Network Director

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This episode was produced by Grace Kim, hosted by Herbie Villaflores, and graphic by Romi Sheng.

 

00:10 — Introduction to the Episode and Guest

02:06  — Career as Respiratory Therapist

09:07  — Heart Transplant Story

23:40  — Connection with Patients

36:19  — NHPI Healthcare Barriers

41:07  —  Career as Musician

47:54  —  Advice for Future Generation

52:13  —  Closing Remarks

 

00:10 — Introduction to the Episode and Guest

Herbert Villaflores: Welcome everyone to a new episode of the Asian Pacific American Medical Student Association podcast. From roundtable discussions of current health topics to recaps of our panels with distinguished leaders in the healthcare field to even meeting current student leaders within the organization, this is White Coats and Rice. My name is Herbie Villaflores, and I’m an MS1 at UMKC and a current National Podcast Committee member here at APAMSA. I’ll be your host for today. Today, we are joined by Mr. Sean Tiwanak.

And we’re so grateful to have him here for the native Hawaiian and Pacific Islander podcast. So let’s hear a little bit about who we are here with today.

Sean Tiwanak: Aloha everybody. My name is Sean Tiwanak. I’m currently living in Hawaii and Honolulu and I was born and raised here, part Hawaiian, part Filipino, and my mom was, we would say Haole which is Caucasian, so a mix, which is typical here in Hawaii. I have a background in the medical field, pharmaceuticals, and also currently doing real estate appraisal work, which is valuing properties. So I’ve moved out of that and my family has a lot of roots in the medical field.

And I had my own experiences as a patient, you know, during the last twenty years, which was very fortuitous in a way that I had the background that I have and I’m sure all of you in the medical field. You know, hopefully, you know, your experiences will not only help you professionally, but also in your personal lives and with the people around you as well.  

 

02:06  — Career as Respiratory Therapist

Herbert Villaflores: So you are a man of many talents, it seems like. I know you work as a respiratory therapist in Hawaii. How did you get to work there? 

Sean Tiwanak: Well, that’s actually a really roundabout story. You know, I find people who become doctors tend to plan their path and commit to it from early on when you start college. I was a little bit different. I was really into music. I was supposed to go to Air Force Academy. I declined that. I wanted to go to Los Angeles and I went to school at Loyola Marymount for a while. And I truly wanted to be in music and things like that. But life is a series of progressions and you don’t always end up where you plan, what what you plan, right? You just end up doing things. I never thought I was gonna be a respiratory therapist. It wasn’t on my radar. I didn’t even know what it was, right? And for people who don’t know what it is, it essentially in your line of work in the future, you’ll probably be dealing with respiratory therapists either in an intensive care unit running the ventilators and other type of life support or in ICU and then just general respiratory care, which has to do with administration of medication and therapeutic devices that help patients with emphysema and whatever, right? And in very, very extreme things like adult respiratory distress syndrome and so forth, really critical.

So I was actually bounced around a lot after my first few years of college. I didn’t know what I was gonna do. And just one thing led to another. I was in a construction field and ended up there and I got a really bad injury to my wrist, and they put me through vocational rehab, and they said the only thing that we can find for you, they don’t want me lifting anything over a certain pound, like 25 to 30 pounds, is a respiratory therapist. And I said, What’s that? So I just transitioned into the respiratory therapist field, which is great for me because I was always very good in science. And my mom’s nickname for me is Doc, you know. And I think some people, especially if you’re going to be in the healthcare field, you are kind of naturally a caregiver, and you have a part of you that’s altruistic and you want to help people, right? 

So that’s where I found a real connection in what I did as a therapist. Not only helping people live, but just a connection that you make with people. So I went to respiratory school here in Honolulu and I did that for a number of years. And then I transitioned into- I got a business degree while I was working. And I was gonna move up in the hospital. My dad said, well, what do you wanna do? Are you trying to make money or do you wanna like, you know, serve humanity, so to speak? I said, I want to make money. 

So he said, get a business degree. So I work around the hospital. And my dad was a major administrator for St. Francis healthcare system and he helped build the hospitals and what you call the hospice centers and the dialysis. He’s done a lot of work like that over the years. So I ended up working for Merck and AstraZeneca in Washington, and I went back to Oregon, and then I moved to the East Coast and I worked for AstraZeneca in the corporate offices doing kind of like this. We’re doing- back in the day, this type of video conferencing was a new thing and I was involved in this type of marketing that had to do with like Zoom. But back in the day it was you know, fledgling, I guess.

But I will just say this much. I had a period of time where I got and this is a message to all the young students and people out there. I got into the routine of working these night shifts and just doing my job and it got really tedious. It got really, you know, I hated it after a while. I just had all these patients I had to see in the morning, and what changed for me was taking the time to just connect with the person that I was seeing, even if it was like four or five o’clock in the morning, end of my night shift, and connecting with the human being that was there, not just a patient, not room 482 or 357, like you tend to do, but you know, Mr. Takahashi or Janice, you know, and connecting with that person really is what made it fulfilling for me to be doing medical work.

And of course sometimes you just save lives, you know, and that’s exciting too. You know, doing things and you know you made a decision and people are alive because of you. And there are people alive because of things I did. And I got to meet later and been in a coma for months and things and those are very rewarding, but it’s the day in and day out and connecting with the individual person that often gets lost in healthcare. I think it’s really, really a payoff that you can have every moment. 

