You may have a picture in your head of what medical school is like, but getting there and succeeding there, isn't always a straight line. For Dr. Michael Natter, connecting the dots of his journey with diabetes and his passion for art helped him paint the portrait of the doctor he is today.
You may have a picture in your head of what medical school is like, but getting there and succeeding there, isn't always a straight line. For Dr. Michael Natter, connecting the dots of his journey with diabetes and his passion for art helped him paint the portrait of the doctor he is today.
See Dr. Mike Natter's drawings on his instagram page:
https://www.instagram.com/mike.natter/
Michael Natter:
Medical school is learning this very complex language of medicine. And what I was trying to do is translate that into my own visual language. I found myself drawing kind of these cartoons and these kind of funny puns, and I would show them to my friends. And at the time I had the only social media platform I had was Facebook. And so I would post them to Facebook, and after a test or two know, some of my friends would come up to me and say, yo, Natter, I actually got a couple points because of that cartoon you posted.
Interviewer: When you're speaking, do you
Natter: Images, I think, in pictures. Mostly, yeah. I'm Dr. Michael Natter. I'm a clinical assistant professor of medicine at NYU Langone Health.
Narrator: Can a picture be worth more than a thousand words? For some, that answer is yes.
Dr. Natter: When you translate complex topics visually, you're breaking down barriers, not only for yourself to understand them, but now, as a physician, I help my patients understand them.
Narrator: For SiriusXM, M and NYU Langone Health, This is Vital Signs. I'm your host, Rose Reid.
Dr. Natter: I was a pretty happy kid. Um, but it was interesting because I kind of didn't fall into any particular bucket since I really enjoyed the arts, but I also enjoyed sports. Um, I had wonderful friends growing up, and so I had a really happy, um, enjoyable childhood.
Narrator: Dr. Natter, like a lot of kids, had many interests and hobbies, but one of them was his favorite.
Dr. Natter: I think that we're all drawn to do art personally.
Interviewer: Pun intended?
Dr. Natter: Pun intended. Um, but for me, it was something that I was doing that I kind of never stopped, and it was just so natural for me. So I was always doodling, but I would also try and make more formal pieces. And I was very, very fortunate that I grew up in a household that was so supportive of that. And so, um, my parents would always offer if they wanted to take me to the museum. So we'd go to the Met and the MoMA and the Whitney and the Frick. And it was so inspiring as a young kid to I mean, just to grow up in New York City is just so wonderful. It's such a cultural beacon, and you're surrounded by all this. But then there's also the street art and the different personalities of people that you're seeing that are creating different forms of art. And all of that, I think, is very influential on a, uh, subconscious level.
Narrator: But Dr. Natter's happy, normal New York City childhood would soon be put on hold.
Dr. Natter: So when I was nine, there was a bit of a turning point for me, or an inflection point. Um, I became very ill two weeks after my 9th birthday. I was very, very tired. I was waking up at night to urinate. I was very, very thirsty. It was the kind of thirst where you could drink the entire contents of your refrigerator in terms of the liquid that was available and still not feel quenched. And it was just this repeatable, uh, process of waking up to pee, then waking up to drink, then waking up to pee, then waking up to drink. And it was, um, not sustainable. It was so much so that I couldn't focus, I couldn't work, I couldn't play. I was just so, uh, focused on thirst and then needing to urinate, and then just feeling exhausted from all of it. I think both myself and my parents were trying to explain it away. Oh, it's the summer. You're very thirsty. Oh, you've been playing a lot of basketball. You're very dehydrated. Um, I don't think at any point I felt like there was something very seriously wrong.
Narrator: As summer transitioned into fall, the easy explanations just didn't quite cut it any longer.
