Article In Brief
In a year when COVID-19 derailed the traditional Match Day celebrations, a group of newly matched residents discuss what brought them to the specialty and how they hope to make their mark on the field.
COVID-19 cast a pall over this year's Match Day as celebrations and graduation ceremonies were called off. Newly matched residents found it challenging to plan for their new lives as flights were cancelled and rental agencies lacked personnel to show new apartments.
“It's bittersweet,” said Felicity Cooper, a medical student at Penn State University who matched to a neurology residency program at the University of Rochester.
“I found out that I matched into an amazing residency program and that was one of the happiest days of my life. But in the background, Match Day ceremonies across the country were cancelled, and I made the most of it by having a small brunch with my family. ... I have to start preparing to move to upstate New York in the coming weeks and months—there are no apartment showings, making an already difficult time even more difficult. I'm more afraid than hopeful, but I do think that joining the workforce of physicians at a time where we are needed most is rewarding in itself and hope to have a meaningful role in patient care in the near future.”
Indeed, Cooper's enthusiasm for the role she hopes to play in neurology was a common theme in conversations with five other newly-matched neurology residents. In interviews with Neurology Today, they shared their stories about the events and people that had brought them to this Match Day and the hope of making their mark as future neurologists.
Cooper credits her grandmother, who raised her along with five other children in West Philadelphia, with always instilling the importance of education. Her grandmother was so proud when Cooper graduated college at Lehigh University that she spent days telling strangers about her accomplishments. On graduation day, her grandmother beamed and said nothing of her own failing health—she was in renal failure and would be gone three months later.
Her lessons were indelible. “She taught us to take advantage of everything,” said Cooper, a behavioral neuroscience major who would go on to spend a year in the AmeriCorps' City Year program with hopes of helping keep high school students in her community on track to graduate. (At the time, 44 percent of students in Philadelphia had dropped out of high school.)
She was different. She always wanted more learning. After City Year, Cooper completed a master's degree program at Thomas Jefferson University and afterwards secured a job working on rare dementias in the Center for Neurodegenerative Disease Research at the University of Pennsylvania. It was there that she was inspired by many mentors to become a doctor. And so she did, at Penn State.
“I wanted to be a physician-scientist,” she said. Always interested in brain diseases, she piled on rotations in neurology and neurosurgery, and set her sights on the University of Rochester, where she knew that she could experience equal measures of research and clinical care. During her visit, she remembers hearing the founding chair's philosophy about patient-centered care: “You can't always be right, but you can always be kind.” She was sold on the program, and now she will be part of it.
When Aaron Zelikovich was a senior at Northwestern University, he had the opportunity to work in the Muscular Dystrophy Association (MDA) clinic at Lurie Children's. It was 2014 and he was working on spinal muscular atrophy (SMA) clinical trials with pediatric neurologist and mentor, Nancy Kuntz, MD.
Zelikovich would talk to families and explain the possible ways to make their children more comfortable: a G-tube, a tracheostomy, or palliative care. Six years later, he was a fourth-year medical student, studying in his home state of Indiana, and was having very different conversations with his families.
Two new therapies—nusinersen and onasemnogene abeparvovec-xioi—had been approved that were helping patients reach their developmental milestones.
“It was the first time that I saw neurology as a field where we can diagnose and treat and actually change lives,” said Zelikovich. “It reaffirmed my passion and commitment to neurology.”
Graduating in May from Indiana University School of Medicine, he matched at Weill Cornell Medical Center in New York City, where years earlier he had met Neurology Today Editor-in-Chief Joseph E. Safdieh, MD, FAAN, at the AAN Annual Meeting. Dr. Safdieh was then director of the medical student neurology clerkship.
That chance encounter led him to apply to Weill Cornell. “I am so excited about getting to work with Dr. Safdieh, neurologist and migraine specialist Matthew Robbins, MD, and the entire team who will help me grow and develop as a neurologist, an educator, and a scientist.”
