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Learning from My First Patient

The annual University of Michigan anatomical donor memorial service is a time to remember and honor those who have chosen to donate their bodies to science and research after their death, both for families of the donors and University faculty and students. The seat I sat in at the service was an act of random chance; I had filled into Rackham Auditorium with a group of other first-year medical students and was at the end of the line when we shuffled into the chosen row. This left me in the seat next to a family of one of the anatomical donors and a conversation that has changed my experience not only in anatomy but in every interaction I have had with a patient thus far.

When I sat down, all I knew about the woman next to me was that she had lost a loved one and her loved one had been brave enough to donate their own body for the sake of education and research. By the end of the conversation, we had discovered that we had mutual friends and experiences, despite our generational difference. I had also discovered that the family member that had become an anatomical donor was an outgoing, smart, and, above all, kind person who loved their family and were deeply loved by their family in return. They had a lifetime of love, hardships, and memories before they had passed away. And they had decided that they wanted to continue to serve a larger purpose after their life ended. I cried with the woman who told me all of this several times before we parted that night and have thought about this experience often since.

Because of this experience, every time I see the anatomical donor I have been paired with, I think of how much they loved and were loved in return. I think about how they used their body to survive and thrive, to teach and to learn. This reminds me to treat their body with the utmost care and respect as I learn from them. And with every living patient I encounter, it reminds me of how little of their life we see. Outside of the clinic doors, these patients love and are loved in return. By the act of coming to an academic medical center, they donate their time and privacy for the benefit of our learning and we must also treat them with the utmost respect.

The random chance of sitting down next to a woman who was so willing to share the story of her loved one has completely transformed my medical education and deepened the meaning of each interaction I have with a patient, living or not. The patients we encounter in our education have diverse lives and experiences, yet they all choose to be not only patients but also our teachers. With this in mind, we must always treat our first patients, our first teachers with kindness and respect.

The anatomy group that I am lucky enough to learn with (left to right): Samantha Lyons (M1), Kevin McCrawly (M1), Kevin Walsh (M1), and Alyssa Warburton.

A Fiddling Physician

To say that medical training is a big commitment would be an understatement. As an older non-traditional student, the undertaking also meant giving up a life in California that I had already worked to establish, including a prior career and a beloved home and community. Complicating the decision further, in my case, was the fact that I knew I was deciding between time spent playing fiddle and time spent studying. Luckily, I had plenty of time to come to terms with that predicament as I slowly waded through pre-requisite night classes.

I’m in my last year of medical school now, busy preparing for residency interviews in emergency medicine and excited about being a resident soon. I really do love emergency department work. And looking back, it seems like I did get to play some music in medical school after all.

Playing for a dear friend’s wedding on a farm in Pennsylvania. September 2016.

I had gotten some contacts from people back home in California before I came out here. A friend of a friend had a friend who was a mandolin player in Ann Arbor. He kindly invited me to a weekly jam in his garage, and we quickly became fast friends. I got to know and play with his talented circle of musicians.

Playing at Johnny’s Speakeasy, a unique venue in Ann Arbor. October 2016.

There are some nice venues for bluegrass and related genres in the Ann Arbor area. Some spots to check out for this type of music are The Ark, Chelsea Alehouse Brewery, Old Town Tavern, Johnny’s Speakeasy and the Detroit Street Filling Station. There are also a number of traditional music festivals in the summer in Michigan.

As a pre-clinical student, my schedule was laid out for me in advance, so I was able to take some gigs and fit in a little practice time here and there.

A rainy day at Holler Fest with The Emergency Bluegrass System. August 2016.

Double fiddles at the Chelsea Alehouse Brewery with my friend Aaron Jonah Lewis. February 2017. Photo:

M3 clerkships were a different story. We usually got our schedules on the first day of the rotation, so I couldn’t plan on taking any gigs. Nor did I have time to keep up my chops or learn new material. Sleep was a commodity.

M4 year has so far been a mixed bag for music. This year alone, I have spent time in Michigan, Mexico, California, Colorado and Colombia. I have worked in six different hospitals in the last six months. While this travel schedule has certainly made for limited playing opportunities in many ways, I was able to spend two of those months working on a multidisciplinary project of my own, supported by University of Michigan Medical School’s Medical Humanities Path of Excellence.

Together with a talented collaborator I recruited from the U-M School of Music, Theatre & Dance Performance Arts Technology program, we designed and built a brain-computer interface and biofeedback tool using an open-source electroencephalogram (EEG), incorporating real-time digital signal processing of EEG data into electronic and improvised music in live performances. Basically, that means I get to play the violin and DJ with my brain at the same time. Combining my background in music performance and engineering with medical school neuroscience and access to U-M’s diverse resources allowed me to make this concept a reality. We named our act Brain Command.

