S3E3: Being an Activist in Health Care

Margaux: And your brother.

Leen: I was like, she's only a year older. There's no way she could be dead. I was like this is insane. So I freaked out.

Chloe: Who's dead?

Leen: My cat.

Chloe: Cat's dead?

Margaux: No. You should look at Leen's video on Instagram of the cat. You'd think it's dead until the end.

Leen: It's hilarious.

Chloe: Okay. To be determined.

Leen: To be.

Chloe: To continue.

Leen: Yeah. It's like, it's been determined. The cat's not dead.

Margaux: It's not dead.

Chloe: Cats are awesome.

Leen: Cats can be cool.

Margaux: Speaking of, hey, cool cats that listen to us.

Leen: Hey, cool cats. Make sure to subscribe to our podcast.

Margaux: Okay. Hey everyone. Welcome back to Bundle Of Hers, Margaux and Leen in the studio.

Leen: Hi.

Margaux: So today we wanted to talk about activism in medical school and as we've gone through third year, actually, I'm just going to say this, each year that you progress through medical school, you have less and less time to do things that you want to do outside of . . .

Leen: And energy.

Margaux: And energy agreed to do things outside of school that are important to you. That may have been very important to you before you started school or that you want to be a defining part of your career after medical school. And I recently had a patient die on pediatric service, which was really sad for me. And it was also the time when I was listening to the news about all the children on the border, and this kind of really brought a lot of dissonance for me. I felt like we have taken an oath to do no harm and in the hospital, we're here taking care of these children and then I hear about how dire the situation is in terms of health for the kids on the border.

And I don't think it matters what your political stance is, whether those people, you know, whatever that is. At the end of the day, those are human children and their health is not being considered right now and they're endangered. And I feel like as aspiring pediatrician and psych child and adolescent psychiatrist, that really rocks me to my core and I feel so helpless just listening to the news. And then here I am working 13-hour days, I get home and I barely have enough time to take care of myself. And so, it's just seems to be like an added stress. I don't know, Leen, how have you felt in terms of like listening to the news about things that you're passionate about but also managing school?

Leen: My initial passion for even wanting to go into medicine was seeing how, you know, doctors were working on the ground level in Palestine during the uprisings, when there's, you know, innocent people dying from like airstrikes, demonstrations, anything like that. And so that was my initial passion going into med school. I really focused on that before I came to med school. In my premed years, I would volunteer like with the Red Cross Society and things like that.

When I got to med school though, it almost kind of felt to me that there's now this fear of instigating emotions from other people in terms of politics. I don't care about the politics at all, but people will always associate your, whatever your form of volunteer activism with that politics. And to me, I see it more humanitarian than politics. And so, for me it's like now I'm in an environment where everything, I don't want to lose anything. Like this is now I'm in my passion, I'm in my dreams and I'm working towards that. I don't want to lose it.

And of course, now there's less and less time, and I started feeling myself dissociate from those passions. At first, you know, first year I was like, it's fine, we can dissociate from the passions, let's just focus on school. And second year came around, same thing. Although there was one point in second year where I felt, you know, why am I doing this?

Then I found out there was a protest in downtown for when kind of with the political situation, you know, with Trump in the Middle East and then how the people were getting caught in the middle of it. There was a protest for that. So I went to that to kind of refresh my passions a bit and that was it. After that, you know, third year I let it go by. I see all this damage going on. I see this in humanitarian situations, but I can't do anything, let alone speak about it.

But then coming to fourth year when we had to start writing our personal statement. It was really hard for me to find. I had to go back and really dig for that passion. I feel like I buried it under so much schooling and fear that it's like, who am I anymore? Like I don't know activism, I don't know passions, I don't know humanitarian, it's kind of weird how that happens to you.

I wanted to work on doing an away rotation in the Middle East and one thing they were saying is that we're worried on sending people to red air. Like they call it red zones I guess or depending on the state department's classification of how safe that area is. And I turned to the director and I said, yeah, but medicine doesn't have any limits. They're all humans. There's people there suffering as well.

Margaux: They'll always need medical care.

Leen: Exactly. So I mean, we're lucky to be in a safe environment. We're lucky to be not on the border in cages and things like that, but that doesn't mean we should displace ourselves from those situations. I'm actually really frustrated about the children on the border. It's like, why are we not moving people? It's like these are kids. You say damage can be done, I think damage is done. You put kids in cages. I've seen it firsthand in the Middle East with child prisoners and they become agitated. They become very frustrated. They're very much, it's a stress response that they don't know how to deal with. I can't imagine what these kids are going to go through.

