April 2017


What Do You See. Photo by Puja Panwar, M1.

What Do You See. Photo by Puja Panwar, M1.

Spring Is on Its Way
by Anna Shamsnia, M3

There is this tree facing my balcony. I feel connected to it. It feels like a friend. I’m not sure if he knows that I look at him as often as I do. I don't know if he knows that he gives me strength almost every day. He stands so tall, and even though other trees stand so much taller, he is special. I remember him so well in the fall, covered with colorful leaves; red, green, and yellow. The image reminds me of the colorful, hopeful ideas I had had for third year.

But third year has been one of the most challenging years that I have ever experienced. It has questioned my faith, tested my resolve, and at times, it has broken me down, stealing my colors away like the winter did to my dear friend. But he is still standing tall despite being naked without his leaves. So vulnerable, like the many times I have felt while making my way through rotations. But I have persevered. I've looked at my friend, and I've seen myself in him. He has persevered too.

He reminds me of many patients I've seen during this year. Some are lucky to have their family and friends, but at the end of the day, it's them in that hospital bed, and the season of disease has taken so much away from them, but they have stood tall and strong. Today, I look at my friend with his specks of small blossoms, and the sight gives me hope.

It's still not spring, but I feel the season changing; time to grow despite the past, time to take the challenges and hardships of the season and turn them into hope. It’s hard to persevere in a time of vulnerability, to grow without leaves, but spring is on its way. I think he knows me too.


The Art of Humanism: Healing with Words
by Joey Cleveland, M3

When asked the question “Why did you go into medicine?” most any medical student will respond with the genuine, yet common, response “I want to help people.” Although we all strive to remain true to this statement, the first two years of medical school challenge the student with an onslaught of countless hours spent mastering the basic sciences, unfortunately placing the most fundamental aspect of medicine, Humanism, on the sidelines. In my first year of medical school, the term Humanism would be ingrained in my soul forever.

As I was sitting in class for a lecture on neuroanatomy, I felt a buzz in my pocket. As I opened my phone, expecting to just see a loving text message from my mother checking how I was doing, I saw an image of an MRI. It was not just an MRI, but an MRI of my brother’s brain. For almost a year up to that point, my younger brother (20 years old at the time) was beginning to complain of vague balance issues and bladder incontinence and even beginning to develop numbness, tingling, and eventual partial paralysis of his upper and lower limbs. In the latter 6 months of his suffering, his condition began to deteriorate, and he experienced severe migraines that eventually led to dizziness, nausea, and vomiting. My family was terrified. As my brother went from physician to physician, the diagnosis was not showing itself. The vagueness of the symptoms had his care providers stumped. It wasn’t until the migraines and vomiting appeared that his primary care physician ordered an MRI—the MRI that showed up on my phone at that moment. As I looked at the MRI, I saw my brother’s severely enlarged cerebellum dipping downwards out of his skull and impinging on his spinal cord. My brother had a Chiari malformation. As I looked at this image, it was not just another PowerPoint slide, textbook page, or test question. It was not just another diagnosis, pick a multiple choice question, and move on. No, this was my baby brother. At that moment, I was transformed from studious medical student to scared, devastated, and lost family member of a suffering patient.

Artwork by Jessica Meyer, M4.

Artwork by Jessica Meyer, M4.

Although my whole family was scared and at a loss for words, my mother was the one who seemed to suffer the most, even more so than my brother. She somehow felt responsible, despite this being a congenital malformation with no known genetic causes or environmental contributions to etiology. She watched helplessly as he struggled to walk, eat without vomiting, or even muster the strength to overcome his migraines and get out of bed. Amazingly, throughout all of this, my brother maintained his characteristic  strong, positive nature without ever complaining or asking, “Why me?”

As my family and I met with the neurosurgeon who would be caring for my brother, we were petrified. We did not know if we had the strength to handle my brother’s prognosis. The door opened, and the neurosurgeon walked in with an unexpectedly  monk-like calming demeanor. He had the gentlest smile on his face, walked to my brother and shook his hand, and then glanced at my mother. My mother’s face was saddened, and her normally bubbly demeanor had hardened over the past several months since my brother’s  diagnosis. The doctorwalked over to her and gave her a hug without saying a word. My mother’s stress and tension melted away. He gently said to my brother, “I am so sorry for everything you have gone through. And although I am not a miracle worker, nor the answerer to all of life’s hardships, what I do know is as long as you are willing to fight, I will fight on your side. You have endured pain and suffering to an extent that no human being should ever have to know. You have remained strong, inspiring your family and friends to experience what true longing to live truly looks like. And for that, I am in awe of your resilience and strength. I am not the miracle worker, you are.”

