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“Their absence makes me feel sad,
I look around at my peers, envious and curious,
Obsessing over when they will show up.
When they do, they never seem to live up to expectations,
Too small, too uneven, but what’s sure is it’s a sign I’m no longer a child.
It adds to my wardrobe in a hushed way,
I don’t know whether to be proud or embarrassed that they’re finally here.
I look at magazines; should I display them more?
Or will my whole essence be reduced to how big they appear under my shirt.
I’m confused but feel alone with no one to talk to about these new guests.”
Poonam Merai is an internal medicine physician.
She shares her story and discusses her KevinMD article, “There is no other body part that has filled me with such a roller coaster of emotion.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.
Today on the show we have Poonam Merai. She is an internal medicine physician and geriatrician. She wrote the KevinMD piece “There is no other body part that has filled me with such a roller coaster of emotion.” Poonam, welcome to the show.
Poonam Merai: Thank you for having me here, Kevin. I’m just really grateful for your platform and for giving me the chance to talk about this poem.
Kevin Pho: Well, thank you so much for sharing your story, and we’ll get into that a little bit. But first off, can you share your story and journey to where you are today?
Poonam Merai: Yes. So, I grew up in the Chicagoland area. My father was a family practice physician in one of the suburbs of Chicago, and as kids, my siblings and I would be at his office filing papers. It would be patient after patient leaving his office who would look at me and say, “We’re so grateful to have your dad. You’re so lucky to have him as a dad.” Over time, I just came to admire him, and I knew pretty early on that I wanted to be a physician.
Fast forward to undergrad, where I was in this eight-year straight medical program, and I thought, “You know what? If I’m going to med school, let me study something outside of biology and chemistry.” So I actually became a philosophy major and became really interested in end of life and death, and I even got a chance to go to India and study Buddhism and actually study Tibetan medicine.
Coming back, I went to medical school and then started my intern year at the University of Chicago. I had some amazing mentors, and having had patients who were older, I realized, “You know, this is what I want to be doing in medicine. I want to be advocating for these patients, and I want to be talking about the aging process, death, and dying with my patients.” So I pursued a geriatric fellowship at the University of Chicago and then went on to an academic institution, which was great. I think it had its place in my life.
But during that time, I had two kids and became a physician mom, and trying to balance it all was very difficult. Then COVID hit, and it became even more difficult. I wanted to be on the front lines, but at the same time, my children needed me, and with all our caregivers, I was afraid to use grandparents and other people. We just didn’t know a lot at the beginning of the pandemic. And so I said, “You know what? I’m going to pause. I’m going to pause in my life.” I left clinical medicine, and I asked, “What do I want?”
Kevin, I hadn’t asked myself that question in a very, very long time. And when I did, what came up was, “I want time with patients.” What I love about medicine is my time with patients. Where can I get that in the medical field, in the medical system? That led me to concierge medicine. I joined a practice known as Harper Health in Chicago, and it is everything that I thought medicine would be. As I reflect on my dad’s practice many, many years ago, it has so many similar qualities to that practice. I get time with patients, I have amazing colleagues, but I also get to work on myself as a human being, as a mother, and as a physician, on my physical and mental health.
So I just feel so blessed to have had all those other parts in my life. I needed them to get here, but I feel like I’m able to flourish in my current position. So that’s my journey and how I arrived here.
Kevin Pho: What does that say about our current medical system, that some physicians have to go to concierge practices and specialty practices in order to get that satisfaction and proverbial work-life balance that you just described?
Poonam Merai: Yes. I mean, I don’t want to say it’s a sad state of our medical system. I think that the medical system exists to help as many people as possible. But I think physicians and patients are really seeking something different out of this relationship, and more and more people are talking about it and more and more people are making that decision. I think we’re at a point where we’ve had this Great Resignation in medicine, and I think all of us are just trying to find that sweet spot of loving our jobs but loving ourselves and loving all the other parts of ourselves that exist beyond our physician role.
Kevin Pho: All right, let’s transition to the KevinMD piece that you wrote. It’s titled “There is no other body part that has filled me with such a roller coaster of emotion.” Now, for those who didn’t get a chance to read your piece, can you just walk my audience through it and share the story of why you decided to write it?
Poonam Merai: Yes. So, it’s a poem. It’s a poem about a person’s journey, a female’s journey, of having breasts: being a child and basically ignoring the fact that there’s this body part on you, and then aging with breasts. For me personally, the journey was very relevant. I grew up in a Southeast Asian family, and we didn’t really talk about breasts. It was just something I kept to myself and didn’t really talk about with family or friends.
It wasn’t until I had my own children and went through the breastfeeding journey as a physician mom that I actually started feeling pride in that part of my body, because it was sustaining my children. But at the same time as having that pride, it was such a source of anxiety to be a physician mom trying to pump. I remember there was a time I was pumping on the floor of a skilled nursing facility. It was a bathroom floor, and I was just crying because I wanted to do this thing for my children, but there was just no time and no place. I remember trying to find what breast pump would allow me to even wear it portably, go into a patient room, and still allow me to function as a doctor and as a mother.
And then what really prompted this piece was having made the diagnosis of breast cancer in my concierge practice. I had drawn a Galleri test on a patient. It’s a multi-cancer early detection blood test. It was a patient who was in between mammograms. There was really no reason for her to have breast cancer, but she was in her 70s, and we decided to draw the Galleri test, and it was positive for breast cancer.
