S2E13: Aligning Passion with Purpose

Leen: Oh, my gosh. Here we go. I'm like the greatest at recording.

Chloe: It's been a beat since you guys recorded.

Leen: Yeah, I know.

Bushra: Since before Christmas.

Leen: Are you ready?

Bushra: Ready.

Leen: Bushra and I are here in the studio with Dr. Megan Fix. She is an emergency medicine doctor here at the University of Utah and a mentor for us medical students wanting to pursue emergency medicine. So thank you for joining us today.

Dr. Fix: Thanks for having me.

Leen: Could you tell us a little bit about where you went to med school and how that was like, what made you go towards emergency medicine?

Dr. Fix: Absolutely. I grew up in a small town in Michigan, and I went to high school there. A lot of people stayed in Maya High School. They went to the college nearby, and I ended up being very lucky that I was able to go to Stanford for undergrad.

And when I was there, I found the diversity amazing. It was really, really great for me to just see many different walks of life. And I was actually a synchronized swimmer in college, which is kind of a fun fact, and my synchronized swimming team doctor was an emergency physician for one of our national meets. So he actually was a really good mentor for me and helped me kind of through medical school deciding that I wanted to pursue EM.

So I actually stayed at Stanford for my medical school. And when I was a medical student, I loved everything. I loved medicine. I loved OB. I loved surgery. I was just like, "This is the bomb. I get to learn all these things and be this kind of doctor for 28 days." And so my third year, I pretty much loved every rotation. And it was very hard for me to decide. So I was thinking that I really liked OB because you get continuity of care. You work with great patients. There's also procedures. It's very exciting too. OB is very exciting in a lot of ways. So I did an OB sub-internship, and I really loved it. But the month after that, I actually did my EM, four-week rotation, and was just amazed. I was like, "This is it. Everything's here."

Bushra: Love at first sight.

Dr. Fix: Yeah. It was like everything is exciting. I feel like I was always learning. I was on my feet, which is really good for me. And I felt like there was never an end to what I was learning. It was also very active in that you do procedures, that you get to have critical conversations. You have critical care patients. You have kids. You have adults. You have geriatrics. You have women. You have delivering babies still in the ER, believe it or not. And so I found that it really fit my personality, my need for lifelong learning and just being stimulated.

And I also found that the people in EM were very much my peeps. And that's why I tell you guys, when I'm mentoring, that you really want to find your peeps in medicine, but also in life because you're never going to be alone. And medicine, it's a team sport. And in emergency department, to me, it's very much an act of teamwork every day.

The other thing, I think, is really important as you're going through your clinic orientations as a student is to think about when you're on a rotation what you find really exhilarating for you. And so, for me, I found that my ED shifts went by so fast and that by the time I was done, I thought, "Oh, I want to keep doing this for many more hours," because it was something that really appealed to my personality, and that may have been the medicine clinic, or that may have been the OR, that may have been PMNR or peds, or whatever it is for you. You have to live with yourself your whole life.

And so, for me, I felt very lucky that I found my home in medicine, and I did a year off during medical school to pursue teaching. Teaching has been one of my things, as you guys know, for a long time. So I took a year off and was a TA for the undergraduates at Stanford. So I ended up spending five years in med school. One year of that was TA-ing.

And then, I went to residency in emergency medicine in Boston at the Harvard Program at Brigham and Women's/Mass General. And I found that, actually, being cross-country was very good for my medical training because you see different aspects of medicine. You see a little bit different pathology. You see different ways that people practice. And I felt like, for me, that gave me a really good breadth of knowledge that was very beneficial for not only emergency medicine, but for life.

So I was in Boston for four years for residency training. And then, I took a first job as an attending at Maine Medical Center in Portland, Maine, and I was the medical student director there, again continuing my theme of teaching. And then, I came to University of Utah in 2010 as the associate residency director for the residency program in emergency medicine, and I've tried to really diversify and be involved with [inaudible 00:04:12] as well as med students.

