Dr. Janet Osuch

During my recovery process it was suggested to me that I meet with a local Michigan State University (MSU) physician.  I went on to learn that this physician, Dr. Janet Osuch, had trained as a surgeon, and had practiced for several years before she was diagnosed with a brain tumor near her cerebellum, like me.  This was all I knew before contacting her.

—————- Her Story ——————

I was initially trading emails with her prior to meeting with her.  In my first email to her I told her of my tumor and the recovery process.  She, in turn, told me of her situation and how she ended up where she is now.  She told me that in 1998 a 6-centimeter tumor was found in her cerebellum.  She went on to tell me that after undergoing a surgery to remove the mass, she remained in a coma and in the ICU for a week.  After fighting her way out of the coma, she then endured many years of therapy in an attempt to recover from her affliction.  She also had to undergo several follow up surgeries in order to remove the tumor completely.  She was a practicing surgeon prior to the diagnosis, but due to the effects of the tumor could not work in the operating room (OR) anymore.  Now, after five years of absence due to the tumor, she works as a Dean in the College of Human Medicine at MSU, seeing patients for ½ day during the week[1].

————— Meeting ——————–

After trading many emails, we finally decided on a time and a place to meet.  We had initially decided to meet in a restaurant but I reneged last minute and asked if we could meet in her office instead.[2]  I did warn her prior to our meeting that I was suffering from titubation and cautioned her that it might occur during our meet.  Her response was one I’ll never forget: “That’s fine!  Don’t forget, I’m a doctor, I’m used to things like that!”

Her office is located in the bowels of the MSU medical school campus, a location that was, at best, incredibly difficult to find.  I had actually wandered into the wrong building, lost, but was fortunate in that I stumbled across a group of young people (medical student age) following an older (than them) woman.  One of them, as he was leaving, said, “Thanks Dr. Osuch!  See you on Monday.”  I heard this and immediately introduced myself to her, telling her that I was Chris and that we were scheduled to meet then.  “Oh hi! Great, I’m glad you found me, I know my office is impossible to find, walk with me we’ll go together to my office.”  It was in the middle of winter in Michigan, nearly below zero degrees Fahrenheit, yet there was a warmth emanating from her.  She is not a tall woman, 5’3 maybe, not at all imposing or intimidating.  Perhaps it was her glasses or short brown curled hair combined with her smile that created this warmth.  Even after meeting her and noting her demeanor, my first thought was she suffered from a brain tumor?  I could not tell from her gait or speech, if she harbored any signs of a brain tumor removal; if she was, it was escaping my eyes.

Dr. Janet Osuch
Dr. Janet Osuch

After a long walk, we finally reached her office and sat down to chat.  My neck wasted no time after sitting down, and I began to shake, within two minutes of sitting down.  “Is this the titubation you mentioned?” She asked.  After my affirmative response, she then proceeded to ask me what my story was, and what brought me there.  My response was short, something to the effect of “They found a mass in my brain, and they took it out.”  Of course I’m exaggerating and my response was longer and more detailed than that but when she began to tell me of her ordeal with her brain tumor, beginning with, “It was 1998 and…” I realized how short my answer truly was by comparison.

——————- Bees ——————

I noticed during our conversation that she was wearing a pendant on her sweater.  Upon a closer look it was a pendant of a bee.  Before I could ask her about it she explained it to me, “When I was recovering,” she said to me, “I came across a sale of these pendants.  I did some research on them and found that the laws of nature and physics dictates that they should not be able to fly.  Their wing size in proportion to their body size says that they should not be able to fly but not only are they able to fly, they are integral to our planet and how it works.  Without the existence of bees, we as humans would cease to exist.  After learning of this, I immediately bought many of these pendants and always wear them now.  In fact, I always end my first lecture of the year to the medical students with this story of the bee.”  I could sense the weight and the meaning behind her words.  “Bees don’t care that they aren’t supposed to fly, they still go on with their business.  This signified my struggle.  I’m not supposed to be a practicing physician and a dean of a large medical school after having the brain tumor I did, but like the bee I don’t care and I do it anyways.”  I have always admired people who can say and think I don’t give a $%!t.  All successful people have this trait in common.  At some point on their paths to success they had to think or say to someone, “I don’t care what people think, I want it done my way!”  My admiration probably stems from the fact that I do not think like that.  As much as I’d like to have that attitude about something, I simply cannot; I care too much of what is thought of me.

bee01

—————- Spirituality —————–

During our talk the issue of spirituality came up.  Not once did she ask me what I believed in, but she told me that during her ordeal she became deeply spiritual.  I have mentioned religion and its role in my recovery—at that time I said that I would call myself an agnostic, basically I’m not sure if I do believe in a god.  I have close friends that go to church every Sunday, my father (as I mentioned) is a Buddhist, I also have close friends that are staunch atheists- decrying any belief in god- one of my (Jewish) friends told me to You Tube “Richard Dawkins”[3] – a British, theologian author who tours the world giving talks on (what he believes) the absurdity of the belief in a god – when it comes to spirituality and god I have been exposed to a wide array of stances.  My viewpoint before and after has been the same: I simply do not know if a god exists or not.  My experiences with the tumor have not changed my view.  I have recently become fascinated with the study of astrology and the vastness of everything;[4] this may in fact, be the beginning of my journey in finding spirituality through this ordeal.

——– Working ———–

Dr. Osuch was 49 at the time of her diagnosis and surgery, so she was in the full swing of her practice of medicine, well removed from her residency.   Of the many interesting things she had to say, I found the details of her recovery and eventual return to work and society particularly interesting.  She began by telling me that her Physical Medicine and Rehabilitation (PM&R) physician[5] told her that most of her recovery would be in her first year after surgery.  “That one year recovery line just isn’t true—to this day I still find myself progressing on a daily basis.”  I found this comforting, because at the time, I was approaching the one year anniversary of the surgery and had also been told, by multiple physicians, that the majority of my recovery would be in this first year window.

She then went on to tell me that during her recovery, when she was getting ready to return to work, she had a meeting that included her, her neuropsychologist, her therapist, as well as her PM&R physician.  At one point in their conversation, the topic of return to the OR came up.  One of the clinicians turned to her and asked her, “Janet, do you think you can operate?”  As much as she wanted to, she knew the answer to this question was “no”.  I could sense the pain in her voice in telling me this, and I understood.  She had trained and devoted her life to operating, but had to face this reality of never operating again.  I liken it to an athlete at any level when they can no longer participate in that sport.  All the surgeons that I know are generally a grumpy bunch, with the exception of in the OR.  For some reason in the OR these surgeons all light up, as if a child in a candy shop.  I cannot imagine the grief she must have experienced when she learned of this news.

