About this Episode
Episode 157: Published on May 13, 2024
Join us for a conversation with five alumni of Northwestern University Feinberg School of Medicine.
Cats, in Medicine, with Feinberg Alumni
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[MUSIC PLAYING] MAX: Welcome back to Northwestern Intersections, an Northwestern Alumni Association podcast. We'll be talking to alums about their career trajectories and the lessons they've learned along the way. Our guests today join us from Feinberg School of Medicine's Alumni Weekend. Enjoy hearing stories and life lessons from five Northwestern doctors.
Our first guest is Dr. Darren Wethers, class of '88. Listen as he describes his experience as a student and efforts in inclusivity and diversity at Feinberg. What brought you to the medical field and what attracted you to Northwestern Medical?
DARREN WETHERS: I came to medicine through a rather circuitous route. I wanted to do biomedical engineering. I applied to college, got into several engineering programs. But during new student week at my college, they took us to the drafting room and told us about students staying up all night to complete these drafting projects. And I thought, there is no way in hell I'm doing this. So maybe it's not the engineering part I like, it's the biomedical part. And so site unseen, I changed my major to biology, started tracking pre-med, and applied to medical school.
MAX: Interesting. What about Northwestern was appealing to you? What brought you here to Chicago?
DARREN WETHERS: I'm a native Chicagoan, so of course I applied to all the Chicago medical schools. But on my campus visit here, I met some really dynamic students who made me feel like this was the greatest place to be. I had a great feeling being here in downtown Chicago, and I liked that the school was an honors pass/fail curriculum. So it took away a lot of that grade pressure that you would have at several other institutions.
One of the medical schools here in Chicago had a reputation for admitting 125 students, but only having room for 100 in the clinical years. So there was a forced elimination of 20% of the student body, which just seemed really toxic to me and I didn't want any part of that.
MAX: What was student life like here? What do you remember fondly? What do you miss?
DARREN WETHERS: So I remember the first welcoming reception and Lake Shore Center, and it was a champagne reception. And I thought, well, I'm really an adult now because the school is serving champagne. The second thing was being surprised that the school was not very diverse. There were five of us officially who were people of color, two of whom didn't really identify as people of color. So that left myself and two other classmates. And so we became our own support system.
MAX: You're on the Inclusion and Allyship Committee here. What brought you to that and why is it so important to continue these conversations and this push in the medical field?
DARREN WETHERS: I was reintroduced to the institution through a former board president, Dr. Bonnie Typlin. And she really encouraged me to reconnect with the school, sharing with me how much advancement had taken place since I was a student. And so I became a board member about six years ago. Shortly thereafter, one of the other younger board members talked about starting a Diversity and Inclusion Committee of the board. And he and I began talking about it, involved the staff of the alumni board. And they said, well, then the two of you should be the co-chairs. And that's how it started.
But we were intentional about the naming of the committee. Inclusion and allyship allows anyone who's interested to participate. You have to be interested in bringing all people to the table, and you don't have to be a member of an underrepresented group to be an ally for that group. And so anyone with a passion for this work can be a part of our committee.
MAX: What are your goals for this committee? And I'll just ask you really broadly, what are your hopes and dreams for Feinberg in general going forward?
DARREN WETHERS: I think the Inclusion and Allyship Committee has two main purposes, the first of which is to reach out to our alums who may have been similarly disaffected as I was, and to let them know that the school has progressed in ways that I think they would be proud of, and to ask them to come back, bringing all of their emotions, anger, resentment, whatever that may be, and unpack it with us in that safe space.
The second part of that is to reach out to our current students and be a support system for them through their Feinberg matriculation, but also be a bridge from their Feinberg years to their experience as alumni so that they feel they're part of a community when they come over into the alumni space. So the connection with the students isn't tied so much to their matriculation through school as it is the connection we have as individuals.
There are a couple of students that I'm in contact with presently, both at Feinberg and from other medical schools, and we don't have a formal mentorship. It is more of you can call me when you need to, or I'll check in on you when I start to feel like I've not heard from you in a while and see what's going on. And I really enjoy that. But the board writ large looks to mentoring as one of its key tenets, and that's something that we're working toward at the Inclusion and Allyship Committee of the board.
The other is philanthropy. We want to make sure that the students are able to be financially supported through their time here so they don't leave burdened by excessive debt. I've been a contributor toward the Promise Scholarship for the last five years and hope to continue that ad infinitum. But it is to create a way out of no way for today's students.
MAX: What are your tips for someone who's, let's say, just finished medical school on staying involved with Northwestern?
DARREN WETHERS: You know, it's difficult because as they leave the school, they're going into the most intensive training they'll ever experience. And internship, residency, perhaps fellowship, and then starting their careers, maybe starting families. So it's hard for them to be anything other than passively aware of what's happening. And that's all right.
But what we want them to feel is that when the time is right for them, that there'll be a community waiting to welcome them in. And we have to continually make that message through our publications, through our social media, through the Feinberg on the road programs that they do in different cities so that they feel that they're part of a community.
MAX: I also want to shift gears and ask a little bit about your career. Thinking on your trajectory, how did Feinberg help you get started in your career? And then what kind of work do you do now?
DARREN WETHERS: I was interested in primary care when I came. I thought it was going to be family medicine. I was the president of the family medicine interest club until I hit pediatrics and found out I didn't like taking care of sick kids. So you can't be a family practice doc if you don't do kids. So that was out. But I'd already done internal medicine, and I liked that longitudinal care experience. I'm nosy. I want to know what happens next.
I really liked emergency medicine, but I always wondered if we sent someone home, was that the right idea? If they got admitted to the hospital, what happened next? So as much as I liked EM, I couldn't do it because of that nosy character.
So internal medicine was it. I trained at Emory in internal medicine. And one of the ID faculty members had done his fellowship here, Jake Steinberg. And so I was able to continue that Feinberg connection with him. At that time in the late '80s, early '90s, HIV care was really starting to emerge, and I got caught up in that. So for 20 years, I practiced medicine in the Saint Louis area with a focus on HIV and AIDS care and also chemical dependency. And those two worlds really were intertwined for a lot of the patients.
MAX: I want to hear about your current role as a medical officer. What does that entail versus being just a physician? And what are the different responsibilities?
DARREN WETHERS: So after completing my 20th year of practice, I started working as a medical officer for a health plan, reviewing authorizations for care, talking with our colleagues in the field. And I really felt like I was a liaison between the provider side and the business side of medicine. And having been a provider so recently, it was easy to do that.
