A Look into the Medical Life

Aneesh Mazumder

So you have met David, but to introduce myself: My name is Aneesh, and I'm also one of the co-founders of HealthPath Horizons, which, as you know, is a Boston-based group dedicated to empowering low-income students to pursue careers in healthcare. And so what we're doing now is looking to interview people, either doctors or people generally involved with medicine, to write up stories of their real life journeys entering the medical field. And so we thought you'd be a great fit for one of these interviews. So I'm a rising sophomore like David, majoring in neuroscience and government, and I'm also interested in going into medicine. And I think a lot of our viewers will also be interested in going into medicine. So that's sort of why we reached out to talk with you today. And thank you for taking the time to talk with us today. So to begin with, could you share a bit of your background with us? We're interested in learning about where you're from and the environment you grew up in, because we believe every journey into the medical field is unique and valuable.

Dr. Wang

All right, thank you. Aneesh, nice meeting you. I'm glad to be here. Let me introduce myself a little bit. I originally come from China, and I'm from Peking Union Medical College, where I got my MD-PhD, and I also performed my residency training and became an attending at that hospital, which is the top hospital in China. And in 1995, I came to the United States to start my post-op training in SUNY, upstate New York. There, I also finished my board exam and got matched to a residency. So I received a few years of residency training, and then in 2006, I came to MGH. Currently, I'm an anesthesiologist attending in the MGH Department of Anesthesia, Critical Care and Pain Management. And also, I'm an Associate Professor at Harvard Medical School. So I kind of know both systems, both in China and the US, because I got trained in both of those systems. And also during my time at MGH, I've been supervising residents, teaching Harvard Medical students, and training a lot of fellows, and my main work is in anesthesia, including orthopedic surgeries, acute pain management, OB anesthesia and general anesthesia, and also IVF, pretty much anything like that. So that experience gave me pretty good experience for knowing the different systems and knowing how to train the trainees, and hopefully my experience can make some contributions to [HealthPath Horizons].

Aneesh Mazumder

Thank you for the introduction. Since you have had such a long medical career in both China and the US, I'm sort of wondering about the start point. Like, how did you get interested in medicine? Was there a certain point where you realized that this is something that you want to spend your lifetime doing?

Dr. Wang

Well, that's a very good question. I think you're not the first person to ask me that. And I also sometimes ask myself why I like to be a doctor. So actually, to tell the truth, in my generation, I did not have any choice. So it wasn't really my wish to be a doctor, because at that time, I totally did not have any idea. My parents helped me pick out a career which I now love. So medicine definitely is the right thing for me. And I think I was born for medicine, but now new generations have different thoughts. A lot of people have a lot of options. Still, friends and parents can influence them to do medicine, but I'm glad they have their own thoughts and can eventually find out, "Oh, I like to be a doctor. I like to be an engineer. I like to be a software engineer, whatever." So that's their choice. But no matter what you're going to do, you should really understand the field you'll be involved in for your whole life. But in case you eventually change your mind, of course, there are chances everywhere. So what I think my job here now is to help people to perceive their goals and help them to build out their foundations and whatever they like. So I think hopefully my piece of advice is going to help.

Aneesh Mazumder

That makes sense. And so on a similar note, how did you get interested in anesthesiology and critical pain management specifically? Was that an interest you developed in medical school, or was it something you sort of walked in knowing you wanted to work on?

Dr. Wang

So, when I started my medical career in China, I was not an anesthesiologist; I was internal medicine. Eventually, I got special training and became a gastroenterologist. So that was a totally different field. And then after I came to the United States, I did some research work related to cancer and eventually related to anesthesia. And then I start finding that anesthesia definitely is a thing I like, because it covers everything from head to toes, right? Internal medicine, surgery, interventional, GI, IVF, pediatric, OB, you cover everything. So that's what I really like. And also I think we might have a lot of procedures to do, not like surgeons do every day, but we have a variety of procedures to do, and that gives us a lot of freedom, a lot of choice. And eventually even in the field of anesthesiologists, you still have different fields you can pick up, like orthopedics or acute pain, chronic pain, ICU, pediatrics, OB. So there's also your specialty which you may choose to do. So that gives you more choice. And actually before I did my PEDS residency training, I spent one year as a surgery intern, doing surgery. I did like it, but eventually, I thought that anesthesia was going to give me more freedom. And also, if you are not satisfied with only doing clinical work, you can also do lots of other work, like research. For the research, again, any topics should be covered by anesthesia. You can do very basic and/or clinical research. So anyway, there's a lot of choice. So that's my life.

