Network Director

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This episode was produced by Annie Nguyen and Ashley Tam, hosted by Amber Chan, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

0:58 Introduction to Dr. Marcus Iwane 

1:48 Professional Background and Native Hawaiian Health

4:17 The Role of Cultural Identity in Career Choice 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

23:21 Building Trust & Cultural Humility in Medicine 

29:58 Community-Based Healthcare Initiatives in Hawaii 

32:29 Climate Change

35:20 Healthcare Sustainability 

35:20 Work-Life Balance & Personal Life 

46:53 Closing Remarks 

48:00 AMA Outro 

 

Full Transcript:

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

Annie: Welcome everyone to the 8th 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 Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in! 

Today’s episode was moderated by Amber Chan, a medical student at the Hackensack Meridian School of Medicine and member of the 2024 Leadership Committee. 

0:58 Introduction to Dr. Marcus Iwane 

Amber: All right. Um, so just to give a brief intro before I hand it over. Um, this is Doctor Marcus Iwane. Um, he’s born and raised on Oahu, and he’s a board certified internal medicine physician. He earned his medical degree and completed residency at the University of Hawaii. And he’s currently the

chief of Kaiser Permanente West Oahu Medical Office, where he promotes Native Hawaiian health and healing. Um, so he also currently serves as clinical faculty and has been listed on 40 under 40’s Exceptional Leaders as well as best Doctors in America. Recently in 2023, he also completed the Climate and Health Equity Fellowship. So definitely be excited to hear about that. So, I’ll hand it over. Doctor Iwane, if you want to introduce yourself and tell us just a little bit to start off. 

1:48 Professional Background and Native Hawaiian Health

Dr. Marcus Iwane: Yeah. Hi. Good evening everybody. Uh, thank you for inviting me. You know, so I’d like to keep this very casual. So if anybody has any questions, you know, please feel free to ask me anything. So I’ll tell you first a little bit about myself. Born and raised in Hawaii on the island of Oahu, I did all my training here in Hawaii. Uh, that includes medical school, my residency training. I’m a internist by trade. And, yeah, after residency, I’ve been practicing with Hawaii Permanente Medical Group. Um, initially started off with a clinic in Nanakuli, which is a small little community on the west side of Oahu. We can maybe talk a little bit about that if you folks have questions about community health and what that means. And now we’re practicing in Kapolei, which is a little bigger clinic that I can share you a little bit about as well. But my passion is obviously Native Hawaiian health. So I don’t know if any of you on the call have roots here in Hawaii, or are part Native Hawaiian yourself, or have family who are Hawaiian or come from any indigenous background. But that is something that drives me to continue to do what I do, um, to serve our community and help to uplift our, our people so we can talk about Native Hawaiian health or indigenous health as well. That is another topic that if anybody has questions regarding, I can definitely share some viewpoints on. I currently serve as president for ‘Ahahui o nā Kauka, which is an association of Native Hawaiian physicians. I’ll drop in the chat our website. Um, you guys can go to kauka.org and we are a nonprofit, if you also want to learn a little bit more about ‘Ahahui o nā Kauka and what we do. Uh, go ahead and check it out. There’s a little video on the– on the website homepage as well. That kind of highlights a little bit about, you know, how we were formed, why we were formed. We established in 1998. And yeah, it’s a really it’s a really cool and very important organization to be a part of, to really focus on improving the health status of Native Hawaiians. And so yeah, we can definitely talk more about that as well. Um, but that’s a little bit intro to myself. 

4:17 The Role of Cultural Identity in Career Choice 

Amber: Definitely. From what you’ve introduced, you’ve spent most basically all of your medical training based in Hawaii still. Is there anything, I guess, growing up that kind of motivated you or inspired you to really be connected to your roots and really wanting to focus on giving back to the community instead of, you know, coming to like, the continental states or going elsewhere. 

Dr. Iwane: Yeah, that’s a great question. So I’ll share a little bit about my upbringing. Uh. First as a child. So I grew up in Oahu. I’m not sure if any of you have been here before, but, uh, Nanakuli is a– is a little town on the west side of Oahu, and my grandparents used to live there. So growing up as a child, I’m spending a lot of my weekends there. Their home was right across the beach, so that was also another good reason to go every single weekend. But my grandfather was a farmer and he has a child. He would always get me involved with getting my hands dirty in the garden with him, taking care of the– taking care of the grounds and the garden areas. And what really intrigued me growing up was hearing him speak Hawaiian language to his plants. And I was always kind of– always kind of thinking, what is he doing? You know, what is it? Why is my grandpa talking in Hawaiian language to plants? And so, you know, it was something that I really didn’t appreciate until I obviously got a little bit older. I started to learn a little bit more about my culture, including Hawaiian language and everything that comes with that. Yeah. And so, you know, I realized that at an early age, my grandfather was really teaching me the importance of connecting to land. Yeah, connecting to– connecting to the things that sustain us. Yeah. So our people, you know, being, you know, folks who have inhabited Hawaii for centuries. Yeah. You know, coming from a place that– an island that really didn’t have a lot of endless amount of resources, right? So everything was about resource management, protecting our precious water sources. You know, our– our land that sustains us, the fish that, you know, feed us from the ocean. And it was all about sustainability and really focusing on the understanding that, you know, once our precious resources are gone, there is no next state to drive through, right? There’s no next– next area to get more resources. Right. You know, so it was, it’s a very fine balance, right? That our people had a connection to land is so important. And you know that concept we refer to as something called “aloha ʻāina”. So aloha ʻāina. ‘Āina is a word that we refer to as land. And aloha obviously is love, you know, caring for. And so having this concept of aloha ʻāina ingrained in me from an early on, childhood, you know, really kind of helped me to understand the importance of making sure that you stay rooted. Yeah, you stay connected to your community. You stay connected to the land that sustains you. And that in addition to. Connecting to the importance of language. “Ōlelo Hawaiʻi” is what we refer to as Hawaiian language. And, you know, as I started to go through grade school and then eventually in college, I, you know, I took my language courses and, you know, that’s– that’s very important because in language, you that’s where you connect to cultural identity and, you know, through, through all of these things. Right? You know, you really focusing on what we refer to as cultural health. And so that, you know, really helped to lay a foundation for me as a, as a kanaka, as a, as a Hawaiian, as a Hawaiian person, as a Hawaiian, as a Hawaiian male, and, you know, carrying that through, you know, my training, um, really inspired me to figure out how to bring this into my medical practice. And so, you know, I decided to stay home for training throughout my, my college career, throughout medical school, even residency, specifically because of, you know, this connection that I have to to my in my land and being able to understand and care for our people, you know, we, we, we see this as more of what we call kuleana or responsibility that, that we have as, as, as native Hawaiians to really to really be able to take care of our own home. Yeah. And so, so that’s kind of what inspired me, um, to stay home and, you know, get even more deeply connected with community, which I feel has only helped me along once I started to establish my medical career, um, and really helped to build those connections with, uh, with folks. So, yeah, a little bit about why I chose to stay home. I’ve shared there– there’s obviously more, you know, maybe we can talk a little bit about what I do in my free time later. But yeah, I– I could not personally live away from the ocean. So that’s another reason. 

Amber: But honestly such an inspirational story. Just going from like your childhood, being with your grandfather and realizing later in life what you didn’t realize, like growing up that he was instilling in you all these traits that as a child you don’t really appreciate. But I definitely appreciate how you know you consciously are bringing that into how you practice medicine today, because I feel like it really brings a factor of humanism that I think many patients who, you know, may deal with America’s health care system today feel that we don’t really have that provider patient connection as much anymore, like the way things are driven, especially like larger hospitals or like metropolitan areas. It almost feels like patients see the doctor for two minutes and then they feel that, you know, yeah, you’re doing all this stuff for me in the background. You’re treating my physical health, but I don’t really know what emotionally is happening. So I think it’s definitely sounds great that, you know, you’ve been so conscious about that in your practice today. 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community
Dr. Iwane: Yeah, I see something. So, Victoria, I see you put a question in the chat. Uh, Victoria,

where are you from? 