Many people who had gone into the health insurance world did so at the end of their careers when they were kind of burned out. And I was still mid-career at that point in time and looking forward to having a long arc of advancement. Currently, I'm a Chief Medical Officer of a Medicare Advantage Health Plan that's headquartered in Salem, Oregon. And here we're looking after our seniors, many of whom are part of that great generation after World War II and the emerging baby boomers.
Now, some of my older friends and colleagues are starting to hit Medicare eligibility, which is really odd. But making sure that they receive the care that they're eligible for and also that we are good stewards of our tax dollars. If grandma needs a new wheelchair, we want her to have one. But she maybe doesn't need the electronic one with the tilt and space and leg elevation. Maybe she just needs a little manual wheelchair to get around at her senior social. So making sure that the care is delivered in the best possible setting, but also for the best price is what we do.
MAX: Let me ask you this. Looking holistically at medical experience, work experience, where you are now, what's your best advice for students or maybe new medical professionals? And is there anything you would have done differently?
DARREN WETHERS: I would tell today's students to follow their passion. But part of that is figuring out what you're passionate about. But follow your passion, because it's a long career. It can be difficult at times. And if you're not 100% committed to it, it can break you.
I think looking back on my time here, I wish I had reached out for help earlier when I got into difficult situations. And I did. I stumbled in a few classes. But like many of us who'd come in, we got into Northwestern because we were stellar students and we'd always had great grades and we were at the top of our class. And frankly, we're not used to asking for help. So I wish I had someone who would have shared that.
When I meet with students today, I'm very candid about that. I had some troubles when I was here. It wasn't an easy course on the way through, but you can make it through. But here's how. It doesn't help for them to hear from people who are like, oh, I was AOA and honors in every one of my classes. Well, that just makes them feel more intimidated and less likely to ask for help. And so I would have liked to have had me when I was a student come and talk with me.
MAX: Do you have any best memories, most memorable classes, any specific shout outs you'd like to give?
DARREN WETHERS: I have the best memories of hanging out with my classmates here and my friends. This morning my mind was just running through with scenarios of being in the dormitory. Lake Shore Center back then had a bar and grill on the second floor called Jimmy G's. And you could go down there and hear live blues music, get a pizza and a pitcher of beer, watch David Letterman, who was the hot dude at that time. And just some of the mischief we got into. It wasn't all hard work and study. There were just a lot of good times.
MAX: Our next guest is Boris Sheynin, class of '99. Hear his inspiring story of coming to the United States as a Ukrainian refugee and finishing medical school with a family.
BORIS SHEYNIN: My mom was a doctor growing up. She was a pathologist. Usually she would take me to work and she said, OK, take a look. This is going to be it. Look at the microscope. She was a laboratory specialist. So going from there, I was kind of brought up with the thought that, OK, I'll go to medical school. And I was accepted to medical school and then I lost it. That was back in Ukraine. Accepted the medical school in '86. Like everywhere else, the medical education is six years after high school. So you have to pass the exams. I passed the exams.
And when I was in my fourth year, that's one year plus two years of mandatory service in the army, plus three years in medical school, and my family applied to be refugees in the United States. And we were granted the permission. And we decided to go. And I decided that, OK, four years, I'm going to go and now restart somewhere here. So we arrived, my parents, myself, 10-month-old baby.
And then I learned that, OK, I have to start from the beginning, because the education here is different. You have to have a bachelor's degree. So I'm right here in Chicago on the North side. And the I set off for my bachelor degree. I looked up, OK, which one is shortest for the medical school? They had a couple of advisors. And they said chemistry.
And somewhere after my first year, I thought, let me take the exams, the entrance exams. I did the exams. I did OK, and I applied to medical school and before finishing the medical, the bachelor's degree. I got accepted. I applied to two schools, making sure that those are the schools that I would get in.
The other thing that all of a sudden I realized, OK, I'm here. Now I have to work to bring some means too. And the only thing that I knew and I loved medicine. There was quite a lucky road there. And it was a conversation. My parents were very supportive. My wife was very supportive that I did go on and try to go back into medicine. Kudos to them. There was nobody to watch the baby and to help us emotionally, probably it wouldn't happen without them.
MAX: What are your best memories from campus?
BORIS SHEYNIN: It's hard. I have a few good memories. At the time, I think most of my classmates were-- some of them were making fun of my accent. [LAUGHS] It was much heavier. I was one of those people who was commuting. Because we are a family and I happened to work full time while in college and my wife was working full time. So we bought a condo in Wheeling, which is about 35 miles from here. OK.
And when I was accepted in medical school, we have a condo. It's not like we're going to move downtown. My wife has to work. And so we have baby, we have parents who are living close by to watch the baby. So I was commuting. So for me, I was arriving here at 6 o'clock to beat the traffic. And then I was just in lectures.
The lectures were in person at the time. There was not that much of the remote lecture. But I was happy to be there. I was happy to be there. And we always had great students, all the students who show up to classes early and were constant. I think the major key is making friends. Making contact and people helping each other. Some of them I still work with.
MAX: What's your best advice for a current student or someone who's just finishing school?
BORIS SHEYNIN: Take your naps. Exercise. Don't stop exercising. There's life behind it. Always, always pay attention to your close ones. Get yourself in the best physical shape. Make sure that you always keep up with your own physique.
MAX: What's your best-- what's the best advice that you received as a student, or were there any experiences here that helped you in your career?
BORIS SHEYNIN: Multiple people...with experience, you meet people in different positions, you talk about your career choices. You talk about what you'd like to do. And that's medicine as a profession and any profession. So the more exposure you get, the better.
MAX: Our next guest is Dr. Jeff Schaider, class of '83 and '85. Enjoy his stories from campus and what he appreciates about his classmates.
JEFF SCHAIDER: Well, I think what brought me to Northwestern really was the honors program in medical education. In my day, essentially, they had a program where you essentially do two years undergraduate, four years in medical school, you get accepted as a high school student. So it was a very attractive program, from a short perspective, and plus, you're a guaranteed admission to medicine at that point in time. Whether you want to go to medicine or not. Who knows when they're a senior in high school? But that's what I thought I was going to do. And in fact, it worked out very well for me.
MAX: So what kind of medicine do you practice?
