Winners of the Annie Li Yang Student Essay Contest
April 11, 2023
The 2023 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. First place winner was Joshua Rabotnick and his essay “Scar Tissue.” Second place winner was Taylor Lombard with her essay “Medical School: Holding Two Truths.” Third place winner was Patricio Ruano with his essay “Como Te Voy A Olvidar.”
- 1st | "Scar Tissue" by Joshua Rabotnick
By Joshua Rabotnick, Class of 2026
Scar Tissue
Like osteoclasts scraping at the surface of mineralized bone, I remember hoping when I first started medical school that CHM’s emphasis on the humanism of medicine would erode the burnout, fatigue, and callous of my experiences in EMS over the past several years. There’s an almost impossible-to-describe cognitive dissonance that stems from believing that every patient deserves your absolute compassion and understanding, and the realistic exhaustion and sheer inability to emotionally give every patient the humanistic care they’re seeking. For many, or at least myself, this peaked during the COVID pandemic. I don’t know if it was the rubber bands on the N95s constantly impressing into my cheeks all day, or seeing the hundreds of patients waiting for beds to become available in every oversaturated hospital across the country. Either way, COVID was just the straw that broke the camel’s back – a final stressor atop years of understaffing, poor pay, and horrendous work schedules.
All I could think when I got accepted to CHM was that this was an opportunity to emotionally and mentally reset. I wanted to be me again. The me that would stand up to firefighters berating a veteran with mental health issues for calling 9-1-1 for the thousandth time as a new EMT. The me that would mockingly be called the “psych whisperer” for merely having the patience and respect to listen to my patient’s needs as we drove to the hospital. The me that would sit on the side of the highway for half an hour with a mother who walked into traffic hoping to get struck by a car, overwhelmed by life and simply needing a hand to hold. The me that I sold myself as when applying to medical school who I didn’t realize had completely changed in the years since first working in Los Angeles.
This past Saturday, after finishing my classes for the week, I was working a shift as a paramedic when I was sent to the home of an older man with prostate cancer. His wife had called 9-1-1 for diarrhea after he had started a new chemo drug, and she opened the door tearfully explaining that he was just discharged after experiencing hospital-induced delirium with his last admission. His cancer had metastasized and while she wouldn’t say it, he was going to die from this. I assessed the patient on his couch. His vitals were stable, he didn’t feel weaker than usual, and as much as he didn’t want to go to the hospital, he didn’t want to continue burdening his wife at home. “Did you try calling his oncology clinic?” I asked. “They’re not open until Monday or I would’ve,” his wife explained. The diarrhea had mostly resolved, but the patient was a mess. “If I help you get cleaned up, would you rather stay home and follow up with your doctor directly?” I asked, after giving the legal spiel advising of our limitations pre-hospitally and our willingness to come back out if he changed his mind.
I spent the next hour and a half removing the patient’s clothes and wiping away the feces that caked his legs and buttocks. In eight years of EMS, this was honestly something I hadn’t ever done before, always pushing the issue of cleaning patients along to the hospital. “Why don’t you stay there a minute,” the man crassly joked while still smeared with stool, gesturing at his wife who was bent over in front of him throwing pads of soiled wipes into a trash bag. While inappropriate and untimely, it was a sudden reminder of the multidimensionality of human disease which can all too easily become all you recognize in a person. It was something my dad would say, and it was a heart-wrenching glimpse into my father’s own future as he suffers from Parkinson’s. As we cleaned the patient, his wife told us their story of his missed diagnosis, pleading with us to familiarize our family members with the signs of prostate cancer. We redressed the patient and for the first time he smiled, ecstatic to show my partner the artwork he painted which was hung throughout the house. I left the wife with the remainder of the stash of wipes and pads we had in the ambulance, still feeling as though that was grossly inadequate in addressing their needs.“Hey, wait, are you okay?” my partner asked me as I walked back out to the ambulance. I forced a smile and climbed into the cab, hoping she wouldn’t ask again. Perhaps the saddest realization was that prior to this, I couldn’t remember the last time that I’d been “not okay” after a call.
I wish I could pinpoint what it is about CHM’s curriculum that has me seeing the old me for the first time in years. Humblingly, I think it’s the gestalt. It’s the fundamental culture. It’s having physician mentors who actually believe in the NURSing and open-ended questioning they teach. It’s having classmates who expressively want real longitudinal relationships with their patients. It’s drawing out Eco-maps in PCG when I’m anxiously, and I guess naïvely, wishing to jump back into the basic science. It’s seeing physicians in clinic continue to genuinely care for patients who repetitively come in for issues which they themselves refuse to address.
