For now, my time at St Joe’s has ended. My inpatient rotation there ended about a week ago, and I am happy to have had the opportunity to work there. I was definitely nervous at first, because I was assigned to a Hem/Onc floor and I am notorious for crying (as in, I cry when I see someone else crying). Nevertheless, I was pleasantly surprised at how much I enjoyed working with both my team and my patients.
While there was definitely a fair share of tears (what, you want everything?), they were healing tears and gave me a better perspective of what a physician’s role should encompass. Not just prescribing medications and radiation treatments, but also providing emotional and empathetic treatment. Despite my apprehensions, I am grateful for the three weeks at St Joe’s, because my patients there have left a lasting impact on me, both professionally and personally.
In addition, I still was able to attend the inaugural Exercise and Sport Science Institute (ESSI) Symposium and learn more about UM’s exciting new institute funded both by the Office of Research and the Athletic Department. From hearing about new advancements in designing a better football helmet to learning about inertial measurement units and their application in improving your golf swing, I had a blast!
Speaking of athletics, I also went to the unveiling of the new Nike basketball uniforms, with Jalen Rose and DJ Khaled, a few weeks ago. It’s crazy the amount of excitement Michigan Athletics is generating right now!
I had no intention of getting involved in research when I began my medical school journey, and I definitely had no plans to work on a project that would take me to an international conference in Barcelona. My short, one summer stint in a lab had been fine, but in med school I planned to play soccer, work on the leadership team at the UM Student-Run Free Clinic, and spend time with friends and family. That all changed when I met Dr. Kelly Walkovich.
Presenting my research at the European Society of Immunodeficiencies Biennial Conference in Barcelona
We were in our M1 immunology course, and Dr. Walkovich was facilitating a patient presentation of a family whose child had SCID. I’ll always remember the intense buzz of euphoria that traveled from my forehead to my fingertips as I first fell in love with neutrophils, T cells, and cytokines. After the presentation, I contacted Dr. Walkovich, she immediately responded, and she invited me to shadow her at her Immuno-Hematology Clinic at Mott. At the clinic, I became hopelessly infatuated with the patient population, the providers, and the many different disease processes. At the end of clinic, Dr. Walkovich asked me if I would be interested in working on some research projects with her. I eagerly blurted “yes.”
We began with a project on the Duffy antigen receptor and its connection to benign ethnic neutropenia. I gave a 10-minute talk on our findings at the University of Michigan Immuno-Hematology Symposium in the spring, and a few days later Dr. Walkovich called and asked if I would like to go to Spain in the fall. I stammered incoherently for a few seconds before once again eagerly blurting “yes.”
A few weeks ago, I presented at the biennial meeting of the European Society of Immunodeficiencies in Barcelona, Spain. It was magical. I spent all week learning about advances in all kinds of immunodeficiencies, meeting like-minded people from all over the world, and listening to some of the best minds in immunology, hematology, and oncology. Plus, I was in Barcelona, one of my favorite places in the entire world. Jet lag never really even hit me because I was so excited to wake up, find my new friends, eat really good Spanish food, and feel those shivers of excitement every day in the plenary and breakout sessions.
The depth and breadth of opportunities here as well as the flexibility to do whatever sparks your interest whenever that spark happens to hit you never ceases to amaze me. I initially wrote off research because I never felt that zing of excitement early on in undergrad. But then one physician gave an inspiring lecture on a topic I was falling in love with, nurtured that interest, and rekindled a passion that eventually led to me gorging myself on knowledge (and tapas) at a conference in Europe. I love the accessibility of the faculty here, the way the school builds in the time and resources to do whatever you love, and how it allows med students to intentionally pursue whatever they love (even if it’s neutrophils). That is the Michigan difference!
Hello and happy fall! It’s actually starting to feel like fall now. The mornings are chilly, and the heat feels much less oppressive. I saw a few leaves changing colors, and there is apple cider everywhere. I love it so much. Fall also means that we’re halfway done with rotations. We had an intersession week three weeks ago that marked the halfway point. I can’t believe that the year is flying by so quickly, but I’m also very excited for what is to come next year.
On Saturdays, we wear maize.
I admit that it’s been an embarrassingly long time since I’ve posted an update. It turns out that being on the wards and studying for shelf exams is decently time consuming. However, I’ll try to bring things back up to speed.
Last time that I wrote, I was starting my surgery rotation. After the initial shock wore off, I really enjoyed surgery, despite the very long days. I learned how to sew and throw knots, and I touched a carotid artery. I learned anatomy much better than I learned it the first time around, and I saw the inside of a living, breathing person. These are amazing privileges, and I try to always remember that my training is also a privilege, especially on those 4am mornings.
