S3E6: (What to Do) When Your Family's in Medicine

Harjit: Biscotti, bis-coffee?

Margaux: Cookie butter.

Natalie: What's it called?

Chloe: I don't know.

Margaux: Biscotti or Biscoff.

Harjit: Biscoff.

Margaux: The delta cookies?

Harjit: Yes.

Margaux: That's hot.

Harjit: Biscoff.

Chloe: Okay. All right.

Margaux: Harjit.

Harjit: One minute. I just had a carbonated soda. I might have to burp. Oh my God, this is very bad. Okay. So today we are going to da, da, da. I need to do like, you know, as voice exercises la, la, la.

Margaux: Harjit, just start. Why are you being so weird?

Harjit: I don't know. It's been a long time since we've had a guest. I feel like really nervous.

Margaux: Would you like me to start?

Natalie: You could Skype me in.

Margaux: Okay, I'll start.

Natalie: I'll leave.

Harjit: No, stay.

Margaux: I'll start. I got it. Hey, everyone. Welcome to "Bundle Of Hers." Today is Margaux and Harjit in the studio. Bushra and Leen have still left us, but we brought in our classmate Natalie Wall. She's one of our faves, and we love hanging out with her and we finally brought her on the show.

So we've talked a lot about having lack of representation in medicine and kind of paving your own path when you don't have someone who looks like you. But today we wanted to talk about a different perspective, and that is something that Harjit, Natalie and I share, which is having a family member in medicine that kind of helped guide us into medicine. And, for me, my dad is a physician in internal medicine, and he was a big part in helping guide me through the application process to get into medical school, but I think also subconsciously influenced me into going into medicine as a young child. Harjit, how about you, who do you have in medicine?

Harjit: So my middle sister, she graduated from the University of Utah School of Medicine. She's an internal medicine doctor as well. And I've kind of had her guidance for the past couple of years ever since she started this journey of medicine. And that's why I'm super interested in having this conversation, because I've seen how her just being there for a couple of years has impacted my life. So I really want to hear that perspective of how it felt like growing up in a family where someone was a part of the medical field.

And I think, Natalie, that's kind of the biggest reason why we thought you'd be such a great guest because we wanted to kind of understand how your life was like growing up with someone in medicine. Did it either push you away at times from going into medicine, or did it really like suck you in?

Natalie: Yeah, so my dad is an orthopedic surgeon in Scottsdale, Arizona, and I think it kind of swung in both ways. I think being young I got a unique perspective of watching him. He does private practice, which is different than what I want to do. And as such, he has a very different perspective of medicine than I do, because the way that private practice is run I think it's very focused on revenue and kind of having to do enough to provide financially for yourself and for your family as opposed to academic medicine, which is more salary based.

Obviously, there's still incentives to perform well and to do well, but I think it's just a different driving and motivating factor into what you do and don't enjoy in medicine. So growing up I kind of saw I think more of the negative sides of things that I didn't want for myself in medicine. But once I made the decision to go in medicine, I think my dad made an effort to kind of show me the positives and focus on what he loves about his job because he could tell that maybe he had been focusing on the negatives for a little too long.

Margaux: I remember when I, well, I don't really remember, but I remember my mom was telling me that I was born when my dad started internship and he was very busy as I was in that very like toddler phase. And I used to ask my mom like when is dad coming over, because he basically lived at the hospital versus at home. And so I don't think that negatively impacted me. But what are the negative things that you sort of noticed initially?

Natalie: Yeah. So I actually have, I think,a similar story. My due date like when my mom was due with me was actually match day. So I was born like a couple months before my dad started intern year.

Harjit: No way. That's so cool.

Natalie: And so growing up my dad also was never home and also lived in the hospital,and the only time I would really see him, I mean that was before work hour restrictions and things are a lot different. So they literally like lived in the hospital, especially for surgery. And so my mom would bring me to go visit my dad at the hospital. Obviously, I don't remember that because I was little, but I think that that kind of like followed suit.