At the end of the day, what sets CHM aside as a medical school is an absolute refusal to settle for the historical status quo of decoupling medical care from patients’ psychosocial needs. From having a two-week-long orientation to emphasize CHM’s values to outright grading students on their service and care of patients, CHM’s mission is uncompromisingly to create a medical culture of deeply engrained respect, compassion, and advocacy. I have no doubt that it was precisely this culture of patient-centered care that challenged me in that living room to question what caring for that patient meant, and if my biggest area of growth in medical school is in the rehumanization of healthcare, then CHM was unequivocally the right choice.
- 2nd | "Medical School: Holding Two Truths" by Taylor Lombard
Medical School: Holding Two Truthsby Taylor Lombard, Class of 2025
One semester into medical school, I returned home for the holidays and was repeatedly asked: how is medical school? In hindsight, I should have prepared for this question. After all, I had talked about being in medical school for years and those close to me knew of my aspirations. Though usually ready and eager to share my thoughts, I returned the question with a weary smile and an awkwardly long pause. This was not a typical reaction, but I was unable to articulate my experience. I found myself slightly embarrassed when the person stared at me waiting for a response while a jumble of words and feelings left me overwhelmed. I struggled to create the schema of “medical school” fast enough to form a coherent response. We are asked a lot of tough questions in medical school, but I did not anticipate this to be one of them.Oxymorons are figures of speech with apparently contradictory terms appearing in conjunction. Medical school is an oxymoron. Not the phrase itself, but the feelings and experiences that come with being in medical school. The feelings and experiences are rarely consistent with one tone. A medical student may be wildly interested in the new chief complaint and completely bored when it is discussed for the third time in PCG. A medical student may feel exhausted by the day and invigorated by a patient-interaction at the clinic. A medical student may feel smart while completing the WLM and completely incompetent in LGA. Medical school is a practice in holding two seemingly opposing truths at the same time.
I’m beginning to learn to embrace the seemingly contradictory experiences; not putting too much emphasis on one over another. The oxymoronic experience of medical school has me leaning into the word and. I’m practicing being confident in my preparation and feeling inadequate when I don’t know an answer in PCG. I’m learning to balance feeling strong in my physical exam techniques and being readily receptive to constructive feedback from SIM instructors. I was disappointed to not witness the birth of a baby while shadowing and I was excited to learn about placental abruptions which helped me correctly answer a practice board question. I’m eager to continue the medical journey and I sometimes question whether this is the right profession for. By embracing all the experiences, I hope to allow each its place in my medical journey. As an attending, I hope to be confident and humble; skilled and always learning better techniques; steadfast and still leaving room for a healthy level of doubt.
I recently attended a lecture hosted by an interest group. The guest speaker, an accomplished and successful physician, shared that the most scared person in the room is the attending. Not the medical student. Not the intern. Not the resident. The most scared person in the room is the attending. Why? They are tasked with making the final decision. A decision that could greatly improve a patient’s condition or possibly cause harm. When the physician shared this idea, I was immediately a little defeated. As an ECE student, I have many moments when I feel unsure and look forward to a future of confidence. The thought of always being a little scared felt disappointing. Then, I thought of the word and. Attendings may often feel a little scared because of the gravity of their decisions and they are confident in their training and ability to make decisions that benefit the patient. The best physicians must be able to hold two seemingly opposing truths at the same time.
Fortunately, the spiral nature of the Shared Discovery Curriculum creates space to practice holding both truths. Repeated discussions about the same content, weekly experiences in clinic, and many practice questions allow for feelings of confidence, doubt, courage, inadequacy, despair, triumph, defeat, and hope to consequently or simultaneously exist. For that, I’m grateful.The Shared Discovery Curriculum nurtures students to embrace the parts of them that are insecure and fragile; embrace the parts that are human.
When I travel home this summer, I will be ready. Ready to answer the question: how is medical school? I will smile and say “Medical school challenges me professionally and personally. I experience moments of triumph and defeat. I am constantly intaking more information than I can reasonably process and I’m trying my best to learn and understand. I believe in medicine and its role in helping others and sometimes it’s hard to see the ways in which the medical system fails its patients. It feels right to be here and it feels really hard. I’m grateful to learn at a school where it feels safe to stumble and try again. I’m grateful for peers and professors who embrace all the different feelings and experiences of medical school. I’m grateful for the space to grow as a professional and nurture the parts that make me human.”
