S6E19: Diverse Narratives of Med School’s Third-year

Mariam: Okay. I'm trying to think of how . . . Sorry. Okay. Forget what I just said. Cut it out. Sorry. Oh my gosh, you guys. I suck at cold opens.

Lilly: No, that was good.

Mariam: No, it was terrible. Anyway, hello. Welcome back to "Bundle of Hers," to our lovely audience. We are in the virtual studio. So this is Mariam, and I am very excited today because we have two special guests on our episode today, two of my classmates, fellow newly minted MS4s, Lilly and Luti. I will let them introduce themselves. What's something that you want our audience to know about you?

Lilly: I'm so excited to be back on the podcast. I'm Lilly. I'm a rising or current fourth-year at The U. I am a very proud dog mom. I have Aussies. And I also tend to pick up way too many hobbies. So right now I'm currently doing a lot of pottery and Pilates, and it's been really hard, but interesting because I feel like as a med student, we like to be good at things and I suck at both. So it's been really fun to try and learn something new.

But otherwise, I'm super excited to go into fourth year and I'm excited to talk a little bit more about how that went.

Luti: And my name is Luti. I'm grateful that the "Bundle of Hers" would have me on the show with them. I am also a rising MS4 here at the University of Utah. And I am a kid dad. I have two little kiddos. They are 3 and one is 7 months now.

I am the self-proclaimed pickleball champion of the University of Utah School of Medicine. I don't know what that actually means. There's probably a lot of people way better than me, but it's a pretty fun game.

And I am Tongan by heritage and struggling to work my way through medicine in this very, very new world, but it's cool because I have cool friends to help me get through it.

Mariam: Yes. Shout out to all the cool friends in medicine. You guys are way cooler than me. I have no hobbies.

So I am really happy that you guys agreed to do this episode. I was talking to our Bundles crew and I wanted to do an episode about reflecting on third-year, or MS3 year, clinical rotation year. I think it's notorious for being one of the hardest years of medical school or one of the hardest years of medical training.

For those of you who aren't aware of medical school training in the United States, you have a total of four years before you get your MD. Your first two years, you are essentially in the classroom all the time and you're learning everything there is to know about medicine mostly in a classroom structure.

And then third year is the big year where you are finally going out and you're taking care of patients and you're essentially practicing what you learned in the first two years.

And clinical year is known to be perhaps one of the most challenging physically, emotionally, mentally years of medical school. And so Luti, Lilly, and I all just wrapped up our third year. We survived, you guys. We survived. And we just took Step 2, which was a nine-hour-long board exam, which officially wraps up our third year, and we are now newly minted MS4s.

And so this episode is largely going to be a reflection not just on clinical year, but just our personal experiences, especially as it's rooted in our identities and how that's shaped a lot of our clinical year and how that has also impacted how we want to practice medicine in the future.

So I like to start with opener questions. For both of you, if there was one word you could use to describe clinical year, what would it be?

Lilly: I would have to say growth. I think that there was a lot of growth that happened during third year, especially for someone like me where I experienced a lot of lows during the first two years of med school. I really questioned if I wanted to continue going through the curriculum. I definitely did not enjoy the classroom setting or the online aspect to school, and also just had a lot of things going on in my personal life that really made me question if I wanted to stay in medicine.

And so I kind of held out hope that once I entered the clinical years, it would be a lot better and I would feel a lot happier. And obviously, when you have higher expectations of things, you're more likely to be disappointed, which I definitely think happened in certain aspects.

But overall, I think the growth I experienced during third year is something that I definitely needed to go through to really recognize and understand if medicine was something that was meant for me.

And also, I think that you change so much over the course of the year in such small increments that you might not notice it, but that people around you will notice, and slowly by the time you get to the end, you'll notice.

Luti: I think what kind of came to mind was jigsaw.

Mariam: Oh, nice.

Luti: Sometimes, some jigsaw puzzles to me, they seem like they are really fun. Everything kind of fits together. A lot of times during third year, though, I felt like I didn't fit in. It was very difficult. It was very slow-going at times.

The idea that's kind of coming to my mind is that sometimes it flowed really well during third year. I felt like sometimes I found teams and found places where I just really fit in and I really enjoyed it. I really learned.

