The Anatomy of an Application

When applying to medical school, all applicants are asked to write a personal statement: An account of some of their most meaningful experiences that have prompted and guided their journey in becoming a physician. Why medicine? Why do you want to be a doctor?

At four or five years old, I would pretend to have my own practice, using stuffed animals (sometimes my brother) as patients. I would wrap their imaginary wounds with blankets or towels, give them shots with my toy syringe, and write fake prescriptions for candy medications. Since then, I’ve never faltered from my path to becoming a doctor, but I have gained a more profound understanding of the profession and picked up some additional skills through my experiences. The technical intricacies, the professionalism needed to interact with patients and families, the emotional toll it can have. I’ve had ample time and numerous opportunities to grapple with all of these considerations as I continue on this path in medicine. Rather than facing discouragement, I find myself more excited than ever. That same determined and compassionate spirit from my childhood still exists within me, and it is what drives me to want to dedicate my life to serving others.

**Students pursuing medicine: here is a checklist of items you should get involved with if you plan on applying to medical school. Experiences may vary.

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Clinical Experience

“I need help. I know I need help.” 55 year old male. Awake and oriented x3. Able to walk. History of schizophrenia, depression, anxiety, and hypertension. Patient reported hearing voices, has poor eating and sleeping habits. Frequent pacing, and staff at this emergency housing location are afraid for their safety. Unemployed.

Sitting in the back of the ambulance with this man lying in the gurney in front of me, all I can do to comfort him in this moment is put a gloved hand on his arm. I’m so sorry. As an EMT, I have seen many patients in the same situation, and have received this call over and over again: untreated psychiatric illness(es), other underlying health issues, little to no income, no family, and the same sad, withdrawn expression as we drive to the hospital. Oftentimes a psych hospital. A psych ward. The looney bin. A place for crazies.

I never want my psych patients to feel that way. Like they’re any less entitled to good care or proper human decency because of their illness. Life is already hard enough. My patient that day told me about himself and what it was like living in the emergency housing. How he couldn’t sleep because of all the moaning, yelling, whispering, the general lack of privacy. He shared a room with a few other residents, so he rarely had a moment alone. The fridge was locked so he could never eat on his own accord; he always had to ask a staff member if he wanted a snack or something to drink. The shower schedule only permitted showers every few days. He could not leave the premises because he was new and on probation for 6 months until he could prove that he wouldn’t be a flight risk. He had been requesting a prescription refill for his medications for a week and it still hadn’t been filled. And that, he said, was the most frustrating part. I will never forget the breaking of his voice as he told me he knew he needed help. He needed his medications. He needed to be better so he could see his kids.

Many patients I pick up are already enveloped by their illness, saying words that don’t make sense or not even speaking at all. Completely unaware and disconnected from the world around them. And, of course, always non-compliant with their meds. So when my patient told me – no, begged me – to make sure I tell the nurses to get him a new prescription, I reassured him I would. I would tell them a thousand times. I would stand over the doctor’s shoulder and watch them write it for you if I could. That was enough to feel the prick of oncoming tears in the corners of my eyes.

I don’t know when healthcare went from only worrying about your current ailment to a frantic scramble of figuring out if your insurance covers your cost of treatment or if you’ll be paying out-of-pocket for care. When medicine and insurance became inseparable terms. Why we have lost so much compassion in the very field meant to care for and heal people. All I know is that when I see Medicare/Medicaid Policy #: 999999999A, my partner and I will be driving to a community hospital instead of a private or teaching hospital. My patient, as you might’ve been able to guess, was going to community.

The Los Angeles Homeless Services Authority reports that, as of 2020, 66,436 people are currently experiencing homelessness. Realistically, there are thousands more out there that aren’t accounted for. How many of them have easy access to healthcare? Homeless people are more susceptible to life-threatening diseases, more likely to have a disability, more likely to be victims of substance abuse, and yet, more likely to not have insurance and/or not seek treatment. There is something seriously wrong with this picture. To me, it seems completely unfair that these people who already have to deal with figuring out where their next meal will come from or where they will stay the night are also forced to be constantly thinking of what happens if they fall ill. If the unthinkable happens. For a lot of us, if we break an arm, we go to the emergency room immediately. If we develop an infection, we visit our doctors and get prescriptions for antibiotics without question. We rely heavily on the fact that we are able to have such easy access to medical help, and while we should not necessarily feel guilty about that, we should feel more grateful. After seeing patients who have to contemplate or even refuse to be taken to the hospital because they’re afraid of the costs associated with a visit, I know I try to.

