A number of pathways can lead to a career in hand surgery. For Dr. Nathan Enoki, it started out in being what he doesn’t consider a good student. Carrying with his conversation with med school classmate and old-time friend, Dr. Richard Marn, Dr. Nathan narrates his journey from becoming a paramedic to his years in the Navy and right down to his current practice as a hand surgeon. He also muses on some of the most important lessons that he learned from that journey. Make sure to stick out as Dr. Nathan hands you some important information that you can use in your own quest for your ideal health career.

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Fixing The Problems At Hand With Hand Surgeon/Orthopedic Surgeon, Nathan Enoki, MS, MD, Part 2

This is part two, a continuation of a guest interview with Dr. Nathan Enoki, a hand surgeon. He talks about how he wasn’t a good student, at least in his opinion. He then became a paramedic and got a Master’s degree. He went to medical school and joined the Navy. He was with the Navy for about ten years and then became a hand surgeon. He’s going to talk about that in this episode. Basically, his origin story and also a bunch of other musings. I split it up like this into two different episodes for his interview because there was so much content and I didn’t want to lose it but also I didn’t want it to be stuffed into one big episode. If you want to go back to that initial episode, it talks about what it’s like to be in search and what it’s like for him to help people from a hand perspective. It’s a great perspective. He is a great guy and gives you a good sense of who he is. Let’s dive right into it.

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You didn’t mention in the past that you were an EMT. I’d like to switch gears a little bit and talk about that. When you were younger, did you have in mind that you want to go and be a hand surgeon or even a surgeon when you’re in high school?

No, that’s an easy one. I was not a good student. In retrospect, looking back at what I did. I think I did okay in the intermediate school years and in high school. Looking back, I didn’t know how to study. It didn’t dawn on me that it was important to read a book, study it and then be able to understand it enough to take a test or to apply it. I wasn’t a good student at all. In fact, when I went to college, I didn’t have any idea what I wanted to do. When I went to college, I knew that I was going to study English because in high school I was always a good writer. It was a knee-jerk reaction to say, “I’m going to study English because I’m a good writer. I don’t know what I’m going to do with it but that’s what I’m going to do.”

It wasn’t until I fortuitously met up with an emergency room doctor when I was in my 1st and 2nd year in college where I thought, “His job is interesting.” That’s when I started looking into doing it but I never went into it with a commitment that I was going to go to medical school. That wasn’t the intent. The thought was, “Maybe I could think about doing medical school but I don’t know if that’s the direction I want to go, plus I’m an English major. What do you do?” To let you know, you don’t necessarily need to be a Biology, Chemistry or Physics major in college to go to medical school. I have a friend of mine who has a Bachelor of Fine Arts, who went to medical school and is a successful family practice doctor. That’s an aside but that’s where I started as not being a good student.

Apparently, you got into medical school. You had to be a better student over time. What made you become a better student, do you think?

For me, it was more of an identification of what it is that I liked doing and that’s important with any career choice, be it in healthcare and medicine or engineering or whatever. I think and believe that people need to choose the career that they know that they would be happy in. You need to choose the people you want to hang out with is what they commonly say in orthopedic surgery. When I started working with this doctor I fortuitously met up with in college in the emergency room, I started volunteering in the emergency room. I thought that this was the most intense setting I’ve ever been in. It was crazy. There are patients in the halls and in hallway beds. It was challenging in there. The challenging thing was to see all of these patients that were there who were sick and who I could even sit there and chat with, help or push them around on the gurney. I found that incredibly rewarding. It was that point where someone decides why they want to do something or why they want to go into a specialty. That’s the reason. It’s something that this profession captures you with and for me, it was the patients.

Meeting the patients, talking to them and being able to help them when they needed that help. That was the draw to healthcare for me. I still didn’t think that I was going to be someone that went to medical school but I did know that’s what I wanted to do. As I worked more as a volunteer in the emergency room, I was there. This was in college. I was a second year in college. I was volunteering there often in the emergency room that the chief of the emergency department basically took me aside and said, “You spend so much time here. I need to give you a job.” He basically gave me a job. First, my title was Emergency Department Hospital Assistant where he gave me a job that I could get a paycheck from.

Where are we talking about here?

Chose the career that you know you would be happy in. Click To Tweet

This was in Honolulu where I’m from and this was at Kaiser Permanente, which at the time was Kaiser Permanente Honolulu. It was a fairly new hospital. I was in the emergency department there.

