To recap: Back in November 2017, I was living in Korea as a new father and was desperate to get back into medicine. I thought my best bet would be to get back into residency but that didn't fan out. In September 2018, I began working for a corporation that provides wound care services to patients in nursing homes. In June of 2019, I started my own private practice. Things were going well, then COVID happened. For more detail, I would refer you to the following posts:
First post on 11/30/17: CA license, but no board cert. How to get life back on track with a baby?
Second post on 7/15/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Third post on 8/2/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Fourth post on 2/21/20: Second update to "CA license, but no board cert. How to get life back on track with a baby?
Fifth post on 8/4/21: 3rd update: "CA license, but no board cert. How to get life back on track with a baby?"
---------
Hi, good folks at SDN. I hope this update finds you in good health and peace in life. Happy thanksgiving!
For those of you who have been following this story, I wanted to start with this sentiment... feels like I'm living in an alternate timeline: the pandemic, the world is burning, there's a war in Europe, so much division, seemingly increasing incidence of random shootings, Twitter in dumpster fire...
Anyways... all of this craziness reminds me to appreciate every single moment we get to spend on this planet. I could have died when I fell from the cliff that day. I had pneumothorax from a fractured rib. The tide did come up to the base of the cliff I was in. Yet I got to enjoy another 11 years of life in good health.
-----
I smoked my last cigarette in December of 2021. I went on a little nutritional journey starting with keto/paleo diet and lost 25 lbs. I cut the occasional beer down to extremely seldom. Moderate coffee intake down to two cups and only in the early morning. I am 42 now but in the best health I've been in since.. I think all of my life. I'm learning so late in life the value of good health. Thankful for my body that's put up with the neglect all these years.
-------
In the last post, I mentioned dignity as the principle goal of our practice. This is still the case.
We're now the largest practice in our metropolitan area. For a lot of the nursing homes, the end of long hallways no longer reek of purification. The patients never knew because their experience was always 1 out of 1, but the nurses appreciate it because neglect and secrecy of bad wounds have become a thing of the past. After all, this is supposed to be the finest city in the country.
---------
I am so thankful for my NPs. They are just the best. So patient with me. And so caring with the patients. I love it when the patients and nurses tell me about all of the wonderful things they've done and crazy wounds they have closed. I don't know what I did to deserve them but I thank my lucky stars.
---------
With the practice running well on its own, I began to take time off for myself away from work. Here is how I spend my time:
1. I love being a dad.
My son is freaking cute and such a GOOD kid. I am so lucky!
He is now five. For his 5th birthday, we had a water balloon fight (3500+ balloon) with a dozen friends. Absolute pandemonium! I was cleaning up the balloon bits out of my yard for months on end and I'm still finding them.
He loves going to kindergarten. I drop him off and pick him up. Then we go rockclimbing at the gym after school. When it's not school night, we also like to play video games and watch football. We're Packers fans, which has been rough on him this year, but you know what? Humiliation leads to humility, and we can all use more humility in real life and in pretend tribalism.
I hadn't mentioned my daughter. She was born in Korea while I was starting my practice in 2019, then travel restrictions during the pandemic basically made it impossible for her to come live with us. She turned 3 this year, and my son and I finally got to go see her in Korea in October. We plan to go back and see her every few months until her maternal grandparents lets her go. It's a long story, but I am looking forward to the day when both of my children are with me.
2. I began baking. Lol.
I was on keto diet, so I never really ate much of it. So I started sharing it to the nurses and CNAs at the homes. They loved it.
Growing up in North Carolina, I loved pecan pies. So I baked all of the pecan pie recipe I can find and finally nailed down my own recipe. This has become a thing in my city. The nurses love the pecan pies. This past week, we baked and delivered 60+ pies to nursing homes in town. It's kind of getting out of hand. I probably need to set up a separate business for the pies and then have my practice buy the finished product from the bakery. Cuz right now, it's going to be hard to explain to IRS why a medical practice is deducting hundreds of dollars of pecans every month.
3. I see wound patients in Mexico.
Being an immigrant kid, I used to be super into global health. I used to correspond with Paul Farmer (RIP) and his PIH partner Jim Kim. My summer month for USMLE step 1 was spent in Geneva, doing research at a NGO called international center for migration and health. During 4th year, I was voted most likely to work overseas at med school graduation. But you know... residency and the general chaotic element of life usually beat our idealistic dreams out of most of us.
