AUGUST 2019

Untitled
by Ahmed Ebrahim, M4

The ED called with intention

"He's got urinary retention."

Creatinine so high,

assigned an AKI.

Sitting on his Foley they failed to mention!

Medicine
by Tasfia Rouf, M2

Medicine

The bitter taste down your throat

They try to hide with sweetness

The mismatched chairs 

In endless ‘waiting rooms’ 

Have all but fallen to pieces

 

“The doctor will see you now”

Once words to evoke fear

Yet somehow amalgamated 

Into this expanse we call career

 

Medicine

Bringing us to the brink of existence

Hours on end, no words—just listen

Lectures, teachings, and knowledge

Based on an oath, a coat, and a shiny badge to polish

 

Until, as if by magic, the oath materializes 

And here 

The mere med student realizes

First do no harm

To yours, to mine, or maybe his

True sincerity comes 

When it’s down to who lives

 

Medicine

Shadowed in nights of full force

When adrenaline kicks in 

And takes by the horns

Those nights are alive

Flaming with passion

Making believe

Miracles always happen

 

And they do, and they’re real

And every other day

Is magic in its own sort of way

Yet all comes crashing down

As these things tend to do

As codes come tumbling in

From code grey to code blue

Medicine

All is silenced by echoes of defeat

Silenced by sirens and screams

  

There are whispers 

There is talk

Things start anew

 

The edges fade

Smiles begin to bloom

 

Medicine

There is beauty in sorrow

Medicine

There is learning in tomorrow

The Dangers of Incentivized Volunteerism
Anonymous

The concept of volunteering and helping others less fortunate is the hallmark of what made America great. No other country donates more money, time, and effort than the citizens of the United States. Many schools, both undergraduate and graduate, along with some employers, ask prospective students/employees about what they have done for their community and/or what volunteering they have completed. This has also played a role in academics as a means to expose students to others who may be less fortunate, or help students understand the differences in society. Academia moved away from calling it volunteering and now calls it service-learning; this is because we should be reflecting on what we have learned and taken away from our experience.

However, the requirement to volunteer for the under-served (US) or under-represented (UR) for school programs may be part of a larger problem in our society. The population of the US or UR in many universities is small given the overall population of the area. Sure, there is poverty, homelessness, the battered, abused, and even animals that require care. But, some university populations can make up almost half of the permanent population and herein lies a problem. 

I get multiple emails, daily, from different groups on my campus that are recruiting volunteers for the charity du jour. Should we, as society, applaud them for their efforts? Or, is there something in the underbelly of college-based volunteerism that is not so great? 

Webster’s definition of volunteer is “one who renders a service or takes part in a transaction while having no legal concern or interest.” Do we not have an interest? Of course, we desire a good grade, to pass a course, and graduate. We have incentive to volunteer and participate in service-learning. 

This, as a whole, is problematic for the concept of volunteering or helping those less fortunate. If schools and employers continue to insist on students’ fulfilling these requirements, we, as a society, will create a population greedier than its current state. These students will become CEOs, supervisors, and leaders of this nation who will see volunteerism only as something that should come with an incentive.  

Service-learning (volunteerism) should be organic; it should be something taught to us by our parents growing up or by our local communities as a way to take care of each other. It should not be used to gain a passing grade or make your campus organization look virtuous.

The sites to volunteer in this community are saturated. So much so that you sometimes have to make an appointment or you may be turned away. I was unable to complete required service-learning hours in a traditional sense because of this incentivized form of volunteerism.   

I relied on unnamed volunteer work that I have done for many years. There was no incentive for me to do this; I did it because it’s important. Volunteering can be enjoyable, but, a lot of time, giving back to others is uncomfortable; it can require you to work in and around those who you do not care for, and you should not receive anything in return. What I get from my volunteerism is that I know it is important to the people I help.

I may not receive credit for the volunteer work I completed. However, my option was to fake it and complete the requirements by doing something I knew little about and cared little about, or do something that mattered to real people that may not meet the school’s definition a service-learning experience.

What have I gained from this service-learning experience? Most people couldn’t care less and do it only for a grade. I can only hope that, as a society, this does not become the norm. 

