ESSAY 9 (When Grandiosity Speaks, Medical Students are Supposed to Listen..

THE MOST DISINGENUOUS LETTER EVER WRITTEN

NOTE: ISN'T IT OBVIOUS, BY NOW, THAT THIS COULD ONLY HAVE BEEN WRITTEN BY
ONE OF THE “HIGH-PRIEST”-TYPE PHYSICIANS?! WHOM, EXACTLY, DO THEY THINK
THEY'RE FOOLING?! CERTAINLY NOT AN UNWITTING “PROFESSIONAL PATIENT” SUCH
AS MYSELF, WHO HAS BEEN PUT THROUGH THE MEAT-GRINDER OF ALLOPATHIC
MEDICINE FOR DECADES NOW, AND HAS FINALLY HAD ENOUGH. PHYSICIAN, HEAL
THYSELF!

Education| November 2021

A Letter to Medical Students from an Anesthesiologist 

Michale Sung-jin Ok, M.D.
Author and Article Information
Accepted for publication August 11, 2021. Published online first on September 14, 2021.
Anesthesiology November 2021, Vol. 135, 922–924.
https://doi.org/10.1097/ALN.0000000000003970
Good morning,
You probably went to bed later and woke up earlier than most of us. Now you are here to learn
about anesthesiology. You are paying a lot of money to be here today. Some medical schools
do not even have an anesthesiology rotation. This 1-week rotation may be the only time you
are exposed to the art and science of anesthesiology before you must choose your specialty.
First impressions are important.
That is a lot of pressure on me.
Let us talk about you. You have excelled at most things you have tried in your life. You have
embodied discipline and diligence. Your middle name is resilience. You always rise above the
challenge. You never give up. [ed. Note: the fact that the author so quickly “jumps” to a circular-orgy
of self-aggrandizement and frank grandiosity speaks to a certain “tone-deafness” towards the “least
among” themselves, namely, the patients. It places the patient, by default, in the category of “loser” at
best, if not a complete failure at life itself, and yet, this author still can't see the forest for the trees!]
But above all, you care.
And that is what I care about.
You dream of the day when you will be equipped with the knowledge and skills to help others
independently. Someone with your aptitude could have picked fame or fortune, but you chose
to serve others.*1 Now, you are trying to choose the specialty that will enable you to become
the physician you always wanted to be.
You are impressionable. We all know that medical school is incredibly stressful. You are
constantly critiqued, and your shortcomings are often publicly discussed. You are somehow
expected to have a great attitude even when you do not have the time to eat, sleep, or even
use the restroom. You often wonder if you are strong enough to be a physician. This
environment can make you somewhat vulnerable. Meeting a kind, relatable resident or
attending during a rotation can be such a great relief. But be careful because this can also
mistakenly steer you into the wrong specialty. Before you commit, ask yourself whether you
enjoyed the specialty itself or enjoyed working with a specific mentor during that rotation. I
know a few physicians who regretfully made their decision based on this factor.
Now, let us talk about my journey to anesthesiology.
As a medical student, I loved all my rotations. There was something valuable and wonderful
about all specialties. Even though I initially pursued primary care, anesthesiology unexpectedly
grabbed my attention, and I have never looked back. It was not my interest in physiology or
pharmacology that made me choose anesthesiology. It was not my passion for exciting new
technologies, gadgets, or even procedures that made me choose anesthesiology. It was the
deeply committed physicians and the way that they cared for their patients that drew me into
anesthesiology.
There is a stigma associated with anesthesiology. When I told an emergency medicine resident
that I committed to anesthesiology, he said, “Oh, so you don’t want to talk to any of your
patients and just want to put them to sleep? That is a shame because you seem like a person
that would actually enjoy patient interaction.” That comment bothered me more than I would
like to admit. His comment suggested that anesthetic patient care is deeply impersonal. He
implied that physicians who really care about people do not go into anesthesiology. Nothing
could be further from the truth.
Now, 10 years after I began my journey into the field of anesthesiology, I can confidently say
that I am an anesthesiologist because I care. If anything, I care more than I knew I was capable
of. I care about learning because my lack of knowledge can have life and death consequences. I
care about sharpening my skills because I am often my patient’s final line of defense. I care
about medical ethics because we must do what is best for patients when they are unable to
guide us. My primary role is to care for my patient’s physical safety during invasive surgical
procedures. But I realize that the emotional and spiritual well-being of a patient is just as
important for their recovery.
I have been blessed with many opportunities to hold my patients’ hands and to comfort them. I
have celebrated my patients’ victories and mourned their setbacks. I have cried with families
who have lost their loved ones and jumped for joy when others made miraculous recoveries. I
have had to tell some patients and even other physicians “no” when it was the right thing to do.
Believe me, saying that I will not do an anesthetic for someone is much more difficult than
doing it. I have learned that the hard way.
I never forget the mistakes that I have made. I always learn from them so that I can be a better
physician next time.
At times, I have been shaken to the core because death was imminent for my patient. In those
moments of overwhelming terror, I felt the weight of that patient’s trust. They trust that I will
do the right thing while they are in a defenseless state. They trust that I will make the right
decisions when every second counts. They trust that when I am in a situation that I cannot
handle myself, I will not be too proud to ask others for help. That trust is a heavy burden.
But do not worry. You will be trained extensively for moments like these. You will learn how to
always be prepared. You will learn that preventing a complication is always better than reacting
to one. When medical crises come your way, you will learn how to systematically evaluate and
treat them. You will learn that during emergencies, you are not supposed to be a hero. You,
with the help of your team, will conquer each situation together. You will win far more battles
than you will lose.
Not many will remember who you are. Your face will not be on billboard advertisements for the
hospital. But out of the spotlight, and sometimes in complete anonymity, you will do your best
work to reduce human suffering. You will use medications and perform procedures that can
take away the cruelest of pains. You will rescue airways, resuscitate, and buy your surgeons just
enough time to finish life-saving surgeries. You will help patients see their families again.
So, I say to you, the aspiring physician searching for a specialty, we are anesthesiologists
because we care deeply about our patients. Join us, and you will find a society of physicians
dedicated to patient safety, scientific discovery, and technological innovation. You will find
expertise that is invaluable to patients at all stages of life. But above all, we compassionately
care for our patients by reducing their suffering through the art and science of anesthesiology. From
a newborn baby taking their first breath to the oldest and frailest of patients, we can help.
We care.[ed. Note: emphases added]
Permission to reprint granted to the American Society of Anesthesiologists by copyright
author/owner.
FOOTNOTES;
*1 It's deeply discomforting to think that there are physicians “running around” (hey, they're in
the same rat-race that we're all in...) out-there who think so excessively highly of themselves
that their own self-perception becomes distorted like that of an image in a carnival “fun house”
warped-mirror. Believe it or not, I'm still “stuck” on digesting the following statement,
“Someone with your aptitude could have picked fame or fortune, but you chose to serve
others.” Really?! Am I supposed to seriously believe that every medical student is just inherently
so exceptional, so brilliant, all the while believing that they “chose” the profession (when, in
reality, it's exactly the opposite way around; medical schools choose their students, and they
are notorious for sometimes being so ridiculously picky that the words arbitrary and capricious
easily fit when describing American medical school admission criteria. An example from my
personal experience at having been rejected for admissions to the University of Illinois at
Chicago Medical School around 1993: After having heard from all other medical schools I had
applied to, I was still completely missing any info from University of Illinois. Bearing in mind
that I was a life-long resident of Chicago (and therefore, Illinois) and this being a State Medical
School, I actually felt that I would at least get an interview to make my case for becoming a
physician. After a few unsatisfactory phone calls where nothing was answered, I decided to go
down to the admissions/registrar's office of the medical school myself, since it was only a short
subway ride from home.
I don't know if other people have experienced the following, because if they have, I
would sure be interested to hear their “take” on what follows; I walked straight from the
subway stop into the admissions office, since it was only about a 4-minute walk, and asked
who was in charge of scheduling interviews for prospective medical students. You can't
imagine my shock at hearing the following reply, rather laconically delivered,

