Why do you smile all the time?
by Srinath Senguttuvan, M2

My sister recently asked me this, and it got me thinking. As a typical medical student, I face the same daily obstacles as my classmates. How much (or how little) sleep am I going to get tonight? Do I have time to watch that lecture today? What time does the library close? Am I going to be able to go to the gym today? (I’ll admit that the answer to that last one is always a resounding yes.) Not to mention the fact that my mom constantly brings up the fact that I am still single and worries that I will end up alone. With all that hanging dangerously over my head, would others blame me if I ever was annoyed, gloomy, or just plain angry? But in troubling times, all that it takes to lift my spirits is a simple glance at my arm. A burnt orange wristband inscribed with “Always Remember” adorns my right wrist. It instantly brings a smile to my face and fills me with energy that allows me to conquer the day. How can this little accessory have such a profound impact? For that story I have to take you back seven years.

My friends and I had just descended upon the University of Texas. We took immediate advantage of our newfound freedom—tailgating, football games, frat parties, and late night food. We thought we had it all. What I did not know was that my roommate and my best friend was suffering. On the outside, he was a happy 18-year-old just like the rest of us. On the inside, he was tormented. But since he continued to have fun with us, we assumed nothing was wrong.

On November 3, 2009, I was awakened in my dorm by a forceful knocking at 7:30 a.m. Thinking I was dreaming, I went back to sleep. Except the knocking continued, growing louder with each passing second. I drowsily put on my glasses and went to open the door. Making my way to the door, I noticed my roommate’s bed was neatly made. I thought he had decided to get an early start to the day, and, since he had been known to leave at odd times, I made nothing of it. I peeked through the peephole to see the dorm security guard. I figured we had made too much noise the night before and it was a simple complaint. I opened the door, and the guard insisted I come to the front office. “All this for a noise complaint?” I asked. No response. As we made our way to the front, I thought of all the scenarios for which I could be in trouble. I was ushered into a room in the front office. Behind the dimly lit desk stood three police officers. I had no idea what to think! They asked me to sit down. They brought me a glass of water. “Your roommate was found this morning, deceased. It appears that he took his own life,” they told me. The gravity of the news shook me to the bone. My life would never be the same.

The following days were filled with more questions than answers. People kept asking me how I was doing. I repeated that I was fine, asking that they keep the family in their thoughts. I felt selfish for being sad. I also felt guilty. How could I not see that my best friend was in such terrible pain? Did he really feel that he could not come to me with whatever was troubling him? The morning of the memorial service, I woke up feeling worse than I had in the few days prior. My stomach was in knots. The tie around my neck felt like a noose. The memorial itself was an emotional train wreck. I saw my father cry for the first time. I saw my best friend’s brother struggling to comprehend why his big brother was gone, never to return. I heard the words of my best friend’s father, “Two days ago I had a happy son, now I have lost him.” When it was time to talk to his parents in person, I wanted to run. How would they react to seeing me? Did they blame me for not seeing that their son was depressed? I was preparing for the worst. I stepped up to his father, and my first words to him were, “I’m sorry.”

His response was one I did not expect.

“Why be sorry? In this time of sadness, it brings us joy that our son’s final days were spent with friends who cared about him very much. Please do not feel guilty. Live your life to the fullest, and carry on his memory.”

Those words have stuck with me to this day. Everything I do, I do in his memory. No task is insurmountable when I think of him. No day is too daunting. Not a day goes by where I don’t think of my best friend. He would want me to live with no regrets, and that is exactly how I live my life. That is why I smile.

R.I.P. Rajiv, I miss you, bro. 

Post Laryngectomy
by Krystha Cantu, M3

His hands were tired marionettes
Propping softly up and down
With mouthed concerns
Words stuck in his throat

Anchored in silence

His wife smiled and conferred
That their love grew stronger yet
Gazes palpable, cemented by years of conversation

Every gesture towards speaking
Galvanized her forward in explanation
As if tethered to the same heart

Speech became an accessory for them
It was then that I slid out the door
Heavy with thoughts about a love that withstands a silent home

Post Laryngectomy
Post battles of greater proportions
It was a quiet snow storm of romance

Conflictions
by John Sung, M1

Introspection and metacognition both
Explorations.
Expressed through alternate media to be
made real,
the intangible exposes the brain’s beauty
and infinite possibility.
While trying to understand,
losing direction and oneself in the labyrinth of the mind,
searching for eternity.

