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.

Personal Statement Throwback

I’ve been reading through personal statements for friends applying in the upcoming medical school cycle and decided to look back on my own. Best of luck to current applicants, and congratulations to matriculants! …

I grew up in a family of philosophers and poets, free-thinkers and political activists, intellectuals and athletes. My upbringing framed limitless goals for the future, which were as expansive as my interests. I wish I could say that my love for science and the desire to be a physician run deep in my blood, but my relationship with medicine began in college. In high school I had said, “I can see myself as anything but a doctor.” The universe only heard ‘doctor’, and my goals for the future shifted dramatically.

My first semester freshman year, I completed the physical science requirement with General Chemistry 103, thereby eliminating any future obligations to science. My chemistry professor shared his philosophies of life to the 100-person audience consisting of mostly pre-medical students. Occasionally, he paused from writing on the blackboard, turned to the large lecture hall, and broke into poetry. Reciting memorized works or thoughts of his own, he often began with, “Science is beauty, and there is beauty in science.” My introductory chemistry course taught me more than the art of balancing reduction-oxidation equations; I learned how to approach the unfamiliar world of science with my background in humanities. Medicine became a marriage between the disciplines of science and humanities, and I see now why my professor found it so beautiful.

Benefiting from an undergraduate liberal arts education, my interests adapted from humanities to the sciences. By the semester of Spring 2010, I declared my major in neuroscience for an interdisciplinary exposure to science and declared a minor in mathematics with a focus on mathematical modeling of biological phenomena. I appreciated the complexities of brain activity determining how we sense, perceive, behave, and function; thus my fascination with molecular networking in the human body began.

The transition into science felt surprisingly natural. My parents and non-nuclear family fostered an environment of self-reflection and independence, giving me the opportunity to grow in any field of my choosing. As my pursuit for a pre-medical education continued, my mother, already diagnosed with bipolar disorder, began to decompensate in mental and cognitive function. The impact of disease goes beyond the biology of the affected person and alters one’s abilities, lifestyle, and relationships. Her battle with mental illness reaffirmed my desire to become a clinician and inspired me to combine compassion, intellect, and curiosity into a career.

My proclivity towards psychiatry brought me to the Child Psychiatry Branch at the National Institute of Mental Health (NIMH) in July 2012. After settling into my research position, I remember meeting an 11-year-old patient in a wheelchair admitted for our childhood-onset schizophrenia study. Dark circles under her eyes, thin, and clearly agitated, this little girl was lost in her own world and could not register my “hello”. About three months later, when I walked into the unit, she jumped into my arms for a hug. Hand in hand, we paced down the hallway to calm her and to talk about the day. At rounds before the girl’s discharge, our team members reflected on her hospital stay. Her father smiled with tears in his eyes as he thanked us for bringing his daughter to life. With careful observation, diagnosis, and treatment, the psychiatry team prescribed her the right dose of antipsychotics that improved her functioning, and to some degree, saved her life.

The girl reminded me that although the human body functions remarkably, we are naturally flawed in biology. Perfect health is nonexistent, and physicians play an integral role in nurturing well-being. The responsibility of physicians goes beyond addressing immediate clinical presentation; they also provide hope for patients to think beyond their conditions and enjoy a better quality of life. I embrace the challenge of a clinician to address patient health within my community, no matter what specialty I ultimately practice.

The distinguishing factors between a good doctor and a great doctor elucidate traits that determine the success of one physician over another. A good doctor is quick-thinking and intelligent. A good doctor is highly organized and dedicated to medicine. A good doctor effectively diagnoses and treats patients. However, a great doctor executes the roles of a good doctor in addition to fostering interpersonal relationships with patients, colleagues, and fellow health professionals. A great doctor builds trust, fundamental for the success of a clinician. Beyond the academic traits necessary to be a good doctor, I believe I have the personal characteristics from my experiences to become a great doctor. In the pathway to becoming a qualified physician, medical school provides the necessary skill sets through relevant coursework, exposure to specialties, and actual clinical practice.

I aspire for a career in medicine, an ambition that feels true to my character. My foundation as a pre-medical student is strong, and I would appreciate consideration to attend your institution. I guarantee that I will be a valuable asset to the medical community, and medical school is the next step of my journey to becoming a qualified physician.

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.