Taking care of yourself during medical school [PODCAST]

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“Like some insidious conditions, feelings can fester. They can spread like cancer, and sap the spirit of nourishment until it starts to die, riddled with doubt and sensations of inadequacy. They can degrade the soul, as though it were suffering from a systemic inflammatory disease. But this progression, like many conditions of the flesh, is treatable. With early detection, the process can be arrested and cured. Talking about feelings, journaling, praying, or finding an outlet in wellness activities that channel joy is as essential to academically thriving as studying, practicing, and pushing to meet the demands of a health care provider.”

Stephanie Wottrich is a medical student.

She shares her story and discusses her KevinMD article, “Joy is our antibiotic. Let not your stings fester.”

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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, 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. Today on the show we have Stephanie Wottrich. She is a medical student, and she wrote the KevinMD article “Joy is our antibiotic. Let not your stings fester.” Stephanie, welcome to the show.

Stephanie Wottrich: Thank you so much, Dr. Pho. I appreciate it. Great to be here.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Stephanie Wottrich: As I mentioned, I’m a fourth-year medical student in Cleveland, Ohio. I go to Case Western Reserve University. I’m originally from Austin, Texas, though. I did my undergrad out at UCLA, so on the West Coast, and I lived in Korea, actually, before I moved here. So I’m kind of making a circle, is what I tell people.

Kevin Pho: You’re in your fourth year of medical school, and now you’re applying to residencies. Over your medical school journey, what’s something that you know now that you wish you knew back before you started that journey?

Stephanie Wottrich: Actually, one of the things that I feel I’ve been able to learn over the last few months, especially in light of the pandemic: I’ve been spending more time with a friend who’s been emphasizing how important it is sometimes to take time just to be, if that makes sense. Not even necessarily in a state of meditation, although of course that’s also great. I love yoga; I love things like that. But not constantly being in motion, because I would consider myself a person who gets a little bit addicted to efficiency at times, especially as a med student. It constantly feels like I have to be doing something.

Over the last few months, I’ve been realizing that it can be therapeutic even just to push everything aside and just sit and not do anything at all. So that’s something I’ve been working on, at least personally, trying to be a little bit more forward about in my own life.

Kevin Pho: So give us an example of what exactly that looks like, because I think what you’re referring to is being present in a moment. And I think that sometimes, as a medical student especially, that is very, very difficult with the amount of things that you have to do. So give us an example of something that you’ve changed in your own life in order to follow your friend’s advice.

Stephanie Wottrich: One of the things that I really like doing, especially these days, because the weather is literally perfect outside, is I will just leave my house and walk down to something called Wade Oval at our school. It’s like a lake, and there are some trees, and I will just go there and sit, and I won’t do anything. I don’t go with anyone. I just sit and enjoy the weather, and I try to think about not so much my day, but just reflect on things that maybe happened or feelings I felt throughout the day.

I don’t go for more than, you know, five or 10 minutes. It’s a nice walk, it gets me outside, and it’s really nice to not feel the pressure of having to do something, like go somewhere with an intent, with a plan, with a time schedule. I just go. And sometimes, if I can’t go that far, I’ll just go sit out on my porch for 10 or 15 minutes and come back inside and get back to work. It’s very healing, in my opinion.

Kevin Pho: Wow, it’s wonderful advice, and sometimes it’s important to take those moments whenever we can get them. So let’s talk next about your KevinMD article, “Joy is our antibiotic. Let not your stings fester.” Now, for those who get a chance to read your story, can you just walk my audience through it and share the story of why you decided to write it?

Stephanie Wottrich: As I mentioned early on in the article, pretty much the whole meat of the story is based on a dream I had about a year ago, right around Christmastime. But it was a very unusual dream. I’ve had very vivid ones before, but with this one, I remembered every detail very intricately, despite the fact that I also woke up in a state of sleep paralysis. Usually, when that happens, I’m, you know, gripped by fear. I instantly forget the dream and start freaking out. But I woke up, and I was lying there not moving, and I was focusing on this dream that I had.

