Tom Tremoulet AB '91 MD

Coming into Harvard, I had done advanced coursework in math in high school and so, I thought I was going to major in math. Most of my family were engineers with my father, sister and uncle all electrical engineers. I was originally considering a slightly different scientific path as a pre-med having seen my mother at work as a nurse. I thought math would be a natural fit for me until I took Math 22. I got my butt kicked, and realized pretty quickly the caliber of students in applied math. It didn’t help that I was also trying to do drama productions with the Harvard Radcliffe Drama Club and playing soccer. I realized if I was going to do math and pre-med, it was going to be a hard and rigorous road. I decided that I should look elsewhere, if I was ever going to leave the science center!! I was also surrounded by intense science types in my roommates: one of them went on to get a PhD in physics at Harvard, one got a PhD in chemistry at Harvard, and another got his PhD in chemistry at Cal Berkeley. On reflection, I found logical reasoning and thought that I admired in math, and I enjoyed philosophy. Narrowing down further, I realized that most of my academic interests revolved around the interaction with the individual in society and I ended up in the Government department among a small cadre studying political theory. On graduation, I took the LSAT for the heck of it because I couldn’t figure out what else to do and it seemed to be what all the government concentrators were doing. Most of my peers were going to grad school or getting their master’s, or looking to start in consulting firms or banking houses. At career fairs, I found myself visiting booths for these firms, but then I was fascinated by the booths for Teach for America and the Peace Corps. So in the end, I decided if not then, when so I applied for and was accepted for two years in the Peace Corps. 

I ended up going to West Africa, to Mali, and I received training in agriculture. I was teaching people gardening, and it was interesting and fulfilling, yet I saw a lot of malnutrition, and parasitic disease. These people had a really hard life, but they were resilient and had such a rich culture—they were smiling and happy and grateful for everything that came their way. I decided at that point that I really wasn’t done with medicine.  With the intent of getting back to international medical work, I came back and told my parents that I was going to move back to Cambridge. I crashed with an old friend of mine from the Government department who was getting his PhD. At the time, I was paying for groceries, working temp jobs and doing some per diem work in set construction with the American Repertory Theater. I was eventually hired as a lab tech and secretary at one of the research labs at Harvard Medical School in the Department of Cell Biology. I ran with this for a couple of years while I was getting my pre med requirements done at the Harvard Extension School. A great perk was that I was able to tap into the advising system for pre-meds at Quincy house and after several interviews and a handful of acceptances, I finally ended up at UCLA’s school of medicine, quite attractive as I paid in-state tuition after my first year and knew I’d be paying for graduate school with loans. 

At UCLA, I felt I had a leg up on other people because I had lived out in the real world (obviously, I am biased). I was looking hard at each field during my clinical rotations, and I was not afraid to ask the incredible GI surgeon about why he chose GI surgery—something a medical student at the bottom of the ladder wasn’t expected to do.. In the end, I chose emergency medicine because I liked working with my hands. Surgery was too long a trek as I was already five years delayed. I met my wife, an LA native, in medical school. She had actually graduated just five years after me at Harvard. I did my residency in Emergency Medicine at Harbor-UCLA. My wife completed her residency in pediatrics at Cedars-Sinai, and we relocated to San Diego for her fellowship. I remain in awe of her academic and clinical work while I spend my time primarily clinical.

I am amazed to realize that it’s now been 19 years that I’ve been practicing Emergency Medicine. Three years ago, I was offered the position of chair of my department, and I felt it was time I assumed more of a leadership role… and then came COVID and it has been just a bit more challenging then I signed up for…

How has your experience in studying political science helped your medical career?

The current pandemic has given me a bit to ponder. I have always been a student of  the individual’s role in society, and it’s just very fascinating and at times upsetting to see people’s response to COVID. Studying political science or any kind of liberal arts background helps you understand bias and follow logic in what you’re reading. Add to that knowledge of statistics about case-controlled, versus anecdotal articles and paying attention to p values and how well-powered a study is and you can make some decisions. Unfortunately, even among physicians whom I see as scientists, much of this has gone by the wayside during the COVID pandemic. There’s a lot of anecdotal stuff out there that’s just junk. 

There really is a lot of emotion out there right now and the cross-cultural elements I learned in the peace corps made me realize how important it is to be respectful of other people’s positions. Here in San Diego, I’m at times practicing border medicine. I feel I’ve become more attuned to the Latinx population. I also need to respect different Asian cultures and middle eastern ones. I think the pandemic has really highlighted how much variation we have in terms of how people approach things—trust in government and trust in science among other things. 

As they say, life is what happens when you’re making other plans. I haven’t had a chance to get back to international medicine, but I think I’m coming close to the end of my time - domestically at least - in emergency medicine. Recently, it’s been rather exhausting, and I hope in the future I get back abroad where the work might be equally exhausting, but fulfilling.. 

How do you approach difficult conversations with patients and their families?

My last shift, I had a 95 year old who came in and was in respiratory failure. What we were doing, trying to resuscitate her, was brutal with chest compressions, intubation and such. This woman had been pulseless for ten minutes by that time, and by description she had probably already had a major stroke. To have a conversation with a family bedside in the midst of resuscitating, was challenging. I stepped aside and talked to the family, explaining that what we’re doing right now is probably breaking more ribs, prolonging the inevitable with no real meaningful recovery possible.. We could keep her on machines and keep going, or we could let her go peacefully. 

These are hard conversations you have, I don’t think anyone feels they get easier with practice. I also think there is a certain amount of compassion fatigue that we have, definitely ICU doctors, especially during this pandemic. It’s not the type of training that we can get in medical school. 

When I was a medical student over 20 years ago, they were starting to have courses in  “art of medicine” and being more empathetic when talking to people. In medical school, we learned about how you can discuss these end of life issues calmly in an office setting, not so much while actively trying to keep someone’s heart going. 

What advice do you have for current students or career professionals now in the field?

Tom with Family

Before you get into medicine, take inventory of your coping skills and be sure to have a social network in place or make one during training. One of the things I found out about myself in the peace corps was that I was more resilient than I thought. I had the confidence to come back to the US and choose my path and felt that I could always find a job to pay the bills while I made this work. I also respected that the road might not lead to becoming a physician. Everything will work out as it is meant to be. There are a lot of different roads and sometimes, it seems insurmountable. But that being said, my own road was very windy. 

Burnout in medicine is definitely a problem, and you really have to tackle it with hobbies you love. For me, it has been my family. I have an eleven year old and a fourteen year old daughter, and I try to disconnect by dragging them and their mom on hikes or bike rides and I love cooking for them all. Focusing on them; helping in math or proofreading a paper or coaching soccer helps me disengage from my chaos at work. 

I also always tell myself that I’m going to make sure I enjoy the path and live in the moment. I make sure I am appreciative of the things I am learning, and I try to tell myself, I never just want to “get through” this for some future goal next month or next year. That’s a hard credo to follow and I do not succeed all the time, but I feel that it’s a good checkpoint to have with yourself as you navigate your own journey.

Tom Tremoulet MD

Emergency Medicine Physician 

AB 1991 | Government 

Interviewed and compiled by Felicia Ho