And there were other moments during third year where I just felt like it was kind of a challenge to really know what my purpose was in that team or what the heck I was doing there with the people there, if I even had a role there or if I was just being in people's way, just trying to fit a really, really weird-looking Tongan piece into a totally wrong jigsaw puzzle. But anyway, that's kind of my overall third-year experience.

Mariam: Yeah. I like how you kind of talked about not knowing what your place is as a medical student, because I think I spent maybe 75% of this year just trying to figure out how to take up space. And it was always a really challenging thing to do, especially on the wards because everybody there knows that you're a learner. And nobody really expects you to know anything, but they also expect you to know everything at the same time. So trying to fit into what those expectations are can be really challenging.

I'm going to be honest with you guys. This was my opener question, and then I didn't think about how to answer it, so I have to think about this.

I guess the first word that comes to mind is chaos. And I think you both kind of alluded to how I would answer this question. I didn't know what my place was a lot of the time. I always felt like my mind was being pulled in different directions trying to fulfill a lot of expectations on my team and seek out a lot of external validation from the attendings I worked with and the residents I worked with, and also the patients that I cared for.

But also, another thing, too, the chaos aspect of things came from the internal struggle, seeing if this was where I fit in, if medicine truly was for me. Luti, you mentioned trying to figure out what your place was as a Tongan person in medicine. Also, trying to figure out how my identity fit into this process as well, which is something we are definitely going to talk about today.

That kind of just leads into my next question. How have your personal identities shaped your experience of clinical year? Luti, I'd like to start with you. No pressure. But you kind of mentioned this jigsaw puzzle and there are all these different pieces that go into this puzzle that is third year. And you mentioned your identity as one of those big pieces. How has your identity as somebody who's Tongan, in addition to your other identities, shaped your experience of this year?

Luti: I don't know if there's a really perfect way for me to say this. So if I sound super all over the place, I apologize.

But kind of thinking back on third year, I saw maybe four, maybe five different Polynesian people in healthcare while I went through my third year.

It was so funny. I feel like every single time I saw one, I thought it was so fun. I'm like, "Oh, man, that's my auntie. That's my uncle. Oh, yeah, that's my cousin, guys." Every single time I saw some kind of Polynesian-looking person, even if they weren't Tongan and if they were someone or something.

But it's a very strange world, I think, being a Polynesian med student in medicine just because there are not a lot of us in there. It can be a little isolating in that regard. When I do feel like I'm somewhat alone culturally . . . I didn't have a single attending or resident who was Polynesian of ethnicity or anything, so I think the isolation definitely can be felt.

But I think, overall, I was able to use my traits as a Polynesian, just the values and the morals that I was kind of brought up and that my parents taught me and my cousins and all the community that they kind of integrated into me. I felt like I was able to use a lot of those strengths, and those were the things that kind of made me successful during my third year and able to connect with patients and maybe stand out as a med student with my team, because they haven't seen a Polynesian med student before.

And I don't think it just has to be Polynesian students to bring those strengths to the table, but I definitely think there was some of that there. I don't know if I'm clear about that, but . . .

Lilly: No, I really liked what you said, especially when you said isolation because that really resonated with me during third year. I feel like the majority of the time I felt very isolated, whether it was from my team or my peers or my loved ones. You just never can be the perfect person for everyone, especially when you are a person of color.

I myself identify as Afghan and I'm a first-generation student. And so there really isn't anyone to explain to me how everything works or just kind of walk me through what to expect. And so I think everything that happened during third year was just kind of a curveball and you just roll with it once it happens to you.

During my time going through all of the different rotations, I had two people who identified with the same ethnicity as me, which was the most exciting thing that I think I ever experienced in medicine, was finally seeing a provider who looked like me and who spoke the same language as me. That was really exciting for me, but definitely far too few and in between.

And obviously, when you have this kind of expectation of what you think it looks like and what it's going to be might not always be what it is. So even when I would find that representation and get super excited about it, the clinic would be so busy or we'd have so many patients that you really couldn't sit down and have that deep heart-to-heart with this person who doesn't know you.

