S3E4: The Food Situation

Harjit: We have so many episodes on so many things.

Margaux: I know. So cool.

Harjit: We're just like popping, man.

Margaux: Hell yes.

Margaux: Whoop whoop. So Harjit, are you hungry?

Harjit: I'm like always hungry. If you know anything about me, I love food. I was about to explicitly say something, but I love food.

Margaux: That's how much you love food.

Harjit: That's how much I love food.

Margaux: So today I wanted to talk about food, and eating habits in medical school, or lack thereof.

Harjit: I think there's a lot of lack thereof.

Margaux: I think so too. It's something that I found interesting, how we are always taught to tell patients, you know, dietary modifications and lifestyle modifications to help with certain disease processes. And part of that is, you know, having a good, well-balanced diet, whatever that means, because we're also not taught that very thoroughly, right?

But what I've noticed since starting third year is that I have had horrendous eating habits. That's just my own perception of eating habits. I want I put this out there that like, this episode is not about food restriction or diets or healthy . . . Like this is about how I feel my own eating is and my perception of it. So you, Harjit, will also be able to put in your perspective of what this is. And it's not meant to shame anybody or say what is a good eating regimen or not. It's just that when I started third year, I was at Primary Children's and luckily there they feed you all the time. There's always free food in the residence lounge, which is amazing, but it tends to be foods like cookies and donuts and bagels and trail mix and then maybe some apples that are old, right?

Harjit: Yes, I know. And like you said Margaux, some people, it suits them, but yes, even for me, it's hard foods on my stomach.

Margaux: Yes, and I think like having those things occasionally is good. But when I started third year became so overwhelmed in the schedule of, you know, wake up so early, that I didn't have time to make breakfast, and then round forever, barely make it to lunch, you know. Sometimes they have free lunch and sometimes you round through lunch and then by the time you finish rounding, you're so hungry, that you just you know, go to the snacks and you eat because it's free and it's available. Or you go down to the cafeteria and eat the quickest things which tend to be like grilled cheese and pizza and french fries. And nobody has time to like actually put together a salad from the salad bar. And the salads in the boxes are always very sad and expensive.

Harjit: Yes, or even foods that are not salads, it's just really hard to make something good for you to eat with kind of this crazy schedule. I'm currently on my sub-internship in medicine and we also get lunch during our wards, which is like a super-exciting time of the day, because we're so hungry from walking throughout the hospital. We're like, "Yes, we're going to get some food." And in ways it makes my life easier because then I don't have to think about packing something. But then in ways it's also like I'm so used to eating out and away from the home that it kind of takes a toll on your body, you know.

Margaux: No, I definitely noticed that too. As my diet has shifted to be more carb centric, I started to feel really sick and kind of sluggish. Part of that is, you know, the stress of being in third year and working long hours and just the stress that we put on ourselves for grades and learning everything that we do. But on top of it, not having my diet that I used to eat and not being able to eat consistently, I found that to be a big barrier for my own personal health. I tend to get migraines pretty easily.

And as I progressed through third year and kind of spiraled into this, sort of, I would say, a hunter-gatherer type grazing, where, you know, I just eat whatever was there and available in the hospital, I got a lot more migraines. And I had a serious conversation with my own doctor about, you know, diet actually does play into this. Towards the end of third year, I had to be more mindful, or I wanted to be more mindful of the food that I ate, but it took a lot of momentum. So now I try to make oatmeal every morning and just have it in the fridge and ready to go. And then try to have, make a salad or some leftovers to bring for lunch. The problem then becomes there's very rarely space to store food as well for medical students during the day. So I don't know, Harjit, how have you kind of managed the food, the floor?

Harjit: The food situation?

Margaux: Yes.

Harjit: I have to kind of go back to how I grew up with food. So my mom, she, you know . . . We cooked a lot of Indian food at home and we still do. I think it was very important for her to preserve her traditions and cultures through food when she came to this country. And I also think that in my community, in my culture, food is like a vital being that makes a community. Like people come together for food, there's different meanings to food, there's different traditions surrounding food. So in that sense, I've always been eating at home, right.

And also financially, we weren't so well-off when we were younger so we didn't go out and eat a lot. And when we did go out, it wasn't the best food in the sense like, I think our favorite place was Taco Bell and we'd get it once a week. That's how much we used to eat out. Then cut to, I'm in college, right? I am a big girl now and I didn't pack food so I would just eat whatever was available. And I realized I didn't see it but like you said, Margaux, that the choices we make are very multifactorial, right? Like I'm stressed so I'm going to eat whatever is the fastest or whatever I have access to or like whatever is the easiest, right? Then coming into med school, it's completely different because our schedules are like whack. Can I just use the word whack?

Margaux: So whack.

