Reflections of an Olin Physician

Hi, my name’s Sam Sun, Olin ’12. PGP asked me to write about what I’ve been up to for the last 5 years, so here goes. 

 

 

Prelude

 

“You’re responsible for making your own happiness.”

 

From 2008-2012, only ~1 Olin student went to medical school each year.  Why did I go?  For me, medicine was an extension of bioengineering.  I saw myself identifying problems in medicine and healthcare, leveraging scientific and technological tools to solve those problems, and working closely with industry to develop novel products.   

 

At Olin, I felt like I fell short of those goals.  During end-of-year SCOPE presentations, I remember feeling impressed with my classmates’ robotics projects for defense and agriculture companies, and thinking: “wow, they’ve done much better work than I have.”  I had focused on external metrics (GPA, etc.) to give medical school admissions committees what I thought they wanted; as a result, I shied away from internships and classes that would’ve helped me meet my personal career goals.

 

In medical school, I resolved to change my approach, and iteratively ask myself:

  • What do I want?
  • How do I get it?

Photo by: Ceth Stifel

 

Back to school

 

“In the hospital, you’re nobody.  You’re a peasant.  But here [in medical school], you’re protected.  Here, you’re king…okay, not quite, but at least you’re a prince.”

 

After graduating Olin, I went to medical school at Washington University in St. Louis, HDK’s old stomping grounds.  (HDK, or Helen Donis-Keller, was my academic advisor at Olin and a former geneticist at WashU).  Med school is divided into: preclinical coursework, clinical rotations, and electives.  After receiving an MD, graduates complete a 3-7 year residency program – an apprenticeship of graduated responsibility – before practicing as independent physicians.  

 

My first year was almost euphoric.  Classes were graded Pass/Fail.  It gave me a lot of freedom to do what I wanted academically and socially.  It also gave me exposure to WashU’s senior faculty.  After a trip to San Francisco, I remember listening to a lecture by a hand surgeon who’d invented nerve transplantation as a method for restoring movement to paralyzed patients.  I spent that evening dissecting an arm in Anatomy Lab, pretending to be a hand surgeon to my cadaver. 

 

My second year involved more work and less daydreaming.  Preclinical coursework is capped by the USMLE Step 1, an 8-hour long exam that covers a wide swath of basic science (e.g. biochemistry) and pathophysiology.  It is impossible to “cram” for Step 1; it is instead comparable to a year-long hike.  In lieu of new hobbies and new travel experiences, my time was filled with lectures, flash cards, and color-coordinated notes scribbled onto review books.  Old fashioned, but effective.

 

Aside: Why do doctors have to memorize a bunch of stuff?  If a patient comes in with chest pain, can’t you just read about chest pain in an ad hoc, on-demand manner?

               This is a question I asked myself.  Unfortunately, the “learning by doing” model has at least one flaw when applied to clinical medicine – biology has a lot of cross-talk across organ systems and across spatial scales.  To put it another way, you can’t “google” the answer because you wouldn’t even know what to type into google; you need a knowledge base to give context.  Hence, whereas many medical schools sprinkle supervised patient encounters into the preclinical curriculum, none (that I know of) drop students into clinics/wards/ICU’s/OR without preparation.

 

IDEA Labs

 

“Say you have a goose.  If that goose looks like a duck, walks like a duck, and talks like a duck…no one will second-guess you if you call it a duck.”

 

Early on in medical school, I cofounded an organization called IDEA Labs (now Sling Health) that develops biomedical engineering solutions to clinical problems.  (If this sounds familiar, it’s because I was missing Olin at the time).  I met a group of MD/PhD students in late 2012 who were interested in medical device design and commercialization.  Together, we created infrastructure to connect students from business/engineering/medical backgrounds, help them identify clinical needs, and give them resources (funding, equipment, mentors) to build proof-of-concept prototypes.  We also negotiated with WashU’s Office of Technology Management and Vice Chancellor for Research to allow student teams to retain IP related to their projects. 

 

I enjoyed working on IDEA Labs as its first managing director and interim president.  However, while I enjoyed selling and promoting the vision of IDEA Labs to university and industry leadership, I felt like my role was ultimately neither technical nor creative.  After a certain point, a business or sales person could’ve run IDEA Labs (eventually, this is what happened).  So, I moved on.

Robert Langer, an MIT bioengineer, visiting IDEA Labs in St. Louis. 

Photo by: Sid Hastings, Washington University

 

Big Science

 

“The world is so vast.”

 

I was admitted off of WashU’s waitlist in May 2012.  I had already made plans to attend a different medical school where I would room with two classmates and a very friendly corgi.  I turned to a neurosurgery resident at MGH for advice.  He and I had never met, but we had lived parallel lives – we both grew up in Fort Collins, CO; we participated in the same nerdy activities under the mentorship of the same wacky chemistry teacher; and we both attended specialty STEM colleges (Caltech and Olin).  I immediately liked him and I followed his two pieces of advice:

  • Go to WashU
  • Don’t feel obliged to get an MD/PhD

 

Aside: An MD/PhD is a combined degree for training physician-scientists, or scientists whose research methods and goals are linked to their clinical practice.  Critics say that those pursuing an MD/PhD receive a watered-down MD and a watered-down PhD.  That is, they complete fewer clinical rotations than their MD-only peers, and their publication requirements are more lenient than their PhD-only peers.  I’ve always wanted to pursue a physician-scientist career path; however, I was never convinced that an MD/PhD was the optimal route for doing so.

