Med School is not as Glamorous as you may Think | August 20, 2016 National Day of Solidarity to Prevent Physician Suicide

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http://espn.go.com/espn/feature/story/_/id/12833146/instagram-account-university-pennsylvania-runner-showed-only-part-story

A nice reminder for all social media users. I first came across this news story three years ago and even wrote a blog post about it. Out of the blue, my research PI (who is a psychiatrist) sent me this article at the end of my senior year and it elicited even stronger emotions. I felt compelled to start a draft, which I didn’t finish until now. A lot has happened in my life since then, but I was reminded again of this story as I attended the National Day of Solidarity to Prevent Physician/Medical Student suicide at my medical school a couple weeks ago.

Since the era of sending mail through horseback and the advent of phone calls, we have always portrayed the positive parts of our lives, but the difference now is that Instagram and other social media has consumed more of our day as we endlessly scroll past people’s filtered accomplishments, happiness, and picture “perfect” moments.

All of Madison’s friends shared some form of struggle, yet she still felt alone because social media didn’t match up with what they were privately saying. This really urges me to be real with people I talk to. I’m not going to pretend like I live in a world of rainbows and butterflies. No one lives a perfect life. This is what it means to be human. We are all in this together.

‘People are also often encouraged to put filters on their sadness, to brighten their reality so as not to “drag down” those around them. The myth still exists that happiness is a choice, which perpetuates the notion of depression as weakness.

As a family, they had never talked about suicide. Jim never considered it a real possibility — just the dramatic ending to someone else’s story. Jim feared that speaking about suicide would make its likelihood greater.

Bill Schmitz Jr., former president of the American Association of Suicidology, points out that depression does not have a one-size-fits-all prognosis. “The course varies,” he says. “In a way, it’s the same as cancer. For some, we might prolong life for months, for years. For others, it can be very sudden.”‘

  • These three paragraphs summarize the myths of depression and gets at the very root of mental health stigma in our nation. Yes, happiness is a choice, but when a person is suffering from a mental handicap, their brain chemistry has changed to where you are not in full control anymore. With that being said, depression is a real disease and not a personal sign of weakness. A lot of us want to please those around us, but we also need to be in-tune with ourselves. Your body is all you’ve got in this world; love it and take time to nourish yourself physically, mentally, and spiritually. The quote, “Speaking about suicide would make its likelihood greater” is similar to the sexual education dilemma. I think it’s important to talk about taboo topics rather than sweeping it under the rug because the more open we are, the more opportunities we have to help ourselves and others.

“It’s OK to not be OK. It’s OK to show people you’re not OK.”

  • Most important message I took away.

“I run because it’s therapeutic for me. Because every time I run outside, around my home, I am reminded of the beauty of the world, of which I often forget. Yet at the same time, I am fully aware of beauty — it simply saddens me because of reasons I have not yet conjured up. I suppose I am sad. But at the same time I am happy; and miserable; and joyful; and stressed out; and calm, and everything in between. I am everything. Every emotion, rigged in every format, and developed through every machine. I am numb but I am not.”

  • I can totally relate to the first few sentences as a runner, but the latter half is where the message is. We are all bodies of emotions and feelings. This is a very beautiful thing. Never feel alone in your thoughts and feelings because somewhere in the world, someone else is or has already felt that way. When you need help from yourself – tell someone, ask someone. We are all in this together.

Revisit my first post about this news story: https://journeyoflifeandmeaning.wordpress.com/2014/01/22/what-if-we-car…ore-loved-more/

Excerpt: “Make sure that whoever you talk to or come in contact with, that you are okay with how you made them feel with your words and gestures if that was your last day on Earth. Try to develop that deep connection with people so that maybe you can save someone’s life. This is a powerful realization for me. You don’t need an MD to save people’s lives – just genuine care for one another’s well-being by opening up, being vulnerable, talking deeply and loving thy neighbor.”

Developing a Healthy View of Social Media

Recently, I had a friend tell me that she didn’t want to take a picture because she was so concerned about being too fat and ugly. I hadn’t seen this friend in over a year, so I wanted some memories. This saddened me a lot and I tried sharing my perspective that you should never measure your self-worth based on numbers on the scale or what you see in the mirror. She wanted to be perfect. I said that’s not possible. She said “90% perfect then.” She even turned down entering in relationships because she said she didn’t want to disappoint them with her physical looks.

