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Scot: Hey, Troy. What was one of the things that everybody said about being a new dad, and you're like, "Eh, really?" and it turns out it's true? What was the one thing? Do you have something?

Troy: I think the anxiety that comes with it, that's probably the one thing. I heard people say, "You will lie there at night, and you will just listen to her breathe. And you will just make sure you are hearing her breathe." And I was like, "No way. I would never even do that." I have absolutely done that. So, yeah, that's definitely true.

Scot: Oh, man. Transitioning into fatherhood, like any chapter, can be really, really challenging and it can have an impact on your health. I mean, how many times have you heard guys say they stopped exercising or eating right after they've had kids, or their sleep is just constantly impacted after that? Or just even emotional health issues. It's a big change in your life. And we have a guy that has just become a new daddy, Dr. Troy Dadsen.

Troy: Dadsen, with a D.

Mitch: Dr. Troy Dadsen.

Scot: With a D.

Troy: There we go.

Scot: And this is a Sideshow episode of "Who Cares About Men's Health," where we're going to get a new daddy update, where Troy is going to tell us some of his experience as it relates to his life, and back to the Core Four that might be able to help other new dads.

"Who Cares About Men's Health" provides information, inspiration, and a different interpretation of men's health. My job, I bring the BS. I'm Scot Singpiel, and I chose not to have kids because I was afraid I'd screw them up. So that's why I don't have kids.

Troy: Scot, I was deathly afraid I would screw them up too. But I have a kid now, and hopefully I don't screw her up.

Scot: Now that is the MD to my BS, new daddy, Troy Madsen.

Troy: Yeah, that's me, bringing the baby to the show.

Scot: And nieces and nephews are enough for now, says Mitch Sears. He's on the show as well.

Mitch: Yeah. I'm good for a bit. Yeah, I'm good.

Scot: Okay. Because I just made that up to be clever in the intro, and then I asked myself, "I wonder if that's true. I wonder if he actually wants to have kids at this point."

Mitch: I don't know. No.

Scot: No?

Mitch: No. We'll see. I mean, we'll figure it out at one point or another.

Scot: Okay. All right. Troy, it's great to have you back on the show for a new daddy update. So I've got one question for this episode of the podcast. Tell us all about being a new dad.

Troy: So I'm just going to go into a 20-minute monologue now.

Scot: Actually, just give us an update to start off with. How's it going so far? How long's it been and how's it going?

Troy: So things are going incredibly well. It's been two months. She just turned 2 months old. Her name is Adeline. We call her Addie. That's her nickname. So she goes by Addie. She was born just over two months ago.

And I will say the delivery experience itself went incredibly smoothly. It was funny. It was just about . . . Well, it was one week before she was due. And Laura, my wife, was at the vet with one of our foster dogs, Arthur, who, Scot, you know well. You saw pictures of him at least. Very cute little guy. And Laura calls me and says, "Well, Arthur is doing well, and I think my water just broke."

Mitch: She buried the lede? Ugh.

Troy: Yeah, she totally buried the lede. She started with, "Well, Arthur is doing well. Everything is good. And I think my water just broke."

Scot: Well, from a comedic standpoint, that is the delivery. So good for her.

Troy: Yeah, exactly. From a comedic standpoint, yeah. So she came home. We went in to the hospital. So we got in there about noon. Addie was born about 2 in the morning. Came out with her eyes wide open and just the most beautiful little girl I've ever seen. Obviously, I'm very biased.

Scot: Of course you are.

Troy: And then I had about an hour with her alone because they just had to watch her over just in the pediatric . . . just the neonatal care unit. So I had about an hour in there with her alone, just sitting there with her, and just looking at her and just thought, "Wow, this is absolutely remarkable."

And every day since then, I've felt the same way. Every day it is just . . . Just to see her grow, and develop, and her mental development as she's become more attentive and more focused on our faces. Just in the last two weeks, she'll smile. I'll look at her and she'll see me and she'll smile, and look at Laura and smile and laugh. We'll laugh and she'll laugh, and it's just the cutest thing in the world.

And she's just my little best buddy. We walk around during the day. She loves to ride around in this pack. I've got this little pack that sits on my chest, and she's facing me and she just loves that. She'll ride around all day.

Some days, after a long run, my legs are tired and I'm like, "I don't know if I can be on my feet for another three hours carrying this kid around." But she loves it, and she'll fall asleep. And she'll look around, look outside at the squirrels and birds and whatever else.

It's like I've got this new little best friend at home now. And quite honestly, just really enjoying it.

And I think probably the biggest surprise in all this has just been how smoothly everything has gone. Again, me being kind of the pessimist, where I see so many things that go wrong in pregnancy just throughout my medical career, and just being aware of those things. And so I think just every day I'm so grateful that everything has gone as well as it has, and everything continues to go well, and just really enjoying the time I have with her.

Scot: You know what? As you were talking and as we're having this conversation, Troy, it just dawned on me talking about the new baby and going into depth about details about the new baby is something that we tend to think that women do, right? That's my perception.

Mitch: Yeah.

Scot: But then as you're talking about this, and I'm sitting here and I'm listening, I'm like, "I don't know if guys talk about . . ." Do you get asked by other guys about how it's going, and are they expecting an in-depth update? Are they just expecting, "Eh, it's great"? What's your experience with that?

Troy: Yeah, I think it is definitely less of a guy thing. I have had one friend in particular who has seemed genuinely interested, who has texted me. And we really haven't talked. It's been more just text. But he's always like, "Oh, send me pictures." I don't know if he's just being nice. I think most guys it's kind of like, "Hey, how are things going?" And you're like, "Oh, things are good. She's great." But he has seemed a little more interested.

But I think it is not a conversation I would say I've had a lot beyond having the same sort of conversation with my parents or siblings. Kind of telling them about things. And even then, when I say siblings, I'm talking about my sisters.

So, yeah, I don't know that guys have that sort of conversation a lot, but we'll see.

Scot: Yeah. I want to jump in and ask, this friend of yours that has shown some interest, does that make you feel different? Do you like that? Do you like talking about her? I guess what I'm trying to get at here is maybe we should do this more often for our friends that have become new dads, because they would enjoy talking about it. It would make them happy.

Troy: I think it would make them happy. But I also kind of feel like I don't want to be the guy who is always saying everything about his cute little girl and showing everyone pictures because I'm kind of like, "Do they really care? Am I over-sharing? Is this too much? Do they really want to know all this?" So there is that sort of guy thing in me too, where it's kind of like, "Do they really want to hear me say all this stuff?"

Scot: If the shoe was on another foot, if it was not you with the new baby, but a friend of yours that you would consider a close friend, would you want to hear about it?

Troy: That's a good question. Probably at this point I would a lot more than I would have a year ago. I think as you're going through it, and you're having those experiences, and then others share that with you . . .

I think six months down the road, if I have a friend who has a new baby and they're sharing their experiences with me, I think then there's a certain amount of nostalgia and reminiscing that you would experience as you hear their experiences.

But let's say a year ago, I don't know that I would've been that interested. And that's just simple reality, just because it wasn't really part of my life. I didn't really have a lot to relate to there.

So that's kind of where I'm sometimes hesitant to say too much and feel like I'm over-sharing, or being that kind of irritating person who's showing them 100 pictures of my new baby and they just don't care.

Scot: I mean, I am actually genuinely interested. Even though we're doing this for a podcast episode, I'm genuinely interested in hearing about your experience and hearing about it in depth. Although there are other people in my life that I would not be, but I consider you a much closer friend.

So I think I want to flag this as a little takeaway. At least my observation is if you have really close friends and you're not having these discussions, maybe open up because it's really going to make that other person feel really good. They want to talk about it, I would imagine.

Troy: They do. Yeah, I think so.

Scot: You say you want to talk about it.

Troy: I do. I love talking about her. I really do.

Scot: Don't just peg this as this is something that women do. Men can do this too.

Troy: Yeah. There are so many cool experiences just on a daily basis, just little tiny things. Again, like I said, when she started to just focus on us more, and you could tell her eyesight was improving and focusing on our smile, just the laughs, and the little sound she makes. And talking to her, her looking at me and then her moving her mouth and making little noises like she's trying to talk too.

It's just silly little things like that, but it's just like, "Wow, this is so cool." Every day she entertains me. I'm not bored at all. Every moment I spend with her I find interesting and entertaining in some way.

Scot: So you said what's been surprising for you, and definitely it sounds like you've been blessed how well things have gone, because that doesn't necessarily happen in all cases. But what's been kind of challenging?

Mitch: Sure.

Scot: What do you deal with there?

Troy: Yeah, I think some of the challenges . . . Fortunately, I think I did have some preparation for them. I will say this, and I don't want to say this in a negative way at all, but leading up to this, I received more unsolicited advice than I have ever received at any point in my life.

I can only think of a couple cases where I might have asked for some advice, but the amount of advice I have received was astounding, as people found out we had a baby on the way. But that's a good thing. I think it helped me out a lot.

But I will say one of the things that has been a big adjustment is just expecting everything is going to take a whole lot longer. If we're getting ready to go out anywhere, you just expect it's going to take a lot longer to do that.

There were some unexpected medical issues very early on. Not major issues, but just some things that came up where it was, in that first week, multiple visits to the pediatrics clinic. The first couple days, we were just down there every day. It was a little stressful. No question about it.

Scot: Yeah, I didn't know about that.

Troy: Yeah. It wasn't big stuff. I mean, it was just stuff that comes up.

Scot: But at the time, it probably was, right?

Troy: It wasn't. I mean, that's the thing. Again, I knew of so many things that could possibly go wrong that I felt very grateful that that was all that we were dealing with. It wasn't big stuff. It was just like, "Okay, I've seen this in the ER. I've dealt with this. This is what we do." But it was an added level of just a little more complexity.

Scot: Yeah, it makes your life even more busy because you've got all these appointments and more traveling and stuff.

Troy: Yeah, exactly. So that's why it was a relief to just kind of get through that first week. And then at the end of the week, the pediatrician was like, "Hey, everything is good. We'll see you back here in a couple weeks." So I was like, "Great. We have two weeks where we don't have to come and see a doctor." So that was nice.

But yeah, I think in terms of just unexpected things that have come up, I think it helps having . . . Working in the medical field definitely helps to at least kind of know a lot of what you could deal with.

I will say, though, maybe one of the most unexpected things I have dealt with is how you truly as a medical professional lose all objectivity when you're talking about your own child. It's very different.

I may see a rash in the ER and be like, "Oh, that's what it is. No big deal." I see a rash on her, I'm like, "Oh, wow. It could be this, this, this, this, and this, and I'm really concerned." I'm a little different because I'm overthinking it.

But I will say, I think every parent runs that risk of turning to Dr. Google. You Google stuff and you see every awful thing that it could possibly be. And that's kind of where my mind has gone at times, like, "Oh, it could be this, this, this."

Yeah, I think we all face those anxieties as this little person who we just are so involved in, and care so much about, and don't want to mess things up on, that we might overthink certain things. So I think that happens to everyone, regardless of whether you're in the medical profession or not.

Mitch: So one of the things that I'm finding really interesting hearing about this kind of dialogue is being someone who has not really thought about kids much. When I was younger, there were some medical things going on. I was told I might not be able to have them, etc. If you were to have talked to me a couple years ago about any of this, I probably would not have been interested. I just would've been like, "Uh-huh. Babies."

Scot: Even with Troy?

Mitch: Even with Troy. I would've . . .

Troy: No offense, Mitch. I would've felt the same way.

Mitch: I would've been appreciative of his excitement. But me, myself, I'd be like, "Cool. Let's see what else we can talk about."

But in the last few years . . . We made the joke about nieces and nephews, and I have some, and I've interacted with them. I was the youngest of my family. I didn't have babies to hold, and there was no real child interaction until just recently in my life. And there's kind of an excitement about it, right? They're new. They're trying new things out.

