S3E1: Choosing Your Speciality: Expectations vs Reality

Margaux: I can start unless you have a strong feeling.

Chloe: Start it. Bushra can fake it.

Bushra: I'm a fake person. It's okay, Chloe. I got you.

Margaux: You're fake news, Bushra.

Harjit: Fake news.

Margaux: Shots fired, guys.

Chloe: Mark it.

Bushra: Mark. Mark.

Chloe: No space. Just mark it.

Bushra: Mark.

Margaux: Hey, everyone. Welcome to season 3 of "Bundle of Hers." We're super excited to be back in the studio for a whole new fresh season. And in terms of all of our lives, so Leen, Harjit, Bushra, and I are all in the studio and we just finished our first sub-I. So that means sub . . .

Bushra: Internship.

Margaux: Sub-internship. What is the sub? Just the sub literally? Okay.

Harjit: It's internship.

Bushra: Literally, the step before internship.

Margaux: Exactly. Sometimes it's called acting internship. We've all finished that, which means that we had to make a big decision about which specialty we wanted to apply to for residency. And that was a big decision.

I think a lot of people apply to medical school thinking they know what they want to do and that inevitably changes for most people during medical school, especially during third year. When it comes the time to set it down on paper, a lot of the expectations that I had at least kind of changed a lot. And I decided to go into triple board, which is pediatrics, adult psychiatry, and child and adolescent psychiatry. It's a joint program. And so I just finished my pediatric sub-I.

Harjit: Nerd.

Margaux: I know. Overachiever. And I think I had a lot of expectations about how the sub-I would be and should be that were not met. I think the theme of the talk today is about expectations and in choosing and navigating picking a specialty.

Some moment in third year, there will be a moment of clarity for most people. That doesn't happen for everybody.

Bushra: That's a damn lie.

Margaux: Case in point, Bushra. For me, that point of clarity came during my psych rotation. So that's when I started thinking about psychiatry and child and adolescent psychiatry. And then during my surgery rotation, that was kind of crystallized when I realized I really did not want to be a surgeon and didn't like surgery.

So I think even though I had the expectation of wanting to do ortho first and second year and going into third year thinking that, my expectations were kind of jumbled as I went through each clerkship and really found what I liked and did not like.

But, Bushra, if you'd like to speak to you how that moment of clarity didn't happen to you, I think people would be interested.

Bushra: I wish I had that moment of clarity. I think, for me, even starting med school, I had an idea of what I wanted to do and it was more primary care oriented. And then I do my family medicine clerkship and I hated it. It was just not for me and I couldn't understand why, because this is what I thought I was going to do. I thought I was more of a clinic person, and then I realized with every rotation that came, that one clinic week, which most people look forward to because the schedule is more relaxed, I couldn't . . . I hated it.

So for me I started to explore other things. I also had anesthesia in the back of my head too because I had kind of an extensive background in that and I really did like my anesthesia elective that I took. I liked it because it was very physiology heavy, very process-based, very pharm-based, and I tend to thrive in those.

Then the other thing I was thinking about was emergency medicine. We don't do a clerkship in emergency medicine, so I had no way of getting my foot in the door other than through shadowing, which I had done a couple of times, but it wasn't at any kind of extended period of time. Cut to I'm going to do an emergency medicine sub-I and then kind of make my decision fully after that sub-I.

What I realized for me is I genuinely do like anesthesia and emergency medicine, but I think for me, what I would have missed if I had done anesthesia is being a diagnostician and the face-to-face time with patients. And also I really enjoyed kind of the variety of patients that we see every day in the ER with differing kind of severities too. There's a lot of learning to be had there.

And so that's how I made my decision with emergency medicine. There wasn't a moment of clarity where I thought, "Oh, the emergency medicine gods just smiled down on me and that's what I was going to do." So it was more just a pro and con type situation.

Harjit: And, Leen, you also decided to do emergency medicine, but I feel like you kind of had thoughts about it much prior to even starting third year.

Leen: Yeah, I think it was towards the end of second year. It's always when you get towards one of those board exams you just start doubting yourself a lot. And so, I was thinking, you know, "It's okay. I wanted to do primary care. I'll do something . . ." I even loved pathology. I loved physiology and things like that, but something inside me just didn't settle very well, so I had to go to what that unsettling feeling was.

