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Reflections from an “M8”

Eight years is a long time. Eight years ago, 2018 sounded like a mythical year, the one where I would graduate with both my MD and PhD. Eight years ago, I never thought the day would arrive where I would Match and find out where I would continue my training in residency.

Learning some very “real life” skills in the casting lab.

Well, all of those “mythical” things will happen in the next few months! At times, it has felt like an arduous journey. However, it doesn’t feel like that long ago when I was spending hours in the anatomy lab, studying for Step 1, peering through the microscope learning how the small intestine develops, and then starting clinical clerkships after four years outside of the hospital. As I now look forward to the next big step, I have had time to reflect on how being at Michigan has helped me along this sometimes-winding path.

Couldn’t have made it through my PhD years without my awesome mentor, Dr. Gumucio!

Four years of work … condensed into one PowerPoint!

I still remember that first day in Ann Arbor when I met my future classmates. From my interview day, I felt that Michigan was a community where I could not only learn the academics behind medicine and conduct world-class research, but also feel supported amongst a community of peers, faculty and administration. Even now, when many of my friends with whom I started med school are across the country finishing residency, I continue to keep in touch with them and consider them among my closest friends and confidantes.

As I’ve grown and developed professionally, I have had innumerable mentors, formal and informal, who have helped me navigate the intricacies of conducting research, writing a thesis, and now planning to pursue a career in Internal Medicine-Pediatrics (which I didn’t even know existed as a specialty eight years ago!). The support here has been second to none, and as I’ve traveled nationally to look at residency programs, I have sought out that unique personal and professional support.

Thinking back to these last few months on the residency interview trail, it was for sure one of the most exhausting experiences of my life: traveling around the country (literally, coast to coast), being confused about what time zone I was in, and making sure I had my suit and tie freshly prepared each day. Still, it was truly a once-in-a-lifetime ride. When else will I see amazing academic medical centers and experience so many new cities in such a short time, with protected “vacation” time from other obligations? However, I felt that my support at Michigan prepared me for the process, and I had a ton of fun! Now that it’s over, after meeting my colleagues pursing Internal Medicine-Pediatrics, “my people” as I affectionately call them, I truly can’t wait to start training in July.

The interview trail wasn’t all suits and hospitals, I got to explore the country, too! Like hiking in the foothills outside Denver!

Eight years. Eight long years have led up to this moment, this time in my life where I’ll finally no longer call myself a “student.” So many people have been integral to keeping me motivated to remain energized when the end seemed so far off, whether it be through food (I’m Italian, I never say no to pasta), mentorship or diversion. I know that I have been shaped personally and professionally by my time in Ann Arbor. Wherever I go, I know I’ll be a proud Wolverine. Where I go, I will Go Blue!

Changing Medical Student Wellbeing – A Peer Support Initiative

While taking a year off of medical school for depression and anxiety, I decided to start a peer support group, something I had wished was available to me during my struggles. I had been supported by faculty and staff immensely during my first semester of medical school but felt so isolated from other students. I thought I was the only one struggling so much to make it through the pre-clinical curriculum. I attributed so many of my feelings to “medical school is just hard.” Later, I learned that although medical school is challenging, it becomes nearly impossible when you’re struggling with mental health issues.

Through the support of my counselor, M-Home director, and others in the Office of Medical Student Education, I started putting together peer support meetings. At the onset, my only goal was to open up the discussion about the emotional hardships and growth that occurs during medical school. We learn so many important things in medical school, but rarely do we have time in our busy schedules to sit back and personally reflect.

I was greeted by overwhelming support from my classmates after I disclosed my mental health struggles. Everyone I talked to about my depression and anxiety was candid in their responses. I started having open, honest conversations with my peers about mental health struggles they or someone they knew had experienced. Being transparent with my peers allowed them to open up as well. I was unveiling this thin disguise that many medical students wear: portraying themselves, intentionally or not, as being perfectly fine.