Beta test of the brain-computer interface at the Kerrytown Concert House. December 2016.

Brain Command at a house concert in Ann Arbor. March 2018. Photo: Aisling Zhao

While I am committed to prioritizing my residency training over playing music, it would be lying to say that it is not a little hard to see my friends getting to play gigs that I am no longer available for, or that I might not be able to hack right now. I guess I just focus on making peace with the idea that maybe I can’t do everything I want to do all at the same time. I have been blessed to get to play as much as I have in the past and will be happy to get back to it when I am finished with my medical training, as a full-fledged fiddling physician.

A Month of Wilderness Medicine

From the moment I started medical school at Michigan, I had been looking forward to September of my M4 year, and not for the reason that might come to mind first – residency applications – but for the Wilderness Medicine elective. Spending a month mostly outdoors learning how to care for injured hikers, climbers and kayakers as well as a week backpacking at Isle Royale National Park seemed too good to be true. Then I heard about the caving. I had found the catch. I’m rather claustrophobic and there was no fiber of my being that wanted to go into a cave. The allure of backpacking on Isle Royale, however, won out and that’s how I found myself in a cave outside of Bloomington, Indiana.

One of the stunning views from our trip Isle Royale National Park that never grew old. Photo credit – Owen Brown, M4.

The caving trip was the last in a series of adventures of the Wilderness Medicine rotation. The first adventure was a drive to Copper Harbor, Michigan, population 108, on the tip of the Keweenaw peninsula followed by a 3.5-hour ferry to Isle Royale National Park, the least visited National Park. On Isle Royale we backpacked for five days along rugged, rocky coastline and across the central ridge of the island. In the evenings, after a dip in the frigidly refreshing Lake Superior, we had peer teaching on different wilderness medicine and survival concepts including foraging, emergency shelters and animal trapping. Upon our return to Ann Arbor, we kayaked and practiced drowning rescues, went rock climbing, and participated in the Midwest MedWar – a trail race with medical obstacles and orienteering. Suddenly three weeks had passed, which meant it was time for our our last adventure – caving.

We arrived at Buckner cave, outside of Bloomington, in the heart of cave country midday on the last Monday of the rotation. Once we got geared up and packed – helmet, headlamp, backup flashlight, backup candle, knee pads, snack – we entered the cave led by several members of the National Cave Rescue Commission. We spent five hours exploring the cave starting with about a ten-foot army crawl followed by hands and knees crawling that gradually progressed to crouching and then to standing. Our path – the Circle Route – consisted of narrow passages that opened into rooms where our group of just under 20 could sit comfortably and learn about various medical scenarios that occur in caves from strains and sprains to pelvic fractures to heart attacks to hypothermia – many similar injuries and medical conditions one would expect to see in the hospital just with fewer resources and tighter quarters. My favorite session was practicing with the Palmer furnace – a surprisingly effective hypothermia prevention technique that involves a candle and a garbage bag. Within minutes, I was nice and toasty in the 55 degree cave.

After a night tent camping in the field next to the cave, we spent an hour learning about how to actually extract an injured or sick caver using two different types of litters. Then we tested our knowledge by actually coordinating a mock rescue ourselves. Surprisingly the rescue was less about medical knowledge and more about communication, teamwork, problem solving and preventing hypothermia. After several hours, our group of 16 successfully got our “patient” out of the cave! Much to my surprise, I actually really enjoyed the cave rescue scenario. By focusing on the problem and what needed to happen to get the team out of the cave, I forgot about my claustrophobia.

Cave rescue in action. Photo Credit: Phil Azouz, M4.

Starting a Student Org to Solve Medical Problems

When I first started college at the University of Michigan, I had never expected to get involved in entrepreneurship, let alone lead and advise other students in their ventures. Yet here I am, seven years later, one of the founding presidents of Sling Health. Over the past two years of my time in medical school, as part of Sling Health, I’ve helped students from across the university form and develop multidisciplinary teams to address health care problems with innovation and entrepreneurship!

Here is a part of our executive board this year (from left to right): Ayush Arora, Allison Powell, (M2), Mario Russo, and Emily Dixon. Not pictured: Sudharsan Srinivasan (M1), Abhinav Appukutty (M2), and Phillip Yang (M1)

But how did I even get into entrepreneurship?

Oddly, almost overnight. During my senior year studying biomedical engineering at Michigan, I created an alternative communication device for people with ALS with another biomedical engineer. We didn’t want to leave it in the classroom, so I found myself plowing full speed ahead with the venture to hopefully get it to the people who needed it.

Leap ahead to getting into medical school. When I was looking at schools to apply, I had a driving biomedical engineering/design emphasis. Beyond just the medical school itself, would I be able to still pursue my interest in the collaboration of biomedical engineering and medicine?