And to me, it was thinking back to when I was . . . I don't know. I want to say a toddler and I wanted to be a doctor. What did toddler Leen see a physician as? And to me, it was the doctor who was running around from patient to patient trying to get information from the patient and making sure everybody who needs to live is living, making sure everybody . . . you know, it was kind of a very dramatic picture. And I didn't find that . . . I guess I found little pieces of that in all my rotations, but nothing truly brought it together like emergency medicine did.

When I finally just convinced myself, I was like, "Okay, I'm just going to do emergency medicine," though I doubted myself strongly in the beginning. I'm like, "I could never do emergency medicine. I'm not cut out for it." But the more I thought of me doing emergency medicine, the more this butterfly feeling start to grow in my chest, right? It's like, "Oh my gosh, I'm going to do this." This is what little Leen imagined herself being a doctor, like a badass woman. Am I allowed to say badass? A badass woman running around doing all these things from patient to patient, from highs to lows, and things like that.

And so, as I went through the clerkships, you know, I started out with neurology and it's like, "Okay." I hated sitting in clinic in neurology, but I loved the brain attacks, right? And then I went to internal medicine and I hated sitting around, but I loved talking to the patients and giving them diagnoses, telling them what we're doing next for them. Same with surgery. I wasn't a fan of doing colies all day long, taking out people's gallbladders.

But when it came to traumas, I was like, "Oh my gosh, I'm in the bay before everybody else." And so I think that's when I was like, "Okay, I've just got to accept the fact that I think I like emergency and I'm going to run with it."

Harjit: I like how you say, "I just have to accept the fact that I liked emergency." One thing that I've realized over this past month and a half is that our fields really choose us. And what I mean by that is I think we're really deeply connected to what we gravitate towards because of either the way we grow up or what our identities are.

So I'm actually going into psychiatry, which I'm so, so excited about. I did my psychiatry rotation first and we got to pick our schedules. Not everyone got what they wanted, but I got everything I wanted, so I was excited.

I didn't have a single clue what I was going to do. I didn't know what kind of doctor I was going to be. I was just like, "I'm going to be a doctor." I put psychiatry first because I was like, "I'm not doing that." I just felt like I didn't understand that field and I was like, "Oh, I don't think it's something I'll be interested in."

And I remember I was happy there every single day. There was not a day where I didn't feel fulfilled. And then I went through every other rotation and I enjoyed a lot of the other rotations, but something just felt like I would be reminded of the time I had in psychiatry.

So then I did elective in child psych and I think that really solidified it for me, because a lot of psychiatrists have said, "Oh, you can like adult psychiatry and not like child and adolescent psychiatry, and that doesn't mean you don't like psychiatry." But I was like, "If I like both of these, then it must mean I really like psychiatry."

So I did child psych and, again, I had that same feeling. Every day, I was happy. Every day, I was there and it meant something that was important to me. So when we think, "What was my expectations of psychiatry?" it was completely opposite of what I felt when I was actually doing that elective.

I think this summer I've been thinking a lot and I think I've always been meant to do this type of work because of the person I am and the way I grew up and the identities I carry. I love stories, and I feel like in psychiatry you really get to see a story not as a sole thing, but playing into bigger systems and bigger pictures.

And I think that's one thing we all do on this podcast a lot. So it's really cool to hear y'all coming to this sense that, "Oh, this is something that I could do." And I also think Bushra's story is also really cool because she didn't know for sure. She liked more than one thing, but she was like, "Oh, this is maybe something that I really see myself doing."

Margaux: Harjit, I like what you said about when you did psychiatry, you didn't really know what the field was. I think a lot of med students and a lot of people have misconceptions or carry the stereotypes of each specialty. And my advice to up-and-rising medical students and third-years would be to try to approach each clerkship knowing what your bias is and your stereotypes of that specialty are and knowing that you may not actually know what it's about until you're in it.

And so I think that was the same experience for me too, is having this romanticized idea of what surgery was from "Grey's Anatomy" and from working as a medical student where I didn't have duties and I wasn't working awful hours. And then I got into the surgery rotation and it was completely opposite of my stereotype and expectation for it, and I think that was a little bit jolting. Whereas if I had to come in with a blank slate, so to speak, and sort of experienced it as is, it might've been a different experience.

