The Human Side of Medicine: Living with Chronic Illness in Medical School
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Welcome and Introduction
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Kara Wada, MD: Welcome back everyone and welcome to our new listeners. This is the Becoming Immune Confident Podcast where we talk about all things, allergies, autoimmunity, anti-inflammatory living, and building the skills to live with more confidence, especially when our health throws us, you know, for a loop. And I am so thrilled to welcome our guest today.
I think you are going to gain so much inspiration and just learn so much from the very soon to be Dr. Stephanie Moss.
Meet Stephanie Moss: Trauma-informed Advocate and Activist
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Kara Wada, MD: Stephanie is a trauma informed advocate. She's a health disparities activist, Endometriosis and Infertility Warrior, and a fourth year medical student, soon to be MD, at RUSH Medical College in Chicago.
Through her lifelong dedication to diversity, health equity, inclusion, and disability, she has striven to be a voice for marginalized communities. She is part of the Family Medicine Leadership Program, Tight Lipped Medical team, it is on the Infertility Committee at the American Medical Women's Association.
She also serves on the International Society of Study of Women's Sexual Medicine Advocacy Committee. During COVID, she co-founded the Chicago Homelessness and Health Response Group for Equity. Stephanie shares her experiences through her narrative medicine writing and public speaking with her work being featured on notable platforms such as MedPage Today, the Endometriosis Foundation, KevinMD, Doximity, and the American Medical Women's Association.
First of all, thank you so much for joining me in this conversation and the one thing we didn't mention is you also host your own podcast too, which I'm sure we'll talk about. You've been very busy the last few years. I would love though, you know, to hear a little bit more about your story.
Stephanie Moss, MD: Yes, thank you so much. Uh, yeah, it's been definitely a whirlwind of different things. I definitely like to keep busy. That is kind of my own personal, I like to say, trauma response is I get anxious if I'm not doing anything. So my response is do something. And so as I've been going through my life, I've learned how to move my busyness to actually be productive. And one of the things that I associate most with and take on as an identity is an advocate. And so, like you said, in my bio, I've really tried to be an advocate for others who don't have a voice themselves and especially using my new platform as a future doctor, actually a future psychiatrist. Um, I am very excited to continue on in this track of advocacy.
Stephanie's Chronic Illness Diagnosis and Perspective Shift
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Kara Wada, MD: So, you were diagnosed in kind of and forgive me if I'm getting the story wrong a little bit, but with chronic illness during medical school and that, I mean, not only is medical school, you know, a stressor and incredibly challenging on its own, but then you layer that on top of being a patient and a student. Can you tell us a little more about how that diagnosis and journey changed your perspective and how did you navigate that?
Stephanie Moss, MD: Yes, great question. So you are correct. I came into medical school not having specifically any chronic health conditions that I knew of. However, as I started going through my studies and learning, I started to learn in school a lot of the things that I thought were "normal" in quotes, more actually part of a health condition and actually symptoms specifically pain. I had grown up most my life thinking that pain was normal and it wasn't until I actually learned as a medical student that people shouldn't be in pain, that all these different things are something that I should actually get diagnosed. And through my years and struggles of eventually getting diagnosed with a chronic pain condition and a mental health condition, that really helped me really appreciate what patients go through and also be, like I said, an advocate to help other individuals be empowered and learn how to advocate for themselves and their own needs and their own pains.
Kara Wada, MD: I'm curious how those conversations went with your healthcare team, because I certainly have heard many a story where, you know, the student came in and then, "Oh, you're just worried that it's something you're studying like."
Medical Gaslighting and Power Dynamics in Healthcare
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Stephanie Moss, MD: Oh, yeah, I actually just wrote, I just did a podcast episode on this because it really made me very angry that when I learned about these being symptoms and then going to a medical provider that was specifically for medical students. That was the very first thing that that doctor told me is, "Oh, you're just having medical student anxiety. It's just you learn about something and you see it in your own body."
And even when I kept saying like, "No, these are symptoms I've been dealing with for over 10 years," there was still that dismissive and I've learned throughout my advocacy journey that how that's considered gaslighting is medical gaslighting.