 

After all, WashU’s best-known physician-scientists (e.g. Tim Ley, Jeff Gordon, Roy Vagelos) had MD-only degrees.  I had hoped to work with Tim Ley, HDK’s friend and former colleague, during my first semester at WashU.  He had sequenced the world’s first cancer genome in 2008.  I expected he’d echo HDK’s enthusiasm for genomics; instead, he told me: “Cancer genomics will be dead in 5 years.  Choose a different career.”  Hmm…

 

Initially, I worked with a neurosurgeon on biomarkers of treatment response in meningiomas, a type of brain tumor.  After presenting my work at a neurosurgical conference in San Francisco, I listened to a talk by Jaron Lanier, a bearded computer scientist.  (Neurosurgeons ask the weirdest people to give keynote speeches).  He posited that “siren servers”, or repositories of data and analytics like Facebook and Google were disrupting industries and livelihoods by claiming everyone’s data for free, instead of paying everyone appropriately for their data.  The implication of his talk was that siren servers are powerful and evil; nonetheless, I became convinced that I should identify and leverage siren servers in medicine.

 

In late 2014, I was encouraged by my neurosurgical mentor to work with Li Ding, Tim Ley’s scientific collaborator at WashU’s Genome Institute.  She was a key player in The Cancer Genome Atlas (TCGA), an effort to systematically catalogue the genomes of every major class of human cancer.  TCGA and other acronym-laden consortia for cancer research (e.g. ICGC, CPTAC, GENIE, Parker ICI) represent siren servers in academia.  As such, they serve as wellsprings of scientific insights.

 

As WashU’s Genome Institute converted from an “institute” model of staff scientists to a “university” model of students and post-docs, I became the first medical student to work with Li Ding.  More than anyone I met at WashU, she loved her work.  I was continually impressed with her ambition, drive, and scientific vision.  My research with her centered on “precision oncology”; that is, using comprehensive molecular phenotyping (e.g. genomics) to identify and exploit therapeutic vulnerabilities in cancer.  Ironically, during my last semester at WashU, I again met with Tim Ley to ask for career advice.  He clarified: “The discovery phase of cancer genomics is over.  But, the application of cancer genomics to clinical medicine is just beginning and will last 20 or more years…I can’t see when it’ll end.”

 

An uplifting tradition for students leaving Li Ding’s research group.

Photo by: Matt Wyczalkowski

 

Choosing a medical specialty

 

“You got to be you.”

 

Some months after I started clinical rotations in the hospital, I looked around at my clinical mentors and realized – I don’t want any of your jobs.  Some of my clinical rotations were incredibly fun.  But they weren’t what I wanted. 

 

To me, it’s always been of utmost importance to find a career combining my engineering and medical interests.  For a long time, I thought that career was in neurosurgery.  Brain-machine interfaces, optogenetics, electroceuticals…it felt like the human brain was the next frontier for science and medicine.  However, clinical practice is very different from the research lab, and I felt entirely unsuited for the day-to-day activities of neurosurgery. 

 

Instead, I gravitated towards radiation oncology, a medical specialty that uses focused radiation to treat benign and malignant tumors, among other conditions.  I could still treat patients I had cared for in the neurosurgical unit with brain cancer and arteriovenous malformations; however, I traded a scalpel and cautery for precise, computer-assisted radiation therapy. 

 

MD: Makes Decisions                                 

 

“I know what nurses do.  And I know what doctors do.  What do you do?” –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– “Dad…I am the doctor.”

 

Prior to specialization, radiation oncologists are required to complete a year of internship in medicine or surgery.  Throughout medical school, I had avoided inpatient (hospital-based) medicine in favor of outpatient (clinic-based) medicine, with its quiet and controlled environment.  But, in mid-2016, I somehow found myself in the cardiac ICU, where I started a yearlong internship in inpatient medicine at the University of Colorado.

 

…It was hard.  :/  Occasionally fun…surreal…formative.  Mostly hard. 

 

Aside: In terms of day-to-day mechanics, it was almost like playing an MMORPG, or real-time strategy game.  Patients arrive to the hospital as unknowns, with multitudes of possible conditions.  You gather data, form hypotheses, make decisions, and enter orders (which are executed by nurses, therapists, and consulting physicians) in an iterative process.  You move from diagnosis to treatment to prevention and, almost as if you knew what you were doing, patients get better! (…hopefully)

 

I’m glad I did it.  I learned more medicine in the past year than I had learned in all four years of medical school.  But I’m glad I’m done. 

"Derive happiness in oneself from a good day's work, from illuminating the fog that surrounds us."

[View of downtown Denver from the University of Colorado Hospital.]

Photo by: Kylie Adamek

 

Afterword

 

“I woke this morning at the crack of dawn…”

 

This July, I’ll be starting a radiation oncology residency at Baylor College of Medicine in Houston, TX.  With my department’s support, my residency will be tailored towards a physician-scientist career path.  Though I look forward to it, I wonder if it’s wise to split my effort between medicine and science.  I wonder if I can measure up to my counterpart at UCSF who has had better training and a better record. 

 

I am quite sure that I cannot. 

 

But then I remember.  Of those I met during the last five years, the ones who inspired me shared a common thread.  That is, they believed in and pursued their own ideas and visions, wherever they led.  I can’t help but do the same.

 

 

That’s all.  Thanks for reading!  If you have any questions, or if I can help with anything, feel free to contact me at sam.sun@wustl.edu or sam.sun@bcm.edu.  

 

-Sam

Posted in: Alumni Speak