In 2022, the EJI Excellence in Medicine Foundation dedicated nine scholarships to extraordinary medical, dental, pharmaceutical and physician assistant students in New Jersey. The students generously shared some of their biggest lessons and insights from their education experience. The first three student columns are listed below, with the other columns to come in subsequent issues of MDAdvisor.
Roberta Hutton, MPH
Roberta Hutton, MPH, is a medical student at Hackensack Meridian School of Medicine, Class of 2022, and will soon start a residency in general surgery at the University of Miami – HCA Florida JFK Hospital in Atlantis, FL.
Socially Responsible Surgery
One of the core beliefs of my newly established medical school, Hackensack Meridian School of Medicine, is that any physician, regardless of specialty, can meaningfully impact the determinants of health and improve the care of patients and the community at large. These beliefs resonated with me, as I set out to combine my interests in public health and surgery.
Public health is a vast field ranging from data management with statistics and modeling to health policy and economics, and to the philosophy and study of health equity and social determinants of health. My focus was in evaluation and monitoring, as I felt strongly that interventions that were designed in an effective and deliberate way would have the greatest impact on public health. However, I also felt strongly about pursuing a career in surgery—a field that was stereotypically focused only on “cutting” and caring minimally about the patient unconscious on the table. I had a difficult time balancing these two sides—my interest in effecting health on a community scale versus my love of the operating room and effecting immediate change with my own hands.
Therefore, this new medical school offered a big promise, to show me how I could do both. The Human Dimension program is designed to have students interact with the community and learn about the impact of social determinants of health. I worked with a wonderful woman from New Jersey and helped her find transportation to office visits, psychiatrists who would take her insurance and services to help manage her finances and SNAP eligibility. Mostly, however, I just listened. She shared with us her challenges and accomplishments, her joys and fears. After one such conversation, she told me, “You know what? I think you will be a great surgeon.” This was inspiring. Could I have a greater impact on my future patients’ health by being a more empathetic physician? Could I use these lessons of communication and understanding to help mitigate the burden of disease, prevent further complications and improve relationships with my patients? Absolutely.
The surgeons I have sought out for mentorship have shared this vision. For many, this has taken the form of the Golden Rule, which guides them to treat their patients as they would want their own family members treated. Others focus their research on social determinants of health and health disparities. Additionally, surgeons have used their professional status and patient relationships to help enforce healthy behavior change—lose weight, stop smoking, go for cancer screenings. There is a great national movement trying to unify these efforts to change the stereotype of surgery, to improve care and health outcomes and to bring together those with interests in public health and surgery. This movement is called Socially Responsible Surgery. I helped bring this movement to my medical school, and I hope to carry its ideals and mission onwards to residency. Take a moment to listen, to empathize, to find a way to effect change, and to have a lasting and important impact on patients and their communities.
Ila Nimgaonkar, PhD
Ila Nimgaonkar, PhD, is a medical student at Rutgers Robert Wood Johnson Medical School, Class of 2022, and will soon start an internal medicine residency at the University of Washington, Seattle, WA.
Liminal Spaces
Like many bright-eyed, pre-medical students, I entered medicine with a desire to heroically heal the sick, while connecting emotionally and spiritually with patients. Now eight years older and marginally wiser, the word “heal” has become a more nuanced and complicated term to me. In my chosen field of internal medicine, so many of the conditions I will see are chronic and cannot be “cured.” My role will not necessarily be to fix the pathology, but often to aid my patients in living comfortably and gracefully with a new diagnosis that will become a major part of their lives. I will be, often, the ferryman guiding my patients across a life-changing threshold that will transform them forever.
I remember a young patient during my medicine rotation who came in for an unusual infection and learned that he was HIV positive. I visited him every afternoon during the week he was hospitalized to ask how he was coping with the news. He shifted through denial, anger and grief. “How will my community ever accept me? Will I be able to have children? Will I die young?” he asked, through tears, suddenly so alone. “We have very good medications to control the virus. You’re going to grow very old and have normal old-people problems like back pain one day,” I told him. A small smile. The beginning of acceptance.