And so it's so exciting to hear Troy, someone I've worked with, someone that I care about, my friend, having these things for his own baby, and his own experience. So it's different and I appreciate it.

Troy: Well, thanks, Mitch. I will say that, too, in terms of what other people have said . . . and I've heard it for forever. Everyone has always said, "When you have kids, it completely changes your life." I never heard anyone say it changes your life for the better. They always just said it changes your life. I feel like my life is a lot better. I love it.

Scot: Oh, that's awesome.

Troy: This has been good. I will say this has been great. It has absolutely been a huge change.

And it's so funny because that weekend she was born . . . She wasn't due for another week. We had planned out at least five different activities we were going to do that weekend. We were going to go to the symphony. There was a Gorillaz concert that Monday. We were going to go to that. We didn't buy any tickets. We were just like, "We're going to wait until an hour before." So obviously we canceled all . . . we didn't do any of those things.

We haven't gone to any concerts, no shows, nothing like that since then. It completely changes your life. There's no question. But those are minor things.

Scot: The trade-off is worth it.

Troy: It's well worth it. I'm absolutely enjoying it.

Scot: All right. Well, let's jump to the Core Four check-in, because fatherhood does change a lot of things, right? Your life is flipped, turned upside down. And sometimes it can be hard to maintain some of those things, and a lot of stuff changes. So, Troy, how are you doing with the Core Four? Let's go ahead and start with eating. Has the eating changed at all?

Troy: No, it hasn't, and I feel fortunate there. The one big change I will say early on is that I wasn't eating as much. And it's funny, I actually lost a few pounds in the first month. I think I just wasn't eating as much. Just busy. And then with kind of sleep patterns being off, for me personally, I wasn't eating at night.

So in terms of the time-restricted eating, intermittent fasting, whatever you want to call it, usually I'm doing 12 hours. So then I was actually having nights where I was going 15, 16 hours.

Scot: Without eating? Okay.

Troy: Without eating. So I think that may have been part of it. But it's been good. I have tried to focus on that, on making sure I'm not eating a lot of sweets, or stress eating, or snacking in the middle of the night if I'm up, things like that.

Scot: So you have had to make a conscientious kind of effort?

Troy: Oh, for sure. Yeah, there's no question. And I knew that was potentially going to be an issue with snacking in the middle of the night if I'm up with her, or, like I said, kind of stress eating, turning more to sweets, that kind of stuff. So I have tried to make a conscious effort to say, "Stick with what you're doing." And it's been going well, so that's good.

Scot: How about activity? I think I already know the answer to this. You've been such a dedicated runner, and you've had such a running habit that I'd imagine that it's been pretty easy. Or no?

Troy: I would not say easy, but fortunately, it has been consistent. And I'm still fortunately . . . Again, this had to be a conscious effort, and I feel like we're in a good spot now where I feel like I'm good with keeping going with this. But I really wanted to say, "I'm going to keep doing this and I don't want this to be something that I just give up."

I think it was John Smith . . . He said a couple things that stuck with me. Number one, he said, "With every child, pick one of your hobbies and forget about it. You're going to lose it." So I was like, "I don't want it to be running."

But then he also said . . . He offered to go to Buffalo Wild Wings with me or something. And he said, "You just need to do stuff just so you feel like yourself."

And so kind of tying those two things together, I just thought, "I want to keep running," because when I run, that's how I really feel like myself. I just love that time. I enjoy it. I'm out there with my dog. And so I've been able to keep that going and be consistent.

It's been something with Laura where it's like, "Hey . . ." We both say we want to support each other to do these things we enjoy. She loves going to classes, like exercise classes, fitness classes, so I'm here to help her do that. She helps me to make sure I have the time that I'm going out going running.

Scot: That's awesome.

Troy: So that's been a conscious thing to make sure we're doing that. That's been good.

Scot: Yeah, communicating with your spouse and just planning out how that is going to be possible.

Troy: Yeah, exactly. It is so much more complex when you've got a little one at home, and you're trying to balance childcare and all that. It's a whole lot different than when you're just kind of doing your thing and like, "Hey, maybe I'll go running at 6 this morning. Eh, maybe I'll go running at 7. Maybe 8." It's much different when you're making sure you . . .

So, anyway, so it's just been a matter of organization, and making sure we're communicating, and sticking with what we like to do.

Scot: It takes more work, man.

Troy: Yeah, it does.

Scot: Not only are you bringing more work home with that kid, but it just takes more work doing the things you did before the kid. How about your emotional health? How's that doing?

Troy: It's been good. There certainly has been an element of anxiety. There's no question about it. Anxiety of making sure I'm not doing anything that would ever put her in harm's way, doing anything stupid, anything that . . . I don't know. You just read so much, like, "Put the baby back to sleep. They have to lie on their back. They can't lie on their stomach. Nothing in there that could suffocate them." I can't have any blankets in there, no toys. Stuff like that. I don't want to do anything like that, and I want to know everything I need to do to make sure there's nothing that could potentially harm her.

And these are just little tiny things. I'm not talking about dropping the baby. I'm talking about making sure there's not a blanket that she could somehow bunch up in her face and suffocate. So there's definitely that element of anxiety, and I think every parent experiences that.

So, yeah, from an emotional health standpoint, I think a little more anxiety. But at the same time, I think there have been so many positive things from an emotional health standpoint too. Just the reward and joy in being able to interact with her.

You asked about running and fitness. I think this kind of thing brings so much more meaning to just health and diet and all those things, just because I want to be a healthy dad for her. I want to be healthy. I want to be here for her in the long-term. I want to stay healthy. It's not just about me running marathons or trying to qualify. I want to keep running because I want to stay healthy.

A lot of things we talked about on the podcast have had a lot more meaning as I've thought about those in terms of just healthy lifestyle, and being healthy, and doing that for her too.

Scot: So there's a lot of extra overhead you have to deal with. If you think of the mind . . . And this is just an analogy, right? It's flawed like all analogies. But if you think of the mind as a computer, everything you have to keep track of is just another processing unit, right? You've added so much more, all the things you talk about that you're just trying to pay attention to make sure that your child is safe. So that kind of fills the cup.

Are you doing anything additional to help with your mental health or help bring a little bit of relaxation from that kind of anxiety or that stress?

Troy: I've been watching a ton of sports.

Scot: That's what you do, huh?

Troy: Watch so many sports. And it's been a great time to have a baby. The month of October and November, it's just like sports heaven. There was the World Series. NBA starts up. College football and NFL are in full swing. That's kind of my release in a lot of ways, watching sports. It's distracting.

Scot: It helps turn your brain off for a little bit.

Troy: Yeah, it turns the brain off. Yeah. And it's fun too, because it's time we're kind spending together. I'm carrying her around, have the TV on, walking around with her with the little pack on, and she really enjoys that. And so, yeah, that's probably been my thing.

But you're right, I think you do need that sort of release where you just be . . . And not to go down on the dark side, but you have to be aware that some people, it just becomes so overwhelming. And the sad part is, again, as a healthcare practitioner, I've seen the cases where it's become completely overwhelming and you see the shaken babies and you see those who have been abused, and it is just absolutely horrible. And you just ask what led to that? How did people get to that point? I don't know all the dynamics there.

And then there's postpartum depression. We've talked about it in men, as well as in women. So that's something. And I worried about that going into this. I wondered, "Is Laura going to experience this? Am I going to experience this?" I've had many patients in the ER, women in particular, who have experienced postpartum depression.

So, again, I think you do have to have that release. You do have to have those other things where it's a distraction. And we've tried to have other activities, like planning activities every week with her where we're going out on walks. We're planning this week to go do this little drive-through Christmas light thing where you drive through and see Christmas lights. Just little things like that that you can look forward to, activities you can do together.

And as I'm saying this, I kind of feel like a jerk. I'm sounding like I know what I'm doing. I have absolutely no idea what I'm doing. Let me just say that up front.

Scot: Fair enough.

Troy: I have no idea what I'm doing. We're just trying to figure this out. But this seems to be working. And again, two months into it, so far, so good.

Scot: Yeah. And I think the important message is I think sometimes people feel guilty if they're not 100% with the new child all the time. But you still do have to take time for yourself, whether that's something you enjoy doing, or just even some downtime where you can just turn the brain off for a little bit.

And if you're having struggles with that, that's an important thing to talk to a professional about and get some tools to help work through that.

Troy: That's it. And I've had to tell myself that a few times. I've had to just say to myself, "If I'm not in a good place emotionally, I cannot be emotionally available to help her out." I've got to be in a good place. Laura needs to be in a good place. I think every parent needs that.

Yeah, you've got to be able to . . . whatever that means. Like you said, if you need professional help, if you're just turning to family members, whatever, friends, to get some help, being able to . . .

Scot: No shame in it.

Troy: Yeah, no shame at all. You've got to be the best parent you can, and that's how you do it. You've got to be in a good place emotionally.

Scot: All right. Core Four check-in, the last one. I think I know what the answer to this one is going to be. That's why I saved it until last. Sleep.

Troy: Sleep. Again, this whole process has been so pleasantly surprising. I dreaded the sleep piece of this just because I've struggled so much with sleep. I really just thought, "This is going to be awful. We're not going to sleep."

So what we did very early on in the first couple days is we decided we're going to split up the night shift. So Laura took the 9:30 p.m. to 3:30 a.m. shift, and I took the 3:30 a.m. to 9:30 a.m. shift. And I set my alarm. Every night at 3:30, I got up, took over for her. I was then able to bottle-feed her. Laura had dedicated sleep time. At that point, she was feeding like every hour or two. She wanted to eat, and she needed to eat. She's growing a ton. So that's how we did it.

We did that for six weeks. And then at that point, she got to a point where she's sleeping more consistently and much longer stretches. So we haven't done that since then.

And Laura . . . thank you, Laura . . . has been the one who gets up with her at night now, which some nights it may be once or twice, fortunately.

But it was interesting doing that regular sleep schedule. So I was falling asleep at like 9:30, sometimes 9:00 before Laura's shift started. Doing that consistently, it actually worked out pretty well.

And I thought a lot about what Kelly Barron talked about, about sleep hunger. If I've ever had trouble falling asleep before, I now know if I get up every morning at 3:30, I will not have trouble falling asleep because I had no trouble falling asleep.

So it actually worked out pretty well, where just having that regular sleep schedule . . . It was kind of nice in a way. It was always tough to get up that early, but . . .

Scot: But it's consistent, which is . . .

Troy: It's consistent.

Scot: . . . not a thing you've ever really had before.

Troy: Yeah. I mean, in stretches I . . .

Scot: You're taking the male paternity.

Troy: Yeah, exactly.

Scot: Do you get crap for that from the other guys?

Troy: I sure do.

Scot: Do you?

Troy: Sometimes it's very subtle, like, "Wow, they didn't have that when I had my baby."

Scot: "Well, yeah, how lucky am I?"

Troy: I'm like, "I'm so glad I have it." So I'm very fortunate. Yeah, I have been on paternity leave. That's something the university offers, and I am so grateful for that. This would've been much different trying to do crazy shifts along with this for the last two months.

Scot: And it's something that not everybody has, so it's just one of those great things.

Troy: I know. I mean, that being said, I think most people, at least you can . . . Yeah, you take FMLA time, but . . .

Scot: It's whether you get paid.

Troy: I mean, I get paid. Yeah. For me, it's like eight weeks. Well, it's really six weeks paid, and then two weeks of just leave. That's technically how it works out.

Scot: You highly recommend it if it's available to people and they can make it work.

Troy: I will say that. I will tell anyone if you have that option, take it with no shame whatsoever. Do not feel ashamed. Do not feel you have an obligation as a man, because you're a man, to say, "Well, I'm not going to take it because I'm a man. I'm going to keep showing up at work. I'm not going to take paternity leave." Absolutely take it.

