October 2020

How I learned to stop worrying and love … the nanoparticle: A visual journey

By Christian Boada, PhD Postdoctoral Research Associate

It is something surreal to study something that you cannot see. For the better part of 5 years I devoted my time to studying nanoparticles as part of my PhD. Trying to study, synthesize, and manipulate something so impossibly small, about 1/100,000 of the thickness of a piece of paper, is hard to wrap your head around. However, despite their size, these nanoparticles have incredible properties and are incredibly useful as medical treatments. There is even a whole arm of nanotechnology dedicated to the study of the application of nanoparticles toward medical treatment, nanomedicine. It has proven successful in the treatment of cancer and atherosclerosis. During my five years studying these particles, they have surprised me in more ways than I can recount. Despite constant probing, challenging, and testing, these particles continue to challenge my assumptions and expectations, and I have grown to have a certain fondness for them.

I must admit that there have been many instances where my skepticism led me to dismiss the efficacy of nanoparticles before an experiment had started. I often performed experiments looking more to discard strategies. In other instances, even when an experiment was working, I was waiting for the result that would disprove my theories or render nanoparticles useless. To this day, the fatalist within me is waiting for the good streak to end, although that has not been the case yet.

My research involves a specific type of nanoparticles made of lipids, called liposomes. To give you an idea of how these particles are made, the analogy I use is one of soup. If you have ever stopped to observe the surface of any hot plate of soup (a chicken noodle soup would work best), you have probably observed the little droplets that form on the surface. If you stir the soup, these little droplets become even smaller and as you keep stirring, they will continue to do so until you can’t stir any harder. You can make liposomes the same way by placing lipids in an aqueous solution and introducing energy (heat, pressure, physical agitation) into the system. Liposomes of diameters of 50 to 300 nanometers can be easily made in this manner and can be used for a variety of applications, from cancer, to cardiovascular disease, to antibiotics, and now, even COVID vaccines. The usefulness of liposomes is based on their capacity to encapsulate different medications and change how they move around the body, rendering them capable of repurposing old drugs and decreasing the toxicity of certain small molecules.

The chemical composition of liposomes resembles that of the cell membrane in that they are both made from lipids. However, normal cells also contain a large spectrum of proteins within their membranes. My research focuses on creating liposomes with a large swatch of proteins on the surface. This was not an easy task by any stretch of the imagination. At the beginning there was a stretch of about six months where no experiments were working. My principal investigator was not happy, and I had a committee meeting with no real data to present. I thought about nanoparticles constantly, what I was doing and what else I could do. This began a process where thinking about my research made my hands sweaty and became directly associated with stress. The negative association developed into a full-on vicious cycle in which thinking about nanoparticles would make me anxious, so I would stop thinking about them, but then my ability to come up with reviews or grants would suffer substantially and it would stress me even more. As experiments started to work out, my anxiety decreased and with much effort, I was able to procure some grants for my laboratory. For the next two years, my actions were motivated by fear—fear of failure, fear of being an eternal graduate student, fear of an expiring visa, and the fear of the invisible countdown of dwindling funding that bears down constantly on a graduate student. Let’s not underestimate the power of fear—it’s quite an effective source of fuel, but this fuel runs DIRTY and is not sustainable long term.

If necessity is the mother of invention, procrastination is that nervous cousin that takes a nap when he has a lot of things to do and not much time to do it. For me, procrastination was a useful tool, as the occasional YouTube rabbit hole would lead me to places I did not expect and helped me learn things that later became useful and helped me become a better scientist. One example of this is a rabbit hole that led me to come across certain types of 3D illustration programs I learned to use as a personal project. My research in nanoparticles required me to develop a capacity for imagination that allows you to visualize these particles. I would see little circles in my sleep.

Messing around with some of these programs, specifically one called Blender, I started to create some test illustrations to see if I could make some Pixar-style 3D illustrations. I achieved this goal with a modest level of success. This was enough to encourage me to continue to create these images, each time with an increasing degree of sophistication, and was the beginning of a visual journey (quite literally) to the unseen.

