On Deciding to be a Second Year HHMI Med Fellow

This has probably been the longest hiatus I have taken from blogging since I started this a few years ago.

The time between February and today has been intense, wonderful, stressful and fun. March was hard. April was better, and May is off to a good start.

Without further ado, how I decided to be a second year HHMI fellow.

The Dark Times

Since the start of my fellowship year, I have known that I could be in the program for one or two years. The thought of two years away from medical school sounded crazy, but at our kick-off meeting in September, I definitely wanted to pick the brains of the students who had decided to do that. Their reasons often took the form of “promising projects” and “prolonged curiosity.”

To be 100, the beginning of my research year was pretty difficult. Learning finicky iPS culture was challenging, but the interpersonal aspects—including technical support/help with my project was even tougher. Honestly, I came right off taking Step 1 (definitely most draining standardized test prep I and many ever experience. MCAT is really cute in comparison), was exhausted, a medical student pretty used to being told what to do—not driving her own research project. I have been curious about sickle cell anemia and the iPS system since the very start but curiosity is not enough to get things done.

So when I saw those second year fellows, in love with science and their projects, I wanted to be them, but just did not feel like I would get there.

 One of my neighbors asked me once what it would take for me to stay another year (very early in the year). I broke it down for her like this:

  1. My project is going well, and I see a publication on the horizon.
  2. An amazing man fell from the sky so I want to stay in Boston longer.
  3. My PI asked me personally to stay.

I definitely thought that number 2 was going to be the most likely option actually. In hindsight, I chuckle. But seriously, I thought 1 and 3 would be VERY unlikely. Especially number 3.

My lab experience really changed course in November 2016. The people in my lab responsible for this know who they are, and I am so grateful to them. Right before my first lab meeting, I remember them staying with me so late to help me squeeze out the last bit of data I could, and I remember just feeling so supported. I felt a part of a team, and that people actually cared about the science that I was trying to do. Moreover, I felt like they cared about me.

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Boston shut down for the February snow storm but not the Daley Lab. Indian food to warm our frozen souls.

A Pot of Risotto

As winter rolled along, I gained more confidence but there was definitely some large barriers I had to making RBCs from iPS cells that could actually model sickle cell anemia. I won’t get into that here but just believe me. After the January HHMI Investigators meeting, my HHMI program officer reached out to me about something and asked how lab was going.

In short, I told her that it has certainly been one of the best years of my life so far, and that is actually saying quite a lot given how difficult it was in the beginning. I love what I am doing. I told her that sometimes I think casually about a second year in the program but since my PI became HMS dean, I was not sure if another year in the lab would be ideal for everyone.

February happened.

My lab has an annual retreat in New Hampshire. There, all of us in the Blood group had to give 15 minute talks. After SO MUCH affliction (think the 7 plagues of Egypt) facing my cell lines (mycoplasma, bacteria and bad luck), I was feeling pretty insecure about my presentation.

Later that evening, I along with a few other lab mates were helping my PI make dinner for everyone in lab. He actually does this, and is surprisingly a good chef! At one point, I had the task of stirring the risotto and for 3 minutes or so we were alone in the kitchen.

And then the most unexpected thing happened. He asked me if I would like to stay and told me he would support me in it! My project could benefit from another year of work he said, and HHMI actually CONTACTED him saying that they would love for me to continue in the program.

I was already a little warm stirring that gigantic pot but was legit sweating after this.

I did not have an answer for him. I did not know what I wanted, and I honestly never thought I would find myself in this situation.

I told him I would get back to him, and I really did not have much time. For one, the intent to apply notification to HHMI was due a week from then (March 1). The application was due April 1.

I needed to decide and SOON.

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Risotto

Soul Searching

A second year will be important in how I market myself as a physician moving forward. Do I want to be a physician-scientist? Do I think I actually could be? Should I even worry about it? True indecisiveness is painful for a very decisive person!

I called my program officer and messaged another fellow just to get a sense about why this may be a good idea again…?

First thing, I knew my parents would give me some push back. They are physicians so they obviously have very informed opinions about careers in medicine. However—not as much academic medicine. My parents want what is best for me. They are immigrants who definitely prioritize, security in regards to career. Delay in anything (I remember I wanted to take a gap year between undergrad and med school and that was not…welcomed) almost appears to be a question of doubt and being unsure. I know what my motivations are in medicine and life, but as parents, they just want me to get that MD as soon as possible so I can stand on my own two feet, and they can worry about me less.

Taking a year off in the first place was a little challenging with them, but it being at Harvard seemed to be very helpful…!

