One Older Med Student’s Path: From Grief to Growth to Giving [Episode 219]

Our guest today has a very unusual path to medical school. I’m going to let her tell her story with very little intro from me. All I’ll say now is she once upon a time had a career in finance, did her postbac at Columbia and attended Rutgers New Jersey Medical School where she earned her MD. She did a residency in pediatrics, also at Rutgers, and is now in a pediatric neurology fellowship at Children’s National Medical Center.

Let’s learn more about Dr. Deborah Horenstein.

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Can you tell us a little about yourself – your background, where you’re from? [1:25]

I was born in Brooklyn and grew up in Long Island. I went to college at Northwestern and started out studying theater. I became more religious (I’m Jewish), and started observing the Sabbath. I decided that a career in theater wasn’t going to coincide with my religious practices, so I switched to communications, with a minor in economics; and then decided to study econ fully. I transferred to Barnard in NY and graduated with a degree in economics.

I moved to LA, worked in finance, got married and had kids.

How did you come to pursue a career in medicine? [2:45]

I was blessed with three daughters. My youngest daughter was very complicated medically, and I became almost a fulltime caregiver. Her illness encompassed 12 different specialties. Her primary condition, which was an immune dysfunction, was actually something they’d never seen before.

She got a lot of care at Children’s Hospital of Philadelphia. And she needed a bone marrow transplant, which we did at Duke.

She passed away after a lot of complications. She was eight. Her name was Ariella.

I decided to use my experience to pursue becoming a physician, so I could help other children and families.

What was the hardest part of getting back into the “student” saddle? [5:50]

Definitely taking exams! Throughout my daughter’s life, I was reading a lot, researching a lot – so studying wasn’t anything new. But taking exams was hard.

How did you handle it? [6:45]

Through a lot of prayer! I definitely studied a lot – I’m a disciplined person – I put in a lot of hard work. And I used self-talk, trusting that I knew the material.

Economics doesn’t have the same kind of time-breakers as science and medicine – previous exams for me were about writing essays. It’s definitely a big challenge. Whether it’s in postbac, med school, boards – it pushes you to the time limit. Part is studying and knowing it really well; part is calming your nerves; and part is trusting and having a belief in yourself.

What was the hardest part of the application process for you? [9:20]

I was limited in where I could apply – I had a family, so I needed to be able to commute. I basically had seven schools I could apply to. The postbac program at Columbia recommends (even for the very top students) applying to 20 schools, because of the sheer number of students applying.

One of the things I didn’t have information about – I wasn’t aware of how to contact schools after applying, to stay on their radar. Once I started doing that, I got three more interviews.

There is a certain reality to the number of applications they get – if you can stay on their radar it’s a benefit.

What did your daughters say about your decision? [12:05]

They were very, very supportive. They were preteens when I first went to the postbac.

It was also about the fact that my decision was about helping other people. They knew what we had been through, and appreciated what I was doing.

I made a point of being available when they were home from school – that was important for me, after everything they’d been through. And I knew the more time consuming part of my journey would be when they were older.

As a non-traditional medical student, I had to accept I was in a very different place from my colleagues who were right out of college – I had a multitude of priorities.

Have you ever thought about quitting? [17:10]

Only once. In my third year, on my surgery rotation. It was a really rough rotation – you had to be there at 5 am (and I had an hour commute) and the hours were very long, and surgery is a tough rotation. There were times I wondered what I was doing. But that passed!

As a physician, how do you draw on your experience as a parent of a sick child? [19:35]

I share my story very, very selectively. Most of the time I don’t tell it at all. But I know parents sense something different from me – I’ve often had parents tell me they’re so happy when I come into the room. And I’ve had attendings comment that the personal connection I make with patients and families is really valuable to the medical team. Without my even having to share my story, the patients sense that I can understand them.

You were inducted into the Gold Humanism Honor Society at New Jersey Medical. What is humanism in medicine? [22:20]

Empathy, respect – that’s what humanism is about. I’m glad you brought up Rutgers because they’re really devoted to humanism in medicine. At the very beginning of med school, during the white coat ceremony, someone from the Gold Humanism Society spoke about what humanism means – how to learn it from other physicians, how to find physicians who have compassion, empathy, and humanism. That stood out in my mind. I was grateful to be selected as part of the Humanism Society. The Gold Humanism Society is a national thing. It’s valued when you apply to residency.

How are you selected? [25:17]

You’re nominated by your peers or faculty, and voted on by faculty. It’s both for med students and physicians.

There were 20 of us inducted out of 175 in the class. And about half of that 20 were part of my group of friends.

People often ask me how I related to people in med school as a non-traditional student – I tell them I related on the basis of my values. So it’s not a surprise to me that so many of my friends were also in the Gold Humanism Society.

There was a medical school fair at Columbia while I was there – admissions directors had come to speak. Dr. George Heinrich, who was the admissions director at Rutgers, spoke, and I was very impressed by what he said. He spoke about the humanism of someone who, as a med student, sat with the family of a patient who was going through surgery, and how valuable that was. That spoke to me, and I actually told him afterward how moved I was. It was his discussion of the values of the school and their commitment to humanism that made such an impression on me.

What advice do you have for non-traditional applicants or for applicants with 5, 10, even 15 years of experience in another field who decide they want to go into medicine? [29:10]

It’s a tough road. Usually they have other commitments – children, etc – so they’re not only focused on themselves and medical school.

So in making the decision to do this, be clear on why you’re doing it. It’s a long haul and it’s not easy – it takes a long of time and energy, and it needs a strong motivation.

Be aware you’re not going to have the time you had in undergrad, so you may not be a top 10% student – you can’t have that expectation. You have to do well, but you may not be at the very top because of your other commitments, and you may not be able to go into the most competitive specialties.

Any other advice for premeds and residency applicants? [32:45]

If you’re going into the most competitive specialties, your grades are paramount. But there are other aspects people don’t talk about as much.

I had a number of fellowship directors comment on what outstanding letters I had. The reason I had powerful letters is that my letter writers knew me really well and knew me over time. Developing longstanding mentor relationships – even as a premed – enables recommenders to provide detailed and meaningful examples in their letters. You’ll all have good grades – it’s the additional materials that can distinguish you.

You need good grades because they have to know that you know the material. But the other stuff is really important. It’s how they distinguish between you and your colleagues.

What do you imagine Ariella thinks about all of this? [38:25]

I think she is so proud and so happy that other children will have the kind of doctor who will listen, and will get the care they need.