I don't think I still would have chosen it because, like you said, we are innately attracted to the specialty that is within us, within our passions. And so, I think ultimately that's why I didn't do surgery. But I think having those expectations . . .

And so I have a question for you, Leen. You had this image of what you thought a doctor was from when you were younger, and I'm curious how did that change or compare to your actual experience on your sub-I?

Leen: That's a good question.

Margaux: Sorry.

Leen: No, this is a good prep for interviews.

Harjit: Yeah, that is actually a really good question.

Leen: That's a really good question. I think in terms of how it compared to my sub-I, I would say I found myself at times in my sub-I pausing and just internally freaking out in a good way, saying, "Oh my gosh, I'm actually doing what I want to do. This is me imagining a physician when I was a kid. I never thought I'd see myself doing this." I'm in med school, but for some reason that image does not solidify until you truly find your passion in medicine.

One thing for third-years or second-years going into rotations is remember the times that you are happy not because your team was awesome and your residents worked great with you, but the time you were happy because of what you were doing. I would say, you know, remember those times where even if you are in the worst-case scenario, do you still love this?

Harjit: Yeah. Leen, I thought it was really powerful when you said, "I never saw myself doing that," and I kind of have a question on that. Why did you have that thought?

Leen: I think even going through premed, I never watched a single medical show because I thought,"I can't do that." I see them running around being all "Grey's Anatomy"-like. I never watched any of those shows because I thought, "I can't do that. I can't be as assertive. I can't be as strong as those doctors or residents that they're acting like." I'm studying the material, I'm learning it, I love it, but can I truly be a person or a leader in a time of chaos and where people need me? Can I really be that person?

Even going through third year, at the beginning of third year, I was like, "I don't understand how the medical system works at all. I don't know what rounding is. I don't know the whole hierarchy." It was really hard managing that.

But after I got past all that and I realized how we approach diagnostics in this field and things like that, by the time I hit my sub-I, I found myself doing the things that I thought I could never do just without even thinking about it.

And so it kind of woke me up just a little bit. I was like, "I'm actually here doing it," and that stemmed the butterflies in my stomach. I'm like, "I have to keep going."

Harjit: And I think that moment is so powerful and it's one that a lot of us forget. We can do this. The human mind and the human body can expand in ways that you never think could, but you can do this even though you've maybe not seen it growing up or you've not seen yourself being in that way.

And I think, Bushra, you're also a first-generation student. So I kind of wanted to know . . . you've maybe never seen this growing up, like a doctor or seen images of that being around you. So you being in this position, how is that reality?

Bushra: Being a first-generation student and now being a fourth-year medical student and I'm going to be a doctor in eight months, which is interesting to say. But for me, growing up I always knew I was going to be a doctor. I knew it internally and I would say it. I would just say it as a kid growing up because that's the only thing I could think of.

But I did have a brief period in time in college where it was like, "I don't know. A lot of people want to be doctors, but that doesn't necessarily mean they're going to do it. So who am I to think that I'm going to do it?" You know what I mean? And so, I had that kind of internal struggle because I didn't have anyone to look up to who's walked that path before me.

Leen: Someone you can relate to in that sense.

Bushra: Exactly. Every day, you're trying to figure out the next step and the next step and the next step, and it's hard because you're kind of on your own. You don't have resources. You have to do it on your own. I mean, eventually, I got here, but I had to put a lot of work into it.

And so, for me, now that I see myself here and I'm a fourth-year medical student and I just finished my sub-I, and it's so close, I can taste it, right? It's just so close that I can . . .

Leen: Mm, the taste of medicine.

Bushra: Exactly. I think, for me, I feel more proud of myself that I got here and I'm going through it. And not only that, but I'm doing well, too. I just can't help but feel pride in that.

The other thing is it makes me smile to think that there are a lot of people in my community that look up to me because I'm the first one to do it.

Leen: Isn't that's scary?

Bushra: It's a scary position to be in, but I'm glad I can fill that role that I didn't have when I was going through it. I never realized how important it was when now I feel like . . .

There are several people that I know that are going to be applying really soon because I did it, and I can give them the advice and this is what I did and this is the resources that I found that worked for me. It makes me happy to think that there are going to be more female Somali doctors, refugees who are applying to med school because now they see that they can do it. You know what I mean?

