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imperfect

Social media paints layers onto our lives that are flawless, perfect, and fantastical. Many talk about how our Instagram feeds are “highlight reels” of everyone we follow, and this is so true – why would anyone want to flaunt their mistakes, imperfections, and difficulties? There are some people who do “keep it real” but even then, it is always in the context of a happy ending or an edited, attractive picture. I follow a few who bare it all without reservation, and I applaud them and thank them for their sincerity. If I’m being honest, though, probably 95% of the images and messages I see online are glowing with happiness and success, highlighting beautiful faces and bodies, and exhibiting the highs of life. There is absolutely nothing wrong with this! Life is beautiful and should be celebrated as such. It only stings on the days when nothing you do goes right, you fall into the sticky trap of comparison, you cry because of loneliness, you learn of sad or heartbreaking news, you feel unattractive and tired, or you just downright have a bad day. Except for those days. I would argue that more times than not a pretty picture is covering up layers upon layers of real, true human flaws and imperfections. We are not perfect people, and I’m tired of acting like we are. I’m tired of trendy photos that I hope will get me likes, or posting photos that I think others will find interesting. I am tired of narcissism running rampant through online outlets, making young girls feel the need to flaunt their bodies to attract boys or post photos with silly captions to fit in. The stakes are high when it comes to social media – what will other people think of this? Will I look trendy? Will this impress people? Am I going to be accepted if I post this photo of myself? These are things I think all the time, and I have a feeling I’m not alone. I am trying to use my social media to grow readership, but in all honesty, I would still write even if no one read my writings (and, in fact, I do write things that I don’t let anyone read). I write because I love it and it is an outlet for my wandering, captive thoughts. Despite this, the truth is that I am human. I have bad days where I feel overwhelmed, inept, and lonely. I have days were my world feels shaken and hopeless. I have days where I feel unloved and unappreciated. I question my choices, my circumstances, and my feelings all the time. To act like things are all good, all the time is unfair and inauthentic. No one lives that way. So, if you’re like me, out there reading and seeing images of beautiful people with their lives perfectly held together with a smile and a list of accomplishments, please know you are not alone and that you are not the oddball out. I am right there with you, holding my head high on the days I feel inadequate and exhausted and bowing down in thanks on the days I feel untouchable and accomplished. The good outnumber the bad, but the bad enable me to fully appreciate and experience the good. Feeling uncertain makes the times I feel certain even more confirming and exclamatory. Feeling inadequate intensifies the times I feel competent and appreciated, successful and rewarded. Feeling alone makes those times I am surrounded by friends and laughing with sincerity even more sweet. All of these things make me feel innately human, wrapped up in the whirlwind of life; sometimes bound to reality by the steel anchor of defeat and other times floating in the clouds with the kite of triumph. It’s all a balancing game, and I’m here to proudly admit to feeling down some days. I am here to forgo what others want to hear and will instead speak the unwavering words of truth: we will fall, hurt ourselves, experience the pain, dwell in the defeat, and then pick ourselves up, wipe off the hurt, and smile for others to see how far we have come, what we have accomplished, and how cool we look doing it. Just don’t forget that before that ending occurs – the part you see on Instagram and on Facebook – the first few steps have already happened and will happen again, too. It may not always be pretty but it is simply the circle of life; despite the hard days, we are all so blessed and should be thankful we get to live it.

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remembering names

I write this (admittedly random) post as somewhat of a disclaimer, an apology, and a public service announcement. Everyone has those qualities about themselves that are of utmost annoyance. (Admit that you do.) For me, my inability to remember names really causes me a lot of grief, stress, and embarrassment. People laugh whenever I say to them, “It is so nice to meet you! I will try so hard to remember your name, but please forgive me if I don’t.” The truth is, nine times out of ten I do forget that person’s name and have to battle the shame and humility of asking again. This really isn’t a good quality to have. People like it when you remember their names, naturally, and it may come across as an insult if you don’t. This post isn’t a “I struggle with this but here are three things to do so you don’t”, because I haven’t figured out how to remember people’s names. If you know a way, please enlighten me.

