Cisco Gomez –
Physician – Neuro ICU Fellow* at University of Pennsylvania
*In order to be a fully trained doctor (also known as attending) in the U.S. (or pretty much everywhere else), you must complete many years of education/training. First, you have to receive your college/university bachelor’s degree fulfilling pre-medical school course requirements. You then go to a 4-year medical school. After that, you go through residency training which is usually 3 to 4 years long depending on the specialty you’ve chosen and focuses on teaching you specifically how to treat patients. Note that a first year resident is commonly referred to as the intern. Either you are finished with your training by the end of residency or you have to do additional fellowship training if you are going into a very specialized field of medicine (sub-specialty) as Dr. Gomez has. On top of it all, there are multiple exams you must take along the way. The exams will be explained later in the interview.
I met Dr. Gomez at a Groupmuse event in Philadelphia. He had such a friendly and warm aura about him. It was so easy to approach him. I was thrilled when he agreed to be featured.
Hazel: When did you come to the U.S.?
Cisco: I came to the U.S. in 2012. I had finished 6 year combined pre-medical and medical school program in Caracas, Venezuela. That’s how it works there. You don’t have a separate pre-med program and medical school like in the U.S.
Hazel: So does it mean you wanted to be a doctor when you were in high school because you had to choose this path from then?
Cisco: Yes. At 18, I knew for certain that I wanted to be a doctor. I only applied to one pre-medical/ medical school and my mom was furious because of the risk I was taking. I had to then apply to law school and communication school to appease her. I got into all of them but only wanted medicine.
Hazel: What aspect of being a medical doctor that made you so certain?
Cisco: My dad developed lung cancer while I was in senior year of high school which eventually metastasized to his brain. In the end, we decided to take care of him at home by sharing the duty among family members and some home nurses. He even had a stroke right in front of me. Several months of taking care of my dad made me realize I could not imagine doing anything else but medicine.
Hazel: I’m sorry to hear about your dad. By the way, your English is so good! How did you learn it so well in seven years?
Cisco: I was lucky and received bi-lingual (Spanish and English) education from K through 12 in Venezuela. My father was a renowned psychiatrist and my mom a strategic consultant and they valued education above all else for us. My little brother was born with cerebellar palsy and we travelled a lot to Miami for his doctor’s appointments.
Hazel: I am familiar with cerebral palsy because I have a cousin who has it. He is smart as a whip but just has challenges with certain motor functions.
Cisco: Exactly. Initially, he couldn’t walk and had delayed development in hearing and vision. But, my brother is the pride of our family. He is super smart. He now plays the piano and has had two university degrees in computing. He lives in Orlando, Florida now.
Hazel: What made you choose your specialty?
Cisco: I initially wanted to be a psychiatrist. Then, I wanted to be a surgeon. I made friends with interns when I was in my third year and they’d let me tag along for calls. I remember my first time assisting surgery; it happened accidentally. They were doing damage control surgery on a patient with several gunshot wounds to the abdomen, and I’d just popped my head in to tell them the dinner lady was around. The surgeon yelled something to the effect of “why is he just standing there?” the OR (Operating Room) nurse ripped off my bracelets and literally scrubbed me in. Someone handed me a bunch of small intestines to hold. It was awesome. Eventually, the residents would ask me to come in, too. They were so short staffed that they would sometimes leave me to handle patients on my own.
Hazel: So going back to your specialty, you chose neurology for residency. How did you choose that?
Cisco: This is a long story… Bear with me. When I came to America, I had to decide which specialty to go into before applying for residency. Initially, I thought I’d like to go into internal medicine or infectious disease, seeing how common they were back in Venezuela. As part of my decision making process, I ended up doing an interventional radiology observership at Oregon Health and Science University (OHSU) and fell in love with that. I thought that would be the specialty for me since they could treat stroke in real time. I wondered if my dad would have done better if he’d had that. In order to go into neuro-interventional radiology, I had to do my neurology residency first then sub-specialize in neuro-interventional radiology after completing a fellowship. So that’s how I started the neurology residency at Rutgers University.
Hazel: But then what made you change your mind and end up sub-specializing in neuro-ICU?
Cisco: I loved the OHSU experience but during residency realized that neuro interventional radiology was not for me. I wanted to be in a specialty that required me to think about how everything worked and apply physiology. I needed the specialty to be more cerebral (pun intended!) in nature.
I initially also considered neurology as it would involve a lot of thinking but realized I was not patient enough for it. In neurology, the outcomes may not come so quickly.
