Tag: Graduate School

Autoimmune Disease in Graduate School

Graduate school in the sciences is, by all accounts, challenging. This is widely publicized and for the most part incoming students have an idea of what hurdles they’ll need to overcome on the road to an MS or PhD, at least in concept. In the U.S., one expects rigorous coursework, difficult exams, hands-on research training from senior lab members, committee meetings, a candidacy exam, a lengthy writing process, and a final defense. The specifics differ between fields and countries, but generally the process is well outlined for prospective graduate students.

When I started my PhD I may not have felt prepared for everything, but I thought I had a complete picture of the challenges I would be facing over the next several years. I couldn’t have been more wrong.

At the end of my first semester I was suddenly hospitalized with severe abdominal pain. One week later I returned home diagnosed with an autoimmune disease for which there is no cure. Over the past nine months I have faced some unique challenges unlike anything I was prepared for when starting graduate school, and now that things have stabilized I feel ready to document what I’ve learned.

The original purpose of this site was to promote inclusion and self-advocacy for autistic natural scientists so this topic may seem out of place, but I feel it’s thematically appropriate given the overlap in coping strategies and resources. Further, unlike the autism issues I tend to focus on, there are a litany of blog posts and articles online discussing living with a chronic illness in grad school. Rather than repeat these existing resources I want to focus on issues most relevant to those with autoimmune diseases. What follows are lists of challenges associated with managing this type of chronic illness in graduate school and resources or support structures helpful in doing so, informed by my experiences over the last nine months.

Challenges

Symptoms

Time management skills are key for graduate students as they try to fit classes, teaching, meetings, research, and maybe even some social time into their days, but unexpected symptoms can throw a wrench into the works even when your planning is on point. My symptoms have cropped up during exams and a couple of key meetings. Aside from being distracted, I was outright embarrassed when I had to cut meetings short to rush to the restroom. I also imagine a symptom-less exam would lead to decreased stress levels and perhaps an increased score compared to one taken in constant pain. Exhaustion is also a major concern, whether as a direct symptom of the disease or while recovering from episodes of pain.

Managing Treatment

In the U.S., managing a chronic health condition requires an additional time commitment beyond scheduling and attending appointments. The American system also places the responsibility to coordinate different bureaucracies on the patient, necessitating several hours on the phone just to receive care. I regularly had to call my insurance company to verify that providers were in-network with my plan and to understand coverage stipulations that I then needed to relay to my doctor. My medicine is purchased from a specialty pharmacy which must also receive approvals from the insurance company, which in my case took about five multi-hour calls over the course of a month. When mistakes inevitably happened it fell to me to figure out what went wrong and to call each company to correct the issue. I estimate that I collectively lost 4-6 hours per week to these responsibilities over the first several months with my diagnosis, severely cutting into my working hours.

Travel Logistics

While not applicable to all autoimmune diseases, the challenges of traveling with medication that requires constant refrigeration have been significant for me. Travel-sized insulin coolers are available that can keep meds cool for 24-30 hours, but trips to remote field stations sometimes take longer than 30 hours and refrigerators/freezers need to be mapped out along the route to refreeze the gel-based ice pack. If you experience a non-trivial loss of power while traveling with medication you may be stuck ordering a replacement dose. Insurance may not pay in all such cases, and specialty medications are often prohibitively expensive without insurance. For example, one dose of my medicine costs about $3,300 as of September 2023. I suspect these prices would be less of a consideration in other countries, though I have no personal experience ordering medicine outside the U.S.

Additional Health Concerns

A common treatment strategy for autoimmune diseases, in which a patient’s immune system attacks tissues it shouldn’t, is to apply an immunosuppressant. An unfortunate side effect is that the patient may now be considered immunocompromised because their immune system is less able to fight off infections. Those receiving this type of treatment need to take additional precautions to prevent infections, as simple colds may last for weeks instead of days, and something more serious like a COVID-19 infection could require hospitalization.

Financial Cost

As I’ve mentioned previously my experience comes exclusively from the U.S. This issue is likely to vary across national boundaries, but it is a significant concern for Americans of nearly any economic standing. Graduate students are likely to have health insurance either through their school, an independent plan, or through a parent. Most student plans will not have small deductibles or out-of-pocket maximums as such benefits drive up premiums. As a result, the out-of-pocket costs of diagnosis, hospitalization, and specialty medications can pose a significant financial burden. In my case the initial hospital stay alone cost over $4,000 after insurance.