And I think it's a number of reasons. Number one, I feel like it's really helped me to be available to kind of do that shift schedule and help Laura out. It's been great for just being there with Addie, with my baby, to bond with her.

But then also, we've kind of been a little bit isolated. We're not really going out. And this is something our pediatrician told us, like, "Keep your circle tight. Don't be going out and doing a lot of things out in public. There's a lot of flu. There's a lot of RSV. There's COVID."

So it's been, I think, a good thing for her health too, where her immune system is very susceptible, where we've just got kind of our tight little circle here and we're not out in public a lot.

I think, again, don't be ashamed to take that time off for a number of reasons.

Scot: All right. As we wrap up this episode, what would you like to learn from our experts? Do you have any experts you'd like to have on the show to talk about dad issues?

Troy: We need pediatricians on here. I think every episode we have going forward should be pediatricians. What do I expect three months, four months? I know that's not practical.

I would love to have Kirtly on here more. I think she's so insightful. I thought so much back to what she talked about with pregnancy, and what to expect, and how to be emotionally available. And I think that's a really important thing going forward. How do you continue to do that as a husband and a parent?

Beyond that, I think diet and exercise are always going to be a challenge, because there are going to be different challenges at every phase of her life in terms of just her needs and the time investment. So I think anything we can continue to talk about there. It's just a great reminder and motivation to keep focusing on those things.

Scot: Yeah, reminder to keep focusing on maybe ways to make it simpler, or easier, or less time consuming, which isn't always possible. I mean, you can only shave it down so far. But those are good insights.

Troy: Yeah.

Scot: Well, Troy, congratulations.

Mitch: Yeah.

Troy: Yeah, thank you.

Scot: I'm so excited and happy for you, and every time your wife posts pictures on Facebook, I love it.

Troy: So many pictures. So many.

Scot: That's all right. It's a well-documented growing up she'll have.

Troy: There's no question about that. Yeah, no doubt.

Scot: All right. Well, Troy, thanks for sharing your insights about being a new dad. I hope that that is helpful to you if you're a new dad, and maybe you can take one of the things Troy talked about and apply that when you are expecting your child, whether that's, "Listen, I've got to make a conscientious effort to make sure that I still exercise, or that I find something that I can do that gives me a little break with my brain for a few minutes a day."

What were some of the other things you talked about? Don't have those stress foods in the house if you think you're going to eat them. But on the other hand, if you need some stress food sometimes, then go for it.

Troy: Yeah, go get those Oreos.

Scot: Everything is just kind of in the middle, in balance and moderation.

Troy, congratulations on being a new dad. Thanks for sharing your experience, and thanks for caring about men's health.

Troy: Thank you, and thanks for talking to me about it. Like you said, it's fun to talk about it. And this is the most I have talked about it since she was born and it's really fun to talk about it. So I appreciate you listening to me and letting me chat about it.
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Interviewer: Are you concerned that your teen might be suffering from depression? Now, sometimes it can be difficult to tell the difference between moodiness and actual depression, and that moodiness can be common in a lot of teens.

But psychologist Dr. Thomas Conover says you should look at how your children are doing in what he refers to as key life areas. That's school, extracurricular activities, social, and family life.

Dr. Conover, let's just start with school. Why is school performance one of the clues that you use when evaluating children for depression?

Dr. Conover: For teens, school is their primary area of function. It's, in my mind, equivalent to holding down a job or a career for an adult, right? And so if an adult is still functioning in their primary vocation, then that's a good sign. Same way for a teenager. If he or she is still doing well in school and not seeing a decrement there, then whatever is going on with the teen, you've got some reassurance that things haven't gone completely south.

Interviewer: What about extracurricular activities? Some kids just aren't into school, or don't necessarily perform well in school.

Dr. Conover: Well, I look for their performance in school with comparison to earlier performance too. So if you have a kid who was somewhat of an indifferent student and just wasn't that academically inclined throughout their school life, kind of a solid B/C student, then that's what I would be looking for the child to be doing going forward. So I'm not concerned if there's sort of indifferent performance when that's been the norm.

It's really looking at, "Has that gone downhill?" Do you have a child who normally got straight As and is now getting Bs and Cs, or a child who normally gets Bs and Cs who is now failing or having incompletes? That would be more concerning in terms of school performance.

And for those youths . . . let's say you have a child who's an average student and maintaining that performance, but who is an avid athlete, plays a sport year-round, and is withdrawing from that. That could be a concern as well. So looking at function in the academic realm is important, but there are other areas of function too, right?

So other activities are very important to look at. Social function. A normally developing or typically developing teen is a very social creature. It's a time of life where you're learning how to be independent, and you're transitioning in typical development from being reliant on your family as a primary source of your activities and values to your peer group, which in my mind and experience serves as somewhat of a transition to being fully independent. Having your own ideas about things, your own values, your own priorities for your activities.

So, in that vein, your typically developing 15-year-old is going to really want to be out there and socializing with peers. A lot of times, nowadays, that does take place over cellphones, social media, and the like. And so it's important to take that into account, that just because a teen isn't going out all the time doesn't mean that they're not socially engaged.

But a parent can reasonably expect that their teen is going to be interested in what's going on out there with their peers. And if they're more withdrawn or less interested in that than they used to be, that's a concern.

Then there's also family function, and it is normal and expectable to have a teen be less interested or less enthusiastic about certain family activities than he or she used to be. That is normal and expectable.

Then I would go back to the idea of, "Well, just how pervasive and intense is it?" Do you have a teen who says, "I don't want to go to family dinner at grandma's this Sunday. My friends are going out. I want to meet up with them," but who ultimately you can cajole and negotiate and get the teen to do it? Or do you have a teen who has a big blowup over that and ends up leaving the house and you don't know where they went? I'm giving fairly stark examples, but the gray area in between can be evaluated.

I haven't mentioned the threat of self-harm, or aggression, or worse, suicide. That would be an obvious red flag. If inquiry into a teen's mood or a parent making a request or demand of the teen leads to any sort of threats or acts of self-harm or aggression, then that's something that a parent would want to seek help for urgently.

Dr. Chan: Interested in hearing about taking a gap year, managing your wellness, and learning how to attend med school virtually? On this episode of "Talking U and Med Student Life," hear what first-year med student, Lily, has to say about what brought her to The U and how she is navigating med school practically virtually.

Welcome to another edition of "Talking U and Med Student Life." I have a fantastic guest today, first-year medical student, Lily. Hello, Lily. How are you doing?

Lily: Good. How are you?

Dr. Chan: I am hanging in there. We're in the middle of a pandemic. What an amazing, unfortunate, unprecedented challenging time we're living in. How is your family? How are your loved ones doing?

Lily: Yeah, definitely. Well, first, thank you so much for having me on your podcast. I am so honored. But yeah, it's definitely not the way I expected to see medical school start, especially online. I was super excited for all the hands-on experiences we would have, so this has been quite an adjustment.

But everything has been good so far. My family is actually in New York right now. So I'm just transitioning on my own here. But they're all doing good. They're just quarantining and trying to be safe.

Dr. Chan: So I want to start, before we talk about . . . because I'm just fascinated what does medical education look like in the era of COVID. I want to start back at the beginning, Lily. So, when did you first know you were going to be a doctor? When did that first idea come to you?

Lily: Oh, gosh. Well, at first, I actually wanted to go into pharmacy because when I was little, my grandpa was a pharmacist. And he was the wise owl of our family. He didn't speak very often. But when he did, everyone listened. And I come from a really, really large family. I have over 70 cousins and over a dozen aunts and uncles. So that's kind of a big room to be able to quiet when you talk.

And my mom actually . . . so my family is from Afghanistan, and my mom was a pharmacist in Afghanistan as well. So that was just always a career I really wanted to go into. And as I started progressing through high school, I was doing more shadowings in hospitals, and I started to notice how passionate I was about working with actual patients and being able to have conversations with them and check in on them and have more longitudinal relationships where you get to build rapport and trust with them.

And in my experiences, I wasn't really getting enough exposure to patients. I was definitely learning a lot about the medicine side of things, but I realized that I wanted to focus a lot more on patients. And that's when I started to look more into MD perspectives, which was very daunting because I am a first-generation college student, and I am the first female in my family to be attending medical school. So to fathom even graduating from a university and to now be in higher education . . .

When filling out forms for school . . . my parents in America are kind of registered as having a GED or high school diploma. It's just been really mind-blowing to see that transition through just our generations.

But yeah, so as I started college, that's when I started kind of focusing a bit more on medicine and being involved in health science programs that really navigated the ethics side of things so that I could kind of understand the humanistic portions of medicine a lot more. And that just kind of fueled me more and more, and I continue to pursue medicine and here we are.

Dr. Chan: Was it hard coming from a family of pharmacists to pivot to medicine, or are they pretty supportive?

Lily: They're super supportive. So it's kind of interesting because my mom always wanted me to kind of study something and not have a super stressful job. She just wanted me to be able to settle down and have a family and be comfortable. And so just knowing that I want to pursue medicine and be in school for so long, and be stressed out all the time, and studying all the time, she was really nervous for me and kind of wanted me to maybe focus on something else. But my dad was really persistent about me wanting to pursue whatever I wanted to.

That's kind of the American dream, is being able to start from anywhere and get to where you are. And my parents have struggled a lot being refugees here in America, and so I think, for them, it's really like a prideful thing to see that their children have been able to accomplish so much.

So I definitely think he was kind of hesitant at first because we also just don't understand, like, the process of Western institutions and going into medicine. But as I've kind of pursued it, they've become more and more encouraging and supportive.

Dr. Chan: How was that with your parents being refugees growing up? I mean, did they talk about it? How is that part of you? How has that helped you in your journey to become a doctor?

Lily: Oh, yeah, definitely. My parents are very proud of their identity. We're all from Afghanistan, and my parents moved here a little over 30 years ago. And it's really interesting to kind of hear about their experiences and realize how privileged I am from all the hardships that my parents have endured for me to be able to be where I am today.

My dad always tells a story that kind of sticks in my head when he first moved to America. He learned English in three months out of the stress of needing to be able to maintain a job. He can't lose his job, so he needs to understand the language. So he learned a whole new language in such a short period of time in order to maintain a job. And he tells stories about how when he first moved to Utah, he was in a tiny one-bedroom apartment. And he used a hot plate as a heater for his apartment, but also to cook on, and that's just mind-blowing to me. That's not even one of the large hardships that he's faced.

But yeah, so I was definitely raised to be very prideful of who I am and where I come from. And so I've definitely watched my parents work insane hours and incredibly hard to make sure that we feel like we have everything that we need in order to go through college.

But of course, that was a bit far-fetched when it came to medicine just because my parents never actually went through Western education. And so, when it came to FAFSA, or applications to college, or the MCAT, or the ACT, all of those things were definitely very foreign to my family, and I just had to learn to navigate that kind of on my own with them being like, "Good luck."

Dr. Chan: How did your family end up in Utah? The Afghanistan-Utah connection, what brought them here? I'm just curious to learn more about that.

Lily: So my grandma was actually sponsored by her oldest son to be in Utah, and my dad was actually living in Oakland, California, working for the airlines. And so, when my grandma was initially here, a lot of my dad's family was here.

When my parents got married, they were alone in Oakland, California. And my mom did not speak the language. She didn't have a driver's license, no family, nothing. I'm sure it was terrifying. And then my dad was working for the airlines, so she would be home alone, basically, for the majority of the weeks and stuff. And so my grandma was really trying to push for them to move here to be closer to family so that my mom would have more of a support system. And so they decided to pack up from California and move here, and we've just stayed here ever since.