And they'll probably never know, but it meant so much to me to see them in that space that I could finally start to maybe see myself a little bit more in that space.

But on the normal day-to-day going through my rotations, sometimes I would be the only female in the entire room, whether it was in the OR or on the care team.

And sometimes, when we go talk to patients . . . I myself speak English as a second language, and so navigating the healthcare system on the other side of the stethoscope, I've just seen so many times where there's been communication breakdown and the loss of justice and autonomy and informed consent with patients.

From my own family and just being in the doctor's office with my parents, being on the other side of the stethoscope and sitting in the room where we're talking to the patients, I would just see these kind of repeated patterns where providers will be talking to patients using what they thought was more basic English, not so much medical terminology.

And they thought that they were really getting their point across to the patient, but even I could just see in the patient's eyes that they had absolutely no idea what the doctor was talking about. And sometimes they would try to navigate conversations with patients where their preference would be to have an interpreter. And so I think as the medical student, it's being able to kind of notice those small things.

Usually, like Luti was saying, when I'm in the room, I don't know what I'm supposed to be doing. I don't know necessarily what I'm contributing to every single patient. And sometimes you just don't want to be in the way or overstep in any way.

But definitely, as the year went on, I started to realize it's okay for me to pick up the phone and call an interpreter and put them on speaker and just have it available. Otherwise, we're going to go through this whole 30-minute conversation with this patient and we're going to leave thinking we did such a great job, and then they only understood maybe a third of what we said, which is a horrible, horrible feeling. You leave and you feel like you didn't do anything right for them.

And so I think having all those experiences on the other side and knowing what it feels like when the provider leaves and you feel more confused than before they walked in really helped me acknowledge that very early on and try to somewhat address it without being like, "You're doing this wrong and this is inappropriate."

Mariam: Yeah, I can relate to a lot of what you both said as well. I think this year was really interesting. Like I mentioned, it felt really chaotic. And I mentioned a little bit my internal struggles too.

Something that I have been talking a lot to my peers about is just going into medicine, we had these set of values that were rooted in our identity. And I don't know about you guys, but I was pretty . . .

I was reading my personal statement the other day that got me into medical school and I was like, "Wow, I was so connected to my purpose and my identity."

I've talked a lot about my backgrounds. My mom is from Afghanistan. My dad is from Iran. I'm from Georgia. I'm from the South. I feel like I have all these intersecting identities that have really informed and influenced who I am, and how I want to practice medicine, and why I pursued this path to begin with.

And I was reading this personal statement and I was like, "Oh my gosh, I was so self-assured." And now, after going especially through third year, you see a lot of the things that you preach about that you care about put into practice in the healthcare world, and sometimes it doesn't translate in the ways that you thought they would.

And I can give an example. I think stories are very powerful. When I was on my family medicine rotation, I was at a clinic that actually would see a lot of Afghan patients.

I don't know what you guys thought about family medicine. I loved it, but I never had any idea what was going on. Family medicine, you could get just a broad range of things, which is what's exciting about that specialty, but also really challenging.

We had an Afghan patient at the very end of the day. We were taking patients later in the evening. Everybody was so exhausted, including myself. It was Hour 12, a busy clinic day. And I see this patient, not even realizing she's Afghan, by the way, until I read her name and she had an Afghan name and I was like, "Oh my gosh, she's Afghan."

I was really excited about this patient. But she had a really complex chief complaint and I was like, "I don't know how I'm going to help this person."

And long story short, I went back to the attending and we were kind of talking through differentials and what next steps would be. Again, long story short, I left clinic that day just feeling extremely disappointed that I couldn't give this patient a lot of answers.

It was kind of just an interesting reflection because I thought it would be just this beautiful experience being able to connect with Afghan patients this year. And I have had beautiful experiences connecting with patients from my community. But also, at the same time, having to figure out how to fit that role of medical student and how to also integrate my own personal values too, I feel like that's been the most challenging thing about third year.

Luti, you were talking about how something that you did this year takes some of the values that you have in your community and implements them into the clinical world. I'm just curious, do you have any specific examples for our listeners who are kind of wondering how to do that?

