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: 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

FOLLOW DR. KO: The Unfortunate Case of the “Drug Mule”

Screen Shot 2013-12-31 at 6.08.10 PMOn a crisp Saturday morning, Internal Medicine Residents from all over the state of New York trickled into the University of Rochester’s School of Medicine, sporting ties and dresses in lieu of their usual white coats and scrubs. In their hands they clutched a precious cargo, a cylinder that protected a poster to be used for a presentation about their research or about an unusual clinical case.

I was among the ninety-seven young (when does one cease to be called young, I wonder?) residents who had been selected to present their work at the annual New York American College of Physicians’ abstract competition. I had to rush to the airport right after work on a Friday afternoon, and then with barely six hours of sleep, (no, six hours is not enough) drag myself up and out into the cold air of Rochester, firmly gripping my poster, all the while wondering why I was giving myself all this extra work on my only free weekend of the month.

But then, as soon as I got a glimpse of other young physician’s work and ideas, my somnolence evaporated. How stimulating and motivating it was so see the talent out there! I especially remember one resident who was doing a double residency in Internal Medicine and Pediatrics. One residency is a daunting enough task, but two! And then I watched in amazement as he juggled his research poster with one hand, and his toddler with the other. It never ceases to amaze me how people can raise children and be in residency at the same time. His poster illustrated two years of laboratory work during which he exposed mice to different degrees of radiation and then extracted their stem cells to measure the relationship between the radiation exposure and the death of the cells. Fancy stuff. When I asked him how he had time for residency, family and research, he simply replied: “I don’t, really.”

My presentation was not nearly as fancy, but did make for what I figured would be a captivating story. It was about a “drug mule” I had encountered during my rotation in the Intensive Care Unit (ICU). She was a young woman barely out of her teens who was brought into our Emergency Department after suffering a seizure on the street. She subsequently went into cardiac arrest and was brought back to life after more than twenty minutes of CPR. Before her heart stopped, she was able to tell us that she had tried cocaine for the first time.

While in the ICU, our patient was kept on mechanical ventilator support for over a week because she could not breathe on her own. A number of people claiming to be her relatives showed up daily to visit, and her alleged mother raised concerns about my patient’s enlarged abdomen. We did an abdominal X-ray and saw nothing unusual. Eight days later, a nurse found pellets of a white substance in her diaper! That’s when we opted for a CT scan and found numerous other drug pellets that had not been picked up on the X-ray. It turned out that she had been paid to smuggle a load of cocaine into the U.S., probably never realizing the risk she was taking.

I found only one study comparing the sensitivity and specificity of different imaging modalities for detection of concealed drugs in the human body. A CT scan, although costly and laborious, is definitely the way to go when someone is suspected of concealing drugs in their body. This is especially so when there is imminent danger to the individual’s life, as was the case with our patient. Given that one or more of the drug pellets had already burst, a steady stream of cocaine was leaking into her system causing havoc.

When I first set out to become a doctor, research was not at all on my mind. I wanted to be a clinician, to be with patients. Forget about lab rats and data collection, forget about grant applications and writing papers. That “stuff” wasn’t for me, so I thought. But that changed during my third year of medical school, when I first got my feet wet in research on Transient Ischemic Attacks. Despite the small role I played in the project, I felt an indescribable satisfaction from giving back to the scientific community. I was, in my own very small way, contributing to the advancement of Medicine!

The judges seemed taken by my presentation about the cocaine overdose. I felt I had told a story, showed images, presented some data, and had effectively conveyed the message I wanted my audience to take home. However, I had to rush back to the airport before the announcement of the winner of the poster competition was made. I had entered this contest for fun, really just “for the heck of it”. But then a very welcome surprise came through my phone as I was to board my plane: I had won! Out of the fifty-seven contestants in my category, I came in first. Certainly worth the plane rides and the early mornings! All those years working at the McGill Office for Science and Society had seasoned me properly!

Who would have thought back then that I would be representing the state of New York at the National American College of Physicians conference? Not me.