In February, out of pure boredom on a random Sunday, I went down to Mexico for street tacos. This afternoon re-kindled my desire to do international medicine, and now I had nobody telling me what I can and cannot do. So I joined a non-profit organization of healthcare worker and pilots that provide healthcare services in remote locations in Baja. That's how I ended up flying for the first time in Cessna.
I come across a lot of congenital cases. Microtia and limb malformations. I usually refer them to the Shriner's in Tijuana but am never sure if the parents can even pay for the trip up north.
I do ditzle cases. Ingrown toenail, cyst excision, minor scrapes and bumps. But a lot of times, it's chronic back pain and joint pain in patients who overworked themselves in the salt mines all their life. Or some crazy stuff... like a young 31 year old woman with cirrhosis needs liver transplant in the middle of nowhere.
In one of the trips, a volunteer who went with us fell and dropped her knee on a rebar sticking out of the sidewalk at night. The clinic was too far from our hotel, and the roads there are too dangerous at night. So I repaired that laceration in a hotel bed. (Blurred photo) There was grit all in the infrapatella fat pad. We didn't have gloves, and it was strange to do all of that with bare fingers. I cleaned the wound with bottled water for a good hour. The dentist was an oral surgeon and had some sutures. I deliberated a lot on whether I should just pack the wound or close it. At the end, I ended up closing the wound because she was going to fly back home next day in non-pressurized cabin, and I didn't want the wound to start bleeding while they were up in the air. In the end, the wound healed without much drama.
Also in Mexico, I met a 21 old guy who hurt his foot in an ATV accident. A surgeon had placed a skin graft on the dorsum. Most of the graft took but the central portion had died over the denuded foot arch bones. That wound reminded me of a page out of an old burn surgery textbook, where it described decortication as a solution to this exact problem (the book was written prior to flap reconstruction).
Every month, I went down to him and chipped away at the bone with a rongeur. It's been 8 months now, and the darn trick worked! He's got granulation tissue over the bone, and the skin had formed a bridge across the wound so that the wound is now divided into two smaller ones. This is not in modern reconstructive textbooks, but where flap reconstruction is possible, decortication is still a valid solution. I am really pleased with that case.
--------
One of the pilots from the organization flies me up to Monterey once a month to this swanky nursing home. There, I took care of a retired army general who had pressure wounds down to the calcaneal bone. It smelled awful. Unfortunate that medi-cal patients in our town were receiving better care than the general.
We cleaned up that wound. It granulated by my second visit, and the patient passed away before my third visit. I'm glad the family didn't have to smell the wound for the couple of months.
---------
In House of God, the Fat Man's Law 8 is "They can always hurt you more."
That is what I am scared of. I know the suffering doesn't end just because I own my practice and don't have to answer to a boss.
"They" can always hurt you more.
----------
Despite all the successes I've had, I feel the same as I once did as a 13 year old boy new to this country.
Someone told me, "Welcome to the land of the brave and the free. You can be whoever you want to be as long as you work hard." Another told me, "You don't belong here. Go back to your country."
One senior resident told me that I was going to be a great surgeon; my gen surg program director told me that I would never become one.
The nursing homes in San Diego chose my practice over others; my former employer sued me for noncompete.
The dichotomy is born from just actions that threaten status quo. I am fearful of this aspect of our society at every single scale: from education, to healthcare, and the politics. Nowhere have I heard this dichotomy more clearly laid out than in Allen Ginsberg's Howl. That poem resonated deeply with something inside me and spoke to the totality of my experience of growing up in America.
In the second part of Howl, Ginsberg describes the ever consuming Moloch - institutions that devours humanity for profit.
"Moloch whose mind is pure machinery!
Moloch whose blood is running money!
Moloch who entered my soul early!
Moloch in whom I am a counsciousness without a body!"
I am forever thankful for the education I received at my alma mater, and I truly believe I received world-class education there. However, one thing from that time tarnishes the memory of my education is the the insistence on pain assessment and management. I drank the coolaid and used to prescribe opioids like candy to my patients in gen surg days. Then, while I was recovering from my spinal fracture, I got hooked on Vicodin and took it way longer than I really needed to. I only stopped taking it after a terrible episode of constipation which led to subsequent anal abscess and a fistula.
In my own practice, I ended up meeting all these homeless patients on methadone and Suboxone who became dependent on opiates because they started taking vicodin or percocet for back pain or an operation. Each of these patients could have lived a life full of purpose and joy but through illness of chance became a means by which pharmaceutical companies and the Sackler family fattened their bottom line.
