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Knowledge Across Disciplines

The opioid epidemic. Universal health care. Drug availability. What do all these have in common? They are themes and problems in the current-day communities that I found constantly crossing my mind. The situation at hand is that no matter how much I thought about them, I seemed to always encounter a knowledge gap that “road blocked” my thoughts from advancing. This is due to the fact that today’s problematic situations are multifaceted, with each component requiring the input from experts found in various disciplinary fields. Now, imagine what would happen if you had a team of diverse individuals, spanning across a number of fields including engineering, business, law and various health care professions, all sharing their expertise and experiences to solve these problems. This is one of many approaches at solving multifaceted problems at hand. This is exactly what Launch I.V. seeks to build.

Students discussing the Opioid Epidemic during the Launch I.V. Symposium

Launch I.V., founded by three medical students, is a student initiative that fosters and promotes multidisciplinary collaboration across the University of Michigan. Given that there were only a few groups around the UofM campus that offered opportunities to actively discuss and collaborate with other students outside of the classroom from the fields of medicine, pharmacy, dentistry, social work, engineering, business, social sciences, etc., this became the mission behind Launch I.V. During the first year, we chose to focus our efforts at Munger Graduate Residences because of our mutual goal to foster multidisciplinary collaboration. As a resident of Munger, I live with six other randomly assigned roommates studying biochemistry, aerospace engineering, philosophy, business management, accounting and public health. This provided me with the opportunity to network and build friendships with people I would not normally engage. The other Launch I.V. co-founders and I saw this as a growth opportunity for this community, thus, decided to organize several events over the course of a year to build an initial membership within the building.

One of my favorite activities is the bi-weekly Launch I.V. talks. Every other Saturday, a cluster of students across different fields gather around to discuss important issues over coffee and food. Some of the topics have included rural health care, wearable fitness devices, drug supply delivery, etc. Interestingly, I discovered that it is sometimes impossible to keep the discussion focused on a single topic. People are curious, and students all love to talk about their specific field. This means that sometimes I find myself listening and learning about lithium batteries, the European educational system, and classic movies when the initial topic was something completely unrelated such as obesity prevention.

Through my role and collaboration with the two other co-founders, we were able to organize a multidisciplinary symposium where students, faculty, and industry experts gathered to discuss the opioid epidemic. We designed the event to include a faculty panel, followed by an interactive case study. This was my first experience in organizing an event of this nature, which took a lot of time and effort. However, we partnered with the Munger staff and other groups such as the Interprofessional Health Student Organization (IHSO) under a common goal of promoting multidisciplinary collaboration. After many late nights of planning and countless cups of coffee, we were able to plan, organize, and execute a successful event.

Establishing Launch I.V. has truly been an incredible experience. I am passionate about our mission to foster multidisciplinary collaboration, and hope that others realize how important this is for a successful career.

All The World’s A Stage

“Gregory, remember thy ‘washing blow!”

That’s my cue to steal an apple and power-walk away, before the apple seller catches me by the shoulder and we enthusiastically join the brawl that has just erupted in the marketplace of “fair Verona.” A few scenes later, I’m peaceably circling my dance partner at the masked ball. Stagefighting, dancing and mastering Elizabethan English are some of the many perks that I enjoy as an ensemble member in this year’s “Shakespeare in the Arb” production of “Romeo and Juliet,” not to mention building up my stores of Vitamin D, since throughout May we’ve spent about nine hours a week practicing in the glades of the Arboretum. While I’ve been relishing all these parts of the Shakespeare in the Arb experience, I’ve also come to appreciate one part that I didn’t expect: practicing good scientific communication.

A recent dress rehearsal for this year’s Shakespeare in the Arb.

It’s my third summer in Ann Arbor as a grad student. While my former classmates are now transitioning into their roles as new M4s, taking on more clinical responsibilities but also exploring career interests through elective rotations, I’m finishing up the first year of my PhD in a basic-science-focused breast cancer lab. I’ve met a lot of new friends and colleagues over the past year, and of course in the process have been asked the age-old question: So, what do you do? When explaining my work in the lab, my answers range from “investigating the role of a highly-expressed small GTPase involved in actin cytoskeleton regulation” to “there’s this protein that we think might cause aggressive breast cancers to spread.”

My attempt at finding a swashbuckling look for my Shakespeare in the Arb debut… before our costume director stepped in.

Funnily enough, I’ve found there’s some similarity between explaining cancer biology experiments in layman’s terms and translating “Shakespeare-speech” into a performance that modern day audiences can understand. It’s not enough to rattle off phrases like “whose misadventured piteous overthrows” and “the serial dilution of the Src inhibitor”– my tone of voice, my body language, and the rest of the context I give should help both my audiences grasp my meaning. I find that when sharing something I’ve learned in the lab, stripping what I want to say down to its most basic components and building from there based on my audience’s response is an effective way to get my point across.