Let me start by explaining why I don’t remember names. First and foremost, I feel that a name is somewhat meaningless and insignificant. I could meet you and say my name is Samantha and then proceed with every other accurate description of who I am without changing anything about who I really am. A name is a label, literally, and I don’t think labels are as important as the objects they describe. You could call my coffee “valendwarf” and I would still love it because I love the object of coffee, not the name that it holds. So when I meet someone, yes, their name is often the first fact I learn about them and often the first I forget. The other stuff, the good stuff, is what matters so much to me. I care more about a person’s interests, passions, ambitions, relationships, and every other aspect of their life way more than a name. SO forgetting a name isn’t as bad as it seems – it just means someone is paying more attention to the other details that are more important.

I have tried ways to remember names. I first Googled, “Ways to remember names” which later escalated to a frustrated, “Why do I forget names?” search. These two proved to be helpful as I was met with some useful tips. Some of the most common ones include things like as soon as you meet a person, connect their name with a physical quality about them. Sarah has red hair and blue eyes. Or connect their name to an aspect of their personality. Auguste is very outspoken and likes to talk. Another helpful tip I’ve discovered: use their name almost immediately in a sentence. I have found that this actually is helpful. I don’t know the psychology behind it, but it seems that by taking an external, arbitrary name and internalizing it into your own vocabulary helps establish its importance in your short-term memory and later long-term memory. This reduces my rate of forgetting to about 50%, which is a big increase from 90%. Nonetheless, these little tips are helpful but not totally effective.

I guess I’m trying to say, if you forget names, don’t beat yourself up about it like I do. Maybe it just means you’re more interested in the other aspects of a person instead of a simple label they use. I love meeting new people and hearing about their life and goals and personality, but I hate forgetting names. It is one of my worst qualities and something I hope to improve on. If you have tips for improving this, let me know – and I’ll try to remember your name 🙂

 

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who you are

Your life experiences unquestionably define who you are and guide where you belong in the world. We are each given unique stories – challenges, triumphs, memories, passions – that aid us in figuring out what type of life we are to live. Since I’ve been in college, I have met people from SO many different walks of life, and it has been one of my favorite aspects of moving out of a small town and into a more culturally and ethnically diverse city. The people I’ve become very close friends with come from all over the world and from every background – Russian, African, Indian, Egyptian, Irish, Ukrainian, American, Muslim, Christian, Hindu, atheist, agnostic, poor, rich, sick, and every quality or descriptor in between. The love I have for each of these people is specific and unique to the friendship that we share, and I’m so glad that I’ve come to know them and their story. Along this journey though, I often found myself asking “Who am I? Where do I come from? What characteristics define me?” and yesterday I again happened upon this internal self-discussion after a conversation I had with a friend in my lab. He very casually told me, “Mary, I can finally hear your Southern accent!” which lead down a rabbit hole of conversation on the lifetime struggle of talking with a “twang” and how “cute” it is (Ha). I told him that sometimes people assume others with a Southern accent are less intelligent, less capable, or have certain ideologies. For this reason, I had become accustomed to avoiding phrases that make me sound more Southern. What I have learned though, through encountering others that embrace and welcome their cultural identity, is that I am Southern and I do have a Southern accent. I was raised in a small town and my identity is comprised of those memories that I created as a child. I had this unnerving feeling when I entered college of not having an identity at all, not belonging to a defined “group” with certain values. I often felt like others were very different from me (because, well, they were and still are in many ways) and didn’t share a lot of the experiences I had while growing up. Instead of shaming away from this I began to cherish my own culture. I shared with people what it was like growing up in a small town in Tennessee (as compared to Chicago or Memphis or New York City). I delighted in the fact that I had (and have) certain challenges different from others and that those things make me, me. This acceptance and confidence has permeated into other aspects of my life. Previously at work, I sought to make myself very . . . uniform. I dressed simply and didn’t feel comfortable sharing the intricacies and details of my personality. This was largely in part because I worked with male supervisors and male colleagues and didn’t want to be perceived as less intelligent or less focused on my career. I’ve learned though, by being surrounded by team members that fully accept and cherish who they are, that who I am doesn’t negate my abilities but encourages them. Speaking of my passions and my childhood memories, wearing the clothes that make me feel confident and feminine, and accepting that I am an empowered, capable female, has strengthened my work ethic and confidence, not taken away from it. Yes, I wear eyeliner and like to do yoga. I didn’t take ten AP classes or go to a private, preparatory high school, but I do have the capability to learn and to succeed just as my peers do and have demonstrated that learning is more important than formal education. This is so important, because I really feel like people who may not fit into certain groups need to be encouraged to come from a position of strength instead of weakness. Don’t let the influence of those around you – their maleness (or femaleness), intelligence, appearance, or success – alter the way that you view yourself. What I have learned since accepting that I have a past that makes me better, not worse, and a future that is as bright as the person next to me, is that people love me and appreciate my work for exactly who I am. They like that I can have a conversation about growing up in a small town and how I like to enjoy myself in Nashville. Just because I wear makeup and have my hair fixed doesn’t mean I don’t get called on during meetings to answer hard questions or given hard tasks to complete. I no longer feel like I have no identity because instead of trying to create one that didn’t exist, I accepted the one I already have. There is great power in knowing who you are, growing in who you are, and loving who you are. Not only is there power, but there is indefinite peace.