Mystery Man
by Celina Brinker, M2

For a year now, his repetitive chorus has never been lethal.

I guess in reality, I had only seen him hanging on other people.

Before that year, we were ostensibly acquainted,

And for others like me, his spoken truth remains untainted.


Several times we’ve shared the same room,

I knew one day he’d probably be my heirloom, 

He moved swiftly, powerfully, and in silence

I knew one day we would form the greatest alliance.

It was odd to think he has many clones. 

It could be argued that,

He could really put you in the zone. 

For some though, my he was a her,

But for what it was worth, both had the same throne. 

So here we are only one year later,

Trenching through this long, first chapter.

Eventually it felt as if the thrills died down,

Timidly we waited for our endless nights on the town.

Hollowed out right through his core, 

Only it wasn’t obvious and easy to ignore.

Set on learning his manners so fixed and ridged

Could he, I thought, be the mark of the privileged?

Objectively, he could see the parts that made you whole

Peering into what’s known as the window to the soul.

Effectively he opened every single window. 


When we met a year ago, I gleamed with enchantment, 

We were a duo that would soon make a statement.

I found myself under the most magical spell, 

We just fit together, and I wouldn’t dare bid farewell.

And one night, he lay his head against my chest, 

He seemed to see right through my bullet-proof vest.

I’ll never forget when I realized … he’s my hub. 

He whispered in my ear ever so softly,

“Lub-dub, lub-dub”.

Everest
by Kory Gill, DO

Other Lives
by Ghanshyam Mudigonda, M4

9,192,631,770 periods of 

vibration of 

the ground-state of 

the caesium-133 atom 

determines the length of 

one second. 

Quite endless, in my opinion. 

Because, in that one second, 

Mrs. P imparted Astrophysics to ancient scholastics 

Transcribed the texts in Alexandria 

Codified the stars into pictographs and wisdom 

Touched the cosmic gases of Alpha Centauri 

Serenaded congregations with volume and vibrato 

And ended wars with tact and empathy. 

An 83-year-old 

Who worked as a teacher 

Liked to draw and sing in her free time 

Often went stargazing in West Texas 

Horseback riding in further west Texas 

And talked about her grandfather 

Who served as a general in WW2. 

What else does such a wholesome person experience 

That one second their brain herniates 

Maybe she lived 

9,192,631,770 other lives.

Twitter and #Pathology
by Lacey Durham, M4

I was first exposed to pathology at the beginning of my third year at Texas A&M College of Medicine. With a condensed pre-clerkship curriculum, my classmates and I were given several months of elective time before finishing our core clerkships. The purpose of this time, known as Career Exploration, was to give students early exposure to a variety of fields in medicine. At that point I was intent on becoming a pediatrician, so I signed up for every pediatric subspecialty course that was offered. After the results of the elective lottery were released, I looked through my schedule and was surprised to see that I had somehow been enrolled in a course labeled “Combined AP/CP Pathology.” I honestly had no idea what AP/CP stood for or what on earth a pathologist did, but in the spirit of Career Exploration, I decided to keep my schedule as it was. In retrospect, I think I may have accidentally clicked pathology instead of pediatrics when adding courses to my lottery list. Regardless, it later turned out to be one of the best accidents I ever made.

To make an exhaustingly long story short, it took about a day in pathology for me to reconsider my dream of becoming a pediatrician. I remember being overwhelmed with admiration when the lab manager gave me a brief tour of the path lab before she introduced me to the pathologist. As we walked through the lab, I was amazed by the rows of sophisticated equipment and technology. The sheer volume of science that was happening before my very eyes excited me. I was introduced to Dr. Daniel Perrault, and after we went into his office, I was surprised to see that there was an actual microscope sitting on his desk. I had always liked microscopes and had even been considering going into pediatric ID or hem/onc because that’s where I thought the doctors used them. How on earth had I made it through two years of medical school and STEP 1 preparation without realizing that pathologists were the ones who looked under the microscope? Up until that point, the only words that came to mind when I thought of pathology were “unsocial,” “basement,” and “autopsies.” So far, Dr. Perrault was quite welcoming; his office was on the second floor and had windows, and, from what he had said, it was unlikely that there’d be any autopsies while I was there. For the rest of the day, we sat at his two-person microscope looking at slides and signing out cases. I was amazed. It was the first time that I was actually seeing images of the diseases that I had read about.

