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ACP Resident/Fellow Member:
Joshua M. Liao, MD
Internal Medicine Resident
Baylor College of Medicine, Houston, Texas
Brigham and Women's Hospital, Boston, Massachusetts
Member, ACP Council for Resident/Fellow Members; Member, ACP
Education and Publication Committee
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
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
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
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
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:
August 2014 Issue of IMpact
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