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Únicos, Unidos, y Orgullosos

At the beginning of February, I had the pleasure of attending the Latino Medical Student Association Midwest Regional Conference at the University of Chicago Pritzker School of Medicine. At the conference, I attended different workshops on topics like food deserts/swamps, and trauma-informed care and how it applies to Latino communities. I networked with many Latino medical students from around the Midwest. I also heard a wonderful talk from Dr. Harold Fernandez on his experience as an undocumented immigrant in the United States. His talk was inspirational, and he left us with one piece of of advice (well, two if you count his shameless plug for plant-based diets): he encouraged us to create our own happiness and joy on our journeys to medicine. His message really resonated with me as it matched my own goals that I have been working on recently.

Medical school started off rocky for me. I dived in head first, putting in hours and hours of time to study hard, signing up for tons of extracurriculars, and often neglecting to take care of myself as a consequence. I quickly learned how unsustainable my habits were and how quickly they were leading to burnout. I knew I had to make a change but I couldn’t figure out what I was doing wrong. I soon realized I was neglecting to tend to my own happiness. I was blowing off friends to study, I wasn’t doing fun things outside of school, and I hadn’t yet made an effort to build a community within the medical school.

One of the hardest things about medical school is finding balance. The demands of medical school eat up the majority of my free time so much so that taking a break from studying is often a guilt-inducing decision to make. And that’s what I’ve found myself struggling with since med school started. I can’t even imagine throwing in the demands that some of my classmates have: families, marriage, relationships, commuting, etc. Sometimes prioritizing my studies makes me feel selfish; I’m always letting somebody down. But I’m also often letting myself down, sacrificing my own sense of happiness. It feels hypocritical to sacrifice my own well-being when I will be making a career out of taking care of the health and well-being of others.

But medicine IS a career of sacrifice. It’s a long road to becoming a physician and there are a lot of compromises to be made on this journey. But having seen family members make sacrifices for this career and even watching my classmates on their own early journeys, I have re-committed myself to one principle: I won’t sacrifice my own well-being for anything. Becoming a physician is part of my purpose in life, and I’m working on making the journey towards that goal as meaningful and enjoyable as possible. YES, there will be sacrifices to be made, but there are little things I can do now to ease the path for myself.

Spending the weekend in Chicago with my classmates and getting the opportunity to meet other Latino medical students, I found myself so grateful for the opportunities and the wonderful people in my life because of medical school. Coming back to Ann Arbor after the conference to immediately study and take my GI final exam was rough, and I asked myself “do you regret going to Chicago this weekend?” I missed out on CRUCIAL study time! No, I don’t regret it because it was such a fun experience! I understand GI physiology and pathology to the best of my abilities, and I don’t regret losing the time to really know the ins and outs of copper metabolism. I also don’t regret going to trivia the other week with my friends because I had a great time (I’m usually so bad at trivia but I knew the answers to THREE questions!! I carried our team honestly). I don’t regret participating in Biorhythms (the medical school dance performance) because it was some of the most fun I’ve had since starting medical school. I don’t regret taking the time to go off campus or study outside of Taubman every once in a while.

I also don’t regret my involvement in extracurriculars, including signing up to be the social chair for the because it means I get to bring that very excitement and energy to my classmates and work on building a community. I’ve had the pleasure of getting to organize mixers and potlucks, and watch my classmates enjoy themselves while building the friendships that I wanted to get out of medical school. I feel so proud to be a part of the Latino community in my class and attending the Midwest regional conference only solidified this for me. It made me feel recommitted to my identity and my purpose.

Now I tell myself if I’ve gone the day without a genuine smile or laugh, it probably wasn’t a very good day (which is OK, not every day in medical school is going to be amazing or ~fun~). But I’m working on creating the spaces, the community and the experiences to bring this kind of excitement and happiness into my life. I’m learning how to balance fun and work and how to prioritize myself in order to really give my all to my work and to my community. I am excited to see what other experiences the rest of my medical school journey will bring me 🙂

Maintaining a Passion for Dance During Medical School

A few months ago, my shared some advice. To paraphrase, he said during medical school you spend a lot of time studying, so finding well-being may mean prioritizing some activities that truly make you happy, and then scheduling studying around those activities. That morsel of advice motivated me to find ways to incorporate one of my lifelong passions, dancing ballet, into my schedule.