Dr. Natter: It was either a Saturday or Sunday because I was not in school, and I was extremely thirsty, and I was drinking a lot of root beer and orange juice and whatever I could get my hands on. And I became so ill that I was so tired. And so we couldn't really get up, and I began to vomit. And my parents got very concerned, and they called their friend of theirs, who was a physician, and he said to take me to the emergency room right away. And so my dad kind of scooped me up, and from there, it kind of got a little bit dark. I can't remember all of it. I just remember being kind of laid out into a gurney in the ER, and then kind of waking up a day or two later.
Narrator: He was diagnosed with type one diabetes. Type one diabetes can appear at any age, but most commonly occurs between four and 14 years old. Dr. Natter was only nine, but his condition was very serious, and he was headed towards a diabetic coma.
Dr. Natter: I was brought to the emergency room. The first thing that was done was, uh, a basic set of labs. Um, and those labs very quickly revealed my serum blood glucose - the blood sugar was extremely high at the time. I was told that I held this record, which I'd rather not have held, for the highest blood sugar on record at that hospital, which was about 1600.
Narrator: Diabetic comas can occur when your blood sugar is either too high or too low. Dr. Natter's level was 20 times higher than the normal range of 80 to 140.
Dr. Natter: It was pretty traumatizing. I remember being in the pediatric ICU. I think it was uptown at Mount Sinai at the time. And I just remember having wires and tubes and IVs connected to me and monitors and the screams of other children. It was dark. Yeah. Uh, it was pretty traumatic. I was in the hospital for a full two weeks before I was able to be discharged and kind of set up.
Narrator: Dr. Natter returned to his childhood life of sports and school and friends, but now living with a chronic condition.
Dr. Natter: Growing up, I played a lot of basketball, and exercise is very good for diabetes. But exercise can also lower one's blood sugar. If you become too low, as I said, you have those symptoms, and so it's forcing you to stop. It's forcing you to have to remove yourself from the moment, which none of my peers would have to do. And that, on a number of occasions, was very frustrating to me. Everyone experiences their highs and lows blood sugar wise differently. But, um, in general, for me, it would also kind of limit me. So if I was doing something that was cognitively heavy, taking a test, um, or if I was out on a date, let's say, and my blood sugar was a mess, um, it impacts it. And I would find myself on occasion just being like, this sucks. This really sucks. There was plenty of technology compared to when we first kind of knew about what diabetes was many, many years ago. But back then, it was big syringes, multiple injections a day. Um, not the greatest flavors of insulin. By flavors, I mean the, um, kind of makeup of the insulin was not as high tech as it is today. The glucometers, which are the devices in which you test your blood sugar on, were these big bricks, and they took a massive sample of blood and 60 seconds to count down. It was a whole ordeal. And so, if you went to school or you went out of your house, you basically had a suitcase with a cooler to keep your insulin and your syringes and everything else. You get raised eyebrows in the bathroom when you're loading up your syringes. So there was, uh, a whole culture and kind of true baggage, both emotionally and obviously physically with this disease.
Narrator: He carried around his baggage throughout the rest of his childhood and into his young adult years. As he arrived at college, like most young adults, he wanted to have a good time, but knew he couldn't be careless.
Dr. Natter: In college, you do experiment, you do drink, and you do, um, stay out late and do things that you weren't doing before. And that was a difficult time to keep my sugars in range as much as I wanted. Um, I was always very aware that the biggest danger of being Type One acutely is low blood sugar that can be potentially fatal in a shorter period of time. The kind of, uh, push and pull of diabetes is that if your blood sugar is high for a long period of time, you're bathing your organs and your nerves and your blood vessels in a lot of excess sugar, which eventually causes complications that a lot of people are familiar with, like blindness and amputations and kidney disease. But especially as a kid, you are not, as I guess, scared by those. And the feeling of going low is actually so abrupt and so acute and so disruptive that you're, at least for me, much more aware of the lows and much more kind of concerned of the lows. And so I think a lot of people and myself included in those situations when I felt more vulnerable when I was away from home or I was not in an environment that was familiar, I would probably find myself running a little bit higher with my blood sugars. Now, I know it's not good. It was not ideal. I would have preferred to be in range as much as possible, but given the circumstances and given the technology at the time, I think I did a pretty good job, everything considered.
