December 2020

Silver Linings: Introducing the December 2020 Issue

By Thomas Nguyen, Chairman of the Board

In many ways, COVID has defined 2020. It has permeated into every aspect of our lives, like rainfall in cracks of drywall, or wild thistle in the outskirts of a field, inching toward the center. We wake to news of rising cases, deaths like ripples in a pond. The light of this year is dim, but like always, it is there. We must not forget that. For the last issue of 2020, I challenged Board members of The Synapse to find their “silver linings,” something unexpectedly positive that has come out of this year for them. Here are their responses:

• Lena Ayari (Managing Editor): I’ve been able to spend time doing hobbies I haven’t had time for before, such as gardening and trying new recipes.

• Farah Wazir (Acquisitions Editor): I’ve had the ability to slow down and spend time with those who matter the most. Additionally, I love cooking, and this year gave me time to explore my hobbies and pursue them with more passion.

• Jordan Garcia (Associate Acquisitions Editor): Since starting medical school, I’ve felt a tremendous amount of guilt every time I’ve slowed down or taken a break. But I learned this year that ambitionless joy oftentimes transcends joyless ambition.

• Sarah Elmer (Staff Writer): I learned to be more intentional about my friendships because of the mandated social distancing. Since I couldn’t see my friends in person every day, I had to be more intentional about making time to communicate with them, which I think helped to strengthen a lot of my friendships.

• Brianna Covin (Senior Copy Editor): I finally found out what I want to specialize in. When I scrubbed in for the first time, I knew right then that no other field could top surgery. That, alone, made up for having my Step 1 exam canceled twice. 

• Alex Powell (Senior Copy Editor): I reconnected with the people (and dog) who matter to me most.

• Tasfia Rouf (Copy Editor): With all the extra time this year, I completed the couch to 5K app. It was my first 5K, and now I run pretty consistently!

• Ahad Azimuddin (Copy Editor): When COVID-19 caused us all to social distance, I knew I could count on phone calls and Zoom meetings with friends to keep from feeling lonely. However, I also realized how caring our professors were in making sure students were OK. I never expected to develop such encouraging and inspiring relationships with faculty during times like this, and I’ll always be grateful for their support.

• Cerci Hammons (Design Editor): Doing everything from home allowed me to spend more time with my spouse and both find new hobbies and continue old ones. Overall, being home more often helped to give me more of the support I needed, with how tough this year was scholastically, socially, and psychologically.

• Kimberly Coffman (Associate Design Editor): Being pulled from rotations unexpectedly allowed me to spend more time with my son. Virtually interviewing instead of traveling also made coordinating childcare much easier.

• Christian Encarnacion (Social Media Manager): I got to spend more time with my family. With online classes being the norm, I got to stay back home more often, and their support really helped me get through this unexpected year.

• Dr. Gastel (Faculty Advisor): The need to work remotely has led me to expand my repertoire of approaches to teaching and advising. Even when I can work in person again, this larger repertoire promises to serve me—and my students—well.

•  Dr. Wakefield (Faculty Editor): During this time, my faith has deepened, as has my love for family and friends. It has caused me to appreciate the acts of kindness of others and to be able to pass those forward.

As evidenced by the above statements, the pervasiveness of COVID does not mean that good things cannot come from this year. It also does not mean that, when they come—and they do—that we cannot enjoy them. My “silver lining” is that I published my debut poetry chapbook, Permutations of a Self, with Texas Review Press this year. Doing Zoom readings was not what I had in mind for a publicity tour, but I am incredibly grateful for the opportunity and will always cherish these memories. To our readers, we hope that you have found found your own “silver linings” this year. We hope that, maybe, our issue can be one of those “silver linings” for you.