I had a heart transplant in 2020. So I was in Cedar Sinai and it was during COVID and nobody could touch me. And everybody came in with gowns and masks and shields. And it was very isolating during that period of time. And I had one doctor, and she came and she grabbed me by the hand and just that alone was so comforting as a patient, that real simple, just with a glove on, you know, I could but just that connection. And I had my ukulele, because I’m a musician and I was there in the bed. One of the doctors who’s now a transplant doctor at Cedar Sinai, she was a fellow at the time. And then one of the nurses said, “Hey, you should find someone to sing” and the doctor came in and we sang.

And then that went viral. It went all over the world. We sang a song together. And I was laying in my bed on a balloon pump, I was laying flat, you know, because I couldn’t get up. And it was before my transplant. But it’s the real human interaction that you can really touch lives. And that’s good medicine, you know, not just the pharmacology and the technology, but you, your humanity and your spirit and just the simple little things can bring so much healing to people. And in my case it was very simple things. And then the music was also part of that. I know that’s a mouthful, but I feel that’s really the takeaway from my experiences.

Herbert Villaflores: Yeah, that’s a great answer. Thank you. It was good, I like that.

 

09:07  — Heart Transplant Story

Herbert Villaflores: Let’s talk more about your heart transplant and how that was. I know that was a few years ago when you mentioned how you went to Los Angeles during COVID. What was that like as a respiratory therapist and seeing the other side of it? 

Sean Tiwanak: Taking a step back. So I was a specialist in cardiopulmonary, everything about hemodynamics. I knew all the medications because I sold them all from AstraZeneca and Merck and, you know, your beta blockers and angiotensin receptors. Two blockers and ARBs and what you call the ACE inhibitors, and mechanism of action inside and out. I know how it works and what it does to the body’s hemodynamics and in these different disease states, right? 

So I had a bad flu. I was in Reno. I had gotten a business degree. I left pharmaceuticals and always wanted to be an entrepreneur. And I had a background with doing tile. So I got my contractor’s license. I had a contracting company doing tile and granite in Reno and a tile store. I got really sick one winter. It was a bad flu. And most of my workers, you know, Mexican transplants, they can handle, but us Polynesians, especially Hawaiians, we’re not used to diseases and things, right? Our bodies are not- when they say when you go to Mexico, don’t drink the water, right? Like we certainly shouldn’t do that. That’s okay for them.

So everybody got really sick. I had a viral infection and it hurt so bad. My chest hurt so bad. I didn’t know what was going on. I never felt that kind of pain. You know, it was a gastro- they say coxsackie B2 virus to be more specific, potentially, because it started as gastric and then it became a very, very bad upper respiratory infection flu, right? I thought maybe I had pneumonia. I heard crackles in my bases and stuff, I still had my stethoscope, and it was difficult walking, maybe like fifty feet, twenty-five feet, and a lot of pain under the rib cage, right? Upper abdominal pain. And I thought, okay, I got- I probably have pneumonia. 

And so I went to an urgent care and the lady said I had asthma and she was a PA and I go, no, you can’t tell me I have asthma. I know the definition. That’s reduced by 50%, your FEVs are twenty-five to seventy-five. I know all that stuff. So no, I don’t have asthma. Sorry. Sure enough, I start Cheyne-Stokes breathing the night before I was supposed to have a doctor’s appointment. And this had been going on for about a month. And so I was literally like sleeping and I’d wake up just after sleeping and be going like [rapid breathing], right? So I know that’s when you call code. 500 cold blue already. Your resp- that’s my training. That’s an imminent sign of respiratory failure and cardiac failure, risk for cardiac arrest, right? Cheyne-Stokes breathing. I knew what that was. If I didn’t, I wouldn’t be here. And I think a lot of people die. You see stars and people, they die because they don’t know that’s imminent death, right? 

Or imminent or- so I knew one of these times I’m not going to- I went to the couch and sat and it was happening. And I said, I’m not gonna wake up from one of these. So I went in the room. I told my wife, hey, I gotta go to the emergency room. She was really upset. I said, I’ll go drive myself. She took me reluctantly and I went in. Everybody in the ER at two in the morning thought I just needed a note for work. And I said no, I own the company, I don’t need a note. I’m really sick. I just look like this. I looked okay to them.

And that’s another lesson. It’s because somebody looks fine, doesn’t mean they are. So I asked for a chest. They thought- they were reluctant to do anything. But I said, Can you do a chest x-ray? I got crackles in my bases. And they said no, you don’t. I’ll listen to you, right? Ex respiratory therapist, I got a $300 stethoscope at home, says different, right? They didn’t listen to me, to the patient.

They did a chest x-ray, came back into the room and said, Mr. Tiwanak, have you had a heart attack? I said no. Nobody is working harder than me, the whole company, right? I’m the owner. They said, “You have severe heart enlargement”. And it just washed over me. All the stats that I knew. 50% survival rate within the first year when you’re diagnosed with enlarged heart like that.

I said, what I got going for me? You know. And then, so then I come back to this, they took me in to do an echo, a 15% ejection fraction. And if you don’t already know what that means, it should be 55 to 60. So my heart was- so forget what percentage decreased it was, but it was 15%. I thought, my gosh, then they took me in to do a nuclear thing, nuclear study. With the thallium, it was twelve percent. And I said, You know what? As a respiratory therapist, I never saw one person walk out of an ICU with an ejection fraction less than 12, 15. They never left. None of them. But what was the difference? I told myself, well, the difference is you’re 37, you’re otherwise healthy, you’re not morbidly obese, and you have no co-morbid conditions, no diabetes. That’s what was wrong with all these other people. They had all those other things going on. So I said, I have a chance.

