A month and a half ago, my dad, across the ocean, was diagnosed with cancer. I needed someone to talk to about it — and the University of Milan came through.
One of the most important things that a university offers — especially to a med school class of students from around the world — are support services like counselling, health and well-being promotion, disability accommodation, and so forth. I know these are important because I used to work for Columbia Health, which provides such services to Columbia University students in New York. We at Columbia Health dealt with issues ranging from immunizations and nutrition, to LGBTQ advocacy and gender-based violence response. Thousands of students came to us every year, and it was, to me, personally, very satisfying to see the difference we made both in their lives and their education. Healthy students are academically successful students; this is something that good schools have known for centuries. The University of Milan also offers student support services, and they are important to know about, if you are considering going to — or are already a part of — the school.
One morning in April, while, at IMS, we were in the middle of tricky unit on neuroanatomy, my dad phoned to tell me that his urologist had diagnosed him with kidney cancer. Since I am the medical student in the family, my mother and brothers turned to me to ease their worries; it was up to me to examine the doctor’s report, research kidney cancer, and describe the situation to my loved ones in a way that was both comprehensive and simple to understand, giving them clarity and hope. All of this required me to keep emotionally cool — to go into “functional mode”, as an acquaintance of mine put it. Being in a calm, functional mode is something that I am used to, having worked in an ER, and as a radio news anchor, narrating crises live on-air.
While I was acting as my family’s point person on the science of my dad’s cancer, I had to keep my cool for school, too. Our anatomy and biochemistry classes required tight concentration. Conceptually, the material was so dense that if you missed a word of lecture, you could lose an entire train of thought. In addition, we were doing intricate labs, including the opening and post-mortem of the cadaver of a woman who had died just two weeks earlier. My father’s surgery for kidney removal was scheduled, literally, for the day that we students were to watch our first cut into a human body.
I have mentioned before that I sometimes feel like a duck: seemingly placid above the water, but, hidden, paddling madly beneath it. During long classes or labs or phone calls with my family, I was keeping my cool. However, in the down time, when I was alone, like right before bed, I was doing a lot of reflecting on my father’s mortality. Medical students, I think, cannot avoid seeing the parallels between their study and real life. Medicine is not an abstract discipline, separated from day-to-day activity, like, say, medieval paleography or cosmological astrophysics. (OK, paleographers and astrophysicists, take issue with me.) Health and illness are all around us: I am just thinking about yesterday, when I encountered 1) the little old lady with kyphosis who lives across the street from me, 2) news of the sudden death of Kimbo Slice, and 3) the debate about whether the Rio Olympics should be cancelled due to Zika virus. Sickness and mortality present themselves to us endlessly; they are everywhere, whether or not we wish them to be. That is one reason why, as a field of study, medicine is so absorbing, and a great provider of consolation.
In any case, I realized that during the following months, I would be coping with my dad’s cancer while trying to pass the rigorous IMS curriculum, and that it would therefore be very important to keep my emotions in check. I needed to be able to speak with someone removed from the situation — not a family member, nor classmate, nor professor — and who was psychologically astute, whom I could tell what I was really feeling, and who could monitor me regularly to make sure that I did not myself fall into an emotional hole. I could have done this by seeking out an English (or German)-speaking therapist in Milan. (My Italian simply is not good enough yet to be able to express my feelings with the nuance required for effective counselling.) However, my experience at Columbia Health had been so excellent, that my thoughts first turned to the University of Milan, to see if it could provide a similar service.
The great news is that it does. IMS administrators put me in touch with COSP, the Centro per l’orientamento allo studio e alle professioni (“Center for Orientation to Studies and Professions”). COSP is a huge organization which helps prospective students, enrolled students, and alumni, with everything from deciding whether to come to the university, to setting up internships, to career placement. For prospective and current IMS students, it is worth highlighting three particular areas of activity of COSP: disabled student support, tutoring, and psychological support. You can click on the links to learn more. I, of course, turned to the third; as for the first two — if you are dealing with a disability, or are struggling academically — the University of Milan has a system in place to accommodate your individual needs.
More, now, on the psychological support office: it is organized in cooperation with the School of Medicine’s Institute of Psychology, and San Paolo Hospital, which has an excellent reputation for psychotherapy and is also one of the teaching hospitals where we IMS students will probably end up doing clinical rotations. COSP has a sort of hotline phone number which you can call Monday through Friday. The administrator who answered graciously spoke English to me, and said that he would try to find an English-speaking counselor. Within two days, I had an appointment with one.
I would like to step back for a second and reflect on how remarkable that is. The University of Milan probably has fewer than a thousand students who speak English as a native language — out of a population of more than 60,000. At most, it’s less than two percent of students. Nonetheless, COSP was able immediately to find a psychologist who specializes in student counseling, and who could conduct it in English. At Columbia Health, I believe, counseling was available in languages like Spanish and Chinese, but the percentage of the student body who were native speakers of these was considerably higher than two percent. That COSP was able to find an English-speaking counselor — and find her so quickly — was just a really great service. And, it is inexpensive: appointments are 7.50 euros; the rest is subsidized, I believe, by the university.
