November 2017

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Why Medicine
By Julie England, M2

I grew up on a farm in West Central Texas. I have always drawn parallels between my family’s world of agriculture and our world of medicine. From evidence-based practice, to business, to lessons in integrity and compassion for others, these two worlds consistently mirror one another. The lines below illustrate the connections between my two favorite worlds:

In medicine, we have:

A long day of hard work, every day

A continuous supply of new problems to solve; and sometimes, the problems develop faster than the solutions

A calling to serve the world by treating and listening to its people

A responsibility to be wise stewards and protectors of our patients and their health

A family of people who work hard together

The realization that we have poured our work, our intelligence, and our hearts into meeting the basic needs of another. Hopefully, their life is better, fuller, richer, because we were there.

On my family’s farm, we have:

A long day of hard work, every day

A continuous supply of new problems to solve; and sometimes, the problems develop faster than the solutions

A calling to serve the world by feeding and clothing its people

A responsibility to be wise stewards and protectors of the land and its produce

A family of people who work hard together

The realization that we have poured our work, our intelligence, and our hearts into meeting the basic needs of another. Hopefully, their life is better, fuller, richer, because we were there.

Julie England, M2, and father, Lanny England, in their family's 2017 cotton crop in Runnels County Texas. Julie explains, "My dad's lessons in 'farmer logic' played a big role in developing my love for medicine." Photo from Julie England.

Julie England, M2, and father, Lanny England, in their family's 2017 cotton crop in Runnels County Texas. Julie explains, "My dad's lessons in 'farmer logic' played a big role in developing my love for medicine." Photo from Julie England.

Why medicine?
I have been working in this field my whole life. It is my purpose.
I have simply changed specialties from “farm kid” to “future physician.”


Interview with Barbara Gastel, MD, MPH
By Puja Panwar, M2

Barbara Gastel, MD, MPH faculty member and editorial mentor for The Synapse. Photo by Sarah Fulton, M2.

Barbara Gastel, MD, MPH faculty member and editorial mentor for The Synapse. Photo by Sarah Fulton, M2.

I understand you’re a medical school graduate whose career has focused largely on writing and editing. Can you give me a general outline of your career path?  

It began in elementary school—I always enjoyed books presenting medical narratives, for example about how they figured out what caused yellow fever. My interest in both science and writing continued through junior high and high school and developed into a double interest in science and journalism.

When I was in college, I was interested in everything and so entered a program called “combined sciences” where you could create your own major. Through this program I pursued a combined biology and history of medicine major.

I knew that after college I wanted to do something that combined biological sciences and communication. To me, the two logical possibilities were science journalism and something in a healthcare field.

Whatever I was going to do, a medical background would be helpful. So, I applied to medical school. I entered the Johns Hopkins University School of Medicine with a totally open mind regarding a career direction in medicine.

Once I got to medical school, medical humanities and writing were still my favorite parts.

I became a student assistant editor of the Johns Hopkins Medical Journal. I really liked working on that, and at the end of my third year of medical school, after much reflection, I decided to seek a career in medical communication.

At that time, I had a year of electives left. I spent my fourth year getting a master’s in public health. I took a lot of international health then, and I enjoyed the diversity of the public health school … There were people of all different nationalities and occupations and stages in life.

While classmates were applying for residencies, I was looking for jobs. I sent a letter and resume to NIH … and it led to a job at the National Institute on Aging. Meanwhile, I had applied for the AAAS Mass Media Science Fellows Program. That came through, and so I deferred working at NIA and spent the summer after medical school helping with the medicine section of Newsweek.

After working at NIA and elsewhere in government, I decided to focus on freelance writing and editing.  Soon after, though, I obtained a position teaching science writing at MIT. While there, I received a call saying that Beijing Medical College (now Peking University Health Science Center) was seeking someone to teach scientific writing. I took a leave of absence from MIT to teach in China for a year and ended up resigning from MIT to spend a second year in China. I taught in China from 1983 to 1985.

Between my 2 years of teaching in China, I attended a dinner party while back in America. At the dinner party I happened to sit across from the dean of the UCSF medical school. He asked if I’d be willing to come for some interviews, and then I was offered a job as assistant dean for teaching at the UCSF medical school. I spent 4 years there after coming back from China, but I didn’t see myself spending the rest of my life as a medical school administrator … so I started looking around.

I saw that the Texas A&M journalism department had a job with a science writing emphasis. I came for an interview and was offered a faculty position in the journalism department; I received a joint appointment in the Department of Humanities in Medicine. A few years later, the science journalism master’s program started, and I’ve headed this program most of the time since. Since 2004, when the journalism department closed, I’ve been in the Department of Veterinary Integrative Biosciences, where my work has included designing the main writing-intensive courses for biomedical sciences undergraduate majors. Now, most of my teaching is graduate teaching in science journalism and medical humanities teaching.