Bushra: So one thing that kind of makes my heart sing is when you use the word "diversity" because that's literally what we spend a lot of time talking about, especially here. I feel like that is something that we're lacking here. And while steps are being made to kind of progress in that area, I often think that there is a sense of urgency to do more now, especially in this time. What are your thoughts on that?

Dr. Fix: Yeah. I think that's a great question. And I think, being a student, you are in the perfect position to make a change because universities are aware a lot of change happens. I think that probably for University of Utah, it's like anything. Change takes time. And if you feel the sense of urgency, you're going to reach out. And that's exactly what this podcast is, right? You're reaching so many people and talking about what is passionate for you and what's something that is important. And that can create change in just the culture of our place, right? So the more that we speak out, the more that we have mentorship, the more that we are reaching out to people who are representative of diversity, the more that they're going to want to come here.

Bushra: Right.

Dr. Fix: So I think exactly what you guys are doing is the right approach. My personal view is really to make change by being a good role model and by being a good advocate for whatever you feel passionate about. So I feel really passionate about mentoring women, for example. So I really like to be a strong role model for the residents and medical students.

But I also feel very passionate about education. And that's not just women-specific, that's everybody. And so I feel that if you're enthusiastic and you really represent whatever it is that you want to be positively, a lot of times in our world today, there's so much negative information. That goes along with trying to promote diversity. You're trying to promote whatever it is that your cause is. I just think that being positive about it will bring other people on board, right, because that's contagious.

Bushra: Yeah.

Leen: That's true.

Bushra: I often find that when you meet resistance . . . at some point in your life, you are going to meet resistance to change because a status quo has been met for so long. And so any change could be viewed as threatening. But I often find that kind of engaging in a positive way is more conducive to a more, I feel like, well-rounded conversation even. So I really resonate with that thought.

Dr. Fix: And you'll see in your medical training, right, you'll see people who respond to conflict by being more boisterous, louder, and kind of putting other people down. That definitely has been a culture in medicine for a long time, and I'm not sure it's the right way. But as a med student, I'm sure you will see those behaviors and you'll think, "Hmm, I'm not sure I really respect that person." But you'll see someone else respond to a conflict and say something like, "I'm going to put the patient as the most priority here. What can we do as a team to get this patient the care that they need, right?"

Same goal, same outcome, calm, positive, with the patient outcome in mind, and I bet most med students will say, "Wow, you know, that's a way that I want to behave when I am an attending because I saw that that was a calmer, better way to handle a conflict." And I just think that's another way to be a leader, is to show that you can behave positively without yelling and screaming, and calling people names. And all that stuff, it's just not professional. And over time, I feel that that's where change is created.

Leen: I love that you said, especially, you know, being in the third year medical rink, oftentimes, we do tend to see the kind of the more chaotic side of personalities. And it's really a struggle when we want to try to connect to that field and we just . . . you're placed in the middle of all that drama and you're like, "How can I manage this?" And so I love the idea that, you know, in the future, you can also be the change. And I think that's also something we love to emphasize here as well. How can you navigate when trying to find a mentor that . . . you know, how can you figure out whether you're actually allured to the mentor for their personality versus the actual specialty?

Dr. Fix: I think that's actually a really good thing, because I think that you should have many mentors. I don't think you should have just one mentor. Let's say as an MS1, for example, you find a mentor. You are allured to them because of their personality and really jive with them. That's great. Go shadow with them. Walk in their shoes. See what they do. And if that doesn't really fit with you, you can still have them as a mentor for life, for example.

So I always tell my mentees, "I will still love you even if you don't come into EM." And I really mean that, because I want all the students to be happy. And I've had students that I've mentored go on to residency in other things and then come back. And we've talked about life, about having kids, and being a physician, and how to balance your work-life and having a spouse, and working out and being healthy, and cooking, and all these other things that are really important to me. But I met them as an MS1 or an MS2.