You would go out of your way, you volunteered in the ER department. You walked in and said, “I’d like to volunteer here.”

They have procedures that you have to go through in order to volunteer there. With the assistance of the doctor that I met that worked there, he got me involved in there. Getting started there was challenging. The nurses didn’t know what to do with me. One of the toughest nurses that I’ve ever worked with came up to me on the first day and says, “What is it exactly that you do?” I told him, “I don’t know what I do. I’m not able to do anything but I’m happy to help.” They kept giving me tasks and jobs. After a while, I started learning the ER tech’s job. I became a hospital assistant. About a year later, they promoted me to an ER tech and that’s when I had my own patients. I was taking care of the patients with minor traumatic injuries, helping with laceration repairs, helping set fractures, put on splints, put on casts, bandage wounds, do EKGs and do CPR in the ER as a college student. That’s how I started in there.

My interest grew then I started saying, “What are those guys on the ambulance doing?” I started making friends with those guys and said, “I want to hop on with you guys and see what you do when you go to someone’s house, when you take care of patients on the street, on the side of the road, in their home or in their apartment.” That prompted me to go to EMT, Emergency Medical Technician school. At that time, EMT Basic was the first level. I think it’s still called that now. I enjoyed doing that so much that I eventually left the ER job and I started working on the ambulance.

I did that and then took the next step after a couple of years to do EMT paramedic training, which is a lot longer and more intensive where you learn to manage medications, start IVs, intubate, defibrillate, read EKGs and those things. Be more of a team leader out in what they call pre-hospital medicine where you’re taking care of patients out on the streets and in their homes. I loved that. It’s interesting because the further along I progressed in healthcare and the more I learned about what I could do in healthcare, the more I realized that there are things that I could not do. In retrospect, that is a truth. What I always say is the more you learn and the more you know, the more you realize that you don’t know enough. When I was a paramedic and when I started getting good at that, I realized that there was an end to what I could do for that patient. I couldn’t do any more. That was it. That’s all I could carry in my truck. That was the key to say, “If you want to do more for these patients, you’ve got to go to medical school. That was it.

Was there a moment in time where you said, “I need to get to the next level,” or it just slowly dawned on you?

It was something that was always in the back of my mind. I had emergency room doctors that would always tell me, “Why don’t you go to medical school?” Maybe it was a lack of commitment. I don’t know what it was. It was laziness, perhaps. I don’t know. You get to a point where you realize that, “Now is the time. I need to do this. I can’t do any more than what I’m currently doing unless I do more training, to get more schooling.” That was the moment and fortunately I got into medical school at that time and I moved on from there.

Having gone to medical school together, I know hand surgery was not on your mind. You were interested and were committed to going to emergency medicine. How did that even come about? Did you matched and went to an ER residency?

 

I did not. I changed my mind and at the risk of upsetting all of my emergency medicine colleagues, I’m going to still say this. As you go through medical school, my rationale for going to medical school is to try to do more for my patients. My only exposure to healthcare was in the emergency room at that point. It was a natural progression for me to say, “I’d like to do what doctor so-and-so does in the ER and be like him or be like her.” When you go to medical school, you realize that there are many facets of healthcare and medicine that you never knew existed before. What turned me on at that point was to be able to fix as many things as I could possibly fix. It was at that point in medical school I said, “The guys that fix a lot of things are the surgeons.” I left medical school planning on doing a general surgery residency with the thought of branching out into general surgical subspecialty at some point. I paid for medical school with a Navy scholarship, which throws in a whole different set of commitments that takes time and allowed me some time to think about what I was doing and what I wanted to do. Hand surgery came much later.

It’s the first year after medical school, right?

That’s right, first year after medical school surgery internship. One of my favorite rotations was orthopedic surgery. I thought fixing bones, fixing hips and repairing fractures with all kinds of hand tools. I thought that was incredibly neat, not to mention the fact that it still satisfied my mission. Orthopedic surgery is basically trauma surgery. Extremity trauma is common and that’s what I was a part of. That’s what I enjoyed doing and fixing. Managing when I was a paramedic and fix as a surgical intern. In the Navy, after your general surgery internship here, you typically will spend 1 to 3 years or so as a general medical officer with a Navy unit of some sort.