Support Structures

Formal School Accommodations

Most universities will have some form of accommodation process for students with disabilities. These programs typically include students with chronic health conditions and are how students are granted extra time on exams, more generous attendance policies, deadline extensions, and other accommodations designed to make coursework more accessible. You will likely need to provide documentation of your condition to access accommodations, but the process should be outlined clearly on the university website. I heavily recommend students with any chronic illness initiate this process as early as possible, even if they don’t think they will use the accommodations. Having a formal agreement in place guarantees you will be given some leeway if your symptoms cause an unexpected problem, even if your instructor tries to put up roadblocks.

Scheduling Freedom

Outside of classes, graduate school is probably one of the most forgiving workplaces for those with chronic illnesses. In most programs you will manage your own schedule and thus be able to plan your days around your symptoms and energy levels. While unexpected flare-ups can still derail meetings and other scheduled commitments, for the most part you should be able to rearrange your schedule as needed.

Lab and Department Support

As a grad student in the sciences your lab will be your primary source for all kinds of support. The professors, postdocs, and other students you work with will ideally support you through both your research and the general struggles of grad school. Your ability to cope with a chronic illness will be greatly aided by flexibility, understanding, and occasional help from your lab-mates. You don’t need to share details of your condition beyond your comfort level, but making your colleagues aware of your struggles will make them more likely to understand if you need to cancel a meeting last-minute or to send you their notes if you miss a class.

Support Groups

At larger universities you may be able to find formal support groups for disabled students, or perhaps for students with chronic diseases specifically. While I haven’t been able to participate in such a group, I have read testimonials from students who highly value them for the chance to talk with people going through similar challenges. When I have met other people with autoimmune diseases it has felt validating and relieving to discuss and complain about the pains we deal with, and that alone has often made me feel more optimistic about managing my condition. Further, comparing notes with other people dealing with the same insurance company can help you cut through the bureaucracy more efficiently than you otherwise would. I recommend taking advantage of campus support groups for these reasons.

Additional Funding

There are a number of funding sources available to graduate students with autoimmune diseases or other chronic illnesses. Sometimes these funds are intended to offset medical costs, other times they are general scholarships or research awards set aside for students with disabilities. Universities will often provide internal awards through a disability office. These are typically less competitive than national awards and should be the first place you look, but there are also external sources like the Foundation for Science and Disability (http://www.stemd.org/) and the Buckfire Law firm (https://buckfirelaw.com/scholarships/disability/). [Note: Both links are current as of September 2023, and each is for a $1,000 award] Look for other funding opportunities like these and keep applying! They exist to support students dealing with chronic illnesses and other disabilities, and there is absolutely no shame in applying to all of them.

Rebate Programs

If you have been prescribed an expensive medication there may be additional ways to pay beyond your insurance policy. Many drug manufacturers make so much money from patients’ insurance companies that they have established programs to ensure patients stay on their medicine. This is often done through rebates, where the manufacturer reimburses patients for some or all of their out-of-pocket expenses up to a certain amount. I’m not an industry expert on this topic, but I would encourage anyone facing untenable medication costs to research support opportunities that may be available through their drug manufacturer.

The greatest lesson of my autoimmune disease experience has been patience. Patience is required to push through the insurance process, patience keeps me calm and reduces the chances of symptom flare-ups, and patience allows me to strategize when tackling travel logistics with my medicine. Patience will help at every stage of grad school, doubly so if you have a chronic illness. My intention is for this collection of support structures to serve as a starting point for grad students who find themselves suffering from an autoimmune disease or similar condition. With the right support and a lot of patience you can make it through.

Photo Credit to Charlotte May via Pexels

Formal Applications: How to Stay on Top of Everything

For most people, job applications are an occasional frustration. It’s common to stay in the same position for years at a time, and frequently the application process can be bypassed through personal connections. Scientists are not most people.

Whether you are trying to build a career in academia, industry, or government, you will have to fill out complex formal applications at several stages. These applications might be for admission to an undergraduate or graduate program, consideration for permanent or seasonal jobs, or for funding opportunities like scholarships, fellowships, grants, and research assistantships. Intense competition within the natural sciences means you will likely need to handle multiple applications for each academic year, field season, or funding need, and each application will ask for different components.

It can be a lot to keep track of, and I have known the frequency and intensity of these formal applications to drive students away from pursuing academic careers. Further, they can be a double-edged sword for Aspies. While many of us are drawn to the consistency, clear expectations, and sense of progress offered by the application process, we can also be prone to executive dysfunction, increased stress, and anxiety.

The purpose of this post is to share the strategies I have developed for managing the moving pieces involved in a formal application, whether it be for college admissions or a prestigious funding opportunity. The advice I share here is general and some points may not translate well to specific applications. However, the sequence and practices I recommend are valuable tools that can help you feel less anxious and more in control as you navigate your application.

