S8E5: Navigating Medical School's Hidden Curriculum and Finding Your Path in Medicine

Lilly: Do you know what's so interesting that Kirsten and I have in common? And it's not something that I feel like a lot of people have in common, and it's something I'm really proud of, is that we both have run the New York City Marathon, which is so freaking cool.

I loved Brooklyn and Queens. Those were the coolest neighborhoods to go through because it was just a block party. And I loved seeing my family throughout the course because they gave you that sliver and boost of energy that you needed.

But I also hated the water stations, because I don't know if it was like that for you, but there was so much Gatorade on the ground that my shoes were just sticking to the ground and you just hear this sticking sound every step you took. I feel like my shoes are permanently damaged from that.

Kirsten: Maybe I'm not that observant, but I did not remember that.

Lilly: Well, welcome back, everyone, to "Bundles." And if you're new here, welcome to our podcast. I'm one of your co-hosts, Lilly. I'm a second-year neurology resident at the University of Utah.

I am so excited to be back in the virtual studio with one of my fellow co-residents, Kirsten Myers, to chat a little bit more about what it's like going through medicine as an outsider, being one of the first in your family to go into medicine, how that's really fueled our interest in public health and the challenges that we've faced and gone through during this journey. So thank you, Kirsten, for joining me.

Before we dive in, I just want to make a brief disclaimer that all of the views and opinions that we share on this podcast are those of our own, and they don't represent any of the institutions or our employers.

But Kirsten, I'd love you to tell our listeners a little bit more about yourself.

Kirsten: Thanks, Lilly. Thanks for inviting me here. It's fun to have this conversation. Yeah, so a little bit about me. I grew up a little bit of everywhere, but mostly in Oregon. Went to high school there. My family's still out in the Portland area.

I ended up going to med school at University of Washington after taking four years off. Had a little bit of a winding road, but ended up there eventually. And then I've been here at University of Utah in neurology with Lilly. I'm a third-year applying for a fellowship now, which is exciting, but daunting a little bit. It's crazy how fast the next step comes up in medicine, especially.

But yeah, I'm excited to be thinking about being an epileptologist and a community-minded neurologist in general. So yeah, that's a little bit about me.

Lilly: And I think that immediately makes me start thinking what was your life like during those four years in between your journey? But also just to hear more about what brought you into medicine. What was the thing that drew you in? What was the pull?

Kirsten: Yeah, I was diagnosed with Type 1 diabetes, diagnosed when I was 17. And it was just a life-changing diagnosis, mostly because I grew up outside of medicine. I grew up in a faith-healing religion called Christian Science. And in that religion, you don't take medicine. It's part of the official guidelines. You should avoid medication at all costs.

For example, my grandmother was a Christian Science practitioner, and that's someone who leads people through prayer to eventually get healings. But in order to be officially recognized as a practitioner, you can't have any prescription medications to your name.

And so getting diagnosed with Type 1 and realizing, "Oh my gosh, I'm going to have to take insulin my whole life," was crazy, a big existential crisis. And in that, I was exposed to, "What is this medical world of doctors, patients? How do I be a patient first off, but then what are the roles of doctors?"

I really felt I was missing a lot of help during that time. I felt alone in that diagnosis. And I wanted to be part of a healthcare profession that would be more of a human first and foremost, and then a physician. So that kind of drew me to pursuing medicine eventually.

Lilly: What was the belief that you were taught growing up about Western medicine? Was it more this foreign chemical in your body, or what was kind of the thought behind it?

Kirsten: More of kind of the thought that our bodies here on earth are material beings and illness is an extension of that materialism. So in order to be more kind of in line with God, you have to really pray and realize your materialism existence and then, basically, see that illness is not real because all this is not real in a sense. So a little bit out there.

Lilly: Wow.

Kirsten: So a lot of it is about praying and seeing that this illness experience is not real and that I just need to align my thoughts more with God in order to be free of this illness, because the more spiritual my thoughts are, the less illness I will have, if that makes sense.

Lilly: Oh, that's so interesting. No, it totally makes sense. But I can imagine just how confusing that must have been when you're so young and you're having your whole identity questioned when you realize your body isn't functioning the way it should be.