“They Were Better Off Because You Were There”: A Conversation with Mark Sicilio, MD

By Sarah Elmer, M2, and Thomas Nguyen, M2

Another morning spent by the window in the same blue chair. Gusts of grass blow across the lawn, curling beneath leaves and gently lowering them to the ground like feathers. Across the street, a stranger’s light flickers on. And then a symphony of lights. Silhouettes moving about, maybe deciding on eggs or toast or both for breakfast. Darkness hiding in corners, becoming smaller with each passing hour. Dawn the same as it has always been. For medical students, mornings may seem eerily quiet, a harbinger of the onslaught of lectures to come. But even as medical education continues to change, the early mornings and late nights of medical school are a mainstay. Generations of medical students have come before us, sitting in their own blue chairs, watching the world wake up around them as well. Dr. Mark Sicilio, assistant clinical professor and a graduate of the charter class of the Texas A&M College of Medicine, is someone who knows this life well.

Sicilio was born in Fort Worth, Texas, but grew up in College Station, Texas. He attributes much of his original interest in science and teaching to the strong academic influences that he had in his family. His father, a chemistry professor at Texas A&M, was one of the first people to expose Sicilio to the field of science. Sicilio recounts the many hours he spent playing on campus as a child, running up and down the chemistry hallways. His mother, a teacher, was deeply loved by her students and instilled her love of teaching in Sicilio early on. His father’s background in science combined with his mother’s background in teaching introduced Sicilio to the possibility of becoming a physician and educator.

Every physician and medical student has their own story of when they realized that medicine was no longer just an interest, but a calling—Sicilio’s story is particularly unique. “My twin sister and I were in Sunday school at A&M United Methodist Church and the teachers asked me what I wanted to be in second grade,” Sicilio said. 

“People said fireman, teacher, nurse, homemaker. My brother was in the Air Force Academy, but I thought ‘Why go far away when there’s a lot to do here?’ God spoke to me, and he said to be a doctor. This was in the second grade, so that's when I said I wanted to be a physician. It’s sort of weird, but I knew what I wanted to do at that moment, and I never turned back.”

Choosing Pediatrics

Sicilio performed well academically and was accepted to the Texas A&M medical school as an undergraduate. “I happened to have higher than a 4.0 when I got in, because I took PE [Physical Education] when I could get the credits without the hours. So even though I got some Bs, which tore me up, overachiever and such, that neutralized it so I had a 4.08.” When he got to medical school, Sicilio realized that his classmates had also been high achievers like him in college. “I got into school, and I was sitting there surrounded by geniuses. There were 32 students, 31 from A&M and 1 from Stephenville.”

The adjustment to medical school was tough. Sicilio recalled, “Six weeks into it, I sat there going ‘This is no fun.’ I mean, it was no fun. Half of the class were National Merit Scholars or Presidential Endowed Scholars. And they didn’t tell us, so we’re sitting there thinking that we’re slow, but we didn’t realize we were sitting next to geniuses that had 100 more IQ points.”

Sicilio started to think about what he wanted from his medical education. “Unlike middle school, junior high, high school, and college, I was sitting there going ‘ugh,’ and I didn’t want to feel that way for the rest of my life.” Sicilio said he had given a lot to medicine and would continue to do so in the future, but he didn’t want to “take care of someone from the womb to the tomb and feel like I didn’t know the best about delivering babies or neonates or sick kids, or adolescents or old people or heart attacks and strokes.” It was then that he decided he wanted a narrower focus.

During a walk to the library, his best friends in medical school asked Sicilio what he wanted to do in the future. “I said, ‘I don’t know, but it’s not going to be family medicine, because I can’t take it anymore,’” Sicilio said. “They responded with, ‘You know, you’re sort of childlike, has anyone ever told you that? You’re going to be a pediatrician. You seem like you get along great with young people.’” 

Inside the library, Sicilio pulled Nelson Textbook of Pediatrics from the shelf. He said, “That is all I needed. I saw it, and I said ‘This is so cool.’ And that was it from then on. Everyone knew I wanted to be a pediatrician.”