Aneesh Mazumder

And you know, since you had to make that transition from, you know, China to the U.S. with two very different healthcare systems, what do you think was the hardest part about getting to where you are now?

Dr. Wang

I think from my generation it was a little bit difficult, because we got training and education in, and were familiar with the system in China at the time. But when I switched to the United States, there were different systems, especially different residency training, and I felt a huge difference. Though for your generation, you may not experience that kind of thing, but I'd like to share my experience. For example, when I was a resident in China, we did not have very formal resident training at the time. Now they do. But what I did is I just spent one intern year before I graduated from medical school, and then on the first day after I graduated, I became a doctor, a formal doctor, and I did every kind of duty I was supposed to as a doctor. So at the time, I was only 21, maybe even younger than 21, and now I think that is so scary. But you know, we did have a lot of experience. We did have a lot of senior attendings or residents who showed us and guided us, even though we did not go through a formal training model. But I think throughout the practice, we grew up pretty well, and I gained a lot of experience. And after I transferred to the United States, and eventually I decided I'd like to go back to medicine, I passed the Board, got matched, and started my residency again. I did feel totally different. First of all, language was a big challenge for me. And culture. And not so much the social culture, but the academic culture. So the way we treat patients is totally different. For example, whenever I answer a question like, how do you release this kind of information, I go by my experience in China, but my answer is always wrong, and I never figured out why it is different. So this is a cultural norm which I missed, right? And it's hard to catch up, but during this time, I think I will catch up slowly, eventually. Even with a culture and language barrier, still, I think my training in China helped me a lot, especially in PUMC Hospital. For example, sometimes when I deal with tough patients, language slows me down, culture may give me a little bit of trouble, but based on my experience, I can immediately reach out, find out what's going on with this patient, and bring up my thoughts. And even my seniors were kind of surprised how I think that way. I said, I don't know why. It's my experience, it's my muscle memory. So that means wherever you get trained, that experience stays with you, and even if you don't realize it, someday it'll pop up. So then the one proper thing to prove my experience is in the last year of the residency. You know, being chief resident is an honor, and it's hard to get it. And also, it's not only nominated by the faculty, but also voted by the co-workers, co-residents. And surprisingly, I was voted as the chief resident. So a lot of people ask me, "your language is not as good as ours, your experiences are different compared to American-born physicians, so how can you be a chief resident?" So I think it doesn't matter. Your memory, your experience, your motivations, your passions, your efforts, those can make you an excellent person. Yes, I do believe that even now I'm in MGH, I deal with a lot of excellent grads. You know, it's very competitive to be a resident here. But when I work every day, I learn from them too, and I'm sure they learn from me. And this is a good experience. It makes me think how we can be excellent physicians for outstanding students. So based on this, I think I can better share my experiences and teach all the trainees.

Aneesh Mazumder

Yes, I think that totally makes sense, and I definitely agree that all these students will definitely be learning from you, you know, whether in the lab or in the hospital or from these interviews. And sort of on a more positive note compared to the previous question, do you think there has been a sort of fulfilling moment? Or what do you think has been the most meaningful part of being a doctor?

Dr. Wang

So I think one thing is that, no matter how smart you are or how good at a field you are, passion is the key. I've seen a lot of kids pushed by their families or parents or friends to be doctors. "You need to be a doctor. Doctors are gonna get a lot of good things." Well, if you do not have your own passion, I don't think you can make it. You can make a new doctor, but I don't think you can make an excellent doctor. So you definitely need a passion. And of course, with passion, you need to know how to do that. After setting that goal, how do you proceed? So during this time, of course, you need a lot of help. Yeah, one thing is that at the beginning, I think your organization is definitely a good one to help them to start with that. So I think that's key.

Aneesh Mazumder

Yeah. And so moving towards more, sort of specific questions, about healthcare in general. Could you explain, you know, the different types of specialties you work with that exist in the healthcare system? So some of the people, like, for example, nurses that you might be working with.