Melody Ko

FOLLOW DR. KO:The Infamous Month of July

July calendarThere is a reason why people say that July is the most dangerous month to go to the hospital. Every year, on July 1st, newly minted M.D.s, fresh out of medical school, don a long white coat, heavier than the student’s short coat, perhaps representing more weighty responsibilities. At the same time, the most experienced senior residents graduate and move on, leaving behind residents who have not logged in as many hours, or seen as many patients to take over.

Surely, this new shift in residents, along with the fact that we, the “first-years,” know nothing (or at least that’s how we feel and that’s what we are told), has an impact on patient care, complications and death rates. Lack of medical knowledge isn’t necessarily always to blame here. The former first-year residents get promoted to senior residents and have to adjust to a whole new range of responsibilities and adapt to a different pace of work. At the same time, the new interns, who so far had mostly been shadowing doctors as students, all of the sudden need to take charge. Unfamiliarity with the hospital’s computer system can also result in prescription errors and duplicate orders.

Dr. John Young and his team from the University of California in a study published in the Annals of Internal Medicine, has actually shown that hospital death rates increase from 8% to 34% in the month of July. Scary, I know. Especially for those who get sick during this precarious time. On the other hand, hospital administrators are well aware of this phenomenon and are taking the necessary measures to minimize the effects of this transition. In my program, for example, two senior residents are specifically designated to monitor and coach the new doctors. Instead of seeing patients, they peruse the halls to make sure that the interns get the help they need and provide guidance if needed. Morning reports and noon conferences are temporarily canceled to give us more time to finish our work.

Nevertheless, the hospital is definitely more hectic than usual in the summer months, with a lot of us looking like headless chickens running in circles. Not ideal, but inevitable in order to train and produce new doctors. In July we are headless chickens; by next April the same headless chickens might save your life. . Try not to get sick in July.

Melody Ko

FOLLOW DR. KO:Souvenirs from Thailand on My Body

The hole on the bottom of my left foot has finally closed up. Now all that is left is some scar tissue and hyperkeratinized skin, more commonly known as a callus. After physical trauma, such as friction or injury, dead skin cells in the most superficial layer of the skin proliferate as a protective mechanism, resulting in the esthetically not-so-pleasing hard skin. Sometimes these calluses disappear on their own with time, other times interventions are required, chemically with salicylic acid, for example, or mechanically by rubbing with a pumice stone. Although I could certainly do without it, the sight of my scar and callus brings back fond memories of Thailand, where I spent a month backpacking before signing my life away to Residency.

It happened during a three-day trek in the jungle near Chiang Mai, the northern capital of Thailand. The trek started with a promenade on elephants through the woods and into the river, then a hike up nonexistent paths under the unforgiving Thai sun, with our backpacks weighing on our backs and sweat dripping from every pore. It was the most gruesome three-hour workout I have ever put myself through. One of the trekkers even vomited from overexertion.

Singing with the Lahu Children

We managed to reach our destination for the day, a small hill tribe village inhabited by the Lahu people, before the sky opened up with a torrential tropical rain. The Lahus hosted us for two nights in one of their bamboo huts. Since there was no electricity at night, we occupied ourselves with Sangsom Thai rum while our guide played the guitar under candlelight. Going to the bathroom was an adventure of its own. With only my dying flashlight to light the way, I had to carefully go down a slope made muddy and slippery by the rain. Then came a balancing act on a few wobbly steps to descend to the “washroom” which consisted of a hole in the ground for our bodily wastes. In this part of the world, squatting is the way to go. The washroom was also equipped with a tub of water for flushing and washing. No paper of course.

As I gingerly stepped down the wobbly and slippery steps, I kept muttering to myself: “Be careful, do not fall, do not fall.” Lo and behold, I fell and slid all the way down. That was my first injury of the trip: A big road rash on the back of my left shoulder. Although it was only a superficial excoriation of the skin, open wounds are prone to infection, especially when you’re in the wilderness and caked with dirt. Luckily, one of the other campers had packed some iodine solution so my wound could be cleaned and disinfected. The wound eventually healed without complication, and I have a scar on the back of my left shoulder to remind me of my voyage to the Lahu toilet.

