Hello My Name is L. acidophilus

hi lacto

The old adage “you are what you eat” might not be as correct as saying you are your bacteria (that feed on the food you ingest). Ok, I know this is pretty gross, but bear with me here! It’s actually way cooler than it is disgusting. If who we are was really as simple as what we ate, then your friends whom you do paleo diet fads with or the boozy brunch club you meet with on the weekends should think and feel the same as you. When you really think about it, the way in which we process information, perceive our social interactions, and regulate our emotions can’t be as simple as the food we eat (although it certainly does play a crucial moderating role).

By now you have probably heard about the microbiome — the collection of microbes (bacteria, archae, viruses, fungi) that share a body cavity with us — and have heard the staggering factoid that you are more microbes than you are you (over 100 times as many microbial genes reside in your body than human genes) (1). Over the past couple of decades, microbiome research has exploded and has been primarily concerned with characterizing the types and composition of bacteria living in our gastrointestinal tracts (the “gut microbiome”) and how these community structures differ between “healthy” humans and those with disease states (like obesity, cancer, inflammatory bowel disease, and even autism). A lot of this blossoming program of research owes thanks to the biotechnological advances that allow us to not only sequence our entire meta-genomes (figure out what types of bacteria we have and their community composition) but also characterize our metabolomes (the collection of metabolites that we and these microbes produce that influence our health).

So why would I posit that when considering what makes us “us,” we should think more about the bacteria living in our guts than the food we put in them? Before completely throwing the baby out with the bathwater, I first need to pay this old adage some respect in that it does emphasize the correct location, just not the right players. Did you know that the gastrointestinal tract is densely innervated with neural fibers (the enteric nervous system) and connected with the vagus nerve, which essentially acts like a bidirectional highway between your brain and your gut? In fact, the GI tract is so densely innervated that it is referred to as your “second brain,” a fitting title given that it is home to the majority of your microbiome, which in total weighs approximately the same amount as your brain. These bacteria also produce neurotransmitters like GABA and serotonin that can directly communicate with the neurons of the enteric nervous system. Recognizing the direct relationship between the gut and the brain, researchers from psychologists to microbiologists have begun interrogating what we are referring to as the “gut-brain connection.”

How does the gut-brain connection impact what makes you “you?” Depending on who you talk to, there are a lot of different conceptions of the self and what makes us who we are. In terms of genetics, you are certainly your bacteria. But going beyond the genome, in my program of research, I emphasize the role of cognition (how we think) and emotion regulation (the way we generate and respond to emotions) in what makes us who we are, recognizing that the two processes are intricately intertwined. Psychological researchers have been uncovering the impact of the immune system on our brains for quite some time, and given that our gut bacteria can influence immune processes like the inflammatory response, it makes sense that we begin to look at how our bacteria can modulate immune-to-brain communication. If you didn’t know before reading my last paragraph, you’d probably laugh at the idea of events taking place in our guts having any impact on how we think and experience emotions. But even before this article, you inherently did know this fact to be the case — have you ever felt something was wrong in your gut? Did you ever make a decision based on gut feelings? See, you’ve been experiencing the gut-brain connection this entire time!

Most of the work done in probing the influence of bacteria on cognition has been conducted in animal models (2). This is because in order to support a role of causation, we must be able to directly control the variable of interest. But it’d be pretty hard, and frankly unethical, to control for the microbiome in humans. Therefore, researchers have developed mouse models that are completely germ-free, which allow us to directly interrogate the influence of the microbiome on behavior. How? We can observe how these germ-free mice behave under various experimental conditions compared to their microbial-rich friends: germ-free mice have been shown to have cognitive deficits in short-term recognition and working memory (3). We can assess the role of the microbiome in cognitive functioning in humans through observing patient populations with diseases characterized by microbial dysbiosis, like inflammatory bowel diseases (IBD). Not only are individuals diagnosed with IBD more likely to be diagnosed with depression and anxiety, they also have decreased cognitive function compared to controls (as measured by verbal IQ) (4).

