About a month ago, I attended a lunchtime lecture in which the speaker mentioned that a study found the majority of physicians believe their profession is a “calling.” While this figure didn’t entirely surprise me, it was strange that such a significant number of physicians would attach themselves to as loaded a word as calling. What exactly does a calling look like in the 21st century? It certainly retains a sense of the sacred or extraordinary. TV shows, both fictional and real, have explored or leaned heavily upon medicine as something called to. William Osler, the seminal guy doctors quote to other doctors, refers to medicine as a calling. So does Paul Kalanithi, a neurosurgeon who was diagnosed with terminal cancer before even finishing his training.
As a future doctor, I wonder what exactly the substance of my own calling is. For many, perhaps, the personal statement is a good place to start. In fewer than 5,300 characters, we were asked to summarize and produce our own journey to medicine. The admissions process is rigorous and the application extensive. Many callings must be, in so many characters, recorded there. Unfortunately, my personal statement reads more like a disguised tribute to JD and Turk, two lovable TV characters that probably have more to do with this whole thing than I’d like to admit.
Medical school certainly feels like a place to mature into a calling. It begins with the ritualized putting-on of the white coat and ends with a 2,500-year-old Greek oath. And the education of a medical student is extraordinary in the literal sense of the word. One day of our Doctoring Course is devoted to breaking bad news. We spend hours in the Anatomy lab with men and women who have passed away and yet are teaching us. We learn how to use touch as a tool — for example, an afternoon class devoted to inspection, palpation and auscultation.
During a post-summer storm run on the west side of Ann Arbor
A calling seems to entail a lifestyle. Medicine certainly seems to. Long hours, scrubs or a white coat, and nights on-call all make a doctor. Are the sacrifices that medicine asks – of your time, attention, and years of training – the substance of a calling? Is a calling a justification for nights spent working and events missed? I think Osler would disagree. In regards to a calling, he says that the heart is exercised as much as the head. A profession that asks so much of us – whether weekend call or your heart – may not be something simply put aside each day after work.
I’m two months into medical school and really don’t know anything about a calling. We’ve begun studying the cardiovascular system and I really enjoy it – I finally see how the things I learn could be used as a doc. I look forward to volunteering at the Student-Run Free Clinic because I want to listen to a heart or take a blood pressure that’s not my classmate’s. I am excited for clinical rotations next year because I can finally apply some of the knowledge I’ve learned to people outside of myself. There’s nothing mystical in these things.
However, I have so much to experience in medical school, residency and beyond. I haven’t yet delivered a baby or placed a central line. I haven’t yet broken bad news to a family or prescribed medication. I haven’t yet made a mistake that could affect someone’s well-being. Maybe a physician’s calling isn’t some artifact of the admissions process or a quote by Osler, but rather a dynamic, uncomplicated thing – work that is challenging and rewarding. This is not unique to medicine at all, but something I’m looking forward to finding.
My research year is absolutely flying by. I’ve accomplished so many things already: submitted two abstracts to a symposium and helped get a case study published, made major progress on my primary project using cerebrospinal fluid (details to come), learned how to do two different (rodent) surgical procedures and started work on developing a protocol for a third, and found (legit!) reasons to purchase an obscene number of scientific kits. I’ve also been having a positively fabulous time with my darling labmates – who loooooove being referred to as “darling,” I assure you – who are all pre-meds and seem to be convinced that I know things! I do my best to not prove them wrong. I mostly succeed. There have definitely been some bad days where science attacks with a vengeance and everything is the worst, but the vast majority of my experience has been awesome accompanied by awesome with a side of awesome.
Michigan Medicine team at RunTough for ChadTough event, including myself and aforementioned darlings in the center.
The primary project I’m working on that is truly “my baby” is the use of digital droplet PCR, or “fancy pants PCR” as I like to think of it, to detect cell-free tumor DNA in the cerebrospinal fluid (CSF). The idea is to be able to use something as simple as a lumbar puncture to characterize a brain tumor without having to do a biopsy (which, in the brain, is somewhat less than ideal.) Additionally, we’re hoping we can use this method to monitor response of brain tumors to treatment with serial lumbar punctures in addition to the usual serial imaging. We’re still in the way-early stages, but have successfully detected tumor DNA in CSF, woohoo! I’ve also learned how to design PCR assays myself, which is pretty sweet. There have been lots of roadblocks that we’re still working to overcome (free-floating tumor DNA is not exactly spewing forth like a fountain; the stuff is rare), but we’re definitely making our way forward.
I realize this still isn’t quite the most appealing thing you could imagine, but when the alternative is literal brain surgery…
I’m also helping out with our lab’s efforts to generate a mouse model of DIPG, a rare pediatric brain tumor that has a downright depressing prognosis. We’ve recently been successful in generating tumors in the correct region of the brain, the pons, but not with an ideal cell line (doesn’t very closely resemble the genetics of actual human DIPG.) We’re getting there! I had a teeny tiny bit of exposure to rodent surgery as an undergrad, but it’s wild to do these procedures now that I’ve been in on real-deal human surgery. Let’s just say I’ve become mildly spoiled from my prior experiences.
