FEBRUARY 2020

Dr. Amy Waer: Defying “The Typical Personality”
by Sarah Elmer, M1, and Thomas Nguyen, M1

It is just after 7 a.m. on a Wednesday. As we are led down a hallway, light shines through the windows and the sky is in that gradient between a rusted yellow and smooth indigo. A chorus of blackbirds occasionally breaks the silence with song. The world is still asleep, but it is stretching its arms like a newborn about to wake up. There are many things on the list to talk about today, and they arrange themselves like lines on a hopscotch court: life growing up, practicing as a general surgeon, taking on the role of interim dean. As we enter the office, the sound of clicks on a keyboard slowly fades. A soft voice welcomes us with a smile: “Please come in. Make yourself comfortable. I’m still moving in and rearranging things, so that’s why things might seem a bit out of place.”

On first look, Dr. Amy Waer seems like the embodiment of academic medicine—poised, polite, well-dressed, and very focused. However, after a short conversation with her, it is clear that she is much more than just an administrator for the Texas A&M College of Medicine. Since the beginning of her medical training, Dr. Waer has been known to defy stereotypes. Her path to becoming a first-generation college student, a general surgeon, and the Interim Dean and Executive Dean of Education and Academic Programs embodies how she defies expectations. 

Waer was born in Ohio and moved at age 3 to Phoenix, Arizona, where she spent the majority of her childhood. As the only child of two very hard-working parents, Waer had the drive to succeed instilled in her from a very young age. “I am very proud to say that I am a first-generation college student,” Waer said. “My father was an upholsterer and my mom was in banking. Kind of all self-created but neither of my parents went to college. So, I am very proud to be first-generation.” 

Before entering college, Waer initially thought that she would follow her mother’s footsteps and enter the world of business and banking. When she started high school, she could choose to either be on the business track or the science track. For the first three years, she followed the business track and took courses in typewriting, stenography, and accounting. However, she did not enjoy the classes and wanted to switch over to the science track during her last year of school. 

“At the end of my junior year, I told my mom ‘I want to switch to the science track for my senior year,’ and she said ‘Oh I’m not sure,’” Waer said. “At the time I was working at Baskin-Robbins for a summer job, and she said, ‘Well, why don’t you go volunteer at a hospital and see if you like it. If you like it, then sure, switch over for your senior year.’ So I did—I volunteered at a hospital in Phoenix. It was actually with a plastic surgeon’s office. I got to go with him in his clinic, over to the operating room, and just fell in love with it. I came back and told her that not only did I want to switch over to the science track, but I wanted to go and be a surgeon.”

Alhough the business world was not intriguing to Waer as a high school student, she finds herself using the content from her high school business classes in her current position as Interim Dean and Executive Dean of Education and Academic Programs.  “The irony is now being the interim dean and the executive dean, there is a lot of business, and there’s a lot of budgets,” Waer said. “All that accounting from high school comes in handy.”

After graduating from high school, Waer attended college at the University of Arizona in Tucson, where she doubled majored in microbiology and biochemistry and minored in chemistry. When asked how she was able to balance such challenging and rigorous coursework, Waer said: “I stuck purely with the science because that’s what I’m passionate about and loved.” Throughout college, Waer’s determination and drive to enter medical school never faltered. When she told her parents that she still had the same dream from high school—to become a surgeon and save lives—they were surprised.  

“They were shocked that I even wanted to go to college,” Waer said. “I mean, they were always very supportive—but they always thought that I should be a librarian, which I kind of thought was funny. I’m not sure why. I was very probably book-wormish when I was growing up and still love books. So when I told them I wanted to go to medical school, they were very supportive but quite shocked.”

Waer was accepted to the University of Arizona College of Medicine for medical school and started her medical education in 1988. As she was starting her clinical rotations, a general surgeon, who later became her mentor, initially discouraged her from pursuing a career in general surgery. 

“He told me initially, ‘I’m not sure you have the personality to be a surgeon,’” Waer said. “He wasn’t saying it in a mean way—I was very quiet, very shy, very introverted.” 

The general surgeon told her that she should do her OBGYN rotation before her general surgery rotation to see if she liked the former better, thinking it would be a better fit for her personality. However, two weeks into her clerkship, Waer did not feel the same passion or energy for OBGYN that she’d previously experienced with general surgery during her time in the operating room.

