Difficult Conversation #1

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During one of my rotations, my patient was a 40-something year old lady with leukemia who was admitted for her chemotherapy.  In one of her urine samples we found Trichomonas vaginalis, which is a sexually-transmitted infection (infects the vaginal tract but can come out in urine sometimes).  I had to sit down with her and ask about her sexual history.

Are you currently sexually active?  No.  When was the last time you had intercourse?  2 months ago.  She smiles shyly.  How many partners do you have or have had in the past?  She laughs a little to ease the awkwardness.  Just one, my husband.  How long have you been together?  25 years.

I pause and take a deep breath.

The reason I ask these questions is because we found an infection in your urine, and it’s an infection that you get from sex. … Oh my God! … There was a half-second delay in her response as it clicks in her brain that her husband must have cheated on her.

I expect her to break down and cry hysterically, but thankfully she keeps calm.  I try my best to express sympathy but I need to continue with my explanations.

I’m sorry.  (About what?  I don’t know, everything that is happening to her, from her leukemia to her husband’s infidelity.)  The good news is that with antibiotics, there is 90-something percent chance of getting rid of the infection, and we’ll give it to you today.  Side effects can be some headache or nausea, but most people don’t have any problems.  Also, after you take this medicine, you shouldn’t drink alcohol for a while because it will make you feel sick.  I know you don’t drink alcohol and won’t be drinking while you’re in the hospital for your chemotherapy, but I need to tell you these things.  She nods as I finish the “good news” and get ready for the part that is a bit more challenging.

But we need your husband to get treated with antibiotics.  Since he is not our patient we can’t give him the medicine.  You need to tell your husband about this and tell him to go see a doctor to get treated.  Okay.

Awkward pause.  I am still waiting for her to start crying, or to flip out.  She doesn’t.

Do you have any questions?  She probably has no questions but might need to talk some stuff out.  Or is there anything you want to talk about?  She shakes her head no.  I give a small sigh.  I’m sorry about all this.  Let us know if you come up with questions or need anything else from us.  We put in the orders for your antibiotics so the nurse will bring it to you later.  Okay.  Thank you, doctor.  I keep telling her I’m a medical student but she keeps calling me doctor.

I hang up the interpreter phone we’ve been using for this conversation.  I wish I knew how to speak Spanish.

 

Simeon Koh

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Throwback: “The Kind of Place that Harvey Mudd was for Me”

Since my non-college friends have no idea what my undergraduate experience was like at Harvey Mudd College, I thought I would write a throwback blogpost.  This is a speech I gave at a senior lunch banquet event near graduation almost exactly 5 years ago.  Enjoy!

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The Kind of Place that Harvey Mudd was for Me

written 05/12/2012

            If someone were to ask me to describe Harvey Mudd College, I would tell that person about a class I took in the spring of our sophomore year.  There was carbons lab, where I accidentally learned how to dissolve my wrist watch and get it to drip all over my arm.  There was STEMS where I was taught to pretend that everything is just a mass on a spring.  But actually, the one class that best embodies the essence of Harvey Mudd College was a class called Real Analysis.

            In Real Analysis I learned to question the very definition of real numbers and everything I knew about mathematics.  What do you mean I have to prove how to add two real numbers?  Proof by common sense and elementary education were strictly prohibited.

            Real Analysis was perhaps the hardest class I’ve taken, and my first experience of struggling in math.  I wasn’t getting the concepts as quickly as some of my peers, and I couldn’t help feeling incompetent in math, a subject I had always felt confident in.  Professor Su said this class was “the gateway to being a math major,” and I think he was trying to motivate us or something.  However, to me the “gateway” to mathematics never felt so narrow and without space for an incompetent student like me.  In a way, that’s the kind of place that Harvey Mudd was.

            Fortunately, there’s more to the story.  During that semester I was doing a book study with Prof. Su outside of class, and I was uncomfortable.  Sitting before me was a super smart incredible professor, and I felt really unworthy to be hanging out with him because I wasn’t doing so well in his class, and I thought I might disappoint him once he got to know me personally.  But at our last meeting, we were talking and he said, “I want students to understand that professors don’t value students based on their academic performances.”  I’ve heard that from friends, upper classmen, deans, whatever.  But to hear from my own professor, whom I really love and admire, at a time when I felt ashamed of my intelligence and thus unworthy of his friendship, that I wasn’t just a student in a seat, not just a letter grade or a number on my transcript, but a valuable person who he wants to know on a personal level, was perhaps the most incredible moment of my college career.  And that’s the kind of place that Harvey Mudd was.

