End of M1
By Vivy Phan, M2
2 miles of level trail
2 miles of steep switchbacks
1 mile of rocky scramble
Finally at the top looking down
When I finally feel it
The weight of the uphill is released
It suddenly becomes clear
The switch is flipped
Adrenaline pulsing in the grade
In logic turning into words into action
Commitment to the self
Release of external holds
Finally at the top looking down
When I finally feel it
By Chikamuche Anyanwu, M4
Autumn leaf in wind
Wistfully dance to the breeze
She awaits her end
This is something I wrote last year after we were required to participate in the palliative care rotation as part of our AIM track responsibilities. A couple of my peers and I visited an end-of-life care facility near St. Joseph. The name eludes me now, but I won’t forget the look on the woman’s face I saw that day.
It wasn’t my first time there, and I had little tolerance at that time to being surrounded by death. What I was hoping to be a quick and easy visit was just that: a quick and easy visit. But the memory of her lasts till this day. She was this little old African-American lady. Calling her cachectic would be an overestimation of her description. Bones. Skin on bones, was what she was. They were repositioning her when I came in. At one point I feared that one wrong move and they would’ve fractured any number of bones on her body.
In contrast to the rigidity of her appearance, she was readily malleable. Her body moved with the ease and fluidity of silk. Her face, however, was hardened. You could tell she’d lived a tough life. One part of her face was affixed, but slightly lower than the other side. Stroke, I remember thinking. She had that crooked toughness you see in war veterans. Though she spoke in soft grunts, her demeanor screamed at me, “This ain’t nothing.”
They had placed her in a position that allowed her to face the window, because it was important that she get exposure to natural light. You could see the rays of the setting sun through her window. The warmth it carried was still evident within the room. And though she lay there, dilapidated in her state, the look in her dark brown eyes showed the strength in her will. She seemed ready to die. There was a certain melancholy amongst the nurses in the room. Disappointed that she had no family with her, they showered her with words of encouragement.
I, being who I am, stood at the very corner of the room. Silent, but observant. I’ve always had this superstitious belief that the further away from dying I am, the further away from death I’ll be. Not my death per se, but the deaths of those around me, especially my family and my patients. Of course I’ve been surrounded by dangerous situations growing up, but I have never witnessed actual death, nor do I care to do so. As an aspiring surgeon, it’s one of the things I hope to avoid, whether in a hospital room or on the operating table. I’ve heard, however, that it’s inevitable. It may take years to come to terms with this, but at the moment I would like to believe that I can do something to prevent it. I don’t know if the lady I’m talking about has passed away. I do know, however, that at that moment when I saw her, she was ready. I can only hope that that when our time comes, we too can face it as she did: with the sun on her skin, the calm of her heart, and the determination in her eyes.
By Eric Estrada, MD
Editorial note: Dr. Estrada is in the CHRISTUS Health-Spohn Texas A&M Family Medicine Residency Program Class of 2020 in Corpus Christi, Texas.
It’s official—I, along with many others across the country, am no longer an intern. We have survived the sometimes brutal, but necessary, transition in our careers where we finally take charge as physicians for the patients we care for. The growth I have undergone as a doctor over the past 12 months is obvious to all around me—the staff, my attendings, my patients, my peers, and myself. I feel—and am—more capable of tackling any challenge that presents to me, whether it be in clinic, the wards, or night shifts.
While the title of “Upper Level” is one I’ll be growing into over the next year, I am still responsible for supervising and guiding the new residents paired with me during any given rotation from day 1 of 2nd year. This is probably the one thing I feel I am not ready to take on just yet, as I have just recently mastered the flow of things myself.
Nonetheless, I hope to take my experiences from my intern year and use them to help guide me into the upper level I’d like to be: patient, approachable, and calm enough to let the new doc make their own decisions and mistakes, all while ensuring patients are receiving the best standard of care we’d expect for ourselves and our families.
I may no longer be the new kid on the block, but that doesn’t mean I don’t have more to learn. I am excited to see what the next year of residency brings, to continue learning from my patients and my attendings, but most of all to see the same growth I experienced during my intern year in this new class of residents. Good luck Interns, it’s going to be a great year for all of us!