After doing many literature searches, talking to staff and faculty in the medical school, and others in the community, I have become determined to change the culture in medical schools around mental health struggles. You would think that of all places, medical schools would be the one place that mental health issues are readily talked about. I participated in a project spearheaded by my classmate and friend Rahael that shows this is not the case, and much more needs to be done to remove the stigma of speaking out. Unfortunately Michigan is not alone, and not the worst offender, in medical student mental health interventions.

As the peer support group and advocacy program grows, I challenge the faculty, staff, resident, fellows and attending physicians in our school and hospital to demand better mental and physical wellbeing initiatives for medical care providers. If we can get those at the top of the health care pyramid to require wellness initiatives for all medical care providers, I believe that we can change the culture around mental health struggles, and start to tackle the high rates of physician, and student physician (medical student) burnout, depression, anxiety and suicide.

As a quote from one of my favorite movies goes,

You see a lot, Doctor. But are you strong enough to point that high-powered perception at yourself? What about it? Why don’t you – why don’t you look at yourself and write down what you see? Or maybe you’re afraid to.” – Clarice Starling, Silence of the Lambs

My Pet Rooster

A rooster, while a bit unusual, is one of the most endearing gifts I have ever received. Uganda was full of surprises: acres of untouched grassland to explore, opportunities for exciting research, and the privilege to learn about a new culture. Never did I imagine I would walk out of the hospital with my first pet rooster.

I had come to Uganda to study the impact of short-term international surgical teams at Lacor Hospital for my global health master’s capstone project. In between my designated work, I decided to shadow Ugandan physicians to expand my clinical exposure. I followed them through the medical wards, aiding in taking patients’ vitals, changing bandages, and escorting patients to get their lab exams. Here I met A.O., a 35-year old farmer with severe kidney disease who was stuck in bed 42 for a month. The necessary drugs to treat his condition were out of stock, and limited staff meant interns with little experience were managing his care.

After 36 days, his condition improved and he was discharged. A few days later, A.O. returned to the hospital with two roosters in hand as a thank you for saving his life, one of which he gave to me. Though I felt that I did not have any meaningful contribution to his recovery, he would not accept my refusals; so I came home that day with Tucker, a beautiful plump rooster and an annoying alarm clock. My first pet rooster was a visual representation of the impact a physician can have on someone’s life as well as a reminder of the sobering reality that it was only chance that separated me from A.O. Access to quality health care was something I did not deserve any more than he did. Tucker was one of many inspirations along my premedical path to pursue a medical education.

My experiences domestically and abroad have played a pivotal role in my motivation to obtain a medical degree. From conducting research in a resource-limited hospital in Gulu, Uganda to working in adolescent sexual/reproductive health policy and implementation in San Francisco, California, I have had the privilege of engaging with the medical field in a variety of different contexts. Having worked in diverse settings not only reinforced my aspirations to become a physician, but it made it important for me to attend a medical school that combined academic rigor with a unique breadth of opportunities to intertwine the realms of medicine and social service; a medical school that would equip me with the tools and vision necessary to marry my passions for global health and medicine, and to become part of a team of impactful health professionals at the local and international level.

As I started the long arduous medical application cycle, I remember being instantaneously drawn to the University of Michigan and their mission statement. They were different. In choosing a medical school, I was looking for more than just learning about the pathophysiology of chronic pancreatitis, the Krebs cycle for the umpteenth time, the anatomy of the left lung, etc. I knew I was going to get the same medical education no matter where I went, but it was Michigan’s investment in their students’ other passions, empowering their students to be the voice of change in health care, believing in their students to make impactful differences in their community, and promoting academic excellence alongside compassionate and inspiring leadership that made Michigan different. At Michigan I knew I would become more than just a knowledgeable physician. I would also have infinite opportunities to grow as a leader and know that I would have the support and encouragement of an entire team to become the well-rounded, cultured, and socially proactive individual I have always imagined myself to be.

