of preference, while the programs do the same with their candidates. On March 6th in Canada and March 16th in the U. S., a candidate will be matched to a program via an algorithm depending on their respective list. That day where residency applicants will hold their breath until blue and then cry from joy or desolation, is fittingly called the Match Day. I agonize over my Rank Order List. A single click on the computer, a small tweak in the rank order could determine where I will spend the next couple of years of my life, and potentially change my life in a dramatic way.  I worry about where I will match, if I will match.

Frustration. Girl from an immigrant family is determined to become a doctor and save lives after witnessing destitution in Cuba. Her relentless chase of her dream whisked her all the way to the beautiful island of Grenada and then to New York City, and now her dream is about to come true! Ok, let’s hold the Kleenex for a second here. Being an International Medical Graduate (IMG) is a massive pain in the posterior. And being in the American system while not being an American citizen is… well, I’m going to say like having a thrombosed hemorrhoid. Never had one, but I’ve been told that it is excruciatingly painful. The paperwork, the equivalency exams, the puzzling language in legal documents and on websites, the phone calls and emails, being given the chase-around with phone calls and emails, the visas… All that is enough to make one laugh and cry in the matter of seconds. No, I’m not bipolar, just a medical student having periodic mini meltdowns. Don’t worry, it’s normal.

Grateful. Despite all my whining and complaining, I am so grateful. Grateful for my parents to have always prioritized education. Grateful for being given this opportunity to follow my passion. Grateful to all those who believed in me when I didn’t believe in myself. Grateful for always having found that small open window when all the big doors were closed. Grateful for those who helped me overcome my difficulties. Grateful for growing up in a country where freedom is often taken for granted, and in a city that prides itself in diversity and culture. Grateful for my health. Grateful for my future.

Of course, once in a while, I can’t help but wonder. I had good grades, I had good MCAT scores, I had a good CV, and I had good letters. Wouldn’t my life have been so much easier had I gotten into a Canadian medical school? I wouldn’t have to worry about all this equivalency and visa nonsense. But they say that the harder the battle, the sweeter the victory.  No use in playing the what-if game. And as always, although the road may seem long and tortuous for now, I will keep on going and going and going, laughing and crying in between.


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