With those words, my brother, my family, and most especially my mother were put at ease. No drugs, IV lines, or treatments were implemented yet, but medicine was truly at work already. This doctor healed my brother and family with words. He showed me what Humanism in medicine truly is.

Amazingly, the day after my brother’s brain surgery, he opened his eyes, and in a few days, he was eating and drinking with no IV lines attached. Within one week, he was walking again! Beyond the great amount of technical skills and expertise involved in his surgery, the most memorable aspect of my brother’s treatment and recovery that my family remembers was the words the neurosurgeon used on our first visit. And those were words I will remember for the rest of my life.

In my third year of medical school, I would utilize my experience with humanism in medicine to deliver compassionate and empathetic patient care. During my elective rotation in neurosurgery,I realized that I found a specialty that to this day still gives me the chills. This was an elective I chose to do based on my family’s intimate history with this field. As I showed up at the hospital at 5 a.m., I checked the OR schedule for that day. A particular patient stuck out to me. It was a 19-year-old man who came in to the ER with complaints of tripping, severe headaches, and vomiting. The MRI from the ER showed a mirror image of what I saw on my phone over a year prior. It was a Chiari malformation. I flashbacked to my own brother. As I walked into the ER, I saw the patient lying on the gurney with his mother and father at his bedside. The boy, ill-appearing and scared. The father, anxious and concerned. And on the face of the mother, a desperate, helpless, and saddened affect. I instantly felt that this was the moment I would remember why I came to medical school. Not only to help people, but to exist as the human element. At this moment I gently smiled, shook the boy’s hand, the father’s hand, and as I motioned to shake the mother’s hand, she hugged me. I spoke with the same softness and gingerly tone that I remembered from my first year of medical school. No amount of science, biochemical pathways memorized, or mechanisms of action of any drug was utilized at this moment. I spoke to the family and said that I was here to help them endure through this time period. I spoke words of kindness, support, and love. I saw on that gurney not just a patient, but a human being, just as if it was my own baby brother lying there, scared and in need of help. I saw my own mother and father there helpless and frightened. I told them that they were not alone. That we were all here to support them; as long as they were willing to fight, we would fight on their side.

Later that day, I was standing in the operating room, at the head of a bed where a young 19-year-old man, almost the same age as my younger brother, was lying motionless and vulnerable. It was my first brain surgery. Never before had I felt that way; I was almost frozen in my position, becoming ever more cognizant of the incessant beeps of the cardiac monitors, the drips of the anesthesia in the IV lines becoming ever louder. I was participating in a surgery to attempt to repair a Chiari malformation in a person not far different from my own baby brother. As the neurosurgeon delicately removed a section of the skull and layer by layer peeled back the sheets of dura and arachnoid mater, I saw for the first time the human brain. This was the first time I had ever seen this precious, essential part of the human body, pulsating with every beat of the heart. But it did not evoke the same feelings I had when learning about the brain in anatomy lab first year of medical school. It wasn’t just an anatomical structure to memorize in all detail for an upcoming exam. No, it was the very structure that holds this young man’s dreams and being intact. And, at this point in time, his personality and ability to dream were threatened by an overgrown cerebellum invading into the very structure that allows him to be human. After hours of delicate manipulations of the cerebral vasculature and normal cerebellum from the overgrown tonsil, we finally had it out. And for a moment, I was standing there, holding a piece of this young man’s cerebellum in my hand. The next morning during rounds, I was able to speak with this man and had the privilege to tell him that we removed the structure impinging on his spinal cord. Although he was still recovering, I saw a smile and tears running down his eyes.

After the operation, I was asked by the neurosurgeon to go tell the family the good news. The mother and father hugged me and told me, “Although the surgery was truly a miracle, the greatest medicine our son and family received in this experience was your words and kindness. Thank you for being not only a great care provider, but for being most importantly, a human.”

This experience humbled me to such an extent that I will forever remember that in healthcare, the greatest medicine is not merely the treatment, but fundamentally, the element of Humanism.


Peruvian Jack and Jill
by Rui Wang, M1

A stern man walks into the room and sits down. “Hola, cual es tu nombre?” I ask.

“Jack.”

“Me llamo Rui, mucho gusto. Como estas?”

Jack tells me that his fingers have been hurting for several years, that he has had a wooden splinter in his eye for the past 4 years, and that he has a headache. I ask him to tell me more and learn that he drives a motorcycle taxi, that he used to be a carpenter and got hit in the eye by a 2x2, and that he forgets things often. I try a joke about how I always have trouble with 3 things: names, faces, and… remembering what the third thing is. Jack does not laugh.