Harjit: They're like so whack, they're all over the place, right? What I'm trying to say is it requires a lot of coordination and sometimes it's just so hard because I'm like thinking about, you know, waking up in the morning and rounding on all my patients or I'm thinking about other people's needs, I think that I put myself on the back seat. I think there's a lot of factors going into the type of foods I eat and if I'm happy with that or not.

Margaux: I really agree with that, Harjit. Food is has a lot of cultural significance for different people. One experience that I had that I kind of actually started to think a lot more about my own food choices and how we talk about food with patients is when I was on pediatric outpatient clinic, and I was working with a doctor who was Indian, and we had an Indian patient. And for the six-month well-child checkup, they usually talk about introducing finger foods to the baby, you know, and starting to introduce solid foods and transitioning from milk. And most of the time, you just tell parents, you know, anything, they can, you know, mash with their gums is fine.

But what I thought was so cool was interaction between this doctor and patient and her family was about the specific types of Indian food. And she specifically referred to dal and I can't remember what else, but I thought that was so cool because it was really empowering the family. I feel like if it had been a different provider who had just said, "Oh, just give, you know . . . start with Cheerios," that could be very culturally dividing, right? It can really separate how you feel about, not only your healthcare but how you associate your own culture with health.

Harjit: Right, because then when you start giving examples from your life experiences or your knowledge of foods, they might be like, "Oh, then is my food bad to eat?"

Margaux: And it comes back to cultural awareness as well in that situation of the doctor knowing what kinds of foods to recommend, and knowing the family very well, obviously but I think that was very important. Then from that point on I, kind of, started to think more about when we were telling patients with chronic kidney disease all of a sudden, now you can't eat X, Y, and Z. But when you talk to the patient, and their favorite thing is apples or plums, like now you're telling them like you can't eat this, are they going to comply?

No, until you have like an honest conversation of like, "Well, I know you like apples, or I know fruit is a very important part of your diet," and let's talk about how maybe you can incorporate this instead of it's very black and white, you know, yes or no, like don't eat this, don't eat this, which I think is what our mainstream society teaches us about food. It is, this food is good, all of a sudden, like 10 years later, this food is bad, right?

Harjit: Right.

Margaux: It's very black and white.

Harjit: You know, shifting this conversation from us to a broader perspective is one that I think I've been thinking about more because of all these barriers is for me to, you know, eat what I want to eat. It's also made me think a lot about access to food. I mean, we're privileged in the sense that we're getting an education and we live lives that allow us to, and this is specifically me that I'm talking about. There's other med students who maybe don't have the same access to foods the way I do.

But then looking at, you know, the world and our patients, a lot of people don't have the same access to food that is required for them to make the best choices for their body or eat what they want to eat, you know. And because of that, like I think we've kind of discussed, like fatphobia in a prior episode, but I think, you know, me being in this position has made me able to think about this a little bit more. Sometimes you're forced to think about things when you're in a certain position and you never thought about those things before. And it's just, I think, very important for us to be cognizant what access do we have, and Margaux, like you said, everybody's food choices are for their bodies. And we are not the ones to decide. Carb-heavy food might not suit me, but it might be okay for another person.

Margaux: I think that there's a lot of talk and stigma about certain foods in medicine, but without a lot of data to support it, but it still tends to be the trend. I think there are, on the other hand, there are things that we know to be good and beneficial. But to your point earlier about being now in this situation of having limited access, in a way, because of our time has also made me think about our patients who, instead of working 12-hour days because we're in school, they're working 12-hour days because they have to work two jobs, to live and to survive and to barely eat. And with their paycheck, they can only afford what they can afford. That food may not be the best choice for their body and for their needs but at the end of the day it's all they can afford. And when we as healthcare providers tell them, you need to change your diet, without having a detailed conversation about what that might look like . . .

Harjit: That's so unfair.

Margaux: For that patient, it's totally unfair. It's really hard because it's a systematic problem. It's not our problem that the food that is accessible is not always the best food. But opening up conversations about food and access to food can start to help break down those barriers and help us understand what barriers exist, help patients understand that we are not judging them for the situation that they're in and for what they can and cannot afford but just making it less stigmatized.

I think food is so stigmatized. Especially like you were saying, it's stress, we go to eat. When we're stressed and then we eat what is available, which always tends for me not to be the best thing or make me feel very good. But then we feel guilty about it and so it's a spiral.

Harjit: Right, and that guilt is very mentally hurtful, you know. I think a conversation that I want to make apparent during this talk is that I think there's a lot of people who think that if I start eating healthier, if I'm doing my part, you know, making the right food choices, I'm in general helping out because people are leading by example. But I think that you also made the point that this is a systematic problem. So it's very important for us to tackle these systematic things, because food is another industry that is linked just like health, just like education.