Luckily, I did not have to look far to find ways to dance. Most importantly, I had the opportunity to choreograph a ballet dance for Biorhythms, the biannual student-run dance performance (proceeds from the show are donated to charity). To prepare for the performance, I met with medical school peers for an hour each week to teach the choreography. It felt absolutely incredible that I was able to grow as an artist and choreographer while in medical school. Furthermore, the friendships that my classmates and I formed while dancing (and laughing) made the weekly study break priceless.

A pre-Biorhythms performance photo with my friends.

In addition to Biorhythms, I have attended a few ballet classes at a local studio. Recently while practicing a difficult ballet combination, I smiled thinking about how my movements related to the biochemistry and anatomy that I learned in lecture. I felt the burn of lactate build as my muscles used anaerobic metabolism, and I named the muscles in my back that helped me maintain correct shoulder placement. Already, I was seeing through the lens of medicine, and medicine was enriching my understanding of dance!

Finally, participating in an event that shared the joy of dancing with patients was particularly rewarding. Last year, my friends and I performed excerpts from the Nutcracker ballet during a dinner organized by the Child and Family Life team at University of Michigan’s Mott Children’s Hospital. It felt very special that our dancing could bring smiles to young patients and their families. This year, that tradition continued. After a long day of lectures, I walked over to the children’s hospital and felt my own sense of joy as I watched my friends spread the magic of dancing to patients and families.

Long before I was a medical student, I was a ballet dancer. Now, I am so thankful to have opportunities to explore intersections of my interests, and to have a support network that encourages me to continue dancing as I develop into a well-rounded future health professional. Wherever the journey of medical school takes me, I am excited to be dancing into this next phase of my life.

From Michigan Undergrad to Michigan Medicine

I remember adjusting to undergraduate syllabus-based learning (and inevitably missing an assignment or two) while an undergraduate student at Michigan. Eventually being given a list of due dates and exams at the beginning of each class became the norm, and I developed into a more independent learner.

Considering my transition from Michigan undergrad to M1 year, I used the same strategy I always do during life’s transition periods – don’t think about it until it’s happening. So, I arrived at M1 year ready to reorganize my academic life to best serve med school-style learning, whatever that happened to be.

As for what I found: keep in mind that I can only speak for Michigan Medical School, which has a unique condensed/accelerated curriculum where we finish M1 in August and enter the wards for clinical rotations as soon as M2 year begins.

What I soon learned is that while med school has more material with a new syllabus every few weeks instead of every few months as in undergrad, there is also more flexibility in our M1 year to study as we please since we are considered adult-learners. Classmates of mine have newborn babies, new spouses or just a new pet. Whatever the reason, Michigan Medical School is wonderful at understanding that life happens. If we need a bit of time away from Ann Arbor for whatever reason, we have the flexibility to do so.

What has most amazed me about being a med student at Michigan is the collaborative environment of our class. We all share resources, and even have access to resources from classes of students who came before us.

There has been a major change in the learning environment now that didn’t exist as strongly in undergrad, which I love. This is the drive of my classmates. We could all sit in a classroom and be told we need to complete 0% of the work to pass, and most all of us would choose to do it all anyway and do it well, not to pass but to be the best doctors we possibly can one day soon. I have never been around more driven, passionate and dedicated individuals than I am while a student here.

This is a blessing, but can also be a curse if the actions of colleagues causes one to become overwhelmed or discouraged with his/her own path. I am motivated by the actions of others, but have learned that staying true to who you are and being able to express this is most important. Finding what makes you happy and what allows you to de-stress is key, and should be prioritized in medical school. For me, this includes a side bartending job, where I can bond with my community in a completely different way than I do in medical school.

Being a medical student is humbling and horrifying. The journey is incredible, and I am so honored to have such dedicated colleagues, mentors and academic faculty members here at the University of Michigan Medical School to further shape me and my classmates into the Leaders and Best. Go Blue!