She then quickly changed gears and asked me what my return to my residency has been like.  “Interestingly, the people who distanced themselves the most from me were my own colleagues.  To them, my diagnosis hit too close to home.  If it could happen to me, it could happen to them too.”  I have been fortunate in this sense, as every one of my colleagues has been extremely understanding and supportive of me during this ordeal.

I left our meeting feeling hopeful—everything she said stuck with me (and still does to this day) but knowing that someone had gone through a similar ordeal as mine, and came out stronger gave me hope.  Until then it felt like I was the only person to ever have gone through this.

 

[1] She sees patients to counsel them on any possible genetics links of breast cancer.

[2] I was worried about my titubation and did not want it to occur in a public place such as a restaurant.

[3] Check out this video of a recent interview he gave: https://www.youtube.com/watch?v=pcbV53uAURg

[4] To think we, on Earth, represent a single blade of grass in a large field is mind boggling.

[5] Whom she speaks very highly of and is subsequently also one of my PM&R physicians.

 

 

Sisters…

Today I was hoping to post articles written by my sisters—their perspective is unique in that not only did I grow up with them, but they were both there for the surgery as well as after the surgery. I could write a whole post on my sisters. People often ask me what, if anything I have learned from this experience—this is a question that I have no great answer to—I do know that love has gotten me through this. Love and passion for medicine and their patients got me a diagnosis. Love from Amy and my cousin Pauline got me in touch with top notch neurosurgeons. Love from my wife kept me strong after the diagnosis. Love from Alice and my mom helped me through the hospital phase of the recovery. Love from my dad kept me looking forward. Love from Bill (my stepdad) has been vital to my recovery. Love from all my friends (including colleagues and college friends) has helped me integrate back in to society. Even an act as simple as holding a door open takes love- love and compassion for my situation. How does this relate to my sisters? I know that without them and their love I would not have had the strength to endure this. I admire them both, before all this happened I would have easily called them both my heroes. I strongly believe that stress and pressure can reveal a lot about a situation or a person: pressure has the ability to create something as destructive as a tornado and the ability to make something as beautiful as a diamond. The amount of stress this whole situation must have put on my sisters I can only imagine, but like beautiful diamonds they came to my side without hesitation. I asked them both if they could write something for the blog—again without hesitation they agreed. This is what they wrote:

Amy(my older sister):

I will never forget the day that I received the news about Chris’s tumor. I had missed several calls from Chris that day, and several from my mother. At the time, I was a mother of 2 kids under 2 years old, and a few months pregnant with our third. I’m sure any mother of toddlers or babies can attest to how hard it is to keep track of where your cell phone is, let alone answer it. When I saw all these missed calls from my family in succession, I remember worrying that something was wrong. I called my mom back, and she blurted out, “Chris has a brain tumor.” She continued on but to this day I still have no idea what she said after that first sentence. I started sobbing and wailing uncontrollably. I had never felt so devastated, scared, helpless, and sad before in my life.

As an Emergency Department doctor, I am used to delivering this type of news to families on a regular basis. This is probably the worst part of my job, but I have learned to distance myself and not get emotionally involved with every patient. It’s a matter of survival and in the best interest of my patients. I am compassionate, but cannot be truly empathetic, lest my emotions cloud my judgment at a crucial emergent moment for this patient, or for the next patient I see.

Despite all my experience with death and disease, there was nothing that could prepare me to receive that news about my brother. I had been lucky—no one in my immediate family had suffered serious illnesses. Until that moment, I thought I was a strong and stoic person. I have never felt as vulnerable and scared as I did that day.

I knew that it would be important to Chris that I be there before the surgery and immediately afterwards. I made arrangements to fly to Michigan the day before the surgery, and return the day after. I wanted to stay longer and be with Chris, but my daughters had never been separated from me, we had no childcare help, and my husband did not feel comfortable with my extended absence. My mother-in-law (or 2nd mother as I call her) was gracious enough to come to help us with the kids while I was away and Amir was working. Still, our first daughter is a “spirited” and extremely sensitive child. We were afraid that my extended absence would be too traumatizing for her. She had had bad childcare nanny experiences as an infant, and we did not want to potentiate her insecurities. I felt so incredibly guilty for not being able to stay with my brother longer after his surgery. I felt pulled in two different directions.

I remember on the car the ride to the hospital (we drove from Okemos where Chris lives, to Ann Arbor), I cried the whole way in the back seat and hoped that Chris did not see me. He seemed so strong and calm. It’s always hard though, to figure out exactly how Chris is feeling. I remember the pre-operative area and all the residents who were coming by to do their usual pre-op interviews before the attending checked in. I remember looking at the nurses and physicians taking care of us, knowing exactly how they perceived us, and wishing I could explain to them how it felt to be on the patient’s side.

The surgery day was the longest day I have experienced. We sat in the main lobby of the hospital, were given a website where we could check the status of the surgery, and Fleur carried a cell phone and would periodically receive updates on the surgery from a nurse in the operating room. Nobody expected Chris’s surgery to take as long as it did.

In the U of M surgery waiting room- because of the double vision I was experiencing I wore an eyepatch prior to the surgery
In the U of M surgery waiting room- because of the double vision I was experiencing I wore an eyepatch prior to the surgery

Finally, late that evening, we were told Chris’s surgery was over and we could see him in the recovery area. I don’t think any of us were prepared to see how Chris looked and how much pain he was suffering after the surgery. I will never forget the vivid imagery of Chris being extremely swollen from head to toe, moaning incoherently, and in obvious pain. Since his neurosurgeon was a pediatric neurosurgeon, the staff was mostly accustomed to treating children, not someone as big as my 6’2” brother. I will never forget that the first coherent words out of Chris’s mouth in the recovery area were “Amy…Amy…Amy” He kept moaning for my help. I had to hide and fight back my tears. I remember that Fleur was so understandably overwhelmed with the whole situation. Poor Fleur was 8 months pregnant, exhausted… and to see her husband this way must have really put her over the edge. She had to excuse herself to compose herself. Meanwhile the doctor side of me kicked in and I became annoyed that the nurses were giving my 6’2, 180 lb brother meds dosed for babies. 1 mg of morphine after a 12-hour brain surgery??!! You’ve got to be kidding me. I immediately requested a change in dosages and types of medication. My brother was in so much pain and vomiting despite the medications given so obviously they weren’t working. I knew I was being the typical difficult family member and the nurses were probably annoyed with me, but I really didn’t care. I wanted my brother in as little pain as possible. Chris was in excruciating pain. At my urging, the nurses called Chris’s neurosurgeon and his pain medication dosage was doubled and anti-emetics (nausea) changed completely. He seemed much more comfortable.

