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Episode Transcript

Dr. Ivaniuk: Greetings everyone and welcome to another episode of the career development series of the Sharp Waves podcast. I’m Alina from the ILAE Young Epilepsy Section, and today I am absolutely thrilled to interview Dr. Meriem Bensalem-Owen. 

Dr. Bensalem-Owen: Good afternoon, Dr. Ivaniuk – thank you very much for the opportunity to speak on the ILAE Sharp Waves podcast. I’m honored and touched by your invitation.

I’m Meriem Bensalem-Owen. I’m a neurologist specialized in clinical neurophysiology and epilepsy, and I practice at the , where I direct the epilepsy program and the epilepsy fellowship training program as well.

So my father is Algerian and my mother is Bulgarian. I was born in Algiers and grew up partly in Algeria and partly in Italy. And to complicate things a bit, I went to a French school in Milan.

I basically joined medical school, for me it was kind of a calling. After I graduated from high school I went directly to medical school in Algiers, in North Africa. Our medical system is very different than where I currently practice, which is the US, since there is no college system in Algeria, like several other countries. We do eight years of medical school. I was the first one in my close and extended family to end up graduating from medical school. My parents are both retired engineers, so we have lots of engineers and lawyers and teachers, but I was the first doctor in my family. But I inspired a cousin to become a doctor too so that’s great.

So what motivated me to go into medical school is really to help. I saw several relatives suffer from acute and chronic illness. But also, myself, as a little patient – I was a little patient. For 11 years I wore a back brace for scoliosis. So I was kind of exposed to the medical field in that way.

Early on in high school, I already knew I wanted to be a doctor. When I went to medical school, I went with the goal of joining . It didn’t go as planned, I never joined Doctors Without Borders, because life is full of twists and turns and surprises of course.

Dr. Ivaniuk: The years of your medical study fell into the time of the Black Decade in Algeria, the war. How did it impact you personally and how did it change your professional perspective?

Dr. Bensalem-Owen: it did have an impact on me. For those who might not know what the Black Decade refers to or stands for, it was a decade of civil war in Algeria that ended in 2002. It was a difficult time for me to be in medical school. We had returned from Italy, and I finished my last two years of high school in the French school in Algiers. And during that time, just before the war was officially declared, a year before, the school was closed, so I think politically they knew something was going on and were preparing. 

Medical school was exciting but very stressful, and I only realized that once I left Algiers or Algeria to pursue my training. Once you live there, you just go with the flow. You don’t realize how much stress—you always have to look at your back and be careful, we had military and police checkpoints and curfews—you really had to be careful, going out at certain times, and returning back home, or staying in the hospital just to be safe. So I did learn to work in difficult conditions. My heart goes to everyone living in war zones or in a wartime environment. 

This did also help me connect emotionally with my fellow students and professors. We sadly had one of our professors murdered during this time. Some people considered intellectuals were actually potential targets. And I did face several situations throughout medical school that were mentally taxing and on a few occasions, I faced personal life-threatening situations just because sometimes you end up in the wrong place at the wrong time. Once was in the street, and once was when I was doing my rotation in orthopedics. We had armed people coming and shooting, and it was very scary. 

When I speak about it now, it’s so surreal, of course this was many years ago. And I'm thinking I could have burned out or just left medical school from that, but I think it really helped me grow, and also I suppose it was because I was younger, we have a different outlook on life back then.

Dr. Ivaniuk: Thank you for reflecting on this time. I suppose, no I know, that it was hard and so as you mentioned, you can only appreciate it if you look back in retrospect, and while you’re going through it you just go with the flow. Returning back to your career pathway, after you finished your medical studies, what drew you to pursue neurology, and how did you decide where to pursue future training?

Dr. Bensalem-Owen: After medical school I felt I needed to further my training abroad, and again it was taxing and I was ready for something different – it was 8 years of living in a difficult environment. So I came to the US for my neurology training; this was really not planned initially, but it happened. As a foreign medical graduate, relocating to the US and starting internship and neurology residency brought a different set of challenges from the ones I had in medical school. I came alone here; I had no family and no close friends here in the states. I had met my future chair, Dr. Joe Berger, and he said, “Meriem, you have to apply to my program,” and it was at the University of Kentucky. And I have to admit and I’m very embarrassed to say that I didn’t even know where Kentucky was then! But he and his family were so welcoming and supportive and he considered himself as my American father. 

And so I had to train and practice when I came here, the challenges were that I had to train and practice not only in a different system, but in a different language. So for me it was a total adventure—Kentucky, and all in English. And so it was a big adjustment but it was fun, it was very interesting, I had fantastic memories of my residency and the same thing—the bonds, the friendships I made, they’re a very special time.