Luti: I was just kind of thinking back on some patients that . . . When I was over at Primary Children's, I had one patient. To this day, it was one of my favorite patients to take care of.

To kind of frame this, I always felt like whenever I saw a Polynesian name on our patient list, I would always want to take care of those patients just because it was always fun to walk into those rooms and they'd be like, "Oh, man, who are you?" I'm like, "Oh, I'm a medical student." They were just super surprised because they'd never expected it.

They meant a lot to me and I felt like they were really meaningful interactions with these patients. We really just talked a lot about family and who they know at home and who do I know. And we always connect the dots pretty quickly just because it's a pretty small community.

Honestly, we talked a lot about different kinds of foods we loved. That was super effective because you don't get that kind of food in the hospital. So it was kind of just a good way to connect and make them realize that we're human too on the caretaker team, from the providers. We are human, we understand them, and we definitely are not just robotic people trying to just provide care and medicine and therapies here in the hospital.

But those are a couple of things that kind of comes to mind right off the bat.

Mariam: Yeah. Luti, we are going to work on you validating yourself. Somebody's going to hear this and be like, "Luti is awesome. And now I want to apply to medical school because I can be a full person in third year."

And this is, again, why I wanted to do this episode, because reflecting on third year is, "How do we remain true to ourselves in medicine?" I think that's the biggest danger, is losing parts of yourself in this process.

Luti, I think it's really beautifully said that being able to just stop being this clinical and medical person and being able to just be a human with somebody is actually a very healing experience, and especially in a lot of different cultures.

I think back on that example that I gave with the patient that I had. My experience was kind of the opposite. I have big regrets that I couldn't let my guard down and ask more about this patient's story because I was so caught up in trying to be a good medical student.

Lilly: Yeah, I think about this a lot, especially when we have these conversations around family. Growing up, my community is the patients that we are currently serving. I grew up in this 15-mile radius. All of the hospitals that we rotate to are hospitals where my family members have been hospitalized, where I've seen people be born and people pass away in my family. And so there's something really beautiful, but also traumatic about that.

And so I think walking through the halls of the hospital, I really feel that sense of, "These patients are here on the worst days of their lives and we have the privilege to be the people that they interact with. And so how do we make this a little less hard of a day for them? How do I make these patients or my team members feel like they're safe and cared for?"

I really liked what we talked a little bit about when it came to your family and how your cultural values really play into that.

And so going through the year, you're constantly changing your rotation, your team. I mean, almost every week you have a new person who has their own set of rules and their own way of viewing the world and the way that they want you to do things. And you feel like you need to be more pliable.

I for one definitely felt like, "Okay, I need to adjust the way that I interview patients. I need to adjust the way I write my notes about patients because that's how my attending wants me to do that." But also, I don't want to change the way I speak to patients or how I check in on patients, regardless of whether or not this attending cares.

And so for me, I always put myself in the shoes of "What were moments in care that my family members received that really stood out to me being the child or whatever and seeing this happen?" I really, really loved it when people were vulnerable and people would share things and people treated me the way that they would want their family members to be treated.

And so just small things that I feel like build community with patients in your team is just genuinely showing that you care about them.

When I was on my neurology rotation, we had a patient who was there and I would just go check on her all the time because she was my one sole patient. That was my first time really having that ownership, and so I wanted to make sure that she felt really cared about. And so I'd regularly go sit with her and chat with her.

As a med student, you don't know if you're allowed to do that. Is that okay to just walk into this patient's room and sit with them? What if I'm bothering them? What if it's annoying?

But I just remember all the times that I was in the hospital. It was just so nice to have someone come check and talk to you outside of just drawing your blood and seeing what your vitals look like.

And so we'd sit with her and paint her nails, ask her what she's going to do when she leaves. And I feel like those were ways that really built rapport and trust. As a medical student, I just feel like I don't have any of that type of authority or ownership to be able to build community.

But in reality, they always say during third year you have no control over your schedule, your calendar, where you are, what you do. But at the same time, I feel like out of everyone on the team, we have the most control over what we do because we really aren't going to make or break the team. Whether I'm there or not is not going to stop the wheel from turning.

