About Ugly Docling

I've been blessed with the adventure of a lifetime: medical school! In the hospital, I see humanity at its worst and at its best. I've been bled on, peed on, puked on. I've delivered babies, prevented suicides, even "cured" cancer. Through it all, I am learning how to tend to the suffering--with competence and confidence, but most of all with compassion. I write about my experiences, and welcome your feedback, in the hopes of bringing doctors closer to the society they serve. So please comment. Don't be shy.

Giving and Receiving Feedback

Feedback is a big part of residency training. Written evaluations have an impact on future training, employment, and promotion opportunities. In most programs, faculty and residents aren’t taught how to give feedback, and, as a result, it’s usually done poorly.

I gave this talk when I was at Dartmouth, to help bridge a communication gap between our residents and attendings. What I am about to share is drawn from the literature on feedback in medicine and other disciplines, as well as from my own background as a Psychology major at McGill. The discussion below refers specifically to Radiology residency training, but the principles can be applied more broadly.

Feedback is a specific kind of communication: to share with another person the impact of their behavior. The purpose is to help the other person become more effective, as they change their future actions based on the effects of their prior actions.

We need feedback in any productive collaboration. When done correctly, it makes all relationships function better.

Feedback is not Yelp!
There is a common misconception that I feel drives most of the ineffective and inappropriate feedback we get and give: We rate attendings and residents like we would review a restaurant on Yelp. While we may feel that we are doing the natural and helpful thing by giving a very straight-forward judgment of someone’s performance, for example “This person is unfit to be a radiologist because X, Y, and Z,” it’s actually unprofessional and unproductive. In our workplace evaluations, we’re NOT supposed to be warning other customers to avoid this establishment! We’re supposed to help all establishments thrive. We’re supposed to use this opportunity as a conversation starter about how things can be improved.

Ineffective feedback will go ignored.
In preparing my talk, I chatted with attendings and residents one-on-one, and heard from both sides that giving feedback is futile. They say the same things year after year, and yet no meaningful changes result. No matter how incompetent a resident is, that resident will still graduate. No matter how horrible an attending is at teaching, that attending will remain in their position. In fact, many feel that bringing up concerns only leads to retaliation. So, if anything, evaluations get more “toned down” and meaningless with each cycle.

There are a lot of reasons why feedback can be dismissed as invalid. Some of it has to do with our own cognitive biases. We generally hold a positive view of ourselves, and believe that we are competent, hard-working, worthwhile individuals. This bias allows us to live with our own shortcomings and to keep trying when we make mistakes.

In social psychology, there is a well-known phenomenon called “fundamental attribution error.” We judge ourselves differently than we judge others. We attribute our own negative actions to external factors (e.g., I missed a key finding because I was reading a high volume of cases at high speed, with frequent interruptions, and I was really stressed out!) We attribute other people’s negative actions to their own character (e.g., You missed a key finding because you are lazy and haven’t done enough studying.)

How to Give Feedback

When giving any kind of criticism, you’re delivering bad news. I use this term intentionally because “delivering bad news” is a doctorly skill that doctors take pride in. You have worked hard to gain this skill and should use it here! Tell a resident they suck at radiology with the same care that you would tell a patient they have cancer.

Everything applies in this analogy: establishing a good rapport, choosing an appropriate time and setting, sitting down, watching your posture and tone of voice, and gauging the other person’s reaction at every step of the conversation. You must come to an agreement on the diagnosis, and only then can you move on to form a treatment plan. You cannot just blurt out, “You have cancer!” in the waiting room. You cannot just jot down the diagnosis in the chart and never have an open discussion with the patient. You cannot give critical results without alerting someone.

For feedback to be effective, it must be well-intended, tactful, credible, and actionable. These principles are inter-related.

