More than twenty years ago, the year I was born, my father underwent a coronary artery bypass graft procedure and almost died due to unforeseen complications. He has a twenty-five year history of poorly controlled diabetes, hypertension, and hyperlipidemia and throughout my childhood I witnessed firsthand the suffering that these comorbidities caused himand in effect, our family. I accompanied my father numerous times to the emergency department and doctor appointments then, and continue to do so. I called 911 and then rode along with him in ambulances as he complained of severe chest pain and dyspnea. Witnessing my dad being brought out on stretchers countless times made me feel helpless but motivated to investigate the intricacies of his diseases. In medical school, my curiosity for understanding these disease processes only grew as I learned about the complex interplay between comorbid pathologies. As an internal medicine resident, I will further dedicate my career to the physiology, treatment and management of patients suffering from these distressing, and often overlooked illnesses. During my internal medicine core and sub-internship, we dealt with patients with multiple comorbidities and non-communicable, chronic disease. For example, there was a fifty five year old African American man with chronic obstructive pulmonary disease, diabetes mellitus, heart failure, uncontrolled hypertension and, chronic renal failure on hemodialysis who presented with shortness of breath and bilateral leg edema. I noticed the patient guarding the upper right side of his abdomen; I performed a complete physical exam on him, but focused on that. He had upper right quadrant tenderness on palpation, which I reported to my attending. I suggested that it could be congestive hepatopathy due to right-sided heart failure along with his bilateral leg edema, and that we should order an echocardiogram to evaluate his heart further. This showed that his ejection fraction had reduced significantly from his prior records to less than 35%. From speaking to the patient further, I gathered he had been skipping his furosemide dose because of increased urination, which he had not admitted to until now. As a team, we formulated a plan that involved patient education, optimizing his medication, and the placement of an AICD. I felt a sense of gratification, knowing my thorough physical exam, detailed history and, education on AICD usage helped improve this patient's management and quality of life. Experiencing how the interactions between these disease processes manifested in this patient ensures that me that there will always be more to learn. I experienced also, how important interactions with specialists such as endocrine, cardiology, pulmonology and nephology were, as they added depth to management to the patient. For me, he was a patient who typified my experience in internal medicine. In addition, I find internal medicine to be a very emotionally rewarding field, because of the moments of comfort a physician can provide, in critical moments. I recall, for example the hospital course of a sixty-year-old Caucasian female patient with cervical cancer and metastasis to the brain. She was refusing to eat and had no family to support her during this time. The attending, residents and nurses all had tried to convince her to eat but had little success. I imagined myself in her shoes and started to empathize some of the feelings she must have been experiencing. I sat by her bed, just to keep her company. After two hours, she eventually opened up to me and confessed that she was scared she was going to die and had given up on life. I began to spoon feed her banana pudding and I still remember her smile to this very day. Though I will have different availabilities with regard to time, as a resident, I know that I will strive to create the emotional space for such connections with patients in residency and afterwards. With the knowledge and experience I gain from your residency program, one day I hope to become a hospitalist and then pursue a fellowship in cardiology or endocrinology, so I may provide this specialized care that patients in urban areas so desperately need. I plan to take an active role in research during residency, specifically in cardiovascular health, and find a program that supports such endeavors with state of the art facilities. I also am interested in program with protected didactic time so that I may continue to advance my knowledge and develop my clinical skills in a structured manner. Having rotated at an urban hospital New York, I look forward to working in a similarly culturally diverse environment to provide the finest patient centered care, and learn the most from cases, while also serving an underserved, and marginalized population. It is with this vision I hope to be a great addition to your residency program and be given an opportunity to manage complicated patients, where once I was merely watching diseases progress in my father.

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