After a less than stellar grade in his intro chem class, Louis Chang felt his chances of med school slip away. But instead of pursuing one of his many other interests, he doubled-down and became a chemistry major, facing the challenge head on. That mix of tenacity and trying something new came in handy again later when he DID eventually become a doctor, but not in the specialty that had once seemed fated. Find out how trying a little bit of everything before going all in can lead to a life of no regrets.
As a young person, Louis Chang would make lists. Lists of long term, mid-term, and short-term goals as well as the daily tasks that he needed to do to achieve them. When he didn’t finish his daily list, he would push it to another day. One major goal was medical school right after college. But after a less than stellar grade in his intro chem class, he felt his chances at med school were over. A momentary detour afforded him the opportunity to take a range of other classes from government to German, but he actually stuck with chemistry as a major, facing the challenge head on. The breadth of experiences he had during college and his true interest for organic chemistry, however, made him question his original idea of medical school so he didn’t even take the MCATs before graduating. Instead, he worked in a chem lab at the NIH, almost pursued a PhD, and ultimately realized bench science was a little too isolating.
Unsure what was next, he tried his hand at a law firm in DC but pretty soon he knew that wasn’t the right fit either and finally applied to med school. The mix of tenacity and a willingness to try something new came in handy again when he actually did follow the to-do list toward his anticipated speciality, only to find out life had other plans.
In this episode, find out from Louis how checking out the detours can help you leave no regrets …on today's Roads Taken with Leslie Jennings Rowley.
About This Episode’s Guest
Louis Chang a neurosurgical spine specialist with expertise in minimally invasive surgery for spinal disorders. He also is an Assistant Professor of Neurosurgery at Johns Hopkins Medicine.
For another story about navigating the path to the medical life that feels right (this time in urology!), listen to our episode with George Huang.
Find more episodes at https://roadstakenshow.com
Executive Producer/Host: Leslie Jennings Rowley
Music: Brian Burrows
Email the show at RoadsTakenShow@gmail.com
Louis Chang: It's striking how kind of like my mindset going into college was one thing and then coming out, I was doing something completely different, but not in a bad way. Now, I wasn't thinking to myself like, you know, wow, what, where did things go wrong here? It was just kind of like a continuum.
Leslie Jennings Rowley: After a less than stellar grade in his intro chem class, Louis Chang felt his chances of med school slip away. But instead of pursuing one of his many other interests, he doubled down and became a chemistry major, facing the challenge head on. That mix of tenacity and trying something new came in handy again later, when he did eventually become a doctor, but not in the specialty that had once seemed fated. Find out how trying a little bit of everything before going all in can lead to a life of no regrets…on today's Roads Taken with me, Leslie Jennings Rowley.
Today I'm here with Louis Chang and we are going to talk about all the things we expect and all the things we don't expect and how it gets us to where we are. So Louis, thanks so much for being with us.
LC: Thank you very much. Thanks for inviting me. I'm really happy to be here.
LJR: Great. So when I do these interviews, I start with the same two questions and they are these: When we were in college, who were you? And when we were getting ready to leave, who did you think you would become?
LC: Hmm. When I started college, when I got into Dartmouth, I was elated. I was so happy that I was going to finally leave New York City and embark on my journey of independence. And I...I was very regimented. I remember in high school, it probably started in junior high school, I mean, I had daily tasks that I would kind of outline for myself. I had, well, I broke it down to like, maybe like long term goals, medium term goals and short term goals. And then I would break it down to like daily tasks that I would have to do to get to those goals. And then if I didn't get to those tasks that day, then I would kind of move it over to the following day. I was very determined. I was very diligent about this throughout much of middle school and high school. And I think a lot of us are kind of like that. I mean maybe, you know, I wrote things down but a lot of us maybe just kind of just did it mentally.