  • Your intention must be to help the other person to improve, not just to prevent them from being promoted. Malicious feedback is not credible and will not be heard or acted upon.
  • The appropriate time to give feedback is after a sufficient amount of time has passed to make an accurate assessment, and with an appropriate amount of time left to observe a change. Mid-rotation is great.
  • Nothing should end up in the written evaluation that hasn’t already been addressed verbally.
  • If you give a “critical low” numerical rating, such as a “1 out of 10” in medical knowledge, you should feel obligated to write a comment explaining your rating.
  • Be kind! Avoid judgmental labels. Nobody has gotten this far in life by being “dumb,” “lazy,” or “unprofessional.”
  • Use specific examples, not sweeping generalizations. Nobody can even begin to process a comment like “This person doesn’t care about patients,” so it will never result in meaningful change.
  • Use facts and observations as a start, but also include how the behaviors you’re describing make you feel so that the person can understand the impact of their behavior.
  • Speak for yourself! Don’t refer to other people’s views or “general perceptions.”  
  • Only bring up things that the other person has control over. If the behavior cannot be changed, bringing it up will only create resentment.
  • Keep your assessments within the scope of your role.
  • Don’t underestimate the power of encouragement. Residency is hard! Being an academic attending is hard! And most of us are already hard enough on ourselves!

In my full lecture I give detailed instructions, and I illustrate each point with examples of well- and poorly-written comments, both critical and complimentary, given by both residents and attendings.

I also break down and analyze the most common ineffective comments. For example, saying that a resident “needs to read more” implies you know the resident missed your pimp question because they didn’t read enough, and that spending more hours in front of a book would have fixed that problem. Perhaps they simply misunderstood your question. Perhaps they studied sources that contradict what you’re teaching. Perhaps they are so exhausted from staying up late every night reading that they can’t retain anything they’ve read. By passing a premature judgment, you are shutting down what could have been an opportunity to understand and mentor that person.


How to Receive Feedback

This part is just as important as the giving of feedback. Proper reception of feedback helps the person giving the feedback to feel heard, and validates the entire process. Your goal is to enact meaningful change in your own behavior and thereby to improve yourself. Even if your criticizer didn’t do their part correctly, try to do your part correctly. If nothing else, they are continuing to judge you as you react to their criticism, so don’t give them any more reasons to criticize!

  • Relax. Assume the other person is trying to help you, and it’s in your best interest to be open to suggestions.
  • Invite feedback in specific areas. It shows that you are receptive and self-aware. It also helps to keep the comments more focused, constructive, and useful.
  • Listen actively. Don’t defend. Clarify any vague criticisms. Summarize what you got out of your conversation at the end.
  • Take time to respond. If it’s a complex problem, telling the other person that you will reflect and get back to them will show that you understand the importance of what they said and really want to change.
  • Close the loop. Verify the plan, set a time for follow-up, and monitor the results together. This helps the other person be invested in your improvement and recognize your efforts.


This lecture should provide a platform for honest discussion and understanding between faculty and residents. Where people are willing to adopt the suggested methods, there should ideally be improvement in the quality of written evaluations as well as performance. However, because we are all human, expect this to be a slow process! It takes a lot of effort to give evaluations as a guide for improvement and not a means of catharsis. And some people will always be resistant to change. But at the very least, raising awareness of cognitive biases and communication flaws should help curb ineffective feedback from those who care, and at least put ineffective feedback in context coming from the rest.


Here is a PDF handout of this article:
Giving and Receiving Feedback

Merry Christmas! You have cancer!

Trauma CT


When bad things happen, radiologists tend to be the first to know. Anytime you ski into a tree, or drop your baby, or have a stroke, anytime you go to the ER and get an X-ray or CT or any kind of imaging, you are being seen by a radiologist who makes the diagnosis behind the scenes. In fact, with the exception of psychiatrists and dermatologists, I really can’t think of any doctors who could practice medicine as they know it without radiologists.

As a radiologist, my X-ray vision is skewed toward negative outcomes. Day after day, bad things happen to (presumably) good people. This year I worked the weekends of Thanksgiving, Christmas, and New Year’s, and I got to thinking about how many people had their lives ruined during the holidays.

On Thanksgiving, I saw a guy actively bleeding out from complications of a botched gallbladder surgery.

On Christmas Eve, I had to call several patients to tell them that they had breast cancer. I did my best to offer support and give them a plan for moving forward, but in the end there is just no appropriate way to say, “Merry Christmas! You have cancer!”

On New Year’s day, the first case I opened up was a head CT for a lady who went to sleep on New Year’s Eve and never woke up. She had a brain bleed larger than the brain that she had left.

Why do so many bad things happen on holidays, and especially on my shift? Because they happen every day. If I simply show up to work on a holiday, I am guaranteed to meet unfortunate people. And I’m also bound to interact with hospital staff who are grumpy about having to work on a holiday.