Victoria Shi: I am from new Jersey, but I’m currently doing my medical school in Kansas City. 

Dr. Iwane: Oh, fantastic. Awesome. 

Victoria Shi: Thank you so much for being here tonight. 

Dr. Iwane: Yeah. No. My pleasure, my pleasure. Uh, so I see your question. Yeah. What are some unique health challenges or needs of the Native Hawaiian Pacific Islander community that you feel are important for all clinicians to be aware of? So that’s an excellent question. You know, and so I kind of– I’ll kind of give a roundabout answer to that one, uh, by sharing another story. Um, because I like to share stories. So, you know, one of the very first patients that I began to care for right out of residency training was a young Native Hawaiian man who was diagnosed with really bad and uncontrolled diabetes. And, you know, I kept really trying to push medications. Yeah, trying to get his– his diabetes under better control, trying to stress the importance of that because, you know, his grandfather and his father, you know, both ended up having end stage renal disease on dialysis. And, you know, a lot of these bad complications and diabetes. And, you know, I felt like at his stage in his life, he, he, you know, he was at a point where he could make a difference. Yeah. And prevent, you know, his kidney function from declining and prevent his eyesight from getting affected and other things, you know, including decreasing his risk of strokes or heart attack. And so, you know, really, really pushing the medications, including lifestyle changes for him. And, you know, he really kind of seemed almost resistant to, you know, wanting to take medications. I didn’t know how engaged he was. And yeah, I couldn’t really understand why he wouldn’t want to get his diabetes under better control. And, you know, so it wasn’t until until while, you know, he he talked to me and he, you know, he said, “hey, you know, it’s not it’s not that I don’t want to take my diabetes, you know, or get my diabetes under better control by taking medications. You know, at the end of the day, I really gotta figure out, you know, how am I going to pay for these medications? Or how am I going to put food on the table to feed my family?” And so, you know, that kind of took me aback at– understanding that there’s so much, factors outside of just the medical care we deliver that influences health and wellness. And so, you know, Native Hawaiians, Pacific Islanders, especially here in Hawaii, you know, have the highest rates of chronic disease, diabetes, heart disease, obesity, hypertension. Um, we have the highest cancer incidence. Native Hawaiian females have the highest infant and maternal mortality across all ethnicities in our entire nation. And so how can this be, right? Why are people so sick? You know, I think there’s a lot of things that influence health and wellness outside of, you know, genetics, right? Outside of predisposition to getting certain certain conditions. You know, we’re talking about social cultural determinants of health. And so that’s something that’s very important for all of you to kind of understand is that, you know. Actually what we do within our four walls of the medical clinics, our hospital systems is just about 11% of a patient’s overall health pie. Yeah. The larger part of that is, you know, access to food, right? Uh, access to places where you can exercise safely, you know, so the list goes on and on. Education. And so there’s– there’s many things outside of just what we do in medicine that influences health and wellness. Yeah. So recognizing that I think is is important specifically for Native Hawaiians. Yeah. And this story is very similar for various indigenous peoples across our nation and including the world is, you know, we gotta factor in our historical determinants. 

So what are historical determinants, right? These are things that we refer to as non modifiable determinants to health. So um the impact of colonization marginalization of– of our people, you know, taking us away from ancestral and sacred lands. Yeah. And so through this you know transformation. Yeah. Through– through generations. Yeah. This generational trauma is what we refer to. It impacts health and wellness even hundreds of years down the road. And so, it’s so, you know, I think a lot of that is also a big factor, right. That we have to– we have to learn about, especially for our specific unique populations that we care for. Um, here in Hawaii, it’s obviously, you know, our Native Hawaiians and Pacific Islanders that we need to really kind of focus on so that we are approaching healthcare from an understanding and a place that, you know, we’re really a small part of the solution. So– so I think there’s a lot of things that– that, you know, we can learn. I can tell you, folks that Hawaii’s population of of Native Hawaiians is actually decreasing. More and more Native Hawaiians are now moving to various states around the continent because the cost of living is, you know, it’s hard to make it here in Hawaii. So we actually now have more Hawaiians living outside of Hawaii than we do actually here. So this is I’m I’m so happy that, you know, we’re having a conversation this evening with you folks because you folks are all going to be seeing Native Hawaiians one day. Yeah. In your– in your respective areas. And so, you know, the West Coast, uh, you know, Washington, Oregon, California, Las Vegas, right. Even Arizona, there’s– the population of Native Hawaiians and Pacific Islanders continues to grow. And so in order for us to really make a difference, and in order for us to be able to establish relationships with, with the people that we serve. Yeah, including Native Hawaiians and other indigenous populations, we gotta understand them. Yeah. We gotta understand where they came from. Uh, understand these historical contexts, all these factors outside of just their physical health. Yeah, that influences their well-being. So. So that’s just a brief, uh. Answer, I think to your question, Victoria, but yeah, it is– it is important to, to understand those things. 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

Amber: I think you definitely highlighted some pretty important points there. You know like historical significance and how that impacts health down the road too and the generational trauma. So I guess that kind of made me wonder as well. Like as a native who’s practicing and working with this population, do you feel that you know, the native population and indigenous peoples have, like these communities have a mistrust of health care professionals and like the medical system because of how, you know, they’ve been treated over the years and just the effect of colonization and being marginalized in the past, having a trickle down effect now?

Dr. Iwane: Yeah, that– that is definitely alive and something that is a real challenge, you know. So what’s– what’s very important to note is that. You know, and we’re. We’re trained. Right. In a very Western way. You know, we’re trained to practice medicine, you know, by evidence, right? Um, by the book. And, you know, and so, you know, it’s very it’s very much, oh, you have this and, you know, you do this, this, and this, but a lot of a lot of indigenous cultures around the world, right? Not just Native Hawaiians have their own traditional healing methods. Yeah. That have been, that have been, have and continued to practice for centuries. Right. And so I think it’s important to note that or be aware that, you know, there are folks who– who do practice traditional healing methods. Yeah. And, you know, be open to hearing those. Uh, you know, one of the things that I love to do and where I go traveling and whatnot is always go check out some bookstores or different, different, different local areas that may sell, you know, books on on local plants that maybe are used traditionally for healing, you know, just to kind of read up because a lot of things are very similar across different cultures that you folks are starting to realize. 

Dr. Iwane: And so, so having an open mind and approaching– approaching your patients and community from– from a standpoint that– a standpoint of humility and curiosity, I think is something our great skills to have as a– as a clinician. I can tell you that that will only make you a better clinician because you’re able to build stronger relationships. Yeah. So, you know, the relationship between health care provider and the patient, I feel– and the patient’s family I feel is the strongest therapeutic force, even stronger than a medication we can provide for anybody. Right. Without that trust, without that foundational relationship its going to be very hard for you to, to, um, make change, right, to inform folks, to engage with them. And so and, you know, having a good relationship with, with your patients and their families, you know, is therapeutic not only for them it’s therapeutic for you, too, right? That’s what keeps us going, right? That’s what keeps us coming back every day for more. Right. Um, because medicine is really challenging. No matter what field you decide to go into, whether it’s surgical field, specialty, primary care, um, they’re all very challenging in its own ways. And so, you know, making sure that you have that foundation right to rely on it. That foundation is really, how do we build that trusting relationship. Yeah. So like you mentioned Amber, the generational trauma, the cultural trauma that our people have experienced, you know, even if it happened 100 years ago, for many it seems like it’s still happening. Yeah, there’s inherent racism and perceived discrimination is a real thing. Yeah. It impacts it’s a chronic stressor that increases– has been shown to increase risks for mental health disease. It increases risk for higher risk behaviors. Yeah. That impacts health and wellness. It also has been shown to affect cardiovascular reactivity and recovery increases the risk for diabetes. And so the list goes on and on. And so you know I think– I think it’s important right to talk about these things you know in forums. Yeah. Such as this. You know a lot of folks kind of like don’t feel comfortable talking about it. But it’s very important to talk about, you know, it’s not about pointing a finger or, you know, blaming this person or that person. Right? It’s about– it’s about the cultural humility. Yeah. And so wherever you folks go, wherever folks practice, you are going to have, you know, you’re going to be on indigenous rounds and in indigenous communities. And so learning in partnership with your folks and your population that you care for, I think is is extremely important. 