So if, for example, you have a mentor, you really like their personality and you decide not to go into that specialty, just be yourself. Just be gracious and say, "I have loved working with you. I found that my passions really lie in this specialty. But if it's okay with you, I'd love to still continue our mentoring relationship because I've gained so much from you." And that's really showing that person that you respect them as a person, not just as a physician. Because being a physician is one aspect of my life as it should be one aspect of your lives when you're done. But you have so much else to give and to gain from mentoring relationships.

Bushra: What are the struggles to just kind of being a whole person and not just what you do? Well, you spend so much time trying to achieve this goal of being a doctor and that's what we focus on for so long. And I think we tend to focus on that more than other aspects in our lives, and we've actually had several discussions on that. So how do we kind of go back to being a whole person?

Dr. Fix: For me, personally, it involved a self-journey of my own personal identity in that I did go through really a hard time when I was a resident. I was pretty depressed, and I had to do a lot of soul-searching and figuring out what is really important to me. And I did a lot of counseling. I really figured out that I am the best me when I practice good self-care and good relationships. And that actually does not at all really involve my career.

So what I mean by that is that I need to be centered in myself. I need to be able to get exercise, eat well. I really like to cook and do whole foods and make sure that I'm using vegetables and fruits. So I do that as a base. And so if I'm getting sleep, I'm getting good exercise, and I'm eating well, and I'm communicating with my husband and my children, then I'm good, right? So then, I'm good and I have much more to give to my career. If I do too much in my career realm, I'm not going to be good at all of those other things.

So, for everybody, this is going to be a little different. And my personal feeling is that you need to understand what your number one and number two priorities are, and those need to be well fed. If those are well fed, it will spill over into the rest of your career.

And I have some amazing colleagues, for example, who have chosen not to have children but are married, and they are amazing at their career. But they have this other degree that they need to fulfill. So that might be music or that might be travel, or it might be something else, right? And so whatever it is for you, you need to have those priorities. The first and second priorities have to be met, and then the other things will fall into place.

So I feel that I'm very effective in my career because I have those other priorities taken care of. If I find that I'm a little bit off and, again, that's where the mindfulness and working on myself and having balance, and having done counseling a lot in my life, it's really helped me realize that when I do get off, I need to focus on those priorities again.

Bushra: One thing that you touched upon is wellness and mental health, and getting counseling. As we all know, residency is going to be very time-consuming. What is the advice that you would give to maybe incoming interns and residents who kind of struggle with that? I don't know. I just feel like there's still . . . as much as we do know and as much as we get educated on mental health, I feel like we still, as medical students and residents, still don't reach out to get help. So what are your thoughts on that?

Dr. Fix: Yeah. So there's a couple of things. First and foremost, I would say everybody needs to really know their self. I think it would be very easy to be an undergrad, to be a medical student, and to jump through all the hoops that we make you jump through without ever taking a moment to actually step back and soul search, and really feel about who I am. What's my identity? What do I need in life? What is driving me? What's my passion? What is really my purpose? And I was fortunate to be able to take some time out and do some retreats and things that really helped me get to that base. And once you have that base, I feel like you're much more able to know when you need a little check-in or when you need some counseling, or when you need to reach out.

So, first and foremost, knowing yourself and knowing what your triggers are. If you have a family history of mental health problems or if you've had someone in your family who's gone through something really terrible, that can also be a trigger. So know yourself, number one.

And then, number two is the culture of medicine thing. I feel that our culture in medicine is very much a culture of you got to, like, fake it to make it. You got to look good. You got to know all the answers, and you can never fail, right? You can't fail. You can't fail and get into medical school. You can't fail and get into residency. And I don't think that is a right way to look at this.

Failure is what makes us human beings. Failure is what makes us grow and learn. And failure is not bad. But I think we feel that if we're having a struggle, it's not okay to talk about it. And in my career, I've had many people that I've been touched by or have had conversations with who have mental health struggles. I think that's part of being a human being and that's part of being a physician as well, so the more that we talk about it the more that we make it normal.

