Category Archives: Month One

Panoramic view of Harvard Medical School

Deciding What to Learn

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by Month One •

Here I am, week 6 of medical school. Intro to the Profession is becoming a fond but distant memory. The Molecular and Cellular Basis of Medicine course, or MCM (what we call biochemistry), will come to an end in just a week and a half. Then, I will spend the next 5 weeks learning as much about human anatomy as I can. I’m starting to get the feeling that this medical school thing is going to be finished before I can take a breath, before I am completely comfortable with my level of knowledge. That feeling is somewhat overwhelming. As a physician, I will have people’s lives in my hands, but the word “hands” is only a metaphor, and an overly simplistic one at that. I wish being responsible for a person’s life was as simple as just holding on to a ball, an egg, or even a delicate flower, never letting it drop… never breaking it. However, the fact is that IT’S NOT! It’s not simple at all. The idea is supposed to be that I study cell signaling today so that I may save someone’s life or health 20 years from now. Is that a long time to remember something? Maybe, but that is not the problem for me. The problem is that I’m still not even close to comfortable with my level of knowledge on cell signaling, and we finished talking about many of those pathways last week. Now, I have new things to learn. So, it’s time to move on.

I probably don’t need to explicitly iterate this, but medical school is extremely fast-paced. The current body of medical knowledge is simply overwhelming to a young, and very green, 1st year medical student. A simple PubMed search for “diabetes” yields 414,545 peer-reviewed journal articles, which would literally take me 10 lifetimes to fully understand. When doing a search for the word “cell,” the results yielded a whopping 4.79 million articles! How in the world am I going to acquire the knowledge I need? How can I distinguish the absolutely essential information from the merely very important, or that from the somewhat important, or the somewhat important from the rarely relevant, which someday may prove to be essential for any one of my many patients? What may not seem important to even the most reputable experts, whom I have the distinct honor of learning from daily, may prove to be vital to saving my patient’s life in the future. I understand that my professors have to filter out the “less important” stuff (and I’m sure they’d love to teach it), but the fact is that it’s all important, or it could be. However, they only have four years to teach us. So, the question becomes what do I learn? How can I cope with my inadequate level of knowledge? How will I be able to do that in 20 years?

I can tell you that I have no clue what the answers to my questions are. I have no cure for my self-doubt. It’s absolutely frightening! This medicine thing is an extremely imperfect science loaded with judgment calls made considering only one’s own, and often biased, knowledge of statistical likelihoods. What happens to the small percentage of the people who aren’t within the norm? And to those people who have illnesses with mechanisms that I did not deem worthy of my effort to learn? They die. They become permanently disabled. They suffer immense pain. Am I okay with that? Does it just come with the territory? I don’t know, and I probably never will. What I do know is that now—the second month of medical school— is the time for me to start becoming somewhat comfortable with my very limited knowledge. I’m trying very hard, but so far, it seems to be am exercise in futility. I’m afraid my conscience may do me more harm than good. I hope that in my career I will be able to cope with the guilt associated with having a limited knowledge of the human body, despite there being an abundance of information out there. I will try to do the best that I can, but I am only a human being with a very limited capacity for storing information. That is a truth that continues to haunt me.

Devon's Childhood Home

What Does it Mean to be Disadvantaged?

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by Month One • Tags: , ,

Over the last few weeks, I’ve been involved with various institutional organizations, programs, and initiatives that focus on some sort of inequity or disadvantage. I’ve attended an SNMA (Student National Medical Association) regional conference, meetings for social activism, meetings for groups that work with disadvantaged high-schoolers, diversity committee meetings, talks about race related health disparities, and other related functions. Because the perception of my story is one of overcoming seemingly insurmountable adversity, my classmates tend to approach me regarding social justice issues. I think my classmates know that I am extremely passionate about issues of race, class, and gender related disparities, both in health and in other areas (e.g. education). They are probably also correct to believe that my background afforded me a unique set of experiences that ostensibly prime me for a career in that field. Further, they are correct in their belief that these issues are very personal to me because they directly affect those closest to me. Although they are certainly correct about these issues, I think many fail to appreciate the nuances in the mechanisms that underlie systems of privilege and how those may have directed my course.

My classmates and others tend to view me as a person who was extremely disadvantaged and underprivileged—a person who had next to nothing going for him. That sentiment couldn’t be further from the truth. In reality, I am, and have always been, a very privileged person. First and foremost, I was born in a country where there is some mechanism for class mobility, albeit a pretty ineffective one. Not unlike President Obama, I am widely accepted as “black,” but I am in fact half “white,” which affords me some level of unfair societal advantage. Yes, I was born poor, but to a strong mother who did not succumb to the pressures of poverty; she was not drug addicted, abusive, or willing to give up on her children. I had a stable father figure in my house; he entered my life when I was very young and did not leave until he passed a few years ago. I lived in a household that obeyed the law, enforced personal responsibility, and essentially created a home environment that would allow its progeny to prosper. I would often be told to “look outside.” “What you see is not normal. This is not how we want you to live.” My parents managed to do this even though they both worked very long hours. I never wondered whether my parents cared for me. I never wondered if I would eat the next day. I never wondered if we would have heat in the winter. (Despite having heat, our very old house was so poorly insulated that we had to cover all windows with sheet upon sheet of heavy  plastic.) My parents essentially created a positive microenvironment (that was not unlike those of the most privileged) in the midst of an extremely destructive macroenvironment. It is no coincidence that none of my siblings have turned to crime, illicit drugs, or other deviant behavior. In fact, we have all done very well, and my younger sister even graduated college with a 4.0 GPA as well (before I did). There was certainly something special about what my parents did in that little house on Hazelton St. Were people murdered, mugged, and jumped on a regular basis in my neighborhood? Yes. Were drugs and gangs out of control? Yes. Have I heard my fair share of gun shots and bullets whizzing? Yes. But, my mom and step-dad did their best to protect us from that horror.

