S3E10: Adapting to New Environments

Bushra: All right, everybody. Welcome back to the "Bundle of Hers." You might be surprised to hear . . . what are you doing? Hello? Can you hear me? Hello?

Leen: It's a broken Bushra.

Harjit: It's like a walkie-talkie [inaudible 00:00:14].

Leen: It's terminator.

Harjit: Say, "Over and out."

Bushra: Can you hear me?

Margaux: Let me just turn it off. How do I do this?

Bushra: I don't want to talk to you.

Harjit: She doesn't know this function. Something new is happening.

Bushra: Sorry, you guys.

Harjit: Let me mute it.

Bushra: Okay. Hello, everybody. Welcome back to the "Bundle of Hers." This is Bushra speaking, and you guys might be surprised to hear my voice because I've been gone for a while.

Margaux: So long.

Harjit: So long.

Bushra: But it's good to be back, baby.

Margaux: We're so happy to have you back and . . .

Bushra: We also have Leen.

Leen: Hi.

Bushra: That is the wonderful voice of Leen Samha. We are officially done with our away rotations. We each did two.

Leen: Thank you, Lord and everything out there.

Bushra: Well, Leen was in two different coasts. I was in the East Coast and then the Midwest, and it's been a long, tiring . . .

Leen: Adventure?

Bushra: And so, with that in mind . . . by the way, we have Margaux and Harjit here, too.

Margaux: Always.

Bushra: Y'all want to say hi?

Harjit: Hi, guys.

Leen: Oh, yeah, I forgot about them. They're here.

Harjit: What do you mean you forgot about me?

Bushra: As per usual, they're always here. They were holding down the fort while the two of us were out there in these streets, trying to survive, and, you know, struggling.

Leen: Learning the ways of the . . . yeah, the wildlife.

Bushra: With that in mind, we're actually going to talk about navigating a new experience and a new kind of life with these away rotations and how they kind of set us up for our future experiences, as we have some decisions kind of looming over our heads in the next few months.

Let's talk a little bit about our experiences. Do you want me to start, or do you want to start, Leen?

Leen: Yeah, go for it.

Bushra: So I was in North Carolina for a month, and then I did a rotation in Madison, Wisconsin. And these two states are completely different places. Demographically, I think the cities are different. The people that are there, the patients that you treat are different. Going there for the first time, each city, I think each time was hard for me.

I thought I would be a little bit more comfortable the second time around just because I'd gone through it before, but there is something about leaving your comfort zone, leaving your safety blankets, leaving all of the things that you have grown to be familiar with to go into the unknown. And so, for me, that gives me a lot of anxiety.

I think for me also, that first week is always the toughest just because you don't know how you're going to fit in. And you don't know the hospital system. You don't know any of the doctors. You don't know any of the residents. You don't even know the other medical students that are going to be on those rotations with you. Kind of figuring that out, I think, was a huge piece.

And for me, going into it, I didn't really know how to prepare for that. I had lived in Utah my whole life. I never moved from Utah. I never had to start over. And that's kind of what it felt like. I didn't have a community in North Carolina or in Madison. But the thing is we all build our own communities, and that was the task at hand that I found myself kind of trying to tackle every single day.

What about you, Leen?

Leen: So I was in West Virginia and then I was in Stanford, two very different, completely different places in terms of population, region, and patient population even. For both, navigating kind of culturally . . . I mean, Morgantown's very diverse, more diverse than what I would have expected. But still, I think your patient population was not that diverse in terms of ethnicity and background. There was a lot of . . .

You know, it's just a very different culture that you had to kind of figure out, navigate, and just kind of understanding . . . you know, you really have to dig into that culture so that you can be able to treat your patient population. I think that was the hardest part. But I absolutely love cultural emergence, I guess. And it was very multicultural emergent for me.

And then in Stanford, it was a whole different population. Actually, I think Stanford was interesting because now it was diversity everywhere and I was no longer the unique person. So I was like, "Oh, my gosh."

Harjit: Yeah, you were no longer the only Palestinian, because you're from Cedar, right?

Leen: Yeah, exactly. And so I was like, "Oh, wow, this is how it would have been if I was raised in a community, a Palestinian community," or something like that. So I don't know. It was really interesting that way.