Along the way I had several mentors and sponsors. What I would like to say is that some of these mentors and sponsors were not always in my field. One colleague and mentor who was redefining for me was Dr. Brenda Fahy. She’s an anesthesiologist. We did fantastic projects with her and publications regarding EEG education; she wanted to broaden EEG interpretation to non-neurologists. 

I mentioned my prior chair Dr. Joel Berger and also my current chair Dr. Larry Goldstein, who has been very supportive. I also found support and mentorship and sponsorship from colleagues through my involvement in professional organizations outside my institution. They’re numerous—Dr. Jonathan Edwards, Dr. Laura Galloway, Dr. Aatif Husain, Dr. Frank Drislane. I also had role models like Dr. Suzette LaRoche, Dr. Sue Herman. So I’m just very grateful for these colleagues and my colleagues in general, and all of these friendships that we ended up professionally nurturing.

Dr. Ivaniuk: It’s great that so many people helped you along the way and you’ve been able to find so many supportive mentors. When and why did you decide to enter the epileptology field?

Dr. Bensalem-Owen: during my residency in neurology I found the brain captivating. Neurology isn’t just about the brain, but I was captivated by the brain. And then I found epileptology to be a very dynamic field that offers a multidisciplinary approach in terms of investigation and management. And during my training as a resident I was intrigued by the variety of symptomatology, the seizure semiology, that’s produced by a stimulated brain. One of my mentors during residency, Dr. Toufic Fakhoury, was key in me choosing epilepsy. 

As much as I find the brain captivating, I find epilepsy cruel, very cruel. It’s a frequent neurological condition with intermittent crises, as you know, that can dramatically disrupt patients’ lives. Seizures, even if they’re brief, can have devastating effects on people and their loved ones. Seizures can cause injuries, death, and epileptology offers this incredibly opportunity to help patients and their loved ones, so that’s why I chose epileptology.

Dr. Ivaniuk: You have so many professional responsibilities, and you are also a single parent. What has that experience been like? Do you have any advice for other physicians who are in the same situation as you?

Dr. Bensalem-Owen: I had my child during my clinical neuro/epilepsy fellowship. In January, in the middle of the fellowship. At that time I was still married but my ex-husband and I lived in different states. He was finishing his neurosurgery residency and then he did a pediatric neurosurgical fellowship eventually. We were apart for some time during his training, my training, so our child stayed with me. But then eventually I became officially a single mother, but that was as faculty. As a trainee I did have a child by myself, but my mother – she had retired and she was able to come and help me, so I was very fortunate that she could do that for the last few months so I could finish my fellowship.

It was not easy, and I’m part of a small category of people – full time working physicians who are single parents. I’m the only one in my department in this category, which makes me kind of an outlier.

But yes, how would I advise single parents? I would say that it can be done. Is it going to be easy? No. Some days will be extremely difficult, but each day has an end, that’s what I think. At the end of the day, the day will end, and what cannot be done today can be completed in the following days. So sometimes we think we have to accomplish everything on the to-do list and do all the things and sometimes that’s not a realistic option. You take one day at a time, and what is accomplished is accomplished, be grateful and move to the next day, leave a little bit for the next day. That’s how I see it nowadays. And also there is always a solution. Sometimes we feel very helpless, we feel overwhelmed, but there is always a solution. It may not be what we initially had in mind or intended, but there is always a solution at the end of the day.

And also I would advise single parents, or parents in general, or anybody struggling, to ask for help. Don’t be afraid to ask for assistance. It took me some time to understand this, and maybe a little bit of pride. I was in a particular situation as a foreign medical graduate, and then imagine being a single parent and then divorced, it puts you in all this like, very particular category, and for me I didn’t want people to perceive this as a weakness or a way. So a lot of things I kept to myself. And I am really happy to see the new generation who are more transparent and okay to be vulnerable and ask for help. I think this is fantastic.

And remember to be kind to yourself because sometimes we have all these expectations, especially us in the medical field – I guess just to choose this field we have a certain personality and we don’t accept failure and if things don’t go our way sometimes the way we want them to go we’re hard on ourselves, so we need to remember to be kind to ourselves.

Dr. Ivaniuk: The part of your professional activity that I find really fascinating is that you are running the epilepsy fellowship program. Share the details – how do you run it and what can make a successful launch for an epilepsy fellowship program?

Dr. Bensalem-Owen: So it’s a new program and that’s a challenge by itself. The program has expanded – so initially we were a couple of epileptologists, and then four, five, eight, and now we’re 10. Of course not everybody is with the program 100% of the time but everybody is involved. So we had a large volume of patients and lot of opportunity to teach and educate. 