Dr. Hubbard Interview
by Joseph Joo, M1, & Hanna Chen, M1

Could you share how you decided to choose a career as a physical therapist and an anatomist? Also, could you comment on your journey to becoming a faculty member at TAMHSC?

          Well, it was a journey, maybe a convoluted journey. I had some accidental fortunes with some things that fell my way. I was not a good undergraduate student. I did not know what it was like to sit down and study, because school came easy. It came naturally—I showed up to class, read the books, took the exams, passed and then moved on. But as I was getting to the end of my undergraduate career, I was concerned that I really didn’t have much to show, and in a short while I was going to actually have to go out and get a job. So the easy option was keep going to school. I had a roommate that was pre-physical therapy and was applying to physical therapy schools. I had been through therapy many times throughout high school and college; I thought that’d really be something that I’d be interested in. So I applied to just one program on a whim, to see what it was like and figure out what I needed to do to apply for real the following year. Lo and behold, that one school offered me an interview, and I talked my way into the program. USC is one of the most stringent schools of all, but apparently I said the right things at the right time, and they accepted me.

          So I graduated and went off to Southern Cal having no idea what I was getting myself into. It was a two-year master's program at the time; I graduated and started working as a physical therapist, really specializing in orthopedic sports rehabilitation. We had lots and lots of aspirations, wanting to work with high school, college, and Olympic athletes. But what I really found was that you’re going to see everybody, treat every condition that comes in, and know when to send patients off to a specialist. That’s what I evolved into—a physical therapist that could see virtually any type of patient, from an athlete, to a pediatric or geriatric patient, and even someone with neurologic conditions. As I went on, I realized that the success of the treatment was based on how well patients knew what was going on and their compliance with the things we needed them to do. So we were always educating everyone—educating the staff, educating the patient, and then educating some of the other physical therapists in continuing education, but for me, there was always something missing.

          I ended up with a patient who was a faculty member at Texas A&M. At that time, they had a Ph.D. program to train licensed allied health professionals to a doctoral level so they can teach in areas of their specialty. I found the program really intriguing, especially the fact that I could customize the program into a very specific specialty area, and the area I was interested in most was anatomy. I was able to get into the program and link up with Dr. Wayne Sampson and Dr. John Gelderd in the College of Medicine, who became my co-chairs and took me through medical anatomy as a student. At the same time, I was taking educational pedagogy courses and running my clinics. I was doing all that at the same time, and they cut me no slack whatsoever. I did all the things the other doctoral students had to do, but I also funded myself throughout.

           I was able to do all those things in four and a half years and come out with a Ph.D. in anatomy. Then Dr. Sampson offered me a teaching assistantship, which I accepted. I also still maintained my physical therapy practice. It evolved from there into “I really, really enjoy teaching.” The healthcare system, especially the reimbursement strategy, was changing dramatically at that time, and I was spending more time trying to get paid for what we were doing rather than actually treating the patients—that wasn’t very fun. So there was an opportunity to go into teaching full-time and I could still see patients on a part-time basis, which is what I still do now. That actually gave me the best of both worlds, where I’m able to teach these things that are near and dear to my heart and also see patients because I enjoy seeing patients. So that’s how I came about.

We know that you “wear many hats” as an anatomist, physical therapist, lecturer, researcher, and also as a referee, among many others. Could you share with us what inspires you to be so actively involved in many different roles?