            There was also a guy name Ryan Muller, who tutored for Real Analysis, and here is why he was incredible.  I was at Analysis tutoring, and Ryan Muller, stayed an extra 2 hours to save our butts once again.  That was nice.  But the story doesn’t end there.  Later that night I was working on Analysis in Platt.  It was 2 AM and the night was still young, and so was I.  I looked up and I saw Ryan Muller working on the circle table near the coffee machine.  It was 4 AM and the night was no longer young.  I looked up and I saw Ryan Muller worn out but still working.  I finished around 5, as the sun came up, and I left Ryan alone and working in Platt.  And here’s what I thought:  “Are you kidding me?  You had this much work but you spent an extra 2 hours tutoring us?  Ryan Muller, you are so incredible that I want to be just like you.”  And that’s the kind of place that Harvey Mudd was.

            You see, it’s true what they say that with great trials, comes strength that help us get through.  It was a tough 4 years getting through this narrow “gateway” to higher education, but it was also an incredible 4 years learning from professors and fellow students who helped me and inspired me to stick it through.  I am still light-years away from being like Professor Su or Ryan Muller, but I intend to take that part of Harvey Mudd along with me wherever I go.

***

Simeon Koh

5th Alumni Weekend at Harvey Mudd College

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Last weekend I was back at Harvey Mudd College in Claremont, CA for alumni weekend.  Every year they have a weekend event for all the alumni to come back and see old classmates, see how the college is doing, and donate money back to the institution.  Every 5th year they make a bigger deal out our reunion with special events and stuff, and usually have a greater turnout than usual.  This was my 5th year reunion, and I knew this was the last time most of our class of 2012 was going to gather in one place (the 10th, 15th, etc. will have some decent turnouts but definitely not as much as this one), so despite my exam coming up within a week, I decided to fly over to California for the weekend.  It was totally worth it.

Having been a small school with < 200 people per class, where almost everyone lived in the dorms, we were already a tight-knit community but I still wondered if anything was going to be awkward seeing old friends again or whether we would feel the distance that the last 5 years has put between us.  Of course, once I got there I realized that my worries were totally unwarranted.  If our college memories were a TV show, somebody had simply pressed the pause button for 5 years, and simply resumed play as if we had never left.  Some of us may have lost weight, others may have gained some, some guys grew out their beards, some have rings on their fingers; but overall consensus was that we all look exactly the same as we did back in 2012 in senior year.  The only mystery was why the current college seniors on campus looked so young.

I could go on and on about those familiar buildings that contained our college memories, and the new buildings that replaced some of them.  However that would take too long and may not do it justice within a single blog post.  Five years doesn’t seem like a long time, but really it has been 9 years since we first met as freshmen.  Some of the details of the fall semester of 2008 is starting to become fuzzy, but the overwhelming feeling of belonging and the bizarre quirky fun we had from 8AM classes to 6AM all-nighters still remain as clear as if it were yesterday.  There has never been and probably never again will be a place like Harvey Mudd for me.

I’m thankful for the opportunity to get together again with about 100 of my classmates (>50% of us) but incredibly sad that we’ll never be together like that ever again.  One Saturday was not enough time, but apparently 4 years weren’t enough either.  I wish us all great and bright futures, and hope I do a better job keeping in touch with you.

Simeon Koh

05.07.2017 - HMC Alumni Weekend

2.5 Years Later, Adventure to Jim’s Original

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When I made friends in the Chicago area, they would occasionally rave about Jim’s and promise to take me there.  Apparently it’s a popular late night hole-in-the-wall hot dog/burger stand for college kids in Chicago.  People talk about it as one of those guilty pleasures associated with strong nostalgia of the youthful frigid nights when they would gather people to go devour greasy sandwiches and hot dogs and nibble on the spicy chili peppers.