Leen: They see a representation of themselves in it, and that's powerful.

Bushra: Exactly. And that in and of itself is so powerful, the view that "Someone who has the same background as me, that looks like me, that has the same culture as me, same ideas as me . . ."

Leen: Experiences.

Bushra: ". . . is doing it, then that means I can too." And that thought right there, that's the ember that this is going to light the flame for generations to come. And I'm not saying, "Oh, I am the shit"

Harjit: But you are.

Leen: Don't tear it down, girl. You are the shit.

Bushra: I don't know how to say that more eloquently than that, but I'm just saying that, like Leen said, representation matters because of that. It influences people who never thought in their lives that they can possibly be in that same position.

Harjit: And I think that's such a beautiful thought. And I know it works and I know representation matters because I too am a first-generation student, but I have a sister who's older than me, and I think if my sister didn't go to med school, I wouldn't have the confidence to even apply. It was almost a thought that, "Oh, this is a thing, but I don't think we're ever going to get there."

And I know how powerful it is for me even to have a sister who's five years older than me and went through this path even five years before me. Seeing her go through her journey, it was very difficult for our entire family, but because she did it, I know I can do it. And just that mere fact has given me the confidence to get through every single day.

I know when I was an undergrad student, the difficulties and challenges I went through really took a toll on my mental health. It took a toll on my identity. It took a toll on the person I was. And just having my sister as an example that she did it, I think, is what really is carrying me through.

Margaux: So it sounds like it just takes one person to change the expectations, and I think that's such a positive note to carry forward, especially when you are faced with feeling like you're the only one struggling. I think that's a common theme for many medical students throughout medical school, especially third-year and on the sub-I.

And so, yes, we need to fight for that representation and set the expectations. But also, I want to encourage everybody that if you feel like you're alone or what you are looking for is not there, to create it and create that own expectation.

Leen had this expectation or this image of what a doctor looked like before she came to medical school. And in my mind, I had these set ideas of what it would be like to be a pediatrician or a child and adolescent psychiatrist and how I want the interactions with my patients to be.

And then I hit the floors on my sub-I and am totally struck with the opposite and feeling like there was not enough time to talk to the patients the way I wanted to, feeling completely overworked with all the notes and the floor work and answering pages and emails and working on my application, and this sort of ideal image of what I wanted for my career kind of shrank.

And there were times at which I even considered dropping out of medicine. I think that's a natural part of it too, and it's okay if you feel like that because you don't have what you're looking for in front of you represented in front of you.

But what kept me going is coming back to that image of what I wanted, even if I couldn't see it or wasn't experiencing it in real life. In that moment in my sub-I, I was like, "I'm going to be an attending, and even if these attendings don't do what I want to practice, I'm going to practice that way."

And I think all of you are such amazing representations for each of that, for everybody going forward, for chasing your own dreams, for setting our own ideals of what practice should be in a system that maybe isn't built for us.

Harjit: And I love, love, love that you say that, Margaux, because I think one thing all of us really are passionate about is being ourselves. And for us to be ourselves, that means we are going to be different than other attendings. There's only one Harjit Kaur, and that is the uniqueness and the diversity that this field deserves.

We are here to create healthier individuals, healthier communities, healthier societies, and that will lead to a healthier world. And you can't create that if everyone's the same because new ideas can never be born.

Margaux: Exactly.

Leen: And I think a thought that's really difficult to fight and I guess challenged me throughout my sub-I was that healthcare is a business in the United States and it is set up to be a business model, right?

Harjit: A hundred percent.

Leen: I think that's where it leads to the overwork of residents and the burnout and the depression and things like that that plague the healthcare professionals in the United States.

And I remember one time during my sub-I, I spent a little too long talking to a psych patient. And for that instance, when I went back to my resident and they were saying, "How long were you in there for?" and I was like, "Thirty minutes," and they were like, "No, you can't do that in ED. In emergency medicine, you've got 15 minutes per patient," my heart just sank. I was like, "Maybe this isn't what I want to do, because this isn't the change that I want to implement."

For a second there, I was like, "Oh, I can't do this. I cannot be an emergency doctor in this business model." But the thing that kept me going was, in the future, I'll be my own attending. "I'll be my own attending"? That sounds cool. I'll be an attending and I'll be able to set the rules on how I want to manage my workload in that sense, and I'll be able to give time that each person deserves when they come to seek care in my ED.