23:21 Building Trust & Cultural Humility in Medicine
Amber: Yeah, definitely. Oh, yes, I see Reanna, you’re unmuted. Do you want to ask a question?

Reanna: Yes. Hi, Doctor Iwane. Thank you so much for being here today. My family is from Waianae, so I have roots there. And I’ll actually be out at the University of Hawaii soon for my OB-GYN rotation with maternal fetal medicine. So I think yeah, I’m– I’m so excited to, like, come and I go to school in the Bronx. So I have some experience with like underserved communities. But I was wondering if you have any advice for just medical students in general when they are even just on a clinical rotation, we don’t have very much time with our patients. So how– how do we incorporate cultural humility and build that relationship in a– in a short period of time? 

Dr. Iwane: Yeah, that’s a great question. You know, and I think, you know, part of that is. It comes with time. You know, I think the more, uh, the more folks you’re you take care of, the more people you talk to. You develop your own style of how you build that rapport. So, you know, I can tell you that mentorship is extremely important. Yeah. So I wouldn’t be in a position I am today without having awesome mentors. Yeah. And so, you know, you learn from your mentors, right? You can see how your mentors interact with patients and how they are able to build relationships. So, you know, one of my mentors, I don’t know if you folks have ever heard of him, Dr. Noa Emmett Aluli, um, so he is a family physician on the island of Molokaʻi. And, uh, you know, one of the things that really kind of stuck with me as I started to spend time with him in his clinic before, even before I went to medical school, uh, was his ability to– to make that instant connection. Yeah. With his patients. And, you know, for– for Uncle Emmett. Right? It wasn’t so much about them, about the medicine. Right? It was about that connection. And so, you know, when, when I would see him talking to his patients. Yeah. He will be talking about what’s your last name or who who your mom, who your dad or, wait, where are you from? You know, and so, you know, he’s trying to figure out he was always about that connection on a, on a humanistic level. Yeah. And so finding that commonality with, with your patients, I think is, is probably the first step, you know, that we all should be trying to aspire to reach. You know, I think the challenge that you mentioned is we have such a short time right, in primary care. You know, we’re on 20 minute visits, but after the patient gets worked out, right after the vitals and everything gets done, uh, I maybe have ten minutes in the room with the patient right before I gotta hop onto my next one. And so, uh, in the busyness of the day, you really you. It’s very easy to get caught up in addressing your needs as a physician rather than the patient’s needs. Right? And so it’s okay to take a pause. Right. It’s okay to slow down and just kind of like talk story. You know, most of the time I can tell you if it’s a brand new patient for me or even if it’s like a patient I’ve been taking care of for ten years, sometimes I hardly– we hardly even talked about medicine in the exam room. You know, we’re talking about fishing. We’re talking about where did they last go on their on their most recent vacation. Right. You’re talking about their grandkids. We’re talking about oh their son got married and you know so it’s it’s that type of connection that I feel like matter most to our patients. So yes we do have to address their medical needs. But unless you can figure out how to– how to build that relationship, right. And get to know people on a personal level, you know, it’s it’s going to be it’s going to be hard, right, to continue to engage with them. And so that’s kind of like something that that I would actually focus on. You know, when I go in to see, see my patients and I encourage, you know, you folks all to kind of also take cues from, from various mentors and see how– see how you know, your, your preceptors, you know, interact with their patients. Everybody has a different style, right? And so yeah, here, here in Hawaii, we’re all about the connection. Yeah. And so connection is not only personally but you know, connection is from a family. A family centered approach. Yeah. So so to me that to me that’s what matters. Right. And yeah you it’s fun because you find some really interesting things about people. You know, they, they do all kinds of really cool stuff in their life. And, you know, it’s just that’s what– that’s what excites me, you know, to, to learn more about them. You know, every time I see, see a patient. Yeah, I’m learning something new about them, which is super awesome. Yeah. And it’s these things that you remember. Yeah. But it helps you to also ground yourself as a physician, too. Yeah. So so awesome. No, I’m glad that you’re going to be coming out here. You know, you feel free to message me if you want to come out and check out, check out our clinic over here in Kapolei. 

Reanna: I would love to. I’m staying with my uncle. He lives in Makakilo. So it’s perfect. 

Dr. Iwane: Perfect. Yeah. Perfect. Yeah. Awesome. 

Reanna: Everything has changed there in West Oahu. So much the past. Well, the past 20 years, I feel like. 

Dr. Iwane: Yeah, yeah, yeah. So. Yeah. If yes, please send me a message. I’m not sure. Amber, does everybody have my email? 

Amber: I can send it out in the. 

Dr. Iwane: Actually, I’ll just type it in the chat right now. Yeah. So? So please feel free to email me anytime if you folks have questions. 

29:58 Community-Based Healthcare Initiatives in Hawaii
Dr. Iwane: You know, I guess I take a little bit to kind of talk about, you know, what we’re doing specifically over here in Hawaii within Kaiser Permanente. So maybe, maybe we’ll see you soon and you can come check it out over here. But, you know, we’re talking we you know, I talked a little bit about sociocultural determinants, right. And how that influences health and wellness. And if we– if we drill down health and wellness even to life expectancy per zip code. So if we’re looking at different zip codes or zip code where Reanna has roots, you know, if you come from this zip code, your life expectancy is actually 10 to 12 years less than if you if you reside just five, ten miles down the road. And there’s different pockets like that across all islands in Hawaii. Yeah. And typically these pockets are rural areas. These pockets are areas that have a very high concentration of Native Hawaiians. These are where what we call our homesteads are located. And so, you know, it’s it’s it’s really frustrating. Yeah. To to see this. Yeah. How can your life expectancy be determined by where you live? So that really kind of alludes to the fact that, you know, there are a lot of other things that are in the wellness. And so what we’ve done specifically in our– the clinic that we– I practice that here in Kapolei is really focusing on on that cultural health aspect. Right. And building programs and building community partnerships specifically to address these needs right, within our our vulnerable populations, our native Hawaiians or Pacific Islanders. Actually, our Filipinos have a very, uh, high rates of chronic disease as well. Um, so what we’ve done over here is we’ve we built this almost like center of, of excellence for Native Hawaiians. And so, you know, within our, our clinic grounds, we have a walking pathway that has garden beds and we have a traditional healing mala or garden, and we have taro patches, two that we actively farm on our clinic grounds. And so it’s a different way of approaching health and wellness. And so, uh, you know, you’re not just you’re not just a physician, right? That comes in practices within our four walls. But, you know, your reach goes far beyond that, right? Community partnerships. 