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aha! moments in cancer treatment

I think we can all appreciate those “wow, this is amazing” moments of life. They can be many and varied, but at some point everyone has those intense feelings of gratitude and satisfaction. I’ve had a few of these moments lately when reading about immunotherapies for my research. I love the idea of using the defenses and machinery that our bodies already possess to fight off foreign invaders, such as cancer. The human body is pretty extraordinary — and the ways we fight off cancer are as well.

One of the steepest learning curves for me has been remembering the names, classes, and side effects of cancer drugs. There are SO many cancer drugs out there, and more get approved for clinical use every single day! With the help of some charts created by my PI (like this one published in the New England Journal of Medicine) and some really extensive notes, I feel way more comfortable with cancer therapies than when I started. Most people have heard of “chemotherapy” as a treatment for cancer. For years, chemotherapy has long been the go-to induction treatment for many types of cancer. I think of chemotherapy as the biological version of carpet-bombing – it is very limited in specificity and comes at a cost of collateral damage. Chemotherapies (literally “chemical treatments”) induce apoptosis, or cell death, of cancer cells through many mechanisms. They may interfere with DNA replication or alter the metabolic machinery necessary for providing fuel for cellular survival and reproduction. Chemotherapy drugs are most efficacious against cells that divide rapidly (i.e. tumor cells) but come with many of the side effects we associate with cancer – fatigue, loss of hair, dry skin, and general myalgia. Traditional chemotherapies are still used but mostly in combination with newer drugs and at lower cumulative dosages.

The advent of targeted therapies for cancer has redefined the specificity of cancer treatment (the word “targeted” gives it away). These are usually small molecules or antibodies that target kinases, or phosphorylating enzymes, that are overexpressed on cancer cells. Targeted therapies may work intracellularly through small molecules that slip inside the cell and stop cancer-promoting enzymes or extracellularly by recognizing receptors involved in tumor pathogenesis. Instead of using a carpet-bombing approach, targeted therapies are designed to selectively target cancer cells. One of the targeted therapies we study is trastuzumab (Herceptin). This is a monoclonal antibody (an immune system molecule that recognizes one complementary receptor) that binds HER2, a kinase expressed on cells. HER2 is overexpressed on HER2+ breast cancer cells, among other HER2+ cancer types. Once trastuzumab binds HER2, it inhibits a signaling pathway that normally promotes cell survival. Trastuzumab is one example among many, many other types of targeted therapies used to treat cancers. Targeted therapies have literally saved hundreds of thousands of lives and will continue to do so as scientists “fine tune” their targeted activity.