Musings on Medical School: Week One
Michelle Won, M1
Interview with Carrie L. Byington, MD
By Mouctika Paluri, M2
Carrie L. Byington, MD, serves as dean of the Texas A&M College of Medicine, senior vice president of the Texas A&M University Health Science Center, and vice chancellor for health services of the Texas A&M University System. Dr. Byington's research has focused primarily on bacterial and viral respiratory pathogens in children. A national leader in pediatrics and infectious disease, she has received awards from the Robert Wood Johnson Foundation, the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the National Institutes of Health. Notably, she is also an elected member of the National Academy of Medicine and National Academy of Inventors. Dr. Byington is both board certified and nationally recognized in both general pediatrics and pediatric infectious diseases. She received her bachelor of science in biology from Texas A&M University and doctor of medicine from Baylor College of Medicine, both with honors. She trained in pediatrics at Texas Children's Hospital and completed a fellowship in pediatric infectious diseases at the University of California, San Francisco.
MP: What led you to specialize in pediatric infectious disease?
CB: Sure—I have always loved microbes and infectious diseases, even from a very young age. As an undergraduate at Texas A&M, I took some classes in microbiology, and it just seemed to come easily to me. Slowly, as my knowledge and interest in pediatrics grew, it became clear that infection was the number one cause of illness in children. That just made me even more interested in infectious disease (ID) as a specialty. I loved the intellectual challenge of ID. Oftentimes, it really is like a puzzle—figuring out what infectious disease or microbial pathogen, virus, or bacteria is present. But, when you find it, there is usually something you can do about it. It was both exciting and rewarding for me, as a physician, to be able to make a diagnosis and give an appropriate, effective treatment that actually helped the patient recover. However, now that we’re in the era of antimicrobial resistance, everything is different and I am pleased to be working with investigators at Texas A&M to find new solutions.
MP: Was ID a popular specialty when you graduated from medical school?
CB: No, not at all! I recently delivered the keynote speech for the residency commencement at Houston Methodist Hospital and I said, “You know, I’m an infectious disease physician—the ultimate nerd of medicine.” The heyday for ID was in the 1900s when antibiotics were being developed, and by the 1960s infectious disease was considered an obsolete specialty. However, with the emergence of HIV in the 1980s, increasing antimicrobial resistance, pandemics, newly recognized pathogens like Ebola and Zika, and climate change, there’s a lot more interest in ID today.
MP: Could you tell us a little bit about how your career led you back to the Health Science Center and to A&M?
CB: I was a very happy practicing pediatrician and investigator in Utah, but what I would say led me back here was the potential that I saw at Texas A&M. It is a very interesting time in the healthcare in the United States, and I believe transformation is required. As a practicing physician, I would say, “This can be better, this has to be better.” It has to be better not only for all children but also for all Americans. We all deserve to have affordable healthcare and the positive health outcomes we want. I began to become very interested in healthcare transformation over the last 5 to 10 years. When I looked at what A&M had to offer, I saw that we possessed a lot of the ingredients needed for meaningful transformation and I hoped that we could put these ingredients together to produce a health system for the 21st century.
One of the things that we don’t have is a hospital, and I think for the first time in our history, that’s an advantage. It is an advantage because the way we deliver healthcare in the 21st century is going to be outside the walls of a hospital and will mean moving closer and closer to where patients live, work, and go to school. That’s not to say that we will never need a hospital. Today, a lot of things must be done in a hospital—complicated surgeries, chemotherapies, intensive care, etc. But a lot is being pushed out to the community. Texas A&M, as a land grant school, has a mission to serve all the counties of Texas. That mission aligns beautifully with population health, community-based health, and addressing health disparities. I see potential for Texas A&M to lead healthcare transformation in Texas and in the US.
MP: What is your vision for building a closer relationship between students and administration?
CB: Well, I love to try to get to know all of the students. The number of campuses has been a challenge. I have visited all the campuses, of course, and I am always looking for ways to increase face-to-face contact and open dialogue with students. This is how we can learn the most about each other. I can hear about the stressors and the priorities of the students. Some of our discussions have led us to review our approach to best prepare students for Step 1. We have also talked about how we can get more clinical experience, including electives, built into the curriculum. When I hear student concerns, they become priorities for me to work on as dean with our leadership. We have made a lot of progress in preparing for Step 1 and in increasing clinical exposure. However, I still haven’t been able to address the issue of food on our campuses. I am still working on that!