Narrator: Dr. Natter had figured out how to manage his diabetes, and now it was time for him to tackle his next obstacle - figuring out his life.
Dr. Natter: Growing up in New York City, you ride the subway and you see different types of professionals on the subway. And I always know if I saw, like, an astronaut on the subway, I would have this being washed over with awe and admiration and how noble and amazing would it be. But also knowing the reality that I would never be able to be an astronaut. And I was okay with that. I kind of saw doctors in that same way, these really amazing professionals, uh, that are helping to make people healthier and saving lives and must be so smart and dedicated to do what they do. I could never do that. I went into college not knowing what I wanted to do, knowing I had an interest in medicine, but not believing enough in myself and having academic confidence enough in myself to try to be a doctor. And so when I went to undergrad, I went to Skidmore College, uh, primarily because they have a strong art program. And I would sit in the art studios and I would draw forever. I knew that it was such a wonderful experience for me, because after the class was done and 3 hours was up, I was like, I will stay here another 3 hours if I could. I love this. And I kind of very diligently and purposefully stepped over the algebra and the calculus and the organic chemistry. I was like, I'm not going to take any of that. Until I started to take some of the neuroscience classes again, just out of interest. I was like, these are interesting topics. I'm not the smart kid, so I'm not going to sit in the front row and think I'm going to ace this class, but I'm just curious. And so I had a professor, um Flip Phillips, and he saw my interest and he saw that I really liked this because I was interested, not because I was looking for a grade. So he kind of took me under his wing. He brought me into his lab, and we started to do some work together. And by the beginning of my senior year, it became very apparent that I said I need to try to go to medical school. I remember what he said to me when he said, oh, you should come to my lab and you can write a thesis. And to write a thesis is not mandatory in my undergrad at that time. I said, oh, well, I'm not that kind of kid. I'm not the thesis kid. He's like, what do you mean? I said, well, that would require me to do statistics and math and things that I am just something that I don't do. And he goes, I'll take care of that. He just so quickly pinpointed the things that were my obstacles and my roadblocks, which I perceived as and knocked them down. Don't worry about it. We'll do it together. I'll take care of it. We can figure this out. And it was that kind of approach that I think made what felt like this impenetrable field of only smart people can be in this field and only academics and accomplished people. People that I didn't ever associate with as myself. He made that much more welcoming and opening and told me that I am part of that field. So I think that was a really big turning point for me.
Narrator: As, uh, he suspected, medical school wasn't easy. But his art became a surprising ally in his journey.
Dr. Natter: To get into medical school, you have to just talk about how great you are and you dance and you're a violinist and this and that. But then once you get into medical school, they flatten you out into this two dimensional you need to be this repository of a voluminous amount of knowledge that you retain and regurgitate at a moment's notice. And so you don't become this three dimensional person anymore that you needed to be to get in. And what I saw my colleagues around me doing in the first year of medical school was they would take all their notes and the lecture and the textbook and they would synthesize it into a one page, kind of dense outline that they would memorize word for word. And I thought that's what you had to do. And so I started to do that. I did fine. But I kept doodling on the margins of those notes. So when the test would roll around, I really couldn't remember any of the text or the highlights or the underlines. I remembered the silly doodles that I was making. And that's when I started to think about that. And I said, well, why don't I try and take advantage of this a little bit more? Even if this means that I won't ace my tests, but I'll pass them, I'm going to go ahead and trade in notebooks in, buy sketchbooks and just try and draw as much of my notes and visualize as much of my notes as possible. I expected to do just as well, maybe a little bit worse if necessary, but I was okay with that because it would have made me happy and actually enjoy the process of learning medicine, which is all I ever wanted to do. And to my surprise, I started crushing my tests. I did very well after I made that switch. I learned what I needed to do to learn. And I was just so happy because I started to not only do well, but I was enjoying the process. In the first year of medical school, you're, uh, being thrown out all of this very esoteric information. You're learning, like, biochemistry and abstract ideas. These things have, like, 18 syllable names. They all sound the same. And I'm sitting there, and everyone around me is sitting there very diligently, and I'm sitting there like, what is he saying? What is going on? Oftentimes, I wouldn't necessarily draw the image in class because they would be talking so fast and I would miss bits of information, but I might do a quick doodle and then finish it off afterward. And in that moment, I did a quick caricature of the professor, and he is just vomiting words that just like, with 18 syllables. And then the next panel is just me covered in the words, like, looking very perplexed. The classic, uh, image that people talk about in medical school is it's like trying to drink from a fire hose or a fire hydrant. The volume is very big, but the rate that it comes at you is very big. And so I also made this cartoon in my first year of med school that I always think back at of me just being pummeled by the fire hydrant and having the little 18 syllable words kind of spitting off in each direction.