Bushra: So my experience is kind of opposite because I was at Duke, which is in Durham, North Carolina. The first thing that I noticed is that it was diverse. My first shift in the ED, I had several African-American patients. In my four years at the University of Utah, I think I've only had one African-American patient.

Leen: Wow.

Bushra: One. And so, initially, right in front of your face, you see the difference, right? And I actually found comfort in that. I felt comfort that the patients that I was treating looked like me. I felt comfort in the fact that the residents that were treating those patients looked like me. I felt comfort in the fact that the attendings that were teaching those residents and treating those patients looked like me. As nervous as I was, I was so excited as well.

Leen: I almost had the opposite effect. I think, for me, when I was finally working with diverse populations, diverse providers, I realized I'm so used to one certain type of mindset or, you know, kind of background. I was like, "Oh, my gosh. What if I can't connect with them?" And so, I kind of got this impostor syndrome going on. I had to reset myself for a minute there. I was like, "It's okay. Try to connect with them."

Harjit: I think the experience of people of color, when they are in a majority or even a lesser . . .

Margaux: Representative.

Harjit: Yeah. The experience is very different. So I think in that way, we have a very different perspective. I already feel like I have a very different perspective than Leen because I grew up in a very diverse neighborhood in Utah, and Leen grew up in Cedar. So I feel like that's a cool thing, but I also want to make an important point here.

The point is that all of us have very, very different experiences. All of us. Every single one of us. We are saying people of color. We're fighting for certain oppressed people. Every one of us is unique in our own sense, you know?

Bushra: I think that you raised an important point in that we are all products of our environments. The areas in which we were raised influence the things that we experience and the things that we come to believe. And so, like you said, we all grew up in different areas of Utah. Our thoughts are sometimes completely different from each other.

Harjit: One hundred percent.

Bushra: Which is something I feel like people don't understand because I feel like a lot of the times, we get lumped in together.

Harjit: We've had this struggle here.

Bushra: Yeah. And we all have, like, three different personalities, three different ideologies, three different ways that we live our lives. Our identities are not just the color of our skin.

Leen: And on a bigger scale, you know, sometimes even just as women you get that same effect as well. And we don't all think the same way, act a certain way, because that's where the whole stereotype and negative perceptions come from.

Margaux: Just to clarify that, we . . . I don't identify as a person of color, just to throw that out there. But I definitely can sympathize and empathize with that sense of community when you guys have gone out of Utah. And I, having lived outside of Utah for a while before medical school, have had that realization, too, of how different communities are outside of Utah and Salt Lake City, maybe in a very different way that you guys have experienced it.

But it's definitely kind of cool to leave when . . . I think you get a lot of perception that medicine is like this, like how we were trained here and at this one institution. And then you leave and, suddenly, there are so many more perspectives out there, and it's kind of like a bigger world. I think that's so exciting.

And what I really like about residency interviews is to go and see and meet new residents and see different institutions and how they run things differently, and how communities are set up differently.

But one thing I wanted to ask you guys is . . . I haven't done an away rotation, but I felt like every rotation that I switched, so from OB/GYN then to surgery then to IM, was completely different work environment, completely different learning tools and techniques. And the first week of each rotation for me was always so hard just because I was getting used to new people, new attendings, new residents, new team structure, team dynamic, rounding rules and regulations, and information and how the patients are managed and treated in their different diseases and illnesses.

Towards the end, I became more consciously aware of this. But the first week, by that Friday or Saturday, I would be feeling really down and depressed. And I was basically impostor syndrome, like Leen was talking about, like, "I shouldn't be here. Why am I not doing great? I just finished this last rotation really strong and now why am I on this new rotation?" And I'm back at square one and I feel like I'm incompetent.

And then I started to realize, "No, it's just because I have so much new stuff all at once that I'm trying to juggle." And usually, like you said, Leen, in a hot minute, you get back into it. You figure it out. You get rapport with your teammates and you figure out the system and you figure out the diseases, and then it becomes a lot easier. And then, by the end, you feel great.