MP: Could you tell us about where you see our medical school or the medical community going in the future?
CB: I really see us making a name for the Texas A&M College of Medicine in Texas and beyond. The Texas A&M College of Medicine has a lot of strengths. One of our greatest strengths is our commitment to A&M core values and traditions. For the new students starting in July, the orientation looked really different. Orientation was based around our core values and our identification as Aggie healthcare providers. We have a name and a reputation that identifies us across the state. People know and recognize Texas A&M, they know what A&M stands for, and I want them to see that we stand for those values in healthcare. We also have strong traditions at Texas A&M, and I am excited that we will begin to focus more on the tradition of Aggie rings. You will be hearing about this very soon! We’re going to be announcing ring scholarships that our faculty and staff are supporting. As Aggie physicians and scientists, we are all tied together by our values.
The second thing that’s really important to me is that we excel. I want the state of Texas to look to us as a unique resource. I would like for us to excel in rural population health because of our land-grant mission, because of where we’re located here, and because we have real expertise in that area. Beyond this, Texas as a state is struggling with access and delivery of healthcare to its rural populations. I also want us to excel in military medicine, which honors another A&M tradition. This includes caring for those on active duty and veterans. I would like to bring medical students to our campus who intend to have careers in military medicine and who are either going to be commissioned when they graduate or are veterans of military service. I’d like us to be known as a military friendly campus. In the coming year, we are going to be adding a department of military medicine. We’ll be adding military content to the curriculum with the help of Dr. Israel Liberzon, our new head of psychiatry and an expert in post-traumatic stress disorder in veterans. We have expanded our elective and clerkship rotations to Fort Hood and to the 59th Medical Wing in San Antonio, and we are working to expand clinical experiences and service delivery in the Temple, Waco, and College Station VA facilities.
The third area of emphasis for me is engineering medicine. We are amongst the first in the nation to launch such a program. We have hired leaders, including Dr. Rod Pettigrew, in the last year, and we have invested in developing the Houston campus to support EnMed. We are interviewing applicants now for the inaugural class of EnMed, which will matriculate in July of 2019. Over the next few years, we will add engineering and technology content into our curriculum, first on the Houston campus and later on all of our campuses.
MP: What are your thoughts on the role of the humanities in medicine?
CB: We cannot be physicians without being human. I have this discussion with the dean of engineering regularly. We both believe that artificial intelligence (AI) has a role to play in medicine and will certainly be a part of engineering medicine. However, I contend, AI will not replace human physicians. I believe there will always be a role for humanity and human connection in medicine. Physicians who can look you in the eye and hear your concerns are those who are able to understand the human condition. Medical training that includes art, literature, poetry, and experiences with individuals from all walks of life and from all over the world is vital. These experiences make us well-rounded physicians and better human beings.
I have embraced the humanities in my own life. My youngest child is an artist, and as a family, we have spent a lot of time in art museums. I also read widely, and it is a primary way that I learn. I read about science every morning, and I read novels, essays, or poetry in the evenings. Reading has been very enriching to my own life as a physician, and it’s touched my research in a number of ways. For example, the last paper I published was a collaborative work that I did with the theater department in Utah—we examined the impact of a play about genetic research on the audience members and how the play influenced their willingness to participate in genetic research and how they felt about informed consent for research. Using a theatrical production is a novel way of trying to understand a scientific research problem. I am a big believer in the humanities in medicine and so proud that one of the founding departments of the College of Medicine is Medical Humanities.
MP: What are a few milestones or turning points you can think of in your career? What have those meant to you, and how do they shape the way you think?
CB: There are a lot of things that I reflect on. I had some hurdles to overcome within my own family and community about the role of women in science and medicine. When my family realized that I was doing well in science courses and that I was getting interviews for medical school, there was a real turning point where they got behind me and became my greatest advocates. That was a milestone. Then, in medical school and after, I suffered a little bit of impostor syndrome—maybe a lot of impostor syndrome. There was a turning point that I had to make in my career where I acknowledged that I really did belong in academic medicine. I was making contributions that were equal to those around me. That’s a hard thing for many women and underrepresented minorities to recognize. It took a long time, and I was a full professor before I recovered from impostor syndrome.