“I saw him in the hallway and he asked ‘How are you liking OBGYN?’ I said ‘I’m not,’ and he said ‘You’re committed to general surgery?’ and I said ‘Yep,’ and he said ‘Okay.’ The funny part is the personality thing of not being the ‘typical surgeon,’ which at that point sometimes implied being pompous or a jerk. We still laugh about that—the typical personality.” 

Waer said the most memorable surgery of her early career she performed as an intern. Her mentor, also a general surgeon, provided a watchful eye throughout the operation but gave her full control. “He let me essentially do an open inguinal hernia repair as an intern, pretty much just being my guide, but letting me run the whole thing—and it was so exciting,” Waer said. To any medical student who has taken medical gross anatomy, the words “inguinal hernia” are enough to provoke a feeling of anxiety. We think of the proximal rectus abdominal muscle, the superficial and deep inguinal rings, and the inferior epigastric artery—all places where lesions could have permanent consequences and implications for the patient. Similarly, Waer said she remembers thinking, “This is really complex,” which “was a bit nerve-racking,” but adds that “The challenge of it is what I loved. The patient did well, and it was successful, and that to me was very fulfilling.”

Outside of medicine, Waer uses the same attention to detail and manual dexterity to fuel her creative outlets: “I love interior design, landscape architecture, and gardening.”

“I also used to have a jewelry business where I sold on Etsy and really enjoyed that. I brought all my stuff from Tucson when my husband moved out a few months ago, and I keep telling him I need to start that back up.”

But these hobbies are more than just a mere pastime—even as dean, Waer recognizes the importance of carving out time for oneself: “I don’t think there’s ever going to be a perfect work-life balance,” Waer said. “It’s more a matter of prioritizing, but making time for yourself and your family and friends is critical because that’s what keeps you from getting burned out. You have to do that intentionally; otherwise, this can be all-consuming.”

Waer adds that she goes on “Sunday drives” with her husband as a simple yet effective way that she counters burnout, saying “we’ll get up early on Sundays and drive somewhere—Brenham or Waco or somewhere—and just go for breakfast or lunch.” Waer plans these trips and incorporates them into her busy schedule as a way of intentionally making time for herself and her loved ones.

Finally, when the topic shifts to her vision for the College of Medicine, Waer is again straightforward and precise in her response. “Number one is to get successfully through accreditation with the LCME,” Waer said. “Number two is to work on the clinical affiliations, to solidify our partnerships. Not where we’re doing just one-off contracts all the time, but where we have a more collaborative relationship with them—I’m talking the major ones. We have a lot, but Baylor Scott & White primarily, CHI St. Joseph, and Houston Methodist.”

She continues, “Number three is the financial sustainability of the College of Medicine—trying to make sure that as we go up in our class size that we’re not always in the red. And then number four is improving the clinical and research mission, and how that exactly looks we’re working on the strategic plan. So those are my priorities as interim dean. If I became the permanent dean, those would be the same. And more too,” she quipped, with a small chuckle. The list of visions that Waer has is grand yet concrete, evidence of someone who has given this question many hours of thought. And to achieve these goals, it will take many more hours of hard work, staying on the front lines of medical education, and always leading the College of Medicine actively. It might seem unattainable to some, like wishful thinking. But who knows? Waer is someone who is known to defy stereotypes.

First Position
by Sreeya Cherlo, M1

Squeaky clean floors

High Ceilings

A contained frenzy

Whisked into a studio

Back in my element

Stethoscope

  traded for ballet shoes

A reminder

Be professional

Looking into blue eyes

Stepping into her shoes

A grandma

A former nurse

Whose taken histories before

Formatted in the classical ballet 1st position, where the heels are together and the toes are turned out.

Moments of Joy
by Ahad Azimuddin, M1

"When you're a doctor, you can treat me," she would say after refusing to let me pay for our lunch together. She was proud of the pun. I, on the other hand, felt crushed. We both knew that by the time I even begin medical school, she will no longer be alive. I will never be able to treat her to a nice lunch, let alone treat her medically. Yet she still laughs. Her name is Joy, and despite being in her early sixties with a nine-month cancer prognosis, she has been living up to her name. 

