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Hosts of Hosts, Cartagena, Colombia, and $2450

September 15th, 2017 was the magical day that our M4 class submitted ERAS applications for residency. I remember staying up until 5:00am with my M4 friend Bill Mallett ruthlessly critiquing, editing and perfecting our personal statements all that night. Although he applied in anesthesiology and I in plastic surgery, the application process is the same across fields, and refreshingly more streamlined than the medical school application. We ensured to hit “submit” before 8:00am that day so that our application would be time-stamped the same as all of the other early applications. The relief that followed was divine!

Me and my kiddos, Nathan, Harvey and Autumn (left to right)

If you didn’t know already, I have three children (that’s right, three), and you can imagine how tight our budget has been given that my wife is a homemaker and we live on medical school loans (borrowing maximums are only very slightly larger for families than for individuals). We had been saving up for interviews for over two years, but it still didn’t seem like we would have enough to pay for the nine interviews I attended. There were rumors that interviewing students would sometimes stay overnight with a UM Medical School (UMMS) alumni instead of booking hotels or Airbnb’s, but it seemed too good to be true–I always thought they must have had some sort of preexisting connection through mentors or some other means to make that happen. BUT, NO! It is so much more than that. UMMS placed Amy Chappuis, one of our staff, in charge of managing the H.O.S.T. (Helping Our Students Travel) program. Briefly, all I had to do was enter the dates and locations of the interviews I had received into my HOST website profile, and my name became available to UMMS alumni who had volunteered to host students. I only posted five of my interviews, because I had already made accommodations with friends and family for others. One or two weeks after posting, five alumni (that’s right, five!) reached out to me offering their spare bedrooms for my overnight stay during interviews. That is a 100% response rate!!! What’s even better is that as I visited them, each one was simply amazing in their hospitality; one host even volunteered as my personal chauffeur for the weekend (no Uber necessary)! No other students from other medical schools that I met on the interview trail had anything similar to this going for them as they interviewed…

My wife Jamie and I after an interview in Galveston, Texas

As a plastic surgery applicant interested in burn reconstruction, my application was very unique–and, because of its peculiarity, very well received at many institutions. I certainly experienced the “Michigan difference” on the interview trail; many faculty members that interviewed me had connections in some way with Michigan. However, just as soon as interviews came to an end, I found myself in Cartagena, Colombia with Healing the Children, a volunteer group of plastic surgeons led by Dr. Robert Gilman of our plastic surgery department. Dr. Gilman collaborates with a group from Harvard to take two chief plastic surgery residents each summer to perform cleft lip and palate, pediatric hand, and burn reconstruction at no cost for indigent patients. My role was to gather data for my IMPACT project (similar to a senior capstone project), for which I am researching the barriers to health care that recipients of these gratuitous surgeries experience in their local systems that drives them to seek humanitarian care. The local newspaper reported on our visit and caught me in action! For IMPACT projects, the school gives funding to students with big ideas: I applied for and received a $950 internal grant from the school to cover travel expenses. While I certainly worked my tail off, I also had time on our final day to make it to the beach. In the middle of February. 😀

Playas de Bocagrande, Cartagena, Colombia on February 17, 2018

Match Day is just around the corner–March 16th, to be exact! There is nothing quite like it. Far from a feeling of anxiety and dread, I feel very excited! Most of my friends agree with me that they would be elated if they matched into either of their top three to five programs. Thankfully, coming from Michigan, it is rare to not match at your top program, and exceedingly rare to match below your top three (or not match). What could possibly make this better? Well, just this week I received an e-mail from the financial aid office that a group of alumni had donated to help cover the costs of interviews for students, and that I (because of my financial need situation) was chosen to receive a $1000 grant!!! Wahoo!!!! Totally unexpected, yet at the same time totally consistent with my four-year experience as a University of Michigan Medical Student.

So, a little math:

~$500 saved through HOST program + $950 IMPACT grant + $1000 interview grant = the Michigan Difference (or, $2450)

I’m blessed. Go Blue!!

From squiggly lines to pretest probabilities

I think it’s that squiggly line.” We stood huddled around a laptop in one of the library group study rooms, puzzling over one of the lecture slides, unable to tell which pink blob in the sea of pinkish-red lines in the microscopic slide was the red neuron. While racking our brains over the image, someone jokingly said, “I can imagine us looking back at this moment and laughing about it.” And he was right, somewhere in the whirlwind of our third year, a pink blob of cells had transformed from a meaningless jumble of shades of pink on a page to a meaningful decision on treatment choices.