I’m not really one to say that the interpretation of dreams has meaning or is some kind of subconscious manifestation of anything. It could; I don’t know. But while I was sitting there, I was thinking to myself, “This seems very significant,” especially in this day and age, as I mentioned, where wellness is becoming, I think, more important and more emphasized to students and health care workers. But it’s still definitely a work in progress, I think.

And so in the dream, in summary, basically, I get very sick. Of course, it doesn’t really make sense, as it is a dream, but it felt very real. And I end up with bones falling out and teeth falling out. It sounds very dramatic, but, you know, in the dream it’s very scary. And when I woke up, I thought, “What is this telling me? What can I take away from this?” And the biggest thing I thought was, OK, it’s like something that started very small. It started as a bee sting and, in the dream, became something very big. And I started thinking about how emotions and feelings can be like that too. When you don’t say anything and you just internalize all of that, it can become something very big from very tiny things.

Kevin Pho: So how do you think those lessons from that dream can be applied to what you’re going through as a medical student?

Stephanie Wottrich: I definitely think it was, at least for me, a renewal of the importance of wellness and of emphasizing taking time for yourself to do things that give your life meaning and things that you’re passionate about. These are things that I think are discussed, as I mentioned, among med students. We have sessions about wellness. It’s talked about. But it’s still very much the culture, at least in my experience, that med students are kind of tacitly expected to constantly be working, to constantly be doing something. And sometimes it gets to the point where you even start neglecting your wellness. You start neglecting things that are good for you, whether it’s exercise or some kind of sport or reading, whatever activity that might be. And I really do think that over time, that becomes very damaging.

So I wanted to get my thoughts out on paper, not just to emphasize it to me, but potentially to anyone who might read the article. It’s something you don’t always think about, why you feel the way you feel. But you just know you’re annoyed or you’re angry. Everything feels like it’s built up inside, and you don’t really know why. And sometimes it’s from really small things that become a really big problem.

Kevin Pho: So wellness and burnout have been at the forefront on my blog. On this podcast, we talk about it at all levels of medicine, whether you’re an attending, a resident, or a medical student. So from a medical student’s example, when you gather with your fellow colleagues and talk about wellness, what exactly do you guys talk about?

Stephanie Wottrich: Well, personally, as I mentioned, I love yoga, and I think that that’s definitely growing in popularity these days. So oftentimes, when I’m talking with either attendings, like when I was on my integrative medicine and wellness rotation, or friends, I’m constantly telling people, “Oh, I know it seems weird at first. I thought it was weird too, but it’s weirdly kind of calming if you give it a try.” But there are other types of meditation too. There are apps like Headspace, which I’ve tried; it was a long time ago. There are just so many options.

And so whenever we kind of bring up either apps or yoga or whatever it is, it always turns into this conversation about things that we’ve tried, things that work, and things that don’t. And I think that that’s really important, to have that conversation not just with colleagues but, again, like I mentioned, with some of my attendings. During my wellness rotation, we talked about different resources that they often will mention to patients, and I mentioned some things that I’ve done, and it’s always very productive. It kind of seems weird to bring up, at least from a medical standpoint, at least at first. But like I said, it’s just always been a very productive conversation, in my experience, when the topic of wellness comes up.

Kevin Pho: Is that mostly driven by the students themselves, or is it driven by administration?

Stephanie Wottrich: That’s actually a really good question. I’ve never thought about it. I feel it’s kind of split. Definitely, the administration is constantly telling us, “Oh, wellness is important.” We do get emails as well saying they’re doing this wellness event, or sometimes they give out things like cookies or snacks to students, and they’ve recently started doing yoga in our brand-new medical building as well. So I do think it’s becoming more and more emphasized among administration.

But as for the students, I was surprised: A lot of people really do think it’s important as well. And so whenever there are these events going on, people often text each other and ask who’s going and who’s not. There’s actually a lot of interest in it, at least in our group chats and my own smaller chats. So it seems to me like it’s pretty split, excuse me, in terms of both administration and students finding it very important.

Kevin Pho: So you’re a fourth-year medical student, and as you approach the end of your medical school journey, what kind of changes would you make if you were in charge of medical education? What kind of changes would you make to emphasize wellness in a curriculum?