Joy and I met by chance. While embarking on my very first solo trip through Europe, I became stranded late at night at an airport in Luton, a town on the outskirts of London. Hurricane-force winds had canceled my flight. Storms had shut down public transport. When I attempted to draw cash to pay for a taxi, the ATM had eaten my only debit card. I had no food to eat, no place to stay, and no mode of transportation. Sitting alone and anxious, I felt a tap on my shoulder. It was Joy, who, from watching afar, had become in tune with my distress. Without hesitation, she offered me food, a ride, and a place to stay. 

"Why?" I asked. Her answer was blunt: 

"I have stage IV pancreatic cancer and about nine months left to live, so I might as well do some fucking good before I go," she responded. 

Taken aback by her candor, I accepted the offer. As I followed her to her car, second thoughts began to seep into my mind. This was a woman I did not know, and I hadn't the slightest clue where she was leading me. As I was about to open my mouth to politely decline her generosity, she turned to me. She said – "I hope you're not a criminal or anything … and if you are, you can't be bothered to kill me. I'm on my way out anyway."

From there on, our night consisted of conversations about life, death, and everything in between. I shared my dreams of becoming a physician. She shared her nightmares of becoming a patient. We bonded over our fondness for books we had both read. We asked each other questions about our lives. We learned through each other's widely different perspectives. I was a young man with a life left to live. She was a woman with a life she was about to leave. 

Two months later, I returned to London, and we began to meet regularly for lunch to continue our dialogue. I became attached to Joy, the stranger who showed me empathy when I was vulnerable. My moments with Joy have helped me learn more about the complexities of life. She has shown me that it is important to be myself without fear of failure or repercussion. She has shown me that despite what goes on throughout the world, there is an inexhaustible value in compassion. She has shown me that, sometimes, the world needs more people to live life and take a chance for the better. Joy took a chance in helping me, and I can never be grateful enough. Since meeting her, I have accomplished goals in my personal life and professional life that I never would have been brave enough to do on my own. I cherished each lunch we had together, looking forward to time passing until the next. Each time I saw her approaching in the distance, I felt excited to hear more about her life. Yet, each time I saw her up close, I felt pain seeing that the sclera of her eyes had become just a little more yellow than I had last remembered. 

This encounter occurred at the end of February 2017. The year I applied to medical school. After I returned to the United States, I continued to keep in touch with Joy via phone, email, and WhatsApp. In September, I remember stressing to her about having not received a single medical school interview. She somehow felt certain that one would come. The day after I received her words of encouragement, I received an invitation to interview at Texas A&M. 

Over time, the messages between us became few and far between. Joy's responses slowed. With each subsequent message or call, I was reminded of the incredible lessons and experiences Joy had to share with me. However, with each message or call, I would also be reminded of her worsening condition. We both knew of the underlying inevitable, but I never felt prepared to speak it into existence. We ended each interaction with an "until next time" or "can't wait to catch up again." 

On Wednesday, November 15, I woke up to the smallest vibration from my phone. I had pre-matched to Texas A&M. Elated, I did what most of us had done when we got our acceptance: I jumped all over the room until I had no breath left to breathe. Then I called my loved ones—my parents, my sister, my cousin. Then I called Joy. There was no answer. I sent her a message relaying the good news. Over the following weeks, still no response. It was November. Nine months from when we first met. 

I never received any information about her condition or her death. We were strangers before we met and had no mutual contacts. This was one of my first experiences facing the death of someone I cared about. To this day, I still grapple with the complexity of how I feel. Until the day I put on my white coat, I hoped that I would look at my phone to see a WhatsApp notification from Joy. Before writing this, I pulled up my web browser and searched her full name and address, followed by the word "obituary." 6.2 million results in 0.42 seconds, said Google. I closed the tab before reading a single word.  

It's been nearly three years since I met Joy, and I still struggle to find an effective summation of what she had represented to me. I may not even be able to put it into words until the day I die. All I can say now is that until I die, I might as well do some fucking good before I go.