And I think we've been talking about this since day one on the podcast, that there are bigger connections than what we see, it's just, I think, that med school, you know, kind of has forced a lot of us to see like, "Oh, this is a problem." I mean, a lot of us maybe also have, the way we grew up, have already seen this but, you know, it's just very, eye-opening I think.

Margaux: I agree, and it's something that I didn't really expect to be a difficult part of med school. Eating, right? You think it's such a basic thing? A basic . . .

Harjit: It's like a need, right?

Margaux: A basic, yeah, a basic part of your life that you don't really put much thought into until your schedule is drastically changed. And then I at least started to really notice and I noticed the impact that it made on me and it made me . . .

Harjit: And in your life, right?

Margaux: Yes, in my life and in my health. And it made me then think about, well, how is this affecting my patients or will it affects my patients?

Harjit: Yes, and it does, every single one of them. Even the ones that "eat healthy."

Margaux: Whatever that means.

Harjit: Yes, exactly, whatever that means. And I think that's the thing, we're complicating that conversation, right? Because there are no set rules. And like we said, that it's all about context. I think that's where I urge everyone to think a little bit more.

Margaux: Hopefully, we can start to have more conversations that will change the system as a whole because that's the whole point of our podcast, right? Is starting these conversations as little jumping stones into hopefully a bigger change. And the more you talk about something that's a problem the more you can start to act on it, and the more you'll be able to deconstruct it.

Harjit: Yes, I totally agree with that.

Margaux: So now that we've talked about sort of this very negative part of medical school, let's talk about things that we . . . coping strategies. I'm in psyche right now. So we're all about the coping strategies. Harjit, how have you coped in third-year and now in fourth-year with eating habits and eating and food in medical school?

Harjit: I think the number one thing that I've done, and this is just not med school, there was a part of my life where I didn't have a good relationship with food. I try, I'm trying, sorry, because it's still not happening, but I try to make good choices for my body. I know what doesn't suit me. What I mean by that is there are certain type of foods that make my stomach upset, or there are certain type of cheaper alternatives that are actually okay with my body. Making good choices and not making choices out of, "Oh, my God, I'm feeling so tired, let me just eat this," but rather than, "Oh, I can get this cheaper option but it's okay for my body." I know, that's an extra step to think about but in the end, it always makes me feel better that, "Oh, I made a choice that was good for me and what I like to eat."

Margaux: And I would second that too Harjit and I think that that perception should always be in flux. So for example, right now, I'm feeling very stressed about our applications being due in two weeks and I've noticed that I've had like an increased cravings for carbs, which tends not to be the best with my stomach. But sometimes at the end of the day, I allow myself that space to eat whatever is there, because I know that, you know, the stress is only temporary. And rather than fighting these urges, and this guilt, just eat it, it's okay, it's not going to kill me. And then, you know, in two weeks, when my stressors change my preferences will change. And I think it's important to recognize the ebb and flow of stress and different responsibilities throughout all different rotations in your third and fourth-year. So I think that's one thing I would recommend, is just trying to be okay with listening to your body's cravings.

Harjit: Yes. By the way, guilt is like an emotion that is so destructive. And I think that I love that you said that, because it's just like, okay, it happened. It wasn't a bad thing. It wasn't a good thing, it was just a thing that happened and now move forward or take the next step.

Margaux: Exactly. And if it becomes a problem, where then you're actually being like drastically impacted by it, not even drastically when you're being impacted by it, then maybe you can reconsider those choices. But like I've noticed, for me, in these past two, three weeks, I've really had been fighting these food urges. And so I think just letting yourself the space to be okay with that. And that includes snacking on graham crackers and saltines from the nutrition room. Pro-tip, you know, the graham crackers and the peanut butter and the saltine crackers will get you through a day. If you're rounding and you are like your stomach is growling and you're getting hungry like just stop by the nutrition room. Or, you know, what I do is I've squirreled away a bunch of little saltines in my pockets so . . .

Harjit: I love that.

Margaux: That's my second pro tip. When you do have time, like, you know, bring snacks, like granola bars or whatever with you, just because you're going to have times where you can't go to the free lunches or whatever. And it helps to just have an extra little something in your backpack.

Harjit: I also have some more tips now that you've shared some, Margaux, that I just thought of. I know a lot of us put our needs after other people. So put your needs first, especially when it comes to peeing, pooping, eating and drinking, I always ask this . . .

Margaux: 100%.

Harjit: I always ask my patients, "Are you peeing, pooping, drinking and eating okay?" Because it's like basic things, right? And if you're on rounds, and you have to go pee, go pee. If you are hungry, get food? Because if you're not in balance, how will you ever do anything for anybody else? I think that's number one.

