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On Making an Impact

You know those days that you spend forever planning, and then they’re over before you know it?? I had one of those this past Saturday. Here’s the story.

I’ve spent the past seven months on leave from class doing research with the Michigan Opioid Prescribing Engagement Network (Michigan OPEN), a group started by three faculty members here at the University of Michigan who wanted to develop a preventative approach to the opioid epidemic by improving post-operative and acute care opioid prescribing practices. Now in our second year, we work to accomplish these goals through education, development of prescribing guidelines, quality improvement interventions and safe disposal. This past Saturday, our efforts to promote safe disposal culminated in our largest state-wide medication take-back event yet with 27 different sites in 17 counties participating. Some of these sites had collaborated with us several times before, others – like the one I organized – joined for the first time.

Some of the pills we collected and passed off to the Pinckney police for safe disposal.

Given the risks associated with keeping leftover prescription medications at home, and a general public unawareness of proper disposal options – like authorized drop-off sites in your area – I think there’s a lot of value in organizing local take-back events. These initiatives go where people already are, making the drop-off process easy, and providing education on safe disposal through a friendly, community-based approach. Having volunteered with the UM Student Run Free Clinic (UMSRFC) for the last two years, I especially wanted to bring Michigan OPEN’s take-back events to Livingston County. With the support of the UMSRFC, the local board and police, and the Michigan Institute for Clinical and Health Research, I managed to get the village of Pinckney added to our list.

Our awesome group of student volunteers and officers who made Saturday’s event a success. And the sun finally came out! ☀️☀️

Organizing the event involved weeks (or was it months?) of conference calls, ordering supplies, designing flyers, and lots of tweeting. When April 28th arrived, it was – of course – cloudy and freezing. But our wonderful student volunteers and police officers came with plenty of enthusiasm. By the end of the day, 20 people had dropped off medications, and we had collected nearly 9 pounds of pills, including 638 opioids. More importantly, we had many valuable conversations with community members on what compelled them to come, and how to take action in the future. Some had heard about our event by social media or local news, others had simply seen us as they drove through town. Many took our information sheets on year-round disposal sites in Livingston County. And nearly all asked when we would return.

While the exact date is still TBD, our team is already looking forward to our next Medication Take Back Event at the Pinckney Town Square Park, across the street from our little clinic. Our first event might have been small, but it unquestionably made an impact. We collected thousands of pills and brought people together to talk about our future goals for the community. The solution to the opioid crisis feels distant, but I believe it starts close to home, through initiatives in the spaces where we already work. It will be through collaborative efforts – like our event on Saturday – that we will manage to make a lasting impact.

How Flexible Are You?

Not yoga-wise, but given the lecture Friday on degenerative disc disease, maybe we should all consider it.

This is a very important question to consider and revisit with a modified, “how flexible can I learn to be,” specifically when learning how to create a balanced life in medical school.

Some coin it as efficiency, which doesn’t encompass the idea entirely since efficiency is essentially how quickly you can improve on a repeated skill. However, with our curriculum, you are in a sequence for no more than three weeks, and your mastery of navigating a study guide may prove to be of little use in a shorter time frame.

You are faced with the same challenge each sequence: “How am I going to tackle this sequence?” a.k.a. “What is my study strategy this week?” Since the answer to this question will usually determine how much remaining time you have to incorporate outside activities (whatever that may mean to you: spending time with your significant other, baking, exercising, Netflixing), I advocate for the strengthening/finessing of the broader skill of being flexible. This includes taking cues from your environment and knowing what resources are available for your use.

One of the weekly yoga sessions offered at the med school.

(In full disclosure: I have by no means perfected this skill, but I know the importance of being flexible after having completed three-fourths of the Scientific Trunk. When I choose correctly, it shows in the more balanced weeks I have, as compared to when I choose incorrectly.)

There are entire sequences that I did not stream a single lecture. For one week, the route I chose to take was a bundle of flashcards, learning objectives and reading the assigned textbook written by the sequence director. For another, it was only reading a study guide, reviewing the slide deck and watching osmosis videos. And, in yet another case, flashcards only was the main staple for the week. I remember the surprise that some people expressed when they heard that I did not stream at all: “How could you not?” My answer: because for me personally, there are better ways to cover and master the material we will need to know for the week’s quiz and on the wards.

One error in a slightly ambiguous slide could have consumed hours of my study time, but I knew that for that topic I could look to Pathoma (an online medical course review resource) and spend approximately 12 minutes at double speed to figure it out. Meanwhile, in another sequence using outside resources was a phenomenal beginner’s mistake and would prove to lead me down a road of extreme time-wasting, to the point where I almost understood less than when I had begun.