So they did what they could and I knew right away. This is, you know, how you get hurt and you say this is gonna leave a mark or scar? This is permanent. End stage. I knew already. There’s no coming back from this. I’m not gonna escape this one. Yeah, my luck ran out. So I just took it six months at a time, thinking, you know, if I can last six months, because the thing that’s gonna get you is an arrhythmia, right?

And then just day by day, six months. So many times I wonder should I call the emergency room? An ambulance. Since I was a musician, I remember being at home and I could walk to the couch from my bed. That’s an- out of breath. So I said, about a month into it, I said, I wonder if I can still sing a song. So I picked up my guitar, I started playing a song by Don Hanley called End of the Innocence. And it was literally like this. I go “Remember when the days were long” [breaths] “Roll beneath the deep blue sky”. And I had to take a breath after every phrase and I thought my music is over. I’ve recorded albums and stuff. I was like a serious musician. I thought that’s done for me. So I finally made a goal of myself to like, you know, over time sing a song all the way through. That was a six month goal, and I did do that.

Then another six months, I told you, I want to stand up and sing a song. So I finally made that happen. Ultimately, I had the defibrillator. But what was the key point here? Since I had a background in pharmacology and hemodynamics and respiratory therapy and advanced respiratory techniques, I was able to save my life and live with this for 15 years. And when I was sick, I tell you, I thought I was gonna die so many nights, but I would do things that I learned in Respiratory. Like you will learn about inverse IE pressure controlled ventilation. And that is when you increase the area under the curve by keeping the breath in longer, increasing the time for gas exchange between oxygen and carbon dioxide, and then exhaling quicker and in- it’s sort of the instead of the inspiration IE ratio of like one to two, it’s like three seconds to one or something like that. And so I would do these things to help save myself. And ultimately had the defibrillator and things in it. 

And I got to where I was performing music and things like that regularly, many times feeling like passing out, but ultimately it caught up to me in 2019. I think I got COVID and then I was on. Oxygen 24 hours a day. I got to the point where I was playing some tennis too, which was also amazing to me. People would say well, you’re so sweaty. What’s wrong with you? And I think, yeah, you know what? You don’t know. To me, I’m a miracle already. I’m here playing. 

Then got to the point my pulmonologist told me, Sean, there’s nothing else we can do for you. You need to get a transplant. And I didn’t want one. I never wanted a transplant. I thought I wanted my own heart and I was hoping technology would catch up with stem cells and organ things. That’s why it took fifteen years before I finally did it. And it was out of sheer necessity. Things happened in the government, especially in the early 2000s, I guess. Maybe we know where they kiboshed all the stem cell research and I was- it crushed me because that’s what I was counting on. And I went to get shots of stem cells in my heart in Dominican Republic, and it helped a little bit, but my heart was too far gone. 

So ultimately, I was planning my funeral in 2020. I had a song list, everything, because I’m not gonna make it. That’s done already. I know I’m at the end. I had an episode where it had like thirteen times- my heart, my defibrillator shocked me. I’d just pass out and it was really bad. And I was lucky I made it through that, you know, just it in a period of like an hour at home, right? In the ambulance. And that had to do with electrolyte balance, you know, with potassium and sodium. If those things are off, then you’re gonna have big problems with your, you know, your heart beating. And so I was in VTach mostly, yeah. 

So anyway, flash forward. Got into a program at Cedar Sinai. They immediately took me in. It was during COVID, so I couldn’t get the pulmonary function tests and everything else that you needed to do before. You gotta basically be healthy to get a transplant. I’ll throw this in. They didn’t care about how I was doing medically. The first thing they did was a sociologist and a psychology- psychiatric evaluation. That’s the first two things they want. They want to make sure you’re a good patient and they also want to make sure that you’re going to be compliant and that you have a good social support system, family, and that you don’t have behaviors that are not worth it. Cause I think that year it cost about 1.8 million dollars on paper, you know, with all the hospitalization.

And I think that Cedar Sinai was probably a million two or something when I looked at all the bills later. I didn’t pay all of that. Thankfully I had insurance, right? And I don’t know how things are now, but for me, it- you know, that’s a humongous expense. So they’re very careful about who they choose for this kind of stuff. And I’m very compliant. Daily medication, right? And at that time I was on oxygen and I got a heart transplant.

I needed to be stabilized for two weeks. Cause you just can’t go in, be sick and get a transplant. Everything has to be just right. Your pulmonary pressures have to be within a range, like less than 25. And mine was like 40. So they had to optimize things before I could even get it. Then they put me on the list five days later. I got- and I think partially because of my blood type A positive. I got an offer. First one that the heart was good enough, they said there’s something wrong with it when they took it out. And then the next morning they had another one. So after six days on the list, I got it. I’m still in touch with the family. That sometimes happens. You are able to contact them. 

But my donor was a 26-year-old guy they called Superman. And he had a seizure. He got hit in the head doing dare devil stuff. Maybe one too many times started having seizures, and- that’s his name is Zach, and I know a lot about him and his family. I’m in touch, I was just in touch with them this week, in fact. And visit them in California still. But how am I now? Not on oxygen. I play league tennis, you know, my men’s team. I don’t want to say I’m 59 now. But my men’s team came in first in the region and qualified for nationals. 