"I saw the best minds of my generation destroyed by madness, starving hysterical naked,
dragging themselves through the negro streets at dawn looking for an angry fix,"
We did that. We helped the Moloch destroy "the best minds of our generation" and those people are now "mad and hysterical, looking for an angry fix" in the streets. I don't know how everyone feels about this, but I am humiliated that I was part of that at one point. I don't prescribe pain medications at all, and am wanting to learn about street medicine.
------
To me, this entire thing feels like a puzzle. You got three pieces: "mind", "Moloch", and "Soul". Moloch the destroyer endlessly devours the "best minds of our generation". The power dynamic seems impossible for humanity to win against giant institutions. Yet these institutions cannot exist without humanity. In the footnote of Howl, Ginsberg offers a coded solution.
"Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy!
The world is holy! The soul is holy! The skin is holy!
...holy the Angel in Moloch!
Everything is holy! everybody’s holy! everywhere is holy! everyday is in eternity! Everyman’s an angel!
Everything is sacred. Even the addicts and homeless and their irrational, destroyed minds are holy.
"Holy the solitudes of skyscrapers and pavements! Holy the cafeterias filled with the millions! Holy the mysterious rivers of tears under the streets!
Holy forgiveness! mercy! charity! faith! Holy! Ours! bodies! suffering! magnanimity!
Holy the supernatural extra brilliant intelligent kindness of the soul!"
Magnanimity refers to magnus & animus: greatness and soul; it is the great soul that is generous or forgiving. Magnanimity is why the kindness of the soul is brilliant and intelligent. If we are able to transcend beyond our ego, the soul can finally be freed to exert its kindness onto the destroyed mind and the Moloch. I believe magnanimity is the answer to the puzzle. It offers the dissolution of the dichotomy between mind vs. Moloch, individual vs. institutions, healer vs. academia, and patient vs. healthcare system.
----------
Now I know what I must do. I need to forgive myself and others. I am in need of magnanimity. I want that. Healing wounds through forgiveness and kindness. I want to prove that person right who told me that I can be anyone I want to be as long as I work hard. I am going to work hard to become that guy who made putrid smells in nursing homes a thing of the past in this country.
Sorry for all of this rambling, but I really wanted to do this update so I can give thanks and appreciate all that's transpired. I continue to post in the future.
Now, I gotta go do a Black Friday I&D. Dr. Haller used to say "For a general surgeon, a day without pus is a day without sunshine!"
First post on 11/30/17: CA license, but no board cert. How to get life back on track with a baby?
Second post on 7/15/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Third post on 8/2/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Fourth post on 2/21/20: Second update to "CA license, but no board cert. How to get life back on track with a baby?
Fifth post on 8/4/21: 3rd update: "CA license, but no board cert. How to get life back on track with a baby?"
---------
Hi, good folks at SDN. I hope this update finds you in good health and peace in life. Happy thanksgiving!
For those of you who have been following this story, I wanted to start with this sentiment... feels like I'm living in an alternate timeline: the pandemic, the world is burning, there's a war in Europe, so much division, seemingly increasing incidence of random shootings, Twitter in dumpster fire...
Anyways... all of this craziness reminds me to appreciate every single moment we get to spend on this planet. I could have died when I fell from the cliff that day. I had pneumothorax from a fractured rib. The tide did come up to the base of the cliff I was in. Yet I got to enjoy another 11 years of life in good health.
-----
I smoked my last cigarette in December of 2021. I went on a little nutritional journey starting with keto/paleo diet and lost 25 lbs. I cut the occasional beer down to extremely seldom. Moderate coffee intake down to two cups and only in the early morning. I am 42 now but in the best health I've been in since.. I think all of my life. I'm learning so late in life the value of good health. Thankful for my body that's put up with the neglect all these years.
-------
In the last post, I mentioned dignity as the principle goal of our practice. This is still the case.
We're now the largest practice in our metropolitan area. For a lot of the nursing homes, the end of long hallways no longer reek of purification. The patients never knew because their experience was always 1 out of 1, but the nurses appreciate it because neglect and secrecy of bad wounds have become a thing of the past. After all, this is supposed to be the finest city in the country.
---------
I am so thankful for my NPs. They are just the best. So patient with me. And so caring with the patients. I love it when the patients and nurses tell me about all of the wonderful things they've done and crazy wounds they have closed. I don't know what I did to deserve them but I thank my lucky stars.
---------
With the practice running well on its own, I began to take time off for myself away from work. Here is how I spend my time:
1. I love being a dad.
My son is freaking cute and such a GOOD kid. I am so lucky!