Now, immunotherapies. These are the current Holy Grail of cancer treatments. I am still learning a lot about the biology behind immunotherapies. Surprisingly, most immunotherapy treatments don’t care at all about the cancer cells. Instead, they focus on the cells of the immune system. We have cells in our bodies called T cells that essentially patrol for foreign invaders. Dendritic cells, another type of immune cell, “show” the T cells pieces of degraded protein, or polypeptide. The T cell then either recognizes the polypeptide as a normal part of the body or as foreign. If it recognizes it as foreign, the T cell will become activated and initiate an immune response. This is a normal process and keeps our bodies healthy and free of disease. Except in the case of cancer. Like most things, the immune system has its own set of checks and balances. The T cells (those monitoring cells that give approval for an immune response) have a protein called programmed death-1 or PD-1. Other immune cells have the receptor to this protein called programmed death ligand-1 or PD-L1. These two molecules fit together like puzzle pieces. If the T cells inappropriately initiate an immune response, cells with PD-L1 will bind PD-1 and effectively stop the T cells from killing anything.

Unfortunately, some cancer cells overexpress PD-L1 so that the immune system is always put on hold and does not attack them (which it should because they are foreign). The cancer cells become “hidden” from the immune system and continue to thrive and reproduce. But, aha!, some scientists much smarter than me once asked, but why doesn’t the immune system recognize cancer cells as foreign? And after a lot of research, thousands of pipette tips, and some vigilant clinical trials, today people are being cured by their own immune system. A new cancer drug, pembrolizumab (Keytruda) is a PD-1 inhibitor that binds to PD-1 on the T cell that normally functions as a brake (or as a signal to not kill). It is like sliding in another puzzle piece so that the original cannot fit anymore. This means that those pesky cancer cells that overexpress PD-L1 can no longer hide from the immune system. Pembrolizumab and nivolumab (Opdivo) have had remarkable response rates. A recent paper published in the journal Science (here) demonstrated how these immune checkpoint inhibitors may be used to treat cancer cells with a shared genetic deficiency. This recent publication and growing knowledge of immuno-oncology, cancer genetics, and precision medicine are transforming cancer treatment. I think this stuff is pretty cool, and I always leave feeling amazed, humbled, and grateful for the work that people are doing to save lives.

If you think this stuff is also pretty cool, check out the New York Times dedicated section on immunotherapy. A few articles from my lab are here and here as well. Thanks for reading!

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thoughts on a beach

There are fewer things I want more than to become a physician — truly, when I survey my life for my heart’s deepest desires this worthy role sits at the fundamental core. But then I ask myself, why do I want to be a physician? I have always thought it not only wise but necessary to question every little thing. I was once infatuated with philosophy and while I don’t read it as often as I used to, the inquisitive and questioning nature it taught me never left my mind. So I ask myself – why do I want to be a physician? The answer is complex yet innately obvious to me. There is no short, one-lined answer for my reasons but instead a summation of all my unique life experiences that have lead me to this decision. I have explored other career options that align with my passions: I’ve thought of becoming a professor and teaching chemistry; I’ve considered going to graduate school and being a lifelong researcher; I’ve discussed working in industry as a chemist; I’ve toyed with the idea of being a science writer and journalist. I love teaching others and guiding people to discovering knowledge about themselves through learning difficult ideas and concepts. I think learning is one of God’s greatest gifts to man – I truly believe there is nothing that cannot be learned given enough hard work and time. I am amazed by the human body, the biological systems that work harmoniously within, and the chemistry that, literally, composes all of life and the physical universe. I love reading literature because I get to live through the stories of so many different people, experience their culture and hear their thoughts. I like doing science because it teaches me how to think creatively about the problems that are causing disease and illness. Research brings together the basic science of biology and biochemistry and allows me to do the thinking, the dirty work, and hopefully, discover the solution to a patient problem. But in my searching for the vocation I want to commit my life to, each of the prospective alternatives fell short in a specific and important way. For most, I could not help people in their most vulnerable state. I was missing the intimate and trusting physician-patient relationship that I was attracted to in the beginning. Medicine brings together all of the things I have found myself passionate about for such a long time: passions true to my being, woven into who I am and who I will want to be for the rest of my life. For me, becoming a physician has nothing to do with prestige, honor, or pay. No one in my family is a physician and I’m not being pressured down this career. It has everything to do with using the skills I’ve been blessed with to do the things I love to help others live a healthier life free of disease. I don’t just want to be a physician; I want to be an advocate, an encourager, a teacher, a confidant, a scientist, and a calming, present voice amidst the stormiest times of my patients’ lives. I want to inform and educate others about science and health and learn from those around me in every way I can. I want to write and read and maintain who I am in the long nights and ceremonious mistakes that a life of practicing medicine promises. I want to some day be a wife and a doctor and execute both in the best manner possible. These are the things I envision and hope for my future. So when I feel like my pathway becomes blurred by the constant lull within me to be better, do better, and achieve more I step back and ask myself – to remind myself – why I want to do this. I am journeying this path in life, not for anyone else, but to satiate my unquenchable desire for knowledge and service, challenges and relationships, through triumph and defeat – and that alone makes this pathway my own. I will not lose myself in the circuitous trap of comparison but will instead find myself lying with peace on this beach, reading legendary Nabokov, and dreaming of my future as an endless learner, a trusted confidant, and, ultimately, a healer. 

