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Provider Pulse Ep. 26: Which Hard to Choose - Dr. Angelo Cabal and Finding Authenticity on the Path to Medicine (Part 2)

• Dr. Duncan Reid, MD @ EthnoMed.org

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Part 2: "Which Hard to Choose" (Part 2 of 2)

What happens when you do everything “right” and still don’t get in? When two full application cycles pass with no interviews? When you abandoned a degree program only to face rejection?

In part two of this Provider Pulse episode, Dr. Angelo Cabal picks up his story in Chicago, where a hard truth and a single conversation with his mentor push him to walk away from an MPH program and start over. Back home in San Diego, Angelo studies for the MCAT, moves in with his parents, and finds the patient-facing work he’d been longing for as a lung cancer clinical research coordinator.

But even with strong letters and meaningful experience, two consecutive medical school application cycles end with no interviews. Angelo talks candidly about shame, self-doubt, and the moment he decides to take an expensive leap into a post-bacc program—buoyed by the support of his oncologists and patients who keep asking, “How are your applications going?”

From there, he describes finally getting interviews, being accepted to UC Irvine, and discovering that the hardest part was getting in. We follow him through clinical rotations, an away rotation at Harborview Medical Center, and matching into internal medicine in Seattle, where he now cares for immigrants and refugees in the International Medicine Clinic.

Angelo closes with a message for anyone who has been rejected, rerouted, or talked themselves out of medicine: never let someone make you feel like you don’t deserve what you want—and seek the mentors who help you believe that you do.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Angelo 25_09_23

Provider Pulse Ep.26

Cold Open 

[00:00:00] 

Angelo: Never let someone make you feel like you don't deserve what you want. Because I think, like psyching myself out of wanting to be a doctor, I felt like I wasn't qualified, you know?

And I think that kind of had stayed with me. I feel like I talk myself outta medicine through those other career paths for a long time because I just didn't feel like I had the confidence

Duncan: Welcome back to the Provider Pulse series of the EthnoMed podcast, where we discuss the paths of diverse individuals to a career in medicine. In part one of our two-part [00:00:30] series, Angelo Cabal shared his journey from Manila to San Diego through underfunded schools, to UC Berkeley, and eventually to a crisis point in Chicago.

Enrolled in a public health program, Angelo realized that he had made a mistake. Again, and left the program after a pivotal conversation with a mentor, an epidemiologist who was also a physician. Now in part two, we follow his journey back to San Diego and the five year long path that led him to medical school, starting with his [00:01:00] decision to leave his MPH program.

Angelo: I, started the program, I was a couple months in, and while I was enjoying what I was learning, this kind of gut feeling started kind of growing in me that this also wasn't the thing I wanted to do as a majority of my time professionally.

ACT 1: FOLDED IN HALF

Duncan: A faculty mentor, an epidemiologist who was also a physician. Asked Angelo a simple question, have you thought about medicine? That conversation changed his path.

Angelo left Chicago and called his parents. It was time to go home.

Did you feel [00:01:30] like that decision was made that night that you were going to pursue medicine?

Angelo: I think in my soul, yes, but in my head, I wanted to be a little bit more measured because I realized that going to basic science going to public health, I need more time to finalize my decisions before pursuing the next degree because those are the things that are laid out in front of you, right?

Going through life. It's like, what's next? The next step? What's the next degree? And you're not really thinking about your process, And so I knew I wanted to do [00:02:00] healthcare, but I actually called my parents the next day to, just catch them up on everything that had happened. And I was like, I can tell you right now it's not this that's next but I want to come home and just take things step at a time. I really have a lot more time to think about what I want to commit to, because that's just me repeating the same mistakes I had made

with the two other career paths I, had gone down 

Duncan: How did they react to that?

Angelo: They were sad. I think. they were a little shocked too. And I think they were a little afraid, but when we talked, [00:02:30] they kind of saw how, burdened that I was with making a decision. So I think, overall they had no choice but to kind of just trust that this is what was going to happen and kind of just have to trust the process, you know?