The Medical School Experience 

When Sicilio was a student, the medical school campus in Bryan had not yet been built. Instead, the medical school was housed in two buildings on Texas A&M’s main campus. One of the buildings was the Olin E. Teague Research Center, which also housed the office of the president of Texas A&M. The other building was the Animal Industries Building, a beautiful historical building with carvings of cows and sheep, located right next to the Olin E. Teague Research Center. The Teague building was one of the few air-conditioned buildings on campus, and the medical school occupied the first floor, basement, and sub-basement. 

The president of Texas A&M had his office on the first floor of the Teague building while the cadaver lab was located in the basement. This posed a problem early on. Not long into their first semester, the president’s office called the medical school to complain about a “clank clank clank” sound and a terrible smell that started every morning at 8 a.m.

“Well, it was the cadaver tanks. As they were lifting up the cadavers out of the formaldehyde, it would go ‘boom boom boom boom’ [and would] fill the room with the smell of the cadavers. The president’s office moved from that building, but we did not,” Sicilio said. “We displaced the president of Texas A&M.”

About the day-to-day life as a medical student, Sicilio said, “They pushed us so hard—so very, very hard. We were in class from 8 a.m. to 5 p.m. Monday through Thursday, except for Tuesday afternoons, which was our preceptorship. And then we got off at noon or one o’clock on Friday. We and the faculty were going through it together, and I hope it feels that way now.” 

 A big difference Sicilio noted between medical school when he was a student and now is that “the students have a lot more support now than they did back then. I think the students, appropriately, reach out and sort of insist upon being engaged with Student Affairs. Student Affairs has always been great, but my God, with Gary McCord and Wei-Jung Chen, that crew [is amazing].”

One of Sicilio’s colleagues, Dr. Patricia Watson, a psychiatrist and head of the Department of Humanities in Medicine, also went through medical school with him as a member of the charter class. Sicilio remarked, “She was one of my buddies and was the same then as she is now. She is just so smart and a communicator. We didn’t know that she’d go into psychiatry and train at Mayo then. She thought she’d be a pediatrician as well.”

Sicilio noted of his medical school experience, “We basically were in a cauldron together. The school was going to get accredited or not based on how we did, and we knew that going in.” As a result, Sicilio said he and his classmates had a much different mindset than typical medical students. “We were all very loyal—we were not just doing it for ourselves, but we were doing it for the team, for A&M.” 

This loyalty stemmed not only from the fact that many members of the charter class had gone to A&M for undergrad, but also from initial uncertainties of  A&M having their own medical school. “When we were interviewing, it was originally going to be the A&M Baylor College of Medicine, and you would spend the first 2 years in College Station and the last 2 years in Houston at the Medical Center. But the LCME or whoever it was came through and said A&M was strong enough to stand on its own.” In the end, it was decided that students would spend the first 2 years of their medical education in College Station and the last 2 years at Scott & White Medical Center (now Baylor Scott & White Medical Center) in Temple, Texas.

Sicilio continued working hard during the clinical years of medical school. “I studied so hard—I studied as hard in third and fourth year as I did in first and second year, which nobody does,” Sicilio said. “Nobody studies as hard in their fourth year as they do in their first year, because they’re already on their path to residency. I didn’t travel anywhere. I stayed at Scott & White in Temple and studied until 7-8 p.m. every night after working in the hospital. And when I took a vacation, I went to a meeting at Johns Hopkins.” His hard work paid off. When Sicilio took his inservice training exam during his pediatrics rotation, he scored in the 95th percentile on the American Board of Pediatrics shelf exam.

“They Were Better Off Because You Were There”

At the end of medical school, Sicilio applied to only a single residency program—Scott & White in Temple.

“I applied to one residency, and only one residency, which is not what you’re supposed to do,” Sicilio said. “The Dean said ‘What happens if they don’t want you?“ And I said ‘Well, they told me they wanted me as an intern. They said “We would really love for you to stay here.”’”