While we can’t make a human completely germ-free, we can influence the types of bacteria that populate their guts. The one case where I think “you are what you eat” really holds up is in probiotics (ingestible microorganisms). Researchers at UCLA conducted a randomized experiment in which they instructed some healthy women to drink a fermented milk drink and others to drink a milk drink that did not contain any probiotics or nothing at all twice daily for 4 weeks (5). They subjected all participants to an emotion-eliciting task while in an fMRI scanner and found that this short probiotic intervention affected activity of brain regions that control central processing of emotion and sensation. Another group of researchers conducted a similar study and found that subjects who received a probiotic treatment showed reduced cognitive reactivity to sad mood, and this effect could be explained by reduced rumination and aggressive thoughts (6). In another study linking cognitive processes and emotion regulation, researchers found that participants who were administered probiotics for just 30 days demonstrated decreased self-blame scores and increased problem solving scores (7). These results were found in a healthy population and may have implications for cognitive affective processes in patient populations, which are crucial to coping with disease.

So, the next time you think about who you are, and why you think and feel the way you do, make sure to consider that your body is a universe that provides a home to trillions of microbes, and that we coevolved with these tiny inhabitants since the dawn of time. In fact, we wouldn’t be us at all without them.


1.        Qin J, Li R, Raes J, et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature. 2010;464(7285):59-65. doi:10.1038/nature08821.

2.        Allen AP, Dinan TG, Clarke G, Cryan JF. A psychology of the human brain–gut–microbiome axis. Soc Personal Psychol Compass. 2017;11(4):1-22. doi:10.1111/spc3.12309.

3.        Gareau MG, Wine E, Rodrigues DM, et al. Bacterial infection causes stress-induced memory dysfunction in mice. Gut. 2011;60(3):307-317. doi:10.1136/gut.2009.202515.

4.        Dancey CP, Attree EA, Stuart G, Wilson C, Sonnet A. Words fail me: The verbal IQ deficit in inflammatory bowel disease and irritable bowel syndrome. Inflamm Bowel Dis. 2009;15(6):852-857. doi:10.1002/ibd.20837.

5.        Tillisch K, Labus J, Kilpatrick L, et al. Consumption of Fermented Milk Product With Probiotic Modulates Brain Activity. Gastroenterology. 2013;144(7):1394-1401.e4. doi:10.1053/j.gastro.2013.02.043.

6.        Steenbergen L, Sellaro R, van Hemert S, Bosch JA, Colzato LS. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain Behav Immun. 2015;48:258-264. doi:10.1016/j.bbi.2015.04.003.

7.        Messaoudi M, Lalonde R, Violle N, et al. Assessment of psychotropic-like properties of a probiotic formulation ( Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011;105(5):755-764. doi:10.1017/S0007114510004319.

What is your “Program of Research?”

Program of research is a phrase you are going to hear a lot when you first start graduate school. People will ask you about your program of research and you will think to yourself… wait what? I just got here. I have maybe one or two publications. How the hell am I supposed to know what my program of research is when I have barely done any research at all?

The answer is you shouldn’t know — and if you say you know, you’re lying. Dr. George Slavich, a researcher at UCLA within the Cousins Center for Psychoneuroimmunology presented his work on the inflammatory basis of depression in my class on the biology of chronic disease last week. Before diving into his very exciting program of research, he brought up this very term and how frustrating it can be when you are early in your career to be asked about yours. This was beyond validating for me, as I have been struggling to come up with my program of research the past 2 months since starting graduate school.

Dr. Slavich brought up two intriguing points on this matter. The first is that instead of thinking about your program of research, you should reframe your way of thinking in terms of what you are passionate about. What questions keep you up at night? What do you genuinely want to study and why? What gets you going? By letting your passions be your guiding force, you will naturally hone in on a program of research without fretting about defining one up front. The second is that if you think you know your program of research now, you are wrong. Your body of work is going to naturally evolve over time through a series of unforeseeable happenstance events. Your advisor might leave your university for another, your partner might get a job in a different city, your field might incorporate a new technology. These are all factors that will inevitably shape your interests, introduce you to new people, and present opportunities that you just cannot have anyway of knowing about now.