32:29 Climate Change 

Dr. Iwane: You know, I talked about the importance of mentorship. So we have high school students that come out, or medical students come out and work the land with us. Right. Going back to. The importance of aloha ‘aina. Yeah, that I talked about early on setting that foundation. Right. That understanding that, you know, our health is directly connected to the health of our land. And so being able to work the land, being able to harvest kalo, right, or taro and incorporate that into our diet is important culturally. Yeah. And so there’s a lot of other things that, that, that we do, um, to focus on that, uh, within our, within this specific clinic that, that we have built here in Kapolei. So, you know, the other thing that’s important, right? Aloha ‘aina is also it’s also a concept of being good stewards. Right? Environmental stewardship is a– is a big thing. And so, you know, putting in energy efficient features over here. Right. To reduce our carbon footprint and reduce our greenhouse gas emissions is also very important. So that’s another big passion of mine too is you kind of mentioned earlier about the climate. Yeah. Climate change and how climate change impacts on health and wellness of our communities. And so, you know, we constantly talking about these things, right. And trying to figure out how to be on the leading edge of, you know, being good stewards of what we do in in medicine. Right. You know, health care sector, you know, contributes 8.5% of greenhouse gas emissions in this country. That’s huge. That’s huge. 8.5%. This is you know, that comes from the health care sector. Yeah. A sector that should be taking care of people and taking care of our land. Right. How come we are destroying it by emitting 8.5% of greenhouse gas emissions? Well, you think about it, right? Everything we use. Yeah, all of our– our single use devices, you know, processing of labs, processing of, you know, all of these types of things. It takes energy. Yeah. It you know, this waste has to be disposed of. And so, you know, we’re having conversations about how can we be better stewards of all of this. Yeah. So so yeah, it’s very interesting. But yeah got lots to talk about. 

Amber: I think that’s really cool having, you know, having high school students even come in and work the land physically and really being able to connect. And it’s like being able to pass that on generationally and how, you know, like harvesting things brings it back into your diet. And it’s like this self rewarding cycle. I think that’s really cool. I wish I had something like this here that my school could do. 

35:20 Healthcare Sustainability 

Reanna: I had I have a question I’ve always sort of had the struggle of like with the health care sector. And like in my background, I studied like environmental engineering and sustainability in undergrad. And so it really like shook me when I, you know, started medical school and saw like all the single use items we have and like we– for sterility, we have to have a lot of these plastics and single use items. But I was wondering if there’s any suggestion you have or like if your medical practice has put into place some sort of effective like reduction of waste or recycling of items that you’ve found to be like really useful and like very satisfying to see that in practice. 

Dr. Iwane: Yeah. So I can tell you it’s really challenging to make such a big change happen. So across a large organization. Yeah. And so, you know, just bringing it back to understanding that, you know, change starts at home, right? It can start with you and, you know, making a conscious choice of, you know, how we how we support our environment, right, individually. So I can tell you agriculture, yeah, is a big contributor to greenhouse gas emissions. And so, you know a two pound, two pounds of beef, right to have two pounds of beef land on your plate. That’s actually equivalent to about 160 miles of greenhouse gas emissions driven by a car. So that’s just two pounds of beef, right? So, you know, figuring out how to– how to how to support local I think is also another big thing. So you know, for us over here in Hawaii, everything has to come to us by boat or plane. Right. And so that’s a huge amount of, of energy that needs to to make that happen. Yeah. You know, a lot of these things we have come to rely on in our everyday life. And so how can we be better stewards of supporting local, of supporting sustainable organizations? Yeah. Within your own communities and also being a little bit more mindful of, you know, the types of things that, you know, we’re eating. Uh, because I give you the example,  85% of food that we consume here in Hawaii is not from Hawaii, but yet traditionally, yeah, our lo’i kalo systems or our agriculture, traditional kalo system supported a population of upwards of a million people. And so I think about that. Right. We have come so far away from land stewardship, from resource management, right, to relying on something that is not even produced here in Hawaii. And so how do we get back to rebuilding that, that model of sustainability of land and resource management? Because food grown locally, wherever you are at right, the shorter distance of food has to travel from from the ground to your plate, the better it is for not only the environment, but it is for your health too. Less processing, right? The food is always fresher. It’s more beneficial to your health. So I always kind of encourage folks to think about how they eat, the types of foods that they eat, the type of things that they buy, you know, and so just making a little conscious effort starting at home. Yeah. And so that includes even, you know, lower carbon forms of transportation, right. Like electric vehicles, LED lights, all those types of things. So but yes, change is necessary. I think a lot of folks, you know, across the nation now, especially in the health care sector, is looking individually within their own organizations on how they can reduce their own greenhouse gas emissions and carbon footprint. So but but yeah, I think we have a long way to go, you know. But but we’re getting there. 

Dr. Iwane: Which is which is why, you know I think individuals like you folks. Right. If you are interested. Right. If, if, you know, environmental stewardship and environmental justice is a passion of yours, you guys should really harness that passion. Yeah. There’s so much environmental groups out there, right, that are doing fantastic work. So partner with them. Right. Get involved with these nonprofit organizations. One of the things that I completed in 2023 was what we call a Climate and Health Equity fellowship. So as a ten month fellowship based out of DC, to have physicians get trained in everything that we need to know about how climate impacts health. And so it’s a really cool fellowship because I got to meet so many folks across the nation. All physicians. Yeah, we’re passionate about this work. So the reason why there’s a big push to educate physicians about climate change is because there’s this critical intersection between how climate impacts health, but more importantly, it’s not universal across the board. Much like social and cultural determinants, the impact of climate on health is is more severe for specific vulnerable populations. And these are our indigenous communities, our brown and black communities, our redlined communities. Right. And these are the communities that folks that we’re going to take care of. And so the other important thing is to notice that there’s this thing called a trust veracity index. So it looks at all professions across the entire nation. And guess who are amongst the most trusted professionals amongst everybody? 

Reanna: Doctors. 

Dr. Iwane: Yes, it is physicians and nurses. And so we have to use this, right. We have this very unique position. Yeah, that you folks are going to be entering as a physician. Yeah. Your voice matters. Okay. Your voice matters in the exam room. Your voice matters outside of the exam room. And so we can all be leaders, right? In advocating for what’s right. Yeah. For our people and our communities. So, uh, so that is something, you know, that is, I think, going to be growing in popularity and importance over the next couple of years, especially as, you know, our our global warming continues.

 

Amber: Yeah, it’s definitely I feel like I would echo everything you’ve been repeating how the importance of just having these conversations and just starting that thought process, like plant a seed in all of our minds and, you know, as we’re going day to day working with our patients and encountering all these single use, you know, medical supplies, it’s I would definitely admit it’s definitely not in the forefront of my mind, but having these conversations always plants that idea were, you know, looking back, I would say today I probably threw out like 13 gallons because I have so many patients in contact rooms and. Then people are, you know, using the disposable stethoscopes and the amount of gloves and everything we’ve gone through. And it’s so difficult to try to balance, you know, how we can advocate as physicians and I guess lead by example and demonstrate it when at the same time, I feel like we’re bound by the other medical side of things when it comes to these things. But I did notice we’re coming to our last five minutes. I know, Doctor Iwane, you were, you know, excited to share a little bit about what you do in your free time outside of medicine as well. Um, so if you want to wrap it up and end by sharing a little bit of what your life is like enjoying the beaches and the culture and life there, we definitely love to hear it. 

35:20 Work-Life Balance & Personal Life 

Dr. Iwane: Yes. So. So yeah. So I am married. I have two children. Uh, so our son is 11 and our daughter is 6. And so, you know, it’s a lot of time outside of, you know, taking care of patients and the daily grind of being a physician is obviously spent with family. So family is a big, a big thing, you know, that is what grounds me. And, you know, I think that work life balance. Oh, look at that. Yeah. Yes. So that work life balance as a physician is extremely important. Yeah. You know, family is is really everything. Yeah. Family is who you can fall back on in your tough times, you know, and even celebrate with you and your good times. Yeah. And so, you know what? One of my, one of my best friends is, is also one of my colleagues. You know, he he always she always tells me, yeah, we’re all going to pass away one day. Right. And so what do you want. You know, people to write on your, on your, you know, your, your gravesite or your tombstone or whatever it may be. Right. Do they want– do you want people to know you, as you know, Dr. Iwane, he was a great physician. Dr. Iwane, you know, he is a great, you know, you know, clinician or whatever, you know, or would you want people to remember you as, you know, uh, Dr. Iwane, you know, he was a he was a great father, right? A great mentor. Right. You know, so, you know, it’s I think it’s important to really focus on what matters most to you. Um, and remember that through your medical training and even as you, as you start practicing because. You know, like I said, medical, the field of medicine is– it is a challenging profession. Yeah. But it is also, in my opinion, one of, if not one of the most rewarding. Yeah. When you can make the difference, right, when you can see that smile on your patient’s face, right? You know that that’s what keeps keeps me coming back. Right. And so, you know, besides family, you know, I love the outdoors. Fishing is like one of my my biggest, most favorite pastimes. And I love hiking. And I do a bit of hunting too. So just kind of being outdoors. And that allows me to also connect to our environment, connect to the land and that’s grounds me. And you know, just having that– that time right to, to rejuvenate. Yeah. To kind of re-energize and you know that that’s important. Yeah. So whatever it may be. Right. If you guys don’t have hobbies you know that is okay. You know. But I encourage you folks to explore your passions. Yeah. Whatever it might be. Because in the tough times. Yeah. That’s just going to keep you going, right. Or to your happy place and, you know, take care of yourself. Yeah. That’s important. 

