Dr. Raja Pillai PhD, (MS4)

In April, the National Alliance on Mental Illness (NAMI) chapter at the Renaissance School of Medicine hosted “You’re Not Alone,” an evening dedicated to highlighting the impact of mental illness in our community. NAMI students read aloud stories anonymously submitted by fellow medical students, hospital staff, and faculty. A number of students shared their own mental health stories, including executive committee members Kathryn Hill (MSTP GS1) as well as Dr. Raja Pillai, PhD (MSTP MS4), who spoke candidly about his struggles with depression and balancing the many pressures of medical school. Shortly after the event, Raja sat down to chat with Nuri Kim (GS3) about his involvement in NAMI and his motivation in organizing “You’re Not Alone.”

What is NAMI? Why did you get involved?

The National Alliance on Mental Illness chapter at Stony Brook is part of a larger nationwide organization. Our mission reflects that of the larger organization: increasing awareness of mental health and illness, advocacy, and education among student and faculty in the medical profession. We try to do that through things like “You’re Not Alone.” We are also planning some fundraising walks in the future and events for increasing access for students to have better healthcare.

I’m interested in mental health in general. I feel it’s an important thing to address and destigmatize. I’ve had my own mental health struggles. It’s unfortunate how little it’s talked about or addressed in general.

When I was a first year clinical student, one of the things I was involved in was peer counseling. In second and third year, I ended up taking over peer counseling with a classmate of mine who has since graduated. Peer counseling died off while I was in medical school, and I think that was because a lot of people were not comfortable going to classmates about really personal issues. I saw NAMI as another way to [work with] mental health in a different way from peer counseling.

What is “You’re not alone”?

One of the first year medical students, Zoe Lazarus, suggested this event that happens at other colleges called “It Happens Here,” where people anonymously submit stories about their experiences with sexual assault and other people read them. She suggested doing something like that at Stony Book – and that was perfect.

I’d wanted to put something similar on for a while, where people share about their own experiences. But I was struggling because I couldn’t think of a good way to ask people, “Hey, can you share your deepest, darkest secrets? Thanks!” Zoe’s idea brought in the missing piece: anonymous stories read by other people.

What were you hoping to achieve by hosting this event?

I just want people to talk about this subject. Mental health is usually brought up through: (a) mandatory wellness “things that look good to the public,” or (b) in the news when someone has done something horrible to themselves or to others because of mental illness.

As far as I know there has been a significant increase in lip-service, but not many other types of services, and I just feel like if we want to have any hope of destigmatizing mental illness, we have to talk about it. A lot of people who talk about destigmatization, but when they actually have to talk about their feelings, they’re very reticent. Which is understandable, but progress can’t be made otherwise.

Was there anything about the actual day of “You’re Not Alone” that surprised you?

Oh, yeah. I had read all these stories submitted by both students and faculty beforehand, but there’s something about having someone read them that adds this whole other layer of emotion. I really did not have any expectation of how the emotions of the night would be. I think it ended up being a lot heavier than I had thought. There were tears from speakers and by the audience. I, myself, felt very emotional as I was sharing my own story toward the end, and I hadn’t expected to.

I was very inspired by what other people were willing to share because a lot of people shared really traumatic things, It takes an incredible amount of courage, and it meant a lot that people would share their own stories or that people would volunteer to read really heavy things for other people including stories about suicide and abuse.

And I was also happy to see that there were a good amount of students that showed up to listen. Another thing I had no expectations on was [turn out]. We got about sixty percent full, which is pretty good. It makes me feel good that we can try to do this again next year, and there may be sustained interest.

As an audience member, I agree that it was an astonishingly brave thing for members of NAMI and the community go up and share their own stories, yourself included. I think it takes not just a lot of courage, but a lot of self-knowledge and faith in mankind to do that.

I sort of thought my own story was pretty tame compared to a lot of others that were shared.

Nevertheless. When it’s yours, no matter the content, there must be some element of fear because it’s yours.

That’s probably true.

Like you’re literally exposing your insides.

Yeah! Psychiatry and surgery are both invasive.

So what do you think were the main strengths of the event this year?

I think the main strength was that for a period of time—about an hour and a half—everyone was on the same level. A group of people showed their vulnerabilities—just laid it out there. And the people listening were taking part in it. Everyone was participating in his or her own way. I think for a moment, I felt more connected with a lot of people than I normally do.