Finally, I had a brush with illness myself—when I was 42, I was diagnosed with breast cancer. For a year, I was unable to see patients because of the chemotherapy. That was another real turning point in my career. I spent a lot of time writing grants and papers. I was in my office a lot more than I had been when I was on the wards seeing patients, and I learned that I could be a good mentor to young people during that time. I also realized that was a very fulfilling part of my work. My career took a little bit of a different path after that.
We come into medicine from a lot of different directions, and we experience many things in our lives in medicine. Those experiences shape who we are, and they fold our trajectory. I’m not happy that I had cancer, but I know I would not be sitting here talking to you today if that had not happened. Sometimes our lives take us to places we didn’t expect to go.
Fun facts about Dr. Byington!
Favorite place to eat in BCS: This is a tough one for me! I spend a lot of time at The Stella [Hotel] for business meals, so I want to give them a shout-out. The Stella has been so helpful with all of the recruiting we have been doing for the College of Medicine and the Health Science Center. My very favorite thing to eat there is breakfast. A treat for me is to walk to The Stella on Saturday or Sunday and stop for breakfast. I always order the crème fraiche waffles served with berries, and they are awesome!
Changes in BCS since undergrad: Oh my gosh, it’s unrecognizable! I was as lost as lost could be when I returned. First, BCS has grown. None of the places I go to today were here in the 1980s! Secondly, the medical school was not in Bryan. When I was here as an undergraduate, the entire medical school was in the Reynolds Building. I used to walk from my dorm room in Haas Hall to the Reynolds Building to participate in research in the physiology department. BCS and the campus is a different place now and I love it. I love all the changes and I love living in Bryan.
Favorite book: I have hundreds and hundreds of books to suggest [Please check out the Dean’s Bookshelf at https://www.tamhsc.edu/about/leadership/svp/bookshelf.html.] One novel that people might enjoy is Cutting for Stone, by Dr. Abraham Verghese. It takes place in Ethiopia, an interesting political and cultural setting for the story of twin brothers from a mixed-race union where the father was a physician and the mother was a nun. It is a fascinating story, the medicine is accurate, and there is also a very humanistic quality to the book—reflecting on what it means to be a physician. I loved it.
I also like to read poetry, and Mary Oliver is my favorite poet. One of the beautiful poems that I share with young people is called “When I am Among the Trees.” Here are the last lines—“It is simple, they say / And you too have come / Into the world to do this, to go easy, to be filled / With light, and to shine.” That’s why we’re here, and when I look at the medical students, that is what I see. I see you shining.
[Dr. Byington is also an avid Harry Potter fan and has read the entire series to both of her children as bedtime stories. She’s a proud Gryffindor and has visited Harry Potter World in both Orlando and Hollywood!]
Favorite hobby: I love walking, and I am training right now to go walk the Camino de Santiago in Spain. I’m going to do that in October. I’m going with my sister, and we will be walking about 100 miles—we are really excited about that!
I also love to travel. Since returning to Texas A&M, I have been able to visit so many different parts of Texas as part of my job. The last place I visited for vacation was Scotland in June of 2017, when I took my daughter to visit the University of Edinburgh, where she is starting school in September in the College of Art and Art History.
Words of wisdom for the incoming M1s and the new school year: I can’t wait for the new school year—we have lots of great things planned, and it is going to be a fun year. I would remind everyone to come to the tailgates! Tailgates start August 30—we have a tailgate for every home game and there is always food and drink. The tailgates are 3 hours before each game. Our tent is across from the MSC, and you do not have to have a ticket to the game to come. Lots of people come socialize, have fun, and meet students from other colleges and other campuses. Tailgates are fun, please come! August 30th is the first one!
Haiti: Land of High Mountains
Text and Photos by Deepam Joseph and Lauren Wilding, M4s
You leave the Port-au-Prince airport squeezed in a van and it hits you. The sights. The smells. The sounds. And you realize just what it means to be in a country where most of the population lives on under two dollars a day. Where unemployment is rampant. Where family structures have broken down and women are left to care for children alone. You realize that here, everyone is poor. There is no middle class. There is no considerable difference in socio-economic status between rural and urban areas. The population of Port-au-Prince is 2.7 million—larger than that of Houston. Yet at night, a huge portion of the city sits in darkness—most of the electricity runs off generators.
