Episode Eleven: The First Years

For Krunal, it was a car accident. For Jess, an unrelenting, life-threatening illness.

The students who come to medical school come with different reasons for pursuing a career in medicine. In this episode, we hear from six Duke med students — each in their first year — as they share their motivation, their hopes, and their fears.

Krunal Amin, Sonali Biswas, Grant Cabell, Fred Heller, Elana Horwitz, and Jess Rames are first-year medical students at Duke. They came to the Voices of Duke Health listening booth in August 2018, soon after they started their medical-school journey


Krunal: For me my story is a lot of trial and error. But I think it starts pretty personally, even though I didn’t realize it at the time. I was in middle school and so my mom actually worked here at Duke. She was a microbiologist and she actually on a drive back home got into a pretty bad bad accident and ended up needing a lot of neurosurgical procedures to sort of correct a lot of the nerve damage in her spine and in her head. When you’re in middle school and you see your parents scared that’s just not something that you’re used to seeing. And so I think it’s really a jarring experience. And my mom, I think, really both my parents, and developing this really awesome relationship with this neurosurgeon. And I remember that being like a really impactful thing when I was young saying like, whoa, this was a situation where my parents were scared and they put their trust in somebody else. That’s really cool.

Karishma: This is Krunal. That was the first of many moments that slowly but surely convinced him that he wanted to be a doctor.

Krunal: There’s nothing I’d rather do than then be the person who sort of like interfaces with a patient and is sort of that kind of like that neurosurgeon was for my family.

Karishma: This is Voices of Duke Health, I’m Karishma Sriram. Today, first year medical students: Krunal, Jess, Fred, Sonali, Elana, and Grant. Their conversation was actually recorded a month into medical school, back when they were all bright-eyed and bushy tailed. Over many of our past episodes we’ve heard from some seasoned physicians at Duke, but today, we’re going to take it back to the beginning of the whole medical journey, starting with, how these students landed here at Duke in the first place.

For Jess, it started when he was 15, and he got really sick.

Jess: I had an Epstein Barr virus infection. Like most people get mono and they recover easily. I was sick for like maybe a month and a half, two months. I ended up in the pediatric ICU. I just really wasn’t fighting back. You know, my immune system could handle the viral load and they had no idea why. So I had like you know eight doctors at once like trying to figure it out and knowing no one ever did.

It was one of those things just like it took so much time to recover from. And not knowing why is like probably the most frustrating part. And that’s kind of what- it was then not knowing that made me want to do it now because there’s so much more to learn and even the experts don’t know, and I find that interesting. Have a job where you’ve never really done learning.

Karishma: Fred’s motivation was also tied to illness. His dad had a stroke when he was young. Luckily, he was okay…

Fred: But he did have to retire and so I had to stay at home dad which was lovely. You know we go to the supermarket, we would cook dinner. I mean I would run around screaming while he cook dinner. But I do kind of think about the way that in my life growing up illness was kind of omnipresent because even as he came through about as well as he could he did have to retire. He was constantly taking medications. He, you know, they made him overweight. They made him sleepy. And I was forced to think about the ways the stories that we generally tell about ourselves, they kind of shunt illness to the side or they put it at the very end, or it’s something like with you, Jess, where you know it’s an event that happens and you get past.

If I could tell providers now and also my future self is to just have some sensitivity to not just the you know the nuts and bolts of illness and the treatment plan and all of that but the way in which the experience of illness is really shaped by how things are presented, how you feel supported, you know, whether you feel this is something operating on you or something in which you are playing an active role.

Karishma: So now knowing what brought them here, I kind of wanted to get a sense of where they see themselves going.

Krunal: I think physicians are really, really well positioned to make a big difference. And one of the biggest reasons that people, in general, really trust doctors and doctors are of all the professional- different professions like you think like lawyers and dentists and all those different things. I think doctors tend to rate pretty highly on just general professions that people trust.

Karishma: And Krunal has thought a lot about this idea of trust, especially in relation to policy.

Krunal: I think a lot of times physicians, at least I’ve observed, tend to sort of steer away from that because you know how dare we talk about money and medicine and politics is always sort of a taboo thing to bring up sometimes because there’s so many different perspectives. But, I don’t know, I think I think physicians are in a really important place to sort of weigh in on that and think about that from a sort of a patient-centered way. You know, physicians, nurses, everyone part of the care team are the ones who are actually interacting with a patient and can can usually know sort of how different policies can impact different people in a very unique way. And so I don’t know what I’m going to do in the next 10 or 15 years but I want that to be I think a really important part of my professional identity as well.

Karishma: Sonali also wants to be involved in quote-unquote “non-medical” things like policy and business. But she brings up a good point about distrust too.

Sonali: I understand the conflict also, trusted is a really tough word. Because I think we are trusted to know the most about the field that we’re in. And not necessarily trusted to take care of people with their best interests at heart. So I think-

Karishma: Why do you think that is?