That gave me time to think about whether or not I wanted to do general surgery or orthopedic surgery and I chose orthopedic surgery. Hand surgery came later. When I was an orthopedic surgery resident, I came across this fascinating individual. His name is Dr. Joseph Sheppard, who was my mentor in hand surgery. He was an orthopedic surgeon. I was drawn to the kinds of things he did in surgery, the kinds of patients he took care of with hand and wrist problems. That’s what pushed me toward a hand and wrist fellowship training to do the specialty.

You did mention briefly your military experience, your time with the military. Can you tell us a little bit about that experience and what your responsibilities were?

Technically, if you graduate medical school, pass your board exams and complete an internship year, you can be licensed to practice medicine. Now in the United States, you’d find it hard to practice medicine in any civilian practice with that meager training there. You’re not going to be able to find a job anywhere. Especially in the military that has a lot of operational or military type of requirements, they need doctors and they’ll use you to the maximum of your ability without pushing you to do things that you’re not able to do or not qualified to do. They will not make you do something you’re not qualified to do but they will use you as a doctor because there are a lot of things that they can use you for.

For example, many military units require some sort of physician supervision and physician input and planning. When I was a part of my unit, I basically ran the squadron’s medical department. I was considered the medical department head for a squadron of approximately 400 or so Marines. You have to take care of everything from their routine coughs, sniffles and colds to their annual physicals. Make sure their immunizations are correct. You need to give them briefings and reports to update them on why they’re getting certain immunizations or what health threats they may be encountering when we go to a certain part of the world. You also are the point of contact and their primary care physician when they need to get referred for more for higher levels of care.

For instance, if I had a Marine with stomach problems, the first doctor they would see would be me. I would then contact the appropriate specialist and talk to them about this particular Marine and coordinate the care from there. You become a primary care provider for that unit. When you’re deployed, especially if you’re deployed in an austere environment, all bets are off. You are it. You take care of whatever comes. In 2003, I deployed with my unit to Kuwait and then we were part of the invasion of Iraq. I was probably the only doctor within 50 to 100 miles in some instances in theater. To the Marines, you’re the doctor. You’re subordinate. People who are working with you are your corpsman and they are “doc” to the Marines as well. You have to be able to not only train your corpsman but provide them leadership and the support of a doctor because essentially most of them are trained at the EMT level, maybe some a little bit more and maybe some a little more junior than that. You have to train them, keep their training up and keep them up to speed on what they need to do.

Commitment is the only thing that can keep you going in a healthcare career in a time like this. Click To Tweet

During that time, what did you learn that you probably would not have learned if you were not enlisted?

First of all, the reason I took the Navy scholarship was that the Navy provided me a scholarship that helped me pay for medical school. For people who are or will be, perhaps in my situation where you can’t let finances dictate whether or not you’re going to go to medical school or not. If you want to go to medical school, there will be ways to pay for it. You don’t have to join the Navy or the Army or the Air Force to do it. There are a lot of opportunities for scholarships and other programs that can be taken advantage of to help pay for that tuition including student loans and other systems and plans like that. There’s a public health service that you can take advantage of that will help to take care of your medical school tuition. That’s the reason why I did it.

I personally don’t think that if I had to do it all over again, I would have and the reason for that is even though it’s not residency, it’s not formal training, getting that experience as scary or crazy as it was sometimes. It was invaluable. I got to do a lot of things that I never would have been able to do before. I’ve seen parts of the world that I certainly wouldn’t have volunteered to go and see. In the military for me, you make these lifelong friendships. I still have friends in the Marine Corps that I still keep in touch with and they’re your friends for life. I would never have met these guys and girls if I didn’t do this. I got to do things. I got to ride on the back of helicopters. I got to fly airplanes and ride in some fancy ones.

The most important thing that I got out of that is we all think that doctors have this difficult life where we work all the time and we’re committed to what we do and how we do it. People in the military, it didn’t occur to me until I served with these people. They have an incredibly difficult life. They are incredibly committed to their jobs. They’re constantly moving and oftentimes never home. Their work is dangerous. You develop an appreciation for what these folks do and how it impacts upon their families when you serve with them. That’s the biggest thing that I got out of that and it is the primary reason why I choose to practice at the VA.

I feel like I’m taking care of the guys that I served with and I feel like I’m helping to give them back something to repay them for the huge sacrifices that they made when they were on active duty service. It helps me in my practice. That experience and interaction with those people helps my practice because it gives me something a little bit more to work for when I work at the VA. I see my friends in the faces of all of my patients that I take care of.