You can imagine that this can turn some radiologists pessimistic and paranoid. Our experiences tell us that skiing, horseback riding, and shoveling snow from rooftops are rash, often fatal, activities. So are pregnancy, driving long distances, and even walking down the street minding one’s own business. In our work, we never meet the thousands upon thousands of skiers who do not ski into trees.

Since I started radiology residency a year and a half ago, I haven’t done much writing about my job. I’ve been missing the meaningful interactions I used to have with patients as a medical student and Internal Medicine intern. No one who’s been through the process would say that medical school was a happy time, yet I wrote a book about all the times and places I found joy. Happiness was a commitment I made on a daily basis. I was really good at being happy!

The past year and a half have slowly taught me that even the most grounded and solidly-learned of lessons can be forgotten with disuse and complacency.

One of my Christmas cancer patients, on hearing the bad news, nevertheless told me how lucky she felt that I had been a part of her care. She said, “Dartmouth should be very glad to have you as part of the team. If you hadn’t been looking at my mammogram, who knows how much this cancer would have grown in another year.”

It had been one of the rare circumstances when, as a resident whose job is largely to duplicate the work of supervising physicians, I caught something subtle that my supervisor had missed. I had been feeling particularly ambitious that day, reading about twice as many mammograms as residents normally do in a day. I just felt an urge to push through all the patients that had been scanned that day. This patient came up near the end of my list. The “normal mammogram” report had already been sent out. We immediately called her back for further imaging and then for a biopsy, and sure enough, it was cancer.

It was the first time since starting residency that I thought, “Thank goodness I came to work today!”

I’ve since tried to take that attitude more often, acknowledging and valuing the good that I can bring to the patients who will never know I have been evaluating them. When I’m asked to interpret a study that feels too difficult, or contains a bad outcome, I try to remember that I may be contributing something that no one else can. And more often than not, I’ve felt grateful to have been there for that patient.

In 2016, I would like to renew my commitment to being happy in the things I have to do. Happiness is truly a choice. As I’ve learned, it’s a choice we must continue to make time and time again, no matter how well we think we’ve got the hang of it.


Happy X-Ray Day!

On this day in 1895, Wilhelm Conrad Röntgen discovered the X-ray.

V0029523 X-ray of the bones of a hand with a ring on one finger

He was a physics professor in Germany, and had been working with cathode rays. His experiments involved discharging streams of electrons through various vacuum tube apparatuses. In one of these experiments, cathode rays were allowed to exit the vacuum tube through a thin aluminum window. He covered the aluminum with black cardboard to shield the fluorescent glow, yet he still noticed the beams escaping onto a barium platinocyanide detector plate several feet away. Figuring he had discovered a new form of radiation that could penetrate opaque objects, he called it “X,” the mathematical designation for the unknown.

After various repetitions of the experiment with different tubes and metals, he went on to take the first clinical X-ray: a picture of his wife’s hand. The produced image was of her skeleton, as X-rays could pass through human tissue but not through bone. When she saw the picture, she exclaimed, “I have seen my death!” This turned out to be a prophetic statement, as she and most of the scientists who played with X-rays in the early days would eventually die of cancer.

Röntgen initially continued his experiments in secret because he feared for his professional reputation if his observations were in error. He published his initial paper, “On a New Kind of Rays,” in December 1895, and by January 1896 the news of X-rays had swept the world. Soon commercial fluoroscopes came to common usage in such unlikely places as carnivals and shoe stores. At the same time, X-rays found their use in various clinical settings such as surgical operations and diagnosing bone fractures.

Röntgen was awarded the first-ever Nobel Prize in Physics, and is recognized as the father of Radiology. Indeed, the whole medical specialty grew up surrounding his technology, now encompassing fluoroscopy, computed tomography, mammography, ultrasound, nuclear medicine, and magnetic resonance imaging.

Level Up






On my first day of Radiology residency, I was assigned a pager and a white coat with my name embroidered on it. I chuckled along with my fellow first-year radiology residents. “What are we supposed to do with these? Does anybody ever page a radiologist? What, will they want us to carry stethoscopes too?”

Now two months later, I find myself clinging dearly to any remnant or semblance of my former doctorhood!