Margaux: Yeah, and now that I'm on my psychiatry sub-I and hearing how many adverse childhood experiences have negatively impacted the lives of so many patients that I am caring for right now really makes me feel these children who are having an undoubtedly very traumatic experience that will impact them for the rest of their lives.

So it's their physical and their mental health that is being impacted and that sort of really aches at my core. I'm glad to hear that you say that you also dissociated kind of from the news during third year because that's kind of was also my defense mechanism was to just turn off the news, ignore it and kind of, you know, one foot in front of the other, get through third year.

But in the back of my mind, I always wondered like, is this my privilege that I have to be able to turn it off that I can turn off the news and like turn a blind eye to it and go on with my life because it's not directly impacting me right here right now. And I wonder how, if you know, Palestine being more innately tied to your identity and culture, how is it to turn it off and to dissociate? How was that process for you?

Leen: I mean I definitely lost a big part of myself in the sense I always used to tell myself when I was a kid, it's like, "Okay, well if it wasn't for war and occupation and Palestine, I'd be a video game designer," something like that. But even as I tried to go to through those avenues, it's like I feel very strongly tied to these people's plight in life. It's not their choice to be under occupation. It's not their choice to be, you know, they're not even under the lens of the world leaders in a sense for their human rights and they're just peaceful living.

To dissociate from that was like, well, why am I here? Why was I in med school in the first place? I didn't come to just go get a five to nine job and just see patients, write notes and go home. That is not what I'm here for. And that became really hard for me in second year when, especially towards the board exams and then third year towards the board exams. And I said, well, what's the point? What's the point of me doing this? And then now writing my personal statement, I really had to find that fire in me and relight it up.

And I'm still working on that. I think as I started to try to go back into the community and trying to meet people who have the same passions as me, it's helped a lot in the sense of trying to get my words back out. It goes back to do I have that privilege as turning off my thoughts and my worries about those kids as well in the borders, you know, because at the same time it's like, it's not affecting me, but is it?

And I don't know. I feel like it's such a hard place to be. I think especially for, I don't know, for me at least, like it's like this is why I'm in medicine. I'm not in medicine to like be in safe. I mean, we're always trying to be safe, but I'm not trying to be in safe areas. Like that's not the purpose of why I want to go into medicine. I'm trying to reach people who have no stability and I feel like doctors bring a piece of that stability. We can bring a peace of mind to a community that has none.

And so, when I see that, when I see that, you know, families being torn apart, when I see people just worried about everyday life now in the U.S. around me, land of opportunities, dreams and things like that and this is what's happening, I don't know, it's shocking to me.

It's absolutely shocking, especially because we're raised with the notion of when we learn history and all the horrible things that happened in history, we say, oh, but you know, we're a land of peace and that will never happen again, right? And so, it's like we need to check ourselves. We need to make sure that we understand humans are humans in the end. And I think one privilege that I am kind of proud of is that we're in medicine and we understand that humanitarian side.

Margaux: I really agree with that, Leen. I think that's kind of one thing that drives me in all this dissonance and feeling helpless right now is that like I'm working towards having an MD so that I can have the power to go and do something about it. Something that I want to do and feel like I can do and offer help. Right now, I can't do that because, you know, I'm a medical student, but I'd have to keep reminding myself that the way I will help in the future is, you know, like through having an MD. I feel like we talk about third year, like it's this isolated event where we're so stressed and we have no time.

Leen: Super isolated.

Margaux: And now we're kind of coming, you know, the shade has lifted, so to speak, and we're feeling like, "Oh we're writing our personal statement and having time to sort of reconnect after we've been disconnected." But the reality is residency is more demanding time wise and emotionally wise. So how do you think that you're going to go forward in residency and carry on this passion because it's going to be another four or five years before we can actually go out and fully have autonomy over our schedules and what we want to do, right?

Leen: I think though, once you have that degree of like for me, having that MD is very important to me because now I know that there's nothing that can take that away from me. That knowledge of being a doctor, nobody will ever take that away from me. And so being a resident, I'm now actually going to be working one on one and actually being in charge of patient care. I think that that will help me be able to implement my passions with those patients versus you know, when you're a med student and you're constantly thinking about the next shelf, thinking about tests and all these, you know, it distracts us.

But then, you know, those moments when you're on the wards and you have that one patient that you connect with and you know, you're able to kind of, I don't want to say translate, but become that bridge between the patient and the team, I feel like that's something we'll be able to do every single day from MD on.

Margaux: So at the end of the medical school?

Leen: Yeah, exactly.

Margaux: I think that's true, Leen. Like you said, the knowledge can never be taken away from us whether we have that official title and obviously you have to practice within ethical limits, but it's something very powerful moving forward.