Dr. Chan: That's wonderful, Lily. And then you mentioned being a first-generation college student and navigating the Western education system. How did you do that? I mean, did you have mentors, or what kind of resources did you have? What did that look like when you started looking at colleges?

Lily: So it was actually interesting. I went to school here, and then I also ended up pursuing my undergraduate at the University of Utah. So I've been a through and through Utahn. But it was hard. In high school, I didn't understand anything about scholarships or FAFSA or how to apply for things. And I really wanted to pursue being able to attend college, but I was very nervous about the financial burden and the ability to pay for all of those things and pursue a degree. And so it was a lot of learning from my peers I think in undergrad.

As I was kind of looking at out-of-state colleges, I didn't have the best experiences at my high school with having support to pursue those opportunities. I definitely had advisors telling me, "It's really expensive to go out of state," or, "Some of the schools you're looking at are really expensive," and, "Even if you were to get in, you might not be able to afford to stay." And so it was kind of discouraging going through that route.

And so I ended up asking some of my friends who were also applying to college and whose parents knew a bit better how to navigate the system what they were doing. And that's how I started learning about different application systems.

And my cousin, who was in college, was able to help edit some of my personal statements and stuff. But it was very trial by error and just kind of doing it but not knowing what I was doing. But I was fortunate enough to get into the University of Utah, and from there, I was able to find a lot of mentors, especially BIPOC mentors, who understood my struggles and understood how difficult it was to navigate the system kind of blindly, because you really don't know and there's no one that was kind of ahead of you to explain it to you. My brother went to the University of Utah, but he himself also struggled. And so it was really nice to be able to find mentors.

I was involved with student government and also doing research and a part of the health sciences program at The U, and all of those leaders were able to kind of steer me and explain to me things to focus on or to put my time and energy into. And they were great resources for me.

Dr. Chan: Lily, what did you do for student government?

Lily: So I actually did a couple of things. I was involved in student government for four years, and I sat on assembly, representing my college for one year during bills. And then I also was the director of diversity for two years, doing programs and conferences, educational seminars and trainings. And then I also was the chief of staff my senior year, so just kind of doing more of the administrative duties.

Dr. Chan: That's so cool. It sounds like it grew year after year too. The entire time, were you still medicine all the way, or did you think about political science and law school, or anything like that?

Lily: Yeah, what was really interesting was, in my undergrad, I probably didn't even seem like a pre-med student because I surrounded myself with people outside of medicine. And so I was involved in student government where those were kind of the predominant majors like you were explaining. And then I also was an anthropology major. And so a lot of people in that field were also not pre-med, and they were interested in research, or they were interested in going into Ph.D. programs.

And I honestly really enjoyed that because I didn't feel like I was always talking about medicine in my classes, or there wasn't this constant kind of competitive atmosphere with being pre-med and wanting to achieve great things.

But it never really steered me in a different direction. If anything, I think I had a different perspective in those spaces, where I was able to kind of relate what I was learning in student affairs to how that applies to healthcare and patient care, and then also bringing in my very different experiences because I wasn't a political science major in that environment.

Dr. Chan: And it sounds like heavy academic load, you're involved in student government, and yet you still have time to volunteer. What kind of community service activities were you doing during this time?

Lily: Honestly, looking back, I'm amazed that I was able to do so many things. But I think that that's the time in your life where it's really important to push yourself to do all these things.

For me, honestly, as I was pursuing extracurriculars to do, I obviously was referencing what schools wanted you to kind of hit in regards to subjects and categories. But I didn't want to pursue any type of extracurricular activity that was just checking a box because I didn't think I would enjoy it. I was putting in so much time every week to be involved. And so I wanted to make sure that whatever I was doing was going to be something that I was genuinely passionate about and something that I would be doing outside of a pre-med check.

That being said, I kind of tie back into my identity and what I was passionate about. And so I tutored refugee women at the Women of the World Center. And that was an amazing experience. I did that for about two years. I was able to help them just navigate basic English skills to be able to describe symptoms when they go talk to a doctor, or how to find groceries in the grocery store, or navigating public transportation, and really just the essentials in order to survive in Salt Lake or wherever they're living so that they're able to do their daily activities.

And that was really nice because you build friendships with them, and they end up feeling like they're a parental figure to you. A lot of them would call me their daughter and stuff, and so when I left, it was really sad. But I think that doing those kinds of volunteer trips were really enjoyable.

But outside of that, I also was in a student organization called United in Service for Humanity where we fundraised for the children of conflict in Syria. And we would do ice skating events downtown to raise money for these foundations. And we would also participate in a Day of Dignity downtown, where we would have health screenings, and we'd collaborate with the School of Dentistry for dental screenings, and then have hygiene kits just for people experiencing homelessness, since that is a pretty large population in the downtown area.

Dr. Chan: So, Lily, everything I'm hearing . . . and again, you're on the podcast so people know you got into med school, obviously. But it sounds like you have all these activities, all these experiences, you have these wonderful defining moments that are making you you. Leading up to the decision to apply to med school, though, I do know that you took a gap year. So can you just talk about that? What kind of went into your decision for that? Because it sounds like you could have applied right after you graduated or during your last year, but you decided to wait. So can you just talk about that a little bit?

Lily: Yeah. It's kind of interesting. I think people have either really strong feelings about a gap year or really strong feelings against a gap year. I actually decided to take a gap year because I was shadowing a lot of physicians during my last two years out of college. And I'd always ask them these questions and a lot of them were telling me, "Take a gap year. Take a gap year because you're going to be studying, you're going to be in school, you're going to be doing this full-time for the next eight years of your life. And during your gap year is when you're able to really focus on things that you're passionate about and also kind of grasp that this is really what you want to go into."

And so I didn't want to just take a gap year and just kind of sit on the couch and do nothing and relax, even though that's well deserved for any students who are graduating, especially during COVID times. So that's totally a valid reason also, if you wanted to spend time with your family. But for me, I just wanted to make sure that medicine was something that I genuinely wanted to go into and that I was passionate about. And I also wanted to make sure that I was giving my body and mind a break to be able to be recharged for medical school.

So during my gap year, I ended up working in mental health at the University Neuropsychiatric Institute. That was an amazing experience that I honestly think contributed a lot to my ability to answer questions during interviews and experiences that I was able to pull from. I honestly think that that was one of the largest things that I was able to utilize during interviews. I just learned a lot during that experience.

But I also was able to just learn like adulting skills of being able to cook and pay bills and take care of life outside of college, which was really nice because now that I'm in medical school, you don't really have time to figure that out. You kind of have to just do it all at once.

Dr. Chan: Lily, I love how you worked at UNI for a year during your gap year. What kinds of responsibilities/jobs did you have at UNI?

Lily: So I worked in UNI as a psychiatric technician, and so my basic role was to make sure that patients are safe. I actually worked the night shift, so I was just making sure that they were safe throughout the night and making sure that they have whatever they need.

The specific unit that I work on actually works a lot with individuals experiencing homelessness, undocumented domestic violence, a lot of very vulnerable populations in Utah that I really hadn't had as much experience with as I would have wanted going into medical school. So I'm really grateful for that experience.

But since it is a unit where it's a free service, we really get anyone from any walk of life, whether it's college students or older parents or whoever it may be. And so my main priority was just to make sure that they were healthy and safe, that they felt comfortable, that they had whatever they needed.

My unit also had a social worker and a medical provider as well. And so I was able to really learn those interprofessional relationship skills as well during my time.

Dr. Chan: I'm sorry, Lily. Did I ever interact with you? Did you ever see me on call? Was I ever floating around? I feel bad because I wasn't like, "Oh, yeah, Lily." I can't remember seeing you there, so . . .

Lily: No. I don't think that we actually ever overlapped. My unit is kind of isolated from inpatient. We're more of a transitions unit.

Dr. Chan: Oh, I see. All right. Because when you said UNI, I'm like, "Oh, I'm there sometimes, a lot of time." Cool. All right. So you're wrapping up your gap year. You have your eyes towards medical school. What was your strategy applying to medical school? Did you cast a broad net? Did you put all your chips on Utah? How did you kind of approach this decision?

Lily: So I actually spent my gap year also studying for my MCAT. I wanted to really focus on that because standardized testing is very stressful. And so I kind of started that after I graduated. I was doing that and taking my exam.

And then from there, I made a list of the schools that I wanted to prioritize. Definitely the University of Utah was at the top of that list because I have family and friends. And growing up at this institution, I just was able to kind of understand the values of the school.

And so I really didn't cast a very large net I would say. I think it's important to be very intentional about the schools that I was applying to since it is a very expensive process and I didn't know how I was going to pay for all of those applications.

I actually didn't apply as vast as people may recommend sometimes. But I applied to 15 schools, and the ones that I focused on were ones that had a focus on inclusion, diversity, and social justice efforts at their universities. And also, I looked at institutions that would be closer to any extended family that I may have on the East Coast. I think it's really important to have a social support system while you're in medical school, so that was something that I prioritized.

And then I also kind of focused on what types of specialties that they had and what were the things that I was passionate about going into.

But then from there, even if I received interviews, I really prioritized, "Do I see myself being happy and being well there in that environment?" And there were some schools that I decided to not pursue interviews with because I didn't feel like they would be as prosperous to me as other schools that I was willing to interview at. So I think it's important to be kind of selective, but also not so selective that you minimize your ability to get in.

Dr. Chan: I totally get it. It's fascinating, again, because I've done this for a few years now, and just to hear your experience wending your way through the process, being very thoughtful and mindful of your values, and the direction you went ahead in your career, and just the research you have to do into this stuff.

I always tell people all med schools look the same, and we have accreditation standards we all have to meet, but, yeah, there are different priorities, different cultures, different programs that are kind of nestled and embedded within all the different med schools you look at, and to find one that resonates with you and mirrors your core values, I think, is extremely important.

Lily: Definitely. I was surprised also with how much research you ended up having to do. I had an entire spreadsheet color-coded of all of the pluses and minuses for institutions. And then from there, you kind of have to even go outside of the school and wonder, "What is the community like? What is the city like? Will I feel safe there?" and other things that you have to process as well.

Dr. Chan: And then, Lily, when did you get in? When did I call you?

Lily: It was, like, the second to last week of November.

Dr. Chan: So pretty early in the process. Did you ever waver? Did you ever think about going somewhere else, or did you feel pretty committed?

Lily: I felt very committed to the University of Utah. I did have some pending interviews before and afterwards, but once I got the call, it just kind of clicked and it felt right.

And I was really excited to go to The U. I feel like I was almost thinking of these other institutions as more of like, "If I don't get in, then this is where I could be happy at." But I was also wondering if I didn't get in, which I thought definitely was something that could have happened of maybe being waitlisted and applying again next year. Then that was kind of where my mindset was at. Would I want to pursue a different school, or would I want to wait on a waitlist and reapply next year?

So I think just as I was processing all that, I realized what school I definitely wanted to go to.

Dr. Chan: And I think when I talked to you on the phone, if I recall correctly, you were pretty shocked and just overwhelmed with joy. I remember it was really a good conversation.

Lily: Yes.

Dr. Chan: So I guess to kind of pivot to what's going on now, I'm curious, from your standpoint, you're coming to The U, you're an incoming medical student, and then COVID starts happening, and it gets worse and worse and worse. Before med school started, what did that feel like knowing that you're going to be a doctor, but you're not yet at med school, but we're just being consumed by this public health crisis? What was that like as an incoming student from the outside looking in?

Lily: I felt like it was a lot of . . . "hurry up and wait" is a phrase that I've heard a lot. And I definitely think that's how I felt. You're stuck inside, you're quarantining. It's the time where I would want to be able to be more involved and more engaged and see what things the School of Medicine is doing for outreach and participating in those things, especially before our course load gets busy and stuff.