And a complete change of life. And a lot of that has to do with knowledge that you all are gaining out there. Without the knowledge, you can’t be a good caregiver, a practitioner, and you certainly can’t be a good patient. And those are all important and will help you in your life as you move forward in every way. As you move forward and the people around you, you know. 

I’ve been able to be with people and ICU, just that you know because they had bad diabetes. I had a really, really close friend of mine who’s actually very famous here and he told me, Tiwanak, I’d rather die with the sugar than live without it. And he died eating the sugar with his diabetes. And that has to do with your education and your ability to just have the willpower to do the right things. But then you all can still be there for those people and their time, their hour. Yeah. Then that’s I think the gift of medicine. 

 

23:40  — Connection with Patients

Herbert Villaflores: Yeah, that’s a really inspiring story. Let’s talk a little bit more about when you sang with the surgeon in the video. What do you think the importance of connection with your patients like that is? You touched on it before, but as like medical students, how can we incorporate that into our future interactions with patients? 

Sean Tiwanak: You know, when I was a respiratory therapist, I often saw medical students go into the hospital. And they were- I remember I really was upset one time because I’m dealing with this patient and they learned about sternal rub or testing the sensorium of the patient who was out, and they were rubbing her chest really hard and she would go “Ugh” and they kind of laughed like, “Wow, it worked” and like did it again, like kind of laughing at them. So I’m like, dude, it’s not a toy, but it’s somebody’s mom right there. 

And I know when you’re under, you know, you sense these things, and maybe you’re- I had a patient on one of these beds and whereas you know, and when she came out of her coma, she said she had dreams she was on a boat. Of course, she thought she was on a boat. She’s like this. So I go back to connecting with the person, yeah, and not forgetting that human being that’s there. And I think, you know, I have been rounded on so many times, like they come in.

Here’s Mr. Tiwanak, blah, blah, blah, blah, blah, blah. Sometimes they’re talking over you like you’re not there, right? And as a patient experience, it’s dehumanizing, and it’s a little aggravating, I guess. And maybe even a little bit embarrassing because they’re talking about you, not with you. 

And I’ve also been rounded on where they are like- I see them every day, they’re like friends already. And they treat you with humanity and that- I think really helps the patient to be more in a position to accept the advice that they need to hear and also emotionally, you know, have the hope that they need, right? That connection and positive outlook, positive attitude, and feelings are a very important part of healing. You know, if you’re depressed, it’s easy to get depressed if you’re sick. You’re not gonna get out of bed, you’re not gonna do the things you want to do. And I think it alters your body’s chemistry too. I think it’s proven stress, what that does, you know. And when that doctor sang with me, it was a lot of joy in the room, right? I didn’t know I was gonna survive. 

I made the goodbye video, you know, before. But at that moment, it not only touched my life, but because it went viral, it actually inspired a lot of other people, you know. So you never really know what your actions are going to do. And in this case, it really made a big impact on a lot of people. And people had seen this video all around the world. And it’s just something that happened in the room, but with today’s technology, anything’s possible.

And people will go on and live their lives, and it can have a far-reaching impact. But in the immediate, I just say just connect with the people. They’re all interesting. They all have a story. They all feel and they all have pain and they all, you know, need a little bit of comfort. Sometimes a pat on the shoulder is so much. A hand on the shoulder, you know, that human connection is huge. And of course we have to be concerned, right, about boundaries and contamination even, things like that. But as much as possible, you know, those little acts go a long way. And acknowledging people, right? You know, how are you today? So and so, right? It’s just- really be there present. 

And I found that the staff that I dealt with was- had a great attitude. And in fact, the doctors that you mentioned are still in touch with to this day. So it can have a real impact, what you do well beyond administering the right, you know, order, you know, or doing that procedure, that A line or whatever it is, right? Central line, whatever you’re doing, right? Far beyond your technical skill. There’s something about comforting people that goes a very, very long way. And I think I was very fortunate when I went out to Cedar Sinai, I was just you know, for the most part, just fantastic, the people that I dealt with, you know. And I was in the bed with the ukulele. I needed something to- even though I had a central line, a Swan-Ganz catheter, you know, high frequency oxygen, a balloon pump, you know, and foley catheter a whole bit, right? I still was in my bed with this ukulele, you know, and then sitting in bed, you know, when the doctor and I were singing.

[Singing] “Won’t you stand by me? Who’ll stand by me? Wo stand now, stand by me, stand by me.”

So all those things, I think they’re very healing, you know. Part of the whole human experience. It’s not just, you know, like it’s like psych and food, like you go eat. It’s not just about eating and what you’re nourishing yourself with. It’s about the experience. It’s about the atmosphere, the presentation. You know, when you go to a restaurant, it’s about the community and the communal aspect of sharing with people. It’s way- and it’s same thing in healthcare. There’s a- I guess a holistic picture and it’s easy to get pigeonholed in the little thing that you’re doing.

Like I remember my day when I was coming into Respiratory, I remember this very vividly, it was 1990s, 1992, let’s say, ‘93. So AIDS was still out there, like you’d see these AIDS patients, not HIV positive, I mean AIDS patients. They had the melanoma things all over their arm and they were in right. And you go in with a mask and you’re so scared. Just to touch them with your stethoscope. And I remember the first time I had to put a nasal cannula on an AIDS patient, it just freaked me out. I was so scared, you know. But you know, your knowledge will get you over that. 