And it really, it hurt me a lot at that moment, but then it also helped me realize how common it is, especially in the chronic health community that there are health care providers that maybe they just don't understand the severity and aren't able to empathize with the patient.
And that's really been one of the points of my personal advocacy is teaching not just patients, but also health providers, my fellow medical students, nurses that we need to be more aware of our actions, of our words, and know that our patients come in with already, we have a very significant power dynamic and to acknowledge that power dynamic and notice that even if you say something slight offhand or something that can really impact someone's psyche and emotions, and maybe will prevent them from seeking care later on, which could be further on very damaging and can put someone's health at risk. And that's really been part of, I know that we talked about, so I recently created a podcast called, 'Life of a Patient-Doctor,' because I really want to show that duality of being a patient myself and a doctor and how one feeds on the other, of how my experiences of one can support and help the other in vice versa.
And through sharing my experience, I've also been able to interview other healthcare providers like yourself, and other that who are both patient-doctors and it's been so amazing to hear all the stories, and kind of bring that humanity back into medicine.
Kara Wada, MD: I think that's, um, one of the things I worry about with medicine becoming more corporate across the board, whether you're in, you know, private practice and, you know, it's bought up by private equity or even within academics where there's increasing pressure on the financials. All these little things that kind of have eroded away at that, the essence of what that patient-doctor relationship is, that human to human connection, and I think you hit the nail on the head, if we come back to that shared humanity. That's what we know heals, that heals the trauma, that heals our bodies. It heals a lot. It's thought to be the essence of a lot of the placebo effect. We could use a little bit more of that.
Stephanie Moss, MD: Right?
The Power of the Placebo Effect and Human Connection
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Stephanie Moss, MD: Oh, it's interesting that you bring in the placebo effect because I think a lot of times we water it down, but you know, from a psychology perspective, from a mental health, that is so huge and so important because even though we're not providing something we can physically see, it's changing the brain chemistry. It's changing who the person is and can actually have change in the body. So yeah, that's a whole nother thing.
Kara Wada, MD: Maybe for a part two conversation.
Stephanie Moss, MD: Yeah, that's a, that's a part two thing on itself. I just had to bring that in because I don't know. I feel like a lot of times when in science we use that word placebo, the idea is we're not giving anything and that's not true.
That person feels and thinks that they're receiving something and just that emotion of hope and perseverance can really impact the connections in the brain and impact lives.
Kara Wada, MD: Yeah, placebo is not a dirty word.
Stephanie Moss, MD: Nope.
Failing a Major Exam and Advocating for Accommodations
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Kara Wada, MD: Um, you experienced some challenges during your medical education, including having trouble with one of the big exams that we have to take. What was going through your mind kind of when you hit that pretty big, you know, hurdle. And in looking back, how did you get through to this other side?
Stephanie Moss, MD: Yeah, such a good question. I remember the emotion so strong and I can really even picture that time period where I found out I failed. And I remember going out, we live in Chicago, so my husband and I went, we were just walking on the beach because I was trying to just take in that process that I had just failed step one, which is the huge board exam. And I really felt like a failure. I felt that I was cut out for medicine. I felt that all my work was for nothing, that this was the universe telling me that I really shouldn't become a doctor, that I should change careers.
And I am so glad that my husband forced me to stand up and said, "No, we got to this far. You are not giving up and we will figure this out." And that's exactly what we did. And I was able to connect with a friend who was also in medical school and she had disabilities herself. And she said like, "Hey, did you know that your health condition that you recently were diagnosed with? Did you know that that actually could get you accommodations and that might be additional support for your exam."
And up to this point, I thought that accommodations and accessibility, I didn't associate the identity of having disabilities. And thus I didn't associate that I deserved to receive help or support. And once I was able to come to terms with that identity or at least that I do deserve help. And it's not that it makes me weaker or less smart, it just means that this exam isn't built for people like me. Or especially I'll give a just a quick overview of this exam, this is an eight hour exam where every single hour, you get less than five minutes to take a break.