…In This World
by Rhett Butler, M3

… In this world

Hope is given by those who use it most

A mother, a child in a difficult fight to be clear of

Hunger for those without means

Homes and still lives swallowed by the earth and sea

Wars deemed worthy by man’s God

Man forgetting the place of God’s man

Just a world, simply a world

And yet astonishingly, our world

Perhaps unique are we

Recording history while history records our actions

How do we leave this world?

Is there an end to war?

Gods reconciled?

Are homes rebuilt and lives restored?

Means afforded to those who may starve?

A cure for an ailing child?

A prayer for the vigilant mother?

A debt to be paid, history will tell

For the hope, these give to all

Through struggle, suffering and pain

It is not optional, the price is love

They need all the love they can get

… In this world

“Tips for Surviving Pre-Clerkship”
by Jordan Garcia, M3

1. Bring picket signs and bullhorns to orientation week. When you’re told that you get only six psychotherapy sessions per year (SIX?!), distribute picket signs quickly. If they stand firm at six, pass out the bullhorns. 

2. When “tuberculosis” comes up in conversation with non-medical school friends, they will turn to you. Nod knowingly as you excuse yourself to bathroom and promise to explain when you return. Lock door, wipe sweat dripping from forehead, and Google search “tuberculosis.”

3. Not being a gunner can be challenging. Browsing the internet? You’ll see peers winning the Nobel Prize. Eating with friends? You’ll spot the Presidential Medal of Freedom dangling from a neck. When the urge to become a gunner makes hours seem like days, or summer vacation seem like weeks, seek help from M3 non-gunners. 

4. The secret to pursuing competitive specialties is self-care. Get an early start now by developing a healthy respect for, among other things, laughter therapy, birding, and shameless arguing with people online.

5. If you have a question during lecture, but your microphone doesn’t work, come up with a solution yourself. You could: Talk louder, write the question on a piece of paper and pass it down, or impress your professor by harnessing a cup-and-string telephone.

6. If you develop a cough, it’s probably allergies or the common cold. Use Zyrtec or drink hot tea, and it’ll likely resolve on its own. However, keep in mind, it could be eosinophilic bronchitis, Bordetella bronchiseptica, or a vascular malformation in your upper airway. 

7. When a lecture isn’t available before a test, or eCampus crashes during a quiz, the world isn’t coming to an end, and your medical career is not finished. In fact, the Curriculum Committee actually worked with eCampus and IT to engineer those “glitches.” Years from now, you’ll be thankful for this holistic training.

8. Always keep your composure. Make digital audio files of casual responses to commonly asked questions. When Mom calls a few weeks into second semester asking, “How’s Intro to Disease going?” Simply put phone next to laptop speakers and play pre-recorded file.

9. Ever been to a party and dared someone to do something impossible? Then regret it the moment they say, “Hold my drink”? Similar things happen when you tell your school it can’t fit a course into a given period of time.

10. When learning how to identify diseases and disorders, you may wish to use this information to help out family and friends. However, your good intentions may go unnoticed when diagnosing your spouse with a personality disorder.

11.  Medical training is an arduous journey. You will face both the horrible and the beautiful parts within yourself and others. How you respond—be it with compassion or fear—is your choice. However, do be compassionate with yourself for not knowing what tuberculosis is. For next time—it’s an infectious disease caused by bacteria that usually affects the lungs.

“I need you to tell me if everything is going to be okay.”
by Sarah Elmer, M1

Toward the end of the Foundations in Medicine II (FOM II) block in December, first-year medical students wrapped up the semester by listening to lectures about various genetic pathologies. Our block directors organized a genetics panel. Members of four different families talked about their personal experiences, either living with a genetic disease or caring for someone with a genetic disease. The idea behind the genetics panel was to remind the M1 class that the diseases we were learning about are not limited to pages in a textbook. In fact, for some people, living with a genetic disease is part of everyday life. 

One of the panelists was Quentin, a young man who was diagnosed with trisomy 21, commonly known as Down syndrome. Quentin’s dad was asked by a student what we, as future physicians, could do to best support the families and caregivers of those born with genetic diseases. 

With his voice breaking, he quietly said: “I just need you to tell me if everything is going to be okay.” For some of us, that statement hit close to home. I understood the sorrow in his voice as a mirror of my own, because my youngest brother, Marshall, was born with trisomy 18.