The morning of my flight home, I really felt that I needed to stay to be with Chris at least a few more days. He seemed to be in too much pain and needed me there. At one point, he grabbed my hand and said “Amy stay with me.” I really wanted to stay with him. I called my husband and even from the background noise and sound of chaos, I knew I was needed and had to return home. Amir said to me, “The girls really need you, they are going crazy.” I asked, “Can I stay an extra day or two?” Amir replied promptly, “No, you need to catch your flight. The girls need you.”

Amy and her family
Amy and her family

Even though Chis seemed obtunded post surgically, he must have heard this conversation because I will never forget, he pulled me to him and mumbled, “Amy, you have to go home. The girls need you.” A few hours earlier he was pleading for me not to leave. I felt so touched and heartbroken at the same time. My brother, who had just undergone brain surgery, was still trying to be considerate towards my family and me. I truly do not know a single soul as kind and genuine as my brother’s. That moment was so telling about Chris’s character and heart. It still brings me to tears if I let myself think about it.

Recovery

Recovery has been slow but steady. I don’t think any of us expected Chris to have as many deficits as he has, but after speaking to my good friend who is a neurosurgeon (and has been a godsend to our family and me throughout this whole ordeal—Dave and Jeanie Jho we are forever indebted to you), we have realized that this is all normal, and Chris has in fact improved and is progressing as expected. Even though it is subtle, his voice has changed. It is more monotone and has different inflections. Because of this, it makes me sad to talk to him on the phone. A stranger may not notice, but as his sister any difference seems large to me. His speech does seem to be improving, even though I’d have to say this is the area in which improvement is slowest. Physically, he has come so far. Immediately post surgery, he could not even stand without assistance, could not even use his bedside urinal without help. Now he can work out, walk sideways, and even play Ping-Pong. He still struggles with balance and his gait is not like it used to be, but he is improving every day, and I am extremely proud of him and deeply admire him. I have no doubt he will continue to improve and will recover fully, with just the physical scar and a stronger spirit left visible when this is all over.

 

Alice (my younger sister):

There are no words to explain the whirlwind of emotions that one goes through during a time like this. Hope, fear, sadness, uncertainty, those are just a few. All I knew was that I wanted my big brother to be get better and for the tumor to be benign.

I arrived in Michigan a day before the surgery. The surgeon had expected the procedure to take between 10-12 hours, which actually turned out to be 16 hours. I really thought the worst part would be the waiting period. Waiting for 16 hours to know if Chris was going to be okay, and to know what kind of tumor he had. Don’t get me wrong; it was a horrible feeling, having a knot in your stomach for 16 hours straight. But the harder part, in my opinion, came later when I realized the effects a benign brain tumor could have and how much my brother would have to go through to recover.

Alice and our baby
Alice and our baby

After 16 hours, I remember going through just a moment of hope and relief when the doctor came out to the waiting room and told us that the tumor was benign and that my brother would be okay. That feeling quickly went away when we were allowed to see Chris. I slowly walked up to his bed in the recovery room; he was on what looked like the tiniest bed, laying on his side in a fetal position. As he slowly tried to turn to his back, I lost all control I thought I had over my emotions. I have never seen my brother like this: he didn’t look like himself, his entire face was extremely swollen from being in surgery, and he was in so much pain and agony. All I could do was cry.

When they moved Chris to the ICU I really didn’t know what to do, I felt helpless. My mom, sister and Fleur were all over the staff. With their medical backgrounds, they knew exactly what to do for Chris. My mom would rub my brothers legs, making sure no blood clots would form, that he was getting the medications he needed, that he was getting enough fluids, and making sure the wounds weren’t infected. With no medical background, I tried to help as much as I could, which didn’t seem like much. I just sat by my Chris’s bed awaiting any instructions from him or my family. At night when my brother would wake up, he would never really ask for much, many times he would just hold out his hand for mine, that was the only comfort I could offer him.

Laughter, it was the nicest sound I could hear from Chris after the surgery. We tried to joke around together, the way we used to when we were younger. My brother still had double vision after surgery so he enjoyed listening to his iPad. At night when he couldn’t sleep he would ask me to play one of his favorite comedians and we would both just listen and laugh together. Because my sister had to leave to take care of her kids, I would always try to record videos of my brother so she knew he was doing okay. I always tried to get videos of him laughing, in hopes that it would bring her comfort as it did for me. I know it was difficult for her not to be there with him.

To some people, recovering from a surgery to doesn’t seem like a big deal. Usually it entails a few months of physical therapy, and sometimes less. Most times you will make a full recovery as long as you do what your physical therapist says. This was definitely not the case. What my brother has been going through for the past year and few months has required much patience, diligence and self-motivation, and he has had to maintain all this while knowing that he still may not make a full recovery. The first time the physical and occupational therapist came to Chris’s room it saddened me to see my brother struggle to do basic things—walking, sitting, and standing– that most people don’t think twice about. I could see the pain and frustration my brother had every time he attempted to do something that was once so easy for him. However, this frustration didn’t stop him from continuing to work hard. If anything, it seemed like my brother turned this frustration into motivation, motivation to improve enough to leave the hospital and be with his family.

 

 

Mom & Dad

This post is devoted to the points of view of both my mother and father.  I asked them both for their perspective on my situation and this was their response (please excuse any grammatical errors as English for them is a second language):

Mom:

The operation took over the estimated time. That worried me!!  I asked myself, would he have been better off having had the surgery in UCSF or UCLA who had the surgeons that Pauline[1] recommended? Chris’s one-week stay in the pediatric ICU (PICU) at the University of Michigan hospital was very tough. I was really worried that he may become addicted to pain medications. However, his insistence of avoiding the use of any pain meds not only relieved this worry, but it also showed me his mental strength and toughness. I knew that no matter how tough the process of recovery was he would get to the finish line.

My older sister, mom, and wife in the surgery waiting room
My older sister, mom, and wife in the surgery waiting room

To me, the most important part of Chris’s recovery was the in-patient rehab. He was 100% focused and had a tight daily schedule.  I tried to help him get rid of any distractions and always made sure he could put all his attention into the task at hand.

Regarding Long Beach Island (LBI)[2]I wish we did not go to LBI and wished we continued to stay in the hospital for just one more week. To this day, I regret the decision of taking Chris out of inpatient rehab early because of my commitments in LBI.  I do think one more week in inpatient rehab would have made a difference for him and his recovery.

His vision recovery is the most important to me!!  Him being able to gradually feed and dress himself and eventually get rid of his wheelchair were triumphs of the recovery process. His speech recovery also makes me proud (Finally my Chinese-English came in handy).