As our ensemble prepares for the upcoming performances in June, I’ll continue honing my communication skills in the hope that what I learn in the Arb can be put into practice in my everyday interactions, not only as I currently explain my research, but also in my discussions with future patients. After all, Shakespeare once wrote: “[Find] tongues in trees, books in the running brooks, sermons in stones, and good in everything.” And I intend to find as much as I can.

The Music of Medicine: A Kidney Transplant

This past February, I was lucky enough to pair two of my loves: medicine and economics. As a non-traditional student with a past life in economic consulting, the latter has helped to inform my experience of the former, and one of the more interesting ways that they overlap is when considering the transplant market. Dr. Alvin Roth (an economist!) won the Nobel Prize in 2012 for his work on the kidney transplant market, so when I signed up to shadow a transplant surgery through Wolverines for Life (WFL), I was so excited to learn that I would be observing a laparoscopic donor nephrectomy. WFL is a collaborative effort between the UM community, American Red Cross, Be the Match, Gift of Life Michigan, and Eversight Michigan, all dedicated to saving lives through organ and tissue donation, and they coordinate a program that provides M1s with the opportunity to observe transplant surgeries.

This was the first surgery that I had ever observed, and I truly had no idea what to expect.

Learning to suture on pigs’ feet with the Emergency Medicine Interest Group (with my friend Boone!) was the closest I’d come to the OR before this experience.

I arrived at the OR as aggressively early as one might expect for a first-timer, befriended a nurse in order to figure out the scrubs “vending” machine, and somehow found myself outside of the operating room. I breathed an internal sigh of relief when I was told that I wouldn’t have to scrub in (that seems complicated), and then I followed the resident into the room.

It was truly incredible witnessing the beautiful choreography of a well-oiled operating room as the team prepped the patient. The surgeon requested some happy pop music, which played in the background as he did one final check and then made the first incision.

I don’t have the words to describe what it was like to see inside the human body for the first time. Medicine has a formal vocabulary for it, but the feelings that I was experiencing were much more similar to those that I get while listening to a symphony than to a med school lecture. The left renal vein strumming effortlessly across the midline, the pulse holding the beat as we crescendo’ed towards the kidney, the heart conducting the entire orchestra—everything was breathtakingly in tune with everything else, and I had front-row seats.

And suddenly, the kidney was in the surgeon’s hands. I snapped out of my trance and took a look at it, realizing how different it looked from the kidney of my anatomy donor. Just like Mozart’s Requiem sounds different when played by two separate orchestras, even though each is following the same score, two human bodies bring together the same organ systems to form two unique people. Our patient hopefully knew how much the gift of his kidney would change the life of its recipient, but he probably didn’t know how much it has also shaped mine.

Lessons from Across the Pond: Part 2

Time continues to pass at a surprising rate, and I find myself with yet another term complete. Lent term, what our winter term is called at Cambridge, has come to an end. My courses brought more insight into a variety of topics, ranging from building a business strategy to understanding time-based cost models of, relevantly, hospitals.

The Cambridge MBA Team ready to take on the Kellogg Case Competition

While my Healthcare Strategy concentration doesn’t begin until next term, I was pleased that in several of my classes health care topics seemed to make an appearance. This integration of health care into the business curriculum served as a reminder that health care systems, regardless of our perspective, are indeed businesses. In January, I joined a stellar team of four other Cambridge MBA students to compete in a Healthcare Case Competition in Chicago at the Northwestern Kellogg School of Management, allowing application of our course principles to a real-life health care case (and a school-sponsored trip to Chicago!).

Dr. Sanjay Saint at the THIS Institute launch

In addition to the case competition, I looked for other ways to stay involved in the health care space, and I found myself at the launch of THIS (The Healthcare Improvement Studies) Institute. I joined the celebration of a promising initiative to improve health care research in the NHS, and was pleasantly surprised to find out that one of the speakers was none other than Dr. Sanjay Saint, a clinical leader and M3 lecturer for our internal medicine rotation at Michigan. No matter how far you find yourself in the world, there seems to always be a Michigan Medicine connection to make you feel right at home.