Throughout my childhood my dad was never really home, and I was really involved in dance and extracurriculars and my dad never really attended those things. And I have younger siblings now, and it's just such a contrast in how involved he's able to be in their lives now versus how involved he was in mine and my sister's lives growing up, just out of obligation of, you know, having to be present and be available for his patients, which I understand but I think that that was kind of hard.

I think another negative would be kind of the stress of running your own business. I think that really took a toll on my dad, and I think that in some ways might have kind of sucked the passion out of what he did, because instead of being something that he could do and just focus on this idealistic practice of helping people, he had to focus on whether insurance, like whether he could bill insurance for X, Y and Z and whether they were going to reimburse appropriately and how that was going to factor into how much money he was making every year. And so it was interesting to kind of watch this journey of like passion or lack thereof in his medical, I guess, like path or career.

Harjit: I think seeing that, you know, there was times both Margaux and both Natalie in your lives, especially those developmental years, where your fathers had to in a sense choose their work for medicine over spending time with you all just because that's what their goals and dreams were a part of. Did you ever feel like they resented that?

Natalie: I don't know. Margaux, do you have any thoughts on that?

Margaux: I don't get that. I've actually never asked my dad about that, you know, directly, but I never got the sense that he resented it. I think timing wise it worked out because I was so young and obviously I don't remember that he wasn't there, and then he did make a good effort to be there as best as he could when we were growing up and I think also fostered my interest in science.

He never actually, you know, said you are going to be a doctor or you should go into medicine. It was always just kind of an option for my sister and I, and obviously she did not choose that path. So I don't feel like he was forcing us. And my mom too. She was in a PhD program for neuroscience. They're both very science-oriented people and gave us the opportunity to go into science and I think I pushed into it, whereas my sister didn't, and I don't think he had any regrets about how he had to balance his career.

I'm sure there were times when it was like so hard and there were like, there was that pull of like really wanting to have the system be different, where you could balance your family versus your passion. But I think at the end of the day they both, I think speaking for your dad too, I think they both ended up with strong, courageous young women.

Harjit: Yeah, 100%. And I think that's kind of the beautiful thing, because you both are such powerful women. I wonder that sometimes having a parent or someone for the most of your life that is so committed to their path in medicine, did they ever say, "Oh, this is a lot of work. This is going to be really hard. There's hardly any time for anything. I'd missed a lot of great moments that you've guys have had in your life."

Margaux: And I think on that, if he really regretted it, I don't think he would have been as supportive when I did decide I wanted to go into medicine. I think he would have been more forward. And like you said Natalie, your dad, once he realized you did want to go into medicine, actually started talking to you about the positives.

Natalie: I mean, you have your support system in your kind of social circle, whether it's friends outside of medicine or family members or partners, which is really great, but it's really nice to have someone that like actually understands what it is to be super tired after doing a 30-hour call shift and someone that understands what it's like to have to do that Q3 as opposed to someone that just kind of sees it from the outside.

So it's been like a unique opportunity and a really positive experience I feel like for the relationship between me and my dad to be able to like kind of decompress with someone that not only gets me but also gets this like life that I've embarked on.

Harjit: Do you feel like you're closer with him now?

Natalie: Yeah, and I don't know how much of that is just a factor of being older and more mature, and not wanting to argue with my parents about everything and how much of that is because now I have something I can like really relate to him with. But I think it's definitely changed the context of like the conversations that we have. We have more adult-like conversations now as opposed to like parent-child conversations that I had when I was 18, 19, 20 years old.

Harjit: Yeah. It's so cool to see how like your relationship shifts with a person who's in medicine. Like I've started having those kinds of conversations with my sister. My mom will still be like,"Why are you at the hospital so late? What are you doing?" And I was like, "Don't you remember? She used to stay out so late too at the hospital." And she's like, "Yeah, okay. I get it." So I don't get that much, it's a little bit easier for me. Not a little bit. I would say it's very much like changed my experience in medicine versus my sister's.

Having her there and having her perspective has really been super comforting for me. One thing I noticed when I have conversations with my sister now is she's always like my number one cheerleader and always helping me with my confidence. So we're currently applying for residency programs. Wait, why are you laughing?