And so one thing that was really great for me on my sub-I is on that Friday, on my first week when I was feeling really down and depressed, the resident, I didn't even tell him this but he texted me that night. He was like, "Hey, I just wanted you to know you did a really great job this week." And it was so unsolicited and that made so much of a difference for me.

And so I'm just curious if you guys had any experience, or how did you get through that first week or weeks in your sub-Is?

Leen: I don't know. Again, everybody's experience is very different. But for me, you know, I kind of figured that this environment was one where it's like all for themselves, but we're still on a team. Especially as a med student, you kind of have to jump in and be like your own independent factor and get yourself going. You're a self-starter basically, right?

And then from there, once you're a self-starter, people start noticing that. Then you start to kind of build rapport and they help you out. At least that's what worked for me. By the end, they start noticing these things. Not by the end, even by the end of the week, I think they start noticing these things.

Bushra: I think, for me, I separate things into hospital life and then outside of hospital life. As far as hospital life goes, when you're doing your sub-I, there are certain chief complaints that you need to know as a sub-I. Like, you need to know how to treat chest pain or what the differential diagnosis for chest pain is and what you're worried about.

And so, as a sub-I, keeping that in mind, keeping in mind your patient and their chief complaint, and what diagnostic test you want to do, and what treatments you want to do really showcases your skills to the attending.

And I think what your goal is, is to make sure that they trust your clinical judgment. And that first day, maybe it's not going to happen just because it's your first day and you don't have that rapport with anybody yet.

But I will say that word gets around. Like Leen said, if you're a go-getter, if you are proactive, if you seek out your own opportunities to learn, people will notice that. And there's no time to be shy and let other people invite you to do things. You invite yourself. You're in charge of your own learning opportunities.

One thing that I appreciate at one of the programs is that they assign you a mentor. And so you'll hang out with them outside of work. You'll explore the city with them. And then a lot of the times, after a shift, you'll go out. You'll go out to a bar or you'll go out to get something to eat after a shift, and intimately get to know someone outside of the work space.

And I think that is helpful in trying to decide whether a program is right for you or not, whether you can see yourself as part of the team. The residents as your colleagues . . . because, you know, a year from now, we're not going to be students anymore. We're going to be colleagues. You know what I mean?

Harjit: I think it takes a lot of courage. I don't know if you both were forced to do this, because a lot of people who go into emergency medicine do an away rotation so you had an extra push, but where do you get that courage from? Is that a work in progress? Is that something you just have? And what were your thought processes surrounding that?

Bushra: Well, obviously, for emergency medicine, you have to do away rotations. So part of it is you kind of are forced.

Leen: They literally drag you out of the . . .

Bushra: You're forced to do it. But a lot of people do away rotations just to experience a rotation away from your institution at programs that they're interested in.

As far as where I get the courage from, I think . . . here's the thing. And you guys can agree with me or not, but I've been kind of thinking about this a lot. Every year we've gone through school, we go through a change. Every year, something changes.

Harjit: Yeah.

Bushra: And with that change, there's a lot of anxiety. There are a lot of things that we're worried about. There are a lot of what-ifs, right? But we've survived all those things. We survived Step 1. We survived our clerkships. We survived submitting our applications, our ERAS applications. So it's just another thing.

Now, the question is what do you want to get out of it? What's your goal? You're going to do it, right? So what's your goal at the end of this? Is it to network? Is it to gain perspective? Is it to learn about an area that you've never been to before? What's your goal?

So I think, for me, it's a learning opportunity. Not just medicine, but everything outside of medicine, too, like my life outside of medicine and how I envision it. And so I think that's what my biggest push was in doing these away rotations.

Harjit: I think that's a good mindset to have. And I think that's one that I will, for sure, use when we go into the next phase of our careers.

Leen: I mean, for me, I have been really thinking about this a lot lately, too. You know, it's the same reason that I ended up being able to go through undergrad and then moving away and going to med school, and then now doing away rotations. I have a great support system.

But culturally, women don't usually do this. They don't go, you know, far away places. This is very unusual for us. In the end, you just have to do it, right? That's really like . . . looking back on it, it's like, "Why did I get through med school? Because I had to do it. Why did you go through away rotation? Because I had to do it." I just had to push myself and say, "This is going to get me to my goal. This is what it's going to be."

