S7E1: Authentic Exploration in Medicine

Introduction

Hạ: It's weird being a working bee. But hello. Hi, dear listeners, Bundlers. Is that what we call you all? Bundlers? But anyhow, hello. It is Season 7. Woohoo. Can we have some cheers in the studio here?

All: Woo.

Hạ: Yeah. Great. Amazing. Hearing this voice, you might think, "Oh, this voice sounds pretty familiar." And if so, you are correct. This is Hạ. I have been here for a couple of seasons. If the voice doesn't sound familiar, then I'm really sorry. I don't know what to say about that. I guess you've just managed to skip every single episode I'm on. I won't be offended.

But I have two new voices in the virtual studio today who I'm really, really excited to have join me, and I'll let them introduce themselves.

Austen: Hi, I'm Austen. I'm a second-year at the medical school, and I'm so excited to be joining "Bundle of Hers."

Lilly: Hi. My name is Lilly, and I'm a fourth-year medical student applying to neurology. And I'm really excited to be back on the podcast as a regular host.

Hạ: We are so stoked to have Austen and Lilly with us joining in as some of our new co-hosts. As you may or may not know, Margot, Harjit, Leen, and Lina have decided to move on, and we will really miss their voices dearly. They have been such powerful people to have on our podcast and they have really helped guide the podcast in wonderful ways.

But we are so excited to have new voices, including Lilly, Austen, Laurel, and Alizah, who you will be meeting as the season progresses. And of course, our good old Mariam and her cat, Timmie, will be joining our podcast for this season still. So be stoked. Follow @timmiejoon on Instagram. Always have to fit that plug.

Exploring "Bundle of Hers"

But for some of our listeners, this might actually be the first time that you're listening to "Bundle of Hers," even though this is the seventh season. So for Lilly and Austen, how would you describe "Bundle of Hers" in a few words for our new listeners?

Austen: I feel like "Bundle of Hers" has been a podcast where you can come and not only listen to the experiences of others, but really share and bond over those experiences.

I feel like even though all of the hosts have had different upbringings and distinct identities, I feel like there's a lot that we can learn from one another and a lot that we can really bond over and connect with.

And so I feel like "Bundle of Hers" is a place where you can come and listen and connect to people whose stories might not be exactly like yours, but you can always learn something.

Lilly: That was so well said, Austen. I feel like when I'm listening to the podcast, sometimes I find myself . . . Usually I'm listening when I'm driving and my eyes get super wide and I start aggressively shaking my head, agreeing with exactly what they're saying or thinking about a similar story or experience that I've had and just thinking, "Wow, there are people who have felt the way I've felt."

And I think sometimes you have those kinds of conversations with your close friends where you guys just get more and more excited and vocal and loud about whatever it is you're bonding over.

I think "Bundles" is like that because we're sharing these experiences that you don't hear a lot about in medicine that should be heard and should be listened to. And I think that it's something that's just really great to resonate with and feel like you belong.

Hạ: Love that. Retweet. This is so great. See. Oh, my heart. I'm just so stoked to have you two on board. And every time you say something, I just feel all warm and happy inside.

But instead of focusing on my fuzzy feelings, we do have an episode to chat about, because this is our premiere episode, which is very, very exciting, and it means it's a chance for us to introduce the theme for Season 7.

For context, throughout all of our seasons, we like to have a theme that helps guide the ways that we approach or think about the episode topics that we do throughout the season.

Last year, last season, we were focusing on identity and finding power from identity. And I believe the season before that, we were focusing on radical honesty. And so this season, we have a new theme that we're super excited about. Lilly, do you want to do the honors of announcing it to everyone?

Lilly: I would love to. So this year's theme is exploration and discovery, which sounds so perfect and on brand.

So when I think of exploration, I think of two different kinds. One is where you're kind of dipping your toes to see if you like something, and the other one is kind of when you dive straight in and have no idea what you're going into. It's kind of like entering an abyss. And for me, I feel like I'm going through that right now with applying for residency and interviewing in all these different states.

And then discovery feels more like figuring out who you are and who you want to be, which I also feel is happening a lot with just where I see myself in the future and how I can get there.