Finally after 2.5 years, I had my first Jim’s experience.  I dared not try to match everyone’s deep desire for it, but I like to think I started my own collection of memories at Jim’s last night.

As with most adventures, the food requires proper spontaneity of the setting.  In our church small group chatroom, somebody mentioned that he got Jim’s 3 times this week.  Then all these Chicago people unleashed their longings for Jim’s.  Reading these messages, I knew I had to jump in strategically in order to finally get myself to Jim’s.  Despite everyone’s love for this place, it’s not everyday that people talk about Jim’s.  And when people talk about their cravings, often the conversation dies without a solid conclusion to their cravings because human beings are prone to the comfort of their daily routines and there is the barrier of coordinating people’s schedules to make a trip to a place like Jim’s.  So at the peak of everyone’s excitement, I asked them to take me to Jim’s, accentuating the sad story of the past 2.5 years of hearing so much about Jim’s yet never having experienced it firsthand.

One immediate “omg” was unleashed and with the momentum of the conversation, a critical number of people expressed their availability and willingness to go to Jim’s next Wednesday after our Bible study.  My strategy worked!

What I hadn’t expected was when somebody said “let’s go now.”  Unsurprisingly most people couldn’t go on such short notice, but this person seemed super on fire for Jim’s, citing the slightly chilly drizzing weather as the perfect atmosphere for a Jim’s run.  For a moment, I hesitated because I, too, am human and didn’t want to get out of the house but the Tookish part of me took over and I said let’s do it!!!  In the end three of us ended up at Jim’s.

The excitement was very apparent during our trip as my friends wanted to pay for our food, telling me about the necessity of going halfsies on the polish hotdog and the fish sandwich and nibbling on the hot chili peppers while eating the fries and drinking grape soda.

The Mexican guy who gave us our order asked us, “ggochu manni?” which is Korean for “lots of peppers?”  Apparently all the drunk Korean college students teach him Korean.

As for the food, it was indeed very good.  The polish with the grilled onions was really good, and my favorite was the fish sandwich with the greasy but crunchy fish patty stuck between the buns and cheese and sauce and onions and happiness.  The fries were warm, crisp, and with the perfect amount of moisture.  The hot pepper was a nice contrast, and the carbonated sting of the grape soda intensified the spiciness.  We stood at the stand (no chairs in this place), finding shelter from the rain and eating our food and making memories.

Simeon Koh

My First Car Accident

Last week Friday I got into my first car accident.  I was hanging out at a friend’s apartment playing board games and having a good time, then left close to midnight.  I realized I was going north instead of south, and had to turn around.  I was in the right lane and wanted to make a left turn to turn around (I’m not sure why it didn’t occur to me to turn right and make a loop that way).  It was late at night and I didn’t see any cars so I made a left from the right lane.  The next thing I know something hits my car hard on the left and I spin.

I hit my head on the driver side window before the airbag went off.  Once I came to a stop, I turned on the emergency lights and examined myself.  Airway, breathing, circulation all were ok.  No loss of consciousness.  No bleeding or cerebrospinal fluid leaking out of my ears/nose.  No obvious skull fracture, no cervical spine tenderness.  Some tenderness where I hit my head on the window and ringing in my left ear but Glasgow coma scale 15 out of 15 and no paralysis.  Abdomen ok.  I guess 2.5 years of medical school paid off because I was able to determine I didn’t need a CT scan or any other reason to go to an emergency room.  It would have been interesting to be sent to the nearby hospital and be reunited with the trauma surgery team that I rotated with last month, but I’m thankful it didn’t come to that.

The police officer appeared out of nowhere and checked on me and figured out what happened (totally my fault).  Thankfully the other driver wasn’t hurt either and his car was driveable.  My car had to be towed, and after getting a ticket my friend drove me home.

***

In the summer of 2012 as I was nearing the end of leading an urban missions team in Los Angeles Urban Project, I had a conversation with another team leader about my plan to get a car and how to find the balance between buying a nice car with the need to save money for charitable deeds.  He told me that it’s not about what car I buy, but what I do with my car.

With that conversation always in mind, I’ve done my best to be a blessing to others with my car.  I used it to drive my grandparents to all their doctor’s appointments.  I used it to run errands for my parents.  I used it to drive friends to church, grocery store, airport, or whatever needs were around me.  It’s ironic that after 4.5 years trying to be a blessing to others, the last thing I would do with the car is to cause great harm.