But I just felt very out of the loop. It was difficult because a lot of my classmates and I wanted to get to know each other, but because of COVID, no one really wanted to meet in person and no one knew anyone yet. And so it was a lot of navigating kind of the unknown and a lot of just impatiently wanting to be involved, especially since I was still working at the time up at UNI.

We had medical providers who were talking about potentially going to New York and helping at their hospitals there. And for me, that's something that I resonate with so much, especially having family that's in New York and stuff, being able to kind of be at a crisis and help out as needed.

But kind of being stuck and knowing that I didn't really have the skills to help in that sort of way yet was kind of frustrating. But also, I was really, really excited to see how this would shift our curriculum and what we would be prioritizing in the upcoming years. And I've been really impressed with how much that's been integrated into our learning so far.

Dr. Chan: Lily, what does medical school look like for you? With the pandemic and everything going on, what does your typical day or week look like? I mean, how is that going?

Lily: Honestly, just learning off of off Zoom University, as we call it, I am even more impressed for everyone who was going to medical school in person. I really don't know how they had time to do everything they did because I already feel so incredibly busy, and yet I am not even leaving my home to commute anywhere. So just impressed by all the students that came before me.

But basically, I wake up pretty early in the morning, probably around 6:00 a.m. and I just take the dogs on a walk and start getting ready for the day. And then I'll just be reviewing material and studying until classes start. You attend classes in your sweats or whatever you're comfortable with. But we'll sit in class for a few hours. And then once classes are over, it's typically a reviewing of that day or reviewing for the next day.

And I feel pretty consistently it can get a little rundown if you just stay at your desk all day, and you stare out the window and see other people outside, but you're kind of inside just staring at a screen. So I've been trying to learn how to navigate Zoom fatigue and potentially sitting outside, or taking breaks and going into other rooms and just getting more sunlight in the day.

But it hasn't honestly been as hard as I was imagining it going into it because I've never really been an online learner before. A lot of my classes were always in person. But at the same time, I'm really grateful that we're able to have one day of classes in person so that I'm able to see my peers and my colleagues and also be engaged with anatomy in person. I think that's something that I was really excited about.

Dr. Chan: So it sounds like, as I know the schedule, Monday, Tuesday, Thursday, Friday are all Zoom. Correct?

Lily: Yes.

Dr. Chan: And then Wednesday is in person. So what's different about Wednesday? Is that your highlight of the week, and what kind of learning activities are you doing on Wednesday where you come to campus?

Lily: Definitely. Wednesday is definitely the highlight of the week. You're going through quizzes on Monday, or you're going through really dense material on Tuesday, and you feel like this is a really long, tough week, and then you get to Wednesday and you get to go on campus and feel like a medical student wearing your scrubs and with your badge and going through the hospital and going through the labs. It kind of rejuvenates you for the rest of the week, at least for me.

But yeah, I get to school, and we have anatomy labs in the morning, and we have our cohort there. We're masked up and wearing our goggles, but we're able to look at cadavers and talk about things and relate them all in person from what we've been talking about online. So that's really, really nice. I've always really enjoyed anatomy lab, so I'm grateful that we were able to do that.

And then from there, we go through Histology. It's kind of a hybrid version where we're not necessarily at the microscopes looking at slides, but we're able to sit with our same cohort and go through slides and talk about the activity in that manner.

And then from there, we go to Clinical Methods. So really, Wednesdays are like a full day of classes from 8:00 to 5:00. But they breeze by. They go so fast. And with Clinical Methods curriculum, we get to learn the process of actually being a doctor in regards to taking patient histories or vital signs or doing different types of examinations, and then correlating that to different diseases that you may see.

So it's really the process of learning all of the things that you actually see in clinic versus what you read about in your books. And it's been really enjoyable. I'm really grateful for all of the instructors that bring their experiences into the classroom to help us navigate that.

Dr. Chan: You kind of talked about earlier with COVID, with Zoom, it was initially difficult to kind of get to know your classmates, and build a culture, and get to know them. Is it still kind of a struggle, or is it good to have that one day a week in person? How is that going, just that connection with your classmates?

Lily: I think it's hard because a lot of us have immunocompromised people at home or maybe ourselves. And so it's definitely been difficult to pursue a lot of friendships outside of classes and whatnot. Also, just with COVID and quarantine in general, you want to make sure that you're following all of the state guidelines.

But it really has been nice to be able to see people in person, connecting faces to masked faces, I guess. It's nice to get to know the people, at least in my immediate groups, and build friendships from there.

One of the girls in my group, her name is Arielle, and we actually take our dogs to the dog parks on Fridays now since we met through these in-person labs. And it's just been nice to kind of get outside in a safe way.

But outside of that, I think that I definitely would love to get to know my classmates more. Hopefully, as the curriculum goes forward and as things change with COVID, that may happen at some point. But I think that our cohort does a good job of communicating online and then also studying together. So I feel like I'm getting to know some people. It would be nice to get to know more people as time goes on, though.

Dr. Chan: And going back, as we talked about earlier, Lily, your core values, what you're interested in with healthcare disparities in Utah, with cultural humility, have you been able to do activities during the first few months of med school? I guess just how does that look like now for you? Have you been able to do those types of activities to kind of go back to your core passions and values?

Lily: We do have a Friday class called Layers of Medicine that I really enjoy going to. My group there is the same group that I see on Wednesdays, and we're able to have conversations relating specifically to kind of the major issues that we see in society and those disparities that are observed in healthcare.

It's been really nice to have those conversations as well as having different ethics professors come speak to us throughout the weeks and really pinpoint some of these issues and have us dialogue on them.

So I do feel like I am, curriculum wise, getting exposure to those things. And I'm excited to see how that progresses as we move forward.

Outside of that, because of COVID, it's been kind of difficult to get involved with student groups and interest groups that are focused on those things, since they're not really meeting in person because of the large group sizes. But I have been able to meet some people who have been involved in those groups and find out more about what they're doing.

I also currently sit on an anti-racism working group with the School of Medicine administrative staff, and that's been really nice to meet with them every week and get to know my peers in other years and really discuss what the future of our culture here at The U looks like and how we want to be a more inclusive and equitable place.

Dr. Chan: Lily, I appreciate your insight as you've gone on this journey towards becoming a doctor during these incredibly challenging and unprecedented times. And you alluded to it with going to the park, but what do you do for wellness? What do you do for resiliency? What do you do to take a step back and make sure that your batteries are charged? What would you share with others out there listening?

Lily: It's really interesting because no one is going to tell you, "It's time for a break," or, "It's time to go take a bath," or, "It's time to go eat something." There's no one kind of hovering that's going to know your schedule the way you do and have those mindfulness checks on you.

And I really have struggled with that because that's something that I've had to learn to navigate as opposed to, "Class is done, and I've finished studying, and now my night has begun." It's really been a lot of learning, "Okay, now I need to cut it off," because you could always study and you could go on for hours and hours. And so that's something that I'm still learning how to navigate.

But I definitely think having a schedule has been very helpful. I will schedule in my breaks for the week and when I want to be done. After class on Friday, Friday night, that is the night that I'm free, that I'm able to spend time with the dogs and spend time seeing my friends, or even just talking to my parents on FaceTime, or just making time for things that kind of help you take a break from the workload.

I also think it's nice to just have small rewards to look forward to. Like, maybe you want to go on a hike, or maybe you want to go on a drive, or get ice cream on Saturday. Just small things to kind of look forward to throughout the week really help to energize you to get through your materials and you can enjoy those breaks.

But on the daily schedule, I think it's just good to schedule in those lunch breaks and breakfast breaks, and, "I'm going to go on a walk outside," or, "I could keep going, but it's 9:00 p.m. and that's my cutoff." Just having those kind of reminders are really helpful.

I definitely felt, "I don't have enough time for baths," but you definitely can schedule time for baths if you really want to. And so I think it's just kind of really managing that and having people around you that support you but also know when to say, "It's time for a break."

Dr. Chan: Lily, it sounds like you're doing really well given the circumstances of everything going on, being a first-year med student in the era of COVID.

I guess the last question before we wrap up, any advice for anyone that's listening out there who is thinking about going to medical school, or is considering it, or maybe just questioning their decision and trying to figure out what their path is? What would you say to them? What would be your advice?

Lily: Definitely. I would say don't be afraid to pursue great heights. I think that medical school sounds incredibly daunting and difficult, but it's not impossible. I'm here and there are so many other students that are here, and you can definitely get there as well.

Reach out to mentors, your peers, people who are in medical school. Gather bites from them. One of the biggest things that I've learned is people are always willing to help you in medical school. No one wants you to fail. No one wants you to do poorly. And I think that that's something that's really, really important.

And just be involved as much as you can, even with COVID. If you're able to do something online to be a part of the healthcare system, or to be doing something that kind of gives you more exposure to that, I think it's important to have that exposure to see if that's something that you're passionate about. But also recognize that there are so many different fields that you can go into and you don't need to have it all figured out by the time you step in the door. And it's okay to feel that way.

Dr. Chan: Lily, I'm just happy you're here. I'm happy that you're going to be taking care of my family and loved ones one day. And I'm excited to see . . . I'll have to have you come back on the pod, but I'm really curious to see if you become a psychiatrist. We'll have to talk a little bit more about that when you get a little bit closer to making a decision. But I appreciate your time and I just appreciate you. So thank you for being on the pod.

Lily: Thank you so much. And thank you so much for thinking of me. This was a wonderful experience.

Dr. Chan: How does being a medic in Afghanistan inspire one to become a doctor? Why is it important to start both the admissions process and relationship building early? What is medical school like as a non-traditional student? Today on "Talking Admissions and Med Student Life" I interview Carson, a fourth-year medical student here at 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: Well, another great medical student, a fourth-year medical student. Carson, how are you doing?

Carson: I'm doing great. It's nice and sunny outside, so it's a good day so far.

Dr. Chan: And just a little bit about yourself, a fourth-year?

Carson: Yep.

Dr. Chan: And excited for the match, which is very soon.

Carson: Excited, apprehensive.

Dr. Chan: We're not going to talk about that just yet.

Carson: Sure.

Dr. Chan: I kind of like to build this momentum, just like . . .

Carson: Got to keep them waiting.

Dr. Chan: All right. So let's jump back a few years.

Carson: Okay.

Dr. Chan: When did you decide to become a doctor? Where did that come from?

Carson: So to actually become a physician was . . . it's going to sound clichÈ, but I was actually in Afghanistan when I decided I wanted to be a doctor, working as a medic. Going through high school, like, I'd done phlebotomy classes and stuff like that, knowing that I wanted to do something in medicine. Worked as a sterile . . . I can't even remember what it's called now but cleaning surgical instruments in the [inaudible 00:01:23].

Dr. Chan: A scrub tech?

Carson: Well, no, I wasn't a scrub tech. But it was a sterile tech, because I was the one cleaning them, packaging them . . .

Dr. Chan: The autoclave?

Carson: Yeah, yeah, all that stuff. And then worked in a lab, and then got an EMT when I joined the National Guard here in Utah and started working as a combat medic while in uniform. Deployed to Iraq and worked as a line medic there, and, you know, I was really happy with doing that. And then, got deployed again to Afghanistan and we had a very . . . the base that I was on kept getting rocketed all the time, and sometimes it made it so that, you know, the physicians couldn't actually get to the hospital where casualties were coming in just because they were sheltering in place and stuff like that.

And there was one casualty, very, very specific casualty that it seemed like it took days for the providers to get there. And just me practicing my skills that I, you know, was comfortable doing and doing what I knew just wasn't enough, and it's like, "Okay, I have to be able to do more." And that kind of started me down the road. I started looking into, you know, what does it take to get into medical school? I ordered some MCAT study prep stuff and had it delivered out there. And yeah.

Dr. Chan: Does Amazon deliver to Afghanistan?