Number two, be cognizant about the conversations and the way you're talking about food and also body image, and we've had this conversation before, around your classmates, around attendings, around residents, especially around patients, because we don't know what they've been through, what their relationship with food is. They are a context, and because of that, I think it's really important about the way we speak about food. Like you said, Margaux, "Oh, man, I can't eat this, because it's so bad," you know. I think that's very important because everyone's in a different position. They might be having a stressful day and for them, they want that thing and we shouldn't make it sound like a bad thing.

Then, I think finally, this is actually for all the brown peeps in the audience. Because I remember when I was younger, my mom, she wanted me to pack lunch and take it to school and I was like, "I ain't taking curry to school because it smells," you know. And I think like a lot of us have shame with our own food because of us taking it to school, and it's smelling different or smelling weird, you know, own that. So if you have a certain type of food, that is not the general trend, you know, bring it to your jobs and bring it to work, because that's the right food for you. And now I bring curry all the time and it makes . . .

Margaux: And we all enjoy it.

Harjit: . . . yes, and we eat it together and it's just good. I'm so happy that I've come to that now that I'm like actually proud of my food. And I bring it to school because I'm like, yeah, it's different but dude, everything's different. So like . . .

Margaux: And it's food.

Harjit: . . . it's food. Like, we just need to get to that point. And I don't think I've struggled that much here though because everyone likes food that's different, you know, but it's just a thought that I had when I was younger.

Margaux: On that note too, Harjit, I would encourage medical students to know that you're not going to be negatively evaluated on how many times you go to the bathroom throughout the day. People are not paying that much attention. And if you say, may I go to the restroom, people are nice, residents are nice, attendings understand these basic needs. Just ask, don't ever feel like you have to get a UTI because you're on rounds and have to hold your pee. Yes, pee, poop, eat.

Harjit: Yes, don't ever feel like you can't eat. If it's your time to eat, eat. Listen to your body. And I think that in the end, that's another common theme that I think we talked about is, everybody's body is different. Listen to it, know who you are, know what you want, and get it, you know.

Margaux: Get it.

Harjit: Get it girl, or boy or non-binary, identifying individual. I think we had a great conversation and I want to put it out in the world, if anyone has thoughts about food or anything we talked about, please share with us on all our social media platforms @BundleOfHers. Also, in addition . . .

Margaux: Furthermore.

Harjit: Furthermore, it's at Bundle Of Hers Podcast on Facebook. Man, Facebook, why you got to do me like that? Okay, on that note, in our last episode, we thought it'd be a great idea to start sharing some of the comments we've been receiving on our social media platforms and there was one that really stuck out to me. Margaux had posted an Instagram post about a patient that had passed away while she was on service.

Margaux: We appreciate all the love that you guys gave on that post and your thoughts and your own experiences, that was very helpful in processing that situation as well.

Harjit: There was a comment that I actually wanted to share on that post. So Dr. Deon Davis said, "We have all been there. I'm thankful to know that you had your team there with you to help you process this. We learn about it in medical school, but there's definitely no preparation for when it happens the first time." Margaux, what do you think about that comment?

Margaux: I think it really resonated with me. I think it's very true. There's not a lot you can do to prepare for it. I appreciate that a lot of you shared your own experiences and your own support, like Dr. Davis. It helps, it really helps. And I think the more you talk about it, the easier it becomes to process because it's not an easy thing and it shouldn't be an easy thing. And we're only human. So thank you, Dr. Davis, shout out to you. Thanks for supporting us.

Harjit: And I actually want to plug another thing. After we posted that picture another doctor reached out to us who is actually a part of the University of Utah at the VA. She's a hospitalist. Her name's Dr. Amy Cohen, an amazing physician that me and Leen have got the pleasure of meeting. She actually wrote a article on "The Washington Post" and it's titled "Have you ever seen someone die? A doctor recounts her angst of shutting off life support for a dying patient." And it was such a beautiful article that I encourage everyone to read it because it really talks about, you know, being there, helping this patient but then them dying and how to process that afterwards. And I think her article is really kind of takes you to that place and helps you think of what would you do if you were in her position. So thank you Dr. Cohen for supporting us and sending this article.

Margaux: And thank you to everyone for all your support and love. Keep it coming, we want to hear what you think, what you want to hear and just your random thoughts.

Harjit: Yes, and also, eat whatever you want today.

Margaux: 100%.

Harjit: Me and Margaux are going to go get fries after this because . . .

Margaux: Milkshakes.

Harjit: Oh, my God, can we get milkshakes too? OMG, I love fries and milkshake.

Margaux: Me too.

Harjit: I don't usually say OMG. I don't know why I said that.

Margaux: It's one of those days.

Harjit: Yes. Bye-bye.