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That is quite the non-traditional route! Do you ever feel like you would want to have done your residency, or know what you would’ve gone into?

I feel like I did the equivalent of a residency in my own field. My summer at Newsweek and my time at NIH served as excellent postgraduate education.

I also feel that I use almost all the components of my medical background, though not in a conventional way. I use lots of medical content, I do a lot of problem solving, I do a lot of counseling, and I’m quite involved in service. It seems like I have all the pieces that I really liked about a traditional medical career, without having the pieces that I didn’t like as much. 

But, had I gone the clinical route, I would have gone into psychiatry. I really enjoyed that rotation.

That’s beautiful! It’s so fortunate that you’re able to have the parts of medicine you wanted, while focusing on the passions you had from the beginning with communications and scientific writing. I’m aware you travel a lot to different developing countries to teach workshops on scientific writing and how to publish papers. Can you share what it is you do with AuthorAID and where you’ve been?

Since its very beginning, about 10 years ago, I’ve been involved with AuthorAID, a project to help researchers in developing countries to write about and publish their work. Week to week, my involvement is largely online—for example, writing blog posts or adding material to the resource library. I also travel overseas to teach workshops on how to write and publish scientific papers and on related topics. I’ve been to Ethiopia, Kenya, Tanzania, Rwanda, Ghana, Bangladesh, Sri Lanka, Nepal, and Pakistan, to list some.

Do you have any advice for us medical students as we go through our medical careers?

Follow your heart: Choose an aspect of medicine you love, pursue it wholeheartedly, and be open to unexpected opportunities. Although there may be detours and delays at times, a productive and rewarding career almost naturally will follow. Enjoy the journey!

This interview has been condensed and edited.


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Poetry
By Hasan Sumdani, M2

I want to be a doctor because of poetry
The present illness is a story
The histories are secrets
Progress notes are dramas

Only doctors get to know everything
Labs are diaries
Images are portraits
Assessments are ultimatums

Only doctors know emotion at its extremes
Pathology is experience
Anesthesia is surrender
Empathy is pain

We take some sickness
Classics are still unique
Hurting is special
Needing is meaning


Humanizing Health
By Sarah Joseph, M1

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Because I grew up in a family of physicians, medicine has always been a great influence in my life. My childhood was a learning process in itself. I fondly remember how my father always answered the phone “Dr. Joseph.” He worked long hours—especially during his residency—but somehow always made time for us. I remember always wanting to be just like him. If having a physician parent wasn’t enough, every single one of my nine aunts and uncles were also physicians, and most of my cousins became physicians as well! We were and are truly a “doctor family.” With so much familial influence, it had always seemed like, for me, medicine would be the most natural career choice.

However, after going to college I realized that though medicine sparked my interest,  I was more passionate about social issues—particularly wealth disparity and systemic social injustice. At this point, I decided to switch gears and pursue a degree in law. I began taking courses in sociology and government, and even started taking a preparation course for the LSAT exam. I was well under way to pursuing this path when an opportune expereince changed my mind.

In the spring of my sophomore year of college, I traveled to Honduras with Global Medical Brigades. Although I had partaken in various medical missions in the past, this particular mission offered me an incredibly unique, transformative experience. Instead of having limited interaction with foreign patients, I was able to speak directly with local health professionals and learn about the society’s struggles from active community leaders.

The local health professionals—Honduran doctors, nurses, and hospital administration officials—explained to me that changing health outcomes in underserved communities requires both educational reform and infrastructural change. Band-Aid fixes were simply not enough. After speaking at length with community leaders about various barriers, both tangible and intangible, to healthcare access, it became clear that various aspects of societal injustice were rooted in health inequity.

As I opened my eyes to the consequences of poor health access and subhuman living conditions, I realized how much health affects a person’s ability to thrive in society. Sub-par health standards do not just affect disease susceptibility but oftentimes define it. Beyond this, the significant impact of wealth disparity, rooted in systemic injustice, on positive health outcomes cannot be denied. Inadequate health effectively disables the potential for upward mobility in society, further marginalizing the marginalized. But through successful intervention, prevention, and unbiased medical care—people can at least attempt to overcome adversity. Through these realizations, I began to see the potential physicians have in changing the course of healthcare—particularly healthcare delivery to the disenfranchised.