The psychologist was awesome. She was not a native English speaker, but had worked in the US, and her command of the language was elegant. I quickly explained to her my situation, including about my dad’s cancer, my role as family point person, and the intensity of our course schedule. She got it, and was able quickly to process the range of emotions that I had been masking in daily life, such as the fear of losing my father — the person I trust the most in this world, the most patient and tolerant man I know, such that my nickname for him is “My Dad the Dalai Lama” — the guilt I felt at not being with my family in Connecticut during his health crisis, and the loneliness of not quite having anyone in Milan with whom to speak about all this. Counselling provided a safe place for me to emote, without the risk of bothering others in the process. The psychologist helped put these feelings into perspective, as a healthy reaction to finding out that your parent has cancer.
The good news is that now, a month and a half later, my dad is doing quite well. He had his kidney tumor removed, and as far as the doctors know, is cancer-free. More — perhaps less obvious — good news, is that I learned a lot in the last month about some of the emotional challenges that I may face in my future career as a physician. First, of course, doctors have to cope with the sickness — and almost certainly eventually, loss of at least one — of their patients. A lot has been written about the awe, pride, and terror of the profession. With patients, most physicians learn to stay calm; but what happens, I asked the COSP counselor, when a doctor’s loved one gets sick? What does an ER specialist do when it is her dad in the ER? Or for that matter, what does a radio news anchor, who constantly reports on the tragedies around him, do, when he faces tragedy himself? When you wear a mask all day professionally — for the benefit of your patients, or listeners — how do you take that mask off and allow yourself to cry, shiver, or mourn over a personal matter? I certainly do not have a complete answers to that question, but the COSP counselor has allowed me to at least begin exploring them.
As the IMS-Milan — and other nascent English-language med schools in Italy — expand their offerings, they have the opportunity to make student support services more accessible. New student orientation, for example, is an ideal time to introduce COSP’s disability, tutoring, and psychological support services, in English, to the English-speaking IMS student body. Furthermore, the IMS is based in its first and second years out of LITA Segrate, a lovely facility and neighborhood on the outskirts of the city, which provides a perfect environment for people from the university community — either experts, or just we students ourselves, within a peer educational framework — to address the same kind of issues that I and my colleagues did at Columbia Health, such as eating and sleeping well, time and stress management, or intercultural communication. One organization available for IMS students to contact, to help commence peer advocacy, might be the national organization SISM (Segretariato italiano studenti medicina), which offers student-to-student education on subjects such as women’s rights and AIDS. I attended a meeting of SISM’s Milan branch, and they are really nice people.
When you think about it, support services are extremely important in an international medical school environment. Among international students, you have truly brilliant adventurers — some, in our class, as young as 17 — arriving sometimes literally from the other side of the planet, into a country where they do not speak the language, having to find housing, figuring out their way around the city, all of this often on a quite low budget, and meanwhile required to attend incredibly tough coursework in an academic and social culture often very different from that of home. For a lot of them, English is not even their first language — so they are studying in a second language, while learning a third. And the wonderful thing is: they succeed! I constantly say how absolutely amazed I am at my IMS classmates, who have found ways to navigate through this forest on their own. It is really an incredible accomplishment, and just daring to be an IMS student deserves huge praise. I am 39, and have lived in six different countries, and even for me, it was not easy moving to Milan and getting used to med school. The dozen or so IMS students local to Milan and its surroundings — also amazing people — often have the good fortune of families nearby, built-in social support networks, comfortable housing and home-cooked meals, old teachers and mentors, and so forth, to lean back on. All of these come with, of course, their own challenges, but being hometown probably ultimately gives these students certain natural advantages — as well as the chance to help support their international peers.
When I was 16 — just one year younger than my youngest classmates — I went to a boarding high school in the neighboring state of Massachusetts, and from the moment I stepped on campus the school had my life sorted out. Everything was set up, from a dorm room to a meal plan to a sports and activities fair, to a house counselor and infirmary responsible for my well-being, to inauguration ceremonies, to a welcoming committee waving signs in the school’s characteristic blue, accompanied by bagpipes and our mascot, a gorilla named Gunga. It was great; I was able to dive right into my academics.
I am not sure that the IMS needs a mascot, much less a gorilla. (Maybe we could borrow the mascot of the Polytechnic University of Milan, Leonardo the Lion? Or Charisse?) Nonetheless, the University of Milan — and, perhaps, the other English-language state medical schools in Italy — do have all the structures in place, to offer a robust student support system.
Erik Campano is a graduate student in Umeå, Sweden, studying the ethics of artificial intelligence in medicine. He formerly was an academic consultant to the English-language medical school of the University of Turin. Erik completed his Bachelor’s of science in Symbolic Systems (cognitive science) at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. Erik grew up in Connecticut, is a citizen of the United States and Germany, and his family is a mix of Filipino, Italian, and German.
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