Dad:

                  When Chris called me and informed me that he had a 4 cm brain tumor at his cerebellum, I was on my way to San Francisco for a trip. Not long before that, he informed me that he was chosen to be the Chief Resident in his residency program. That was quite an honor.  When he informed me, I congratulated him but told him that health and family are the most important things. It seemed a coincidence that he soon had problem with his own health. I have encountered a few coincidences during the course of Chris’s brain tumor diagnosis and treatment. I later wondered myself, did my comment originate from my sixth sense or was it merely another “stoic” reaction to his exciting honor?

My father, Rei-Kwen Chiou
My father, Rei-Kwen Chiou

Another coincidence I encountered was when a patient came to see me after Chris had his surgery. As a Urologist that has practiced for over 30 years, I had never encountered a patient with a brain base tumor. But this patient told me that she had a cyst in her cerebellum. She was handicapped with many restrictions on her activities. She told me that she was advised by a top neurosurgeon in Oregon that she could not have surgery. “If you have surgery, you will die.” That neurosurgeon informed her. Watching her struggling even to walk, I truly felt blessed at Chris’s recovery thus far, even though he was still in the early phase of his recovery. Was God trying to hint something to me?

                  Another coincidence came when a patient gave me a brochure and tried to sell me a metal pen that he said was filled with special crystals. According to him, by waving the magic crystal pen, many neurological conditions would be healed. It was a few hundred dollars to buy one of these pens, however, my reason for not pursuing this was not the money but the principle that even in the most desperate situations, I did not want to submit to what Chinese called “mi xin” (a belief in something without sound reasoning or evidence). But I wondered, why had I never encountered that magic crystal pen except for after the discovery of Chris’s tumor?

                While I encouraged all the standard medicine and rehabilitation, I did teach Chris some Taoism health practices that I have found helpful for my own health, including meditation (based on Lao-Tze and his follower Huang, Yuanji) and some basic Tai-Chi exercises. I also showed him acupressure exercises that I adopted from various sources of Taoism and traditional Chinese medical literature.

                 From the very beginning, I recognized that although the tumor was benign, Chris had a tremendously difficult tumor to surgically remove and it had begun to cripple him. My anatomy class in medical school has taught me the complexity of the brain base adjacent to the circle of Willis: the area is covered with network of blood vessels and vital centers of our brain. Every vessel leads to a part of brain tissue that is vital for our life.  Every spot that the tumor attached to has vital function related to our body and life. That is why the patient of mine with a tumor in her cerebellum similar to Chris was told that if she had surgery, she would die.

                  My first conversation with Chris focused on 2 points: First, was that we needed to find the very best surgeon to do that surgery for him. Second, was why did we not make the diagnosis earlier. I recalled that I asked Chris to have a CT scan of head a few years ago to evaluate a headache he had been complaining of; it turns out that Chris was going to have the CT scan but stopped the study because of vertigo. It is likely that Chris had had that tumor for many years, and it would have been much smaller if we had detected it several years ago.

                  That thought reminded me a Taoism saying: “Do your Kung-Fu at the initial phase of things; Do not do a heroic life fight at the end phase.” Such a saying can be traced to Lao-Tze who wisely wrote: “Journey of a thousand miles begins with a simple step in front of you”. Not only journey, a lot of things in our life are that way. It began small but it grew to be a monster. It is effortless to nip a bud; it is tremendous work to cut down a tree. An ounce of prevention (or early detection) is worth a pound of cure.

                  However, we have to deal with the situation the best we can when it was detected. As a surgeon, I have vision for various phases of processes and have a habit of assessing the odds.  Surgery always carries risk, but we are blessed with tremendously skillful surgeons in various fields.  With a surgeon’s thinking, I know what Chris has to go through and knew that Chris had an excellent chance for surviving the surgery and attaining a reasonable recovery. I told Chris: “We will find the best surgeon and you are going to do well.” I recall that I also mumbled: “I am not sure you will be able to continue to practice medicine.” But I spoke so softly on that, just talking to myself.

                  Although in my career as a Urologic Surgeon, I have performed many major, meticulous surgeries, I always admire surgeons who strive to be the best in surgery in their field.  I would be too nervous to take that kind of risk operating at the vital center of our being. For these surgeons, one minor mistake can cost the life of the patient.

               Chris was fortunate to have a great and devoted mother who slept in a cot for a month at his bedside in the hospital. At our age and health condition, I don’t even think I could have survived that. When I visited Chris during his rehabilitation time, I was most impressed by the interaction between him and his mother. They were giggling all the time. But when I saw Chris wearing his glasses (with one eye blacked out to help his double vision) quietly holding his newborn son in his arm in the hospital lobby, I felt sorrow of Chris. Watching him hold a beautiful new baby in his arms also reminded me of when I held Chris in my arms and what surrounded Chris’s birth.  

Me holding Cormac with my stepdad and mom
Me holding Cormac with my stepdad and mom

 

                  We lived in an apartment in Minneapolis, fortunately on the first floor. I was in my residency, just as Chris is now in his residency. That night, we went out for a movie. When we returned to our bedroom, we were getting ready to go to bed.  Chris’s mom then fainted at the bedside. It turned out that her water had broken. When she regained her consciousness, I told her, “Don’t move, just lie there. I will go get the car.” I drove the car to our back yard and took Chris’s mom to the car. The apartment security came over and inquired why I had just driven my car to the backyard in the middle of night.  I simply told him that my wife was having a baby and rushed off.  Chris’s mom delivered Chris soon after our arrival to the hospital. It was a dramatic and unforgettable experience but it was a pure joy holding Chris in my arms. But now, I feel sorrow for my son who is holding his own son in his arms but is going through the roughest time in his life.

                  My brother Yen told me that for a period of time during his teenage years, he was occupied by the worry of death. He couldn’t sleep, he couldn’t eat for a couple of weeks. Our father then told him: “Just live until you can no longer live.” This simple statement brought him back to living from the dark cloud of death. Yes, in life, we have no guarantees, we can die any day or we can get a serious illness.  But as long as we live, we live. One day at a time, one moment at a time, we live for ourselves and our families. No matter what we have to go through, no matter what we have to endure we must do the very best we can with all the physical, mental, and spiritual strength we can muster.  As Chris’ grandpa put it, we must live until we can no longer live. We should always strive for the best and never give up.      

 


[1] My cousin, Pauline, both a surgeon and a writer made many phone calls to people she knew in the field of neurosurgery.

[2] I spoke of LBI in a previous post

Insurance

Insurance, even in the medical field, was always something I ignored.  Patients often ask me, “Will this be covered by insurance?”  As a medical student, my reply was simply “I don’t know” and as a resident physician I often had the same response.  I must admit with the advent of electronic medical records (EMR) along with more of a direct hand in patient care I have become more knowledgeable about the subject.[1]  When it came to signing myself up for health insurance, my approach was to ask those in a similar situation what they were doing (i.e. colleagues) and sign up for the same plan.  My wife had a similar approach to me.  Since my colleagues were signing up for the hospital insurance policy, called Sparrow Physician’s Health Network (SPHN for short) I casually signed up for the same policy. This tumor has given me a different perspective on the insurance process.

