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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.

What becoming a doctor taught me about being a social worker

Like a number of my peers, I am a career changer. Having started in social work, I shifted course four years ago this month, returning to school to complete the dreaded pre-medical sciences. Social work is an amorphous field, one that both the public and practitioners sometimes struggle to define. After all, it seems like they do everything, from individual therapy to foster care case management to public health education. More and more, physicians are also being tasked with “doing everything.” A growing body of research, for example, has linked adverse childhood experiences and other social determinants of health to poor outcomes over the lifetime. Interdisciplinary practice is clearly the linchpin of addressing these intersections, but the field continues to struggle to understand how.

Piloting a sexual health curriculum in rural Rajasthan, India as a social work student.

As a social worker, I thought a lot about how to create change and how to empower others to be thoughtful, value-informed actors in their communities. The sudden transition to studying the basic sciences was, thus, jarring. Whereas in social work I often worked in the liminal space between the rational and irrational (what makes us act the way we act and think the things we think?), the sciences were somehow both rigidly delineated and also impossibly abstract (see Schrödinger’s cat). To my great surprise, however, I began to think like a scientist over time, applying rigid rules to natural phenomenon. Nobody cared about how the molecules felt, only how its electors were distributed. But then medical school happened. Medicine exists somewhere in between these two, which is why it is often described as both a science and an art. While this maxim was originally used to describe how to treat illness when we only had a partial understanding of its mechanism, it is evermore becoming a way to understand the relationship between the physiologic and the social. For example, physicians today are working to understand both the underlying mechanisms of COPD and why people don’t stop smoking. As physicians, we are taught to understand the body rationally: X process leads to Y disease. But the waters become muddied when we factor in human behavior: Why would someone smoke when they know the harms to be so great?

In my previous career I often struggled to describe what I knew how to do. As I’ve embarked on a new process of professional acculturation, however, I’ve begun to realize that my previous training gave me a way of thinking systemically, evaluating how individual experiences relate to the larger sociopolitical processes that shape everyday experiences. This, for instance, can help us understand how an individual opiate addition relates to prescribing patterns, the legal system, economic markets, and public health infrastructure. With my growing knowledge of medicine, however, I’ve been better able to understand the biophysiological processes that underlie both pain and addiction, creating a much richer understanding.

As the interaction between society and health becomes even more clear, medicine and medical education is changing. For example, our Doctoring course helps us to both learn how to listen to the heart and to counsel patients on exercise, and the Paths of Excellence give us an outlet to explore fields such as public policy and the humanities. It was in this spirit that I initiated two projects this summer to help us be better advocates for health. In one, I am working with the Center for Experiential Learning and Assessment to develop a self-reflection module paired to clinical simulation. Physicians are given the tremendous privilege of working with patients on some of the most stressful, emotional and personal aspects of their lives. How we process these situations, and learn from them, is an important professional skill if we are to gain comfort navigating these complex situations. In the other project, I am preparing a study to examine sexual violence amongst gay and bisexual men. Given that life experiences can impact the health of our patients in myriad ways, better understanding their context can lead to tools to identify and address these factors.

As summer draws to a close, I am struck by the tremendous intellectual diversity that defines medicine. From basic scientists to clinical investigators to public health researchers to health care economists, all collaborate to give an understanding of what makes us healthy and what makes us sick. No one discipline can do it alone, but also our collaboration is only as effective as our insight into what we bring to the table.

Leading a C.A.M.P. Trip: Mentoring and Reflection

The new Creating Adventurous and Mindful Physicians (CAMP) program at UofM aims to provide an opportunity for incoming M1 students to venture into nature while reflecting on the transition to medical school and their anxieties leading up to Launch week. To lead these students on this journey, several lecture-hardened M2s were tapped due to their experience navigating the new curriculum and willingness to sacrifice the first week of their admittedly short summer vacation. I was one of these lucky guides chosen to embark on this school-sponsored trek into the woods.

From growing up in what was essentially a fancy cornfield with houses in rural Southwest Michigan, to hunting and hiking the wooded areas near Ann Arbor during college, I always found the outdoors to be a sanctum where I could relax and reflect. Nature can be a truly soothing resource to relieve the increased stress of medical school. I wanted to help students recognize the therapeutic aspects of nature and the wealth of natural beauty to be found within 45 minutes of Ann Arbor. Additionally, there was a similar, albeit unofficial, trip when I started which I missed due an unfortunate obsession with the (then optional) pre-work modules, and I needed to redeem that mistake.

My initial fantasy of the trip involved me being the “wise old sage” character to a group of bright eyed youngsters about to embark on an epic journey, think Gandalf and Hobbits. Realizing that was a bit extreme and very unlikely, I accepted that I would simply be there to answer their questions and maybe give them pointers on hiking, nature, surviving Neuro, and finding the best study spots in Taubman.

My experience during the trip was quite different. Yes, I answered plenty of questions, discussed tricks of surviving in the library, and also showed a trick to vaguely identify poison ivy. However, I found myself reflecting on my start last fall, the weight of beginning medical school, nerves about my ability to succeed and perform, and the sheer overwhelming nature of it all. These are the same anxieties and fear I have about starting my clinical years as an M2.