Given the limited ability for observation inherent in the study of nanoparticles, to have something more tangible was a great relief. These illustrations not only allow me to visualize abstract concepts but give me a starting point to engage more people and a new way to think about my research. Developing illustrations about nanoparticles allowed me to think about my research in a creative way, unhindered by the more mundane concerns about grants and experiments. Ironically, without my thinking about these things, this new perspective allowed me to think more critically about my work. I was coming up with new ideas more frequently and excited to talk about my work. The new outlook kept me from anxiously and resentfully thinking about science outside of work, giving me a sustainable balance, and my research is better for it. The illustrations are great to engage a wider public because the images serve to engage and grab people’s attention and then give me the opportunity to explain scientific concepts behind the images. The process of making illustrations for my research is how I learned how to stop worrying and love … the nanoparticle.  

Preventing COVID-19 virus spread during work and life: My experience

By Erxi Wu, PhD Associate Professor of Pharmaceutical Sciences

On February 2, 2020, I traveled to Washington, DC, to participate in a National Institutes of Health (NIH) grant peer review study section. As of that date, the COVID-19 virus had been confirmed in more than 25 countries and territories. The pneumonia of unknown cause detected in Wuhan, China, was first reported to the WHO Country Office in China on December 31, 2019. As of February 1, 2020, a total of 11,821 patients with COVID-19 had been confirmed in China. Simultaneously, the Centers for Disease Control and Prevention (CDC) confirmed eight cases of the novel virus in the US, and two cases were from Wuhan, China. Some countries sent planes to evacuate their citizens from the China epicenter and imposed travel bans or travel restrictions from mainland China. On January 31, the US Department of Health and Human Services (HHS) Secretary declared the US public health emergency in response to the COVID-19 threat. The US began to enforce restrictions on travelers from China, including a 14-day monitored self-quarantine to ensure the traveler had not contracted the virus and did not pose a public health risk. On February 2, when I traveled to DC, there were eight confirmed cases of the novel virus in the US. 

In preparation for my trip to Washington, DC, a student of mine gave me some surgical face masks to wear while traveling, so I put them in my carry-on baggage. On my flight from Texas, not a single traveler was wearing a facemask at the airport or on the plane, so I chose not to wear a facemask. On my return trip to Texas on February 4, I observed only two people wearing face masks, so I kept mine in my carry-on luggage. Face masks worn in public are commonplace in several Asian countries, and I was worried about how I would be perceived for wearing a face mask in the US. I was concerned about the stigma associated with a mask-wearing person in public. Did I have an illness, or was I immunocompromised (for example, receiving cancer therapy)? Or was I showing common courtesy on my trip? I did not want to give the impression to my fellow passengers that I was ill.

Once I returned home and the COVID-19 virus continued its pandemic infestation of the US, I sought to study practical measures that might slow the infection rate in my community. Social distancing and “flattening the curve” became a daily mantra for my friends and me. Our research institute recommended that its researchers work from home beginning March 16, 2020. Meanwhile, on the same day, President Trump issued coronavirus guidelines for America, “15 Days to Slow the Spread.” The CDC issued similar guidelines. Yet, 15 days later, the coronavirus infection rate was still in exponential growth nationwide, with no quick end in sight. On March 29, President Trump announced that the coronavirus guidelines (now called “30 Days to Slow the Spread”) would remain in place until April 30.

Several countries, such as South Korea and Japan, developed public health plans to contain the transmission of COVID-19 quickly. As of April 28, 2020, South Korea’s data showed 10,752 confirmed cases and 244 deaths (5 deaths per million). Japan’s data showed 13,576 confirmed cases and 376 deaths (3 deaths per million). In contrast, the US data showed 960,916 confirmed cases and 49,170 deaths (184 deaths per million). What are we in the US doing differently from these other countries? I asked myself—is social distancing enough? There are no approved drugs or vaccines for COVID-19, although early phase I clinical trials are ongoing. Testing for the virus is just starting to catch up with demand. Therefore, mitigating the rapid spread of the virus is the most essential treatment/prevention step right now. After discussing these population data with my postdoctoral research fellow, we both strongly believe that individuals, especially those engaged in essential businesses, should wear facemasks, especially in any encounter involving two or more individuals. This action will help prevent the community spread of COVID-19 via asymptomatic aerosol transmission. We recommend that everyone in the healthcare setting be required to wear facemasks. This includes medical staff, support staff, research staff, clinic/hospital patients, and all visitors. We hope that government officials will support and enforce these guidelines to help prevent the spread of the virus and save lives. In those infected, the coronavirus can cause significant morbidity and mortality. Wearing a face mask will protect both healthy individuals and those with medical comorbidities.