And I had this interest, this passion of going into medicine, even early on. And, and I don't know exactly what kind of inspired me into that. Maybe it was just kind of like, you know, pop culture stuff that I was exposed to, my parents, especially my late father, who was very influential in my life and, you know, all these things kind of added up. So it's hard to say exactly what kind of drove me in that direction. But I also did a lot of volunteer work in high school too, and I did four years of volunteering at a local hospital in Brooklyn where I grew up. It was kind of a funny volunteer program. It wasn't just showing up and being assigned to transport a patient or bring this to there or being a unit clerk or something like that. They had a program, and there were a lot of kids that signed up for it, and they had classes that were given by the more senior volunteers, maybe college students on, you know, basic anatomy, basic pharmacology, things, you know, just background information for medicine. And I stuck through it all four years. I was very, very interested in doing that. And, and by the end, the bonus, the prize of getting up to the ranks and that volunteer program is that you get to shadow a subspecialty or specialty of your choice. I shadowed the urology department there towards the end, and it was just a great experience. And I think all these things kind of really drove me to think about what I want to do later on.
And so when I went to Dartmouth, I really had this expectation, this, this goal of going through as a pre-med and graduating, jumping into medical school, doing the four years, doing the residency, whatever number of years of residency, depending on the specialty, becoming doctor. I mean, like everything is just all defined, all like predetermined, just like the way I
LJR: Lists and goals and tasks.
LC: Kind of yeah, exactly. Yeah, right just like my daily tasks my long term goal my short term. Everything was just kind of like very just spelled out for me, by myself. And so that was, you know, basically the me, the Lewis going into, into school and everything just kind of changed. You know, kind of a little bit suddenly, but then over the course of the following few years through, through college, I just started taking all these different classes and I was kind of toying with the idea of maybe double majoring in something like a basic science, but with something else like government or even German. I mean, it was just like these things were they weren't like really like a sustained, you know, thought for a few years. But I mean, but there were, you know, there were there were actually I was kind of working towards, you know, the course requirement for some of these minors or, or double majors. But in the end, I actually majored in, in hard science. But when I was, well, about to graduate or leaving college, I didn't end up going to medical school directly like I had envisioned. It was quite different, and I actually didn't go to medical school until four years after graduating from college. So I took quite a bit of time off to do other things and to pursue other interests that I found while I was in college.
LJR: Was that a direct, like, I had so many opportunities in this liberal arts environment to try things and didn't even know I was going to love them, and wow, maybe there are other things. Was the thought, I need to take this time to explore those because I know I still want to do medicine and that will be a prescribed path? Or is it I want to do these things now just in case it turns into something other than medicine?
LC: I think it was probably more of the latter.
LJR: Oh.
LC: Yeah, I wasn't, yeah, it's kind of strange. I'm trying to trying to think back into what my mindset was at that time. [LJR: Yeah.] I wasn't so sure that I was going to necessarily go into medicine when I was about to graduate. In fact, I put off taking the MCAT, which was the admission test for medical schools. I didn't take it until a year and a half after I graduated from college. I think when I was going through college, I thought, yeah, you know, I really like medicine. I thought I was going to be a doctor, and I really wanted to do that. But now I'm not so sure. And I found this other passion, which was chemistry, and it's kind of funny…My freshman year, taking one of the intro chemistry courses, I remember I struggled and I took AP chemistry. I thought I was good in science and, you know, but I still studied. I mean, I didn't, you know, I didn't take anything for granted. I still worked hard and, but it was a big class and it was one of those very competitive classes. And there were just so many smart people in my class to compete with. I remember I got my final exam back and I knew what I was going to end up with. I ended up with a C plus in one of these intro chemistry classes and I was just devastated and I thought to myself, wow, I think my chances of becoming doctor is pretty much over, you know, one class, you know. But that was my mindset back then, you know, I thought I had to be perfect straight A student or at least an A minus student or something like that.
LJR: But maybe that was a gift, right? So if that was even fleetingly a idea that you had that, okay, this is over, that dream is over. Now I've, I better embrace some other things and go take some courses in German and all of these things. Maybe that was a gift because you ultimately recognized, okay, no, I can do my own path, but you know?
LC: Yeah, I think I was part of t kind of made me think about other things. But at the same time, I did what I thought would make the most sense, which was major in chemistry. I thought, okay, well, you know, this really challenged me and I think I'm going to try to prove it to myself that I actually could do this.
LJR: Nice.
