We were lucky to catch up with Andrew Pham recently and have shared our conversation below.
Andrew, thanks for taking the time to share your stories with us today Let’s go back in time to when you were an intern or apprentice – what’s an interesting story you can share from that stage of your career?
My first day of spine training was my longest. On August 1, 2017, as the sun was barely rising on a much cooler summer morning than I had been used to for quite some time, I turned off Cambridge street and approached the entrance to the storied Massachusetts General Hospital. I had recently packed everything I owned into the trunk, back seat and passenger seat of my Honda Civic and moved from Charleston, South Carolina where I had completed five strenuous years of orthopaedic surgery residency training. In the interim, I had studied for, taken and passed my written boards and felt ready to tackle the final phase of my training. I was going to learn how to become a spine surgeon; and I was going to learn at Harvard.
With enough self-belief to wrestle a bear, I confidently walked through the glass doors, strode through the main lobby and ended up in the wrong building. Massachusetts General Hospital, or MGH, was made up of several different buildings and sections that at times were hardly connected both physically and in architectural design. I had wandered over into the Lunder building, which to my credit, was where a lot of the patient care happened; however, I was supposed to meet my future mentors and colleagues in the Yawkey Center for Outpatient Care. After reviewing the email three extra times and getting lead by signs on the wall, I ended up where I was supposed to.
Our day as newly minted spine fellows (the designation for trainees who aren’t clueless neophytes but not yet ready for the big show), started the same way it did all across the country with other fellows. We got brief introductions to the staff that we would be working with, a prepared powerpoint on the goals and expectations of the fellowship and then just as quickly as we had sat down awkwardly, we were released to the halls of the hospital to take care of our clinical responsibilities. I had gotten a quick check out from the outgoing fellow twelve hours ago but he was more interested in signing off his pager to me than he was explaining what to do when it went off.
It was with these gaps in knowledge that I set out on my day. I quickly went to meet and check in the patients that I was going to be operating on that day. I verified their consent for surgery, put my initials on their back and rushed over to the inpatient unit to check on the patients who were on my service. I made my way back over to the Lunder building and into OR 72 where my mentor walked me through his particular way of positioning and covering the patient on the operating room table. As we moved through the case, I was able to show what residency training had taught me while absorbing new tips, tricks and techniques from my mentor. We did three surgeries that day and as 7:00 PM rolled around, I did my final checks on my patients for the night and grabbed my bag to go home. So far, having gone through this same regimen throughout all of residency, this was all routine.
About 20 minutes after I had stepped inside my apartment I got a phone call from the on call resident that there was an inbound gentleman who had fallen and presented to an outside hospital with a fracture in his cervical spine with profound weakness in his arms and legs. At 11:00 PM I was at the patient’s bedside examining him. This prompted a STAT MRI which revealed he had suffered an injury to his spinal cord that necessitated immediate surgery to decompress his nerves and stabilize his spine. The clock on my phone read 4:13 AM as I put it down by the nurse’s computer and went over to the scrub sink to prepare for surgery. My mentor and I performed the surgery and as I trudged out of the operating room, I looked up at the clock and it was about 11:00 AM. About 31 hours had passed since I last slept, 16 since I had eaten and I was instructed to go home and get some rest.
I wanted nothing more than to be able to oblige but I had a scheduled orientation at Newton-Wellsley Hospital to get my badge. I walked the 20 minutes to my car and routed myself to my next appointment. As I got in my car, I received a text message in the groupchat from my colleagues in residency asking how everyone’s first day of fellowship gone and I simply replied: “I’m technically still on my first day”. The car ride was a blur but I do recall my phone dying midway through, prompting me to charge my phone briefly at a gas station. I proceeded this by missing my exit and my phone died again. Fortunately, there were enough signs that led me to the hospital but the instructions for where I was supposed to meet the staff was in my email which was on my phone. I parked my car in the visitor lot and walked into the lobby of the hospital where again I charged my phone until I had enough power to turn it on and check the email with the instructions on where I was supposed to go. By about 4:30 PM, I got back into my car and made my way home with my new badge in hand. At 6:00 PM I finally laid my head down to rest.
In my field, we are all striving to be perfect, faultless physicians who take perfect care of our patients; never making a mistake and healing everyone. My 38 hour first day of fellowship is a microcosm of my journey towards this goal. I’ve made mistakes, had failures and learned how to overcome them and improve myself. The pursuit of perfection goes hand in hand with error and hardship and advancement requires tenacity and grit to persevere through adversity. The rigors of medical training force this lesson upon its students and it has largely shaped the person I’ve become.
Great, appreciate you sharing that with us. Before we ask you to share more of your insights, can you take a moment to introduce yourself and how you got to where you are today to our readers.
I was raised in a suburb of Chicago before moving to Frisco, Texas during high School. As long as I could remember knowing what it meant to have a job, I wanted to be a doctor. It started with an infantile enjoyment of playing with a plastic stethoscope and evolved into a desire to leave my mark on this world by helping and healing people. I went to Baylor for undergrad where I was pre med and got a degree in Biology. During my freshman year, I was hospitalized for a month where I underwent two major abdominal surgeries. Experiencing first hand what it meant to be hospitalized, I knew that I wanted the opportunity to one day apply everything I learned to improving the experience of my patients.
After college, I received my medical degree from the University of Texas Medical Branch. Orthopaedics immediately appealed to me as I was fascinated by the anatomy, tools and instruments, and the functional benefit and improvement in quality of life that it afforded to patients. I completed my residency in orthopaedic surgery at the Medical University of South Carolina in Charleston, South Carolina. My curiosity drew me towards spine surgery and was accepted to the Harvard Combined Spine Surgery Fellowship in Boston, Massachusetts.
Coming out of training, I practiced for three years in Washington, DC until my longing for a homecoming overwhelmed me and I returned to Texas to work as a spine surgeon at Austin Sports Medicine. Clinically, I’m a strong believer in total patient care and utilize a multidisciplinary approach looking to employ all possible non-operative treatment options. Having gone through multiple surgeries and being hospitalized for an extended period of time, the gravity of surgery is not lost on me and I believe that in most cases surgery should be utilized as a last option. When it does come to surgery, I have a particular interest in the utilization of minimally invasive and motion-sparing techniques and I’m constantly looking for ways to improve my patients’ outcomes and experiences.
Putting training and knowledge aside, what else do you think really matters in terms of succeeding in your field?
I’ll admit I heard this first from a TED talk but I feel it has to be grit. When people ask about what life has been like as a surgeon, I tell them that in many ways it’s like any other job. There are some bad stressful days with plenty of good days in between. What seems to really differentiate people in my field is how we approach adversity. Whether its failure, exhaustion or hard work, those that succeed in medicine tend to have the determination to continue when everything else is trying to get them to quit. This mentality is what got me through my toughest moments such as in college when I would be studying as friends were attending parties, in medical school where l was taking out student loans while my friends started careers, in residency and fellowship during a 30 hour shift at the hospital, and now as I juggle building a practice while dealing with both the joys and difficulties of patient care. It’s not immunity to feelings of disappointment and frustration nor is it skill and intelligence that elevates me above adversity; but rather a willingness to embrace the struggle and the determination to not quit that pushes me through to the end.
Do you think you’d choose a different profession or specialty if you were starting now?
I have frustrating days and sometimes this job stresses me out to where I can’t sleep but still, at the end of the day I feel lucky to be in a profession where people trust me to heal them. There’s no better feeling in the world than giving someone their sense of self back and seeing and feeling their gratitude drives me to continue my job and keeps me filled with a sense of purpose. I wouldn’t trade that away for anything.
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