Austen: I love that, and I completely agree. I feel like when I hear exploration and discovery, I feel energized and I feel motivated. I feel like those two concepts are inextricably linked. I feel like you cannot have a new experience without learning something either about yourself or someone around you. Or I guess people could theoretically have a new experience and not learn anything, but I feel like that's generally pretty rare.

But I feel like even though they're so linked, they are distinct entities. So I feel like exploration focuses on new experiences. It focuses more on the process and the opportunity to learn, whereas discovery is actually learning lessons from those experiences, and putting those lessons into practice kind of thing.

And so I'm excited that this is the theme of the new season, because I feel like there's just so much that exploration and discovery can apply to, whether it be about personal exploration and discovery or professional or whatever it may be. So I'm excited about this new season and this new theme.

Hạ, how about you? Whoa, that sounded insane. Sorry. Take 2 of that. Hạ, how about you? What are your thoughts about this year's theme?

Hạ: I feel that it is very much in line with a lot of the themes that we've been exploring throughout past seasons, which are still very identity-based. But I also really like how, as you both alluded to, or I guess actually you've explicitly said, is that it kind of feels like exploration and discovery is really hitting both sides of the coin.

It's really encompassing all of a person's identity, and also really encompasses the turbulent journey that it means to be someone navigating the healthcare system, navigating medical education, and also navigating life in general. I feel life is just about exploring and discovering, and then re-exploring and rediscovering. So I was really, really stoked about it.

I'm excited this premiere episode is coming. We're recording and it's getting released at a really nice time to start thinking about the theme, because it is the start of 2024. And as we all know, everyone loves to reflect at the beginning of a new year.

For some context, this premiere, we're going to particularly focus on the word "exploration," and the finale, which will be led by Alizah, Laurel, and Mariam, will focus on discovery. So it's kind of a fun, cute bookend-y way of doing it. We're so literary. We love it.

Austen: Yeah, so cute.

Hạ: Also, FYI, I feel like outlines are there to help guide the convo, but they do not define the conversation. So we can go off or on script as much as we like.

The only thing in this outline that is necessary for me to say is that my views do not reflect those of my employers or my coworkers. I do not reflect you. Please do not sue me. Thank you. That's all I have to say.

Balancing Identity and Medicine

We're called "Bundle of Hers." We relate to medicine. Our whole title is a pun of "bundle of his," by the way, for anyone who didn't quite figure out that that was the pun for these seven seasons now. So I think it's always good as we're thinking about exploration to start off about what exploration in medicine means. How do you two feel about having that convo?

Lilly: Well, first, I want to start off by saying as well as a happy new year, it's also almost Lunar New Year for Hạ and everyone else who's celebrating. So if you are celebrating that, happy Lunar New Year.

For me, our new year is actually in March. So I think I have a little bit more time to manifest and think of resolutions.

But when I really think about exploration, I am mostly hyper-fixated, as most fourth-year medical students are right now, on residency and where I could possibly end up this coming June or July.

I just finished completing all my interviews for residency, which is a terrifying time for anyone who is pre-med or new to kind of understanding what happens in med school. But during your fourth year, you basically apply all across the nation in hopes of getting a spot to work as a resident for four years, or three, I guess, depending on your specialty.

But you go to a different hospital, and you learn how to be a real doctor, which Hạ is doing right now. You're basically focused on figuring out what kind of doctor you want to be, and where you can learn and grow. You interview at a bunch of places and then you hope that somewhere will take you and you'll match into the residency the same way that they want you to get there. Well, I'm not explaining this very well. Probably because I don't understand it well myself.

Hạ: I think you're doing wonderfully.

Lilly: So basically, it's kind of like toxic dating. You hope they like you as much as you like them. You make a rank list of all the programs you like in order of your top program. And then the programs that you interview at do the same, and you hope that you're just as high on their list as they are on yours.

So it's kind of terrifying because you don't actually know where you'll end up. And for me, I feel very split. I'm interviewing all across the nation, so when I think about exploring the next four years, it could be quite literally anywhere with or without close support or family.

It's just a lot of changes, as someone who's only ever lived in this 30-mile radius of Salt Lake City, Utah, my whole life. It just seems like a lot of "into the abyss." So for me, I think going into the next couple of months and the rest of the season, it'll be a lot of unfolding of where I'll end up, what kind of physician I'll be, what kind of people I'll be around, what mentorship will look like, and hopefully finding somewhere where I'll feel very included and safe and welcome.