Sicilio did end up matching into the pediatrics residency at Scott & White in Temple. His academic success in pediatrics continued after medical school and into his pediatric residency board exams. “It wasn’t because I was smart—it was because I worked hard,” Sicilio said. “Find out what you love and work hard, and it will go well for you. Do your best.”

One of the more difficult parts of medicine that Sicilio had to overcome during residency was learning how to cope with the death of his patients. One of his role models, Dr. Robert Myers, was chair of pediatrics at Scott & White and later became president of Scott & White Hospital. One morning, Sicilio ran into Dr. Myers at 4:30 a.m. and asked him why he, the president of Scott & White Hospital, was at the hospital so early. Dr. Myer’s response was simple: “I want to make a difference as long as I can.” 

“I asked him ‘How do you cope with kids dying of cancer or from a car wreck or SIDS?’ and he said, ‘They were better off because you were there,’” Sicilio said. “It’s a perfect line, which I had never heard anyone say before. Now I say it all the time.” 

Searching for a Sign

As Sicilio was nearing the end of his residency training, he was conflicted about his next steps after graduation. He had been accepted into a pediatric hematology/oncology fellowship at Johns Hopkins University in Baltimore, Maryland. However, he was having doubts about whether to accept the position or to move back to College Station to open a general pediatrics clinic with Scott & White. The faculty at Hopkins asked him to come up to Baltimore for a month to rotate with them so that he could get a better understanding of what a hematology/oncology fellowship would be like.

Sicilio accepted the invitation. “Every one of the patients I had taken care of, except one, died that month,” Sicilio said. “I couldn't take it. I can take a lot, but … I didn’t want to feel like this the rest of my life. It’s not that I didn't try hard, but it’s that it would completely absorb my life. I wouldn’t be who I am.” 

After returning from Baltimore, Sicilio found comfort in his faith and kept praying for a sign from God to tell him what he should do. On his first morning back in Temple, he sent up a silent prayer as he rode the elevator to the pediatrics department. “I said, ‘Lord, I need a direct sign, and I need it now … am I going to go to Baltimore and do a fellowship, or am I going to stay with Scott & White and do general pediatrics in Aggieland where they need pediatricians?’”

As it turns out, Sicilio got two signs that morning that told him to move to College Station after graduating from residency instead of moving to Baltimore.

First, as he stepped off the elevator the morning of his first day back at Scott & White, he saw a neonatal nurse taking care of two premature babies from College Station. That neonatal nurse, Lisa, eventually became his wife. 

Sicilio recalled proposing in a memorable way. “I asked my then-nurse to marry me on the A&M campus under the Century Tree by the Academic Building on Independence Day,” Sicilio said. “I actually had to ask her to come back because I was so eager to ask her to marry me that I forgot to get on my knee.” 

Second, the director of the pediatrics clinic in Temple ran into Sicilio that same morning and told him that he really wanted to talk to him about opening the first Scott & White pediatrics clinic in College Station. 

“[The director] said, ‘I’d really like to sit down and talk with you about what you’ve been telling us that Scott & White should do since you interviewed for medical school—Scott & White should have a clinic in College Station,’” Sicilio said. “So, I came home to College Station.”

Molding New Physicians 

Sicilio stayed in College Station, but it was by happenstance that he came back to A&M to teach. “Dr. Paul Ogden was my cadaver mate in the charter class—when the class size expanded 5-6 years ago, he was the interim dean and said ‘Mark, would you like to come on full-time at the medical school, because you love teaching and molding new physicians?’” 

At that time, Sicilio had been with Scott & White for 35 years and had enjoyed doing some teaching at the College of Medicine for many years, so the decision was an easy one. “I said ‘absolutely,’ and I have been here ever since. I hope to go as long as my health allows and as long as I am helpful. I don’t ever want to hang around and not contribute.”

