Personal Stories, Uncategorized

My Interview at Yale Medical School

On Tuesday, March 8th, I was absent-mindedly surfing the web in my London apartment. Outside my room, my roommate and a couple friends were goofing around with coloured cotton balls. I had joined them for a while, but my mind was occupied with something else. I opened my email inbox. “Yale Medical School,” I typed into the search box. I did not expect any news, as the official date for acceptance notification was not until two days later, or so I was told.

Maybe it was my fingers running across the keys, or maybe it was the little rat running in the back of my mind, but I was brought back to my interview day a month earlier. It was snowing that day. In fact, it was snowing so hard that my flight from Toronto was delayed by two hours, which meant I missed my layover flight from Detroit. Thankfully, there was another flight later that day. That, however, delayed my arrival at New Haven, so I missed the last shuttle to Yale. It was a one-hour ride from the airport to Yale campus, so when I called the shuttle service at Bradley airport I was already thinking of alternative ways to make my way there.

“Is this CT Limo?” I asked the person who picked up the phone. CT Limo was the name of the shuttle service.

“Yes,” said the operator.

“Hi, is there another shuttle left?” I asked.

“Let me check…” I held my breath.

“We have one left. He leaves in ten minutes.”

“Great! How do I pay?”

“Uh…ask someone at the airport. We should have a rep there.”

They did not. No one at the terminal knew how CT Limo operated or who was really in charge. All they knew was that a shuttle arrived at certain times during the day and carried travellers to and from the airport. But sometimes, it did not arrive as expected. In fact, it seemed like CT Limo missed about ten percent of all of its promised departure times.

I was becoming increasingly anxious as I waited on the promised platform. Shuttle after shuttle came and passed, bringing passengers to the local car rental agency. The day waned. It stretched a red yawn right across the horizon before falling into a deep slumber. At half past six, a white van bearing what looked like a Mercedes logo pulled up. I had a déjà vu to the time in China when I travelled in a black cab (a privately owned taxi, much like Uber but not as accountable or legal).

The driver stepped out. He did not speak much English. He went for my bags. I hesitated. What the heck, I thought to myself, and stepped into the van.

Yale Medical School is located in New Haven, Connecticut. Since its founding in 1813, it had served as the training grounds for many outstanding physicians, from Harvey Cushing, the father of neurosurgery, to Vivek Murphy, the current Surgeon-General to President Obama. When I arrived that night, I met with a few students whom I had been in contact with. One of them, Aaron (names changed), graduated from Yale as an undergraduate and the other, Raj, was from Stanford. We sat in the cafeteria of the medical school residence. In the studio next door, a ballroom dance class was underway.

“Thanks for chatting with me,” I said. “I know how busy you are.”

“Not really. We just finished an exam,” said Aaron. “We’re catching Deadpool later. I’d ask you to come but you probably need your rest for tomorrow.”

I agreed.

“I have a few questions I’m dying to ask,” I said.

“Go ahead.”

“How are you liking the Yale System?”

The Yale System had been Yale Medical School’s educational philosophy since the early 1900s when it was first proposed by Dean Winternitz. Under the System, classes are optional, exams are anonymous and self-directed, and medical students can take classes at any of the other Yale schools. I already had plans to study history and law if I had the time.

“We love it,” they both said, summing up what I had read online. Over the next hour, we talked about how they had taken advantage of the System, what classes were like, and what research opportunities there were. I could tell that they were very enthusiastic about their school and the Yale System. Their passion was infectious. At 9 PM, as I got up to leave, I remembered one last question.

“I understand that you’re Canadian,” I said to Aaron. “Are there many international students here?”

He thought about this for a while.

“I think there are ten of us. Five are Canadian. But…” At this, he hesitated. “…we all did our undergrad in the States.”

Ah well, I thought to myself, I guess I won’t expect too much. I had known that the majority of the medical class already had a postgraduate degree. Compounding on the international factor, the odds were not good. But I resolved to enjoy this experience as much as possible.

“Thank you for your time, guys. I really appreciate this.”

“Good luck tomorrow!”

At 8 AM the next morning, I walked from my Airbnb apartment to the medical center. As I walked, I marvelled at the day. The sun had poured itself onto the streets and pavements of Yale’s campus, and the air had a balmy breeze with a hint of spring.

The night before, I had made up my mind to accept whatever outcome that came. As a matter of fact, I had adopted that mindset even before I began my application in July. Truth be told, there are many reasons why students apply to medical school, and wanting to become a doctor is only one of them. Another reason is that we are afraid. We are afraid of a future of uncertainty, of experiencing a setback, and of coming to grips with our limitations. More than anything else, we are afraid of losing significance, of our sense of pride. I was with my friend the day he received an interview invitation to one of the Canadian schools. I saw his hands shaking as he opened the email. Gosh, I thought to myself as I watched him, do I base my identity on my success so much as well?

In Aequanimitas, William Osler, the great Canadian doctor, co-founder of Johns Hopkins Hospital and one of my heroes, discussed the single most important trait of doctors. He called it “imperturbability”, the ability to remain calm and grounded in all situations. Just as in the biblical parable of the man who builds his house on solid rock, a doctor must also build his identity and principles on firm foundations. The ability to succeed only constitutes a portion of that. Aequanimitas, I repeated to myself as I entered the admissions office.

