Steve Jobs

Just about anyone I’ve spoken to knows that I was reading Steve Jobs by Walter Isaacson because I raved about the book to EVERYONE. I finally finished it last night. I was reading the Kindle version so it’s hard to approximate how much of the book was devoted to references toward the end (according to the %, it should be ~25%), but I was definitely reading the book non-stop for at least a week and it still took me that long to finish it. Regardless, I loved the book.

Disclaimer: I am NOT an Apple fan (I don’t own a single Apple product). I am not a techie person at all. And I definitely hate biographies. What honestly convinced me to read it was the insanely high # of positive reviews on Amazon and Goodreads and the fact that it was already loaded on my Kindle.

So you can assume that the fact that I loved this book says something either about the subject matter himself or about Isaacson’s writing style (gonna go with the latter since the main reason the book was great was due to its almost gripping/dramatic/cliff-hangery style). Some people think that this may all be some great marketing ploy, but Jobs never even got to read the book let alone make edits to it before it was published (the only part he played was in deciding the cover, which is hilariously quintessential Jobs). I think Isaacson did a brilliant job in gathering numerous resources to present an unbiased view of Jobs. I loved reading about how Apple and its products came to be, the development of Pixar, and Jobs’s way of managing a company and how he saw the future. I think all of it in itself was very inspiring. For example, I’d say here are some life lessons I picked up myself:

1) Do something you’re passionate in. Seriously. You’ll never achieve the same level of success if you’re just doing something for money — as was shown by Sculley’s leadership of Apple in addition to Microsoft’s downfall. As Jobs repeatedly mentioned in the book, he was trying to create a lasting legacy of a company and great products, not a profit. He also wanted a team of people who were equally passionate about the product, and as he said, when you put A players together, they like to play together to make great things.

2) The reality distortion field — if you think and believe and act like something will work, it will. Probably this follows point #1 in that when you really put your mind behind even the craziest ideas, you can make the impossible possible.

3) Focus. This goes back Apple’s rise to power, which was generated because Jobs realized that he had to focus on only a few products to make them excellent. I noticed that other companies are doing something similar now — for example, much to my chagrin Google decided to boot out Google Reader because they wanted to focus on other products (they also eliminated Wave, etc). I think we all know deep down that when you focus on a few things, you’re better, but it’s nice to get that refresher once in a while.

4) How you present yourself and behave is important. That includes Jobs’s strong eye contact, the way he could turn on charm when he wanted to (and equally turn it off to get you to beg for it back), the way he built his company and himself on design and simplicity and perfection and sophistication. It also includes some of his flaws. Be honest (like he was) but you don’t need to be nasty or rude to achieve your goals (as he learned later). Don’t abandon your family either. Take time for what’s important.

5) Take time for yourself. Maybe this wasn’t something Jobs was good at, but it’s definitely something I picked up as a lesson. He took walks all the time to think and discuss and tried to eat healthy foods (albeit to the point of crazy sometimes). And he admitted himself later that it was probably when he was taking on the role of CEO of Apple again plus running Pixar that he overworked and began to experience health problems. In America’s capitalist society we’re trained to be robots, keep pushing, be better than everyone else, sleep less, do more. But the thing is, we’re humans and unfortunately (as I also learned the hard way), eventually we get sick, and you HAVE to stop. If only we could all learn that lesson before it was too late.

I also noticed I have a weird connection with the guy. We love perfect things. We like white. We like clean. We like obsessing over fonts. It’s great! (however I prefer sharper edges and not rounded rectangles… and that’s why I don’t like iOS)

Personal updates — I know I’ve been MIA. Med school does that to you, I guess. I finished my first year. It was incredible. Long, stressful at times, but amazing and exactly what I wanted. I’m happy with where I am. I love my friends and my peoples and I’m enjoying exercise (!!!) and I love my kitty and I feel so calm and blissful. It’s great!