Asking those who have gone before you (by referencing Code Blue, our compiled tips from older med students, or speaking to them directly), and brainstorming with classmates what internal and external resources are available to cover the week’s topics are crucial. But being willing to ditch a study strategy when it’s not working is the hardest but most important thing to learn because everyone likes routine.

As for me this week in Musculoskeletal Week 2, it looks like I’ll be doing a lot of going to the gym to learn about muscles I never knew I had until I feel them the next morning, yoga with a peer instructor who will in practice highlight material we need to know, and hanging out with cadavers who can show me a thing or two about origins and insertions. Then, when I have the free moment that I have worked for and to bring some balance to my week, I will go back to lorio’s and see if Stracciatella or Tiramisu has returned to their gelato menu.

Big ‘I’s, Little ‘U’s

“There are no big ‘I’s or little ‘u’s here” was the first pearl of wisdom my supervisor gave me on my first day of work at N Street Village (NSV). Though I didn’t fully understand her at the time, I would carry those words with me to work everyday for the next two years.

My NSV coworkers and I in our “office” during a team meeting.

NSV is a non-profit organization in DC that provides wrap-around services to women experiencing homelessness, poverty, addiction, or anything in between. I worked in the day center, a safe and communal space for women, with services ranging from meals, showers, laundry, and a vast array of emotional, physical, and mental support groups. My experience at NSV was transformative and humbling. I learned how to deal with unexpected crises, witnessed the direct impact of systemic barriers to upward mobilization, and learned to meet people where they’re at when it comes to decisions about their lives and health. I was also able to share my choices for wellness; I taught a dance class every week and led a walking group (though walking was often replaced by playing charades in the park or women teaching me songs and games from their childhood.) Though I saw many women on the worst days of their lives, I was also privileged to share so many moments of joy with them.

As the beginning of medical school drew closer, I was apprehensive at times about my decision; I feared how much time I’d spend studying and that the pressure of school would make NSV a distant memory. I wasn’t sure that the skills or lessons I acquired would stick. Nonetheless I trusted my gut, and when July 2017 came, I packed up my bags, said goodbye to all of the strong and wonderful women I knew, and moved to Ann Arbor.

It’s eight months into medical school and I can safely say that not a day goes by that I don’t think about the women at NSV. I would like to say that’s all of my own volition, but I owe much of those reminders to Michigan’s opportunities and intentions, allowing me to weave my past experiences in with the new. Through patient panels I’ve learned more about substance abuse, intimate partner violence, and social determinants of health. My fellow med students have exposed me to skills they’ve gained through backgrounds in economics, social work, teaching, and beyond. I’ve had the privilege of being on the leadership team of the Student Run Free Clinic, spending time talking to patients and using skills that I first learned at NSV but have nurtured and refined even more in medical school. In our Doctoring course, we are continuously corrected for using too much medical jargon–not because faculty wants to be critical but because they also know there are no “big ‘I’s or little ‘u’s” when it comes to compassionate patient care.

Over spring break, I went back to DC and visited NSV. I was greeted by warm smiles and exuberant hellos from so many old faces. The feelings were mutual–I was elated to see individuals to whom I grew so close not long ago. In the months since I left, some women had gotten housing, become employed, reached new sobriety milestones, or were simply taking life day by day. We cheered, high-fived and hugged. It was just like seeing old friends, a tug at my heartstrings–difficult to tell the difference between happiness and sadness.

As I walked out, Ms. C, a woman particularly dear to my heart stopped me and said, “When are you going to come back and be my doctor?” And just like that, I knew my experience was not lost and a new one had just begun.

A goodbye sign the NSV community made for me before I left for medical school.

Topography of a Spring Break

The author’s Yiayia with her father’s model built during the Golden Gate Bridge’s construction from its scraps.

My family’s been on the same San Francisco hill for the last one hundred years. Emigrating from Greece in the 1910s and 1920s, my great-grandparents built the first house on the block (48th Avenue then was a sand dune) and ran restaurants on the road that wraps around the hill and connects the Outer Richmond to Ocean Beach. My Yiayia raised her family a block away, the home in which my mother was raised. Standing in front of her house, looking down 47th, you see the city sweep out down the peninsula – Golden Gate park interrupting rows of houses ending at the beach and ocean.

I’m from Kentucky, a landlocked state known for its rolling hills. I now live in southeast Michigan, an area that is as boggy and flat as it is beautiful.