The first people I met that day were the other interviewees. Because it was a Wednesday, there were only six of us. Three of them were post-graduates. Then the Dean of Admissions, Richard Silverman, arrived. He was an elderly gentleman with white hair and round-rimmed glasses. Beneath them, his eyes flashed with the unmistakable glint of intelligence mixed with a cheeky playfulness.

He talked. He joked. We laughed nervously. “You guys look tense,” he said. “You know, there was once a girl who interviewed here. She was so eager that when she got into the interview room, the interviewer asked her the profound question ‘did you find the place without any trouble?’ to which she answered ‘Yes, no trouble at all’ and launched straight into ‘which reminds me of a time in my research experience…’”

We all laughed. I knew we were thinking of the same thing: pre-meds are such keeners. Then we caught ourselves and smiled sheepishly.

“This is a chance for us to get to know you, and for you to know us,” concluded Richard Silverman. “So enjoy yourselves! You guys will do just fine.” Then he left with a curious wink.

Later that day, I stood outside my interviewer’s office in the Department of Surgery. I looked at my watch: Five to two. I’ll wait for five more minutes, I thought to myself. A lady wearing a white lab coat walked past.

I had already had an interview that morning. My interviewer, an upper year medical student who was an aspiring pediatric oncologist and amateur chef, had come off as a friendly and genuine person. In fact, ever since I met the two students from the previous night, I had begun to form the impression of Yale students as unexpectedly humble, quite unlike the stereotype of students from elite institutions. (Although, I might add that this could only apply to postgraduate schools, and also make mention of my extremely small and self-selecting sample size.)

That morning’s interview had gone smoothly. Yale used a traditional, one-on-one interview format, which allowed for deeper conversations. My interviewer himself had chosen to print off pre-set questions which he had made based on my primary application, but our conversation often diverted depending on what he wanted to know more about. Our discussion ranged from the humanities in medical practice to the idealisms of new doctors.

This afternoon’s interview was going to be different. Dean Silverman had introduced our interviewers by name that morning, from which I took away three things about mine. First, he was a big deal in the department, whatever that meant. Second, he was famous for wearing bow ties; in fact, one of them had sold for $3000 at a charity auction. Third, Silverman had chuckled when he read his name. Whatever that meant.

2 PM. I knocked on the door. Nothing. I knocked louder. “Just a second!” came a yell from inside. “Alright!” I yelled back. What a way to make an impression, I thought to myself. The door opened. I was greeted by an elderly gentleman with thick glasses. I glanced down. He was wearing a brown bow tie.

“Come in, come in,” he said.

I stepped into his office. It was a surprisingly small space made even smaller by the assortment of items piled on his desk. Books, files, stationery and other objects I did not recognize took up residence at seemingly haphazard spots, and a large but old flat screen computer monitor took prime location at the center. A single large window faced the East, upon which a firm layer of dust softened the gentle sunlight that floated in. There was an old wooden rocking chair facing his desk. It did not look comfortable.

I found his office so curious that the first thing I did was to slump into the chair. A jarring protest from my hip against the hard backing reminded me that I was at an interview, so I squirmed to the edge of my seat and kept my back as straight as I could.

“So you’re from Canada?” was his first question.

“Yes, but I was actually born-”, I began, but a loud clicking sound interrupted me. Kr-kr-kr-kr-kr-kr… It was the heater tucked away in the corner of the room.

“I spent my childhood in Canada too,” he said. “Victoria Island. You know that, don’t you? We used to go kayaking and we’d see whales.”

In ordinary circumstances, I would have been happy to hear his story. But because it was an interview, I was also hoping to present my own. He apparently had different ideas.

“We would kayak off Nanaimo, and sometimes we would see seals.”

“Seals that far south?” I asked. I could not stop myself. I had gone kayaking in the same area, and I never saw whales nor seals.

“Yes…but I left when I was ten,” he said. I expected him to go on.

“So what do you do for fun?” He asked suddenly.

I was just about to carry on the conversation in the same tone that he had: relaxed, casual and somewhat aimless. But I caught myself just in time. Was this an interview question? Has the interview finally started? Violin, writing, martial arts, I thought to myself and said so.

“What kind of martial arts?” he asked.

“I’ve been practicing Seikido – a martial art based on Taekwondo and Aikido – since freshman year. But I’m also hoping to explore some Chinese martial arts. I’m going back to China to do that over the summer.”

He nodded. Over the next hour, I found an unusual pattern in our conversation. Whenever I began to talk about my “selling points”– the Science Case Competition, Backyard Labs, Friends of MSF – I sensed his attention drifting. I had to cut a few of my points short because of it. On the other hand, he seemed interested in what I thought to be irrelevant material.

“So what’s your favourite course?” he asked.

I smiled sheepishly. I had prepared an answer involving an especially hard course I had taken and how I had shown perseverance by succeeding in it. But having interacted with him for a while, I decided that that answer would not suffice.

“I picked up the Lord of the Rings series a few years ago and loved it,” I said. He nodded emphatically.

“I loved it so much that, in one summer, I read the book series twice, watched the movies six times through, and watched a ten-hour documentary on it.” I could sense his interest growing.

“I learned that Tolkien loved trees. His description of forests and the Ents are some of the most evocative. So I took a course, Evolution of Plants, to better appreciate his work.”

We both laughed at how ridiculous I sounded. But after interviewing at a few schools in both Canada and the States, I think this might be one of the most distinguishing criteria between the two. Canadian schools tend to emphasize “traditional doctoring qualities,” so scenario questions and questions about volunteer experience were common. In the US, I had a lot more questions about my passions, research and leadership activities. In fact, one of my proudest achievements, creating the Science Case Competition, was not even mentioned during my Canadian interviews.