Another important measure to mitigate the spread of COVID-19 is the non-contact handheld cutaneous infrared thermometer for fever screening. Research shows that over 98% of COVID-19 patients tested develop a fever of over 100 degrees Fahrenheit as part of the illness’s initial cluster of symptoms. Therefore, although the fever will not appear in every individual, a non-invasive temperature measurement can be used as a cost-efficient quick screening tool. When the public enters our hospitals or clinics, we must be sure we can quickly determine if they pose a risk to our patients and medical staff. Measuring the body temperature in place of a yet-to-be-invented quick medical test will help identify individuals that may require additional testing. Unfortunately, this virus is very contagious, and most of the public does not realize they are infected before developing symptoms. Hopefully, new rapid tests can be manufactured in large quantities to determine who has acquired the disease. 

When I was a high school senior, a classmate infected with a contagious skin disease wanted me to share a bed with him. I said yes. When I came back home to tell my mom about this, my mom said no to sharing. But I insisted that I needed to share the bed with my classmate and friend. A few days later, I was infected by this skin disease. It caused difficult symptoms. I felt itchy all the time and could not focus on my studies. The odor of the treatment drug, sulfur cream, was terrible. It was also the college entrance examination time, and I did not do as well as I had expected. I recovered from this skin condition after almost one year. This whole episode resulted from not following my mom’s advice, and I regret my choice. Now I take extreme precautions for preventing infections with COVID-19, not only for myself but also for my family members, colleagues, and others. 

In addition to following the CDC guidelines, I wear a mask whenever I leave my home and have even begun to experiment with online shopping. I also regularly check myself for a fever using a thermometer. I always bring a small bottle of hand sanitizer or a spray bottle of 70% alcohol. Before I enter my house, I spray the alcohol onto my hands and my shoes. I assume that I “see” the COVID-19 virus everywhere. These practices may seem extreme at times. But we must remember, we are living in extraordinary times. 

I think there are still people in this country who have not taken this pandemic seriously. I, together with my postdoc Dan Qi, have already written a paper on COVID-19 prevention, which was published in a leading journal, Genes and Diseases, in April 2020. Here, I advocate that everyone should continue to “wear a face mask, take precautions, protect yourself, your family and our country!” as COVID-19 has not disappeared yet. I believe that if everyone follows the guidelines and takes extreme precautions as I do, we will be back to normal work and life soon.

Dear College Mom

By Priya Pai, Undergraduate Biomedical Sciences Major

Editor's note: For this issue, we invited submissions from Texas A&M University undergraduates, in addition to members of the College of Medicine community. We hope to make doing so an annual tradition.

Dear College Mom,

I am writing this letter in order to say a big thank-you-so-much for all the lessons you have taught me over the years. The values of perseverance, determination, and time management are truly what have gotten me through the first few weeks of living on my own while taking difficult courses at the same time. I’m glad I’m not just now discovering that laundry does not magically fold itself when I’m busy, and food does not fill an empty plate just as I feel the beginnings of hunger. I am so thankful that you didn’t give up on me during the years when the last thing I wanted to do was listen to you. I realize now that all the advice you gave me, and the way that you pushed me to balance more and more things over the years, truly allowed me to experience both the freedoms of college and keep up with my schoolwork. Yeah, you read that right. I basically just gave you the perfect opportunity to punch the air as you read this and loudly exclaim, “I told you so!” That’s right, you College Mom you, take the win!

In addition, the importance you placed on healthy eating and enough sleep has influenced me to avoid staying up late unless absolutely necessary; this has required me to manage my time extremely well, invest time into eating well, and prioritize schoolwork over fun when it comes down to the wire. It’s important to note here that I was very excited to eat chicken sandwiches, pasta, and everything except a vegetable, whenever I wanted, when I left for college, but that got old pretty quickly. Speaking of home-cooked food, I’m still waiting on that care package …

Humility, especially, has served me well during these first few weeks of adjusting to college life and realizing that I am no longer close to being the most intelligent person in the room; but I am still one of the most hard-working. However, I would like you to inform my brother that I will still be smarter than him when I come home (perks of being the older sibling, buddy). 