How would you say your experience at the bench informs the way you see or articulate issues in mental health or in other aspects of your life?

This part of my life [involving mental health] helps inform my research, and I think this is true for all MD/PhD students. If you experience an illness and then you later research that same illness, you realize how easy it is to turn a complex condition into a mouse model in your mind. When you’re writing papers on major depressive disorder, you will write the same few sentences: “Major depressive disorder is the second greatest cause of global burden and is predicted to be the biggest by 2030. It is characterized by — and so on and so forth.” You think of it so coldly. But having experienced it myself and having seen the clinical side of it, I’ve seen that major depressive disorder is such a complex entity.

And then the other way around: Just the science—more than anything else—has humbled me. It’s very tempting to say that we know that major depression is a disorder of the brain and neurotransmitters, chiefly serotonin…. We don’t even know what major depression is, really. We don’t even know if it’s one disorder or multiple disorders, and once you start to do the science, you really see that.

At the same time, it’s really exciting to see that maybe with these scientific methods we can separate: “Maybe you have this type of depression that will respond to serotonin, or maybe you have this type with will respond to norepinephrine, maybe you have this type in which actually your brain is fine you just need a lot of cognitive behavioral therapy.” Although of course we know that CBT alters the structure of the brain, and it’s fascinating…

But it’s important not to separate the fascinating intellectual journey from the real grounded emotional one.

Something that the event highlighted for me was just how common a lot of these things are. There were so many motifs that recurred throughout multiple stories—and specifically in the context of healthcare and people in academia… Given that sense of how common mental illness is in health sciences generally, do you see any common pitfalls among those in the MSTP community?

I think medical students — and graduate students, to a lesser degree – wear hardship with pride. People sort of on some level want to be in the worst circumstance may be to prove that they can get through it. As soon as I started medical school, people were talking about how they were studying, how little time they had for anything else—but with a certain measure of pride, like I said before. And I think that feeds into this larger attitude in medicine that we give ourselves completely because we are great people, and we are great people because give of ourselves completely. That’s an unsustainable cycle. At some point, you have to take care of yourself or you will become jaded. You’ll stop caring about your patients. You’ll become bitter and angry and resentful.

I think self-care really needs to be a common theme both in graduate school and in medical school. With medical school there’s this generational thing: “I had to go through this so I have to go through this,” and then on our end “Wow, these people went through this. How can I not go through this? Am I weaker?”

And in graduate school, there’s this idea that, “Well, you’re the workhorse. You’re there to spend sleepless nights and get the data out. Once you’re the PI, you can tell everyone else what to do.” (For the record: My PI was not like this!)

That attitude can serve you in the short term, but it will not work in the long term. And if it does “work,” you may be successful, but you’re not going to be happy or content. Maybe there are exceptions, but that’s my point of view on it.

What is self-care? Could you give us a short list of things that either you do for your own self-care or that exemplify self-care more generally?

For myself, I need a creative outlet. If I have to do that same thing day in and day out, I tend to fall into negative cycles of thinking, particularly comparing myself to other people unfavorably and worrying what other people think about me. So what I need to do is to make sure that other sides of myself that I know. I develop other sides of myself like writing plays, creating adventures for Dungeons and Dragons. Even simple things like going to the gym and making my own food that tastes good. Just sort of reminding myself that I am a complete, multidimensional individual who is not just a student.

I also sometimes do mindfulness meditation in the morning. During the wintertime I will have my breakfast, I will take my cup of tea upstairs. I will sit with my bright light and just focus on my breathing for about ten minutes. And then do a short body-scan, where I one by one, check in with how each part of my body is doing. That’s something I learned to do over months of practice because at first it’s really hard to do that.

Thank you, Raja, for your time.

Third year medical student Alexander Jares, PhD, tells Tyler Guinn about his motivation for getting involved with medicine and research and his experience in pediatrics.

What are some experiences that pushed you towards MD-PhD training?

“Prior to entering college, I had initially envisioned a purely clinical career, however freshman year of college I enrolled in a seminar and discussion series tailored to incoming science majors, in which senior faculty would come and give talks on their research. The scope of the topics was broad. For instance, we had a fascinating talk on how birds make iridescent colorful feathers, but also a talk on single nucleotide polymorphism (SNP) mapping in disease. Crucially, we had small discussion groups moderated by senior basic science and medical school faculty for which we had to read and present primary literature related to the talk. This experience drove home three key points: (1) there is incredible depth to any biological area of study, (2) engaging with this depth required further scientific training and (3) I wanted to have more access to that depth and scientific training in addition to a clinical career. Connecting the dots led me to MD-PhD training as a career starter.”

