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Interviewer: According to the Centers for Disease Control and Prevention, more than two million Americans experience a brain injury each year. While some of these injuries result in relatively short-term impact on a day-to-day function, others can lead to long-term challenges or even a permanent disability.

Today, we'll be speaking with Zoe, a young woman who experienced a traumatic brain injury after an accident and the long journey of her recovery and the daily experience of overcoming the long-term challenges of life after an accident like this.

And to help us better understand the medical side of a traumatic brain injury, joining us is associate professor of neurosurgery at University of Utah Health, Dr. Ramesh Grandhi, the doctor who helped stabilize Zoe after her accident.

Zoe, why don't we start with what kind of led to your traumatic brain injury in the first place? What exactly happened?

Zoe: Yeah. Well, interesting story. I had just moved to Salt Lake City in August of 2020, and this occurred . . . or rather, my accident occurred December 5, 2020. So I had just shy of five months in the state, really.

So I hadn't experienced a lot, but a friend and I really wanted to ski together. I bought a season pass at Alta, was really excited to get up there. And it was day one, in fact, of the ski season that this happened. So really did not get any other skiing in, obviously, but this was day one.

Yeah, I mean, I don't remember a whole lot about the day itself. I have spotty memories of the drive up to Alta, getting to Alta. I actually have some spotty memories of being on the lift up to the first run. After that, I don't remember anything. I remember a bit of skiing, and that's really about it in terms of the day.

And then subsequently, upon waking up, I have absolutely no memory of the remainder of December. My memory is really spotty from about Thanksgiving up to December 5th. So Thanksgiving, I would say, is the last clear memory that I have and everything else is kind of spotty. It appears in my head almost as if I made it all up.

I've had to ask a lot of people, especially family members, "Did this really happen? Can you describe this thing to me or remind me who was at Thanksgiving again?" I never would have guessed something like this when I first started skiing with my dad 10-plus years ago.

And I was maybe 500 yards behind several of my friends, so I was alone during the actual collision. I ran into this group of trees that sat right in the middle of the run that I was on at Alta.

In this tree well, it was icy. I slipped on the snow evidently and collided with some trees in the tree well. What I would assume happened at that point is I was knocked unconscious by the collision and then fell and was hidden by this tree well and this group of trees. And then because I wasn't found until about four hours later, I had become buried or covered by snow by people skiing by, obviously.

Interviewer: Sure. So you're spotty memory-wise from Thanksgiving to . . . When did you start to remember things again?

Zoe: Right. So really, my lucidity, I would say, started to come back right around January 6th, 7th, 8th, right in that area. This is purely what I was told, is that I woke up somewhere mid to end of December. The rest of December went by. I was then transferred to a long-term care facility outside of Salt Lake City. And right around that, again, 6th, 7th, 8th of January is when I have memories that I'm able to go back on and say, "Oh, yeah, that was right in the beginning of January." Before that, though, I have no memories.

Interviewer: Wow. So, Dr. Grandhi, I want to go to you at this point. When did Zoe come into the care of you, your team, the University of Utah Hospital?

Dr. Grandhi: As I recall it, I didn't find out about Zoe until Sunday morning first thing. I know that she presented as a transfer to our hospital, and clearly, she had traumatic injuries. And the first principle of what we do is just stabilize the patient. The trauma surgeons and a number of other services are super important and are our partners in making sure that a patient is appropriately stabilized.

And then my partner was actually on call and received the first call about her. He then got in touch with me. We do a really nice job within our department about communicating about patients with traumatic brain injuries, and specifically, patients with severe traumatic brain injuries.

So I remember that Sunday morning very well because she was downstairs in our surgical ICU. I went and saw her and just looked at her images, and then went out and talked to her dad who was sitting in the waiting room all by himself.

I remember the exact seat he was seated in early on that Sunday morning, probably around 8:00 a.m. or 9:00 a.m. And he was just by himself. I just walked up to him and told him what my assessment was of the situation based on looking at her head CT and things like that.

And at that point, it was just me trying to tell him that we're going to do our best to take care of her, that she presented with what we call a severe traumatic brain injury, and what the principles of managing patients with that are, and also, honestly, giving him hope.

Interviewer: When we talk about traumatic brain injury, is it a lot of skiing injuries, sports injuries? What is the most common type of traumatic brain injury?

Dr. Grandhi: Traumatic brain injury is a significant burden in the Western world. It's the number one cause of death amongst young folks in the Western world.

Traumatic brain injury falls into three buckets: severe traumatic brain injury, moderate traumatic brain injury, and mild traumatic brain injury. And oftentimes, patients with mild traumatic brain injuries don't even come into the hospital. We call it a concussion. And oftentimes, a patient may stay at home after hitting their head, or being involved in a sports injury, or a motor vehicle collision, or falling and hitting their head.

The burden of traumatic brain injury in the United States today is about 2.5 million patients per year. So many patients don't even come into the hospital. Many patients are discharged from the ER.

Interviewer: Zoe and her accident, of those three buckets, what did hers fall into, and why?

Dr. Grandhi: Zoe had a severe traumatic brain injury. And the way we diagnose severe traumatic brain injury is quite simple. We just gauge it in terms of what their neurologic exam is when they come in. So are they able to open their eyes? Are they able to speak? Are they able to follow commands?

Interviewer: And Zoe was unable to do those things?

Dr. Grandhi: Correct.

Interviewer: Wow. Zoe, do you remember any pieces or parts of the story? How did you feel when you were first, I guess, coming out of it?

Zoe: Yeah. Again, like I said before, the first memories I have are really in the long-term care facility that I was transferred to after leaving The U. I think it was sort of a slow realization.

And then since then, I would say I've noticed things that are sort of side effects or fallouts from having a severe traumatic brain injury: getting frustrated much more easily, being able to jump to anger much more easily, having very little patience, amongst many others. So it was very much a slow realization and slow rollout. And then still to this day, new things come up.

So it was much more slow. It wasn't similar to if you broke your arm and someone said, "Oh, you broke your arm," and then they casted it up right then and there. It was much more prolonged than that and slow realization.

My initial thought, honestly, was because I was awake and lucid and conscious, "Oh, my brain is fine. Well, everything is good. I can speak. I can see. I can hear. I can eat. I have my motor functions." And so, initially, I didn't think too much about the effects on my brain, and that did come up much later and still continues to this day.

Interviewer: Dr. Grandhi, when it comes to treatment of a case like Zoe, what was done to help Zoe get from the accident to where she was stabilized and in, I guess, a longer-term facility to kind of monitor her?

Dr. Grandhi: Well, I think we need to kind of dial it back a little bit to understand the management principles of patients with severe traumatic brain injury. And it starts, honestly, in the pre-hospital setting in which those who are on the first line understand how to manage a person, particularly with a pathology as significant as severe traumatic brain injury.

So first things first, getting the patient stabilized in the field, making sure that people are very cognizant of taking care of the patient, immobilizing their neck. Again, we don't know if a patient has had an injury to the cervical spine. Zoe clearly hit trees, so she could have very easily had damage to her neck, to the bones of her neck, spinal cord, etc. So getting a patient stabilized at the point of injury, then making a decision of where the patient goes.

There is data to show improved outcomes in patients who have a severe traumatic brain injury who are taken to Level 1 trauma centers. So understanding where to send the patient when the patient comes in.

Again, we have a huge bevy of services that are there in the ER, in the trauma bay awaiting a patient, because there's pre-hospital notification. And so if a person is coming in as a Level 1 trauma to a Level 1 trauma center, we do have orthopedics right there. Neurosurgery is right there in the trauma bay. Obviously, trauma surgery, the ER doctors, a number of different services and specialties are there awaiting the patient.

Airway management is important, worrying about circulation, blood pressure, ensuring that there's no intra-abdominal injuries. After that, there are a lot of scans that are ordered inclusive of CT scans that are literally performed head to toe to make sure that we're not missing significant injuries that need actionable treatment, such as rushing a patient up to the operating room for an intra-abdominal injury.

That being said, once that is done and there's nothing imminent that needs to be treated emergently, the patient is generally taken up to the ICU. And in Zoe's case and a patient with a severe traumatic brain injury, they're ventilated, and then there's a lot of management that occurs then predicated on blood pressure management, good oxygenation for the patient.

And for patients with severe traumatic brain injury, when we know a patient has a severe traumatic brain injury, we place particular monitors in the patient's brain because we're obligated to make sure that we have good control of intracranial pressure. So we want to make sure that we know what a patient's intracranial pressure is, and we need to keep it below certain thresholds.

We clearly know what the patient's brain perfusion is in terms of what's the state of blood pressure to brain tissue. So we monitor a patient's systemic blood pressure, their body's blood pressure well, and have to get the brain perfusion pressure in a particular range.

That's a quick summation of the management principles of a patient with severe traumatic brain injury. Not every patient requires a big-time operation and removing part of the skull or sucking out blood, but when we do place brain monitors, we do have to drill a small hole in people's skull to place these monitors. We have to remember that brain injury comes in many different flavors, even severe traumatic brain injuries.

Interviewer: So you just keep an eye on all the things that are going on with your monitors and everything to see whether or not there's injury?

Dr. Gandhi: Absolutely. And we use CAT scans liberally to help us understand more about the evolution of the brain injury. Zoe did have blood in her head, no question about it, but we did not feel that this blood would require us to take her to the operating room for an emergent surgery to remove the blood.

Interviewer: It's my understanding that Zoe then was a part of a study dealing with neuromonitoring. So for someone who's listening right now, what exactly is neuromonitoring, and why is it so important that we do research with it?

Dr. Gandhi: Whenever someone is classified as having a severe traumatic brain injury, we know from years of research and guidelines and a lot of work from really experienced, savvy, thoughtful leaders in the field that patients should get particular things monitored.