Through my previous experience in entrepreneurship, I got connected with medical students looking into founding a chapter of Sling Health on campus. Sling Health is a student-run organization that brings together graduate and undergraduate students from multiple disciplines including medicine, engineering, law and business to collaborate and address medical problems. We created an incubator to support team formation, development and acceleration into health care solutions.

The University of Michigan as a whole was the perfect fit for Sling Health. Our task was to unite students with different perspectives but similar passions.

With extraordinary support from the University of Michigan Medical School, the Zell Lurie Institute, the AAMC, and our national Sling Health chapter in St. Louis, we were able to found our chapter and hit the ground running.

We are now in our third year as a Sling Health chapter, coming full circle to our first event of the year, Problem Day! During the last month, we had interested members apply, including team leaders interested in leading a project. Our team leaders, equipped with a couple of clinical problems they are interested in solving, pitched ideas to members. Members then mixed in with the leads, discussing backgrounds that align with one another to find a project they fit with.

Teams forming at Problem Day this year

Looking forward, teams will present their progress at a series of Design Reviews throughout the upcoming year and receive feedback from professors across campus. The faculty are extremely influential in ensuring student success both in and out of the classroom, and many of them take time from their weekends to guide our teams!

Our experiences both define and guide us towards where we want to be. I could not be happier with seeing teams learn, sometimes struggle, but flourish. I had many people who helped guide me through this process when I first started, and getting to be a guide and mentor for others has been such an incredible part of my first two years at the medical school.

Seven years ago, I never would have imagined I would be here today helping push the needle on medical innovation. As I start my clinical rotations, I look forward to seeing Sling Health grow and continue to have a positive impact on the medical entrepreneurship community at Michigan!

Dust or Bust: If Medicine Doesn’t Work, There’s Always Graphic Design

June 2018

“Kris-Ti-An, what’s this JerkXJollof thing you do? I see fancy pictures of you guys and cool graphics; do you think you can make Twitter graphics of professors presenting at my D.U.S.T. symposium in August? If so, this will be your first job in our lab!” said Dr. Ghani.

And like that, I had made it to the big leagues. This was my first job as a newly minted researcher and student in the Master of Science in Clinical Research program. Not quite what I expected when I joined the team but hey, we all having a starting point! I could tell my future as the lab’s go-to graphic designer depended on this, so I worked tirelessly to produce a product even Donald Trump couldn’t refute as fake news. Now you may be wondering, like I at the time, what is D.U.S.T. and how does it relate to Urology?

D.U.S.T. (Developments in Ureteroscopic Stone Treatment) is an annual endourology symposium led by Michigan Medicine faculty Dr. Khurshid Ghani (director) and Dr. William Roberts (co-director). Each year at D.U.S.T., world renowned urologists are invited to give talks and demonstrations on the latest techniques in the field. What started four years ago in Ann Arbor as a small meeting composed mostly of residents has now expanded to a robust symposium nestled in the heart of Chicago attracting community urologists and major academic players alike.

August 16, 2018

The day had come at last. As I sat through grand rounds listening to Dr. Mahesh Desai, who had flown from India to present at the symposium, speckles of dust twinkled in my head. While I knew very little about percutaneous nephrolithotomy, Dr. Desai’s pride and joy, I knew that in a few hours I would be on my way to the beautiful city of Chicago for a well-needed change of scenery where my Twitter artwork would be on display for the masses. Like I said, the big leagues! After grand rounds had finished, my lab mate Ali Aldouhki and I heard a familiar British accent call out to us saying, “Kris-Ti-An, Ahh-Lee—you boys ready?” This was the beginning of a tiring but very rewarding weekend.

Ali and I assist Dr. Matthew Bultitude with his presentation during conference registration.

I had volunteered to drive Ali to Chicago, which hadn’t seemed like a problem until I remembered something very important: I’m addicted to trap (a subset genre of rap) music. While Ali was a cool guy, most of time we had ever spent together involved shooting lasers at fake kidney stones (aka our research) and there was definitely no music involved. But crossing cultural boundaries is sorta my thing, so I figured it would be okay. We jammed out to Lil Baby, Travis Scott, Gucci Mane and a smidgen of Drake before I handed him the aux cord. After some relaxing traditional Arabic music, we switched it up and bumped some original rap straight from his home Saudi Arabia. The trip was off to a lit start.

Dr. Khurshid Ghani greets guests at the opening reception of D.U.S.T. 2018.