Natalie: My application has been done for like a week. I'm just too scared to press the submit button. So I keep thinking about that.

Harjit: So we're currently applying to residency programs, and I was telling my sister I'm a little overwhelmed in picking like what programs are right for me. Like there's no magic one database that tells you, "Oh, this is your score, this is the type of personality you have." Could you imagine a computer like picking out your personality?

Natalie: That'd be great.

Harjit: But there's nothing that puts that forth. So my sister goes, "Where do you want to go?" I tell her a whole bunch of schools that I'm really interested in, but they're super competitive. And she's like,"So do you want to do them?" I was like, "Yes." "Then apply there." She's like, you just need to first try before you even say that, "Oh, I can't get in there," because you will never know what that school is looking for because every school is so different and program directors change often. And you never know what a program director is going to be looking for.

And so I was like, yeah, [Monu 00:10:50], but I'm scared. And she's like, "You know, when I was in your position, I was scared too." And she's like, "I didn't have an older sister to tell me that you can do it." And she said,"I'm here to tell you can do this." So when she said that, I felt like I can because she's a doctor and she made it and she's doing a good job. And kind of along that same line, my question is for you, Natalie, do you feel like your father being in medicine really helped your confidence? Because you are a very powerful woman.

I know you're laughing about this, but like when I see you and I see how passionate you are about things, you are not overconfident, you're the right amount of confident, you know, like the hitting the sweet spot. Like you know you know, and you know you have to learn a lot still. And so that's kind of the question I want to ask you. Like how has it impacted your confidence having someone in medicine?

Natalie: It's kind of funny because my dad is a very tough love kind of person, and kind of the running joke growing up was that my dad got parenting skills from like his attendings when he was an intern because that's kind of how he treated us. He was very much, he was pretty hard on me. I mean I think appropriately so. And I think that a lot of the way that I am now, especially with, you know, trying to be confident, decisive is because of that. So I'm very appreciative for it.

But I can also relate a lot to kind of how your sister has been your cheerleader. I feel like my dad very much has fallen into that role, which is kind of funny because I know he's always like wanted the best for me and always has felt like I could have whatever it was that I wanted, but he wasn't someone that would explicitly say those things. Growing up it was kind of always like pushing you a little harder and trying to make me set my expectations a little higher.

Especially now going forward to apply to residency, he's very much the type of person that he's like, well, if you want it, you can do it. And sometimes I have to try to convince myself, well, he's a little out of touch. It's been 30 or 40 years since he's gone through this process.

Harjit: You're like, "You're not hip, Dad."

Natalie: Medical schools have changed a lot. It's gotten more competitive.

Margaux: Step one matters.

Natalie: Step one scores matter now, and it's not just like warfarin that you need to know. It's like a whole list of anti-coag, you know, whatever. Things have changed a lot, but I definitely appreciate having someone in my corner that even if I don't necessarily always believe what he's saying is there to tell me those positive things. Because I think that that's one thing that medicine really lacks is kind of that positive reinforcement. I think it's getting better, but it's definitely not a field that tells you what you're doing right. It's a field that tries to teach you by telling you what you're doing wrong, which we all, you know, get used to and become better and grow from that but can be a little wearing on your self-confidence at times.

Harjit: You need that balance. And Margaux, what about you? How has having your dad in medicine like affected your confidence?

Margaux: I feel like I've picked up a lot of, just by diffusion of hearing his conversations over my whole life about medicine. And so I feel like I came into medical school with just sort of an innate understanding of how the medical system is and functions and who you talk to and what department runs what and this, that and the other. I remember early on, I think maybe in season one, Leen was talking about how she started, came to medical school and didn't know like what rounding meant or what an attending was.

And so, for me, that was kind of something I realized I didn't know that I had the privilege of like coming in knowing all of that. And I think it was just, it was never like a direct conversation with him, but just picked it up throughout my whole life. So I think that's one thing that really helps. And like you, Natalie and like your sister, Harjit, he also is a champion for me and actually never pressured me to go into any specialty, but always encouraged me to like try everything and supported me when I was going to do ortho. He was like 100% on board with that. And then when I switched to psych, he was 100% on board with that, and he sends me like articles in the mail, like from JAMA or whatever, of the month and he's like, "I thought you would be interested in this." That's like psychiatry related.