All of the lessons you taught me (or forced into my very grumpy and unhappy brain) have given me the foundation of who I am as an individual—someone who can be independent and stand on her own two feet but not be too proud to ask for help when needed. I will always be thankful that I am lucky enough to have you as my mother because you have guided my growth into the person I am today. Unrelated side note: Care to deposit some $$ in my account? Pretty please, with sugar on top??? Also, I don’t think you’ll care too much about this, but I got a big tattoo. On my neck. The night after you dropped me off. See you next month!

Love, 

College Student

Why I Want to Be a Healer

Anonymous

I look at the 6-year-old girl: 

Scared, screaming

As her neighbor holds her,

While her cousin presses

Hot metal just out of the oven

On her cheek.

She screams, cries for help—

That was me,

Experiencing one of the countless mistreatments

I had been put through by others.

To grow to be the compassionate version of me today,

To not tolerate the pain and suffering caused by other people,

Because I know the different forms of pain

That I have deeply felt.

Life Lessons from Tennis

By Priya Pai, Undergraduate Biomedical Sciences Major

I started playing tennis in the 7th grade, not having any experience at all. I ended up practicing with some of my older friends on the team every Friday afternoon because it was the one day they didn’t have regular team practices. With their help, I became halfway decent at the sport and figured out what worked for me and what didn’t in terms of how to swing and foot and hand placement, and preference in racket weight and string thickness. By the time I was a freshman in high school, my older friends had already talked to the coach about me and recommended me as one of the few freshmen allowed to play and have a private tryout. During the tryout, I did well and was one of two freshmen starting on the varsity tennis team, where I played through my senior year. I made some of my closest friends through playing on the team, ended up with an invaluable relationship with my coach, and have priceless memories of late-night bus rides from tournaments. I learned that I am not as unathletic as I and most of my peers and family had assumed because I had never played a sport for the school before. I also learned that it was gratifying to come out of my comfort zone. The pain, sweat, and tears were tiny sacrifices compared to the self-confidence, physical gains, and emotional bonds I have forged through my tennis experience.

I failed my first exam in honors biology even though I felt like I was prepared. I didn’t fail it very badly; I was only a few points away from a C. But to me, it hurt quite badly. As the cliché goes, I was the salutatorian of my high school and had never failed a test before. However, it is important to keep in mind that most of the people in the honors section had taken AP Biology and earned credit for the class but were retaking the course either for a GPA boost or as professional school prerequisites. In contrast, I am from a rural town of East Texas and have most of my college credit from dual credit. My school didn’t offer AP science classes at all, so I was learning this material for the first time. In contrast, most of my class was reviewing material they had already learned and gained an in-depth understanding of the coursework. I called my mom when I got my grade back, and she made me feel better. In retrospect, I felt I was compounding everything by keeping it to myself. Since I was ashamed of failing my first exam, I put in even more time preparing for the next exam, practicing on Quizlets that I had found covering the material and redoing study guide questions.

I think that there is a common thread in both of these experiences because in both, putting myself out there and putting in the long hours practicing led to and (I have high hopes) will lead to payoff in the long run. I would say I am more courageous in putting myself in challenging academic situations because I have done that multiple times and have never found anything so complicated that I couldn’t handle it with enough time commitment. I am willing to put in the time and continuously work at something while looking toward the future.

My Nature vs Mother Nature

By Sara Ali, Undergraduate Public Health Major

This painting represents the duality of balancing a healthy life and being a pre-med student. All too often, we get so caught up in our classes and work that we don’t get to observe the beauty of the world around us and see just how much we can learn from it. Some of the best experiences I have had as a pre-med student are the times when I’ve been in nature and had the opportunity to take a break and unwind. With the current pandemic, it is especially easy to get consumed with work and delay personal time. However, sometimes the best ideas come from taking time out for ourselves and recognizing the motivations that keep us going each day.

They Were Better Off Because You Were There

By Nancy Gonzalez, M2

“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray ...” — Rene Leriche, La philosophie de la chirurgie, 1951 

That morning started like any other Tuesday morning. I woke at 6 a.m., drank French press coffee on the porch, then meditated, staring across the fields into the blue pre-dawn sky, ringed by a row of houses at the end. I always notice the row house at the end. They get up early and stay up late. I see their window light glowing early in the morning. I have no idea who lives there, but the glow of their window light is comforting. In HEAL class, we discussed dealing with difficult outcomes—specifically, those caused by medical errors. But the discussion broadened, because sometimes despite not making errors, a good outcome cannot be had. Dr. Sicilio brought up a story about the first patient he lost. “My mentor told me something, and it stuck with me. Even when you do everything, and you still can’t save them, they were better off because you were there. They were better off because you were there.” 

