MAY 2019

by Leslie Herd, M1

by Leslie Herd, M1


Congrats Grads
by Iqra Qureshi (M3)

Today you’re like a tree that gives fruit to whoever comes by, 

but they wouldn’t have recognized you back when you were about to wither away

and you needed to be nourished with kindness and wisdom.

Challenge is your fuel; spoon-feeding is your downfall.

Don’t spoon-feed me; it defeats the purpose.

Give me the tools of your wisdom and toss me back into the wards.

I made it to these waters, and I’ll figure out how to swim.

Fast-forward:

You’re the kind of doctor who  puts people at ease when you walk into the room.

You’re the kind who  inspires people and makes them believe anything is possible.

You’re the kind whose busy clinic they’d  take a road trip for:

the kind who  fixes what needs fixing and heals those who need healing;

who celebrates with people on some days, 

and on others, helps carry them through the darkness only they can see.

 

Your story is written into the way you are and the way you do things;

all the words you can find couldn’t capture what the people who’ve known you can read.

The courage and lessons have stayed, and the rest is buried

under countless memories that you don’t remember forgetting.

This journey has carried with it the pain of healing and growth, not the pain of suffering.

It has ingrained in you the ability to stand on your own two feet:

to see in the dark, to build your own contentment and take others with you,

to value people, to work hard and have faith, and to value yourself

even after all the mistakes you made before finally figuring it out.

 

Then, one day, you realize you made whoever risked putting their trust in you proud,

and that your success belongs to the people who refused to give up on you.

They gave you direction, and you put in the work.

Now you have the skills to serve those who need them;

they can be sure that they’re in good hands.


An Argument for the Humanities
by Bailey Baker, M1

The humanities are frequently viewed as a subject within itself; it is an institution with no practical relevance in the scientific realm. However, as we progress through our studies, we may come to witness how much there is to learn from the fine arts. When we look at the world refracted through art, we are able to see the human experience through the eyes of individuals who are oftendifferent from ourselves in their gender, age, race, education level, religion, or sexual orientation. Further, it is sometimes necessary to seek out protagonists who diverge from our beliefs and be willing to empathize with their views, choices, and hardships. The careful exploration of novels and artwork with these characteristics has the potential to open our vision to a wide synthesis of life, and it may teach us to extend our sympathies and cultivate a sense of compassion despite obstacles that may be faced. Becoming an effective physician involves empathetic judgement, however, the complexity of life can make these decisions challenging. By exercising compassion, clinical objectivity may work hand in hand with empathy, and the conditions for healing are maximized. 

Through indulging in the arts, we may witness a distinct improvement in our thinking skills and problem-solving abilities. We should take advantage of these academic byproducts through applying them to our preliminary work in the basic sciences and capitalize on their potential to change the way we view medicine. Although diagnosis and treatments can be simple at times, there will always be an occasion that will challenge our aptitude and intelligence. In these cases, most will agree that lateral thinking, or, “thinking outside the box,” may bring a much-needed remedy. However, you don’t always have to think outside the box if your box is big and rich enough in the first place, and that is where the value of the humanities makes its voice heard.


Cartesian Cartography
by Christian Cable, MD, MHPE, Clinical Professor of Medicine

Rene Descartes had an unusually expansive mind.  In mathematics, he bridged geometry and algebra with the Cartesian Coordinate system that bears his name.  In philosophy, he questioned his own existence and famously answered:  Dubito, ergo cogito, ergo sum; I doubt, so I think, so I am.

Cartography is the study of maps.  In Boy Scouts, I learned that a map is more important than a compass for navigation. So, Cartesian Cartography is my attempt to organize the thoughts and ideas that are important to me with an alliterative title.  Let’s start with the one that means most to me:

 
Screen Shot 2019-05-12 at 11.30.14 AM.png
 

On the y-axis is love in increasing amount.  Perhaps negative love is hate; more probably it is apathy.  On the x-axis is like in increasing amount.  Negative like is dislike.  So, think about the different quadrants.  They are numbered I-IV from upper right clockwise.  I hope that your deepest life partnerships reside in quadrant I. Approaching twenty-five years of marriage with my wife Jill, I enjoy her company and find her likeable.