JEFF SCHAIDER: So I do emergency medicine. So I was actually at Cook County Hospital, which is the public hospital here in Chicago for 30 years. I was the chairman there for the past 15 years or so. When you're the chairman of emergency medicine, you still do direct patient care, plus you have all the headaches of being a chairman as well.
So I would say, which is a better job? Seeing patients. The days of seeing patients at the busiest ER in the state was a much easier day than actually dealing with all the other problems I was dealing with when I was in my office.
MAX: So you basically just doubled you up.
DARREN WETHERS: Pretty much so. Pretty much so. Exactly. Exactly. It's not an easy job. Let's just say that.
MAX: Best memory at Northwestern? And what's your advice to current med students?
JEFF SCHAIDER: Yeah. God, there's so many great memories at Northwestern. God, if I had to pick one, I mean, obviously all your friends and stuff like that during cadaver labs. I'll tell you a funny story. So in my day, our cadaver labs, we actually had-- everyone was divided by their-- it was alphabetical. So my last name is Schaider. So I knew all the S's and the R's, because we were on the same room together. And we were a group of S's and next to us was the group of R's.
And they were fairly competitive, the R group, let's just say that. And we had to pump our cadavers up in order to dissect the cadavers. And their cart was defective. So that when they went up, something happened, but it would always drop down really low.
So there was something different about their cart, lifting up and stuff, and it was really a hassle for them for whatever reason. So we would always laugh about it. We didn't say anything, but we sort of knew that they had a defective cart. So one time we came in and then all of a sudden, our cart dropped and theirs went down smoothly. They switched the carts. So we knew that happened actually.
So what did we do? We switched them back. And then we were just cracking up when we saw their cart drop and they were so surprised we switched the cart back. And in fact, one of the women that was in the other group, I still tease her about it to this day. Competitive, nice rivalry. In fact, she delivered my son. She delivered my son. She did a great job. So in fact, we still remain close.
MAX: I'm glad the relationship smoothed itself over.
JEFF SCHAIDER: She was a fantastic physician, so she did well in her cadaver dissection.
MAX: Would you do anything differently if you could or is there any advice that you wish you'd known that you would give to students?
JEFF SCHAIDER: I think what-- again, I've taught students for the past 35 years or so, medical students and residents and such. The key thing to being a good physician is seeing a lot of patients to push yourself. And that's what I tell all of them. You've got to-- the only way to learn is by seeing. It's an apprenticeship. So the more you see, the better you get.
So I've always told people when I'm working a shift within the emergency department or whatever they're doing, see as many patients as you can. Treat them well. Learn how to take care of patients. Because the better you are, the better physician you'll be. But if you're a good physician, and I find those are the people that can relate to the patients the best, because they have the confidence as far as diagnosis.
They don't have to waste time thinking about stuff. They sort of know it. And they could actually hold someone's hand and really provide good care for them. That's especially true in the emergency department. It's been a great career seeing a lot of different patients and really helping a lot of people, which has been really nice.
MAX: Our fourth guest is Dr. David Lee, class of '89. Listen as he shares his experiences and academic medicine.
DAVID LEE: When I was looking for a mentor, I had done a lot of cardiovascular research in college. And I thought, my future is in cardiology. That's one of the things that is really kind of meaningful to me. I feel like the heart is incredibly special organ, because it's with you every single day of your life. It's beating there. It's part of who you are. It has emotional significance. There are so many wonderful parts about cardiology. I said, I'm going to be an academic cardiologist.
So I want to go work in a cardiology lab summer after my freshman year of med school. And the guy who was running it was the Chief of Cardiology named Mike Lesch. And he's the most laid back individual you'll ever meet. I mean, this is a person who was very famous, went to Harvard Medical School, has a disease named after him because of something that happened in medical school sort of serendipitously.
So I went to work for him. He was my mentor. And he actually guided me on my next step, which was when I decided to take a leave of absence to go do a year of research in another cardiology lab at Harvard with a cardiologist whom he had worked with when he was at Harvard Medical School. And it was one of those really sort of special connections.
So I took a year off, moved to Boston, sort of was an adult. I'd go into the lab every morning and work. And I met all these incredible cardiologists who were very inspiring to me. I met a lot of fellows who sort of influenced how I thought about medicine and what I wanted for a career in medicine.
But when I finished my year, I realized I'm not going to be an academic cardiologist. Because these guys, they're in the lab all the time. Because they were doing clinical and research, every time someone showed up in the ER with chest pain, we had to stop our experiments, because you can't really ignore somebody who's in the ER. So then we went and we'd have to sit around, get that stabilized, and then we'd start our experiments.
But I just realized that in order to be an academic cardiologist, you need-- or in order to do academic medicine, if you want to do research, you need protected time. And so I actually switched to anesthesia, because you're either in the OR or you're not in the OR, which means that you have time to do lab work if that's what you want to do, or you can do clinical work or you can do research or you can do academics and teaching. And there's so many different options. So that's why I decided to do that.
And I'm very grateful that Northwestern allowed me to take the time off to do a leave of absence. I came back. I fell into a wonderful class that started here after I did originally. But some of my best friends are in that class. And I'm looking forward to having my 35th reunion with them tonight.
Medical alumni board is-- I didn't even know it existed until one day when the development people called me up and said, hey, how would you like to think about joining our alumni board? And I was like, well, what's that all about? And your immediate response is when a development person talks to you, it's like, how much money do I need to put into this whole thing? And so I joke with Larry all the time. But I'm very good at not necessarily me giving money, but pointing him to other alumni I know who do have a lot of money to give. And so it's been very productive for him. But that's a whole different thing.
The reason I joined the alumni board is because I feel like this is a chance to shape how, in many ways, the direction of the school. And the composition of the board is very interesting, because a lot of the people who are on the board are people who went through the HFME program, which is the combined undergrad medical school program, which unfortunately is not in existence right now.
But the people who went in were people who were very smart, very driven early on in their lives to decide that, OK, when I'm going to start college, I'm going to become a doctor, which for most people takes a while for you to figure out, this is what I want to do. And the people who are on this board, it's probably 75% of the people went through HFME.
And the reason they're on the board is because it was such a special time for them. And they are very invested in the future of the school and the direction of the medical school. And they have a lot of opinions about how medical education should be and what's special about the school. And there's a lot of wonderful things about the school. I mean, clinical you have a good experience.
There's great hospitals now that when the time I was in medical school, we were just talking about, none of these buildings existed. And now there's all these brand new buildings like this one. And you're like, wow. This is what practice is like. But we had a good time when we were there in the olden days, and it was fine.
