Interview Invites: The Waiting Game

I thought that applying for graduate school was the most stressful couple of months of my life… I was wrong. Yes, it was a lot of work over a period of about 10 months: researching programs that seemed like great fits, cold-emailing potential mentors to gauge whether they would be entertaining new students during my application season, applying for the NSF Graduate Research Fellowship Program, and then actually getting around to writing statements for the actual applications. I won’t get into everything that went into what seemed like a 5 year process of applying to graduate school here — that definitely warrants its own post.

My point is that while applying to graduate school was an insane process requiring a ton of work and research while juggling a full-time job and a consulting gig, I had control over every step of the process. Once I learned which programs I was interested in had faculty members conducting research that I wanted to work on AND were accepting new students into their lab, I ended up applying to only 5 programs. I have heard that the average prospective student applies to ~15 programs, so my approach was anything but typical. Applying to a small set of programs allowed me to really focus on every single component of each application and tailor every statement to that program and the faculty members I was interested in. For someone who is just now realizing how type A of a personality I have, the ability to be meticulous and focused was oddly comforting.

I thought I would feel intense relief once I pressed submit. It felt like my entire life was leading up to submitting these applications and I thought that once they were out, my stress would be lifted and I would be able to operate like a real person again (actually hang out with my friends and enjoy New York City without my mind being partially occupied by the thought of what to write next in my statements).

I was surprised that once my applications were out, I was more stressed. The anxiety really set in: what if I don’t get an interview? I started to second guess myself in ways that I never did during the application process. I wondered if all of the work I had done was for nothing. How embarrassed I would be if after everything I did and all of the work my mentors and friends did reviewing my statements, writing me recommendation letters, providing support and encouragement, if I didn’t even get an interview. I would crawl into a hole and never come out.

I started obsessively checking thegradcafe.com (which YOU SHOULD NOT DO!). For those of you who do not know about it, this is a website where applicants can post interview invites and admissions decisions. It seems really helpful since this kind of information is not made publicly available by most programs. Essentially, if you do not get an interview invite, you will not be accepted into the program. Therefore, it seems like a good idea to know when others are getting invitations so that if you do not get one you can move on. Sometimes I would refresh the psychology search results at an hourly rate. Just slightly obsessive. For the first couple of weeks in December no one had posted regarding interview invites from the programs I had applied to. I was in the clear, it was still too early. This was a blissful couple of weeks, but it didn’t last long.

It was Monday evening, December 26th, 2016. I will never forget. I was home in Florida to spend time with my family during the holidays prior to moving to Israel. My grandparents came over to our house to celebrate Hanukkah and I was still incapable of enjoying my freedom from the application process. Instead of focusing on my time with my family, I was refreshing thegradcafe.com, when someone posted an interview invite from one of my programs. My heart dropped. I had convinced myself in the span of 30 seconds that my life was over, I would not be getting into graduate school, and that I was moving to Israel to do research in a lab that would not contribute in any way to my professional development anymore. I started coming up with plans B, C, and D. My academic career was over before it started, and it was time to move on.

I knew that this reaction was completely out of control. I had put years into this process, and a single post from a stranger on a website convinced me that it was all for nothing. That was when I decided to block myself from thegradcafe.com and really enjoy my time at home with my family. I had been away from them for nearly 8 years, and was about to move across the world for at least 5 months. It was time to get some perspective and grow up.

Three days later, on December 29th, I received my first interview invite. And no, I did not post it to thegradcafe!

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#5 Friday Fun Fact – Mommy, where do my microbes come from?

The Two Brains

The first colonizers of the baby’s gastrointestinal tract and skin actually come from the mother’s vagina. As the baby makes it’s way down the birth canal and out into the world, it is coated in it’s mother’s vaginal microbes, which then make the baby their new home. It is believed that this initial colonization is critical for kickstarting the baby’s immune system. What happens with cesarian sections? C-section babies still get colonized, but their bacteria more closely resembles that of mum’s skin and the hospital surrounds. Some people people believe that the microbiome might be responsible for the higher rate of immune-related disorders (e.g., asthma) that occur in C-section births. See post from Arielle Radin for some more information on a potential solution to this problem – vaginal swabs for C-section babies.

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Clinical Experiences at Bellevue Hospital

bellevue

*all patient names have been changed to protect patient privacy

Juan could not meet me at the hospital for our scheduled study visit because his brother needed to use the MetroCard his family shares to get to work. I have been living in New York City for over seven years and I had never heard of a person sharing a MetroCard, let alone with an entire family. Juan had collected a stool sample for one of the research studies I manage, which our lab uses to characterize the types and composition of bacteria living in his gastrointestinal tract. To lessen Juan’s burden of finding transportation and to preserve the integrity of the sample, I took the subway to meet him at his home.  At the time, Juan was just 19 years old, attending community college and living at home with his mother in a predominately Hispanic rent-controlled apartment complex in Bushwick, a Brooklyn neighborhood that is now a quintessential case study of New York City gentrification. His lack of access to guaranteed transportation is not Juan’s only obstacle to healthcare – like many of the patients I work with, Juan is under-insured, making the costly biologic therapies required to maintain his remission seemingly out of reach.