When Dr. Perrault released me that day, I practically skipped to my car in glee. My entire view of medicine had changed in such a short period of time. I had so many questions about pathology. Was my experience today representative of the entire field? I needed to learn more. I tried searching “pathology” on Google, but most of the results were for speech pathology. One of the first articles I found described a career in pathology as diverse and stimulating.1 The authors went on to explain the numerous subspecialties that pathologists could go into, including cytology, neuropathology, and hematopathology, and emphasized how pathology was underrepresented in medical schools in the United Kingdom.1 After one day in pathology, I could appreciate how misinformed I felt about the entire field.

I continued my search online but found it difficult to find answers to basic questions about pathology: How long is training? What’s the difference between anatomical pathology and clinical pathology? How often do pathologists do autopsies? How competitive are residency programs? What kind of lifestyle does a pathologist have? I was only beginning to learn about pathology, and I already had so many questions. I looked at the latest NRMP Match Data (2017) and learned that only 216 of the 601 positions offered for pathology that year were filled by US graduates. I noticed that almost 60 positions were left unfilled in pathology before entering the SOAP.2 Was this common for pathology? I didn’t understand why there were so few medical students choosing to go into path. I was certain that my ignorance of the field was a fluke, but maybe it wasn’t? Or maybe there was something bigger that I was missing? Ultimately, I came across online discussion forums about pathology. I found dozens of threads discussing how awful the job outlook for pathology was and how recent graduates couldn’t get jobs unless they completed one, preferably two, fellowships.3 I noticed that pathology online was represented as a bleak and fading discipline. I worried if I would end up not being able to find a job in the future. When I brought up switching to pathology to my friends in medical school, they echoed the same messages that I read online. Did they, too, consider pathology at some point in the past, only to be turned away by what they found online?

After my two-week elective in pathology was complete, I knew for certain that I would be switching specialties. I had spent many months in pediatrics and could confidently say that I had never felt the same level of excitement for pediatrics as I did for pathology. I asked a faculty advisor to switch to pathology, and after meeting up with her and bringing up the job market, she replied, “Ignore the online threads. There’s plenty of opportunities in pathology if that’s what you really want to do.” I decided to sign up for more pathology electives, and, throughout my rotations, I met more and more pathologists who offered the same advice that my advisor did. It was through these real-life connections that I realized pathology was not being accurately represented online.

With each passing day, I found myself more intrigued. When I would see a disease in clinic, I would wonder what it would look like under the microscope. I wanted to get better at recognizing normal histology, and I wanted to learn more about recognizing diseases. I wanted to talk with real pathologists about their experiences and ask them why they chose to go into pathology. I desperately wanted to sit and look at cases under the microscope again. Because of this, I started searching hashtags for pathology on social media. I started first on Instagram and Twitter by searching #pathology. For almost a year, speech pathology overwhelmed my search results. I noticed that other fields, like emergency medicine, were pretty robust on social media, and I was frustrated that I was having such a hard time finding pathologists. Eventually, I came across Jerad Gardner (@JMGardnerMD), Sanjay Mukhopadhyay (@smlungpathguy), and Syed Z. Ali (@sza_jhcyto) on Twitter. I saw that they were posting beautiful images with teaching explanations known as “tweetorials.4” Through them, I was able to find countless other Twitter accounts to follow and dozens of hashtags to search. I was looking at #TwitterPath every day, and through this online community, I was able to learn more about the field itself and see countless cases that proved tremendously helpful each time I had the opportunity to do a pathology elective.

