S1E11: Nontraditional Routes to Medicial School

Harjit: Welcome to the "Bundle of Hers." This is Harjit. Bushra and I . . .

Bushra: Do you want me to do it?

Harjit: Yes, you start it.

Bushra: Hi, welcome to the "Bundle of Hers." This is Bushra and Harjit, and we are interviewing our classmate today, Justin. How are you doing, Justin? Welcome.

Justin: Hi. I'm great. Thanks.

Harjit: So me and Bushra . . . actually, I think what really prompted us to have a conversation with you is we had this discussion on Facebook, of all places, around team-based learning. It's this new learning style. And I remember you made a suggestion or a comment, but then you also kind of gave us a background about yourself and how you ended up coming to medical school. I always knew you were a non-traditional student, but that really was something that kind of showed that to us. Do you remember that, Bushra?

Bushra: Yeah, I remember it.

Harjit: I know it's a bunch of, again, labeling things. There's a traditional, non-traditional, but I honestly believe everyone has their own journey getting into medical school. So, I think before that, you actually worked in the healthcare field, correct?

Justin: Yeah. So I've been in EMS for 10 years now. I worked as an EMT for a year, went to paramedic school, and now I've been a paramedic for nine years.

Harjit: And so how did you get into that?

Justin: I, not very purposefully, kind of started in high school. My senior year, I did an internship class, and one of the options was to go intern in the emergency department at Utah Valley. And so I went. It was an interesting experience. I had no real previous exposure to healthcare other than my older sister is a nurse.

And then after that, that next summer after high school, my dad found an EMT course, asked if I wanted to take it, and I said, "Yeah, why not?" Took the EMT course, got certified.

Wasn't really planning on doing anything with it, but while I was in school at Southern Utah, one of my neighbors worked for the county ambulance service and basically convinced me to apply, and I did. Got a job down there running on the ambulance and really enjoyed it. At the time, it was one thing that brought value into my life, I think, one that was really worthwhile. And decided to pursue that as a career.

So I eventually decided to kind of put my graduating from college plans on hold and went to paramedic school at The U, graduated there, and decided to get into a career up here in Salt Lake as a firefighter paramedic. Did the firefighting route because in Salt Lake, pretty much to work as a 911 paramedic, you have to be a firefighter, so I did that too.

Harjit: What kind of really is fulfilling about that job or that career path?

Justin: Oh, gosh. I guess there are so many aspects to it. As far as the job and the job functions go, it's just getting to be there for people. You don't want them to have a bad day, but when people do have bad days, it's really fulfilling to be the one to respond, to answer that call, to be part of the crew that goes and helps people on those days.

And it's a unique position and opportunity to do that for people. And I think it's also unique to be good at it. You work as a crew for years, and your teamwork, you really develop and become really good at what you do. And to be able to do that as a team and know that you're doing it well, I think there's a lot of pride and fulfillment from that.

Harjit: Yeah. Do you remember a really defining moment that you're like, "I cannot believe I'm doing this"? Something that's really moved you. Do you remember any such experience?

Justin: There are those kinds of experiences sprinkled throughout different points in your career, kind of mean different things to you. And a lot of times, for me, it's been when I've gotten used to something and realizing that I'm driving a fire truck or that I'm riding in the back of a helicopter, and it feels normal to me. You're just like, "Wow, I can't believe I get to do this."

But then there are other circumstances that really make you think about what it is that you're doing, because at some point it feels like work. I think it was a summer or two ago, we were flying, picked up a patient from the Uinta Mountains. It was this older gentleman that was having a stroke. And so we landed, and we met with the ambulance that was taking care of him, and his family had brought him down out of the mountains until he could get cell service and call an ambulance.

And so we took care of him, we load him up in the helicopter, and I still remember taking off the ground and looking down and seeing his wife down there. I can only imagine they've been married for 50, 60 years, and just realizing how cool and unique and an awesome opportunity that I have to take care of people. That's her loved one being flown away in a helicopter to a hospital 50 miles away.

Yeah, you get little experiences like that that remind you how cool and awesome the opportunities that we have to take care of people are.

Bushra: Being a paramedic, you already have a cool career, in my opinion. So what made you want to go into medicine and be a doctor?

Justin: Oh, I think a lot of that came from wanting to be a better paramedic. So one of the nice . . . or I guess the benefits of doing something, starting out in your career is you get to kind of watch yourself change and watch the progression, where the first couple of years are really kind of learning how to do the job and kind of understanding it.