I was the most nervous about telling them about this development. There was some pushback: “what does this mean for your loans?” “Would your PI recommend this to his own child?” “You will be behind.” “You will forget what you learned in your first two years” “what if he asks you to stay another year again? Would you?”

That was difficult, but then another amazing thing happened—I received an email a few days after my first convo with my mom about this from HHMI. I learned that they had nominated me to be a delegate at the the International Achievement Summit. I’ll probably talk about that more in the future, but it’s a big deal. It also gave me a bit more peace. HHMI is an amazing organization, and the people who run my program take a special interest in me and my success. It is very clear. I was accepted as a delegate and will be going to London in October! 🙂

When I told my parents about this, they were excited as were visibly less apprehensive about everything. Truly a wonderful gift to myself as well as to them.

I then talked to my Urban Health pathway advisor from Case Western. You can read more about her role in getting me to HHMI here. But in sum, she is the reason. Out of the blue she called me to ask how I am, and I told her everything. It is almost as if she knew. So much about this decision mirrors what happened over a year ago before I reached out to my PI. Seriously a hint of destiny in everything.

I ask my American Society of Hematology career development mentor and he approved! I also consulted a hem attending at Brigham/Childrens who is so wise (her gut was for me to do this) too. My neighbor, a radiation oncologist also told me she took two years off at my stage in medical school and winded up a-okay.

Everyone outside of my lab, was “Go for it!”

Those inside my lab were less enthusiastic. They wanted me to flee, because they know exactly how hard it is to work with the iPS system and how long it takes to get published. Their opinion really mattered because it was actually the most informed. The project just was in a really tough spot and they knew.

But every time they pushed back, I felt bad because I wanted to stay. And, it was then that I realized what I actually wanted.

More than anything, however, I wanted to have peace about my decision to stay and have a plan just in case the project failed.

I met with my PI to discuss my concerns, and he did a pretty good job putting me at ease.

 However, it was a few  fundamental advances in my project that changed everything for me. Modeling SCA, still a lofty goal, came a bit more down to earth. It became possible. I had hope and more support from my co-workers. The stars aligned and I submitted my application (after a few legit all-nighters).

What makes this story beautiful to me is that I kind of took a step out in faith with the decision to stay. I decided aka told my PI before the magical data happened. And, that made the process that much more meaningful. And, I learned more about a passion I had for what I was doing that I didn’t even know was there.

I am so excited for the year ahead. What do I lose? Graduating earlier than expected, will not see some good friends next year. But again, the real friendships stay alive even with the distance. I realized that when I visited Cleveland in April. Super busy third year friends came out of the woodwork to see me, and it really was comforting. Our friendships matter.

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What I can gain with this year is a mystery. I will learn more, I will engage with a question that still intrigues me, and will continue to be supported by a lab environment and medical institute that shares some of my goals.

I’m already off the beaten path. Might as well keep on it.

If I would have left, it would have been about fear. And, I am pretty sure I would have always wondered what this opportunity would have been like. Medical school is there (my deans are super stoked that I’m doing this and so supportive). I sincerely look forward to my return to medicine.

But right now, I want to keep doing this. I enjoy the work, and I’m getting PAID to be curious. PAID to explore in a setting that is safe.

TLDR

It is curiosity that brings scientists to the lab bench and passion that keeps them there. When experiments fail (as they often do) or contradict one another, a scientist must reflect on her internal commitment to what she is pursuing. My commitment is unwavering because my connection to sickle cell anemia is literally in my blood.

I want my work with patients to inform my research in profound ways that will benefit them in the future. The first fellowship year provided me with the intangible gifts of being in a research setting: learning how to troubleshoot, design experiments, ask questions, and actively seek mentorship and support. Completely new to stem cell biology, there is so much I had to learn in this year from culturing iPS cells to using the flow cytometry machine independently. As grateful as I am for the opportunity to grow in critical ways, I am ready now to produce something tangible for the field.

I want to see sickle cell anemia as only a pediatric disease safely cured via hematopoietic stem cell transplant. I hope to dedicate my career medically and scientifically to improving this process for not only SCA patients but also those with other diseases requiring this procedure. This is where I hope to be an expert, still taking care of a panel of patients with hemoglobinopathies while actively engaging in science. Another year learning as well as publishing in a top stem cell laboratory will increase my expertise as well as credibility in pursuit of this goal.

Feel free to ask more questions in the comments if you like! Check out the press release here.

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So much more to update on: especially ASCI meeting! That’s coming soon!

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