One of the reasons why I’m an advocate for pathologists on Twitter is because of its impressive community of medical professionals. At the touch of your fingertips, you are connected to pathologists across the world.5,6 Experts become accessible. Those you admire are regularly posting cases and sharing clinical pearls; it makes it feel as if you are sitting across from them at the microscope. You can follow hashtags and live tweets from conferences that you’re unable to attend and learn alongside those who are actually there.5 Users can freely share information across the globe with those at all levels of training. When compared with other social media networks, Twitter’s maximum 280 characters per Tweet facilitates sharing information that is quick and to the point.6 The #TwitterPath community is engaged and supportive. Twitter has allowed me to follow and connect with fellow women in pathology and in medicine as a whole. An article in JMIR Medical Education in 2018 reported how important it is for young trainees to be able to find female role models online who “look like them” in order to provide supportive environments and help close the gender gap in academic medicine.7 I couldn’t agree more. When I see pathologists like Maryam Sayah, MD (@PathologySayah), Rola Ali, MD (@DrRolaAli), and Erin R. Garrett MD, MS (@ErinGarrettMD) post cases and tweetorials, I am especially excited. I do look up to them as role models, and I’m eager to follow suit in the future.

Through Twitter, I have connected with hundreds of current residents and fellows in pathology programs across the United States. Direct messaging on Twitter has given me the opportunity to ask questions I was unable to find the answers to elsewhere. Of the 162 programs that offer first year positions in pathology through the Match, only 37 have associated Twitter accounts, and only a handful of those are actively managed.8 Of note, it was through Twitter that I first learned about the University of Michigan Department of Pathology (@UMichPath). Once I looked into the program, I knew that it was a place I wanted to check out. Now, I feel so lucky to have been given the opportunity to visit for an away rotation all the way from Texas.

The attitude that pathology attendings and residents have on social media substantially affects the way that I view the programs that they’re affiliated with. When multiple users from the same institution are sharing cases and making an effort to teach others across the world, I feel that education is prioritized in that program. When I read supportive comments between colleagues discussing a case, I feel that comradery is emphasized. When I see pathology residents and attendings offering to help in any way possible when I post a question about pathology on Twitter, I look at them as people that I would be fortunate to work with in the future.

If you’ve been anti-Twitter for a while now, let me ask you to reconsider. When I asked University of Michigan pathology professor Dr. Henry Appelman if he had a Twitter account and he said, “No, why?” I responded that he should get one because there are people, like me, all over the world that want to learn from people like him. Could you imagine how amazing it would be if the pathologists we looked up to shared cases with us that they’ve been holding onto for years? Or better yet, imagine scrolling through the comment section of a #GIPath case and seeing a comment from Dr. Appelman that says your polyp looks like a giraffe, or a cowboy boot, or a fish. I can’t imagine anything more fun than that … Can you?

References

  1. Child, M., & Gupta, L. (2009). A career in pathology. BMJ. doi:10.1136/sbmj.b629
  2. National Resident Matching Program, Results and Data: 2017 Main Residency Match. National Resident Matching Program, Washington, DC. 2017.
  3. PathologyGIT. (2016, Feb 24). Re: No JOBS in Pathology. Retrieved from https://forums.studentdoctor.net/threads/no-jobs-in-pathology.1185558/
  4. Mukhopadhyay, S. (@SMLungPathGuy). “1/ Are you new to Twitter? Are you a pathology resident or a pathologist? Are you wondering what to tweet about or where to start? This brief tutorial is for you. Pathology on Twitter is awesome. #Tweetorial = Tutorial of tweets. #pathtweetorial = Pathology version.” 18 August 2018, 4:18 PM. Tweet.
  5. Freitag, C., Arnold, M., Gardner, J., & Arnold, C. (2017). If you are not on social media, here’s what you are missing! #DoTheThing. Archives of Pathology and Laboratory Medicine, 141, 1567-1576.
  6. Oltulu, P., Mannan, A., & Gardner, J. (2018). Effective use of Twitter and Facebook in pathology practice. Human Pathology, 73, 128-143. doi:10.1016/j.humpath.2017.12.017
  7. Lewis, J., Fane, K., Ingraham, A., Khan, A., Mills, A., Pitt, S., Ramo, D., Wu, R., & Pollart, S. (2018). Expanding opportunities for professional development: Utilization of Twitter by early career women in academic medicine and science. JMIR Medical Education, 4(2). doi:10.2196/11140
  8. Pathology Residency & Fellowship Programs on Social Media. https://pathinfo.fandom.com/wiki/Social_Media_Guide_for_Pathologists

Everest, by Kory Gill continued

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