2019 Reflections and Outlook

This article is actually published a bit late. To those who care, here is an account of what I have been doing during the past year's gap away from clinical practice.

Life can be very complex, or very simple. Currently, the issues I have concluded upon are:

1. If I continue in clinical medicine, can I get through future residency training with my constricted visual field and hearing impairment?
2. If the visual field constriction and hearing impairment impact specialty practice, which specialty would be the best choice?
3. If my vision deteriorates to total blindness in the next twenty or even ten years, do I have any livelihood skills other than being a physician?
4. If I am to develop a second skill for a livelihood, what direction should I take?

PS: I carefully examined the story of a completely blind psychiatrist, and there were still many obstacles in his employment journey. To simplify the problem: it is impossible to perform a physician's duties while completely blind.

Cross-Disciplinary Exploration

To answer the question of whether I can find other skills for a livelihood, I started part-time working and studying at the NCKU Institute of Medical Informatics through a recommendation.

If I completely abandon my medical expertise and dive into the IT field, my late start guarantees I will lag far behind others in professional IT domains. Starting from the Institute of Medical Informatics at NCKU offers a compromise that integrates my existing expertise.

I initially expected to contribute to the lab with my medical expertise, but to my great surprise, the performance targets I completed for my boss were all achieved using skills I had originally just played around with. I used to lack confidence that my abilities could earn money in the industry, but after this year of experience, I believe that my existing foundation is sufficient to apply for entry-level engineering positions. What I lack is merely industry experience, much like a newly licensed physician lacking residency training.

Counting the magical achievements of this past year:

1. Using Google's released open-source code for smart speakers, I built a smart speaker prototype with laboratory-specific characteristics (using Python, Bash scripts, and Linux system knowledge).
2. I helped colleagues maintain the operation of an old system from the Department of Foreign Languages and Literature. Because the environment was based on Ubuntu 8.04 (yes, you read that correctly, it was that old), I simply used Virtualbox to successfully migrate it to a new machine.
3. I built a direct, non-virtual Hackintosh environment for colleagues to remote into and write iOS apps.
4. Using Jupyter Notebook paired with pandas, I helped a collaborating physician from MacKay Memorial Hospital process emergency department form data totaling about 20GB in file size, learning pandas data manipulation techniques.
5. Due to business needs, I browsed Github and casually coded a web application with a basic account permission verification mechanism to interface with the lab's original PHP.
6. Finally, because I had experience collaborating with professors at the College of Medicine in writing grant proposals, I was poached back to the College of Medicine to try setting up a server and creating a chatbot myself (darn it, I originally wanted to just use Google's services, but since clinical data could not be easily uploaded, many things had to be built from scratch).

In addition, because the lab professor was eager to start a business, I rushed to write four or five startup proposal drafts, coming into contact with different investment, budget, and accounting terminology and industry planning processes. Communication and competition across disciplines—finance, computer science, and medicine—always spark different perspectives when working together.

Because I helped the professor a lot, I was recommended for admission to the Ph.D. program at the NCKU Institute of Medical Informatics. Perhaps there will be opportunities for further advanced studies in the future.

Return

Although I made gains in IT skills, my family still worried about my economic independence, as a handyman's salary doesn't save much money. While studying at the Institute of Medical Informatics might allow me to combine medical and IT expertise for employment at a startup, such as HTC or Google, my family strongly hoped I would stay at NCKU Hospital as much as possible out of concern for my restricted mobility. And indeed, securing the medical license first would make my credentials more convincing out there.

Making a comeback to apply for NCKU Hospital's one-year PGY program, I reviewed my past failure and knew the preparation direction better this time. After passing the OSCE, in addition to the national exam, I read the ICU Book pocket guide and the Massachusetts General Hospital Resident Manual. At the same time, I faced my issue of poor speaking skills, not only memorizing but also repeatedly reciting verbally.

Unsurprisingly, after getting onto the PGY list, the next hurdle was the national written exam, for which I could not entirely rely on past papers. Word had it that the national exam question bank changed starting in 2018, so the benefits of reading the old First Choice and older past papers for the new questions were lower than before. I scheduled my time so that in the two months before the national exam, I read the detailed explanations of the past exams and each subject's First Choice at least twice. Ultimately, I officially obtained the title of "Physician."

Upon arriving as a PGY, I was soon to face the issue of choosing a specialty. However, due to my visual defects and hearing impairment, my choices were limited. Surgical specialties and radiology were out of the question, as I feared I could not endure the fatigue during training. The order I ranked them was Family Medicine, Neurology, and internal medicine subspecialties. Radiation Oncology was also suggested by seniors, but the training program's heavy requirements in diagnostic radiology felt unfeasible. Family Medicine seemed the most viable but still held hidden concerns: community service and rural assignments inevitably involve exposure to the scorching sun, and UV exposure is still damaging to the retina.

In the end, I returned to NCKU to continue working as a physician, but the path forward remains just as uncertain.

State of Mind

One evening after starting as a PGY at NCKU, I went out to handle some errands (copying license registration documents, photos, and other miscellaneous things). While riding my scooter, I vaguely felt a sense of unfamiliarity and sluggishness; I could no longer keep up with the flow of traffic as well, nor could I react as instantly. I could only slowly reduce my speed, letting my consciousness catch up with the colorful rush of the evening.

No, I believe my vision and hearing shouldn't have worsened yet, and even if they had, it shouldn't be this obvious. Perhaps, this slowed pace, leaving just a bit of leeway, is the composure I should have had all along.

I don't know from which popular science article I read this, but regarding the biological instinct of the "fight or flight" response, it roughly stated: when facing stress, the primitive cortex becomes more active, while blood flow to the prefrontal cortex—responsible for higher-order thinking and planning—is reduced. Ah, perhaps pretending to react instantly and projecting passionate drive is ultimately just being a primitive beast that bares its fangs and claws at the slightest rustle of leaves.

Getting nervous about things I can't hear, panicking over things I can't see, and being neurotic in a restaurant with beautiful lighting and good atmosphere for fear of knocking things over—what normal people see as relaxing enjoyment is to me just another kind of drain in my tiring daily life. Joining clubs to show activity like a normal person, joining dinners to pretend I'm not antisocial... But in the end, after clarifying my own existing disabilities, I deeply realized that any effort to keep up the pace is just another source of stress.

Only by rationally facing the problem can one have a chance to find a solution. Regrettably, after learning about my visual field defect, I was heavily struck by many things, and it was only a few years later that I began to step onto this path. I must try my best to eliminate the rush and unease that once deeply entangled me, and retract the claws that randomly pounce without a target. For life to move forward, one does not rely on unrestrained momentum, but on the composure settled within a little leeway.