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Research

Gaia. Holly. Jafar. Kazaam. Loki. Modi. These are the monkeys I work with each week when I come into lab. They’re macaques, to be exact. They all have their separate personalities too: Jafar and Kazaam – the sweethearts. They like to press their chests or their bottoms to the cage bars and wait for scratches. They’ll also be the loudest to hoot and holler when we take one of the other monkeys out of their cage (they think we might be hurting their friends). Holly is a mean girl. She’s particular and fussy. She refuses to do work at times and snatches the fruit and vegetables we give her out of our hands. And she’s learned how to pinch. Not just grab, but pinch. Bad news for those of us who work with her. Loki and Modi are new, so they’re still getting used to the lab environment. They like to make faces at you and get riled up if you stare back at them for too long. They despise getting out of their cages. And last but not least, sweet Gaia. The key to our Parkinson’s Disease research: Gaia, our Parkinson’s monkey. The left side of her body moves significantly slower than her right and when she sits in the chair we use to move her from her cage to our testing space, she’ll put her left arm out as if she can’t see and is feeling her way through darkness. She likes being pet behind her ears. And she doesn’t eat the peel or rinds of fruit so she’ll throw them on the floor after eating the good bits.

Working with monkeys takes a lot of patience – Loki alone takes almost 20 minutes to get out of his cage. They get antsy. Sometimes they won’t cooperate. But I’ve grown to care for them, nonetheless. They’re curious and funny at times. Cute, even. And through my research, I feel like these monkeys and I have a shot at making a real difference in the field of medicine. Through attending our paper review sessions, practicing lab techniques every time I come in, and learning how to analyze data, it feels like I'm making some sort of contribution.

More importantly, why did I select this field to research? Being a neuroscience major interested in neurological diseases is a large factor, but two other reasons are closer to my heart: my best friends’ dads, both diagnosed with Parkinson’s. One of them is a neurologist himself, aware of the signs of Parkinson’s onset; he had noticed some of these showing up in his own life in the weeks leading up to his second opinion diagnosis: trouble sleeping, tremors in his hand, dizziness, and unmistakably enough, loss of smell. Although he wasn’t positive, he was fairly sure he already knew what he had and what they would tell him.

I often think of him and what that would be like. To know you have this degenerative disease with no cure. To know all the ways your body will eventually betray you before your mind starts to go. To know that your daily movements will become increasingly difficult as the years go on. And worst of all, to be acutely aware of the adjustments your family has to go through to accommodate the changes in your health: medical bills, routine doctor appointments, frequent trips to the pharmacy. Their constant worry about how this disease will progress. Constant worry about losing you.

The irony of studying the brain only to have your own brain turn on you in the end, I imagine, must feel – forgive me here – mind-blowing. Frustrating. Outrageous. Shameful. But why?

Doctors are supposed to be the ones who take care of others, but no one really talks about what happens when the doctor is the one who gets sick. Maybe it feels like, in some strange way, you’ve failed somehow. Doctors forget about their own mortality and when they come face to face with it, they must figure out how to adapt just like everyone else. People always say “doctors make the worst patients.” And my friend tells me that her dad is no exception. He’s stopped taking his meds for the time being because he doesn’t like the side effects. He still comes into work, maybe even more so now to compensate for the years of research he believes to have lost already. This is how he’s adapted: he lives as if he’s already out of time.

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Volunteering

When COVID hit in March of 2020, I was sent home from school, bringing an end to all of my in-person extracurriculars. At home, I struggled adjusting to doing school completely online. I really, really struggled. Being away from people took its toll on me. And I’m not talking about my family; of course, they sort of helped me get through the seemingly endless isolation. But it was different. I missed being in a setting where everyone else around me seemed to be on the same page: going to the library to study, scurrying to classes, making appointments for office hours. I missed being around that type of productivity.

After about a month or so, I could see many aspects in my life start to deteriorate. It started with my physical health: I was going strong at first, following 2-week home-workout programs that had gone viral on Tik Tok or Youtube. Making use of my neighborhood’s community gym, trying to distract my mind by watching Friends on the treadmill. But even that got difficult after a while. Eventually, just the idea of going outside for a walk seemed like an impossible task. As far as eating habits went, I would come downstairs to eat once or twice a day (sometimes, though, I would take multiple trips to the fridge, checking what we had just out of boredom. It was as if I expected new groceries to appear out of nowhere since the last time I checked.) At the end of August when I went to my yearly physical check-up, I had lost 13 pounds.