Choosing to pursue medicine was not a decision I made lightly, but rather a decision I made knowing and understanding my own privilege. My parents, who have played such pivotal roles in my path, were the ones who first taught me what it truly meant to be privileged and how important it was to take that privilege and pay it forward. For this, I could not be more grateful.

In realizing my obligation to promote health and awareness, I have been drawn, inexorably, to medicine. As I move forward, I hope to stay true to my ideals and fight towards my ultimate, personal goal: quality, affordable, accessible healthcare for those in all walks of life. Because illness afflicts all people—irrespective of age, race, religion, sexual orientation, cultural identity, linguistic capability, social class, socioeconomic status, immigration status, and/or personal beliefs. Illness simply does not discriminate.


Interview with Mark Sicilio, MD
By Alexander Hsu, M2

How did you know you wanted to go into pediatrics?

It was a psychological choice for me. I wanted to take care of the future. The future is what you touch as a pediatrician. Who do you want to devote your energy to? To me it is the future. There is no better recruiter to pediatrics than the children. The innocence, the opportunity, and the impact are what made me choose pediatrics.

How do you calm kids down if they are scared?

You are honest with them. They can recognize that you are committed to them, and they know that you are going to be gentle. You go through it with them, you don't abandon your patients.

M2s (from left) Johnny Cummock, Rachael Counts, Kieran Boochoon, Puja Panwar, and Neha Rao along with Mark Sicilio, MD, and a future medical student (Johnny’s baby) on a Humanities in Medicine elective field trip to the home of Anson Jones, MD, last President of the Republic of Texas. Photo provided by Mark Sicilio, MD.

M2s (from left) Johnny Cummock, Rachael Counts, Kieran Boochoon, Puja Panwar, and Neha Rao along with Mark Sicilio, MD, and a future medical student (Johnny’s baby) on a Humanities in Medicine elective field trip to the home of Anson Jones, MD, last President of the Republic of Texas. Photo provided by Mark Sicilio, MD.

If you weren't in medicine, what would be your dream job?

Pediatrics is my dream job, and teaching A&M medical students is my dream job. I suspect if I were the president of A&M University they would either carve a statue of me or fire me because I was so passionate …

I love this university and what it can do to make the world a better place. I am so proud of the students that come here. It is a world class university community with inspired students, faculty, and staff.

What's an experience in residency you can't forget?

They are too numerous to count. But one of the best experiences I have had was after one of our patients, a child with cancer, died.

I asked my role model, Bob Myers, the chair of the pediatrics department, “How do you do this?” He said, "Mark, never forget that they were better off because you were there.”

More so emotionally or medically?

Just your presence makes it better.

You want to leave a mark on everyone you touch.

Absolutely. We're just passing through. We are passing through this world but once. Therefore, any good that I can do, let me do it now, for I shall never pass this way again. We have a lot to be thankful for as physicians—to be students of medicine, to collaborate and help humankind.


I Believe
By Anonymous

I encountered a patient recently who raised three children alone with no college degree. She did her absolute best to provide for her kids and ensure their basic needs were met, even when that meant sacrificing her own. Understandably, she experienced extreme stress and pressure, and her vices became smoking cigarettes and eating cheap gas station potato chips. To this day, she still engages in these habits. Tasked with raising her children, she never scheduled regular doctor’s visits for herself. To someone unaware of her back story, the woman would appear middle-aged with a 30-pack year smoking history, no regular screening tests, and a poor diet. This woman would be a difficult, and frankly frustrating, patient to treat. She doesn’t want to be sick, she doesn’t want to smoke cigarettes, she avoids the doctor and regular screenings because she is terrified of discovering she has cancer, yet she doesn’t change her habits. It’s such a simple fix, right? However, this lifestyle and these coping skills are all she knows. With a full plate of child-care and providing a home, change is all but comforting.

“It’s not about what they deserve; it’s about what you believe.” When I first heard this charge, it struck me how this idea aligned with everything that I felt regarding medical practice. I chose medicine because I truly value human connections and relationships above anything else in life. Like many of you, I believe that individual lives matter. And I believe that all our patients deserve compassion, whether they have lived a life filled with cigarettes and beer, or one filled with kale and green smoothies.

Ideally, we would be able to help patients change their lifestyles for the better, to truly help them live healthier lives. When we can’t “fix” a patient, that doesn’t allow us permission to give up on them or pass judgment on their decisions that have roots in circumstances or beliefs we couldn’t possibly understand. We can try to show them compassion, encouragement, and support, even when it seems futile. Even when it seems like they have brought their situation on themselves.

Whether it be a physician, a psychologist, or other medical provider, we are in a unique and privileged position where people come to us as they are, on their bad days and possibly on their worst days. I want to show my patients I will be there for them. Yes, I understand how idealistic and clichéd this sounds.

