Compartmentalization in Grad School

When I went to PA school I of course knew it would be difficult. I was ready for the long nights of studying and felt prepared for rotations after doing two years of patient care in a hospital. I had also juggled a master’s program while working in the hospital and building my blog and Instagram at the same time. Mindful multitasking was my love language. So when interview day came around, I felt level-headed and like what I had done before, both academically and socially, had prepared me for PA school.

So much so that when my interviewer asked how my readers would feel when I would have to give up blogging, I thought it was a trick question. Just a question aimed to derail and distract me (and indeed it did. I was in fact waitlisted at Northeastern before hearing word of acceptance a few months later.)

But as I entered the program, I gave more and more thought to her question, and I think she was genuinely serious. PA school is grueling. Demanding. It takes a lot from you and out of you, as does any grad school program and many jobs. The expectation is to surrender your former self and dedicate every part of you to this new identity, which truthfully I just wasn’t willing to do.

I am forever grateful to my blog and IG for giving me something other than medicine to identify myself as. It allowed me to stay rooted in nutrition and integrative medicine while in a very traditional western medicine curriculum. It also gave me a happy distraction, forced me to stop studying sometimes, and kept me on track with meal prepping and healthy living. It no doubt made PA school more challenging, but not just for the time constraint reasons.

It was incredibly frustrating to be in the classroom and hear an instructor say “go ahead and eat your French fries. There’s no evidence based research that food affects your skin.” And then popping on Instagram, “for clear skin, you must be gluten and dairy free, consume no refined sugars, take a probiotic, and do a colonic 4x a week.” (okay maybe a bit of exaggeration but you get the point.)

Constantly torn and confused. Wondering which way was “right.” I felt like I was straddling the realms of hyper-western medicine in one of the most prestigious meccas of medicine in the world (Boston, MA: home to Brigham, MGH – colloquially called man’s greatest hospital), Harvard, Dana Farber) with hyper-integrative medicine. The people I follow, the podcasts I listen to, the books I read in my spare time are holistic and functional, keen on tapering off medication or avoiding medication in general.

This was the most challenging in my first semester. It was so incredibly frustrating when nutrition was only spoken about as “maintain a healthy diet” in classes. Or learning in our nutrition class that canola oil is a vegetable oil so it’s “healthy.” Or when we had a lecture on diabetes and the class began with a video showing an individual consuming large amounts of butter as a means to parody obesity. In fact, it wasn’t just frustrating, it was infuritating.

But as I continued to crawl through the program, a professor said to me “you don’t know what you don’t know.” And this really stuck with me. I could actively choose to be frustrated and unhappy, or I could learn the why. I could lean entirely into PA school rather than trying to straddle both worlds and resist it.

A few more things helped:

1. Compartmentalization: I had to really separate church and state, or in this case PA school and blogging life. I honestly felt like I was living two different lives. One in which I was happy and bubbly and showing colorful foods and doing yoga and meal prepping. And another where I was in the library for hours on end cramming the pathways of the renin-angiotensin-aldosterone system. I wasn’t ready to be able to combine the two (and am still not.) I asked questions in some classes about supplements and dietary interventions, but for the most part I just threw myself in learning the prescribed curriculum.
2. Sticking with the realization that “you don’t know what you don’t know.” I went into the program feeling so firm in my convictions of where I saw myself as a PA. And this mindset made me so resistant to learning in the beginning. It was and still is so incredibly hard. Especially if you feel like you don’t necessarily “fit in” to the program or job you’re in. But being open to learning, even the things that are sometimes looked down upon in the integrative wellness community like antibiotics and NSAIDs, etc. made it so much easier. And then allowed for a far more balanced approach when thinking about how I would actually utilize these things as a provider.
3. Speaking up and adding in my questions where I felt it was appropriate. I think I was known as asking the supplement or the gut health questions and I’m okay with that. I’d often save these questions for the end with guest lecturers and go up to them as they were leaving. This way, I knew it wouldn’t derail or distract from the main points of the lectures. And I was always happy when I did. We had a hepatologist PA give one of our GI lectures and I asked about coffee and coffee enemas (he had mentioned in his lecture that drinking coffee is beneficial for those with hepatitis) and he was incredibly open to my question!
4. Shutting the fu** up sometimes. There were a few times when I could feel my frustration rising and a question burned in my throat – ie when we learned canola oils are “healthy”. If I felt emotional before asking a question, knowing I’d begin it out of a place of frustration rather than open curiosity, I’d hold on to it. There were a few times where I let it rip and I regretted it every time. Because not only is it disrespectful to the professor who’s dedicating their time to you, you’re not even able to form the question in the way it was intended. I was then able to unpack WHY I was so frustrated in the first place, and it was never from a curriculum standpoint (because realistically classroom curriculum can’t keep up with pace of which things are changing in the nutrition world. And this is especially true when I’m not even learning about nutrition. I’m a PA after all).
5. Reminding myself that my differences add to a more diverse classroom environment. It can be really hard to ask that burning question. Especially when you feel the energy in the room is horrifically poor and that everyone just wants to leave. But it enriched my learning experienced one hundred fold. And maybe (just maybe) made it so that my classmates felt comfortable asking me tons of questions outside of class? Or idk maybe this is just what I’d tell myself.