But I only mentioned that because all I could focus on was that thing that I needed to do, and it took all of my energy, not to have my hand shaking. Can I do it? You know, is he gonna know this is my first time? Right. This is gonna be you. First time you’re gonna be sticking something in somebody, something sharp or cutting something. Then you don’t want them to know, hey, this is my first time, right? So, once you get over that, then you really can find a connection and I think a joy in your work. ‘Cause otherwise you can’t- it can become tedious because you’re just doing repetitive acts all the time, right? And you’re tired, you know.

Everybody’s gonna get tired. Medical school is like, doctors have to have the hardest, they have to go through all night, you know. 24 hours, I think coverage is typical, right? So I hand it to you. And you know, like I said, you guys plan for this and it’s rewarding, but not- I can’t think of a lot of- most people float through life like me and it’s one thing to the next to the next to the next. And you just sort of grow- build on each one. But you know, it’s so much commitment, and I really applaud you for that. And I will be honest about one thing. When I was a respiratory therapist, I thought about going to medical school because my teachers had said we expect that you’re gonna become doctor, Tiwanac. Okay. So after a few years of Respiratory, I asked the doctors around me, and healthcare was changing at the time.

And I guess I talked to the wrong guy at two o’clock in the morning and meeting a patient and he said- he goes, “There’s a lot easier ways to make six figures”. And I was like, Okay. It talked me out of it. But just- but I’m encouraging you. It’s a reward, and your impact on human beings is profound. Life changing for so many people. And look at me. Change life. I wouldn’t be here if it wasn’t for people like you, you know, doing their jobs and caring, right? And skillfully, you know, doing what they do. 

And still to this day I’m taking medication every day, and I get follow up with the transplant clinic every three months. So, it’s not permanent. You know. I’ve met someone this year who had 36 years of transplant, but it used to only last ten years because the body ultimately rejects it and you get this- vasculopathy is what they call it. The difference is sort of like getting plaque in your coronary arteries, except the plaques usually just happen in one spot. This is like globally, it’s black, it’s like you know, it’s like and then you’re done. You need another transplant. 

I’ll tell you something to watch out for as medical people in training. So I worked in a training hospital, right? Then I worked in a community hospital. The community hospital was more like when we did our like morning kind of rounds, right? Or they would say, you know, this is Tanaka, you know, Fred’s in again, you know, like that. In the training hospital, that’s where you have to be careful and cognizant because it’s usually this in 329 and it’s about the numbers of the rooms and stuff, and you get disconnected from people so easily in those environments. You almost have to remind yourself. And I found that to be true because of the setting. You know, large, you know, for here large, the large hospital here versus the community hospital, which would be the more medium sized hospital. 

So like I said you will find joy in taking that moment to like, just connect with that person. If they’re tired, let them sleep and all that stuff, right? It will make your life- it will make the hours more pleasant. Let me put it to you that way. You know, way more enjoyable. Way more enjoyable. And I found a joy in my work again by doing that. You know, and then because I’m in Hawaii, one thing that’s my motto and it’s helped me over the years is like I don’t always feel like I’m good enough. Healthy enough, strong enough, awake enough, skillful enough.

All you can do is bring your aloha. Bring your aloha. And somehow things work out. And I’ve seen it time and time and time and again. I tell myself that, like, like you’re doing this thing. And bro, just bring your aloha. And that’s the Hawaiian style. Yeah. So if you can do that and you figure out what that is inside you, and you just bring that good energy, that good vibe, the love, bring the love. Things are gonna be very good for you. You know, it’s people- it’s like karma, I guess. Yeah, some people look at it that way. You create it. You get what you give. And that’s what I do. I just try to bring the aloha and somehow things work out. 

 

36:19  — NHPI Healthcare Barriers

Herbie Villaflores: So I’m gonna ask you a little bit more about, I guess, your work in Hawaii as a respiratory therapist. What are some of the biggest barriers to care or like adversity that these communities face? That you’ve seen. 

Sean Tiwanak: Ooh, you know what? That’s a really big question. I’ve been in there and the unit they bring the patient up, they’re admitting them and the first thing the doctor asks, “What kind of insurance does this person have?” And their treatment will be determined by that answer. You know? Because it is a money making and venture for the most part.

Not everywhere, but you know, depends on the type of hospital it is. But really, I mean, in Hawaii, you really have a lot of people here that don’t have access because it’s not always valued to live the life that most people see. This is the way you should live your life. You have a corporate job or whatever and you got insurance and all of this. Some people work their whole life just so you can live on the beach, right?

Well, guess what? People do that in Hawaii without a job or anything. And they love it. They just- people have different values and they don’t have anything. And they’re very skeptical of, maybe because of what they hear and social media doesn’t help either. Believe in medicine and believe in science, and they always think it’s a big conspiracy that the Pharmaceutical companies have, they don’t want to heal you. And that’s not true. Okay. They do have a profit motive, right? They need to make things that are gonna make money, right? But I’ve always felt that here, you know, people are concerned about a lot of things that I think are not important, but maybe what they should be is providing more access to health care. 

So somewhere along the line of this argument between, you know, government healthcare and private, you know, I think there is a way we can develop something so that more people, their problem is they don’t go in until it’s too late, you know. 

And I mean, I’ll give you a good example. I’m planning a trip and I’m going to Japan shortly. While I’m there, I’m getting my body scanned and all this stuff. MRI and stuff is cheap. A lot of people do that. You know, it’s not as accessible here, you know, to do things like that. And just to have the peace of mind to know that, you know, my mother had a glioblastoma, which is a very serious brain cancer and she passed relatively quickly from it if you know about that at all. So you do wanna make sure you’re okay, right?