But at the same time, because of that, I am able to just blend into spaces and create space for myself, which is really hard, but at the same time, if I do go sit with a patient for an hour, no one's going to really be mad at me because I'm still doing something that's important to my learning and my education. And I think that's what makes a big impact on patients.

One of the things I really hope to do in the future is work in more community health center and underserved community-based practice. And so I got to rotate at one of the free clinics here in Utah, and it was kind of interesting because we'd have patients coming in who hadn't seen doctors in years and I would see them.

Because I was a med student, my attending would say, "Oh, yeah, take 40 minutes to interview this patient," when usually appointments are 15 minutes. He'd be like, "Just take your time. Do a full physical exam. Really get as much learning as you can out of it," which was so generous and kind, but that also meant that I got to spend 40 minutes getting to know this patient.

And I just remember at the end of one of my appointments, my patient who was Spanish-speaking was asking the interpreter . . . She was like, "So I'll see you next week, right?" And I was like, "I'm just a med student. I won't be here next week." But she really wanted to see me next week.

I thought that was so interesting because we think we have such little say or such little effect on patients, when in reality, because we have that flexibility of an undefined role, we can make that space for ourselves.

So, for me, I think community building is really that one-on-one individual time where you really connect with people outside of their disease, outside of their lab tests, and outside of what they're treated for.

At the end of the day, this could be someone that I see in the grocery store and I never knew that all of this happened to them, but I still want to treat them with the same dignity and respect that I would want anyone to treat my loved one who was in the hospital.

Mariam: Well, this is why I think it's so great to have you guys here, because I think every time I've had a conversation with you guys about medicine, it really goes back to how we feel more connected to our communities outside of medicine and also how we can find that community inside of medicine.

And it's less about performing, because there's so much . . . We've talked about this a lot on the podcast. There's so much pressure to perform in this system. And a lot of that pressure to perform is rooted in a lot of white supremacist ideals, right? Medicine is wrought with a lot of problematic racist norms. And so the ways that we're pressured into our training is sometimes to just kind of adhere to those values and almost neglect some of our own.

I thought it was really powerful, Lilly, when you said, "I wanted to treat the patients the way that I would have wanted my family members to be treated," because I feel like we all come from backgrounds where we saw a lot of our family members get mistreated within the medical system. What's the whole point of us being here if not to create those spaces for our own patients?

Luti, I was wondering, has this year shaped how you want to practice medicine? Has it changed how you want to practice medicine?

Luti: I do feel like it has shaped that humanistic part of the kind of doctor and provider that I want to be. I do want to go into a more surgical career down the road, but I do feel like I never want to forget connecting with these patients and really just making them feel like they're human, we're human, and we want to understand each other and provide the best care that they need to make sure that the patient knows that I care for them like they were family.

At times I shed tears with some patients and I was like, "Oh, man, maybe I'm just a crybaby." I don't know if we actually felt like we were family, but it kind of felt like that when I was taking care of them.

I want that to be the relationship I have with every patient I have in the future. I know it won't happen and I know there will be some situations where patients might be a little angry with the care team and the care provided or with the decisions that they feel like are decisions that they don't want to have. But I honestly hope I can always remember that humanistic part of medicine going forward.

I feel like that's the most important thing within medicine. I feel like it's super healing. And even though we think that the way that they're going to heal is just with the medications that we give them and different therapies that we might provide for them, I do feel like healing mentally, spiritually, holistically comes from when we just connect with them as human beings.

Mariam: Yeah. And by the way, if you've cried with your patients, then that's just a beautiful thing. You should feel so proud of that.

And your patients, especially if they come from your communities, are kind of like your family. I know that if I have an Afghan or an Iranian patient and they know that my parents are from either of those countries, they do expect me to speak Farsi with them or to share my background with them. They feel entitled to that.

It's a very validating feeling almost because you're like, "Oh, thank god. I can stop being this robotic med student and I can just be myself." And I can practice healing in a way that I think is very unique and very special, because there's so much healing in connection.

And the work that we're doing is healing work. Just like you said, it's not just prescribing medications and having them come back to check their A1C and their blood sugars and stuff. It's about establishing these relationships, and you can do that in any specialty.