But in the moment of my greatest fault, I’ve been blessed with much grace.  I expected my parents to flip when I called them about my accident, but instead was told everything is ok and that I needn’t be too stressed as long as I’m not hurt.  When I described to my friends my terrible lapse in judgment, everyone was so understanding of my mistake.  My classmates have been driving me to my rotations everyday, and my church friends drove me to church and back.  When my insurance told me my car is totaled and I would getting a check for the value of my car, my parents wanted to send me more money so I can buy a new car instead of a used one, an option which I politely refused since I know they’ve been saving up to replace their 15 year old van.  It still baffles me that they want to buy a new car for someone who just totaled his own.

Anyways, it has been an inconvenient week without a car but one with much undeserved blessings.  I hope from now on I can be just as forgiving to others when they make mistakes.

Simeon Koh

 

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2017 New Years Resolutions

It’s that time again where many of us make resolutions for the new year.  For some, it may be getting that promotion, for some it may be losing X amount of weight, for others it might be developing spiritual disciplines.  Although many of us won’t make it through the year with our resolutions, it never hurts to try!  At least for the first month or so we would be doing things we wouldn’t do otherwise!

My 2017 New Years Resolutions:

1) Do 10,000 pull-ups this year

2) Read 1 chapter of the Bible a night

3) Write in this blog at least once a month

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This wouldn’t be an interesting blog post if it ended with that.  So here are my tips on making/keeping New Years Resolutions:

(A) Keep them few and simple.  There are a bazillion things I want to do with my life, but only enough willpower for a couple at a time.  So I limited my resolutions to 3 items, and hopefully that will make it more likely to keep them.

(B) Make them challenging enough, but keep it easier than you’d like.  In my opinion, this is not one of those things where you shoot for the moon and hope to land among the stars.  I have never met a person who was disappointed for accomplishing their New Years Resolution too easily.  Rather, people are disappointed when life gets busy and they have to give up on their resolutions.  So underestimate your abilities and give room for surpassing your goals!

For example, many people attempt to read the entire Bible in a year but stop somewhere during Leviticus.  I expect I would fail by the end of Genesis.  So I’ll do 1 chapter a day.

(C) Keep enough flexibility so you can recover from occasional mishaps.  Often, once you miss a day or two it becomes ridiculously difficult to catch up on certain resolutions.  So design your resolutions so you can get up immediately after you fall because the problem is never that we fail with a single fall, but we grow tired of always playing catch-up.

For example, 10,000 pull ups in 365 days comes out to about 27.4 pull ups/day.  However, I’m going to rest at least 1 day a week, so subtract 52 days, then 13 additional lazy days just for kicks, leaving 300 days.  Then 10,000/300 = 33.3 pull ups/day, which is still doable.

Of course, I won’t start with 34 pull ups/day in January.  I’m starting with 15 (3 sets of 5) and increase as I want.  And I purposely didn’t specify how many reps and how many sets because that’s complicated and gives me the flexibility to do 34 sets of 1 pull up if I wanted to.

 

(D) Reward yourself for doing a good job. Our goals are almost always things we want to do but don’t have the desperation to actually do them.  So create incentives for ourselves.

For example I want to keep writing in this blog, but it’s been hard because medical school sucks in general as well as time.  Plus I started writing for the Medscape medical student blog, leaving less time/energy/brain to write here.  So I need some positive reinforcement every time I write here.  I plan on rewarding myself with a nice meal, a new CD, new clothes, 5 lb bag of gummy bears, or something ridiculously happy.

Anyways, please share below if you have any New Years Resolutions, or if you have additional tips on keeping them.

It’s good to be back!

Simeon Koh

Thoughts from Church Retreat

Last weekend I went on a church retreat.  The highlight for me was a seminar on social justice.  The speaker was a lawyer who works with the urban poor populations, especially women who turn to prostitution to pay for their drug addictions.  I won’t try to summarize the seminar here, but let’s just say I was moved by the heart she has for these women and her willingness to put her skills and resources to love those in need of God’s love.