Dr. Wang

I do think that to be a good physician, not only should you have a solid knowledge base and passion, but you must also really be good at communications. Because when we work, we're not working alone. We work as a team. You're not only working with your co-physicians, but also the surgical team, the nursing team, the patients. So communication is super important, and that part may not be learned from school, right? There's no such school to teach you how to talk, right? So that part can come from your working, your experience. Just putting more attention to that and doing more training of your communication skills is a key thing to do. In terms of the different specialties, it totally depends on the individual. If you really like this one, then go ahead, you can be excellent in that field. Surgeon is good, anesthesiologist is good, dermatologist is good. All are good depending on if you like it, and the good thing is that during the rotations or throughout all the exposure to different environments, you do have the chance to feel that environment and put your foot on the floor and see which part you feel is most comfortable—which part you think you're going to spend your whole life on. If you're not sure, you can switch off. There's time. We do have some residents who've been trained as surgeons, and eventually, they're like "Oh, I think I want to be an anesthesiologist," and they go back to training again. Happens all the time. Or, for example, my colleague. He graduated from MIT, found a very good engineering job in Boeing, and suddenly went "I'd like to be a doctor." Okay, so he went back to medical school, started his residency at like 40 years old. Eventually, he's now a very successful doctor. And I'm sure that the first half of his experiences were still treasures for him that helped him to become a good doctor. So any kind of experience is never a waste. They always help you to reach your goal. And you can shift these things any time. As long as you feel a passion for it, do it.

Aneesh Mazumder

Yeah, I think that makes sense. And how would you advise, you know, aspiring students to explore a job they want to go into? So whether it's just a specific specialty as a doctor, but maybe also as, you know, like nurses or physician assistants, or other key points in the healthcare system.

Dr. Wang

Okay, so I do meet a lot of people who have different kinds of thoughts and goals. The key thing is that I never push them. I never push and force them to do this or do that. What I'm gonna do is always encourage them to think, to compare, to feel it for themselves. And what I can do is I can share my experience, share my thoughts, and tell my stories, tell my experience. And then I let you pick. I will never try to sell something to you and go, see, here it's like this, here it's like that. And of course, you need to understand more details. My job is to provide all the information I can and let you go. Or if you still cannot make your decision, okay, come in, talk with people and see if you like it or not, right? So in doing it this way, people will say, "Yes, this is my dream place," or "Oh, I'm sorry I misunderstood this one. Maybe it is my home." So I think it gives people more freedom to pick if we can just provide the chances for them.

Aneesh Mazumder

Yeah, I think that totally makes sense. So pivoting now, what is your daily lifestyle like? You know, as an anesthesiologist, do you get much free time? And if you do get free time, what do you like to do in your free time, and does this differ between the different types of medical specialties?

Dr. Wang

One word: busy. But I like being busy. So, I can tell you what my typical day is like. Because I'm far from the hospital, every morning, I have to deal with the heavy traffic. I hate that, so I usually come up pretty early. I hit the road at five o'clock in the morning, and the traffic's still there. But it takes me about 30 minutes to get to the hospital, like I arrive at 5:30, and then usually we start a case at seven. Residents might start to prepare at like 6:00 or 6:30, so I do have some free time in comparison. I'm glad I'm not a resident anymore. So I go to the gym next to the hospital and run and swim. They've got a very nice gym there. So that is the only chance I can exercise and take a shower before coming to work. So at this point it's 7:00, and, of course, my resident has already prepared the room. We're going to start seeing the patients. And usually our patients are very sick. You really need to focus on them, and usually the night before, we spend 30 minutes, sometimes longer, with the residents to talk about the plan. How can we prepare for them, what kind of future plan are we going to do? How sick is the patient? You know, these kinds of things have to be prepared, because we do not have time to talk in the morning. And so in the morning, we start seeing patients and see how we can make them better. We meet the patients' family, the surgeon, surgical team, and nurse team. Then we huddle and finalize all the plans and try to see what is the best plan for the patient before we start a case, because during the case it's usually very intense. So we gotta watch the patient very closely, and we have to really make all our plans based on how we anticipate the patient's condition might change. And right after I finish one case, I move on to the next. So it's pretty intense. Usually, I cover two rooms with the residents. We take care of the patients, but I also try to teach the residents. We slow down, we discuss and I try to let the residents learn something they cannot learn from a book, just talking about anything we're interested in. And at this point I know the residents are pretty tired from working so hard, so we give them a 15 minute break in the morning time, 15 minutes in the afternoon, and 30 minutes at noon for lunch. That's what we try to give, but occasionally, for the residents and me as well, we don't get any breaks. Because when we get some really sick patients, we all have to be involved. We forget to feel hungry, and we silence our phone, and oh my gosh, it's almost five o'clock, right? And so, you know, we all try to help each other because we need to help each other. For example, one day my room may be pretty safe, and everything went very well, but my colleagues suddenly had some crisis in their operating room. We have to rush in to help out, right? So it's a lot of teamwork, the day goes by quickly, and we feel busy. And at the end of the day, when I change out of my scrubs, usually I take a shower before I go, and I see the cars in the traffic—I feel exhausted. But also satisfied, right? The worst part is dealing with the traffic. But anyway, you go through a very busy day, but I think we are definitely spending each day very nicely. We make a difference, we save lives, we teach our residents. You feel that it's worth it to spend the day like this.