Narrator: Soon, he wasn't the only one enjoying the benefits of his doodles.
Dr. Natter: If you add a layer of humor to the visuals, it also makes that material a little bit stickier. And so I found myself drawing kind of these cartoons and these kind of funny puns, and I would show them to my friends. And at the time, the only social media platform I had was Facebook. And so I would post them to Facebook just as kind of like a repository to kind of digitize, uh, and keep a track of whatever drawings I had done. And after a test or know, some of my friends would come up to me and say, yo, Natter, I actually got a couple points because of that cartoon you posted. And it made me so happy, because, again, it proved the point that there's something here. It's not just nonsense. But it also was nice to feel like I was helping my colleagues in a way that was so natural to me. So all of that together made my medical school experience actually really wonderful.
Narrator: He had figured out his diabetes. He had figured out medical school. And now it was time to figure out a specialty.
Dr. Natter: I really, really didn't want to pigeonhole myself when I went to med school. I always thought I wanted to do endocrine, but I said, I want to have an open mind, and when I rotate through every other specialty, see if maybe this would be equal or better than fit for what I want to do. And I really found that what I really relished was the rapport and the interaction with the patient and a lot of these other specialties, they have that as well, but it's a little bit fleeting. And in these kind of chronic conditions where you see your patients every three or six months and you really develop a rapport with them, they're like your family. I like that. I really, really like that. And so there were a handful of fields that had that. Um, but then every time I rotated through them, I kept coming back to this. I just know endocrine. It's literally in my blood, and I understand it. And I know that you don't need to share the same condition with your patient to be a good empathetic doctor. I know that for a fact. But I will say, with chronic conditions, there is a sense of, why am I here? This doctor thinks they know more than I do about my own body. I do this every day. And there's also this kind of uncomfortable feeling of I always described it as going to the endocrinologist as a type one diabetic is like going to get your report card at the end of the school year. They see what your A1C is, which is kind of a marker for if you're, quote unquote, in control, but it's the way that we see how the blood sugars have been over the last three months. And there's just so many variables that go into blood sugar from a minute to minute, day to day, let alone the A1C, which is the three month average. And it always feels like it gets boiled down into you're not doing well enough, you're not trying hard enough. And I think it's hard to really relate and understand that unless you yourself are doing it. Now, again, I have plenty of colleagues that do a wonderful job of empathizing and understanding that. Um, but you can feel a palpable shift in the room when you talk to the patient and you explain, I do this, too. Like, I get it. And that rapport is just something that is very strong and I think really helps a lot in the doctor patient relationship and in what I really strive to do in medicine and why I went into it in the first place, which is really to make those connections and to help people.
Narrator: He makes those connections not just by sharing the personal experience of diabetes, but by getting to know his patients on a personal level.
