January 15, 2018

Hello From the Other Side

By Domenic Fraboni

By: Kevin Shim

As I sit down to write my thesis I have spent some time thinking about the differences between graduate school and medical school thus far. I want to try to explain them to you using a half-baked analogy with the goal of highlighting (what I think are) some important differences between life as a medical student and life as a graduate student:

Some of us have decided to swim laps. People watch very closely as you swim them, and there are a dozen timers and digital contraptions to capture your speed. You feel pretty miserable when you swim a lot slower than the other swimmers, even though you slap each other on the butt and say good job to each other no matter what. There's clearly a fastest swimmer who keeps talking about matching into plastic surgery. You know that if you swam more practice laps your time would go down and you would feel better. But the pool is cold in the morning, and you’re exhausted, and ‘Stranger Things’ is far more enjoyable anyway.

Back and forth you swim laps. As soon as you touch the wall on one end you flip around underwater and swim another one. Once in a while, after you've finished the pre-set number of laps, you hop out of the pool and immediately check your time. Then you sit down with your coach who tells you to remember that thing-about-the-angle-of-your-stroke you had talked about, provides you one unit of reinforcing feedback, squirts energy drink in your face, and reminds you that your next set of laps starts in 1 week.

Others have decided to swim for a different purpose. You swim in a huge body of water, probably an ocean, but you don't really know because it’s misty and foggy in all directions and you can’t tell how big it is. Before you slide into the water your coach tells you: just find some new land and you'll have made it.

By definition, nobody knows where this new land is, what direction it’s in. No one has seen it before, so you don't really know what you are looking for. You have only a generalized idea of how far away it is (its really far).

Figure 2 – Not the Island You Had Hoped For: The central finding of my thesis publication. There is no improvement in survival outcomes of mice challenged with melanoma when new immune checkpoint blockade therapeutic antibodies are added to our established treatment regimen of Vesicular Stomatitis Virus (VSV) and adoptive transfer of CD8+ T cells (Pmel) (squares, inverted triangles). This is in comparison with a negative control isotype control (ISO) antibody (triangles).

As you slowly begin to swim you encounter a lot of people. Your coach floats by pretty regularly in her canoe and provides generalized tips and ideas about how to find the land, but at some point, you realize that she actually doesn't 100% know where the land is either. Though she has a great deal of wisdom about seafaring, washing up on the shores of the land she discovered simply isn’t your goal (there is no found-America-second day). “Don’t worry!” she says, “just start swimming, you’ll know it when you find it!”

Often you find other swimmers. They have been swimming for years and are looking for land too. They also have some generalized notion of where the land might be: "swim towards the brightest star you see" or "keep following the wind", they say. They're helpful - but you're not sure you know where they're going either sometimes. It's tough to really say that you're any closer or further from the land than your other friends in the ocean. But you care only somewhat, mostly because you know that everyone has to find their own land and you are quite preoccupied with finding yours.

On some days you furiously freestyle in one direction and you're filled with the drive and dedication to find the shore. On other days, you grab the log floating past and just hold on to it and float for a while, it’s really the only thing that you can do. Because there are really no landmarks, no sense of the passing of time besides the coming and going of the sun, you can float for days. Or swim for days - only to collapse in a heap on a sandbar to catch your breath and wonder where you even are. Psychologically, it’s horrifying. You have no idea when you will reach the land, and on some days you really freak out because you believe in your heart of hearts that the land really is not there. There's no way that it could actually exist.

Figure 1 – Adrift: Lying on a log.

Worse though, much worse, is the feeling as you lie on the log - dead tired and ready to cry - is knowing that if you were stronger or had bigger lungs or gills that you could still be swimming. No one is stopping you from still swimming towards getting to the land except your own lack of willpower. Someone tells you to remember work life balance and you throw a seashell at them.

Then, suddenly, you find yourself on shore. Bubbling with pride, you are able to ignore the fact that the island you have discovered is essentially a logical extension of the chain of islands your coach has found (and thoroughly published on in J. Island Disc. 1998-2014). What you have a difficult time forgetting though, is the time you spent floating in the ocean clinging onto a log, or legs burning as you kicked your way towards land.

Each activity (even though they are both swimming) has a different headspace to become lost in, with its own set of joys and challenges. At the end of the day, waking up to practice swimming just 20 more laps is simply a different task than waking up to find your island. Maybe there’s a way to truly understand both, or maybe I’ll just lie on this log a while longer.

Author Bio: Kevin Shim is a 6th year MD/PhD student currently in his 3rd year of medical school who enjoys strategy board games, drinking beers with friends, and Immunology. 

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