Next up was family medicine. It was a rather short rotation at three weeks long, but I enjoyed every minute of it. I loved the variety throughout the day, as we saw everyone from children to senior citizens. The scope of family practice is astounding, and every day was different. I spent my time at the Chelsea clinic site, and it was a great experience. The public health part of me really enjoyed the focus on preventive medicine, and I just really enjoyed my time on family med.
After family med was another quick three-week rotation: neurology. We spent a week each on three different services, and I spent time on consults, inpatient, and pediatric neurology. The brain is an absolute black box, and it was great to learn a little piece of the mystery. I was a little scared of the rotation after our M2 neurology block, but it ended up being pretty great to see the things that we learned M2 year applied to patient care.
Now, I’m on obstetrics and gynecology, which we generally shorten to ob/gyn. In my three weeks on service, I’ve scrubbed into gyn surgeries, spent time in gyn onc clinic, spent time in ambulatory clinic helping with pre- and post-natal visits, and watched several births. Labor and delivery is the most emotional setting I’ve worked in so far. There is every kind of emotion, and I admit that watching parents cry joyful tears over seeing their babies for the first time made me a bit sniffly too. I have one more week on ob/gyn, and I am excited to see what it brings.
Quick break between surgeries… Bouffant caps are all the rage.
That was a whirlwind tour of the last couple months. I’ve been pushed and stretched in many ways, and I know there is only more of that to come. Despite the fact that there are good days and bad days, rotations that I like more and rotations that I like less, it is an incredible privilege to be able to learn in this setting. I want to take a moment to thank the patients who allow us to learn. I know that every patient I see has made a conscious choice to let a student see him or her, and I thank them for allowing me to speak to them, examine them, and learn. Hopefully one day, I’ll be able to make them proud.
There we have it. We’re halfway done with the core rotations of third year, and it’s October. For me, it seems like time is moving much too quickly. However, a lot has happened during the past few months. I’ve learned a lot (but definitely still have so much more to learn…), and I’ve started to figure out what I may be interested in doing as a specialty (and if nothing else, I have definitely crossed a thing or two off the list). It turns out that sometimes life is surprising, and sometimes the last thing you thought you’d ever do may be the one thing you can’t stop thinking about. I still have a few months to decide, but I’m definitely experiencing warm fuzzy feelings toward a certain specialty. We’ll see if it ends up being the one I choose.
However, I don’t have to make any decisions today, so for now, I’m going to enjoy the last bits of summer and the beginning of fall. I hope that you do the same. As always, thanks for reading, and until next time, spend some time outside and have some apple cider for me.
This week in doctoring, we talk about breaking bad news. How to tell someone that his or her loved one is dying or is dead. We hear heartbreaking stories from parents of dead children, of organ donors, and of heroes. Their sorrow seems so palpable and fresh despite the years that have passed that we can’t help but listen transfixed, rooted in their stories. On the other hand, we also hear uplifting tales from organ recipients, from doctors who are also patients, and from people whose lives have been saved and irrevocably changed. Never has the line between the finality of death and fragility of life seemed so close.
On a Tuesday afternoon, the ER is packed. Our clinical reasoning elective mentor is busy with getting caught up as he is just starting his shift so we ask the attending signing off if there are any cases that would be good to visit. “There’s a burn patient coming in. You should definitely see that,” she tells us. I watch the bustle of the resuscitation bay of the main ER as paramedics cart the patient in.
I don’t know who he is, how old he is, or even what his name is. But his body is covered in burns. Even watching from afar, I see that his skin is an angry red, sloughing off in chunks. I’m no expert, but it looks bad. “His burn surface area is 45%, which we estimate using a 9 by 9 by 9 rule”, an off-duty attending explains to me. I can’t imagine what that must feel like. I hope he’s not awake I think to myself.
“We found him rolled up in a blanket and he was covered in burns,” the paramedic explains. “There was a bonfire outside. It smelled like kerosene.” The room is crowded with lots of people in multi-colored scrubs. Everyone is talking. Space is limited. Who is in charge I wonder? And even more people come in.
I watch the screens beep as the patient’s HR increases. The resident is intubating the patient to secure the airway. The screen then beeps with alarms and I feel as though time has stopped as the patient’s heart rate drops to asystole. The resident immediately starts chest compressions. It happens so quickly that I barely have time to blink. Someone else (maybe an attending?) switches over to do compressions too. Perhaps it is only then that I realize that death is a possibility. “We need more people to do chest compressions – med students.” All of a sudden, I am no longer just a spectator.
Empty room in the ER
“I have a pulse,” the resident calls out before we can even find gloves, which are difficult to find when you actually need them. I don’t think I’ve ever been as relieved. He’ll be okay, won’t he?