For some reason, even though Dr. Sicilio said this to me before, it struck me more poignantly that morning. I didn’t know why yet. 

I was supposed to start preceptorship the previous Tuesday. Scheduling had fallen through. “We can make up any time you want,” my preceptor told me. “Actually, I’m rounding in the hospital on Sunday, on-call all weekend if you want to join.” Hell to the yes. 

I saw several patients that day. The first one I will always remember. For the first patient, I was just supposed to do a focused physical exam, as the history had already been taken. (The physical exam had already been done as well, but who's counting?) 

“Can I please move to the chair? I can’t sit like this.” 

“OK, let’s get you to the chair.” I stood by the chair as a spotter while the clinician helped the patient toward the chair. Then the patient reached out for my hand. I took it. Together as a team of three, we made it to the chair. 

“Better. I feel better.” 

“They’re going to do a focused physical exam now, OK? I’ll be back.” Our preceptor left us alone, two nervous medical students, taking extra time with hand sanitizer and beyond-thorough scrubbing to calm our nerves. 

“Hi, I’m a medical student at A&M,” I began with the PoM script. The patient introduced themself and wanted to know how we liked A&M. 

I listened with my stethoscope: lungs and the four chambers of the heart. Chamber sounds so intimate—like a secret place or sanctuary. I listened to the carotids for bruits and looked for jugular venous distension. I checked the extremities for edema. I visually inspected the abdomen for signs of distention, enlarged liver, ascites ... Even for a second-year student, the physical exam told no lies, made no false promises. I felt like a ghost trapped in the walls, watching the same scenario play out again, but without the ability to intercede. I made the observations. I saw the glass falling in slow motion from the countertop, pivoting toward the tile floor. Gravity inexorably sucked it down at 9.8 meters per second squared, despite flailing of ghostly hands—how few, yet how they creep, through my fingers to the deep …. Can I not grasp them with a tighter clasp? (1) Human mortality is 100%. The options were presented. Informed consent was obtained. “Maybe no one can ever have truly informed consent,” a clinician had said on the HEAL panel. “Can you really understand fully, even with a medical degree, what you agree to? The risks you’re taking?” Do we ever really know the full weight of our decisions to act or to not act? 

“Can you bring me my water?” 

“Of course. Well, I hope you get to go home soon,” I said. I set up the water glass, with the bendy straw accessible, handing it to the patient. 

“Me too. But I don’t think I will. I’m so tired.” 

“I’m sorry to hear that. Well, can we get you anything else before we leave?”

“Yes, can you ask if the bath people are coming? They were supposed to come yesterday, but it ended up being the shower people. And obviously, I can’t stand up to shower, so I sent them away. Then these other people came, and they gave me a sponge bath right here in my bed. I thought for sure it would soak the sheets. But they managed it. They changed it all out.”

“Oh, I see, so they have quite the system. That’s pretty impressive. Well, we will ask about when your bath is.” 

We kept our word. That was important. Allegedly, the Bath People were on their way. I hope they made it. I hope my patient got a decent, delicious bath and felt refreshed. 

That Tuesday morning, I was back to my regular schedule. I would go to preceptorship, properly outpatient this time. We had hours of exclusively telehealth visits over the phone. I went over the histories, laboratory findings, and studies with my preceptor before the calls. Then we would briefly discuss the differential diagnoses afterward, why clinical suspicion of some disorders was lower, why others might be more elevated. Then I asked about my patients from Sunday, beginning with my very first patient. 

“That patient—that patient died,” my preceptor said. My ears were humming, and I could hear her far away going into the medical details of what happened. Of what we already had known was going to happen. Of what the patient had been informed would happen. The glass fell from the countertop, and gravity exerted a force in the negative direction of 9.8 meters per second squared. Gravity might even be particles—gravitons. I just hope the Bath People got there and did a damn good job. 

If someone had presented that case to me and asked what I expected prognostically, I would have said, “Not awesome.” If someone had asked me if I expected to lose patients at some point in my career, I would have said, “It is part of the job. It is inevitable.” But if someone had asked me what I thought would happen in my preceptorship, on the very first day, I wouldn’t have said, “I expect to lose my very first patient.” 