He is now five. For his 5th birthday, we had a water balloon fight (3500+ balloon) with a dozen friends. Absolute pandemonium! I was cleaning up the balloon bits out of my yard for months on end and I'm still finding them.
He loves going to kindergarten. I drop him off and pick him up. Then we go rockclimbing at the gym after school. When it's not school night, we also like to play video games and watch football. We're Packers fans, which has been rough on him this year, but you know what? Humiliation leads to humility, and we can all use more humility in real life and in pretend tribalism.
I hadn't mentioned my daughter. She was born in Korea while I was starting my practice in 2019, then travel restrictions during the pandemic basically made it impossible for her to come live with us. She turned 3 this year, and my son and I finally got to go see her in Korea in October. We plan to go back and see her every few months until her maternal grandparents lets her go. It's a long story, but I am looking forward to the day when both of my children are with me.
2. I began baking. Lol.
I was on keto diet, so I never really ate much of it. So I started sharing it to the nurses and CNAs at the homes. They loved it.
Growing up in North Carolina, I loved pecan pies. So I baked all of the pecan pie recipe I can find and finally nailed down my own recipe. This has become a thing in my city. The nurses love the pecan pies. This past week, we baked and delivered 60+ pies to nursing homes in town. It's kind of getting out of hand. I probably need to set up a separate business for the pies and then have my practice buy the finished product from the bakery. Cuz right now, it's going to be hard to explain to IRS why a medical practice is deducting hundreds of dollars of pecans every month.
3. I see wound patients in Mexico.
Being an immigrant kid, I used to be super into global health. I used to correspond with Paul Farmer (RIP) and his PIH partner Jim Kim. My summer month for USMLE step 1 was spent in Geneva, doing research at a NGO called international center for migration and health. During 4th year, I was voted most likely to work overseas at med school graduation. But you know... residency and the general chaotic element of life usually beat our idealistic dreams out of most of us.
In February, out of pure boredom on a random Sunday, I went down to Mexico for street tacos. This afternoon re-kindled my desire to do international medicine, and now I had nobody telling me what I can and cannot do. So I joined a non-profit organization of healthcare worker and pilots that provide healthcare services in remote locations in Baja. That's how I ended up flying for the first time in Cessna.
I come across a lot of congenital cases. Microtia and limb malformations. I usually refer them to the Shriner's in Tijuana but am never sure if the parents can even pay for the trip up north.
I do ditzle cases. Ingrown toenail, cyst excision, minor scrapes and bumps. But a lot of times, it's chronic back pain and joint pain in patients who overworked themselves in the salt mines all their life. Or some crazy stuff... like a young 31 year old woman with cirrhosis needs liver transplant in the middle of nowhere.
In one of the trips, a volunteer who went with us fell and dropped her knee on a rebar sticking out of the sidewalk at night. The clinic was too far from our hotel, and the roads there are too dangerous at night. So I repaired that laceration in a hotel bed. (Blurred photo) There was grit all in the infrapatella fat pad. We didn't have gloves, and it was strange to do all of that with bare fingers. I cleaned the wound with bottled water for a good hour. The dentist was an oral surgeon and had some sutures. I deliberated a lot on whether I should just pack the wound or close it. At the end, I ended up closing the wound because she was going to fly back home next day in non-pressurized cabin, and I didn't want the wound to start bleeding while they were up in the air. In the end, the wound healed without much drama.
Also in Mexico, I met a 21 old guy who hurt his foot in an ATV accident. A surgeon had placed a skin graft on the dorsum. Most of the graft took but the central portion had died over the denuded foot arch bones. That wound reminded me of a page out of an old burn surgery textbook, where it described decortication as a solution to this exact problem (the book was written prior to flap reconstruction).
Every month, I went down to him and chipped away at the bone with a rongeur. It's been 8 months now, and the darn trick worked! He's got granulation tissue over the bone, and the skin had formed a bridge across the wound so that the wound is now divided into two smaller ones. This is not in modern reconstructive textbooks, but where flap reconstruction is possible, decortication is still a valid solution. I am really pleased with that case.
--------
One of the pilots from the organization flies me up to Monterey once a month to this swanky nursing home. There, I took care of a retired army general who had pressure wounds down to the calcaneal bone. It smelled awful. Unfortunate that medi-cal patients in our town were receiving better care than the general.