After arriving, I was introduced the conference coordinator Christina who I had been anonymously chatting with for two months. We hit it off by bonding over the Dr. Ghani quirks that you only understand after rehashing a graphic design for him 100 times until it’s perfect. I knew at that moment if the conference was anything reminiscent of that process, I was in for quite the show. As we walked around setting up I was blown away by the quality of the signs, brochures, visual media and overall aesthetic Christina had created for the conference. To top it off, the graphics that I had toiled over were displayed as brilliant 3’x5’ posters adorning the entrances. Mama, I made. My expectations for a beautiful weekend were confirmed that evening at the opening guest reception. As I stood sipping Pinot Grigio and nodding at the sunset from the rooftop terrace overlooking the Chicago River, I knew the hustle was worth it.

Rooftop terrace views at the Loews Hotel.


Dr. Manoj Monga takes visual puns to a new level.

The opening of the conference began with Dr. Ghani standing on stage in front of a roaring, introduction video, similar to how Steve Jobs would introduce an Apple event. And like an Apple product, this conference was sleek, flashy, and wrapped in an intelligent design. While Ali and I ran the mics, cued up presentations, and ran the Twitter wall, participants witnessed a seamless Broadway level production on the latest opinions in endourology. Talks were bursting with cutting edge techniques from world class faculty, an industry sponsored skills lab demoed the latest in laser technology, all while the Loews’s hotel staff supplied a constant assortment of grade A food and beverages. And while I’m sure the participants enjoyed the all the educational aspects of the conference, they had no choice but to be inundated with laughter after Dr. Ghani’s colleagues managed to sneak in a few Photoshopped pictures of him in various costumes in their final talks.

At the end of the tiring weekend Dr. Ghani asked, “Well Kris-Ti-An, what did you think?” While, I admitted the conference was an amazing success because of the brilliant minds that worked diligently to make it so… HONESTLY, I couldn’t help but to think: Would D.U.S.T. have been a Bust without my Twitter graphics?

Graphic displaying Twitter handles of speakers at 2018 D.U.S.T. Symposium.

Lessons from Across the Pond: Part 3, the Finale

St. John’s Mayball

“Three suitcases just won’t work” I whispered to myself in defeat as I (unsuccessfully) tried to force my gown into an overly-packed bag. This past year living in the UK has given me many things, complicating my attempts at packing to return to Ann Arbor. I collected art from a variety of countries I had the privilege of visiting. I now own my very own Harry Potter-esque gown. What is my favorite of the things I’ve gained from my year living abroad, you may ask? The memories. The year was filled with once-in-a-lifetime experiences, ranging from discussions with experienced astronauts to over-the-top Mayballs (extravagant formal events hosted by the colleges in June as an end-of-the-year celebration). It was with tearful eyes and a full heart that I said goodbye to my home-away-from-home, Cambridge, and to my new cohort of lifelong friends.


A beautiful Cambridge sunset.

Similar to my previous semesters, I added to my newfound understanding of business with continued coursework. This time, my personal experience became relevant as I began the health care electives. How impactful is management in medicine? How is value-based care successfully implemented? How do we organize and capitalize on the mounds of data we are now collecting through technological advancements and electronic records? These are the questions I sought to answer as I engaged in “Health Care Coach Nights” and an “Organizing Health Care” course. While I unfortunately did not walk away with the catch-all answer to solving the health care crisis or lowering all insurance premiums, I was able to discuss these pressing issues with leaders in the field, and expand on the minimal understanding I was able to gain in medical school. This was followed by working with KPMG in a south England NHS hospital emergency department, tackling ongoing issues negatively impacting care delivery. I was able to lead my own quality improvement project and gain a Lean Six Sigma Green Belt (who said nerds can’t get belts?!). I am looking forward to taking the tools I’ve gained during this year and translating them to dissecting these critical issues, to better understand, and ultimately improve, health care as we know it.


My volleyball team at MBAT after a victory! (prior to my injury)

There’s no learning that surpasses first-hand experiences. While in France for the annual MBA Tournament, a sports competition amongst MBA students from across the globe, I was able to experience emergent care abroad. A volleyball incident led to a facial laceration (don’t ask how…) landing me in a hospital in Versailles, France. Being in a foreign country emergency room, unable to fully communicate with a provider and unfamiliar with the reimbursement system, left me concerned and uncomfortable. While this was a new experience for me, so many of the patients I have seen and will see moving forward in my career are experiencing just that feeling. Given how minor my injury was, saying I can fully understand how these patients feel would be a stretch, but I most certainly gained a level of empathy that I hadn’t reached before.

As I return to medical school, I eagerly anticipate joining the Class of 2019, and attempting to re-learn all of the medical facts I once regurgitated in my sleep (azithromycin is what class of antibiotics again?) and prepare myself for the next part of this journey. Though my days ahead are sure to be filled with long days, late nights, and countless call shifts, I will be sure to follow the future leaders that I got to know so well during this year. Congratulations to the Cambridge Judge Business School 2017-2018 class – until next time!


My class at the end of the year summer soiree.