I complete the patient encounter and present the history to the doctor. We hand Jack a Ziploc bag of 60 ibuprofens for his pain.

“How much?”

“It’s free,” I say, smiling.

Jack laughs this time, but I tell him we’re on a mission trip and reassure him that the ibuprofens are indeed free. Jack smiles for a millisecond and leaves.

Unusual Friendships. Photo by Puja Panwar, M1.

Unusual Friendships. Photo by Puja Panwar, M1.

A woman walks in with a young child. “Hola, cual es tu nombre?”

“Jill,” she says.

“Y tu bebe?”

“Rebecca.”

“Me llamo Rui, mucho gusto. Como estas?”

Jill tells me that her shoulders are sore, that it’s hard for her to wash herself in the shower without feeling pain. Rebecca squirms in her mother’s arms, and Jill makes a pained expression, so she sets Rebecca down beside her. I can tell she feels a little relief in her shoulder after setting her daughter down.

I ask her to tell me more about her shoulder pain. She says it feels like someone has punched her, that both of her middle fingers and thumbs hurt too, that it feels better when she’s working and not thinking about the pain. I ask about her work. She runs a food cart that serves arroz con leche and works 14 hours, 7 days a week. I empathize with Jill about how difficult her work hours sound, and she says she is very stressed. She expresses that it’s difficult to raise her children with her work schedule, that her parents are very sick, that her uncle had just passed away last week. I tell Jill I am very sorry that she is going through so much in her life, and I notice a tear escape her eyes.

We give her 60 ibuprofens, show her how to stretch her shoulders, and advise her to get a wrist brace. She asks if I could pray for her. I oblige and put my hand on her back and pray for her health and family. Jill starts sobbing, and I begin having this “dust-in-my-eyes” feeling. We hug, and she leaves.

Peru has taught me that even though we have limited expertise as first year medical students, we can still provide health emotionally. Through bouts of mistakenly diagnosing pancreatitis, correctly diagnosing osteoarthritis, and handing out lots of ibuprofens, I have learned that caring about these patients and their lives can have a deeper impact than bandaging their physical pain with a short supply of painkillers.


Service and Self
by Britton Eastburn, M1

When this now-famous statement surfaced in the mind of Neale Walsch for the first time, I wonder if he stopped to consider the irony it presented; the further we venture away from our comfort zone, the larger it seems to grow.

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Plant me in a developing country surrounded by malnourished children in desperate need of basic medical attention and, you will find me fully within range of my “comfort zone.” Alternatively, place me in a middle class ranch-style house down the street where an able-bodied father of two watches from the porch as I repair his privacy fence, and you will find me just beyond the borders of comfort. This is precisely the thinking that led me to skip out on The Big Event for the past two Aprils after having faithfully participated during my first three undergraduate years. Through my own selfish reasoning, I had concluded my time would be better spent knocking out some of my own weekend projects; after all, I was more strapped for time and money than most of the local households I had served in years past. This selfish reasoning may also be described as immature, narrow-minded, and unfruitful—it benefited no one, myself included. When we decline opportunities to serve others, we decline an opportunity for growth.

While I certainly am still a proponent of a triage system when it comes to allocating aid to those in need, I am also slowly learning what it means to truly embrace the mindset of a servant on a perpetual basis and how to better appreciate selfless service in and of itself, without assigning it value or merit based on the needs of the recipient. The selfless component is key—any service which lacks this component is not really service at all, it’s just work. An attending physician running through morning rounds is simply working (albeit exhaustingly), but when the same physician stays over an hour past his shift to read to a patient with sudden-onset blindness, he becomes a servant. Initially, this realization left me with somewhat of a Martin Luther complex, throwing every bit of humility I believed to possess into question. Would I have still gone on all those service trips if my friends had not also gone, or if nobody would ever know of my good deeds? Would I have still pursued medicine if our society treated (and paid) physicians the same as nurses? Although I cringed at the thought of being considered an absolutist, I inevitably sank into the trap of believing there was no such thing as a truly selfless act. If I make an anonymous donation knowing it will make me feel good about myself for a while, how can I call it selfless? Although the semantics of this philosophical debate are trivial at best, it nonetheless gave me a new outlook on life that more or less brought me to where I am today.