As I had said, we want to get invasive arterial blood pressure monitoring so that we can get a good second-to-second, moment-to-moment gauge of what a person's blood pressure is not using one of those expandable blood pressure cuffs. So this is something that allows us to know on a moment-to-moment basis what a person's blood pressure is doing.

We also ensure that the patient has adequate ventilation using a breathing tube. We study their intracranial pressure via an intracranial pressure monitor.

Finally, one of the things that has been important recently in the care of patients with severe traumatic brain injuries is the concept of whether brain tissue oxygenation can help guide therapy for a patient with a severe traumatic brain injury.

So historically, many university centers across the world, many experienced Level 1trauma centers have been using brain tissue oxygenation monitoring, basically almost as though you had a pulse oximeter of brain tissue. Many folks around the world have used brain tissue oxygenation monitoring as another way to help manage their patients with severe traumatic brain injury.

Here at the University of Utah and also many sites throughout this country and across the world in a separate study have decided to do a randomized controlled trial on this and understanding whether it will bear out in a huge patient population of improving outcomes. And Zoe was enrolled in that trial, and the trial is called BOOST-3.

Interviewer: So what exactly is BOOST-3 looking to do?

Dr. Grandhi: What we're looking for in the BOOST-3 trial is to determine whether using brain tissue oxygenation monitoring in the care of patients with severe traumatic brain injury improves outcomes at six months.

This is over and above using traditional monitoring techniques such as intracranial pressure monitoring and cerebral perfusion pressure monitoring that are already used commonly as part of guidelines that have been established in taking care of patients like Zoe.

Interviewer: So, Zoe, we've been talking a lot about kind of the medical side of things. I want to go back to you. What was it like when you first had Dr. Grandhi or any of the other specialists kind of explain the condition to you and what was going to be expected moving forward?

Zoe: I think in all the research that I've done and the people around me have done and then my discussions with Dr. Grandhi initially and shortly thereafter, and from what I gather from all of that, is that it's largely unexpected. The results and the things that come of it are known and yet unknown, right? It's things that they know come from a severe traumatic brain injury and then there are things that you don't really know will come up until they come up and until you experience them.

So from what I've been able to dissect from this injury is kind of pick apart, or notice rather, the moments in my own life where the thought comes into my head saying, "No, this isn't really you. This isn't really the Zoe that has made it to this point." "This is the TBI speaking," I guess, for lack of a better term or phrase.

An example would be if I'm feeling really, really agitated one day or even one hour and then the next hour I'm back to feeling normal again. So it's really quite a rollercoaster, I would say.

Interviewer: But what did it feel like to kind of hear that? I mean, as an outsider, as someone who's never experienced this kind of thing, that sounds kind of scary to me.

Zoe: Well, I would say more jarring than frightening. As the patient or as the person with a severe TBI, you don't necessarily . . . or I didn't, at least, necessarily believe the things that were being told to me. Not that I would think, "Oh, Dr. Grandhi is a liar," but I didn't necessarily believe it until those things started to show up for me in my own life later on and as time went on.

So months later, it's coming up on a year, so a full year later, I notice things that they told me initially that I might feel or that may come up. And at the time, I was thinking, "Well, I feel fine now, so we're good. We're all good here. Have a nice day." So it wasn't until up to this point that I think, "Oh, okay. I see what they mean by this progression and regression of things that may come and go," and things that I might feel that I didn't think I would feel at the time.

So it was definitely helpful to hear that then, and thinking about it now, "Oh, okay. They were right all along. They know what they're talking about."

Dr. Grandhi: I think it's really important to understand that while we as physicians, particularly as neurosurgeons who take care of patients with severe traumatic brain injury, I look at Zoe, and we raise our hands and we run a victory lap saying that she is a success.

And first things first is just in the acute setting, there's more research coming out that shows that if you are able to get a patient through the acute brain injury setting and manage them correctly and take care of them, we should not be nihilistic about where they will be one year later.

There's new research using big data sets that show that patients such as Zoe who come in with severe traumatic brain injury can have favorable outcomes at one year. Part of this data set also shows that 20% of patients can perhaps have no disability at one year.

But that being said, Zoe's experience alludes to the fact that we cannot forget about our patients. They still sometimes experience some sequalae that are hard to just kind of put a finger on. Like Zoe talks about, just agitation, maybe irritability, maybe memory issues.

So this is a process, an evolution, and it's really important for us to be able to support our patients, get them the correct resources, and really kind of steer them and continue to shepherd them through the process, which may take many more years.

Again, the concept of neuromonitoring for patients with traumatic brain injury only pertains to patients with severe traumatic brain injury, patients who are in a coma, patients who come into a hospital in a comatose state.

And I think we're going to learn a lot through this study as well as over the next years of how to really target various treatment thresholds and really tailor a patient's care to perhaps the type of pathology that they're coming in with.

So this is really important to patients with severe traumatic brain injury, but for the audience out there who is interested in traumatic brain injury in general, because most of the patients who experience a traumatic brain injury don't come in like Zoe in a coma, we're learning a lot about traumatic brain injury in general.

We're learning that there are so many different components to living with a traumatic brain injury. We are understanding that there are perhaps new ways of diagnosing patients and understanding what's called biomarkers and their role and understanding whether they're different symptoms, sequalae, or phenotypes that people experience after a traumatic brain injury.

Finally, it's really, again, very important to support our patients because it's not just the acute recovery stage. One of the people who trained me told me the biggest misnomer in patients who come in with mild traumatic brain injury, which is sometimes called a concussion, is there's nothing mild about it if you experience headaches two months after the fact, or if you have problems with staring at your computer screen if you're a person who works on computers and have eye strain after that, or have problems with balance. There's nothing mild about it.

And now the question is, "How can we support our patients better and get them the needed resources they need to get back on their feet and get their life back in order?"

Interviewer: So, Zoe, you're 25 now. It's been a year since the initial incident. How have you felt along the process? And how do you mark your own success and, I guess, healing from this particular incident?

Zoe: It actually took quite a while for me to recognize my own success, my own progress. It's really been just recently, actually, that I've been able to think to myself, "Oh, okay. You can actually do that thing now that you weren't able to do three months ago, four months ago."

It's more so just the ability to recognize those things. And I wasn't able to recognize those things previously. So it's been really difficult to measure my own progress based on what that looks like or what that has looked like in the past year.

I mean, highs, overall, I would say the ability to remember. Honestly, my short-term memory was completely restarted, completely obliterated in the beginning, and I wasn't able to hold a memory for several minutes. I would forget the thing before. So my working memory and my short-term memory have improved significantly.

Luckily, nothing really ever happened to my long-term memory, so I was able to remember years past. I could tell you where exactly I was and who I was with, especially right in the early beginning.

One of the most difficult things, but probably does not top the list, that I've experienced from the fallout, if you will, is the changing of relationships in my life. Friendships and various other things that have been really difficult to not only maintain, but to offer my lived experience as it is and as I see it and as I experience it. It's extremely difficult to explain the mindset that I have and where my brain is at on any given day.

And luckily, some of them have had extreme understanding and extreme patience with me. And that's really all I ask of the people in my life now, is, "Please be patient with me and my progress and the things you likely don't see on a day-to-day basis." On hour-by-hour basis even.

I've told the people closest to me, "This could be a years-long journey process, if you will, for my mental state, so the patience is so appreciated."

And then the highs . . . To be quite frank, I think the highs for me personally, they've been recognized by the people in my life for a while now, for the last year, but I personally have not been able to see or really process or digest those highs.

So it's really just been very recent in the last few months that I've been able to look at myself and say, "Wow, you can do that now after being completely immobile for nearly two months," or, "Wow, you can move that way again," or, "You can stretch that way again."

I used to and would eventually like to get back to very, very involved in hot yoga. I used to do hot yoga frequently. And before that, I was a gymnast and a dancer. So in the beginning, it was very excruciating for me to, say, not even touch my toes. And that was a huge blow more so to my ego than anything else, but a huge blow nonetheless.

And so I think the highs now are being able to recognize that, "Hey, I am able to touch my toes," and I stretch, and I exercise, and I do all these things every single day to better myself.

Initially, it was very much like, "Wow, you aren't able to do this? What happened?" And then it was up to a few months ago that I started telling myself, "No, you have to be much more patient to yourself, much more kind to yourself," than the completely and constant berating myself for why I'm not able to do something, or accomplish something, or say something in the way that I want to say it, etc.

Dr. Gandhi: I think that was just incredible to hear. As I said before, we run laps when we look at Zoe, but to hear her personal experience and understand that this is not over for her and understand what she goes through and also understand what defines us is the little things that make us who we are. Zoe touching her toes, doing hot yoga, it's incredible. It makes us really take a step back and understand this as a human experience, understand this as a personal experience.

The privilege of being able to be involved in Zoe's care and the care of others is not lost when you hear these things. The story of Zoe and patients like Zoe is not done in December 2021. It's an experience that she's going to live through and get through for the rest of her life.

She's sitting 10 feet away from me right now and her mom is right here as well. She's going to get there, and we just have to do everything we can to support her. She's just incredible. And to just hear Zoe, hear her voice come through in this experience is just profound for us. As many times as I've seen Zoe, I've never known these little things about Zoe, and it's amazing to hear.

Interviewer: To find out more about traumatic brain injury as well as the services offered through the brain injury program at the Craig H. Neilsen Rehabilitation Hospital, visit the link in the episode description.

Interviewer: According to the Centers for Disease Control and Prevention, more than two million Americans experience a brain injury each year. While some of these injuries result in relatively short-term impact on a day-to-day function, others can lead to long-term challenges or even a permanent disability.

