Mia Essay

Anna became weak and malnourished herself with two years of breast-feeding on a highly restricted diet. Mentally, she and Mathai had reached their nadir. Mia’s brother, Mathew, was also feeling the effects of a family in crisis. Mathew had almost been kicked out of Chinese school for acting out in class, and he once threw a tantrum during one of Mia’s many hospitalizations, culminating in his storming out of the room. It is hard for a six-year- old who is as active and intelligent as Mathew to have the patience to deal with his sister’s disease. When I had lunch with the Mammens, Mathew jabbered nonstop about soccer, kindergarten, and his new video game and was disappointed when his parents explained to him that I couldn’t play because we were talking about Mia. I’m not sure what Mathew must think about this whole situation, but he is as affected by Mia’s disease as anyone else.

Mia’s health also continued to suffer despite Anna’s best efforts at providing nutrition through her breast milk; her hair was turning white and showing other signs of protein de ciency. Breastfeeding was neither sustainable for Anna nor suf cient for Mia, and total parenteral nutrition (TPN), an intravenous food source, represented a shot-in-the-dark hope to keep Mia fed. However, this option was not without its risks. Although Anna’s physical health required that she stop breast-feeding, should TPN not work, Anna’s milk source would be gone and there would be no alternatives to feeding Mia. Given her mysterious intoler- ance of elemental formulas, her risk of intolerance was even greater. It came time to think about issues no parent ever wants to think about, let alone set up legal documen- tation to address. Although Mia’s parents have been emotionally taxed with physicians insinuating neglect or gross incompetence on their part, signing a Do Not Resuscitate order for their two-and-half-year-old daughter forced them to confront issues of life that many individuals have never faced. Anna and Mathai had to accept that the physicians were no closer to a diagnosis of this charted “unknown metabolic disease” and that Mia had deteriorated signi – cantly. A recent MRI showed shrinkage and a mysterious deposition of mineral throughout Mia’s brain. The image showed a clear deterioration from the rst MRI when she was initially admitted. The once vibrant child now ap- peared with partial vision, mixed tone in her muscles, an enlarged liver, loss of most of her muscle function, and,
the worst symptom of all, extreme pain. From a few steps and a crawl, Mia had regressed to being unable to hold her head up again. Anna and Mathai faced these challenges head on, agreeing that the most important goal was to increase her quality of life. With crossed ngers and many prayers, Mia was put on TPN. Thankfully, it was successful. It seemed that if Mia’s digestive system could be avoided all together, some of the mutiny inside her could be bypassed.

But after many hospitalizations, bitter realizations of their daughter’s dire situation, and placing their lives on hold, Mia’s parents took her home and started her palliative care. She was given oxycodone, valium, steroids, and anti-seizure medications and referred to see a gastroente ologist, a neurologist, a developmental biologist, and an endocrinologist regularly. During this lull in the tidal wave of Mia’s disease, Anna and her husband finally re-experienced one of the small pleasures of life—going out to dinner, their first opportunity in over two years.

It was during this calm that I went on an appointment with Mia. Anna was surprisingly joyful because she was excited to share with the physician that not only had she gone out to dinner, but she had also eaten what she wanted and had two glasses of wine. Chicken breast dieting and two years of breast-feeding made those two glasses of wine the most appreciated and desired glasses of wine in the world. Yet despite this transient pleasure, there was still the fear of what Mia’s future would hold.

I went to the Mammen home to see what daily life with Mia was like. Palliative care was not exactly what I had pictured. Anna slept in a tiny bed with Mia at her side in a room lled with syringes, TPN kits, gauze, and tons of medication. The only vestiges of childhood were Mia’s favorite pink plastic horses lining a shelf, one of which her brother had bought her for Christmas, and some frilly dresses Anna had bought her. In the morning, Anna would bathe and dress Mia in a trying fashion. Mia’s muscle tone and rigidity forced Anna to get in the shower with Mia and hold her as she attempted to bathe her without Mia slipping out of her hands. Following these baths were the dreaded diaper changes. A regular and unnoticed occurrence for most children, diaper changes for Mia meant whole-body muscle spasms, screams of pain, and some- times seizures. I apprehensively watched her eke out a tiny smile as Anna dried her from her shower and kissed her cheeks, preparing her for the moment ahead. Then she would place Mia on her back and scramble for the wipes and diaper as Mia’s eyes rolled back, her hands ew up by her head, her body began to convulse, and a sound so disturbing it made one stop dead in one’s tracks erupted out of the child. As soon as the diaper was on, Anna would hold Mia to her chest, apologizing for her pain and plead- ing with her to stop. Mia would eventually calm down, her breathing slowing to a normal pace. Mia would then have her TPN infusion, and Anna would take Mathew to karate and Chinese school—all in a ‘normal’ day’s routine.