It all comes down to motivation. So long as the intent to serve and help others is present, you can behave selflessly and still enjoy the collateral benefits without berating your own conscience. Better yet, the benefits that arise can reinforce the thoughts and behaviors that were rooted in selflessness to begin with. If you save a patient’s life and find yourself elated for weeks to follow it, doesn’t mean you saved them for selfish reasons, it means you had the right motivations when you applied to medical school.

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Swinging full circle, I regress to why a service day spent planting flowers along a driveway with a new Mercedes parked in it falls outside my comfort zone. Rest assured, it is not because I don’t believe in serving people who can serve themselves. The virtue of service is found in the act, not in the actor or the audience. Still, when the audience is a poverty-stricken village or a sick patient, the actor need not dig too deep for the right motivation. These situations are comfortable because I know I have the right motives. When the needs of the audience are not as clear, however, I begin to question my own intentions. Herein lies the discomfort. Is this really a service day? Or is it simply a self-fulfillment day? If I am not here for the right reasons, is it wrong for me to even be here at all, hiding behind a pretentious veil of servitude? Nobody enjoys having their integrity questioned—least so when the questioning comes from within.

Thankfully, this dilemma comes with a silver lining. Anytime we are compelled to reflect on the virtue of our own intentions, we uncover a deeper appreciation for our most innate motives, helping us to better understand why we think and behave the way we do. The more we know about what inspires us from within to do good, the more we can inspire others to do the same. After all, most physicians know that they want to help people, but the greatest physicians can tell you why


Jason and Nitin’s Cooking Adventure - 
Always One Step Behind

by Nitin Agrawal, M1 and Jason Mallet, M1

Remediation. Something we all have feared going through medical school and something a few of us unfortunately have had to face. We don’t think that we can ever understand the true stress of remediation exams, but we do understand the stress of preparing meals when busy with school. That’s why we felt so fortunate to have the opportunity to help make meals for our friends who needed it most during remediation exams. What follows is a recipe for how to make a meal, featuring friends, class lov,e and some questionable “cooks”:

1)    Find a friend.

After hearing about the opportunity to help out our classmates who had to take remediation exams, we met up at noon to set out on a cooking adventure.

2)    Get coffee.

We went to Starbucks to get chai-flavored black gold, a crucial part of any endeavour in medical school.

3)    Look up recipes on the way to HEB.

We had planned to look up recipes the night before, but that obviously did not happen (procrastination at its finest). Mama Agarwal walked us through the main course, and a few minutes of googling helped us find the dessert recipe on the world famous Delish.com’s ‘Easy’ section.

4)    Get ingredients.

Jason held bell peppers up to the light, pretending to inspect them in order to fit in with more seasoned shoppers. We tried to convert ounces to liters but realized medical students have forgotten how to do math (thank goodness for the calculator on ExamSoft).

Johnny Football versus Alabama. Bleacher Report.

Johnny Football versus Alabama. Bleacher Report.

5)    Put on football ('Bama vs Florida).

Pretending the Aggies are in the SEC championship game, Gig ‘em!

6)    Start cooking and realize we are in over our heads; consult Puja (the real cook).

Jason cuts vegetables as Nitin mans the stove, until Puja walks in, gasps in horror, and exclaims “You’re doing it all wrong!”

Even after one semester of anatomy, we still lacked the cutting skills to properly cut vegetables. Sorry Dr. Chen!

7)    Finish main course.

Apply taco seasoning liberally.

8)    Start dessert, fail miserably.

That “Easy” dessert recipe in our hands became a complicated mess. Our recipe called for melted chocolate, but ours somehow ended up burnt and arguably more solidified than before.

9)    Go back to Walmart with Camille.

We were still clearly in over our heads once Puja left, so we called in Camille for reinforcements (thank goodness for medical school neighbors).

10)   Repurchase baking chocolate.

While we were buying baking chocolate, a kind stranger reminded us that the chocolate was not directly edible (our amateur cooking skills were clearly visible at this time).

11) Remake dessert.

Second time’s the charm!

12) Package the food.

Is a used nonfat yogurt container appropriate packaging? We consulted more of our classmates, Ghanshyam and Emma, for that decision.

13) Reflect on the experience over a beverage of choice.

Cooking this meal was an enjoyable experience, but it also served as a reminder that medical school is a difficult journey for everyone. While medical school requires a lot of individual effort, it is important to remember that in the end, medicine is truly a team sport. We are all working toward a common goal: improving the lives of our future patients. We must rely on one another through the good times and the bad. While we were fortunate not to have to remediate this block, we realize it could easily be any one of us next time. If either of us do have to remediate next block, we are expecting a 5-course meal (with extra taco seasoning).

P.S.: A special Thanks to Ghanshyam and Emma for organizing the meals!