Med school is a time where you get tools that help you. And sometimes they're very serendipitous things like having the right mentor who sort of guided me into this research fellowship that I took a leave of absence from. And if I hadn't done that, I'm sure I wouldn't be in the same position I am now. I'm sure I wouldn't know what it was like to be an academic cardiologist until I figured out that it was not what I really wanted.
And that's what's great about medical school is that, at least the way it was set up then, is that you have the option to take time off and do what you need to do and learn different things and have good mentors. And I think that's something that's still here and it's still part of the culture and it's still part of what makes this a special place to go to school. And I think that it will continue along that path, hopefully.
I think the thing that really should be the next big thing is tuition free medical school. And I live in New York. I practice in New York. NYU went tuition free and it became the hot school. And there was just a very large announcement of an endowment for a tuition free in the Bronx. And that's going to be the next really hot school. And Albert Einstein is going to be the place that everyone wants to go.
And that seems to be a thing that I feel like hopefully Northwestern will follow in that. Cornell, I have an academic appointment in Cornell, and they're almost there. They talk about it all the time. So I think that is the next big thing in medical education that hopefully will happen here and hopefully will allow people to not necessarily have to always worry about landing a job that will pay for their debt when they graduate from med school.
Which was another thing that Northwestern was really good about is when I graduated from med school, they had a debt ceiling. So in other words, if you add a certain amount of debt and Northwestern had loaned you money, they would forgive that amount of money above that debt ceiling. But they don't have that anymore. But it would have been something that was probably a nice thing to have at the time. So for some people, it was really a life changing thing. One of my classmates, she was a pediatrician and she had a lot of debt when she graduated med school. When Northwestern sort of forgave that, she was in a much better position.
MAX: What's your best advice for students or someone who's just graduated?
DAVID LEE: Well, I would say that right as the time starts when you are thinking about what you want to do, it has to be something that you love. And there has to be a passion and you have to know that this is something you can envision yourself going into and that you're not doing it for the wrong reasons.
I think that sometimes people pick careers or make career choices based on what they perceive will be the right thing to do in terms of prestige or financial gain or whatnot. And I mean, maybe that's true in the short run, but it's hard to build a career in something when you're not passionate about it.
MAX: Our final guest is Dr. Nupur Ghoshal. Hear as she describes her experience on campus and staying involved with the Alumni community.
NUPUR GHOSHAL: What brought me to Feinberg was the MSTP program, which is commemorating its 60th year on campus this year. We're one of the first and earliest MSTP programs in the country, still loud and proud all these years later and a proud alum of that entity at Feinberg.
Favorite Feinberg memory that comes to mind is we were also in the early days of a little bit of reconfiguring the curriculum. And so we had an element called problem based learning, which at the time I remember my father going, you don't know enough yet to do problem based learning, at least as a first year. But I think it best modelled what we do in day to day now.
So you have a little bit of information from a patient. You start generating some thoughts, and that helps winnow down the next set of questions you might ask or the exam you might do or the tests you might order. You get some more information. It's iterative. So you get a little bit more information and fine tune your thought process. And in a nutshell, what we do in everyday practice. So I think that's-- while we might have been a guinea pig year for the problem based learning, it's something I kind of value having moved forward in my medical career.
In terms of what Feinberg offered career wise or preparation for career, I want to take that two different ways. One is that I'm a neurologist now at Washington University, a dementia specialist. But that meant that I need to have exposure to neurology early on. So I was able to do my neurology clerkship in my third year of medical school when I came back from grad school.
And that was important, because neurology then was still an early match. So it would have been difficult otherwise to make that decision, informed decision about going into neurology without having that clerkship early on. So in many schools, it's still actually not a required element of their education, their medical education, to even a neurology clerkship required. And if it is available as an elective, it's often in the fourth year. So huge kudos to Feinberg to making sure that, A, neurology was essential, I was able to avail it as a third year.
The other part that I want to address is that I think Feinberg really fully prepared me to be an MD full on before specializing. So felt very well trained across the board and disciplines across the clerkships. So there were several instances as a resident that there were emergencies, not necessarily neurological ones, where I could identify it. So you have to understand what's the issue at hand. It is an emergency or at least an urgency. Can I manage it? Do I know who to call? So I think that was helpful as well.
And then in terms of there's often a question about if there's anything I would do differently, not so much. I think it was an intense period of study and set me well on my way, kind of very foundational training. And maybe if I had a little bit more bandwidth then to have enjoyed more of the city, which I get to do now as I'm part of the alumni board. So you may have heard in a previous podcast from Darren Wethers, who is our President-elect for the alumni board. I'm the current president of the alumni board.
And it took a step away from Feinberg after being there for eight years in the MSTP, and it came back for a neuroscience meeting where about 35,000 neuroscientists descend on any given city. But I particularly chose a hotel that was just South of campus so I could pop back over to Terry. Terry eighth floor was my home for four years for my PhD. And started to reconnect and reconnect through an alumni outreach event here in St. Louis.
Came on to the board in about 2015, 2016, and then started a women in medicine Initiative that was aligned with the overall strategic initiatives for the medical school. And then stayed on the board, worked on that agenda, if you will, and then became board president. So currently serving as your board president and looking forward to being ex-officio as Dr. Wethers takes over for me in the not too distant future.
MAX: I'll ask you one final question, the same question that I asked Dr. Wethers. What's your best advice for someone who is either just finishing medical school or maybe who has just finished medical school? And what's your advice to someone who might want to get more involved with the alumni community?
NUPUR GHOSHAL: Good questions. Tough ones, too. Best advice for a recent graduate, right? So to not think that just because you've graduated, you've decided on your area of expertise, whether that's to stay in general medicine, subspecialize, stay in academia, go into private practice, so forth, is that no doors ultimately are closed to you.
So as I said, it was MD PhD. And so you might envision a very academic physician scientist career, which I largely have. But I actually wear an admin hat as well. I'm a physician advisor for our hospital. So would that been part of my 5 or 10 year plan? Absolutely not. But when that opportunity came forth and was available, it was a space I could step into. I think it's largely informed one of the other hats I wear, which is when I attend on inpatient service with our trainees. Kind of understanding that 50,000 foot view I think is very helpful when you can get mired in day to day activities at the hospital.