This seminar was so good for me was because it rekindled the little bit of heart I have for the poor and marginalized people in our communities, especially children from broken homes.  During college God taught me how to start loving the urban poor, and before med school I did my best to donate some of my earnings and pray for social justice.  However, med school sort of put out any time/energy to engage with these issues.  I am so busy and drowning in my training that I cannot also pour out myself for others.  (I’m the one who needs to be poured into nowadays!)

I often fear that somewhere along my medical training I would lose the heart of God for social justice.  I know right now I need to be focused on my studies so that later I can help others, but I keep imagining that by the time I’ve obtained the skills to make a big difference, I would no longer have the desire to use them for good.

I know I am not going to go start volunteering regularly at a soup kitchen or donate my non-existent money to mission organizations any time soon.  On the surface it’s going to look like this seminar made no difference in my life.  But I’m still thankful because it made me realize that the itty-bitty heart for the poor and the marginalized is still somewhere deep deep inside me.  May the good and loving God keep the fire alive until the time is right.

Friends in California in Chicago

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This past weekend 3 of my friends from California flew over to Chicago to visit.  I had feared that it would be too cold for them, but they must have brought the sunshine of Southern California within their hearts because this weekend was the warmest it has been in a long time.  All the snow melted and it was beautiful.

If I were to summarize what we did in Chicago, it would be that we ate a lot.  We ate deep dish pizza at Lou Malnati’s, went to Shake Shack burgers for dinner, bought donuts at Firecakes (which we ate for early morning snack the next day), ate brunch at Yolk, dinner at Xocos, brunch at the Purple Pig, and a second brunch at Wildberry.  But somehow the most frequent place we visited was Garrett’s popcorn shop and Walgreens (I found out that Walgreens’s headquarters is in Chicago and therefore there is a Walgreens store everywhere!).  Somewhere during all the food we went shopping, I got Snapchat, went to the natural history museum, lost all the data on my phone, took a morning walk/run along the Chicago river, found the statue of Benito Juarez, etc.

I won’t go into detail about everything we did because what we did really doesn’t capture the happiness that I felt during those couple days.  It was just so cool to have my hometown friends that I’ve known since middle/high school just randomly fly over during my spring break just to hang out in Chicago.  For those 3 days they helped me forget about all my problems and thrive in the every minute of the present.  It’s incredible how you can find escape from stress when you’re with friends.  Who needs drugs when you have friends?

Anyways, I just wanted to brag about what cool friends I have and how lucky I was to have them in Chicago for those precious few days.

 

Simeon Koh

A New Creation, a Dentally Insured Grown-up Gentleman

Yesterday I took full advantage of my dental insurance and got 4 cavities fixed.  That might seem like a lot, but psh I got 5 more to go.  I did pay $278.90 for the 4 cavities, but considering my insurance paid $534.10, I feel not so bad.  The dentist office people gave me a sheet that says by the end I would end up paying $692.50 for the 9 cavities, but my insurance will pay $1382.50; if I had no insurance I would have to pay everything which comes out to $2075.00.

Before you judge me for my cavities (or maybe it’s too late), I have to tell you that they really didn’t seem bad to me.  I didn’t have any tooth pain, there were no visible black cavity spots, and I didn’t have bad breath (at least I don’t think I did…).  But now I’ve learned that cavities don’t have to be black and brushing my teeth regularly isn’t good enough.  If it weren’t for my wisdom teeth, I would have never known I had so many oral problems.

In November, my impacted wisdom teeth were pushing out again and started to hurt.  I’ve known for years that my wisdom teeth were very slowly growing out crookedly but they didn’t bother me enough so I just let it sit.  I was half in denial and half trying to convince myself that waiting for them to come out more would make the job easier for the dentist (that’s how much of a nice guy I am!).  But this time it hurt so much that I would wake up several times in the middle of the night.  So I found a dentist.

Confession:  until this time, I hadn’t been to the dentist since probably middle school (or maybe I went one time in high school?), which is like minimum 8, maximum 15 years ago…  People I’ve told this have been unanimously horrified.  Apparently it’s a thing that people actually go to the dentist.  After all my baby teeth were out, I didn’t get black cavities and nothing hurt so I never felt the need to go.  Also, for most of my adolescence my family didn’t even have health insurance; so what makes you think we had dental insurance?  To the doctor I would go once in a while because I needed to get some forms signed for participating in sports or to get into college etc. but nobody made me go to the dentist.