1) Search for Places to Apply

This may seem obvious, but I mention it here because it can be easy to jump on the first decent opportunity you come across and to stop searching after that. Just because the position or program you found is good doesn’t mean that there isn’t another equally good or better opportunity to be found. It would be wise to complete a thorough search at the very beginning of this process to avoid missing anything important. That said, you must know when to end your search. It can be just as easy to get so bogged down making lists of places to apply that you never actually start an application!

My advice is to start by defining your search parameters. Ask yourself what exactly it is you are looking for. If you are choosing an undergraduate program, try to identify the qualities, courses, resources, or programs that you want from your college experience. For graduate programs, consider what research themes and methods you would like to explore, what connections and mentorship style you would like your advisor to have, and what resources for further career preparation you need your program to provide. When looking for jobs of any sort you should start by deciding whether you need a seasonal or permanent position, or if you are open to either. The same should be decided for full-time/part-time. From there you can worry about the kind of work you would like to do. When looking for funding determine exactly what type of research or equipment the funding is needed for and consider the different types of organizations that might be interested. Also consider the amount and type of funding you would like. Do you need a small one-time payment to cover an expensive piece of equipment, or are you looking for a multi-year fellowship to support your graduate education?

Once you have identified these qualities, you should define the length and depth of your search. For example, if you are looking for a seasonal field position in your area, limit yourself to local job postings/fairs and a handful of searches on Google, Indeed, Linkedin, Glassdoor, etc. It will not be worth your time to search for positions on national and international platforms like the Texas A&M Conservation Job Board if you are limited to jobs in your area, because anything local that appears on these bigger lists will likely also appear on your basic local searches. For undergraduate and graduate programs, figure out which desired quality or resource is most important to you or most uncommon, then limit yourself to investigating the programs with that quality. If, for example, you want to do regular field research on salamanders, limit yourself to schools within the natural range of salamanders. If your desired research area is very niche, there may only be a handful of labs working in that area and this step is done for you. For funding, repeated searches are necessary to stay on top of every relevant opportunity. In this case I recommend that you limit yourself to searching one or two funding sites (Pathways to Science, NSF, etc.) at a time. It is always ok to come back later and look for more funding, but you can’t afford to paralyze yourself by searching infinitely either.

2) Make a List of Application Components

Once you have decided to apply for a job, funding opportunity, or academic program, you should thoroughly read over the solicitation and make a list of everything that is expected of you. For some jobs this may be a short list, requiring only a cover letter, resume/CV, and a couple of references. For grant applications and graduate program admissions, there may be as many as 10-15 different required documents and forms. Write all of this down in one place and be sure to separate components into sub-lists for each office if you must send things to multiple emails or offices (very common with graduate admissions).

3) Identify Components that Require Significant Time or Effort

Some application components will require a lot of effort (writing cover letters, statements of intent, various essays) and others, while simple, need time (ordering standardized test scores or official transcripts, waiting for people to write you letters of recommendation). Your next step is to identify every component within each of your applications that falls into either category. These are the requirements that can sneak up on you and give you a nasty surprise if you don’t start on them early enough. I usually put a little asterisk next to components that require me to write more than a paragraph, and a circle next to ones that involve ordering documents by mail or asking for letters of recommendation.

4) Make a Timeline for Completing Components

Find the deadline for your finished application, then lay out a timeline between now and then. You don’t have to write out when you will complete every single component, but find a specific place on the timeline for each of the components that need a lot of time or effort! This is the key to my application strategy. By plotting all of the tough components that have the potential to sneak up on you on the same timeline, you will be completely safe from last-minute crises so long as you stick to the timeline.

Your timeline will be heavily personalized because it has to fit around your existing schedule, but there are a couple of considerations you should make regardless. For anything that involves other people, greatly extend the time allotted from what you think they will need. Depending on the academic level I have heard that the acceptable amount of time to ask for a letter of recommendation is anywhere from four weeks to three months prior to the deadline. My position is that, in academia, earlier is always better and there is no such thing as too early! You will probably have to remind your letter-writers multiple times, depending on how early you ask them. Put those reminders on your timeline. Likewise, you should account for how long it will take for things like standardized test scores and official transcripts to arrive. Some universities can send transcripts digitally through document services like Parchment, but others will need to mail them. Plan for this on your timeline. Finally, you should absolutely seek feedback on your essays, personal statements, cover letters, research proposals, etc. No matter how experienced you get, having a second qualified set of eyes look over your writings can make a huge difference in quality. Especially while you are a student, this will massively improve your chances of landing the job/funding. Remember to incorporate time for feedback into your timeline.