Zelikovich has decided to go into adult neurology with an eye towards his past work with pediatric neuromuscular patients. “We will soon be having these kids survive into adulthood and I want to put the pieces in place to help them thrive,” he explained. He is hopeful he will be able to start his residency on time, despite the fears and realities of training in the era of COVID-19. He is excited to join his future colleagues in a few months and have the opportunity to take care of patients on the frontlines in New York City, an epicenter of the viral pandemic.
If Tina Kiguradze's parents had their way, their daughter would be studying mathematics, pondering numbers and theories in a post-doctoral program, following in the family tradition. Both her mother and father, even her grandparents, were mathematicians.
Kiguradze was raised in the rural countryside in Russia and was 16-years-old when she graduated high school and made her way to the US to meet up with her father. He had taught in Japan and in several European countries and was being recruited to the Florida Institute of Technology.
Kiguradze did not speak English but it didn't stop the teenager from enrolling in college at the Florida Institute of Technology. She quickly fell into step, selecting business as her major, and a minor in mathematics, of course. It wasn't long before she realized that she wanted a more social profession, and that math and business were not going to be her calling. But medicine, yes, that would feed her temperament to help others. She graduated with a bachelor's degree, pursued a post-baccalaureate pre-medicine program at Northwestern University, and headed into a hospital volunteering to work with dementia patients and those with movement disorders.
Her experiences made her next step—medical school—obvious, and she was accepted at the University of Central Florida. She knew early on that she wanted to spend her career as an academic neurologist.
“I used to watch my dad scribbling in his pad and coming up with new ideas, and neurology is still uncharted territory, and there are so many questions that need answering,” she said.
In medical school, she would always find her way to brain disease. She was the stroke person on her internal medicine team. She remembers her first patient with amyotrophic lateral sclerosis and the discussion that centered around his care and exactly how much he wanted done.
“I learned to put my patients' desires first and meet them where they are, and not where I want them to be,” she explained, adding that she had her heart set on Washington University School of Medicine in St. Louis because of the school's commitment to physician-scientists. The visit cemented her decision.
“I listened as David Holtzman, MD, chair of neurology, talked about his vision for the field, and our responsibility to conduct high-quality research so that we can take our findings back to our patients.” She got her wish.
During her neurology residency, she hopes to focus on dementia and work on developing and testing drugs to slow the progression of these diseases. She will keep her pad handy, for scribbling and coming up with new ideas. These days, she's been thinking a lot about the delivery of care to elderly patients and wonders if there are better aging-in-place clinical management plans that could be designed to provide medical care in their homes.
Growing up in Jamaica, West Indies, Kristina Rankine remembers spending time with her grandparents and seeing the older community always sitting in chairs. Of course, she didn't have the vocabulary to understand stroke, cancer, or sickle-cell disease, but she knew that she wanted to change that picture and have those older and much loved relatives up and about and healthier.
Rankine's parents were both teachers. Books spilled out from every corner of their house, and she read them. As a teenager, she was drawn to Oliver Sacks, who always had an interesting way of spinning stories about his puzzling medical cases.
After high school, she moved to the United States and headed for Georgia Southern University as her father had already set down roots in the area. She majored in biology/pre-med with a minor in chemistry.
From early on in her life, Rankine loved a puzzle, which is the stuff of science. She was accepted into a summer research program at Penn State and worked with Charles Lang, PhD, a physiologist whose lab has advanced an understanding of glucose and protein metabolism in skeletal and cardiac muscle. After college, she joined AmeriCorps and spent three years at an inner-city middle school in Maryland that ranked lower than 90 percent of other schools in the state. She wanted to understand how people can make changes and leave things better than before.
She learned the importance of listening to the community that you aim to serve. Rankine decided that she was on her way to medical school and chose a spot at the Charles E. Schmidt College of Medicine at Florida Atlantic University, where she gravitated even further towards neurologic diseases. She felt a kinship with stroke patients and understood instinctively that patients “need to be heard, and I was listening.”