Harjit: That's so cute. I love that. That is so sweet.

Margaux: Yeah. So he supports me in little ways like that. But I also appreciate that we've been able to keep . . . I was little bit worried about coming here for medical school and being so close and connected, but we've been able to keep a good balance I think of respecting each other's boundaries and he'll support me when I need it, but also giving me the autonomy to explore on my own, which I've appreciated.

Natalie: I have to ask, since you grew up with a dad in medicine, would you round with him on weekends?

Margaux: Oh no.

Natalie: That's like, I kind of joke. So I lived with my dad full time, and he was a single parent. I have a step-mom also, but there was like weekends where it's just my dad and he was on kid duty, but he'd have to go round on his patients.

Margaux: He'd take you?

Natalie: It's kind of a joke in our family that like, I like knew the charge nurses really well, because he would just kind of drop us off at the nurses station and feed us like doctor's lounge cookies while he'd go see patients. But that was like one of my favorite memories growing up is like going on rounds with my dad and him kind of like dragging me as this like, you know, 12-year-old little kid into patient rooms and like introducing me to his . . .

Margaux: His patients?

Natalie: . . . post-op patients and just like his patients getting excited that there was someone other than like an old white guy in the room at 7:00.

Harjit: That's super cute.

Margaux: So my dad actually went into outpatient medicine, so yeah, I think he did, you know, inpatient during residency and then switched into the outpatient setting. But I do remember occasionally go and he'll do house calls where he'll go and like help his patients set up like the pill boxes, especially when they've been like, you know, given a bunch of different new meds. And for a single old person, that's really hard to manage. So I do remember going to people's houses with him to do sort of house calls like that.

And then another good memory I have is going to his office and then like waiting, like when he'd pick us up from school and then we'd have to go wait in his office, and my sister and I would put all of his paper clips together so that when he inevitably it was probably the nurse that hated us more than him. But like, you know, you pick up a paper clip and they were all chained together.

Harjit: Oh goodness. That's so funny.

Natalie: I have good memories. There's just good experiences I've had with my dad in medicine. I actually, so the first time I was in the OR I scrubbed a surgery with my dad, I actually passed out.

Harjit: Oh really?

Natalie: Yeah. I was like 19 years old. It was like an open left total shoulder replacement. I passed out, and I remember like going home and crying and be like, "Dad, I can never be a surgeon." Like I passed out in the OR and he was very comforting. He was like, ah, I did too. Like it's okay.

Harjit: And going back to a couple of years ago, I remember when we first met, you told me you weren't initially going to go into medicine, and I kind of wonder did your dad being a doctor kind of, was there moments you're like, I don't want to live a life like him so I need to do something else, but then medicine is like your calling in your love and you just kind of fell into that.

Natalie: I guess it's kind of hard to say. When I was like six years, everyone was like, what do you want to be when you're older? I wanted to be a plastic surgeon. That or marine biologist. I was convinced that I was going to train dolphins or like reconstruct people's faces. And you know, as I got older, I started to question whether the reason I wanted to go into medicine was because I wanted to go into medicine or whether it was because that's all I knew. My mom is also in medicine. She does oncology pharmaceuticals.

Harjit: So you really did think about that aspect.

Natalie: I definitely did.

Harjit: I have so much influence in medicine.

Natalie: Yeah, and I was kind of worried like am I making this life decision based on what I, not that anybody ever explicitly said it was expected and not that I ever felt like it was expected, but I was wondering if I knew enough outside of kind of my own home life to be able to make that decision. So I tried a few different routes, and ultimately medicine was kind of that one thing that I realized I always actually did want for myself.

Harjit: Yeah. And I'm really happy you brought that point up, because we do have a lot of our classmates whose parents or someone in their family just like us are in the medical field, and I always wonder is it like you're going into like a family business or is it this really the path that you want and kind of what distinguishes that.