Duncan: And then going back to that faculty advisor,

Angelo: Mm-hmm.

Duncan: because it sounds like that conversation after knowing you only a few months was very important. Do you remember having a conversation like that with any other advisor or adult while you were an undergrad?

Angelo: No, I think maybe, Sam, the [00:03:00] mentor I had previously, . Because we had come from similar backgrounds. He was a little bit more candid, but in terms of actually planning the next steps, and like saying something that made you really feel seen as like a mentee, I hadn't had that experience yet, but he kind of hit the nail on the head that one thing that matters to me is just being authentic and having integrity.

So, I kind of took that with me moving forward, like truly.

Duncan: It sounds like these two people who took the time to have these discussions with you had inordinate impact on your life's [00:03:30] direction. Yeah. And then especially this second person. Mm-hmm. Sitting there, it sounds like he gave you the courage to listen to what you are already feeling, but weren't able to verbalize and possibly give you the courage to go and change directions.

Do you feel that way at all?

Angelo: Absolutely. When he told me that I'm not the type of person to avoid hard things, as long as I know that I'm fully committed to them . I think he was able to see that and it gave me the courage to be like, I might wanna do medicine.

It's gonna be hard, but you at [00:04:00] least, it's what you want to do in the long run. So, it'll probably be worth it 'cause I had struggled with so much indecision before, you know?

Duncan: Back in San Diego, Angelo described this moment to a friend as a time when his life had been folded in half. There was the before and the after, this defining event.

 

Duncan: So you called your parents, you said, well, I'm coming back to San Diego. Yeah. How was it going back to San Diego?

Angelo: Oh man. I think it was just when I needed, I was talking to a friend the other day and he was [00:04:30] asked to reflect about the time in his life when he felt like the life he had lived thus far had been like, folded in half.

Like this is the before and this is me now. And that was that kind of time for me because when I moved back to San Diego, I had concepts of a plan, to pursue medicine, but it was like really just starting over and it was very humbling too, because I moved back home with my parents. I decided to start studying for the MCAT first and kind of just slow down and just kind of just take things a step at a time. So my general [00:05:00] plan was just to study for the MCAT and then get more exposure to healthcare and shadow physicians, you know, kind of as a stepwise thing.

But I knew at that time that I also needed to take it slow because I came back with a lot of baggage still about how things had gone so far. So yeah, it was hard, but my parents were really supportive. I got back in touch with a lot of good friends, that I had lost touch with.

And, overall it was just exactly what I needed to kind of reorient myself towards, the things I needed to do next.

Duncan: Angelo had a plan study for the MCAT [00:05:30] and get clinical experience, take it step by step. But he also knew he needed to slow down to heal from the years of false starts and self-doubt.

But already diving into a plan, you're already getting your stuff together. And how many years did it take to get everything else together for that?

‌

Angelo: Ultimately getting into med school took five years after all that I studied for the MCAT, did well. I was volunteering at, the cancer center at UC San Diego, to get more patient experience.

And I really enjoyed that. I thought that was maybe what was [00:06:00] next for me. So I began working there full-time after I took the MCAT and while I was getting my applications together. And even though I had some idea that I wanted to do medicine, that's when I really knew that this was it.

Because I was a clinical research coordinator for our lung cancer patients, so I got to see, patients that were coming in for monitoring for their clinical trial that had lung cancer. I got to see them every month. I got to develop a relationship with them.

And I found out that that's the person facing [00:06:30] experience I was looking for. And also applying science to their benefit and that's when I realized that, I made the right decision.

And I'm like fully into this career

ACT 2: NO INTERVIEWS

Duncan: Angelo had finally found what he was looking for, working directly with patients and applying science to help them.

He was ready. He applied to medical school.

 

Duncan: And had you seen much medicine firsthand before then, or many doctors?

Angelo: No. No doctors in my neighborhood. No doctors in my family. I volunteered in [00:07:00] college and everything, but, not with doctors, so my plan was to get more experience and more shadowing, but it also worked out that it was also my job, and I got to work with the oncologist too, who were treating the patients.