——————————- The Policy ————————————-

The day I was diagnosed with the tumor was a whirlwind: speaking to my primary care physician (PCP), seeing the neurologist, getting the MRI, and telling my family was a blur.  I do remember getting a phone call from my PCP to see how I was doing and him advising that I meet with the local neurosurgeon first, and then seek a second opinion if I was at all uncomfortable.  At the time I did not think much of the comment mainly because I anticipated I would proceed with the local neurosurgeon, ‘Dr. Smith’[2].  As we found out how rare this tumor was in this location, both my wife and I became more uncomfortable with the encounter with Dr. Smith, along with his expertise in the field[3].  Thus, in addition to some encouragement from family,  we obtained a second opinion from a neurosurgeon at the neighboring University of Michigan.  The neurosurgeon there gave us more time, acknowledged the rarity of the tumor, and despite his significant experience, recommended being seen by a pediatric neurosurgeon (a specialty not offered at Sparrow).  He stated “if it were my son, this is who I would want to do the surgery”. This was because my particular type of tumor and specifically its location were much more common in the pediatric population.  After seeing the pediatric neurosurgeon, and doing some background research on him, we felt more comfortable and scheduled a surgery with him – actually it was a no-brainer decision.

page 1/2 of the summary from my visit with 'Dr. Smith'
page 1/2 of the summary from my visit with ‘Dr. Smith’

 

page 2/2
page 2/2

The topic of payment came up only once prior to my surgery.   When we decided to get the second opinion from University of Michigan (called U of M here) my wife called the insurance company to clarify.  They stated treatment at U of M would be considered  “out of network” and we would be responsible for $5,500 deductible.   From what I read, even if a local surgeon could competently perform the surgery, if the patient decided to go to the University of Michigan, SPHN would cover all treatments that were deemed “reasonable” after meeting the deductible.  However, according to their policy, if the surgery was out of the scope of the hospital’s competency, they would indeed cover 100% of the procedure.  My thinking at the time was that because this is brain surgery I should go with the most qualified, and at the worst, my insurance company would cover approximately 80% of the surgery.  I did not have the luxury of time to sit and ponder my options. 

Now, with time to think about the process before and after the surgery I became more and more convinced that my insurance should cover 100% of the procedure.  This thought wasn’t because it would be easier on my wallet, it was the principle of the situation: by only covering part of the procedure, SPHN is making the statement that this procedure can be done locally.  If this is not true,[4] then it is possible that in the future, someone who suffers from a similar tumor might be swayed to have the surgery done locally and thus put his or her life at risk in the hands of an inexperienced surgeon.  Because of this thought I put in several appeals to SPHN to cover my surgery.

——————————— Meeting ————————————-

After several appeal attempts with my insurance, I was asked to attend an internal hearing regarding my case.  Their headquarters is located in the heart of Lansing in an inconspicuous building next to the hospital.  After arriving, I was warmly greeted by their receptionist who instructed me to wait.  After being called forth, I entered the room in which I would plead my case.  The room was a small one, just large enough to fit a round table with seven chairs around it.  Somehow even though it was a round table there were five people (those that would be assessing my case) all sitting on one end of the table.  My wife and I would sit facing these five people.  Thinking back, the setting and everything from the waiting room to the layout of the hearing room, was designed for intimidation, as this was a room designated to hearing appeals such as mine.[6]  Being in contact with several of the physicians in Sparrow, and having rotated through the neuro intensive care unit, to our best knowledge Dr. Smith had not performed any posterior fossa surgeries in the recent past and that he may in fact be falsely credentialed.  We made this clear in the hearing, and in fact requested they produce the number of posterior fossa craniotomies this surgeon had performed.  However our concern fell on deaf ears.  We were repeatedly reminded that this surgery could be performed locally, we were informed of such by writing, and that for this reason our appeal was denied.  I remember being extremely nervous for the hearing, suffering from a particularly bad episode of titubation and having to rely on my wife to retell our story.

About a week later I received a letter in the mail telling me that my appeal had been denied.

page 1/2 from an SPHN letter
page 1/2 from an SPHN letter
page 2/2
page 2/2

—————– The Bottom Line ——————–

 My thought is that the bottom line for all insurance companies is money.  I think that this is the case for most, if not all, companies.  The main question that comes to their mind is: does this make me money?  I do not blame them for such thinking; the CEO of Blue Cross Blue Shield is not thinking the he or she wants to help people with their medical needs, they’re thinking how do I make the most money possible?[7]  If I were in their shoes I cannot say I’d make a different call but in my eyes if this bottom line interferes or somehow has a detrimental effect on life then this is when the issue of money should become moot.[8]

In my experience not all the insurance issues have been negative ones. While still sustaining a large hospital bill, the majority of my surgery and stay at the University of Michigan was covered by insurance.[9] Once I transferred to Sparrow Hospital, all of my costs were covered.  Without SPHN I would not have been able to receive the outpatient therapy that I did.  To me health insurance provides some security in case bad luck were to strike.  And for the most part it is great for the community, providing people with the services they otherwise could not have.  But there are certain cases in which the security they provide needs to be questioned—unfortunately, in my case, the cracks in their foundation were revealed and these questions need to be asked.


[1] The EMR will often tell me, before I prescribe a medication, if it is indeed covered by insurance.

[2] I have changed his name to protect his identity.

[3] If you remember from an earlier post, when we asked Dr. Smith about the recovery process, he intimated that I might be in the Neuro ICU for a ‘few days’ (true) at which point I’d be transferred to a general medical floor (also true).  Then I would be discharged home (untrue).  He then predicted that I’d be back to work in 2 weeks (it is now over 15 months after the surgery and I have still yet to return to work).

[4] My wife and I have made several attempts to ascertain Dr. Smith’s operating room experience, including his expertise in the field of posterior fossa tumors but have been met with an incredible amount of resistance with no records to show for our efforts.

[6] Surprisingly, my chair was level with theirs as a classic intimidation technique is to have the attender’s chair lower than the person running the meeting, this can be subtle or even unnoticeable. 

[7]Of course, like with everything else there are exceptions to this rule: Steve Jobs and Bill Gates simply wanted to make computing accessible, the money that followed was a byproduct of this desire.

[8]for example in my case– if someone else were in my situation and was told that they should go to their surgeon, with him/her performing many of these operations I would hope this would be the truth.  Unfortunately it seems that in my case, ‘Dr. Smith’ was not truly qualified for this sort of operation and should not have been ‘suggested’ for the operation).