I remember picking up the phone, about to make that phone call, which a lot of primary care doctors have to make, or the ones who are breaking this bad news. Because I have this relationship with her in this concierge practice, I’ve gotten to know her and I’ve gotten to know her family, I knew it was going to be a really, really hard conversation. And I realized that it’s going to be hard for her, but it’s hard for me. I don’t think in my career I had ever acknowledged that it was tough on me to have these tough and difficult conversations with patients.
So I remember having that conversation with her and then going home and also reflecting on the multiple family members I’ve had who have also had breast cancer in their late 30s, so young. I remember just sitting on the rug of my home and writing this poem, and it just flowed. I think I was able to get out of my head, which is what we oftentimes do as physicians. It’s how we are successful: We operate at this intellectual level. But it was getting out of my head, going down to my body, and saying, “How do you feel? How are you going to process this?” And the poem was the outcome.
Kevin Pho: So why a poem versus, say, a narrative? What made you choose this form to really express your thoughts and feelings about this?
Poonam Merai: Yes. It started off almost free-form, but it was almost like there were these stages. There was the childhood stage. There was a teenage stage, where society wants me to view breasts one way versus the way I want to view them. Then there was the mother phase. Then there was the medical phase, where there’s breast cancer. And then there’s the stage where I meet patients, in the geriatric phase, where I’ve had patients who have named their breasts, who will talk about how they love to be free at home, not in a bra. Having those conversations with patients brings me closer to them.
For some reason, going through each of the stages, it flowed out as a poem. It didn’t flow out as a blog post; it was a poem. And I’ll tell you, I don’t write a lot of poetry. I love to write free-form, but not necessarily poems. But this is how it came out.
Kevin Pho: After someone reads your poem, what are some misconceptions? What are some things that you want to clear up? What are some of the things that you want them to come away with?
Poonam Merai: Yes. I mean, I think from the health care provider standpoint, as providers across the whole spectrum, from pediatricians to geriatricians, we deal with this anatomical part of the body, right? Pediatricians are helping children through the growing phases of breasts, and then teenagers, and then as geriatricians, we are talking about perceptions of breasts with our older patients. So if one has the luxury of time to really ask our patients about that, this is part of their health care journey: dealing with the emotions that come with that body part.
And I think for patients, it’s about being able to have that conversation with their provider and to feel safe, whether this is a body part that’s brought them pride, whether it’s breast augmentation, or that’s brought them fear through a breast cancer diagnosis, or this sense of detachment that I see with a lot of my older patients. Just to have that conversation. I think just talking about it allows us to open up about it, and so it creates that open space.
Kevin Pho: So when you have these conversations with your older patients about breasts, what’s their reaction? Are they surprised, or are they wondering why there’s so much conversation about that body part? In general, what are some of the reactions when you start talking more in depth about this?
Poonam Merai: Yes. I’ll tell you, their body language changes. They go from tense to almost taking a sigh of relief. It’s almost like that invitation has allowed them to finally talk about something that they’ve maybe wanted to talk about for a while. No one’s really asked them about it. This is not something they may have freely talked about with family members. And there are other patients who will skirt right through the topic and move on to something else.
So I think it just gives them an opportunity to release and say what they need to say. And I’ll tell you, I think I’ve laughed more about breasts in those conversations than I have in a long time. So yes, it just opens the door.
Kevin Pho: What are some of the sample questions that you ask in the exam room that approach this topic?
Poonam Merai: Yes. So if they’ve had a breast cancer diagnosis, I’ll often say, “You know, these have probably been friends and foes your entire life. Tell me more about that journey.” It’s usually something related to their journey. For patients who may not have had breast cancer, I like to say, “I like to be open about all parts of our body. I’d love to know more about your journey with your breasts.” So in that sense, I’ll just open up the question, and they’ll either be very brief about it or have some great, great stories about it.
Kevin Pho: We’re talking to Poonam Merai. She is an internal medicine physician and geriatrician. She wrote the KevinMD piece “There is no other body part that has filled me with such a roller coaster of emotion.” Poonam, we might not have very many geriatricians on the show, so tell me some of the rewards and challenges of the field.
Poonam Merai: Well, I’ll tell you, I think the rewards are that patients who are older have so much love to give. They love to have time with their providers. They love their relationship. I think that’s what they grew up with, and that’s what they value in the medical system: time with their providers. It’s so wonderful as a geriatrician to have that space to be able to form that relationship.
Some of the challenges are oftentimes helping the health care system see the value in our older patients. So much of what I do is advocating for older patients within the system, and sometimes I feel this great desire to help trainees and to help colleagues and specialists open their minds to see that age is just a number. Patients can be 80 years old and robust or 80 years old and frail, and so to look beyond just that number and see the patient behind it. It’s been such a rewarding experience because of that.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Poonam Merai: Yes. I’ll tell you, Kevin, the poem was important, but I think the poem was really a metaphor for me to express myself. Having been at the brink of burnout as a physician mom, expressing myself has been what has helped me and kept me sane through my journey as a physician. I hope that every clinician is able to pause, maybe not as long as I did, but at least is able to pause and reflect on where they want their life and their career to be, and then to manifest it, to put it out in the world and work toward that.
We have to build our careers as physicians, and we should. It would be lovely to be able to do that our way. And so be very intentional to create that space in our busy, busy lives to figure out what we want. It starts with that simple question: What do we want as physicians, as human beings, as mothers, as fathers, et cetera? What do we want to get out of our careers and our lives?
Kevin Pho: Well, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.
Poonam Merai: Thanks for having me, Kevin.
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