My left foot, however, was not so lucky. On our last day of the trek, we walked barefoot to a river for some white water rafting. The water wasn’t exactly clear, but more of a muddy yellow color, perhaps partly from all the wastes oozing from houses on the banks. Later that evening it was back to our hotel in the city where I was finally able to take a hot and thorough shower. That’s when I noticed I had a tiny splinter on the bottom of my foot! Being a doctor now, I figured I would just take it out myself. So off I went to my toiletry bag to take out a pair of tweezers that I normally use for my eyebrows and I rummaged through a travel sewing kit for a needle. Being a properly trained physician, at least in the mind of those who granted me a degree, I rubbed alcohol on my skin and on my makeshift surgical instruments, and then proceeded to operate. I’m not sure if the entire splinter came out, but I wasn’t too worried about it. I kept applying topical antibiotic on the small wound, and that would be it. Or so I thought.

In the course of the following few days, the small wound that I had created turned red and slightly purulent, meaning containing pus. The infection was really small and I deemed it insignificant, not much different from a pimple. I squeezed out the pus and continued applying topical antibiotic ointment, thinking that it would go away on its own. Then the redness started to spread. The pain intensified. A week later, the middle of my very small wound had turned black, a sign of necrosis. Necrosis is premature cell death in living tissue, and can result from infection or poor blood circulation. If left untreated, it can progress to gangrene, meaning that there has been tissue death. Treatment is debridement of the dead tissue, or possibly even amputation of the gangrenous limb. Without medical attention, it can be lethal.

Neither death nor amputation struck me as an attractive prospect so I decided I had better drag myself to a hospital, quite literally, since I could hardly walk. By that time, we had made our way to Pai, a lovely northern village best known for its high hippie concentration. Just as I suspected, the doctor prescribed an I&D which stands for incision and drainage, or incision and debridement, a procedure that I have myself performed multiple times. The doctor makes an incision with a scalpel over the abscess to let the pus drain, then uses a pair of forceps to go inside the cavity and clean out the residual pus and dead tissue. All this under local anesthesia, of course. Except that the process of getting the local anesthesia is rather painful, or so I had heard from patients I had treated. They were absolutely right, as I now learned. After the I&D, the cavity is packed with sterile gauze, to be changed daily, which meant that I had to go back to the hospital every day. I left the hospital with a hole in my foot, one week’s worth of oral antibiotics, and a newfound appreciation for what I had put my patients through.

So that is the story of the hole in my foot, and now I have a hyperkeratinized scar as a souvenir. It is not my only one though. Throughout the rest of trip, I fell from a motorbike, the number one tourist killer in Southeast Asia; got stung by jellyfish multiple times while scuba diving; scraped my knee while deep water soloing (a form of free rock climbing on sea cliffs); scratched myself on sea rocks, sea urchins. I have marks all over my body from all over Thailand.

It was a wonderful trip. Residency should be a breeze.

FOLLOW DR. KO:Distance Makes the Heart Grow Fonder

For the past couple of months, the whirlwind of residency applications, letters of recommendations, interviews, the Match, uncertainties about life and trepidation about what is to come had me so dizzy that I lost track of why I am doing this. This, becoming a doctor.

As my dear friend Mustafa who is about to finish his residency once told me jokingly: “My parents told me a big lie. They said that all I had to do was to work hard, become a doctor, and everything would be fine. I worked hard, I became a doctor, and everything is not fine.” What he meant was that the hardship does not end the minute we get accepted to medical school, as I once so naively thought; nor does it end after we graduate. Exams keep on coming even though school’s out forever. After med school there is residency during which you compete for fellowship, then comes the job search which is not as easy as some depict it to be. I know, because I see it everyday.