          There are a lot of things we are all interested in; we’re not in a little silo. There is a huge world out there that we need to be a part of and need to participate in. Future physicians are going to be at the pinnacle of society, there’s no doubt about that. You’re going to be looked up to—but that doesn’t mean you neglect everything else. You want to be as good of a physician as you can. You want to be a well-rounded physician, but also need to be a good member of the community. You need to participate—in family, church, social, and recreational activities. If your only contact with the external environment, outside of your personal family, is your patients in your clinic, you get “silo-ed” into that. I hate to use the term, but you’re going to get stuck in a rut. You’re going to do the same thing over and over again; it’s going to get monotonous, it’s going to be mundane. You’re going to get bored with things. So we’re trying to teach you guys to be lifelong learners, lifelong participants, not only in your chosen profession, but also to be actively involved elsewhere.

          Some people are involved in politics; some are very involved in their religious organizations. I don’t sit idly well. I get bored really easily, but there are so many things and that’s one of the challenges—to be able to find time. I am able to say, “This is my study time, this is my research time, this is my teaching time, this is my recreation time, and this is my personal time.” I kind of use my sports officiating time as recreation time, because it’s a great stress relief. I don’t hunt, fish, or run. I pretend to run on the field, but it’s mainly short bursts of activity, mainly dodging to stay away from players or to stay out of their way. But it’s enjoyable, and when I’m out on the field, nothing else is a concern to me. When I’m seeing a patient, I’m able to just focus on the patient and do that because I enjoy what I’m doing. I hope I convey during lectures and labs that I enjoy what I do, because that’s really the light of my life. You’ve got to take care of yourself and enjoy what you do. If you get stuck in a rut or a silo, you’re going to stop enjoying it and it’s going to come back and haunt you because you’re going to be less efficient and less productive. So while you’ve got to be careful not to overcommit yourself and over-involve yourself in too many things, it’s very important to be well rounded, to not lose sight of yourself, and to not forget what got you here. You must absolutely do those things for your self-interest and well-being.

In light of your recent knee operation, how would you say that going through rehabilitation, as a patient this time, will contribute to your continuing experience as a physical therapist?

          This is actually the fifth surgery on my left knee. I can tell you horror stories about my first one back in the medieval days—I had my first knee surgery back in 1970. Things were a lot different than they are now. I had an ankle-to-thigh-length plaster for 10 weeks, and they cut that cast off and I went out to practice the next day. The coach had me running laps, and I think back now and see the contrast. The biggest thing for me is that things are always evolving; we’re so much better now than we were in the past. So you have that relationship [referring to Dr. Hubbard's understanding of having gone through similar injuries himself], that camaraderie with these other individuals. Now as a practitioner, you can kind of relate to that, to say, “I understand how you’re feeling; I’ve gone through it myself.” The patient appreciates that, but we always have to remember that they’re the patients, and they need our guidance, experience, expertise, and not so much commiseration.

          I know at 3 weeks, at 6 weeks, and at 3 months, this is what you ought to be able to do. Although I went through that, we also have to remember that not everybody is the same. Not everybody progresses at the same rate. My mother went through total knee replacement and never walked unassisted again. While we need to remember that something is what ought to happen, we need to also have to remember that this is a unique individual. How can we get you on the best level for you? Not everyone wants to work again, not everyone wants to play ball again—that’s contrary to my personality. But some people just want to have a stable knee, while others just want be pain free. So we’ve got to differentiate—am I trying to accomplish my goals for the patient or the patient’s goals for themselves? If we think the patient’s goals are a little shortsighted, then we can introduce them to a higher-level option. When I try to push my values and myself on them, they are not always receptive. That’s when we get into that grey area of asking—how aggressive should I be? That’s where the patient-provider relationship comes in. Every patient is a unique individual.

At this point in your career, if you could look back at yourself 20 years ago or so, just beginning out of grad school, what would be the biggest advice you would give to your younger self?

          Never think you know enough. Never think you know it all yet. We’re creatures of habit, and sometimes we learn something one way—it may not necessarily be the right way, and not necessarily the most up-to-date thing—but always try to re-educate yourself to stay on top of things. There’s not a lot of change in anatomy, the biceps brachii is still going to be superficial to the triceps. But there are different ways of looking at things. Ask yourself, did I really learn it completely? Did I really learn it accurately? What does this new text say in relation to some of the old books? Just try to always try stay up-to-date and on top of things.

