A medical student shares a story about language [PODCAST]

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“My mother screamed. It meant my father needed a doctor — now.

But why?

We just visited the hospital days before to refill his drugs. He would be better if he used the drugs. Magic drugs. That is what he called them. I stood up from the mat where I slept beside them to find him not moving.

But why?

When he got sick, he moved. He moved a lot. Then, he got better and stopped moving. But he always moved first. My mother noticed me. Her eyes reminded me of a movie. The warrior dropped her sword in the middle of a battle. Her comrades were all dead. But she was not. I never understood why she dropped her sword. She could have fought and lived. But she died. My mother held the same look as the warrior.”

Sarah Fashakin is a medical student.

She shares her story and discusses her KevinMD article, “What my father taught me about language.”

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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 Sarah Fashakin. She is a medical student, and she wrote the KevinMD article “What my father taught me about language.” Sarah, welcome to the show.

Sarah Fashakin: Hello, nice to meet you. Thank you for having me. I’m really glad to be here.

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

Sarah Fashakin: My name is Sarah, again. I am a medical student. I was born and raised in Nigeria, and I came to the United States when I was 17. I did my undergrad in Texas. I love Texas. And then I came to Boston to get a master’s in public health, and then last year I started medical school.

Kevin Pho: So you said you grew up in Nigeria until you were 17, and then you went to the States for undergraduate, postgraduate, and now medical school. Tell me some of the challenges that you faced during your journey.

Sarah Fashakin: I was drawn to medicine for various reasons, but one of them was also because of my grandmother, who had Parkinson’s. It was normal, and then she passed away when she was like 78, which was normal at the time. But then when I came here and I started studying more into and experiencing Parkinson’s disease and Parkinson’s disease patients, I realized how she passed away early, earlier. So much could have been done. That was one of the things that really turned my head.

And coming to the United States as a young girl, not knowing much, there was a bit of culture shock, and I was unfamiliar with the terrain, but I got by, thank God. When I was in Texas, I had so many nice people willing to explain different things to me, because you’re in a different country where things are done differently. Even English is different. I learned via British English, and I came here and then I had to learn American English, how words are pronounced and spelled, and just little things like that.

But it’s been a wonderful, fantastic journey so far, honestly. I have gained so many friends and so many experiences that are invaluable. And to be honest, even if I may have struggled, I don’t have any regrets. I think each experience was important for me to have.

Kevin Pho: So you’re in your second year of medical school now. Tell me what kind of path you think your medical journey will lead you to.

Sarah Fashakin: I think it’s going to lead me to be a pediatrician, perhaps also delving into education as well as being a practicing clinician. But we will see, because I am starting clinical year next year, and I have been told you may change whatever you want to do. So I’m keeping an open mind. I still have that sliver of thought in my head that it is possible I may change, but that’s OK. The important thing is that I end up doing exactly what I actually want to do, because I know it’s going to last for the next 30 years. Whatever I choose, I must enjoy it.

Kevin Pho: So let’s talk about the story that you wrote on KevinMD. It’s titled “What my father taught me about language.” Now, for those who didn’t get a chance to read your story, you can just walk my audience through it and share the story of why you decided to write it.

Sarah Fashakin: Yes. So to summarize the story, it is a three-part story. It starts from the very end and walks its way to the beginning. But really it is a story of a daughter who lost her father to asthma, and it’s also a story that shows the relationship the daughter had with her father and with her mother. They weren’t very wealthy; however, there was a lot of love in that family. But the main issue at the time was the fact that the father didn’t have good medication for his asthma, and it was getting serious, severe, and he did pass away. And it’s a story of a girl just writing about that, and how she felt, how deeply it hurt her, basically, to lose her father.

Kevin Pho: Now go into more detail. Tell me more about the relationship between the daughter and the father, and some of the challenges they faced through his medical condition.

Sarah Fashakin: Yes. The relationship was very jovial. The father was the one who taught her about English, the English language. She learned how to write from him. She learned how to use those big words from him, words you don’t even hear, like “balderdash” and “buncombe.” You don’t hear them in common-day English, but her father was very much a scholar in that aspect. He wanted to make sure he passed across proper grammar. He wanted her to stand out in terms of using the English language. So this girl was young, she was about 8 or 10, but she was very proud to be her father’s daughter. And that was the relationship that she had with her father.

However, her father had asthma. He was using theophylline as his medication. I mean, we know that theophylline as a medication for asthma is not very commonly used in the U.S. anymore, because there are better ones. But that was mainly what they had back then in the country, because this is a story based in Nigeria. So that’s why that was the medication that was used.

And according to Nigerian standards, they were not even very wealthy to start off with. She was sort of excluded from the conversation about her father’s health. She only heard the tidbits that she overheard, some things through the door, when her father and mother were discussing it. They excluded her from the conversation. She also only observed the severity of her father’s condition through signs like the skin patch and the side effects of the medication and everything. She was just observing it through her father, but she was excluded.

Kevin Pho: Now, as you reflect on the story, and of course you’re going through a medical education journey yourself, what are some of the things that you’ve learned after reflecting and thinking about this story?

Sarah Fashakin: Yes. One thing I have learned is, to be honest, this story was actually based off of a friend that I had when I was growing up. She was my best friend in college, sorry, mistake, secondary school. I remember her calling me frantically. I said the girl was 10 or so, but really she was more like 17. She called me frantically in my first year of college at Baylor University, and it’s a very expensive school for Nigeria. She told me that her father is dying.

And in my wildest dreams, I was 17 years old, I had just started my medical journey, I could never imagine that someone could die from asthma. I’ve been exposed to asthma so much growing up, and even here I hear of people who have asthma. I didn’t think anyone could die from asthma. So I started exploring why. Why would he die from asthma?