[9] The total bill (including anesthesia, surgery, consultations, and hospital stay) was over $100,000.

My Wife…

For my next few posts I wanted to get the point of views of the different people involved in this whole ordeal.  I wanted to begin with my wife; in this post she recalls the day of my diagnosis:

My wife and son at  an animal exhibit in Florida
My wife and son at an animal exhibit in Florida

I was in a Bigby drive-thru about to get a coffee en route to my clinical site in a neighbouring city when Chris called.   He didn’t sound like himself.   His voice was wavering as he told me he was in the neuro-ophthalmologists office.   He went on to say he had been having double vision and it had progressed to the point that he was unable to work. He had told Dr. Pearson (his PCP, and also a faculty member), who had promptly referred him to Dr. Kaufman (the neurologist).   My whole body was already sinking as he went on to say with a breaking voice that the doctor thought the brainstem might be involved. An MRI was scheduled shortly.

I knew Chris didn’t want me to tell anyone else what was going on at this point, and I had patients scheduled in clinic – I couldn’t just cancel.   But I knew this was serious.   I proceeded to drive down to Mason, and as soon as I arrived I scanned my schedule. I asked around to see if any of the other residents in clinic could take my last few patients, but everyone had a full schedule.   So I personally called my 4pm patient and rescheduled – quite a bold move by me as we do not set our own schedules – Deep down I knew something was going be found on that MRI. Here’s why:

Chris had struggled with vertigo since I had known him, more than 12 years – we had met my sophomore year in college on the tennis team, and started dating the following year. Chris’s vertigo was positional, brought on by laying flat or looking up. The former meant he slept slightly propped up with 2 pillows and the latter was problematic when he served on the tennis court. He had seen an ENT when we were first together and it was thought to be BPPV (benign positional vertigo), special maneuvers were performed with no relief, and thus the ENT had recommended an MRI to rule out any masses. However, due to his vertigo and inability to lay flat, Chris declined at that time.   And I did not think much more of it for a while. Several years later, his sister, Amy, an Emergency Department physician had also commented that positional vertigo does not usually persist the way Chris’s had and thought he should get imaging and more workup, and as I got further in my medical training I better understood what she was saying.   In addition to the vertigo as the years passed I had noticed Chris’ poor balance, which always seems odd as he was so athletic. On the tennis court his groundstrokes were great, but he always seemed to be teetering backward/sideways after his shots – his balance was his weakness. In Dominica, on a hike up a river bed in the jungle, while others scampered up the rocks, we were left waiting for Chris as he stumbled his way up – I wouldn’t let him hold our son while we hiked. And more recently I had noticed there were times at home he would seem to stumble for no reason.

This was serious… fortunately I had a very understanding and sharp attending that day in clinic. I briefly explained why I had to leave early. I expressed my fear; that he had had concerning symptoms for many years, and she wisely said the chronicity of his symptoms were a good sign.   My doctor brain knew this to be true, at the time I only felt dread. Speeding along the highway overtaken by both racing and paralyzing thoughts I mistakenly drove the wrong way, towards the hospital, and then had to turn around to go to the MSU clinical center. I remember at the time it seemed ridiculous that in all my rushing, I had gone the wrong the way.

My son and my wife- my wife is pregnant in this photo
My son and my wife- my wife is pregnant in this photo

I finally arrived in the clinic, slightly out of breath.   I saw Chris, his head between his legs in the small waiting room within the clinic. He looked up. I wanted to be strong and tell him everything would be okay. He was still waiting for the results of the MRI.   “The receptionist has scheduled an appointment with the neurosurgeon tomorrow morning at 8am – that can’t be good,” he said. We waited.

I don’t remember the exact order of things, but I do remember that Dr. Kauffman, a large man with a presence, was extraordinarily kind.   I think he first asked about Chris’ symptoms.   As Chris spoke my first reaction was sadness/hurt/shame all in one.   I knew it was self-centered and petty but I felt hurt that Chris had not shared his symptoms with me. He had been experiencing double vision for 3 days and I hadn’t even known. He reported noticing slurred speech for several months and hadn’t mentioned it to me. But then I recalled I had not even been present at home to allow him to. In the past 5 days I had worked two 24 hour shifts over the weekend due to a scheduling error for an intern, and the previous night I had stayed up most of the night working on a presentation that morning. The little time I had been home had involved me sleeping, working on my presentation, taking care of my son and a friend’s birthday party somewhere in the midst.   We had both been working hard, and Chris NEVER complains. I felt shame that all those symptoms he had been experiencing over the years had been pointing to a brain mass and I hadn’t done anything – I hadn’t pushed him enough to follow up. I felt I had failed both as a wife and as physician.

We moved to the room across the hall and, as I remember it, Dr. Kaufman said something along the lines of “I can’t be sure, but it has the appearance of a dermoid tumor, a benign tumor”, he went on to say “I don’t know if it can be removed or not”. He brought up the image of the tumor. It was large — taking up the expanse of the 4th ventricle and pushing on neighbouring, important structures. And it was obvious – a person without a medical background could have spotted it easily on the scan. As he talked more, the image seemed to stare at us. I didn’t want to see it anymore. I wanted to turn the screen off.

The office was now closed, Dr Kaufman had given us time beyond his scheduled day, and at the end of our visit he gave us both bear hugs. The hug stuck with me. It concerned me. I thought he said it was benign – but the hug felt like he wanted to express his condolences. We had come in different cars and as we walked out of the building into the parking lot, arm in arm, with tears in our eyes, it felt odd to have to drive separately home. We called Chris’ parents first.   They were driving home to Chicago from Omaha, NE and on hearing the news immediately changed course to Lansing. Chris’s sisters were next. Over the next few hours as the news spread, I was amazed at how Chris’ family stepped up. His older sister had contacted her friend from her undergraduate studies, a neurosurgeon for advice. His cousin, a surgeon, who was in France, at 2 in the morning was trying to contact surgeons she knew.

The next morning we anxiously arrived at our appointment with the local neurosurgeon. The visit was brief, but brought relief as he confirmed he felt this was a benign epidermoid tumor. He described the surgery, and recovery which sounded straightforward, 1-2 days in the ICU, 1-2 days on the floor, 2 weeks recovery total.   He seemed confident.   Little did we know what we were in for.