Let’s be honest. We are all affected by our outside looks to some regard. We can’t change this because our exterior is what others see first. I don’t want to sound like a perfect person because I am not. I still get very bad acne in my mid 20’s and I’ve been battling this since middle school. It’s been worse recently most likely due to medical school stress. My acne makes me feel less attractive, it takes me more time in the morning to make sure people won’t be staring at my acne rather than my eyes, and sometimes it prevents me from going out if I have a really bad breakout.

However, I think I am half way there to the wisdom of not caring what others think of you. As long as you are okay with the energy you give off to the world every day, it doesn’t matter what clothes you wear, what your face looks like, how fat or skinny you are, etc. I don’t untag photos of myself because “people might find me less attractive” and I don’t care if I’m laughing so hard in a picture that you can’t see my eyes. It’s all about the feelings of the picture – the happy emotions it elicits, not the way you look and the thoughts of what other people on your social media might think of it.

At the end of the day, I am happy with myself if I spread kindness, warmth, deep care for others, and positivity in the world. Think about the kind of energy you want to radiate from your soul.

National Day of Solidarity Lessons

  1. The osteopathic handshake is a hug. It was cute to see all the presenters hugging each other when they passed the mic and it reminded me of the hug fest we had during orientation week. As DO’s, we are known to be more hands-on and more open to expressing the caring touch. I really do believe in the healing power of touch and this is a huge reason why I enjoy learning OMM.
  2. Get enough sleep. Fun fact: 7.7 hours is the average hours we should be getting. I make this a priority and it’s been really helpful in keeping me awake and alert for school.
  3. Practice healthy selfishness. I love this phrase. Never ever forget to take care of yourself.

Med school is not as glamorous as you may think. I know I didn’t really think about what daily life was like for a medical student until I was one. I was just concerned about getting in, but the hurdles don’t stop there.

  1. You spend so much time staring at a screen studying that the next time you feel the sun’s warm rays or talk to a person about something non-medically related, you feel like a new person.
  2. All day, every day, even weekends and breaks, all you think about is studying. You feel guilty if you have too much free time. The material isn’t hard in and of itself, but there is so much content that it’s not humanly possible to master every detail. You keep striving to learn everything and fall short.
  3. You schedule to see your friends during the one free weekend after you take the block exam and before starting a new block the following week. You have less time to spend with family and friends outside of the medical world. You might miss important life events, like birthdays, weddings, reunions, graduations, etc. People might even move on without you… That’s one of the hardest things about this lifestyle. Non-medical people in your life might never understand what you go through and they move on because you can’t provide the kind of attention and time they seek. There are so many articles and videos out there about personal sacrifices people in the medical profession make (I do have something positive to say about this. See #6 in the “good things” list).
  4. You don’t get enough sleep because you are constantly wanting to study more and/or you have to get up early for another day of new lectures.
  5. If you’re away from family, you have to worry about managing life outside of school, such as cooking for yourself, expenses associated with eating out, cleaning, and other miscellaneous chores. You might experience being homesick.
  6. You put life on pause in a way. If you haven’t found your life companion, good luck dating and finding someone that puts up with your lifestyle. If you have found your life companion, wishing you the best during this challenging journey and may love endure, sincerely.
  7. Your apartment/room is a madhouse because you wait until exams are over to clean it.
  8. You spend your whole Friday, Saturday, and Sunday at the library/study rooms before a big exam.
  9. You’re constantly accumulating $200k+ debt while in school.
  10. You often let go of a few hobbies and forget about what truly makes you feel alive.
  11. You end up double speeding YouTube videos you watch for fun because that’s what you do for lectures.
  12. While you may see your non-medical school friends traveling the world, making money in a job, going out every weekend, getting married, having children, buying houses, and settling down, you’re concerned about passing the first two years of didactic learning, then rotations, then applying for residencies where you work long hours with modest pay, then finally securing your first position as a board-certified physician. By this time, you’re in your 30’s (older if non-traditional). While I’m not saying these things can’t be done simultaneously, it’s just more to think about and juggle.
  13. Medical school takes a toll on you. Four of my fellow medical students developed strands of white hair halfway through the year. You might experience feelings of depression, anxiety, and inadequacy.

Good things!