5) Synthesize Your Timelines

For the most part, you are likely applying to more than one job, funding source, or academic program at the same time. Once you have completed steps 2-4 for each of them synthesize your timelines into one master timeline. Now you only need to stick to one timeline, which includes the major components of every application. If you followed these steps completely you won’t have any last-minute surprises about missing documents, forgotten requirements, or sudden deadlines. If you are like me and normally manage your life through a day planner, your application timeline can be easily integrated into your planner and you won’t even have to keep track of a new document!

6) Create If-Then Dependency Plans

For most types of formal applications dependency plans can be simple. When applying for college admission or seasonal jobs that will all start around the same time, you are likely to hear back from each place you applied at about the same time. This will allow you to choose the best program/position that accepted you. For these situations, all you need to do is have a general sense of which jobs or programs you like more.

Things get a little more complicated when timelines aren’t synchronized. Sometimes when applying to multiple jobs, academic programs, or funding sources you will hear back from one and be expected to accept or decline before you hear from another. Other times one application may be dependent on the success of another. This frequently happens when applying for outside funding while simultaneously applying to a graduate program. In these situations, I find it helpful to create an if-then dependency plan. I will consider which entity (job, school, funding agency) I am likely to hear from first, then plan what to do next after being accepted (positive plan) or denied (negative plan). Carefully consider whether you would be happy with this job/program if they made you an offer and needed a response before you hear back from anywhere else. Likewise, if this position is no longer on the table where will your priorities lie? Which opportunity would be best for you excluding this one? These plans can get complex and highly varied, especially when dealing with the world of academic funding. I can’t write out a universal plan here for those reasons, but remember that when making your plan you need to have a thorough understanding of both when you might hear back from your various opportunities and whether/how they depend on each other.

Advice for Specific Types of Applications

Big-System Job Applications

Jobs within massive organizations like universities, state or federal agencies, and big corporations can be subject to extensive regulations and regularly receive hundreds of applicants. This necessitates a complex job application system to advertise positions and screen applicants. You’ll know that you have come across a “big-system” job like this if the application requires you to set up an account on the hiring entity’s website.

There are a couple of things you should know about this type of job application. First, the initial cuts will probably be made by a computer algorithm. If your application doesn’t survive these cuts, it likely won’t ever be seen by a human being. These algorithms generally look for pre-defined keywords in your application materials, so don’t be afraid to mention the desired qualities/skills from the job posting explicitly. You can even use the same phrasing as the job posting. This will increase the chances of your application passing the algorithm and being seen by a hiring manager.

Frustratingly, you will probably have to upload your resume/CV and then later enter pretty much everything from that document into a form. This is so the algorithm can more easily parse through everything. Personally I find this infuriating (If I have to enter the details from every job I’ve had in the last ten years then why do you need my resume???) but it is very much the norm with this type of application and you should be prepared for it.

Lastly, don’t be surprised if you come across a job posting from yesterday with a closing date set for today or tomorrow. Sometimes (particularly for government jobs) there is a requirement that all open positions be posted publicly, even if the intent is to hire internally. I generally don’t bother applying for these jobs.

College Admissions

Undergraduate admission is a different world from most other types of formal applications. Employers, funding entities, and graduate programs will all want to hear about your relevant experience, and in some cases what your specific plans are should you receive the position/funding. Generally you should tailor your resume/CV to the position, emphasizing experience related to what you are applying for and removing things that aren’t relevant. When applying to colleges almost the opposite is true. While this should never come at the expense of writing a coherent personal narrative, you are expected to include as much detail as possible! List every extra-curricular activity you have been involved with, every leadership position you have held, all of your work experience, and maybe even a hobby if it relates to your personal narrative and/or intended field of study. My reason for including this section is to advise against treating your college application like a job application. Colleges want to see a well-rounded person with both refined interest in their intended major and well-rounded experiences outside of that field. Do not be afraid to include something just because it’s unrelated to your program.

Scholarships and Academic Funding

This is the area where I (at the time of writing) have the most experience. I can’t yet speak to applications for funding at the professional level, but as an undergraduate student much of my free time was spent searching for and completing research-centered scholarship applications. The most important piece of advice I have for this type of application is to craft a narrative. If the scholarship is for college students in any program, talk about your journey to your program, how your program is benefitting you, and what you will do with your degree. Don’t get bogged down in technical descriptions of your work. For research-based scholarships, talk about what draws you to the process of research and to your field specifically. Talk about the methods and techniques you find interesting, and don’t forget to link everything back to your personal narrative and future plans. I can’t get more specific than this because the narrative needs to be a personal one but remember that applications with an easy to follow narrative are ones that will appeal to the funding entity.

Photo Credit to Pexels