It’s an abrupt and humbling change of pace, becoming a radiologist. Of all the medical specialties, this one is hands-down the hardest because it really is like nothing I’ve ever done in medical school, and I’m starting from scratch with minimal foundation from my previous education. I remember the daunting, sinking feeling I had while being told during orientation, “Don’t give up. You will see your senior residents nonchalantly spewing out diagnoses that you have never even heard of. Just keep studying.” After being at this so intensely for 5 years, how could there still be anything in medicine that I’ve never heard of?!

Only a couple weeks prior to this, as an Internal Medicine intern, I was running the hospital, making big decisions, receiving thanks left and right for saving patients’ lives, and frequently being reminded by my attendings how I was wasting my talent by going over to “the dark side.” Then all of a sudden, I was stripped of all my glory and confined to a dark room all day, doing something I sucked at and being told again that I was entitled to stupidity. To make matters worse, my first rotation was Fluoroscopy, which is not even like the rest of Radiology. The work involves acrobatic photography and heavy machinery; learning it is like learning to ride a bike in Boston during rush hour. Everyone was kind in helping me, but I couldn’t help anyone. My only dignity rested in micromanaging the lives of the Internal Medicine interns calling me for consultations; it was a pittance of consolation.

Since the beginning of July, I’ve been aching to be a good doctor again. All the studying is helping, but there is something more to be gained by experience—and in that regard, the years can’t pass quickly enough for my taste.

Thankfully, the learning curve is insanely steep, which means that I am constantly reaching new summits as I clamber my way up. It seems that every couple days I can look back and say I am drastically better than I was before. I owe a lot of this to the help of my senior residents; I am so impressed by them, and I’ve improved so much while trying to emulate them. The long list of things I’ve come to terms with over the last few weeks includes: abdominal radiographs, operating fluoroscopes, dictating reports when other people can hear, shouting out answers in large conferences, and talking to surgeons.

And lumbar punctures! Four weeks ago, I asked my neuroradiology fellow if I could observe him doing a lumbar puncture. An hour later, he insisted that I get right to performing my first lumbar puncture. I struggled through the next few, usually trumped by attendings who had the nasty habit of jumping in to complete the procedure. One attending asked in front of an already-nervous patient, “Does she even know how to use the fluoroscope?” I filed away these notable memories and kept asking for more. I just wanted to be good at something, even if it was something everyone else considered simple. In the second week, my goal was to do one without any physical help, and then without verbal help. In the third week, I started teaching my medical student to do the procedure. In the fourth week, I got to teach an attending who was out of practice. I went so far as to cut my own umbilical cord, telling my neuro fellow that I didn’t need him anymore (which I only hoped was true, knowing he wouldn’t let me live it down if it wasn’t). On my last day of the rotation, I did the whole thing alone within ten minutes, surprising an attending who had walked away expecting to see me still struggling when he got back.

Back when I first chose Radiology, I was attracted to “the intellectual challenge of having familiar concepts swept out from under my feet,” and now I get exactly what I wished for. Fluoroscopy is over. On Monday, I’ll be starting out as an idiot again; new rotation, new learning curve. I expect the stupidity cycle will continue for about six months before I get to revisit something I already know. At this rate, I guess I am starting to see how, in four years, I could totally be nonchalantly spewing out unheard-of diagnoses too.

Radiology Personal Statement

Two years ago, I embarked on the exhausting and exhilarating journey known as the 4th year of medical school, where residency programs and applicants court one another for a season and dreams are made or broken. As the newest generation of 4th year medical students (including a few of my own “doclings”) now bravely set forth on this path, I thought it would be appropriate to stand with them by doing something brave, too—publicly posting my personal statement. After all, it was through writing this personal statement that I became convinced I needed to apply for Radiology. I hope my words will prove helpful to at least a few people who feel, like I did, doubtful and overwhelmed at the start of a long year.


I am so happy to be choosing Radiology as the path to becoming the kind of doctor I’ve always envisioned: smart, cooperative, and compassionate.