And then I found myself at Year 4 or 5 a little complacent. I felt like I could handle most of the calls that we went on, and then there were a couple events where it really stood out to me that I've got to get better at this. And so I started looking beyond the paramedic textbook and the stuff that I had already learned and started to learn more.

Yeah, it was really those kinds of things, trying to dig deeper into some subjects and learn them better and then finding the resources that really started to click with me.

I think I remember I was trying to learn about the kidney, and that's when I found the Khan Academy. And wow. To find, one, amazing teachers that I could really understand the intuitive lessons, and then two, that I could understand them.

That's a big part of my, I guess, non-traditional course, is that when I was in college, proper college, when I was a freshman and sophomore, I was terrible. I was a bad student and I didn't really have the vision to drive the discipline to really understand, to really put your head down until you understand a subject or a concept. And so a lot of things I just thought I was bad at, I was just . . . I kind of accepted that I was bad at science and math.

And having worked as a paramedic, I kind of started to see the benefit of some of these things that you could learn, and then found good teachers and found that I could understand them.

Then I started to go back and really look at all these subjects that I had put away forever. And it just kind of steamrolled from there, where I gained more enthusiasm and excitement for all the content.

Yeah, it was a fun couple of years because I started reviewing subject by subject. I more or less developed a curriculum for myself where as I was learning how to learn better, I started to apply it more.

So I wanted to learn more about respiratory problems, difficulty breathing, and so I developed a process where I had my old anatomy textbook from my sophomore year, where I'd read the lung chapter out of there. I found a couple other textbooks that had good reviews on Amazon. I'd read physiology, then I'd read the pathophysiology, and then I'd read the pharmacology. I started approaching that for everything, and it was fun.

Bushra: It sounds like you took your education into your own hands and kind of made your own curriculum.

Justin: Yeah.

Bushra: Which is really interesting. I've always been kind of the type of person to need guidance when it comes to . . . or structured learning, rather. And so it's amazing what a great teacher can do for your learning process and also your confidence too. And you somehow created that within yourself, I think, with . . .

Justin: Yeah. Well, I think the benefit for me was . . . It's kind of funny. It was kind of backwards. I saw why it mattered first and then went back and tried to learn it.

And then I guess to answer your original question, is that process of learning and just gaining more excitement and enthusiasm for medicine and science and then realizing that I could learn this stuff, that I wasn't just bad at science in general.

Harjit: That there's a reason now that you have . . . Because I think a lot of people . . . I remember I've always wanted to be a physician since a young age as well. I used to go to appointments with my parents because they didn't speak English, and I used to think it was so interesting. I always wanted to know how things work.

But I remember I did well in math and science, and then I was like, "Oh, I can do this." But I feel like a lot of people, if they feel like they're not good at math and science, they totally take that off as an option. Do you see that a lot too, Bushra?

Bushra: Yeah. I feel like when in undergrad, especially freshman year, I had an inkling. I wasn't 100% committed to anything. So I was like, "Yeah, I think I'm interested in medicine," and literally everyone was like, "Well, next year you probably won't be interested in it anymore. It's too hard," or, "Most people come in and say they're pre-med, and they all drop out anyway," kind of thing.

And so I think that mentality of you're probably going to be bad at it, or you don't necessarily have the natural knack for learning the sciences means that you can't go into a career choice that you're actually excited about is kind of . . . that's probably a defeatist attitude. And it's kind of detrimental to your learning psyche and trying to fulfill what you want to do.

I think it's one thing if you go into it and realize you're not interested anymore, but if you go into it and think you're not smart enough to do it is different.

Harjit: I agree with that. Was there any point you ever felt like, "This is something I want to do, but is it something I really can do?"

Justin: Oh, yeah. That was kind of the turning point for me, was realizing that it kind of . . . I don't know. You get those butterflies, and you start to think, "Maybe I can do this." Because I was scared. I was really scared about it, committing to this or at least trying.

I kind of joked about being a bad student, but at SCU, my freshman year, I was a C student. I didn't do well. And then my last semester down there, I failed every class except for anatomy. I failed Gen Chem and Calculus. And so, for me, that was just . . . I was scared to do those subjects again. I was nervous about them.

And then also, too, because I'd kind of noticed a pattern where I'd start a semester well and then get around Week 5 or 6 and then just kind of taper down where I couldn't sustain that kind of effort.