Leen: Having that knowledge, it stems back to my background as a Palestinian. When we were kicked out of our country, those who had educational backgrounds were able to support themselves as refugees in other countries. Those who didn't lived in refugee camps and they still live, you know, some of them still live in refugee camps. And so education for us became a form of activism in Palestine.

During the occupation when my parents were there, occupation still going on, but during the '80s and the '90s when they were in college, they would shut down the schools because they realized that that was a form of activism for Palestinians. And so, my parents would sneak from alleyway to alleyway to professors' offices or houses to get their degrees. So for me, I think once I get that MD, like I have to remind myself, being in med school is my form of activism. My step of getting towards what I want to do to change the world in my way. Well, that sounds weird, but you get my point.

Margaux: Yeah, no, totally. Leen, I love that you say that. That education is activism. And I think that, while I can't physically go and do anything that I want to right now in terms of activism due to time constraints and cost constraints, education is something whether through getting my MD right now and becoming a doctor or educating myself more about the issues online in the spare time that I have. I think Instagram is a great way to sort of stay connected a little bit within healthy limits. There's always boundaries, for me anyways, on social media.

Leen: The cat videos.

Margaux: When you're talking about politically sensitive issues and being tied to a academic institution, how do you navigate that? Do you feel like you have to always say like, I'm not affiliated with, or like, "These thoughts are my own and not affiliated," even though like you're inherently connected to the institution and like, do you ever feel . . . sorry, that's like a thousand questions all at once.

Leen: No, no. I get what you're saying though. Like I think so for me when I do my research or when I go to the Middle East and I, you know, work in those clinics, I understand how like the university can be worried and things like that, but I think at its basis we're all on the same page when it comes to humanitarian issues and humanitarianism. Humanitarianism? What am I trying to say? We're all on the same page when it comes to humanitarian . . .

Margaux: Issues.

Leen: Issues. Okay. At its basis with the university and myself, we have a common goal and we have a common belief in being humanitarian. And no one can ever tell you that you're wrong for that. As much as they want to throw politics at you, as much as they want to throw whatever beliefs they have, when it comes to being a doctor, the biggest moral we have is being humanitarian and nobody can disagree with that.

Margaux: I agree, Leen. And I think that supporting people who are able to do that right now like the doctors and many different healthcare workers who are putting themselves out there right now and doing the job that we wish we could physically be doing right now. For me, the step that I've taken to sort of quell this anxiety, so to speak, that I have about my inability to actually go and do what I want to do. So I think that's one way to manage it but I think . . .

Leen: It's hard. It really is. I mean, going into med school, they like in your premed application, they love to see all this like volunteer work and all these experiences and then you get to med school and it's like they're trying to squeeze you down into like this shape to say, "Nope, this is the way you're going to be." Those of us who were able to kind of burst out of that shape are, I feel like, we're truly going to be the ones who change things in the future. But it's hard because it's emotionally draining. It's physically draining. And that over four years really takes a toll on you.

Everybody's so focused on their scores but let me tell you, your 260 doesn't matter to the kid who's in prison. Their 260 doesn't matter to the family who has an air bomb dropping on them any minute now. Your 260 doesn't matter to the people who are starving. You guys keep focusing on this numbers, numbers, numbers, it's all we care about grades and numbers but what are you here for? This is not why I'm here.

I understood med school's going to be hard with studying and you know, you have to get all this information but I never thought that people would put value on my education on being an MD. As I said, it's my form of activism. They would put a value of that with a number. I never thought that would happen.

And then here I'm in med school and they say, "Oh no, your MD is this much. Your MD is this number." And for me that was just, that tore me apart. And I think that's when I first started dissociating to be honest. But I think now coming to fourth year we have time to recognize these things and now we're closer to the goal, so I think we actually can see that light at the end of the tunnel. We can say, no, like that was just a phase. In a sense that there was a hard time we had to get through and we understand now how the world thinks. If we disagree with that, we're going to be better than that.

Margaux: I agree, Leen. Fourth years kind of like that sort of re-evaluation point where we're writing our personal statements and we're really coming back to what our core is, what our passion is that drove us to come into medicine and is going to continue to propel us forward.

And I really like thinking of it as a jumping stone into the future and sort of getting revamped and re-excited about yeah, these are my passions and okay, yeah, I didn't have time in third year but I won't have time in residency, but now I know how I can start to do a little bit more or be more aware of these passions going forward. And like you said, you'll have a little bit more responsibility to sort of take charge and sort of chip away at the system.

Leen: You'll be able to form your own miniature activism while you're there to sustain your soul until you're attending.