Branching Out in the Clinical Years

I’m sure many of you have heard about the new curriculum at UMMS, where the second-year medical students hit the wards after just one year of bookwork. At many other universities, this process begins at the beginning of third year. At Michigan, the curriculum is all “Trunks” and “Branches”— we are in Ann Arbor, after all. Some confusion remains about these changes and I am here to set the record straight, or at least give you my perspective on what it is like to be a “Branch” student.

During Branch years, there is life beyond studying and shelf exams! Here I am admiring the Transcending monument in Detroit, MI.

So far, I am halfway through my third year of medical school. I have completed a year of classroom learning (the Scientific Trunk), followed by a year of core clerkships, such as surgery, pediatrics, OB/GYN, internal medicine (the Clinical Trunk). Before the start of my third year, I had also taken Step 1 and Step 2CK. For perspective, friends of mine at other institutions with a traditional curriculum have completed Step 1 and are about halfway through their core experiences at this point. I now have roughly 10 months of elective time before I fill out applications for residency.

That time is aptly named the Branches. The goal of the Branches is to allow us to take electives that interest us and give opportunities for further career exploration before applying for residency. I can do electives in dermatology or ophthalmology or radiology, all specialty electives that students rarely get to experience during the core clerkships. We also have time to complete a Capstone for Impact project in whatever field we want, which can springboard people’s future career paths.

For me, I have set my mind on primary care and am using the Branches to further immerse myself in the endless possibilities that I will have for a future career as a family physician. Through a partnership with Henry Ford Hospital, I packed a few bags and will spend the next six months doing various clinical rotations and scholarly work in Detroit, Michigan to help serve the urban underserved population. I will also complete my Capstone through this elective experience. My friends have chosen different paths; one wakes up at 4 am to break and set bones on her orthopedic elective, another friend has spent a month on anesthesia intubating and extubating people during surgery. Other classmates have taken this time to finish up some research projects, and others still have taken a couple vacation weeks to travel wherever their hearts and loan money will take them.

We all have different paths with the end goal of receiving an excellent education to get us there. The Branches allow us to individualize our learning plans and it seemed daunting at first to pick what we will learn, but I can tell you that it has given me life in medical school. It’s refreshing to wake up every day and do something YOU choose to do. Even if it turns out that orthopedics was not what you thought, at least you can say, “tried it, not for me, next.” You won’t be stuck wondering if that was your calling, or choose a residency without trying it and then hating it. I start on emergency medicine this month and who knows, maybe I’ll fall in love with it and switch career goals. That’s the beauty of the Branches, we have time to really figure it out.

HEAL: Health Care for the Homeless

Ruth:
Healthcare Education and Access Liaisons, better known as HEAL, is the health care for the homeless group at the University of Michigan, where students partner with physicians and community health workers to provide basic medical care and social services to the members of the Ann Arbor community experiencing homelessness. Due to the variety of barriers that this population faces in accessing health care from an often unbending medical system as well as their historical mistreatment by health care providers, there is great complexity in HEAL’s work. More than an act of service, HEAL is a learning opportunity for students to enter into these men’s and women’s spaces and act as witnesses to their suffering. We try to better understand their challenges with overcoming poverty, addiction, abuse, etc., so that we can provide culturally-competent health care and social services to the homeless.

A core component of HEAL’s work are twice-weekly street runs, facilitated by Jim, a nurse/street navigator, and Dr. Russell Pajewski, an internist at Michigan Medicine. Each run is different, but all of them begin in the early morning at a local church and may include visits to camps, warming shelters or Washtenaw County Community Mental Health. First-year medical students Allan Metz and Eric Steinbrook describe their first street run experiences:

Allan:
My HEAL run started on a cold morning at St. Andrew’s Episcopal Church in Ann Arbor, where the church was serving a free breakfast to those in need like it has done everyday for the past 36 years. Another medical student and I went around to the individuals in the church, speaking with them about their day and getting to know their stories. Typically, our conversations would shift focus to their health concerns, with some individuals even wanting physical exams like blood pressure screening. We were able to help some individuals bandage up cuts and abrasions they had sustained since our group had visited with them last. We worked closely with a physician and a nurse while at the church, and this allowed us to address more pressing health concerns such as chest pain, flu-like symptoms, and stomach issues by helping to set up clinic appointments and writing prescriptions. Our team was also able to provide information on shelters to stay at if there was interest, or programs to help with food insecurities in this population. It was a really interesting and eye opening experience to see health care delivered in such an unsuspecting place outside of the typical settings I’ve experienced it. Even if the medically-related things we did that morning were just to address the symptoms of an ailment, starting the conversation around a person’s health and how they can work to stay healthy seemed to be the real goal of the morning.