From Dr. Slavich’s advice and sharing of his own career trajectory, I took away a key message: don’t force it. Be open and fluid with the way you are defining your program of research. When an opportunity arrises to learn a new technique, or analyze your data from a different perspective, or work with someone outside of your field, be open to it. And be true to your passions — I am obsessed with the microbiome, and even though that isn’t something in many health psychologists’ programs of research, I am passionate about incorporating it into mine.

So instead of making tables and schematic diagrams about your program of research as a first year PhD student (that’s what I had been forcing myself to do…), take a step back and allow yourself to follow your interests. Organically, you will end up with a strong, yet malleable, program of research.

It’s Not Just an Airline. It’s Israel.


Recognizing the Recanati winery name on the bottles in the El Al business lounge and the Barkan label on the bottle of crappy complimentary wine served in-flight just made me realize two things: I have worsened my wine addiction in Israel, and I weirdly feel more like an Israeli on this flight than I do an American. I have flown on several El Al flights throughout my life, and each time in the past I have been surprised by the amount of action. Usually domestic flights in America are pretty uneventful — people politely fall asleep in their seats or entertain themselves on their iPads and whenever someone from the window or middle seat has to disturb their aisle neighbor to get up to use the restroom, you get the sense that they feel bad for being a nuisance. This is NOT the case on an El Al flight. As I have written this one paragraph, I have counted 24 people walk past me. The two elderly orthodox men in front of me are are conversing in Hebrew and standing in their row leaning on their reclined seats so that their fingers are in my face while I am scrunched up with my arms like a T-Rex just so that I can continue typing on my very small tablet. I actually need to type this with one hand and hold my paper cup of crappy free wine in the other, they are shaking the chair that violently. And while this type of utter disrespect for personal space would have appalled me in the past, I expect it now.

In fact, I was more weirded out by how polite people were on my Jetblue connecting flight this morning from Tampa to New York City. Wow, just now, the woman across the aisle from me stood up and started leaning ON MY SHOULDER. You cannot make this stuff up (*orders another glass of the complementary wine, anxiously anticipating for when the bottle will be up for grabs in the flight crew’s quarters*). And now she is actually reading over my shoulder in such an intrusive and obvious way that I suspect she is reading this very sentence right now — Shalom Mrs. 28D, how do you find the content of my blog, interesting? As I write this, 5 orthodox men walk past me (and shove past her) with their tallit grazing against my face.

So I find myself in seat 27C trying to understand why I am so relieved to be on this characteristically horrible flight. I think it boils down to this — these people, including Mrs. 28D and my orthodox buddies reclining literally on top of me, are my family. And even though you can’t pick your family, you love them because they are yours. These are my people — yes they might be rude and obnoxious and just downright absurd sometimes, but they are mine. And I am theirs. And I know this because I expect them to act this way, I know them. I know this because I smiled when I saw the assortment of wafers available for dessert in the business lounge. I know this because I understood snippets of words as the El Al check in crew spoke to each other in Hebrew. I know this because while waiting in line to board I could overhear complete strangers play Jewish geography and share about when their grandchildren did Birthright. And I could hear the same phrases and same conversations my grandparents have had in the past.

We are a collective. In fact, I recognized a young couple with a very young child from my flight from Tampa similarly trying to figure out why El Al agents weren’t at the check in desk at JFK when we arrived. Without hesitation I asked them if they thought we were there too early and what they were planning to do while we waited. Of course we exchanged information regarding where we are from, why we are going to Israel, the typical back and forth you have with a stranger who is a part of your tribe.