I myself have been a difficult and noncompliant patient, experiencing more hardship than I share with my peers. Hardships that have changed my life forever. Maybe, I cope through my idealism. But I would rather believe the best in people and fall short than miss out on helping someone when all they needed was someone to care, listen, and support to make a life-altering difference. I understand some patients will be beyond my reach; I cannot help no matter the amount of grace and compassion I show them. But I would rather try and fail than live jaded, remaining faithless in people.

 

I know this patient. She is my mother. She is my provider. The idea strikes me that, maybe I’m not unlike her. I could have been her. We all could have been her.

"It’s not about what they deserve; it’s about what you believe."

I believe in kindness, in compassion, and in people.


Fear
By Ty Fields, M1

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Why did I choose a career in medicine? Easybecause, ever since I was little, I have been terrified of going to the doctor.

Sounds strange, doesn’t it? Sometimes, I wonder if Dante had a point, that people are drawn to their own personal hell.

As a kid, I would lose sleep anticipating one of those dreadful visits. Terror surged through my body whenever a syringe was mentioned, only to worsen when it was actually time for the shot. However, things got better as I got older. I became morbidly fascinated by the medical field. I researched everything in advance—I knew what shots were coming up and when I would need to get them. When I was old enough, the doctors started asking me if I wanted them, instead of asking my mom. I stopped feeling so helpless.

I know too many people who have prolonged their suffering purely out of fear of going to the doctor. Loved ones have hidden injuries to the point where they healed improperly and were irreparable. We are failing these people—clearly the idea of autonomy is one that sounds good on paper, but not always one that best serves patients. Especially the anxious ones.  

More times than I could have ever imagined, I have seen loved ones crushed when they learn they have a serious illness. The transition from a disposition of childlike wonder to a demeanor consumed by despair is one of the more painful things I have witnessed someone go through. But, at the same time, I’ve seen people who shrug their shoulders and speak of what a good life they’ve had. How can one person be dragged down to the depths of despair, when another with the same news celebrates? If we could just answer a part of this question, we could radically improve quality of life for people who would have otherwise lost all hope. Despair is not a necessity. Death is inevitable, but losing who you are isn’t.

I know that a sense of control is at least a piece of this elusive solution. For those who have not experienced this type of fear, it may not be easy to see what would make it better. That’s the problem in itself, though—these people don’t want to be “made” better, they want to be given the option to get better. The best example I have of how to do this is one that is admittedly a little embarrassing, for me. I have dealt with anxiety in general my whole life, but this anxiety is considerably worse when it comes to receiving health care. I have what could be considered a “phobia” of getting surgery. The first time I was told I needed my wisdom teeth taken out, I shut down. The dentist saw that I was tearing up, so he took my arm in his hand—and “comforted” me that my veins were very visible and would be easy to puncture. He traced a path with his finger telling me where the needle would go, while pressing me to schedule the surgery for the coming spring break. I left that particular dentist’s office and never came back.

Years later, another dentist urged me to go through with the procedure, but this time was different—it was a suggestion. When I finally admitted I hadn’t gotten them removed yet out of fear, this dentist came and sat down beside me. “Tell me more about that,” he said, and after a beat, “Is it the needle that bothers you, or something else?” After talking with him, I was still terrified. I knew in the pit of my stomach that I was one of those people who would never wake up after going under anesthesia. The certainty of a black abyss staring at me for the rest of eternity screamed at me from the back of my brain. But as soon as I got home, I made the call to an oral surgeon to set up an appointment. Although I was never truly able to get these thoughts out of my head, I knew it was the right thing to do if I wanted to be healthy. All it took was feeling in control of my situation and feeling that my fears, however irrational, were respected and acknowledged as real to me.

Until I met that dentist, I had always left from doctor’s appointments with a quiet anger. I was angry not only at my own anxious reactions, but with how the news was delivered to me—I knew I could have done it better than that and I would have known what to say to someone like me (or at least, what not to say). After experiencing what it took to persuade me to make a decision that was best for me, although it terrified me, I knew it was possible to help other people who expereince similar fear to make the right decision for their own healthcare. If I had talked to my loved ones about their conditions, maybe they wouldn’t have been afraid to seek help or become completely resigned to despair. This was exactly the type of doctor I wanted to be; I knew my place in the world. I hope that, throughout my career, I inspire my patients to do what terrifies them. I know I cannot take away a patient’s fear of pain or uncertainty, but I can give them the tools to realize that they are doing what is best for them.

Fear is involuntary. It is what we do with it that we get to choose.


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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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THANK YOU

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.