 

My older son, wife, newborn son, and I right after his birth
My older son, wife, newborn son, and I right after his birth

 

Then and Now part 2…

In the summer of 2006 my wife and I found out we were to have our first child.  Shortly after we also learned we would be attending medical school together.  Our main priority in choosing a medical school was that it be somewhere we could attend together.  We had difficulty finding a US based medical school that would take both of us and thus opted to go to the Caribbean for school at Ross University.  In April of 2007 we began our journey in medical school.  Before then, on Christmas evening of 2006, our first son, Christian, was born.  It turns out that Ross was an ideal place to raise a baby.  He was in a daycare during the day when we were in class, but the daycare was right in the middle of campus and the classes were scheduled so that we could see him frequently.  It actually worked out so that we didn’t have to provide the daycare with any food for him[1], as we saw him frequently enough that he didn’t need or want food at the daycare.

My wife, I, and Christian in his daycare at Ross
My wife, I, and Christian in his daycare at Ross

  At Ross, the students take all the basic science courses in their first two years in Dominica (i.e biochemistry, histology, physiology, etc.) and the 3rd and 4th year clinical rotations—where students get more hands on experience– are completed in the states (i.e surgery, psychiatry, family medicine, etc.).[2]  My 2 favorite rotations during this time were both Family and Emergency Medicine.  When it came time to decide which to apply for, several factors came in to play: I mentioned earlier that both my sister and mother are Emergency Department (ED) physicians, their involvement in the field almost made it a family business.  I believed that the lifestyle of an ED physician would be more conducive to family life, as spending time with my wife and son were of critical importance to me. Also, the salary is typically higher for an Emergency Medicine physician as compared to a Family Medicine physician.  Thus, I opted to apply for Emergency Medicine.  My wife had her sights set on Family Medicine.  When applying to residency, most programs offer something called the ‘Couple’s Match.’ This is a program for people in our similar situation: couples entering training who desire to be in the same place or program.[3]

Me during medical school, simulating a delivery, in Saginaw
Me during medical school, simulating a delivery, in Saginaw
Me and my medical school classmates in Saginaw.
Me and my medical school classmates in Saginaw.

Once I began my training in the ED I realized it wasn’t for me.  The hustle and bustle in the ED was too stressful.  Eight-hour shifts easily become 10-hour shifts and there is no ‘down’ time as an ED physician. The name of the game is productivity: in medicine this translates to how many patients you can see. You are caring for as many as six or seven patients at once (this number increases for more seasoned physicians) and you are constantly bombarded with questions from all angles and parties. Finally, there are always cases that you need help with[4], and for these cases you need to call for help.  NO one likes to be called at 3am no matter what the situation, and it seems these specialists (even though for the most part they are getting paid to be ‘on-call’) especially hate hearing from the ED[5], thus it’s not unusual to have a contentious conversation with someone you’ve called for help.  Please don’t get me wrong, if anything I now have more respect for people that can do this job[6], but I just realized that this work was not for me.  Thus, near the end of my intern year I made a switch from Emergency Medicine to Family Medicine.  I was moving along well in the residency, when one morning I awoke with double vision.  Then…well, you know what happened next.

————- After —————

Every day I am grateful to be alive and thankful that this mass turned out to be benign. Unfortunately, however, the removal of it has left me severely impaired.  The first deficit you’d notice when I walked in to the room is my slow and odd gait.  Where it might take five or six minutes for a normal, able-bodied person to walk from point A to B, it takes me double that time.  My gait is wide due to the damage the mass did to my cerebellum.[7] I now walk with my feet abnormally wide, in almost a shuffling pattern.  The next deficit you’d probably notice, if you looked me in the eyes, are that my eyes are slightly misaligned; in the area where the mass was are several nerves that control various functions of the eyes (i.e. dilation, constriction, and movements of the eyes themselves) damage by the mass to the nerves that control the muscles of eye movement impacted the way my eyes are aligned giving me some double vision.  Next, if I spoke, you’d note the delay in my speech.  It’s hard to describe my speech pattern except that it’s slow and doesn’t sound right.[8]  I’ve had speech pathologists tell me that they can detect issues with control of my phonation.[9]  Then, if we spoke long enough, or if you at all brought up a subject of discomfort to me, my head will begin shaking. This can last anywhere from five to seven minutes.[10]  Then as I walk away, you’d notice the giant scar on the back of my head (although I’ve been told that my longer hair now hides most of it).  Thankfully, all of these deficits are improving—I still walk slowly with a widened gait but now in therapy I’m able to jog (while holding the side rails) on a treadmill.  My vision is getting better day by day, and now as long as I have a second to focus on an object it stays single (I am still unable to track a tennis ball being hit back and forth without getting nauseous).  Various people tell me that my speech is becoming more and more coherent.  The scar will remain there for the rest of my life and will not change.  This is what a scar is by definition.[11]  I hope in the future it serves as the only reminder of this ordeal.

Me with my family at a wedding recently
Me with my family at a wedding recently


[1] Those who put their child in daycare might know that they typically need a day’s supply of either breastmilk or formula for the baby.

[2] The idea behind the 3rd and 4th years of medical school is two-fold: 1. It exposes you to the more practical clinical world and 2. It allows you to choose which specialty you will enter.  This is a critical time in any medical student’s life.  This is the time when you decide what you will be doing for the rest of your life.  I included a funny algorithm that sums up this decision.

This is the algorithm I am talking about
This is the algorithm I am talking about

[3] There are some stories from medical school where a significant other uses the Couple’s Match to break up with their boyfriend/girlfriend.  Luckily, in only a few instances, the significant other will choose not to enter the Couple’s Match and not let their boyfriend or girlfriend know.  Then on Match Day when the ‘Couple’ finds their destination are in separate places the fate of their relationship is discovered.

[4] This ‘help’ can range from a cardiologist for a heart attack to an admitting physician so the patient can be managed elsewhere in the hospital.

[5] As with everything, there are always exceptions to the rule; some physicians, as much as they hate hearing from the ED, realize that this is for the patient’s good, and that acting hostile towards the calling ED physician is an exercise in futility.

[6] In fact, as I mentioned in an earlier post, I now hate it when anyone puts down the ED.  Whether it be to admit a patient or because someone thinks they can do the job better, I hate it when clinicians even roll their eyes at an ED page.

[7] There are whole books just devoted to the study and the analysis of gait; different gaits can stem from injuries to various parts of the brain.

[8] I once overheard someone saying that I sounded like a ‘retard’.  Even though this was incredibly hurtful and not at all politically correct, it is the most accurate way I’ve heard my speech described—I do sound like a mentally challenged person.