Another thing that we kind of talked about and I think Margaux alluded to this and I think we should have a conversation about it because we are the Bundle of Hers. We always talk a lot about privilege and how that factors into these topics. And like I said, Margaux, you alluded to it that you had someone in medicine, you understood this system a little bit better. And I will say I feel so privileged that my sister was in medical school because I can already see how my life is different than when none of us had higher education. My life has completely shifted and that has just been a couple of years.

So how have you stayed grounded as a person and understood that you do have privileges and kind of what was your journey to that? Because a lot of our listeners are first-generation students, are students that don't have someone in medicine.

Natalie: This is something I think about quite a bit. I mean, coming from a family where, I mean we grew up financially stable and I'm white, like I am sheltered from a lot of the things that a lot of other people and a lot of my classmates deal with solely on a basis of socioeconomic status and it's by no doing or earning of my own and I'm extremely aware of that.

That said, I guess with regards to things that keep me grounded. So my dad was the first person in his lineage. I mean him and my uncle to go to college. My grandparents were extremely poor. They grew up a family of coal miners in the middle of nowhere, Pennsylvania. So he has I think that unique perspective and always enforced that upon us. Like when I was old enough to drive, he was like, you need to get a job. If you want to pay for all these things, you need to pay for it yourself. So I really respected that.

Likewise watching him, especially being in private practice and living in this affluent city where a lot of his patients actually can pay for their procedures and surgeries with cash so they can bypass insurance altogether, sometimes I wonder if that has anything to do, like kind of the patient demographic that he's chosen to care for has anything to do with why it seems like he's fallen out of love a little bit with medicine and with surgery. And that's something that I'm like extremely passionate about is wanting to always integrate underserved communities into my practice, because I feel like surrounding yourself with the things that are different than you is what keeps you grounded and keeps you aware of, you know, the things that tie you all together.

Burnout is a huge problem in medicine, and sometimes I wonder, at least in the case of my dad, if kind of the lack of that has anything to do with why he feels the way that he does about medicine now. That's just kind of my two cents on that issue. And that's like something that I do think about a lot. And one of the things that I hope going forward kind of keeps me grounded to recognizing not only where I came from, but kind of where I want to help others to go in the future.

Harjit: Yeah, I love that, Natalie, because we were really good friends and we've had a lot of conversations on privilege, on white supremacy, on underserved communities, like a variety of topics and I've always felt very comfortable having those conversations with you. And I always wonder, especially when people grow up in certain communities, like what drew them to want to know about this. So kind of having that insight of your father and him always reminding you of about how he grew up and what he had to go through, it makes sense now. So thank you for that insight. What about you, Margaux?

Margaux: Like I talked about earlier, how I kind of really recognize that innate privilege that I had about learning the medical system growing up was by talking to Leen and actually realizing that she had no idea what the word "rounding" meant or what an attending meant or what the hierarchy of training was or what step you have to take next.

And so I think it's so important to have conversations with people around you and to like really dig deep and understand like their background and create a safe space so that they can feel comfortable telling you that. Like, I didn't know what rounding was and even though it seems like everyone else in medical school did. So I think that's the first thing that is really important to recognizing your privilege because sometimes you may not even know that you have it until someone else doesn't have it.

And I think that's something that my dad and my mom are both very good about having conversations and talking. Like you, Natalie, I was very privileged to grow up with a stable financial situation and go to private school, and I don't think I really truly appreciated that until now. I'm more mature and can think back and reflect on how important it was and how it shaped me to think critically from a young age, but to also want to know and ask and be inquisitive about other people's experiences, recognizing that they are not going to be like mine and understanding how we're all coming from a different place, but that we can come together and change and that diversity is great. It seems like I don't know where this is trailing off as like, yeah.

Natalie: Yeah. Kind of like what you said and having these conversations with people and realizing that things that you didn't ever really consider a privilege, being able to step back and recognize that they are. Like one of those things that I think about a lot is the privilege of growing up in a neighborhood that allotted me the opportunity to go to a really good school. Education was an expectation in our household. Because of that and because of the school I went to, the teachers that I had has allotted the opportunity to go to a good college and you know, likewise be where I am today.