Yeah, I think what changed for me is just getting the confidence, understanding things. And then really, there were a lot of lessons I learned at the fire department, being a firefighter, being disciplined, and learning how to work hard. I didn't really know how to do those when I was younger.

So I look at medical school, nontraditional, this or that, it would have been virtually impossible for me to do this at any other time in my life. I just didn't have the tools.

Harjit: I think that's so amazing that you recognize, "These are the things that I got, and now is the time for me to take this next step." Have those fears or saying, "Oh, I failed these classes," impacted you? Right now you're in medical school, so has that impacted your confidence in that sense?

Justin: Yeah, but not negatively. I think it's made me more confident because I see where I was and where I am now. And where I really gained a lot of confidence was in the pre-med classes, taking the exact classes that I had failed before, but this time getting an A because I was stubborn about it. I studied and studied and studied until I understood not just well enough to pass a test or a quiz, but to really understand it because I wanted to know. Yeah, that gives me a lot of confidence.

I've failed before, and I know what that feels like, and I'm okay with it, and I'm not that afraid of failure. You go through that academic background, I guess, and some of the things I've done professionally where I've failed or seen failure, and it's an expected part of the course. Failure here and there. And I think having those kinds of experiences helps you to develop a plan for when you do fail, because it's going to happen.

Harjit: Yeah. How do you become okay with failing?

Bushra: I'm scared to death.

Justin: Oh.

Bushra: Yeah, I need the answer to this question, right?

Justin: I don't know. I mean, everyone fails in different ways, in different circumstances. For me, it was transitioning out of the beating yourself up about it and seeing just how useless that can be.

You feel bad every time you fail. That's intrinsic to it. You don't need to add to that. You don't need to dwell on it.

And really, some of my biggest failures have turned into successes. Those feelings that kind of just . . . Like, knowing how poorly I did in school before and wanting to right that made me more disciplined, made me a better student.

Some of the times I've failed at work as a paramedic, maybe I wasn't quick enough to realize the situation or treat a patient the way we needed to. That call is done. It's over. I can't go back and fix it, but I can prepare for the next time.

For me, it's just realizing that failure is part of it and that failure is a tool to help us keep going and be better, and just using all the positive aspects out of failure.

And it's funny, my nurse educator at AirMed, she always has a . . . All through orientation she always said, "It's okay if you screw up. No one's going to take away your birthday." But it's true, right? What's going to happen? I mean, there really aren't a lot of failures that we can have that we can't recover from.

And it's amazing too. I mean, we might even fail a year of school, but I'm confident we can recover, and you can move on. It might be inconvenient, but you can take those lessons and you just move on and adapt and just make the most out of your day and of your life.

Harjit: We kind of talked about you getting into medical school, so how have you . . . You kind of spoke a little bit about how you used to learn. You started using Khan Academy, kind of building your own curriculum. How has that kind of transitioned into medical school for you?

Justin: It's taken a little bit to find the resources I like. I think some units are more difficult than others to kind of integrate and use the resources. I like to treat lectures as a resource. I know that probably hurts the sensibilities of some administrators, but to me the lecture is like a textbook. It's like a presentation or a YouTube video, and I get the most when I integrate.

So some of the units like MCC I found difficult because a lot of the material came either only from a textbook, like a dense textbook, or from lecture. Whereas now with some of the other subjects we're learning, I'll take the GI, I get to watch Pathoma, visit First Aid, look at "Robbins," and then watch lecture too and just kind of make my own kind of lecture outlines, if you will.

So for some of the stuff where I've struggled with the lecture, what's really helped me is taking that approach again and kind of make my own PowerPoint for a lecture. I had to do that with the GI bugs, because that lecture, I did not get it at all. So after that quiz, naturally, I went back and I made my own version of the PowerPoints and integrated everything.

Harjit: That's awesome.

Justin: Which is funny. I used to do that . . . I talked about studying as a paramedic, going subject by subject, but I would make my own PowerPoints for no one but me. But that's where I kept track of everything. That was my own textbook, is, "This is what I think is important, and they're all laid out here."

Harjit: That's so great.

Bushra: I don't have that kind of initiative, to be honest.

Justin: Well, it's actually . . . The PowerPoint, I love it. I still do it for work. Now, as paramedics, flight nurses, we have to go to the OR and practice intubations. And so I have an OR PowerPoint, and I update it every time I go to the OR. And so every lesson I learn, I keep in the one place. And every time I go back, before I go, I review that PowerPoint, like, "This is what I learned last time. This is what I'm going to focus on this time." And so it kind of bookmarks where you're at, so you can hopefully just keep on moving.