LC: …and I could come through it and do better than a C plus going forward. So it was both. I mean, I think it was probably like. Yeah, you know, there, there are a lot of other things out there that I, that I could also study, but at the same time, like, I, I want to, you know, take my deficiencies head on. You know, just kind of, you know, go through it. And I ended up really loving chemistry and actually I did okay. I did all right in the end. And I had a lot of good mentors in chemistry and I sub specialized, I guess—I don't know what you call it back then—but I fell in love with organic chemistry. And that's kind of like how I ended up, after college, I ended up at Bethesda. I found a research opportunity with the NIH doing organic chemistry research as it pertains to medicinal chemistry. So yeah, I mean all these things kind of like, kind of shape me away from medicine a little bit. And I actually thought maybe I should, you know, get a PhD in chemistry. I was actually on the track for that, just for a short period of time. So my preceptor at NIH, he has…or he had an adjunct professor role with a university and he asked me to be his first graduate student with the intent of five, six years or whatever it is to get a PhD in chemistry. So I went through all that. I then took the GRE and did all the admission things. And yeah, I actually started the coursework and the track of becoming a PhD in chemistry. And then maybe a year into it, I just, I just thought, well, yeah, I'm not so sure about this anymore. Let me try something else, but still within organic chemistry. So I got a job in San Diego working in a biopharmaceutical company doing research, but, you know, in the private sector.
Thinking back, it's just it's striking how kind of like my mindset going into college was one thing and then coming out, I was doing something completely different, but not in a bad way that I wasn't thinking to myself, like, you know, wow, what, where, where things go wrong here.
LJR: Yeah.
LC: It was just kind of like a continuum. But then, you know, in the end, I just kind of got back to what I wanted to do in the first place, which is fine . Because I could have ended up being a Ph.D. in organic chemist right now. But you know, it's just where my interests, you know, kind of led me and what I wanted to do later on.
LJR: So what was the moment where you thought, okay, I got take the MCAT and I want to get back on the track.
LC: Yeah. You know, I really, I mean, I enjoy doing chemistry research and bench research. But I just thought it was a little bit in a way isolating. I mean, and I really enjoyed interacting with people and I don't know. It was just one of those things where I, it wasn't like an aha moment or anything. [LJR: yeah.] It was just, you know, I tried it for a little while and I thought, well, this is interesting, and, and I love the, the mental exercise of synthesizing compounds and doing all that. But sometimes I think doing experiments also were, I don't know, a little bit frustrating to me sometimes, and I, I thought, well, maybe I should reconsider a really short term. You know, I like medicine and I've always wanted to go into that. So why not just take the study for it and take the MCAT. So I'll have that in my back pocket just in case. But I actually didn't end up applying for medical school until, you know, maybe, I don't know, a couple of years after I took the MCAT. Because I then explore the career of law too for a short period of time.
So, so after my stint in San Diego, I was there for about a year working in industry biopharmaceutical. I wanted to move back to the East Coast because. You know, 80, 75, 80 degree weather, bright and sunny every day. It was just too boring. I wanted, I wanted to have that four seasons again. But, but really I you know, I thought to myself, well, there's another part of me that was interested in law, maybe government. So let's just give it a little bit, you know, maybe a hot minute to see what that's like. And so I looked around, I got a job as a legal assistant at a very prominent corporate law firm in Washington, D.C. And that was the other thing that Dartmouth, I think, kind of shaped that path was. You know, I don't know what language you, you took in
LJR: Italian.
LC: …and then did you go abroad to Italy?
LJR: Mm-hmm. Yeah.
LC: So, yeah, I mean, that was really encouraged. We were really encouraged to do that one semester abroad to really, you know, solidify our language skills. And I should have done that with German because I think I would, it would have been useful later on for me. But instead I chose the away program to Washington, D.C., with the government program. [LJR: Oh.] So that's why I was, I was, yeah, kind of thinking, should I double major in Govy or, or minor in Govy? But I had a fantastic time. I mean, it was like, you know, it was the, you know, such a great rotation or in a way semester for me. And I also fell in love with DC. I mean, I was there for probably a couple of trips before then. But this was like the first time that I was in DC for extended period of time. And I just loved it. We stayed at some like extended stay hotel in Roslyn, Virginia, which is like Northern Virginia. And my internship was near the White House. And it was with actually, this is kind of interesting…This is how I kind of meshed chemistry with government. We all were, you know, we all had to intern at a society or, you know, some kind of, you know, government
LJR: Agency or something.
LC: Yeah, exactly. And I reached out to one of the synthetic organic chemistry manufacturing organizations. based out DC.