Eric:
The four of us followed a lightly trodden path that led into the woods behind a local supermarket. We were on a “street run,” part of HEAL’s efforts to offer holistic care to the homeless of Washtenaw county. Our team–made up of a social worker, nurse, physician, and myself–makes weekly visits to camps, and no two visits are the same. We might provide medical care or help draft applications for county housing. Our mission is best summarized by Dr. Jim Withers, the Pittsburgh physician who founded the street medicine movement in 1992: “We offer health care that comes to you as you are, on your terms, accepts you, acknowledges your strengths, and that is committed to you no matter what.”

That day we made visits to eight tents behind the parking lot. We met one man for the first time: he was new to Ann Arbor, and had just found his way to this camp. We recognized another man who was in particularly good spirits that day. We talked with him for 10 minutes about the long and difficult process to find stable housing, and our social worker set up a time to follow-up with him the next week. As we piled back into the car–off to visit another camp–I felt gratified to have started building relationships, which are at the foundation of HEAL’s work.

Finding Spanish Opportunities in Medical School

When you receive an interview from the University of Michigan Medical School, they ask you to share something unique about yourself that you can do. While some responses are funny, like being able to eat a 3-lb. cinnamon roll or talk like Stitch from “Lilo and Stitch.” Others are more serious:

“Can run an ultramarathon.”

“Can read Arabic and Hebrew script.” 

“Can build and race cars.”

I can honestly say everyone in my class has a passion outside of medicine, a skill they are trying to enhance, or a hobby they love. Whatever this may be for you, I think a natural concern for applicants is, “Can I continue this while in medical school?”

2016, living in Nicaragua. My host-mom and host-sister are two of the most loving people and the best teachers. My friend who recently graduated from UMMS did a global health rotation in Nicaragua, and I hope to do the same.

After graduating from college three years ago, I set out to learn Spanish. This involved living in a Spanish-speaking country, traveling and getting involved with organizations locally. One of my main goals when starting medical school was to not only maintain the progress I had gained, but also improve.

I have found the opportunities to learn, practice and apply a second (or third, or fourth) language are everywhere if you search for them. Since starting medical school four months ago, I have been able to translate at a free clinic for migrant workers, where medical student Spanish-speakers are paired with non-Spanish speaking clinicians. I have worked with Washtenaw Health Initiative to help Spanish-speaking community members enroll in health care coverage. I have also helped orient Spanish-speaking patients at the in Livingston County.

These experiences have been some of my favorite experiences thus far in medical school; however, my most educational Spanish language experience has been the student-run medical Spanish elective. This is a class where a small group of medical students meet in the evenings two or three times a month with a Michigan Medicine physician who is either a fluent or native Spanish speaker. The session is entirely in Spanish and usually begins with the physician pretending to be a patient as the students walk through an entire visit, starting with taking a complete history. We then discuss the case in-depth, and possible diagnoses and treatments.

November, 2018. Volunteering for Washtenaw Health Initiative to get the word out about open enrollment for health insurance and connect people to resources.

During a year where our academic material focuses on the details of organ systems, drug mechanisms and anatomy, this course, refreshingly, has an entirely clinical focus. We not only learn Spanish medical vocabulary and phrases, but as a group we walk through creating a differential diagnosis and learn more about how doctors think. It has also been a wonderful opportunity for students among different classes to spend time together.

Whether you are interested in improving on a second language, taking piano lessons (seriously, these are offered to medical students), or perfecting your Disney character impersonations (consider auditioning for The Smoker), just because you are in medical school does not mean you need to put these goals away for four years. In fact, I’m learning it’s better if you don’t.

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