Keeping my priorities in line, I made sure I could come back to Michigan mid-term to be in the 100th Galen’s smoker. After a lovely (and tearful) reunion with my soon-to-be graduating friends, I was back on a plane to start the next part of the term. Half of our term consisted of the Global Consulting Project, an opportunity to work abroad with a team of MBA students on a specific project. In an effort to branch out and expand the repertoire of experiences I gained from this year, I opted to participate in a project in Kuala Lumpur, Malaysia working for a fintech start-up in the cryptocurrency space. In the four weeks I was doing the project, I learned more than I can describe in this short blog, and was able to see what it was like not only to work for a start-up, but also to work in a culture with infrastructure and norms very different than what I am used to in Michigan. The diversity of cultural exposures continued as I concluded this project and traveled to India, to be part of the wedding of one of my classmates in Delhi!

At the Sangeet, ready to dance!

This past term was filled with submersion in new cultural experiences, application of coursework to real-world problems, and of course strengthening of the bonds of friendship with my classmates here in Cambridge. Looking forward to another term, and trying to pretend that this year never has to end!

 

 

An Unexpected Lesson

I’m going to be up front with you and let you know that I am not always on top of checking my email inbox. So, months ago when I was clearing out the dozens of unread messages in my inbox, I saw an email about the Clinical Reasoning Elective (CRE) at Michigan and deleted it without a second thought. Fortunately for me, my friend and classmate does read her emails and texted me to see if it would be something I would be interested in. This course has turned out to be one of the most meaningful experiences I have had during my time here at Michigan.

The Clinical Reasoning Elective (CRE) is an optional course for first year medical students. Students who choose to participate in CRE work one shift a month in either the adult or pediatric emergency room, or on an inpatient floor. My partner and I were placed in the fast-paced adult emergency room, where we have the opportunity to see patients and work with our attending to hone our clinical reasoning skills.

CRE has given me the opportunity to take the skills that I have learned in the classroom and use them in practice, and has taught me so many new skills that I can bring with me onto the wards in a few months. Perhaps more importantly, connecting with patients and being part of the health care team in my preclinical years has helped to keep me motivated through our weekly quizzes and exams. The patients I work with during my CRE shifts always give me a renewed sense of purpose, and I value the time that I spend in the ER as an integral part of my education as a student physician. My time spent during CRE has helped to make me more confident in my skills, more caring for my patients, and more careful about reading my emails.

Where the Sidewalk Ends

There is a place where the sidewalk ends

And before the street begins,

And there the grass grows soft and white,

And there the sun burns crimson bright,

And there the moon-bird rests from his flight

To cool in the peppermint wind.

-Shel Silverstein

Since entering the first clinical year of medical school, I’ve started to think a lot about endings. That is, what it means to have finally arrived at the end of something.

The accelerated curriculum adopted by our school has precipitated all sorts of awkward conversations on the wards about trunks, trees and branches. This is the first time that students have begun clinical training in their second, rather than third, year of medical school, and many attendings and residents still refer to us as M3s. For the first time, I’ve felt like the amount of experience I’ve accrued is not worthy of my title. Answering the question “So what year are you?” has been very conflicting for me. I can see the skepticism take over a patient’s face when I tell them I’m a second year. But it somehow feels worse to say I’m an M3 and have them overestimate my abilities. When we, the students, are brought face-to-face with the incompleteness of our knowledge – which happens often – we are told that time will bring experience. In high school, in college, I knew this to be true. I would wear my class year like a badge of honor: “I’m a senior now. I’ve done my time.” I point to my badge sheepishly now: “I’m a clinical student. But I’m technically an M2.” When does M2 year end for us? When does M3 begin?

Whether you are an M2 or an M3, the clinical years are just as emotionally as they are academically taxing. I have not seen a person die, but I have seen a person dying. I have watched lab values skyrocket and plummet, analytical proxies for the signs of impending death. How exactly do you define when a person has reached the end of their life? A last breath? A final beat of the heart? A silent brain? It’s a philosophical and ethical dilemma for the ages, but what frightens me the most is watching physicians make the final call. They take in the gestalt of a patient and declare that this person is not long for this world. One day, I will be the one leaving a patient’s bedside, slowly shaking my head, calling it the end.

You take on the burdens and concerns of your patients because you love them. But there are also loved ones outside of the hospital that need you, your time, your energy. Life happens outside of the wards. Things come to an end out there, too. I’ve mourned the end of friendships, relationships, the end of my parents’ marriage. Endings that are just as messy and difficult to pinpoint and define.

Soon, I’ll have to accept that as doctors, as adults, we will be the decision-makers in life. No longer are there the neat bookends of a school year to let us know that it’s time to move up and on. No longer can we rely on other people to declare what is so or not so, alive or not alive, dead or not dead. Maybe I hold on to my M2 status because it is something familiar and safe. But I also don’t see much wrong with spending a little more time in this liminal space; at the cusp of professional responsibility; where the sidewalk ends and before the street begins.

A view of Lake Michigan at Sleeping Bear Dunes.