A Tragic Reality Check

Alas, the further I fall into the abyss of medical science, the less I have been writing. Balancing passions of life is quite the challenge, but we shall carry on.

I could talk endlessly about this module, Musculoskeletal, and about the countless hours of dissection, labs, lectures, and feeling legit in scrubs. I could talk about all the work that has gone into clinical exams and our first [terrifying] Integrated Clinical Skills assessment. I could discuss the struggles of the average medical school student. Maybe I will talk about those later, and maybe I won’t.

The reason I wanted to post on a late Saturday night [when I originally wrote this] is because I need to talk about some grave reminders we get when we experience serious reality checks: 1) we’re human, 2) we don’t live forever, and 3) there are more important things in life.

At 12:36am Friday morning (I know because I looked straight at the clock when I was abruptly shaken awake), my boyfriend told me his former roommate and close friend attempted to commit suicide. I was shocked but not surprised. I know that might not make sense to others, but it’s certainly a distinction to me. At that very moment, it was like my mind went clear. Looking back, I would have expected my response to include panic and tears. But it didn’t.  I remained quiet as Andrew described how his night progressed, how he walked from a bar to visit his friend, how his friend’s current roommate broke the news, and how he drove to a nearby hospital in a panic.

Lying in bed that night, vigilance had taken over. I felt alert as if an emergency had taken hold, as if my fight or flight response was in full gear. I knew I had to do something. Both Andrew and I knew that we had to wait until the morning, when he figured out exactly which psychiatric facility we could find our friend and when we could visit.

Navigating rush hour traffic that evening frustrated me as we headed to a hospital nearly an hour away. With a gallon of fruit punch in Andrew’s hand and a box of chocolates in mine, we were armed for some loving and ultimately enjoyed our visit, all things considered. After signing in and dropping our belongings in a locker, a kind employee escorted us inside to a room filled with grey foldable tables, rectangles lined against the wall by the window, with fold-out chairs tucked under. The only individuals in the room were exactly who we expected: the man himself and their other former roommate with his girlfriend. The following hour and a half was full of laughter, nostalgia, and light-hearted talk regarding grave circumstances.

I kept looking at the wall of art made by the patients, abstract colors, sketches, landscapes, quotes both deep and snarky accompanied by illustrations. I desperately wanted (and still want) a one-on-one talk with him. He’s one of my favorite people. I get how his mind works. I see where he’s coming from. And I desperately wish I could help. Way back, he helped me in a dire family situation when I had nobody else I could call – I knew he would help with no reservations or judgment.

I came to a realization a couple months back when William and Mary had their most recent suicide – there is a stark polarity in decision-making when it comes to the choice to live. Because, when you think about it, every day you live is your choice. To a certain extent, that is quite empowering, whether or not it seems like a decision you would ever consider.

I graduated from an amazing institution that has been criticized as the “suicide school” in Virginia, the College of William and Mary. I can’t say I know all the statistics, and I can’t vouch for one side or the other. Certain people believe this to be a horrible misperception of our university, and others think the title reflects a greater problem that needs to be addressed. The facts I know are the following: there were 3 suicides during my 4 years at W&M and one this past August. If anything is for sure, these unfortunate tragedies reflect the vulnerability of our college years and the need to support one another.

In the William and Mary community, if you didn’t know the person, you knew a friend, a classmate, a hall mate, a professor. The campus went quiet a day or so before the shock wore away. Quickly thereafter, we fell victims to the same stress and runabouts of daily activity, until we would hear horrible news again, this time a new name, a new story.

My heart goes out to those with depression. It’s a crippling disorder that makes you consider your options in ways that most people don’t. For now, I am grateful my friend is alive and has not been permanently harmed from the event, physically at least. The mere thought of losing him hurts my soul, a reality check that both curbs my frivolous complaints and inspires me to move forward in my career. Right now, I want to be a psychiatrist so badly, more than I have every wanted something in my life. I want to help people like my friend, like my lost members of the Tribe, like the countless individuals out there struggling from severe depression, as well as other individuals suffering with mental health illnesses.

If there’s anything I wish for humanity, it’s compassion. Unconditional compassion, for our friends, neighbors, and strangers. I am convinced this world would be a far different place if we listened to compassion as a paramount factor in decision-making. Maybe then it would be easier to seek mental help. Maybe then we could save precious lives.

There are some great articles out there on the subject, and just a few suggestions for anyone’s interest:
-The challenges of suicide prevention on campus after three suicides within a year: http://www.washingtonpost.com/wp-dyn/content/article/2010/11/12/AR2010111202853.html
-About Tracy L. Cross’s research on suicide in the gifted: http://www.wm.edu/news/stories/2013/cross-book-explores-suicide-among-the-gifted123.php
-Blog post of a Tribe member’s own struggles, written after the most recent suicide at W&M: http://wmblogs.wm.edu/skyler/one-tribe/

The End of an Era

This past Friday, I completed my two-year Postbaccalaureate IRTA (Intramural research training award) fellowship at the National Institute of Mental Health. I have grown during the past two years in ways I had not previously imagined. It was much more than science, medicine, child psychiatry, clinical interviews, rounds, diagnosis screenings, brain imaging, neurocognitive testing, DNA extractions, blood/plasma, cell culture for iPSCs, manuscript-writing, and working closely with famous collaborators from around the world – no, this experience was so much more than that.