LJR: Like a lobby, lobbiest group?
LC: It was a lobby group. Yeah, exactly. And they accepted me. They took me on and it was great. So I got to see the legislative side and the regulatory side of chemistry. But, you know, it was, it was a fantastic time. I remember there were many days that my friend and I would actually walk from Northern Virginia all the way into DC. And it was like, wow. I mean, it was like, it was a long walk, but it was beautiful though. And that kind of reverberated. I mean, I really remembered it. When it was time to figure out what I was going to do after graduation, and there were a few things I was toying with, but, working at NIH really interested me for research side of things, but also being In the D. C. region, and then when I was coming back, when I went to come back from San Diego, you know, that kind of that experience, that memory kind of led me to look into D.C. again instead of Chicago or New York City, you know, stuff like that. So, yeah, I mean, that experience at the law firm was good, too. I mean, I can't say anything bad about it. I just it wasn't what I wanted to do, though. [LJR: Yeah.] And within a few months of starting it. I thought, yeah, I can't see myself doing this day in and day out.
LJR: Yeah. It's good to have that knowledge, like the firsthand knowledge, trying it and then realizing…I actually expected you to say that you took the LSAT,
LC: LSAT? No.
LJR: But it seems like you got out before that, recognizing this might not be the place for you. So you did have the MCAT under your belt, so you could apply at that point, kind of recognizing that there, you were back to your old lists. And, and kind of, we, we've talked to a lot of doctors, we know kind of this whole progression. You had already gotten a taste of some of those rotations in your earlier volunteer life experiences. So when was it that you kind of pinpointed where your place in medicine was going to be?
LC: You mean the specialty within medicine or just so…I didn't really figure out what I wanted to do in medicine until probably my third year of medical school, but I thought, I thought I was going to go into urology.
LJR: Right. Because you'd been with them.
LC: Yeah, because again, you know, my exposure to that field in high school. I was like 16, 17 years old and I was—back then it was a different time. I mean, like as a high school student, I was in the operating room with these urologists and they were doing nephrectomies and all these great surgical procedures. At the time that I was like, wow, this is amazing. And then I also shadowed them in, in clinic and I was with them Day in and day out. I mean I still remember one of them taking me to the U. S. Open the tennis tournament. He was a big tennis, tennis fan. And I really, you know, I still play tennis. Not not good anymore, but I'm a very avid tennis fan. So all these, like, very positive experiences kind of shaped my perception of like, wow, you know, urology is kind of a cool field that you get to do a little bit of medicine, a little bit of surgery. Yeah. I mean, I've always kind of been very interested in doing things with my hands and taking things apart, putting things back together. So I just thought that this was a good field for me. And then in medical school, during our first year, we have to do kind of like a observership with, with a clinician in their office setting. And I would say like the vast majority, maybe 90 percent of us. would be assigned to like a primary care physician or, you know, an internist or, you know, some, some very general practitioner. So you kind of get a feel of what, you know, just a breadth of what's out there. I was in that small subset that was assigned to a subspecialist. I mean, the assignment had nothing to do with your background or anything like that. So somehow I was assigned to a urologist.
LJR: Oh gosh.
LC: So I thought, well, this is a sign. I mean, this has got to be, I was destined to be a urologist. And no, I had a great experience with him too. And so when it came time to pick our elective rotations, actually towards the end of third, maybe fourth year, of course I picked urology rotation. At the same time, I thought, well, you know what? I really enjoyed, I knew it was gonna be something surgical. I knew I wanted to go into surgery. I enjoyed neurology rotation. I enjoyed neuroscience and I thought, well, you know, maybe I'll do that as well. I'll do a rotation in neurosurgery. And I remember doing the urology rotation first and coming out of it, I thought to myself, yeah, this was kind of boring actually. And no offense to any urologist out there . To me. And I think it was just kind of like the experience that I had because a lot of the urology procedures that I observed were just a one person kind of, you know, they didn't need really any assistance in doing like cystoscopies or these procedures. And so I was just kind of like, you know, just against the wall, just watching and just, you know, trying to absorb. But I wasn't really getting into the action so to speak. But then I did my rotation with the neurosurgery department at the medical school and it was like a totally different experience. I mean, they had me scrub in. They—of course under supervision and guidance—I put in screws in the back, you know, pedicle screws for fusions. And I mean, I was, it was hands on, I mean, from, from day one. And it was just such a, such a great experience. And the chairman there was, he was just so, he was very affable. You know, it's a lot of, you know, a lot of what happens to us also is kind of determined by like the people that we meet, not just like the profession itself. But the people we meet could be very influential and this chairman is just like…he was just such a personality and he was just really took me under his wings and kind of guided me and mentored me. And, and then I said, well, you know, I think, you know, between the two, I would definitely want to go into neurosurgery over urology. And then I did a couple more rotations. These were external rotations. Not surprisingly, these rotations were down in this area, one in Baltimore, a couple in DC. So I just knew geographically, this is where I want to end up. And so, yeah, in the end I did match in neurosurgery residency in Baltimore.