  1. You become close with your medical school classmates because of the shared struggle. With a small class size, you truly become a supportive family.
  2. You get to be a sponge as you soak in all this new information. You’ll look back and think “how in the world did I gain all this knowledge in four short years.” Learning is fun!
  3. What kind of career allows you to learn something new every single day for the rest of your life?? When I feel bogged down about studying, I step back and think how awesome it is that we have a wealth of information at our finger tips.
  4. Making new and exciting memories (e.g. unintentional twinning with my classmates and end of block gatherings with the whole class).
  5. I look forward to working out now because it’s the main release of my day. It feels so good to lift or run off all the stress you felt during the day. You just have to schedule it like you’re going to lecture. Hopefully this will prevent the med school 15 haha.
  6. I have a lot of classmates that have supportive significant others, even a few starting families. It’s not impossible. If you are privileged to have already found your person while in medical school and your relationship withstands the hardships, you know they are a keeper. Count your blessings for finding someone so understanding and patient.
  7. Medical school is a unique and special time. You only get to do this once. It’s four years where you really don’t have real responsibilities. Your job is to learn as much as you can. These four years will pass by fast, so make the most of it and slow down to be grateful for your daily opportunities.
  8. A long line of people would die to have your seat in medical school. In the 2016-2017 application cycle, 21,030 out of 53,042 applicants matriculated into medical school. That’s 39.6% acceptance rate. If you’re a medical student right now, be very grateful for this life-changing opportunity. Source: https://www.aamc.org/download/321442/data/factstablea1.pdf
  9. How lucky are we, as medical students and beyond, to have such a wide array of activities to experience and accomplish that’s worth documenting? Seeing your first standardized patient, volunteering at the free clinic, studying, OMM, taking Step 1, student organization events, conferences, presenting research, leading a health careers exploration camp for high schoolers, welcoming new students on campus, new friendships, field trips, wearing scrubs, holding human hearts and brains, learning new clinical skills, rotations, graduating, starting residency, etc. Follow my medical journey on Instagram: ghrellen where I explore what it means to be a strong female physician humanitarian 🙂
  10. When you learn about diseases that people in your personal life have and you start thinking about how it’s affecting them and possible treatment options: cystic fibrosis, immune thrombocytopenia purpura, GERD, lymphoma, Wilson’s disease.
  11. You become happy with very little. Sometimes, we go through such low points in this journey that we become more appreciative of the little things in life, such as having a free weekend off to spend with friends, breaking up the studying routine to get lunch with classmates, or taking a few minutes to be appreciative of nature outside the window.
  12. I normally go on a long run shortly after noon on Wednesdays, weather permitting. As 1st and 2nd year medical students, we have a lot of flexibility and decision-making power to choose how we spend our day. Of course, this changes in 3rd and 4th year, so I’m trying to be consciously grateful for this freedom while we still have it.
  13. At the end of this journey, we are in one of the most meaningful professions. In what other capacity do you get the chance to become so intimately involved in all spheres of another human’s life? We have the unique opportunity to save lives, reduce suffering, and love humanity every day.
  14. Remember, it’s not solely about the destination, it’s the journey – not only the journey of medicine, but the journey of life. We are in this space and time only once. Step back and be grateful for everything you have.

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I challenge you to live a #lifeunfiltered

~lntan

Day 21 (Friday, May 23): “It’s Not How Much We Give But How Much Love We Put into Giving” -Mother Teresa

Woke up around 7:45am. Wore the green white-flowered sleeveless Kurti. Breakfast around 8:35am: round bread, veggie curry, omelet, and tea. Received some compliments on my Kurti. Rachel was interested in getting her pants fitted after someone mentioned that the store where I purchased the Kurti provides free tailoring.

We took traveling vans to Manasa Jyothi. Our Mysore minivan crew got excited to see Chand again, but sadly he wasn’t driving. Adam was my seat buddy! He complimented that my Kurti makes me look more oriental. I was like “I know.” I’ll embrace my Asianness. Haha. Dr. Raj rode in our van also. It was a 45-minute drive. Adam and I talked about dreams, X-Men, and my lizard story. Manasa Jyothi has been my favorite field trip so far. The woman from the Netherlands has really done something spectacular, and she’s only 37 years old. Truly inspiring. I hope to pursue a passion like that.

IMG_5619As we passed through the white stone-walled threshold of Manasa Jyothi, I felt an indescribable feeling of happiness and comfort. A trampoline and playground emerged with numerous joyous children swinging, riding bikes and running around. At first glance, one would not suspect that these children have suffered more than we could imagine. The story of how Maartje van den Brand and Shobha Madhyastha founded and manage the school inspires my future endeavors in life.