Dr. Natter: I relate to my patients in the way that I would want to be related to, which is like family. And so I'm a little bit more casual in that respect. But I think some patients really, really like what my kind of go-to approach is, which is this warm sense of, like, I see you kind of like, I would see my mom, and I want to know about what's going on with your life outside of your A1C and your diabetes. I want to hear about what your kids are doing and that kind of stuff. And other patients, they don't necessarily want that. They want to be in and out, and they want you to tell them what it is. Cut and dry. And so I do try to, uh, meet my patient halfway.
Narrator: Just as learning complicated and detailed medical information in med school proved challenging, so did explaining the complexity of a chronic disease to a patient in his practice.
Dr. Natter: I have this belief that every patient has a right to understand the pathophysiology of the condition that they're dealing with, um, for many reasons. But the main one being, I think, when you understand your condition, um, you're more agile in how you can approach and treat and manage it, especially chronic conditions. So when you don't speak English, or you don't have a high level of education, or even a medical education, or even a basic, um, 9th grade biology education, or your cultural differences, all of those can be barriers to understanding medical topics. To expect in a 15 minutes visit that I'm going to be able to get across to you, um, what your condition is, how to treat it, why it's important, all the subtleties and nuances of it. I think that drawing is such a wonderful way to break those barriers down. But in addition to doing that, you are creating a rapport with this patient. So in a very digitalized age, when everyone's on a computer or a phone, when you pull out a piece of paper and scribble with a pen, even if it looks terrible and doesn't resemble the idea of what you're trying to get across, that is so valuable. And I've had a lot of instances where I was so kind of flattered and also confused by at the end of the scribble and at the end of the visit, the patient asks to take home the paper. And I said, well, it's just a bunch of scribbles, because inevitably, when you're talking as you're drawing, it ends up being just lines. And they're like, no, no, this was really helpful. And so there's something to be said about that exchange that I think is it's not taught in medical school. It's not kind of emphasized, but I think a lot of, um, it separates, I think, the doctors that are able to really, uh, communicate well with their patients, uh, versus the other ones that are a little bit more kind of digital and kind of locked to their computers.
Narrator: He never really left his art behind. Instead, it carried him through the toughest times. And even today, he uses it to reach people in a way he never imagined.
Dr. Natter: So I started out really as a fine artist that's kind of morphed into an illustrator. And then initially in med school, it was teaching myself medicine through my art and then others through my art. And then through medical training, it's very emotionally heavy, and there's a lot of just kind of trauma that we experience. And so then my art kind of took on this extra role of catharsis. So there's this cathartic bucket, this processing of seeing really horrible things. So I think for me, art has really been like the linchpin of really all of my success. But the whole reason I was able to get into medical school, get through medical school, get through residency, get through fellowship, and then, um, by accident, kind of amass, uh, platform on social media that I had never intended for. So it's been really an amazing journey. What I hope is next for me outside of my clinical career is I do really want to make two books. I would like to make a visual textbook of medicine for medical students and residents. And then I also really want to get involved - there's a big movement called graphic medicine, which is this melding together of kind of comic books or graphic novels and, um, a narrative about medical things. And so that could be from a physician's point of view or a patient's point of view. And it's really getting a lot of traction, and there's a lot of books in that space. And I want to make my own graphic novel that would fit well in that space as an autobiography.
Narrator: Vital Signs is a co production of NYU Langone Health and SiriusXM. If you'd like to see Dr. Natter's illustrations, you can find him at Mike Natter - that's M-I-K-E-dot-N-A-T-T-E-R on Instagram or click the link in the podcast description. The podcast is produced by Jim Bilodeau, Jennifer Hofmann, and Keith King. This episode was written by Keith King and sound designed by Jim Bilodeau. SiriusXM's Executive Producer is Beth Ameen. Don't miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone Health, tune in to Doctor Radio on SiriusXM Channel 110, or listen anytime on the SXM app. To get in touch with our production team, email vitalsigns@siriusxm.com for the Vital Signs podcast. I'm Rose Reid. Join us next time as we bring you stories of medicine made personal.