Sonali: Why do I think that is? Well, I think the distrust comes from the fact that physicians are in a really high point of privilege. And to a lot of their patients it’s kind of hard to trust someone to have, you know, the patients best interests at heart when what the patient’s best interests are don’t necessarily align with what the physician has to face in a day to day basis. Like most physicians don’t have trouble accessing healthcare of course. So I think patients may have a tough time seeing physicians as people who care about those things when they don’t necessarily have to.

Karishma: So these first years have been thinking a lot about why they want to be here, what kind of physician they want to be, how they want to leave their mark on medicine. They have hopes, but they also have fears.

Elana: We’re like at the cusp at the very- we’re about to step into it. So it all seems glossy in a way and like heroic and inspiring, and I don’t know. I’m afraid of it going the other way and feeling like, well, we’re all going to get sick and die eventually or, you know.

Fred: I mean we are, yeah.

Elana: Yeah, and like to be reminded of that every day might make you a little bit less inclined to live more. Hopefully it makes us more inclined.

Jess: Or you just get desensitized to seeing that every day. And it’s like you become just indifferent to it. That’s what I’d be more concerned about I think.

Karishma: And what if those negative feelings in whatever shape or form impacted their relationships with their patients?

Elana: I want to treat patients, you know, the way that I’ve- differently than I’ve seen other people treat them, or the same way that I’ve seen my you know my role models treat them. But I’m just so afraid that I’m going to get to finally after years and years of training and get to be an attending and then have an interaction with the patient where I step away and I think like that was exactly what I didn’t want to be you know. That was why I went into this so that there aren’t physicians treating patients like that. And I know it’s gonna happen and if I can step away from that and be like hey I gotta change or I gotta maybe make a change because whatever environment I put myself in is making me treat patients in this particular way.

Karishma: And I was wondering, where did this fear come from? Well, Elana knew this doctor and noticed some things about him.

Elana: It just seems like he sort of puts his patients into these boxes and then thinks about them as just in a group of that type of patient. And I want to like always be thinking about my patients holistically and be thinking about the different ways in which their lives affect how. They need to be treated. And so to look at each patient like a challenge instead of just another one of these or another one of those.

Karishma: And Jess was a little more worried about expectations they’d have to face and had already been facing.

Jess: They want everyone to be very well-rounded and likable but at the same time have done all these things and it’s like you’re expected to fit more into, you know, 25 hours in a 24 hour day basically.

Karishma: And this really feeds into anxiety.

Jess:  I struggle with it almost every day and I think part of it is we’re in an environment where everyone is extraordinarily talented and have interesting stories. And you just- it seems like everyone has their life’s lives together and they know what they want to do.

And everyone because they act friendly and open about everything they’re not really telling you that underlying feeling of anxiety, you know they’re not really expressing it. They’re like “why’s everyone so anxious?” you know, that’s always the question. I know exactly, because I feel that a lot, you know?

Karishma: And Fred was worried that those expectations and anxieties might encourage putting career above self.

Fred: There’s a lot of pressure to lead the pack and in order to lead the pack, you have to really be decisive early on so that you could build that resume. And if you want to you know navigate to the sort of position where you can be this sort of doctor that you want to be, that kind of takes excelling and not being the sort of person that you want to be for a lot of your life. You know, it takes back-burnering relationships and you know really spending all of your time studying, research. I feel like everyone storing nuts for winter kind of you know they want to make sure that they are someplace where they can live the kind of life that they want to and they’re not sure that that they could trust that they’ll get there.

Jess: I think it’s a dangerous position to put yourself in because I think I know I can become obsessional about these things and it be like consume everything else you know and then you’re kind of left with only that. And like just a hollow feeling.

Karishma: This is something Grant can really relate to, he learned from experience how tough it can be to put other priorities on the back burner.

Grant: There are definitely a lot of times I would skip out on different like social events or you know maybe going to see like a movie with friends or going to a sports game with friends, because I was like I’d rather you know go spend this time in the library and make sure that I know all of 20 amino acids or something like that. And so I think that being out of school and being away from that environment allowed me to kind of really take a step back and see what’s more important to me. And it’s definitely influenced me this year. I mean also pass fail doesn’t hurt either. Being able to like you know be like hey you know these extra two hours of studying really aren’t going to make that big of a difference. I’d rather go get dinner with friends or I’d rather go kick Krunal’s butt in NHL and things like that.

Karishma: And then I asked them what they would say to their future selves if they were struggling with burnout.

Grant: I definitely think you’ve got to you’ve got to give back to what got you into medicine in the first place. I think what’s really cool about having this conversation is I mean now we’re all going to be on record with saying like what’s what was important to us.

Krunal: Hold each other accountable.