To this day, Mia has her good days and her bad days. Some days she will bless her family with her smiles, a small window into Mia’s soul, as if she has triumphed for a brief second over the mutiny inside her. She will enjoy stroller rides and listening to children’s television with her brother. She even enjoys “playing” Nintendo Wii against Mathew, as Anna slips the controller in Mia’s sleeve and wiggles her arm for her. On bad days, pain medication is not even strong enough to take the edge off, and spasms take hold of her body, leaving her in a deep sleep by day’s end and exhausting Anna. Bad spurts are further compli- cated by her erratic sleep schedule. In addition to losing many developmental milestones, she is gradually losing motor control of her extremities. She doesn’t make much noise at all anymore except for the repetitive grinding of her teeth, an outlet for her pain. Only an extremely at- tentive mother can tell when she is in pain and when it

is more than normal. Recently, this careful attention has amounted to catching a treatable small bacterial infection around the bottom of Mia’s central line that nevertheless required yet another hospitalization. Sadly, Mia’s parents have been told that the source of the bacteria was likely Mia’s gut, and that these infections will continue to happen again and again.

Mia today is an infant-sized two-and-a-half-year-old girl with slender extremities, graying hair, and a glazed stare. Despite this sobering image, I can’t help standing in awe of her strength as she endures hours of the same vision and physical therapy everyday. I watch as her mother fo- cuses every ounce of her attention on the simple rhythmic movements of her arms and legs and tells her how beautiful and strong she is for persevering. I can’t help laughing as her mom tickles her stomach, and Mia’s mouth opens as wide as possible, producing a huge grin. After therapy is over, Anna picks up Mia and holds her in her arms, and Mia turns her head up toward her mother, unable to see her but recognizing her touch. They face another day, difficult, but together.

What have I, as a future physician, learned from my experiences with Mia? Perhaps most importantly, as illustrated in some of the anecdotes above, pediatric chronic disease is not easily removed from its context. Mia’s entire family has been changed from this experience. Anna once related an experience in the grocery store, where she no- ticed people starting at her. One woman approached her and asked how old Mia was. Deciding whether or not to lie, she stated that Mia was six months old; however, the nosy bystander was not to be placated and asked her why the baby had so many teeth and so much hair. Annoyed and embarrassed, Anna raced through the check-out line and ran for the door.

Moreover, I have learned that when we do not have answers, it is then that we are particularly called upon to be more than just healers of the body. To this day, Mia does not have a diagnosis and has confused physi- cians repeatedly, yet each physician has affected the Mammens, having made some days easier than they could have been and some days more trying than necessary. Some physicians have dealt with Anna’s hysterics and anger directed towards them over lost blood samples or ignorant staff who have asked whether Mia drinks milk or exclaimed, “Your daugh- ter looks young for her age.” Those who sympathized eased Anna’s concern and earned her trust knowing someone else also had Mia’s best interests at heart. The leadership required to save a child’s life pales in comparison to the strength and leadership required of a physician when a child’s life cannot be saved.

Lastly, I see from Mia’s case precisely how much a patient can affect an individual. Mia may not talk or walk or ask cute questions, but, more than any child I have ever met, Mia has taught me a great deal. She has given me perspective on my own life and my hopes for my career in medicine. Every time I see her I can’t help being in awe of her ability to deal with the struggles of living in pain and ghting her disease and still managing to smile as if she were somehow comforting me. I start feeling that somehow this child is ahead of her time, knowing something I don’t—possibly some secret hidden meaning of life to which she is guiding me. Meeting Mia, for me, was like a wave to the sand, gone in a moment but leaving an imprint I will never forget. I remember now walking into the PALS Halloween party to meet Mia and Anna for the rst time and seeing this smiling bundle dressed up as Yoda. I was hoping I would help Mia in some way by being her PAL, but little did I know that she would do more for me than I could ever do for her.

Ah, the personal statement. Perhaps there is no part of the application more anguished over, more edited and re-edited, more emphasized than this.

First off, as the applicant you should embrace the personal statement! An applicant doesn’t always have control over how his or her final microeconomics grade turned out, or his or her GRE verbal score may be a little lower than desired. But the personal statement is a place where the applicant has full control. So feel empowered!