“Tell me about your research,” he said. I explained how I was using machine learning to model how humans sense touch.

“When you model the receptors,” he said. “Which neurons are you modeling? Merkel or Meissner?”

I blanked. I wanted to shoot myself in the foot. I had read it before, but because it was not relevant to my model from a computational standpoint and I had not taken a physiology class, I was not sure. Fifty-fifty chance. I thought it was Merkel…or was it Meissner? I can’t believe I missed this when reviewing! Should I guess? I decided that I had better be honest.

“I’m actually not sure,” I said with ironic confidence. “It’s not essential to the model I’m designing. All that matters to me is that the neurons I model are the ones involved in tactile discrimination. They adapt slowly to changes in pressure, so in the lab, we just refer to them as SA-1 neurons.”

He nodded with a somewhat-satisfied-but-still-a-little-skeptical look.

“Neuroanatomy was the focus of my lab,” he said. “I’m not in the lab anymore. I’ve been focusing on education over the past couple of years.”

“I’m interested in education too,” I said. “As you can see from the science case competition…” I trailed off hopefully. Just ask me to tell you more about it! He nodded. I decided to drop it.

“Yale has the Anatomy Project that invites high school students into the anatomy lab,” I said. “I think it’s a great experiential learning opportunity for those students. I’d like to get involved in it if I come.”

“I created that.”

“Oh! Congratulations on its success,” I said.

“Yes, yes…a student of that program from one of the community schools, you know, underprivileged area, ended up coming to Yale Medical School.”

“That’s wonderful.”

“Yes, yes…” he said, more to himself than to me, then he looked at his watch. We were over time. “Well, it was a pleasure to chat with you.”

“Likewise,” I said. “Thank you for your time.”

I left that interview with mixed feelings. Later that evening, I received a message from my friend. “How did it go?” she asked. “I really have no idea,” I replied.

 

On Tuesday, March 8th, 2016, I was absent-mindedly surfing the web in my London apartment. It had been a hectic few weeks, with midterms, assignments and interviews all rolled into one continuous barrage. But I felt strangely peaceful amidst it all. Maybe it was because I understood the role of chance in this process, or maybe it was because of my friend’s muttered prayers that echoed in the dark, but deep down inside, I knew that I would be O.K. with whatever the outcome may be, that I would not lose my sense of worth, and that my success or failure doesn’t really matter in the grand scheme of things. I opened up my mailbox. “Yale Medical School,” I typed into the search box. I read the first result that came up. I blinked hard and read it again. It had gone into my spam box so I did not see it all day. But it was real. I couldn’t believe it. It was a letter of acceptance.

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Personal Stories, Philosophy

A Life Lesson from Professor Tom Haffie

I knocked on the door. There was shuffling on the other side, and a subtle but familiar anxiety rose in my mind. Still nervous, after all these years? I wondered to myself.

The door opened, and Tom Haffie’s face appeared in the crack. He was a late middle aged man whose hair had started turning white, and whose eyes shone with a glint that suggested that he knew more about you than he cared to show. He usually gave a rather serious impression, but he smiled as he greeted me.

“Hi Charlie. Come on in.”

“Hi Tom,” I said as I entered. “These are for you.” I handed him the items in my hands. “Green tea and raisin tea biscuits. Hope you still like them.”

“Always have. Thank you. Have a seat.”

It was three years ago when I first met Tom in this very office. He was my first year biology professor then, but our relationship had progressed over the years. In fact, we recently published a paper together.

Yet in some part of my mind, I still thought of myself as a freshman who wanted to pick his professor’s brains. I remembered the first time I visited, when I’d asked him a question about Okazaki fragments. “Hair splitting” was the phrase he used to describe my question. “You will never have to think in such detail,” he had said.

“How have you been?” I started, watching him break the raisin biscuit into bite-sized pieces.

“Busy, as usual…You remember Elysia?”

“The chloroplast-eating sea slug from first year. How can I forget?”

“New research came out…” he said, gesturing at a paper on his desk. “Turns out it doesn’t actually use the chloroplasts for photosynthesis after all.”

“You’re kidding!”

“And there is no evidence of lateral gene transfer either.”

“You mean to say…”

“The slug just digests chloroplasts for food.”

“So my first year was a lie?”

“I’m hoping you didn’t just learn about the slugs.”

I chuckled, partially at his comment and partially because I imagined myself as a naïve freshman and couldn’t help it. When I stopped, I noticed that a stillness had settled in the room, like time had frozen and there was no one in the world talking except us.

Tom was a master of silence, and maybe that’s why it can be unnerving talking to him. He injected long pauses between sentences, and each word that came out always seemed adamant on asserting its effect on the listener. As a freshman, I’d often wondered what to say to fill in those pauses. But now I steadily met his gaze and waited.

“So…how’s life?” he said ten seconds later.

I updated him on my medical applications. In fact, I’d recently been rejected by McMaster’s medical program. He didn’t have to know that.

“You know, I’ve been reflecting recently,” I said, and I felt his gaze intensify. “I have two competing motivations in me.”

He nodded.

“I am driven by curiosity. I want to try a bit of everything, to learn different things while I’m young. That’s partially why I picked bioinformatics, because I knew I’d learn all the health-related stuff in medical school. But at the same time, I can’t help but be influenced by how everyone around me is doing. Despite all of my achievements, my ego wants to be recognized, and oftentimes it gets in the way of what I really want to do: to learn.”