Grant: Yeah, like what got us here, you know what I mean? But that’s the kind of thing- medical training is really long and it’s really tough, right? And so that my advice would be to remember back to what got you in it in the first place and then try to go find that again. And you know maybe it changes maybe whatever got you into medicine in the first place is not really what drives you now. And so maybe you need to find something else that still that your passionate about or what’s really important to you. But I mean like at least for most of our stories it really sounds like there’s kind of a common theme of personal connection like connecting with others is really important to all of us. And so that’s something that like if any one of us, you know 15 years down the road are being like I don’t want to do this anymore, I’m so burned out, like I would be like Krunal like Sonali go like Go connect with a patient like go and like sit down or have a conversation with someone and like really realize like the humanistic side and why you got into this in the first.

Karishma: And Krunal thinks it’s important to find empty space in your life.

Krunal: For me at least in the past it’s been really just regenerative. So you know for example the summer I didn’t do anything and it was fantastic and I felt like when I got to school I felt so rested and full of energy. I think it just gives your- gives some space for your mind to wander and for you to do sort of whatever you want. And so for me that was just you know reading whatever book I felt like reading and it was not necessarily medicine related or not necessarily related to anything I did in the two years beforehand. But it was just kind of what I wanted to do at the time. It wasn’t a productive thing by any measure but it made me feel good. And so I guess to the extent that anyone can, just try to carve out some time to just sit and do nothing is really important.

Grant: So how do you do that now? Like I mean definitely being in our first year of med school we’re busy.

Krunal: It’s been awhile since I’ve done that, it’s a good question.

Grant: Like how would you like plan to do that if other people are going to like take that advice to heart?

Krunal: I feel like you have to be really intentional about carving out time I think. I think it is possible, but you have to sort of- it’s kind of-

Grant: Schedule your free time almost?

Krunal: Yeah it’s kind of weird like kind of brain twist, but yeah, you have to plan to do things unplanned. Maybe that could mean you know I’m going to spend like 9:00 p.m. to 11, instead of going trip to trivia, I’m going to sit there in my room and just like do whatever I feel like doing. And so I think you just have to schedule it was like a practical piece of advice for it.

Sonali: I think that a lot of it comes out of mindfulness, when I’m working out I’m like if my mind’s wandering then I have to be really intentional about being like nope, focus on the work out, look outside all those trees, don’t do anything, don’t think about anything that’s worrying you, like this time is for like self-care only. And then also I feel a big part of it is not feeling ashamed for when you are taking that time to yourself because I feel like that makes any amount of free time feel like a burden. And that’s really really unfortunate.

Karishma: And then we got to my favorite question—what are they excited about?!

Sonali: What I’m really excited for by the end of med school is to see sort of what changes I go through, because I have no idea what’s coming. And I’m really I’m really excited to have no idea what’s coming.

Krunal: I think what’s exciting about being here is I mean we have so many different like role models come through like every single week and you kind of like put your- think of yourself as being in their shoes and 10 years and you’re like wow that be pretty awesome. But that happens like, 18 times a week. And I think that just sort of optionality and all those different possibilities is really exciting.

Grant: I also think it’s interesting both you guys were talking about what you’re excited for are looking at stuff that’s like way down the road. Like you know five years 10 years I’m really excited for like tomorrow or for like Monday. Like I think that we like so much that we don’t know. And just having that experience of- we all kind of talked earlier about being lifelong learners and being able to you know the reason that we came to medical school is because we want to be here and learn things. And so I’m just super excited that you know, I think Duke really jam packs you know not only our first year but all four years with learning something new every day whether that’s in a clinical sense or in you know building that knowledge foundation that will then help us clinically. It’s just, you have so many opportunities to just kind of grow as a person and really learn and that to me is really exciting.

Elana: Getting to this point takes a lot for forward thinking and I think my mind often was just in the end goal. But like, it’s fun. Like it seriously is fun. You’re like in physics like getting in a problem, and like that’s fun. Like think about it like that, you know. And like when we came here and we were doing our MMIs, I was totally unprepared but like you get in there and you get this interesting question and that’s fun, like just roll with it. And you want this for a reason, you want it because it’s fun, and the whole thing is fun it’s not just getting there. And so like seeing everything as an opportunity to like have an interesting conversation, like when you go into your interview like have an interesting conversation and like you’re passionate about this, you could talk forever about the things you passionate about. That’s why you’re here and that’s what’s good about this moment. Not what is gonna to come. So, to take every day as like as a good day and not as a day to get you to another good day.

Karishma: Thanks to Fred, Jess, Ilana, Grant, Sonali and Krunal for coming by our listening booth and sharing their thoughts.

Published by Anton Zuiker

Communications Director for the Duke Department of Medicine, longtime blogger and leader of BlogTogether, and co-founder of ScienceOnline.

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