Intro to Anatomy thoughts

Before we first went into anatomy, we were asked to describe our feelings for a word bubble. I chose “epinephrine”, probably because I’m a dork, but also because it was accurate — I wasn’t really just anxious/nervous/excited, I was a bit of both, and all I felt was my heart rate speeding up and slight sweating and just adrenaline. I wasn’t sure how to feel. In the past, I’ve shadowed many surgeries, and I was never nervous around operations on open bodies. Something about the fact that we’d be with dead bodies, however, made me feel… eerie? I didn’t know what to expect. All I knew was that I wasn’t alone in my feeling in the room.

As we changed into our scrubs, I felt the rush more. I frustratingly tried different combinations to get into our lab until I finally got in, and I was the first girl. The minute I saw the body bags, all I wanted to do was find my body. Immediately, I adjusted. I didn’t even notice a smell, although I’m sure there was one. When I found my body, the bag was partially cracked open, and it was all I could do to keep my hands away from the bag so I could open it all the way.

I wanted to wait until after our first true lab and dissection to see how I felt, and I suppose intuition always wins — I love it. Before the class, we watched a video about what it meant to donors, and many talked about how they wanted to be more beyond their deaths, how they wanted to keep teaching, etc. As desensitized as I am to the whole “OMG, there’s a dead body in front of me that I’m cutting into” feeling, I haven’t stopped forgetting what a gift it is for us to be able to have these cadavers. Even in my fury of excitement as we reflect muscles and palpate structures, I still think about how lucky I am that someone was so kind enough to donate her body to me to let me learn and further my education. I have never had any anatomy — I’m not even kidding. I never even had to memorize the bones or the muscles of the body when I was in elementary school. I’ve literally had no anatomy. So in addition to learning this whole new language of terminology, I’ve also had to learn about where things are, what they are, how they are, etc. I won’t lie, it’s been tough. I spend hours on the pre-lab readings hoping to identify as many things as I can on various forms of art/pictures. In the end, there’s nothing like learning from touching the muscle in my hand or feeling the bumps of the spinous processes. I’m so thankful to the donors in our program that they are able to help me learn anatomy.

One of the cooler things to me too is how everyone’s body is so different. My friend and I were discussing how something that you’d even think you’d take for granted, like the number of vertebra, can vary between human to human! What does that mean for evolution? Who knows. I think it’s fascinating that you can try to extract someone’s life and story from their body postmortem. My program doesn’t let us know about details of death (or life) until maybe later, so it’s truly all a mystery to me. But I know that even the basics we’ve seen already reveal much. For example, I now know that if I were a cadaver, I’d be a pretty boring dissection since I’m probably all bone and fat with very little muscle. That sucks. I really need to work out more. I may not have exciting skin lesions on me, but I have had enough sun exposure that I may have some macules worth checking out. Is my story cool? What would future students know about me? Here’s a girl who either goes outside a lot or is extremely sensitive to sunlight or doesn’t wear sunblock (middle is true). Here’s a girl who clearly avoids the gym (true). Here’s a girl who is really frail — why? What happened to her? (kidney failure) I just think that’s so great that you can guess at all these stories about someone.

I’ve so long wanted to donate my body to future patients that I never thought about another purpose for it. But as someone said in our video, what if your organs aren’t the best organs? (e.g. cancer/other diseases, you’re old, you’re missing some, etc.?) Is there any other way I could give back? Probably. I think it would be pretty great to donate my body to medical education if I couldn’t put it toward live patients. I’d hope that they would respect me as much as I respect my cadaver, but even so, I’d be dead, and the best I could hope for was that these future students would get something out of my body.

A Glimpse into Oncology

(NOTE: all identifying patient information is excluded and/or has been changed. also these are patients from different locations, different doctors, different departments, and different times in which I’ve seen them… I’m truly trying to minimize ability to identify them. If anyone thinks these are too personal, please tell me so I can remove it. Thanks!)

[1] We’re called up to the hospital because the doctor’s patient was recently admitted. First we look over her scans again. Although I have close to no experience reading images, even I can see the abundance of round balls in the brain that probably shouldn’t be there. It looks bad. Doctor sighs. The resident thinks she’s done for. Doctor agrees; the patient has at most two weeks left. We rush up to the room just to let her know that we’re here for her if she needs anything. She’s frail and old but she’s smiling. Does she know why she’s been hospitalized? Maybe she does, and maybe she’s made peace with it? Or is this a coping mechanism?