Before unpacking love, move to quadrant IV.  Do you have family members you dislike?  Tolstoy claimed that all happy families are alike, while unhappy families are unhappy in their own ways.  Unless your family is peculiarly small, we all have members we dislike, yet love.  So, what do we mean by love - - a famously slippery word?

An ancient letter describes love with two adjectives:  patient and kind.  What a miserable list.  This suggests that love is more of a choice than like is, and that patience is required. Keep your own counsel on quadrants II and III and join me in a desire to recognize and move as many relationships as possible into the upper half.


I Am Feeling Rattled
Anonymous

 
I+Am+Feeling+Rattled.jpg

Medicine is the Ultimate Love-Hate Relationship
by Sara Benitez, M3

I hate taking tests. 

I hate the pressure. 

I hate putting studying first. 

I hate how time-consuming this profession is. 

I hate being away from my family.

I hate never feeling good enough. 

I hate learning all of the details. 

 

AND YET…

 

I love patients. 

I love making a diagnosis. 

I love the intimacy of listening to a patient’s heart. 

I love serving others. 

I love the feeling of getting it right. 

I love realizing how amazing the human body is. 

I love the brain and all of its neurotransmitters. 

I love discovering and unveiling a patient’s story. 

I love the complexity, even when it’s overwhelming. 

I love explaining labs to patients. 

I love feeling like I helped even in a minor way. 

I love being there in the most difficult times. 

 

Despite this dichotomy, the love for medicine keeps us going.  


Heart & Skull
by Dani Shahin, M1


PoM1 Reflection Paper
by Sara Yasrebi, M1

Medical students are often told horror stories of physicians who have lost their empathy and compassion and the dangers that follow. We are told by friends and family that many doctors seem stoic; it is as if they’re only in it for the money. What we are mostly warned of is that in the midst of our overwhelming studies we forget who we do this for – the patient. I never thought I would be subject to this. However, as I left my White Coat Experience last month, I felt not just joy and gratitude, but shame that I did not realize the true magnitude of the opportunity I was given before entering Ms. Jane Doe’s room. 

Within the first minute of our conversation, Jane and I immediately clicked. Her first question to me was the classic, “What kind of physician do you want to be?” I responded by saying that I wasn’t sure, but I knew I wanted to do something in women’s health. She beamed as her face seemed to illuminate with delight. Almost immediately, Jane poured out her life story and confided in me that she was born with a condition called Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), in which she was borne without any female reproductive organs or genitalia. Knowing that I was a medical student, she seemed to expect an answer along the lines of, “Wow, how interesting!” Instead, I held her hand and replied, “That must be very difficult for you. Would you like to tell me more about your experience?” Her eyes glistened as she responded and said how much she appreciated my empathy, but it was not the most difficult event in her life. 

She continued by telling me that she underwent reconstructive surgery to create a vagina and had since lived an almost normal life. I was in awe at her experiences – she taught all over the world. However, one experience transformed her life and forever affected every aspect of her being . While teaching in Africa, she unknowingly contracted HIV. When she returned to the United States and got her diagnosis, she fell into a depression. This was made worse by the poor reaction of her physician who shamed  her into silence about her diagnosis, even though it was undetectable HIV. She then went on to reveal more discriminatory stories, like this past July, when her dentist refused to prep her because he thought that she was a risk to his office. I was astonished by what Jane had endured and the horrible treatment she received   from medical professionals. Her voice almost broke when she admitted that people were afraid to hold her hand. 

It was at this point that I reached over and took both her hands in mine. I was not quite sure what to say, but this seemed to communicate more than words could. Jane and I were overcome with emotion – her needing to vent this anger, and me absorbing what had happened to this kind woman. With her hands still in mine, I told her that both her, and her story, were incredibly powerful. What struck me was that this conversation began with the simple question – What kind of doctor do you want to be? – and ended with both of us being open to each other and feeling less alone. 

