The Best of Times

I was prepared for the worst when I started my inpatient medicine rotation at Riverside County Regional Medical Center. Here is what I had heard:

1. The medical teams average between 25 and 35 patients with no definite cap (could be more and is usually not much less). Rounding with the medical team can last 5-6 hours...and then you split up and begin to work.
2. The commute to and from Loma Linda is a 30 minute drive along a 2-lane backroad littered with potholes and train crossings.
3. The hospital uses a paper-based charting system (as opposed to the VA hospital where everything is on computer).
4. You are on-call every fourth day and must stay at the hospital overnight when on-call.
5. You will be in the hospital rounding on patients instead of in church on Sabbaths.

Sounds pretty fun, huh? However, while all these things are true, no one told me about the following:

1. Very few patients will turn down a request to pray with their doctor.
2. I would need to buy Steps to Christ in bulk and in at least two languages.
3. Patients would want to study the Bible in the hospital (up to two hours with one of my patients).
4. I would have a precious half-hour of protected prayer time with the Lord at the beginning and end of each day (during my commute).
5. Inpatient medicine would enhance my walk with the Lord and my commitment to serve Him.

Ye are the light of the world. A city that is set on an hill cannot be hid. Neither do men light a candle, and put it under a bushel, but on a candlestick; and it giveth light unto all that are in the house. Let your light so shine before men, that they may see your good works, and glorify your Father which is in heaven.

Matthew 5:14-16

A Man Worth Marrying

I came across the following story many years ago. I do not know the source but it accurately describes the type of man I am aspiring to be through the grace of the Lord. Perhaps it will inspire other young adults as they prepare themselves to be godly husbands and wives.

When Ruth Bell was a teenager, she was sent from her childhood home in China to school in Korea. At the time, she fully intended to follow in her parents' footsteps and become a missionary. She envisioned herself a confirmed "old maid" ministering to the people of Tibet. While at school, however, Ruth did give some serious thought to the kind of husband that she might consider. As she tells in her book A Time for Remembering, she listed these particulars:

"If I marry: He must be so tall that when he is on his knees, as one has said, he reaches all the way to heaven. His shoulders must be broad enough to bear the burden of a family. His lips must be strong enough to smile, firm enough to say no, and tender enough to kiss. Love must be so deep that it takes its stand in Christ and so wide that it takes the whole lost world in. He must be active enough to save souls. He must be big enough to be gentle and great enough to be thoughtful. His arms must be strong enough to carry a little child."

Ruth Bell never did become a full-time missionary in Tibet. However, she did find a man worth marrying: Billy Graham. As his wife, Ruth Bell Graham became a missionary to the whole world!

Helping People

The following is a paper I wrote (under considerable time constraints) about my experiences so far in my internal medicine rotation. It was for class credit, but I hope you enjoy it as well.

Reflection Paper #1
Tim Arakawa
November 9, 2006

During medical school interviews, one of the most common reasons that prospective students give for choosing medicine is “I want to help people.” I repeated that line as well during my interviews and genuinely meant it. However, somehow during the first two years (not to mention the additional four years of research for the PhD program), the driving motivation for my career choice began to get lost in textbooks, journal articles, and written examinations. Fortunately, returning to the wards has helped me to refresh my original desire to help others physically, mentally, emotionally, and spiritually.

I happened to be rotating through the VA hospital when I met Mr. L. He was admitted for pneumonia and had a rather uneventful recovery. Nonetheless, Mr. L was also an avid smoker and, since he was potentially at risk for numerous pulmonary and cardiovascular problems, I took the opportunity to speak with him about his nicotine addiction. After further probing, he seemed to be on the verge of the contemplative stage so I told him that we had many resources to help him stop smoking, and to let me know if he was interested. He didn’t mention anything about it for the next few days, but, before he left the hospital, he told me that he would talk to his wife and hoped they could quit smoking together. I gave him some handouts on smoking the morning he was discharged and I still distinctly remember seeing him resting in his hospital bed, eyeglasses perched on his nose, intently reading the potential consequences of his smoking habit. It felt good to make an impact on his lifestyle choices.

I remember examining another patient in the ER one night, although our first meeting was not under the best of circumstances. Mr. W had an extremely altered level of consciousness secondary to severe intoxication with alcohol and amphetamines as well as some minor head trauma due to falling. When I saw him in the ER, he could not communicate well, responded minimally to commands, and just stared at me with bloodshot eyes. As a new medical student, I remember the frustration of not being able to get any history from him and doing an incomplete physical exam. We just admitted him and treated him for drug overdose. The next morning, he was able to say a few words and, by the following day, he was communicating fine. Although Mr. W had some serious medical issues, it felt good to be able to restore him to his normal mental state.

At Riverside County Regional Medical Center, I had a patient who presented with cough, shortness of breath, and back pain. After a complete work-up, we finally determined that Mr. R had lung adenocarcinoma with metastases to his bones, a poor prognosis. He was young (in his forties) and had smoked for decades. I accompanied the senior resident to break the bad news to him. Unfortunately, the senior resident was in a rush and didn’t take the time to let him process the new information so afterward I stayed behind and explained the diagnosis and answered his questions. I appreciated the opportunity to help him emotionally when others were too busy to care.

But perhaps the best part of medicine is to reach the spiritual needs of my patients. This is the real reason I wanted to become a doctor. Whether it means praying with a patient recently diagnosed with terminal illness (I prayed with Mr. R) or leaving a spiritual booklet with a patient struggling with why God allows good people to suffer, doctors have a unique opportunity to address the whole person. Mr. A was a good example of one who had spiritual questions and felt safe enough to ask me about them. I shared a Bible text from his personal Spanish Bible lying at his bedside and left him a booklet that contained answers to his questions. Since he is still in the hospital as I write this, I plan to spend more time with him as I am able.

As medical students at Loma Linda University, we are taught to treat the whole person, including the physical, mental, emotional, and spiritual. Combining this with compassionate, competent care has been a dream of mine and “helping people” continues to provide fulfillment for me as a physician-in-training.

Epilogue: Mr. A is currently reading Steps to Christ in Spanish and looking each Bible verse up in his Santa Biblia. We have had numerous long talks about spiritual things during his hospital stay. Today we talked about how Jesus gives us the power to live a life free from pecado (sin). We prayed together that the Holy Spirit would guide him as he studies God's Word. He will be receiving a Spanish version of Desire of Ages shortly.

Scheduling Rotations

For those who would like to know why my blog entries are few and far between, here's what my junior year of medical school looks like...

Rotation Schedule

Family Medicine	9/4/06 - 10/1/06	Kaiser Permanente Riverside
Internal Medicine	10/2/06 - 10/29/06	Loma Linda VA Hospital
	10/30/06 - 11/26/06	Riverside County Regional Medical Center
	11/27/06 - 1/7/07	Loma Linda VA Clinic
Psychiatry	1/8/07 - 2/18/07	TBD
OB/GYN	2/19/07 - 4/1/07	TBD
Surgery	4/16/07 - 7/8/07	TBD