Today, we'll be speaking with Zoe, a young woman who experienced a traumatic brain injury after an accident and the long journey of her recovery and the daily experience of overcoming the long-term challenges of life after an accident like this.

And to help us better understand the medical side of a traumatic brain injury, joining us is associate professor of neurosurgery at University of Utah Health, Dr. Ramesh Grandhi, the doctor who helped stabilize Zoe after her accident.

Zoe, why don't we start with what kind of led to your traumatic brain injury in the first place? What exactly happened?

Zoe: Yeah. Well, interesting story. I had just moved to Salt Lake City in August of 2020, and this occurred . . . or rather, my accident occurred December 5, 2020. So I had just shy of five months in the state, really.

So I hadn't experienced a lot, but a friend and I really wanted to ski together. I bought a season pass at Alta, was really excited to get up there. And it was day one, in fact, of the ski season that this happened. So really did not get any other skiing in, obviously, but this was day one.

Yeah, I mean, I don't remember a whole lot about the day itself. I have spotty memories of the drive up to Alta, getting to Alta. I actually have some spotty memories of being on the lift up to the first run. After that, I don't remember anything. I remember a bit of skiing, and that's really about it in terms of the day.

And then subsequently, upon waking up, I have absolutely no memory of the remainder of December. My memory is really spotty from about Thanksgiving up to December 5th. So Thanksgiving, I would say, is the last clear memory that I have and everything else is kind of spotty. It appears in my head almost as if I made it all up.

I've had to ask a lot of people, especially family members, "Did this really happen? Can you describe this thing to me or remind me who was at Thanksgiving again?" I never would have guessed something like this when I first started skiing with my dad 10-plus years ago.

And I was maybe 500 yards behind several of my friends, so I was alone during the actual collision. I ran into this group of trees that sat right in the middle of the run that I was on at Alta.

In this tree well, it was icy. I slipped on the snow evidently and collided with some trees in the tree well. What I would assume happened at that point is I was knocked unconscious by the collision and then fell and was hidden by this tree well and this group of trees. And then because I wasn't found until about four hours later, I had become buried or covered by snow by people skiing by, obviously.

Interviewer: Sure. So you're spotty memory-wise from Thanksgiving to . . . When did you start to remember things again?

Zoe: Right. So really, my lucidity, I would say, started to come back right around January 6th, 7th, 8th, right in that area. This is purely what I was told, is that I woke up somewhere mid to end of December. The rest of December went by. I was then transferred to a long-term care facility outside of Salt Lake City. And right around that, again, 6th, 7th, 8th of January is when I have memories that I'm able to go back on and say, "Oh, yeah, that was right in the beginning of January." Before that, though, I have no memories.

Interviewer: Wow. So, Dr. Grandhi, I want to go to you at this point. When did Zoe come into the care of you, your team, the University of Utah Hospital?

Dr. Grandhi: As I recall it, I didn't find out about Zoe until Sunday morning first thing. I know that she presented as a transfer to our hospital, and clearly, she had traumatic injuries. And the first principle of what we do is just stabilize the patient. The trauma surgeons and a number of other services are super important and are our partners in making sure that a patient is appropriately stabilized.

And then my partner was actually on call and received the first call about her. He then got in touch with me. We do a really nice job within our department about communicating about patients with traumatic brain injuries, and specifically, patients with severe traumatic brain injuries.

So I remember that Sunday morning very well because she was downstairs in our surgical ICU. I went and saw her and just looked at her images, and then went out and talked to her dad who was sitting in the waiting room all by himself.

I remember the exact seat he was seated in early on that Sunday morning, probably around 8:00 a.m. or 9:00 a.m. And he was just by himself. I just walked up to him and told him what my assessment was of the situation based on looking at her head CT and things like that.

And at that point, it was just me trying to tell him that we're going to do our best to take care of her, that she presented with what we call a severe traumatic brain injury, and what the principles of managing patients with that are, and also, honestly, giving him hope.

Interviewer: When we talk about traumatic brain injury, is it a lot of skiing injuries, sports injuries? What is the most common type of traumatic brain injury?

Dr. Grandhi: Traumatic brain injury is a significant burden in the Western world. It's the number one cause of death amongst young folks in the Western world.

Traumatic brain injury falls into three buckets: severe traumatic brain injury, moderate traumatic brain injury, and mild traumatic brain injury. And oftentimes, patients with mild traumatic brain injuries don't even come into the hospital. We call it a concussion. And oftentimes, a patient may stay at home after hitting their head, or being involved in a sports injury, or a motor vehicle collision, or falling and hitting their head.

The burden of traumatic brain injury in the United States today is about 2.5 million patients per year. So many patients don't even come into the hospital. Many patients are discharged from the ER.

Interviewer: Zoe and her accident, of those three buckets, what did hers fall into, and why?

Dr. Grandhi: Zoe had a severe traumatic brain injury. And the way we diagnose severe traumatic brain injury is quite simple. We just gauge it in terms of what their neurologic exam is when they come in. So are they able to open their eyes? Are they able to speak? Are they able to follow commands?

Interviewer: And Zoe was unable to do those things?

Dr. Grandhi: Correct.

Interviewer: Wow. Zoe, do you remember any pieces or parts of the story? How did you feel when you were first, I guess, coming out of it?

Zoe: Yeah. Again, like I said before, the first memories I have are really in the long-term care facility that I was transferred to after leaving The U. I think it was sort of a slow realization.

And then since then, I would say I've noticed things that are sort of side effects or fallouts from having a severe traumatic brain injury: getting frustrated much more easily, being able to jump to anger much more easily, having very little patience, amongst many others. So it was very much a slow realization and slow rollout. And then still to this day, new things come up.

So it was much more slow. It wasn't similar to if you broke your arm and someone said, "Oh, you broke your arm," and then they casted it up right then and there. It was much more prolonged than that and slow realization.

My initial thought, honestly, was because I was awake and lucid and conscious, "Oh, my brain is fine. Well, everything is good. I can speak. I can see. I can hear. I can eat. I have my motor functions." And so, initially, I didn't think too much about the effects on my brain, and that did come up much later and still continues to this day.

Interviewer: Dr. Grandhi, when it comes to treatment of a case like Zoe, what was done to help Zoe get from the accident to where she was stabilized and in, I guess, a longer-term facility to kind of monitor her?

Dr. Grandhi: Well, I think we need to kind of dial it back a little bit to understand the management principles of patients with severe traumatic brain injury. And it starts, honestly, in the pre-hospital setting in which those who are on the first line understand how to manage a person, particularly with a pathology as significant as severe traumatic brain injury.

So first things first, getting the patient stabilized in the field, making sure that people are very cognizant of taking care of the patient, immobilizing their neck. Again, we don't know if a patient has had an injury to the cervical spine. Zoe clearly hit trees, so she could have very easily had damage to her neck, to the bones of her neck, spinal cord, etc. So getting a patient stabilized at the point of injury, then making a decision of where the patient goes.

There is data to show improved outcomes in patients who have a severe traumatic brain injury who are taken to Level 1 trauma centers. So understanding where to send the patient when the patient comes in.

Again, we have a huge bevy of services that are there in the ER, in the trauma bay awaiting a patient, because there's pre-hospital notification. And so if a person is coming in as a Level 1 trauma to a Level 1 trauma center, we do have orthopedics right there. Neurosurgery is right there in the trauma bay. Obviously, trauma surgery, the ER doctors, a number of different services and specialties are there awaiting the patient.

Airway management is important, worrying about circulation, blood pressure, ensuring that there's no intra-abdominal injuries. After that, there are a lot of scans that are ordered inclusive of CT scans that are literally performed head to toe to make sure that we're not missing significant injuries that need actionable treatment, such as rushing a patient up to the operating room for an intra-abdominal injury.

That being said, once that is done and there's nothing imminent that needs to be treated emergently, the patient is generally taken up to the ICU. And in Zoe's case and a patient with a severe traumatic brain injury, they're ventilated, and then there's a lot of management that occurs then predicated on blood pressure management, good oxygenation for the patient.

And for patients with severe traumatic brain injury, when we know a patient has a severe traumatic brain injury, we place particular monitors in the patient's brain because we're obligated to make sure that we have good control of intracranial pressure. So we want to make sure that we know what a patient's intracranial pressure is, and we need to keep it below certain thresholds.

We clearly know what the patient's brain perfusion is in terms of what's the state of blood pressure to brain tissue. So we monitor a patient's systemic blood pressure, their body's blood pressure well, and have to get the brain perfusion pressure in a particular range.

That's a quick summation of the management principles of a patient with severe traumatic brain injury. Not every patient requires a big-time operation and removing part of the skull or sucking out blood, but when we do place brain monitors, we do have to drill a small hole in people's skull to place these monitors. We have to remember that brain injury comes in many different flavors, even severe traumatic brain injuries.

Interviewer: So you just keep an eye on all the things that are going on with your monitors and everything to see whether or not there's injury?

Dr. Gandhi: Absolutely. And we use CAT scans liberally to help us understand more about the evolution of the brain injury. Zoe did have blood in her head, no question about it, but we did not feel that this blood would require us to take her to the operating room for an emergent surgery to remove the blood.

Interviewer: It's my understanding that Zoe then was a part of a study dealing with neuromonitoring. So for someone who's listening right now, what exactly is neuromonitoring, and why is it so important that we do research with it?

Dr. Gandhi: Whenever someone is classified as having a severe traumatic brain injury, we know from years of research and guidelines and a lot of work from really experienced, savvy, thoughtful leaders in the field that patients should get particular things monitored.