And no, we are not perfect. In fact we are far from it — and we are shameless about it. The man behind me is now tapping intensely on his tray as if he wants to make sure I know he is back there. I asked him to stop and he was sorry — he had no idea. A woman across the plane is using flash photography. With an expensive professional camera. Why on God’s Earth would you want to document this unbearable trek? Mrs. 28D actually asked to SEE each of the meal options for dinner before deciding on meatballs or chicken. These are all things I am noticing while listening to music and writing, trying my absolute best to be unaware of my surroundings. I think that’s one of the things I love most about this plane full of crazy people. We all know we are crazy and pushy and rude and we are unapologetic about it. I say “we” because pre-Israeli residence Arielle would have torn her hair out in response to these behaviors. Now I expect them and can not only bear them, but find them annoyingly comforting.

The best part of this is that I know the majority of my family members on this 11 hour plane ride from hell feel the same way. We are all annoyed. We are all annoying. And we are all willing to put up with it and each other because we love our destination that much. And one of the best parts about living in our destination is that we will continue annoying each other on the bus, at the shuk, and everywhere else because that’s just what we do and who we are. And I love absolutely every single one of them for it.

Clinical or Experimental Psychology PhD?

I thought I was the only one who applied to both clinical and experimental psychology PhD programs. I know it seems like an indecisive move on my part — by now, I should know whether I want to be able to practice as a clinician or not. I will admit it is indecisive to apply to both (and makes your work that much more cut out for you in terms of researching and narrowing schools of interest and tailoring statements to specific programs). I actually had a situation where I was interested in both the clinical and experimental programs at one school and only after emailing potential mentors and writing both statements did I realize that the portal would not allow for applications to multiple programs.

This makes sense since by the time you are ready to pursue a PhD, you should know what your ultimate career trajectory will look like. And I did: I wanted to do research that satisfied my intellectual curiosity and had a direct positive impact on patients’ lives. For the longest time, I had come to terms with that meaning I must pursue a clinical degree. But when it came time to look into clinical programs that had faculty conducting the kind of research I saw myself doing, the pickings became very very slim. Most clinical psychology programs have faculty that are researching traditional psychopathology, which makes sense since most clinical training revolves around treating mental illness. When you think of a psychologist, depression and schizophrenia come to mind, not cancer and chronic disease.

This is where you need to make a choice: what do I prioritize, research fit or program fit? I struggled with this for some time, I didn’t want to give up the prospect of clinical training but at the same time I didn’t want to pretend to be passionate about research that frankly does not interest me. Allowing research fit to dictate which programs I ultimately applied to helped me in two respects:

1. It naturally narrowed my program selection down to 5 schools (which is an absurdly low number of programs to apply to).

2. Revealed to me that choosing an experimental program over clinical would not be a deal-breaker: I was going to graduate school to do research and I viewed clinical training as an added bonus, but it wasn’t my primary purpose.

Ultimately, I applied to 4 clinical programs and 1 experimental. These 5 programs were very different from one another in various respects: some had dedicated behavioral medicine/health psychology tracks, some included biological training, one was within a developmental program (pediatrics), and they were spread out all over the country. Applying to only 5 schools was definitely a statistical risk — these programs have around a 2-5% acceptance rate and limiting myself to only 5 programs made my chances that much slimmer. But I think strategically it made sense for me given my niche research interests. Only having 5 applications allowed me to take my time learning about each program in detail and tailor my statements in depth.

To my surprise I received 4 interview invites out of the 5 programs I applied to. Focusing my efforts on a few great fits worked to my advantage. It also helped me prepare for interviews in a focused and targeted manner. I was secretly hoping that I would only get one or two interviews so that I wouldn’t have to choose between clinical or experimental but this was not how my situation turned out and I think it was for the best. Going into interviews having to identify which would position me the best in terms of my career goals helped me formulate my questions and evaluate the programs in a personally critical way.

I actually asked students and professors their opinions on the clinical vs. experimental dilemma and believe it or not, a couple of the current students had been in my predicament! Hearing that I was not the only one entertaining both paths was reassuring — I wasn’t indecisive or ignorant on the manner, I was just trying to determine which existing program would fit best with my niche and alternative career trajectory. In the end, I felt most at home within the experimental program that I applied to: my interviews with all of the faculty and students felt like conversations rather than interrogations. I also realized that clinical training would take a significant amount of time away from my research productivity and I decided that this was not the best setup for me.