Sicilio started his role in the medical school teaching HEAL (Humanities, Ethics, Altruism, and Leadership), which is now PoM (Practice of Medicine). He said, “For the 42 years since the medical school first started, we’ve been trying to get a consistent discussion of [incorporating] HEAL curriculum throughout the four years of medical school. Now PoM is trying harder to do that, and we’re working with faculty, clinics, and hospitals all around. I think it’s finally going to be accomplished.”

In the five years Sicilio has been a full-time faculty member, “PoM has progressed remarkably,” Siclio said. “Dr. Waer [dean of the College of Medicine] and Greg Hartman [senior vice president and chief operating officer of Texas A&M Health] have a wonderful relationship with Baylor Scott & White, and with a good relationship and appropriate expectations on both sides, it is our hope that physicians from BSW who want to teach and are great at teaching will have some opportunity to do so.”

For now, faculty members take care of the teaching responsibilities. “There’s the saying, ‘There’s no free lunch.’ Dr. Watson and her team work really hard to get it done. And the expectation has also been very high. Everybody doesn’t make an A just because they’re in the class.” 

As for the future, Sicilio remarked, “In 10, 20, 100 years, I hope the Department of Humanities in Medicine will still be here and that we’ll have all sorts of former students and anyone who’s interested come teach. I’d love to see faculty across the nation who are Aggies.”

Wrapping up the interview, Sicilio reflected, “Looking back, I realized that so much of my life was spent preparing for and being in medicine. So much of it.” For many of us, the decision to pursue medicine was similarly just as thought out. We spent years turning an interest into a reality by completing all of the prerequisite courses and accumulating experiences that would prepare us to embark on this journey. And then we took our first steps on this path to becoming a physician, which meant starting our days early and ending them late. We hear the last sounds of the night. Neighbors emptying the day’s trash, the rattle of stray cans rolling into the street. The bus making its last stop, with the hiss of its brakes. Lights going out, one by one.

What It Means to Be an Aggie Doctor

By Tasfia Rouf, M3

As future Aggie doctors, we will always strive for excellence. Still, in medicine, time and time again, we are reminded that we are fallible as humans. Yet what makes a great physician, and a great Aggie, is how we can own up to those mistakes—how we learn from them while communicating effectively with our patients. It is never easy to say “I don’t know” or “There were complications due to errors on our end.” This is only possible through integrity and by forming strong bonds that build trust. Recently, in going through my surgery rotation, I have seen this play out. When there is a particularly long or complicated case, our faculty will take patients and their families to conference rooms to discuss the case in detail. Drawing diagrams, going step by step to explain intricacies, and explaining the potential for errors—all of these actions serve to empower patients and allow patients to act as advocates in their care.

I am a first-generation student of immigrant parents. They worked tremendously arduous jobs, mainly in the service industry, to raise my sister and me. I have seen first-hand what it looks like when physicians treat their patients with little respect. English is not my parents’ first language. Growing up, translation services for Bengali were either not readily available or not sought out for my parents. I have seen the frustration of feeling devalued, especially when vulnerable, having entrusted the care of yourself and your loved ones into another’s hands. To this day, my mother tears up as she relays stories of taking my five-year-old self, fevered and ill, to the busy emergency room. She was unable to understand what doctors were telling her and confused about what to do after having spent all night in the waiting room.  

I carry these stories with me every day. During my family medicine rotation, I realized the unique opportunity we have as medical students. While attendings and residents have to juggle various responsibilities, medical students have more time to spend with patients and families, often acting as a sounding board for their frustrations. One afternoon while taking a history, I found out the patient had recently moved. After asking how she was liking and adjusting to Texas, she opened up regarding her struggles with her son and how she moved for his education but continued to find herself distanced from him. She delved into details of her troubles raising him, struggles with alcoholism, and her son’s past suicidality. I was able to spend the afternoon with her, humbled by the sheer gravity of the position medicine had given me. This patient had chosen to share such intimate details of her life with me, to allow me space in her vulnerability.