Anyways, in November I got my 2 wisdom teeth pulled out (Thanksgiving was fun) without insurance which cost ~$1000.  But more urgently my dentist said I really needed a deep cleaning lest I develop periodontal disease which is apparently something scary, and that also cost ~$1000 without insurance.  That was a lot of money, but apparently even if I had signed up for dental insurance they wouldn’t cover expensive things like those until 6 months of being insured.  So I paid everything out of pocket and thought it was the end… until my dentist said now I gotta get my 9 cavities fixed, which would cost another $2000.

So that is the story of why I have dental insurance (cavities are covered immediately when your insurance takes effect, unlike deep cleaning).  I am now a new creation, a dentally insured grown-up gentleman.  Since November I have been brushing my teeth with much more vigor, flossing every night, and using a mouth wash every night.  Learn from my experience and join me, friends, in taking care of our oral health.

Simeon Koh

Adventures at a McDonalds Drive-Through

Last week, I had a relatively productive day at school.  I accomplished my goals for the day despite numerous distractions and left school at 2AM.

If I were a body image-conscious supermodel, I would have just gone home.  But since I am not, I stopped by McDonalds 24-hr drive-through.  I ordered 2 breakfast burritos and 1 hash brown.  I may not be very conscious about body image, but because I am an environmentally conscious citizen, I turned off my car while I waited for the has brown to cook, rather than to let the greenhouse gases pollute the air.  Then I got my food and turned the keys… and then the car wouldn’t start but the car alarm went off.  Interesting.  Awkward.  Terribly embarrassing, as the McDonalds lady looked at me with her widened pupils.

I use my car remote to turn off the alarm and try again.  Same thing.  Just alarms going off at a lonely McDonalds drive through at 2:30 in the morning.  I try a couple times, check under the hood, etc. with no luck.  Thankfully since my car is less than 5 years old I could call “Hyundai roadside assistance.”

“Are you inside your vehicle and at a safe location?”  she asked.

“…Yes… I’m in a very safe place.”  I replied.

I spend several minutes explaining that I was stuck at a very safe McDonalds drive-through and give her my information and etc.  During this time I’m getting more and more anxious, not because I’m afraid for my life or anything, but because my phone battery was at 5% and this lady at Hyundai roadside assistance was very very calm and … not rushed.  Thankfully my phone survives the conversation and the lady assures me that someone will be over “soon.”

Meanwhile I knocked on the drive-through window and asked the McDonalds lady if I could charge my phone.  She took my phone and charger, and I became probably the first non-employee to charge my phone via the outlet next to the McDonalds coffee machine.  Then I sat in my car (since only the drive-through was open, the restaurant itself wasn’t open) and ate my burritos and hash brown because I had nothing else to do.  I thought of studying (oh the disease of being a medical student) but I was too cranky for that.

In retrospect, I could have called my apartment-mate to come jump-start my car.  I also could have asked the McDonalds lady or other customers (who I learned start coming around 3:30AM) to jump start my car.  However, I was dumb and didn’t think it was the batteries because the lights and my alarm (especially) worked really well, and because I hadn’t noticed any leakage in the battery when I checked.  It was also 2:30AM and I had faith that someone will be over “soon.”

The person finally got there around 3:45AM (the person for some reason was at the Wal Mart across the street instead of the McDonalds and tried calling me but my phone was charging next to the coffee machine when he called).  But somehow I got in contact with him and he brought a portable battery starter and got me going in 10 seconds oh my goodness.

If I had known that a portable battery starters existed, I could have walked over to the Wal Mart across the street and bought myself one and gotten out of McDonalds in less than 30 minutes.  Instead I suffered alone in the car in the cold (it was less than 20F that night) for an hour and a half, occasionally blaring my car alarm in the middle of the night and ruining everyone’s 3:30AM McDonalds experience.

Anyways, I got home around 4AM and went to bed as a cold miserable and cranky man.

Simeon Koh

P.S.  Why does the car alarm go off if my batteries are no good?  There must be a gentler way of letting me know.