Winners of the Annie Li Yang Student Essay Contest
April 25, 2022
The 2022 Annie Li Yang Student Essay Contest asked students to reflect on the connections between their clinic and classroom experiences and how that impacted their growth as a medical student and physician-in-training. Momin Samad won first prize for his essay “Efficient Humanity.” Second prize was awarded to Eliza Burr for the essay “In the In-Between, Finding the Humanity in Medicine” and third place to Daniel Brown for his essay “Vertigo.”
First Prize Winner
Efficient Humanity
By Momin Samad, Class of 2022
It’s almost astounding how quickly medical school goes by, in retrospect. The present feels almost non-existent while the future so distant. But even more astounding is how many transitions we experience in during medical training. How many firsts. How many have taken place and how many still left to experience. There are moments you will never forget, that make their way into your emotional psyche and set up permanent shop. That show their faces when you least expect them: maybe on the back of your eyelids as you try to sleep, perhaps in the voice of passerby. The unfortunate outcomes that revisit you, but you try not to let haunt you. The first time I saw a human being die. The first time I had to deliver bad news. But there’s good too and graceful moments. The first time I delivered a baby. The first time I helped someone quit their addiction.
And amid memorizing the clotting cascade and presenting on rounds, transitions presenting themselves as personal growths and setbacks happen too: The first time I answered confidently in LGA. The first time I didn’t finish at the top of my class. The first time the attending actually agreed with my plan. The first time I failed to close my first wound in the OR. The first diagnostic catch. The first time my classmate passed away. Oh, wait.
Every year I receive an email from CHM with the subject: ADM: Annie Li Yang Student Essay Contest. And every year, I mark it as read and scroll on. Part of the reason is because I’m a terrible writer. But the other part is because the contest reminds me of one of those transitions, a very unpleasant one. Annie and I were friends in the same small group, Adams 1. While I still vividly remember that dreaded day when my classmates and I received the news, I will not discuss those moments. Why? Because I think that would do Annie a disservice. When I think of Annie, I am reminded about the friendship we developed, and the lessons she taught me during these transitions.
Annie was brilliant and quiet. It took time for her to open, and our friendship flourished over the course of the semester. She taught me that it was okay to be reserved, to not know what specialty you wanted to pursue, and most importantly to laugh at yourself through the chaos. However, our serious discoveries, along with our classmates, happened during an overlooked transition, at the end of first semester. Annie and I realized the effort it would take to succeed in medical school and sacrifices we would have to make. Our classmates and I gained an understanding of how we learned best. But whether several of us realized it or not, we started to lose a sense of purpose. The word “jaded” already began to be whispered and the same smiling student taking pictures in their pristine white coat started to develop stains on it. These metaphorical, and sometimes literal stains carried us and shaped us through the next three and half years.
As Annie did not return the next semester, I reflected on two themes that developed during our time together and they stuck with me for the rest of medical school. There was efficiency, and then there was humanity. Yes, one thing I was struck by was the burden of what can only be described as logistics, and the stark reality of how encompassing it can become. Logistics during first and second year remind me of doing hundreds of Anki cards, meeting benchmarks for standardized exams, and fulfilling SCRIPT competencies. However, this phrase graduated during the last two years. When you hit the hospitals and clinics full time, you hear residents complain about “scutwork” and you finally get it. There is a massive amount of paperwork. There is a lot of time spent hunched forward and typing progress notes, cranking out discharge summaries, re-entering orders, and being put on hold with insurance companies. There is monotony and there is waste. You are asked to perform tasks you thought a child was capable of, but you still somehow get wrong. Yes, I placed the prescriptions in the green folder. Yes, I updated the white board for the night team. Yes, I put in the morning lab orders. This is the reality of most of each day, every day, and it can consume so much of your time and mental energy – if you let it.
And then there’s humanity. It’s the main reason many of us went into medicine in the first place. It re-ignites you, moves you, and changes you. I have written countless notes these last few years. My fingers and smart phrases repeating the pattern of the lines “Heart regular rate and rhythm, lungs clear to auscultation” on the computer. But none of it made an impression. No, what I remember is the patients; the strikingly emotional encounters remain crisp. The early ones form a deep mark and I wonder if they all will – if their impact is a function of our inexperience, or if it’s a more enduring feature of this profession. These patients have taught me in every possible way. About this job we call doctoring. About life. You remember, forget, and remember again why you chose medicine in the first place. Humanity is the reason you did this, and it’s everywhere. You just have to open your eyes again. You can lose the picture for the brushstrokes, or you can repel the forces that threaten to jade you and remain luminous, grateful of what is around you, appreciative and humbled by the role you are in. It’s easier said than done.
Now, as I finish my last year of medical school, my goals are humble. From pushing to learn everything possible to the one goal that towers above all: to do good. I want to do right by my patients. Patient care is what you make it; there is so much you can give to the people whom you went into this field for. I will spend time with them, know them, and see them as someone like myself, as Annie mentioned. At times there will be enigmas, but I will do my best to work them out. I will make mistakes, but I will learn from them. I will be diligent. There will undoubtedly by many moments where I will not know the best course of action, tiny decisions sprinkling the day with each having potentially ominous consequences. But no matter what, I will do right by my patients. I will do right.
