A Change of Heart, But Not of Spirit – Interview with Alin Gragossian, DO
October 28, 2020
You might be familiar with Alin Gragossian, DO, from her blog, A Change of Heart
, which provides insight into her experience as an ICU-fellow-on-call turned ICU-survivor.
Originally from Los Angeles, CA, Dr. Gragossian is a 2016 graduate of Lincoln Memorial University-DeBusk College of Osteopathic Medicine. From there, she accepted a residency in Emergency Medicine at Drexel Hahnemann in Philadelphia, which was interrupted when she was hospitalized and received an emergency heart transplant in the middle of her third year of residency.
NBOME sat down with Alin to talk about her extraordinary Road to DO Licensure and how she persevered to reach her goals.
Let’s start at the very beginning. What first inspired you to become a physician and why did you choose to become a DO specifically?
I can’t tell you of a specific event that inspired me, and I don’t have anyone in my family who is a doctor. When I was five, a neighbor got hurt on our street and there were a bunch of ambulances. My parents said I was very interested in what was happening. Maybe, subconsciously, my drive to become a doctor came from that experience.
I started volunteering in the ER in high school and I found myself wanting to go there all the time. I continued volunteering there throughout college, going on to become an EMT and shadowing the same physician. I was driven to do everything in that field.
As to why I chose to become a DO—osteopathic medicine stood out to me because of the way DOs approach the patient. They don’t just look at one part or one system, they look at the patient as a whole. I was intrigued by that as a basic principle.
Do you think the osteopathic approach helps a lot in the ER?
When it comes to the more chronic things like back pain, foot pain, or knee pain that have been going on for a while, or patients with chronic conditions, you definitely look at it from a more osteopathic approach. Having that background knowledge absolutely helps
There is so much about being a DO that is special and unique. We often hear the phrase ‘osteopathic distinctiveness’ used across the profession. What does that phrase mean to you, personally?
I’m not an MD—it’s not that MDs are no good—it’s just that I went to school to become a DO and that’s my distinction. I’m part of a minority of physicians that went through a special kind of training to learn more about the osteopathic approach to medicine. I’m very proud of being a DO and if the credentials on my badge are mistakenly printed with MD after my name, I will specifically call to get it changed because I really like showing that I’m a DO.
Thinking back to your COMLEX-USA Level 1 and 2 prep, what was your approach to studying?
I took COMLEX-USA Level 1 after my first two years of medical school. We actually had a one month break to take the exam. I would wake up and literally study from 8am until 8pm—I even made a calendar for myself. I would do one topic in the morning, followed by questions in the afternoon.
For COMLEX-USA Level 2-CE and 2-PE, I took them after my third year during rotations and we didn’t have a break to study. Yet, at the same time, that test was more on clinical application, which we did a lot of during practice. It was a lot easier to remember that than the basic science. I would go to my rotation in the morning and in the afternoon, I would dedicate time to studying certain topics and then do questions at night. I definitely had a set way of studying and always allocated a time of day to do it.
What advice do you have for students preparing to take COMLEX-USA now?
Just answering questions—do as many question banks as you can possibly get your hands on. It’s not so much about getting the question right—it’s more about learning from what you got wrong by reading the answer and retaining what it was.
How would you advise DO students considering residency programs that might not be as familiar with COMLEX-USA?
Talk to somebody in the program, like the program coordinator, about the process. And if you’re unsure whether or not they are familiar with COMLEX-USA—ask! And if they don’t accept COMLEX-USA, find out why. Maybe it’s because they’ve never had a DO student before. Maybe it’s because they aren’t sure how it works. For the most part, most programs do accept DO students. There are probably some that historically haven’t, but in the future, everything should be more balanced.
For most of the emergency medicine programs I applied to, I already knew somebody in the program through an emergency medicine interest group at my COM. The program I ended up going to—which was Drexel—even had a resident who was an alumni from LMU-DCOM. Check out the various specialty interest groups at your school, see if there is anyone in a program you are interested in, and ask them for advice.