46:53 Closing Remarks 

Amber: Yeah. That’s definitely some great advice that I think as students we can all try to really take

away and actually explore. I know it’s so difficult for students. Once you start school, the hobbies, the priorities aren’t exactly up there to be pursuing them as much. But you’re definitely right. You know the things that will ground us at the end of the day, whether it is going outdoors or knitting, whatever the climbing the hobby is, is always going to be there for us at the end of the day and this exam will be over, you know, the next thing you know, but the things that really ground you are really still there. Great words to end on. Thank you, Doctor Iwane, for taking the time to speak with us today. 

Dr. Iwane: Yes, absolutely. And like I said, you folks have my contact information, my email. You can go ahead and share it. You know, even to the broader– who put in joining us today. If you folks have any other questions or want to reach out any time, okay? 

Amber: Thank you. Enjoy the rest of your night. 

48:00 AMA Outro
Annie: And that’s our latest installment in the Ask Me Anything series. If you have a specific physician or specialty that you’d love to hear from, let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone!

Listen here:

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This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Time Stamps:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:23 Introduction to Paul Tominez

02:06 Plant Parenting

06.28 Pharmaceutical Chemistry Major

10:10 Solo Traveling to 5 Countries in 1 Year

13:31 Military Match

16:46 Specialty Exploration and Why General Surgery

25:30 Challenges With Moving and Adjusting to New Places

29:43 Prioritizing Your Joy 

31:48 Hopes For Future Career

34:26 This Or That? Questions

37:42 Advice for Pre-Health and Medical Students

 

Full Transcript:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

James: Welcome everyone to the seventh episode of the APAMSA 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 James Chua, second year medical student at Touro Nevada, and the current fundraising director at APAMSA. I’ll be your host for today.

00:23 Introduction to Paul Tominez

James: For today’s episode, we have Paul Tominez, a fourth year medical student at UCSF School of Medicine and a proud graduate of UC Davis where he received his degree in pharmaceutical chemistry. During his time in APAMSA, he has served as the Region 8 director and now serves as one of the Membership Vice Presidents on the executive board. Originally from the island of Guam, Paul is an Army Health Professions Scholarship Program recipient, and he has recently matched into, well stay tuned for the rest of the episode to find out where. But spoiler, it’s another island. Former collegiate rower and highschool athlete, Paul’s interests include staying on top of his fitness by running and working out. He’s also an avid solo traveler, having a total of five countries under his belt this year. Without further ado, join us as we explore Paul’s incredible journey in medicine, his insights on leadership, and the unique passions that shape his inspiring story. Paul, welcome to the show. How are you doing today?

Paul: I’m doing good James, thanks for having me.

James: Yeah, no, we want to get as many of the executive board members on this podcast just so we have a very, more clear insight on to who you guys are, because you guys are like the leaders, you guys are shaping basically the next generation of APAMSA.

Paul: Yeah, we’re kind of this weird enigma in APAMSA that we have all the directors reaching out to our local chapters that we kind of just work in the background and a lot of people don’t get to meet us in person.

James: Yeah, you guys are pulling all the strings. But before we get on to the interesting questions we have in store for you, I have a couple questions myself. Just so I and our viewers or listeners can get to know each other better.

Paul: Of course.

02:06 Plant Parenting

James: So first, you are a plant dad.

Paul: Yes, I am.

James: Tell me more about that.

Paul: Yeah so I guess I started my collection in medical school, I think it was during my second year. But growing up is actually where I started taking care of plants so growing up on an island. We had this big yard that like was basically ours to do whatever we wanted to. So, my dad would plant a lot of fruit and vegetables. My mom would plant all of her flowers and other more decorative plants. And from like the earliest age I can recall like helping them in the garden in the afternoon. And like I’d get off school, change and then we’d be outside playing with my dogs, planting things, getting things, like harvesting, whatever we had growing that summer. And then in high school, I kind of cleared out this plot of land and we actually like built like, where it was like a farm and we had like a bunch of eggplant, papaya, I think we had cucumbers and maybe like several like pineapple plants and dragon fruit. And my dad was in the army, so he deployed like, I think later that summer, so I was the one mainly taking care of it. And it was actually like pretty relaxing. And I kind of lost touch with that during undergrad. I didn’t have any plants in Davis, but then in medical school, I stopped by Home Depot one day and was kind of just strolling around as one does in Home Depot. And I picked up two plants and then now I have an entire collection sitting by my window. And I think I probably have an addiction but I need some control.

James: Wow. How many plants – what would you say your favorite plant is?

Paul: Oh, I think it was the first one I got. It’s called a Ficus Audrey, but the interesting story behind that is that… So back in Guam, the other name for Ficus Audrey is called the Tatamuna Tree. So Tatamuna are the spirits back home in Guam that kind of like watch over you and you don’t just respect them. So another word is that these are big Banyan trees, the massive ones you see in the movies with all the things hanging down the sides. So I didn’t know that at first, I didn’t know this was the same plant. So now I playfully think that I have a big banyan tree growing in my apartment with spirits that may or may not be there. And it’s been growing really, really well. It was a super easy plant to start off with. And spoiler, unfortunately I’ll have to get rid of all my plants at the end of the year, but shhh. We’ll get to that soon. 

James: Yeah, I’m sure they’ll go to a very good home. It’s also interesting though because, so you grew up to some degree like growing your own fruits and vegetables.

Paul: Yeah, we also had calamansi. My nino had like tangerines in his yard. I remember seeing bananas. Obviously an island we had a lot of coconuts and avocados, mangoes yeah a lot of like very tropical fruits which I took for granted and then coming out to California’s like oh shoot you’ll have the same kind of fruits that we have back home.

James: Yeah no it’s funny because I also so I’m in Vegas a very desert climate environment, um one of the first things that my dad gave to me as a gift was a potted calamansi tree and it was already fruiting right? But like, lo and behold, my roommate, so I kept it indoors. I was told you can keep it in its pot for 5 or so years, and I was like “Perfect, by the time I’m done with medical school, I’ll know where I am for residency,” and than I can put it like, in the ground. But then I kept it inside and then my roommate kinda got mad because he was like, “yo, I think these are kinda toxic to dogs and worried that my dog is going to eat them all.” And I was like, “Oh man.” So I had to move it outside and then within a week it just shriveled up. 

Paul: Oh no, I didn’t know they were toxic to dogs because we have plants back home and I guess I never saw my dogs eat it but.

06.28 Pharmaceutical Chemistry Major

James: I am not studying to be a veterinarian and I cannot speak on how strict of a dog father my roommate is. It’s whatever, but in any case enough about plants I want to talk a little bit more about your medical journey because I think that’s why we’re all here. We want to get to know you know what motivates you and what drove you to become a physician but even before that something when I was reading about your history something that I was really interested in is, you received your degree basically in pharm. How did that translate over to medical school? Were you considering becoming a pharmacist first or something like that?