In the end, I felt that choosing an experimental program dedicated to Health Psychology was the perfect fit for me: I would be able to do the research that interests me while having direct clinical application to patient populations that I am passionate about helping. While I won’t be the one delivering the clinical interventions, I will be designing them and that is what I want to do. If I hadn’t given myself the opportunity to explore all options, both clinical and experimental, during my application process I wouldn’t be as clear about this as I am now.

So apply to both. If you have any question at all, apply to both.

Balancing Ambition and Vulnerability


Juggling ambition and vulnerability is something that I have been struggling with over the past couple of years. Holed up in my office at Bellevue Hospital during the week and spending my weekends in coffee shops essentially defined the majority of my last year living in arguably the greatest city in the world, New York. In hindsight, I still can’t believe the number of times I flaked on plans or just didn’t even bother trying to make them, getting into the habit of valuing my work over my relationships. However, I don’t in any way regret how I spent my time there — the energy and pace of NYC is conducive to becoming a complete workaholic. And the hard work paid off: now I am able to live in arguably the greatest city in the world, Tel Aviv. But unlike my time spent in New York, which never had a tangible expiration date and lasted a solid 8 years, I am coming to terms with the fact that my time in Tel Aviv is terribly limited. I am already 1/5 of the way through my experience here and I am still learning how to balance several competing interests (lab, the start-up, friends, exploring Israel, alone time).

In a way, knowing that my time in this beautiful country with all of the fascinating people I have met is precious is forcing me to resist my habit of completely committing all of myself to work. For example, choosing to spend the afternoon in the park basking in the sun, hours that could have been spent in lab or working on my biosketch for an upcoming grant, is a decision that I would have never made while living in NYC. But knowing that my time here is limited reminds me of how crucial it is that I take the time to be wholly present, to be in tune with my surroundings and to feel everything in the moment. Finding the right balance between committing yourself to your work and enjoying your life is all the more difficult when your work is something that you are intensely passionate about. I have chosen a career path that necessitates a blurring of work and personal spheres, and I really couldn’t see my life in any other way. But when the mental and emotional energy you dedicate to work impedes your ability to be vulnerable to others, so much so that you view relationships (platonic and romantic) as a threat to your professional success, I know I have tipped the scales in an unhealthy way.

Living in Israel has provided me with the opportunity to challenge myself to be better balanced: to refine the skill of seeking both professional and personal development. I can recognize now that I used my work in New York as an excuse to not engage in social opportunities, to not be vulnerable to people, and to ultimately not be vulnerable to myself. Excelling in my work did provide me with a newfound sense of self-worth, autonomy and confidence. But I think learning how to share myself with others and viewing those shared experiences as advantageous to my work is the next step. So I have decided to challenge myself to be vulnerable over the next remaining 4 months in a way that I have never been: I want to maintain my independence and dedication to work, while also being vulnerable to others and to my own feelings, and find the synergy between the two.

The picture of the hodgepodge graffiti above was taken while on my way with a friend to Casbah, the cafe I have been spending most of my time reading and writing in over the last couple of weeks. I find it represents one of the small ways that I am trying to find balance: instead of disappearing for hours into a coffee shop, I am inviting my housemates and friends to work with me at the cafe. It also reminds me of all of my competing interests, which on the surface appear to be unrelated, but somehow can coexist in a fashion that ultimately makes each individual piece that much more valuable.

So the vulnerable truth is this: I am allowing myself to truly connect to a place and people for the first time in ages, and I can’t stop smiling.


Protocols and Purim

Since I last posted, I have experienced two more wonderful things about living in Israel:

  1. For the most part, the entire country celebrates Jewish holidays.
  2. For the most part, scientific research is a universal language.