Neurology, she was learning, “is not a one-size-fits-all” and she became adept at building trusting relationships with her patients. She spent part of a spring and summer in Haiti and Nepal, working with and learning from patients and medical staff, and she saw, as she did in her students, that “you can do more with a lot less.”
Rankine returned to medical school with a singular focus to practice neurology. It helped that her mentor, Patricio Espinosa, MD, chief of neurology at the Boca Raton Regional Hospital, is also the kind of doctor who likes to spend time getting to know his patients. “I kept wanting to come back to his clinic, and he was always encouraging.” She matched to Washington University School of Medicine. “Neurology is captivating,” she added, “and I enjoy everything about it.”
Guang (Max) Liu
Guang Hao (Max) Liu is staying put. He is a medical student at the University of Iowa Carver College of Medicine who has ranked in neurology and chosen his home medical school because of its commitment to research and clinical care.
An MD/PhD candidate, Liu, who was born in China, moved to Germany at age 11, and then two years later to the United States so his father, a neuroscientist, could complete a post-doc degree at Yale School of Medicine. Science, medicine, and technology have always taken up much of his brain power, and a strong interest in the way people think and behave. It is no surprise that he settled at the bench of Gloria Lee, PhD, who is credited with developing a mouse model of abnormal tau protein and an understanding of how tau mutations lead to behavioral-variant frontotemporal dementia.
Through research and seeing patients, Liu was frustrated by the lack of disease-modifying treatments for Alzheimer's disease after seeing the devastating impact the disease has, not only on the patients, but also on their caregivers. This motivated him to become a clinician-scientist and continue his research in neurodegenerative diseases.
He also hopes to emulate the bedside manner of his clinical mentor, Nandakumar Narayanan, MD, PhD—the enthusiasm he brings into the clinical exam room—in his future practice.
“He taught me how to listen to our patients so that we understand what they are going through and devise ways to help them,” Liu explained.
While on his rotation on the stroke unit, Liu also saw the importance of timing to receive clot-busting medicines to increase the odds of recovery. Seeing a lack of awareness to the importance of timing and recognizing this community need, Liu founded the Iowa Brain Ambassadors program that trains medical and undergraduate students about the signs of stroke (and Alzheimer's disease). They share their knowledge with the public at farmer's markets and local events. He was inspired by a similar program at UCLA where he did his undergraduate studies in psychology and biology.
In addition to science and medicine, Liu had been an avid clarinet player and takes part in the hospital's faculty and staff orchestra—and every week they practice in the hospital atrium, giving way to music as another path to healing.
Mikenzy Fassel's earliest passion was not for the brain; it was for horses. Her parents ran an Equestrian Center in Golden, CO, where Fassel would shadow the veterinarian who took care of their eight horses and the dozens of horses they boarded. She went off to college and majored in equine sciences but it wasn't long before she realized that she wanted to work on mending people.
During her freshman year at the University of Colorado, she shadowed a pediatrician at a Kaiser Permanente Clinic. She completed her undergraduate degree at Colorado State University. When applying to medical school, she fell in love with the kindness of the Iowa community and knew that would be her home.
A neuroanatomy class clinched her passion for the brain, and neurology was her first clerkship. “I kept an open mind in my core year but nothing was as rewarding as neurology.”
Fassel was surprised that only four of her 152 classmates chose neurology. She's been part of the medical school's research distinction track and works with burn patients on a study of social determinants of health. Her Iowa mentor is Tracey A. Cho, MD, vice chair for education and clerkship director. She has had long talks with him about his work in neuroimmunology and why he chose to become a neurologist.
Fassel is also considering specializing in multiple sclerosis or cognitive neurology, and definitely sees a career in academic medicine. She said of starting her residency in the midst of the pandemic: “I never imagined starting residency during a pandemic and am uncertain what the next few months will bring. However, seeing the selfless response from frontline providers and sacrifices made by the community reminds me why I chose medicine.”