Harjit: You've kind of mentioned that you're still working while in medical school.

Justin: Yeah.

Harjit: So I think that's something that I would really want to talk about. How is that, working and doing medical school at the same time?

Justin: Yeah, it's kind of . . . I don't know how to approach it really. As a paramedic, you just work a lot. I worked full-time for South Salt Lake City for eight years, and one year into the job, I got my part-time job. And it's like every firefighter has a part-time job. It's just what you do. And so seven out of the eight years at South Salt Lake, I had a part-time job. Probably for 7 years, I worked 80, 90 hours a week. You just got used to it.

The year before I started medical school here, I worked full-time for the fire department, and I worked full-time for the hospital. You don't notice it because you just start. You just keep adding stuff, and your ability to do it all increases.

Kind of like how school feels. It feels like so much at first, but you get caught up, and then you start adding an interest group or this or that along the way. And that's honestly how it feels.

So I guess, in that context, work doesn't feel that bad because I used to work way more. I used to work . . . Well, yeah, I used to work 80, 90 hours a week. Now I only work 30 hours a week.

Harjit: Wow.

Bushra: I feel like . . .

Harjit: You worked 80, 90 hours a week?

Justin: Well, yeah. I mean, it's as a firefighter, though, so the hours are different.

Harjit: Oh, okay. Yeah.

Justin: So at the fire department we worked 48-hour shifts on a 6-day rotation, so that averaged out to be 56 hours a week.

Harjit: Oh, I see.

Justin: And so, essentially, when I say "work," I was at work for those hours. You've still got to eat, sleep, exercise, and that sort of thing for 80, 90 hours at a time.

Bushra: I feel like clinically you're probably one of the more advanced students in our class, and I'm going to guess that kind of has to do with your paramedic background. So do you . . .

Justin: It's mostly "Grey's Anatomy."

Bushra: That's my thing.

Justin: Oh, I'm sorry.

Bushra: I always say, "Oh my god, I totally saw that on 'Grey's Anatomy.'" But do you now, as a medical student that's working as a paramedic, see your patients differently from a medical student/future physician standpoint, or no?

Justin: Yeah, a little bit. I mean, clinically, it's been pretty fun still working because the job hasn't changed. I'm still a paramedic and still seeing the same kinds of patients, but what I see is different. I see different nuances in every patient. It's fun, and it's a really kind of exciting part of the job that I get to kind of like, "Yay," to myself every time I see something different.

Occasionally, it might impact care, but for the most part, that's a big part of being a paramedic or working in the pre-hospital field. You might have all these complex situations going on, but you have to prioritize what you're doing. You could have someone from last week's CBL or something like that with the metabolic disorders or this or that, but you boil it down to "Are they breathing? Are they perfusing?"

Bushra: ABC.

Justin: "Do they have good circulation?" And then you go from there.

But it's cool especially, too, working as a flight paramedic out of the University of Utah Hospital. I get to see a lot of patients in a lot of different areas and clinics all the way around the Intermountain West. So I get to see doctors in ERs in Wyoming and Montana and Idaho, or PAs and NPs, and kind of quietly observe them, the way they do stuff, without them really knowing that I'm doing that. And it's cool.

As we do now, we shadow, but it's cool to kind of take notes and see how I want to be or how I don't want to be.

And just to see the same kind of thing with someone that's sick and needs to go somewhere else in so many different settings, because you can learn so much from other people just watching them. And not just them, but the way their actions impact other people around them in a team atmosphere and things like that.

I've got to see a lot of emergency physicians over the last 10 years, and to see the dynamics in their different ERs. Some of them, if something doesn't go their way . . . Maybe it's something you did pre-hospital or something like that. You bring a patient in, and they just can't get over it. They just can't get over that you didn't do it the way they wanted to without you knowing that they wanted it that way. It just derails everything, and they just can't get over it, and they won't move on. It's amazing, that quality. Other people, they can just roll with it. And just seeing how that changed the team dynamics.

And then just seeing, too, not just on the side of the healthcare workers but different people, the way they interact with patients and family. My favorite stuff is just seeing how to better interact with people and family. Some people are fantastic at it, and some people are just not so much.

Harjit: I really think it's amazing that you basically do you. The path that you've taken is really what you want to do and what you see your future as becoming. When I was pre-med, I always was like, "Oh, I have to do this, and then I have to do this," because this is how people get into medical school, right?