So it took a while in the end to figure out what subspecialty I was going to go into. And I never in a million years would think that neurosurgery was going to be what I was going to go into. And, in fact, I remember when I just got into medical school, I went over to a friend's house who we grew up together in the same neighborhood in Brooklyn. I mean, I had known him since third grade. And his father kind of jokingly said to me: So what are you gonna go into, neurosurgery? And I just kind of laughed I said no way I'm not going into that field because It's so demanding, so stressful from what I envisioned, what I knew of it, that I would never in a million years go into neurosurgery. And then he just said, kind of jokingly, Oh, what are you afraid of? Brain and blood? And I just said, yeah, yeah, that's exactly it. [LJR: Right.] But I blew that off from the very beginning and luckily, you know, I'd never really you know, had that kind of take hold in my, in my thought. Because I, you know, eventually this is what I became.
LJR: Crazy.
LC: Yeah, it was crazy.
LJR: And I remember when you said that you had realized that bench science might be not for you because it was isolating. It's interesting that when looking in urology, which you had thought might be an option, you didn't like it because it was like, they didn't need assistance and it was kind of a one man show. And then you got into this kind of, yes, high stress, but team sport, if you will. And so that seems to suit you more and maybe more of the kind of bringing the people part of law or Govy or whatever into it. Is there anything to that?
LC: I don't know. That's interesting. Yeah, I never really analyzed that before myself, but I appreciate you pointing that out. I guess I didn't really. Yeah.
LJR: So day to day. You're my first neurosurgeon, I think, that I know. So day to day what does neurosurgery look like and my guess is there are many flavors of that and you just talk from your own perspective of what you do.
LC: Yeah, there are there are many flavors of that. So you could be a general neurosurgeon where you're basically ,you know, jack of all trades. You could do cranial spine, even peripheral nerve, meaning like carpal tunnel release, things like that. And that was basically what, when I finished residency, I was basically a general neurosurgeon. And then the other flavor is that you could either go into academics or kind of a you know, community neurosurgery role. And then now there's a lot of like hybrids. You could be in private practice and community neurosurgery, but then be involved in an academic program. It's a little bit blurry now, this field.
And that was the other thing that was really kind of surprising to me looking back is I didn't think I was ever going to go into academic neurosurgery. I started out in as community neurosurgeon and I was fine with that. I was quite happy with it. But over the years, I guess there were different things that occurred and kind of evolved. And then everything in my life has been like, kind of like delayed. You know, meeting with you was delayed. I didn't do a fellowship immediately after residency. I worked for several years and then I went back and did a fellowship to subspecialize even more.