Leriche wrote about a cemetery contained inside the surgeon. Perhaps many surgeons, many physicians knew cemeteries at young ages. Perhaps this emboldens us to step into the ring with Death and sometimes block the left hook that would have taken someone too soon. There is a callous fearlessness born of pain, squaring off with Disease, forcing it to fight fair—a seemingly passionless, immovable focus, forged in a refiner’s fire. Those difficulties and dark nights of the soul have been transmuted into peace, into that deep focus. I’ve contained a cemetery since I was 12, learning the phrases pulmonary embolism and non-Hodgkin’s lymphoma—then acute lymphoblastic leukemia, diagnosed post-mortem after a misdiagnosis of mononucleosis, then the fatal overdose, the cardiac arrhythmias, car accidents, suicide, glioblastoma ... I remember the beautiful young priest who truly saw every member of the parish. With brilliance, she spoke in a clear voice in support of the marginalized. When my arms were folded across my chest at the Eucharist, she blessed me. And now, less than a year later, I know I was better off because she was there—but what about her? I hold within my hands grains of the golden sand ... (1)

Perhaps Freud was right about one thing: the guilt of the survivor. “What if you had taken her to the doctor sooner? A better doctor.” “What if you had helped her demand a second opinion?” “What if you had engaged more, asked more questions?” “What if you had made a more persuasive argument?” It must be worse when something could have been done or avoided when it is the responsibility, not the survivor's guilt. Physicians, being mortal, make mistakes—and sometimes they lead to poor outcomes. But now is always the time to build resilience against failure, always driving and pushing toward better. Get up. Get back in the ring.

Thou art slave to fate, chance, kings, and desperate men, And dost with poison, war, and sickness dwell, And poppy or charms can make us sleep as well. And better than thy stroke; why swell'st thou then? (2) 

A strong internal locus of control has many benefits: excellent work ethic, no excuses, always pushing forward. But it bites back when everything boils down to, “It was in your control. You could have done X or considered Y.” For some, instead of taking credit for good things that happen, with cruelly selective logic, we explain them away. “I got lucky.” But when something terrible happens, “I could have prevented this.” Could you have? Aren’t other people allowed to exercise their locus of control? I don’t want to go to the doctor. “I don’t want this life-saving measure. I would prefer not to take this medicine. I’d like a DNR.” Aren’t we allowed to not be omniscient? And isn’t human mortality 100%? And soonest our best men with thee do go, rest of their bones, and soul's delivery …. (2)

“They were better off because you were there.” My grandfather was better off because I sat with him drinking his obligatory one gallon of water to flush out the chemotherapy. “I hate water,” he cursed. “It doesn’t have a taste.” “Yes it does, Grandpa.” “No, it doesn’t.” “It definitely does ….” “OK, fine, but that’s actually the minerals you’re tasting, not the water itself. So water doesn’t have a taste.” I laughed, and then he started laughing too. He was better off because I baked his favorite dessert, homemade apple pies, to help with the cachexia, but mainly as a mental health measure. “We don’t put ice cream on ours. We put cheddar cheese on it. A nice slice of cheddar cheese.” “That’s weird, Grandpa. I’ll take a big helping of vanilla ice cream, thanks.” He was better off because when he was tired, on the last morning of his life, I read to him out loud from The Fellowship of the Ring by request. 

And my patient? Were they better off because two awkward medical students attempted small talk and fumbled with their stethoscopes? Were they better off because I held their hand and asked after the status of their bath? Death, be not proud, tho often thou hast been called Mighty and Dreadful, for thou art not so …. (2) 

I think about the First Law of Thermodynamics. Matter cannot be created or destroyed. It can only be transformed from one form to another. As a teenager, I struggled with why I had to experience the loss of loved ones at such a young age. I know people who are in their forties and have never been to a funeral. I envied that. I envied the youthful hubris of my friends: thriving, partying, feigning immortality. I may have known the fragility of the body—but I also know the invincibility of the spirit. 