I worked with a dynamic group of individuals who taught me how to feel confident with my own knowledge while remaining humble in that I can never learn everything. I managed quite a difficult role in the group, where I was basically put in a Postdoc position as a Postbac (I legitimately took over full-time roles of both a PhD and a lab technician). Assuming far more responsibilities than granted a typical IRTA, NIH forced me to grow independently and sometimes to only rely on myself. Research can be a tricky, political profession. NIH is more than a place of scientific research and application of medicine at its finest. I have the utmost respect for any and all individuals who choose this field as their career path. I consider myself extremely lucky to have been offered my position. It’s been fun, busy, stressful, and downright challenging – ultimately worth the experience of a lifetime. I’m taking these life lessons with me everywhere I go.

After my final day in the lab, I headed down to Williamsburg for a family vacation in my old college town. It was a fabulous way to celebrate two years of work after graduation (as well as celebrate a couple of family members’ birthdays!) in my home away from home.

Eternal Optimism

Eternal optimism: a coupling of words I do not believe I have heard before today. In times of adversity and hardship, an eternal optimist looks on the bright side – the glass half full – the grass greener – things could always be worse and we are headed in the right direction.

I just arrived home from The Atlantic‘s Health Care Forum in D.C. where today’s experts in medicine, public health, public policy, and health administration (a medley of self-proclaimed eternal optimists) gathered to discuss our nation’s health care system and future direction. Considering I have been pursuing health care as a career for the past five years, I should have heard the phrase “eternal optimism” before, but this was one of my first experiences where the primary discussion was policy as opposed to health itself. Perhaps health practitioners are forced into realistic worst-case scenarios, and policy-makers are forced to plan optimistically. Somehow, I thought it would be more the opposite. Politicians by nature disagree constantly; the voice of the opposition endlessly proclaims how the current administration is screwing up. That’s one of the many reasons we alternate between Democrat and Republican administrations. On the other end, practitioners provide treatment options, suggesting that patients can heal, that there is hope. Even hospice care is a field that empowers patients to take control and accept their conditions as they are – to enjoy the short time that is left, living to the fullest capacity. In any case, it seemed that eternal optimism was a theme throughout the talk, and it got me thinking…

I consider myself extremely fortunate. My parents immigrated from Iran to earn American educations and to live the American dream. It might sound cliché, but it’s true. I constantly hear about my friends who want to get out – out of their current city, state, region, or the country altogether. Meanwhile, I am a total homebody. I love where I grew up, and I cannot imagine living permanently in any country besides my own. My parents raised me in a manner that made me appreciate something certainly taken for granted in the United States – freedom. Even within the household, my brother and I were free to believe what we wanted, say what we believed, and do what we wanted. Both of us became independent at a young age with discrete moral beliefs and thrived as very different individuals who chose very different paths. That is the beauty of freedom.

There are classic human rights we automatically think of: freedom of religion, freedom of expression, and freedom of assembly (to name a few). I think one big freedom has unfortunately become a privilege in our country – an appropriate standard of living. “Everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care” (UN Universal Declaration of Human Rights). Certainly, not all things are in our control. A lot of health is determined by genetics, but we have the power to change the environmental and societal impacts on health. We can assume very different prognoses of a sick child  based on where the family falls in the socioeconomic hierarchy, and nobody should be okay with that.

Again, I consider myself extremely fortunate. I have always been healthy. Anytime I complained about co-pays, my parents reminded me to never think of money when it comes to health, that life is more valuable than any dollar amount – especially for preventative services. Unfortunately, the money game for Americans changes quality of life, access to resources, and health outcomes. A big part of today’s health forum discussion revolved around treating the social determinants of health, like education and poverty, investments with positive downstream effects that ultimately reduce costs. The US spends a whopping 17% of its GDP on health expenditures, and yet we have some of the worst health outcomes in the developed world. Stemming from talks of “eternal optimism”, I see so much potential in where our country can head in terms of health care policy, a potential that I do not want to see wasted as I progress up the ladder as a medical professional.

Preventive health care should be the epicenter of medicine, where diseases are detected and treated in early stages. We would like to think we are invincible; in reality, we will all die sometime between this very second and the next century. It’s a shame that primary care is downplayed in the hierarchy of medicine. Specialties are glamorous: there is more money and more respect. At least we are on a positive trend in the medical education system incentivizing careers in preventive health care, but health policies should encourage preventive health as well.

I have heard talk about rationing health care due to limited resources and high expenses, but we can change this thinking if we approach health care differently. When you address treatments before a disease state progresses, you avoid greater costs down the line. For example, it’s better to pay tens of thousands a year for hepatitis treatment early on than to wait until the disease requires a liver transplant upwards of a half million dollars (an intriguing article in case you’re interested in hepatitis C health care spending in relation to new drugs on the market: http://www.usatoday.com/story/news/nation/2014/03/03/stateline-hepatitis-c-drugs-health-care-spending/5973133/). Besides catching chronic and acute illnesses at their early stages (behavioral illnesses included), we should publicly address the burden of health costs. For a chronic illness like Gaucher disease (although this is quite rare), annual enzyme replacement therapy costs about $200,000 a year. Imagine the quality of life of an individual with Gaucher disease who has to struggle with both a physical ailment as well as the unrelenting costs of a chronic illness. Paying premiums suck, but knowing that the money is an investment in one’s future health and covers treatment costs for other individuals with severe health problems makes me better understand the complexities of the system.

We have a long way to go, but I see why there is so much eternal optimism; it fuels movement into a positive direction. By no means am I as educated on this topic as I should be, but I think these are interesting topics to ponder. Hopefully we can all sympathize with the plights of the current health care system and think of ways to improve it for the future of our nation.