Learning a new wet lab protocol and celebrating Purim (Jewish Halloween) by dressing up in costumes and drinking way too much because that is what the Megillah tells us to do probably don’t seem at all related… but I think there is more to the connection than just alliteration. Stay with me here.

Purim fell on a Sunday this year (which is the first day of the week in Israel) so the university was closed that day. Of course the festivities started as early as Thursday night, which left room for at least 4 days and 4 nights of parties, costume changes, and back-to-back hangovers. Coming from New York City, I thought that I had a pretty good handle on partying… but Israelis take it to a whole new level. My housemates and I entered the holiday weekend quite strong, with group costumes and dancing until the morning hours. But I only lasted 2 of the 4 nights. Even so, I was pretty proud of my stamina given my pathetically long hiatus from fun as a result of applying and interviewing for graduate school.

Because the university would be closed on Sunday, I decided to work remotely from my favorite cafe and catch up on reading since I am essentially teaching myself the immunology component of psychoneuroimmunology. As I was reading a dissertation from a former lab member, my PI sent me a text on Whatsapp (how most Israeli’s text) to let me know that if I wanted to come to the lab to do work he would be there and could let me in. I messaged him to let him know that I would be spending the day working remotely at home, to which he replied with a string of emojis (including various alcoholic drinks) and pictures from his Purim weekend. I think it’s pretty obvious to say that this type of casual and friendly exchange is not typical in the States. But in Israel, professionalism takes on a casual style that is pretty foreign and difficult to get used to. Luckily, the project manager that I work with for the healthcare startup company happens to live in my neighborhood and he was working next to me at the cafe so I was able to ask for his help in responding. He was like obviously just send him a picture from your Purim party…

I have always said that I don’t have a professional version of myself. In most situations I am the same person when talking to my friends, family, coworkers, study subjects, and bosses. My casual and authentic tendencies are translating very well in Israel and I am finding that this is having an impact on my work (here is where the protocol comes in!). I have wound up working mostly with a current PhD student in the lab who, like me, began her academic career in psychology and is now doing her doctoral work in physiological psychology. This is a huge perk because when she is explaining experiments and methods to me, she understands my background and is able to translate biochemistry-heavy concepts into explanations that make sense. Not only is she a great teacher, she is also letting me tag along with her to audit her classes (which happen to be in English!) in genomics and bioinformatics. And on top of all of that, she’s really fun to hang out with all day and lets me pick her brain about growing up in Israel.

Because the work culture in Israel is more casual than in America, I feel more comfortable asking questions and giving my opinion. This has allowed me to say yes to opportunities that otherwise would be extremely intimidating. Auditing courses in genomics and bioinformatics is one thing, but saying yes to running a wet lab experiment by myself without any prior formal bench-work training is an entirely different level of confidence. Admittedly I am a pretty confident person (otherwise I wouldn’t have moved to Israel), but I know when I don’t know something and running an ELISA is something I definitely do NOT know how to do. Sure, following a protocol is like following a recipe. You just go step by step, adding and removing various ingredients to a plate. But what if the recipe is in Hebrew…?

I know, I know. I have been taking Hebrew lessons. But conversational Hebrew typically doesn’t cover words like “pipette” and “reagent diluent.” So I did the only thing I could think of, I made my own protocol. I watched the 2 day process once and spent this past weekend writing up my own English protocol, including schematics of the experiment (I can’t help myself, I love a good figure — see below) and concentration calculations of reagents from this particular ELISA kit in order to know exactly what I need to do and how much of each reagent I will need to run one plate.

ELISA Schematic.png

Sure, while it would have been easier to follow a protocol written in English, I am actually grateful for the experience of having to write my own. Writing a protocol from scratch tests your knowledge of an experiment and ensures that you actually know what you are doing and why you are doing it. One funny aspect of this though is that because I am learning these techniques for the first time in Israel, I am learning the names of equipment that I am unfamiliar with in Hebrew. So even though my protocol is mainly written in English, some terms are still written in the Hebrew language, for example, קלקר (“cal car”) is the word Israelis use to describe the Styrofoam egg-crate looking tube holder. Cal means “light” and car means “cold,” so I actually learned 3 new Hebrew words from writing an ELISA protocol!