Next to decline was my schoolwork with my overall mental health following shortly after. I would take classes from my bed (and often, fall back asleep). It became increasingly hard to make it to club meetings. My assignments would sit untouched until the night before it was due. Instead, I spent anywhere from 8-10 hours on my phone, vicariously living through other pre-med students who posted morning routines or “day in my life” videos. I wanted to try and emulate their productivity so badly, but my tank was empty. I felt hopeless and extremely discouraged. How was I going to be able to handle becoming a doctor, let alone medical school if I couldn’t bring myself to do all the things I needed to be doing as an undergraduate? After binging Tik Tok after Tik Tok, I would take a break by sitting in the shower. Not even to clean myself, only to sit. Just to feel something, I told myself. Just to feel anything. I think my record might have been 5 showers in one day (Sorry, mom. Our water bill must have been outrageous.) Funnily enough, even though Tik Tok seemed to be the root of many of my struggles during COVID, it was also a saving grace. Because a lot of other students were frantically searching for alternative, online opportunities, there were a lot of suggestions for websites where you could find volunteering. For me, that website was called 7 Cups.

As a 7 Cups volunteer, you would be asked to chat with anonymous people who simply needed someone to talk to. Because the website is not meant to be a crisis hotline, you were NOT able to give any advice to them. Instead, we were asked to guide them through their own thoughts by active listening or if in an emergency, you could provide the person with a number to a real crisis hotline. Now, you might be wondering, if there were real crisis hotlines out there, then why wouldn’t people go straight there? What was the point of 7 Cups? That was a question I asked myself a lot before starting. Only when I started having conversations with people did I understand the value of their stories.

3 chat requests. Average wait time: 1:58.

With each new request came a different person, a different set of problems. A fight with a girlfriend, losing a job, problems figuring out money; it would always be something new. But the one thing that remained constant was the general feeling of loneliness. It was the feeling that you had nowhere else to turn to, no one else to confide in. A feeling of being stuck. And after my experience with COVID, I could empathize with that. We were all just lonely people looking for a release, for someone to listen to our worries and carry some of the weight they bore on our shoulders. And because that was my role as a listener, to be the weight-bearer for these people, that was also why their stories meant so much to me.

It’s an interesting concept, disclosing your entire life and your fears to a complete stranger completely anonymously. I would never know them, but I would know all the ways they’ve been vulnerable. Weird, isn’t it? I would talk to them for anywhere between 30 to 45 minutes, making sure to respect the 7 Cups guidelines, but also making sure that I was asking questions that seemed as genuine as possible. What specific part of this person’s actions made you upset? Why do you think you felt this way initially, and did you feel any different after you stepped away from the conversation? Although still very therapist-y, the more questions I asked, the better I got to understand the person, the human, behind the screen. I learned about the range of emotions a person can feel in different situations and how people expressed that emotion. After they had said their piece, they would say thank you and log off. Once I finished all of my conversations for the day, I would have a warm glow in my face and a feeling to sit up a little straighter. For a while, I thought this was an emotion closely resembling pride: it felt good that I was able to have helped someone in some way, even if it was something as simple as having a conversation with them. But looking back, I believe this was, more accurately, me feeling good about being trusted. These people left their hidden feelings with me and they were able to walk away, their shoulders feeling ever so slightly lighter.

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Shadowing

After a neurosurgeon spoke at one of my American Medical Student Association (AMSA) meetings, I was immediately entranced by the idea of an operating room. Fluorescent lights buzzing, the clatter of surgical instruments on the tray, the soft whirring of machines. I wondered, Are people talking? Do they play music to help pass the time? Or do they stand for hours in silence? Medical jargon is probably being thrown around. Scalpel. Retractors. Pass me the clamps. This would continue for hours, depending on what type of procedure is being performed. After the club’s presentation, I felt compelled to approach the surgeon and ask if I would be able to shadow.