Carson: Amazon doesn't deliver to Afghanistan, which is really . . . well, at least they didn't then. This was back in 2010, I think. Yeah, 2010, exact. But I delivered it to my house. And then from there, it's easy to ship anything to an APO. But yeah, that's where it started.

Dr. Chan: But I'm thinking Carson, like, let's jump back even further, like what prompted you to join the military? And then how old were you, and did you come from a family of military or . . .

Carson: My grandfather retired from the Air Force. My stepfather was in the Air Force, medically retired out of there. Actually, I was kind of peer-pressured into it a little bit.

Dr. Chan: Oh, really? Okay, let's hear it.

Carson: I mean, not peer-pressured, but I had a couple of . . .

Dr. Chan: Those recruiters cornered you?

Carson: No, my friends cornered me, which was horrible. I shake my fist at them every time I think about them now, just kidding. No, they had joined the Utah National Guard as electricians to work on helicopters, and I was like, "Oh, that's really cool. Like, you guys are doing some really cool stuff, and I want to be cool," was part of it, I'm sure. And then I wasn't in school at the time when I joined. I was 23, and I had just barely moved back to Salt Lake City from Boise, Idaho. And I was just tired of working 80 hours a week, and I was like, "Well, I know I want to do something. I need an education. I've been putting it off for years." I'd had a four-year gap in my undergraduate studies, and I was like, "Well, I can't pay for school without this job. But I don't want to be in this job. I want to be in school. So what else can I do?" And that's when the National Guard money started weighing in, because hey, you know, you can get money for school and they'll help. So that was, I say, you know, the biggest reason to join the National Guard. But like I said, I'm sure my friends had some play in it.

Dr. Chan: Were you aware that you could be deployed?

Carson: Yeah, I was aware.

Dr. Chan: Okay.

Carson: I mean, this was 2007. So, I mean, we'd been at war for six years already and stuff along those lines, so I knew it was . . .

Dr. Chan: Possibility.

Carson: Possible. But at the same point in time, you know, I enlisted as a medic. The unit that I enlisted into down in Riverton, which is just south of here, their medical unit, they set up a hospital. So I didn't think it was going to be any frontline work or anything along those lines. Typically, the hospitals are a little bit more reserved from what I knew at the time and held back a little bit. So, like, yeah, I'll be fine, not a big deal.

Dr. Chan: How many times did you go over?

Carson: I went twice. In 2008 . . . well, years, 2008 I went to Iraq, and that was with a unit out of Washington State. And then in 2010, I went to Afghanistan with that actual unit I enlisted into here in Utah.

Dr. Chan: Which was better for you?

Carson: They were both great.

Dr. Chan: Okay.

Carson: So Iraq has . . .

Dr. Chan: Because sometimes, like, when I talk to vets, they say like, "Oh, this happened . . . Iraq . . . " Like there's a huge difference between the [inaudible 00:05:33].

Carson: Yeah, so I mean, some big things happen in Iraq. I mean, I call it the fun deployment, because I was part of a cavalry troop. So we were out on the roads driving around all the time, going from place to place. And I was working as a line medic, so . . .

Dr. Chan: What's a line medic?

Carson: So a line medic is someone who's forward with the people out doing the boots on the ground, that kind of work.

Dr. Chan: So a World War II example is they have the little cross on their helmet?

Carson: Sure.

Dr. Chan: Okay.

Carson: I mean, I really like "Band of Brothers," and I really like those red crosses on the helmets, but I would never wear a red cross on my helmet.

Dr. Chan: Okay.

Carson: But, yeah, out there with . . . you're forward with whoever it is.

Dr. Chan: Again, just to really simplify it, and I feel bad. Like, if someone gets hurt, do they really scream, "Medic"?

Carson: You'd be surprised.

Dr. Chan: Okay.

Carson: Yes.

Dr. Chan: All right. And whatever you're doing, you drop everything and run.

Carson: Medic or doc, something like that. Yeah, drop what you're doing and go running. That part's fairly accurate.

Dr. Chan: Fair, okay.

Carson: But yeah, I mean, Iraq was, you know, I call it the fun deployment. It really had the opportunity to build some really strong connections with some people I was with, because, you know, we were out running around, getting shot at, doing all sorts of fun stuff. Well, getting shot out wasn't fun, but you know what I mean?

Dr. Chan: Wasn't as fun.

Carson: It wasn't as fun. No, that wasn't as fun. It was a little scary the first time, and then about after the 30th, it's like, "Meh, there's armor on these vehicles, it's fine." And then I call Afghanistan the educational one.

Dr. Chan: Okay.

Carson: So I was still a medic. I was a more senior medic, and so I was kind of responsible for helping train some other medics and making sure their clinic runs smoothly. And since I had some more experience, I was allowed a little more leeway with what I could do, because there's a very, very well-known "see one, do one, teach one" mentality within military medicine. And if your providers are comfortable with you doing something, you know, check in with them, "Hey, I'm going to do this," and you get the sign off, go for it.

And I got to . . . at first, it was just working in the outpatient clinic, and then it was as a like supplemental staff to the trauma bay. So when more patients came in than they could handle, then I would sneak my way onto a bed and work there. And then I would see the individuals or casualties come in and go from the trauma bay to the operating room, and I would peek my little head around the corner and be like, "What's going on in there?" And then that turned into me weaseling my way into there, and then working as a circulator. And I got the excellent opportunity to first assist on a couple of cases, and it just kind of built. So it was very educational. And I think that's actually why I fell in love with surgery actually, which we'll probably talk about later. But yeah, super great exposure, super great experience.

Dr. Chan: And how much schooling had you finished during this time?

Carson: So I was about halfway through my undergraduate career.

Dr. Chan: Okay. And during your deployments, are there online classes available?

Carson: Oh, sure.

Dr. Chan: Because sometimes like, you know, I've had other vets come through, and there's that joint services transcript. So I get the sense there is some educational lessons that can be done even if you're in some foreign country. So tell me about that. Carson: So the joint services transcript from my understanding is basically a transcript of everything that you've learned or all of the classes or courses that could potentially translate into university credit.

Dr. Chan: Oh, I see. Okay.

Carson: So for myself, since I went and got an EMT-B and then continued that out with what we call whiskey training from the medic field, a bunch of those hours, actually none of those hours transferred over to this university, to the undergrad university here in Utah, but at other schools that could have transferred and counted for some general education electives. I think I got four hours for physical education that transferred over onto my transcript. But outside of that, like I tell my soldiers going through deployments, like when you're off, you're off. Make sure you guard your off time, because there's always going to be work to do, but if you're off, you're off.

Dr. Chan: There's always something to do.

Carson: And there's always the opportunity. I mean, you can take online courses, you can do whatever you want. Well, not whatever you want, but I mean, if you want to take an online course, there's nothing stopping you.

Dr. Chan: Okay, okay. And had you taken the pre-med reqs before you left, or was that something you needed to do afterwards?

Carson: That's something I needed to do afterwards. I actually started working on a biology degree at Utah State University in 2002. Like I said, I took a multiple-year gap to go work, and then had the realization I need to get back into school. And that's when I kept going on that biology degree path. And then coming back from Afghanistan is when I really hit the pre-med reqs really hard.

Dr. Chan: Was it hard to walk away from military? Or what did you think about? Because I know there's [USUHS 00:10:20] and . . . there's all these kind of different paths to becoming a doctor within the military.

Carson: Sure, yeah.

Dr. Chan: I'm just curious how you ended up choosing your particular path, yeah.

Carson: So luckily, I haven't had to walk away yet, which is great. I'm actually still a combat medic in the Utah Army National Guard, which is great. I turned 13-years army old last month, and it's actually been really good. National Guard is part-time, you know, one weekend a month, two weeks a year. I'm air quoting here for whoever can't see because sometimes it's a little bit more than that.

Dr. Chan: Just a little bit more sometimes.

Carson: Just a little bit more sometimes. But they've worked with me very well. Schools worked with me fairly well to make sure that I can do that because I actually really do like it. I did apply to Uniformed Services, interviewed there, was waitlisted. I mean, but ultimately, Utah is home, so I was happy to come back to Utah.

Dr. Chan: Okay, all right. So you're going through the application process, tips, advice you would give to those out there? Looking back, would you have done anything differently?

Carson: I would have started a lot earlier.

Dr. Chan: Okay.

Carson: That's probably . . . Yeah, the number one tip is start early. Before I was accepted to medical school here, I was in graduate school at Tulane working on a master's degree.

Dr. Chan: Yes. I remember when I talked to you on the phone, you were right around Louisiana.

Carson: Yeah, I was in Louisiana. I'd just gotten back to Louisiana from Germany, but yeah, running around Louisiana. And I had gone to the pre-medical advisor there. Even as a graduate student, they were willing to help, which was awesome. And one of the things that they had said over and over, have everything ready to go so when you can click the button, you click the button, because, you know, first off, no one likes to, you know, procrastinate and stress at the last minute. Some people in my family would say that if I didn't procrastinate, I'd get nothing done, which was probably right at some level, but start early.

If medicine is something that you really want to get into medical schools where you definitely want to go, build the relationships with the individuals who can help you there . . . help you get there, excuse me, early. I mean, being on the admissions committee here as a student member . . .

Dr. Chan: As a fourth year.

Carson: . . . as a fourth year, right, sorry, some of the greatest things that I see, that I enjoy seeing are extremely long shutters . . . Wow, that was a weird word, extremely strong letters of recommendation from professors from wherever who really know the individual that they're proffering the letter for. It lets us know that it's not just, you know, someone that you went to ask at . . .

Dr. Chan: Some template, yeah.

Carson: Yeah. It's not a letter that I'm going to worry about finding different pronouns or anything along those lines because it's a copy and paste job. And, I mean, put your nose to the wheel. I mean, getting into medical school is a hard job. And then completing medical school is a hard job, and just get ready for it. Tell yourself, "Hey, it's going to be hard. It's going to suck for a little bit, but it's worth it."

Dr. Chan: How did you end up at this program at Tulane? What was kind of decision making that went into that?

Carson: Yeah, so . . .

Dr. Chan: Because I get asked this question a lot about . . .

Carson: Should I get a master's degree?

Dr. Chan: Yeah. Like, kind of post-bacc master's degree programs? And it's very controversial in the pre-med world, so . . .

Carson: Yeah, so to be completely honest, I didn't get into medical school . . .

Dr. Chan: The first time you applied.

Carson: Yeah, the first time I applied, yeah. My GPA wasn't horrible. I thought that I could use some more work in science just to kind of bolster that GPA and give me an opportunity to find some more letters of recommendation. And I really wanted to show to the committee that I was continuing forward momentum that because I got to know I didn't, you know, stick my head in the sand and sulk or something . . .

Dr. Chan: And feel sorry for yourself.

Carson: Yeah, and then just reapply next year and have the same questions asked, "Well, you know, what has he been doing?" That could have some demonstrable evidence that I was still working towards that goal.

Dr. Chan: Okay, great. So I guess I'm curious, like I got a series of questions in my mind, like, when you started medical school, do you feel your undergrad and your master's program prepared you academically? Or do you feel like oh, this is like a whole new ballgame? Do you understand what I'm saying?

Carson: Yeah, absolutely. So I think that part of my graduate school, a lot of it helped me.

Dr. Chan: Okay, good.

Carson: Because my master's is in cell and molecular biology. So understanding signaling cascades, all sorts of random stuff like that really helped in some of the courses to the point where I probably didn't study as much as I should have. I felt a little overconfident, but I got that confidence from taking those courses.

Undergraduate school, to be completely honest, I don't know. I think for me personally, and it's going to sound kind of weird because I'm an older . . . I was an older candidate, but it took graduate school for me to kind of grow up to realize that, you know, it's not just go to class for three hours and then go hang out with friends and then whatever, but it's actual work.