Welcome to Planet Medicine
by Bevan Johnson, M1

Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more qualified to check a pulse than a two-year-old. Day one is the first and last day you will ever wear your pristine and spotless white cape—soon to be decorated with pen marks, coffee stains, and HIPAA-protected body fluids. It all begins as you shuffle down the dark and silent hallways into the medical abyss to embark on what seems like an endless journey. Correction. It is, in fact, endless.

After months and months of studying the geographical lay of the human body, you will impressively confirm it contains a heart, a brain, and occasionally a pack of kidney stones. You will go on to hunt for nerves, break nerves, memorize nerves, and nerves will get on your nerves. Once in the cranium, you will study the brainium. It’s no easy task to unravel the intricate and downright confusing array of synaptic fireworks that orchestrate life as we know it. The experience of the brain studying the brain is truly a great honor. Nowhere else in the solar system does this sort of conundrum occur—except in any introduction to neurology class, or in any twelve-year-old who has ever thought about what they were thinking about, or in 2010 when the film Inception was released. But besides these few scenarios, it will be entirely exclusive to you. Research shows it’s twice as amazing as a hospital operating without coffee. See no references at the end of this article.

The Texas A&M University Health Science Center in Bryan, Tx. Photo by Dr. Xin Wu.

The Texas A&M University Health Science Center in Bryan, Tx. Photo by Dr. Xin Wu.

On planet medicine, what was normal before is no longer normal now. The more drugs you can fit in between your ears, the more heroic you become. Instead of receiving a recommendation for rehab, you receive a high grade for pharmacology. Rather than exhibiting the usual side effects of a typical drug abuser, medical planet residents are often found talking to themselves, banging their heads on desks and other hard surfaces, and cycling viciously through labeled white index cards. At high doses, these individuals may even interrupt their procrastination sessions to actually study—very rare. Treatment for this includes lying horizontal for long periods at a time, which allows for the slow leak of knowledge out of the ears. If the individual prefers to remain vertical, bars will sell them mysterious liquids that promote head shaking and sideways walking—allowing for moderate ear leakage. This vertical method is known to have some adverse side effects.

Similarly, sports are completely different on planet medicine. As time passes, you increase your participation in full contact clinical skills. Day one you prove to have strong Wi-Fi contact, next you learn good eye contact, and finally you partake in full contact. Unlike in other sports, where opposing teams are allowed comparable equipment and swagger, the rules here allow the provider various weapons while the patient is given a gown and insurance number. In most cases, neither team wears a helmet—except orthopedics, where you can’t tell the difference between an astronaut and a surgeon. Another point of difference is that many sports use gloves. While other sports aim to catch things with their gloves, planet medicine sports attempt to avoid things with their gloves. Research suggests Chuck Norris is predominantly responsible for this evolutionary divergence.

At the end of four long decades (equivalent to four earth years), you are finally ready to return to the world as you previously knew it. “No more studying”—not true. “No more long hours”—definitely not true. “And no more complaining about school”—true, residency is now your chief complaint.

So why do brave young souls hop on the inter-synaptic, intergalactic neuronal train that only stops at 911 Medical Avenue? It’s simple. Neurological cognitive behavioral research concerned with alpha, gamma, and Alabama neurons shows that subsets of the human population that are geared toward altruistic maintenance of the human condition would markedly attenuate their self-actualization by pursuing any other vocational endeavor. Although none of this is necessarily proven or true, it’s as clear as cataracts.

The reason someone gets off the train at planet medicine and chooses to ride the solar cycle four times, to complete the cell cycle one trillion times, and to never understand the Krebs cycle even one time is different for each person. The opportunity to avoid a real job for four more years might be the seller, the chance to be part of the world of medicine may seem stellar, or the ability to heal others could be the propeller. But in all cases across the spectrum, the individual has sensed a significant calling to serve others (p-value: <0.0001). This person isn’t afraid of trauma, disease, or the uncertainty of what may come through the doors. He or she is driven by passion, curiosity, and caffeine.

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On Becoming a Change Agent:  Reflections on My Experience in a Quality Improvement Initiative
by Jacob Cobb, M4

Artwork by Jessica Meyer, M4.

Artwork by Jessica Meyer, M4.

Currently within the United States healthcare system, there is a substantial drive toward achieving quality care (1). As a result of this push, many (if not most) hospitals and hospital systems in the United States are manning quality improvement initiatives in preparation for the coming value-based repayment revolution that the Centers for Medicare and Medicaid Services (CMS) is planning on implementing in the future (2). As a third year medical student, I was given the opportunity to be part of one such initiative at a small community hospital in the Round Rock, Texas area. I jumped at the opportunity to get involved and to help re-shape current medical practices for the better. Now, more than a year into this project, I’ve had some time to reflect on our progress and our shortcomings and wanted to express those to my colleagues.  