It’s strange I know, but I always think of death occurring elsewhere. The patient with ovarian cancer or the patient with heart failure who is at the end of line treatments. Yes I’ve met them, but they’re alive when I see them you see.
Eventually I imagine I will have to face death and perhaps my own limitations. It is a frightening concept, but a very real and universal part of doctoring – or so I’m told. But, at least not today. I don’t know what his end outcome will be. No doubt his path to recovery will not be easy. Life and death are held in a delicate balance.
Nonetheless, he’s alive. And for that I’m thankful.
*** The details mentioned in this post have been modified to protect patient confidentiality.***
In 1893, Anatomy at Michigan was probably taught like this! Now it’s much more hands on, students work in groups of four with each donor.
Anatomy class is an irreplaceable and unique learning experience during our M1 year; a tangible trip through the human body that allows us to explore and learn without fear of causing harm. Without anatomical donors, we would not have this opportunity. I recently spoke at the Anatomical Donations Memorial Ceremony, an event for the families of those who donate their bodies to our education. I thought Dose of Reality readers might enjoy hearing my thoughts as well! Here are the reflections and gratitude that I shared at the memorial:
“To our donor,
Today we learned about the anatomy of the legs. Those words might sound simple, boring maybe, but I want to thank you because with your help, it was amazing. When I got home, I spent a long time in front of the mirror, running my hands over my own legs, finding the structures that I knew were inside. Here is my femoral artery pulsing. I’ll have to live three more lifetimes until it has pulsed for as long as yours did. Here is my Achilles tendon – I never realized just how thick and strong it is until you showed me yours. Here are the soft bellies of each of my muscles, so smooth and so powerful at the same time.
Donor, for the first time I am grasping the beauty that lies beneath the skin, because you selflessly allowed us to see the beauty beneath yours.
I’m not sure if you’re watching, Donor, what we do in anatomy class, so I’m not sure if you know that I was the one who made the first incision that first day of class. I hope you heard me whisper, “thank you,” and heard my classmates later do the same. And if you are listening, I hope you don’t mind when our concentration strays to talking about our classes or to wondering about the future and the types of doctors we will be one day. Then again, maybe you like hearing about the process you stepped into, and knowing about the people you are helping us to become. Rohit said he might become a surgeon! Me, I want work with the same patients over time; so I think I’ll go into primary care. You’ll probably laugh when we all end up somewhere different than where you heard us plan this semester. Like a good advisor, you’ve helped foster our dreams, confident that whatever we do will be worthy of your help. We won’t let you down.
I wonder about what you did, in your life. You graciously share with us some of the most personal elements of you, but other things are left unsaid. These hands, did they once cradle new life? Your well-worn feet, to what corners of the world did they walk? I held your heart; did it beat strong and nervous in love? You can’t tell us, but just know that we wondered, and appreciated that the answers are important, even if we can’t know.
It is incredible to think, Donor, that you started as one tiny cell. That the one cell multiplied and changed and grew and formed all of you – all the structures we learn from and marvel at, all the things we can’t know. I think about that amazing fact almost every class. At the end of the day, we learn the anatomy and physiology, but I think the most important thing you teach us is just how beautiful and incredible this thing we call life really is, and for that I thank you.”
The first step in addressing health disparities in minority communities is acknowledging they exist, but we can only expect to see significant progress when the physician workforce demographics matches that of the population it serves. We have to increase minority presence in healthcare, but how?
“I’m no art buff, wine connoisseur, or genius; just fortunate, tenacious and a bit lucky.”
There are many barriers that block minority students from pursuing careers in health related fields spurring from lack of resources to the total absence of knowledge on the process of becoming a physician, but in my opinion, two of the biggest minority deterrents are the lack of representation and the social expectations of how a physician should look and act.
To unpack that last statement, many individuals of minority status are intimidated by the expectations that are synonymous with increased socioeconomic mobility of physicians; like the understanding of “highbrow” culture, politics, fine art, exotic cuisine—all of which usually require a certain level of status to interact with. In short, social constructs convince them that they aren’t polished enough for such a career.
I’m no art buff, wine connoisseur, or genius; just fortunate, tenacious and a bit lucky. To present myself as an example that any minority that “tries hard” can become a doctor is deceptive, and undermines the complexity of representation in medicine. And for that very reason I try to use social media to portray the many dynamic attributes that can comprise a future physician. Whether that means taking over the Umich Snapchat account on the behalf of the medical school, or rapping the lyrics to my favorite Curren$y song on Twitter. I want onlookers to realize that choosing a career in medicine shouldn’t depend on where you come from, your dialect, style of dress or customs—but whether or not you are committed and willing to serve mankind to the best of your ability.
So how am I hoping to influence the demographics of medicine? Using my social platform as a method of recruitment, all while challenging the status quo and revealing the new physician.