- 3rd | "Como Te Voy A Olvidar" by Patricio Ruano
By Patricio Ruano, Class of 2026
Como Te Voy A Olvidar
As I played my favorite Corridos playlist, elderly “Luisa” danced in her Palliative Care bed. It was my first rotation of my Middle Clinical Experience, and I found the juxtaposition of starting on Palliative Care wards mere weeks after celebrating the great life stage of completing my first year at CHM extremely cathartic. This celebration of my completing my first year of medical school was monumental to my family, being the child of immigrants fleeing home countries for survival. I am the only in my extended family who was given the opportunity to pursue college. To me, pursuing higher education was to sacrifice some part of my life of origin in pursuit of dreams that extended generations deep. This sacrifice included missing carne asadas, quinceañeras, bodas, cumpleaños, and other life events. This sacrifice pushed me to forgo the grieving of my abuelita, who I call Tita, suddenly passing in September of 2020. At any other medical school, this sacrifice would have led to years of preclinical work that would have drawn me further away from the communities that sparked my passion in the power of medicine.
My ECE year was filled with hundreds of vaccines, hours of patient education, and bonding with families during subsequent visits at the FQHC I was assigned to. Although I am already prideful of my Guatemalan and Salvadoran heritage, this pride multiplied as I entered the ECE experience. “Hi, my name is Patricio Ruano, I’m the medical student helping you today,” I’d say further emphasizing my Guatemalan dialectical accent in my name as I entered patient’s room. I was reminded of my spark each time I saw a patient’s eyes widen in silent identification of our shared heritage, as they needed no further cue to switch to Spanish. “Mijo/a” is a common term of endearment and love used by Latinx elders when addressing youth. “Muchas gracias, Mijo” became the wind under my wings carrying me to learn pathologies of disease or minutiae of anatomy each day.
Not even two weeks into the MCE I would find my spark again. As I was donning PPE to enter Luisa’s room, I heard Como Te Voy a Olvidar playing through the door, accompanied by who I assumed was Luisa’s family conversing in Spanish. Finishing tying the knot on her gown, my attending physician asked, “Want to take the lead?” As the Michigan summer carried shimmering light through the hospital windows, I entered Luisa’s room with my preceptor and introduced myself, extenuating my accent once more. Luisa had been on the Palliative Care wards for months and would not be leaving the hospital, that was not something we could change. In my head, discussions from our WSGs and Palliative Care articles cycled through as I identified information I’d need to obtain to best care for Luisa at this stage and goal of her care. Pain, comfort, and … her I’s and O’s! I walked over to the food tray by Luisa’s bed, uncovering it to find a full meal. “Senorita, veo que no desayunastes. ¿No te antoja a comer, o ay otra problema?” Luisa’s listless stare, previously locked on the TV, panned to me. As her eyes met mine, I recognized the silent eye-widening I’d seen in my ECE patients. Her silent voice replied “Te aparaces … como mi sobrino. Acércate, mijo, te necesito decirte algo.” I inched closer to her bed as she continued, “No quiero frijoles, ni huevos. Quiero…. POLLO! BIEN FRITO!” Her arm shot up past my face; her index finger ascending to the sky in defiance of the food in front of her. She remarked at the music playing, asking me to change the song.
As I played my favorite Corridos playlist, elderly Luisa danced in her Palliative Care bed. Her family gathered, documenting her liveliness on video as they announced that this was the most they’d seen her move in months. After assessing her pain and comfort, and thanking the family for being present, my preceptor and I left Luisa’s room. In my final glimpses of her, I was reminded of my Tita.
The MCE continuously placed me in scenarios where I could lead community in the clinical setting, integrating the basic sciences and humanities taught by the myriad clinicians and professionals among CHM faculty and community leaders alike. This included education in simulation lab on charting gender-affirming information, and immediately using the skill the next day as I confirmed with a Spanish-speaking patient who had a 5-alpha-reductace deficiency that “El” was to be his pronoun in his chart. After learning how to create a working differential in the ED, I took the lead again greeting the eight-year-old as I entered the room with an “Hola hola hermanito!” At any other medical school, this would have been impossible with traditional education of two years away from patients – away from the very people that brought us to medicine. These clinical experiences, and many others, nurture my spark to trudge on this path of doing right by my patients and my communities.
After my day with Luisa, my mind was filled with how grateful I am that I can continue to be present to lead my community through key moments of their lives. Driving home from the hospital, I wept. I recognized the privilege allowed to me to be present for Luisa and her family as soon as the first weeks of my second year of medical school. I could be present for someone in a way that I couldn’t for my Tita in her final moments of life. I only hoped that Tita saw me in her final provider, in the same way Luisa saw her nephew in me. In writing this, I am now realizing that I was captured in the video frames of this moment in Luisa’s life by the head of her bed, dancing alongside her. I am a part of Luisa’s and her family’s life, and they are forever a part of the kind of physician that I am becoming.
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.”