As I obtained her medical history, I realized how difficult it was at times to be mindful. We are instructed to ask all females about their last pap smear or menstrual period. I found myself beginning those questions but having to divert quickly  to not make her feel uncomfortable or ignore her diagnosis of MRKH. It seemed so easy to practice on friends who have had little surprises or variabilities in their medical history. Practicing on someone who I had just met, with conditions I was not familiar with, was completely different. 

I have thought about Jane often   in the past couple of weeks. I entered the  room expecting a generic rundown of her medical history and a simple review of systems. It wasn’t until after I left that I realized- nothing is generic. If you express empathy, establish trust, and ask the right questions, every patient is unique with their own story. Every patient can transform and teach you more than you could ever learn in a classroom. This experience taught me to never take any person, patient, or experience for granted. Jane was my first patient and has changed the way I will approach every patient to come.   


Enjoy Every Moment As It Comes
by Xin Wu, MD


Imagine You Are Alive in 2000 BC…
by Matt David, M1

Imagine you are alive in 2000 BC. Let’s call you Emi – your mom and dad named you after an Akkadian ruler from the 22nd century BC. Since birth, you’ve lived in the countryside on a farm along with your 4 brothers and 2 sisters. You’ve recently started having “spells” in which you fall over unexpectedly, only to wake up a few minutes later feeling weak and confused. Your parents and friends tell you that when you fall over, your body arches, twists, and spasms.

You’ve probably already figured out what you have... the modern you has probably figured out what you have in this pretend scenario: epilepsy. The earliest description of epilepsy hails from over 4,000 years ago – a Mesopotamian document in the Akkadian language. In it, we find out how your family might have regarded your recent onset of seizures:

“his neck turns left, his hands and feet are tense... [he has no] consciousness... antasubbû - the hand of sin”

Your parents call the exorcist who informs them that you have been cursed by the Moon god. For the rest of your life, in addition to living with the terrifying knowledge that you could have another “spell” and collapse unexpectedly, your community shuns you. You never get married; your friends are too nervous to be around someone cursed with antasubbu.

How different would your life be had your family simply known what we now know? That is: diseases, including those of the mind, have physical causes. As a person trained in the sciences, it is possible to take this for granted... But it is so, so important to not take this for granted. A substantial number of our patients and their families still believe in the same root causes of disease that humans had in antiquity – probably more than most of us are aware of this.

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The continuing tradition of attributing patients' physical ailments to non-physical entities goes back thousands of years, as seen in ancient Mesopotamian writings on epileptic seizures caused by deities. Here we see Mesopotamian Deities on a Sumerian cylinder seal, c. 2300 BC; in the Pierpont Morgan Library, New York.    Courtesy of the Pierpont Morgan Library, New York. Sourced from Encyclopædia Britannica:    https://www.britannica.com/topic/Ea/media/175484/5315

The continuing tradition of attributing patients' physical ailments to non-physical entities goes back thousands of years, as seen in ancient Mesopotamian writings on epileptic seizures caused by deities. Here we see Mesopotamian Deities on a Sumerian cylinder seal, c. 2300 BC; in the Pierpont Morgan Library, New York.

Courtesy of the Pierpont Morgan Library, New York. Sourced from Encyclopædia Britannica: https://www.britannica.com/topic/Ea/media/175484/5315

The realization of the physical reality of diseases is one of the greatest gifts mankind has ever received. We no longer have to fear the wrath of capricious malevolence because every disease has an answer that is physical. We no longer need to let those who suffer from maladies, like depression, add to their suffering the pains of ostracization. We no longer have to let those with chronic pain or fatigue syndromes wonder what they might have done wrong to deserve their illness. These patients have done nothing wrong, and there shouldn’t be one more day added on to the millennia-long history of misplaced fear, judgment, and suspicion. The cells in their bodies and the proteins and ions and electrical activity between them are the actors on the stage of life; it is the interaction of this system with the environment that is responsible for what the patient experiences.

