His house was disheveled and well off the road and seemed to be slowly melting into the creek that ran in front of it. It was the second day of the two-week data collection period of my research into the Costa Rican healthcare system. My confidence to knock on strangers’ doors and ask them about their views on my topic was steadily increasing. His sister let me into a dark room with dust in the air and told me to sit down at an old plastic lawn table that may have, at some point, been white. He sat across from me and I began to ask him questions aiming to hear his opinions on the recent dengue public health campaign in the region. What he gave me was a story that helped teach me the scope and impact of health.

When he was 15 years old, he contracted leishmaniasis. This is a treatable, parasitic infection that uses sandflies of the genus Phlebotomus as a vector and results in scarring. I had heard all of these facts from my study abroad program. He continued to describe to me how his scars, recognized by potential employers as signs of the often stigmatized leishmaniasis, led to a fruitless search for a career that left him impoverished. He now lived with his sister who had been ostracized by her community, as no one wanted to visit her home in which her shunned brother resided. The insight I have gained through reflection on this experience has added substantially to the way I approach others and has been an important motivator in my desire to pursue medicine.

I recognized that his disease was not his fault. After years of research with Dr. Freedman on atherogenic mechanisms, I have an understanding of dozens of molecular pathways involved in this prevalent, vascular disease. I also have learned that not all of them are necessarily regulated by diet or lifestyle. Instead, many are controlled largely by genetic predisposition. This Costa Rican man did not have a choice in whether or not he would contract leishmaniasis, and this lack of control is less the exception, and more the rule no matter the country.

I also realized that his poverty was a major reason he could never receive the sort of treatment that would have been necessary to prevent such scarring or remove its evidence. I have seen the effect that poverty in the US can have on access to healthcare after volunteering at the Durham Nursing and Rehabilitation Center (DNRC), a Medicaid facility, each week for nearly four months. The unfortunate truth that I had heard in class and that was confirmed to me at this center is that Medicare, even with the addition of Medicaid benefits, only provides fewer than twenty physical therapy appointments each year. Thus, many residents enter the DNRC with the hope of leaving in a month with adequate therapy and end up staying for years when their insurance coverage runs out. Through this experience, I learned how much of an impact economic status can have on access to healthcare and how that access can shape a person’s life course. The impact of healthcare revealed to me by life without it has driven me to become a physician that goes out of his way to provide care to those who cannot normally access it.

It was clear to me that his health condition, not laziness or personal failings, kept him from finding work. While I was working on a medical brigade in Honduras, a girl in her twenties came into our temporary clinic. She had worsening headaches and blurry vision and was growing increasingly desperate. Due to these conditions, she was forced to quit her job and had no source of income. My mind raced with possible diseases she might have had. The doctor gave her glasses. Within an hour she was beaming and said her symptoms had abated. I learned from this experience how inexorably linked health is to ability to function in society and find employment. It also made me appreciate the impact that a doctor willing to listen and help can have on a person’s life as shown by the simplicity and effectiveness of this prescription.

For this Costa Rican man, it was one disease he had years ago that his society continued to use to define him. He was a victim of leishmaniasis, yet even once this parasite was long dead, it still consumed him. With a bite of a sand fly, his entire life was destroyed, and it wasn’t because of any molecular mechanism, physical disability, or fault of his own. It was my experiences with health that allowed me to better empathize with this man and understand his struggle.

While working a call for Duke EMS, the empathy I strived to integrate into my view of others was tested when we arrived on scene to find an unconscious man at a bus stop. He reeked of alcohol. As people walked by him, they looked down and shook their heads and my temptation to blame him was substantial. Yet, when we arrived in the Emergency Room, the receiving physician did not see him as a man who had ruined his own life. This doctor saw him as someone who, by some combination of genetics, life events, and social influences, was struggling. This man was someone to be helped, not shunned. It is this willingness to be understanding present in every doctor I have shadowed or with whom I have worked, in conjunction with my experiences with health, that inspires me to become a caring and compassionate doctor.