I think neuro-ICU, all in all, is the best fit after all my research and thinking things over. It’s intellectual for sure, but you also get to make a real tangible difference. I learn something new every day and there will be not enough time in my life to learn everything. Having said that, I think the ICU is like being in love. It’s inspiring, beautiful and sometimes absolutely terrifying!
Hazel: That is such a great quote! I’m going to have to use it for your teaser! It’s great that you put so much thought into choosing your specialty. Now, tell me. What has been the most difficult situation so far as a medical doctor?
Cisco: It’s difficult and very humbling to come to terms with the fact that sometimes we can’t change outcomes. I have to acknowledge my limitations. It’s especially hard to be there for patient’s families. There was this one patient who had been sick for months. Her devoted husband came to her side daily. He was such a good man. Unfortunately, despite all our efforts the patient did not get better. The hardest part was seeing the patient’s husband every day and not being able to help.
One of our greatest professors back home told us very early on that we were not there to cure, but to relieve suffering. Sometimes, the best we can do is to help families come to terms with patients’ devastating conditions and relieve the patients’ suffering as best as we can. It’s very challenging, but also very rewarding.
Hazel: What made you make a move to the States?
Cisco: Venezuela was (and still is) politically and economically unstable and is getting worse by the day. There are not many opportunities in medical academia there. The country’s healthcare system is falling apart.
I had to get out of there.
Hazel: What about your proudest moments in your career thus far?
Cisco: As a resident at Rutgers, I had this patient with a week of inexplicable coma. He’d come in with a fever, high blood pressure and altered mental status. Whoever saw him before me chalked it up to hypertensive emergency but he’d since deteriorated, needed intubation and developed a movement disorder. All this didn’t sit well with me so I spent the next 2 days glued to the computer researching. I concluded that he had some form of Von Economo’s Disease, an extremely rare condition mostly described in history books. There were less than 100 cases reported in the U.S. in modern times! I convinced the attendings to give steroids and dopamine; luckily, it worked like magic. In 3 days, he was extubated, awake and making jokes with his wife. After that day, I was a big man on campus!
At Rutgers, I also received teaching awards from the Medical School. I really love to teach, and still get invited over to lecture there!
In addition, I had 7 publications in one year as a third year resident and got inducted into the American Association of Neuromuscular & Electrodiagnostic Medicine’s science editorial board as its youngest member.
Lastly, I’m the first Neurocritical Care fellow to get a job before the second year of fellowship at Penn. I’ll soon be an attending at University of Missouri!
Hazel: I’m amazed by you! You are truly remarkable! What has been the toughest year so far being in the States?
Cisco: Easily, my intern year. I was learning the system, getting used to a whole new environment of clinical work in a different country and writing several chapters for a neurology board review book when I hadn’t started neurology yet. I’d stay at the hospital after work to work on my writing, sometimes even overnight.
Hazel: Wow, impressive! How did you manage to write for the board review so early?
Cisco: You have to pass the Step 2 of the Boards* to be eligible for Residency in America. Thus, when I came over in 2012, I studied with Kaplan, an academy that provides preparation courses for the Boards. Thankfully, I did really well in Step 2 exam. Kaplan then hired me to teach a Step 1 preparation class. Then, they took me in as a junior faculty to write and edit course materials for Step 2. After that, I was approached to write for the board review for Step 3 exam.
*One must pass the United States Medical Licensure Exam (USMLE) Step 2 to get into medical residency program in the States. When Dr. Gomez moved to the States in 2012, he had to study for Step 2. In total, USMLE is comprised of three exams. Step 1 is taken at the end of second year of medical school. Step 2 is taken at the end of fourth year of medical school. Step 3 is taken after first year of residency. These exams are also called “the Boards.” There is another exam at the end of residency to test your knowledge in your specialty.
Hazel: Unbelievable! You must be a genius. Did you get any sleep?
Cisco: Hardly. I slept about an average of 5 hours on weekdays for months during my intern year. But I really do love what I do. So in the end it was all worth it.
Hazel: My biggest congratulations! I’m so happy for you and awed by your accomplishments!
Cisco: Thank you. I really have worked hard.
Even though, it was his day off, Dr. Gomez still came into the hospital to prepare for his presentation he was giving the next day among other things. Doctors like him keep us healthy and the medical field keeps making strides in its fight against seemingly incurable conditions today. I’m deeply humbled by all his work and accomplishments in his short life of 33 years. Thank you for your time, Doctor!