I don’t know what the answer is, but I do think that there needs to be some kind of hybridization of the care systems or bifurcation. Like in England, like they have public medicine and private medicine. It should be able to treat everybody. Everybody should be able to get checked up and not wait till it’s too late because that’s a common problem. I just had a friend talk to me about that. All of the people that he knows. You know, in his community, which is a Filipino community, they wait too long. Then they wait till they’re too sick. They can’t do anything about it. Early intervention, right, we know, is critical. Especially with, you know, certain disorders more than others, right? even simple stuff like blood pressure and diabetes and, I don’t even want to say the other word that we all know is our, you know, C word. You know, stay away from that, right?

But I know insurance has been changing too and you will probably know a little bit more even in your current understanding, you know, how things are in that regard. I think it will take a private – and some very creative – you know, ’cause we really can’t rely on the state governments and things like that to do that. But you know, we do need that. We do need to take care of people. I’m very fortunate. Not everybody’s as fortunate as me.

 

41:07  —  Career as Musician

Herbie Villaflores: So I know you have to leave soon. So I’m gonna ask you a few questions. I know you’re a musician. I want to ask about that. What kind of music do you play? And how did you get started with that? 

Sean Tiwanak: Well, I’m old already, right? Comparatively speaking, right? Although I don’t feel it, right? So to me it’s just a number. I started playing ukulele when I was like five years old. And about that age, I got my first Beatles record for my birthday.

And it was like a toy, like a record player, was a toy to us because it’s not like you know on your phone, you pick any song, right? You got this record and you put it on a thing, and sometimes it makes mistakes and jumps and so it was fun, you know, to put a record on and sometimes scratch doesn’t work right, you know, broken or whatever. Play with the needle, make sounds, you know, it was a good, it was a cool thing, and I’ve always been into it and started playing guitar when I was about ten.

I think I was almost thirteen years old when I started playing, you know, in the church choir, guitar player and by high school, I was the Eddie Van Halen of my school, literally playing Eruption. But not like now. You can watch videos. Back in my day you had to like back up the tape, listen to a little bit, back it up and figure it out. So I think that- learning how to do it that way. I think kinda just- I play a bunch of instruments now. I play the ukulele. This one is like a custom, it’s built like a guitar, like an electric guitar, so you can hear it in the notes and stuff. And I moved to ukulele because as a heart failure guy, it was easier to lie in bed with an ukulele than a full on guitar. And so I do play piano and violin, a bunch of stuff. 

But I will say I could tell you a short story. Brother IZ you know, from Over the Rainbow, was one of my patients. He was so big, they put the two beds together and a bar, and we had a stethoscope in his room that was like five feet long. And so we put on this thing, and you couldn’t use your stethoscope because it couldn’t reach his heart. You know to reach his lungs, you know. So big. So we talked about personal breathing and things that you would tell people you know, what to do to help their heart failure and all this stuff. And he wasn’t able to do it, you know. And you know, of course you can’t expect everybody to be able to make those kind of changes, right? And when I had heart failure, I told myself, the thought kept coming into my mind. You guys tried to tell Brother IZ what to do. Now can you do it? Can you do it- be the proof in the pudding? You do it now. You know, can I? Can I follow my own advice, in other words? 

So I really took that to heart. And when I came back to Honolulu, I was playing at Princess Kaiulani Hotel and sitting in with my friend playing ukulele. First song was Over the Rainbow. And bang, I hit my ukulele and it broke completely in two. The body separated from the neck. And I’m standing there on this stage with my two pieces in one in my hand, both sides. I was just horrified. And the microphone shocked my lip because it was wet, because it was raining. And I thought, brother IZ must be mad. Sorry brother IZ. But since then I have played that song, I can guarantee you way, way more than he ever did. And I got two thousand times, you know, like [singing] “Oh somewhere, over the rainbow, way up high. There’s a land that I heard of once in a lullaby. Where happy little bluebirds fly, be on the rainbow why, oh why can’t I?”

Anyway, thank you, thank you, thank you, thank you. I’ve done lots of lots and lots and lots and lots of beach weddings and performed that song so many times. So when I came back to Hawaii with the heart failure, it was really just my goal to just enjoy my life. I didn’t think I had a long time to live. I didn’t think I was gonna make it to 40, you know, 45 was- so the fact that I lasted 15 years, I just wanted to play music and be an artist. I got involved with things and so I played a lot and lots of beach weddings and used to play five nights a week actually in Waikiki and stuff. Which brought me a lot of happiness and you know sharing music and it’s own reward. Cause you certainly don’t get paid a lot of money doing music. It has to be something else that gives you a payoff. And again relating it back to what we’ve been talking about in the same way. It’s not about the money, and it’s not about your job that you’re doing, but it’s the impact that you make. 

And I was a weird respiratory therapist. When I went to work, I thought, people need me. I was Recipe Man. And I run up the stairs and stuff. And I guess getting to work, and I said, “People need me”. I remember back in my day, you had to collect a paycheck. And somebody came up to me about a week after the paychecks came out and they’re from human resources say, “Sean. Your paycheck’s been sitting in the office for like a week or two weeks”. And I’m like, I forgot why I was working. I thought I was just here to save lives, you know. So if you can adopt a little bit of that in you and pick up your paycheck then I think you’re gonna be just fine. 