[2] A team of us load her onto the apparatus. The doctor and resident place the scary-looking metal devices into the patient. She’s on her last round of radiation for her cancer, and she’s clenching her teeth and gripping my hand. I don’t feel the pressure of her grasp because all I can think about is how brave she is and how much this must hurt. After, she’s crying. We tell her she’s so strong, and she’s so happy because she’s done for the foreseeable future.

[3] We walk into a cold room where a man is being strapped into a glass frame. He’s on harnesses and chains and velcro, and I can’t help but think that it looks oddly like someone in a Houdini water torture cell chamber. Still, he’s grinning. He’s about to get blasted with full-body radiation in preparation for a transplant that might save his life. I could see that being something to smile over.

[4] I see a survivor. He wears his hair long, perhaps proving his success and how he no longer needs chemo. He was diagnosed with his cancer decades ago. Genetic analysis showed that he had lost p53, a critical tumor suppressor gene that is implicated in many cancers. Doctor said, it didn’t look too great for him. He took his drugs and got his stem cell transplant. With the transplant, there’s risk for another blood disorder that could develop into cancer (myelodysplasia). They’ve been following up on him, but he’s well beyond the time frame in which post patients develop the side effect. Doctor thinks he’s “cured” (I hear that word is never used in oncology). It makes me wonder — when I’m ten years out from my disease remission, am I “cured” at last too? Or will I keep having to make routine visits to my nephrologist? When do we get “cured” from chronic diseases? (Is that even possible?)

[5] I’m so impressed by how positive she is. She has papers with questions and appointments, and she’s so on top of her disease management. She’s also curious about her imaging and asks us to teach her about what’s going on. In a way, it reminds me of me. It also reminds me of previous patients I’ve seen; isn’t it so intriguing how some patients end up learning so much about their disease that they could almost be specialists in that field? I was so in awe of her energy that it took me by surprise when she asked about her eyesight. It had been growing worse since her treatment, and she wanted to know the prognosis. She wanted to go back to her normal life. I looked at the doctor. He told her it was unlikely she’d regain her vision. She started crying. In those few minutes I saw everything about what we’d been learning in the past few weeks about “breaking the bad news”. It makes me wonder what happens when you are at the crossroads of quality vs. sanctity of life. I can’t imagine ever losing my eyesight and how distraught I’d be. But when you’re fighting a disease as aggressive as cancer, there are casualties. When do you draw the line? I really don’t know what I’d do if I had to choose.

Wisdom from class

Ugh, I should really write my Berlin post. It feels like at this point, it’d be a waste, but I do have it all written out in my Moleskine, so the only thing that’s holding me back is pure lack of time (or perhaps laziness).

We’ve been learning about cancer this past week (and this coming week). Thankfully, I still think it’s a field I’m open to (as in I haven’t been grossly proven wrong, whereas with some other fields, I definitely feel a huge aversion to [esp. embryology… *shudder*]). Last Friday, we had this talk about end of life care. I thought it was going to be really depressing, boring (it was an out of class lecture), and/or stuff that I already knew. Somehow, it was a great lecture, probably the best of the ones we’ve had out of class and definitely better than some of the ones we get in class. The professor had this one GREAT quote that just shook me, which was “You cannot feel guilty about not being able to cure an incurable disease“. I don’t even know why this impacted me so much since I’m not doing any curing of any sort right now, but it just felt so revelatory that I had to share it here.

“Diversity” in med school

The big “day” has arrived; I’m finally in med school in my first year. It’s incredible. For all the awful thoughts I had leading up to (thinking I wouldn’t have any friends, I might fail out, it was the wrong choice), it’s been only fantastic.

Yes, I am lagging on Europe posts. Yes, they will come.