Throughout my rant, he nodded along with an amused look on his face, like he knew exactly what I meant and maybe a little more. When I finished, he drew a slow breath. Outside, the snow had begun to fall. Flakes of iridescent crystals hung onto the window pane briefly before evaporating into the morning sun.

“Charlie…you have so many expectations, about life, about yourself, about everything,” he said. “…Did you ever question these expectations?”

“Question them?”

“Yes, how do you know that they are the best for you?”

I considered this for a moment.

“For example, your aim is to go to a certain medical school. But maybe that isn’t such a good choice. Maybe you end up hating that school. Maybe you go to that new city, and the second day you get there you get hit by a bus, or maybe you meet some girl there who breaks your heart and destroys your life.”

I’m amused as I write this. For one thing, his bus illustration echoed the one I used in a blog post three years ago. For another, that very evening after my conversation with Tom, my friend and I were walking near my apartment when a car collided into a van, knocked its front bumper off, and skidded onto the pavement where we had been five seconds earlier.

But I was also amused by his girl comment.

“That reminds me of a story I once heard,” I said. “It’s supposed to be about marriage, and I think it works for life too. Do you want to hear it?”

“Sure,” he said.

“They say picking a partner is like picking a corn in a corn field, but you can only walk in one direction, and once you pick a corn, you’re stuck with it. (This analogy probably doesn’t work very well in modern times.) Some people start walking, and they see a pretty large corn. They think to themselves, there’s probably a bigger one up ahead, so they give this one up. But as they keep walking, they realize that the corns get smaller and smaller…”

Tom began to chuckle.

“…until finally they settle for a small one and live their lives in regret.”

At this, Tom let out a long, drawn-out laugh. I’d never seen him laugh like this before, and it was very unprofessorlike. I joined him out of politeness, but I couldn’t see how my story could be that funny.

“No,” he said when he finally stopped laughing. “Marriage is not like that at all.”

“How so?”

“There is no concept of bigger and smaller corns. Plus, what if you’re the type who likes small corns?”

He glanced at his watch.

“Another student is coming in soon. I’m going to have to kick you out for now. We’ll chat again.”

Then he took another slow breath and looked at me intently.

“You’re at an exciting time of your life, Charlie.”

“So are you, Tom.” Then I cast an exaggerated glance at his white hair. “A different kind of exciting,” I said, grinning.

I left his office and entered the snowy world outside, feeling oddly lighter than before.

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Personal Stories

A Most Incredible New Year

The harsh winter air numbed my face, but I kept on running. A slight tremor was running up and down my spine, but whether it was because of the cold or the adrenaline I could not tell. Rounding the corner, I was greeted by flashing lights and the piercing scream of sirens. The paramedics had arrived first.

Earlier that morning, Mel (name changed to preserve anonymity) was going about her usual business. She had gotten up early, taken a shower, brushed her hair, and prepared breakfast for her nine-year-old son and mother. She glanced at the clock: 8 AM on New Year’s Eve. Her family would be awake soon. It was at that time that she first felt a dull ache in her lower abdomen. She had an ominous feeling then, like a receding wave just before the tsunami struck and all hell broke loose, but the pain subsided and she thought little of it.

She had found out that she was two months pregnant a day before. This was welcome news, and she was planning to call her husband in China at midnight to tell him about it. It would be a New Year’s surprise, she thought. They were about to have a new child, their son a new sibling, and their family would finally be complete.

But the pain grew worse in the evening, and then there was blood, and she began to feel numb and breathless and cold. Her mother and son panicked.

“What should we do?”

“Call…call an ambulance…”

Her son bolted for the phone. Mel’s husband would have to wait.

“And…” she said to her mother. “…hand me my cell phone.”

 

It was 9 PM, three hours before the New Year, when I received the call.

“Is…is your mom…at home?” said the voice.

“No,” I said, and before I could ask who it was, the caller hang up.

I returned to my computer. It had been an eventful day. My eleven-year-old brother’s friend had come over, wolfed down his lunch, jumped around like a madman, and promptly puked on the floor right next to the sink. I had just cleaned up his mess and sent him home when I received the call.

I sat at my desk and thought about the year ahead. Will it be a good year? I mused. Then I laughed at myself. Good? What is good? Four years at university had instilled in me an aversion to vagueness. Instead, I decided to imagine what medical school would be like, and what I would do if I didn’t get in. I thought about four more years of school and an additional number of years doing residency, and I thought about whether I would enjoy being in the hospital for the most part of my young adult life. I thought about where I would go, and where (or if) I would settle down.

At this, the parakeet I’d bought for my mom as a Christmas present issued a shrill cry. I looked at her and examined her cage, trying to figure out what it was that caused her to assert her presence, while she looked at me reproachfully for not understanding whatever it was that she wanted me to understand. She shook her head in annoyance. I think she’d given up on me.

I remembered showing my mom how to train the bird. I would hold a piece of millet in my hand, extend my other arm, and speak a command. The parakeet would fly onto my empty hand, and I would convey my approval by clicking my tongue and feeding her some millet.

“She’s so cute,” my mom said. “If anything should happen to her, we’d all be devastated.”

Outwardly, I agreed. Secretly, I doubted that the bird had any real human attachment. Unlike mammals, bird brains are ancient and basic. Sure, it could learn tricks, but the underlying motivation is obviously treats, not sentiment. But the tendency to anthropomorphize  non-human objects is universal, and from an evolutionary point of view probably useful, as the very same neural circuitry underlies parental instincts.