I love that Radiology is “brainy,” requiring great mental power and flexibility. Radiologists are central to the practice of medicine, as diagnoses and treatments so often pivot on the proper understanding of imaging. Of course, as a proper Physics geek, I am intrigued by the technology that continually increases our ability to know more and diagnose more. But what I love most about being on the cutting edge is the intellectual challenge of having familiar concepts swept out from under my feet. It’s not enough to memorize the pathognomonic patterns—those may change along with advances in imaging modalities. For radiologists, there is a real advantage to reasoning by principles and not by rules; the difference being that a rule may forbid stepping off the roof, but the principle of gravity also extends to not jumping off a cliff.

I want to be a good colleague, one who uplifts and brings out the best in others. I’ve seen how a good radiologist can turn others into better doctors. During my Internal Medicine rotation, a very patient Radiology lecturer introduced me to the Physics principles of imaging and systematic approach to reading films, which opened my eyes to a new level of reasoning and sparked my interest in becoming a radiologist. In learning how shadows translate from densities, and densities from pathology, I finally began to illuminate what I previously saw as a mystery in medicine. I realized that there is an order and logic behind the shadows, revealing the answers to those who understand. I am excited not only to gain the diverse knowledge and skills that radiologists employ when consulted by physicians of all specialties, but also to continue working as part of a diverse team.

I want to be a good person, one who respects other people regardless of where they stand in the hierarchy. I love that Radiology, far from being an antisocial desk job, requires clinical skills and bedside manner. I was impressed that of all my mentors, it was a radiologist who stressed the importance of cleaning up my own sharps and treating nurses with respect, and who, in answer to a 90-year-old lady asking if he would recommend the thoracentesis, considered his own wife. Even though it may be easy to dehumanize the dozens of scans that populate the computer screen each day, I will not abandon my philosophy of what it means to be a doctor: to heal and affect positive change through personal relationships. I’m happy to know that a dark cubicle does not preclude this, but rather makes it even more important.

As I reviewed my experiences to choose my future, I realized that the answer lay much deeper than, “Do I like thinking or cutting? Do I want to treat diabetes or gallbladders?” What it took for me to love all my rotations was a good attitude, a strong work ethic, and a commitment to being happy. I know these qualities will serve me well in the difficulties that I will undoubtedly encounter in my career. Ultimately, my decision is based on the kind of person I want to be, and I look forward to residency as the next step in shaping that person. In this regard, I am seeking a program that will expand my boundaries, where I will grow intellectually, work as a productive member of a supportive team, and provide excellent patient care.


Heralded by screaming lights, a man was dropped on our doorstep. Sepsis. Diabetic keto-acidosis. The brink of death.

He was also cachectic from decades of drug abuse and malnutrition, and didn’t have much reserve to fight the illness. He was struggling to breathe. He looked on with hollow eyes. We knew right away he wasn’t going to make it through the night.

Because the foreseeable outcome was so extremely grim, we were upfront in asking this man exactly what he wanted from this hospitalization: How did he want to die? Would he have us pave for him a comfortable end? Or would he have us wring out every last drop of frail existence before throwing in the rag?

To our surprise, he didn’t give us permission to let him go. In previous months, his life had been repeatedly spared in hospitals. But each time, he was restored to lessons unlearned—if he was better, he was better enough to overdose. So said his family, but he didn’t believe it.

So onward we fought.

These are Medicine’s most trying moments. I have sent off many people from this world, now—always when they’re ready, and sometimes when they’re not. It’s humbling and gratifying to be the last friend in a well-lived life, the one to bestow a parting IV and hospital blanket in the final glow of sunset. It’s frantic and dissonant to be the desperate arm over the cliff, the one obliged to hang on until the last futile chest compression. So often I’m assigned the latter role by patients with too many regrets in too little time.

Miracles are doled out too, in small packages of insulin and antibiotics. This man survived to wake up tied to a hospital bed, and—this is the miracle—to think to himself, “This ain’t me.”

The next few days were excruciatingly painful. We gathered everyone—patient, family, and doctors—to have a big heart-to-heart. The man expressed his resolve to come off all narcotics forever. The family had heard it all before. The medical team decided to test his resolve by taking away his pain medications gradually. We had legitimate reason to be skeptical, as he had legitimate reason to be in pain. Every morning, I asked about his pain. The answers went from “Okay” to “It’s 8 out of 10, but I can get used to anything” to “It was more than I could take last night, but I’m bound and determined to do this.” I don’t know how, but every day his smile grew wider and he was able to walk farther. All the while, his severe joint deformities were a constant reminder of his strength in coming face to face with this pain for the first time in so many years.