And diabetes is a really serious disease to have, because if it's not treated, you could die from complications of diabetes. So that is kind of scary to think that you may not have had access or wanted access to certain things that could have complicated your wellbeing.

Kirsten: Yeah, very scary. And I was pretty sick when I was diagnosed. I had to go to the ICU, and so it had kind of been brewing for a while, but a lot of that was overshadowed by being like, "Oh, you need to just get your thoughts more in line with God."

And then when I was actually diagnosed, going to church, I had people tell me, "Oh, God gives us these challenges that we just have to work through." And that was really hard to realize, "No, if I don't take this medicine, I'm going to die. It's not just a challenge that's been bestowed upon me." It's just an acceptance of the journey.

Lilly: There's that phrase of "God gives his hardest battles to his strongest soldiers." And I'm like, "I don't want to battle anymore. I don't want to. I'm okay. You can pass me sometimes." It's really hard to swallow that kind of pill when you're like, "I'm good, actually. I'm tired."

It's interesting, though, because although I come from a completely different faith . . . I'm Muslim. I grew up in an Afghan household. My family, and I think our culture in general, has kind of similar beliefs in regards to Western medicine, because there's also Eastern medicine and other types of medicine besides the Western medicine that we're mostly taught in medical school. And it was one of the reasons I initially was really interested in DO school because I thought treating the whole body and having OMT as an option for my patients would be really unique and interesting.

But I grew up in a household where I had osteomyelitis when I was 12. And for those of you who don't know what that is, it's a bacterial infection that you can get that goes into the bone and infects the bone, which is so bizarre. Sometimes that can be a complication of poorly controlled diabetes, but I had it because I had a bad dental infection and it settled in my ankle.

I remember screaming and crying at home because I was in so much pain. And my mom was going to work and she was like, "Well, I guess you can't go to school today." She was trying to figure out what to do for me and she cracked an egg yolk on my ankle and she was like, "This will help treat that."

And I stayed at my grandma's house for my mom's entire work shift just crying because they thought this egg yolk was going to cure me.

And then she came to pick me up and . . . Don't get it twisted. My mom is such a caring, loving, wonderful mom, but obviously, it was beyond the means of an egg yolk. So she took me to urgent care and I ended up getting admitted for a week at Primary to be treated for osteo and get it drained. It was pretty gnarly.

But it is interesting because I always think about Eastern medicine and just homeopathic medicine and other options, especially in neurology where we see patients who have neuropathic pain, who have migraines, and there are other options. There are other things that you can try, and some of it helps and some of it doesn't.

But it's so hard to tell your patient, "You definitely shouldn't do this because there isn't good evidence." If it isn't harmful, at least in my eyes, I think if it's not harmful . . . Even though there's not evidence-based medicine around it yet, I guess it doesn't hurt to try it and see if it helps.

And we do have some studies for things like magnesium and massage and acupuncture that can be helpful for some things. So I think there's room for both, but also, I think it's important that we create good enough rapport with our patients where if we are pitching Western medicine to them, they have that buy-in to also want to actually take it. There are also so many times we do harm with Western medicine and interventions as well.

Kirsten: Yeah, 100%. I feel like there's just so much polarity in terms of Western medicine, like, "Oh, take these medicines. This is the only way." It's true we have evidence that backs up all that, but I do feel like some of the non-Western medicine beliefs . . . Or even what I grew up in, sometimes I miss kind of the approach of quelling your mind through prayer and that sort of reflective practice, which I feel like is sometimes absent from our approach in Western medicine where it's, "Just take the medicine. That fixes everything," and all that.

Lilly: Yeah, that's so true. And you're the first person in your family to go into medicine. Is that right?

Kirsten: Yeah.

Lilly: I feel like that journey . . . Because I'm very similar, at least in my immediate family. I've had family who studied medicine in Afghanistan. But it is interesting being in medical school. I'm curious to hear how you felt, but at least for me, I remember when I went to the University of Utah, we do have a lot of people who have parents or siblings or relatives who are already in medicine, who either encouraged them to go into medicine or exposed them to medicine early on and sparked their interest.