As a future Aggie doctor, I have learned and continuously strive to be culturally competent and emotionally available for my patients while respecting their ideals and background. Patient service is my passion—ingrained in me through my own personal life experiences and instilled through my professional guides and mentors here at A&M.

Who Am I?

By Lema Noubani, M2

For two months, every Wednesday afternoon, I reported to my preceptorship site at exactly one o’clock in the afternoon. Four hours later, I drove away, gaining a new title, becoming a new person in the eyes of another patient. These were the first moments that I could truly realize who I was or who I was becoming. 

One day, in the middle of my interview with Ms. Jones, Dr. White knocked and entered the room. When ushered to start my oral presentation, I began: “Ms. Jones is a 30-year-old female presenting with irregular bowel movements and bloating. She states that it started about a month ago …” After concluding my presentation, I was asked to continue the interview while Dr. White watched over me. “Do you take any medications?” I asked. She shook her head. “Do you take any pain medication or anything over-the-counter?” I repeated. Ms. Jones started to shake her head, then quickly retracted by saying, “Wait, I take Fioricet twice a week for my headaches.” Instinctively, Dr. White interjected with, “You’ve never mentioned that to me before. Is that new?” The mystery of Ms. Jones’ episodes of alternating loose and hard bowel movements was solved by the reinforcement of one question. It was my first win. I am a problem solver. 

The following Wednesday, when I entered Jamie’s room, the startled look on her face immediately showed her hesitancy to speak to a stranger. As I progressed through the interview, she was probably wondering how we could be the same age, yet sitting on different sides of the same room. It may have been the same thought that helped her open up moments later. Jamie suffers from irritable bowel syndrome. It is a diagnosis of exclusion; it basically suggests that the doctors couldn’t figure out the root cause of her situation. Running through the series of tests to get to this conclusion left Jamie in a state of depression, for which my preceptor prescribed her an antidepressant. After months of using the medication, Jamie confessed that she stopped the treatment. Sitting on the exam table with her head down and her hands motioning through her thoughts, she explained her body’s reaction to the medication. When Dr. Jones walked in to survey my interview progress, I explained that Jamie would like to stop taking the medication. She knew her body, and I am just an advocate. 

On my last day, my preceptor decided to challenge me. She sent me in to see a patient who had her worst days behind her. At the top of my blank sheet, I wrote: “CC: f/u [follow up] on mood and anxiety.” I entered the room to an unexpected visitor. She sat, holding her purse tightly to her stomach, as I introduced myself. “Hello, my name is Lema. I’m a second-year medical student, and I will be helping you today.” I ran through the same series of questions I’d been rehearsing all day, only to find my pencil relax at the answer to my next question. “Have you been having any suicidal thoughts lately?” I pushed my desk to the side, leaned back in my chair, and listened. Ms. Smith, a woman in her 50s with two children, chose to run away from her abusive husband to start her life again. Her tears softly ran down her cheek as she shared the trauma she endured for 20 years, and the hardship that came after. When our meeting came to a close, she said, “I didn’t expect to speak with you today, but I’m so glad I did.” I am a confidante.  

These are only a few of the attributes I learned to embody for my patients in those two months. As I move further along in my training, I will tack on more elements and build myself toward my full potential as a physician. I’ve learned a tremendous amount of knowledge in medicine and how to practice it, but the most valuable lesson I absorbed is who I learned to be for my patient. 

Docere

By Nicholas Tan, M1

This piece was written after the head and neck dissection in Medical Gross Anatomy.

In gross anatomy laboratory, donors are customarily presented to us with their heads, hands, and feet bound tightly by thin swaths of cloth.