Duke Secondary Essays

Tell us more about who you are. You may provide additional information that expands your self-identity where gender identification, racial and/or ethnic self description, geographic origin, socioeconomic, academic, and/or other characteristics that define who you are as you contemplate a career that will interface with people who are similar AND dissimilar to you. You have the opportunity to tell us how you wish to be addressed and treated.

As part of a meeting for a club I joined shortly after arriving at Duke, we played the stepping game. To begin, participants line up in the center of a room. Then, another person reads off a series of life events and background characteristics, some of which are advantages and others, obstacles. When we agreed with the former we would step forward. When we agreed with the latter, we would take a step back. I am a white, cisgendered, heterosexual male from a high socioeconomic background with supportive and married parents. Needless to say, my nose hit the front wall first. The object of this game was not to isolate people, but rather to share the limitations in perspective that come with privilege; if all you take are steps forward, it is hard to see anyone else in the room. After arriving on Duke’s diverse campus from a racially and socioeconomically homogenous town, I had already begun to realize some of the challenges that I had never had to face, and thus never had to consider. Yet, after playing this game, I realized that if I wanted to be able to connect and empathise with most people, I would need to actively seek out exposure to new and different perspectives. Furthermore, I would have to be willing to listen to them and believe in their importance.

This mindset has driven me to pursue activities in college oriented toward learning from diversity. One of the most memorable and salient experiences of my life has been with the DukeEngage Turkey program. As I patrolled the beaches for long hours each night to protect loggerhead turtle nests, I also had the opportunity to speak with other members of the rehabilitation center. For example, one fellow volunteer from Turkey was Kurdish and a communist, two characteristics that face substantial persecution in that region. For this reason, she had actually spent months of her life in prison for nonviolent protests, often just by association with members of her religious community. This was difficult for me to comprehend as it was so different from any situation I had ever faced. Yet, by sitting with her each night and listening to the isolation and fear she has felt as a persecuted minority, I have gained more openness and empathy that has impacted all of my interactions since.

It is not simply my exposure to diversity itself that will allow me to connect with people from different backgrounds in a clinical context. Instead, it is my constant desire to seek out and learn from these views. It is my firm belief that the values and opinions of others should be used to inform perspective and drive compassion that will help me in my path to becoming a physician.

How has race/ethnicity/geographic origin/socioeconomic status/advantage/disadvantage/religious affiliation impacted your development so far as well as the impact that these may have had on your path to a career in medicine and your plans for the future.

My mother is a primary care doctor and a major influence on my career choice. It is not her prestige that has pushed me toward becoming a physician myself, but rather her perspective that is so clearly influenced by her profession. Growing up, I often asked about the patients that she saw. I asked these questions hoping to hear strange or extreme cases, but I never received my desired responses. Instead, she provided me with stories about her patients’ lives and experiences. She spoke of each of them, not from a purely medical perspective, but from a personal one and did so with incredible insight. She was not just a healer, but also someone who directly influenced every aspect of the lives of dozens of people every day in a positive way. Furthermore, it was clear that these traits were intimately connected with her practice of medicine due to the profound connection she made with her patients. Her attitude toward her interaction with patients instilled in me the desire to be more understanding of the actions of others due to the unseen influence of their backgrounds. It also inspired me to join this career that fostered these same values.

Describe the community in which you were nurtured or spent the majority of your early development with respect to its demographics. What core values did you receive and how will these translate into the contributions that you hope to make to your community as a medical student and to your career in medicine? What improvements do you think might make the described community better?

I was fortunate to grow up in an affluent community in Ridgefield, Connecticut with two parents with college degrees and one who is a physician. My town was quite racially and socioeconomically homogenous. This led to a relative lack of diversity in not only demographics, but in life experience as well, especially for those students who had spent most of their lives in Ridgefield. It should be acknowledged that the political landscape in my town was divided, with roughly half of the student body on either side of the political spectrum. However, due to a similarity in experiences, many viewpoints on major issues such as poverty or immigration were informed not by experience, but rather the interpretation of the experiences of others. Thus, in general, our ideological differences were primarily just differences in the news channels we watched and the political leanings of our families.