In your 3rd year of residency, you received a heart transplant, how did you pick up where you left off?
I was in the middle of my third year of residency and had just matched into my ICU fellowship. A few weeks later, I got very, very sick. It was so sudden when I went into cardiac arrest and needed a heart transplant. So, instead of starting an ICU fellowship, I became an ICU patient. I went back with 6 months left of residency only to find out that Drexel was shutting down the whole hospital. So not only did I have to work through my health condition, but I also had to find a new program.
During the five months I was recovering, I continued to do board review questions so I wouldn’t forget emergency medicine. Then I found a new program at UPMC Pinnacle in Harrisburg, PA. Initially, I couldn’t see patients face-to-face because I was still immunosuppressed. I did mini shifts and then finally started seeing patients in October of 2019. The first couple of days were awkward, but muscle memory kicked in and I remembered everything pretty quickly.
I obviously didn’t know I was ever going to need a heart transplant—I’m 30 years old and completely healthy. But I was lucky to be in a residency program that was truly supportive. Faculty, attendings and co-residents were always there for me in case I didn’t feel comfortable or if I needed help.
As an ICU-survivor, but also as an ICU-fellow-on-call, you must have experienced some unexpected challenges. Tell me a little about what you’ve overcome to get to where you are on your Road to DO Licensure.
As acute care physicians, there’s always a lot of craziness around us—there could be a code, a trauma, and a stroke all at the same time and you have to know how to stay calm. You can’t just sit there and panic. I don’t know if I was always like this or if emergency medicine shaped me into who I am, but having the ability to stay calm is essential. That’s also what helped me get through my heart transplant. As scary as it was—as annoying, as angry, and as sad as I was—I had to just take it, deal with it, and show people that you can go back to living like you normally would.
We know there is already a tremendous amount of stress and anxiety tied to this journey—how did you manage all of it? What worked for you?
You have to have balance. Recently I found out I had been put on the schedule for multiple days in a row without realizing I had two 24s that week and no day off. Speaking up about that is important. I could have been fine that whole week without the day off, but I said something about it and told them, ‘this has been a crazy week for me.’ It ended up just being a mistake. Speaking up when you feel overwhelmed, making time for yourself, and having an outlet is very important.
I personally like to write. That’s just my way of dealing with things. Different people like to do different things—some of my colleagues write music, some of them like to draw, and one of my co-residents even makes videos and has channeled it into doing things related to COVID-19. Find the thing that makes you happy, know when you feel overwhelmed, and be able to speak up.
You just moved to New York City to start the latest chapter of your life. Tell me a little about the Critical Care fellowship you’re currently doing.
I’m doing a critical care fellowship at Mount Sinai Hospital in New York City. It’s a medicine and surgical-focused two-year multidisciplinary fellowship. We rotate through all of the ICUs throughout the Mount Sinai Hospital system—neuro ICU, transplant ICU, surgical ICU, and medical ICU. At the end, we take the critical care boards. It’s similar to doing a home critical care fellowship, just without the pulmonary part. Most of my peers are all medicine trained—there are a few of us who are emergency medicine trained too so it’s interesting to have a good mix of people around me.
What’s next after this? What are you looking forward to the most?
After my fellowship, it would be awesome to stay on the east coast (because it stole my heart, quite literally). I would love to have a job where I do both ER and ICU because I’ll be boarded in both. I want to stay in academics and work with residents, teaching medical students what I know, learned, and experienced.
Based on your hands-on experiences, what advice do you have for those who are coming after you?
Don’t let anything stop you. There is going to be a lot that challenges your way of thinking and challenges you personally. There are going to be things that happen to you that you wouldn’t ever think would happen to you. There will be people who tell you that you’re not going to make it, and things that happen that will make you question whether or not you should be doing this. But, at the end of the day, if you really want to do it, don’t let anything stop you.
Feeling inspired by Dr. Gragossian’s story? Become an organ donor and advocate for others to become donors too. There are many myths around organ donation, and it’s important to realize how unfortunate circumstances can breathe new life into someone else who is in need.
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