IMG_1240Manasa Jyothi is a residential school for mentally and physically handicapped children. They recently moved to their current resident in Kundapur. It’s a modest-sized school that has grown gradually over the last ten years (started in 2000). They have around 18 children between 5-18 years old. The infrastructure can hold up to 35 children. Services include individualized programming based on each child’s needs, free medication and medical care, good hygiene and health practices, daily teaching, exercise, yoga and free medical equipment (i.e. wheelchairs, helmets, back braces). They are challenged to be independent by making their bed, washing their hands and brushing their teeth. The primary goal is to keep the children healthy and clean according to western standards. The secondary goal is to provide a safe and educational home. Tertiary goal: inclusion of disabled children into normal schools. When the Government passed the Right to Education Act in the parliament, disabled children were not included in this article. It is one of ADAPT’s greatest achievements that after much lobbying an amendment of the Right to Education Act was made. This means that more than 30 million disabled children will now have a right to education in India as well. Inclusion in education of children who are differently abled in India still has a long way to go. Two of the students will attend a normal school next term.

IMG_1245A range of staff is available and needed, such as teachers, volunteers, a psychologist, physiotherapist, speech therapist, and occupational therapist to provide unique care for each child. The philosophy is that the children learn best when they are safe, happy, and valued. Every child has this right. They aim to build the children’s self-esteem by teaching them to value themselves and develop other positive qualities (e.g. independence, honesty, integrity, respect for others). They have a non-violence principle and focus on verbal and visual (sign language) communication. The school is funded privately by a trust and does not request money from the parents. This is important for children who do not have loving parents to take care of them properly at home. Manasa Jyothi serves as their home, education and transition into society. In India, the stigmatized status of disabled children renders an unhealthy and sometimes dangerous lifestyle. The children end up on streets, beg for money to survive or are abused. The vision of Manasa Jyothi is to change the stigma by showing the interaction between handicapped children and care-takers.

IMG_1388I enjoyed seeing and hearing Maartje talk about her humble beginnings with Manasa Jyothi. Maartje is a physiotherapist from the Netherlands. Her father has been an inspiring force in her life as he has dedicated the last 15 years of his life working for UNICEF and the UN to improve human rights of people in prison. After graduating and volunteering for an NGO for a year in the slums of Indonesia serving mentally and physically disabled children, she felt a calling to do something good for the world in 2007. She gave up her physiotherapy practice and left family and friends to move to India. She found her way to Manasa Jyothi and was only planning to volunteer for three months in order to improve the health care and education. As time passed, she learned of the horrid things that were happening to the children, such as molestation and abuse. She was so disturbed that she went to the police, which is uncommon to do. People told her to “look the other way”. After three years, she decided to leave and started a foundation in 2009 with help from family and friends in the Netherlands. She mentioned that in our countries (US and Europe), people would be willing to help, but here no one wanted to get involved. “Foreign people come here and think ‘oh this place is too nice. Why do you need more funding?’” It’s a struggle retaining workers at the school because of the stigma behind disabled children. Frequently, workers leave before getting married because “what will the neighbors think if she works with handicapped children?” The woman’s status decreases if she works with handicapped children rendering her less desirable for marriage. Maartje learned the local language, Kannada because she believes communication is pivotal when helping people of a different background. She always says it’s her last year, but looks at the children and can’t leave.

IMG_5610It was shocking and eye-opening to hear the children’s stories. Vino’s parents came to get him fully drunk one day and Maartje now refuses to let him go home. One parent was quoted to say “let God decide if she lives or not”. One girl was locked in a hut for seven years. Another girl had her uterus removed by her parents. Several have cases of cerebral palsy, which developed during birth. Seeing the children at Manasa Jyothi now is a complete turnaround. Vino is awaiting admission to a normal school. The children are clean, smiling, and laughing as they are riding their bikes, chasing after each other or swinging on the playground. I had the opportunity to watch Maartje interact with a girl through sign language, and I could sense the love and connection. The girl looked at Maartje as if she were her mom. I admire that Maartje experienced first-hand a (public health) issue and was courageous enough to pursue a solution to the problem when all odds were against her. A quote on their website http://manasajyothi.jimdo.com/ encompasses my thoughts and feelings about this school: “it’s not how much we give, but how much love we put into giving.” –Mother Teresa. I hope that one day I can live life giving back to a cause I am passionate about with love.

IMG_5608Afterwards, we headed to the beach in Kundapur, which was surprisingly pretty clean and serene. Stopped by a restaurant for lunch. Dr. Raj ordered us a 5-course meal with samosa, naan, three types of curry, gulab jamun, yogurt, rice with raisins, veggie noodles, fried tortilla chip, white rice, more curry and ice cream with fruit. There was a lot of food.

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Dr. Raj’s family joined us for lunch also, and we got introduced to them at the end. We met his brother-in-law, sister, brother and two nieces, one of which is attending Manipal for medical school. His sister is an OBGYN and brother-in-law is a pediatrician.