Paul:  Yeah, so I think I decided my major back in high school. I really liked my chemistry teacher and the class. I took AP Chem and really, really enjoyed the topic. So I kind of knew I wanted to major in chemistry in college. Kind of jumping ahead. So for college at Davis, there’s a general chemistry major, which I applied into, but then I was kind of going through the requirements and it required linear algebra, a bunch more complicated math topics, which I had no interest in taking but they had pharmaceutical chemistry as an option and that aligned a lot better with the pre-med requirement so I went into medical– I went into undergrad knowing that I wanted to be a doctor already so, I switched majors because it was a little bit more easier to integrate the requirements for medical school while also avoiding the death of linear algebra, super extensive quantum physics. And I was able to switch pretty easily because I had a few friends taking those classes and I don’t think I would have survived taking those. 

James: Yeah. No, I can definitely relate. When I went to my undergraduate, the University of San Diego, I received my degree in biology, just general bio, no specific specialty within it. But I remember like, I was doing really well in my chemistry classes. So I thought I was like, “Oh, maybe I should major in like biochemistry instead”. And then, you know, I love chemistry I love organic chemistry too. But when they recommended you have to take inorganic chemistry or these really niche chemistries, I was like, this is… this is not for me. And I also, like on a similar note to your linear algebra, for us, one of the requirements is like AP Cal– or uh, Calculus 1. And so if you’re a Biochem major you have to take Calculus 2. And I was like, I didn’t even need to take AP Calculus– or like Calculus here because I took AP Calculus and that covered it, so I was like “I can’t do anymore man, like physics is gonna be the end of it”.

Paul: I know, because like I didn’t make that change until maybe three quarters of the way into my first year of college, so I was already taking the calculus for engineers and that definitely was like a rough time. I wish I’d made that decision a little bit earlier, but you know, hindsight is 20/20. And then, yeah, I’m glad I kind of switched out of it because I had to take one semester of physical chemistry and took it during the pandemic, and that was a rough time. I’m glad I avoided the subsequent classes that would have followed after that. 

James: Yeah, no, I can only imagine, I can only imagine how difficult that journey may have been, but hey, it got you to UCSF nevertheless, so.

Paul: It did, yes. 

10:10 Solo Traveling to 5 Countries in 1 Year

James: Yeah, but even though– before we talk more about your medical journey I want to talk about your traveling. So we have five countries this year, huh?

Paul: Mhmm, ya, five countries this year.

James: Have all of them been solo?

Paul: Yes, they have, or I guess, technically, they’ve all been solo. One of them, my friend joined along, but he could not continue on with the trip because of some other personal reasons. But for the most part, yeah, they’re all solo. This is my first time traveling solo internationally. And the other few times I’ve been internationals with my family. And it’s been something I’ve been thinking about doing for the longest time, but I was always scared to do it. One, because traveling internationally by yourself, you don’t know what to do if there’s something that goes wrong. How do you ask for help? I was also worried about the language barrier, navigating public transportation, but things actually worked out really really nicely. 

James: So which countries did you end up– places did you end up visiting? 

Paul: Yeah, so I took my first trip in September of this past year. So I went to London first and then I took the Eurostar to Brussels and Belgium and then I went down to Paris and I went up to Amsterdam. I spent about, I think I was gone for 10 days, 10-11 days, and then I recently got back from Montreal, I think I left the day after Thanksgiving. I spent like five or six days there.

James: Yeah. How did you find the time to do that being a third/fourth year in rotations?

Paul: Yeah, I guess one of the nice things about UCSF is that once you submit your ERAS application, your schedule lightens up very nicely. So over the span of September until now I’ve had a very light class schedule. I only had one rotation that I had to do. I’ll be going back to the hospital in a couple weeks. So I was doing quote unquote research during the time. So I was able to do that on the side while also getting to travel internationally. I saved up a lot of credit card points so they would pay for my hotels very nicely. And yeah it was a nice experience. I’m hoping to take a few more trips hopefully before graduation. 

James: Yeah no I really, so since I’m only a second year and I don’t know how truly rigorous rotations are, I’m always like I know Match for us normal folk for us civilians is in March right and so I’m just hoping that when March rolls around it’s like oh from March to May and May is our graduation it’s like alright everyone, let’s go on the vacation that we all talked about for four years. 

Paul: Yeah. Yeah. Even before that too, like if you’re able to get all your rotations done, like just advice for anybody who’s able to do this, if you’re able to pack everything earlier on, let’s say finish and like, I know a lot of my friends are finishing in like December, January. So between February until graduating, they’re traveling the world and staying at home doing whatever they want. So if you have– if your school has the capability to push things a little bit earlier on in your fourth year, definitely I would take that. 

13:31 Military Match

James: Yeah. Well, since we’re already on the topic of medical school and all of that. Let’s just start. What– so I kinda spoiled it just a little bit in the beginning but what field or specialty of medicine are you interested in and why?

Paul: Yeah, so I applied into general surgery this past summer, so once again I am one of the Army HPSP recipients. Our match process is a little bit earlier, we found out our results a couple weeks ago so I matched into general surgery at Tripler Army Medical Center in Honolulu, Hawaii.

James: The pink hospital correct?

Paul: Yes, the pink hospital. They currently have a big I guess Christmas tree outside you could see it from like off the cliff.

James: No, it’s funny, so I was actually very interested… So let’s dive more into this. So you mentioned that your dad is in the army, right? Yeah. So did that play a big role into you choosing the Army HPSP? Or did it play a role in you choosing gen surg?

Paul: Oh definitely. Yeah. I guess for the Army specifically, so my grandpa was also in the military. I think he served in the Korean War I want to say. Don’t quote me on that. And then my dad was, served in the Army for I think 33 years. And then a bunch of my cousins are also in the Army, not in the Army, but in the Air Force. And then I went to what’s called a DoDEA school, which is like a school for all military kids and federal workers to have their children go to the same campus. So I was surrounded by a lot of like department of defense people and children. So that was definitely a big influence. And then I guess for me, the financial aspect of it was a big part because being from Guam, you are not considered in-state for anywhere besides University of Hawaii. So the cost of medical school would have been egregiously expensive for me wherever I went. So it kind of helped take off that financial burden of being able to attend medical school. 

James: Gotcha. You know, something that I don’t share with a lot of people, but I now I guess I’m going to share with every person listening, is that so my dad was also in the Army. And so for a brief moment, I was really interested in doing HPSP. But, um, also on that note, since my dad when he was active duty, he was once stationed in Washington in Tacoma. And so that’s actually where I was born. I was born in Madigan. And so I was, yeah. So I always think to myself that even though I’m in M2 right now, that maybe one day like I could sort of circle back and end my story in like Seattle slash Washington, you know, like that’s where I was born and that’s where I want to end my career you know? But we’ll see, we’ll see. 

Paul: Ya, I actually did a rotation up there at Madigan 4 weeks this past summer. They have an excellent general surgery program and they have a couple civilian doctors who work at the hospital. If you’re interested in general surgery, you can definitely work up there. 

16:46 Specialty Exploration and Why General Surgery

James: I’m currently interested in psychiatry, but you know, you know, things, things really could change. And on that, oh yeah. Yeah. Yeah. Because when I was, again, doing my research about you, you know, two years ago on your APAMSA’s bio, it said that you were interested in emergency medicine. So why did you switch from emergency to gen surg?

