A Farewell to Emergency Medicine
What over a decade on the frontlines taught me about urgency, equity, and the need to act earlier.
This weekend, I work my final stretch in emergency medicine. With just 3 shifts left, I’ve found myself quite sentimental thinking about that last shift.
One last day walking into a crowded ER, patients spilling into the hallways. One last day of running to codes trying to pull life back from the brink. One last day of seeing anybody and everybody who walks through the doors.
After more than a decade of training and practice, I'm leaving not from burnout or bitterness. In fact, I still love emergency medicine for all the reasons I fell for it as a student.
Rather, I’ve found a new calling in precision preventive care. Before turning the page, I want to honor the patients, mentors, colleagues, and experiences that shaped me. Here, I also hope to share my reflections on the system, the people, and what medicine has taught me about urgency, equity, and hope.
1. Awe & Adrenaline: When Medicine Jumped Off the Page
Setting: UCSF (San Francisco, CA), 2013
It was my third week of medical school.
That morning I’d sat through hours of lectures on cardiology drugs, diagrams full of arrows showing how each medication affected sodium, potassium, and calcium channels in the heart. My head was spinning.
That evening, everything clicked. A woman arrived with a dangerously fast heart rhythm called SVT — her heart was racing at 180 beats per minute, her face dripping with sweat and anxiety.
The nurse pushed a medication called adenosine, a medication that briefly stops electrical activity in the heart to reset it. For 5 long seconds, her heartbeat flatlined on the monitor. I held my breath, wondering if she’d come back. Then her heart restarted in a normal rhythm.
She let out a slow breath, her face finally calm. I exhaled too.
That same shift we reset a dislocated kneecap and cared for a homeless man who was somehow still awake and groaning with a blood alcohol level of 0.780 — an almost impossibly high number I’ve never seen matched since.
Reflection: The emergency department is where medicine came alive. The diversity of cases and the adrenaline hooked me, and I loved the ability to see patients from all walks of life.
2. No Barriers: The Language of Trust
Setting: Highland Hospital (Oakland, CA), 2015
A mother from Mexico arrived in the middle of the night bleeding early in pregnancy. As I didn’t speak Spanish at the time, I had to tell her she was miscarrying using a phone interpreter — her tears, my helplessness, the distance between us that no technology could close. That moment ignited a lifelong fire in me to break down access barriers and speak across divides.
I began actively learning Spanish so I could close that gap, even a little, and later would work with a startup focused on breaking down language barriers in healthcare.
Reflection: People may not remember your differential diagnosis; they remember whether you reached them.
3. Medicine Without a Safety Net: Global Health & Systems Reality
Settings: Muhimbili National Hospital, (Dar es Salaam, Tanzania), 2014; later work in Colombia, 2018; Ecuador, 2019, Malaysia, 2019; India, 2022
In Tanzania, I worked with a team led by Dr. Teri Reynolds to expand bedside ultrasound training — imaging used to detect internal bleeding, guide procedures, and more. Here, I watched children die of things that wouldn’t have taken their lives if they’d been born somewhere else — burns, malaria, diarrhea. I saw young adults die from brain bleeding, sepsis, tuberculosis — many survivable if in the US. That contrast never left me. It made me realize how fragile life is when infrastructure fails.
In Colombia, Ecuador, and Malaysia, I saw versions of the same pattern: heroic clinicians battling fragmented systems, patients arriving late, and persistent gaps in transport, supply, and data.
My work in India was a turning point. Here, I saw how traditional aid could help, but scaling quality care through donations and grants alone felt too slow.
On my first day in the ER there, a 3-year-old arrived seizing from a high fever, his parents armed with smartphones and Google search, asking if this was the cause.
I began to realize that technology — networks, diagnostics, data, AI — could leapfrog infrastructure gaps faster than traditional top‑down aid models. That seed would later grow into my interest in startups, investing, and scalable health platforms.
Reflection: Training matters. Tools matter. But systems — logistics, data, incentives — determine who lives and who doesn’t.