And I think being a doctor gives us a really unique position of power to do that. But I think it's really exciting to have a generation of medical students like ourselves that wants to bring back that aspect of community and those values that we had in the communities that we grew up in back to medicine.

I think that's the ultimate . . . Oh my gosh, I'm getting goosebumps, you guys. Sorry. But I think that's that ultimate experience, and I think that's going to bring a lot to our patients in the future.

And I think this year is a really challenging one, but I think it's a really good year to reflect on for those who are interested in medicine or doing something similar. These types of years are really interesting because there is a lot of growth that comes in these years.

Lilly: And I really, really loved how Luti talked about crying with his patients, because it blows my mind when people don't cry in certain situations. I just feel like the inner human in you is going to just react to what's going on.

I mean, when I was in a patient room and this family was just trying to understand why their child was starting to lose a lot of function and personality and all these different things, the doctor had to slowly ease them into the understanding of the fact that this is the first few signs showing that her body is shutting down from her cancer.

And having that conversation and then having him kind of address that and then also start talking about how brave and how strong she is, I just couldn't even fathom a single dry eye in that room because it was just such an emotionally difficult thing to go through. I definitely was crying and emotional and had to debrief with my attending afterwards.

I don't know why some people have this perception that we shouldn't treat people the way we would treat family members because that makes us too sensitive or too close, or we shouldn't cry with patients, because at the end of the day I feel like why wouldn't you want a provider who's going to treat you the way they would treat their family member? Doesn't that mean that they're going to do everything possible to take care of you? That's how I view it, at least.

And if my doctor doesn't cry with me when something horrible is happening, it really makes me wonder if this is just another shift for them and I'm just another number. You know what I mean? So I thought that was really beautiful.

I think as far as how third year impacted the way I want to practice, it's kind of a twofold thing of how I want to practice with patients, but also what it would look like for me as a professional in the field.

When I was on my family med rotation, they would do this thing called Women in Medicine where they would get into a conference room once every few months. I wish, obviously, it happened more often than that, but it'd be once every few months, and I was just lucky enough to be there during a week where they were doing it.

And they had a very, very vulnerable and very intimate conversation with all of the women staff just about how they were doing and just checking in with them about their mental health, their physical health, and just how everything was going in the last few months.

It was a very heavy conversation, especially as someone who had just started that same week, to hear how these people were sharing about some of the things they were struggling with, especially with mental health.

We see it in the news all the time about residents. I think over 300 residents have committed suicide during residency, and that's just baffling to me. And so I think that having this conversation and having people talk about struggling with these thoughts in this space with their colleagues and with attendings and with other team members there really opened my eyes to the fact that we should be having these conversations before it's too late. There should be a space where we can have these conversations.

And that's something that I definitely will be actively looking for when I'm applying into residency, is what will that support look like for me on the other side when I'm no longer a student and I no longer have some of those resources that we have. When your team really does become your family, how will I be practicing in that team and what does that look like?

And then on the other aspect of just being in the medical field as a doctor, I had these really high expectations of finding a woman of color that would really mentor me and really be that person for me, take me under their wing, treat me like their little sister, and really invest in me and give me all the time in the world to feel like I belonged in that space.

Then each time that opportunity came by during third year, I had such high expectations of it happening, and then it didn't happen. Or worse, it was the complete opposite and I felt almost like they couldn't care less if I was in that space or not, even though I felt like I'd worked my whole life for this huge monumental moment to happen that just never came.

And I think I had to step back during third year, especially after all that had happened, to recognize that women of color are working in the system that I'm also struggling to just get through. They've been in this system for much longer than me, and there is so much systemic racism that they experience on a day-to-day basis that sometimes they're just trying to survive and get through the day. They probably have so many things going on that honestly they don't have enough in their cup to pour into mine. And I think that was a really hard pill for me to swallow because I wanted that so, so badly.

And so I think going into the future of how I want to practice medicine is I definitely still want to be that role model, to be that mentor, to take people under my wing, to do the whole leading by example.

But at the same time, I think giving a bit more grace to the fact that we have all these difficult experiences that make us sound like, "Wow, you've been through so much. You're so resilient."