Then again, are humans all that different from birds? Certainly, we are more complex, we have emotions, we build, create, and destroy. We connect and relate with each other in subtle and powerful ways. But like all elementary beings, we share the same biological components and face the same physical constraints. My gut tells me that there is something special about humans, but my brain wasn’t convinced. Maybe on some higher level we, too, seem like birds. Either way, I didn’t think I would cry if something happened to the parakeet.

Another shrill sound brought me back to the present. It was the telephone again. Was it my imagination, or was there a sense of urgency to this particular call? I picked it up.

“Can…you…come…?” the voice on the phone said.

“Who is this?” I asked.

“Your neighbour…Mel.”

“I’ll be right there.”

 

When I rounded the corner to Mel’s house, the paramedics were already making their way upstairs to her bedroom. Mel was lying on her bed. Sweat poured from her face as she gasped for air like a fish out of water. Her son, nine-year-old Lawrence, was in tears. I clasped his shoulder as I entered the room. I saw a familiar fear in his face: the fear of a child who thought his mom was dying.

“Everyone stand back,” said one of the taller paramedics. “Who are you?” he asked me.

“Her interpreter,” I said.

“Alright, you stay. Tell her to control her breathing. If she doesn’t get that breathing rate to come down, she’ll be in big trouble.”

For the next thirty minutes, we struggled with Mel to find out what her problem was. I flipped between Mandarin and English, trying to be as helpful as I helplessly could. When they decided that she had stabilized enough to be transported, the paramedics brought in a stretcher for the ambulance.

“You need to come with us,” said the tall paramedic to me. I admit with some guilt that I felt excited about this. This was my first time in an ambulance, and thankfully it wasn’t as a patient.

During the ride, the tall paramedic quizzed her on her symptoms. When did she last eat? How profuse was her bleeding? How much pain was she in, on a scale of zero to ten? I knew the results of this interview would reach the hands of a triage nurse, who would determine the level of urgency her problem was. The more urgent the problem, the higher on the priority list Mel would be placed. I briefly considered colouring my translation a bit to make her condition sound worse, but eventually decided against it. She looked bad enough as it was.

Ten minutes later, we arrived at the Urgent Care unit of Markham-Stouffville Hospital. Mel was wheeled into the triage area. Oddly, besides the patient, nothing about the place seemed particularly urgent. It was New Year’s Eve, so few nurses and paramedics were on staff, and the ones that were there were in a lighthearted, almost festive, mood. I felt some indignation for their apparent frivolousness, but realized that they’d probably seen so many emergency cases that they’d just gotten used to it.

A nurse came over to check on Mel. “We’re just waiting for the doctor to arrive,” she said, and moved on to the only other patient in the room. That other patient was an elderly woman hooked up to a dozen tubes. She could barely speak, and her heart monitor occasionally gave sad, isolated beeps.

It would have been disrespectful if I’d said it, but I thought she was what the medical community called a “gomer”, an elderly patient with so many problems that no doctor was able to treat her completely. These patients could go in and out of emergency rooms for years, each time tumbling through the healthcare system in a series of examinations, medications and, most importantly, observations.

It was 10 PM when a bed opened up for Mel. “Wait on that stool. We’ll call you when we need you,” a nurse said to me. They wheeled her into a room and shut the curtains, sealing Mel in and the rest of the world out.

 

There was a digital display in the Urgent Care Area, its lights prominently displaying the time in red. Red is an interesting colour. Although it was probably there for prominence, red can mean many things. It can mean life, its being the colour of blood. It can mean sex, which sometimes precedes life. It can also mean a sunset at the end of a day, where the longer wavelengths of red pierce through the atmosphere while shorter ones are scattered by dust and debris.

At 11.45 PM, a nurse emerged from the curtains. I sneaked a peak at the heart monitor behind her and saw a blood pressure reading of 53 over 30.

“What’s going on?” I asked.

“We think it’s a cornual pregnancy,” she said. “The pregnancy is in the wrong place. We’ll need surgery immediately.”

The cornus is part of the Fallopian tube. In a normal pregnancy, the egg is fertilized in the tube, but migrates to the uterus before attaching itself and developing any further. In a cornual pregnancy, the fetus is prematurely stuck in the Fallopian. By 8 weeks, which was Mel’s window, the fetus would have grown to about 1.2cm in an area that was usually less than 1cm wide. Four hours ago, Mel’s Fallopian tube had ruptured, causing its contents to spill into the surrounding peritoneal cavity. Her abdomen had filled up like a water balloon with blood and infection. Over the next two hours, Mel would lose two litres of blood out of the roughly five litres that her small frame held.

The nurse brought me into the room, where the gynecologist asked me to translate the surgical procedure and risks to Mel.

“We will make three incisions around the abdominal area, two on one side and one on another. We will insert a small camera to help us see inside. We’ll also need to insert a syringe to remove the blood.”

I translated. Mel nodded weakly.

“As with any procedure, there will be risks.”

Mel nodded.

“There may be infections.”

Mel nodded.

“There may be bleeding. It may affect other organs.”

Mel nodded.

I’ve heard of a healthcare critic in the States once comment about how patients are easily taken advantage of in their state of weakness. Of course, in America, where health services besides those under Medicare and Medicaid are covered by private insurance, the conditions are much more auspicious for doctors with questionable morals. But I could now see his point. Mel was in no condition to argue or negotiate. Thankfully, there was no need to.