I think the experience of celebrating Purim and learning a new experimental protocol within the same week is representative of Israeli culture. People here work extremely hard and efficiently, but also know how to live. They allow for a blending of personal and professional interaction, which I think ultimately enhances their work. I am looking forward to integrating this type of work culture, and my newfound scientific Hebrew vocabulary, into my doctoral training this Fall!


2 weeks in, already at home.


I moved to Florentin, Tel Aviv on February 20th, 2017. It has been nearly two weeks since I left everything and everyone I knew back home in America and it only took 1 day for me to find a dog-friendly cafe across the street with superb free WiFi, great coffee, cheap beer, and chatty baristas who already have my coffee order (coffee eem chalav skedeem — espresso with almond milk!) ready for me in the morning and are offering me a bartending gig.

In the past 2 weeks I have done several sightseeing excursions, including an overnight trip down South to Eilat where I sat in the middle of desert sand dunes alone with my thoughts for 30 minutes, spent the night at a kibbutz, hiked in the Red Canyon, and snorkeled in the warm waters of the Red Sea. And while this trip along with the other programmed events included in my participation in a Masa-sponsored internship program have been awe-inspiring and informative, they are not the main reason why I am so happy to have done this crazy thing.

The best part about moving to Tel Aviv is the undeniable feeling of being at home in a country and city that could not be more unfamiliar and more familiar at the same exact time. Nothing about this place is anything like the small coastal town in Florida I grew up in, nor does it resemble New York City in any way, shape or form. But for some reason, the language, the people, the energy, the food, and the graffiti all come together in such a perfectly familiar way. So much so that I feel like I was always meant to live here. For example: I have been spending every day for the past week in intensive Ulpan (Hebrew immersion) and even though the Hebrew language sounds and looks nothing like English, hearing it and speaking it and writing it just feels right. When my teacher asked why I wanted to learn, I immediately responded that it was because I felt Hebrew was the language I was meant to know. Even being left-handed, as silly as it sounds, allows me to write in Hebrew better than I do in English.  While I had struggled to learn French for nearly 8 years, within 1 week of Ulpan I am already very comfortable speaking and reading Hebrew.

I also very much identify with the spirit of the Israeli people. Everyone here is so direct. People say what they mean, and do what they want. It’s that simple. You never need to wonder whether someone actually wants to see you, or if they really do like you. And while this way of interacting might come off harsh, I respect the directness and appreciate the clarity (coming from a place like New York City, I definitely do not miss people being fake or flaking out on plans). I wasn’t surprised to love the Israeli culture or the people who live here — I have been fortunate to visit Israel several times throughout my life and have always managed to make friends (some I have already managed to see!). What I was surprised by was just how much I love the people participating in my program with me. In Tel Aviv, we have 13 participants (8 women and 5 men) from around the world (South Africa, Canada, England, America, and Australia) all interning in different fields ranging from consulting to journalism to social justice to science. While we all come from different places and are pursuing different career paths, we relate on a level that I have yet to experience at home. I think it takes a specific type of person to uproot their life completely to move to the Middle East for 5 months with a bunch of strangers.

So while I sit here at my neighborhood cafe with a Great Dane to my left and a Pug to my right, I can’t help but feel immense gratitude for the opportunity to live in a country that, within 2 weeks, feels more like home than any other place I have ever been. I am so excited to begin my work at Tel Aviv University on Sunday (which is the first day of the week in Israel) and to see how research and academia differ in Israel compared to the states. Based on my initial meeting with my PI, I think I will feel just as at home in his lab as I do in my neighborhood of Florentin. And while I begin this journey knowing that it must come to an end so that I can begin my doctoral work stateside, I already know that making Aliyah (moving to Israel permanently) for postdoctoral work is on the table. I’m curious to see how my experiences over the next 5 months influence that initial feeling. Stay tuned!

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!

#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


*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.