My parents were often eager to have intellectual discussions with me around the dinner table. Topics of these conversations ranged from economics to medicine to news and current events. The excitement and expectation I felt leading up to each of these dinners set a framework for my current desire to find out more especially about subjects about which I know little. One of the most important conversations I had with my parents focused on my observation of one particularly passionate, but impersonal and generally fruitless political argument at my high school. In response, my mom brought out two coasters and placed them on opposite corners of the table. Each coaster represented a party in an argument with the goal of hitting the other with enough force to reverse its course so that the two would slide in the same direction. In other words, each aimed to convince the other member of the of their opinion in the discussion. She then slid the coasters and, as each stayed on its side of the table while traveling from one end to the other, they missed each other entirely. She told me that the path that each coaster took represented the value systems of each party in an argument. If the two are incompatible and no reconciliation effort is made, then an argument can never be productive because neither point of view will be in any way impacted. It was from this lesson that I learned the importance of not only challenging my views by hearing the arguments of others, but also challenging my system of belief by recognizing the validity of those held by my peers.

For my community to improve, or at least more successfully shape each other’s opinions, the fact that value systems must be recognized and respected in order to communicate effectively should be recognized and actively employed. This could be accomplished by first learning more about a person before arguing against his or her opinions.

I believe that my ability to recognize the validity of the values of others with experiences different from my own is essential in communication. As a physician I will employ this skill set in order to make the most of the invaluable relationship between myself and my patients through mutual respect. The trust that this sort of connection will bring will allow mutual decisions to be made as to the patient’s treatment plan.

Describe a situation where you have chosen to advocate for someone who is different from yourself. What does advocacy mean to you and how has your advocacy developed? How do you see it linked to your role as a physician/leader? What risks, if any, might be associated with your choice to be an advocate?

When I first entered Duke, I was eager to participate in activities that would allow me to give a voice to those who could not speak for themselves. This is a common and generally beneficial desire, but one that is frequently misguided. For example, in the second semester of my first year, I attended Greek Ally Training hosted by the Center for Sexual and Gender Diversity. Though this training was genuinely useful, after only a few hours, I felt as though I could speak on behalf of a large and diverse group of individuals with which I did not identify. This first attempt at advocacy among peers ended with a conversation with a friend and member of the LGBTQ+ community. It focused on the problems that can result from allies speaking so loudly and confidently that they drown out the voices of the people personally suffering. This allowed me to see the potential problems that can arise from well-meaning but uninformed advocacy.

When I decided to create my student organization, Duke Helping Hands for Alzheimer’s and other Neurological Disorders (DukeHAND), I began my next major attempt at advocacy, but this time I was determined to do so in a more ethical manner. Rather than speaking on behalf of people with neurodegenerative disorders, I spent time volunteering with them at a local nursing home and spoke with them about their experiences. Upon realizing the value in this activity, I began to focus the club’s efforts on encouraging volunteering among the student body. I then expanded this purpose to sharing the thoughts of the elderly with whom we interacted such as the value and wisdom that they have and the way that they feel ignored and dismissed because of their conditions. In this experience, I learned the meaning of ethical advocacy: not providing a voice for those without one, but rather amplifying the voices of the people who speak but are not heard. Each person has the most knowledgeable voice and the greatest understanding of their own situation. Sharing these opinions with others who would not otherwise hear them is infinitely better that providing one’s own interpretation of their situation.

This practice is essential as a physician as it not only means making positive change in patient care, but also making those changes in a way that accounts for the ideas of the patients themselves. The risk that is especially present with advocacy within the medical profession derives from the fact that the people making decisions regarding changes in practices and treatments are often not the people directly impacted by those changes. For this reason, I believe it is critical to be mindful of and value the opinion of the patient.