“Do you have any questions?” asked the gynecologist.

At this, Mel beckoned me closer. “Will…it…hurt…?”

I was struck by her childlikeness when she asked it. “Will it hurt?” That’s what my brother asked before he had his first injection in kindergarten. At that I wanted to say of course not, I will make sure of it! But I had to stick to my role as interpreter.

“You will be completely under,” the gynecologist said, smiling.

The consent forms were signed, blood transfusion was set up, and we waited outside the OR for the anesthesiologist. I looked at my watch: 11.59 PM. In the distance I could hear the nursing staff chant. “Ten, nine, eight…”

I thought back to last year, when I spent New Year’s Eve at a sleepover downtown with my friends. And the year before that…I couldn’t remember any more.

“Three.”

“Will it hurt?” Such a simple question.

“Two.”

I will probably cry if something happened to the bird.

“One.”

“Happy New Year, Mel,” I said.

Another year. Another year alive. It is going to be a good year.

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Personal Improvement, Uncategorized

The Curse of being a High Achiever

By some accounts, I may be counted as a high achiever. For starters, I graduated top of my class in elementary school. This was back in Singapore, where they had an inhumanely stressful Primary School Leaving Exam to classify students into secondary schools by ranking. I then graduated top of my high school in Canada. This was a school known for its academic rigour, as evidenced by their underperforming sports teams. I was involved in extracurriculars, had several leadership roles, and was considered well rounded by my peers. But despite all that, I was not happy.

If I were to introduce myself in a group setting and had to share one interesting fact, depending on the situation, I might either use the fact that my Chinese name is phonetically spelled the same way as “Viagra”, or that I’ve travelled a lot growing up. In fact, when I was 14, I left my parents for Canada, which was then my fourth country. Growing up in a strange place alone can really challenge a 14-year-old, but that was what I wanted when I asked my parents to send me in the first place.

That said, I felt out of place. I was heavily entrenched in Eastern culture, with its emphasis on community, duty and fidelity, and had a muddy awareness of the Westerner’s values about individuality and self-expression. To some of my friends, I was an “old” figure, a throwback to a time of outdated values and beliefs. To others, I was simply that kid with the strange accent. Amidst all this, I was searching for my own identity, my own uniqueness that can gain recognition, respect, and, yes, even love, in this strange new world.

Unromantically, I found those in grades. I did well in school, and people respected me for it. Slowly, I began forming an idealized image of myself that was brilliant, witty, and out-of-the-world intelligent. I fed it over the years and it grew and grew while I shrank and shrank. I kept people at a distance, and spared little time for romance, although in high school I did have a girlfriend. I delved into work, because in work I found surety and control. I did not want others to expose my insecurity, because I hated to think that after all these years of developing an ideal version of myself, I was just an ordinary guy, lonely and afraid.

I first considered going into medicine in freshman year. I remember speaking with someone at my volunteer place who had been diagnosed with cancer and, as I was busy that day, for the entire time she was sharing her story, I could not stop thinking about an assignment question I had been mulling over. I was disturbed by my lack of empathy. I knew that I had the capacity to empathize, but because I valued schoolwork – my definition of self worth – so much, I did not spare any attention to care.

How can I heal someone else when I could not even heal myself? I thought. My friends say I think too much, and that is probably true. But therein also lay my one salvaging quality: I was keenly aware of my own cognitive dissonance. I believed that learning was more important than grades, yet I could not dissociate my own sense of self worth from my transcript. I believed in the value of human connection, but my own insecurities prevented me from pursuing them. I was a walking contradiction. I knew it, and I wanted to change it.

Three years of soul searching later, I am still learning. I am still exploring who I am, what my values are, and where my self-esteem really comes from. All I can say is that I’ve now accepted the fact that it’s OK to be an ordinary guy, flawed, limited and still learning.

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Personal Improvement

Why Practice Martial Arts?

Everything went blurry for a few seconds. I soon realized it wasn’t getting any better. I blinked hard. No improvement. I blinked again. The clock stopped, and my opponent came over to see if I was all right. It was then that I realized that my contact lenses had fallen out from a kick to the head. Thank goodness it wasn’t a concussion, I thought.

This was one of my few experiences sparring in a martial arts tournament. I’ve been practicing Seikido – a martial art based on Taekwondo and Aikido – for the past 3 years at Western. Here I’d like to share some of the benefits martial arts can bring. Full disclosure here: club’s week is coming up and I will be promoting Seikido club. Nevertheless, what I am about to write is genuine. It also applies to most martial arts, not just Seikido.

I consider myself somewhat academic. That means I like to think, and would do things to improve or prolong my ability to do so. According to research published in the journal Aggressive Behaviour, martial arts practitioners gain greater degrees of self-sufficiency and self-control than people who do so-called “power sports”, such as rugby. The research was conducted based on longitudinal data from judo practitioners, which controls for selection bias. In other words, martial arts don’t just appeal to cool-headed people. They help develop them.

This makes sense in practice. If you observe a class of Seikido, you will see how much our instructor emphasizes breathing. Practice for a few months, and you will appreciate the importance of coordinating movement with breathe. The process is meditative. Try thinking of anything else when you’re sparring and kicks are flying towards your face. Practicing martial arts is a process of subdued violence, the art of controlled chaos.

Of course, many people who practice martial arts are not there to spar. When I first started Seikido, I was captivated by the self-defence aspect. Take a couple of simple wrist movements, apply them to the right joints, add a few degrees of pronation, and you’ve got yourself a dangerous masterpiece.