Matter cannot be created or destroyed. But it can be transformed. “Be not conformed to this world, but be transformed by the renewing of your minds ….” (3) Instead of being destroyed by our challenges, we master them and demand they bless us before we let them go. Maybe there is a different way to look at those challenges. Maybe it wasn’t a curse to see Death while young, to know the fragility of life, to have a sense of urgency about what we do while we are here. Maybe it was a call to courage, a call to vigilance—call to see the smile underneath the sadness and the sadness underneath the smile. Maybe it was an honor to simply be present, to be allowed to stand beside someone as they make the journey from this life to the next. I think about Elisha watching chariots of fire catch his mentor. “Give me a double portion of your spirit.” Maybe it was an honor to be present, to be blessed by the brief contact. It was an honor to stand by when informed consent was obtained. It was an honor to be present for someone’s transformation. 

I sit on my porch in the dusk, and I see the windows light up from the house at the end of the row. Someone is home now.

1. Edgar Allen Poe, Dream within a Dream 2. John Donne, Death Be Not Proud 3. Paul’s Letter to the Romans, 12:2

Picturing a Scientist

By Alex Powell, G3

Growing up, I knew of scientists who developed pharmaceuticals, put the work into creating the vaccine that would then go into my arm, and created devices that saved lives in the OR. I just never pictured myself as a scientist—because they are so infrequently pictured. The innovation and dedication typically occur behind the scenes. 

Yet, here I am now. Doing science. Thinking, creating, problem-solving, researching, failing, persisting, and learning. I’m in a field where there are seemingly no bounds to knowledge. Every question answered leads to a dozen more unanswered. I learn what I can, and trudge forward with another day, week, month, year in the lab, trying to contribute to the mass of information that collectively improves lives. 

I’ve learned so much doing science. So many pieces of knowledge that always seem to be simultaneously connected and unrelated. 

But what science has taught me the most applies to every aspect of life: the value of resilience. I must always keep thinking, creating, problem-solving, researching, succeeding, persisting, and learning. 

Really Fun Things You Can Do After an Exam

By Jordan Garcia, M4

#1 Start the evening off right by staring blankly into space.

#2 Browse your inbox for messages sent with high importance. Read each carefully, and perform the action required. 

#3 Call up an acquaintance to practice patient-centered interviewing.

#4 Send out a class-wide Zoom link to discuss how unfair it all is. 

#5 See if your infant child makes a good standardized patient.

#6 Explore your career options based solely on your exam rank. 

#7 Attend a virtual benefit concert, and dance like no one’s watching. 

#8 Take up that offer from the person who emailed you about that cup of coffee. 

#9 Binge-watch everything you can find on medical ethics and leadership.

#10 Tell your parents you’re coming home for the weekend, but stay forever. 

Collective Voices, Collective Choices: Shared Experiences of Struggle and Commitment to Forming a Supportive Community

By Sarah Elmer, M2

Trigger Warning: Suicidal ideation is discussed in the following article and may be distressing to some individuals. Thank you to the brave TAMU medical students who took the time to share their stories about mental health and suicidal ideation. Thank you to the College of Medicine and Baylor Scott & White for providing a safe place where this important topic could be discussed.

In September 2020, the College of Medicine collaborated with Baylor Scott & White for National Physician Suicide Awareness Week. As part of this event, Texas A&M medical students were invited to anonymously share their experiences struggling with mental health problems and suicide, whether personally or with a loved one. Students were informed that their anonymous submission would be shared publicly during the week. The following article contains some of the submissions that were presented.

Sadly, these types of stories are not unfamiliar amongst medical students and physicians. The American Medical Association reports that medical students are three times more likely to die from suicide, compared to their counterparts in the general population. Many students and physicians cite the heavy workload, long hours, poor learning environments, low flexibility, sleep deprivation, and isolation as primary drivers that contribute to suicidal ideation and completion of suicide. These factors contribute to a suicide rate that is much higher in physicians than in the general population.

Statistics:

According to the American Foundation for Suicide Prevention:

• An estimated 300 physicians die by suicide in the US per year.

• The suicide rate among male physicians is 1.41 times higher than among the general male population. And among female physicians, the relative risk is even more pronounced—2.27 times the risk in the general female population.

• 28 percent of residents experience a major depressive episode during training, versus 7–8 percent of similarly aged individuals in the US general population.

Between 50 and 75 percent of those considering suicide will give someone—a friend or relative—a warning sign. Every threat of suicide should be taken seriously. While it may be difficult to recognize the warning signs in individuals who are contemplating suicide, there are some behavioral patterns that individuals should look out for if they are concerned that a friend or classmate is thinking about suicide.