Austen, what do you think?

Austen: I feel like I have a lot less to explore now that you've explained what your 2024 is going to look like.

Lilly: You can cut half of that first part out. It didn't even make sense.

Austen: This will probably be the biggest year of my medical education yet. As a second-year, I'm finishing up my didactic learning, which I've enjoyed so far, even though that might be an unpopular opinion for some people. And then I'll be taking my first board exam, which is terrifying to think about. Then I'll be starting my rotations, and that's also kind of terrifying to think about, but really exciting.

I feel like, up until this point, I've been learning how to diagnose common illnesses based off of illness scripts and common symptoms and all this stuff with the hopes that one day I'll be able to help someone. And I feel like come June, I'll be able to help people. I won't be diagnosing anyone or treating anyone alone, but I'll actually get to see patients and interact with people and hopefully have a positive impact on the people that I do interact with.

And so I'm excited about that, as daunting as that seems, and I honestly can't think about it for too long without getting a little bit stressed. As daunting as that seems, I'm so excited.

I've had a good experience in medical school so far, but I feel like I'm ready to start doing. I'm ready to start learning in a new way, having new experiences and really pushing myself to grow. And I feel like clerkships will help me do that. And so I'm super excited.

But in preparation for that, I feel like this year I'm trying to focus on being a more efficient student and kind of a more efficient human. Not efficient in the ways that people think about productivity normally. I think the student part, yes, I want to be as productive as I can be with the little time that I have. But as far as being an efficient human, I feel like medical school is such a weird time of life because it's like you have to be selfish so that you can learn how to help other people for the rest of your life.

And so I think in my pursuit of knowledge, I have kind of let some relationships kind of change in a way that I wasn't expecting. This year, I want to focus on being an efficient student, but an efficient human with my relationships, really using the time that I do have to build those relationships up and continue to develop the relationships that mean the most to me.

What about you, Hạ?

Hạ: It's really interesting hearing you both talk about what you're trying to explore and what you're thinking about within medicine. One of the common threads that I'm noticing is a lot of it is kind of thinking about balancing, with all of the demands that medicine has for you, where your values are and what is most important to you.

It really resonated when you were saying, Austen, about being an efficient human and trying to think a bit more about your relationships and how you're able to bring other people into your life.

And also, similarly, I really understand what you were saying, Lilly, about looking at all of these different places and trying to figure out where is the best fit for you.

I am really trying to explore the best ways for me to really stay true to my values. It's so annoying with medicine because I feel like you're always looking at the next stage and you're always kind of preemptively planning and trying to figure out what's next, and it's hard to live in the moment.

But a lot of times, I think now as a resident, after all of medical school thinking about getting to residency, I'm now trying to think about what it means after residency and what I want in my life clinically.

And so I've been trying to think a lot about what practice settings would work best for me. And it's very helpful that the program that I'm at is multi-site and we rotate at a private hospital, we rotate at a county hospital run by the Department of Public Health in the city, and then we also rotate at a more academic setting.

Rotating through those three different settings and functioning as an intern, having to take a lot more ownership in patients, it's made me think a lot more about what frustrates me and what fills my cup.

And then also just starting new stages, it means that I've continually been exploring what it means to be a resident and what it means to exist in the hospital system.

And also trying to rethink how I identify myself. In the hospital, I introduce myself as the doctor, but I don't really feel like a doctor half of the time. I sit there and I think . . . especially in June, I was like, "Wow, just one month ago, I couldn't sign this order for acetaminophen or ibuprofen." And then now I can totally do it and it really gives me anxiety.

And so it's been a lot of trying to navigate that. It's just really interesting because I feel that medicine is rooted, and our field as a whole is rooted in the concept of exploration. That is how we have all the medical advancements we have. But I never thought about how that exploration that we talk about in medicine . . . there's so much more complexity with it when you start bringing in values and interpersonal identities.

Adaptability and Growth

Lilly: I feel like listening to Hạ share and Austen share makes me really think about how much I'm in the middle of both of your explorations. And it's just so interesting to see how much your life changes in a year and you don't even realize it.

