Alicia and the Big Bad Cat

By Peter Nichols

Alicia Jiang, a high-energy, fast-talking, third-year student at SKMC, is in her second semester of rotations at Morristown Medical Center in New Jersey. “It’s great getting the experience we need to become good doctors,” she says, “but I’m not gonna say it isn’t stressful because, of course, everyone’s judging you.”

Jiang calls herself a “very suburban kid,” a high achiever who’s always excelled and occasionally worried over an A-minus. “A lot of us medical students are Type A,” she observes. “We wanna do the best we possibly can.” That competitive and perfectionist streak is what got her into the Penn State-Jefferson Premedical-Medical Program, where she’s earning both her BS and MD degrees over six years.

But Type A qualities can sometimes be a hindrance too, especially on rotations when students are putting their medical knowledge to use for the first time while coming up against the uncertainty that shadows all medical practice. Nearly every day during rounds, students present to the clinical team what they’ve learned about their patients, then make a diagnosis and outline a care plan.

Jiang likes talking to patients and finds trying to help them enormously satisfying. She even enjoys the challenge of solving diagnostic puzzles. But having to come up with a medical verdict in real time when faced with an open-ended array of possibilities rather than a multiple-choice questionnaire is intimidating.

“That’s not how it works in real life,” she says. “You don’t get four choices: It’s a lot harder.” Still, she has to present to the team; she has to say something because that’s how learning happens on rotations.

“I don’t like saying stuff when I’m not sure about it,” she confides. “So then I fumble and don’t say anything. That can be worse than saying the wrong thing.”

One of the ways she handles the stress is by writing and illustrating storybooks for kids—not so much as an intentional coping strategy but simply because it’s fun. Jiang is president of the Story Initiative, a student-run organization that works with orphanages around the world to create personalized books for their kids.

The Story Initiative was founded four years ago by Nataliya Bahatyrevich, MD ’18, who’s currently a surgery intern at UC Davis Health in Sacramento, California. She and her SKMC friends came up with the idea, contacted the orphanages, found a website that did inexpensive self-publishing, and wrote and illustrated the books. The Story Initiative pretty much follows that model today.

“I like to create things,” Jiang says. “I like to draw. I like to design things and make them look pretty, and I like to write fun, easy stories. When you’re writing stories for 7-year-olds, they don’t care about perfection.” They’re not judging you on the correctness of your narrative or the fitness of your characterizations or the quality of your art. “We just write something that’s fun to read and has fun characters,” she continues. “It’s a low-key and relaxing thing.”

Until it isn’t. Sometimes Type-A Jiang slips in and spoils the fun.

It takes about a semester to create a book. Story Initiative staff emails spreadsheets to orphanage directors, who fill in information about the kids: name, age, gender, favorite movie, favorite book and character, what they want to be when they grow up, and other details about their lives. The authors are then assigned a child, and using the individual’s data, they decide how to write a story that fits the child.

When she takes on a storybook, Jiang does the illustrations but partners with a classmate to work out the plot and design the book. “One of my favorite books is the first one I did,” she says, Falina the Mouse and the Big Bad Cat. “It was a new experience, so I threw myself completely into it.”

The book tells the story of Falina, who longed to venture out of the mousehole to explore and play in the daylight. The other mice caution her to go out only at night because during the day “the big bad cat” with his “sharp claws and terrible jaws” roams the house.

“And do you know what his favorite food is?” they tell her. “It is a little mouse just like us.”

Falina isn’t intimidated. She’s curious and just wants to have fun. The story recounts, in words and pictures, her brave adventure and the lesson she learns.

Jiang worked on the illustrations for the book in a study lounge during the second semester of first year. First, she labored over getting the mouse drawings just right, and then she worked on getting the colors perfect.

“I would spend all my time there with all the watercolor paper and all the watercolors spread out,” she says. “What’s really funny is that I was working on this book during the two weeks before our neuroscience exam. Everyone else was freaking out about the test, and I was freaking out about the storybook.”

Sometimes orphanages send emails with photos of the kids reading their books or holding them and smiling. What started as a relaxing, creative outlet that helped Jiang put aside the rigors of medical school turned into a service project that helps orphans feel better while learning to read.

“Just looking at the photos makes me so happy,” she says. “Seeing them has shifted my focus to where I want to keep this organization going. I think it would be such a loss if the Story Initiative didn’t exist at Jefferson.”

In subsequent storybooks, Jiang’s focus has moved from simply making a fun story with good illustrations toward the kids who read and enjoy them. “I feel like the child is always close by,” she says. “When we get emails from orphanage directors, it just warms your heart to hear them say thank you, and I’m like, ‘No, thank you for giving us the opportunity—we wanna help these kids too.’”

A similar shift is underway for Jiang as her clinical experience deepens. Some residents and attendings are skillful teachers. Others sometimes pounce on errors in a way that makes the medical students feel like cat food.

“They don’t expect you to know or be sure about everything,” she says. “But even when I know that objectively, I still get stuck sometimes. I’m working on trying to get past it. When you do it continuously every single day, you start to realize it’s not that bad. It’s OK if you get it wrong.”

That’s what Falina found out about the big bad cat when she finally worked up the courage to venture out of the mousehole during the day. His claws were not as sharp as she’d imagined, and his jaws weren’t as terrible as she’d been told. There was no reason to hide in a hole anymore.

Says Jiang, “I’m still trying to figure that out.”

Art by Alicia Jiang