The multifarious aspects of Seikido mean there are plenty of diverse practitioners. I’ve met a neurosurgeon who claimed that picking up Seikido was one of the best decisions he’s ever made (it’s starting to sound cultish, I know). There’s also a beer-drinking, poutine-loving philosophy professor who is now in Vancouver. Some black belts have been part of the army or police force. University students come from science, kinesiology, business, art, history, etcetera, etcetera, etcetera.

The central figure holding all of us together is our instructor Grandmaster Petkovic, whom we affectionately call by his first name, Master Zeke. Master Zeke’s idea is that martial artists – including ones practicing other arts besides Seikido – form a global community, bound by similar philosophies of life. The creed behind any martial art always includes elements such as humility, openness, and harmony, qualities that, according to Master Zeke, are desperately needed in our individualistic society. Enter any dojo in the world, he would say, tell them what you’ve been trained in, and there you will find friends.

At the end of the day, practicing martial arts comes back to intrapersonal development. Certainly, other people help you along the way. Kicks to the face can knock a few degrees out of an overblown ego, while a word of encouragement from a fellow practitioner bolsters confidence. That said, martial arts is ultimately a competition against yourself. The best practitioners are not necessarily the ones who kick the fastest, or punch the hardest, but the ones who persevere to the end.

Shameless plug time: If you would like to check out Seikido, follow our Facebook page, and visit our booth at the rec centre next week.

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Personal Improvement

What I Wish I Knew in First Year

Summer has extended this year, but sadly summer break has not. I’d spent most of my four months doing research at Western, so to me summer and school had melded together. But after returning from a trip to Bruce Peninsula a week ago, it hit me: I am heading into my last year as an undergraduate. Over the past four years, I’ve experienced all the excitement, the stresses, the gratification, the heartbreak that university has to offer, and emerged more or less whole. Here are some things I’ve learned in the process. They may come to you as unsolicited advice, as timely words of encouragement, or as marks of camaraderie that tells you that you, too, have been on this unforgettable journey. I make no claims on any special wisdom or intelligence; I simply observe and learn.

On making friends

If you feel lonely, you are not alone. Those of us who act like the most confident, seem the most beautiful, athletic or intelligent may also be the most insecure. Do not let loneliness push you to do things against your values. Do not let it make you bitter and proud. Make friends that you look up to. I am constantly surrounded by passionate people whom I admire, and whom I feel honoured to be friends with. I hope you’ll feel that way too.

On partying

I was never a huge party-er, but I recommend that you check them out. They will challenge you, and offer practical lessons on human behaviour. Pay particular attention (you probably naturally will) to how girls and guys interact. Food and sex are basic human desires, and the means by which people attain the latter provide insight on how they establish value, motivate desire, compete and cooperate. As for food, parties are a great place for those too.

On your parents

University might be the first time you’re living away from your parents. More importantly, this might be when you discover your own values apart from them. You will find that, like it or not, your parents have left indelible marks on your identity. Try not to resent that. I know my parents have made many personal sacrifices so that I could explore, feel lost and make mistakes. It’s my luck to do so.

On dating

Relationships can be boiled down to a few types: mutualism (in which case you hold on tight), commensalism (which ultimately becomes one of the other types), parasitism (hold on if you’re the parasite), and competition (which is more common than you think). That’s the extent of my experience in this matter.

On taking a few risks

University is the perfect time to do things simply because you believe in them, enjoy them, or for no reason at all. I joined the comedy club for a few weeks in first year; it was the most uncomfortable experience in my life. When I started the science case competition (shameless plug here), I did it because I believed in it. If I were a working adult, I’d have to consider things like money and family. But I was an undergraduate who had neither. So are you.

On learning

Don’t let grades get in the way of your learning. I once spent an entire semester without looking at my marks. It was my most stress free semester, even though I was overloading on courses and heavily involved in extracurriculars. I aced that semester.

A good professor can trump course material. Philosophy never interested me until I took Dr. Thorpe’s philosophy course.

Choosing between an interesting course and a bird course is an art. Tough courses can really build you up in the long run. I took a Discrete Mathematics course in second year without even knowing what a proof and a truth table are. I couldn’t understand anything in class, so I learned the material by myself, and did well. Now I no longer fear proofs.

On people

The biggest lesson I’ve come to appreciate is that there is no stupid idea. An idea may be wrong, it may be unwarranted or it may not be conducive to the circumstance, but to call it stupid is a value judgement. Ideas are held by people, and people should be intrinsically valued, regardless of their beliefs. I hope you’ll appreciate this after four years.

On the future

If you look around you, many of your peers may seem to know exactly what they are going to do. Don’t let that worry you. The further you go, the more aware you become of your own uncertainty. So far your school life has been a linear process, but real life is not.

I hope I do not sound too preachy, but these are some things I wish I’d heard when I first entered university. I wish you will make the most of your four years, to challenge yourself personally and professionally, and to grow as a human being. This will be one of the most unforgettable experiences in your life. Grasp on. Make it count. It’s over sooner than you think.

Have an awesome year.