The things that you worry about, you somehow adapt to, and things that I'm already worrying about, Hạ is already starting to adapt to. It really makes me think going through medical school really forces us to be very malleable and adaptable, and forces us to explore in ways that we might not necessarily want to.

With Austen, I feel like it's so great that you're already thinking about wanting to prioritize your relationships outside of medicine, because every year you just get busier and busier. And when I'm in the hospital, the residents are always like, "Go home. Take the extra time to spend doing something you enjoy, because when you're a resident, you won't be able to go home. No one will be dismissing you until your work is done." And I feel like that just continues to kind of snowball as we go through our careers.

And so I think the fact that you're already thinking about those things is going to really help you be successful in doing that. I also really worried about that going into clinical rotations. And I felt like without really noticing it and feeling like I was still kind of failing at it, I was able to slowly make time for those things.

And then all the things that I worry about looking into residency that Hạ is already navigating, it's like, "What will that community look like? How will I navigate the medical system and all of the weird bureaucracy that comes with practicing and being a real physician?" And so I think it just really shows me at least that we're always exploring and it's really uncomfortable.

Austen: No, that's fair. This is Austen, by the way. I don't know if I should introduce myself. I feel like you both brought up such good points. I feel like the field of science in general is always changing. The landscape is always evolving, and so that forces the participants within that landscape, the participants within those professions, to have to evolve and adapt.

And I think one of the cool things about medicine, as frustrating as it is to be in a field that is constantly changing, is that it also gives us the opportunity to evolve and grow with the field, which is cool.

I loved how Lilly mentioned adaptability and being adaptable, because I feel like exploration is only possible if you're willing to be uncomfortable, if you're willing to go through those growing pains and be put in a situation where maybe you're worried because you don't know where you'll end up, or you're frustrated with whatever system you're working within. But I feel like adaptability really helps turn normal experiences into opportunities to grow and develop.

And as frustrating as it is, I think that's probably the part of medicine that I am most excited about. I feel like it'll keep me busy. I won't get too bored because I won't have time to be bored. I'll have to keep moving. And so hopefully it works in my favor, but we'll see.

Hạ: I think one of the most beautiful things about medicine that can also sometimes be hard and frustrating is it is such a humanistic thing. It's rooted in humanity, and humanity is messy and humanity is unpredictable.

Chloé had texted me earlier today asking, "Are you still on for the episode today?" And I texted her back and I was like, "Well, clinic has been kind of messy, but yes, I will get it there." And the response I got back was, "Wow, why do I always feel like pediatricians have messy clinic days?"

Yesterday I was texting my internal medicine resident friends and they were also like, "Clinic was so messy today." So I think it's just humans are messy, but that's what I also love about humans too, is our messiness.

Austen: Definitely.

Lilly: That's why I kind of get nervous when I hear about all these things that AI can replace, on a total completely random tangent, because I just feel like there's nothing that can really replace a person sitting next to your bedside and holding your hand or looking you eye to eye and telling you, "This is the results of whatever," or, "This is your options moving forward," or, "This is your diagnosis. How can I support you?" or, "We're going to start having conversations around quality of life and end-of-life care."

As eloquently or as perfectly and as grammatically correct as an AI could possibly put that together, I still don't think it would hit the same as us as humans having that interaction with our patients. And I think as a patient, I would want that still. And so I think it's okay to be messy.

Hạ: That's so true, and so beautiful, Lilly. It is so interesting because we operate in a very messy field. We are always constantly being forced to adapt and to grow. And then that kind of makes me think a bit more about exploration, not just in medicine too, but also more personally, exploration for ourselves. "Bundle of Hers" is also not just a podcast about medicine. It's a podcast about identity and about the human experience.

Austen: I think I was talking to Chloé about this during our mic check, but I feel like being on "Bundle of Hers" not only gives me the experience to come and share my views and share what I think, but really take a step back and reevaluate everything.

I think sharing ideas, viewpoints, and perspectives, if you go into it with an open mind, can only enrich your own perspective and broaden your own viewpoints.

And so I'm excited about "Bundle of Hers" and about continuing my exploration in this avenue, not only through whatever I'm learning in school or whatever I do in clinic, but actually being able to kind of sit down and digest my thoughts and experiences and then come and listen to the thoughts and experiences of other people who I admire and people who might think different than me.