Yesterday was “Day 2” of our “fake” classes (we’re still in orientation). Our lecturer opened with this quote from Thomas Jefferson: “…but health, without which there is no happiness. An attention to health, then, should take place of every other object.” The point was that health is, well, important. Beyond that, we (students, me, lecturer) mostly moved on. My friend I was sitting next to, however, couldn’t settle on that quote. He brought it up as it was happening, and then later last night he brought it up again (I don’t understand how someone could think so long on a quote, but okay, I will go there). So we ended up discussing it, and this discussion brought up some unique points/observations:

  1. Definition debates exist for a reason — what does it mean to be happy? Content? Joyful? (we already chose physical and mental as the types of health)
  2. I’m more “S” than I thought (we just took an MBTI). See my “argument” later.
  3. Re: the title of this post — almost every medical school asks on their secondaries, what can you bring to contribute to the diversity of our school? It was very easy for me to answer that I would bring a patient’s perspective to my colleagues. At the time, I didn’t realize how important that was. I knew on some level that being a patient would give me a unique view on the practice of medicine, but it wasn’t obvious to me how different it would be and that I might actually bring something to the table until our discussion last night (the other two students were, to my knowledge, pretty healthy). The guy I was arguing with was pretty convinced that it was possible to be happy even without health. I agree, but I think it’s a narrow, naive, idealistic way of viewing it. Sure, I can be happy. In fact, I don’t know a single person who would say I’m not a happy girl. But the kind, quality, and level of happiness I feel is definitively limited by my body’s condition, always, and it’s something I never forget. As much as I tried to explain it to them what it feels like to live every day of your life knowing you (1) will never be cured and (2) are always limited in what you can do, I don’t think you quite get it unless you too are sick. So the third guy (other friend present) finally brought up this quote from F. Scott Fitzgerald: “It occurred to me that there was no difference between men, in intelligence or race, so profound as the difference between the sick and the well.” Apt.

As for my S argument, here goes. Assume the state of happiness one feels is on a sliding scale of points, where you can be 0 (neutral), +100 if you are super happy, and -100 if you are super upset. As a healthy person, you have the potential to access +100 and -100 (if we put those at the extremes). Maybe you don’t ever realize that potential, and the maximum you ever hit is +25, but you COULD hit +100. Now say you are sick. You can only hit +50 max now. Why? Several reasons. Maybe you’ve been beyond +50 before, doing something awesome like skydiving or riding a rollercoaster or getting to eat whatever you want, but now because of your health, you can’t do it anymore so you can no longer access +50 and beyond. Or, and this is a bit abstract, you just can’t go beyond +50 anymore because when your condition changed, your perspective changed. I mentioned in a previous post that patients, or at least I, try to rationalize what’s happening to me and cope with it by occasionally poking fun at my disease/body or often engaging in what could only be called morbid humor. In that state of shifting what you think is now “funny”/”okay”, your framework changes. You just CAN’T access +100 anymore. Everything shifts. What might be a +10 for a healthy person (like graduating high school) is a +40 for me because I didn’t think it would happen given my health. What might be a -30 for a healthy person (like getting a minor surgical procedure, getting a flu shot, getting your blood drawn) is a 0 or even a +5 for me because I’m used to this routine but I also think it’s cool (+).

So I’m a happy, sick person. I tend to usually be on the + side of things. I gained a lot from my disease in terms of “worldly perspective” so I know how to make myself happy — maybe I average +30. But I also know that if we went to Disneyland, I still can’t ride the rollercoasters so maybe the max I might get out of Disney is +50 whereas a healthy person could go to +60.

Overall, what I learned from last night is that it really is important to have people of a variety of opinions and backgrounds in your med school class because you will be learning much from them about how you want to practice medicine. People might moan and groan at that diversity essay (I did) but it’s there for a reason.

I’d like to conclude that I have no idea what my opinion is on that quote. I’m pretty sure I agree with it, but I haven’t thought about it enough nor do I care to) to make a conclusion. I only argued to extensively to play devil’s advocate, which is something I enjoy doing (a callback to my high school debate days). What are your thoughts? Do you need to be healthy to be happy?