CWZ

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Philosophy

Dying in the Age of Immortality

He was in his mid-thirties, and was counted successful by any standard. He’d graduated from Harvard, succeeded on Wall Street, and had a family. But on that particular day, a video of him was displayed prominently in the auditorium, his every move scrutinized by a room full of strangers. Outside, the hospital bustled with activity. Tubes of blood shuttled about, microscopes flickered, MRI machines roared to life. The auditorium, on the other hand, was silent; we were all sitting on the edge of our seats, trying to get a better glimpse of the video. The patient had suffered a violent stroke a month earlier. Since then, his personality had become increasingly erratic and violent. He had to quit his job, and was admitted into a nursing home. Shortly afterwards, he began experiencing seizures, and was brought to the epilepsy unit where I am doing my observership.

A week after I saw that case, I received another piece of news. This time it was about Dave*, an employee at the soup kitchen I volunteer for. Dave was in his mid-forties, and confined to a wheelchair. He’d been haunted by drugs and booze for decades, and had gotten in and out of jail several times, each time for increasingly serious misdemeanors. At one point, he decided that he’d had enough. He took adult classes, learned financial accounting, and became a bookkeeper for the soup kitchen, a post that he held for several years until a week ago. He had succumbed to stage four colon cancer. I mourned at the loss of human potential. Why did Dave and the executive have to suffer? Why can’t we do better? Why did medicine fail?

It’s easy to ask these questions given today’s climate around medicine. In the 1920s, life expectancy in Canada was 60 years, lower than today’s age of retirement by five. The discovery of penicillin by Alexander Fleming in 1928, followed by other antibiotics, marked a pivotal point in the history of medicine. Time magazine’s May 15, 1944 cover featured an intense looking Fleming in a white lab coat. The article ran like this:

May 15, 1944 cover of Time

May 15, 1944 cover of Time

“Medical news last week vied with news of the days before invasion. Under the aspect of eternity, the medical news might even be more important than the military. WPB announced that the wonder drug penicillin, for three years practically a monopoly of the Army & Navy, was now being manufactured in such quantity that it can be issued to civilians. Some 1,000 hospitals will be allowed to buy generous monthly quotas for distribution to patients and other hospitals as they see fit.”

Clearly, antibiotics were exciting news, so much so that it vied for headlines with the war effort 3 weeks before D-Day. Scientific discoveries like these, along with increasing public health awareness in the 20th century, led to a dramatic increase in life expectancy. Canada’s rose by 20 years since the 1920s, and it now sits at number thirteen in the world.

With the advancement of medicine came the denial of its potential to fail. As Siddhartha Mukerjee writes in The Emperor of All Maladies, “When a doctor has to tell a patient that there is no specific remedy for his condition, [the patient] is apt to feel affronted, or to wonder whether the doctor is keeping abreast of the times”. Just weeks ago, an article posted on Science Alert ran the sensational headline: “Immortality is one step closer as scientists turn off the ageing process in worms”. (In truth, in the original paper, researchers prevented the decline of heat shock response with age in nematode worms.)

In this climate, it’s no wonder that talking about death, which was once considered bad luck, is now considered taboo. So-called “new-age religions” are more preoccupied with living than with the afterlife. A casual search on Google revealed that the proportion of books mentioning “death” decreased by half since the 1800s. In this “age of immortality”, Hades is no longer a horror; death no longer holds sway in the public imagination.

According to Atul Gawande, a New York surgeon, this has implications for healthcare. In Being Mortal, Gawande argues that ignoring the eventuality of death deters people from discussing about their values. In Canada and the US, if a person becomes legally incompetent because of illness, her Substitute Decision Maker (SDM) makes medical decisions for her. If the patient had not made explicit directives before she became incompetent, the SDM must make judgement calls based on the “patient’s best interest”. If the patient had not made her values clear beforehand, the SDM is left in a grey area. Should the patient remain on life support, if it means more suffering in exchange for a slim chance of recovery? Should a doctor recommend aggressive chemotherapy for an aged patient who might prefer palliative treatment?

On the individual level, forgoing value discussions with ourselves can lead to a feeling of loss and purposeless. In an article published by the New York Times, Julie Lythcott-Haims, dean of freshmen at Stanford, remarked that “[students] could say what they’d accomplished, but they couldn’t necessarily say who they were”. This loss of identity lies at the root of many psychiatric manifestations, according to the psychiatrist and Holocaust survivor Victor Frankl. During his time as an inmate in a concentration camp in Auschwitz, Frankl personally witnessed the disintegration of personhood. He observed that the inmates who had seemed the most carefree were the first to give up hope, whereas those who had been more thoughtful and introspective proved more resilient. His experiences counselling inmates shaped logotherapy, a form of psychotherapy that helps the patient identify his values and meaning in life.

“Death and the Miser” by Hieronymus Bosch

At the end of the day, death is an integral part of our existence. When the sun sets, when the curtain closes, when the hand strikes twelve, how will we face our mortality? How will we measure the life we’ve lived?

Last week, we held a minute of silence for Dave at the soup kitchen. I bowed my head, violin in hand, and uttered a silent prayer. I did not know Dave very well, only that he’d always seemed positive and hopeful, and that he had a glint in his eyes. That light which had inspired so many has faded, its flame now lit elsewhere. Dave’s story was one of ultimate redemption, from a drug addict and criminal offender to a contributing member of society. As I stood in silence, I remembered the video of that Wall Street executive in a hospital wheelchair, and I realized how closely he must have resembled Dave in his last days. In the end, we are all reduced to our insignificant idiosyncrasies. The way we’ve smiled, the way we’ve talked, the private passions that we’ve shared only with our loved ones. Hopefully, when we meet our inevitable end, we would, like Dave, have left behind a courageous life lived according to our values.

*Names and other identifying information are altered in this article.

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