And I used to say this in my residency after I had gone through my difficult time. I started a wellness group, and we had a lot of meetings. But I would say something like, "It's not if it's going to happen, it's when." We are all going to be touched by depression. Unfortunately, most of us are going to know somebody or know somebody who knew somebody who committed suicide. That's one of the things of today. And I think the more that we recognize that and approach it as something that's going to happen, we'll be more prepared to deal with it and more prepared to prevent it, right?

And prevention is huge when it comes to mental health, because if somebody feels that they are alone, they are much more likely to actually complete suicide. If they feel that they have support, if they feel that somebody else is going through the same thing that they're going through, it's much easier to get help. So I just think we need to talk about it more, not hide it.

Bushra: I agree.

Leen: One thing that I wanted to ask you, ever since I said that I wanted to do emergency medicine to my family . . . I come from a very Middle Eastern conservative family. They're like, "You know, as a woman, you're not going to be able to do it. You need something easy. You need something you can balance." And I just was like, "Challenge accepted." And so this is a question I really wanted to ask you. Could you tell us what it's like in terms of lifestyle and how you balance being a woman in emergency medicine?

Dr. Fix: I'm really a person who looks at the glass half full pretty much in most things. And so, once I decided, as I told you, I was super psyched, I was deciding emergency medicine. With any specialty, there are some things that are going to be challenges. And my view is that you just accept those and you look at the positives. So, in emergency medicine, it's working nights, working weekends, working holidays, right, because the emergency department is open 24 hours, which is an awesome thing about it. But instead of grumbling and being like, "Oh, man, I have to work a night," or "I have to work a this," I accept it and I'm psyched. And I really try to be there when I'm there, be on when I'm there.

But the great thing for me, because I have three young kids, I have three boys, when I had my kids, I was able to work shifts in advanced and have a great three-month maternity leave. I had no ties, no responsibilities, right? So I don't have a panel of clinic patients that need me when I was on leave. So I was able to really separate and be at home with my kids when they were young.

Similarly, when I went back, I was able to work out my shifts so that . . . for example, in the beginning, my kids were in daycare Monday, Wednesday, Fridays. My husband would take them on Tuesdays, and I would take them on Thursdays. And I always worked the Thursday overnight because they'd be sleeping during that time, so I could be with them all day and then have worked overnight. And then Friday, they would go to daycare and I could take a nap.

So I think that you can work it out in any way that works for you and your family. But I found those challenges, actually, to be really benefits in the end because you can work it out. You just have to find a way that works for you. And for me and my husband, he's awesome. He's super supportive and we worked it out.

I think being a woman in EM also, you know, certain specialties are classically mainly men, and EM's one of those, I found that a challenge too. I feel like as I came in as a resident, I wanted to learn from whoever was able to teach me. That could be a man. That could be a woman. That could be a specialist of some other specialty. I didn't feel at all that people looked at me like I was a woman. I felt like, "Oh, here's an EM resident. She wants to learn. She's engaged. She's coming early. She's staying late. She's really wanting to do her best and be the best for the patients."

So, wherever you are, think about you as the best version of you, the positive you, the you that's learning the most that you can. There's no reason that you can't do it because you're a woman unless you feel that you can't, because you can. You can do any specialty. So yeah, for me, it was really very positive. And whatever you're doing, just dive in and be whatever that is, and take it all on.

Leen: I love that. That's awesome. Thank you.

Dr. Fix: Yeah.

Bushra: It's amazing what a shift in mindset, where it can get you. And so I really appreciate that.

Dr. Fix: Yeah. Go for it, girls.

Leen: We're going to do it.

Dr. Fix: You are going to do it.

Bushra: So we've had a wonderful conversation with Dr. Fix. I have a burning question that I want to ask you and that is, what's the craziest thing you've seen in the ER?