That’s a deep level of commitment there, Nate.

They deserve it. I wish I could do more. Unfortunately, sometimes one person can’t do everything. It does. It’s important to have a sense of purpose with whatever job you’re doing. It has to be something that draws you there. It’s something that drags you into the hospital in the middle of the night when you don’t feel like going in. I don’t know if you remember the general surgeon Dr. McPheeters, he was an avid surfer from the University of Hawaii. He is one of the prominent general surgeons at the University of Hawaii Medical School. He told me that the day he realized that he wanted to be a general surgeon was the day that he preferred to be in the operating room performing an appendectomy more than being on the waves surfing. It’s a deeper level of commitment.

It’s something that people need to find before they make that commitment to doing the healthcare career. They need to find the reason why they’re doing this job and it needs to be more than this is a job that will get me a paycheck. It needs to be something more, something that keeps you there, that holds you there and that attracts you to wanting to do this. That’s the only thing that can keep you motivated to continue doing this work especially in times like this where there’s a Coronavirus. Those folks are in the hospital with an incredible amount of commitment to taking care of people. What keeps them there is their dedication to taking care of people. They’re not there for a paycheck. They’d rather be home being safe. That’s my take on it. That’s a commitment for healthcare careers that you can’t write in a book or put in a magazine or an article. It’s something that the individual needs to decide for themselves.

 

Nate, if you could go back and do anything differently in your career path, what would you do?

I probably would have started younger. I wouldn’t recommend my career path to anyone because as you get older, things get harder to do. When you’re a 35-year-old resident, it’s different than if you’re a 25-year-old resident. When you’re 35, things start to hurt more. It’s harder to stay up at night. It’s harder to do a lot of the things you want to do because things like residency is physically challenging. It is exhausting even with 80-hour workweek restrictions. The work is physically exhausting. I admire my classmates who are in residency or they have a lot of energy and a lot of enthusiasm for doing what they do. Sometimes when you’re coming from an older age, it’s harder to keep moving at that pace.

Ideally, you want to follow the path that you followed and follow that path in a straight through manner because the way we’re trained as doctors is it’s a long tunnel. Once you’re in that tunnel, you can’t get out of it. It’s demanding both intellectually and physically and that can be challenging when you’re coming into it in an older age. It’s not to say that it can’t be done. I have a brother-in-law who started medical school at age 35. It can be done. It’s tough and you need the support of your family and your friends but it certainly is not impossible.

For people in healthcare careers, a couple of things that I always tell medical students is that don’t let your finances limit how high you get in healthcare. There are ways to figure out how to pay for school. The second thing is don’t let your age, background or your educational background influence whether or not you decide to go to medical school. If that’s something that you want to do or go to nursing school or become a paramedic or any other healthcare specialty regardless of what your financial status is, academic, family or social background, you can do it. There are always ways to do it.

Nate, are there any particular resources that you would recommend someone to listen into, look into or read about organizations to research or venues to attend regarding your career, either as an orthopedic surgeon or as a hand surgeon?

For orthopedic surgery, there’s the American Academy of Orthopaedic Surgeons also known as AAOS. They have a website where there are a lot of information for people considering careers in orthopedic surgery. For hand and wrist surgery, there’s an organization called the American Society for Surgery of the Hand, ASSH. They too, have a lot of resources for people interested in pursuing hand and wrist surgery as a career. In general, what people should do and what’s probably easier is to talk to people in the healthcare specialty you are interested in who are doing the job. Talk to a lot of them, get all of their perspectives and add that to your understanding of what the profession is, what it entails to get there and what it’s like to work in those specialties.

That was Dr. Nathan Enoki, a hand surgeon, good friend and a medical school classmate of mine. If you want to get ahold of Dr. Enoki, you can reach him through me. Reach me through my contact page through my website. My website is HCWithDrMarn.com. You can find my email address there and also contact me as well. If you liked this episode, please subscribe to the show. That’d be great. Hit that subscribe button whether it’s on your phone, desktop or laptop. Please consider signing up to my email list. That way, I can reach out to you and provide some of the latest updates that come up and latest news that may be relevant to you. You can sign up for this email list through the homepage of my website. I hope to hear from you and thanks for your time.

Important Links:

• Dr. Nathan Enoki
• Previous Episode – Dr. Nathan Enoki interview part one
• American Academy of Orthopaedic Surgeons
• American Society for Surgery of the Hand

About Dr. Nathan Enoki