As I had said, we want to get invasive arterial blood pressure monitoring so that we can get a good second-to-second, moment-to-moment gauge of what a person's blood pressure is not using one of those expandable blood pressure cuffs. So this is something that allows us to know on a moment-to-moment basis what a person's blood pressure is doing.

We also ensure that the patient has adequate ventilation using a breathing tube. We study their intracranial pressure via an intracranial pressure monitor.

Finally, one of the things that has been important recently in the care of patients with severe traumatic brain injuries is the concept of whether brain tissue oxygenation can help guide therapy for a patient with a severe traumatic brain injury.

So historically, many university centers across the world, many experienced Level 1trauma centers have been using brain tissue oxygenation monitoring, basically almost as though you had a pulse oximeter of brain tissue. Many folks around the world have used brain tissue oxygenation monitoring as another way to help manage their patients with severe traumatic brain injury.

Here at the University of Utah and also many sites throughout this country and across the world in a separate study have decided to do a randomized controlled trial on this and understanding whether it will bear out in a huge patient population of improving outcomes. And Zoe was enrolled in that trial, and the trial is called BOOST-3.

Interviewer: So what exactly is BOOST-3 looking to do?

Dr. Grandhi: What we're looking for in the BOOST-3 trial is to determine whether using brain tissue oxygenation monitoring in the care of patients with severe traumatic brain injury improves outcomes at six months.

This is over and above using traditional monitoring techniques such as intracranial pressure monitoring and cerebral perfusion pressure monitoring that are already used commonly as part of guidelines that have been established in taking care of patients like Zoe.

Interviewer: So, Zoe, we've been talking a lot about kind of the medical side of things. I want to go back to you. What was it like when you first had Dr. Grandhi or any of the other specialists kind of explain the condition to you and what was going to be expected moving forward?

Zoe: I think in all the research that I've done and the people around me have done and then my discussions with Dr. Grandhi initially and shortly thereafter, and from what I gather from all of that, is that it's largely unexpected. The results and the things that come of it are known and yet unknown, right? It's things that they know come from a severe traumatic brain injury and then there are things that you don't really know will come up until they come up and until you experience them.

So from what I've been able to dissect from this injury is kind of pick apart, or notice rather, the moments in my own life where the thought comes into my head saying, "No, this isn't really you. This isn't really the Zoe that has made it to this point." "This is the TBI speaking," I guess, for lack of a better term or phrase.

An example would be if I'm feeling really, really agitated one day or even one hour and then the next hour I'm back to feeling normal again. So it's really quite a rollercoaster, I would say.

Interviewer: But what did it feel like to kind of hear that? I mean, as an outsider, as someone who's never experienced this kind of thing, that sounds kind of scary to me.

Zoe: Well, I would say more jarring than frightening. As the patient or as the person with a severe TBI, you don't necessarily . . . or I didn't, at least, necessarily believe the things that were being told to me. Not that I would think, "Oh, Dr. Grandhi is a liar," but I didn't necessarily believe it until those things started to show up for me in my own life later on and as time went on.

So months later, it's coming up on a year, so a full year later, I notice things that they told me initially that I might feel or that may come up. And at the time, I was thinking, "Well, I feel fine now, so we're good. We're all good here. Have a nice day." So it wasn't until up to this point that I think, "Oh, okay. I see what they mean by this progression and regression of things that may come and go," and things that I might feel that I didn't think I would feel at the time.

So it was definitely helpful to hear that then, and thinking about it now, "Oh, okay. They were right all along. They know what they're talking about."

Dr. Grandhi: I think it's really important to understand that while we as physicians, particularly as neurosurgeons who take care of patients with severe traumatic brain injury, I look at Zoe, and we raise our hands and we run a victory lap saying that she is a success.

And first things first is just in the acute setting, there's more research coming out that shows that if you are able to get a patient through the acute brain injury setting and manage them correctly and take care of them, we should not be nihilistic about where they will be one year later.

There's new research using big data sets that show that patients such as Zoe who come in with severe traumatic brain injury can have favorable outcomes at one year. Part of this data set also shows that 20% of patients can perhaps have no disability at one year.

But that being said, Zoe's experience alludes to the fact that we cannot forget about our patients. They still sometimes experience some sequalae that are hard to just kind of put a finger on. Like Zoe talks about, just agitation, maybe irritability, maybe memory issues.

So this is a process, an evolution, and it's really important for us to be able to support our patients, get them the correct resources, and really kind of steer them and continue to shepherd them through the process, which may take many more years.

Again, the concept of neuromonitoring for patients with traumatic brain injury only pertains to patients with severe traumatic brain injury, patients who are in a coma, patients who come into a hospital in a comatose state.

And I think we're going to learn a lot through this study as well as over the next years of how to really target various treatment thresholds and really tailor a patient's care to perhaps the type of pathology that they're coming in with.

So this is really important to patients with severe traumatic brain injury, but for the audience out there who is interested in traumatic brain injury in general, because most of the patients who experience a traumatic brain injury don't come in like Zoe in a coma, we're learning a lot about traumatic brain injury in general.

We're learning that there are so many different components to living with a traumatic brain injury. We are understanding that there are perhaps new ways of diagnosing patients and understanding what's called biomarkers and their role and understanding whether they're different symptoms, sequalae, or phenotypes that people experience after a traumatic brain injury.

Finally, it's really, again, very important to support our patients because it's not just the acute recovery stage. One of the people who trained me told me the biggest misnomer in patients who come in with mild traumatic brain injury, which is sometimes called a concussion, is there's nothing mild about it if you experience headaches two months after the fact, or if you have problems with staring at your computer screen if you're a person who works on computers and have eye strain after that, or have problems with balance. There's nothing mild about it.

And now the question is, "How can we support our patients better and get them the needed resources they need to get back on their feet and get their life back in order?"

Interviewer: So, Zoe, you're 25 now. It's been a year since the initial incident. How have you felt along the process? And how do you mark your own success and, I guess, healing from this particular incident?

Zoe: It actually took quite a while for me to recognize my own success, my own progress. It's really been just recently, actually, that I've been able to think to myself, "Oh, okay. You can actually do that thing now that you weren't able to do three months ago, four months ago."

It's more so just the ability to recognize those things. And I wasn't able to recognize those things previously. So it's been really difficult to measure my own progress based on what that looks like or what that has looked like in the past year.

I mean, highs, overall, I would say the ability to remember. Honestly, my short-term memory was completely restarted, completely obliterated in the beginning, and I wasn't able to hold a memory for several minutes. I would forget the thing before. So my working memory and my short-term memory have improved significantly.

Luckily, nothing really ever happened to my long-term memory, so I was able to remember years past. I could tell you where exactly I was and who I was with, especially right in the early beginning.

One of the most difficult things, but probably does not top the list, that I've experienced from the fallout, if you will, is the changing of relationships in my life. Friendships and various other things that have been really difficult to not only maintain, but to offer my lived experience as it is and as I see it and as I experience it. It's extremely difficult to explain the mindset that I have and where my brain is at on any given day.

And luckily, some of them have had extreme understanding and extreme patience with me. And that's really all I ask of the people in my life now, is, "Please be patient with me and my progress and the things you likely don't see on a day-to-day basis." On hour-by-hour basis even.

I've told the people closest to me, "This could be a years-long journey process, if you will, for my mental state, so the patience is so appreciated."

And then the highs . . . To be quite frank, I think the highs for me personally, they've been recognized by the people in my life for a while now, for the last year, but I personally have not been able to see or really process or digest those highs.

So it's really just been very recent in the last few months that I've been able to look at myself and say, "Wow, you can do that now after being completely immobile for nearly two months," or, "Wow, you can move that way again," or, "You can stretch that way again."

I used to and would eventually like to get back to very, very involved in hot yoga. I used to do hot yoga frequently. And before that, I was a gymnast and a dancer. So in the beginning, it was very excruciating for me to, say, not even touch my toes. And that was a huge blow more so to my ego than anything else, but a huge blow nonetheless.

And so I think the highs now are being able to recognize that, "Hey, I am able to touch my toes," and I stretch, and I exercise, and I do all these things every single day to better myself.

Initially, it was very much like, "Wow, you aren't able to do this? What happened?" And then it was up to a few months ago that I started telling myself, "No, you have to be much more patient to yourself, much more kind to yourself," than the completely and constant berating myself for why I'm not able to do something, or accomplish something, or say something in the way that I want to say it, etc.

Dr. Gandhi: I think that was just incredible to hear. As I said before, we run laps when we look at Zoe, but to hear her personal experience and understand that this is not over for her and understand what she goes through and also understand what defines us is the little things that make us who we are. Zoe touching her toes, doing hot yoga, it's incredible. It makes us really take a step back and understand this as a human experience, understand this as a personal experience.

The privilege of being able to be involved in Zoe's care and the care of others is not lost when you hear these things. The story of Zoe and patients like Zoe is not done in December 2021. It's an experience that she's going to live through and get through for the rest of her life.

She's sitting 10 feet away from me right now and her mom is right here as well. She's going to get there, and we just have to do everything we can to support her. She's just incredible. And to just hear Zoe, hear her voice come through in this experience is just profound for us. As many times as I've seen Zoe, I've never known these little things about Zoe, and it's amazing to hear.

Interviewer: To find out more about traumatic brain injury as well as the services offered through the brain injury program at the Craig H. Neilsen Rehabilitation Hospital, visit the link in the episode description.

Dr. Chan: How do you strategize to apply and get into medical school? What activities help prepare you for medical school? How should you consider the financial implications when applying to medical school and residency programs? And why are couples slow to announce that they're dating while in medical school? Today on "Talking Admissions and Med Student Life," I interview a couple, Nisha and Milo, both former fourth-year medical students who recently graduated from the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world, this is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah, School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay. Well, welcome to another edition of "Talking Admissions and Med Student Life." I got two great guests on today, Milo and Nisha. How are you guys doing?