Seven months into my first year of medical school, spring break was not only a much-needed change of pace but also a change in landscape. Visiting San Francisco for the week, I didn’t stream any lectures, review flashcards or localize hypothetical lesions. But I did explore San Francisco. It meant familiar walks: through Sutro Park, down past the Cliff House, and then the flat, windy walk along the beach. Or along the coastal trail below Legion of Honor, where you turn a corner and there’s the Golden Gate Bridge spanning the entrance to the bay. I know these routes well and they are for reflection and quiet appreciation.

The mouth of the bay.

Some of the exploration is new. One afternoon I take a bus, and then the metro, before climbing a hill to Corona Heights Park. Although there is less wildlife, navigating the subways is also a lesson in topography. It begins with a descent and ends with a climb up and out. Breezes are produced mechanically and carry the smell of oil and other things of a city. I read in the park and wrote a bit.

In Ann Arbor I often take walks. I notice the slight hills and admire houses in Kerrytown and the west side of the city. I let my mind wander between lectures, or in the evenings when I’m done for the day. I’ll walk in all sorts of weather – I’ve made good use of my coat this winter. Ann Arbor is full of reminders of the medical school. There’s the corner where I did tag days for Galens, right by the State Theater. The hospital, massive and lit up at night, can be seen from much of my walk to the Arb and is a sometimes exciting, sometimes intimidating reminder of rotations to come.

An old tree in Ann Arbor that caught the author’s eye.

For me, the landscape of San Francisco is tied to family. In the mornings, instead of an alarm clock, I wake to fog horns and the creak of the my grandmother moving around the house. My great-grandmother died a couple years ago (at 102!), but we still bake her cookies and tell her stories. I visit her house and weed her sandy backyard.

This landscape grounds me because it is a reminder of where I come from – my family, as well as who I am without quizzes, pre-clinical training, or medical ambition. I can read books and my mind doesn’t wander to things I need to get done. I can walk without a timeframe.

Spring break is over and M1s have finished Neurology. The days are getting longer and yesterday it snowed as the sun set and I found a little of the peace I had over spring break. Even though my family isn’t here and I can’t hear the ocean, the Arb was quiet and I noticed flowers beginning to spring up.

Ocean Beach at dusk.

 

 

 

Perspective

I started writing this post on Match Day as I anxiously waited to open my envelope:

Today is Match Day. I have spent the last few weeks in full-blown panic mode, peppered by occasional minor panic attacks. I found out that I matched on Monday, which helped somewhat, but I never realized how much I hated the idea of not being in control of my future until recently.

As many others have said, the Match is a binding contract for the first year, and, despite feeling reasonably secure up until rank lists were submitted near the end of February, that knowledge has affected my stress levels far more than I would have guessed. After all, I understand how the algorithm works (and could probably code a reasonable facsimile of it myself) and I’m going into family medicine, which I love but is not one of the traditionally more competitive specialties.

But nevertheless, here we were. I did not sleep well last night. My alarm went off this morning, turning on the radio, which was just beginning its news report. The top story was that a local Michigan boy had his heart transplant last night after a perfect match was found. The boy had been in normal health in early January but has since developed congestive heart failure and he got his new heart last night.

So, suddenly Match Day doesn’t seem as important. Perspective is something, isn’t it? Helping people lead better and healthier lives is why I want to be a doctor in the first place. No matter where I go, that part will not change.


My family at Match Day – Mom, Grandma, me, brother Jeff, and Dad

It is now a few days after Match Day. I am very happy to be sleeping better, to feel less panicked, and to report that I will be doing my family medicine residency at the University of Utah in Salt Lake City! I am very excited about this new opportunity and what the future has in store.

After my early morning dose of reality on Match Day, I was much calmer as the zero hour approached. My stomach was absolutely tied in knots as I waited in line to receive my envelope, walk back to my family, and open it with baited breath. It is bittersweet to realize that soon I will be leaving Ann Arbor, the city where I was born and have spent more than half my life, and the routines I have developed here. But I will go to Utah, with several of my current classmates, and develop new routines and continue to grow into the doctor I strive to become.

It is now several weeks after Match Day. My family and I are creating lists upon lists to ensure that all logistics are in place for my move to Utah. I have been a Michigan lifer up until now; moving for college/med school was definitely low-stakes – my hometown is 20 minutes away from Ann Arbor. Salt Lake City, however, requires over 20 hours of driving. (I am happy for the invention of airplanes). But I am very excited for my next adventure and am already plotting how to watch Michigan football games with my co-interns.

The Alumni Association’s motto is “For those who leave Michigan, but for whom Michigan never leaves.” And this will absolutely be true for me as well. I am forever changed by my experiences here at UMMS – particularly every time I hear the word “tragedy” 😉 – and they will guide me as I embark on my new journey.