We've got to keep that thought going in the back of our mind even in the most harsh of times, even during residency and being med students and when you're rushed to write notes and get, you know, patients in and out. I think we have to remember that we're not in this for the business, right? Our passions are much greater than that.

Harjit: I think that's another reason why I'm so excited, Bushra, you and Leen are doing emergency medicine, because unfortunately a lot of individuals, because of the way the system is set up, first come to the emergency room. And them just seeing the two of you carrying basically your own goals forward, I think, is very powerful even for those patients.

And also, Margaux, I was going to say that I know that you came in doing surgery, but I actually have a story about this. So when you told me you wanted to be a surgeon, I was like, "Margaux wants to be a surgeon? It doesn't make sense to me." I cannot tell you how happy I was when you picked psych, because you are the type of person I feel like anyone would want to talk to.

That's what I mean when I say that our fields really choose us, because I really see each one of you being, again, a powerful example in your own field because of the way you are, and the way you talk to people, and the way you observe people, and the way that you carry yourself around patients. That's why I'm so excited for this year. I'm really looking forward to it.

What are you guys all excited about?

Margaux: Wait, can I respond?

Harjit: Oh, go on. Sorry.

Margaux: To that point, Harjit, I actually think that I had gotten that feedback from a lot of . . . not a lot of people, but close friends. In first and second year, you kind of play this game of "What do you think I'm going to go into?" or "What specialty do you think that person's going to go into?" And I've had a couple of people, I think you and my other close friends, actually say psych. And at that time, I kind of scoffed and I was like, "Yeah, right. I'm not interested." Like you said, I didn't really understand the field and I didn't . . .

Harjit: I wasn't interested either.

Margaux: The nuances of it, right? But I think that is also really important, that the people around you, the people who know you best, who have that outside perspective, they probably have a lot of good insight into your talents and your skills and what specialty may pick you and that you may pick.

And so even though you guys all gave me the respect of experiencing wanting to do surgery and you all supported me, which I loved . . . I think that having that support group is super important when you're trying to figure out what you want and figuring out sort of nuances of each specialty and what you really want to do and how you envision yourself.

And I think it's so important to formulate what you want in your career, whether or not that expectation is set in your experience in third year and fourth year and beyond. Because ultimately, we go through all this training and we have to play by the rules, but like you said, Leen, you're going to be your own attending, and you get to choose your life at the end.

Hold onto your values and your passions and what ultimately drove you to that and to be in medicine. Don't lose sight of that even when you have those ups and downs that are inevitable in third year and in fourth year.

Harjit: And first year and second year.

Margaux: And always.

Harjit: And always.

Leen: And just living.

Harjit: I know, living. I'm so excited that we're going to have another season of "Bundle of Hers" and also that we're going to be in our last year. What's something y'all are looking forward to?

Bushra: I'm looking forward to finally submitting a cohesive application that represents myself and my values and my beliefs, and finally going on the interview trail and figuring out where I'm going to go for the rest of the next three to four years.

Margaux: Honestly, the first thing that comes to mind that's awesome about fourth year that I'm looking forward to is two months off from anything.

Harjit: That's going to be nice.

Margaux: I'm going to read books and do all these things. I have all these expectations, but also, I'm looking forward to Match Day and to seeing where all of our . . .

Bushra: Oh, girl, I'm going to be a hot mess.

Margaux: To see where all of our classmates have landed and what specialties they've chosen. We kind of get separated from a lot of our classmates in third year, and it'll be cool to see what specialty chose them and what specialty they chose.

Leen: I'm just excited to hold the degree in my hand.

Bushra: Leen Samha, MD.

Margaux: Dr. Samha.

Bushra: It sounds good, huh?

Harjit: It sounds right.

Leen: It rolls off the tongue.

Bushra: Dr. Samha.

Margaux: Well, we hope you enjoyed the first episode of season 3. We really appreciate you listening. And if you're a new listener, go ahead and check out our other seasons. And if you'd like to continue the conversation or add anything or have any questions or comments, hit us up on Instagram @bundleofhers. Until then . . .

Bushra: Bye-bye.

Harjit: Was that good? After we're done, I'm like, "Was that good?" The whole time, I was like, "Chloe, I hope she like this." Is it editable?