Neurosurgery, a specialty that has crossed my mind a few times. The brain, so many intricate structures, nerves, vessels. I wondered how it felt to operate on an organ so essential to human life. I wondered about all of the preparation the surgeon had to do to arrive at this moment, all the schooling and all the practice. But most of all, I wondered what they would say when things started going south as they operated. When blood pressure drops, the heart rate spikes, the patient is losing blood by the second. Blood doesn’t scare me. What scares me is having someone’s life literally in your own hands. Deteriorating. To make a mistake, to slice too deep or to cut the wrong tissue, is to cost precious time and potentially leave the patient with a condition that is worse than what they came in with. If I were to slip up just once, would I be able to handle that? And what happens if that slip up costs me a life? Could I live with that guilt?

I turn to the past to seek answers. As I look at an archived picture of a surgical team at Montefiore Hospital from the 1960’s, I find myself “shadowing” the surgeon who peers closely at the hand of his patient on the operating table, wondering what is running through his mind. He is holding a pair of forceps as a member of his team passes him a clamp. Three others, most likely nurses or anesthesiologists, look on as he works. Although the operation seems quite simple, a thousand thoughts are probably flying through this surgeon’s mind, if not more. The anatomy of the hand, the names of nerves and tissues, the type of procedure he’s doing and all the steps. Complications of the surgery. His expression is focused, but collected. Frozen in a concentrated trance.

The day I shadowed (in person, this time), nearly 60 years later, the operation I observed went similarly to what I believe happened in that picture. As expected, the lights buzzed, instruments clattered, and words like fistula and catheter were thrown around. There were all different types of medical staff in the room: nurses, anesthesiologists, residents. It somehow felt calm and tense at the same time. Quiet. Everything moved along systematically with precision in every movement. The surgeon was enraptured by his work, but still took the time to explain his steps to me and the other students. I couldn’t fully understand all of the terminology at the time, but he had a surety in his voice, and I was impressed by the wealth of knowledge he appeared to have. He would once in a while ask the residents a question to see if they were keeping up. I didn’t see the end of the procedure, but as I left, the surgeon was already wrapping up. A routine surgery, he told me, nothing too serious. A success.

Success. That word echoed in my mind as I walked home that day. Success. The patient was okay. They went home perfectly fine to their family. The surgeon did not have to have the heartbreaking conversation with them, I’m sorry, we did everything we could. Success. Everything my dad’s operation wasn’t.

My dad went to the hospital for chest pain. He sent us a text saying that he was fine and that they were holding him overnight for observation. We would see him soon.

The next day, he was in surgery. And I have always wondered what it was like in the operating room when it was my dad that was on the table. What did they say when they discovered that a blood clot from his chest had made its way to his brain? What did they say when they knew he would not wake up? Did they discuss how they would break the news to the widowed wife, my mom? Did they think of me, one of two children who lost their father? I couldn’t tell you exactly what happened in that OR, but the words I do know they said? Time of death, 10:56.

As an aspiring surgeon, I am terrified of the day that will inevitably come where I have to break that news to a family. Tell them we did everything we could and that we’re sorry for their loss. There is no easy way to go about telling someone these things. No way to avoid the emotional turmoil brought upon these families, uprooting everything they know as normal. As a surgeon, you not only take on difficult schooling and long surgeries, but also all of the pain of loss and grief from hundreds of patients and their families. And as someone who has been on the receiving end of that loss and grief, I am grateful for the kindness and patience of the surgeons who operated on my dad, who allowed us time to grieve and say goodbye.

I wonder how the surgeon in the picture did it. Endured the heavy burden of the job. I’d like to think that his current patient survived and maybe that’s how he kept going. Small wins. I’m sure he lost patients too, but I imagine that seeing the faces of relief and joy of patients who survived and their families is a feeling unlike anything else. Not every patient is going to have a smooth-sailing operation, but not every patient will pass away. And holding onto that thought is what keeps me going.

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The path to becoming a physician is long and arduous. There’s no denying that. This experience varies between individuals: journeys all start in different places, compiling a mosaic of trials and lessons along the way. But the one thing that all aspiring doctors must have is passion. A passion to learn. A passion to help. A passion to heal. Without this, how could one possibly expect to continue down this road?

Through all of the requirements expected of me for medical school, I have had endless opportunities to learn and connect with people. Whether it was a physician or a patient, every interaction had something to teach me, both about medicine and about myself. My journey has been one of personal growth, through observing and listening. Using the basic science I’ve learned in school and how to apply it in the clinical setting. Pushing my boundaries and exposing myself to new experiences. And becoming a more compassionate individual in order to use that compassion in the way I treat and, in the future, heal others.