Margaux: And I agree that you were bringing up how there's all these numbers that we seem to get defined by. And coming back to your core is always going to be super important and recognizing that sometimes you have to play by the rules to break the rules. And when we're residents we'll have a little bit more responsibility, a little bit more ability to change the system, to flex the rules, to, you know, spend that extra time with the patient because you want to and not have someone breathing down your back.

Leen: Yeah. And I think you'll be able to express your motivations and passions a lot easier hopefully.

Margaux: And I think each process it will become more and more and then keeping that site once you get to the top and making that pathway accessible for other people and recognizing the faults in the system and changing them. I feel like a lot of med students get stuck in a concrete sort of tunnel thinking that the system is the way it is. And I've always been one to question and challenge it.

And I think I'm inspired by all three of you too in that we are questioning and challenging and sort of pushing the limits, and I'm excited to see where we're all going to go and how we're going to do that moving forward into residency. So is there, do you have any other thoughts or words of wisdom to rising medical students or third years about staying active or passionate or is it okay to dissociate?

Leen: It is okay to dissociate. It really is. I think with this stressful environment you're in, it's going to happen. But I think what makes your passions more solid is that you're able to track your way back to those passions. How narrow that path is, as long as you're able to have that path back to your passions, that's what's important. That's key. I really think that's key to making it to be honest and wanting to continue to bring change.

As long as you recognize you're dissociating, you know, as long as you recognize, okay, right now I'm very angry about what's happening with these kids and very angry what's happening with the rhetoric that's being thrown around to American people and things like that. Recognize that and then say, I can't change it right now. Or if he can't change it with your hands, change it with words. If you can't do that, keep it in your heart. And so that way you can go back to it and say, okay, this happened and now I remember this and I don't want it to happen again and you're able to feel that passion later on.

Margaux: Very nice way to end the session.

Leen: Okay, cool. On the topic of activism and having that dissociation during first year of med school and throughout, it was actually, you know, doing this podcast was kind of a way for us to keep in tune and you know, tied with our passions and being able to create this platform where we can speak to the unique backgrounds in medicine that are often under heard as well as bring in people who can connect with those identities. And then in a bigger picture, be able to connect with everybody else to say, "Hey look, this is a part of medicine that we feel is being unheard. This is a resource for you to go to or someone for you to talk to and reach out to."

Margaux: And create a community around that.

Leen: Exactly. A few months ago, it was a first year who was very passionate about Palestine, identifies as Palestinian American and she's now a first-year student here at The U. And she was listening to our podcast and she immediately reached out to me and she said, "You're talking about Palestine on a podcast and you're a woman and you're a fourth-year med student at the same school I'm at. I can't believe this is happening. I never thought I would meet someone like this." And I was like, "Oh my gosh, I can't believe I would meet someone like this either." Like I didn't think this podcast would connect me to someone like this, even though I feel like now looking back at it, of course, it would.

Now I've become very close friends with her. And we're always talking about kind of our struggles going through med school from both our cultural background as well as being Palestinian American in medicine and how that we're here for our passions because of what we've seen in our lives and things like that and how the world tries to stop us at every forefront saying, "You're wrong, your passions don't matter, your experiences aren't real." And here we are saying, "No, it does." So shout out to Lena. We appreciate your input. We appreciate you reaching out to us and welcome to medical school.

Margaux: I think it's a beautiful thing too, Leen, what you just described of creating a community in sort of a boiling stone to have these conversations in real life after people have listened to the podcast. I posted about the patient that died and my experience with that a couple days ago and I actually got a lot of support, which was really helpful for me in processing it as well.

But one of the great things that happened is a third-year medical student approached me and asked me how they could better prepare for that situation and they felt it was really helpful to know that that was an experience that was on the horizon and that it is difficult and to know that you can be vulnerable.

And so, I think that was a really great interaction as well that stemmed from the podcast. So we just want to remind you guys that we're here for you. We're very interested to hear your stories, how you're connected to us. If you want to continue, we always say continue the conversation and we're very authentic and honest about that. We want to continue these conversations.

Leen: We need to continue these conversations.

Margaux: Exactly. We need to. And that's why we started this podcast to continue these conversations and it doesn't even have to be with us. You can reach out to your friends and say, "Hey, did you hear that topic on this episode?" And continue it. That's the whole goal. And so we hope you reach out to us, reach out to your friends and continue the conversation on Instagram at Bundle Of Hers on Facebook or on Twitter. Thanks for listening.

Leen: Thanks, y'all.

Chloe: Round of applause. I don't even know how you do round of applause.

Leen: Psychos.