[9] The cerebellum, besides controlling gait, also controls various fine motor movements.  The apparent simple act of speaking is a conglomeration of proper air intake, tongue movements, and very small vocal cord vibrations.  In fact studies of various musicians’ vocal cords shows that they are able to move their vocal cords differently than us non-musicians. It’s a long clip but worth it: https://www.youtube.com/watch?v=9MDn5GgyxyU

[10] See my previous posts titled Titubation

[11] Merriam-Webster’s definition of scar: http://www.merriam-webster.com/dictionary/scar

Then and Now part 1…

I take feedback very seriously and have had many people who read my blog ask me what my disability is.  “Chris I’ve been reading your blog, and am still trying to figure out what your disability is.  Your web address is www.handicappeddoctor.com but I don’t understand what your handicap is.”  I have given a lot of thought to this critique and how I could best portray my disabilities now.  I keep coming back to the conclusion that the best way to accurately describe my current condition is to tell you of how I was before this happened and then try to explain what it is like now.

 

—————- Before ——————

————– Birth ———————-

Much of this will overlap with information on the ‘About Me’ page on this website.  I was born in Minneapolis, Minnesota on the evening of July 3, 1982.  Both of my parents are physicians. My father is a Urologist and my mother is an Emergency Department doctor. I am the 2nd of 3 children with my older sister five years older than me, and my other sister being almost 2 years younger than me.  I grew up in Minnesota until I was 7, at which point we moved to Potomac, Maryland.  This was significant for two reasons: 1. This is where I began playing tennis[1] (a passion of mine that I would play competitively until after college) and 2. I had not been exposed to such diversity before in my life. 

———— Maryland & College ——————–

After living in Maryland for two years, we uprooted and moved to Omaha, Nebraska, where I would spend my adolescence.  Our frequent moves were due to job opportunities for my parents.[2]  I continued to excel in tennis until I was able to achieve and attain a top regional ranking[3] as well as a national ranking.[4]  My older sister created her own niche in music, performing as a solo violinist for Democratic candidate Michael Dukakis when she was 11 years old.  Her musical talents allowed her to gain acceptance in to Juilliard.  She had made up her mind, however, that she wanted to pursue a career in medicine and not in violin, and chose to attend Yale University instead.  My mother, whom I described in an earlier post, felt that Yale was ‘not good enough’ and began pushing for me to apply to Harvard University.  She thought that my talents on the tennis court combined with my academic marks could help me to get accepted there.  Upon hearing of the Harvard coach’s presence at one of these national tournaments, she sought him out and set up a meeting between us.  I would go on to attend and play tennis at Harvard for 4 years.  Besides having the opportunity to receive a top-notch education, it was there that I met the love of my life and future wife, Fleur.  My first day there, down the hall from my dorm room, I also met a future dear friend, Jesse.[5]  My younger sister, Alice, dabbled in many different activities in high school[6] before attending Tufts University.

Fleur and I
Fleur and I

————- After College —————-

Me playing tennis at Harvard
Me playing tennis at Harvard

Unlike my older sister, I was unsure if I wanted to pursue a career in medicine. So I kept my options open by completing all the course work necessary to apply for medical school while majoring in economics.  By the time graduation rolled around in 2004, I was still unsure of what I wanted to do with my future, but knew that I wanted at least to try my hand in the professional tennis circuit.  So for 6 months in 2004 (from June to December) I travelled to internationally[7] to play other aspiring tennis professionals.[8]  Near the end of the 6 months, I decided that I wanted to pursue a career in medicine.[9]  I then took several months to study for the medical school entrance exam (aka MCATS) and moved in with my wife in Brookline, Massachusetts.[10]   After taking the MCATS we moved back to Omaha where I began to work in the Creighton Diabetes Center.

This brings me to medical school and residency, which I’ll discuss in the next post.

My doubles ranking
My doubles ranking


[1] When I was 7, my older sister left for tennis camp, I had not played tennis before but was curious what took her away from me.

[2] My dad completed his training in urology at the University of Minnesota and subsequently took a job in Maryland, then at Creighton University, in Omaha, Nebraska.  My mother’s medical training provided her with more job flexibility, as she found work in every city we lived.

[3] The region, called the Missouri Valley, was composed of Nebraska, Iowa, Missouri, Kansas, and Oklahoma. 

[4] One of the perks of being among the top players in your region is that it gives you the chance to play national tournaments against other nationally ranked opponents.  In one of these tournaments when we were both 16 I played a top ranked boy named Andy Roddick.

[5] I mentioned Jesse, Jesse Oberst, in an earlier post.

[6] Including swimming, tennis, violin, and modeling.  She did not go beyond the high school level in any of these activities.  My take on that is this: she is far and away the most athletically gifted of all the Chiou members but perhaps dabbled in too many different activities to excel in one.  As Malcolm Gladwell would state, she could not attain 10,000 hours of practice due to her wide array of activities.

[7] People often ask me, what I took away from this experience:  my response is that I learned that I was not good enough to play on the tour, and that it allowed me to travel to places like Ecuador and Spain.

[8] I was able to achieve a professional doubles ranking.

[9] There is no ‘aha’ moment here, I simply decided that I craved human connection and helping others and felt that medicine was an optimal medium to achieve this.  Sure, my fledgling tennis career nudged me toward this decision.

[10] Fleur and I were wed in City Hall in Boston during my junior year.  We were already engaged before this, but due to visa issues married sooner in City Hall.  I was 20 years old when we married—I often tell people that I could not legally have a glass of champagne after the wedding.

Christian Interview Conclusion

This is part 2 of 2 of my interview with Christian…

Christian in downtown Chicago
Christian in downtown Chicago

Me: Do you like that dada’s been home more?

Christian: Yes.

Me: Because when dada goes back to work, I’ll be home less.

Me: What do you think of dada’s head shaking?

Christian: Really quickly.

Me: Do you even notice it anymore?

Christian: Kind of.

Me: When do you think it happens?

Christian: In the morning.

Me: The morning, that’s interesting, mama says in the night.

Christian: Really? I think in the morning you’re like this (he tries to imitate my titubation by bobbling his head). And even during the night.[1]

Me: Do you know that the only time you mentioned the head shaking was one time with grandma and grandpa and one time we were with Greg and Megha? Do you remember that?

Christian: Yes.

Me: Do you hope that it might go away?

Christian: Yes.

Me: Do remember me going to see Auntie Amy?

Christian: Yes, by yourself.

Me: So how do you like being a big brother?

Christian: I like it.

Me: What do you like about it?

Christian: That we have a baby.[2]

Me: Do you remember seeing dada in the hospital?

Christian: Yes, I was drinking grape juice and I saw dad in the bed.

Me: Do you remember dada not being home that much?

Christian: Yes.

Me: Why was I not home that much?

Christian: Because you had a surgery.

I included the audio files of my interview with Christian, you can hear our baby in the background…

 

 

 

 

 

 

 

 

 

 

 

 

[1] I’m not sure what he means by this, the shaking does not occur when I sleep.

[2] We were initially worried about their age difference (~7 years) but now realize that it’s an ideal age difference as Christian has been a huge help.