Many diseases may have complex etiologies that are not immediately apparent to the science of medicine. The takeaway is not that we know all the answers, but that with inherently physical diseases, those answers are knowable. We have a destination in mind: a comprehensive physical model of the human body that explains all of human illness.

Despite all the headway that has been made, old habits die hard. Just as epileptics were once called demon-possessed, and depressed people were accused of lacking faith, mental health patients are still often blamed for their illnesses (along with other physical maladies). More Americans believe in demon-possession and exorcism than reject those notions. Popular belief sites still teach patients that depression often has entirely non-physical causes and go on advising them to seek solutions to these causes, for which they are either responsible for or blame-worthy.

Navigating this belief spectrum in our patient populations will certainly be a life-long learning experience. Let’s just not forget that every patient who learns that the unique combination of physical parameters is the cause of their suffering has received a gift akin to time travel itself: they have been taken a ship from 2,000 BC to the present.

Finally, let’s not forget the words of Hippocrates... He was not merely the father of medicine for his insights into the patient-physician relationship, but for his insights that disease had fundamentally physical causes, thousands of years before science would be able to answer most medical questions. He had more than a few strong words for those who attributed mental illness to magical causes:

“The fact is that the cause of this affection [epilepsy], as of the more serious diseases generally, is the brain...” “My own view is that those who first attributed a sacred character to this malady were like the magicians, purifiers, charlatans and quacks of our own day, men who claim great piety and superior knowledge. Being at a loss, and having no treatment which would help, they concealed and sheltered themselves behind superstition, and called this illness sacred, in order that their utter ignorance might not be manifest” - Hippocrates, 400 BCE


The Dangers of Incentivized Volunteerism
Anonymous

The concept of volunteering and helping others less fortunate is the hallmark of what made America great. No other country donates more money, time, and effort than the citizens of the United States. Many schools, both undergraduate and graduate, along with some employers, ask prospective students/employees about what they have done for their community and/or what volunteering they have completed. This has also played a role in academics as a means to expose students to others who may be less fortunate, or help students understand the differences in society. Academia moved away from calling it volunteering and now calls it service-learning; this is because we should be reflecting on what we have learned and taken away from our experience.

However, the requirement to volunteer for the under-served (US) or under-represented (UR) for school programs may be part of a larger problem in our society.  The population of the US or UR in many universities is small given the overall population of the area.  Sure, there is poverty, homelessness, the battered, abused, and even animals that require care. But, some university populations can make up almost half of the permanent population and herein lies a problem.

I get multiple emails, daily, from different groups on my campus that are recruiting volunteers for the charity du jour. Should we, as society, applaud them for their efforts?  Or, is there something in the underbelly of college-based volunteerism that is not so great?

 Webster’s definition of volunteer is “one who renders a service or takes part in a transaction while having no legal concern or interest.”  Do we not have an interest?  Of course, we desire a good grade, to pass a course, and graduate. We have incentive to volunteer and participate in service-learning. 

This, as a whole, is problematic for the concept of volunteering or helping those less fortunate. If schools and employers continue to insist on students fulfilling these requirements, we, as a society, will create a population greedier than its current state.  These students will become CEOs, supervisors, and leaders of this nation who will only see volunteerism as something that should come with an incentive.  

Service-learning (volunteerism) should be organic; it should be something taught to us by our parents growing up or by our local communities as a way to take care of each other. It should not be used to gain a passing grade or make your campus organization look virtuous.

The sites to volunteer in this community are saturated. So much so, that you sometimes have to make an appointment or you may be turned away. I was unable to complete required service-learning hours in a traditional sense because of this incentivized form of volunteerism.  

I relied on unnamed volunteer work that I have done for many years.  There was no incentive for me to do this; I did it because it’s important. Volunteering can be enjoyable, but, a lot of time, giving back to others is uncomfortable; it can require you to work in and around those who you do not care for, and you should not receive anything in return.  What I get from my volunteerism is that I know it is important to the people I help.

I may not receive credit for the volunteer work I completed. However, my option was to fake it and complete the requirements by doing something I knew little about or cared about, or do something that mattered to real people that may not meet the school’s definition a service-learning experience.