What has been your most humbling experience and how will that experience affect your interactions with your peers and patients?

Both while volunteering in rural Honduras and shadowing physicians in the US, I noticed that when it came to decisions about their own care, the opinions of the elderly, and especially those with neurodegenerative disorders, were often disregarded. With this issue in mind, I decided to form an organization to serve local elderly with neurodegenerative disorders through service, fundraising, and raising awareness. When I first created this club, DukeHAND, I posted on Facebook to allow people to sign up for our email notifications. Due to general interest in its cause, we received over 500 responses from people enthusiastic about joining DukeHAND. Thus began a period of excitement that ended abruptly when, at the first club meeting, only three people attended. Rather than feeling discouraged, I decided to view DukeHAND from the perspective of those who expressed interest but did not make it to the meeting. At that time, it was an organization with an interesting cause, but did not yet have many concrete accomplishments. From this exercise, I realized that intentions generally do not motivate people. Instead, my fellow students wanted to see action behind our purpose.

With this concept in mind, I spent the rest of that semester contacting and building relationships with community organizations to create volunteering opportunities. These include volunteering with individual residents on a weekly basis and at popular group events such as Bingo. Communication with these organizations was difficult at times; lack of adequate staff and resources that caused this challenge further illustrated the need for our volunteering efforts and thus I was not discouraged. This process comprised of action and driven by reflection helped me to improve my skills in viewing my own actions from another’s perspective.

Now, after over a year of working to build an organization that contributes actively to community partners, we have over twenty active members who volunteer at a local nursing home for approximately 2 hours each week. This experience taught me the importance of reflection, especially as a leader. This is because it is this decision to analyze that allows this club to continue to grow toward success. It showed me that passion alone is insufficient to inspire. Instead, it is a combination of action, intentionality and thoughtfulness that defines leadership ability. This skill is also critical to the field of medicine. Physicians generally must work with patients in order to ensure adherence to treatment plans and patient comfort. Thus, the willingness to reflect on patient behavior and the ability to inspire action and motivation is critical. In this way, I will be able to best analyze what works and what does not for each unique patient in order to motivate habits reflective of sound physical and emotional health.

What qualities will you bring to the practice of medicine?

Prior to my undergraduate education, I would hike nearly every weekend in the summer and spring and take out my snowshoes and cross-country skis come winter. When I arrived at Duke, the opportunity to backpack and spend a full week in the woods presented itself through Project Wild (PWild). This organization seeks to teach leadership, experiential learning, and personal reflection as well as technical camping skills through an annual backpacking trip to Pisgah National Forest. After participating in the program for a year, I was selected to become a staff member. One of the most important duties of PWild staff is to keep participants safe. Since there is a high risk of injury and sickness given that the trip involves strenuous activity in cold weather, I took a course in wilderness medicine. While some of the skills I learned were similar to those I was using as an EMT, many involved a greater degree of resourcefulness and consideration of environmental conditions.

I then spent the next two March backpacking trips with a group of staff whose primary responsibility is to hike out to groups in need of medical assistance. In my time with PWild, I have realized a unique aspect of Wilderness Medicine that has served as a model to view the rest of the health system. Normally, the processes of discovering treatments, creating treatments, and administering treatments are done by different people. However, the dearth of external resources in the wilderness ensures that all of these steps are left up to one person or, ideally, a team of people. On one occasion, I was called by a fellow staff member leading a crew of participants because her crew members were acting strangely. I had to first determine the problem: hypothermia. I next had to improvise a solution: isolation from the environment using rubber pads, extra layers, and the body heat of a nearby crew. Finally, I had to execute the plan and lead my team in doing so. This experience gave me the chance to practice and improve my leadership and communication skills given the trust it required in both myself and my peers. It also forced me to consider the logical steps that go into treating a patient, and thus insight regarding the different stages of medicine.