These extremities, all salient reminders of our donor's humanity, are temporarily occluded to reduce the shock young medical students experience as they begin studying the human body. As the course progresses and the dissection proceeds down to a wrapped extremity, the cloth covering it is removed. This is always accompanied by the realization that before us lies not an object of study, but a distinct, unique individual. An individual who, like us, has seen the beautiful shades of red, orange, and purple associated with a setting sun; has savored the crisp air of an autumn morning; has endeavored through hard times and thrived through good ones. As medical students, we often get caught up in the science of dissection—making swift incisions through fat and muscle while trying to memorize every action, origin, insertion, and spinal nerve segment. Seeing the red nail polish on our donor's neatly manicured hands humbly reminds us that we are not simply memorizing a model. We are being personally taught.

As we were removing the top of the skull today, the cloth wrapping our donor's face slipped off. The falling cloth revealed a pair of relaxed, calmly closed eyes with fine eyebrows and dark, beautifully long eyelashes. That peaceful, Zen-like expression remained as we chiseled the skin and muscle from her scalp; as we sawed through her skull, bone dust and the smell of burnt flesh filling the air; as we removed her brain and cradled those 80-plus years of unique memories and personality in our hands. Today's experience—and that expression—is something that I will remember for the rest of my life. It is exceptionally humbling to receive the last gift—the last lesson—a person can give.

Gross anatomy teaches us muscles, organs, nerves, arteries, and veins. These are undeniably important in our roles as future physicians. More importantly, however, anatomy instills in us an intimate relationship with mortality. It instills in us a deep-set appreciation of life, gives us a solemn respect for death, and humbly reminds us that as future physicians, we will walk daily the fine line between abyss and fertile field.

When Relatives Become Patients

By Elias Perli, M1

As a medical student, practicing physical examinations and history-taking on relatives and friends is quite common. During a recent patient encounter, I had practiced a physical examination on a relative, but not history-taking. Despite there being a lack of physical touch, as with a physical exam, I thought taking a history from my relative was more personal. A history allows you to learn important details of both the person’s medical and personal life. I will refer to my patient as Mrs. Doe while reflecting on my experience with her to protect her personal health information. 

This experience taught me two things: First, as a physician, setting aside emotions and subjectivity when taking care of friends or family is an acquired skill that I still am developing. While taking a history on my relative, I noticed that I was listening to diagnoses and information I had heard before. But listening to Mrs. Doe’s history was different. I realized that as soon as I had introduced myself as Elias Perli, a first-year medical student at Texas A&M, I assumed a role different from Elias Perli, a mid-twenties Venezuelan man living and studying in College Station. When listening to my relative, my mind and thinking process quickly changed. I was now influenced mostly by the medical knowledge I had learned over the last four months in medical school rather than being persuaded by the personal experiences from knowing this person for over 25 years. 

In retrospect, I find it fascinating how the brain can emphasize abundant information learned so recently, instead of focusing on a lifetime buildup of memories, feelings, and emotions, as with my relative. However, in the moment of taking this person’s history, it was not second nature for me to separate such views. I had to stop thinking about our memories together and instead bring forth the anatomy, physiology, pathology, and biochemistry that I have been studying daily. My way of thinking and responding to my relative differed from that at any family dinner or meeting we had previously had. Because of this activity, I am now more mentally aware and ready when seeing a family member or friend in my role as a medical student. 

The second lesson I learned, which I believe is tied to the first lesson, is to deliver the same service and examination to acquaintances as you would to unfamiliar patients. For instance, during my visit with Mrs. Doe, she told me about her hypothyroidism, insulin resistance, and bilateral hip problems, which I had heard her complain about in the past. However, this time listening to these concerns was different. I did not take such diagnoses at face value and instead wanted to confirm them myself. I realized that, as I would with any other patient, I would want to order labs so I could arrive at and confirm the appropriate diagnoses and/or treatments. Therefore, as part of her plan, I said I would order Hgb A1c [hemoglobin A1c], BMP [basic metabolic profile], CBC with diff [complete blood count with differential], and TSH [thyroid stimulating hormone] labs. As a medical student and future physician, I want to see and obtain data first-hand to use my knowledge and establish a complete picture of a person’s health. 