You know, me and my Dad, we always joke about something called the mahram in our religion, which is like a male chaperon or someone who's going to accompany you, who can help you out through traveling, things like that. And when I'm struggling in West Virginia, I'm like, "Oh, my gosh. Now I know I need a mahram." But it's totally a joke.

And you just realize how independent you can be and how strong you can be, you know? It's really shocking. I still dwell on this and I'm like, "I can't believe I did that."

Bushra: The word independent . . . okay, so obviously, I know I'm an independent person. But I never truly, truly felt that until I left, until I did my away rotations, until that I was forced to be independent in all facets of my life. I'm 26 years old. That's a . . .

Leen: A late bloomer. That's fine.

Bushra: Yeah, exactly, a late bloomer. But the thing is, Leen, you hit the nail. I'm identifying with everything that you're saying right now because I come from a similar culture where women typically don't leave their parents' household until they get married, right? And so they . . .

Harjit: And even then, you have someone taking care of you.

Bushra: Yeah, exactly. And so these things, like moving away on my own, is something . . . I mean, I still to this day have conversations with my mom about it because she really wants me to match in at Minneapolis, which is where she lives right now, because she wants me closer to home. There's a comfort level there.

And then me now doing these away rotations away from my family, being truly independent for the first time in my life, there's something that I gained there for that and there's a piece of confidence that I gained from that that can't be taught. You just have to experience it. So, I just liked what you said.

Margaux: I love that . . .

Leen: You have to problem-solve, right? It's insane what the limits that you get pushed to and the solutions you come up with, and you make it work. I think that's amazing. I feel like that's valuable experience.

Harjit: I agree with that. And I kind of want to reiterate. So, I've actually never moved outside of my home. I still live with my parents. In my culture, too, we live with our parents until usually . . . generally, in the past, it's been until you're married. But I was really fortunate. Again, I'm going to bring up my sisters. They teach me a lot. But I was really fortunate to kind of lead by their example. It's that whole process.

But it's also a very beautiful journey because even seeing my sisters . . . they left. They said they learned a lot and they want to be near home again. And it's like even though they're making that choice, they're making it after they've experienced everything they needed to experience. And I think that's beautiful because it's really like a homecoming for them, you know? That's why I'm not afraid.

And I also am not afraid because my sisters did it and my sisters in med school are doing it, like Bushra, Leen. And then Margaux's already moved and come back.

Bushra: Margaux has all the experience.

Harjit: She has the experience, but . . .

Bushra: She's our godmother because we ask . . .

Harjit: Yeah, Margaux.

Bushra: We ask all of the advice to Margaux because honestly, Margaux's very wise and . . . obviously, a lot of us are inexperienced in all things life, right?

Harjit: She even has a house, y'all.

Margaux: Oh, my God.

Leen: She has a house. She has a husband. She has dogs. She is in med school. Girl, you're goals.

Margaux: I think that's such the great thing about community and having people having paved these paths before you, that you can ask. And even if their path isn't the exact same as yours . . .

Harjit: You're right.

Margaux: . . . you can draw on the experiences of each. But like you said, Bushra, sometimes you just have to live it to feel it for yourself. And I'm so happy that you, Leen, and Bushra had this experience of feeling truly independent and that empowered you on your away rotations. And I'm so excited for you because it's such a great feeling to have. Like you said, you are both already independent, strong women before. But now, it's really put you up to know what you're capable of. Even though you knew in the back of your mind, but just that feeling is so awesome.

Harjit: You actually did it.

Margaux: That is so awesome and I love that you guys got to do it. And anything we can do to create a community to help anyone else feel it, it's so great.

Harjit: Yeah. We are getting these opportunities to . . . I would never leave home just to leave. The only reason I would leave is if I had a purpose. And I think we're getting these opportunities because we are getting an education. We do have those privileges. And oftentimes, a lot of people don't have that.

But I feel like I want to give a shoutout to those people, too, because they're finding independence because they're sustaining their lives in what they have. And so, I think that you can also find independence staying at home, too. It's not necessary that you have to move.