Trisomy 18, also known as Edwards syndrome, is a severe genetic disorder that causes death before the age of one in 90 to 95 percent of children. I was only 11 years old when Marshall was born, and I had a difficult time comprehending and accepting the severity of his prenatal diagnosis. Confusing phrases like “tetralogy of Fallot” and “Dandy-Walker malformation” were thrown around regularly when physicians talked about complications from his disease, but I had no idea what any of it meant. The only thing I cared about was someone telling me the truth—was my brother going to be okay or not?  

Although medical students are taught an entirely new language of medical jargon to communicate with other healthcare providers, we must remember the importance of comprehensible patient-physician communication. After all, how can we create meaningful connections with patients and their families if we do not even take the time to speak to them with terminology that they can understand? 

Despite the odds, Marshall will celebrate his 13th birthday this year. However, the period after Marshall’s diagnosis was filled with uncertainty and self-learning about his medical conditions. Although he has received outstanding medical care from various doctors, nurses, and other healthcare workers throughout his life, the communication barrier still persists. For individuals like Marshall and Quentin, we, as future healthcare providers, need to make sure we do a better job of being transparent with family members about diagnoses and predicted health outcomes without using confusing terminology.

The interaction that the M1 class had with Quentin and his father served as a reminder to us all of the crucial need to view patients and their families as people—not just a series of symptoms or a diagnosis. This reminder could not have come at a better time in my medical education.  

Before listening to the genetics panel, I was feeling so exhausted and burnt-out from the entire semester that it was hard to find meaning in the work that I was putting in for school. While being a medical student is absolutely an honor and a privilege, sometimes it is hard to remember this amid the information overload and sleep deprivation. Unavoidably, mental and physical fatigue ended up taking a toll on my overall well-being and sense of purpose. 

In moments like these, it is easy to become jaded and to forget the reason we started this journey in the first place—our patients. Quentin’s and Marshall’s stories are good reminders that even though we may feel like we are “drinking out of a firehose” at times, the material we are learning is important. For every textbook page with different symptoms and pathologies, there is a real patient who deserves to know if everything will be okay. 

Shame
YoungJee Jung, M2

Someday and sometimes, I feel so much shame. 

It sticks its little tongue and gingerly looks for a crack to seep through and invade.

But I’ve learned to recognize it. 

                                                           Seal the crack. 

                                                                                      Close the door.

But sometimes, I let it through. Allow it to explore its old territory.  

I’ve been in a state of low self-esteem, imposter syndrome, and never being good or smart enough for a while so the feeling that comes back is so familiar. 

                            So comfortable. 

Maybe I’ll let the crack open just a tad bit more,

Welcome back. 

Welcome in. 

I don’t have much to show for these past few months I took off. 

All I know was that the time was for me.  

As the world rolled by, I hibernated and went into a little cocoon. 

To heal, to think, to first numb and then slowly thaw everything out …

To come back to myself … 

And for me, that’s enough. I have that to show to myself. 

Still, I don’t have anything worldly to show for it. 

Still, I have no tangible “productive” thing that I can put on a CV … 

“Me” time sounds so weak and entitled, doesn’t it? 

To the world, it’s a red flag. A possible future liability. 

But, I am not the world.

But, I am my world.

So the most important thing: How do I see it?

For me, getting rest and healing was worth it. 

I am worthy of just being, regardless of what I can potentially contribute.

I am worthy of living and just being.

Then the shame melts away and returns back to its hidden place.

It comes back every once in a while. But only as a visitor. 

It is no longer the owner of this house—of my world. Here, I make the rules.

Go. You must leave—and it does. I am triumphant.

Love-Hate Relationship
by Danielle Mosby, M1

Anxiety and I, we have a love-hate relationship. We aren't heartfelt with one another, but sometimes she's the only one that I can count on, you know? I’ve known her since I was told to fend for myself. 

She’s my best friend, my best friend when I hear the word “addiction” in a medical context. She brings back all of the memories of the cocaine pipe I would find in my toy bucket. Or when I would find my mom on the floor. Or when I would contemplate if my existence would ever mean more to her than her “addiction.” No matter how hard I try to hide those memories. She holds my hand as I hide from the conversation and decide to have no part in the debate going on in front of me. 