Aneesh Mazumder

Yeah. And sort of related to what you were just talking about, you know, some of these experiences you get as a resident, like having to respond to codes, for example, or doing the huddles. Do you think those are key points of what it takes to become a good physician, especially having these experiences early on? Or do you think that these two things can be mutually exclusive?

Dr. Wang

So based on this, I can tell you some sad stories. You know, maybe you've heard that a lot of mistakes happen in the OR. For example, you have one tooth you need to pull out from this side, but you mistakenly, you know, take another one. Or, maybe we should've done surgery on the left hand, but instead we did surgery on the right hand, right? We have had these kinds of things happen before. And so all the systems we've set up are modified based on each mistake, and the purpose for doing that is to prevent similar future mistakes. We do have a lot of committees like QA committees, QI committees, and education committees. I'm so honored to be a member of a lot of these committees to also get a chance to learn how we can improve these systems. And of course, everyone makes mistakes; sometimes because of a lack of knowledge, a lack of skills, or sometimes even from the overall system. The system does not prevent you from making some mistakes, right? But we try to decrease the chances that certain mistakes will be made. So that's why our system is getting more and more detailed, and is constantly learning things. For example, huddles and debriefs are things we set up in recent years, and they help prevent a lot of potential mistakes. But I'm sure that's still not enough. We're still learning. Of course, sadly, we're still making mistakes, but we try to minimize them and create a better future.

Aneesh Mazumder

I think that makes sense. And so this is sort of more tangential to what we were just talking about, somewhat more related to what we were talking about at the beginning. Do you think there are sort of like a set of lifestyles that are compatible with a career in healthcare? As in, do you think that there are certain sorts of lifestyles that aren't compatible? Or do you think that people mostly adapt to the difficulties it takes to work in healthcare, and can make their lifestyle work?

Dr. Wang

I think the medical field is very compatible with a lot of lifestyles, because it is a hotspot, and a lot of people are interested in it so a lot of people try to make a difference within it. And this is a very good field. But you know, from my standpoint, it doesn't matter which specific speciality it is. Either you can be a clinical provider, like a physician who deals with the patient directly, or you do some kind of medicine related research, even as a sort of doctor that does not really deal with patients. Or you could do some public health/global health initiatives, something like that. Nursing is also a pretty wide and necessary field. They're all good, and although you cannot do multiple jobs at the same time, you can pick one that you think you best fit. Nowadays, I don't know as much about other fields like basic science research, which I did for a lot of years, and like public health or related things, are also very interesting. So I wish I could have maybe had some more time to do more things. But, anyway, I pretty much enjoy what I'm doing now. And I think the same thing that if people are interested in a specific field, they also can find the joys of really going deep into that.

Aneesh Mazumder

Right. Now, something sort of related: how do you balance the many things you're doing at once? So there's obviously the medical practice, the research, you know, family life, and other things that you have in your busy life. How are you able to sort of strike that balance?