Second Prize Winner
In the In-Between, Finding the Humanity in Medicine
By Eliza Burr, Class of 2025
I didn’t think I would belong in medical school. As someone who grew up immersed in the humanities, the world of STEM has always fascinated and terrified me. In undergraduate chemistry and biology classes, I learned that the natural world was governed by axioms that created patterns that led to answers that were either “yes” or “no.” And yet, in my literature courses, conversations lived and died by “maybe” and “sometimes.” As my desire to study medicine found roots and flourished, I became more anxious about losing access to the nuanced spaces between definitive answers, the spaces in which I believe human connection resides. I assumed that in medical school I would spend my time constantly, frantically studying mechanisms and memorizing facts; I was expecting to be utterly lost, my humanities background awash among other students’ biochemistry degrees. Admittedly, as any of us will tell you, there has been a lot of studying mechanisms and memorizing facts.
However, as I near the end of my Early Clinical Experience, I’ve happily discovered that medicine is far more concerned with the “gray areas” of human experience than I’d previously guessed.
In our lectures and simulations, we’re taught clinical skills and the basic science behind them; in our PCGs, we discuss the associated mechanisms of action; in our clinics, we’re taught to apply our knowledge to actual patient care.
I recall an afternoon at my clinic during the early days of ECE in which a patient with opioid use disorder (OUD) came in for cellulitis of his legs. One of the physicians at my clinic provides medication-assisted treatment for patients with OUD to support their recovery, and this patient had been recently discharged from the clinic’s program due to consecutive instances of opioids in his urine. When he presented in the clinic that day, he admitted that he had been using opioids to cope with his pain. He was in so much pain that we could barely remove the dressings from his legs, and the physician arranged for him to be admitted to Sparrow Hospital’s wound clinic immediately. I rebandaged his legs and walked him to his car, wondering at his ability to walk at all. My coursework up to that point had taught me how to emotionally support a patient, and I listened as he mentioned that he does not like the wound clinic because they never give him pain medication due to his history of OUD. I empathized; I wished him luck; I regretted not being able to help him further.
Following this experience, I wondered at the proper treatment of acute pain in a patient with OUD. Hearing that he was not being given medication for his pain frustrated me—I wanted to be able to help him seek relief. I had recently learned about the activation of mu-opioid receptors and how their overactivation could lead to opioid-induced hyperalgesia. It seemed simple to me- if a patient was in pain, and if we knew the mechanism by which their pain was caused, shouldn’t we treat it? But after speaking with Dr. Poland and doing some research, I learned that there are no established guidelines for the treatment of acute pain in patients with OUD, and that providers routinely deny these patients medication for pain. It was a gray area, a disparity between what was known and what was done, a space of uncertainty. It wasn’t a space of uncertainty that I wholly agreed with, but it meant that when confronted with a patient with OUD, a provider had to stop, think critically about the patient’s emotions and situation, and work with them to make an informed decision. Unfortunately, in cases of OUD, this does not always happen. I hadn’t expected to find “maybes” and “sometimes” in medicine, but when I began to look, I couldn’t stop seeing them. The decision to treat a patient’s arrhythmia, the adjustment of a diabetic patient’s diet, and the right antidepressant to use—all areas in which treatment plans vary and are informed by social factors that cannot be predicted by algorithmic thinking. In situations like these during ECE, I have been able to use my experiences in the humanities to help me step outside the algorithms and utilize the empathy skills that we were taught in the first weeks of school to provide the patient with whatever relief we can.
I expected medical school to teach me how to conduct the proper exam, identify the correct diagnosis, propose a treatment, and find a cure, and it is true that I am learning these things. However, medical school has unexpectedly taught me that biological systems and social systems are alike in that their realities are much more complicated than the algorithms we learn to understand them. It’s a humbling thought. We are taught patterns to help us identify diseases in LGA, IBL, SIM; then, in our small groups and clinics, we learn the ways in which reality complicates these patterns. Being taught to be receptive to patients’ emotions allows us to take a step back and adjust to the gray areas of medicine. Perhaps more importantly, it allows us to provide some comfort to patients when we, and perhaps the medical field at large, may not be able to otherwise help them just yet.
I am incredibly grateful for these gray areas in medicine. They make me feel at home. They give me hope that medicine as a culture will become more comfortable with the contradictions that patients bring to the table. My classmates and I sometimes share our experiences in the clinic that remind us why we’re here—interactions in which we finally get a long-time smoker to commit to quitting cigarettes, in which we connect with a patient about something unlikely, like old movies, Russian novels, the Premier League. Humans are much more complex, much more mysterious than our mechanisms of action can predict. Even with our current limited medical knowledge, these interactions with patients leave our days a little brighter, and I like to think that the patients feel the same way. For that, the not-knowing is worth it.