And so they kind of just seemed like they were the cool kids. They knew what was going on. They have these interesting connections. They're in the hospital, people know them by first name, and all these things, and I'm sitting there like, "I don't know anyone. My dad's a flight attendant. My mom worked at Nordstrom Rack." Very humble beginnings. I'm the first person to go through medical school in the U.S.

And it's kind of funny because my cousins always asked me, "Oh, Lilly, do you think I should be a doctor?" And I'm like . . .

Kirsten: Ugh.

Lilly: Yeah. And then my brother, he's a PA. He was in school around the same time as me. And I always ask them, "Do you like being in school? Do you like studying? Do you like taking tests?" And they're almost always like, "No." And I was like, "Yeah, me neither."

But I didn't know that that was what medical school was going to be pretty heavily reliant on. And if I would have been told I had to take three board exams over the course of 4 years, one of which would be 16 hours over 2 days, there is no way. There's no way you would have convinced me to go to medical school.

Which I think is kind of funny because I think, looking back, maybe I wouldn't have gone to medical school, but also, it's nice that I didn't know because then I just blindly had to accept that that was my fate in a month or two. "Oh, I just have to take those tests now." And then you get through it.

I don't know if that's how it felt for you too?

Kirsten: Oh, yeah, 100%. There were some people I met in medical school, yeah, with siblings who did the same path, and so they're like, "Oh, yeah, this is the board test you have to be ready for and have your specialty choice here," and X, Y, Z, etc. I felt like I just was like, "Okay, I got into medical school," which was the first battle, because I ended up doing a post-bacc after doing AmeriCorps.

Anyway, it took a while to do those courses and get in and I already felt like, "I worked really hard to get here. Now I'm here. It's all going to work out." But it definitely was like, "Oh, I have to learn how to study."

I think I struggled a lot with imposter syndrome of being like, "I'm here, but I feel like everyone else knows what they're doing or at least kind of puts off that air. They seem all such the smartest people ever."

And I think even more so, it was challenging for me because I ended up failing my first course and had to remediate, and that even just perpetuated this feeling of, "Oh, I don't belong here."

And so it was a struggle of feeling like I have to really just learn how to study, put my head down, and then let go of maybe some more of the interests outside of medicine, like social justice, being involved in social determinants of health clinic stuff in order to just get through med school.

It was definitely a realization of, like you were saying, "Wow. Just tests and study. Tests and study. And hopefully at some point we can fit in more of public health, community, medicine perspective."

I think also what helped me was COVID-19, because my first year was impacted by the pandemic halfway through and I was like, "Oh, I'm just going to study. That's all we have to do."

Lilly: "There are no distractions now."

I wanted to circle back to your outsider perspective and then going in to medical school four years later. What did that journey look like?

Kirsten: I had gone to undergrad and started studying pre-med and I was really discouraged. I remember going to my advisors . . . And I actually had an advisor who also had Type 1 diabetes randomly. He kind of knew some of my story, that I wanted to be able to serve other people with chronic illness. And he basically was like, "You will never get into medical school. You should find something else to do." I had an O-Chem professor that kind of said the same thing. So I was like, "I don't know if I can do this. And obviously, they don't think that I can. I don't have support."

So I did public health in undergrad as my major. I graduated and I was like, "I'll work in more of public health perspective of things." I ended up doing a year of AmeriCorps right after undergrad. And I was in a small farming community, mostly for apples, in central Washington. So I worked with a lot of migrant workers and immigrants from Mexico that were picking apples and pears, and I was working with them on their Type 2 diabetes management.

I just loved the work I did. I was like, "I have to try this. I think I can do this if I try really hard." So I just kind of, by sheer force, got into medical school.

But it took a few years to finish those pre-reqs. I went back to Portland State and just loved that experience there, because at a state school, it's mostly commuters, people with families that are going for their kind of delayed undergrad degree or grad school degree. Everyone is just so collaborative and wanted to help each other get to the next step.

I had such a good experience there and I was like, "I know how to do well in science." I hustled. I did three or four jobs working in the ER, nannying, and then I ended up working for a global health group at OHSU. And then I also worked in health tech for a second while I was applying to med school because I could work remotely, which was really nice.

Eventually got in, which was great. And in that time really learned that, "If I set my mind to something, I can do it."