When I reflect on these things, I have mixed emotions about the impact that my story could have. On one hand, I feel compelled to share my story with kids that are growing up in neighborhoods like mine. Perhaps I can be a symbol of hope for a few kids that would otherwise feel hopeless. I might even be an effective mentor to people who will come after me and who have encountered similar obstacles. On the other hand, I feel danger because the things that privileged me aren’t necessarily easy to measure. How would one measure the effectiveness of parenting in those who managed to defy the statistics? How can someone who has felt extreme pressure to turn to a life of crime be compared to me and my comparatively low pressure situation? I never felt desperate for food, shelter, or other basic needs. So, I often wonder if someone will pervert my story (and similar stories) in order to make the claim that the American Dream is truly tangible for all people and that there aren’t true social mobility issues? Will someone tout me as proof that these issues of virtuously ubiquitous race-related disparity are fallacious? Will people say that I had it just as bad as anyone else? The fact is that people often use the exception to the rule as evidence that the rule doesn’t actually exist. Examples of outliers can be used to champion initiatives that will continue to widen the gap of disparity, and I hope I am never one of those exceptions.

I’ve said all of that to say this:

We are culture of people who are in love with our own hard work and laurels. However, as individuals, we must acknowledge the privileges and unfair advantages that were integral to our various achievements. We’ve all encountered hardship, but not at the level of the people who continue to see generation after generation go to prison and die at the hands of others.  Yes, young disadvantaged kids can achieve their dreams, BUT it takes a person or people to intervene when at critical stages of development. That could be a parent, a school teacher, a physician, or a lowly first-year medical student. I urge everyone, if you are in a position to do so, to help change the life of just one child. I’m living proof that it makes a world of difference. Get involved. Stay involved. You can save someone’s life!

Party in Newton

Humanity in the Basic Sciences?

by Month One • Tags: , ,

I have to admit that when I was sitting in my buddy Eran’s backyard at his beautiful Newton, Massachusetts home, I wasn’t exactly excited about my first week of biochemistry, which was to start the following day. You see, I was just trying to enjoy my Labor Day with a few friends, some great food, and even better conversation. I definitely did not want to think about school or how it was about to morph from the social and personal perspective of medicine, taught in ITP, to an extremely objective and scientific perspective, which is conveyed in MCM (Molecular and Cellular Basis of Medicine…what we call biochemistry, genetics, and cell bio). I just wanted to focus on devouring the perfectly executed gorgonzola cheeseburger Eran had grilled and then placed in front of me. Although we definitely enjoyed ourselves and shared great laughs around that patio table, the event became somewhat imbrued by a general preoccupation with the arduous journey we were about to embark on – basic science medical education. This was especially hard because Eran and a few others were off to their segregated studies of the Harvard-MIT joint medical program called HST. This meant that I would no longer have classes with Eran or my other HST friends, which was also a source of sadness. Before we knew it, everyone “had to go;” the sun was not even close to setting. What kind of BBQ ends at five? Not one I’ve ever attended. Despite the veil of excuses, everyone knew what was going on here—it was time to gear up for medical school!

Ever since Abraham Flexner’s 1910 report on medical education in America, which called for the incorporation of more rigorous scientific education in medical curricula, the first couple of years of medical school have largely focused on biological and biochemical sciences and their fundamental basis in the field of human medicine. Like many others, this made me fearful that I would begin to lack empathy for patients by virtue of viewing them through a series of analytical prisms. Perhaps I would start to divorce these things from the human experience. I am terrified of becoming callus to the human suffering of which we make a commitment to help alleviate. As another HST friend of mine, David Gootenberg, so eloquently (and candidly) put it, “diseases and disorders aren’t interesting; they’re tragic.” (I must say that I could not have said it better myself, so I didn’t even try.) He’s exactly right! We hear this all of the time in the basic sciences—diseases and their processes are “interesting.” However, we rarely take the time to address the tragic nature of diseases: how they destroy families, how they wipe out entire populations, how they prey on the weak, etc. These “interesting” diseases have dire implications and cause immeasurable human suffering. As medical students and medical professionals, we must never divorce the idea of human suffering from the scientific aspects of disease. We must remember that we are here to help the sick and dying. We have a duty much bigger than biological science can account for, and medical education is finally starting to reflect those virtues again.