All of us (M1s) will begin clinical clerkships in about 6 months or so. Could you share with us any parting words of wisdom as we soon move from mostly classroom learning to clinically oriented learning?

           The best advice is: You are there for the patient. You are learning, but even though you are a student, the patient is looking at you as an authority figure, and they are looking to you for answers. First, be as prepared as you can, and there are days when you are absolutely not going to feel prepared. When you find something you don’t know, go look it up. You go find out. It’s okay to tell a patient, “I don’t know, I’ll go find out and get the answer to you.” Now it’s a learning opportunity for you. You’ve got two and a half years of clinical learning ahead of you; it’s a learning opportunity for everybody. Those patients in the bed expect anyone coming in to be able to answer any question they have. They don’t really care that you are not the expert; they just want an answer. If you walk in as a third year student, and the patient asks, “Why are they bringing me a lunch tray at 10:30 in the morning?”—don’t denigrate the facility, don’t tell them that it’s really stupid, but say, “I’ll try to find out and bring you an answer.” They did actually bring me lunch at 10:30 a.m. every day I was in the hospital. But it just so happened that my room was the first room on their route, and by the time they got all the way around the floor, it was probably 45 minutes later.

          Know that you are there to learn, but you are also there as part of the patient care team, so you have a dual role there. Don’t ever be afraid to ask questions—to your residents, your fellows, and your attendings. If you don’t feel comfortable looking something up or if you don’t have time to look it up, just ask somebody. But don’t be afraid to ask for what you don’t know.

Cadaver Ball
by Katya Strage, M1

Cadaver Ball is a long-standing tradition that began when the medical school was started back in 1977. The purpose of the event is to honor the second year medical students as they finish their first two didactic years of school and move on to their clinical years, and to thank the faculty for the tremendous role they play in our education. Awards and superlatives are also given to the first- and second-year students as a fun way to celebrate and acknowledge some of the members of the class. This year, the event was also a farewell for the M2s, as this was the last time they would all be on the Bryan/College Station campus together, before they dispersed to their respective clinical campuses. My amazing Cadaver Ball committee and I wanted to make sure we planned a special evening as a way to thank the M2 students for all of their advice, guidance, and encouragement during our first year of medical school.

Even though Cadaver Ball was on April 15, 2016, the planning for this event started much earlier, back in the fall. It all began with a meeting with Rachel Hohlt, the Coordinator of Student Services, and Mariel Swinney, the M2 Vice President. Both Rachel and Mariel were integral parts of making Cadaver Ball such a success this year, as they really guided me and helped me throughout the entire planning process. We split the Committee into different groups so we could divide and conquer all the various things that needed to be done to create the event. The groups were Logistics, Decorations, Entertainment, M2 Gifts, Awards, Candy Bar, and Public Relations.

The first order of business was the theme. Many ideas were submitted through a poll, including “Awkward Prom,” “Star Wars,” “Haunted House,” and the runner-up, “Harry Potter.” However, after several rounds of voting the final decision was “A Night in Morocco.” After looking at some photos online, we decided the vivid colors, bright décor, and fun activities such as belly dancing and henna would make this an unforgettable theme.

The planning was a long and time-consuming process, but with everyone’s help we were able to create a spectacular night! Everyone on the committee, especially myself, could not have been more pleased with how the event turned out. We had a great time, and we hope that everyone else enjoyed the night! I would like to thank the Cadaver Ball committee for their help; it would not have been possible without all of their time and effort toward making this a night everyone would remember. I would also like to especially thank Rachel Hohlt for her help in making all of this possible!

XOXO

Katya Strage, M1 Vice President
Chair of Cadaver Ball Committee

HAVE A WONDERFUL SUMMER! from the
2016-2017 Synapse Editorial Board

CJ Conlon, Copy Editor
Joseph Joo, Copy Editor
Sneha Raghunathan, Copy Editor
Nina Tran, Design Editor

THANK YOU

To our amazing faculty mentors: Barbara Gastel, Gül Russell, & AJ Stramaski
A special thank you to Barbara Gastel for helping with final edits.
Faculty Editor: Karen Wakefield