Warning Signs:

• Threatening or talking about suicide

• Excessive sadness or moodiness

• Hopelessness

• Sleep problems

• Sudden calmness

• Withdrawal

• Changes in personality and/or appearance

• Dangerous or self-harmful behavior

• Recent trauma or life crisis

• Making preparation

Even though there are many mental health resources available, they can never replace the supportive care that an individual such as a trusted colleague or friend can provide. Medical students and physicians are in a tough profession that cares so much for other people. It is vital that our healers also ensure that they are caring for one another. One suicide is too many. When steps are taken forward into what can be an uncomfortable space, it makes teams and the community a safer place for all. If there is concern that a classmate, coworker, or friend may be considering suicide, it is vitally important to implement the Just ASK protocol, as seen below.  

A: Approach

• Approach the person you are concerned about and ask: “Are you thinking of hurting yourself?”

S: Stay connected 

• You must stay connected with the person. Share with the person the specific signs and symptoms they have demonstrated that are causing concern. Staying connected may mean physically staying with them or remaining on the phone with them. Do whatever you can do to keep them engaged. 

K: Keep them safe

• Keep them safe by getting them to the appropriate resources and ensuring they have the mental health support they need. 

The immense pressure to appear perfect, put-together, and unfazed during medical training is a heavy burden to bear. It is often said that medical students and physicians need to learn how to be resilient; yet, they are not always given a safe space to admit that they are struggling. It is important to realize that there is strength in asking for help. Physicians will dedicate countless hours to medicine in the pursuit of healing others, but it is vitally important that they take time to heal themselves too.

In these trying times, make sure to look out for your fellow Aggies.

Forever Grateful

By Ksenia Vlassova, M1

Find Myself

By Danielle Mosby, M2

I find myself; I find that I lose myself, and I find that I continuously don’t recognize myself. 

I find shame in myself. Shame that I find I may want/need a leave of absence at times for “me,” but shame for the red flag that residencies may or may not see with nothing on my CV.  

I find humbleness in myself. Humbleness that I’m here now at medical school, after I was homeless 16 years ago, working to help keep my family afloat eight years ago, and working to pay for undergrad four years ago, but still finding my way two years ago.

I find hard pressure to succeed in myself.  Hard pressure to succeed after being the first to graduate from high school, the first to graduate from college, the first to go to medical school, and the first doctor, but also the pressure to do it all right the first time. 

I find anger in myself. Anger because I know, well I think I know, that I found what works and I’m trying my best, but anger because I’m barely passing. I’ve had four scares of failing a block, and have actually failed a block. 

I find happiness in myself. Happiness that I finished undergrad, that I passed the MCAT and made it to medical school, and that pre-clerkship is almost over, and I’m still here, and I’m going to be a doctor. 

I find restlessness in myself. I find restlessness because of my will to want to learn it all but restlessness because I’m still trying to learn how to drink through a firehose while taking a deep breath and I don’t know if I’m good at it yet.

I find memories of myself. Memories of the friends I made in undergrad, and the pond hopping, and midnight yells, and football games. Memories in med school of the late nights, with snack bags, and coolers, and the laughs, and having the best conversations due to procrastination. 

I find feelings in myself. I find feelings of mania, but feelings of depression and wanting to hide it. 

I find defeat in myself. I find depression that has taken me to dangerous places that I almost didn’t make it out of; in medical school and undergrad. But each time, I found support around me in people close to me, pushing me to feel better about myself and reach certain goals in slowly learning to give credit to myself.

I find aspiration in myself. I find aspiration to help the homeless children and advocate for the people with drug addiction on the street who need not be overlooked and only considered for care when they have a child. Aspiration in helping kids like me believe they can be somebody. And in helping the LBGTQ+ population find supportive and inclusive help.  

I find life in myself. Life that gives rise to heartache and fatigue and confusion. But this resilience of wanting to remain true, and supportive, and thankful, and curious, and questionable. And thrilled enough to try to explain every medically related thing to my partner, and yet still strong enough to watch the glow in this magical 3-year-old who needed her own stethoscope to practice and mimic me. They remind me of what I needed to remember to see in order to find what I had already found long ago. 

I find that I had already found that I am still myself, and I haven’t fully lost myself. 

I find that I’m just trying to become a better self, while trying to learn to take care of myself. 

August 2020

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A special thanks to ... 

Karen Wakefield, PhD, RN, for being our faculty editor, and Barbara Gastel, MD, MPH, 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.