Paul: So I think during my third year I had so many life crisis of what I wanted to do in medicine. So I came into medical school thinking I wanted to do emergency medicine. That was the only thing I wanted to do. That’s mainly because I did research in emergency medicine during undergrad and during my gap year. I really liked the big, I guess, catchment of patients that you get to see. So it’s a very wide patient population. Everyone ends up being in the emergency room at some point unfortunately, in their life, so you get to see a wide array of presentations. Your ability to come up with different differentials very quickly to provide critical care and a very like adoptions to do that in a very resource limited setting was something that was very attractive to me and also kind of working as like the quarterback to coordinate care for all these patients who are coming into the hospital. So whether they can go home safely whether they need you know be admitted or they need to stay in the emergency room for a couple more hours, maybe a day or so. That was what really drove me to the field, and also the flexibility. So I heard that you can pile your shifts earlier on in the month and then take the last half of the month for you, whether that be traveling, teaching, doing research and so on. But then during my third year, I got more exposed to the different specialties. So I kind of got more interested in internal medicine because I really liked the depth of knowledge that they had for all the different specialties and being able to coordinate care more long term for these patients. And oftentimes when you care for patients in the hospital, like the relationship with them is very intense. So you’re caring for them for a span of 2-3 days to upwards of several weeks. And you get to see them every single day. You get to see them progressing, changing– their clinical status changing, which you don’t necessarily see in emergency medicine, because oftentimes you give them to a consultant or admit them to the hospital for medicine, or they get discharged. You do get to see some repeat patients who come in frequently, but you don’t really get that long-term care that a hospitalist will get. So I kind of got interested in being more like in the hospital, like on the wards through internal medicine. But I still liked the idea of critical care. So I thought of, okay, let’s do a critical care elective or pulmonology elective because I really like– unfortunately really like very sick patients. I like the complexity that they have behind them. And then I finally had my general surgery rotation. It was– I personally, I always felt like surgery could be an option for me. But I had never gotten any exposure to that. So I’m the first one to go to medical school in my family and have any exposure to surgery beforehand. But when I got to the OR I was… “wow, kike this is an incredible environment.” My first exposure was through a pediatric urology elective where, on my very first day being in the OR, the fellow handed me the scalpel, held the skin taut, and allowed me to do the first incision. I was like, this is insane. Like I’ve never held a scalpel before, never had cut anyone before and he was allowing me to do something. So that kind of like stuck with me and throughout the the two weeks of that elective they continued to allow me to do different things they taught me how to suture things closed they taught me how to tie things. One day it was just me and the attending so I was basically just opening for the case with just attending again with limited experience as a medical student, which was a very like incredible like memory that I’ll continue to take with me going forward. And then I had my actual general surgery rotation the week after for two months. So I did four weeks of vascular surgery and then four weeks of acute care surgery. For my time in vascular surgery, I liked it because again, the patients are very critically ill. So a lot of the vascular patients have multiple comorbidities, the cases are very long and complex. I think the longest case I was in was maybe I want to say six or seven hours. And I think that was only planned for like a 45 to hour and a half case. So it ended up just being at one point it was just me and the fellow trying to figure out like what to do. And I was like assisting the fellow in like kind of getting hemostasis and like holding things with like the forceps and cutting things, which was a very good experience. And then a lot of the patients end up going into the ICU. So I kind of got to see that, you get to do surgery but you also still get the care for these critically ill patients as like the primary team. So it kind of combined two interests that I had. And then the following month, so I did acute care surgery, which is basically the consulting service for general surgery. So what that means is that whenever I guess the hospital service needs like a consult from surgery, you’ll call the acute care service. So would that be for like a bowel obstruction or let’s say in the emergency room, they’re admitted for appendicitis or cholecystitis, you call that service in the hospital. And I really liked that service because there’s a lot of running around. So I think at one point, our list ballooned up to like 30 some to 40 some patients. So our patient list was too thick that we couldn’t staple it together. And I really liked the one– again running around. So running between the OR and the floor to check on non-patients. We just had a bunch of cases going on it throughout the day. I felt like the residents allowed me to do a lot. So one, care for the patient and write notes of course, and then also in the OR getting to close, drive the camera for a lot of laparoscopic cases, and then closing of course honestly with just the attending sometimes, which kind of stuck with me as well. And then the very last case of my rotation was an ex-lap and that was the first ex-lap that I had ever seen. And when we’d gone to open the body cavity, the blood was just gushing out of the patient, unfortunately. But that really stuck with me because I got to see how quickly these general surgeons had to think to figure out what’s going on. And while also, again, using their hands to see where the source of bleeding is. And I really liked how quick on their feet they were thinking. Also being able to make a difference in the moment at that time that you don’t necessarily get to see in other specialties. And this emphasis of using your hands thinking critically. Very sick patients continue to stick with me through all of my um through like all the other general surgery rotation that I did. Even in my GYN surgery rotations where they allowed– again allowed me to do a lot of things in the OR continue to stick with me. And ultimately, like it was the teacher I had in the OR that drove me more and more towards that general surgery path. 

James: I can see why you have felt like so inspired to pursue this specific route. I think in my own experiences. So even before, so I mentioned I was interested in psychiatry, but prior to this, I was interested in infectious diseases. And I think that was from all of my mentors throughout my undergraduate and post-grad time. Like they were the ones who like wrote off however many hours I shadowed them in the hospital for applications but when I went with them and learning from them and getting inspired by them, I think that’s what really propels us forward. Especially in our medical journey you know?

Paul: But it truly is. Ultimately, your clerkship year is decided by who you’re working with. You can have a tremendous attending who gets you involved with the cases and teaches you a lot and allows you to do a lot of things. Or you can have the opposite of where you’re basically just shadowing as a medical student, which may not be the most exciting thing in the world. So your teachers, your mentors, your attendings, even your residents will make or break your clinical rotation. 

25:30 Challenges With Moving and Adjusting to New Places

James: Absolutely. But I think medical school has its ups and downs, and so we talked a lot about all of the ups right now and how great your rotations have been. I’m sort of curious about the antithesis of that, like what has been the more challenging part of your medical journey, you know? Like was it in med school? Was it in undergrad?

Paul: Yeah. I think I mean, I’ve struggled a lot throughout my life. I think– so I moved away from Guam at the ripe age of 18. I think I was only 18 for like two weeks before starting undergrad. So I think that was a pretty big struggle trying to figure out how to be an adult, how to manage being a college student, making new friends, building a new support system in a place that was completely unfamiliar without any existing family in like a several hundred mile radius was challenging. So, that first couple of like quarters in undergrad, it was like hard. I wanted to go home almost every single day, I was trying to call my parents every single day. The time difference alone made it hard to be able to make that connection, right? I think towards like halfway through, I was like, “Oh, like this is too much. I’m going to transfer back home and kind of just go back, go to school back in Guam.” But I stuck through it. I was able to find community through my club rowing team. Built a lot of, built a lot of lifelong friends that kind of gave me more balance for, for school. So we had the school side and then I would be working out with my teammates. So that kind of helped keep me cemented at UC Davis and then as the years went on, continued to feel more and more comfortable with being in Davis, you know, buying my own groceries, doing laundry, cleaning and whatever, and then also managing, being a pre-med. And then kind of experience the same, I guess, adjustment in medical school. It wasn’t a big move, so Davis is only what, like an hour and a half from SF, if there’s no traffic. But again, San Francisco is a very different place than Davis. I always joke around that Davis was a nice stepping stone for me, going from an island in the Pacific to California to a small college town, now being in a city of 900,000 people. So I kind of had that same similar adjustment, trying to find like, okay, who do I connect with? How do I manage my medical school? How do I navigate being in a new city? Manage being able to drive in a city, I just got in my car a year ago, so figuring out how to drive in this very cramped city. But I continue to adjust. I think the hardest parts for medical school is that you’re surrounded by such tremendous people, people who’ve done incredible work, both your colleagues, your classmates, the residents, the attendings. Oftentimes you can feel like wow, am I good enough? Am I good enough for this? Am I putting in enough work? But being able to acknowledge that you’ve done the work, you’re here, you made it, like, you’re going to be a doctor at the end of the day. And to remind yourself that constantly really does help to kind of manage your expectations. I think being able build like good work-life balance is something that I’m continuing to work on. I think I built it pretty nicely during my first year and a half, but during clerkships, it kind of took the backseat because of how much you’re trying to learn, how long your hours end up being, kind of, I personally tried to prioritize as much learning as I could for clerkships while at the expense of like, you know, like, my personal wellbeing. So now that I’m in my fourth year, I’m trying to rebuild all the hobbies I lost over the last year: solo traveling, taking care of my plans. And hopefully build that, like, routine for residency coming up in the next six months or so.