So just awareness that as you make decisions, as you should, and start focusing on your areas of expertise and kind of carving out your future that nothing closes. And so we certainly have in our alumni board individuals who have transitioned back and forth between academia, private practice, business entrepreneurs. So all those doors remain open. So never think that just because you made a decision x, that y and z are no longer open to you.
[MUSIC PLAYING]
Our first guest is Dr. Darren Wethers, class of '88. Listen as he describes his experience as a student and efforts in inclusivity and diversity at Feinberg. What brought you to the medical field and what attracted you to Northwestern Medical?
DARREN WETHERS: I came to medicine through a rather circuitous route. I wanted to do biomedical engineering. I applied to college, got into several engineering programs. But during new student week at my college, they took us to the drafting room and told us about students staying up all night to complete these drafting projects. And I thought, there is no way in hell I'm doing this. So maybe it's not the engineering part I like, it's the biomedical part. And so site unseen, I changed my major to biology, started tracking pre-med, and applied to medical school.
MAX: Interesting. What about Northwestern was appealing to you? What brought you here to Chicago?
DARREN WETHERS: I'm a native Chicagoan, so of course I applied to all the Chicago medical schools. But on my campus visit here, I met some really dynamic students who made me feel like this was the greatest place to be. I had a great feeling being here in downtown Chicago, and I liked that the school was an honors pass/fail curriculum. So it took away a lot of that grade pressure that you would have at several other institutions.
One of the medical schools here in Chicago had a reputation for admitting 125 students, but only having room for 100 in the clinical years. So there was a forced elimination of 20% of the student body, which just seemed really toxic to me and I didn't want any part of that.
MAX: What was student life like here? What do you remember fondly? What do you miss?
DARREN WETHERS: So I remember the first welcoming reception and Lake Shore Center, and it was a champagne reception. And I thought, well, I'm really an adult now because the school is serving champagne. The second thing was being surprised that the school was not very diverse. There were five of us officially who were people of color, two of whom didn't really identify as people of color. So that left myself and two other classmates. And so we became our own support system.
MAX: You're on the Inclusion and Allyship Committee here. What brought you to that and why is it so important to continue these conversations and this push in the medical field?
DARREN WETHERS: I was reintroduced to the institution through a former board president, Dr. Bonnie Typlin. And she really encouraged me to reconnect with the school, sharing with me how much advancement had taken place since I was a student. And so I became a board member about six years ago. Shortly thereafter, one of the other younger board members talked about starting a Diversity and Inclusion Committee of the board. And he and I began talking about it, involved the staff of the alumni board. And they said, well, then the two of you should be the co-chairs. And that's how it started.
But we were intentional about the naming of the committee. Inclusion and allyship allows anyone who's interested to participate. You have to be interested in bringing all people to the table, and you don't have to be a member of an underrepresented group to be an ally for that group. And so anyone with a passion for this work can be a part of our committee.
MAX: What are your goals for this committee? And I'll just ask you really broadly, what are your hopes and dreams for Feinberg in general going forward?
DARREN WETHERS: I think the Inclusion and Allyship Committee has two main purposes, the first of which is to reach out to our alums who may have been similarly disaffected as I was, and to let them know that the school has progressed in ways that I think they would be proud of, and to ask them to come back, bringing all of their emotions, anger, resentment, whatever that may be, and unpack it with us in that safe space.
The second part of that is to reach out to our current students and be a support system for them through their Feinberg matriculation, but also be a bridge from their Feinberg years to their experience as alumni so that they feel they're part of a community when they come over into the alumni space. So the connection with the students isn't tied so much to their matriculation through school as it is the connection we have as individuals.
There are a couple of students that I'm in contact with presently, both at Feinberg and from other medical schools, and we don't have a formal mentorship. It is more of you can call me when you need to, or I'll check in on you when I start to feel like I've not heard from you in a while and see what's going on. And I really enjoy that. But the board writ large looks to mentoring as one of its key tenets, and that's something that we're working toward at the Inclusion and Allyship Committee of the board.
The other is philanthropy. We want to make sure that the students are able to be financially supported through their time here so they don't leave burdened by excessive debt. I've been a contributor toward the Promise Scholarship for the last five years and hope to continue that ad infinitum. But it is to create a way out of no way for today's students.
MAX: What are your tips for someone who's, let's say, just finished medical school on staying involved with Northwestern?
DARREN WETHERS: You know, it's difficult because as they leave the school, they're going into the most intensive training they'll ever experience. And internship, residency, perhaps fellowship, and then starting their careers, maybe starting families. So it's hard for them to be anything other than passively aware of what's happening. And that's all right.
But what we want them to feel is that when the time is right for them, that there'll be a community waiting to welcome them in. And we have to continually make that message through our publications, through our social media, through the Feinberg on the road programs that they do in different cities so that they feel that they're part of a community.
MAX: I also want to shift gears and ask a little bit about your career. Thinking on your trajectory, how did Feinberg help you get started in your career? And then what kind of work do you do now?
DARREN WETHERS: I was interested in primary care when I came. I thought it was going to be family medicine. I was the president of the family medicine interest club until I hit pediatrics and found out I didn't like taking care of sick kids. So you can't be a family practice doc if you don't do kids. So that was out. But I'd already done internal medicine, and I liked that longitudinal care experience. I'm nosy. I want to know what happens next.
I really liked emergency medicine, but I always wondered if we sent someone home, was that the right idea? If they got admitted to the hospital, what happened next? So as much as I liked EM, I couldn't do it because of that nosy character.
So internal medicine was it. I trained at Emory in internal medicine. And one of the ID faculty members had done his fellowship here, Jake Steinberg. And so I was able to continue that Feinberg connection with him. At that time in the late '80s, early '90s, HIV care was really starting to emerge, and I got caught up in that. So for 20 years, I practiced medicine in the Saint Louis area with a focus on HIV and AIDS care and also chemical dependency. And those two worlds really were intertwined for a lot of the patients.
MAX: I want to hear about your current role as a medical officer. What does that entail versus being just a physician? And what are the different responsibilities?
DARREN WETHERS: So after completing my 20th year of practice, I started working as a medical officer for a health plan, reviewing authorizations for care, talking with our colleagues in the field. And I really felt like I was a liaison between the provider side and the business side of medicine. And having been a provider so recently, it was easy to do that.