4. Trauma Close to Home: Urban America & Becoming a Physician
Setting: Kings County Hospital (Brooklyn, NY), 2016
It was a hot summer. The streets of America were filled with protestors, and athletes were kneeling during the national anthem on TV.
A young Black man arrived to the ER with a gunshot wound to the head. Blood pooled onto the stretcher; brain tissue was visible. His family’s screams ricocheted through the hallway. I was in my 20s, barely sleeping, still figuring out who I was — as a doctor, as a person. That night the violence outside and the chaos inside me felt inseparable.
Here, I learned how trauma isn’t just clinical — it’s generational. In Brooklyn and around the world, emergency rooms are both frontline and final line for communities torn by poverty and violence.
Reflection: We treat wounds that begin far beyond hospital walls.
5. Training at Harvard: Skill, Grit, & Exhaustion
Settings: Massachusetts General, Brigham & Women’s, and Boston Children’s Hospital (Boston, MA), 2017-2021
On day 1 of residency, I performed my first lumbar puncture — a procedure that requires sticking a long needle into the spine. The patient had dangerously high pressure around the brain. A patient senior resident, Dr. Michael Abboud, taught me how to collect the first few drops cleanly. When clear fluid flowed — no blood contamination — it was called a champagne tap. Doing the procedure saved her vision, and I carried that victory for weeks.
Soon, however, the excitement wore off. In residency, we were all tired. We were working 24 hour shifts on some rotations, 80 hour weeks in the ICU. Calling for specialty help often meant getting yelled at by an underslept neurosurgeon or an overworked internal medicine resident. Everyone was beyond capacity; no one wanted more consults.
By the end of residency, I could feel the toll: my circadian rhythm wrecked by overnights, stress levels always high, recovery incomplete, eating lots of processed foods as I had minimal time or energy to cook.
If this was hurting me in my 20s — with all my training and tools — what were my patients enduring silently for decades before they crashed into the ER?
Reflection: Even the most passionate and idealistic doctors can get burned out by how grueling the training is.
6. When the World Stopped: COVID
Setting: Massachusetts General, Brigham & Women’s, Boston, MA, 2020
COVID hit during my 3rd year of residency. We were on the front lines, learning about the virus at the same slow, shocking pace as the rest of the world. We were wearing cheap gowns and recycled N95 masks, reading news of 30-year-old doctors dying in China and Italy, scared for our own lives.
Some days, we intubated patient after patient — a staggering 15 in one unforgettable shift — putting our faces inches from theirs to insert breathing tubes and help their lungs breathe with ventilators.
And yet, while risking my life, I was also called a “Chinese virus” by a passerby in front of the hospital one day.
Months earlier, while visiting family in China, I'd seen COVID coming. Months before COVID shutdowns hit the US, I shared ICU stories from Wuhan and cried alone watching videos of exhausted Chinese medical staff. When Italy shut down, America finally listened. But by then, the damage was done.
My overwhelming feeling then was grief, not only for the lives we were losing, but also for how quickly compassion was replaced by blame.
Reflection: The US, China, and the global community need to work on health and development with shared urgency, transparency, and empathy, not division.
7. Medicine at the Edge: Rural America
Settings: Adventist Health (Clearlake, CA; St Helena, CA), 2022
My first jobs as an attending were in rural critical access hospitals in Northern California. One shift, I intubated burn victims with severe airway burns from a meth lab explosion. Later, I sewed a 5-year-old’s finger back on after a dog bite, her mom too scared to drive at night to a hospital with a plastic surgeon. Two weeks later, the plastic surgeon sent me a photo. The finger looked good.
In one unforgettable week, I diagnosed two patients with ruptured abdominal aortic aneurysms — life‑threatening internal bleeding from the body’s main artery. In one case, I stood in as anesthesiologist in the OR because the only on-call anesthesiologist was in another case. Both survived.
But both cases could have been completely preventable with earlier detection.