It is important to note that the admissions office sees the personal statement as the most important part of the application. It helps us to learn about your passions, your goals, and your desire to impact the world and make it a little brighter. Due to the volume of applications we receive, we cannot conduct interviews with our applicants, but we do think of the personal statement as a type of interview.

With this in mind, if you could only spend 10 or 15 minutes in front of the Admissions Committee, what would you say? What’s your best sales pitch? We want to hear it.

Our personal statement section is broken down into three distinct parts, with an optional fourth essay. Before we dive into those questions, here are some common questions that we receive at the admissions office regarding the essays.

Question:  Do I have to follow the format of the personal statement?

Answer: Yes.  Please follow these instructions, for your sake and ours. Stay within the stated word limits. And know that you will be judged harshly if you try to substitute a statement written according to another school’s requirements. Following the directions (on all parts of the application) is a critical part of applying to SIPA.

The majority of this entry addresses the first part of the personal statement.  We generally do not provide instructions regarding the second and third parts because we want each applicant to answer in his or her own way.  For the second and third parts, we are interested in how applicants choose to respond to the question and thus have no specific advice on what constitutes a “good” part 2 answer and part 3 answer.

The fourth part of the personal statement is wide open. We provide space where you can include information you wish for the Committee to be aware of that might not be highlighted in other parts of your application or that you feel will shed light on some aspect of your past or future goals.  Part four can focus on things you are proud of, or perhaps not so proud of.  You may also use this part to address any concerns in your application.  The Admissions Committee would prefer to see something in section four, so please try not to leave it blank!

Question:  Do you have any general advice regarding the personal statement?

Answer: Yes, and the rest of this entry will focus on advice for you to consider.

For one, it’s probably not a good idea to quote someone  in your personal statement.  For example, it would not be wise to say something along the lines of the following –

I want to join SIPA because like Gandhi said, “I wish to be the change I wish to see in the world.”

While this is a nice quote and Gandhi was an incredible person, the Admissions Committee is not making a decision to admit Gandhi to SIPA – we are considering admitting you to our program.  Thus we are not so interested in what Gandhi has to say. Rather, we are  interested in what you have to say! Also, when you quote someone else it in essence says, “I could not think of anything on my own to say, so let me let someone else do it for me.”

At SIPA we are looking for creative, passionate, smart, driven, and competent people.  The best personal statements are just that – personal.  We want to hear from you.  The best applicants each year become quotable.  When an Admissions Committee member is impressed with what an applicant has written, they will often call attention to this when discussing the application.  So your goal should be to become quotable, not to quote someone else.

Another note is that your answer to section one should not simply be your résumé in paragraph format.  In order to get your point across in your personal statement it might be necessary to restate information already included in your résumé, however do not restate information without a specific reason or goal.

One thing not to do for example is to tell us in your personal statement where you went to school.  Many applicants will mention the name of their school in the personal statement.  What is wrong with this? Well, you sent us your transcript and you state where you went to school in your résumé, why would we need to be told a third time where you went to school?  Use your personal statement to get across new information that might not be contained in other parts of your application. Tell us things we don’t know. Give us great reasons why you absolutely have to be in our new entering class.

Your answer to part one of the personal statement should particularly be about what you hope to accomplish in the future.  What are you passionate about?  What are your goals?  What impact do you hope to make on the world?  Most of the contents of your application are about your past, we want a glimpse into your future.

One thing we are trying to determine is if SIPA is the right program for you.  We are also trying to determine the type of contribution you will make as a student and alumnus of our program.  We do understand that you might not know exactly what you wish to do, however you should try to be as specific as you can.  For example, if you are interested in development, is there a region or particular group of people you wish to focus on? If you are interested in international security policy, what do you hope to do with the skills you attain while at SIPA?

Strong responses to part one are focused and clear. An example of not being focused is to say that you wish to work for the United Nations. Saying this alone is too vague. The United Nations is comprised of a multitude of organizations, doing a multitude of different things, in a multitude of different places. Listing a broad policy objective without context is also a common mistake. Whatever you hope to do, you should integrate the who, what, where, how, and why elements into your statement.

Address questions such as: Who do you wish to impact? Is there a specific region, city, country, locality you are passionate about? What population do you hope to serve? What concerns you about the future and how do you hope to address policy questions to make a difference? What skills will SIPA help you to develop? Is there a sector that is most appealing to you? (Non-profit, multilateral, for profit, public). Do you hope to go in a new direction and why? Specificity is important.

The most outstanding personal statements each year become a part of discussions amongst members of the Admissions Committee.  Each person is different and has a different history and goals.  Make sure to pour yourself into your personal statement and it will likely stand out because no two people are the same.

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