Milo: Doing well.

Nisha: Yeah. Doing well.

Dr. Chan: Fourth-year students about to graduate in a few days, I think, right?

Milo: Yeah, Wednesday.

Dr. Chan: Wednesday . . .

Milo: Friday. Friday.

Nisha: Friday.

Dr. Chan: Friday. Friday, but it feels like tomorrow. Yes.

Milo: Yes, yes.

Dr. Chan: All right.

Milo: Yeah. There was the quarantine.

Nisha: Yeah.

Dr. Chan: Yeah. Yeah. And we'll talk about that. Yeah. So I want to start . . . I love the story. I love hearing people's stories. So let's go back to the beginning, and Nisha, let's start with you. So when did you first want to go to med school? When did that enter your consciousness, and was it like one moment that stood out, or is it a series of moments that led you to become a doctor? Curious to hear when that started for you.

Nisha: You know, when I was very young, I wanted to be a doctor, but that changed as I got older until I went to college and I realized, you know, I really loved biology, especially human biology and at the same time, I was also an English major and I did a lot of work in research with human rights types of issues. And I realized that medicine was a really good combination of the two where, you know, there's a lot of science and stuff like that, but you also can make a really big impact on people's lives and the health of communities. And so that was when I realized that that's what I wanted to do for sure.

Dr. Chan: And then Milo, how about you? When did you come to the decision?

Milo: Yeah. I've always had an interest and aptitude for science. Initially, I thought I was going to get into research. Cancer has kind of run in my family, and growing up, I would always tell people, "Hey, I'm going to go cure cancer." And I didn't really realize how difficult that would be and what would actually be involved even in cancer research until I got into college and started doing some research and realized that full-time research was probably not for me, although I did enjoy the research. I still had a love for science and got introduced into medicine with the research I did but really wanted to work more hands-on with people and have research be part of what I did, but not entirely what I did. So I was talking to my uncle who was actually in maternal and fetal medicine and he said, "Well, come shadow me. It sounds like what you're looking for may actually be a career in medicine." I went and shadowed him, and he was right. I think it just combined the problem solving, the science, working with people. It just combined everything into a package that fit really well for me.

Dr. Chan: And where did both of you grow up? And, like, where did you end up going to undergrad?

Nisha: So I grew up in Emmett, Idaho, which is a pretty little rural town close to Boise. And I did my undergrad at the College of Idaho, which is in Caldwell, about 45 minutes from Emmett where I grew up. And I double majored in English and biology there.

Milo: I grew up all over the West. I was born in Phoenix, Arizona, and then for my dad's work in construction, we moved really pretty much every year or two. We bounced between Utah, Idaho, and Arizona mostly, ended up back in Arizona when I finished high school, and went to University of Arizona for the in-state tuition.

Dr. Chan: Finances do come into play with these things. So I totally get it. I totally get it. And then while you were in undergrad, for both of you, like, what kind of activities did you do that prepared you for med school? What kind of groups or organizations were you part of?

Nisha: I worked at the women's and men's center at the College of Idaho, where we worked with students that had experienced relationship violence in particular, but were also struggling with other mental health issues. And that, you know, had a big impact or prepared me to, you know, talk to people about issues that were difficult and find ways to help them and connect them with resources. And then I also did some shadowing and with the Idaho program involved in shadowing, and then I did research with the Idaho INBRE Program, which is for undergraduate researchers and we did a biochemical and microbiology research, which also really helped prepare me for medical school and helped prepare me for the kind of critical thinking in particular that you need in medicine.

Milo: And I did quite a bit of volunteering in hospice through a hospice facility in Tucson. I founded a chapter of the Medical Reserve Corps at University of Arizona, which focused on getting communities involved in emergency preparedness and how to respond as a community member if they were to be the first person on the scene of an emergency. And then I got involved in research in speech and language and ended up long-term with an MRI lab looking at language learning and language pathology.

Dr. Chan: And what were . . . how did you, like, what was your process like when you started looking at medical schools? I mean, did both of you look at, like, spreadsheets, or did you go by word of mouth? Like, how did you start coming up with a strategy when you looked at medical schools to apply to?

Nisha: So there's a lot of, you know, pieces that you need to apply to medical school. And I actually found that the University of Utah's website and their requirements were pretty in depth and in detail. So those were the guidelines that I used to make sure I had all the boxes checked off for medical school. And then for me, what was important or one of the things that was important was finances. So, you know, I looked into the schools that had, you know, either scholarship opportunities or that would allow me to have in-state tuition, and Idaho works with the University of Washington and the University of Utah. So that had a, you know, pretty big influence on my decision about, you know, where to apply and for medical school.

Milo: For me, I mostly wanted to stay West. It was where I was familiar with, and my family was planning on staying in either Arizona or Utah. So I applied mostly to Western medical schools, which narrowed the list down pretty significantly. And then finances were also something I had to consider. So I picked public universities that typically had better tuition.

Dr. Chan: And then I don't know if we're going to talk about it, but did both of you get in the first time, or what was that process like or, like, talk about that. Like, if there's any bumps in the journey, like, how did that go?

Nisha: So I applied technically twice. The first time I applied, I had some family issues. Right before the secondary applications were due, my grandfather got diagnosed with cancer and ended up dying pretty shortly afterwards. And so I decided that I wasn't ready to start medical school at that time. And so I didn't finish completing the application cycle. I did apply the following year, and that year, I got in off of the waitlist for the University of Utah.

Dr. Chan: And Nisha, was it like an immediate yes in your mind, or were you kind of fielding other offers? I mean, like help me understand what you're going through right then.

Nisha: When I got accepted to the University of Utah?

Dr. Chan: Yeah.

Nisha: So I had actually taken what, you know, probably a pretty big risk, but I had only applied to the University of Utah and the University of Washington that year. And I really loved the University of Utah on my interview day. And when I got accepted off of the waitlist, it was an immediate yes and that's where I wanted to be.

Dr. Chan: I find, I mean, that's great, Nisha. I love that. And it's interesting, because like I've worked in Idaho for many years and I feel that, like, University of Washington, they definitely have like a bigger brand name in Idaho and I just see purple everywhere that I go. And so, yeah, I'm just curious, like with you being in right, I would argue kind of right in the middle of Idaho, kind of in between Utah and Washington. Yeah. Like, yeah. So I'm happy that it sounds like our website and our interview day really helped sell you on the program.

Nisha: Yeah. You know, I really, you know, I liked the people that I met, and I liked the idea of being in one place for all four years of medical school. And, you know, I really liked the campus, and it seemed like, you know, the opportunity to work out in multiple different hospitals in the area was also really appealing to me.

Dr. Chan: How about you, Milo? How was your journey?

Milo: It was on the longer side. It took me three application cycles to get in.

Dr. Chan: So you hated me, but then liked me at the end, right?

Milo: Well, I didn't apply. So the first application cycle, I put in primaries, but I was actually doing some shadowing with the neurosurgeons at U of A, at that point. And there were some things that came up in the shadowing that made me kind of pump the brakes on going all in on medical school right away. I knew that with the debt you accrue in medical school, once I got in, I was kind of locked in. You really want to come out the other side a doctor, or you get into some financial issues. So, you know, I saw some issues with the insurance companies and just some of the policy that I saw in shadowing. There were neurosurgeons there who were working, kind of fibbing their hours so they could work over the 80-hour limit. And they spent a lot of time just arguing with insurance companies over what they thought was necessary and what would get paid for. And I really had to think if that was worth, you know, because if it was just patient care, I knew that that's what I wanted to do, but there were just some things that I thought detracted from that and I had to consider if that was worth it. So I actually didn't finish the secondaries the first year I applied.

And the second year, I think I applied to I think 8 or 10 schools. I got an interview only with University of Arizona and got waitlisted and didn't end up making it in that year. Then actually, I moved out to Utah because my family was out there and wanted to establish residency in case I got into medical school there. I got a job at a lab that I really loved doing neuroimaging and only applied to Utah that third year because I was with my family doing some research that I really loved. And I figured if I get into Utah, that's really where I'm targeting and that would be great, and if not, then I'm in a good situation anyway, but I did get in that year.

Dr. Chan: So both of you, I mean, this kind of flies in conventional advice I give to people, but both of you essentially kind of suicided applied to like one, maybe two programs. Usually, I tell people like, "Oh, 10 to 15," but it sounds like you both felt fairly confident in what you were doing. Is that accurate, would you say?

Nisha: Yeah. And, you know, I think for me, just looking at the numbers as someone from Idaho, I think statistically I was most likely to get into the two schools that I applied for. It was also cheaper for me to just apply to two schools, and the in-state tuition was also very appealing. So those were kind of what led my decision to just apply to those two schools. My plan was that if it didn't work that year and I hadn't got in, then I would extend my application further and, you know, improve my application as necessary, but I was, you know, willing to apply to more programs the following year if I didn't get in.

Milo: Yeah. You said I had a lot of confidence and I don't know if I had a lot of confidence, but I was in a situation that I was happy with, and if I didn't get in that year, I figured I'd get there eventually. And I was enjoying what I was doing at the time. So it wouldn't have been a disaster if I didn't get in that year.

Dr. Chan: And I can tell you from my end, now I can say that since we're having this conversation four years later, I remember talking to you Milo on the phone and you were so excited. I remember like I thought, "Oh, you're definitely coming." And then Nisha, when I talked to you, you were pretty cool, and I think you're holding your cards close to your chest. I don't know. Maybe you were stunned, but I came away from that phone conversation with you going, "I don't know if she'll come here," because you were pretty cool on the phone. So I don't know if you remember that phone call that many years ago, but that's kind of how I remember it.