Many people who had gone into the health insurance world did so at the end of their careers when they were kind of burned out. And I was still mid-career at that point in time and looking forward to having a long arc of advancement. Currently, I'm a Chief Medical Officer of a Medicare Advantage Health Plan that's headquartered in Salem, Oregon. And here we're looking after our seniors, many of whom are part of that great generation after World War II and the emerging baby boomers.
Now, some of my older friends and colleagues are starting to hit Medicare eligibility, which is really odd. But making sure that they receive the care that they're eligible for and also that we are good stewards of our tax dollars. If grandma needs a new wheelchair, we want her to have one. But she maybe doesn't need the electronic one with the tilt and space and leg elevation. Maybe she just needs a little manual wheelchair to get around at her senior social. So making sure that the care is delivered in the best possible setting, but also for the best price is what we do.
MAX: Let me ask you this. Looking holistically at medical experience, work experience, where you are now, what's your best advice for students or maybe new medical professionals? And is there anything you would have done differently?
DARREN WETHERS: I would tell today's students to follow their passion. But part of that is figuring out what you're passionate about. But follow your passion, because it's a long career. It can be difficult at times. And if you're not 100% committed to it, it can break you.
I think looking back on my time here, I wish I had reached out for help earlier when I got into difficult situations. And I did. I stumbled in a few classes. But like many of us who'd come in, we got into Northwestern because we were stellar students and we'd always had great grades and we were at the top of our class. And frankly, we're not used to asking for help. So I wish I had someone who would have shared that.
When I meet with students today, I'm very candid about that. I had some troubles when I was here. It wasn't an easy course on the way through, but you can make it through. But here's how. It doesn't help for them to hear from people who are like, oh, I was AOA and honors in every one of my classes. Well, that just makes them feel more intimidated and less likely to ask for help. And so I would have liked to have had me when I was a student come and talk with me.
MAX: Do you have any best memories, most memorable classes, any specific shout outs you'd like to give?
DARREN WETHERS: I have the best memories of hanging out with my classmates here and my friends. This morning my mind was just running through with scenarios of being in the dormitory. Lake Shore Center back then had a bar and grill on the second floor called Jimmy G's. And you could go down there and hear live blues music, get a pizza and a pitcher of beer, watch David Letterman, who was the hot dude at that time. And just some of the mischief we got into. It wasn't all hard work and study. There were just a lot of good times.
MAX: Our next guest is Boris Sheynin, class of '99. Hear his inspiring story of coming to the United States as a Ukrainian refugee and finishing medical school with a family.
BORIS SHEYNIN: My mom was a doctor growing up. She was a pathologist. Usually she would take me to work and she said, OK, take a look. This is going to be it. Look at the microscope. She was a laboratory specialist. So going from there, I was kind of brought up with the thought that, OK, I'll go to medical school. And I was accepted to medical school and then I lost it. That was back in Ukraine. Accepted the medical school in '86. Like everywhere else, the medical education is six years after high school. So you have to pass the exams. I passed the exams.
And when I was in my fourth year, that's one year plus two years of mandatory service in the army, plus three years in medical school, and my family applied to be refugees in the United States. And we were granted the permission. And we decided to go. And I decided that, OK, four years, I'm going to go and now restart somewhere here. So we arrived, my parents, myself, 10-month-old baby.
And then I learned that, OK, I have to start from the beginning, because the education here is different. You have to have a bachelor's degree. So I'm right here in Chicago on the North side. And the I set off for my bachelor degree. I looked up, OK, which one is shortest for the medical school? They had a couple of advisors. And they said chemistry.
And somewhere after my first year, I thought, let me take the exams, the entrance exams. I did the exams. I did OK, and I applied to medical school and before finishing the medical, the bachelor's degree. I got accepted. I applied to two schools, making sure that those are the schools that I would get in.
The other thing that all of a sudden I realized, OK, I'm here. Now I have to work to bring some means too. And the only thing that I knew and I loved medicine. There was quite a lucky road there. And it was a conversation. My parents were very supportive. My wife was very supportive that I did go on and try to go back into medicine. Kudos to them. There was nobody to watch the baby and to help us emotionally, probably it wouldn't happen without them.
MAX: What are your best memories from campus?
BORIS SHEYNIN: It's hard. I have a few good memories. At the time, I think most of my classmates were-- some of them were making fun of my accent. [LAUGHS] It was much heavier. I was one of those people who was commuting. Because we are a family and I happened to work full time while in college and my wife was working full time. So we bought a condo in Wheeling, which is about 35 miles from here. OK.
And when I was accepted in medical school, we have a condo. It's not like we're going to move downtown. My wife has to work. And so we have baby, we have parents who are living close by to watch the baby. So I was commuting. So for me, I was arriving here at 6 o'clock to beat the traffic. And then I was just in lectures.
The lectures were in person at the time. There was not that much of the remote lecture. But I was happy to be there. I was happy to be there. And we always had great students, all the students who show up to classes early and were constant. I think the major key is making friends. Making contact and people helping each other. Some of them I still work with.
MAX: What's your best advice for a current student or someone who's just finishing school?
BORIS SHEYNIN: Take your naps. Exercise. Don't stop exercising. There's life behind it. Always, always pay attention to your close ones. Get yourself in the best physical shape. Make sure that you always keep up with your own physique.
MAX: What's your best-- what's the best advice that you received as a student, or were there any experiences here that helped you in your career?
BORIS SHEYNIN: Multiple people...with experience, you meet people in different positions, you talk about your career choices. You talk about what you'd like to do. And that's medicine as a profession and any profession. So the more exposure you get, the better.
MAX: Our next guest is Dr. Jeff Schaider, class of '83 and '85. Enjoy his stories from campus and what he appreciates about his classmates.
JEFF SCHAIDER: Well, I think what brought me to Northwestern really was the honors program in medical education. In my day, essentially, they had a program where you essentially do two years undergraduate, four years in medical school, you get accepted as a high school student. So it was a very attractive program, from a short perspective, and plus, you're a guaranteed admission to medicine at that point in time. Whether you want to go to medicine or not. Who knows when they're a senior in high school? But that's what I thought I was going to do. And in fact, it worked out very well for me.
MAX: So what kind of medicine do you practice?
JEFF SCHAIDER: So I do emergency medicine. So I was actually at Cook County Hospital, which is the public hospital here in Chicago for 30 years. I was the chairman there for the past 15 years or so. When you're the chairman of emergency medicine, you still do direct patient care, plus you have all the headaches of being a chairman as well.