Reflection: Even in America, geography is destiny. Urban hospitals debate calling orthopedic hand surgeons or plastic hand surgeons. Rural hospitals debate whether the helicopter can fly at night. The gaps are real, and growing. Ultimately, what we call emergencies are often just late-stage symptoms of systems that failed upstream.
8. Seeing the Pattern: We Were Always Late
Eventually, I landed my current and last emergency medicine job at Sutter Health in Burlingame, CA. Having trained and worked in 18 emergency departments throughout the US — from Boston to the Bay — and 6 more internationally, the individual cases started to blur, but the pattern sharpened into focus.
Yes, the dramatic cases stick with you — the ruptured aneurysms, the crashing traumas, the codes pulled back from the brink.
But truthfully, those are the exceptions. Most of what we see is far more routine, and my biggest takeaway is that emergency medicine is where chronic disease comes to crash.
Strokes after years of uncontrolled blood pressure.
Heart attacks fueled by diabetes and high cholesterol.
Recurrent urinary infections in frail, immobilized nursing home residents.
Hip fractures that begin the long decline.
Pneumonias in immune‑weakened, malnourished elders.
We stabilized, admitted, transferred — but rarely reversed the tide. We were merely catching people in free fall.
Reflection: I hope we can build a future — globally — where we don’t have to rely on emergency rooms as the backbone of care. Where we can leapfrog over the need for expensive, reactive interventions, and instead invest in the infrastructure of prevention. A future where we catch disease early, or better yet, before it ever starts.
9. Gratitude
To my emergency medicine colleagues:
You’re the fiercest, smartest, most adaptable people I know. You keep showing up when the system is broken. You save lives at 3 a.m. when the world has forgotten those patients exist. You are society’s final safety net.
To the patients and families who trusted me in your most vulnerable moments:
Thank you. I carry you with me.
To emergency medicine itself:
Thank you for teaching me how to lead in chaos, how to listen deeply, how to move fast, and recover even faster, and how to care without conditions. I owe you everything.
Reflection: Emergency medicine is a really hard job. There will never cease to be a need for emergency care, and thank you to all who continue provide this.
10. From Crisis to Prevention: The Shift Toward Longevity
My transition began quietly.
After an especially tough stretch of cases in my last year of residency, I met the woman who would become my wife, then a battery engineer, now a venture capitalist investing in technologies that scale.
We came from different worlds: I was steeped in the immediacy of codes and crises, while she lived in the long arc of innovation. She showed me how the right technologies, scaled at the right time, could impact not just individual lives, but also entire generations.
She was also the first one who teased me that I was already living a longevity lifestyle — daily green tea, blueberries, exercise, and nutrition tracking.
She also pushed me to think bigger: how technology, data, and incentives could bend population-level health.
Those conversations brought me back to lessons from Tanzania, India, and rural America. Whether in Boston or Bangalore, late care is expensive — in money and in lives. She showed me that big impact isn’t always found in the adrenaline of a single save. Instead, it is crafted in the slow, deliberate shift of an entire paradigm.
So I began studying aging biology, biomarkers, metabolic health, prevention models, and eventually started working with and investing in startups building that future.
Becoming a father this past year deepened these realizations. Like many in medicine, I returned to work quickly — just weeks after my daughter’s birth — with not enough time to recover, reflect, or bond. Our system trains us to triage others, but rarely gives us space to care for ourselves.
Which brings me to now.
11. What’s Next
I’m joining Biograph to help build a future where we act earlier, long before disease becomes disaster.
A future where we measure what matters, personalize interventions, and extend not just lifespan, but also healthspan — the years we live with mental clarity, physical strength, and life purpose.
I’ll be prescribing strength training instead of steroids, sleep alignment instead of sedatives, diet changes instead of insulin drips — intervening upstream before the ICU ever becomes necessary.
This isn’t a rejection of emergency medicine.
It’s an evolution of everything it taught me: urgency, humility, and the unwavering belief that everyone deserves care — not just in crisis, but throughout life.
One last shift.
Then, onto what’s next.