He later told me of the transformation that came over him. The morning light was breaking through the blinds. He was strapped at his waist. The nurses were eerily quiet in the hallway. He thought of what we had told him, that we expected him to die from the consequences of his habit. “I haven’t been scared since I was in Vietnam crawling through the jungle. But that night, I was ready to put on my street clothes and run!”

I don’t know if all this will last. But thanks to him, I’m willing to give a second chance to many more of my future patients. I wouldn’t have believed that, with either his body or his mind, he would make such a recovery. Now I’m starting to think I’m in Medicine to be proven wrong—and, in the process, to be made better.

Graveyards In A Hospital

I survived my first week of doctorhood! And, more importantly, so did my patients!

During one of our orientation lectures, we were told that as interns, we are “entitled to stupidity.” Despite all that we’ve been doing the past 4 grueling years, no one expects us to know anything right now. Therefore, we should take advantage of this time to ask questions and make mistakes… you know, as long as we don’t kill anybody.

Well, that’s awkward! In any other profession, I feel like “Don’t kill anybody” would be setting the bar pretty low. Granted, outside of medicine, customers generally aren’t dying to begin with; when people walk into a grocery store, they aren’t complaining of chest pain. But I’ve read enough textbooks and passed enough exams to know how not to kill any given patient, don’t you think?!

I changed my mind at about 3AM today.

My first shift covering the hospital’s Medicine service was overnight on a weekend, after a full regular workweek. Having never even pulled a true all-nighter in college or medical school, I had no idea how this would go. At 7PM I showed up to meet my day-shift counterpart. He was holding a handful of lists, and after about 5 minutes of brief introductions, all 25 or so patients on those lists became mine. That was a chilling moment!

I took the lists, and a slow deep breath. I asked, only half-jokingly, “Are you sure you trust me with all your patients?” He said, “Of course I trust you!”

By midnight I had admitted a couple more patients from the ER, written a handful of orders, and successfully fielded several pages from nurses. I’d finally gotten used to introducing myself as “Dr. Meservy,” and I was starting to feel like it too.

At 2AM, my fellow night intern and I were sitting side by side, typing up our notes on the new patients we’d admitted. I was trying to read up in the literature about my patients’ conditions so I could incorporate good reasoning into my notes. I was constantly interrupted by the pager. Neither of us could stop yawning. We agreed that pulling a life-saving all-nighter was just about the craziest thing anybody had ever expected us to do.

Shortly after 3AM, I received 3 consecutive pages from the same nurse. A critical lab value! Something might kill a patient! After calmly telling the nurse that I would call her right back, I ran over to my senior resident and asked, “WHAT ARE WE GONNA DO?!” Together we made a slew of fast decisions that ultimately reversed the danger and stabilized the patient. This was followed by more deep breaths and more note writing.

In the morning, our management was met with both praise and criticism. We did the right thing overall, but we overlooked some minor details and we didn’t meet everyone’s preferences. In the daylight, our little mistakes became blatant. But in the moment, we were scared and tired and didn’t have much time to act. If the situation had been more critical, with less room for error, maybe it would have made the difference between life and death for that person.

This all leaves me wondering, was it in a hospital that they came up with the term “graveyard” shift? Now I know: if somebody were to get killed, this is probably how and why!

Kids Say…

Shortly after my book was published, I was invited to speak to an elementary school class about what it takes to a book. I talked about plot creation and the publication process, and shared some of my stories.

The kids surprised me by writing some PRICELESS thank-you letters! Here are some of my favorite lines:

“I really like how you overcame being called a nerd and made fun of because you are Chinese. I think it is really awesome that you helped save a man from dying just from your knowledge in Chinese. That is very inspiring. Go nerd kids!!!”

“You showed me to be proud of who I am.”

“I am so thankful that you presented to our class about the most crucial elements to writing a book and how to go about it. It had fascinated me for months previously and I had been wondering how, and I had absolutely no idea at all!”

“How you incorporated your stories in with duck features, such as ‘worked my tail off,’ was great.”

“I do hope you become a famous author, or even a famous rich author!”

“I liked the story about the thought-to-be-crazy Mandarin person. I liked how you could save him from psycho treatment.”