I feel like when we're in a system that kind of forces us to continue to evolve, I think that's good, but it can definitely be exhausting. I think it can be tiring and it can take a toll on you physically and mentally and emotionally.

And so I feel like with exploration, it can be good and it can produce a lot of good, but checking in with yourself and seeing where you're at can be so critical so that you don't feel completely steamrolled by the process.

I think growth is good, but you never want to lose yourself because of your surroundings and because you're being stretched to the point where you don't recognize yourself anymore. And so that can kind of be the downside of . . . I don't want to say forced exploration, but exploration as a by-product of an institution or a system outside of your control.

But I feel like there are ways to kind of mitigate that hopefully. And I feel like "Bundle of Hers" will be one of the ways for me where I'll get to kind of process things and talk about things and learn and grow, but kind of learn and grow on my own terms because I'm actively looking to learn and grow. So I'm excited about that.

What are your thoughts, Lilly?

Lilly: I really liked everything that you said, and it really made me wonder. Correct me if I'm wrong, but it also sounds like you're kind of alluding to this hustle culture that we have of just "go, go, go" in medicine. And sometimes no one even thinks twice, especially in rotations, to ask, "Did you eat? Did you go to the bathroom? Are you okay?"

Sometimes you really have to force that into the routine because I've noticed no one is going to say, "Oh, now is your lunch break," or, "Oh, go get a drink of water." You really have to advocate for yourself and be like, "Hey, I'm going to go use the restroom," which sounds kind of silly, but that's just how it gets sometimes when it's really busy.

And I feel like for me, I think a lot of people can relate to this, whether you're a senior in high school listening to this or a senior in college, or you're just an MS4 like me, but the senioritis gets so real, especially as you get closer and closer to match and your anxiety is peaking. It's really hard to kind of center yourself in your work.

I'll actually share this really embarrassing thing that happened to me. I was sitting in a residency interview with some residents at a program that I was really interested in, and they were kind of asking about our hobbies and things. They were saying something about, "Besides working hard, what are things you enjoy doing?" And I was starting it off just giving word salad. I said, "I don't really like working really hard. I like to have hobbies." It just came out so poorly.

I was absolutely mortified, because obviously we all work really hard. I feel like that kind of goes without saying. Everyone in the healthcare field works really hard, and I respect them. But at that moment, in my head, I was thinking, "Well, I like to do things besides that," but it just came out really poorly. But I stand by it. I think it's important that we work just as hard for our hobbies as we do for our work.

And so for me, with exploring, I think that it's really reclaiming a lot of the time that I lost in med school, whether that's being able to visit my family and spend time with my parents and my brother, or being around to hang out with my friends and all the loved ones who I may or may not see in the future depending on where I end up, and also just remembering what it's like to take care of myself and be able to work out and have my own schedule.

Now that my interviews are over, I'm wrapping up rotations, but I also have a little bit more time to go get coffee with my friends. I actually got coffee with Harjit last week, and it was just so nice to talk about life and not just rotations and my applications. We just talked about travel and our families.

It was so nice because it reminded me, "Wait, I am a whole person outside of my identity as a medical student." And I think we lose that a lot of times because we get so wrapped up in this hustle culture.

Fourth year is really about not just finding out where you're going to go and who you're going to be, but who you are right now and checking in on if that's a version of yourself that you're happy with.

And for me, I'm getting there. I'm trying to remember who I was before med school and what I really enjoyed doing and making sure I'm making time to do those things.

A lot of times, I've actually roped Hạ into some of those activities and I've been like, "Hey, you want to come do this thing with me that's totally not medical related?"

So I'd love to hear more about Hạ and what you think about what your exploration is going to look like.

Hạ: Yeah, it's so interesting talking about hustle and bustle. One of the things that I've been reflecting a lot on is it's not even the hustle and bustle of doing work, work, work, but I felt that upon reflection, now that I've had a bit more space and I've been in new environments, part of the hustle and bustle for me was also sometimes a hustle and bustle of a particular identity that I ended up just somehow creating out of different pressures or different circumstances within medical school. I ended up just creating identities that were true to me.

