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Volume 3, Issue 2
Summer 2007:

Having My Say: Words from an IMG

Fran Yu, MD

Cell 2 Soul. 2007 Summer; 3(2):a13

I am Fran Yu, a resident at the Maine Dartmouth Family Practice Program in Augusta, Maine. I started my residency last year-2005. I will talk about my life as a foreign graduate, who graduated from Medical school in China 20 years ago. The message I want to send to people is that I have gone through a difficult intern year, but I believe I am not alone; I am sure many IMGs have experienced what I have experienced. I am here today, not trying to be ungrateful or unkind, but I want people to realize that no matter how much you can change yourself, people around you must be more tolerant and willing to accept you as who you are.

I have had a great opportunity to know an excellent mentor; he told me that when he was in medical school, people told him: only sharks can swim with sharks; if you want to survive, you have to be a shark too. Medicine is a very competitive field. I committed to stay in this field for the rest of my life. I am not just a visitor, I am one of them, I am a shark too, but I am a shark from a different ocean.

I grew up in a small town in Northern China, my mother a tailor and my father a high school language teacher. I am the youngest among my five siblings. In 1979, inspired by my grandfather, a practitioner of Chinese traditional medicine, I entered Medical school at the age of 15, right after I finished my 3 years of Jr. High. It was not uncommon to enter medical school or college so early in China at that time. As people may know in the late 70's our country just experienced 10 years of the Cultural Revolution. We were in hunger for education, you could go to college if you passed the National College Entry tests. It was the first real challenge I experienced because separating from my family at such a young age was very difficult on me. But all in all, I did not only survive 6 years of medical school but I also was one of the honor students in the class.

In 1989, after 4 years of training in Neurology, I pursued graduate school in the Kyushu University Medical School in Japan. Every one knows the unpleasant historical background between China and Japan, assumed, I might have experienced a very difficult and unpleasant time in Japan, but fortunately I had a good experience in Japan because of several reasons. Firstly, I did not have a language barrier because in Medical school, I was selected to a special class, which was called Foreign Language Medical Class. This was an experimental education which, at that time and even now, in China, there are several medical schools that still have these kinds of classes in order to receive modern medicine faster. They are taught either by English or by Japanese. That year in our Medical school, we had 40 students among 550 admissions. In our class, 80% of subjects were taught by professors who spoke fluent Japanese or the professors who were invited from Japan. By the time I went to Japan rather than having language problems, they were amazed by my fluent Japanese. Also, as I remember, if people only judged me by my appearance, and most people thought I was Japanese at first. I did not feel immediate discrimination because of the advantages of my fluent Japanese and my appearance.

I came to the United States in 1994 at the age of 30. In my life, I can say that all the real challenges started from that time. The US is a dreamed of land, which attracts young people from all over the world. Same as other young people, I came here to pursue my American Dream. I never spoke English or learned English at school before I came to America. My English was so minimal I had to use a Dictionary to read professional articles. You can imagine what a challenge it was to learn a new language from the age of 30! The first three years, I was working in a research lab. Five years of graduate school training in Japan made me a productive researcher in the lab despite my language difficulty. I enjoyed involving in different challenging projects, and was proud of my ability in solving difficult problems and coming up with good solutions. Luckily, I got my green card in 1996. I described it as a boater climbing up to a big ship in the middle of the ocean. He wanted to have a break, and he knew that he would survive another big storm on the ship but immediately he started to wonder what else? Yes, you are right, what else? What I am here for? A Green Card? Having another child with out being punished from the government? That's all? Oh, I knew what I was missing. I was a Doctor, a Neurologist; I remember how much I enjoyed working for my patients in China. I remember what a joy I felt when I watched my patients recover from serious illnesses with my help as a doctor.