Another patient, who I followed longitudinally in an outpatient clinic, was diagnosed with incurable damage to his liver from a long history of heavy alcohol use. I broke the news to him with my team, holding his hand as his eyes glistened; the realization of his limited life expectancy setting in. “If you’ve been putting off seeing your favorite soccer team play or need to re-unite with a long-lost brother you should do it soon,” I told him. After a thoughtful silence, he replied, “I think I’d like to go visit my home country.”
As I stand on my own threshold of transforming from medical student to doctor, I realize how much I have grown and have been changed by the vulnerability, the pain and the intensity of emotion I see in my patients. There is a gentle humility in realizing that I am not the hero, but the ferryman of a patient who will become the hero of their own journey. I still hope to completely cure many patients of their diseases during my lifetime, and I will fight, through my research, to push the boundaries of what medicine can do and to develop more effective therapeutics for patients. But I also realize that medicine cannot always heal, and that there is something beautiful in occupying that privileged space with my patients as they cross the liminal space.
Marshall Yuan
Marshall Yuan is a student at Ernest Mario School of Pharmacy at Rutgers University, Class of 2023, and will subsequently be attending Rutgers Robert Wood Johnson Medical School.
Trust: A Two-Way Street
A soft jazz tune plays in my ear. I can hear the sweet tambour of the alto saxophone resonating above a drum set. You might think that it’s a night out for me at one of the local jazz clubs. Or maybe I’m enjoying an evening of reading and some of Spotify’s best jazz. Not quite. It’s actually the sound of being on hold for the past 15 minutes while calling a physician’s office. From the corner of my eye, I see the patient standing a few feet away, stoic with his arms crossed. The patient had just brought in a prescription for a medication new to his profile, but the insurance company was unyielding: they would not cover it. Intending to offer an alternative to the doctor, my pharmacist and I find ourselves with our hands tied by a telephone queue. Eventually, the patient pokes his head through the counseling window and asks, “How much longer is it going to take?” The pharmacist assures the patient that it would only be a little longer. I can hear one of the other technicians quietly grumble at the patient’s rude attitude.
After we finally confirm the medication switch and dispense the alternative, I call his name for pickup and prepare to ring him up. He hastily shuffles to the front saying, “I’m sorry for my behavior. This is the first time my doctor prescribed me medication. Going to the pharmacy for the first time made me nervous.” At that moment, I realize how terrifying it can be to experience changes in health. I have to remind myself that people aren’t at the pharmacy because they’re healthy. This experience helped me understand that as a healthcare professional, I should be acutely aware of the hardship associated with this change and sensitive to my role in easing this transition.
In another instance, while volunteering in the emergency department of the hospital, I met a woman who expressed her anxiety about being at the hospital for the first time. She was scared and alone. Realizing how difficult it must have been for her, I pulled up a chair. And we just talked. She told me about her vacation from two weeks earlier, about her job, about her most memorable clients. I learned her concerns were elevated by the bad preconceptions of hospitals she had learned from social media. When my volunteer shift ended, she held my hand, and her eyes sparkled as she said, “Thank you.”
At the pharmacy, I learned to trust my patient; at the hospital, I learned how to help a patient trust me. Recognizing that patients can become agitated from the unease of an unfamiliar situation, I realized that I shouldn’t immediately judge patients for this transient behavior. Instead, it is my job as healthcare professional to listen to them and hear their concerns. I should tell the patients that I understand that it is a scary time for them, and that I am there to serve them and facilitate healing. I now understand that by further developing this degree of trust, I can further optimize communication and improve patient outcomes.
Any time I have the opportunity to work with my patients, I now take a step back and try to get to know them as people. Behind every patient there is a story, and behind every patient’s story, there is a narrative I should strive to understand. There is real magic in the opportunity of healthcare providers to foster a relationship of trust with others. Between my successes and my failures in the future, I hope that the ability for patients to trust me will always persist. I am beyond excited to work with my patients, and I cannot wait to meet each and every one of them.