Dr. Fix: There's a lot of crazy things. And actually, emergency medicine is a great field to be involved at when you go to a cocktail party because you have crazy stories every day literally. So it's hard for me to think of the craziest. But I'll tell you one that happened a couple of weeks ago, interestingly, when I had one of my CMC students shadowing with me. So we had a prisoner come in, and he had ingested a foreign body, which can be bad, you know. If you perforate your esophagus or you perforate your stomach, it can be quite life-threatening.

So he came in and he said that he had ingested a bag of drugs. He ingested a bag of drugs. And sometimes if the baggy bursts, then you can get serious systemic effects. So we're like, "Okay, we're going to do an X-ray. We're going to see if we can see this baggy anywhere." And we did the X-ray, didn't see the baggy, as you would expect that you would see the baggy. But we saw a different foreign body, actually, in his rectum. And it was metallic. And the game, oftentimes, is try to guess what the foreign body is. But he didn't tell us about this foreign body. So we went back in and showed him the X-ray. And I was like, "Well, you know, we didn't see the baggy. We didn't expect to. But we saw this." And he was laughing and he's like, "Well, that's why I didn't want to get the X-ray." It turns out that it was a motor for a tattoo gun that is contraband in prison. So he put it in his rectum on the way in.

Bushra: Yikes. I've heard there's a lot of stuff being put up the behind. I watch a lot of "Boston Med" and all those . . . what are they called, like, reality hospital shows? And that's what it kind of reminded me of is some of the crazy, you know, foreign body in the rectum. What is it?

Dr. Fix: So people often ask, "Oh, is it really like 'ER' or, you know, 'Grey's Anatomy' when there's always something crazy happening?" No, but those things you do see over your career. So most days, you're going to intubate somebody. You're going to have somebody with a critical illness, and then you're going to have a lot of people with what we call level three or level two illnesses, which are definitely in need of care, but they're not as life-threatening that it may see on TV.

But every shift, and this is another one of my own personal things, every shift, when I'm leaving or driving home, I always think about, like, something that I really learned that day. Because it may be just a little lady who made you smile, that's a wonderful thing and that happens every day, or it may just be the cool X-ray that you saw, but you see such a breadth of things that you're never going to be surprised because you're always learning. So crazy, yes, every day. Varying of crazy, not a rectal foreign body every day, but something that you can take home and say, "Wow, that was a great case."

Bushra: I think that's what made me interested in emergency medicine, is the variety. You don't know what's going to walk into the door, and it could be something from, like, a skin infection to something a little bit more involved, I'll say. But I am the type of person that likes to know about a lot of things. I always tell Leen and Margaux, and Harjit that I'm the type of person that knows a little bit about a lot of things.

Leen: I agree with you, Bushra. The spontaneity of the things that come into the ED really kind of spark my interest as well as the thing that really dragged me to ED was coming from a country that's, you know, under occupation and I've seen, like, how healthcare can be cut off and we have to constantly watch our backs in case, like, you can't even get bit by a scorpion or whatever. So that kind of thing strikes fear in communities. And I just kind of feel like having an ED open really brings some sense of peace of mind to a community. And so that's one thing that's really attractive for me in that field.

Bushra: In 2020, we're going to be doctors. Leen Samha, MD. Can you see it?

Leen: No, not yet.

Chloe: I love it. I love that she's so positive.

Leen: I'm inspired. I just have a lot going on right now.

Bushra: I'm just like, "Sure, I could do anything."

Chloe: She's so optimistic.

Leen: Thank you so much, Dr. Fix, for joining us today on our podcast. We absolutely enjoyed having you. We hope our listeners will be able to get a little more insight into what ED is like in lifestyle and all about mentoring and trying to find your right mentor in the field as well. So thank you so much.

Dr. Fix: Well, thank you so much, Leen and Bushra. I'm really proud of you, ladies, for speaking your mind and on the podcast. You're really making a difference in med school and beyond. So all the best to you and all the other women at the University of Utah.

Leen: Sweet. Go Bundle.

Dr. Fix: Yay. I love this. Well, that was fun. I hope I did okay.

Chloe: You did great.

Leen: It was awesome.