In 1997, I quit my job and became a full time mother taking care of my two young boys; they were 6 and 2 and I started to read medical books by using a medical dictionary. I made up my mind and I wanted to become a doctor in this country! It was a big decision and no one believed it was going to happen to me. I remembered in the first week I could only read less than three pages per day because there were too many new medical terms to remember. I found that it was much harder than I realized. But I was not going to quit, it was not me. I started to learn medical terms system by system first and then practiced the words by reviewing USMLE test books. Every day, rather than a note, it should be called vocabulary cards because it was full of medical terms that I needed to remember. By 1999, in about two years, I passed Step1, Step 2 and CSA tests although my scores were not high. I considered it was the first success I achieved 10 years after I left my country in 1989, even bigger than I got my Ph.D degree in Neuroscience in Japan in 1994. I said it aloud, "I made it! I made it!" It was amazing, it was unbelievable.

After I passed the tests, I started working in Eli Lilly, a pharmaceutical company in Indiana as a Research Scientist. My self-confidence continued to expand, despite a good research scientist position in Eli Lilly Company. I easily quit my job and started to work in a hospital to do externship or quoted as observation in order to prepare for residency match. Unfortunately I lost my first attempt in the match because of my disadvantage of a long time from medical school graduation and poor spoken English. Almost at same time, my younger son, who was a premature baby at birth, was sent to the hospital with Kawasaki disease because of long standing high fever and dehydration. I realized I had gone too far. I should have remembered that I was also a mother of two young children and a wife; I was too selfish and only cared about my goal, my American Dream but ignored my family. I confessed and made another 180 degree turn: I needed to play a role as a mother and a wife. I was going to forget my "doctor" dream forever. I started working in Wyeth pharmaceutical in Cambridge, MA where my husband also found a job in another pharmaceutical company. Finally my family lived together. We bought a house in Acton, MA. Life was full of blessing and in peace again.

Watching my two sons are growing up, getting bigger and stronger, after a while, wanting to become a doctor and practice in this country started to bother me again. In 2004, my ECFMG certificate was going to expire in a year, what should I do? I should say the last push was from my husband, he is very supportive. Without his support and full understanding, I am sure I would have not gone that far. I only applied in the New England area. I knew my chance to be matched in MA was very low but at least in the New England area would not be too far from my family. I matched to the Maine Dartmouth Family Practice program last year. It was a mixed feeling. It was true that my boys are older and easier. But by the time I started my residency last year, I was not really sure in my early 40's whether I was ready for another challenge or not.

I clearly remember what happened a month after my residency, I was totally exhausted. One day, I was on call with a senior resident, I had to go to ER to admit a patient first. I was totally lost and didn't know what to do. It was the first time in my life I thought that I was going to fail, I wanted to quit. I called the doctor who I mentioned earlier. He came to ER in 5 minutes. After he helped me admit the patient, he stopped me in the hallway, grabbed my shirt from the collar, said: "Chin up, look at me." I felt the shame to look at him because I knew I was a loser in front of my most respected teacher. He continued, "Fran, three years later, I want to see you in the graduation ceremony!" While the tears were running out from my eyes, I said: "I am sorry, I can't make it; I want to go home." During the rest of the week I was totally not able to function. Finally I had to take 6 weeks medical leave and even went to see a psychiatrist and started to take lexapro. 6 weeks later, I came back to normal rotation. I was back to myself again. I saw the improvement day after day. I am more appreciative about the opportunity that I have now. Unfortunately, I was too na´ve, people continue to hold the old impression that I gave to them at the very beginning despite my improvement. I became a spot light, every movement I made was closely observed. In order to survive, besides working hard to improve myself, I continue working on convincing people that I need to be accepted as who I am and my ability need to be recognized from deeper layer. In some occasions, I confronted faculty members and spoke at a faculty meeting. I told them it is true that a language barrier affected my performance, affected people to know the real value as who I am. But the communication is a two step process, I am working hard to adopt every single thing which is new to me, but people also need to learn how to tolerate the difference. As IMGs, I believe if we can overcome the language barrier, cultural differences, passed all the USMLE tests and passed the residency match, how we cannot survive the residency? I am sure that I am not only going to survive the residency but I am also going to be a great doctor because of my compassion to the people and my commitment to this challenging field.

Finally, I would like to give my thanks to my family, my husband and my two boys; to the program, especially to my advisor and my mentor; without their support and understanding, it is hard to believe I can still be in the program today.

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