 

I must admit that I was, for a while, plagued with self-doubt. Life has not turned out the way I had planned it to be, and being goal-oriented, I had trouble accepting not meeting my goals exactly the way I had pictured them. Why do I even want to be a doctor?

Sometimes, it takes a bit of distance to see the big picture. I left New York City a week ago to come back to Montreal to reconnect with friends and family before the real grind of residency begins this summer. During this time, I tried to put the world of medicine out of my mind. Funny thing, that’s when I started to love medicine again.

I attended a lecture on “pain” at McGill University, and I marvel at how much I have yet to learn and I cannot wait to start exploring this deep pond of knowledge! And then I remembered the belligerent man with the rotting legs who eventually showed a softer side, the lovely old lady who coded in the E.R. after she told me I would make the best doctor in the world, the old blind man whom I accompanied home after he visited his dying wife in the hospital; they are the reason I am doing this.

I am so glad I picked this career. But as in any relationship, some space is good. So during my time off, I am offering myself a trip to South East Asia as a graduation present, am continuing my birthday festivities although it has been two weeks (accepting gifts at the OSS address), and reading books that I don’t have time to read otherwise.

Life is good. And I get to spend mine helping others to have good lives, too.

 

FOLLOW DR. KO:Chin up

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.

 

FOLLOW DR. KO: Oh Canada!

It’s been a while since my last update. I have been extremely tired; after spending all day in front of the computer – because we have to document everything we do for a patient – when I come home I really don’t want to keep staring at my monitor and typing.

I just finished six weeks of rotation in Pediatrics (Peds) and now I’m in Psychiatry. I loved the kids in Peds, love them from babies to teenagers. And people working in Peds are generally extremely nice and friendly. They say that Pediatricians are a difference race, I guess that’s true. It’s funny that doctors from the same specialty exhibit the same characteristic personality traits.

Pediatricians are mellow and gentle; obstetricians are boisterous and fight with each other but forget about it two minutes later and become best friends again; psychiatrists are calm and quirky with a unique sense of humor. I wonder where I fit in best. I also wonder which geographical area I fit in best. Alas, I’m already half way through my third year of med school and it is time to think about residency applications!

I have always thought that a combination of Family and Emergency Medicine would be perfect for me. And after some clinical experience, I am even more convinced of my first intuition. I enjoy diversity and seeing a broad range of illnesses; I like patients of all ages; and I also take great pleasure in building relationships with my patients and educating them about disease prevention and management. On the other hand, I also love the fast-pace and the pressure in the Emergency Room. Crises don’t make me panic, they help me focus, and I have got to admit that I am bit of an adrenaline junkie. Therefore, a two-year residency program in Family Medicine followed by a one-year fellowship in Emergency Medicine seems perfect for me, and this program is offered by all universities in Canada. After some research, however, I found out, to my disappointment, that going back to Canada will probably not be an option for me.

According to the CaRMS (Canadian Residency Matching Service) website, a mere total of 105 positions are offered in Family Medicine in the first iteration in the whole country for International Medical Graduates (IMGs) like myself https://w1c.e-carms.ca/pdws/jsp/pd.do?d=919&p=p3&m=1. Most of those positions are offered in Ontario, none in Quebec. So despite my being perfectly bilingual (as a matter of fact, I speak fluent English, French, Mandarin, and can get by in Spanish and Taiwanese), Quebec will not be benefiting from my service. How about Ontario? Well, the province requires a Return of Service of 5 years in an underserved area after you finish your residency. Do I want to get stuck in some frozen village where it’s -20C half of the year for 5 years? I think not.

So maybe I’ll just stay in the big U. S. of A. I don’t know if I can practice Emergency Medicine as a Family Physician here in the U.S., but I’ll probably be better paid and lesser taxed. Unfortunately, being a non-American citizen, I will have to face visa issues which I still do not have a good understanding off. In laymen terms, I’m screwed.

I spent my first American Thanksgiving with another Canadian expat eating turkey in a restaurant with other people who I assume are also expats of some sort (or loners who don’t have families?) Will I remain an expat forever? I guess we shall see.

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