And they were also pretty supportive.

Duncan: So you're actually talking to doctors for the first time

Angelo: Yeah, yeah,

Duncan: And then just to go back, the first time that you talked to a doctor was your, student advisor?

Angelo: yeah. Yeah.

Duncan: that's actually the first doctor.

Angelo: Yeah.

Duncan: And maybe that had something to do with it too, because he made it concrete, right? Yeah. This guy's a doctor and he is like, this [00:07:30] is doable.

And it sounds like you had the same sort of encouragement from these oncologists.

Angelo: Yeah. Exactly. Yeah. They gave me the opportunity to really explore medicine and I remember my interview with the oncologist I ended up working for, she was like, so what do you wanna do? I was like, well, I want to go to med school.

And, she was like, okay. And then, I remember, she went to the person that would eventually like, my boss and was like, hire him. He wants to go to med school. I think he could do it.

Duncan: Everything seemed to be falling into place, but even after knowing what it [00:08:00] is you want, you need to do the work of actually getting there.

Angelo: So, I think it was very encouraging from then on out, from that standpoint of like, I want to do medicine, but it took me five years because actually getting there was also a little bit more difficult. I actually applied the next year to med school. didn't get any interviews. And I tried again the year after that. Didn't get any interviews. Despite like letters and my work experience and everything, it was still kind of a rocky road to figure out how to improve and how to really get in, [00:08:30] even though I think staring down like two unsuccessful cycles is very discouraging,

Duncan: Yeah. How were you feeling at that time?

Angelo: Pretty horrible. I think it was just kind of one thing after the other, right? it was like, oh, like this basic science thing didn't work out. This public health thing didn't work out. Now I'm like, really, in something that I really want to do. That's not the issue now.

It's like, how are you gonna get in? You know, it's only to go so far to this process to finding out what you wanna do, and kind of just being [00:09:00] you know, oh, actually maybe it's not what's gonna happen for you despite how everything has gone.

Right. I think after two cycles it was like, I was very lost and very despondent. so

Duncan: Two application cycles, no interviews. After everything Angelo had been through to get to this point. The rejections made him question whether he belonged in medicine, after all.

What was the key? How did you make it work?

Angelo: I again reached out to mentors. Uh, I think at that point, you've done this every time you kind of hit a wall, always talk [00:09:30] to people, that you trust, you know? And I talk to my friends, I talk to the oncologists, the PIs, I work with.

And, you know, they really challenged me, I think, to be like, is this what you really want? Then, you have to find a way and really think about what do you think the issue is? You know, why aren't you getting interviews? All this stuff. So, I came to the conclusion that it was probably, some of my grades from undergrad, and kind of the pathway to really get through that was doing a post-bacc program. Luckily, UC San Diego had one where I [00:10:00] worked. It was really expensive. And that was, another barrier, I think. But, I was fortunate enough to, have saved enough to take off work for a year to do this post bacc program, 

  I had already gotten that far and it was another, fork in the road where it's like, how badly do you want this, are you sure this is it? And, I just think about the patients I had worked with up to that point. And it wasn't just the oncologist I worked with, the staff that I worked with, it was also the patients that, really motivated me that, I wanted to be in healthcare, just all the positive [00:10:30] experiences with them. All of them had lung cancer. A lot of them had terminal illness. And, every time I saw them each month, they would ask me how applications were going and they were invested, and they're part of my journey too, and part of my motivation to continue pushing forward.

Duncan: You went and did this postbacc so you couldn't work during it. You had to pay for this. How many courses was it?

Angelo: It was a whole year, like, it was essentially doing a whole year of, upper division biology courses just to get the GPA up. 

Duncan: And then you're applying everywhere.

Angelo: Yeah. Everywhere. Yeah.

Duncan: And then how'd this [00:11:00] application cycle go?

Angelo: The last one went well, the one after I did the postbacc 

Duncan: That was your third one?