Nisha: Yeah. I think I was pretty stunned actually. Because I had been waitlisted, I didn't have a lot of hope of getting into the University of Utah. And so I had really mentally prepared myself to do another application cycle. And so, when I got the call, I think I was pretty shocked at first, but also, you know, so that was kind of my initial reaction. But, you know, obviously, I did decide to go here, and I have loved all of it.

Dr. Chan: Do you remember being excited, Milo?

Milo: Yeah. Yeah. I actually woke up to your phone call, and it was earlier than I expected to hear back. But when I saw the number, like it kind of clicked and I picked up the phone kind of thinking that I was going to be on the phone with you. And I was super excited. Like I said, I only applied to Utah because I figured, you know, that's really where I wanted to be and just getting to stay here, stay with my family, go to a really great school, it checked all the boxes for me. So I was very excited.

Dr. Chan: Great. And then I want to jump . . . okay. I love asking this question, especially couples. So what is your first memory of each other? Was it during second look day? Was it during orientation week? Was it . . . were you anatomy lab partners? Like, how did you guys meet initially?

Nisha: So we met and we were in the same clinical skills group actually, which was the first time that I remember meeting Milo. And then we did a lot of studying together that first year. Me and Milo and another one of our friends were kind of in a study group, and we spent, you know, lots and lots of time going through all of the material and writing stuff on the whiteboards. So that's kind of some of my first memories.

Milo: Yeah. Definitely, where we met was the learning communities, like within the first week of medical school. And then I think walking back from classes to our cars, I ran into Nisha and we had like this really nice, in-depth discussion about, like, the world and politics. And it was just such a change from all of the preliminary conversations you have with everyone else kind of like, "Hey, where are you from? Do you know what specialty do you want to do?" Just really kind of superficial small talk and I'm really bad at that. And it was just such a striking change that that really stuck out in my head.

Dr. Chan: Nisha, do you remember this or do you not remember this?

Nisha: Yeah, I definitely remember that and for the same reason because it had been, you know, a lot of just the small talk conversations, which, you know, are obviously important, but were pretty tiring for me. So it was nice to have a conversation about things that I was, you know, that I was interested in and passionate about, and it was just really nice to connect with someone that wasn't the small talk superficial level.

Dr. Chan: And who is your . . . what was the name of your CMC group, and who was your instructor?

Milo: We were Powder Mountain. We started out with Dr. Barrett, who was fantastic, but he had a great job opportunity that he left for. And then we got hooked up with Dr. Glasgow and Dr. English.

Dr. Chan: Okay. I love it. And so it sounds like CMC really brought you together. And then, you know, again, like I've done other podcasts with other couples who ended up doing the couples match. Were you . . . how do you feel about becoming a couple? I mean, I know there's some, sort of . . . sometimes I talk to the med students and there's like this weird code, where they're like, "Okay, we're not going to date each other, but maybe we will." You know, and then, so I've noticed couples are very slow to kind of like announce that they're a couple. I mean, did you guys grapple with that at all, or were you pretty much like, you know, once you guys were together, you're together and you didn't care about like any sort of silly codes like that? Do you understand what I'm saying?

Milo: Yeah. I think it took us a while to get to the point where we were together because yeah, there's complications with dating a classmate who you're going to be in a program with for four years. But I think once we got to that point, I wouldn't say we overtly announced it, but we probably didn't try to hide it either.

Nisha: Yeah. We were really good friends for about two years before we started dating. So it was right before we went into the third year that we were really officially dating. And so we also didn't see a lot of our classmates around that time, which I think kind of made it a little bit easier, at least from the kind of announcing standpoint. And because we had been good friends for so long, at least for me, that made me a less worried about moving forward and becoming a couple and, you know, also with the knowledge that the match was going to come up in two years and so if we were going to stay together, that would probably mean doing couples match together. And so I think, yeah, just . . .

Dr. Chan: I love it. It sounds like it came together quite nicely on a kind of good schedule.

Nisha: Yeah.

Milo: Yeah, it definitely did.

Dr. Chan: And speaking of the first two years, how was that jump from undergrad to med school? Was it relatively easy? Was it kind of like the fire hose analogy? Did you have to redo your entire study kind of skills? Like, how was that jump from undergrad to med school for you?

Milo: Yeah. So I actually took five years between undergrad and med school. So I actually think it was . . . I felt recharged and like ready to go back into the classroom. It was kind of like a fire hose. I forget who told it to me, but when I was a first-year medical student, someone told me the first two years of medical school, like going from undergrad to first year is like going from zero miles per hour to 40 miles per hour. And you just have a lot of adaptation that you need to do. It feels like it's moving really fast, even though the material isn't quite as hard. And it just feels like a really big jump.

And I think I agree with that. I definitely. Maybe it was relearning study strategies after having been out of it for five years, but I felt like it was a pretty big jump and took a lot of adaptation. And then from first to second year is like going from 40 miles per hour to 60 miles per hour where it, you know, it's harder stuff, but you've got a lot of your habits formed at that point, and you just kind of have to lean on them a little bit harder and work a little bit harder for the material.

Nisha: Yeah. I agree with that. I think I had to learn how to process material in a different way. When I was in my undergrad, I took extensive handwritten notes on everything, which was really one of the ways that I learned well, and that was not really possible in medical school or it was at least quite a bit more difficult. So I had to, you know, learn some other strategies besides that. And I had also never really done any group study in undergrad, but I found that in medical school, group study was actually one of the things that worked best for me.

One of the other challenges that I had was going into medical school, I knew that taking multiple-choice tests was not my forte and it was something, you know, that I had not done as well with. In the undergrad, I did not do very many of them. So one of the things I really had to focus on was how to take multiple-choice tests, how to think about those types of questions. And I was actually really lucky because Milo is very good at them, and he was willing to spend a lot of time talking through strategies with me and helping me, you know, focus on the material, learning the material in a way that would kind of let me showcase that knowledge in a different way.

Dr. Chan: Great. It sounds like you guys were like, to you use a business term, a lot of synergy, you know, coming together. It sounds like you were able to kind of really develop some great skills, study skills, academic skills that really paid off.

Milo: Yes, absolutely.

Dr. Chan: And Milo, you alluded to it like a little bit. So if I had a time machine and I went back four years ago and I asked you what specialty you would go into, what would have you said, and then, how did third year either help or not help that decision? So I'm just curious. Yeah. I mean like, what would you have gone into, and then how did third-year kind of play into it?

Milo: Yeah. Mine's pretty easy. I thought I was going to do neurology, and I'm doing neurology. So, yeah. A lot of that was that's the research that really ended up pulling me in towards the end of college, and the five years I took between undergrad and medical school were a lot of neurology research. So I came in with a strong basis in it, knew that I really enjoyed it. Tried to keep an open mind through the first three years of medical school. I gave pathology a good look actually and internal medicine a pretty good look as well. And in the end, it actually came down to internal medicine and neurology, and they're really similar. I think people go into them for a lot of the same reasons, but I've always really liked learning about the brain and the nerves and, you know, they both had similar aspects and I picked the organ system that I liked the most, and that was neurology.

Nisha: For me, I went into medical school thinking I was going to do surgery, either general surgery or urology. And part of that was because I had shadowed a urologist and I got to watch some surgery and I just thought it was like the coolest thing ever. So, you know, I thought that that was going to end up being what I wanted to do. And in third year, my very first rotation was internal medicine, and I really enjoyed it. I think it was, you know, some of the longest hours in third year, but I was always excited to be there the next day and checking on my patients.

And after that rotation, which I enjoyed so much, the rest of the rotations were not as enjoyable as that was for me. Although, for some reason, I was so convinced that I was going to be a surgeon and I was kind of still thinking in my mind that that was the direction I was going to go. And it was Milo who actually said to me, he was like, "It's your life and you can do whatever you want, but you've been kind of miserable since your internal medicine rotation. So I don't really know why you're still going the surgical route." And that made me stop and think and realize, you know, what I really realized that that was what I had enjoyed doing the most. And when I made that decision, it was something that I was really happy with and really excited to do.

Dr. Chan: So a lot of people have told me like it was like finding your people. And it sounds like neurology, internal medicine, you found your people. Would you agree with that?

Milo: Yeah, absolutely. One word that got thrown around about neurologists on the interview trail at least was quirky. And definitely, I'm a little bit quirky. And I just felt like I fit in really well with the neurology crowd.

Nisha: Yeah. You know, I really like, you know, puzzles and problem solving, and that's a lot of what internal medicine is, is you get, you know, someone that comes in with non-specific symptoms and you have to figure out what's going on. And that's something that I really enjoy. And it also made sense because before medical school, I did quite a bit of research in a lab. And one of the things I loved about that was, you know, experiment didn't go the quite the way that we were expecting is, you know, a lot of troubleshooting and trying to figure out what was going on. And, you know, that was an aspect that really carries over into internal medicine, which I enjoy. It's a lot of kind of sitting and thinking. And, you know, one of the things I really love about hospital medicine, in particular, is that you get the answers, you know, you can see improvements and you get, you know, order labs and you can get them back pretty quickly. So there's kind of this real-time feedback on what's going on, which I also really enjoyed.

Dr. Chan: And then going into fourth year, did you, like so, when did, like, the discussion start kind of coalescing around the couples match, and when . . . like, because I know sometimes, students do away rotations. Like how did that kind of factor into, like, as you transitioned to fourth-years?

Milo: Yeah. Neither of us did an away rotation, but I think we had been together and felt like we fit together for a good year and a half previously. And so we just kind of . . . I don't know. We didn't have too big a discussion about it. It was just kind of, "Hey, you want to do this?" "Yeah." "Okay." And we did.