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travels

I’m not sure I’ll ever be able to describe the experiences I had when I was away. People talk about traveling, and the impact it has on your life, and you don’t believe them until you actually have that transformation yourself. You grow up in the comfort of your own country with people that mostly look like you and act like you. For my personal childhood, these people were pretty homogenous to me – in appearance and ideology. When I went to college I realized how much I appreciated learning from other cultures and from people that think differently than myself; I adored meeting those people and developed an appreciation for our differences. This December, I seriously sat down with my dad and asked if I could travel abroad for a Maymester. Going out of the country, admittedly, scared me. After some convincing and coercing, I was given blessings to go to Ireland and England. I would be studying public health of three countries and was ecstatic to learn of an area of healthcare I was less familiar with. The spring semester came with its challenges of exams, family life, a new research job, and college in general but before long I had finished my second year of college and was packing to travel across the pond. I can admit that I really had no idea what I was getting myself into – and that is part of the beauty of it all.

It is overwhelming to think of how to write about my experiences. I couldn’t possibly try to start from the beginning to the end, and I’m kicking myself for not keeping a journal going throughout my journey abroad. Truthfully though, I was going pretty much nonstop and would cherish the few hours of sleep I would get each night. I didn’t find time to write. When I think about what I learned on this trip, so much comes to mind. I’ve decided to just write of my experiences as I think of them – so my first one is below!