No gelfoam for hemostasis? UNACCEPTABLE.
In addition to my work in the lab, there have been multiple neurosurgery faculty members who have been kind enough to have me join them in clinic on a regular basis. It’s wonderful to not be totally removed from the clinical environment and to continue expanding my knowledge of the field I will be joining. I also regularly attend our brain tumor board on Friday mornings which is the ultimate nerdy good time. Faculty members from neuro-oncology, neurosurgery, radiation oncology, neuroradiology, and neuropathology (and I’m undoubtedly forgetting someone) all meet together to discuss the best path forward for patients with CNS tumors. I’ve already noticed fewer things going over my head (though there are certainly still plenty) than at the beginning of the year when I first started attending weekly. It’s amazing how you start picking up lingo just by hearing it frequently.
In summary, my only complaint is that the year is going by too quickly – AHHHHH!
As a clinical student, sometimes the days are long but the weeks and months seem to just zip by. It is hard to believe that it is already fall, and harder still because we had a 80-degree day here in Ann Arbor. (I can’t promise those always in October.)
Our AAP prescription to #PutKids1st
The past six weeks I’ve been on my surgery rotation, which was probably the toughest all year in terms of the hours. Despite the challenge of the rotation, I still made time to travel to Chicago with my research mentor for the American Academy of Pediatrics (AAP) National Conference! We gave an oral presentation on how often the AAP recommended newborn discharge criteria are followed at our children’s hospital. It was exciting to share our work with a national audience and hear their feedback and hear how newborn care is handled at their institutions. This was a project that I started through the Summer Biomedical Research Program (SBRP) and have continued through the clinical year. Working on research now happens in bits of borrowed time on rotations, and often gets pushed through when it’s time to meet a deadline.
Before surgery, I had completed ob-gyn, psychiatry, pediatrics and internal medicine. It has been very rewarding this year to feel my knowledge building upon itself. Even when it seems like disciplines would have little in common, I’ve been surprised how much some information is reinforced with each rotation. Learning from my patients — really trying to understand each of their medical conditions, medications and individual histories — has been much more gratifying than spending time with books and slides.
The beautiful beach in Saugatuck, MI
Taking time for breaks and wellness has been essential to thriving this year. A particularly memorable break was spending 24 hours on the west coast of Michigan in Saugatuck with my college roommate and her family! Even just that day gave me enough of a breather to reset and come back with renewed energy after a tough couple of weeks on inpatient pediatrics. Looking forward to finding more ways to recharge with our Step 1 study period coming up!
On Saturday, September 30, we helped organize and participated in the annual health fair put on by the United Asian American Medical Student Association (UAAMSA) for the medically underserved Asian-American population of southeast Michigan. For over 14 years, this population of patients has gathered at the medical school to receive screening tests, flu shots, physician consultations, and other services. This event is entirely run by the medical students in UAAMSA, and it is one of the most rewarding volunteering experiences that we have engaged in during medical school so far.
Leading up to this year’s health fair, we helped to recruit medical students, physicians, and undergraduate volunteers, while other members of UAAMSA gathered screening equipments, translated health forms, and advertised at local Asian restaurants, churches, and grocery stores. On the day of the fair, participants registered and went through a series of stations set up in the Taubman Health Sciences Library. Some of the screening stations included blood glucose, cholesterol, and bone density, and there were information booths about medications, dental health, and health insurance. If the participants had an abnormal screening result or a specific health concern, they could consult with a physician volunteer at the fair.
There are many challenges to the successful care of Asian-American patients, and one of the reasons we both became involved in UAAMSA was to help address these issues. There is a general lack of data on Asian-American health, and in the few epidemiologic studies available, the dozens of distinct and diverse ethnicities are usually grouped together. Asian-Americans also encounter barriers to receiving quality care, such as language proficiency and cultural orientation. To combat these issues, we collected patient demographics and health outcomes data at the health fair in order to better understand the population we were serving, and we also helped to interpret for the participants who did not speak English.
Our passion for the health fair also stems from having seen these challenges in the interactions between medical professionals and our parents, family members, and close acquaintances. We often try to be there for our family members at doctor’s appointments to facilitate communication and to make the interactions smoother, but this is not always possible with a busy medical school schedule far away from home. This UAAMSA health fair gave us the opportunity to do that by allowing us to engage with the local Asian-American community here at Michigan and to help them understand and receive basic health care screens.
A new initiative for UAAMSA this year was to focus on patient education during the health fair. This was spurred by the fact that many past participants did not have a regular doctor, and some discovered health problems at the fair that they did not understand and would not have known about otherwise. We took special care to explain each condition we screened for so that participants were educated about ways to prevent and manage certain diseases. While we had a lot of fun meeting and interacting with members of the local Asian-American community, it was also very rewarding to provide them short-term care through screening and patient education. We are already looking forward to next year’s health fair!