Using these techniques, I got in a nice groove during didactic year.

But then came rotations, when I had a little bit more time to jump back into blogging a bit more. Again, both a blessing and a curse. One that made me realize the deep divide between schools of thought even more.

On rotations: Heartburn? Try a PPI. Congested? Use Flonase. Depressed? SSRI.

And then Instagram. Heartburn? Apple cider vinegar. Congested? Flower steam. Depressed? Omega-3 supplement, sugar free diet, yoga, and adaptogens.

And even more jarring.

On rotations: seeing someone with life threatening tuberculosis

On Instagram: seeing someone get an infrared sauna installed in their house

And it’s obviously not as simple as this. Not as black and white. But it definitely felt like that at times. This deep, deep chasm of both medical and social class differences highlighted in two very different environments.

So I coped in my own ways, most of which were made possibly by amazing, amazing preceptors. I am forever grateful to my preceptors for always hearing me out. For saying yes when I asked to lead a group session on my psychiatry rotation on the link between and food and mood. For saying yes on my emergency medicine rotation when I recommended elimination diets and food diaries to track symptoms. For my GI rotation for allowing me to create a handout on how to taper off PPIs. For my primary care rotation for taking worksheets on elimination diets I received in my nutrition master’s program. For being able to add just a sprinkle of where I see myself in the future to my rotations.

Sometimes I was in a good place incorporating a little bit of me on my rotations and in the program. And other times it was easiest to compartmentalize. To be just a PA student as I took a break from Instagram. It helped me dive deeper into it to understand, not just temporarily memorize. Or to take some time away from my blog / Instagram to process and unpack the feelings of internal tension. And it always came back to my own black and white thinking (or seeing someone else’s on the internet.) One is not right or wrong. And neither side should be demonized. WE NEED BOTH.

I really think we are in a period of transition in medicine. Where each side criticizes the other – western vs. eastern. My goal is to equip my future patient with ALL of this information. To educate on both so as to come up with the best plan for that particular patient. Maybe start with one and incorporate another, finding the right balance for individualized care and making adjustments along the way. (note: I plan to work in some sort of outpatient clinic – ie primary care or GI. The above statements do not at all apply to the cases that require life saving interventions, like the emergency room or intensive care or hospital internal medicine.)

Overall, I’m grateful for it all. For my professor and preceptors. For my blog and Instagram. For my diverse and rich background. It drives me insane sometimes. Keeps me up at night. Makes me question this path every step of the way. But maybe that’s the point. It forces me to always question. To continue researching and to radically accept the process. However hard and horrible it may feel on any given day. Because on other days it’s liberating and fulfilling and so brimming with passion. My goal has always been to integrate a robust nutrition education into a medical practice. I do not know how I’ll do it, or even that I’ll do it. But I feel confident I have the tools to get me there.