We just returned from a two-week trip to Thomazeau, Haiti, with Live Beyond, a Christian relief/development organization started by Dr. David Vanderpool and his wife, Laurie, after Hurricane Katrina in 2005. They began relief efforts in Haiti two days after the 2010 earthquake. They now live there full-time and host various mission teams each month. Thomazeau is a rural village area about one and a half hours east of Port-au-Prince. While there, we assisted with Live Beyond’s medical clinic alongside a Haitian doctor, an extensive Haitian staff and other providers from the US.
Haiti’s official religion is listed as Roman Catholicism, but in reality Voodoo is Haiti’s national religion and is practiced in some form by most Haitians. Despite common descriptions of Voodoo as a benign island religion, this is not the reality. Superstitions propagated by Voodoo priests have huge negative impacts on the health of Haitians. From fire rituals that leave people with third degree burns to tetrodotoxin darts used by Voodoo priests to make “zombies,” this belief system leaves destruction in its wake. There are also important implications for the health of infants—women are told it is bad luck to have their babies with anyone else in the room, so most of them have their babies on dirt floors in mud huts instead of coming to the clinic. Priests tie tight threads around babies’ abdomens, necks, or arms to ward off “curses/spirits/bad luck.” Women are often told their breast milk has “soured” and to quit breastfeeding, which is a death sentence for Haitian babies with no other source of nutrition. We met a mom and her three-pound infant who was the only one of a set of triplets to survive. This was especially sobering for Lauren, who is herself a triplet. It is incredible this infant and her mom survived at all! The effort these women make to come to the clinics is staggering—many will walk for hours just to be seen for a relatively short period inside.
On the morning of our first clinic day, Dr. Vanderpool declared, “You’re going to see Jesus in the people you meet today, and you will get to be Jesus to them in return.” The energy built around us as we set up our supplies and finished a rapid 30-minute Creole language cram session. We stood to welcome our first patients—a mother and her four children. They had walked several hours to reach this clinic. We asked in our broken Creole, “Ki problem ki genyen?” ("What problem do you have?”) Taking a deep breath, the mother released a rapid flow of concerns for each of her children, and the inflection of her voice conveyed her agony. Our eyes darted back and forth, following the universal language of her pointing fingers, and the picture she painted became clearer and clearer. The Haitian translator conveyed her words—the children weren’t eating well and were steadily losing weight. Examining them one by one, we discovered “doughy” abdomens—a common finding that indicates intestinal worms. We explained this through the translator and treated each child with an albendazole tablet after a lollipop bribe. (Children are the same everywhere!) The joy and relief on their mother’s face impacted us deeply—it was so easy for us to offer a simple tablet, yet this was hugely significant for this mother and her children.
These are the challenges Live Beyond is up against, yet they are seeing amazing changes every day. Having been to the Live Beyond base four years ago, Lauren was inspired by the changes she saw on this trip—the demonstration farm, which had only been a dream, has come to fruition. The clinic and school buildings have been completed. The maternal health program has seen the infant mortality rate drop by 60% in the region through education, nutrition, and vitamins. Those in Live Beyond’s feeding program for malnourished children are now thriving. Haitians are turning away from Voodoo practices and being healed physically, emotionally, and spiritually.
The name Haiti comes from an indigenous word meaning “land of high mountains.” Haiti indeed has a multitude of high mountains it continues to face. The Vanderpools’ vision is to continue pushing back the darkness that exists in Haiti and advancing the kingdom of light. Live Beyond strives to preserve the dignity of the Haitian people by empowering them to change their country instead of giving handouts. Darkness has characterized Haiti for so much of its history, but the Live Beyond staff continues to have great hope for Haiti’s future. There is still so much work to do, but Haiti is being transformed one life at a time.
By Madeline Clyde, M2
Editorial note: Names have been changed to protect identities.
“YOU THINK YOU’RE TAYLOR SWIFT, B****?!”
The endearing words of Krystal Rye.