Intramural sports have been a big part of my time at Michigan. In the fall of my sophomore year as an undergrad here, I joined the IM soccer team of a friend whom I had met at my summer job. Now, I hadn’t played organized soccer since I was 10 years old, but that didn’t stop me from joining the team and bringing several of my friends with me. I quickly found that my primary contribution to a soccer team was that I could get in the way of people trying to score on my team, and so my career as a soccer defenseman was born.
M1 Fall 2015 IM Champions
The team we had joined was pretty good that year, and we made a wholehearted run at the division championship. Intramural sports are broken down into different leagues based on gender, including a co-rec league, plus extra leagues for fraternities and for graduate students. But no matter what your league or division, the goal at the end of the season is to win The Shirt (The Shirt The Shirt). Instead of handing out some trophy that would just gather dust on your shelf, the intramurals program here allows you to literally cloak yourself in glory by awarding a championship t-shirt to the Victors. And when you go to undergrad at Michigan and see people wearing The Shirt around, it’s hard not to want one for yourself.
In my time here (now six years that have absolutely flown by), I’ve been fortunate enough to win four of said shirt, two in each soccer and broomball. And if you’re not familiar with broomball, you should probably look it up, it’s very entertaining to watch. But those aren’t the only two sports I’ve played. I’ve played everything from flag football to innertube water polo (also a very entertaining sport to watch). I’ve by and large been the captain of these teams, because there needs to be an organizer who sets up the team, ensures that all of the players are registered, and generally makes sure everybody knows where and when to show up for games.
When I started medical school here, I didn’t know how much time I would have for fun things when there was studying to be done. I joined or started a couple of teams here and there, and before I knew it, over the course of the first two years of med school, I had played on seven different teams in four different sports. And the best part was, I didn’t find it difficult to balance my school obligations with the games at all. Flex-time quizzing (literally the best thing ever) meant I was able to make time when I wanted to, and take my quizzes when I felt good and ready.
The med school here has done a great job supporting these sorts of endeavors outside of the curriculum. When I enrolled here, I was pleasantly surprised to find that they offered partial reimbursements for the costs of joining an IM team. This was something I took full advantage of during my preclinical years, and then, just as I was about to begin my M3 clinical rotations, I had the opportunity to succeed the graduating IM Sports Coordinator for the medical school. Now, even though I’m roaming the wards and working with patients, I can still help M1s, M2s (and even some M4s), get and stay involved in the intramural sports program that has been such a large part of my time here at Michigan.
I spent this past summer developing an extracurricular course for Spanish-speaking students interested in practicing and improving their medical Spanish. The Advanced Medical Spanish Discussion Course is finally up and running! As I reflect on the process of creating the class (together with fellow M2 and email-acrobat Brooke Weisenberger), I am full of pride and gratitude. Here’s a big thank you to all those who made this class possible.
Two evenings a month, advanced, fluent, and native Spanish speakers meet for an hour and a half to practice Spanish communication and clinical reasoning. Each Advanced Med Spanish class is led by a different faculty member, who acts as patient and teacher. Students interview the “patient” then get feedback from the teacher. This way, we expose students to a variety of medical cases and connect Spanish-speaking students and faculty.
When we started reaching out to faculty back in June to see who’d be interested in facilitating the course, we were met with support and enthusiasm. People were happy to volunteer their time to come facilitate a class. As a result, we get to spend our evenings talking to GI experts about GI disease, nephrologists about (not just one, but both!) kidneys, and Emergency Medicine doctors about… well, pretty much anything.
The patient interview is done entirely in Spanish.
We created this class as part of the Latin American Native American Medical Association (LANAMA) initiatives. I’m on the leadership board for LANAMA, and putting this class together was my passion project. But, as the saying goes, “Nothing good is done alone. Don’t do it alone, get some help. There are people nearby.” Is that how it goes? I’ve never been good at sayings. Thankfully our LANAMA family is very forgiving of verbal gaffes and, as it turns out, instrumental when you’re figuring out how to make a med Spanish class. They are also very generous with their donut budget. ¡Gracias a todos! [Side note on lessons learned in the planning of this course: the nearest Krispy Kreme is a 40-minute drive from Ann Arbor.]
Paths of Excellence
Brooke and I got to work early this spring for a what we envisioned as a informal fall class. Pretty soon into the thinking process we realized – we weren’t really sure where to start.
M2 Jonathan gives an oral presentation in Spanish on our first Advanced Med Spanish Case while M2s Adam Rene (left) and Nick (right) listen on.
Fortunately, we’re both in the Scholarship of Learning and Teaching (SoLT) Path of Excellence, an elective dedicated to mentoring students who are passionate about medical education. I started by meeting with my SoLT faculty advisors and talking through my vision for the class. They connected me with other faculty and resources, and we were off!
This class is not for credit. It’s simply a collection of medical students who want to improve their medical Spanish and clinical reasoning skills. So we were blown away when 37 students, M1s through M4s, signed up. As the co-director, I’m happy to discover that there’s so much interest in the class. As a Latina medical student who believes it’s incredibly important that we have doctors who can speak their patients’ languages, I’m moved.
Now we’re one class in with six more to go! I’m excited to see how the rest of the semester unfolds. Hasta pronto.