Nisha: Yeah. I agree with that. And neither of us did an away rotation, and for a large part, at least for me, that was just due to some of the advice that I got, which was in internal medicine, it wasn't really necessary unless there was somewhere in particular that you really, really wanted to go. And we didn't feel that strongly about any particular place.

Dr. Chan: So, yeah, I guess that segues to my next question, Nisha and Milo, like, what was your strategy for the couples match? Like, how many programs did you apply to? Did you try to identify like a certain geographical area of the country? Or did you just check all the boxes and just took the money and threw it through the window? Like what did you do? What was your strategy?

Milo: Well, at risk of sounding a little bit snooty, I guess, we just took the NIH, like, top 100, I guess top 50, like, funded schools and just went through those, cut a few of them and applied to most of the top 50. Well, no, about half of the top 50. I think most of the top 30. We ended up applying to like 20 . . .

Nisha: Twenty-two programs I think.

Milo: Twenty-two. And that was kind of our initial cut was the NIH list.

Nisha: Yeah. And I think we were really lucky too that our scores throughout medical school were very, very similar, and neurology and internal medicine are pretty comparable in terms of, you know, a program that was good at neurology was also usually pretty good at internal medicine and vice versa. And, you know, and we were very similar in competitiveness, both in terms of the specialties and in numbers, as I said before. So I think that made it a lot easier for us. I think it would have been more challenging if one of us was going into, you know, a very, very competitive specialty, and we might have had to make more sacrifices if that had been the case. But I think that was something that made it quite a bit easier to couples match, and, you know, we got interviews to pretty much all of the same places, and, you know, they were pretty close together in time as well. So that was nice.

Dr. Chan: I love it. I'd never heard of this NIH method. Are both of you thinking of, like, doing research during your residency careers, or what was kind of the logic behind using the NIH?

Nisha: So I actually had met with one of the internal medicine advisors, Dr. Lappe. And I was trying to sort out, you know, because you're supposed to apply to, like, some reach schools and some safety schools and then, you know, kind of schools that are in your range. And I was trying to figure out like, how do I know the competitiveness of schools? And she just, like, Googled the NIH internal medicine funding list, and that's what came up. And she looked at the list and she was like, "This is . . . the order that these are in is pretty consistent with the competitiveness of the schools." And so, you know, and she said like, "These are the schools that I think are, you know, within your grasp. These are the ones that I think are reach programs." And so that was why we used that list.

Milo: Yeah. I think moral of the story is have a good mentor and speak with them regularly, because Dr. Lappe was just invaluable, honestly, to both of us. And she spoke mostly to Nisha, but she gave advice to both of us and we both told her like, "These are our scores, these are our thoughts." And she was fantastic.

Dr. Chan: And I think, so it sounded like 22. So you each applied to approximately 20 some odd programs?

Nisha: Yeah.

Milo: Mm-hmm.

Dr. Chan: And then the interview offers sounded like coming in. Did you have to make hard decisions about turning down some interview offers, or did you just go out and do them all? Like, how did you approach that?

Milo: Yeah. We had to cut some of them. I think we got the majority of the ones we applied to, and we cut down to, I think, 12 or 13.

Nisha: Yeah.

Milo: So we ended up cutting about 10 each. And again, having a good mentor for that Dr. Lappe and on the neurology side, Dr. Wold and Dr. de Havenon spent a lot of time talking with us about which to keep and which could probably go.

Nisha: Yeah. And, you know, at that point, we started looking a little bit more into, you know, how much does it cost to live in that area, you know, some of, like, the benefits offered by the different schools and kind of some of the lifestyle around the schools, which we had looked into initially, but not quite as hard as when we actually got the interview offers and realized we needed to cut down to fewer programs than we had interviews for. So we used that to make some of our decisions as well.

Dr. Chan: And did you, I mean, like, and again, kind of like back to when you were applying to med school, would you, like, call each other or text each other at night and kind of give like each other's opinions, or was there some sort of Google master document spreadsheet where you would kind of, you know, pros and cons? Like, how did you kind of synthesize all this information you were getting as you both hit the interview trail?

Nisha: So we called each other usually after the resident dinner, the night before the interview, and then usually, like, on the way to the airport or at the airport the day after the interview was over and just kind of talked over our initial thoughts. And, you know, we typed some of the stuff that we really liked or, you know, or were more concerned about in a Google Doc. But in the end, it kind of came down to, I think, the feeling that we got at the different interviews and the places that we just enjoyed being the most or felt like we fit in the best.

Milo: Yeah. While I was at the airport, I would write down like in-depth the handwritten notes in a notebook about each program. And actually, when it came time to make the decision, I don't think I even went and looked at those outside of the top maybe two or three programs that we were thinking of. In the end, I agree it just came down to feel, how well you thought the program would take care of you and how well you thought you would meld into the program.

Dr. Chan: And did you send, like, you know, because like in the world of medical education, we call them love letters, like when you start corresponding with these different programs or love emails as it were, did you feel you had to do that, and what was your, like, who would do the writing? Or was there a place that like interviewed one of you and the other place was like not as quickly sending out interview offers, and did you have to kind of use some love letter-ish maneuvers with them? Like, how did you do that? Nisha: So, in terms of the actual interviews, there was one place where he got an interview that I was waitlisted. And then after his interview, I got an interview there. And then there was a couple of interviews that I went on, but they made sure to ask me if my partner had gotten an interview yet and said that they would, you know, press the other program. But for the most part, we got interviews to the same places. And then at the very end, we sent a love letter to our number one program, individually to our respective programs and said, you know, both that this is our number one program and our partner is also going to be ranking this program number one. But, you know, even in terms of that letter, we weren't really sure as to whether or not we needed to send it or not, but decided that it probably wouldn't hurt us to do that, especially because we said very specifically this is our number one program, and we only sent it to one place.

Milo: Yeah. I think on my end, I thought it was important to send that kind of final you're my top school love letter. Towards the beginning of the interview trail, I did send schools kind of thank you letters detailing some of the things that stuck out to me about their school and some of the things that I liked about their program. That kind of fell off around the middle of the interview trail. And actually, a number of schools just outright said like, "Don't do it. It fills our inboxes. We probably won't read them. Save everyone some time."

Dr. Chan: Unless you have a really catchy header line, we're not going to open this.

Milo: Yeah. That said, there were some that . . . I think there was one that actually it sounded like they really wanted us to send a thank you letter on the neurology side. So I definitely sent emails for those.

Nisha: Yeah. And I think almost all of the internal medicine programs on the day said, "You don't need to send thank you cards to your interviews or to the main program. We're happy that you're here. We know that you're happy that you're here. Please don't send us anything," which I think is different as compared to some other specialties. So that was probably pretty specialty-specific.

Dr. Chan: And when you started looking at your list and you started finalizing it's, like, was the number one choice for both of you pretty crystal clear, or is there some horse-trading negotiation? How did you work that out as a couple, because, like, I get the sense from both of you, your applications were very similar and very competitive, but again, my experience with couples match, you know, it's like all things as you navigate in life, there's trade-offs and there's accommodations and there's and yeah. So a lot of people kind of try to figure out . . . like compromise. The word I'm trying to use is compromise. So, yeah, how did you guys do that? Or was that even an issue for both of you?

Milo: It was an issue. There were some trade-offs for sure. So, actually, I had wanted to just stay at Utah. My family is actually right in Holladay. And I really hadn't seen them. They moved after I graduated from high school, and I hadn't really had a chance outside of med school to, like, be near them and close to them. And so I figured like Utah's a great school, I know the neurology faculty, and I love working with them and my family's here. So I had actually wanted to just stay in Utah. And Nisha said, you know, like, "Let's be a little adventurous. This is our one chance to, like, go out, gain other skills and then maybe come back here after that." And so our compromise ended up being we would each choose our top non-Utah school, put those at one and two, and then put Utah third. And that's what we ended up doing. There was a little bit . . . and then we both got kind of our choice in the top three.

Nisha: Yeah. And I was, you know, really appreciative of Milo's willingness to compromise on this one. And, you know, I think we were also lucky though that our top programs, the ones that we had liked the most were similar. So, but I will say even within that, I mean, there were several programs that we both really, really liked, and there wasn't like a clear number one for us. And I think when we were getting ready for interview season, a lot of people made it sound like, oh, they went to this one program, and they just loved it and they knew it was the program for them and it stood out above all the rest. And we had a lot of programs that we really liked. And so we also did do some, a lot of talking and kind of compromising on how we were going to order those as well. And geography did play some of a role in that, but then so did cost of living and other things that were kind of our future goals.

Milo: Yeah. I think Nisha brought up a really good point. Other students, I heard say like, "I went to this place and it was the one for me." And actually, at the resident dinners, that was an answer a lot of the residents gave us too when you ask them like, "Hey, what made you choose here?" They said like, "I just knew it was the one." And I don't think either of us had that feeling about any one school.

Nisha: Yeah. There's a lot of good programs.

Dr. Chan: There's a lot of excellent programs. And now, I'm going to kind of turn to something before you tell us where you matched because it's kind of pertinent to what's going on. Like, what rotations were you on when, like, when COVID started happening, and how was that communicated to you and kind of like the emotions of, you know, I graduate soon, match is supposed to happen. Like, what were you doing at that time and how was that?