And I mean something as simple as just based on where you live can affect what doors are aren't opened to you more easily than other people. Education was something I think I took for granted and felt like it was something that I somehow brought upon myself. Like, "Oh, well, I worked hard and I studied and I did all of these things and that's why I am where I am."

And I think it wasn't until, you know, probably last few years where I was able to step back and be like, well, yeah, I did do those things, but I had this like upper hand of going to a school. Education was like, we were taught well. We had good funding from our state or from our families and I had parents that like emphasized the importance of that and if I needed a tutor in something, I had those opportunities and just being able to recognize that not everybody has that, which to me was just kind of like an expectation.

Harjit: I think because we try to have that lens of understanding others that we'll grow a lot as people. And that's kind of the reason why I think we're all such great friends is because we challenge each other and we want to listen to each other's stories and backgrounds and understand a lot. Like I'm so happy we had this conversation today because I didn't think about a lot of these perspectives of having someone like growing up that's in medicine. So I'm super thankful for that.

Natalie: For me, the biggest takeaway from this is kind of less about focusing about like what it is that we're privileged to have. I think that's super important and super important to recognize, but I think it's important because we can use those things to help other people and by recognizing that it's a privilege and not just something that we did or we deserve, being able to try to lift people up with that perspective.

Harjit: I love that. That's perfect. So we have been doing this new thing, Natalie. I should tell you about it too. We got these super cool pins called stumbling gracefully.

Natalie: I saw yours. It's very cute.

Harjit: It's on my sweater. And we have been active on our Instagram to ask people questions. And the question is those with health care providers in the family, did having that presence further encouraged or discouraged you in pursuing medicine? So our classmate [Jyothi Shermont 00:27:04] has a response that we would like to share. She says, "It encouraged me. I remember looking at an interop pictures or anatomic models my dad would bring home when I was younger and I was so fascinated with them. My dad helped me suture an orange for parent career day when I was in fourth grade. And I remember being so excited to show everyone the pictures at school. My dad is my biggest role model, especially now that I am pursuing the same field he is in and I can't thank him enough for his constant guidance and inspiration." Jyothi, thank you so much for your response and you'll be getting a pin soon.

Margaux: So another response to that same question that Harjit just read is from [Panda Patronis 42 00:27:46], they say, "Definitely encouraged. I sort of assumed as a child that becoming a physician was what one did when you grew up. Other than an astronaut, I didn't consider anything else. A small part of me is still waiting for NASA to contact me about becoming a mission's medical officer."

Harjit: Panda Patronis, we hope you become a medical person in NASA in space.

Natalie: In space.

Margaux: That is so badass.

Natalie: A space doctor.

Harjit: Oh my God. A space doctor. Can you imagine every kid's dream? I want to be an astronaut. I want to be a doctor.

Natalie: I just want to know what happens when you draw blood in space.

Harjit: Oh, what happens? What do you think happens?

Margaux: It like floats. You just like capture it.

Natalie: I don't know. Then you don't have to hang your IV bag. It just floats away.

Margaux: Natalie, you could be like a marine biologist doctor like in the under the sea things.

Harjit: Oh, under the sea.

Margaux: Cardiac surgery underwater in a submarine.

Natalie: I'm really bad at holding my breath and I don't swim well.

Harjit: Okay. Hopefully, our dreams won't shatter forever and ever and ever.

Margaux: We didn't get any responses about a discouraging experience, but if you have a discouraging experience, we encourage you to share it. Just because we don't read your thing, doesn't mean we don't love you.

Harjit: So we want to thank everyone who has listened to our episode. Please share your thoughts and continue to answer our questions. We have super cool pins like I've already mentioned. Get one and be cool. Bye-bye. Bye-bye.

Chloe: Topped up on stress hormones!

Natalie: Okay. Is this not the cutest photo of our Harjit ever?

Margaux: Oh my God, I love it. That is so cute. It's just like her eyes.

Harjit: Because I got in trouble. It was like I got in trouble.