THEM:“Interviews?! We haven't done interviews of anyone, either prospective or already

accepted students, in many years...sorry, but you didn't get a letter because you just didn't
make the cut-off...”
ME: “The cut-off? What cut-off?!”
THEM: “Look, a number of years ago our admissions board simply decided that it would be
much easier for them [this is a constant theme throughout medicine: The clinician's comfort-
level...] if they just fed all of the numeric, hard data into a computer and then let the computer
sort it out very straightforwardly by simply accepting the very top 100 applicants for the fall
classes...”
ME: (in disbelief...) “You mean, whenever a 'new class' is accepted for a giving academic medical
school year, when the students arrive on campus to occupy the dormitories...that's essentially
the 'first-contact' that the school faculty has with these future would-be physicians?!?!”
[completely flummoxed and floored...]
THEM: [upbeat and chipper] “Yup!”
ME: [after what felt like an eternity of awkward silence...] “Um, isn't anyone just a little wary
about inviting people into such a profession without having at least some concept of their
personality structure, and indeed if they even appear to be physician material from their
demeanor, manner of dress, how they express themselves, etc., etc.?”
THEM: [rather emphatically] “Nope! Haven't had a single complaint yet!”
ME: [obviously deflated] “Well, that just strikes me as a recipe for...trouble, at the very least...”
THEM: [now slowly becoming impatient] “Look, kid, I'm sorry it didn't work-out [!] for you, but
this is how U of Illinois does it now...and the fall class has already been chosen and filled, so...
[voice trails off slowly, awkwardly]...best of luck to you!”