We cleaned up that wound. It granulated by my second visit, and the patient passed away before my third visit. I'm glad the family didn't have to smell the wound for the couple of months.
---------
In House of God, the Fat Man's Law 8 is "They can always hurt you more."
That is what I am scared of. I know the suffering doesn't end just because I own my practice and don't have to answer to a boss.
"They" can always hurt you more.
----------
Despite all the successes I've had, I feel the same as I once did as a 13 year old boy new to this country.
Someone told me, "Welcome to the land of the brave and the free. You can be whoever you want to be as long as you work hard." Another told me, "You don't belong here. Go back to your country."
One senior resident told me that I was going to be a great surgeon; my gen surg program director told me that I would never become one.
The nursing homes in San Diego chose my practice over others; my former employer sued me for noncompete.
The dichotomy is born from just actions that threaten status quo. I am fearful of this aspect of our society at every single scale: from education, to healthcare, and the politics. Nowhere have I heard this dichotomy more clearly laid out than in Allen Ginsberg's Howl. That poem resonated deeply with something inside me and spoke to the totality of my experience of growing up in America.
In the second part of Howl, Ginsberg describes the ever consuming Moloch - institutions that devours humanity for profit.
"Moloch whose mind is pure machinery!
Moloch whose blood is running money!
Moloch who entered my soul early!
Moloch in whom I am a counsciousness without a body!"
I am forever thankful for the education I received at my alma mater, and I truly believe I received world-class education there. However, one thing from that time tarnishes the memory of my education is the the insistence on pain assessment and management. I drank the coolaid and used to prescribe opioids like candy to my patients in gen surg days. Then, while I was recovering from my spinal fracture, I got hooked on Vicodin and took it way longer than I really needed to. I only stopped taking it after a terrible episode of constipation which led to subsequent anal abscess and a fistula.
In my own practice, I ended up meeting all these homeless patients on methadone and Suboxone who became dependent on opiates because they started taking vicodin or percocet for back pain or an operation. Each of these patients could have lived a life full of purpose and joy but through illness of chance became a means by which pharmaceutical companies and the Sackler family fattened their bottom line.
"I saw the best minds of my generation destroyed by madness, starving hysterical naked,
dragging themselves through the negro streets at dawn looking for an angry fix,"
We did that. We helped the Moloch destroy "the best minds of our generation" and those people are now "mad and hysterical, looking for an angry fix" in the streets. I don't know how everyone feels about this, but I am humiliated that I was part of that at one point. I don't prescribe pain medications at all, and am wanting to learn about street medicine.
------
To me, this entire thing feels like a puzzle. You got three pieces: "mind", "Moloch", and "Soul". Moloch the destroyer endlessly devours the "best minds of our generation". The power dynamic seems impossible for humanity to win against giant institutions. Yet these institutions cannot exist without humanity. In the footnote of Howl, Ginsberg offers a coded solution.
"Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy! Holy!
The world is holy! The soul is holy! The skin is holy!
...holy the Angel in Moloch!
Everything is holy! everybody’s holy! everywhere is holy! everyday is in eternity! Everyman’s an angel!
Everything is sacred. Even the addicts and homeless and their irrational, destroyed minds are holy.
"Holy the solitudes of skyscrapers and pavements! Holy the cafeterias filled with the millions! Holy the mysterious rivers of tears under the streets!
Holy forgiveness! mercy! charity! faith! Holy! Ours! bodies! suffering! magnanimity!
Holy the supernatural extra brilliant intelligent kindness of the soul!"
Magnanimity refers to magnus & animus: greatness and soul; it is the great soul that is generous or forgiving. Magnanimity is why the kindness of the soul is brilliant and intelligent. If we are able to transcend beyond our ego, the soul can finally be freed to exert its kindness onto the destroyed mind and the Moloch. I believe magnanimity is the answer to the puzzle. It offers the dissolution of the dichotomy between mind vs. Moloch, individual vs. institutions, healer vs. academia, and patient vs. healthcare system.
----------
Now I know what I must do. I need to forgive myself and others. I am in need of magnanimity. I want that. Healing wounds through forgiveness and kindness. I want to prove that person right who told me that I can be anyone I want to be as long as I work hard. I am going to work hard to become that guy who made putrid smells in nursing homes a thing of the past in this country.
Sorry for all of this rambling, but I really wanted to do this update so I can give thanks and appreciate all that's transpired. I continue to post in the future.
Now, I gotta go do a Black Friday I&D. Dr. Haller used to say "For a general surgeon, a day without pus is a day without sunshine!"
