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One Day at a Time

By Dr. Carlos Andres Avila Molina 

“One day at a time.” These exact words I continue to say to myself even after matching and beginning my residency. I had always known my goal was to pursue a residency in the United States. I would read medical books, articles, and other research done in the United States to complement my learning back home. I always thought to myself: “I want to find out how they’re discovering all these new things, participate in them, and hopefully bring innovative techniques back home.”  

Learning arthrocentesis
Working in rural communities

I had the opportunity of working alongside U.S. doctors during their mission trips to my home country. We would visit underserved communities in rural areas to provide them with counseling, management, and treatment. We were able to provide the locals with classes on health prevention and first aid, among others. While working with these doctors, I appreciated their approach on patient diagnosis and professionalism. I was astounded at the amount of knowledge they possessed, how easily they answered the questions and addressed the doubts I had. In the way they took the time to teach and explain things in such an easy way, I felt like they were creating art. This experience further fueled my desire to come to the United States to be able to learn and bring back more help and medical missions for my country, and to hopefully have that same impact on my future fellow colleagues.  

As I was preparing for my Step exams, I left my family back home and I ventured by myself to a different country. It was not easy leaving them behind. For as long as I could remember, we would meet and spend time together every weekend. Soon after I left, my grandfather was diagnosed with stage IV lung cancer and was given only three months to live. Being alone in a foreign country, I felt like returning to my country on numerous occasions to be with my family. I missed them terribly. But every time I felt like this, I remembered: “One day at a time.” The program in which I was studying for my Steps had many international medical graduates from all around the globe, and surprisingly many were going through similar ordeals. They provided me with moral support and became my second family.  

I continued preparing for my exams; unfortunately, a week prior to taking my Step 1 and Step 2 CK, I had family members that perished. This took a toll on me for my exams and I did not achieve the scores I had hoped and studied for. I became extremely sad and overwhelmed; however, my family always kept supporting me and reminding me what my ultimate goal was: coming to the United States for residency.  

Closing the gap

A year ago, I matched into an internal medicine program and everything I had wished became true. I was able to learn at a fast pace. The program I was in provided me all the support and learning tools I needed. Six months into residency, I diagnosed my father with tongue cancer, which was soon confirmed with a biopsy. He underwent chemotherapy back home. While on chemo, he developed multiple infections, went into septic shock and was admitted to the ICU. The program I’m in immediately told me to go back home and be with my father. Once at the hospital, all the knowledge I had obtained so far in residency helped me give advice and ask questions to the physicians managing my father. On a Saturday morning, my father developed a blood clot that completely occluded his left lung. The only solution was doing a bronchoscopy, which was not available at the hospital. A couple of hours later, he coded. As I was the only doctor available at the time, I began CPR on him, but, unfortunately, he did not survive. A week after he passed away, the hospital got a bronchoscope so this wouldn’t happen again.  

My guardian angels

I returned to my program. My heart was torn and aching with the loss of my father. I spoke to my attendees and my co-residents about what had recently happened, and to my surprise, they had experienced similar situations back home. They gave me the support I needed. They were available 24/7 and checked up on me constantly. They made me realize once again that I had a second family in my program. Even though we are from different backgrounds, we all have the same ideals and a similar goal we are pursuing, which is to provide patients and their families assurance that we will do our best job every time with what we have learned.  

Looking back, I would repeat every step of the way and take it “one day at a time.”