Bushra: Yeah.

Justin: Yeah.

Harjit: But I think that . . .

Bushra: The tried-and-true path.

Harjit: . . . when I thought like that, I didn't get into medical school. It was when I thought, "I need to do things that I care about," regardless if I got into medical school or not, I feel like I'm fulfilling my calling, right?

So I feel like I really see that in you, Justin, and I wonder has that always been how you are, or is that something that you developed? Being you, basically.

Justin: No, that was definitely something that took time to find. To know who you are and what you're about, that's something for me that happened in my mid-20s. I'm no longer in my 20s now. I mean, that was kind of . . . yeah, that took a while to find for me. And when I did, it was . . . I don't know. You start being your true self and just kind of boldly living a little bit.

For me, that's actually one of the hard things I have with school, because I know it's like I'm getting into someone else's program. This is their medical school. And so it's hard for me sometimes kind of conforming to the overall plan or schema or whatever.

Harjit: I know.

Justin: I appreciate and love guidance all along the way, but I want to use it as guidance. Just kind of like how I incorporate a lecture into my learning, I want to take someone else's guidance, but I don't want to learn someone else's way or something like that rigidly. I love being dynamic and just being able to scale up, scale down, whatever.

Harjit: I really share that sentiment. It's hard because everything is so standardized. I remember actually on that post you wrote something like, "We're trying to standardize a process that's not someone else's to standardize." And I think that following a career path . . . I think a lot of career paths, there are goals, certain things you have to reach, so you think you have only one path to reach there.

That's the way I felt when I was also younger. I would say like 18, even until I was 21 or 22. I realized that, no, everyone doesn't always have the same path. But it took me a long time to be okay with that. I always felt like I was doing something wrong.

Bushra: I know what you mean, because I think I was kind of in the same boat too. I wasn't really interested in medicine until kind of later, right before I graduated college, and so I had to hurry up and do all these pre-reqs, which is not fun.

But I think along the way, I wouldn't change the way that I did things because I got to experience a lot of different things too with my major and just trying to figure out who I was as a person and trying to figure out what career path is going to make me happy and what I see for myself in the future.

Harjit: Yeah. And I think that all those things, all that conflict helps you gain lessons or tools so you can reach a certain place in life.

So I think I want to end out with asking you a very broad question. Justin.

Justin: Yes.

Harjit: What's the legacy you want to leave on this world?

Justin: Oh my gosh.

Bushra: Oh, that's a deep one.

Justin: Wow. That's an interesting question, and that's a . . .

Harjit: I don't know my answer, so I'm asking you.

Justin: No, I'm trying. I think I know what I want to say. Honestly, that's part of why I want to be here and go to school, is to sort of have a legacy. And not so much I don't want my name on a building kind of a legacy. I want to do things for people and have that be my legacy.

You see so many people that don't have a legacy or won't have a legacy. So many people, they get up in the morning, at whatever time, and maybe they walk over to the dollar store, get a bottle of mouthwash, drink it until they pass out, and that's what they do. Or in other degrees, a lot of people kind of do whatever it is they do during the day, study, work, whatever, watch TV, and go to bed and just repeat it.

Although that sounds crazily familiar, but I don't want that to be the point. I want to have a legacy, and I want medicine more or less to be my legacy because I have so much energy to put into something, and to me, this is the only thing worthwhile in the world to put this much energy into.

I want my legacy to be through other people, to put all this work into something just so that as a doctor, my two weeks with a patient or something, they can go on and have the life that they want. And that is more or less what I want my legacy to be, is just tiny bite-sized pieces with every person that I interact with.

Harjit: That's amazing. Justin, you're amazing.

Bushra: Good answer.

Harjit: You're so wise, and I really admire you, and I hope that as my life goes on, I reach that surety and confidence in myself that the way I'm doing things is fine. So thank you so much.

Justin: No, thank you very much.

Harjit: We're really appreciative that you could come have a conversation with us. And to our listeners, thank you for listening, and we will see you next week. Or hear, listen. We'll . . .

Bushra: This happens every week.

Justin: They will be speaking, and you will listen.

Harjit: Yeah. I don't know how to end this. Bushra?

Bushra: Do you want me to do it?

Harjit: Yes.

Bushra: So that was the end of the show. Please subscribe to our channel and leave a review if you can, and we'll be back with a new episode next week. Thanks, guys. Bye.

Harjit: Thank you.