Angelo: It was my third one. It was kind of the hail Mary round because I, was told that after three cycles, then it's really hard to bounce back from that. So that's also the reason why I did the postbacc too. 'cause it's like, I could keep doing this and I'm gonna keep getting discouraged and lose time, lose money, or you could just really go all out for this last time 

ACT 3: JUST BE YOURSELF

Duncan: The third cycle, the last chance Angelo had done [00:11:30] everything he could Taken a year off work, paid for an expensive post bacc program, raised his GPA now, he just had to wait.

And did you get any interviews

Angelo: Yeah, I got, a couple. and that was, great. I was so excited.

Duncan: and, how was it going to that first interview

Angelo: Well I was nervous ' cause it was like, this is my first interview. I dunno if I'm gonna get more, this might be my only interview so don't blow it. You know, I think it was at Tulane, in Louisiana. And this is [00:12:00] all over Zoom too 'cause this is right when COVID hit, It was the first cycle actually, where they started doing Zoom interviews.

So I was really nervous, but that interview I think went well. We got over that and then interviews started going well. Just going into it don't really think about the consequences doing poorly. Just be yourself, and , things will come easily after that.

And I think overall that worked out well.

Duncan: Angelo was admitted to UC Irvine School of Medicine. Angelo was going to medical school.

Angelo: I ended up going to, UC [00:12:30] Irvine.

In Orange county, Ant eaters.

Ant Eaters. Yeah. So

Duncan: And how did it feel getting accepted there?

Angelo: It was great. I was very excited. I'd gotten, my education at University of California at Berkeley and then San Diego for my post bacc. So it felt like it made a lot of sense and overall, it was a great program and it wasn't too far from home, from San Diego, so I was elated

Duncan: And how was medical school?

Angelo: The first two years, the basic science, like kind of learning about medicine, developing clinical skills, but [00:13:00] not being in the hospital quite yet was challenging. But I had done the post bacc recently. I was used to that type of, rigor at that point.

it was pretty smooth for the first two years. And also I always tell myself that still the hardest thing I've ever done was actually get into med school. Because, it was a years long, process for me.

So I think after I'd kind of cleared that bar, I was like, mentally it was like, nothing can be harder than this. I think about that time where it's there are a lot of things going against you getting into med school, [00:13:30] but now you're in.

It'll still be hard, but it's never gonna be that, hard in comparison, you know. Because I think there was a lot of self-doubt that also piled on, so losing that was, a really big deal.

Duncan: And how were the clinical years? Third and fourth year.

Angelo: Third and fourth year, I think overall the third and fourth year there were some challenging rotations, especially towards the end, because a lot of the harder rotations were at the end for me, like internal medicine and surgery, those are really long ones too. But I think overall, third and [00:14:00] fourth year rotations were pretty positive. A lot of my attendings and a lot of my classmates were very supportive during the clerkship rotations.

So, all of us were just going through it together.

ACT 4: FULL CIRCLE

Duncan: Angelo always had a feeling that he would likely go into internal medicine. The question was where?

Did you always know you were going into internal medicine?

Angelo: I had a feeling because a lot of the topics I was interested in in med school were related to internal medicine. Like I was interested in infectious disease. I liked the GI organs. That's the other thing I was considering. [00:14:30] And, of course, one big thing for me that was always there was hematology, oncology, which, I'd spent years working in.

You know, if you asked me when I started medical school, what I wanted to do, that was the answer. So I think I had a pretty strong signal towards internal medicine, but I was still pretty open to the other specialties. I, really liked pediatrics a lot. I like working with kids, working with babies.

But ultimately I also missed working with adults as well. So I think that's what kind of made the decision for internal medicine for me.

Duncan: And then for residency, where [00:15:00] did you apply? Did you apply everywhere in the country or were you applying to a certain coast

I mostly applied towards the West coast because my family is in the west coast, Southern California. and then also the Pacific Northwest. I've always been interested in it. I love, hiking and camping. And I thought, you know, it's also not too far away from, where I was coming from. During his fourth year, Angelo did something that would prove pivotal, an away rotation at the University of Washington at Harborview Medical Center.