Our cause was to improve care for patients with sepsis. Although a formidable task, considerable groundwork has been done on this issue, and consensus recommendations have come out from an international committee standardizing care for patients with sepsis (3). Through multiple studies, the consensus group was able to show that early standardized intervention reduces morbidity and mortality of patients with sepsis. Because of this foundational work, I had thought that our job of implementing a quality improvement (QI) initiative would be fairly straightforward. However, I could not have been more wrong. Throughout my tenure working on this project with my colleagues in the QI department, we (mostly they) endured countless unprofessional responses to our efforts. As a matter of fact, when my colleagues take to the wards to do their daily quality rounds, it’s quite common for them to come back and tell stories of encounters with healthcare providers at all levels (nursing aides, nurses, physician assistants, nurse practitioners, physicians, unit supervisors) that are the epitome of unprofessional behavior. Those in the QI department face anything from thinly veiled animosity by the clinical staff to having doors forcibly shut in their faces. This is a rampant problem.  

Let’s take a step back for a second; we are ALL on the same side here. We ALL want what is best for the patient. Why, then, were we faced with animosity and malice? Why, then, the resistance to evidence-based medical interventions? Unfortunately, the majority of medical care delivered is still not actually evidence based (4). Yet, in areas of medical care where evidence-based interventions have been standardized, we have seen improved patient outcomes.  The two most obvious examples that come to my mind are the care of patients having acute myocardial infarctions and ischemic cerebrovascular accidents. You would be hard-pressed to find a healthcare provider who doesn’t follow the concept that early, standardized, evidence-based care for patients with these conditions is pivotal in reducing morbidity and mortality related to said conditions. These concepts have become so pervasive in the medical culture that the phrases “time is muscle” and “time is brain” have become ubiquitous. Why, then, are some of us still so unwilling to accept changes in clinical recommendations? Why are we so recalcitrant and rigid about changing our own clinical practices to align them better with the best evidence we currently have?    

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We have seen progress at our small community hospital. Demonstrable and tangible improvements have been made. One such example is that we are attempting to cut the time from first point of access of care to administration of antibiotics to less than one hour (again, in compliance with evidence-based guidelines). We are currently integrating medical students in their third and fourth years of clinical education into this QI project, teaching them the basics of how such a project is run with the hope of creating new physician champions for QI initiatives in the future. These are all steps in the right direction. Personally, I have learned an incredible amount about what it means to be a team player, how a QI project works, and also how to manage my own expectations in order handle failure and other shortcomings. However, another item that I have learned a great deal from is the “hidden curriculum.”

Ask five healthcare providers what the “hidden curriculum” means to them and you will likely get five different answers. Others have defined it as “the attitudes conveyed, sometimes unintentionally via the educational structures, practices, and culture of an educational institution" (5). To me, the “hidden curriculum” is a set of attitudes that some healthcare providers have toward both medical education and the delivery of healthcare services to patients. Tied up in these attitudes is a sense of “this is the way it has always been and always will be.” These attitudes are, in my humble opinion, some of the most dangerous sentiments one can possess when practicing medicine in any form.  In short, they convey a sense of complacency with the status quo. Yet, most healthcare providers would agree that the way we currently practice medicine is not ideal, and there is room for improvement (6). I am alarmed by the possibility of raising new medical professionals in this environment of complacency with the current system. It has been shown that these attitudes, when left unchecked, produce problems associated with “power, hierarchy, and social class" (7). It’s a quintessential catch-22, and I hope to incite my colleagues and fellow healthcare students to be change agents.  

Don’t simply accept the status quo. If we had accepted the status quo, we would not have made any of the advancements we relish in modern medicine: antibiotics, new chemotherapeutics, laparoscopic and robotic surgery, etc. It was only through radical research and quality improvement efforts that we discovered and implemented these now commonplace practices. Don’t approach those of us involved in QI as adversaries. Most of all, do not compromise your values and professionalism. Stand up for us, your colleagues. These efforts are necessary, as our current healthcare system is simply unsustainable. Those of us involved in QI are trying to make the system better, and while it may feel burdensome to you as a current or future provider of healthcare services, quite frankly, we are simply doing our job. 