Dr. Chan: Did you feel that was an issue at all being a non-traditional student and being older than the average classmate? You know what I'm saying?

Carson: You know, I didn't think it was until a medical school that I interviewed at asked me how I felt about being so much older than every other applicant. And part of me kind of went, "Wait a minute, I'm not sure they can ask that."

Dr. Chan: Yeah, they're not supposed to.

Carson: But, yeah.

Dr. Chan: But I can ask you that in a podcast right now because it's all retrospective.

Carson: For sure, for sure. You can't kick me out now Dr. Chan. You already accepted me. I didn't think it was a problem getting into class. I mean, we all kind of, for whatever reason, social explanation you want to, all kind of tend to gravitate to those who are like us, right?

Dr. Chan: Yes. People self-select, and there's, I think our school is really great for non-traditional students. I think there's a lot of people in their 30s, 40s who are here, so . . .

Carson: Exactly. And that was, I don't want to sound vain or anything along those lines, but walking into class going, "Yes, I'm not the oldest one here," was kind of, it's kind of nice. Because, I mean, I was 32 when I started medical school. But no, I don't think age really hurt me in any way.

Dr. Chan: What kind of activities were you doing, Carson, for a couple of years, like in terms of research or community service?

Carson: Yeah. So admittedly, I probably didn't do as much research as I should have. Community service, I was volunteering with . . . backup here a little bit. I actually enjoy education. So spending time with Anatomy Academy and young physicians and stuff along those lines, just helping expose high school and elementary and junior high school students to medicine and to the sciences and stuff along those lines was where I spent the majority of my time.

Dr. Chan: Okay. And then, you know, the first couple of years, the preclinical years, you know, what I know about you then, if I'd asked you, I probably would have heard surgery or emergency medicine. Would that have been accurate? Were you kind of leaning that way?

Carson: Yes, surgery and emerge . . . I can't talk. Surgery and emergency medicine were probably tied for first.

Dr. Chan: Okay. So let's talk about third year. Well, how was your third year? What did you start off with? What was your experience?

Carson: I describe third year in like three separate sections. The beginning of third year was horrible for me, at least I felt so. I felt like I didn't know what I was doing. I had no idea about anything like what medicine was. I felt like, you know, my hair was on fire just standing around saying, "This is fine." But I learned a lot in the first three blocks.

Dr. Chan: What were those three?

Carson: So they were neurology, surgery, and internal medicine.

Dr. Chan: Okay, some pretty heavy hitters there. yeah

Carson: Yeah, pretty heavy. And I kind of wanted . . . it's actually neurology, internal medicine, and then surgery. I knew I didn't want to go into medicine. So I kind of wanted to use medicine as a warm-up for surgery, so that's why it's kind of stacked that way. But it was super busy. I felt extremely inefficient, like I didn't know anything, and that I was being tolerated. And that was just an internal feeling. That wasn't anything that I experienced out on the wards or anything along those lines.

And the next couple of blocks, things got better. Knowledge-base and how to operate in a hospital was a little bit better. I was feeling a little more sure of myself. I knew I didn't know all the answers, but that was okay, because no one's expecting you to. And then the last third of third year was just, I had fun. It was great. Actually, one of my funnest rotations was psychiatry.

Dr. Chan: Okay.

Carson: I was over a UNI.

Dr. Chan: Tell me.

Carson: Yeah, I was going to say. I'm sure you'd love this, just over at UNI just having a blast because while, obviously, I'm not worried about all the medical problems in the background, but there are things that still play into it and lead to disease processes, and it was just really, really fun. I really enjoyed it.

Dr. Chan: Yeah, it's like, I would argue, you know, like each discipline, each field has its own culture.

Carson: Oh, sure.

Dr. Chan: And each discipline has kind of its own patient population to a certain extent, and there's just these personalities among the different doctors and the nurses. And something I've heard, you know, over time, with talking to a lot of students is like as you pick a field, you kind of have to find your people and like what's kind of this culture you want to submerse yourself in? So kind of like third year is kind of like a tour, right? You're going to be a psychiatrist for six weeks, a pediatrician for six weeks, and how does that make you feel? And how do you do? You know.

Carson: Yeah, exactly. I mean, that's kind of something that I was thinking in the back of my head when you started talking there for a second was that that third year like really opened my eyes to the different cultures. And once I saw the different cultures, I mean, I will unabashedly say that I stopped trying to fit in because I had found my people in the surgery world. And that doesn't mean, you know, I was walking around, you know, trying to be a jerk or anything along those lines, but it was just, "All right, there's something here to learn. I don't really fit in here. I kind of feel like an odd duck, but that's fine because there's . . ."

Dr. Chan: And I was opposite, like, I obviously chose to become a psychiatrist, but I liked visiting the surgeon world, but just it was really different. Like oh, yeah, you know, because we got to get at the hospital so early to do all the rounding because the OR opens at 7:00 and everyone has to get to the OR on time, and, you know, it's this cascade effect, and then, you know, you're operating, and all this stuff is happening on the floor. You know, just . . .

Carson: People are poking their head and saying, "What about this?"

Dr. Chan: Yeah.

Carson: Absolutely.

Dr. Chan: You know, I remember just watching surgeons operate and returning pages because like there's a scrub nurse. Like she would hold the phone while, you know, and like the doctor would be giving orders. It was just like, "Wow, this is a lot of multitasking," a lot of stuff going on.

Carson: Yes, there's definitely a lot of stuff going on. But, you know, I definitely appreciate it and enjoyed my time on the other rotations, because like I said, there was something to learn. And really, I think when people start thinking about their specialties, as long as they kind of keep that in the back of their head, there's, you know, there's something to learn here that it makes everything tolerable.

Dr. Chan: Did the pace remind you of your medic days? Or is it completely different? You know what I'm saying, like?

Carson: Pace of third year or . . .

Dr. Chan: Pace of the hospital, you know, just the way things operate, and how there's somewhat of a hierarchical nature to things, and . . .

Carson: Yeah, so the hierarchical nature definitely reminds me of it. There's not an attending physician that I don't call sir or ma'am, for better or worse, just because that's . . .

Dr. Chan: Interesting.

Carson: . . . how it works. And yeah, the hierarchical nature definitely reminds me of my medic time. I would say some services, like the pace, anyway, some services more closely resemble it than others. But no, I'll call it the ring structure of medicine is very harkening to those days.

Dr. Chan: And so it sounds like the hardest part for you was the beginning. And do you think it had anything to do with those first three rotations or is much more just like you transitioning from a second year to third year?

Carson: I think was more of the transition.

Dr. Chan: So anything could have been first and it could have been a little rough?

Carson: Yeah, I'm sure I could have had psychiatry first, and I'm sure I would have enjoyed it. It would have been like, "What am I doing here yet I know nothing?" But no, I think it was just getting in, getting acclimated to the pace, learning how to be flexible, because I think a lot of, well, at least for myself, I don't want to speak for a lot of other people, but I tend to try and find patterns and figure out how things work as far as like stepwise fashion and things along those lines, just because that's how it makes sense in my mind. It's a mystery why, you know, I'm going into surgery, right? And so learning how things flow and everything along those lines. And you switch to another service where the flow is completely different, and it's like, "Wait a minute, there was just a rug underneath my feet. I felt it there a second ago, and now it's gone." But just learning to be flexible, because no matter what you're going to get it just might take a couple of minutes.

Dr. Chan: Did you flirt with any other field, or once you did your surgery rotation, you're all in?

Carson: Yeah, so I've done a lot of surgery rotations, and I still love surgery. Anesthesiology is a sneaky one.

Dr. Chan: Oh, yeah, other side of the table.

Carson: Other side of the table here. The physiology is amazing.

Dr. Chan: You get to kill people and bring them back to life because . . .

Carson: Exactly, it's great.

Dr. Chan: Yeah.

Carson: I shouldn't say it's great. You know what I mean.

Dr. Chan: Yeah, I know.

Carson: The physiology is great, the medicine is great. The pharmacology is confusing but still great. And all the anesthesiologists I spent time with were really awesome about, you know, explaining what was going on, and we'd have a lot of table talks and stuff along those lines. But at the end of the day, I mean, I can't even count the number of times I'd be talking with my anesthesia attending and then find myself peeking over the curtain, seeing what was going on on the other side and be like, "Oh, they're getting ready to do this," and wanting to be like, "I can get that for you. Let me, you know . . ." But anesthesia is sneaky.

Dr. Chan: So you flirted a bit.

Carson: I flirted.

Dr. Chan: A little footsie, a little footsie.

Carson: Yeah, just toeing the line a little bit, just trying to see where it's at.

Dr. Chan: Okay. And you mentioned other surgery. Which ones did you end up doing?

Carson: So I have done plastics, vascular surgery, and foregut bariatric.

Dr. Chan: Wow, that's kind of a diverse group of . . .

Carson: . . . and then a trauma surgery rotation.

Dr. Chan: Okay. Which one did you like the most?

Carson: Yes. I like . . .

Dr. Chan: C, all the above.

Carson: Yes.

Dr. Chan: Okay.

Carson: I liked them all for different reasons.

Dr. Chan: Okay.

Carson: The first one I did was the trauma service. And I loved it because it was kind of . . . it took me back to the days of operating in the trauma bay.

Dr. Chan: Cars crashes, gun shot wounds . . .

Carson: Absolutely.

Dr. Chan: . . . falls.

Carson: Tons of blunt trauma.

Dr. Chan: Fights, drunk fights, yeah.

Carson: Good knife and gun club stuff.

Dr. Chan: Yeah.

Carson: The hours were horrendous, lead long, but I loved it. I thrived. The general surgeons were great. I learned a lot from them. Next one I went to was vascular surgery. Again, very long hours, but it taught me new approaches to stuff, because a lot of vascular surgery is all done endovascular now. So seeing some of the advancements in EVAR and TEVAR and stuff along those lines, I felt that, you know . . .

Dr. Chan: Little toys now.

Carson: Exactly, like my head would explode on every other case, like you can do that? Foregut bariatric was really awesome because I think there's a really on the bariatric side, people who, you know, you can help a really awesome patient population, who, for whatever reason, you know, really need some help, and you can do that, and you can be there for them. And I really liked that one because it wasn't just, "Okay, come in for surgery, we're done." It's a very long, drawn out and involved care process where those surgeons are plugged in with those patients forever.

And, you know, we'd have patients who were, you know, 11 months out and have an issue and guess who's taking care of them? We are, because that's where the service that they belong to. And then plastics was just mind-blowing as well.

Dr. Chan: Yeah. The whole concept of reconstruction, yeah.

Carson: Sure. I mean, I will be 100% forthcoming say, "I'm totally naive thinking about plastic surgery." I'd never really thought about in the past. I thought it was going to be a lot of, you know . . .

Dr. Chan: Cosmetics.

Carson: Rhinoplasty, augmentation things along those lines. And I didn't see a cosmetic procedure until the last week I was on the rotation. The very first case I was on was a woman who had a fungating mass on her right shoulder down to her chest wall. And so she had a forequarter amputation done where they took off her right arm right at the base. And we, I say we, I mean, I was in the room, I didn't do any of the work. But the surgeons actually took a flap from her anterior thigh and actually hooked all the tubes and everything up, all the vascular supply . . . I shouldn't say hooked all the tubes up.

Dr. Chan: No, no, but I like it. I like it. You're talking like a surgeon, yes.

Carson: I do know some words that make me sound smart sometimes. But hooked all the vascular supply up and closed her, and then I followed her in the hospital for a couple of weeks, and she's back at home now.

Dr. Chan: Wow, that's amazing. It's amazing what they can do. Yeah. I know I like to make fun of surgeons and surgery, but I think they do a phenomenal job and . . .

Carson: Yeah, I mean . . .