And break means you stand up, you go through security, you unlock your locker. If you have time in that five minutes, you can run to the bathroom, have a snack, drink some water. If you don't have enough time, you have to run back, go back through security and sit back down. And because of my health condition, I was needing to go to the bathroom more often. I needed water and food and sugar. And also just like needing to like mentally relax and reset, five minutes was not enough time. And so through reaching out to the disability and accessibility coordinator, she was able to work with me and say like, let's extend that break time and just doubling it going to 10 minutes. for a breaktime was instrumental in being able to successfully pass that exam and later on when I did my second board exam, step two exam, it allowed me to do so well on the second exam because I found the resources that I needed to be successful. It wasn't that I was given the right answers, I was just giving a little extra time to take care of my own body, to make sure my brain was prepared to answer those questions in the time period allotted.
Kara Wada, MD: I think, you know, going back to your beginning statement of one, recognizing, you know, having that awareness of, "Oh, okay. This is even a possibility." The process then of coming to terms with that, right? Deconstructing our internalized ableism. So realizing that the world, like you said, is not built for everyone.
And sometimes we need some adjustments to make it more accessible. And there's no shame in that.
Taking a Leave of Absence and Overcoming Challenges
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Kara Wada, MD: One of the other more unique things about your journey is you took a break. You took a leave of absence, which isn't a common choice. Although I think many of us on the other side, having gotten through training and especially those of us within the chronic illness community probably are like, "Goodness, why didn't I?" You know, like, looking back, take us inside kind of that decision. How did you, I want to know how you have the strength to do that, frankly.
Stephanie Moss, MD: That's a good point. Going back, I was between my second and third year of medical school and that's the time given we are normally allotted two months to study and take that step one exam. And we were approaching the end of those two months. And I had yet been able to pass the practice exams. I had done at least 10 at that point, and my hand was kind of forced to some extent that my school did not allow me to continue on with medical school until I pass that exam. So I hadn't even taken it officially. I had just taken practice exam. And I was not passing those practice exams. Now, I do want to state I was doing those practice exams under testing conditions.
So the less than five minute breaks. So I was trying to emulate it as quick as possible. And to some extent, I was told I had take break. Even though I did have some decision in the fact of I could try and take the exam as is, but then I would risk failing and then being kicked out to then, not kicked out, but forced even more to take a break. So I ended up deciding to take a personal leave of absence instead of an academic would be I failed while I was still a student. So I chose to do a personal leave of absence. And I also kind of went with that decision because I knew in a couple of years I would be applying to residency as a job and it was going to be considered a red flag if I was academically of absence instead of personal.
So I decided, "Okay, I'm going to choose a personal." So anyway, and going back and to that time period, it was a lot harder than I expected, because it wasn't just you don't go back to school. My loans were taken away and that's a big deal because my husband and I were both in medical school at that time period.
So we were both fully reliant on student loans, federal student loans for our living income. So then by having to pay back at that point, it was about $11,000 and then pay for my health condition. I had a couple of procedures during that same time. We ended up just going through a horrendous financial disaster of almost being kicked out of our apartment.
So it was just thing after thing after thing, all because I couldn't pass a practice exam. And so there was a lot of very dark and difficult moments, but what kept me going was that idea that I had worked so hard to get into medical school that I wasn't going to let anything get in my way. And I know I've talked with other people with health conditions and they've used the word stubborn and I'm going to use that too. I was stubborn and I think that is such an interesting and key trait that a lot of us possess that is maybe sometimes looked out upon by society, like you call a little child stubborn. But at the same time that is a strength because it is a sign of resilience, a sign of not letting any challenge that comes our way just make us give up.
And I think that's how I kept going was taking in, okay, well, what can I control in the incontrollable situation and just hold on tight. Even if it all I can control right now is hugging my dogs or hugging my husband, I will take that on. I will hug my partner, even if that's the only thing I have right now. And that kind of has morphed into like my chronic illness even of when I'm in pain. Instead of just sitting with the pain and thinking about the pain, which in fact just makes the pain worse because you're focusing all your energy and attention on that. I now have like, okay, I have a toolkit. Okay. Like what are some strategies I have that have helped in the past with my pain? What am I going to do to grab those? Okay. This tool didn't work. Let's choose another one. Okay. This didn't work. Let's choose another, right? So I've used that common strategy in my health condition and also, in my profession.