“The stories that you told about the man who lost his tongue yet every day found something to smile about was sad and had a good morale. I hope I every day have something to smile about.”

“My cousin is in medical school. It sounds hard for her and it must have been even harder for you.”


So, it’s been a month since the book was launched, and I happen to know that roughly 200-300 people own copies of it! Has anyone finished reading it yet? What are your thoughts?

Why I Chose Radiology

One night, months or years ago, my husband looked up from a collection of short stories he was reading, and said, “This one is interesting. The protagonist is a radiologist.”

To this, I laughed out loud. “Why would the protagonist be a radiologist?”

Judging by the lukewarm reactions I’ve received this year when I’ve told people that I was going into Radiology, I suppose most people feel the same way I did: that there is nothing interesting about a radiologist.

Don’t get me wrong, I absolutely adore Radiology and honestly feel that I’ve made the best possible career choice. But, given that my interest in Radiology did sneak up on me at the last minute after I’d already changed my mind half a dozen times between other specialties, perhaps I owe everyone an explanation.

In the beginning, as I’ve mentioned, my intention was to be a neurosurgeon. I never felt like it would give me the life I envisioned, but the work sounded challenging and heroic, and that was what brought me to medical school. I quickly realized that being away from my family for 120 hours a week was even less tolerable than I imagined. The neurosurgeons I met on my Surgery rotation, though very nice, made it clear to me that working one-third time (a normal 40-hour workweek) was not acceptable, even for a woman. In fact, I got the impression that having ovaries was entirely incongruent with Neurosurgery—people simply didn’t make time for babies and lives in that field. A Surgery resident gave me this valuable piece of advice: “Is there anything else that you like besides Surgery? Because you should do that instead.”

Then I thought for sure I would be a psychiatrist. I loved brains. Surgery was invasive, but Psychiatry was also invasive. Coming from a Psychology undergrad, analyzing people was second nature to me. The patients were interesting beyond belief, and I found plenty to write about, so I knew it would make an entertaining career. In particular, I felt at home with the idea of being a child psychiatrist—I had a knack for working with children, and I was inspired by their ability to heal and overcome. But I did not know just how difficult it would be. Halfway into my Child Psychiatry rotation, I was exhibiting symptoms of PTSD. I begrudgingly admitted that I did not have the mental resources to cope with the side effects of being a child psychiatrist.

Next on my list of “brainy specialties” was Neurology. I considered it only briefly. It wasn’t part of the curriculum, so I didn’t get a fair chance to explore it beyond my dealings with stroke and seizure patients. From what I gathered, the diagnostic aspect of Neurology was highly complex and elegant. But the treatment aspect was almost non-existent—for all the time spent figuring out exactly which part of the brain was damaged, there was usually nothing to be done about it.

From there, Pediatrics was a no-brainer (you guessed it—pun intended.) Cute sick kids, stuffed-animal stethoscope covers, doctors acting goofy in exchange for a peaceful listen to the heart and lungs. The idea of being happy all the time won me over almost instantly. Plus, this opened a new slew of possibilities for subspecialties: Pediatric Cardiology, Pediatric Endocrinology, Pediatric Whatever-ology. Since each of these would entail an additional three-year fellowship after residency, I was secretly buying myself more time to really decide what I wanted to be. (What? I like to dilly-dally over life-changing decisions!) It was a great plan, and I felt confident enough to start telling everybody about my decision. This was mid-January of my third year, and many of my classmates were jealous that I’d made up my mind so early. I went forward with it, collecting recommendation letters and setting up visiting internships, until August.

Because I kept telling myself that I loved children and hated adults, as pediatricians tend to do, I thought I was destined to hate my Internal Medicine rotation. As it turned out, I loved Internal Medicine because it was the first rotation in all of my medical training where I felt like I was personally and legitimately a doctor. Much of that feeling came from being introduced to the systematic approach to reading a chest X-ray. We were taught by a pulmonologist whose hobbies happened to include Radiology and Physics. He opened his first lecture with a discussion of radiographic density. I believe “density” was the word that changed my destiny—it activated my inner Physics geek and thereby illuminated what had previously been a black box.