Stories like Juan’s are unfortunately common within a subset of the patient population that I work with. I recruit patients diagnosed with inflammatory bowel disease (IBD) from hospitals associated with New York University’s School of Medicine to participate in longitudinal research studies evaluating the role of the human microbiome in IBD pathogenesis and treatment efficacy. While all the patients that I work with are cared for by the same team of NYU attending gastroenterologists, half are treated at Bellevue Hospital and the other half are treated at Tisch Hospital. The only difference between these two medical centers is that Bellevue provides access to care for under- and un-insured New York City residents. Therefore, much of the patients that I see at Bellevue are immigrants, some undocumented, with nationalities spanning from the Dominican Republic to China. This unique patient population adds a depth of diversity to IBD research that is typically uncommon in the literature.

While the physical presentation of IBD is similar across all ethnic groups and socioeconomic classes, the treatment experience for underserved minorities leaves much to be desired. I have been recruiting patients at Bellevue Hospital to enroll in an IBD registry to study the differences in clinical presentation and care across different races of IBD patients. Even though we found that disease severity and clinical strategy did not differ based on racial group membership, the number of years it took from symptom onset to diagnosis was larger in the African American patient population. This is highly problematic given that IBD is a progressive disease, with prognosis worsening with each year the disease goes untreated. This disparity is purely reflective of access to care, highlighting the increased vulnerability of ethnic minorities when it comes to managing their IBD.

Bellevue Hospital provides a crucial resource to these vulnerable patients, making their IBD therapies accessible and affordable while providing care in a safe and culturally accommodating space. For example, while approximately 30% of the patients that I recruit do not speak English, I can still work with them through Bellevue’s extensive translator services. However, patients who do not speak English are at a serious disadvantage in terms of health literacy as it pertains to their IBD diagnosis and treatments. And while Bellevue provides a unique service to these patients, the difference in clinical care experience between Bellevue and Tisch Hospital is striking. José, a patient enrolled in our study evaluating the impact of gut bacteria on thiopurine intolerance, has learned to take an unpaid day off from work when he has a clinic appointment because he has waited up to five hours for bloodwork in the past. The possibility of missing work or being left without childcare results in Bellevue patients missing their clinic and infusion appointments at a much higher rate than privately insured patients seen at Tisch. This leads to treatment nonadherence, resulting in a greater risk for disease relapse and hospitalization.

While our studies are strictly observational, I have found that by participating in research, our Bellevue patients clinically benefit. Providing direct clinical care to patients was something that I had always thought I needed professionally to feel like my work was positively impacting people’s lives. However, I have discovered the power of research to provide an extra layer of clinical and psychological support to patients who are especially vulnerable in terms of healthcare access. For example, because our study timepoints occur at clinically relevant intervals (at each infusion or clinical checkup) I am able to remind patients of their upcoming appointments and proactively identify and troubleshoot potential barriers to care before they occur. I also serve as an additional liaison between the provider and patient, recognizing when patients are clinically worsening and communicating this to their treating physician.

Not only do underserved patients clinically benefit from participating in research studies, so do the quality and applicability of the research findings. While IBD has traditionally been viewed as a predominately Caucasian and Western disease, incidence of the disease has been increasing worldwide, with more and more ethnic groups being affected. Bellevue Hospital’s culturally diverse set of IBD patients from around the world provides a unique opportunity to study a representative sample of this global phenomenon. It is important to me that I am able to continue studying patients from diverse cultural and ethnic backgrounds in order to capture the complete picture of disease in my research.

I am proud to report that Juan is now 21 years old, about to earn his associates degree, and is maintaining his remission through effective disease management. Even after his participation in our research study ended, Juan would miss his infusion appointments unless I reminded him, often joking that I was his clinic mom. However, he recently asked for me to discontinue my reminders about his appointments because he wanted to be more proactive in his IBD care. I like to think that through his participation in research, I provided Juan with disease management scaffolding. My PI, Dr. Lea Ann Chen, is a physician scientist who solely treats Bellevue IBD patients like Juan. She was recently awarded the Sherman Emerging Leader Prize for her work treating and studying this underserved population. I am grateful to have had played a role in this work. I aim to follow in her footsteps, focusing my research on underserved chronic disease patients in order to not only provide an additional layer of clinical care, but to also ensure that my research findings extend to all members of a disease patient population.

 

TheTwoBrains: “I Study Poop – Adventures of Scientists on the Front Line” Interview

I was recently featured as an early-career researcher on thetwobrains, an awesome blog about the gut-brain axis! Read for entertaining experiences microbiome researchers face, and follow for the latest interesting gut-brain research!

The Two Brains

Hi Brain-Gut Lovers! Today I am introducing a new section of the blog that I am really excited about. Drum roll please…..Da da da daaaaaaa

I Study Poop: Adventures of Scientists on the Front Line

Today we are catching up with Arielle Radin, currently at New York University, and about to head to Tel Aviv University, regarding some of her poop-related love.

Tell us a little about yourself, who are you, what stage of your career are you in, where are you studying/working?

Hi fellow poop lovers, my name is Arielle Radin and I manage translational research projects aimed at evaluating the role of the gut microbiome on human health and disease. Officially, I am a Research Coordinator within the Department of Medicine at the NYU Langone School of Medicine. Since my time at NYU, I have worked for a couple of different researchers (Dr. Lea Ann Chen, Dr. Lama Nazzal,Dr…

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