I think it's also important to remember there's just not one journey. And if you really want to go for something, you can work really, really hard and probably get there if you just believe in yourself and put in that extra effort.

Lilly: Yeah. Let the haters motivate you. Truly.

Kirsten: Yeah. Something like that.

Lilly: I just don't understand why people are in positions . . . And maybe they're burnt out in their own way. But why are you in a position to be an advisor or a mentor to students and then you're just flat out discouraging them from trying? That just blows my mind.

I hear that surprisingly often from people who are incredible doctors, that at some point in their journey, someone was like, "You're not going to make it." And then that just fuels the fire.

Something very similar happened to me in high school where I was interested in going to med school. I was interested to applying to schools out of state. And I think to some degree, it was a lever of discomfort from my college advisor, because she was very much used to people only applying to state schools and local schools.

So she had no idea how to navigate outside-of-the-state applications in like Texas applications and the UC school applications. Everything is different. And I think it was a level of discomfort on her end that she just didn't know how to help me navigate those applications.

But then she also just flat out told me I wouldn't be able to afford to go to school and I was like, "Whoa. Okay, true." I mean, who really can afford to go to school when you're a first-gen and, like you said, work several jobs? But we did it. I worked three jobs in college. I applied for scholarships every semester.

I think her telling me I wouldn't get in and that I wouldn't be able to afford to go, even if I did, fueled my fire and just poached me into it. I was like, "Well, now I have to because one day . . ." And maybe this is me being narcissistic, but, "One day, maybe you'll see my name and be like, 'Oh my gosh, she ended up becoming a doctor. That's crazy.' And then a little part of me will be healed as a child."

I don't know, but it just drives me nuts when you're in this place to mentor someone and instill a belief in them that they can do things. It doesn't hurt you to try and inspire your mentees.

Kirsten: Yeah. But who knows? Maybe being told that I couldn't do something was . . . I had the fuel to get here, like you were saying.

Lilly: It's that tough love.

Kirsten: Yeah.

Lilly: Ugh, gosh.

And talking about social justice as being an outlet for you, it makes me think about my experience also in med school and why I went into medicine being from an underrepresented population where we didn't have any doctors or nurses or front desk staff who spoke the same language as my family did.

And then going into medical school where I've heard attendings, I've heard professors, I've heard fellow med students just make inappropriate and stigmatized comments about underserved populations, especially those who English is a second language for or who have different cultures than Western culture.

I still hear it in the hospital pretty often. And I think that you'd probably experience that at any hospital. I don't think ours is necessarily that much different from the rest of the nation.

It's interesting, because in my head, in going through medicine, to me, it stings instinctual that social justice would be a part of your practice because you care about your patients, your patient populations, those at risk, those who need an advocate, especially when it comes to public policy and laws that impact access to care, the affordability of care, being able to get medications.

I remember taking care of a patient on our stroke team who had a horrible, terrible, awful stroke because he couldn't afford his medications. And he knew he was going to be at risk for a stroke, because we always counsel patients on this. "If you miss your medications, you could have a stroke." But he couldn't afford it, because who can afford hundreds of dollars a month for one pill? It's really, really challenging to do that.

And I just think it's our role with our white coat privilege to be talking to our delegates and Capitol Hill and implementing this in our practice. Our patients are working full-time jobs, they have families, sometimes they have multiple jobs, and they're not medically literate enough in that space to be able to advocate for themselves because they don't know all these hidden costs and detours in their care, like, "You need to fail this many meds before your insurance will approve this other medication that we know is more effective." Playing this game with the system and trying to get the care that you deserve.

And I've always thought it was just a part of the job, but I remember in med school, one of my classmates, when we had this conversation, and they're one of my good friends, they said, "I just want to take care of patients. I don't think it's my job to advocate and go talk to politicians. I think it's my job to be in clinic and take care of my patients."

I get that perspective, but I think the longer you're in the clinic seeing those patients, the more you realize how limited your ability to care for them is if you don't invest and care about what's happening up on the Hill.

Kirsten: I completely agree that if we're going to be physicians for patients from all different backgrounds and all different areas, walks of life, we have to be able to give that same care to all of the people that we serve.