And [00:15:30] when you matched, was match day virtual?

Angelo: No it was in person

Duncan: How would you feel about matching?

Angelo: I felt great. I actually had done a, away rotation at UDub. hematology oncology in Harborview.

Oh, really? Yeah. 

And, I learned so much in the four weeks I was here. And also I really loved working with the patient population at, Harborview.

Duncan: Did you know what Harborview was before you came out here?

Angelo: I generally knew it was the county hospital. My home program at UC Irvine, there's no defacto state funded county hospital. Our university [00:16:00] hospital accepted a lot of like, Medicaid, Medicare patients, But I think, Harborview is the first like, formal county hospital that I've, rotated at.

it was just very cool to see. there were a lot of people from outta state that were also getting treated there. So it was, uh, it was a very eyeopening experience.

Duncan: Harborview Medical Center was unlike anything Angelo had experienced before a county hospital serving patients from across the state and beyond.

Many patients were uninsured and many were from other countries.

So you had a good idea of where you were [00:16:30] matching to after doing that away rotation.

Angelo: I was very excited to come here, but again, my previous experiences with the places I wanted to go, but also have some hesitation to be like, it might not work out. Always stops me a little bit because of that experience.

I should get over it, you know, but there's always that, a little bit of doubt. But I was elated to match here.

Duncan: And how many months are you into residency now.

Angelo: I am, four months in. Wow. Yeah. Yeah. Four rotations in. Yeah,

Duncan: How is it going?

Angelo: it's going really [00:17:00] well. The, Seattle summer was great. there's already been so much learning happening in intern year, and so I'm really enjoying it so far.

 My continuity clinic is definitely a standout of my experience thus far.

I am part of the international medicine clinic at Harborview. And I really love being part of it because it's actually been very consistent with the things I've grown to care about as a person, throughout this entire journey. We take care of patients that are coming from all over the world, a lot of, refugees. I really like [00:17:30] caring for people from minoritized backgrounds and immigrant populations. 'cause that has been my experience and it's been just been very rewarding treating these patients and learning about the world through them.

Duncan: And now that you've gone through, I mean, you've highlighted how complex your journey has already been so far.  How do you feel like all of that has affected the way you treat or you view patient care?

Angelo: Everything that I've been through, when I, meet these patients coming from different places, things haven't gone their way, you know, especially with things out of their [00:18:00] control.

It definitely gives me, a lot of, understanding and patience there are these agendas we have as physicians, you know, take your medicine, please see us in clinic in a couple weeks, so that we can keep a close eye on you.

But they're coming from a different, background, and understanding of healthcare, where they're from, and it's been really rewarding to really develop an understanding of that. And I just think that for me as someone who's been through a really long process of also having things not work out exactly the way they [00:18:30] planned and also, having a process, getting to where I needed to be.

 I'm also kind of understanding that, for their health and for their life, they're also like in a process of getting to where they need to be. I really wanna be able to roll with that, and kind of in retrospect, since we were talking a lot about this mentor that had a really, profound impact on my life.

The one that told me that you want to proceed with things with authenticity? I wanna be a provider that is able to really see them for the things that they need us to be there for them. In the outpatient clinic, hopefully you'll be seeing them pretty [00:19:00] frequently so that you continue to see them as they go along whatever their process is.

Duncan: During his third year of medical school, Angelo worked with a vascular surgeon who told him something that could have changed his path if only he had heard it earlier.

What message would you have? I mean, I can imagine there's some young undergraduate right now that might be struggling with their courses. There might be someone in a post bacc program right now. There might be someone else listening that just got rejected from med school.

Maybe not for the first time, the second time. What's your [00:19:30] message to those young people?