Dr. Wang

Yeah, it is hard to balance. As you know, the typical day pretty much uses up every cell in my body, whether that's medicine, research, etc. But for me, I do still have my mind. That's the reason I like to stay in academic hospitals, like MGH, rather than to go to a private group and make more money. Of course, people do that, and that's fine. But since I do have so many years of research experience, I really want to always be thinking about something. For example, when you work with a patient, you will inevitably find some potential problems. You start to think of how you can diagnose a specific one or avoid a different one. For example, postpartum depression or post op delirium. Is it kind of related to your medication or something else? You need to know why. And those answers cannot be provided by basic research, right? You could use some rat models, some very good ones. But still, you need some data that's closer to the clinic. That gives you the concept of clinical research. So my focus now is on clinical research, not basic. For instance, we have the opioid crisis, so the effect of that is, how can you administer effective anesthesia with less opioids and fewer side effects, right? So based on this question, I designed a lot of studies. We can examine anesthesia with few opioids, or worse, opioid-free anesthesia. And then we recruit a certain number of patients and check their outcomes, see what the pain is like, what are the side effects? And then we can make some conclusions, like, yes, using opioids is better than opioid-free treatment, but it should be used in small amounts. Then, we will need to provide some guidance. And so I also do some work to eventually make some guidelines, to help guide other people to do in the best way. So this part of research is very important. This is what I'm doing. Of course, I have limited time, but when I formulate these research questions in my mind, I just evaluate them for the rest of my time when I go home. Another contributing factor is that I do have a good team. I have excellent residents, medical students, and co-workers. So even though I'm busy, I don't really feel like it's busy because we work to manage everything well. And importantly, I really enjoy my clinical care of patients. I also really enjoy my clinical research studies.

Aneesh Mazumder

Yeah, that makes sense. And how did you get involved in this sort of research—clinical research, and also basic research. And what made you continue it, you know, throughout your career?

Dr. Wang

So, first of all, you need to bring up some ideas. Take the opioid crisis. You need to find out which part you need to study, right? So after you set that up, and you know this question is what you are going to solve, then you can set up your team. As I said, I do have a good group of co-workers, good medical students and residents. So I brought up this question, and asked "Hey, who's interested in this one?" And then okay, let's make this team and do it. And the important thing here is support: support from your department, your hospital, encouraging you along the way. And our department has a unique mechanism, which we call the anesthesia research consult, called ARC, so those support teams are also there. As long as you have your idea, those teams can help you out, right? Whether you don't have time to do paperwork, need your protocol to be revised, etc. So they're there just to save you time and support you well. And you know, we are not good at everything. So we also work with specific people like a statistician after we get all the data. So those people can help you to do this part of work, and even when you write a good paper, they can help us submit it and publish it. So from idea until the published publications, there are a lot of teams and team members who can help you out. So with these systems, you can definitely make your dream come true. So, yeah, that's why I like to stay here in this environment.

Aneesh Mazumder

And so for my final question, what made you gain confidence that you were pursuing, you know, the right career? And what advice would you give to students who come from disadvantaged backgrounds, who may be interested in a career in medicine but don't necessarily have the confidence, or who think it's unrealistic to pursue?

Dr. Wang

Okay, so here's the key thing; before you presume you want to be something, you need to know what kind of person you want to be, right? So you have to see if you really like it. For example, some people just say, oh, the Grey's Anatomy show is so cool, right? So let's go to the hospital to see what it's actually like. It's totally different, right? And then you may be very disappointed. It's not like the dramatic stories between people in the ORs. Or people come up here thinking that surgery is so cool and they'd really want to do a surgery. But when they see the real bloody things, they faint, right? It can totally happen. But anyway, when you're growing up, who knows what kind of things you are going to be? Maybe you'll become the President of the United States in the future, or an astronaut, or just a regular person. So interest is what's most important. Do what you are interested in doing. That's how we, as doctors, can help them—to let them get a feel for medicine.

Aneesh Mazumder

Yeah. That makes sense. Thank you for taking the time to meet with me. These are really detailed answers, and I learned a lot myself.

Dr. Wang

Thank you, Aneesh. It was nice meeting you. Thank you for having me.

Aneesh Mazumder

Have a good day!

Dr. Wang

You too.