I feel like sometimes there's this approach of, "I'm a clinician," like you were saying, "and I just want to diagnose and treat, and then people can figure out the rest." And I feel like that just leaves out so much of the experience of healthcare because then people are just left to kind of try to survive.

Not having any sort of assistance or awareness of the experience doesn't allow those people to access the care that they need. Or most people, I feel like, in general, especially today. And so I feel like it's really essential to have that advocacy piece.

I'm involved with Neurology on the Hill, which has been really great because you just kind of respond to any advocacy acts that the AAN has. But it's made me think about how we can have a voice as physicians, because you get these responses back from senators and congressmen and your address is, "Oh, Dr. Myers."

It just kind of makes it real that, "Oh, yeah, I'm a physician. This is a respected spot in society," and you have this privilege to have a voice and you have to use that voice for good.

And I do think it's hard. I think there are times sometimes on the wards where it's easier to be like, "Okay. Let's just do that." Not talk about that, "This patient has Medicaid and we're leaving out the fact that they cannot apply for rehab or get as many rehab days because of that Medicaid." And we're just going to be like, "Okay. Yep. Next."

So I think sometimes it is being okay with, in residency, taking more time to care for patients that need that more time and being okay with giving the patient the time they need in those situations to help them have the same care that perhaps someone with private insurance would have.

I feel like I'm still learning how to better advocate for patients every day.

Lilly: I'm so curious because Neurology on the Hill is specific to neuro, but I know a lot of other subspecialties have similar initiatives. I've heard of OB-GYN also having days where they go chat with politicians up on the Hill. But what are some of the things that you all have worked on advocating about? Like, examples of things you all have discussed with politicians?

Kirsten: One of the ones that I thought was really . . . or our talking points that I thought was really cool last year . . . Because I went to Washington, D.C., for the national meeting for that group and we met with our congressmen and representatives, etc. And one of the talking points I really thought was cool was just working at continuing coverage for telemedicine.

I think a lot of us just assume telemedicine is something that's accessible now that we've had COVID and it's been a viable way to deliver care to people since COVID.

But as we've come further and further out from COVID, Congress and Senate have wanted to take away some of those privileges because it was sort of passed in emergency situations with the pandemic.

And so we're advocating for continuing telemedicine because it increases access to rural populations and to people that maybe are disabled and have a hard time getting into the clinic or hospital.

So that was cool. We were part of helping extend the telemedicine capabilities for insurance coverage by a few months, but it's, again, at risk. And so shout out to anyone to reach out to your senators and congressmen/representatives and advocate for continuing telemedicine coverage. It's really essential.

Lilly: That's so inspiring. If I take myself back to being a first-year medical student, that would sound so intimidating to me, picturing a resident or anyone being up at the Hill talking to these politicians who have, I feel like, a completely different language from the one that I understand. And there are so many different bureaucratic things that I don't understand. So it's really cool to hear that you're doing that work.

And later on in med school . . . Because I was so passionate about social justice, and the murder of George Floyd had happened, I worked with two of my co-med students on writing a bill with one of our state legislatures to declare racism a public health crisis in Salt Lake City. And it did pass through the Salt Lake Senate, but the state Senate would not hear our bill until we took the word racism out of it, which was interesting.

But it does go to show that I think people who go into medicine are so Type A, highly motivated, very much dig your feet down and just do the work. A lot of times my cousins will be like, "I could never sit and study for six hours." And obviously, you take breaks in between, but they're like, "We just can't do it. That's just not my mentality."

I think that people who go into healthcare, especially medical students, DO students, all of that realm, they can dig that deep and do that work. And I think with the right motivation, you can apply that to advocacy as well.

And you can see real changes happen from that, like you were talking about with the insurance coverage, or talking about bills to try and get more funding towards initiatives. We can do that.

A lot of people try to scare us into thinking we don't have a strong enough voice to do that, but there's still, I think, like you were saying, a lot of respect and understanding of the level of education that you get going through medical school and becoming that title of a doctor. You can use a lot of that to power the voice for your patients.

Kirsten: Yeah, I completely agree. And I hope having these types of conversations helps encourage others to see that, because it is a lot of that steadfastness and grit that gets most of us here that can be applied to making sure our healthcare system is better and more equitable.