What was your research background before starting at Stony Brook?

“I started out in two neurobiology labs in college, with Dr. David Wells at Yale University, studying the protein changes in the brain that underpin learning in a mouse model, and then with Dr. Miguel Concha at the University of Chile as part of a Yale/HHMI program, studying the emergence of brain asymmetry in development in a zebrafish model. However, by the end of college, I was ready to explore what was at the time a fringe field: gene and cell therapy. This interest came about in a roundabout way. I had met with Dr. Joseph Piepmeier, a neurosurgeon at the Yale School of Medicine, to discuss neurosurgery as a career. We had reviewed some of his cases, and during our discussion, he mentioned gene therapy offhand. I was intrigued by the concept: curing genetic disease at its DNA source. As a result, I decided I wanted to learn more about gene and cell therapies and work in a lab full-time before starting an M.D.-Ph.D. program.

I started looking at gene therapy-related labs that did research in non-human primates and found Dr. Cynthia Dunbar’s group at the NIH. After graduating college, I joined the lab for a 2-year postbac Intramural Research Training Award (IRTA) position. I absolutely loved it. My projects spanned mapping vector integration sites, tracking of clonal hematopoiesis with DNA barcoding in a rhesus macaque model, and developing an inducible suicide gene system for induced pluripotent stem cell therapies. In short, these projects were all related to making gene or cell therapy technology safer or at the very least monitoring its safety. This is important because successful new therapies have to be demonstrated to be both safe and effective. At the time, there were no FDA-approved gene or cell therapies despite decades of efforts, largely due to concerns about safety. We’ve come a long way since – with the first three FDA approvals in the space occurring only in the past couple of years.”

How did that influence your choice of Ph.D. lab?

“I chose to work with Dr. Yupo Ma based on his extensive track record in stem cell and cell therapy research. Dr. Ma had interviewed me for the Program, and we had debated the merits of various gene therapy vectors, as well as stem cell therapy strategies. I was impressed by Dr. Ma’s vision, command of experimental details, and translational outlook. I immediately knew that Dr. Ma would provide active mentorship combined with room to experiment and take risks building experimental cell therapy systems.”

What was your work over the last few years over?

“My work was engineering stem cell lines from umbilical cord blood. The generated stem cell lines were consistent with early mesoderm, had uniform properties, were not genetically altered, and could be maintained and expanded long-term in the presence of a small molecule. Differentiation of these stem cell lines to endothelial cells may provide a safe allogeneic source of blood vessels for ischemic disease such as myocardial infarction or peripheral artery disease.”

Where do you see this work going in the future?

“There are hundreds of promising gene and cell therapy trials. The three recent FDA-approvals are only the beginning of a paradigm shift from traditional drugs to ‘living drugs’ or DNA-modifying drugs. My assessment is that, in our lifetime, new gene and cell therapies will cure many very painful and dangerous diseases. For instance, it looks like we are very close to a cure for sickle cell disease.”

Is this something you hope to continue in the future in clinical training?

“Absolutely, I remain fascinated by the scientific, manufacturing, clinical, and economic challenges of developing gene and cell therapies and making sure that they actually get to the patients in need in a manner that’s affordable to them. Making that happen is a complex endeavor with many talented people working together to find solutions. In that context, physician-scientists have an important role to play as stewards of good science, best clinical practices, and advocacy for often very sick and financially stressed patients and their families.”

Alex (left) worked alongside fantastic medical student colleagues: Asha Liverpool (middle) and Alexandra Coritsidis (right). Both Asha and Alexandra provided invaluable advice that definitely made the transition back to clinicals much easier!

How do you see research integrated into your future career after clinical training?

“There will definitely have to be research and new gene and cell therapies. Not doing research in that field for me would feel like sitting on the sidelines while others race to find cures for rare diseases. It’s a matter of personal choice. My career preference is not inherently better or worse than other choices.”

What do you feel is missing from your field currently and what is something underutilize/unexplored?

“Gene and cell therapies are underweighted in medical school curricula and are not that well known outside the field. This is partly due to the newness of the field, its relatively small size, and 30 years of hype that is only now coming to fruition. I sense that that’s changing, and that awareness is expanding, and I am trying to do my very small part to help.”