This patient encounter was an instructive preview of what it might look like with future patients that fall under the group of family and friends. While empathizing with a relative who is also a patient is easier, remaining objective and neutral is more difficult as medical data can become mixed or convoluted by personal information. Ultimately, it does not matter if you have known the person for over 20 years or just met them two minutes ago. The professionalism, empathy, and excellence that come with being a physician must always remain amongst all patients. 

Disclaimer: Treating family and friends is not ideal in medicine, as you may enter into a dual relationship of physician-family member or physician-friend. This situation generally should be avoided in order to provide objective treatment that is not clouded by personal judgment or emotions. However, situations arise where it might be essential or permissible to treat friends and family, or, as in my situation, practice a clinical examination and learn from them and the experience itself.

Why Slowing Down Actually Makes You More Productive …

By Mary Ellen Santerre, MS, MEd, Counseling and Development Specialist

“I’ve got too much to do to take a break.”

“I’ll relax after I’m finished studying.”

“One more lecture review, and then I’ll take a break.”

“Wait … what did I just read?”

Have you said or thought these things in the last day, week, or month? If you’re being honest, you probably have. It’s completely natural to think working harder, even in the short run, is the best method of productivity, because that is what many of us have been raised to think. Except, now we know more about effective study methods. If you’re in medical school, you’re probably a Type-A personality—which is beneficial but can hinder your productivity as well. 

“5 Ways Mindfulness Can Make You More Productive” is a quick read about the many benefits of Mindfulness. What you’ll notice in the article is that meditation is highly recommended. While mindfulness is a form of meditation, I personally find mindfulness much easier and more convenient than other forms of meditation. You can practice mindfulness anywhere, for example while you’re walking or taking a break from watching a lecture. What’s the difference? Simply put, while practicing mindfulness, you become aware of your surroundings—what you see, hear, feel, and even taste.

While focusing on these basic things around us, our brain can slow down and take a break. Our hippocampus tells our amygdala that there is nothing to be concerned about, and, while also breathing deeply, you’re able to actually relax, even if for a short time. This short break (2-5 minutes) gives your brain that much-needed break, and afterward you will be more tuned into the lecture you’re reviewing or the notes you’re studying. I’m a firm believer in this, and if you need assistance, just let me know—I’m here to help.

How to Give It 110% Virtually

By Jordan Garcia, M4

Medical school has always been notorious for being challenging, but during a public health crisis, it is even more so. Global pandemic or not, you’ll still be asked to learn a massive amount of information within an extremely short amount of time. Your free time will still be filled with research projects and extracurriculars. And you will still feel a constant pressure to succeed in everything you do. Virtual learning and being at home all the time may lead to psychoanalyzing or overcomplicating this drive, so simplify your life during these unprecedented times by employing the following strategies:

Review the lesson objectives ahead of time. Wait, they haven’t been posted yet? And the lecture is when?! Shoot the professor a quick email with a friendly reminder. Also, contact the Financial Aid Office, and renegotiate your tuition fee.

Show the professor you’re 110% focused during Zoom lectures by letting no rhetorical question go unanswered. What do you do if you’re the only student with their video on? Nothing. Just continue being awesome.

Look out for your classmates as well. Monitor the chat messages for any lecture-related questions for the professor. Respond accordingly with helpful links to tangentially related research articles and peer-reviewed medical literature.

Don’t be that student who leaves the Zoom call when lecture’s over and everyone’s been dismissed. If the professor hasn’t clicked “End Meeting” yet, initiate a post-lecture discussion by posing obscure hypothetical questions and case-based scenarios.

Send a thank-you email to your classmates and professors after every accomplishment of yours that would not have been possible without them. Indicate the specific achievement or numeric grade in the subject line, and attach a copy of your updated résumé.  

Filter through incoming emails for leadership opportunities. Afraid you’re already chairing too many unrelated interest groups? Nonsense! If you have time to overthink, you have time to chair another organization.

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Share your work with the Texas A&M medical school
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thank you:

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.