Milo: Yeah. I had just finished my core sub-I on cardiology, and I had a planned two-week break to go be at my brother's wedding and he just snuck it in actually. We got back from the wedding, and like three days later everything shut down, and we were told the classes wouldn't happen and no more, no more clinical clerkships or anything. So I just remember . . . I actually did not think it was going to be that big of a deal to be honest. And my brother-in-law, he's a surgeon, and I saw him at the wedding and we were talking about it and we're both kind of like, "Yeah, you know, it's concerning and definitely something to keep an eye on, but in terms of, like, large-scale impact, maybe not." And then like half a week later, I talked to him again, and we were both like, "Wow, we got that wrong." And it was just weird. It's surreal. And honestly, it's still a little bit surreal. Having gone from a really busy sub-I being in the hospital to just being at home and trying to stay away from everyone and figure out what to do with my time, it's a big change. And the whole experience has just been surreal.

Nisha: Yeah. I was on radiology, and it was kind of confusing for a couple of days in terms of what was actually going to happen because we were about halfway done with the rotation. So, you know, we weren't sure if we were going to have to come into the hospital because we weren't seeing patients, or whether it was going to transition to online. But I thought the school handled it very well, and we were, you know, given updates really regularly. So, you know, that helped eliminate some of those questions.

One of the things that I think was harder was that Milo and I had both planned for our advanced internal medicine rotation to be our very last rotation, because we wanted that to help us get prepared for intern year, and that was done mostly online, which was still a good experience and we still learned a lot, but that also kind of shifted some of the plans that we had or in terms of getting ready for internship.

Dr. Chan: How did it feel, Nisha and Milo, to have, you know, the realization that Match Day because like Match Day is traditionally like, I call it the Super Bowl. Like, you've worked so hard for so long to get to this point, and it's you bring together your loved ones, your family members, and it's a huge celebration and, you know, I know the Dean's office, we mourned that we couldn't offer that to you. What was your feeling? Like, did you go through, like, the five stages of like anger, grief? Like, how did . . . when you realized that you would not have a "normal Match Day" or it was it not that big deal to you? I mean, I'm just curious.

Nisha: I wasn't that . . . I mean, I was excited for Match Day, but I had never been to a previous Match Day before. So I also think because some of my friends who had been to the previous Match Days were a lot more upset about it than I was. I was actually really, really sad about graduation. That was the thing I was looking forward to the most. And I think, in my mind, I was kind of hoping like, "Hey, if we do really good quarantine and, you know, maybe we miss Match Day, but maybe this will be over by graduation," which, obviously, was very wishful thinking on my part. But yeah, for me, Match Day was not as bad as missing graduation was.

Milo: Nisha and I were flip-flopped there. I was really looking forward to Match Day and, you know, graduation as well I think maybe to a lesser extent. I really wanted to be with friends and family and open the letter and see where I was going, and just have it be a big thing with everyone around, and I thought that would be a lot of fun. And obviously, you know, it's sad that it's not happening, but luckily, we've still been able to have contact with family, and all the Zoom meetings and virtual meetings have made it still possible to see friends and peers. And so there's alternatives even if they're not quite as good.

Nisha: And I think some of the, you know, Zoom alternatives that we've figured out how to do with family and friends has actually been a really good experience, because when we leave for our residency, we kind of already have some things in place about how to keep in touch with our family that I think had this not happened, would have been, you know, more difficult to implement.

Milo: That's definitely true.

Dr. Chan: And so how did you celebrate Match Day virtually with the med school or with your families? Or how did you do that, and where did you end up matching to?

Milo: Yeah. So Match Day, we spent with our aforementioned best friend that we studied with. We went over and had brunch with her and her partner, and we all opened our match emails together and then kind of video conferenced with our families all at the same time.

Nisha: Yeah. Our program, and I'll just say we both matched to the Yale. Our program had, I think, sent out, like, an automated email saying, you know, "Oh, this is like your new Yale email," about an hour before the official match results came out.

Dr. Chan: Uh-oh, it sounds like a violation. No, I'm kidding.

Nisha: So we knew kind of where we were going. At that point, we weren't sure if it was real or not real, or if it was like a spam or something. But yeah, that ended up being where we matched at. So that was kind of a spoiler for us, but it was also kind of fun because we asked, you know, our family where they thought that we would match on our list. So that was kind of cool.

Dr. Chan: So where did you match to?

Nisha: Yale.

Dr. Chan: Where? One more time.

Nisha: Yale.

Milo: Yale.

Dr. Chan: You got to say, you got to love it. Ivy League. Whoo. So sell me about Yale. What was great about Yale's program?

Milo: Yeah. So I really loved the people there. I met with the . . . so the program director there was just fantastic. By the time I got around to Yale, it was kind of further in the interview season, and the one-hour program director meetings at the beginning, I just felt like they never really said much, but his was fantastic. He just had such a good grasp on what was important to residents and what people had on their mind in terms of choosing where to go. And he had this really cerebral way of talking about that and then provided very concrete ways of like, "Here's what we're doing or have already done in order to address these issues." So it was very clear that he had his finger very well on the pulse of the residents there and their concerns. And he was just a very thoughtful person.

And then there was a doctor that I interviewed with who was doing almost exactly the same stuff that I foresee myself doing, a lot of medical education, ended up getting his masters after residency during his fellowship. And he kind of said, "Hey, I actually requested to interview you because it seems like we had a lot of the same interests and I would love to mentor you." And he just really pulled me in. And actually, come to find out he is the nephew of Nisha's parents' next-door neighbor and they live in, like, a small Idaho town. So just crazy coincidence.

Dr. Chan: Wow.

Milo: But both him and the program director were just so accessible and eager to jump in and help, and they had some really good medical education opportunities as well.

Nisha: Yeah. You know, I felt like the people there were, you know, very nice and very friendly and very passionate about the things that they were doing, which came out a lot in the interviews. And I, you know, really wanted to go somewhere where people were really excited about the work that they were doing and were willing to involve residents in that work. And, you know, one of the things that really stood out to me was that the program director talked to all of the applicants individually, and he, you know, he knew, like, all of our names and he knew facts about us from our applications, which for as many applicants as he sees I'm sure in a week was really, it stood out to me in terms of, like, how much they care about the people that are coming to their program and are interested in knowing them as individuals.

And, you know, they also had a lot of focus on resident wellness, which I appreciated, and their noon conference education just really kind of blew me away in terms of the way that they talked about the cases that they were looking at and, you know, how they approach testing and diagnosis and how they use the cases, like this is how we've changed our policies because of this. Then, you know, really tried to focus on how to, you know, do medicine in a more efficient, evidence-based way. And I really appreciated that as well. So it was somewhere I knew the people were awesome, and I would also get, you know, a really good education and things that were important to me.

Dr. Chan: Nisha, wow, this has been great. And I guess this last question, and it's more kind of a personal question in just what you're going through, but, you know, from our standpoint, from the Dean's office, this class is very unique for many ways because, you know, you're kind of more or less the COVID generation, and you're about to start your medical careers and to be quite honestly, in an area of the country where there's a lot of COVID cases. And I'm just curious like, how are you feeling internally, like how's Yale kind of like, you know, the onboarding? I'm sure that you've gotten a bajillion emails about this, and in the midst of this, all you're supposed to be doing all the normal residency stuff and finding a place to live and all that. Like, what does this mean to you? Like, how does it feel to just know that you're uniquely positioned to start your residency program in the Northeast, right in the middle of a COVID pandemic?

Milo: Well, there's a lot of emotions. I will say that I am actually kind of itching to get back into the hospital. I think having been taken away from it since mid-March, I'm pretty eager to go back and get back to what I signed up for and what I really want to do. But there are a lot of concerns surrounding COVID. And like you said, Yale borders New York pretty closely. It's just a few hours away. So they're kind of right in the epicenter. All of the messages we've got from them are encouraging in terms of they have protective equipment. They've been incredibly supportive and very accessible in terms of asking or answering questions we have. But yeah, there's a lot going on. It's a big transition to go across the country. It's a big transition just to start up internship in general and trying to find housing and get all the paperwork done for a new program. It's a lot going on, but I think we're trying to take, take it as it comes. And I think once I get out there, I'm excited to dig in and get started.

Nisha: Yeah. I'm also excited to get back into the hospital and back into seeing patients. And the program has been really good about, you know, keeping us aware of what's going on and what things are going to be like when we get there. And a lot of, you know, they send a lot of emails that are like have positive quotes or say, you know, like good things that are happening in the hospital. And it's clear that they're really trying to, you know, keep residents as well as possible, and, you know, focus on taking care of each other as well as taking care of patients. And I think that has alleviated some of my concerns as well about that we're going into an environment that is very, very stressful, but to a program in a place that is trying to make it, you know, as safe and as well as possible for the residents.

Dr. Chan: Well, I'm just really proud of both you, and you're just a great example and I'm excited for you and kind of anxious for you too, but I think that's normal.

Milo: Yeah.

Dr. Chan: As you kind of launch into this new part of your career and journey to becoming full-fledged attendings, you're going to be MDs very soon, which is kind of crazy when you think about, you know, you're going to have doctor, MD as the new name, but, you know, I just want to thank you for coming on the podcast and just kind of talking about what you've gone through. I think it's important to kind of explore it, and like I know there are people out there that are listening that will really benefit from it.

Milo: It was a pleasure, Dr. Chan. Thank you so much for having us.

Nisha: Yeah. Thank you. We're really excited as well.

Dr. Chan: All right. Well, you guys take care and maybe we'll catch up in a couple of years and maybe have you come back on the pod and hear how it's going out in Yale. Being a Yalie, is that the right term? Do you automatically now just hate Harvard, and, you know, you officially kind of adopted the blue, but become a bulldog as it were? I don't know. Yeah. So we'll have to have you come back on the pod in a couple of years. All right?

Milo: That sounds fantastic.

Nisha: All right. That's awesome. Thank you.

Milo: Thank you.

Dr. Chan: All right. Take care, Nisha. Take care, Milo. Bye-bye.

Nisha: And you too.

Milo: You too. Bye.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio, online at thescoperadio.com.