I feel very deeply that my experiences abroad will make me a better future doctor. Public health is concerned with the health of the masses – not the privileged, or the wealthy, or the exceptional, but of every man and every woman that is deserving of health. A public health perspective is not focused on individual treatment but on ensuring health opportunity for every person. This means that the woman in poverty with a newborn child is just as deserving of health as the wealthy businessman with a nice sportscar. On the first three days of our trip, I learned about the public health infrastructure in the United States, Tennessee, and Nashville. The Commissioner of Health for Tennessee spoke with passion about healthcare for all, not just in the states, but globally. He spoke of not just improving health but health equity. I learned of government programs that aim to improve the health of vulnerable populations – women with children, the impoverished, elderly people, people in rural populations. I observed with excitement the earnest desire that our public health professionals have to alleviate disease and illness and ensure health for all people. I walked the streets of Nashville with a nonprofit organization and talked to people living in homelessness – people I had often passed. I learned of how homeless people are even more susceptible to mental and physical disease than those that have a place to rest their heads. My heart became more compassionate, more understanding, and more heartbroken for the lack of systems we have to care for people that need it most. I thought of how homeless people were stigmatized and criminalized. What I realized most was my own attitude towards them. People – despite color, wealth, social status, illness, or any other factors – are just people at their core. They share the same anatomy, the same biochemistry happening inside their bodies, the same capacity for illness, the same emotional vulnerabilities. People are people, and sometimes as a society, we don’t treat them that way. People are stigmatized for mental illnesses, HIV/AIDS or other STIs, disabilities, and a menagerie of other diseases. In my own country, I noted these discrepancies. As I traveled overseas, I had lectures on public health in the UK and in Ireland. The same problems exist elsewhere, but I do feel these countries have developed more inclusive health systems. Without getting into the (complicated) details of the healthcare systems across the pond, the UK has a single-payer system that is funded through tax dollars and offers coverage to all citizens. The UK also ranks #1 among healthcare delivery, accessibility, quality, and timeliness; unfortunately, they rank second-to-last in health outcomes (second only to the United States). So, of course, the UK has its problems in improving the health of populations but at least has developed a sophisticated and inclusive (for the most part) healthcare system. Ireland has a much more convoluted healthcare system that has a public component where all citizens get a medical card they use to get public healthcare, and a private component where paying citizens can get private insurance and faster healthcare services. Interestingly, the public healthcare services are more desired than the private because of more extensive expertise in the public hospitals. Nonetheless, all of this healthcare talk is really exciting to me and something I want to be more involved in but probably boring for everyone else… The culmination of my experiences abroad lead me to realize that whether or not you believe healthcare is a right or a privilege – you have to believe that health is a right. Every person is entitled to living a healthy, happy life, free of disease and illness, free of disability, and free of pain. The unfortunate truth is that many people don’t live lives that way now and may never live that way. In my future practice as a doctor, I hope to work to ensure my patients have the best medical care with their optimized health always in my mind. I will value my patients as people with equality and integrity – no matter their race, background, income, homelessness, religious belief, or language barriers. I learned much more on my trip (like where the best pubs are in Ireland and where to get the best Americano in London) but of course this was the important, overarching theme that I wanted to write about first. I will forever be thankful for my travels abroad and hope to write of (perhaps more exciting?) experiences soon!

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London

I’m lying in my bed, with my windows open to the fresh, energetic air of London at night. I’m on Thoresby Street, living in Thoresby House, the yellow colored building with stairs that lead to the red door and a winding, wooden staircase that invites you into my hall. Perched in my bed, I hear the ripping of taxis and blustery honks, buzzing of motorcycles, and roaring of engines; but my favorite sounds so far have been the passing voices that find their way up and into my window. I’ve probably heard four different languages, fluidly speaking with ease and laughter and friendship as the passersby leave a trail of conversation. I can feel the wind blow in (the primary reason my window is open) and feel immersed in London already. I’ve been here for around 12 hours, I’ve been awake for around 34 hours, and I’ve already grown to cherish this city. I think of all the writers that I’ve read who have found inspiration in these streets, written of the exquisite beauty of the brisk walkers, the antiqued buildings, and the overcast skies. Virginia Woolf found London to be the only thing worth writing about – the true love of her life. Sherlock Holmes is one of the world’s favorite detectives (and certainly mine) because Arthur Conan Doyle’s medicine practice was unfortunately failing and writing was his escape. Winston Churchill echoed speeches that are inscribed in history books; and the royal family has been plagued by paparazzi since the establishment. And speaking of plagues – this city has seen them. I couldn’t wash my face and brush my teeth tonight without thinking of the cholera epidemic in London. Multiple diseases have ran rampant through this city and have faced eradication thanks to human intervention. Lots of things run through the old, regularly washed buildings of London. The streets taunt you with their secrets, the lives they have seen and the history that they’ve made. The buildings are beautiful – colored with character and stitched together with shades of red brick. And, oh, I’ve noticed – London is diverse. The people are colored many colors and speak many languages. Styles are different and some of the same. The university district was buzzing with students that held a sophisticated aura of intelligence and creativity. The people look different. They act different. They are different. Yet the real beauty I have found so far in London is that all of these differences are appreciated. Virginia Woolf would have been inspired by the many colors of faces she saw on the street and would have etched them out in unimaginable detail. London will charm you. I will lay here, with a Woolf-like awe, and observe with my ears the many sounds and feelings and emotions and thoughts that this sweet city will send up my window, to touch my heart and to move my hands to continue to write.

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