But at the same time, resiliency doesn't mean that you have somehow persevered and you're on the other side and you can give back to your community. It also means that you're still kind of in the trenches going through it. And I think it's just being kind with myself, that that's something I may or may not be able to do and that's okay.

Mariam: Very beautifully said.

Luti: I agree.

Mariam: Third year is just very eye-opening in that way. And thank you both for sharing these perspectives. I always get a lot out of these conversations.

I wanted to kind of tie up this episode by ending on more of a reflective piece. A few episodes back, we did a "letter to your younger self" episode where we essentially just . . . If we could write a letter to our younger selves, what would we say?

That was a really cathartic and powerful experience, and so we're going to do something kind of similar today except it's a letter or thoughts to our future selves. So, essentially, what would you say to future you as a resident or attending or as a human?

Luti, not to put you on the spot, but would you like to go first?

Luti: I think ladies should go first. I think Lilly should go first.

Mariam: All right. You know what? I'm the host. I'll do it. I wrote a letter because I am formal like that.

Dear future of Mariam, hopefully when you're listening to this you're not cringing super hard at listening to a younger version of yourself on a podcast. Present me is in a very stressful and tumultuous time of life thinking about the future and family and missing community.

I hope that when you read this you're able to look back and say everything worked out. I hope you're surrounded by people you love and that you're centering community in your work. And above all, I hope that love and connection continue to be the primary motivators of everything you do.

If you're still in medicine, I hope you're finding balance and purpose for yourself. If you decided to quit for whatever reason, I hope you married rich. Ha-ha, JK. I hope you're still as funny as your past self. Lots of love. Past Mariam.

All right. Lilly, you ready?

Lilly: That was amazing. I don't know how I'm going to follow that. Okay.

So, first of all, congratulations because I really doubted I would make it to match, let alone residency. That is a huge feat in itself.

I imagine residency is challenging. You're probably feeling overworked, exhausted, and sick of eating stale foods out of vending machines in the hospital. I wonder if after the 20th paycheck you stopped feeling the excitement of being a newly minted doctor and instead questioned how you'd ever pay off all of your debt.

I hope this letter serves as a reminder of the 20-something-year-old version of yourself that questioned you would even get through those first few months of school. You survived hundreds of hours of studying, answered thousands of practice questions, worked in dozens of specialties, and finally made it to the summit point that is graduation.

I hope your program is kind to you, your co-residents are welcoming, and you serve patients in your community. I hope you drive into work and feel pride and warmth in each patient you get the privilege to care for. Also, I hope you call home more often than you think you should.

Mariam: This is a PSA, everybody. Call home.

Luti, what would you tell your future self?

Luti: I have just a little bullet point. So it's not as structured.

Mariam: That's great. Future Luti is going to be like, "Yes, we still do bullet points."

Luti: Dear future Luti, I hope you are feeling successful, but not just in medicine, in every other field of life, including being a father, being a friend, being a husband, and being a mentor to other people who might need you.

Medicine is important and I think this field very much needs loving and caring and genuine providers. But don't forget that you are a much bigger person outside of medicine and your family needs you, your friends need you, and you need you. So don't forget that.

And always remember that you come from a very rich heritage of people whose sacrifices have allowed you to be where you are. Don't forget them, and also remember that your kids also rely on your sacrifices to be able to stand and be successful men and women one day as well. And I think that's it.

Mariam: Well, this is great. Thank you guys so much. I think we're all going to be such great doctors, if I do say so myself.

I'm so happy that you guys were on this episode. This was a great conversation.

And thank you to all our listeners for tuning in. You guys can listen to our podcast episodes on whatever podcasting app you use.

And if you aren't already, you can follow us on Instagram @bundleofhers for all of our latest episodes, cute pictures of us. I don't know. Maybe there will be a cute picture of me, Lilly, and Luti on there.

Yeah, is that it, Chloe? What else do I say at the end? Oh, okay. Everybody, say bye on three. One, two, three. Bye.

Lilly: Bye.

Luti: Bye, guys.

Mariam: Jesus.

Lilly: I'm literally sweating profusely.

Mariam: Did you get that? Lilly's back is literally sweating.