IMG_5631Adam casually used me as a shoulder rest while we were waiting for the van, which coincidentally happens to me a lot when I’m around tall people. He questioned if I get dark easily since I’m part Malaysian. He asked what the other half is. I said Vietnamese and we concluded that the people get pretty dark.

We went to the Hanging Bridge next. I slept a little on the way there. The bridge was beautiful. I got on it, but decided not to cross because it was precariously waving back and forth. I was imagining what it would be like to fall into the water below, and that scared me because I don’t know how to swim thus causing my fear of large bodies of water. Alvian shared my sentiments, so that was nice someone else understood. Kelsey R and Taniqua didn’t go either. The others just went to the other side and came back. Got some good pictures though!

IMG_1405Then, we went to another beach. Everyone took off their shoes and got in the water except me because I don’t like the feeling of wet sand and shoes. Adam thought of the idea to do a shadow O-H-I-O picture, which turned out awesome!

IMG_1423I took some scenic pictures of a canoe, an elusive clear-colored crab and waves crashing on rocks, while everyone else enjoyed the water. I was cooling myself off with my airplane tickets, which serve as good emergency fans by the way when Adam asked if I save them. Me- “Yes.” Adam- “Me too. I keep my movie tickets also.” Me- “Wait. Me too!” Adam- “Did you save the ones from last night?” Me- “Yes (checks purse).” I’ve been collecting movie tickets since Home Alone was in the theaters. Haha.

IMG_1434We had the option of going shopping afterwards. Half of the people hopped off the van and half of us went with Dr. Raj. The department store had saris, kurtis, cotton scarves, and children’s clothes. Nothing really caught my eye, but several people got some quality stuff for a cheap price.

Returned to campus for tea time: fried tofu-like balls. Back to room. Uploaded pictures to computer and dilly dallied until dinner at 7:30pm. I changed my profile picture to one of me and the little boy I fell in love with at Manasa Jyothi. I went to their website, read, and wrote down information because I am genuinely interested and wanted to remember as much as possible. I posted the website under the profile picture.

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Dinner was good: barley rice, roti, Gobi Manchurian, squash curry, and another curry. Had yogurt also. It’s weird – I hated the yogurt in the beginning, but now I really like it as a palate cleanser at the end of the meal. Serves as a pseudo-dessert too. Sat with Kelsey F, Alexa, Adam, and Lindsey. I asked how Sahanna was feeling. She said “better.” Someone said Adam should do a Mohawk. And he turned it on me and said I should do a Mohawk. Lindsey said “that’s gonna take a lot of maintenance.” Adam continued with “buy a leather jacket and wear some brass knuckles.” Me- “I think of Grand Theft Auto when I hear brass knuckles.” Adam- “That’s what I was basing it off of! Get out of my head.” I nod my head a lot when I listen to other people talk. Adam started imitating me and I burst out laughing. Alexa and Kelsey F were like “What’s going on? Did we miss something?” Adam was just being super silly. I haven’t laughed that hard in a while.

Walked back to hostel with Lindsey and ran into half of the girls standing in a circle at the top of the 5th floor stairs. Xhonela, Kelsey R, Lauren, Ashley, and Nikki were there. We talked about experiences in India and bugs. I shared my lizard story. Some shared their excitement for heading back to the states. I find it more worthwhile to make the most of every moment, good or bad. It’s inevitable that we’re leaving, so why pine for that day when you can be happy right now? I constantly remind myself that we won’t ever be in this moment in our lives again. Back at the room, I washed clothes, showered, skyped Arif and mom, tried catching up in the word doc journal in bed, but fell asleep. Sesen posted a comment on my FB expressing her surprise that I worked at Hollister and teased me about having a lot of past lives. It made me think about authenticity and the implications of being a “mysterious” person. I don’t really talk about myself very often – preferring to listen to others first, but one of my goals in life is to be more vulnerable. So I found myself pondering if having different facets of your personality show at different times a good thing or bad thing. I tried figuring this out on Skype with Arif. I want to be an authentic person and thought the way to do this is to be one person across life’s many different activities. He brought up that it’s not really possible to be the same person because we have to act differently in different settings (I remember learning about the term “impression management” in sociology). I guess he’s right. We both concluded that the most important way to be authentic is to make sure your core values stay the same.

Manasa Jyothi Handicapped Residential SchoolMy favorite group photo on the trip.

Another quote from the Manasa Jyothi website: “Consideration like ‘he is mine or he is another’s’ occur only to narrow-minded people. To broad-minded people the whole world is their family.”