Krystal came to the Parkland ER every other day for dialysis, and she always came by ambulance. She had recently developed a nasty biting habit, and her nursing home staff, rather than falling prey, opted to pack her a big bag of her favorite snacks and call EMS to take her. Krystal gave you the image of a grotesquely overgrown baby as they rolled her down the hallway. Roughly 55 years old, she allegedly experienced a “traumatic brain injury in the past,” but no one seemed to know any details other than the fact that she came for dialysis and her blood sugar was always a near-crisis—one not helped by her snack pack, which today consisted of a collection of different puddings. In this particular moment, she sat on the hospital stretcher cross-legged, in a pink graphic tee and an adult diaper, with her enormous belly spilling out between the two. She had light brown hair in mismatched pigtails streaked heavily with gray, and wide, unblinking eyes that always seemed to be on the verge of popping out of her head—reminiscent of one of those troll dolls. She had essentially splatter-painted herself (and the EMT) with the contents of the roughly eight empty pudding cups that surrounded her, one of which had suctioned itself onto her upper thigh.
The “Taylor Swift” comment was directed at me. She said that every time she saw me—presumably because I was the only blonde one in sight, and it had come to be an almost familiar greeting in the otherwise racing ER. I reflexively, and pointlessly, tried to explain to her that I did not, in fact, think that I was Taylor Swift, thank you very much, but it was cut short by a loud, “HI THERE MISS KRYSTAL, HOW ARE YOU FEELING, WE’RE GOING TO GET SOME LABS TODAY, OKAY SWEETHEART?” Krystal responded by muttering unintelligible expletives, reaching her hand into her diaper, and smearing fecal matter on the nurse’s arm.
I had been working as a scribe for about 6 months at this point, and someone had developed a “Krystal Rye dot phrase” where you would type “.krystal” and it would auto-populate her EMR, since her note was basically the same every single time she came in. Interestingly enough, I actually typed her note up every single time and couldn’t bring myself to use the dot phrase. Maybe it was because I sort of liked her and felt it was more respectful to put in the effort, but more so because I was scared that one day I would forget her.
The very first patient I saw at Parkland was my age and dying of AIDS. At 22 years old and in the middle of Dallas. In the room, the doctor talked, and the patient's mother wailed, and the patient's eyes stared out of his wasted body and I just suffocated. I was going to medical school and was going to be a doctor and wanted Chanel boots, and he was dying, and we lived five miles from each other. My age. The only words he finally said:
“But I was a dancer.”
That day, a few of the doctors told me different variations of, “It gets easier as you go on—it stops affecting you in the same way.” But why did I want to stop caring? Why did I have to lose the part of myself that brought me here in order to survive in it? If you go into medicine because you care about people, do you have to care less about people to provide the best care?
Each day after work, I walked through the overflowing waiting room to my car and promised, I will never forget those patients. If I could cling onto the memories of the patients at Parkland—“the least of these”—then maybe I could cling to the idealized vision of medicine that I had at the time. In retrospect, I failed. Some stuck. Gloria Richards, the African homeless lady who brought her dolls into the ER with her each morning. Dennis O’Reilly, who termed himself “Side-Pocket” and prostituted out of his colostomy hole for crack. Ian Black, an ex-NFL player with CTE who came in every day for “seizures,” but really wanted a sandwich. But I forgot the stories of the seemingly hundreds of heart failure patients. I forgot the litany of lacerations and fractures, the late-night overdoses, the countless chest pains and back pains and abdominal pains. The trauma patients who had stopped my own heart faded. I am hopeful, though, that at some point in my career when I struggle to find the balance between reckless care and professional compassion, I can glimpse at it through the wide eyes of my 22-year-old self. And still, whenever I hear Taylor Swift, I think of Krystal Rye and smile.
By Joanna Ma, M1
Getting the call that he had died of chronic heart failure—on the morning of a cardiology test—I felt like we were one.
We both had broken hearts, but in vastly different ways.
Sadly, I had mused before about the coming of his passing. I internalized his mortality with every anatomy lab visit. With every stroke of the chisel, pounding on the bones that held my cadaver’s eyes beneath, I felt jolts of despair ruminating on how it just as easily could be my own grandfather in a tank like this. Only an unknown loan of time separated him from the man I was working on.
Confiding in friends, I found the beauty in tragedy. How many friends smiled sadly and said, "I lost someone recently, too." How many offered to help me with notes, offered to cook for me, insisted I come out with them to dinner. How many didn't mind the storm clouds I carried above me and within me.
This is a community. Your friends won't let you drown.
I will stay afloat.
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