So I had this vision of creating this fellowship, an ACGME fellowship, accredited fellowship, and for that I needed support and I had the support of my chair Dr. Larry Goldstein, and my colleagues. Initially when we submitted it was just for one position, so now I’m submitting to get a second position. 

Now we’re facing different challenges because it’s a new program, even though it’s the only one in Kentucky it’s a new program so we have competition from bigger programs and more established programs, so now it’s about keeping the fellowship running and filling in the slots. So that’s the challenge now and I think it’s a bit challenging in other institutions because of the pool of interested candidates in clinical neurophysiology or epilepsy in general – there is a decreased pool compared to other subspecialties. 

Dr. Ivaniuk: Why do you think it’s like that?

Dr. Bensalem-Owen: That’s an interesting question because I think right now…it used to be… we used to have more than half of our residents who wanted to do an epilepsy fellowship, either epilepsy or clinical neurophysiology, with emphasis on epilepsy. And things have turned, now it’s more other subspecialties such as vascular, stroke neurology, hospitalist, we see a lot of residents interested in being hospitalists or interventional neurologists, movement disorders, so there is kind of a decrease. And for the US, I think it’s because of the cuts in reimbursement. I think that made it more difficult for people.

I think the new generation is very wise and very practical, and of course yes - these are long hours. We have a very different workflow than other subspecialties. We look at hours and hours of monitoring. So it’s a fascinating field but it’s a very different workflow than other subspecialties. And I don’t think a lot of people understand the work we do.

Dr. Ivaniuk: I know you’re involved in some interesting activities outside your professional ones. You are involved in some martial arts, and also you dance tango!

Dr. Bensalem-Owen: I have to thank my son for the martial arts. So this is an activity I shared with my son for several years – he probably started when he was like 4, 5 years old – very young. I had chosen this activity for him – he was very reserved, and I felt that maybe martial arts would instill a bit of confidence in him? So he joined a class and it didn’t go well, and then he insisted that I do it with him. So then we ended up doing it together which worked out perfectly well because we had this precious time together, and we have the most amazing memories, training together and doing competitions together. 

I just fell in love with martial arts and the way it made me feel. It helps me reset mentally and recharge. After 2 ½ years of Krav Maga, I ended up doing capoeira which I found beautiful, but now I’m doing Brazilian jiu jitsu, and I think this is it. This is it – I found it. I’m in love with Brazilian jiu jitsu and I can’t say enough. I feel that Brazilian jiu jitsu is such an intellectually… it’s very physical but intellectually it’s very stimulating. The learning process, the combinations – if I had to compare it to something, it’s frequently compared to chess, playing chess, but physically playing chess, because you end up in very different positions and have to find a solution to get out of it or how to not be submitted. I also think about jiu jitsu as a language. Basically you learn all these little blocks, you put them together and you make sentences and then you make paragraphs and then you learn this language. So for me it’s really like a language, and so intellectually I find it very, very stimulating.

I learned a lot from my grand master in taekwondo. He asked me, and this is a question he asked not just me but other people, he will ask, “What is the most important thing in your life?” and I would say, of course, I was with my son and I would say “My son. My son is the most important thing in my life.” And he would reply, “That’s the wrong answer.” 

Until one day, he told me, “The most important thing I your life should be you. Because if you’re not well physically and mentally, if you don’t take care of yourself, how can you take care of your family and the people who rely on you?”

I still struggle with this concept but it makes sense, and that’s why I think we have to take care of ourselves so we can take care of others.

Dr. Ivaniuk: That’s really inspiring! Thank you. But what about the dances? That’s something so different from martial arts, more elegant I would say. How did you get involved in that as well and how do you combine those?

Dr. Bensalem-Owen: When I was in residency, I did take some classes for ballroom dancing, and I really enjoyed that. And but then I got busy with residency and could not do everything, and so basically my brother’s significant other, at the age of 37, she died from leukemia. But before she died it was, she had a few days to live, and it ended up a few weeks, but I really wanted to honor her because that was a such a, um, such a tragedy for us, for my brother, for her, for her family, and I kept thinking, can you imagine? You’re 37 years old and you’re told you have two weeks to live or a few days to live - what would you do? Because we really take life for granted, and life just passes. And we get worried about little things where we forget the bigger picture, I feel. 

So basically, I ran across a studio that was offering lessons, a couple of free lessons just as a trial and I ended up joining the studio, but I really wanted to focus on Argentine tango. I did that for her, to honor her, because I was like, we really take life for granted and that is so, so wrong. 