Angelo: I'm going to reiterate a very simple message that I actually got, from, the vascular surgeon, that I worked with in the, OR during my third year rotation. And I think if I'd heard this when I was 18. You know kind of in being in my own head about pursuing medicine, like getting kind of scared off, by my way more qualified peers at the time. If I had heard this then, and also kind of really thought about it and applied it, then, maybe my path would've been a little bit more linear. The thing he [00:20:00] told me was, never let someone make you feel like you don't deserve what you want. Because I think, like psyching myself out of wanting to be a doctor, I felt like I wasn't qualified, you know?

And I think that kind of had stayed with me. I feel like I talk myself outta medicine through those other career paths for a long time because I just didn't feel like I had the confidence or like had a template to look at to be like, this is this person, these are the steps they took to get there and they're coming from a similar place I am, you know?

But if I had heard that, if I had more [00:20:30] confidence and was also a little bit, braver when I was that young to really pursue what I wanted and didn't do the mental gymnastics of talking myself out of it, things would've been a little bit smoother.

yeah, that would be the advice I would tell.  

Duncan: What was that quote again?

Angelo:  so the quote is, never let someone make you feel like you don't deserve what you want.

Duncan: And I would, argue that the corollary to that would be find the mentorship or the people that will help make you feel like you deserve the things that you do want.

Angelo: That is absolutely well put. And I agree

Duncan: Never [00:21:00] let someone make you feel like you don't deserve what you want, and find the mentors who will help you believe that you deserve it.

And I think you did find those people. And I think the patience were those people for you too. my next question is, how can you be that person to those people listening?

Angelo: Yeah. when I see someone that's like vaguely interested maybe a younger person or someone who's maybe never thought about medicine. I would just try to reach out and be like, Hey, have you thought about being, a doctor?

This could be you, not forcing it on [00:21:30] anyone, but I'm always willing to mentor someone or just talk to someone, make them believe that this is possible for them because, I don't think we have enough of that going around.

And I think, sometimes that push is, what people need to really start thinking about it. Because I definitely needed that. And, it really just took hearing the right thing at the right time to really turn things around. And there's still challenges along the way. They're inevitable. But if it wasn't kind of that reflection, and going back to the advice I heard, I think I would be doing something completely different right now.

Duncan: [00:22:00] And I think the key take home for me too is that you're with someone with the status and the experience to be that person. Yeah. Well, thanks so much for sharing that story. I think so many more layers than I realized. And yeah, I appreciate your time and I really do think a lot of young adults and people I think that are looking for their path, will get a lot of courage from sharing your story.

Angelo: Of course.

I always happy

Duncan: Yeah. 

Thanks so much. Thanks for having me. 

Angelo: Yeah, 

Duncan: thank you.

From a flooded house in Manila to a pediatric ICU in San Diego, [00:22:30] from underfunded high schools to UC Berkeley, from lab benches to a public health program in Chicago. Through two rejected medical school applications to UC Irvine, and finally to Harborview's International Medicine Clinic where Angelo now cares for refugees and immigrants navigating the same system that his family once navigated.

 Angelo's path to medicine took nearly 15 years from that first thought in high school. It wasn't linear, it wasn't easy, but it was [00:23:00] authentic. His story reminds us that sometimes the obstacles aren't just external. They're the voices in our heads telling us we don't belong, that we're not qualified, that we don't fit the mold.

And it reminds us that mentorship isn't just about giving advice, it's about seeing someone clearly and helping them see themselves. The mentor in Chicago knew Angelo for just a few months, but he saw Angelo's integrity, his commitment to authenticity, and he gave Angelo permission to listen to what he already knew in his soul.[00:23:30] 

Now, Angelo is on the other side watching out for young people who might be talking themselves out of medicine, who might need someone to say, this could be you. You deserve this if you want it, because sometimes that's all it takes. The right message at the right time. From someone who believes in you before you believe in yourself.

 This has been part two of Angelo's story on the EthnoMed podcast. If you or someone you know is considering a career in healthcare but doesn't see themselves in the traditional pre-med mold, we hope [00:24:00] Angelo's story gives you courage. That path doesn't have to be straight, it just has to be yours. I'm Dr. Duncan Reid. Thank you for listening.