 

47:54  —  Advice for Future Generation

Herbert Villaflores: For my last question, do you have any advice for the future generation of healthcare workers and medical students? 

Sean Tiwanak: Advice, huh? Oh man. I would say utilize all the technology that you can. Things are changing fast. I for one, in what I do now, rely on AI. We don’t want that to replace us, but we definitely need to leverage what we do. And if you can leverage it in such a way that it helps you to be fresher mentally and physically- burnout and all this stuff is not good. And things are going to change. But adopt and embrace what you can as things move forward and hopefully the life saving things that we have will continue to progress to give you more tools to do what you need to do with pharmacology and with other- I mean, I watch shows, I love to watch this Japanese TV network and they show Japanese inventions and medical things. It’s amazing to me.

It’s what- how things are progressing. That’s generally where I see these medical advances on the show that I like to watch. Embrace it, get good at it, but then again remember, yeah, it’s all about your humanity. And that’s what makes you so special, right? More special than a robot, more special than any artificial intelligence or mechanical device is you. It’s you. It’s a joy that you can bring people and comfort. 

And I’m gonna go back to that. One experience of that hand, gripping my hand across the rail during that time of COVID was an oasis in a desert for me. And it really helped me because it was hard emotionally and mentally to be isolated like that. And I think that the problem with technology is that it could cause people to be more isolated. And we see that, right? People don’t necessarily relate the same way because of the technology that we have. 

But I say stay motivated, believe in what you do, because you make a huge difference. And you won’t always know it. You won’t always know it. People aren’t always going to tell you, but they’ll talk about you later. And you know, you can know that. And that’s the thing that you can take with you. I had a patient that room A and room B, right next to each other, right? 327, 329, right next to each other. Guy- multimillionaire, dying. Poor Hawaiian man- next door, dying. Rich guy, miserable. Not one thing in dollars could buy him any happiness. No friends, nobody visiting. The old Hawaiian man- happy, happy, happy. Lots of family. I had to finally be the guy to discontinue his life support one day. And his family’s all there. But you know what? I never seen a more happy guy going, you know. And so it’s not just about the money. Just remember that. 

At the end of your life, you’re gonna go look back at what you feel, like you remember the things that mean a lot to you. And it’s gonna be those things that aren’t gonna be about money, you know. And maybe some accomplishments will be things. But definitely your inner relationships with people are gonna be things that you value and/or regret that you didn’t do. You didn’t connect with people, you know. So make those connections, rely on each other. Yeah. And when you get to be an old person one day you’ll look back and you’ll be really happy with the life that you led. Right. And just share, bring the aloha. Uncle Sean says bring the aloha.

 

52:13  —  Closing Remarks

Herbie Villaflores: Okay. Well thank you so much for joining me. This has been really great.

Sean Tiwanak: Yeah, man, it’s been a pleasure. Seriously talking to you. Yeah, thank you. And good luck to everybody out there. Yeah. You can always contact me anytime. You can find me. Got questions, Uncle Sean will be here for you.

Herbie Villaflores: Cool. Well thank you so much and we will see you in the next episode.

Listen here:

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This episode was produced by Grace Kim, hosted by Madeline Pan, and graphic by Romi Sheng.

 

00:07 — Opening

01:38 — What led Dr. Lee into medicine and HPSP

03:48 — How the Health Professions Scholarship Program works

07:05 — Branch options and different paths into military medicine

09:00 — What to consider before choosing military medicine

12:22 — Advice about purpose and preventing burnout

14:16 — Unexpected opportunities from the Navy

17:46 — How the Navy shaped Dr. Lee personally and professionally

21:14 — Choosing allergy and immunology

24:59 — Identity, bias, and navigating stereotypes

29:36 — Advice for women advocating for themselves

31:55 — Myths about allergists

33:45 — Closing remarks

 

00:07 — Opening

Madeline Pan: Welcome back to White Coats and Rice and the APAMSA podcast from roundtable discussions on current health topics to recaps of panels with distinguished leaders in healthcare to conversations with student leaders across the organization. This is White Coats and Rice. My name is Madeline Pan, and I am the Woman in Medicine Director this year and a fourth-year medical student at the University of Texas Medical Branch. I am joined today with one of my committee members.

Carolyn Vo: Hi, my name is Carolyn Vo. I am currently a second-year at Touro Nevada. We will be your host today.

Madeline Pan: We are really excited to introduce a very special guest for this episode, Dr. Rachel Lee. Dr. Lee is a board-certified allergist, immunologist, and internal medicine physician who started her medical school journey as a part of the Health Professions Scholarship Program. After completing residency training at Naval Medical Center San Diego and fellowship training at Scripps Clinic, she served for over 20 years as a medical officer in the United States Navy before retiring as a captain. Today she is a professor in the Department of Medicine at UC San Diego School of Medicine and a professor of medicine at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. We are grateful to have you today with us, Dr. Lee. How are you doing?

Dr. Lee: I’m doing well. Thanks so much for inviting me to speak on this forum here.

01:38 — What led Dr. Lee into medicine and HPSP

Madeline Pan: Since we are filming this episode with the pre-health audience in mind, could you start by telling us what initially inspired you to pursue medicine and when did the Health Professions Scholarship Program, or HPSP, first come onto your radar?

Dr. Lee: Yeah, so I will say that when I was younger, this is way back before Google and social media, so back in the nineties when I was finishing college. I was really, you know, everybody goes through that journey of figuring out what do we want to do when we grow up, right? And I definitely wanted to do something in healthcare.