Today I completed my first full week of MCM, and I must say that I was pleasantly surprised by a few things. First, I get what people are talking about when they say that this biochemistry stuff is interesting! I was literally on the edge of my seat throughout the entire hemoglobin and RNA processing lectures. At first, I was shocked at how interested I became, but then I realized that I was interested because the lecturers consistently bridged the gap of context and relevance. This made this stuff real to me, whereas before it seemed more akin to wizardry or street magic. Furthermore, we have clinic days where real patients come to our classes so that we can see how these pathologies manifest themselves in human beings. What better way to correlate human suffering with these very tedious biochemical processes? As apprehensive as I was about delving into the multiple minutiae that biochem has to offer, it turns out it’s not so bad after all. The basic science aspect of medical education is quickly evolving into a more comprehensive type of education, and I think we’ll be better for it.  I’m truly excited about the things I’ll learn next week! Until then, take care my friends.

"Swimmers" in the Atrium

Future Doctors: Studying Medicine with a Social Conscience

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by Month One • Tags: , ,

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I could do this forever! Dr. Treadway’s Intro to the Profession (ITP) course ended far too quickly! The class brought to light several interesting aspects of medical professionalism, cultural competency, and general principles of doctoring. This week we had more training with high-fidelity mannequins. We also discussed a book that dealt heavily with cultural competency in medicine, engaging in important conversations about the ways that culture, socioeconomic status, and religion affect quality of care. However, the highlight of this course was clearly the case study on an HIV-positive patient.

Over a period of two days, we studied the case of a patient who had acquired HIV in the late 1980′s, before antiretrovirals were available. In small groups, we watched vignettes of the patient who was being interviewed about his medical condition. Not yet  aware of his infection, the class watched as he described his first bout with polycystic pneumonia (PCP), a kind of pneumonia that was a hallmark complication of people with HIV at the time. He described his illness in depth, including his near-death experiences, his arduous drug regimens, and physical incapacitations. He also went into great detail about his mental health, his personal life, and his social history. We, a group of nine, decided that the next course of action was to test him for HIV.

After watching the videos that followed, the class discovered the man was, in fact, HIV-positive and how that impacted his life. He talked about losing faith in his physician and being able to find another top doctor that could help him. At the end of the second day, we actually got to meet him and hear him tell his story; that “second doctor” was there with him. Oddly, it was much harder to hear his story from him in person than it was to learn about it via video clips. In fact, it moved me to tears to hear him tell his very painful story. He cried. I cried. Moving…

However, one part of the interview really stuck out to me. He was asked what percentage of people who contracted HIV when he did lived to tell the story. His response was “I don’t know, 10% or fewer.” He was right; the outlook was that grim at the time. But my question became what made him special? Why did he survive when so many others didn’t? I became preoccupied with that point of contention.

The fact is, this man was extremely privileged in virtually every way other than his disease status and his sexual preference. This was by his own admission. He stated his status of extreme privilege time and time again. I believe that because of his race, class, and socioeconomic status, he was uniquely empowered in the medical arena. I don’t think it’s a coincidence that he survived while upwards of 90% of others did not. While ITP was an absolutely amazing experience, I truly wish we could have seized the moment and talked about substantive issues regarding systems of privilege and oppression.

Talking about Issues of Race and Health Care Disparities

Two of my role models, and second year students at HMS, Kai and Garrett, helped devise a way that our class could demonstrate our desire to talk more deeply about issues of race and the health care disparities that are the results of racial biases. They are part of a coalition of Harvard medical students called the Race In Curriculum Working Group (RICWG), who share my desire to have more substantive discussions about race and oppression. There has been some apprehension by the course director because the belief is that many students may not be ready to have these very uncomfortable discussions about systems of privilege. We desire to make that a key underlying theme of the ITP course.

Eight of my class members and I joined the RICWG in a demonstration on Thursday afternoon when the course ended. Because the faculty was concerned about our class’s ability to “swim” during these conversations and that some students may “drown,” we developed the slogan, “I can swim.” Students willing to swim were supposed to write the words “I can swim” in the end-of-course critiques. We made thousands of flyers with our faces on them, informing the class that we can swim and asked them if they could too. We strongly believe our classmates can swim,; they are ready, and we are ready.  We canvased the atrium of the medical education building with the posters, putting them on busts of famous doctors—literally changing the faces of medicine. Then, as the class left the auditorium for the last session of ITP, thousands of flyers rained down from the fourth floor of the TMEC atrium while we blasted the edited version of Lil Wayne’s, Make it Rain (all expletives removed). Everyone was shocked!

Afterward, we sat down and talked to course director, Dr. Kate Treadway and Dean of Students, Dr. Nancy Oriol. Much to our surprise, they were very receptive to our ideas. In fact, they were touched by our dedication to the subject matter. That reaction meant more to me than they will ever know. Today’s medical education is cultivating a different breed of doctors.  We are a generation of doctors with a social conscience. Our generation will greatly mitigate the social and racial determinants of health in America and abroad. I have never been more proud of a group of people to which I belong. Thank you HMS class of 2016! I love you!