So I would say, which is a better job? Seeing patients. The days of seeing patients at the busiest ER in the state was a much easier day than actually dealing with all the other problems I was dealing with when I was in my office.
MAX: So you basically just doubled you up.
DARREN WETHERS: Pretty much so. Pretty much so. Exactly. Exactly. It's not an easy job. Let's just say that.
MAX: Best memory at Northwestern? And what's your advice to current med students?
JEFF SCHAIDER: Yeah. God, there's so many great memories at Northwestern. God, if I had to pick one, I mean, obviously all your friends and stuff like that during cadaver labs. I'll tell you a funny story. So in my day, our cadaver labs, we actually had-- everyone was divided by their-- it was alphabetical. So my last name is Schaider. So I knew all the S's and the R's, because we were on the same room together. And we were a group of S's and next to us was the group of R's.
And they were fairly competitive, the R group, let's just say that. And we had to pump our cadavers up in order to dissect the cadavers. And their cart was defective. So that when they went up, something happened, but it would always drop down really low.
So there was something different about their cart, lifting up and stuff, and it was really a hassle for them for whatever reason. So we would always laugh about it. We didn't say anything, but we sort of knew that they had a defective cart. So one time we came in and then all of a sudden, our cart dropped and theirs went down smoothly. They switched the carts. So we knew that happened actually.
So what did we do? We switched them back. And then we were just cracking up when we saw their cart drop and they were so surprised we switched the cart back. And in fact, one of the women that was in the other group, I still tease her about it to this day. Competitive, nice rivalry. In fact, she delivered my son. She delivered my son. She did a great job. So in fact, we still remain close.
MAX: I'm glad the relationship smoothed itself over.
JEFF SCHAIDER: She was a fantastic physician, so she did well in her cadaver dissection.
MAX: Would you do anything differently if you could or is there any advice that you wish you'd known that you would give to students?
JEFF SCHAIDER: I think what-- again, I've taught students for the past 35 years or so, medical students and residents and such. The key thing to being a good physician is seeing a lot of patients to push yourself. And that's what I tell all of them. You've got to-- the only way to learn is by seeing. It's an apprenticeship. So the more you see, the better you get.
So I've always told people when I'm working a shift within the emergency department or whatever they're doing, see as many patients as you can. Treat them well. Learn how to take care of patients. Because the better you are, the better physician you'll be. But if you're a good physician, and I find those are the people that can relate to the patients the best, because they have the confidence as far as diagnosis.
They don't have to waste time thinking about stuff. They sort of know it. And they could actually hold someone's hand and really provide good care for them. That's especially true in the emergency department. It's been a great career seeing a lot of different patients and really helping a lot of people, which has been really nice.
MAX: Our fourth guest is Dr. David Lee, class of '89. Listen as he shares his experiences and academic medicine.
DAVID LEE: When I was looking for a mentor, I had done a lot of cardiovascular research in college. And I thought, my future is in cardiology. That's one of the things that is really kind of meaningful to me. I feel like the heart is incredibly special organ, because it's with you every single day of your life. It's beating there. It's part of who you are. It has emotional significance. There are so many wonderful parts about cardiology. I said, I'm going to be an academic cardiologist.
So I want to go work in a cardiology lab summer after my freshman year of med school. And the guy who was running it was the Chief of Cardiology named Mike Lesch. And he's the most laid back individual you'll ever meet. I mean, this is a person who was very famous, went to Harvard Medical School, has a disease named after him because of something that happened in medical school sort of serendipitously.
So I went to work for him. He was my mentor. And he actually guided me on my next step, which was when I decided to take a leave of absence to go do a year of research in another cardiology lab at Harvard with a cardiologist whom he had worked with when he was at Harvard Medical School. And it was one of those really sort of special connections.
So I took a year off, moved to Boston, sort of was an adult. I'd go into the lab every morning and work. And I met all these incredible cardiologists who were very inspiring to me. I met a lot of fellows who sort of influenced how I thought about medicine and what I wanted for a career in medicine.
But when I finished my year, I realized I'm not going to be an academic cardiologist. Because these guys, they're in the lab all the time. Because they were doing clinical and research, every time someone showed up in the ER with chest pain, we had to stop our experiments, because you can't really ignore somebody who's in the ER. So then we went and we'd have to sit around, get that stabilized, and then we'd start our experiments.
But I just realized that in order to be an academic cardiologist, you need-- or in order to do academic medicine, if you want to do research, you need protected time. And so I actually switched to anesthesia, because you're either in the OR or you're not in the OR, which means that you have time to do lab work if that's what you want to do, or you can do clinical work or you can do research or you can do academics and teaching. And there's so many different options. So that's why I decided to do that.
And I'm very grateful that Northwestern allowed me to take the time off to do a leave of absence. I came back. I fell into a wonderful class that started here after I did originally. But some of my best friends are in that class. And I'm looking forward to having my 35th reunion with them tonight.
Medical alumni board is-- I didn't even know it existed until one day when the development people called me up and said, hey, how would you like to think about joining our alumni board? And I was like, well, what's that all about? And your immediate response is when a development person talks to you, it's like, how much money do I need to put into this whole thing? And so I joke with Larry all the time. But I'm very good at not necessarily me giving money, but pointing him to other alumni I know who do have a lot of money to give. And so it's been very productive for him. But that's a whole different thing.
The reason I joined the alumni board is because I feel like this is a chance to shape how, in many ways, the direction of the school. And the composition of the board is very interesting, because a lot of the people who are on the board are people who went through the HFME program, which is the combined undergrad medical school program, which unfortunately is not in existence right now.
But the people who went in were people who were very smart, very driven early on in their lives to decide that, OK, when I'm going to start college, I'm going to become a doctor, which for most people takes a while for you to figure out, this is what I want to do. And the people who are on this board, it's probably 75% of the people went through HFME.
And the reason they're on the board is because it was such a special time for them. And they are very invested in the future of the school and the direction of the medical school. And they have a lot of opinions about how medical education should be and what's special about the school. And there's a lot of wonderful things about the school. I mean, clinical you have a good experience.
There's great hospitals now that when the time I was in medical school, we were just talking about, none of these buildings existed. And now there's all these brand new buildings like this one. And you're like, wow. This is what practice is like. But we had a good time when we were there in the olden days, and it was fine.