Tools for Managing Chronic Pain
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Kara Wada, MD: Do you have any particular tools in your toolbox that are worth sharing?
Stephanie Moss, MD: Sure. Like if we're talking about like from the chronic pain perspective, for example, I have endometriosis, so I have a lot of abdominal and pelvic pain. So a huge, like, portion of my tool chest is, I have a TENS unit, which provides little types of shock and kind of electricity, sometimes kind of like a vibration, kind of like a shock.
And the concept is that is, it tells our nerves to, it's the same nerves. They can either take in pain signals or they can take in signals from these electrical stimulation of this TENS unit. So, the nerve grabs that TENS unit and then slowly my brain starts to dissociate and not think about the pain.
So that's definitely one same thing of I've learned a lot that when you're in pain, all your muscles start to tighten. So I grab one of my massagers and either my husband starts massaging my shoulders or on my stomach or on my back, like all those muscles by then relaxing allows then all my other muscles to relax. And also just, I'll use the term of movement and I understand the pain like physically and emotionally 'cause I wake up sometimes in flares and I know it's the last thing I want to do is move. And I'm like, "Okay, I need to get up." I know that physically getting up, moving the thing that's most painful, it helps me.
It has helped me to know that I'm not hurting myself. Even though my body is in pain, I'm not hurting it by moving, I'm actually helping it. And so somatic movement and doing some movement, walking, stretching, yoga, you know, all these different things. For me, it's dance. All these different things are so beneficial. And we've seen all across the board, pretty much all types of chronic health conditions can be so helped with movement and exercise. So taking that knowledge into action has been really important for me.
Reframing Exercise as a Practice of Love and Kindness
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Kara Wada, MD: It's interesting because exercise on its own can have this initial little blip of inflammation, but the end result is anti-inflammatory. I think though, what's interesting, maybe way to sum up the type of movement you're talking about is it sounds like it's coming from a place of love and kindness rather than punishment. Which is I feel like, often at least, I can speak for my generation, like exercise was always, you know, something you did to like feel the burn and how you speak of it just sounds like it's coming from this place of like love and caring for your body, realizing that it's its own type of medicine in a way.
Stephanie Moss, MD: Yes. Oh, very much so. During my actual leave of absence from medical school, I had the opportunity to get a certification in somatic trauma therapy. And a lot of it talks about that, just the concept of movement and being more in tune. Semantics is the connection of the body and the mind. So being very much in tune with how am I feeling? What are the sensations coming up? What are the emotions coming up? There is so much healing in that and I am with you. The term exercise it's been kind of, there's a box that society has put exercise, you have to be in the gym, you have to be lifting weights. When exercise is yeah, you have to have the little band.
Um, yeah. I know my parents did jazzercise. So like I grew up like with my parents doing jazzercise. So I always knew that. And so, learning how to be accepting of myself and being like, "You know what? This is okay." This is just getting more in tuned with my body and movement and doing only what feels good. And if it's hurting, i'm not doing it right because you shouldn't be in pain.
I think that is also a harder part of transitioning away from the mentality of feel the burn and like it has to hurt like yes, there is a small area where if you feel it you are strengthening the muscle, but there's also a fine line where you then start hurting yourself. And so learning that on balance for yourself is key.
Advice for Students Facing Similar Challenges
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Kara Wada, MD: If you were able to talk to a student or maybe thinking about talking to yourself, you know, five, six years ago, maybe someone is in that position and they're listening or facing similar challenges. What piece of advice would you want them, or want to tell them, or what would you want to let them know?
Stephanie Moss, MD: I think the biggest thing is know you're not alone. I feel that what society, whether if it's through social media, through being the pandemic, there's so many different situations where we're kind of isolated and we feel that we're the only one suffering and that no one else could suffer like us. And that is not true. There are other people that are suffering and all you have to do is ask for help. And that asking for help has been one of the hardest but most important lessons that I've learned over the past couple years. Because when I started to ask for help, that's when I started to learn the stories of others and form friendships with people who did get it and who also thought they were alone and struggling in silence and they weren't. And through that experience I've been able to develop such good friendships, lifetime friendships, and also they have helped me when I have been struggling emotionally.