During the discussions on the trail and debrief sessions in the evenings, I found the advice I was giving them – it will be fine, you will find a way, you have the resources for success – was exactly what I needed to hear for my own transition. Members of my group also provided insight and strategies for tackling the transition that I hadn’t thought of or tried. It was an odd yet refreshing look at the nature of transitions and the importance of trusting yourself to adapt and improvise to whatever challenges await. I was not only able to help them remain calm about embarking on their journey, but I also reassured myself about rising to the next level of mine. It was a powerful experience being able to mentor these incoming students while learning far more from them than I ever expected.

Learning Compassion in Patient Care

Be the change you wish to see in the world.

For years, this motto has served as my inspiration towards becoming a physician, and as the first year closes, I cannot help but reflect on all the training I’ve received that has prepared me for clinical rotations this upcoming October.

There it is! Working on my ultrasound skills in the new Clinical Simulation Center during my free time.

At UMMS, we’re given a wealth of opportunities and experiences, one of which is called Interprofessional Clinical Experience (ICE). The purpose of ICE is to expose us to clinics right from the start by giving students the opportunity to shadow every player in a clinical team on a monthly basis. It’s a way of understanding the role of each player and their contributions to the patient’s care. During M1, I learned about efficient patient flow through the emergency department and snuck a peek into clinical radiology. I got to see some cool stuff, like CT-guided abdominal biopsies and sonographic Murphy signs to check for cholecystitis.  Prior to ICE, these were just words on a PowerPoint, but they now manifested into real-life experiences.

As I walked down the hallway with the ultrasound technologist I was shadowing, I was excited to see what my last encounter of the semester had to offer. Entering the room, I saw a seemingly 60-year-old woman, readily lying down for her appointment. The patient was here on a referral to check a potential abscess that had been hanging around for a few years. Gliding the probe over the mass, the technologist produced an image on the screen via transmitted sound waves.  It was a round and defined circle… makes sense. But… it was also a hazy-white color… fluids should be black on an ultrasound machine, I recalled from my ultrasound elective. I whispered my concerns and subsequent justifications – the technologist responded with a simple nod. She quickly switched to the doppler color flow image mode to view blood flow. There it was: blood vessels running through the mass.

My heart started beating faster and my hands clenched as my mind scrambled to find the one word that could change this patient’s life forever: cancer. Discretely excusing ourselves, we went to share our findings with the radiologist.

What next? I was told that she would be sent home, and her primary care physician would call to convey the news. I understood that this responsibility was outside our scope, but my deep concern still precipitated into a pit in my stomach as I had to silently watch her happily return home unbeknownst of a likely diagnosis of metastatic cancer.

Medicine is a difficult field because of the intense strain on both the body and the mind. While we have the privilege to treat and even cure patients, we also have to see them through their darkest hours. I am grateful not only for the opportunities to develop clinical competency, but also for the continuous reminder to always be compassionate. My training continues to prepare me for the day when I will have to break bad news to a patient in a manner not so different from the aforementioned situation. Fortunately, with the guidance and support from Michigan Medicine, I am confident that we can be the change we wish to see in the world.

LEAD: Early Involvement and Lasting Relationships

Not many people would decide to hike Mount Everest for the first time without some support, be it from fellow climbers, guides, resources, or information from others who have gone along the journey already. The Leadership and Enrichment for Academic Diversity (L.E.A.D.) program at Michigan provided a few of us M0s an early start on our journey into medical school. We were exposed to the learning environment while meeting some classmates and building a support system that will help us navigate through the hills and valleys of medical school. We got to see the unique abilities, talents and stories of some of our classmates, all while getting close and building some early skills in the anatomy lab.

The early start put many of us at ease by providing insights into class materials as well as resources that other students in the program may have had coming in. Special lectures from faculty and administration at UMMS about leadership, health care inequalities and mentorship gave us tools to manage obstacles that may come up throughout medical school. We built upon our leadership skills, bolstered our professionalism, and built an understanding about what it means to combat health disparities throughout our careers. We are all inspired by the commitment the Office for Health Equity and Inclusion (OHEI) has towards combating inequity in the health care system.

I would not be where I am at today without the great mentors I have had throughout my life. My mentors have been football coaches, weightlifting coaches, an organic chemistry professor, and many more. L.E.A.D. paired each of us with an M1 who will be our mentor throughout medical school. I know and feel that I can reach out to him at any time with questions, concerns, or just to chat about Michigan football. In tandem with our student mentorship, we received educational mentorship thanks to the Office of Medical Student Education. We learned about the curriculum, study skills and resources, and support available to us as we work toward our medical degrees.

Many of us enjoyed going out with others from the program to get food, drinks, and play some IM soccer. It is nice to know that going into Launch we will all have some familiar faces and connections to other members of our class. We are all very grateful for the great program that the Office of Admissions and Office for Health Equity and Inclusion worked hard to put together. We look forward to paying it back throughout our years here. Thank you for reading and as always, Go Blue!