So now, I'm not so much a general neurosurgeon, but I'm a neurosurgeon subspecialized in spine. So if you look at these, a lot of these academic programs, you will see, like, you know, everybody is kind of pigeonholed or specialized in a certain little niche of, part of that field. So we have neurosurgeons that are specialized in brain tumors, and then you have functional neurosurgeons who do cranial surgeries, but they treat conditions, movement disorder conditions like Parkinson's and things like that. Then the spine surgeons like myself. And then even within the subset of spine surgeons, you'll have spine surgeons that specialize in what they call complex spine, like scoliosis correction, you know, deformities, things like that, like major reconstruction of the spine. Then you have fine surgeons that, that may specialize in tumors. Like myself, I, my subset is It's minimally invasive spine surgery. And you could use that for a lot of different things to like, not just degenerative spine conditions, but you could also use that in certain deformity corrections to some degree. And so I think to go back to your question, what's my day to day? My day to day is a little bit different than like a general neurosurgeon. You know, I'll see patients in clinic, just like every other neurosurgeon out there. I'll see what condition, what, what's going on with them. And if they need further conservative treatment, I will refer them to like, let's say, physical therapy or pain management, stuff like that. If they've already tried it, if there's something that they need, you know, I think surgery could help them. Then I'll talk to them about what surgery that would be, how I would do it. And then kind of, you know, let them decide if that's what they want to do and then schedule them for surgery. So that's one component. That's like my more sane schedule. And then every once in a while I'm on call or one of my colleagues is on call who's not specialized in spine and something will come in and we'll need more of an urgent or emergent surgical management of that issue. Then that becomes, okay, well, all right, I got to drop what I'm doing. I got to find time for this surgery and put it on. And so that's more of like the unpredictable part of my life. You know, and I think one of the sessions that we were playing on, that's what happened. You know, I was on call that weekend. Something came in, I had to reschedule because. I did that surgery. So, so that's another facet of my life.
You know, part of my day to day would be in the office or seeing patients in the hospital. And part of my other office is the operating room. I mean, that, that probably consumes, you know, maybe 50 percent of my time. And then there's another subset of my time that's devoted to academic pursuits. So publications or research, clinical research. Mentoring students, residents. You know, I have different hats now. I think my life has become a little bit more, a little bit broader, a little, you know, a little bit more responsibilities and expectations and a little busier too, so.
LJR: Yeah, well, and that is the direct, I don't know, response to where you had been before. Your predictable lists and tasks, and I know the path, and then there's a deviation that opens you up to more diversity of things, and the different hats that you were wearing as a student, now you're wearing those different hats in your own field. So, that sounds about right for where you are. I wouldn't say everything in your life has been delayed, it's just been kind of broadened by these extra experiences.
LC: Yeah, I think there are more like detours, I guess in a way. But I think they're, I mean, they're, they're necessary detours because I think if I didn't have those experiences I mean, there'll be part of me that will have some kind of regret. Like, you know, should I've done this? Maybe I should have been a corporate lawyer, you know, I mean, I don't know, or research scientist or something, you know. But now that I have that, you know, in my background, my experience. I could say, well, you know, I've tried that and I like this more. I like what I'm doing right now more. And I think the same with my subspecialty. I knew what urology was from the eyes of, you know, maybe a high school student, a medical student. But I enjoy doing what I'm doing now more than what I potentially could be doing as a urologist. And in some ways I kind of think the same of, you know, where I am now in academic neurosurgery versus a community neurosurgery. You know, I just feel like I have a little bit more impact in the field, you know, I think all these things kind of, you know, just shape where we end up eventually.
You know, I don't make lists anymore, really.
LJR: I was going to ask you.
LC: I mean, I've given up on that.
LJR: Yeah, I think that's probably a good thing.
LC: Yeah, especially now with a couple of kids, I definitely don't make lists. You know, whatever happens, happens.
LJR: That's right.
LC: But I think doing that initially was very good in kind of keeping me focused on, on certain things. But now I just kind of, you know, kind of ride the wave a little bit. You know, I'm almost 50 years old and I've seen a lot of kind of experienced a lot and now I, you know, maybe a little bit more attuned to my limitations and my preferences, you know. And now I could kind of be a little bit more flexible, you know, a little bit more off the cuff, you know, and, and just kind of take things, you know, where things lead me.
LJR: Yeah. Well, it seems like things have led you in great ways and in your ability to take experiences that might not have been on the original list, you can say that you've lived with no regrets. And I, I love that for you. We'll see where the next things take you. But right now, so grateful that you shared all of this with us. So thanks so much, Louis.
LC: Thank you very much. Thanks, Leslie.
LJR: That was Louis Chang, a neurosurgical spine specialist with expertise in minimally invasive surgery for spinal disorders. He also is an assistant professor of neurosurgery at Johns Hopkins Medicine. Here's a show note: We're just a couple episodes away from our planned fall hiatus. If you haven't yet, please take a moment to follow or subscribe wherever you get your podcasts so that you'll be able to access all of our past episodes and you'll be alerted to when the next season will resume. That way, when we're back, you'll automatically start getting new episodes delivered to you featuring another set of guests and me, Leslie Jennings Rowley on Roads Taken.