She was the loving voice in my head when I did my social history OSCE. The voice that I couldn’t stop fighting, shushing, or questioning for those 30 minutes. The voice who followed me all the way into that room and told me it was okay to run out. The voice I heard when I heard that childhood passed, although it wasn't exactly my own. She was the reason I had to try hard to only ask the questions, and the reason I couldn't handle class the next day. 

We officially moved in together when I graduated high school because we already had mutual friends, inside jokes, and boundaries, so it was a no brainer. It happened fast because, in due time, she became the only one who would answer the phone when I called to rant about school. A rant nobody else would listen to because I was first generation and I just needed to “study more.” There were more important things to talk about. 

Anxiety is the reason I don’t talk to you, she doesn't want you to know my name. She’s possessive. She doesn’t like me talking to other people. She’s irrational. Because of her, sometimes I will show up to lecture late, so I don't have to sit next to one of my other friends and make small talk. She's jealous I have other friends even though I live with her. I don't answer questions correctly once a classmate answers wrong. I sit silently. Cause you know, maybe A is the correct answer, but she reminds me C is the answer I need to pick because the answer choice is longer and the words are bigger. 

Because of her, I take the long way to school and sit in silence, because when I hand her the aux cord, she makes sure to play back all the time nobody believed in me and told me I would be nothing.  I have to listen to her … it’s so rude to ignore people! Where are my manners?! Because of her, I still think no one will ever want me. Eight homes in 5 years, sometimes not even a house. I continuously wonder: “Was it me?” How will a patient want me, if nobody else did?

What happens to a girl who is too anxious to ever feel like magic? Can she still fly, although her wings always tremble? Can she forget her lifestyle like the ant who thinks that no matter what she does, she is in danger of being crushed? My friend Anxiety doesn’t like to be made into metaphors. But what I’m trying to say is, she is constantly reminding me how easy I am to crush, as I remember because I try so hard to forget. I am pushing against her weight on my shoulders and that is why I shake sometimes, why I stare off sometimes, why I’m emotionless sometimes, why some days I don’t talk and only cry, and why I don’t get too close. She reminds me that everyone leaves.  

I have to fight to stand up straight and stop rocking. She and I picked out this outfit together. Do you like it?! What about the shoes? Is my hair okay? She says I should’ve worn a ponytail! I tell her that in starting MY career, I am determined to KNOCK HER OUT. Well, I mean I want to! How will I live without her?! I have been fighting her for control of our house for years. Fighting not to crack, wait, stop rocking! Don't shake! Breathe! 

But how can I breathe when she’s the reason nothing works out because no one knows they’re signing up for a package deal?

I understand. I know how hard it is to live with both of us, we don't like feeling out of control. We don’t handle conflict well. We don't handle being yelled at well. Everything you say to us will be repeated and deconstructed and analyzed in our head a million times before we go silent for a while, trying to figure out who gets to speak.  

I’ve tried to cut her off before. I can NOT. We do not handle separation well because of our parents, I mean our family, no, our friends, wait! No, our abuser, no, not that either! No, wait, breathe! So I guess Anxiety and I have to just learn to live together. She is the longest relationship I have ever had. As everyone leaves, she is the only relationship that I can count on. 

So I apologize, but she and I must ask you—ask you not to hurt us, or talk about us, or bully us. We have to ask you to be mindful! Understand that some of us grew up poor, unloved, had an addicted mom who didn't follow the rules, and have had to FIGHT to get here.  Understand that we weren’t so lucky, but we made it, and your comments and ignorance hurt! We ask that you care that some of us are not like the rest of you, and you respect that and treat your PATIENTS and not their DISEASE. Because you have no idea why they may have it. 

Synapse Board Members

Thomas Nguyen, Chairman of the Board
Lena Ayari, Managing Editor Farah Wazir, Acquisitions Editor Jordan Garcia, Associate Acquisitions Editor Sarah Elmer, Staff Writer Ahad Azimuddin, Copy Editor
Tasfia Rouf, Copy Editor

thank you:

A special thanks to ... 
Dr. Karen Wakefield for being our faculty editor, and
Dr. Barbara Gastel for serving as editorial mentor.

The Synapse is sponsored by the Department of Humanities in Medicine at the Texas A&M University College of Medicine.