So for context, a lot of the work that I did in medical school was related to social justice. Now that I'm at a program that selects a lot of people who like to do that work, I kind of had an identity crisis because I realized, "Wait, this identity that was really well known that I hustled and bustled so much in medical school isn't really that big of a deal anymore," which I am very happy about, but it was very weird having to rethink.

And so one of the things that I've started having to think a lot more about is just really thinking about how a lot of what my identity used to be based on was how I exist with the role that I exist within the community, the role that I exist to others, and less the role that I exist to myself.

It started just getting to a point where, with the pressures of residency, the ways that I saw myself in those past ways that worked pretty well as a medical student weren't quite as healthy or worked quite as well as a resident. It was also hard because I didn't have Lilly to remind me to go cycling every week, too, as a resident.

So one of the things I have been trying to do a lot is really reclaiming the things that bring me a lot of joy. I've got a Libby app. I'm using the San Francisco Public Library card so that I can listen to more audiobooks. I subscribe to Book of the Month so I can start reading a lot more, because that was something that brought me a lot of joy. Starting college and academia took that away from me a lot, reading for fun.

I've been trying to just rethink about who I am as a person and I'm trying to define myself as not by medicine or medicine-adjacent work and more by other things. So TBD how this goes, but we're working on it. It's a work in progress too, like you, Lilly.

But residency can get pretty draining and rough sometimes. And whenever I hop onto a "Bundles" episode, I feel like by the end of it, I always feel like pieces of my . . . not pieces of my soul. I would say more my little half-empty cup is filled with a lot more delicious hot cocoa or chai lattes or matcha. It just feels a lot more warm. And you two have contributed to filling my sad, cynical residency heart with joy.

Conclusion

Lilly: I also just love that we're talking about exploration this first episode, because just hearing all the things we're nervous about exploring, I'm so curious as we get through this season and we're reflecting back on these new things we're exploring, how it all kind of pans out.

And for the listeners at home, as you're listening to this and you're thinking about things that you're exploring with this new year and you get towards the end of the season, it's just really interesting to see how much will change and how much will grow, and how much of that will be painful and how much of that will be needed or healing. I just think it's going to be really cool to kind of have this time capsule of it.

Austen: Definitely. I feel like medical education is all about growth, but I feel like we are all at such critical growing periods right now. And so it's fun to be able to come and to talk about maybe the things that scare us and frustrate us.

But just like you said, Lilly, I feel like looking back at the end of the season will be so cool to see where we were and what we were frustrated with or what we were worried about, or what we couldn't even think about without freaking out, to hopefully, fingers crossed, being at the end of the season at the end of the year and feeling maybe just a little bit more confident in where we are and have learned a few things along the way.

Lilly: I'm so excited.

Hạ: Retweet. I don't need to say anything more. Retweet. But yeah, this is such a great convo, you both. Thank you so much to our audience for listening to us. It was so great to get to chat and to kick off the season.

Be so stoked because some fun preview for the season is we'll get to hear the identity episodes from Austen, Lilly, Laurel, and Alizah coming up. I am so excited to hear it. When they release, I will immediately listen at two times speed because I only process things at two times speed now. But know that I do it out of love.

I hope, dear listeners, that our conversation about exploration has gotten you thinking a little bit about how you want to explore this upcoming year, and recognizing that it doesn't need to be a New Year's resolution, but it can just be kind of a wish and a hope for yourself for continual growth.

How do you all want to split doing the promotion piece of things?

Lilly: Oh my gosh. How do we do this?

Hạ: I'm letting someone get the honor.

Lilly: I think Austen should do it.

Austen: Okay. Here's the thing, though. Chloé can tell you I had a hard time with the "listen to us wherever you podcast" during my mic check.

Hạ: But see, you've got practice. You can do this now. We believe in you.

Lilly: Growing pains.

Austen: That's true. Okay.

Lilly: You've got this.

Austen: Well, thanks so much for joining us, you guys. We used to release new episodes every single week, but we're changing our schedule this season, so we'll be releasing episodes bi-weekly. So there won't be an episode next week, but join us again the week after. We'll continue like that through the remainder of the year.

So thanks for joining us. Reminder: You can listen to us wherever you podcast. We'll see you next time. Bye.

Hạ: Bye.

Lilly: That was great, Austen. You crushed it.

Austen: Thank you.