I can’t capture in words alone my excitement to see how my medical school journey unfolds in the next four years, but I know that I am incredibly grateful to have the privilege of pursuing my dream for medicine and global health at Michigan—a dream that all started with a rooster from bed 42.

Embroidering Gingerbread

One of my favorite parts of UMMS is the plethora of opportunities to pursue and develop your passions. For example, last year, I was one of several artists who were invited to submit artwork to decorate the new Taubman Health Sciences Library (THSL) student lounge space.

I have always enjoyed a variety of creative pursuits, including graphic design, music, drawing and, more recently, embroidery. At that time, I had finished a tote bag embroidery kit and was looking for my next project. The opportunity to design for THSL came at the perfect time, and I designed and embroidered my project in a matter of weeks.

That project fueled others, starting small with bookmarks, a snowglobe pillow, and then, finally, the embroidery project that consumed the vast majority of my free time since June. Everyone always told me how the residency interview process involved a lot of available time to pursue hobbies, and so I decided to embroider a gingerbread house quilt as a Christmas present. It was the perfect project, in that each block/gingerbread house was portable enough to work on during innumerable flights but could be assembled into something special.

As time went on, I grew increasingly concerned about whether I would finish in time. I had visions of presenting my grandmother with scraps of fabric, a sort of IOU and a promise that the quilt would soon be finished. Thankfully, by working flat out during the month of December, the quilt was finished, on Christmas Eve. Whew, I cut it close.

I love the finished project. It’s even more fun to look at the blocks and say, “this is the block I did on NICU nights” or “this one I did during lunch periods on Dermatology”. For the last several weeks, I’ve been so happy to no longer need to work on the quilt and getting caught up on my reading/other life activities. I’m starting to feel restless again, though, so it may soon be time to start working on my next project. What that will be, I don’t know, but Michigan will give me the time and space to figure it out.

What I learned from watching a tiny vacuum cleaner

In the last two months, I have been to six surgeries. I have felt warm, viscous, blood course over my gloved hand as I held a retractor during a Cesarean section. I have seen the inside of a man’s abdominal cavity as I held a laparoscopic camera. I have watched as boogers were pulled out of a man’s sinus by a tiny vacuum cleaner. And I don’t even want to be a surgeon.

As a social worker, I often encouraged the teens I worked with to step outside their comfort zone in order to learn more about themselves (and I practiced what I preached, like zip lining!). Medical school shouldn’t be any different.

My journey to medicine began in social work school in Chicago. There, I focused on health disparities and working with teenagers, thinking I would spend my career as a community organizer and health educator. And thus, I was shocked when my advisor connected me with a watchdog group conducting citizen oversight of the Illinois prison system for my social work field placement (a residency, of sorts, conducted in your final year of school). “You should try new things,” she said as I left her office that day, deeply disappointed. She was, of course, correct. My time working on prison reform gave me tremendous exposure. Not only did I collaborate with an interdisciplinary team of lawyers, I also learned that I could connect with people very much unlike myself by being open and honest. I learned that changes in bureaucracy happens both at a policy level but also in hundreds of individual decisions by the hundreds of employees carrying it out. I learned to elicit information not from asking questions but by staying silent, and I learned how to cope with moral ambiguity. But in the end, after graduating, I did not go into prison advocacy, or health education for that matter. Because truly, that wasn’t the point. Instead, I took a job running youth leadership training programs at a synagogue. Go figure.

Which brings me to my first time in the operating room. It was by a chance invitation that I found myself standing there at 7:00 a.m. one morning, the patient confirming his identity one last time before being put under anesthesia. I looked around, at the sterile instruments laid out on the table expectantly, at the phalanx of monitors beeping indecipherably, at the resident typing furiously, at the nurses conducting a stream of seemingly endless tasks. I wasn’t just out of my comfort zone, I was out of my league.

