ACP Resident/Fellow Member:
Love, death, grief—some of life's most memorable experiences—are witnessed every day in the halls of hospitals everywhere, but they are seldom captured in stories written by medical students who are busy putting in long hours studying and doing clerkships.
The following excerpt, from the story, "A Matter of the Heart," was written by former medical student, Joshua Liao, MD. It is about a patient who dies following heart surgery and the brother who loved him "quietly but fiercely." The story was published in the November 15, 2011 issue of Annals of Internal Medicine, and was later selected for publication in the book, On Being a Doctor, volume 4.
Mr. Lucas wasn't my patient, but I knew him well. When his older brother had first come to the clinic with progressive chest pain, Mr. Lucas accompanied him and brought his papers in a large folder. When he'd returned for preop screening, Mr. Lucas took notes and double-checked his brother's medications. On the day of the operation, it was Mr. Lucas who camped out in the waiting room with blankets and a pile of books, ready for the surgeon's periodic updates. . . . And it was Mr. Lucas who was here now—48 years old, with thinning gray hair and tired eyes—gathering his brother's things on his scheduled discharge day, hours after he'd died.
Standing there, I sensed that there would be more like Mr.
Lucas and his brother, people whose stories would push me beyond
the safety of clinical knowledge and technical skill into the space
between medicine's great successes and vast limitations. The
possibility felt like the edge of a profoundly powerful secret. My
patients would never just be diabetics, cancer patients, or
asthmatics—they'd be spouses, parents, siblings, and friends. Those
were the roles that mattered, the ones they had played before
becoming my patients and the ones that would last long
"A Matter of the Heart." Annals of Internal Medicine. 2011. On Being a Doctor, volume 4.
Choosing not to choose
Dr. Liao, now an internal medicine resident at Brigham and Women's Hospital in Boston, is a compassionate physician and talented writer whose articles have appeared in Annals of Internal Medicine, the British medical journal, The Lancet, The Atlantic, Boston Magazine, ACP Internist, and a variety of other clinical journals and publications.
When fellow residents ask Dr. Liao how he finds time to write, he responds, "I choose not to choose," and then explains, "just as I regularly, without thought, call my parents or shower, I write." For this busy resident, it is not about "finding" time—it is about honoring who he is and what he values.
Dr. Liao admits he did not go to college intent on becoming a doctor or a writer. As a high school student, he excelled in mathematics and science, but says he also loved studying English literature. Laughing, he says, "I was torn between wanting to pursue Jacobean drama or marine biology." In the end, Dr. Liao chose "not to choose" and studied both, graduating from Rice University with two bachelor degrees, one in English Literature and another in Biochemistry & Cell Biology.
Right brain, left brain—all pistons seem to be firing in this physician's brain. In addition to being a clinician and published author, he is a talented musician who began playing piano at the age four. Along the way he also learned to play French horn, drums and guitar. His favorite composer is Chopin and his favorite sport is tennis, which he played competitively in high school.
During medical school, Dr. Liao not only studied medicine, conducted research and wrote compelling articles and stories, he also fell in love with fellow medical student, Geraldine Chen. Dr. Chen is now a resident in diagnostic radiology at the University of Pennsylvania. The two physicians will be married by the time this article appears, and since both have family in Taiwan, there will be two ceremonies—one in the U.S. and a second in Taiwan.
Crossing his T's: Texas, Taiwan, Tibet
Dr. Liao was born in Dallas, Texas, to Taiwanese immigrants. He spent the first few years of his life in Taiwan and traveled frequently back and forth between the two countries. He estimates making roughly 40-50 trips to Taiwan in the first 20 years of his life. "The sights, smells, the culture are always with me," says Dr. Liao.
Family, culture, hard work, and education are values Dr. Liao inherited from his father, a financial officer for a global manufacturing company, and his mother, an entrepreneur and businesswoman. "My parents taught me to think of the work I do in context of how I would like to be remembered," he says; and although Dr. Liao did not follow his parents' career paths, he says he has always followed their advice, a simple edict: "Do what you love."
When his parents moved to Shanghai while he was still in high school, Dr. Liao chose to remain in the United States, but spent a year of college in Shanghai after he was awarded a Chinese scholarship from the Ministry of Education. During that year, he had an opportunity to spend time in Tibet observing how telemedicine initiatives could benefit those living in remote Himalayan communities with no access to healthcare. That experience, among others, inspired and convinced him to pursue a career in medicine. "I had been searching for a practical outlet by which to make a difference in the lives of others," says Dr. Liao. "Medicine," he says, "seemed the perfect choice."
After graduating from Rice University, Dr. Liao went onto Baylor College of Medicine where his intense desire to learn was fulfilled by the diverse range of medical rotations. "Surgery, pediatrics, ob-gyn—I loved all of it," says Dr. Liao, whose desire for a very broad education ultimately motivated him to choose internal medicine. "I find it very stimulating to think about the heart, the lungs, the kidneys, and then all of the systems and psychosocial issues—including coordinating care in in-patient and out-patient settings and considering the value of care related to diagnostic and therapeutic interventions."
The art of medicine
In addition to his clinical rounds at Brigham and his academic work in health services research and systems redesign, Dr. Liao is a Clinical Fellow at Harvard Medical School where he teaches medical students to interact with patients and take medical histories. Like Sir William Osler, Dr. Liao believes "the practice of medicine is an art, not a trade."* "I think what we do as physicians is very artful," he says, "we read CT scans and lab results, but ultimately, we use a very subjective process to gather information to linearize a coherent history of an illness and create a narrative about a person."
For Dr. Liao, writing is an art form, vital not only to the practice of medicine and dissemination of scientific information, but one that can be used to bring about effective discourse. In an abstract for a session he taught at a national leadership conference, "Of Medicine and Men: Health Writing for Social Change," Dr. Liao writes, "Writing provides a powerful avenue for action, one that can amplify messages, raise awareness, disseminate thought, and ultimately lead to social change."
From Texas to Taiwan to Tibet and Harvard—Dr. Liao has traveled a culturally diverse path-one that has influenced his writing and provided him a unique platform from which to view the world. He hopes that someday, his experience and skills will take him in the direction of a leadership position in the realms of health policy, systems redesign, and medical education; but, he maintains, "I will always see patients."
For Dr. Liao, the practice of medicine is home to the real journey—"the journey with people through crisis and into the joy and grief waiting beyond it." As a physician, he bears witness to illness, suffering, and death, and knows that when clinical skills and knowledge have done all that they can do, the practice of medicine becomes "a matter of the heart." As a writer, like the Jacobean playwrights he admires, who pull back the curtain on the human condition, expose life's underbelly, and explore what it means to be truly human, Dr. Liao artfully engages his readers, unveils the unique experience that is medicine and what it truly means to be a doctor.
*Silverman M. Murray TJ, Bryan CS. The Quotable Osler. American College of Physicians: Philadelphia; 2003.