MSTP Training:

What scientists or physicians have been role models over the years and what were aspects that you admired about these people? How did you find them?

“There were so many role models, many of which I encountered through classes or via lab. I admired people who were kind, but direct, and who saw their role as making sure the right decision was made and not that they came across as always right.”

What were important activities or habits that helped you with the training so far?

“Engaging with researchers in my field outside my home institution. Speaking with as many people as is reasonable and soliciting their opinions. A leadership position in a national society. Physicians and scientists, and people in general, love giving their opinions, and that’s a fantastic opportunity for learning.”

What are important activities or habits you wish someone would have told you earlier?

“Keep a journal.”

What activities outside of the MSTP were important to you throughout the program?

“I started martial arts training during my Ph.D. The activity taught me the importance of learning from everyone and treating everyone inherently with respect. Also, if you didn’t know what you were doing, it was immediately obvious, and you had to work on fixing it. Notably, I made friends with fantastic people in the community and learned a lot not only about my community but also about how the public processes scientific breakthroughs and how they experience the medical system from the patient side.”

What does it feel like to be on the last ‘leg of the race’ for MSTP training?

“It feels good. If the Ph.D. felt like meandering through the woods foraging for berries, then going back to the clinic is like being part of a huge machine that’s relentlessly moving forward – I think of Charlie Chaplin’s Modern Times. You just have to keep up with a fast-moving conveyor belt. I am also enjoying the social nature of medicine, meeting and working with many different people continuously.”

How has getting the Ph.D. has helped you in the clinic and why is it important to you?

“It’s taught me that biology is very complicated and doesn’t always make sense. No one sat down and rationally designed the DNA code and epigenetics to run like a well-written computer program. I concluded that some things are so hard to figure out that it’s not realistic for medicine to be perfect. For that reason, paradoxically, the Ph.D. has taught me to accept some of the non-evidence-based aspects of medicine and get with the program, because it’s not realistic for medicine to have all the mechanistic answers and the data to back-up every decision, although of course, that’s the goal that we are aspiring to.”

What rotation are you on now? How is it going? Why did you start with this one?

“Pediatrics. I am actually truly enjoying it. The quality of the medical education has been excellent. On a day to day basis, I find getting the history & physical examination from the family and the patient very rewarding. In pediatrics, there is also a wide-range of physical exams spanning many ages. Notably, I was surprised at how fast some of the pediatric patients recovered. One day my patient is on 12 liters of oxygen, and a few days later, she’s breathing on room air overnight. Those positive experiences are, of course, tempered by occasional losses of young patients. It’s important to take the time to process these losses and grieve appropriately.”

Have you found any residents, attendings, or others that helped you with the transition?

“Yes, I found all of the above to help me. 4th year medical students are a fantastic resource on the floors too. They are far more knowledgeable than you, but also can vaguely remember their start on the floors too, and they have plenty of good advice that’s highly relevant to you. Otherwise, I didn’t advertise the transition specifically, because I didn’t assess the need to. I just mentioned that it was my first clerkship and that I was coming in a block later than my colleagues because of research.”

What was the easiest/hardest thing to adjust to going back to the wards?

“Hardest thing was the anticipation of going back. We tend to predict and run worst-case scenarios in our heads when we anticipate something unknown. Once I actually started and got into a routine, it became much easier because there were specific, actionable things I could do to improve my performance on the floors. The easiest thing was actually the early wake-up times, I am a lark and don’t mind waking up at 3:30am. On the flipside, I don’t care much for being at work in the evenings.”

What would you say to students a few years earlier, looking ahead on what to expect?

“#1 Don’t worry about going back to clerkships, the Program chose you because they believe in you, and so you will very likely be fine. The only way you get a 100% chance of failure is if you give up. If you keep on moving, you have an excellent chance of making it through. And then all the standard advice. There are no shortcuts or magic secrets that I am aware of. Show up early, introduce yourself to the team and when you see patients, treat everyone respectfully and with consideration, be willing to learn and appreciate advice from your superiors – which is basically everyone. Notably, it’s important to understand that you are there to learn for your future patients. Your current patients are probably going to be OK without you on the team. Embracing that reality is very freeing and motivated me to take every opportunity to see more patients, spend time with them, and learn from them. As a medical student, you have the luxury of time to observe, listen, and learn. On the flipside, it’s important to learn to build trust fast with the team and when interacting with patients. My approach is to listen well and summarize back key points to ensure that people know that you heard them.”

