From Patient to Provider
Oscar Paniagua-Morales takes health care personally.
At age 24, he was diagnosed with renal failure and both kidneys shut down.
For the next four years, he spent three days a week hooked up to a dialysis machine. From adversity came an epiphany.
“Sitting on dialysis for hours, interacting with the technicians and physicians…it made a lasting impression,” he says. “I want to be a doctor to learn more about my disease and better ways to treat it.”
Before Paniagua-Morales could pursue his goal, he needed a functioning kidney. Thanks to his fraternal twin brother, he got a life-changing gift in 2008. Three months later, he enrolled in college at Colorado Mesa University (CMU).
Since then, he’s been unstoppable, seizing every available opportunity for advancement.
“I was so hungry for knowledge when I started college,” explains Paniagua-Morales, now 34, who was part of the Summer Medical and Dental Education Program University of Nebraska 2011 class. “SMDEP created the path to where I wanted to go.”
That road forward, he hopes, will lead to a specialty in nephrology. “It would be great if all those years on the patient side put me in a position to improve care for people with kidney disease.”
Long before his kidneys broke down, Paniagua-Morales understood that fate could be capricious.
He was 13 when his father was killed in an accident; young Oscar completed one semester of high school in his native Mexico before dropping out to help support his family. At age 17, he emigrated to the United States, where he had extended family in Colorado. His mother joined him a few years later, followed by his brother.
After arriving in the U.S., he decided to forgo high school; instead, he sought work in restaurants as a dishwasher. “The biggest challenge I had when I came here was that I didn’t know English,” he says. “I worked in kitchens and eventually learned the language.” His perseverance paid off in other ways. He learned to cook, and soon advanced from line cook to shift manager, where he trained and supervised other cooks and kitchen staff. Outside of work, he took remedial classes to prepare for the GED exam.
“It would be great if all those years on the patient side put me in a position to improve care for people with kidney disease,” says Paniagua-Morales.
Then came the diagnosis, and his plans ground to a halt. From 2004 to 2008, he underwent dialysis and concentrated on raising the money needed for a kidney transplant. With typical understatement, he says, “You need only one kidney to live. My brother gave me one of his.”
Two weeks before he was scheduled to undergo his transplant, the plot took another turn: his mother learned she had breast cancer, which later metastasized to her brain. Fortunately, surgery and radiation eradicated her cancer. “She has to take medicine to keep the tumors from coming back,” says Paniagua-Morales, “but she’s fine now.”
His transplant finally took place in October 2008; in November, he took the GED exam and passed. The following January, no longer tethered to a dialysis machine, Paniagua-Morales entered CMU as a biology major.
Charting His Own Course
His early years have been packed with more drama than most experience in a lifetime, yet Paniagua-Morales’s most notable attribute may be his perseverance.
“I have never seen a student with his level of desire and ability to chart his own course,” says Forbes Davidson, PhD, Professor Emeritus at CMU and Paniagua-Morales’s mentor.
“The very first day I met Oscar, he came by my office with some questions about course requirements for medical school programs at institutions such as Harvard and Johns Hopkins,” Davidson continues. “I remember thinking to myself, ‘Whoa, maybe you should be more concerned with getting the first year of college under your belt!’”
But Paniagua-Morales resolutely began applying to summer programs at medical schools across the country. At the top of his list was SMDEP, which accepted him at the University of Nebraska Medical Center (UNMC) site. “I wanted to talk to people in the field, professionals who could help me reach my goals,” he explains.
He was excited by the variety and intensity of the program; led by medical school professors, the classes offered him a one-on-one view of how essential topics are taught. “They were so dedicated, volunteering their time to teach us,” he says. “I got a huge amount of feedback, and I learned so much.”
In addition, he made good use of his interactions with the medical students who helped with the program, peppering them with questions: How hard is this? What did you do to get here? What would you do differently? “Advisers are wonderful sources,” he notes, “but you also have to talk to people who are a year or two ahead of you to get their perspective.”
He values the support and camaraderie he found with his fellow students. “You live with people whose goals and challenges are similar to yours. It helps to meet others who are going through the same thing as you.”
Above all, the experience was an affirmation that medical school wasn’t beyond his reach. “Almost 80 percent of the people who did SMDEP with me are now in medical, dental, physician assistant, or pharmacy school,” he adds. “Like me, they were struggling and didn’t know if they could make it—and now they have.”
Since SMDEP, Paniagua-Morales has benefited from four additional internships at such stellar institutions as Johns Hopkins, Vanderbilt, and the University of Colorado. He recently was invited to present his research from the Hopkins program to the Annual Biomedical Research Conference for Minority Students (ABRCMS).
His unique vantage point with kidney disease helped him grasp the human connection between provider and patient from both sides of the stethoscope.
“They were amazing role models,” he says of the providers who treated him during his years of dialysis; the kinship he developed with them resonates with him even now. So, too, does an interaction he observed between a physician and a patient during his time at SMDEP.
“I was shadowing a doctor at UNMC, and he did something different from any other shadowing experience I had witnessed. He was talking to the patient, and then he sat down on the bed and touched her on the arm. The patient really responded to the personal contact.”
That the episode made an impression on Paniagua-Morales doesn’t surprise CMU’s Davidson. “He has a great appreciation for the miracles of modern medicine,” he says. “But even more importantly, he sees the positive effect that physicians can have on an individual’s life.”
Davidson invokes Dr. Francis W. Peabody’s venerable 1927 speech to Harvard medical students, in which Peabody asserted, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”
“I think Oscar will be an embodiment of that statement,” says Davidson with conviction.
Understanding the Patient Experience
“If you’re an underserved student and you don’t have exposure to a program like SMDEP,” says Paniagua-Morales, “it’s very hard to make it on your own.”
Paniagua-Morales is taking additional classes in preparation for medical school; he expects to receive his bachelor’s degree in the spring or fall of 2014. He’s also studying for the MCAT and will begin applying to schools in May.
He praises SMDEP and the vital role it plays in helping students like him navigate the choppy waters of the application process. “If you’re an underserved student and you don’t have exposure to a program like this, it’s very hard to make it on your own and carry yourself through,” he says. “There’s nothing else like it.”
His intimate understanding of the patient experience will be a valuable asset, as he learned during his summer internship at Vanderbilt University. “I was shadowing a transplant team at the hospital, and I talked with patients about how I experienced what they were going through,” he says. “They wanted to know how I handled the medication and its side-effects, and how I survived dialysis.”
“They knew that what I said came from my own experience,” he adds. “It felt great that I could say something useful to them besides ‘Just take your medicines.’”