What have I gained from this service-learning experience?  Most people couldn’t care less and only do it for a grade. I can only hope that, as a society, this does not become the norm.


The White Coat
by Riti Kotamarti, M1

O1n the afternoon of September 10th, the week of our second round of exams, I lumbered into the Mature Well Lifestyle Club exhausted after another late night of squinting at purple and pink histology slides. I was barely prepared for the day; my slacks were wrinkled, my white-coat was mysteriously dusty, and my mind was back at the library. Just a few weeks ago I had looked forward to the opportunity to interview a real patient, but somehow, I lost that enthusiasm among the countless lectures and readings of medical school. 

However, the moment I was introduced to Ms. G, my assigned patient volunteer, I was suddenly catapulted back into the present. She was dressed elegantly in a black sweater; her bright scarlet nails were twice as long as mine and her make-up was exceptional . Instantly, a smile broke out on my face. The two of us were led to a back office room where the door was closed to protect her privacy. 

Before I could even begin going through the interview booklet, we started to chat about the weather, the commute, and the construction outside. It felt natural; I was sitting across from another human being who I wanted to know more about . The structure of the interview was something I was hesitant about approaching, but I forced myself to transition into taking her history. Yet I was glad I did, because in that moment, her story became my story. I was fascinated. With the door closed, our interaction went from polite small-talk to something more intimate. We discussed her widowhood, the loss of her home, and her brother.  This elegant, put-together lady revealed some of the most vulnerable moments of her life to me. And why? I was a stranger to her. 

 Was it simply because I was wearing this dusty white-coat? This coat, that I had left in the trunk of my car overnight and accidentally marked with a blue pen, had this symbolic effect on the woman sitting in front of me. It promised her my trust, confidence, and acceptance. I went from a foreigner in her daily routine to a confidant. And although it was something incredible to experience, it was terrifying.

I did not feel that I deserved to be trusted like this. I could hardly take care of the bamboo plant I had in my bathroom. When Dr. Byington handed me this coat, I didn’t experience a transformation that turned me from a nervous 22-year-old to a practicing physician. How can someone have faith in me just because I had put on an article of clothing?

“I never talk about these things to my doctor. It must be you, there’s something about you.” Ms. G said these words to me effortlessly, yet the effect they had on me was profound. 

It wasn’t simply the white coat on my shoulders. It wasn’t simply the “power-dynamic” that a doctor had over their patient. I truly connected with Ms. G, and this connection is what led to our deep conversation. Ms. G, and this whole experience, reinforced so much more than just how to ask questions and listen closely – it reminded me that I was someone who wanted to sit across from another human being and learn more about them, even before I had ‘M.D candidate’ in an email signature. These are traits that I need to continue to grow and keep in mind.  Coursework will get more difficult, and it is harder for me to squint at histology slides, but I think back to why I walked across that stage in the first place. It wasn’t simply to be regarded as a professional; it was to be there with a man, woman, or child, in their unguarded minutes, as one human being to another.  


Interview with Dr. Julian Leibowitz
by Brianna Basinger, M1

Dr. Julian Leibowitz is the director of the MD/PhD program at Texas A&M Medical School. He received his MD and PhD at Albert Einstein College of Medicine. His current research involves the study of coronavirus replication for the prevention/treatment of diseases such as severe acute respiratory syndrome (SARS)

What led you to choose the MD/PhD program instead of the traditional MD track?

I always knew I wanted to study science since around age nine. I always liked to take things apart. I was good at biology and chemistry, and I was really interested in human biology. I also liked helping people. I’m not sure specifically how I found out about the MD/PhD program, but I discovered it at a time when there were very few of them in the country. In New York, where I was from, there were only two programs. I just remember thinking that the program sounded very interesting. 

What led you pursue a PhD in addition to an MD?

From a young age, I was broadly well read. I started reading Scientific American in junior high school, so I guess you can say I’m your prototypical nerd. Or maybe more of a middle of the road nerd. There were others in the MD/PhD program at Einstein that were way nerdier than me and others less so.   