They've been my cheerleading squad and been able to support me through the ups and downs of life because not everyone's path is linear. And once you recognize that no matter your path, it's okay. It's okay however the journey goes because it's your journey and you are unique and your journey will also be unique.
Kara Wada, MD: That's so powerful. So we've been a little hit or miss on this question over the last few months, but the name of the podcast is Becoming Immune Confident.
Becoming Immune Confident: Building Confidence in Body and Resilience
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Kara Wada, MD: And I'm curious if that phrase, like how that resonates with you, especially taking into account everything you've been through.
Stephanie Moss, MD: Hmm, you know what? I wasn't sure at first because I hadn't in my mind thought of myself with dealing an immune condition. But as I started thinking about it more, I started remembering of the new research coming out of finding that endometriosis, my health condition, is part of an inflammatory and autoimmune style condition. And the biggest thing for me and my journey that has helped my pain is recognizing that my body is going to be okay.
And I think before I had a diagnosis and was learning about all these scary things, whenever pain came up, I started to be very scared that I had like a life or death illness. And once I was able to get diagnosed and learn about the condition and learn how pain works and learn how different inflammatory actions affect my body, I started to become more confident in myself and when those emotions, when those pains started coming up, I was able to, through that knowledge, knowing that I'm not in trouble. I'm not, like, I won't die from this pain. The pain will end. Being more confident in that, eventually the pain and the emotions subsided. I didn't say it's the magic pill that it goes away, but I was able to work through it by being more aware and confident in my own body, in my own path.
Kara Wada, MD: Learning to trust yourself and that you have your own back.
Stephanie Moss, MD: Mm hmm. Yes, exactly.
Connect with Stephanie Moss
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Kara Wada, MD: Where can people find you? Where can they read your writing? Where can they listen to you? How can they connect with you? 'Cause I'm sure folks are going to want to after hearing your story. And I'm just so excited to follow you over the years to come. I think this will be a really fun, you know, I think one of the most fun parts of what I've realized in medicine and I've really loved is watching people who are kind of in that transition state.
I loved adolescent medicine clinic because it was this cool, like launching point, right? For like these young people. And I see you're at this new launching point. And so I'm so excited, but where can others kind of follow along too?
Stephanie Moss, MD: Yes, I think one of the ways, because I do so many things, I think the easiest way is, I've put it kind of all linked to my website, medpsycmoss which is medpsycmoss.com, and it works perfectly now, now that I'm going to be a future psychiatrist, too. So, and then my last name is Moss, so Dr. Moss. And then on social media @MedPsycMoss, and then my podcast, Life as a Patient Doctor. Same thing wherever you get your podcast, but all those are linked on my website. And we'll see, like you said, it's exciting to see how my journey will continue and how I'll be able to continue to grow this advocacy journey.
Kara Wada, MD: Absolutely. We'll make sure to link up all those links. If you click on the show notes, you'll be able to just click on the hyperlinks and get yourself right over to Dr. Stephanie's website and her social media. Thank you so much and best wishes and enjoy this next few months of trying things out, having fun, like I still look back to those last few months of fourth year of medical school. It was so much fun. Like, pressure was off.
Stephanie Moss, MD: Yes. No, thank you. Yes. It's been really refreshing and being able to do stuff like my podcast, something that I never in a million years would have thought that I would been confident enough to get in front of a camera. And now being able to do that and trusting that it's not about me. It's about helping others through my story and through my journey.
Kara Wada, MD: I'm sending a big hug and a high five.
Stephanie Moss, MD: Thank you so much for having me.
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Support the Podcast and Final Thoughts
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Kara Wada, MD: Hey there, amazing listeners. Before we wrap up today's episode, I want to take a quick moment to ask for your support. If you're enjoying the content of the Becoming Immune Confident Podcast, we're bringing you week after week, there's a simple, but incredibly impactful way you can show your appreciation.
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