Med school is a time where you get tools that help you. And sometimes they're very serendipitous things like having the right mentor who sort of guided me into this research fellowship that I took a leave of absence from. And if I hadn't done that, I'm sure I wouldn't be in the same position I am now. I'm sure I wouldn't know what it was like to be an academic cardiologist until I figured out that it was not what I really wanted.
And that's what's great about medical school is that, at least the way it was set up then, is that you have the option to take time off and do what you need to do and learn different things and have good mentors. And I think that's something that's still here and it's still part of the culture and it's still part of what makes this a special place to go to school. And I think that it will continue along that path, hopefully.
I think the thing that really should be the next big thing is tuition free medical school. And I live in New York. I practice in New York. NYU went tuition free and it became the hot school. And there was just a very large announcement of an endowment for a tuition free in the Bronx. And that's going to be the next really hot school. And Albert Einstein is going to be the place that everyone wants to go.
And that seems to be a thing that I feel like hopefully Northwestern will follow in that. Cornell, I have an academic appointment in Cornell, and they're almost there. They talk about it all the time. So I think that is the next big thing in medical education that hopefully will happen here and hopefully will allow people to not necessarily have to always worry about landing a job that will pay for their debt when they graduate from med school.
Which was another thing that Northwestern was really good about is when I graduated from med school, they had a debt ceiling. So in other words, if you add a certain amount of debt and Northwestern had loaned you money, they would forgive that amount of money above that debt ceiling. But they don't have that anymore. But it would have been something that was probably a nice thing to have at the time. So for some people, it was really a life changing thing. One of my classmates, she was a pediatrician and she had a lot of debt when she graduated med school. When Northwestern sort of forgave that, she was in a much better position.
MAX: What's your best advice for students or someone who's just graduated?
DAVID LEE: Well, I would say that right as the time starts when you are thinking about what you want to do, it has to be something that you love. And there has to be a passion and you have to know that this is something you can envision yourself going into and that you're not doing it for the wrong reasons.
I think that sometimes people pick careers or make career choices based on what they perceive will be the right thing to do in terms of prestige or financial gain or whatnot. And I mean, maybe that's true in the short run, but it's hard to build a career in something when you're not passionate about it.
MAX: Our final guest is Dr. Nupur Ghoshal. Hear as she describes her experience on campus and staying involved with the Alumni community.
NUPUR GHOSHAL: What brought me to Feinberg was the MSTP program, which is commemorating its 60th year on campus this year. We're one of the first and earliest MSTP programs in the country, still loud and proud all these years later and a proud alum of that entity at Feinberg.
Favorite Feinberg memory that comes to mind is we were also in the early days of a little bit of reconfiguring the curriculum. And so we had an element called problem based learning, which at the time I remember my father going, you don't know enough yet to do problem based learning, at least as a first year. But I think it best modelled what we do in day to day now.
So you have a little bit of information from a patient. You start generating some thoughts, and that helps winnow down the next set of questions you might ask or the exam you might do or the tests you might order. You get some more information. It's iterative. So you get a little bit more information and fine tune your thought process. And in a nutshell, what we do in everyday practice. So I think that's-- while we might have been a guinea pig year for the problem based learning, it's something I kind of value having moved forward in my medical career.
In terms of what Feinberg offered career wise or preparation for career, I want to take that two different ways. One is that I'm a neurologist now at Washington University, a dementia specialist. But that meant that I need to have exposure to neurology early on. So I was able to do my neurology clerkship in my third year of medical school when I came back from grad school.
And that was important, because neurology then was still an early match. So it would have been difficult otherwise to make that decision, informed decision about going into neurology without having that clerkship early on. So in many schools, it's still actually not a required element of their education, their medical education, to even a neurology clerkship required. And if it is available as an elective, it's often in the fourth year. So huge kudos to Feinberg to making sure that, A, neurology was essential, I was able to avail it as a third year.
The other part that I want to address is that I think Feinberg really fully prepared me to be an MD full on before specializing. So felt very well trained across the board and disciplines across the clerkships. So there were several instances as a resident that there were emergencies, not necessarily neurological ones, where I could identify it. So you have to understand what's the issue at hand. It is an emergency or at least an urgency. Can I manage it? Do I know who to call? So I think that was helpful as well.
And then in terms of there's often a question about if there's anything I would do differently, not so much. I think it was an intense period of study and set me well on my way, kind of very foundational training. And maybe if I had a little bit more bandwidth then to have enjoyed more of the city, which I get to do now as I'm part of the alumni board. So you may have heard in a previous podcast from Darren Wethers, who is our President-elect for the alumni board. I'm the current president of the alumni board.
And it took a step away from Feinberg after being there for eight years in the MSTP, and it came back for a neuroscience meeting where about 35,000 neuroscientists descend on any given city. But I particularly chose a hotel that was just South of campus so I could pop back over to Terry. Terry eighth floor was my home for four years for my PhD. And started to reconnect and reconnect through an alumni outreach event here in St. Louis.
Came on to the board in about 2015, 2016, and then started a women in medicine Initiative that was aligned with the overall strategic initiatives for the medical school. And then stayed on the board, worked on that agenda, if you will, and then became board president. So currently serving as your board president and looking forward to being ex-officio as Dr. Wethers takes over for me in the not too distant future.
MAX: I'll ask you one final question, the same question that I asked Dr. Wethers. What's your best advice for someone who is either just finishing medical school or maybe who has just finished medical school? And what's your advice to someone who might want to get more involved with the alumni community?
NUPUR GHOSHAL: Good questions. Tough ones, too. Best advice for a recent graduate, right? So to not think that just because you've graduated, you've decided on your area of expertise, whether that's to stay in general medicine, subspecialize, stay in academia, go into private practice, so forth, is that no doors ultimately are closed to you.
So as I said, it was MD PhD. And so you might envision a very academic physician scientist career, which I largely have. But I actually wear an admin hat as well. I'm a physician advisor for our hospital. So would that been part of my 5 or 10 year plan? Absolutely not. But when that opportunity came forth and was available, it was a space I could step into. I think it's largely informed one of the other hats I wear, which is when I attend on inpatient service with our trainees. Kind of understanding that 50,000 foot view I think is very helpful when you can get mired in day to day activities at the hospital.
So just awareness that as you make decisions, as you should, and start focusing on your areas of expertise and kind of carving out your future that nothing closes. And so we certainly have in our alumni board individuals who have transitioned back and forth between academia, private practice, business entrepreneurs. So all those doors remain open. So never think that just because you made a decision x, that y and z are no longer open to you.
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