29:43 Prioritizing Your Joy 

James: I can definitely speak as well on how important it is to maintain, you know, these hobbies that you have, that keep you grounded during medical school. I remember like prior to medical school, I used to go to the gym very regularly, but then when MS1 started I was just like no time for studying– or no time for working out, all time for studying. And I think that was just me being like… I was just not prioritizing what needed to truly be prioritized and that’s, you know, your physical and mental health first. And so now that we’re in our second year, I’m– it’s kind of people say it’s pretty wild. But for me, my personal schedule is that I wake up at 3am to go to the gym but mind you that means I go to bed at like 9 to10. I’m still getting about 6 hours of sleep. But I just like starting off my day with that one thing that like is so routine, you know, because things are so rapidly changing and it’s hard to stay grounded. So yeah, yeah. 

Paul: Yeah. I mean, kind of speaking to that. Yeah. I mean, I used to go to the gym a lot, especially during undergrad and honestly during my first year and a half of medical school, but during clerkships, your schedule is not really your own. So being able to fit in like what brings you joy during that time, like it’s a struggle because you can always study more. You can always try to get more sleep, but you really have to make time for the things that bring you joy, whether that be your hobbies, whether that be working out, whether that’d be like working on your mental health, or even meeting up with your friends because for clerkships everyone’s spread across the city or the Bay Area or wherever you’re going to medical school and it’s hard to talk to people at times. It can feel very isolating especially if you’re the only medical student on your team. So making sure you also maintain the connections you make during the first year and a half. Having people you can rely on to kind of like decompress, talk about what you’ve been experiencing like during your clinical day, can really like change your experience overall. 

31:48 Hopes For Future Career

James: Yeah, absolutely. So now we’ve taken the time to talk about all the highs and your incredible rotations and surgery and how that inspired you. And we talked about the lows and all of the challenges that shaped you into the medical student you are today. I’m now curious what we can expect for the future. So in other words, if we had a crystal ball for you and we were trying to predict your future medical career, what is the one thing you are looking most forward to now that you’re going to be what, an 01? An 01– is that not the term? Like for officers?

Paul: Yea, so I’ll actually be a captain which is an 03. 

James: Oh my god, so you’re skipping a little bit.

Paul: Yeah, so I’m skipping a few!

James: So skipping first and second lieutenant.

Paul: I’m actually a second Lieutenant right now. 

James: Oh, okay. Yeah. For medical school year, you commission as an 01and then once you graduate, you become an 03.

James: Got you. Okay, thank you for the clarification. Well, in any case, what do you look forward to in your future medical career or even military career?

Paul: Yeah. So I kind of touched on this before, but it was all again, my decision to go into surgery was based off the residents and the attending that I had. So I’m really, really looking forward to being able to teach as, as a physician over the past couple of months or even over the past year, I’ve been leading a lot of like, suturing workshops, knot tying. And I’ve also been tutoring for the school of medicine and I’ve really enjoyed my time being able to teach younger medical students like all the knowledge that I’ve gathered over the past several years. So I think at least at Tripler they do an excellent job of trying to emphasize teaching for medical students so I’m looking forward to being in that resident position and being able to have like all these chalk talks and teaching medical students how to like suture and knot tie and all like the different surgical pearls. And then ultimately I would love to continue mentoring like medical students and pre meds and others like people in general who are interested in medicine, because I feel like a lot of wisdom can be passed down through the experience that you live. But everyone’s journey is gonna be different but being able to hear what other people’s journeys were like and what the life lessons they took away from that can really help someone navigate this foggy field of medicine that often for people who don’t have family in medicine itself can be kind of difficult to navigate at times. 

34:26 This Or That? Questions

James: Yeah, absolutely, that intergenerational connection between generations and generations of physicians, it really carries on. And I look forward to the day when you know you’re an attending and APAMSA can call back to you so that you can mentor another bright-eyed future captain. But yeah, in any case, thank you for sharing so much about your medical journey. We’ve really learned so much about your professional side and the academic side, but I wanted to end the podcast more on a lighter note. And I’ve been asking every single person we do this 1-on-1 series with a bunch of this-or-that questions just so we end on a goofier note. It’s just gonna be A or B just choose one, you can give an explanation, but it can be pretty rapid fire. I have actually found that every single person I’ve interviewed has to always pause and then expand upon. So, feel free to do that as well.

Paul: Alright I’ll try to be as rapid fire as possible.

James: I’ll just give it to you then. First, city or beach

Paul: Beach

James: Cats or dogs? 

Paul: Dogs. 

James: Text or call?

Paul: What was that? Sorry, one more time. 

James: Text or call? 

Paul: Text. 

James: Black or white? 

Paul: Black. 

James: Morning or night? 

Paul: Morning.

James: Summer or winter?

Paul: Summer

James: Breakfast or dinner?

Paul: Breakfast

James: Would you rather have the power to be invisible or the power to read minds?

Paul: Be invisible.

James: You know, you’re actually the first person to answer that. 

Paul: Oh, really? I think my anxiety would go off the rails if I could read people minds. 

James: Would you rather have 100,000 to spend on yourself or a million you could only spend on others? 

Paul: A million to spend on others. 

James: We have such kind hearted guests, everyone always says that. And then finally, for our final this or that question, would you rather retake step one or retake?

Paul: I think I’d rather retake the MCAT unfortunately. 

James: Okay, so I’m gonna ask you why. 

Paul: I think I’m the first one who probably said that right? 

James: Yes, that is correct.

Paul: I don’t know, I really like basic sciences. I mean I was a chemistry major so like that wasn’t like an issue for me. Really love biology so biology and biochem. So that was like, fine. The only issue with the CARS section, which I think I could do better if I actually practice CARS. And then the psych-sociology is like, yeah, you just do the flashcards. So yeah. STEP1 was rough for me. 

James: Yeah, I really thought we were gonna have like a 100% unanimous step one answer. Way to break the mold. So that’s wild. Alright, well that brings us to the end of our This or That segment. Thank you for your honesty. 

37:42 Advice for Pre-Health and Medical Students

James: As we wrap up this episode of White Coats and Rice we love to close out our 1-on-1 series seeking advice from our guests. So, Paul, what is one piece of advice you’d like to share with someone navigating the journey of medicine/medical school?

Paul: Yeah, I think making it your own journey is a big one. I think there are so many different ways to be successful in this field and ultimately it will be your own experience in the end. So take all the advice that you get, take all the experiences that you see with a grain of salt. Integrate into your decisions but ultimately make the decision because you want to do it. No one else can make the decision for you or people will try to make the decision for you, but ultimately again, like it’s your career, your life. So building that confidence to be able to navigate this incredible field of medicine with confidence is… It can be challenging at times, but once you start to build the repetition of doing that, life gets a lot easier.

James: Thank you Paul for sharing so much about you. It has really been such an honor to have you on the podcast. Thank you for sharing your incredible journey from the beginnings on the island of Guam to where you’re headed next, to the island of Hawaii. It has been so inspiring. If our listeners want to contact you his current email is membership@apamsa.org feel free to shoot him a question if there’s something you want to learn more about, whether it’s maybe a military health scholarship or anything like that I’m sure he’s an open book. To everyone tuning in we hope you found this conversation as meaningful as we did. Be sure to join us next time for more stories that uplift and connect – we hope to see you all at the National Conference at Duke University this upcoming Mar 7 – 9, 2025. Thank you Paul!

Paul: Thank you for having me!