As an older student, and a career changer, I feel that I have some sense of my skills and interests. I like building partnerships for change, synthesizing information and prioritizing goals, working with children and teenagers – all of which have been pushing me towards medical, not surgical, disciplines. “Why am I even here,” I asked myself, intimidated by the charge nurse who kept eyeballing me as I tried to blend in with the tiled walls. And yet, slowly at first, but then all of a sudden, I started to become comfortable and fall into the choreography of the surgery.

With the arrival of the attending, I was invited into the small community of health professionals who would, over the course of the next three hours, become a self-contained universe focused on the removal of a tumor growing in the patient’s sinus. I marveled at the surgeons’ knowledge of anatomy, at the technology employed, at the teamwork exhibited, and at the fact that I didn’t contaminate the sterile field. Near the end of the surgery, peering deep down into the patient’s sinus through a pencil sized hole through his gums, I didn’t know what to make of it all. It had been a tremendously exciting morning, not at all what I had expected, but I also didn’t feel like it was my calling.

Again, by chance, five other surgeries followed in two different ORs. While I didn’t seek out these opportunities, I also didn’t say no to them when they appeared. There is something magical and disquieting about being inside of a body, seeing an artery pulsate or a uterus be pulled outside the abdomen. I still do not think I am interested in surgery, too technical and goal oriented, but I am grateful for the chance to be able to have decided this through experience not bias.

Like my time working in prisons, I have learned a tremendous amount from being in an unexpected environment. I learned that hierarchy is not the same as devaluing other’s contributions. That trust is shared not just between surgeon and patient, but also between surgeon and nurse and tech. That honesty about one’s capabilities is respected by the right kind of leader. And that there is such a thing as a very tiny booger vacuum cleaner.

Making Music in Medical School

At Michigan Medical School, we are constantly reminded to carve out time for ourselves to maintain self-wellness in whatever shape or form that may be for each individual. To me, that means playing ultimate frisbee, hanging out with friends, jamming in my car, and taking plentiful power naps. For others it means journaling, creating and performing music, or crafting various mediums of art.

I never thought I could tap into these more artistic forms of wellness until I received an e-mail toward the beginning of my M1 year advertising a beginners’ medical arts piano class. It was a class designed specifically for medical students who had zero or minimal background in playing piano. I lit up upon reading this – it was like the class had been crafted specifically for my tone-deaf, minimal-background-in-middle-school-flute self! The class was sponsored by the School’s Medical Arts Program, which is directed by Dr. Joel Howell. The Medical Arts Program hosts a multitude of events throughout the year, including trips to museums and concerts, dinners with notable composers and artists, and hands-on workshops.

So, each Friday evening for 12 weeks throughout the fall semester, I made the short trip to the School of Music, Theatre & Dance for the group piano lesson. The class was taught by Annie Jeng, a PhD piano student at U of M. The pupils consisted of medical students representing all four classes, and even a GI fellow who made time for the class! Each week we took a few more steps (and leaps) towards learning how to read a grand staff, keep rhythm, and play scales and chords. Annie would also throw in some lessons on the history of the piano and samplings of contemporary composers. At the end of the class, we each picked a solo piece and hosted a mini recital for ourselves. After this beginners’ piano boot camp, I was proudly able to perform a version of Für Elise by Beethoven (with foot pedal, might I add).

This class offered me the opportunity to step away each week for a scheduled one and a half hours from the mayhem that is medical school. At first, I was thankful for the opportunity to immerse myself in a world that seemed so completely distinct from what I was learning in lecture. However, throughout the class we made connections between the medical and musical worlds that made me realize these two realms of my life did not have to be so separate. After each lesson, I felt rejuvenated and ready to tackle the hours of studying ahead of me.

I am still blown away by the dedication of the Medical School and the Medical Arts Program to provide students with means of balancing their academic and extracurricular pursuits, and allowing students to improve ourselves not only as physicians but as human beings throughout our years in medical school.