Lilly: Yes, I agree. And I think it's so nice and therapeutic to have these kinds of conversations because when you're at work or talking to a larger group of people, it's really hard to tell because politics can be so polarizing in this day and age that some people just want to avoid the conversation entirely.

And then we see big events and big changes happen, like Zohran Mamdani getting elected in New York. What a huge, I feel like, rise of Gen Z voters that was. To have a million-plus people voting in a city election is huge, because my generation and generation right after me, we have poor voter turnout. And that's something that everyone who is able to vote in the U.S. can do regardless of being a medical student or not.

This is something that we all should be utilizing and taking advantage of so that people actually care about our voices and want to talk to us. Regardless of who you voted for or didn't vote for, it's important that you vote, and it's important that you, like you said, reach out to your state and city legislators.

Ultimately, we're the future of the community and caring for those who are getting older than us, and then also our future children or loved ones' children. And I think right now people don't take us too seriously and they think we're a little more of a silly generation.

A lot of times, when I try and talk about these things with my peers, some people are too scared to step on toes to talk about these things. But if we don't talk about them amongst each other, how are we ever going to talk about these things with our patients and say, "Hey, I'm sorry that I can't give you this medication that's really known to help improve your condition and help you move from your MS, or never have another relapse from your MS, or totally stop you from having migraines," or whatever it might be, "because of XYZ in your insurance"? And then when your patient gets pissed off in the room and tries to argue it or talk to you about it, you don't have a good explanation.

So I think it's important that we start having these conversations with one another. And if you are having them, to keep having them. Burnout in the sense of political justice is also very draining, especially when you don't see changes happening or things getting worse. I feel exhausted about it, but then I talk to other people like you and it revives my humanity and I'm like, "Oh, wait. No. It's good to care about these things."

Kirsten: Yeah, I definitely am on board with just we need to care and have these conversations instead of just feeling that we're alone in our feelings or that nothing's ever going to change and being kind of isolated in that experience. So I think that's the only way to spur change too, is by continuing to talk about how it's starting to happen and how we can support continued change.

Lilly: I mean, overall, I hope for our listeners today who are listening to this conversation with Kirsten, you feel some drive and fuel in your tank, to remind you that it's okay if you're the first in your family to want to go to medical school, PA school, nursing school. Even if no one in your life has lived that, you can be that person.

And you really make it realistic for others in your community. Whether it's rural, whether it's city, whether it's migrant or immigrant families, having representation really does impact change.

My brother and I being in medicine has influenced so much of our family to want to pursue medicine, and now we have several people in our family who are healthcare professionals in so many different fields.

I mean, we could probably open up our own little private practice of everything you'd need, like an eye clinic, podiatry. We've got all the stuff covered now, which is insane because our families came to America with not even a dollar in their pockets.

I hope you hear these stories and listen to our guests and see that no matter where you really come from, there's a place for you in medicine.

And sometimes things like chronic illness or negative interactions with the healthcare system can be that drive to push you to go into medicine.

If anything, I think you're even more needed in this field, because if you were to see someone from your community in clinic and now you're giving them that first-time diagnosis of seizures as their doctor and you're telling them, "I think that we need to put you on an anti-seizure medication," you'll be able to navigate that conversation way more eloquently and appropriately than I think any other provider could and have a real impact on their care, which I think is so special.

I love those kinds of one-to-one interactions with patients where they can tell that you see them, because I think that's where we really build the best rapport with them.

That all being said, I'm just so appreciative, Kirsten, that you took the time. She's on call today, guys. So I just really appreciate it. You could get pulled to the hospital at any point. I'm just so glad that you didn't get pulled and you could be here on the podcast with us and share your experiences. And I'm so privileged that I get to learn and train with you.

I hope all of our listeners enjoyed today's episode. And if you haven't already, be sure to like and subscribe to our podcast. You can find us anywhere you podcast, whether that's Spotify . . . What is it? Apple Podcasts, our website. Find us on Instagram, and message us. Let's keep the conversation going.

And in the meantime, we'll chat soon. Bye.

Kirsten: Bye.