03:48 — How the Health Professions Scholarship Program works

Madeline Pan: For students who may not be familiar with the program, can you explain how the Health Professions Scholarship Program works and what it offers to aspiring healthcare professionals?

Dr. Lee: Yeah, so the Health Professions Scholarship Program is a military-sponsored program where they are training future medical officers. For medical school, they offer a full scholarship for all four years of medical school, and during that time you get a stipend for living expenses and they pay for all your books and supplies and everything.

07:05 — Branch options and different paths into military medicine

Carolyn Vo: Do students have preferences for different branches, or is it kind of like a self-finding journey about which branch?

Dr. Lee: Yeah. So there’s actually several ways into military medicine. Mine was before med school I applied and I got accepted before starting med school. Some people are already in residency and they realize they have all this debt, and they’ve actually joined during residency.

09:00 — What to consider before choosing military medicine

Carolyn Vo: For pre-health students interested in this program, what are the biggest considerations that they should keep in mind when deciding if it’s a good fit? And you may have already answered this previously, but what was the deciding factor for you?

Dr. Lee: So I think personally it was really just not having a huge debt at the end and just having that burden. But looking back and looking at current students and residents and fellows and kind of young junior staff attendings, I think everybody in medicine is very like probably type A personality. The military really will say they don’t really care too much about your plans. It’s mission first.

12:22 — Advice about purpose and preventing burnout

Madeline Pan: Looking back on your journey, what is the most significant piece of advice you heard as a pre-health student that has shaped your journey the most?

Dr. Lee: I think one of the biggest things that helped me figure out what I want to do and going into medicine and figuring out my career and various jobs that I’ve had along the way really is choosing a career where we can serve our community. I think that even though it sounds very obvious in medicine, there are a lot of people in medicine as you’ve probably seen that that’s really not the reason they choose it. But choosing a career that ultimately gives you a reason to get up every day helps prevent burnout.

14:16 — Unexpected opportunities from the Navy

Madeline Pan: I’d love to hear about some of your experiences in the HPSP program. Were there any unexpected opportunities or perspectives that came from being in the Navy that you would not have had otherwise?

Dr. Lee: There are so many, I don’t even know where to start. My whole family, my parents and relatives and all the people I knew, I never knew anybody in the military. And I didn’t know anybody in medicine actually growing up. But along the way, the military is going to offer a lot of opportunities that you just never even knew existed.

17:46 — How the Navy shaped Dr. Lee personally and professionally

Madeline Pan: How did your experience in the US Navy shape you both professionally and personally?

Dr. Lee: Professionally, I spent my entire early medical life in the military. So I did my internship, residency. I was an internist for a while and then I went back to fellowship and did my fellowship in allergy. The military is very big on education and they will pay for almost any kind of educational opportunity if you want it.

21:14 — Choosing allergy and immunology

Madeline Pan: I also really liked hearing about your personal life and different roles in your family. Your advice and your experiences are going to help a lot of students who are considering the program. So just to change the topic, I’m curious about your specialty. How did you decide on your specialty?

Dr. Lee: I knew nothing about allergy when I went into allergy. I had initially planned to go into infectious disease. But when I was an internist for a few years, I really wanted to be able to go home for dinner every night, or at least most nights. The more interesting thing was why some people got really sick from the same pathogen, whereas other people never got sick.

24:59 — Identity, bias, and navigating stereotypes

Madeline Pan: How has your identity as an Asian woman shaped your experience in medicine? How did you encounter stereotypes in medicine and navigate them?

Dr. Lee: Everybody has biases, right? We all have whether implicit or explicit. As an Asian woman, people didn’t always see a military officer or a doctor. I used to be very mad when I was younger, but now I don’t take it personally.

29:36 — Advice for women advocating for themselves

Carolyn Vo: With being in the HPSP program and the US Navy, what advice would you give to women in medicine advocating for themselves in environments where they may feel outnumbered or less represented?

Dr. Lee: Always making friends, networking, getting advocates, advocating for other people. I think all those create a network of people who will support each other. Ultimately you’re there. Fitting versus belonging. We belong wherever we are.

31:55 — Myths about allergists

Carolyn Vo: As we’re nearing the end of the episode, we had one more fun, lighthearted question for you. What is one myth about allergists that you’d like to debunk?

Dr. Lee: There’s a myth. But I will say several times when I’ve actually talked to other doctors and when they find out I’m an allergist, they are surprised. There are very few allergists out there, and allergy is a very small field, but it’s a great field if you’re interested in it.

33:45 — Closing remarks

Madeline Pan: Is there anything else that you might want to add before we end?

Dr. Lee: Well, I know we have very little time left, but I want to focus on one last thing: the four pillars of well-being in medicine and life — physical, intellectual, emotional, and spiritual. Keeping those in balance can help prevent burnout and keep you grounded.

Madeline Pan: Thank you so much for sharing. You gave us a lot to think about today, and I’m really grateful that I got to hear your advice and listen to your stories. And to our listeners, thank you so much for joining us for this episode of White Coats and Rice. Be sure to follow the podcast and stay connected with the APAMSA.

Dr. Lee: Yeah, so my I can send my email address to you if people want to send me an email if they have questions about HPSP or other things about allergy in general. So I’m happy to respond to emails.

Madeline Pan: Thank you so much again. I think that concludes the session. And to our listeners, we hope you’ve enjoyed today’s episode as much as we did. Thank you for tuning in and keep an eye out for future episodes. Until then, take care.