Radiology is glossed over in medical school. This is a mistake, because Radiology is ubiquitous and crucial to the practice of medicine—rarely is a diagnosis made without some kind of imaging. I may not have considered radiologists to be real doctors at the time, but I wasn’t about to call myself a full-fledged doctor if I didn’t have a proper understanding of Radiology. So I scheduled two full months of it right in the beginning of my fourth year.

Those two months were tumultuous. I started out with a lukewarm feeling: The work was engaging to varying degrees depending on who was teaching me, and sitting in a dark room all day was marginally tolerable. I often felt like I was watching other people play a video game that I didn’t understand. That is, until one of the radiologists handed me a textbook to leaf through when times were slow. It was the best book I’d ever read in medical school, and I was raving about it to my husband when he asked for the millionth time if I was going into Radiology already. (My husband is himself a huge fan of Radiology.) I retorted that I did not come to medical school just to sit in an office and be nobody’s doctor. But as I became more and more intrigued by what I was learning, I found myself in a dilemma. I started to question my commitment to Pediatrics, and indeed my whole paradigm of doctoring.

It was at this time that I re-read some of my old blog posts to start compiling this book, and I came across a piece I’d written about how to choose a specialty, called “How To Make Lifelong Decisions: Don’t Compare Apples to Oranges. Just Make the Lemonade.” I had forgotten all about this, and it took me completely by surprise. Apparently, I had figured out at some point that choosing a specialty wasn’t about the nature of the work so much as about the kind of person I wanted to be—and I knew, undeniably, that radiologists were exactly the kind of people I wanted to emulate. Besides being the smartest of the smart, radiologists were sensible, sociable, happy, and generally wonderful to work with. And they all loved their families very much.

So then my gears were churning frantically. I only had a couple weeks left to submit my residency applications, and I had everything set up for Pediatrics. Radiology is a much more competitive specialty, and I frankly wasn’t sure if I would be able to get in, especially with such little preparation. I finally came to the Dean of Student Affairs, Dr. Dupey, whom I consider the “Sorting Hat” of my medical school and to whom I give full credit for ensuring that we all match into residency. She looked at my credentials and gave me the thumbs up! I still wasn’t 100% ready to burn the bridge on Pediatrics, so she challenged me to write a personal statement for both (which I’ve included in the following pages.) I found it extremely easy to say why I wanted to go into Pediatrics; that essay took me about an hour. The Radiology one took me an entire weekend. I thought really hard, I got frustrated that my writing was inadequate to express my feelings, and I cried a lot. But when I emerged from this process, I was convinced that, one way or another, I would be a radiologist.

Seven grueling months later, I opened an envelope that fulfilled all my hopes and made all the trials worthwhile: I am going to Dartmouth to become a radiologist!

Woohoo! I made 3 sales!

I must admit, being an author is pretty awkward!

The book was launched this week, as many of you know. But then again, many also don’t know, because I’ve been absolutely terrible about spreading the word. That is my flaw #1 as an author: I am afraid. I tremble at the thought of anything that resembles self-promotion in any way. Instead, I expect everyone I know to read my mind and to ask me about my book so I don’t have to be the one to bring it up in conversation. Anyone who doesn’t read my mind in this way, I assume would not be interested in reading my book.

I even had a book signing! I was told a little bit beforehand about what this would be like for an unknown author. Basically, I would be sitting at a table with my pen and stack of books, and people passing by would try their best to avoid eye contact. Well, my event was part of the medical school graduation festivities, sponsored by a local health foundation, and took place at an art gallery; each of these organizations brought in guests who obviously took a special interest in the art of healing. There were three other medical students showcasing their works of art as well, so we all had families and friends in attendance. Notwithstanding the unusually safe and supportive environment, I still at times had the experience described above.

What I find so dreadful about this new experience is the constant guilt about “selling something,” EVEN THOUGH I’m donating all of the proceeds to charity and I won’t see a penny of it myself! I have loved writing and sharing my stories over the past two years, and I am extremely proud of having accomplished one of my lifelong dreams of writing a book. It was a tremendous amount of work compared to writing blog posts. But suddenly, I’ve turned from an awesome writer to a saleswoman. Seems a little counter-productive, doesn’t it?

Let me just say I’m really glad that I have a real job where I earn a living by showing up and doing what I’ve agreed to do. If my life were to depend on me selling my writing, I’m confident that I would just starve to death.