Stephanie Wottrich: I honestly think that some of the new changes that have been made are really good, and I think that it would have been great if those had been implemented even beforehand. So, for example, the yoga that they’ve started offering on Fridays: Even for people who don’t go, just knowing it’s an option, I think, is really important. Our campus gym as well has been offering more wellness activities. They do guided meditations and things like that.

And I think it’s also really great, not to say the pandemic is great, but just that there’s been such a move toward virtual meetings, virtual resources, virtual, you know, everything. Everything’s becoming virtual these days. And I think that that really helps make things accessible to people. So I wish that that had been more of a thing even back when I was a first-year, including even residency interviews, things like that. It can be really helpful for putting people at ease, so that they’re able, from a financial standpoint and from a comfort standpoint, to do things where it’s most comfortable for them and in ways that are most comfortable for them. And that way, there isn’t such a stress and such an emphasis on having to be somewhere, having to do something, having to, you know. It’s just less constraining, I think, both in terms of the accessibility to activities and in terms of accessibility to things that we already have to do, clinicals and interviews and things like that. It’s just a lot more positive, in my opinion.

Kevin Pho: I know there’s a trend in medical education to make things pass/fail. For instance, I know some medical schools have their preclinical courses pass/fail, and I know USMLE Step 1 is pass/fail. Do you think that would help in terms of the distress medical students face?

Stephanie Wottrich: I do think so. In fact, a lot of the med students talk among each other about how they can, I won’t say put off the exam, but we’re so close to the point at which Step 1 is becoming pass/fail that a lot of people are taking research years. They’re finding other activities to do in between so that they can take the exam a little bit later, knowing that that won’t really be a component of stress. Since most of us get a dedicated study period, when you take those few months to study, you know you’re going to pass. The stress just comes from knowing how good or how bad you’re going to do. So I definitely think that that takes a pretty big degree of stress away from students.

And I would say, in terms of clinical grades, I’m not too sure. I think it’s a positive thing overall. I definitely think the general consensus is that it relieves stress. For example, our first clinical, when I was a third-year and we started rotations, the administration had us do a vote. Our class voted on whether or not the first block, the first, I think, three months, would be pass/fail versus graded, since traditionally Case has always used grades. And the majority did vote for it to be pass/fail. So I don’t know how it would have been otherwise, especially because we were just transitioning back to the hospital after COVID, and everything was so different. So I think there was a degree of just uncertainty as well.

But I’m inclined to believe it definitely does at least take some of the edge off, having to, you know, not only transition into this new era of COVID, where we’re taking care of COVID patients, or even around that, as well as transitioning into third year at the time. So there were just a lot of things going on that could still cause stress. At least that wasn’t a component of it.

Kevin Pho: We’re talking to Stephanie Wottrich. She is a medical student, and she wrote the KevinMD article “Joy is our antibiotic. Let not your stings fester.” Stephanie, what are some of the take-home messages that you want to leave with your fellow medical students and the KevinMD audience?

Stephanie Wottrich: I would say the biggest thing that I’ve been learning over this time, especially since the beginning of quarantine and since writing this article, is the importance of taking care of yourself and really emphasizing wellness and doing things that give your life meaning and things that you are passionate about. That can look like many different things. I think it’s really important to find one or more things that you really like and cultivate them, but not just keep them to yourself. Do your best to share them with other people, because I think that sharing your talent, sharing your gift, is an act of love to other people. And ultimately, the greatest talent, the greatest gift we can give, is learning to love others and teaching others to love by setting an example.

And I would also definitely emphasize that meditation comes in many different forms, and it’s important no matter who you are. There are many different ways to do it, and you can, you know, give it a try and just see what may or may not work for you. There’s a quote by the Dalai Lama that I really like, and I apologize if I get it wrong, but it’s something like, “If every eight-year-old were taught meditation, we would eliminate violence within one generation.” And I really do believe that that’s true. So I definitely think it’s something that everyone should at least try.

Kevin Pho: Stephanie, thank you so much for sharing your time and insight, and thanks again for being on the show.

Stephanie Wottrich: Thank you, Dr. Pho. I appreciate it.

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