Ready or not, here is the story about how a research block is turning into a research year. I’m also laying this all out here just in case anyone else reading is interested in doing something like this in the future. Please feel free to contact me with questions too!
Learning about iPSCs
Second year is over, and this is the moment of general limbo for people in my class. I don’t feel quite like a second year since I’m not in school, but I don’t feel like a third year either. Most don’t feel ready to take on that title of a “third year” until they have passed Step 1 or even had their first week on the wards. I’m going to have to get used to this limbo because I’m officially taking a year off to do a research year in Boston through the Howard Hughes Medical Research Fellows Program! I’m so excited. I’ll be working with induced pluripotent stem cells (iPSCs) and a project VERY LINKED to sickle cell anemia with an amazing physician-scientist named George Q. Daley. This all may seem sudden and new, but this HHMI story really began years before I even came to Cleveland.
Hematopoietic stem cell transplantation is currently the only “cure” for sickle cell disease, but it has it risks and is underutilized. The patient is at risk for (1) severe graft versus host disease (since they need HLA-match donor like a whole sibling) and (2) resistance to the immunosuppressive drugs they must take after the transplant. These problems arise from the fact that these cells are not their own, and they come from someone else with a different immune system. Therefore, patients who are selected for this treatment are sick enough that the general management for SCD is inadequate, but not too sick that they are at high risk of not surviving the procedure. It is a calculated gamble that, if only were safer, could really ease the burden of this disease for more people with it.
I was introduced to induced pluripotent stem cells (iPSCs) during the spring of my first year in college. At that time, I had never held a pipette or worked with tissue culture, but I was truly fascinated by the idea that mature fibroblasts could do what seemed impossible. They could be reprogrammed to a state where they had the potential to become anything. If a patient’s skin cells could become red blood cells, could a patient reject them if those cells were transplanted? Theoretically, no. As I read on about their potential for treating myriad disorders including sickle cell disease, I was both intrigued and inspired. iPSCs became the focus of my final paper for the course, and I revisited it again the following winter at a pre-medical program at the Feinberg School of Medicine. I made a poster and gave a short PowerPoint presentation on the advances, successes, and challenges of hematopoietic stem cell transplantation for the treatment of SCD. Nothing else I had encountered gave me more hope for a cure than that of iPSCs. From then onward, I wanted to learn more about stem cells and their journey to maturation.
Learning about HHMI
My hope for a cure began with iPS cells but even at the beginning of my second year, I did not think I’d have the opportunity to work with them. A September afternoon, I received a phone call + a series a text messages from my Urban Health Pathway advisor. She left a message saying something about “Howard Hughes…program director…call her today…interested.” At this point in the year, I was thoroughly considering a gap-year but one in Cleveland working with my current PIs. I had not really set my sights on HHMI because in my opinion it was what really smart, intense people do—people smarter than me of course. I called my advisor back, and she explained that for reasons she still cannot fully explain (she says “the universe/destiny” now; I say “God”), she mentioned my story/interest in sickle cell to the program director of the HHMI Medical Fellows Program, and she really wanted to talk to me. Nervously, I called the program director back, and she we had a conversation that all but convinced me to apply. The downside: the suggestion to leave Cleveland, my PIs and work somewhere else. I know this could be a positive to many people–especially to go to a flashy and amazing place like Harvard, but I really value loyalty and personal/professional relationships. I didn’t want to see them damaged even when taking advantage of a great opportunity.
First thing I did? I sought counsel. I went to to my UHP advisor, Susan Wentz to talk about how to approach my PIs. I went to my ASH career development mentor, Stanton Gerson to discuss what HHMI was like/how it could impact my career. He knew both of the investigators I was considering and even offered to call them for me if I wanted. I still wanted to discuss this with my research mentor, Jane Little before proceeding further. Over coffee, she candidly told me what she thought and in the end, even though she would love for me to stay, she would support me in this venture no matter what. Having her support was so important in me feeling comfortable in going forward in this process.
In deciding on which mentor to work with, I reached out as well to my undergraduate research mentor, John Cunningham, who helped me remember my great interest in iPSCs. I’ve said this in a previous post, but it took until I came to Cleveland to realize that good mentors do not always have to look like you, but they actually need to care about you. It is to your advantage to surround yourself with people who will advocate for you, tell you the truth, answer their emails and support you. It’s on you to foster those relationships because even though they may care, they are busy and you have to keep on reaching out! You never know when you’ll need them. Also definitely talked to my parents! Can’t leave that out.
So I chose my prospective mentor, but now he had to choose me back. I decided to email him first before asking for help from Dr. Gerson, and he RESPONDED back! After letter of recommendations and a Skype talk, I decided for sure that I wanted to learn from someone of his caliber, and he also welcomed me to the lab.
Most of my winter break was spent on this application. It was draining! The biggest part was understanding the science needed to write the proposal. Having a working understanding of globin gene regulation of erythropoiesis was great from the get go (what I learned in undergrad), but I also needed to write well–so mentor won’t think he made a mistake by choosing me and also so the application can be strong. These apps are also evaluated on the strength of the mentor so pick a good one. Of course, I had to write a personal statement, which was surprisingly easy to write because it all was so true, and then I had to explain every research experience I have had in my life. I started research in 2011, but that took actually the longest amount of time. Your CV is also included along with AMCAS sending your MCAT score (out of your hands now, it is what it is!) Letters of rec from dean, 2 mentors and prospective HHMI mentor are required.
January 11th—the application was sent and then along period of waiting began. Waiting and hoping. All of this came to a head, on March 17th at 11:59 pm when I was in a nervous panic waiting for the news. A weirdly kept Googling HHMI and even checked out the horrible Student Doctor Network (God help me). I thought the email would come in there morning. I was right…but not in how I expected. 12:01 the OFFER was in my inbox and that brings us to now!
So why am I doing it?
When I learned about the Howard Hughes Medical Fellows Program, I knew that this experience would allow me to not only witness but also participate in groundbreaking research. This program will, I hope, present me with new opportunities that resonate with what I hope to be able to do in medicine: to heal and to discover. It was a seminal moment in my life to Skype with a physician-scientist like Dr. George Q. Daley. While we talked about my experiences and motivations to be a HHMI medical fellow, the next step in my journey emerged with clarity. I am so excited to have the chance to learn from a researcher whose work has and will change the world. As I am challenged to think creatively and with innovation, I will encounter what has inspired me to become a hematologist: work marching towards a cure for sickle cell disease.
This research block has become a research year.
Although my posts may be less about clinical medicine and more about life in a new city and in a new lab, I hope you keep reading.
In the next month, I’ll be heading to Chicago and then Italy (yes, more on that later). Arrivederci, Cleveland! See you in a month. STEP 1 time is certainly coming!