I further implore that my colleagues consider becoming involved in QI measures at their current and future institutions. If we are indeed unhappy as healthcare providers with the current state of healthcare delivery in our nation, then what are WE doing about it at a local level? We cannot simply pass the responsibility to others. We must take ownership of the effects of our own actions on the system as a whole. Change starts with individuals. If you are unsure how you can become involved, start by simply speaking with the QI department or QI professionals at your current or future institution.  

In closing, I am incredibly grateful for the experiences I have had as a medical student in QI. However, I am alarmed at the prevailing attitudes of resistance toward implementing QI interventions that I have experienced from a range of healthcare providers.  I am also determined to continue striving to create better care environments for my patients, starting with my own practices and then expanding from there. Will you join this cause, or will you be complacent with medicine as it currently is delivered? An old adage is called to mind that perfectly sums up my sentiments on this matter: if you always do what you’ve always done, you’ll always get what you’ve always gotten.  

Let’s do better together. Let’s be change agents.

See references.


Rejection
Anonymous

Dizzy Plexus. Artwork by Hasan Samdani, M1. 

Dizzy Plexus. Artwork by Hasan Samdani, M1. 

“Dear applicant, we regret to inform you…” the rest of the words trailed off as my frustration mounted. I nearly fell off the treadmill during my evening run. My one big break, my one chance for a life-defining moment was abruptly cut short by this tactless email. I had bared my soul for this application. I’d applied to this program describing my ideas, passions, and dreams, believing the program would fit me perfectly. Apparently, all this wasn’t enough.

I believe all of us have been through one of these moments. Whether in person, by letter, or by email, we have all, at some point, experienced the harrowing frustration of rejection. No matter how much of our work, studies, and preoccupations we use to bury our insecurities, they somehow boil to the forefront of our consciousness when we face a rejection. It is an uncomfortable and isolating feeling.

Rejection has found me multiple times. The academic medical setting, where I’ve found my passion, has been my largest disillusionment. I’ve been told that my passion for people is tangible and that I will make a great doctor one day. However, rejections from humanitarian societies and academic organizations have caused me to believe otherwise. I feel inadequate. I feel my passions are misplaced. I believe I will never be good enough.

Over the years I’ve realized this is not a unique feeling. School continues, hours pass by, and, inevitably, insecurities build into our subconscious. Thoughts race: Am I smart enough? Am I compassionate enough? Do my peers think I’m competent? The judgmental self-interrogation is endless. Rejection orates a resounding “No!” to all of these questions of insufficiency.

But we’ve perceived rejection all wrong. Rejection does not mean we are not cut out for the job. Rejection does not mean we are inadequate. Rejection does not mean our passions are misplaced. Rejection is not an indication that our goals are unobtainable.

Even though this moment of rejection stole my “big break,” I found that rejection was a defining moment. Rejection itself is not a limitation, but it is a sign that I pushed my limit. It is a sign that I did all I could to see what barriers I could break and what expectations I could exceed. Rejection did not magnify my insecurities, but it simply revealed the next direction for my passions.

Like many of you reading this, I have a passion for helping others. And, like most of you, I’ve been told I’ll be exceptional in helping those in need. It does not take the acceptance of an honor society, the honors-pass of a course, or the acceptance into a competitive program for you to follow your passions. Our passions, inborn and uniquely inspired, are not determined or defined by those around us; rather, our own hearts and minds determine our passions. Rejection is a sign that we are pushing ourselves to the limit—that we are living our passions boldly, without retreating when they are pushed aside.

If you are personally facing rejection, please remember this: your passions are not misplaced; rejections do not invalidate your dreams; no individual or organization can determine who you become. Be strong. Be tenacious. Take heart, and don’t let rejection derail your journey.  


Room 105
by Iqra Qureshi, M1

Dylan sighed. “No matter how fast I type or how quickly I move around, I’m always falling behind.”

“The trick to keeping up,” Dr. Hays responded, “is to stay a few steps ahead.”

It was another day at a new job at a local ER. Suddenly, Dylan heard the unit secretary’s voice.

Venice of the East. Photo by Puja Panwar, M1. 

Venice of the East. Photo by Puja Panwar, M1. 

“Oh, that’s frightening. I’m so sorry about that.”

Dylan turned to look at her.

“The doctors here will be able to handle it,” she continued.

It was obvious to him how annoyed she was even though she knew how to hide it.

“Yes, ma’am. Yes.” He could faintly hear something from the phone. “Of course. I’m so sorry.”

When she finally put the phone down, she turned to Dylan and Dr. Hays.

“Febrile seizure kid’s on the way. That was the mom.”

“Great, that shouldn’t be too hard,” Dr. Hays responded. “You can get the chart started before they get here. She’ll be in Room 105.”