Third Prize Winner
Vertigo
By Daniel Brown, Class of 2024
That morning, I had read a paper titled, "The Empathy of Doctors Peaks the Day Before Medical School.” In the clinic, my job was to make rounds, ensuring nobody was short of breath or anaphylactic after receiving the covid vaccine. I was nervous, a first year student already in front of patients. Halfway through the day I heard a woman yell‒ ‘Help, he’s shaking! Somebody please!’, and I rushed to the room. A man was shaking, badly, a tremor filling his arms and hands, panic bright on his face. The nurse and I lied him down. I put a pillow under his head, and his wife told us, ‘It could be vertigo, that happens sometimes, or…’ she trailed off. ‘Or what?’ asked the nurse. ‘I don’t know!’ said his wife, just get the doctor!‘ So the nurse went to find one, asking me to stay with him. Supine now, he still shook, we couldn’t know what was wrong.
Now vertigo, that I could wrap my head around. In class I already had: a disturbed vestibular labyrinth, fibers descending with misperceptions of gravity. Misguided impulses that send the floor spinning, a sensation one should only feel while plummeting or just off a merry-go-round. But this was not a park or a cliff, this was a clinic‒ yet his eyes darted side to side in panic, his wife clutched his hand. I didn't know what else to say or do, only trying to remember if that movement of his eyes was called saccade or nystagmus.
The doctor returned. She was tall and poised, scanning the patient's chart on a tablet. She paused, observing the lying man while the nurse hooked a blood pressure cuff around his arm, put an oximeter on his trembling finger. The shaking had lessened by then, and the doctor asked his wife, ‘Do you have his antivert?’ The wife opened her purse, frowned, ‘We left it at home.’ The doctor asked, ‘Was he upright when the shaking started? Or already lying down?’‘He was upright.’ the wife said. The vitals had come back by then: his blood pressure was slightly elevated, his heart rate was high. ‘Hmm’ the doctor said.
By now the room was feeling crowded. Another nurse had come inside with a medical assistant, and the charge nurse and the receptionist were watching the scene from the doorway. I felt like I was in the way, with little to offer as a first year student, so I stepped from the room, continued my round of welfare checks, and sat down at the nursing station, worried about the man.
I was embarrassed. When I saw him shaking I had frozen, not knowing what to do. While the nurse and I lied him down, I was trying to think of what I would have done if I was the doctor. Between the man's shuddering body, the pleading on his wife’s face, my mind: had gone blank. Sitting at the nurse’s station, I worried to myself. What if that happens again, when I am the doctor that someone sends for?
I flashed back through months of medical school; the countless zoom lectures, the pages of concept maps, the simulated patients. The mouths behind masks behind face shields, all working together to teach me. What was their purpose if I froze when the moment mattered?
My mind searched for more evidence to explain the doom I felt. I thought back to that study about empathy. How could it be true? Was what followed for me a gentle slope towards burnout? I remembered other headlines, about a rising death toll, about higher burnout countrywide. Lines on graphs growing steeper and steeper. Earlier, when the nurse had left that room, asking me to watch the man, I hadn’t even known what to say. I couldn't summon comforting words, let alone helpful information for the panicked man and wife. I had just stood there, thinking to myself, saccade or nystagmus?
This tension was new to me. This balance. Between the intellectual demands of medicine and the human ones, both trying to work in my head at once. Thinking ahead to the responsibility I would one day bear, my confidence was sent spinning, my heart rate quickened, a vertigo of my own, the floor of my future uncertain.
I saw the doctor leave the room, the rest of the staff dissipating with her. I asked a nurse what had happened. ‘It was vertigo.’ she said. ‘He forgot to take his meclizine.’ She turned to chart the incident. I wondered what I would say as I escorted them to the car.
Most medical students don’t have an opportunity like this their first year. To blend the rising curve of learning with real stories of patients and sickness. Thanks to the shared discovery of the CHM curriculum, and the opportunity to enter the clinic, I was given a place to remember that I still have my empathy. I’m grateful for how early in our education CHM puts us on the spot, in front of real patients. It takes people who are really sick, who feel the echoes of an illness in every aspect of their lives, to teach us something greater about care, beyond a diagnosis or treatment plan.
I asked myself what I could control, and went into the room. I hadn’t needed a diagnosis to know his head would feel better with a pillow beneath it, or earlier, before his vertigo, to learn about his three dogs waiting for him at home. My diagrams about balance and equilibrium, though lovely tools, couldn’t walk behind him slowly, hand on his gait belt, making light conversation while his wife pulled up the car. I remembered the conclusion of that paper. It isn’t that students come to care less, it’s that they know more, have to juggle more — so that basic human facts are easier to miss. Thanks to the man with vertigo, I felt steady. He smiled as his wife drove off, we both waved goodbye.
IN MEMORY
The contest is named in honor of Annie Li Yang (1995-2019), one of the inaugural essay winners. Annie was a first-year medical student at the Michigan State University College of Human Medicine. She held a BA from Princeton and would have received her MD in 2022.
In her winning 2019 Inaugural Student Essay Contest entry titled “Patiently Gazing into Patients’ Lives,” Annie candidly delved into her fear of and journey to overcome reductive thinking, stressing the importance of always keeping sight of the individuality of patients and their lives outside of the hospital or clinic. In her words, “what it truly means to become a physician [is] to see the patient as someone much like myself, a member of a wider community and family.”