What was the process of getting into an MD/PhD program like?

When I applied, I was an alternate. Since the dropout rate was around 10%, I began my coursework as if I was on the MD/PhD track by taking a graduate biochemistry course with the other MD/PhD students. At the beginning of my second year, I got in. The program was supported by an NIH grant. I can’t remember specifically how many people got in, but it was around 7-8 people each year.

How is the MD/PhD program different than the traditional MD program?

They are very different. MD education is a mile wide and an inch deep. PhD training is two inches wide and a mile deep. By the end of a PhD education you will be the world’s expert on a specific topic. Most PhD students, by the midpoint of their training, want to focus on finishing and what they need to do to graduate. MD/PhD students don’t do that. They read more broadly. They think, sometimes, more extensively on how things are applied to patients. 

Who should apply to an MD/PhD program?

Someone who is not scared of commitment. Someone interested in research from undergrad or medical school. My goal is to turn out the next generation of physician scientists. 

Is it ok for someone in the traditional MD program to not be interested in research?

It’s ok to not be interested in research. Medicine is a noble calling. PhD’s have more of the mindset of finding a problem and solving it, thus, advancing the field. 

What or who got you interested in the field that you currently research?

I read a review article in The New England Journal of Medicineby Arthur Kornberg, a Nobel laureate for the enzymology of DNA synthesis. Kornberg received his medical degree and served in World War II. After the war, he wanted to cure cancer, so he studied DNA synthesis in mammalian cells. Kornberg wrote that mammalian cells were too complicated, and it took him five years to figure out that E. coli was also too complicated. So, Kornberg went to the smallest thing he could find with DNA, and that was a bacteriophage, phiX174. It has around 10 genes… that was something he could study.  What I took away from that was to keep it simple. Before molecular cloning, studying the molecular biology of viruses was one of the few mammalian systems for doing molecular biology.

What advice would you give to MD/PhD students?

I worked with a freshly minted assistant professor. This was very high risk. Don’t forbid yourself from working with one, but you will not know how long it will take. Also, you can’t talk to other students [to see how working with the professor is]. Talk to a lot of faculty about their projects, talk to their current students, and don’t overthink choosing a PhD advisor. Use your best judgement about the projects and your intuition about the advisor to make a decision. 

What advice would you give to MD students?

The most valuable thing the dean of my medical school said was, “Welcome. You are all getting subscriptions to The New England Journal of Medicine. You are to read one article per week to learn how to think like a physician.” It was relatively painless (there were no tests on the material), but I was amazed by how much I could learn this way. Read. 

How did you choose your specialty? 

I was undecided between internal medicine infectious disease and pediatric infectious disease. During my pediatric clerkship I got sick a lot… I must have caught all the upper respiratory infections in the Bronx. There were a lot of sick kids though, many with chronic disease. I just did not like dealing with the parents. It wasn’t until I became a parent that I realized I was seeing parents at their worst. Einstein has a strict antibiotic policy. Parents would bring their child in with a cold and insist they needed antibiotics. I found it hard to work with those parents. 

An infectious disease specialist on my PhD advisory committee, Dr. Matthew Scharff, recommended that I specialize in pathology. He said this because pathologist had more control over their time and would always have access to a lab. Matt was way smarter than I was, so I took his advice.

I chose pathology even though I never took it as an elective. My wife was very happy because there was almost no evening call time.

What do you think the future of medicine looks like?

I think there will be two competing forces that will shape future medicine. The first is the push for precision medicine. I think we will see more of human genome sequencing and precise therapy for individuals. For example, I can see cancer tumor sequencing or tweaking diabetic insulin receptor promoters as treatment in the future. The second force is the problem of cost. We need cost to be less or have costs distributed differently. 

What do you do outside of work?

I read a lot- mainly history and biographies. I like gardening because my wife likes to garden, and I get to eat what she grows. I really like BBQing. It involves splitting wood and fire and, to me, it’s chemistry. It is an experiment to find the best… and I get to eat the results. 


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