Dr. Chan: It's a hard life because the OR is long and there's a lot of risk involved.

Carson: Sure. Sure.

Dr. Chan: But we need people to be surgeons.

Carson: I mean, at the same point in time, if you can watch someone rebuild . . . I mean, if you can rebuild a pelvis from a fibula, that's an awesome skill to have.

Dr. Chan: So you're going through this experience, Carson, and you're definitely surgery.

Carson: Definitely surgery.

Dr. Chan: How did you pick which path on surgery for fourth year? Because you have to submit your residency application.

Carson: Right.

Dr. Chan: What was your thought process? How did you do that?

Carson: So my thought process is that I'd seen a lot of general surgery just from my time in Afghanistan and the trauma service, which is a general surgery service when there's not trauma going on here. And seeing other surgical services kind of out in the periphery, I will say in the periphery, but obviously they're working just as hard, and wanting to know what I could do past general surgery. So I applied to general surgery and . . .

Dr. Chan: How many programs did you apply to?

Carson: Seventy-seven.

Dr. Chan: Okay.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: A bunch.

Dr. Chan: A bunch.

Carson: But here in academic center, we're very, very lucky because we have a lot of extremely specialized individuals for foregut bariatric, colorectal, plastics, vascular surgery, etc., cardiothoracic, on and on, and I wanted to expose myself to those other subspecialties. So I just started whittling through them. The ones that I thought were most interesting. Vascular, foregut, plastics were the top of the list. And that's everything that I could squeeze in with all the other requirements.

Dr. Chan: I see, okay. So you applied to 77 programs. Did you do any away rotations?

Carson: I did not.

Dr. Chan: Okay.

Carson: General . . .

Dr. Chan: What was kind of your philosophy going into that?

Carson: Yeah, so I sat down with one of my advisors, and we looked over everything and just the general gestalt is that general surgery is not one that you need to do an away rotation. There's definitely others that you 100% have to. Emergency medicine, you have to do an away rotation, but you don't necessarily need it. If there's someplace that you 100% absolutely want to go, I don't think it hurts you. And that was the same advice that I got. I don't think it hurts you. But if you're going to go there, you need to go there under the assumption that you're going to work your tail off. And you're going to walk out of there with an honors in the course and letters of recommendation that have, you know, written in gold ink, basically.

And I don't want to say I didn't want to put the stress on myself, but let's be real, medical school can be expensive. And having to travel to another state, afford lodging, and everything, that played a very large part into it, so . . .

Dr. Chan: So you applied to 77. Are you comfortable sharing how many interviews did you go on?

Carson: Not enough.

Dr. Chan: Not enough.

Carson: Yeah. I think that's the answer that, and pretty much everyone will give you.

Dr. Chan: Okay, all right.

Carson: Yeah, not enough.

Dr. Chan: So you went on not enough interviews?

Carson: Yes.

Dr. Chan: What's going on out there on the interview trail? What was your experience? Are some programs asking you, "Hey, we want to see you stitch," kind of like . . .

Carson: I'm lucky.

Dr. Chan: Okay.

Carson: No one asked me that. I've heard horror stories from other individuals who actually interviewed at places that I wanted to, but didn't get the opportunity to interview at, where they were taken into the operating room and . . .

Dr. Chan: Really? Wow, a lot of pressure on that.

Carson: Yeah, I don't know what I would do. I mean, I'm nervous enough sometimes.

Dr. Chan: Watch you scrub in as fast as you can.

Carson: Yeah, exactly.

Dr. Chan: Ooh, you missed a spot, yeah.

Carson: See, that's a trick though because you're supposed to spend a specific amount of scrubbing, so that's where they try and get you.

Dr. Chan: I'm sure all the doctors we've ever seen have always hit that mark.

Carson: Exactly, not at all. I want to say that someone was asked to tie, which is fine. I will say that if you're thinking about going to surgery, start now because it is a very perishable skill and sometimes when you're under pressure and people are staring at you, you are all thumbs and that's not good in tying suture.

But, you know, my experience on the trail was pleasant. It was fun. I met people from across the nation who I don't want to say were just like me, but we kind of had the same mentalities, had the same goals, and . . .

Dr. Chan: What kind of questions were the residency programs asking? Did they talk about what happened here in med school? Are they talking about, you know, your military service? Like what kind of things would come up?

Carson: Both. Kind of a mix. There were some interviewers at different places that, I don't want to disparage anyone, but it almost seemed as though that they had no idea who I was. And we did a very abbreviated, this is who I am, this is my story. One of the advisors here, I mean, I'm sure you know this, you know, you need to have, you know, a two-minute story about yourself . . .

Dr. Chan: The elevator pitch.

Carson: Yeah, exactly. So I got to practice my elevator pitch a couple of times. Some interviews only focused on my military service, which was great. I can talk about military service all day if somebody wants to hear about it. I'm sure they were yawning as soon as I left the room, but whatever. Very few actually asked about my medical school experience, actually.

Dr. Chan: Interesting.

Carson: I would get it seemed like generic questions. How's school been? What have you liked? What have you enjoyed? But then they'd come with a curveball. And it was just some of the toughest questions right out of the book. It's like they asked you the easy questions first just to . . .

Dr. Chan: Kind of soften you.

Carson: . . . kind of soften you up, and then it's . . .

Dr. Chan: Were they like, what is surgery?

Carson: What are your deepest, darkest fears? Stuff like that.

Dr. Chan: Oh, so it's more like . . .

Carson: No, that was like . . .

Dr. Chan: Oh, I started to say like, was it like surgical trivia questions? Like . . .

Carson: No. No pimping or anything like that. But, you know, what's your greatest weakness? And, I mean, we all sit back and talk, you know, think, well, if I'm asked this.

Dr. Chan: I work too hard.

Carson: Yeah. They don't want to hear that, not at all.

Dr. Chan: Spend too many hours at the hospital, yeah.

Carson: It seems like every answer I gave, which I was genuine and saying, you know, I think I'm weak in these areas, I would get push back, "That's not a weakness, that's everybody. What else?" Just like I have no idea how to appease you right now. That's how I feel, I'm sorry.

Dr. Chan: Well, to kind of transition, Carson. I mean, the match is a little under a month.

Carson: Less than that. March 20th.

Dr. Chan: How are you feeling? What's the emotional kind of . . . to me, like, as I talked to the students, it's just an emotional roller coaster, right?

Carson: It is.

Dr. Chan: And the internet is fantastic, but I think it just causes more panic on certain levels. And I'm sure you've checked out all these websites and, you know, and everyone in your classes, you know, who is also going into gen surg. So, like, how's it feel right now? What's going on?

Carson: So to be completely honest, I haven't really gone online.

Dr. Chan: Okay.

Carson: I've told myself it's going to be what it's going to be, and I don't need to worry myself. So I've kind of detached myself from that. Listen to the Dean of Student Affairs here and, you know, his pitch and the information that he's provided, the data he's given. And I found that satisfactory enough to be able to say, "I'll accept that, and that's great because I can't really change anything at this point in time." But you're absolutely right. It's a totally emotional roller coaster. Can't even say it right now, like choking up about it.

Something that I find interesting is that everyone's on that same roller coaster. It's just whether or not it's uphill or downhill at the same time. And occasionally you meet someone who's at the same spot. But it's nerve-racking, but at the same point in time, it's one of those things I can't do anything about it. So let me go read up on this anatomy so I can look okay in the OR tomorrow instead.

Dr. Chan: Are you the type of person that you allow your brain to like even entertain the idea that there is like a slim possibility you won't match, or do you not let yourself go there?

Carson: I'm the type of person that has a very large portion of my brain that will say, "You're not going to match."

Dr. Chan: Wow, wow.

Carson: Yeah. But again, what can I do? It would be very unfortunate if that were the case. I wouldn't say large. I'd say I'm about 60-40 right now, 60 I'll match, 40 I won't, which is frightening now that I think about it. But that much mental energy has gone to it.

Dr. Chan: But you start thinking about it then, but then, like, a part . . . to me like a way to kind of like modulate that is you have a backup plan. So are you the type of person that's just preparing yourself to like, "Oh okay, we'll I'm going to . . ." we call it the SOAP, the Supplemental . . . I can't remember.

Carson: Offer and Acceptance Program.

Dr. Chan: Yeah, okay, good. And are you someone that's like I just need to practice. I'll take anything. So you'll go to a different field that might be open outside gen surg? Are you the type of person like, kind of like in your past like you redouble efforts? Okay, I'm going to do more research and then redo the match next year and do gen surg for sure?

Carson: No, I have a plan, for sure.

Dr. Chan: Okay.

Carson: I am actually kind of the person who says, "Plan for the worst, hope for the best." So I am planning on SOAPing actually, and working towards that right now trying to make sure that my extreme phone speed dating skills are up and so that if I do get a phone call from a program, I'll be able to instantly turn on the . . .

Dr. Chan: The elevator pitch over the phone.

Carson: Yeah, yeah, exactly that interview switch with different letters and things along those lines, and then starting to kind of put together a plan of what happens after that, if that isn't successful. So there's definitely plans. I've definitely thought about it. But again, I don't want to get emotional or anything about it just because it's one of those if it happens, it happens. And I'll have a plan.

Dr. Chan: Well, Carson, what I know about you is you're a fighter. You're a survivor. You've accomplished so much. And again, I feel bad that like, this roller coaster is part of it. But you're going to be a great doctor.

Carson: It's life. I mean . . .

Dr. Chan: You're going to be a great doctor.

Carson: And I think that's something that I can . . .

Dr. Chan: You're in the worst spot now because it's ambiguous, and you're in this gray zone, and it's hard.

Carson: But, I mean, even really that same kind of emotional roller coaster has gone back. I mean, applying to medical school, am I going to get in? Am I not going to get in, right? I think that's some something that even medical school applicants experience. And suffice it to say is it doesn't go away, it just changes. So it builds character, that process. It builds character.

Dr. Chan: So does serving in the military and going on multiple tours just . . .

Carson: That's just fun.

Dr. Chan: Okay.

Carson: That's just fun.

Dr. Chan: Well, Carson, I really appreciate you coming on.

Carson: Absolutely.

Dr. Chan: Do you mind coming back on after the match and . . .

Carson: Sure.

Dr. Chan: No, not like the day of but like, you know.

Carson: Oh, I won't be here, so . . .

Dr. Chan: Have some time to process it, whatever happens.

Carson: Yeah, I actually won't be here for match day.

Dr. Chan: Oh, where are you going?

Carson: I'll be in Morocco.

Dr. Chan: For fun or for protecting our country in some roundabout way?

Carson: Yes. For anybody who is in the military who might be listening here, I don't want to sound very OPSEC-y. Sorry, I have to put that in there though.

Dr. Chan: Oh, thank you.

Carson: I will be in Morocco.

Dr. Chan: Okay.

Carson: Yeah.

Dr. Chan: All right. So they'll let you know via email then.

Carson: No, I've instructed someone to open my envelope and call me.

Dr. Chan: Okay. Do you have to like sign a form to give permission to someone or you just say, "Hey?"

Carson: I don't know.

Dr. Chan: Okay.

Carson: I mean, I told somebody with witnesses around that it was okay if they stole my envelope and call me.

Dr. Chan: And then they would call you immediately?

Carson: Yeah.

Dr. Chan: Okay. If it's 10:00 Utah time, what time is it in Morocco? Have you already figured this out?

Carson: I can't do math. I don't know.

Dr. Chan: I was just thinking you're going to get this phone call in the middle of the night, so, yeah.

Carson: No, it won't be in the middle of the night.

Dr. Chan: Okay.

Carson: Actually. No, it will not be the middle of the night. But it'll be fun. That will be great.

Dr. Chan: Well, Carson, I really enjoyed this.

Carson: Me as well. Thanks for having me.

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.