And then I learned of the challenges of the medication that is available to third-world countries. I learned of when physicians, and this is not, I’m not trying to speak against physicians, after all, I want to be one myself, but I understand the human nature to also go on autopilot when you’re used to seeing the same kind of patients. You’re very familiar with the medication, the treatment, the type of patient, and so you just go on autopilot, like, “Oh, this is what you do.” And then you just get that one patient, when you’re on autopilot, that’s the one patient that now has more severe symptoms and more severe issues, and you weren’t really mentally ready for that because you’re on autopilot. And that was because I was trying to explore why he would die from asthma so young. Those are the things I learned going into the story.

Kevin Pho: What’s the health care system like in Nigeria? If you could just give us a snapshot. I don’t have many guests from Nigeria on the show, so just give us a snapshot. What is the health care system like over there?

Sarah Fashakin: It’s less regulated, I must say. It’s a system whereby if you are well-to-do, if you’re wealthier in the country, you can get good health care; you have access to it. And it’s also one whereby it’s not insanely expensive, in the sense that if you’re wealthy, you can get by. But the problem is that the majority of the populace in Nigeria aren’t wealthy, so the majority of people do not have access to health care, and the insurance is almost useless in the country. So that is the state of the health care.

You’re in a place where the medical education, in terms of the quality of what they’re being taught as medical students who are trying to be physicians in the country, is so good. I promise it’s so good. But the thing is, when they come out and want to start practicing, they aren’t paid salaries. So you have issues where doctors are going on strike because they are not being paid. And even when they are paid, the place they’re working in, now I’m specifically referring to the public hospitals, the ones that are funded by the government, the place they are working in is very abysmal. Like the bathrooms, I’m sorry, the bathrooms are not very good. They’re not given enough amenities to work, even if they’re willing. All those things, there’s no incentive to want to participate in the health care.

So it’s really sad, because on one hand, I’m a product of Nigerian education. It’s fantastic, it’s fantastic. It’s just, in terms of amenities, where the money is being diverted to is the issue. So if you’re wealthy, you can get by. The majority are not wealthy, so they don’t get by.

Kevin Pho: So for those who aren’t wealthy, how difficult is it to see a doctor?

Sarah Fashakin: It is difficult, very difficult, because there are too many people that want to see doctors, because Nigeria is very big. We’re called the giants of Africa, not because we’re actually giants or anything; it’s because there are just too many of us in the country, which I don’t mind. But there are too many people that want to see doctors.

But unofficially, you can see doctors, like, if you have a friend of a friend who’s a doctor, you can go meet them. That’s how it is, kind of informal. You don’t really have to pay. Like, if I go to Nigeria now, and let’s say I’m a physician, I’m not, but let’s say I was, and I go to Nigeria and my auntie has a medical issue, rather than her going to the hospital, she would just ask me. She’s like, “What is wrong with me?” Those kinds of things you don’t really pay for; it’s just free. So in that sense, it’s easy.

What’s not as easy is getting good medication for whatever you are diagnosed with. Because, for example, take this story. At the end of the day, for most people, most of the medications, the asthma medication would be theophylline. The better ones are not available. What can he do? He can’t travel all the way. He doesn’t even have the money to import anything. So he has to work with what he has, what is available, freely available.

Kevin Pho: We’re talking to Sarah Fashakin. She’s a medical student, and she wrote the KevinMD article “What my father taught me about language.” Sarah, for those students coming from abroad to study medicine in the United States, what’s something that you’ve learned that you could share with them from your own journey?

Sarah Fashakin: So being an international student, just practically speaking, there aren’t a lot of spaces in the United States, in terms of spaces in classes, for international students. So I would say, first of all, even if you’re very passionate about medicine, try not to make it your all in all mentally. It’s a mental thing you have to work on, nothing physical you have to actually do.

Because typically, when people come in from Nigeria to the United States, they’re brilliant. They’re smart. I grew up with a lot of them. They’re just intelligent. They know the work ethic, they know how to work hard, they know how to study hard. I don’t have to get into all that with them, telling them, “Read your book, set your calendar, make sure you’re organized,” having to give them all that detail. They’ve got it down from 16. They already know all this. But the key is making it your identity, so central to your identity.

I say this because initially, I applied to medical school twice, and the first time I did apply, I was utterly crushed when I did not get in. I never thought I would ever suffer from depression, but I felt what’s awfully close to that. I don’t know if I actually had it; I never went in for a checkup, but it felt like I was getting really close to such, because it was my own, my identity. And I had to work on that for the next two years before I applied again. And when I got in, it was a different kind of joy I had. It wasn’t like, if I didn’t get in, I would be how I was the first time. I was like, “OK, whatever happened, I still want to be a doctor, but it’s not my all in all.” Now I’m focusing on other aspects of life.

So that would be my advice, because Nigerians, they’re all bookworms. Academics is so central to your worth in Nigeria. So it would be recognizing that and mentally fixing it.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Sarah Fashakin: I even have to work on being just a medical student; I cannot imagine how much more I have to work when I become a clinician, because we all have other aspects of our life that we have to focus on. But recognize that each individual is unique, and each individual should still also be given proper attention, because you never know when you get that one person, that one patient, that you actually needed to pay full attention to, but you didn’t realize this because you were just going through the motions of whatever you were doing. That is the one central message.

Because the man in my story left behind a daughter. He left behind a wife. And I’m not saying that it was just the physician. We talked about the medication and all the other aspects of things. What I’m trying to say is, make sure that when all is said and done, you can live with a clear conscience that you did right by the family of your patients. That’s what I’m trying to say.

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

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