                              Celebrating the end of M3 with friends

This transition has been bumpy at times – from struggling to navigate through an electronic health record on my first rotation only to scramble to learn a new system at a different facility, to deciphering medical acronyms, nervously presenting during clinical rounds, to trying to avoid contaminating sterile fields during surgical rotations. Nonetheless, at the end of my third year, the way I think about medical problems has fundamentally changed.

Yet I have to say, the more medical knowledge I learn, the more distant the memory of what it is like to be on the other side of the doctor-patient relationship – the side in which clinical outcomes and pretest probabilities do not automatically pre-populate and everything is a terrifying unknown.

Joy, come over here for a minute,” my mom anxiously calls from downstairs. Her face had rapidly become swollen and increasingly itchy over the course of half an hour. It was a textbook case of hives (likely due to consuming some shrimp). “Take some Benadryl,” I unconcernedly counseled. The swelling eventually went down. Seeing my mom’s worried expression, it belatedly occurs to me that only a few years ago even the most benign conditions appeared threatening to me too.

Starting med school, I was overwhelmed by the colossal amount of terminology I didn’t understand. At that time, I remember our doctoring faculty smilingly telling us to treasure the moment. We would eventually become so accustomed to using medical jargon that we would forget what it was like to be a layman. He was right – we’ve come so far that it is hard to recall exactly what it was like to be us a year ago! Within a course of a year, once indecipherable squiggly lines have unscrambled into a message.

 

An M1 Discovers What the Smoker Is All About

May of my senior year of college I was in a show called Deadsville. I remember standing backstage before our final performance trying to appreciate that this would probably be the last show I ever did. I loved doing theater – the check-ins, late rehearsals, camaraderie and silliness. I loved walking into a space and giving myself permission to let everything else fall away. That last performance I tried to acknowledge the enormity of my leaving behind something that I had invested so much of myself in over the previous eight years.

However, that sense of loss was to come slowly over the next three years. It came to me during my post-bac year at a puppet show when I felt dearly the lack of performance in my life, of abstraction, and language that pushes me. It came to me last semester at times when schoolwork seemed tedious.

A typical rehearsal night.

And then I auditioned for the annual musical roast, the Smoker, and it was like I was a theater kid again. Three nights a week I step into a character with a funny voice and goof around. I work in the shop, painting, using a jigsaw and chatting with M4s about what specialties they’re going into. The shop smells like paint, paint thinner and sawdust – things distinctly not of Taubman library.

Setting up Mendelssohn theater, preparing for tech week.

With that said, the Smoker isn’t an escape from med school but an expansion of what med school means. The show is all about medical school – it’s filled with allusions, references and inside jokes. Each character is a professor. The program includes a glossary of medical terms and professor bios for the uninitiated. The directors, actors, singers and dancers are all my classmates. One practices surgical knots in the corner, another reads Ob/Gyn case studies between scenes.

Suzie trying out Method Acting to get into character.

It has been strange and so fun to find such an intersection of my interests. My left brain and my right brain are both very happy (if not exhausted). During the day I’m memorizing reproductive anatomy, learning about the HPO axis, or practicing a physical exam. In the evenings I’m singing, blocking entrances and goofing around. At times, finding the energy to accomplish everything I need to has been a challenge, although Smoker rehearsals have certainly been more restorative than taxing. New friends, performance and creativity from so many people (costumes, set-building, the script, etc) goes a long way. It’s also fun to be part of Smoker traditions: I have Dr. Sisson’s white coat hanging in my closet safe from chocolate or coffee stains that have defiled my own white coat. I’ve learned much Smoker lore and even attended Smoker karaoke night.

Two of the Smoker Czars taking it all in.

With three more years at Michigan, I don’t have to worry this will be my last show.

You can see Christopher and the rest of the Smoker cast this Friday and Saturday at Mendelssohn Theater performing Harry Polyp and the Deathly Hematochezia. Buy tickets here:

https://www.eventbrite.com/e/harry-polyp-and-the-deathly-hematochezia-the-100th-galens-smoker-tickets-41433164711

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.