I mean I tried lots of dances, but my favorite of all is Argentine tango. It just – tango just sweeps you up, that’s how I feel about it. And the similarities with Brazilian jiu jitsu - you grow and you improve. You should not be comparing yourself to others. It’s the same when I go on the mat and do training with Brazilian jiu jitsu with my drilling partners, and we roll – the comparison should not be about how am I, am I better than this one or that one, are they better than me, it should be a comparison with yourself. 

You can’t be good at doing jiu jitsu in a couple of years. It takes decades to improve – there’s so much, the combinations are amazing, so much to learn, and the same thing for Argentine tango. It takes years to find what they call the axis, and that connection with your partner when you dance, and so it’s a never-ending task of refining the technique and it takes years to advance, and so I like the challenge.

Dr. Ivaniuk: Thank you so much for sharing those experiences with us. You have accomplished so much professionally and personally. I just wonder how you find time for all of that?

Dr. Bensalem-Owen: Well, thanks, I feel like right now I’m behind with my life, as I say. It is difficult to manage all. But if I don’t make the time, I’m not going to do it. Because if you think about it, work frequently goes beyond the daily, I mean, the residency but especially in academia, it’s very tricky because a lot of the work that we do is service. There’s documentation, there’s so much that we do, even in private practice of course, but the service we do I mean there, colleagues in private practice do service, are involved with organizations or committee work at their institutions or hospitals. 

And all of this is extra work and it takes time to complete, in addition to being a doctor, in addition to caring for patients. But then you realize that if you don’t set these boundaries, work will continue to erode into your personal life. It does. After hours, you’re doing emails, writing articles for the ones who write articles and love to do that. It just takes a lot and it takes on your personal time. And the solution is not to hope for 48-hour days, the solution is to keep a 24-hour day but to be able to manage and kind of find a little bit of space, even if it’s a short time. 

For instance, for taekwondo, sometimes I can’t do the full hour on the weekends if I’m on call, I honestly, I show up for 15 minutes, but I’ll say at least these 15 minutes were for me. Life becomes busy and we make so many sacrifices that we forget to take care of ourselves. I think we need to reconnect with who we are, and what we like, and what makes us happy or even explore new things. Life happens, and we have to keep that in mind, and we see that every day with our patients and their families. But when it hits your own family, you see things with maybe a different perspective. So really setting boundaries. 

Another thing is, and this is something I had to learn and it takes time to learn, and that’s to say no. if you set your time to with your family or friends then this is your time. You have to say no, be grateful if you’re offered another opportunity, say thank you, but if the decision was to spend that time differently you have to respect it for yourself and others, the people that you love.

My next step is to work on my sleep schedule – I don’t sleep much. Of course because again, you can’t extend time, so something has to give. This is my little weakness and I don’t get enough sleep, and I need to work on that.

Dr. Ivaniuk: I think many of our listeners, including myself, can relate to this. This is advice to everybody – please take care of your sleep – sleep is important, and especially for you as neurologists, it should be crystal clear that we all need to sleep enough.

What would you like to accomplish as you move along? What are your next things on your to-do list – what would you like to accomplish from a professional standpoint?

Dr. Bensalem-Owen: As an epileptologist, what I find disheartening is patients with epilepsy who are being referred to epilepsy centers or epileptologists more than 20 years after their epilepsy has started. This is disheartening. Those are numbers I heard when I was a resident more than 20 years ago, and we still see that. Not too long ago I saw in my clinic someone who had epilepsy 34 years diagnosed and he was only now referred to an epilepsy center. What I would like to do, and this is an idea I’ve had for a long time, we started doing this with one of my colleagues, Dr. Siddharth Kapoor, and it was just the two of us for a long time, is really build a network in the state of Kentucky. We can have patients, patient navigators, the Epilepsy Foundation of Kentuckiana, other epilepsy centers, level 3 and level 4 centers come together and work together and refer patients. 

There is a lot of competition between centers, and I think it shouldn’t happen that way because at the end of the day it’s not about us, it’s about the patients. If we’re doing this for the right reasons, and remembering why we became doctors and neurologists or epileptologists. It’s about connecting people so we can all work together well and serve our patients well and help them.

Dr. Ivaniuk: Thank you so much for your commitment and thank you so much for sharing all of your insights with us today. All of your career pathway. Thank you so much for being with us today.

Dr. Bensalem-Owen: Dr Ivaniuk, thank you so much for again giving me the opportunity to speak with you and thanks for the work you do, and I’m looking forward for the new generation of neurologists, epileptologists such as yourself taking over and doing amazing, fantastic things.

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