Margaux: And on that point, Harjit, I think there tends to be this stigma about going to college and living at home in the American culture, right? And I think that we need to be more open-minded and respectful. There is nothing wrong with living at home with your pa- . . . parents. With your patients. Don't live with your patients.

There's nothing wrong with living at home whether it's for cultural or financial or whatever reason you want. I think we need to break away from that mold of to be independent means to live outside the house.

Harjit: I agree with that because there are so many ways you can be an independent person. I think that the best way to be independent is just be who you are and, you know, fight for that. Hopefully, you'll find people who'll fight with you.

Okay, I have a question. So you moved to Colorado for college. So these were very transformative years for you. How much do you think that was just your natural growth, and how much of that do you think was you were in a different place?

Leen: That's a hard question.

Harjit: Because you left at a young . . .

Margaux: Yeah. So I went to college right out of high school in Colorado. So there are lots of tears when your parents drop you off at college, especially in a different state.

Harjit: Also, you're the oldest, right?

Margaux: Yeah, I was the oldest. And I think I had a lot of privilege because, you know, you get dropped off at the dorm and then you immediately have a community there where you have a roommate and a hall person who's making sure that you're okay, and then a whole school system that is able to support you along the way. So I never . . .

In a way, there was a lot of growth and independence, but I think a lot of it was the process of college, too, like how they set everything up for me to succeed, and I recognize that as a great privilege that I had.

There was a lot of personal growth and now, all of a sudden, getting to choose my own meals at the meal hall, right?

Harjit: Oh, my goodness.

Margaux: No one telling me when I had to be home, when I had to go to bed, when I had to study. So I think that's a lot of the boundaries that I explored and pushed in freshman year of college.

Harjit: So in this phase now, what does independence mean to you?

Margaux: To me, it's that even though I'm this system of medical school or medicine, if there's something that I don't like about it, I can change it or I can at least work towards changing it, that I don't have to conform into the system that already exists if I think there's something wrong or I find that that system is harmful in some way. Pushing those boundaries is really difficult, but that's how I'm defining independence.

Bushra: Yeah, you're pushing difference sets of boundaries. It's crazy that you talk about your college experience because my little brother, he's a senior in high school. And man, I push him so hard to apply to out-of-state colleges because . . . you know, I lived at home not by choice. But I lived at home and I'm grateful for that because I had a place to live. I wasn't paying for anything. But I feel like I missed years of developmental milestones that I wish I had if I had gone out of state, which that also comes with its own things, too.

But for him, I just want him to have a different experience. I want him to question the world that he surrounds himself with. I want him to question everything that he's been taught. I want him to explore things that he never thought that he was able to explore, because I felt like those were the kind of things that were missing when I was growing up. And that's what I feel like I'm doing now as a 26-year-old adult.

Harjit: Which is great, Bushra, because you're doing it now, right?

Bushra: Right.

Margaux: It's never too late, but it's great to have those experiences early on.

Harjit: Early, yeah.

Bushra: So I'm excited for his experience and just to contrast it with mine. The fact that he is . . . we know for sure that he's going to go to college. It's not even a question. It's even a huge step. You know what I mean?

Harjit: Huge step, yeah. Bushra, I really like this concept that we are exploring our own dependence but we are also seeing how we can basically branch it out to others, that we find out what independence means to us, but we also uplift and help others find their independence as well.

Leen: I think independence as an overarching theme is that you can mold yourself or apply yourself to any situation in the future, or if you need to change any aspect of your life or your environment around you, you're able to do so. And I think as physicians, as strong women that we are here, when we become physicians, we're totally going to be able to do that and help others be able to . . . I don't want to say fit into the mold, but create their own molds and . . .

Harjit: I like that.

Leen: . . . be able to apply themselves to the world in ways that they want to change it for the positive.

Thanks for listening, everyone.

Bushra: What?

Leen: Bye.

Margaux: So make sure to continue the conversation or just add whatever comments you want on our Instagram, @bundleofhers, or on Facebook at Bundle of Hers Podcast.

Harjit: Got it, bro. Okay, I'm making this weird.

Bushra: What else is new?

Harjit: Rude.

Leen: She learned it from me.

Harjit: You're rude. Just a freaking sassy pants. She's just dissing me left and right.