I have enjoyed sharing my perspectives with you over these past five years; thank you for reading! As past UM president Mary Sue Coleman would say, “For today, goodbye. For tomorrow, good luck. And forever, GO BLUE!”

Strategically Building & Strengthening the Pipeline: Future Physician Summit

When the list of available positions for the Black Medical Association (BMA) came out during election time last year, I was a little confused on which position I wanted to serve in. I talked with some of my now current BMA executive board members to determine which positions they would choose to see if one would simply “fall in place” for me. After reflecting on my passions and strengths, I decided to run for vice president of BMA. My job would entail mentoring and strengthening the pipeline by working with the Multicultural Association of Pre-Health Students and the Black Undergraduate Medical Association (BUMA).

I am a recent BUMA alumnus (as I like to call myself) and the chance to work with my past organization and give back made me excited. There are not usually many direct opportunities to influence the communities that have shaped you but this was my chance to do just that. One day, Jasmyne Jackson (M4) approached me about an idea she called the Future Physician Summit, an event that would combine BMA & BUMA to expose middle and high school students to medicine. I thought this was a great opportunity to work with BUMA in another capacity and give back to our community.

I have been a part of BUMA since its inception my junior year in 2015. I remember when one of my good friends Tomi Ojo talked to me about her passion to start the organization for black pre-medical students on the University of Michigan’s campus. She felt this was needed because of the unfortunate reality that black pre-meds can sometimes get lost on the journey toward medicine. There are so many factors that play a part here but Tomi noticed, as did many of us, that the same friends with whom we began the pre-med journey were not the same ones with whom we would finish, since many of them changed their major or focus. BUMA would and has served the purpose of providing a space for black pre-medical students to uplift each other, provide resources for each other, give back to our community, and retain more black pre-medical students overall.

While African Americans are 12% of the U.S. population, the American Association of Medical Colleges reports that Black or African Americans represent 6% of medical graduates and only 4% of full-time physician faculty. Exposure to the field and retention of black students in medicine are very important for addressing this racial disparity in the physician workforce. In addition, building the confidence needed to achieve a medical career, providing impactful opportunities for minority students, and early mentorship are all key components to diversifying the field.

To address this racial disparity on all fronts, the Office for Health Equity and Inclusion, BMA and BUMA will be collaborating with Wolverine Pathways to put on the inaugural Future Physician Summit on Saturday, April 7th. Wolverine Pathways middle and high school students from the cities of Detroit and Southfield will be joining us on the medical campus for a day filled with college readiness activities, pipeline panel discussions, mission and vision workshops, a tour of the medical campus, and clinical skills workshops. We will be involving representatives from every part of the pipeline including physicians, fellows, residents, medical students and undergraduate students so Wolverine Pathways scholars can be exposed to the pipeline in its broadest sense.

The Future Physician Summit Structure. Medical Students are at the base and are key components to uplifting the rest of the pipeline

Another key aspect of the event is our “train the trainer” pedagogy. Under the guidance of medical students, the undergraduate students serve as the primary leaders and are responsible for the planning and execution of the Summit. This approach provides the undergraduate students with leadership opportunities and experiences that highlight the importance of service and outreach and in so doing, strengthening the pipeline.

The planning of the Summit has been a great experience so far for both BUMA and BMA students. We have all gained valuable experience necessary to further our careers as future medical students and residents, respectively. The BMA participants have benefitted from teaching clinical information, mentoring, supervising and developing skills that will translate in the role of guiding the success of medical students as residents ourselves. In addition to gaining medical exposure, the BUMA students have practiced event planning and task management, improved written communication, and sharpened their professionalism. Involvement in the planning process has motivated and prepared each level of the pipeline for the next step on their journey toward medicine.

The Summit Leadership Team from left to right: Back row: Tochukwu Ndukwe (M1), Halimat Olaniyan (junior), Reginald Wilburn (freshman), Dara Watkins (senior), Jasmyne Jackson (M4); Front row: Kaela Brown (junior), Jolyna Chiangong (freshman)

Personally, I am very proud of the growth that I have seen with each and every member of the Future Physician Summit leadership team and I am excited to be a part of organizing and executing this event. As a black male of Nigerian descent, I have been given the opportunity to give back to Detroit, the city I was raised in, BUMA, and to other minority communities that surround me. Through my involvement, I hope that I can inspire minority students to choose a career in medicine similar to how programs and events that I have been a part of while growing up inspired me to choose this path. Building and strengthening the pipeline for minority students is my passion! I hope that the Summit’s structure will become the first of many of its kind!