“All right.” Dylan got to work, but something occurred to him—it was a small detail, but no one knows which rooms the patients will go to when they check in.

“How did you know that?” he asked.

“Those rooms,” Dr. Hays responded while pointing down the hallway, “are where the people who aren’t in that much trouble go, and the rest of the rooms in that corner are full.”

Dr. Hays not only had 360 vision, excellent foresight, and a plan to handle anything that could possibly happen, but also a way of seeing right through people. Dr. Hays seemed to understand what someone was trying to say, their personality, and their motivation. Nothing that was going on could escape notice. Once, Dr. Hays and Dylan had seen a patient who was chattering with a smile on his face for almost ten minutes straight, but when they got back to the workstation after leaving the patient, Dr. Hays’ first remark was “Wow, he was mad.” Dylan would have never seen it.

Dylan’s thoughts were interrupted when the door opened and a herd of people came in. It was the child’s family. Just as the family was entering Room 105, a nurse came by and told Dr. Hays, “A lady just came in; she fell and probably has a broken arm.”

“Thank you,” Dr. Hays told the nurse. “Let’s go, Dylan.”

Dylan got up with the computer in one hand, frantically trying to start the chart.

“Don’t worry about the chart too much; do as much as you can in the room, and I’ll fill you in later.”

They started walking.

“When a patient comes in with a fracture,” Dr. Hays told him, "I try and go see them as soon as possible because they’re in pain.”

As they passed Room 105, the door was open.

“Oh, the doctors could care less about the patients. All they really want is—” The door shut.

“How sad,” Dr. Hays mentioned. “Now we’ll never know what we really want.”

Dylan smiled. Soon after they treated the lady with the broken arm and referred her to Ortho, they were ready to see the child. When they entered, they were met with about 6 or 7 pairs of distrusting eyes. Dylan instantly felt uncomfortable and criticized. Dr. Hays did a full physical exam and told them that the child was going to be okay, but the family wasn’t convinced, and their concern translated into an argument. Dr. Hays brought up the data, but they were convinced there was something terribly wrong with the kid and Dr. Hays wasn’t seeing it. Dylan could tell that Dr. Hays already knew what they would say, how they would act, and how to handle it.

When they were back at their station, Dr. Hays told Dylan: “I wish it were more widely known that febrile seizures aren’t a big deal. But I suppose with all those awful stories people hear about SIDS and kids getting real sick out of nowhere and all, it must be the scariest thing to a family.”

“That’s true,” Dylan agreed. He had never thought of it that way, that the family’s seemingly disrespectful response was due to legitimate concern. Dylan realized that Dr. Hays’ patience was born of sincere empathy. Dr. Hays could see the febrile seizure the way the family would have seen it.

“That was quite an unpleasant experience though, wasn’t it?” Dr. Hays asked.

Dylan nodded.

“Don’t let it get to you. They didn’t know any better, and people's misunderstandings don’t make you worth any less. Exercise it off, spend time with family and friends, eat well, sleep as well as possible, and you’ll get through. The things you do every day to keep yourself sane will save you throughout the years.”

“That’s true,” Dylan agreed. His mind wandered, and he fixed his gaze at a jar of pens, furrowed his brows, and stared at them with a worried expression. He admired Dr. Hays' ability to avoid taking people's rudeness personally, but she was an expert in the art. How he would be able to match that level of refinement was beyond him. He wondered how he would be able to juggle everything outside his career while mastering his skills. How would he be able to notice the subtle, fleeting things she noticed, handle what she handled, and keep his calm the way she did? How could he avoid taking such scathing attacks personally and deal with his goodwill coming under question through no fault of his own? How would he be able to do his job well, keep his sanity, make time for himself, and keep his morale high? How?

“Keep trying,” Dr. Hays assured him. “You’ll eventually figure it out.” 

Red, White, Blue Forever, photo by Dr. Xin Wu.

Red, White, Blue Forever, photo by Dr. Xin Wu.


Hanna Fanous, Copy Editor
Garret Hisle, Copy Editor
Hasan Sumdani, Copy Editor
Anandini Rao, Copy Editor

Puja Panwar, Chairman of the Board
Alexander Hsu, Managing Editor
Hailey Driscoll, Acquisition Editor
Bevan Johnson, Design Editor
Britton Eastburn, Design Editor

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A special thanks to... 
Dr. Karen Wakefield for being our faculty editor,
Dr. Barbara Gastel for serving as editorial mentor,
and Dr. Gül Russell for providing support and encouragement.