(Written by Tyler Guinn)

Program Director Dr. Michael Frohman MD PhD, congratulates the graduates: Dr. Himanshu Sharma MD PhD, Dr. Liz Ballinger MD PhD, Dr. Bobby Wysocki MD PhD, Dr. Michael Schneider MD PhD, Dr. Saul Siller MD PhD and Dr. Jeremy Miyauchi MD PhD.

With great pride we congratulate our seven newly minted physician scientists Nadia McMillan (Neuology, BI Deaconess), Elizabeth Ballinger (Child Neurology, Stanford Univ.), Saul Siller (Anesthesiology, Yale Univ.), Bobby Wysocki (Internal Med, NYU Winthrop), Himanshu Sharma (Neurosurgery, Baylor College Med.), Jeremy Miyauchi (Pathology, NYP-Columbia Univ)  and Michael Schneider (Internal Med, Univ. of Pennsylvania). Our exemplorarly graduates will be commencing their medical careers at prestigious institutions across the country pursuing a diverse range of medical specialities. Match Day arrived with an expected dose of nerves, but as envelopes were excitedly torn open anxiety gave way to excitement as eight years of hard work and sacrifice became justified. 

Graduation Reception at the Old Field Club in Setauket

Dr. Howard Zucker, Commissioner of Health for NY State, delivered an inspiring Graduation Day speech, encouraging the new doctors to creatively engage in their careers and push their fields forward through scientific curiosity. “Foolish is the one who fails to wonder why,” Dr. Zucker  advised. We hope our grads heed this sage advice. While we will dearly miss their insightful contributions to our MSTP community, we look forward to the many accomplishments of the class of 2019 and wish them the best of luck with their future endeavors!

(Written by Lillian Talbot)

Margaret Shevik (GS1) had a dream; to bring together students and faculty from across scientific disciplines to discuss the triumphs and challenges women face navigating their professional lives and combating gender inequality. With the support of the MSTP program, Dean Kaushansky and the Office of President Stanley, Margaret and the newly founded Women of MSTP group brought this dream to life by organizing the first Northeast Regional Advocates of Women in Science and Medicine Symposium in the MART building here at Stony Brook University on May 11, 2019. The day was a brilliant success with over 115 people registered from more than 13 different scientific disciplines. We welcomed visiting MD/PhD students and faculty from the Tri-Institute, Hofstra University and Cold Spring Harbor Laboratory. The day’s programing consisted of of panels, presentations and workshops run by a diverse array of women.

Keynote lecture by Dr. Julie Kim, MD PhD from the Geisel School of Medicine at Dartmouth College

Dr. Julie Kim, Associate-professor of Pediatrics at Dartmouth Hitchcock Medical Center, began the Symposium with an enlightening keynote speech highlighting the inequalities women in science are still facing. “If you’re not at the table, you’re on the menu,” Dr Kim advised. She encouraged attendees at all levels of training to find mentors and sponsors early on and to be proactive with these relationships. Dr. Nicole Leavey and Dr. Temis Taylor from the Alan Alda Center for Communicating Science lead an interactive plenary. Dr. Rashmi Rai presented a “Writing an OpEd” workshop, outlining how to construct and publish a timely OpEd article. Dr. Molly Hammell myth busted erroneous opinions about the gender pay gap and a number of other faculty including Drs. Jessica Seeliger, Bettina Fries, Stella Tsirka, Jennie Williams, Helen Hsieh, Nicole Sampson, Carine Maurer, Chioma Okeoma, Frances Santiago-Schwarz, Jill Mahon, Jill Genua and Susan Lane participated in panel discussions. The day provided ample opportunity for networking among students and faculty and marked the start of fruitful cross institutional relationships. We were grateful for the participation of our male colleagues as advocacy of women is far more effective when promoted by people of all genders. The symposium would not have been possible without the support of the MSTP Program Leadership, WiSE, Lynda Perdomo-Ayala and Alison Gibbons. We look forward to carrying on this exciting tradition here at Stony Brook and at neighboring institutions for many years to come. Congratulations Margaret on organizing such an impactful event!

(Written by Lillian Talbot)

We are very excited to welcome two new members to the program leadership: Dr. Helen Hsieh MD, PhD and Dr. Carine Maurer MD, PhD.

Dr. Carine Maurer, MD, PhD.

Dr. Helen Hsieh, MD, PhD