It also emphasized to me a final step in the medical process: alteration of future behavior so as to decrease risk of relapse. In this case, that meant providing emotional support to those crew members that had experienced hypothermia and using this positive rapport to encourage safer behaviors such as keeping a set of clothing dry for sleeping and making sure not to camp on ridges where the wind is the strongest. The foresight required to effectively encourage prevention will mandate constant attention as a physician, yet I believe my experience in PWild has shown me its importance and value.

Outside of the relative isolation of the backwoods, the overarching connection in the medical field is not always so obvious. Working as a researcher I see the scientific and molecular basis for medical treatments and procedures. As an EMT, I am exposed to direct interaction with patients. Each of these experiences has provided me with valuable insight into individual components of the medical process. However, it is from my experience as a WFR that I have a better understanding of the inexorable network that forms the foundation of medicine.

Describe a situation where you failed. What did you learn from the experience? Describe at least one functional impact of the experience.

It started with an idea with a good friend after my first semester of college. We would like to create an app to inform users when their favorite gyms or restaurants would be most busy using predictive analytics. For over 6 months, we read about starting a business with minimal funding. We decided that we would learn to code in all of the necessary languages, including JavaScript and HTML, in order to create prototypes and better understand our goal product. For the time that we worked on this project, we were excited and inspired by the potential to create something novel that would improve the lives of others. It ended with a Google search.

On the right side of the screen resulting from this search was a bar graph showing how crowded my desired establishment would be at each hour of the day, the same information I had hoped to relay to my future customers. For this reason, a family member with far more business experience than either of us advised us to stop so as not to run into legal trouble with Google. This was crushing given that it was a project about which I genuinely cared and that I knew had the potential to make a positive impact on the lives of a lot of people. Yet, at the same time, I realized that my cause in creating this app was to help others and that benefit was still manifested whether I or Google was the one to release it.

I also saw how much personal good had come out of this experience even if we had never created our desired product. One lesson came from the feeling of enthusiasm I had throughout the process. Computer science and business are not in my primary area of study. It was not the field, nor simply the idea that inspired me, but rather all that I was learning. Each piece of information I found to help us accomplish our goals was new and challenged me to employ a different type of thinking. This sense of willingness to take risks instilled in me by this experience translated to everything from research to leadership roles. It also allowed me to look past a disappointing experience with the confidence that exploring novel subjects is worthwhile. In these areas, this same perspective on boldness and desire to make change is extremely beneficial since acceptance of the status quo in detracts from the potential for success.

Additionally, before then, I had never entered the realm of business or technology. Through working on this project I had learned an incredible amount about both fields and thus about how the systems from which I benefit each day were created and run. I also learned how powerful a tool information technology can be and gained a basic understanding of its implementation. I hope to take this knowledge into my career as a physician due to the movement toward modernization of the IT used in the administration of medicine.

It is certain that regardless of my positive intentions and active pursuit of their realization, I will experience failure in the future. However, through resilience and the willingness to reflect, I have realized that taking risks and moving away from what is comfortable allows me to expand my perspective and causes me to be more proactive and forward-thinking in other areas of my life.

What role has research had in your preparation for medicine?

I have found in my research that it is common for many experiments to fail before one succeeds. Thus, my greatest challenge has often been determining what went wrong. This requires a number of skills that I have developed over the course of my research experience. The first is persistence and the desire to continue thinking of new explanations and solutions, even without consistent success. From my experience as an EMT and in other clinical settings I have seen that this same thinking process is essential to clinical medicine as well. Often, the first attempt at treatment is ineffective. It is then necessary to take a step back, reconsider the scenario to determine potential problems, and take a new approach based on this analysis until one succeeds. The second skill research has taught me is the importance of collaboration and realizing when there is a piece of information I do not know. With the wealth of mentorship available to me in my lab, understanding how to best make use of the knowledge of my labmates has been on of my most critical lessons. It includes both admitting to myself when there is some concept that I do not fully understanding and seeking out that knowledge with the help of others. This too is essential in medicine given its nature as a continuous learning process where collaboration and information sharing between doctors improves quality of care.