Beyond the White Coat: The Med Student Tradition Behind Michigan’s Smoker

View Transcript

In this episode of UMich Med Mosaic, host Mackenzie Kay sits down with graduating student Gareema Agarwal and MD/PhD student Mark Adame to explore the history, traditions and behind-the-scenes work that bring the University of Michigan Medical School’s annual Smoker production to life. As outgoing Smoker Czars, they share how they became involved in the beloved student-run comedy musical, the process of writing, casting and producing the show, and the challenges of balancing a major creative undertaking during their medical training.

Transcript

Mackenzie Kay:

Hi everyone, and welcome to UMich Med Mosaic, a medical student-run podcast we've created to shine a light on the diverse backgrounds and experiences of our students here in Ann Arbor. I'm Mackenzie Kay. I wanted to start this podcast to build community through hearing the stories and experiences of my peers. And as an avid podcast listener, I feel passionately about podcasts as a medium. I'm so happy and grateful to be here at Michigan. Through these conversations, we hope to show that there is a no one-size-fits-all definition of a medical student. Whether you're a current or prospective medical student, we hope that you feel inspired by these narratives.

Welcome back to UMich Med Mosaic, the podcast where we explore the stories and experiences that shape life at the University of Michigan Medical School. Today's episode highlights one of the most unique and beloved traditions at the school, The Smoker. For those unfamiliar, The Smoker is a student-led comedy musical and annual roast of the faculty and the med school experience itself. It blends satire, performance, and community in a way that keeps students and faculty coming back year after year to participate and enjoy alike. One of its defining features is its inclusivity. Students with little to no theater experience are encouraged to take center stage. And the content is intentionally crafted so that even those outside of the medical community can follow along and enjoy the show.

At the center of it all are the Smoker Czars. The student leaders are responsible for bringing the entire production to life. From writing and casting to logistics and last minute problem solving, they carry the show from idea to stage. Today, we're joined by two of the outgoing Smoker Czars as they reflect on their years of involvement with The Smoker, how they got started, and what it means to lead something like this, and what The Smoker has meant to them during medical school. I'm so excited to have Mark Adame and Gareema Agarwal on the episode today. Welcome.

Gareema Agarwal:

Thanks for having us.

Mark Adame:

Yeah, thanks. I'm excited.

Mackenzie Kay:

So to get things started, if you could please introduce yourselves and share where you're from and how many years you've been involved with The Smoker.

Gareema Agarwal:

Yeah, so I can start. So I'm originally from the Los Angeles suburbs, and I've been involved with The Smoker since my M1 year. So this was my fourth year in it.

Mackenzie Kay:

Oh my goodness.

Mark Adame:

And I'm also from California, not as cool as the LA suburbs, but I'm from Bakersfield, California. And I got involved with The Smoker about four years ago, so I've performed in it for three years.

Mackenzie Kay:

Okay. And what'd you do your first year?

Mark Adame:

I was too shy to try to sing, so I took on a very small little role as a blind mouse and a med student.

Mackenzie Kay:

Love.

Gareema Agarwal:

It was a good role.

Mark Adame:

Yeah, it was cool.

Mackenzie Kay:

So that brings me to my next question. What was your first experience with The Smoker when you first got started?

Gareema Agarwal:

My M1 year. So we did VaShrektomy, which was essentially our play on the famous and beloved Shrek. And I actually got to play Fiona, which was really fun because I had never done any sort of acting before. But I had a lot of singing experience prior to med school, but it felt like a completely new ball game for me. But everyone was so inclusive. It was such a loving environment. And so it was something that I really enjoyed really quickly.

Mark Adame:

Yeah. And VaShrektomy was also my first intro to The Smoker. I just felt I was starting the graduate phase of my program, and I was like, "I finally have time. I think I'll get started with The Smoker." Contrary to Gareema, I have much more acting experience and much less singing experience. But yeah, so I got involved and, I don't know, never looked back.

Mackenzie Kay:

Love. Walking back to when you first got started or maybe before, both of you alluded to prior experience with music and acting. Can you touch more about that?

Mark Adame:

I did a lot of theater in high school. I was very much a theater kid.

Mackenzie Kay:

Love it.

Mark Adame:

But like I said, I never sang. So even when there were musicals, I managed to get a big part that didn't have any singing, like in Once Upon a Mattress, The Mute King. I was like, "Perfect. That's me. I can do that." But then after that, I went to college ironically at NYU where the arts are huge, but I did not really hold a flame to the NYU Tisch kids. So I didn't do anything in college.

Gareema Agarwal:

Yeah. So I was in my elementary school choir, and then I got super involved with choir all throughout high school too. I did a jazz choir, a more choral-based one too. And then I went to UCLA for undergrad and I did two years of their university chorale, and that was super fun too. But again, never did any sort of acting. That part was always really intimidating for me.

Mackenzie Kay:

You guys are kind of opposites. If you put you guys together, it'd be like a Broadway musical star.

Gareema Agarwal:

Well, that's actually why it ended up working out so well is because I think Mark and I complimented each other really well in terms of our skillset. And we kind of schemed our way into co-czaring together because we knew that we could both fill in for the parts that one of us might've lacked a little bit.

Mackenzie Kay:

And going back to when you first got started with The Smoker, did you ever think that you would eventually become a Czar?

Gareema Agarwal:

I thought about it. I never thought it would actually happen. But I just remember, I feel like the transition to med school was hard for a lot of reasons. It was my first time moving outside of California, things like that. But I remember the Czars were so good at just creating this really supportive community that I hadn't gotten in med school yet. And so I always thought it'd be really nice to be able to pay that forward and be able to create that one day for people. So it was something that was always on my mind, but I wasn't sure if it was going to happen.

Mark Adame:

I feel like being an MD PhD student, I'm here for a long time and there's always at least one of us in the czar-ship. And so I foresaw myself, I was like, "I don't know when it's going to happen, but sometime in the 35 years that I'm here at Michigan, I think I will be a Czar." So I was trying to figure out when is the best time. And after being in The Smoker with Gareema and having a duet together, I was like, I think I found the perfect person to czar with.

Mackenzie Kay:

Just to walk you back a little bit, for anybody who's unfamiliar with The Smoker and what we do here at Michigan, I think it's one of the things that's so pivotal to being a Michigan med student. I think people come here specifically for The Smoker. I personally brought my partner, my partner's entire family, his grandma, his parents, his cousins, everyone to the most recent one. It's so much fun. How would you describe The Smoker in your own words to somebody who has no idea what it is?

Mark Adame:

The Smoker is a student, totally student production, student-based production. Medical students come together once a year and they spend the whole fall thinking of an idea and writing a script to put on a show in the winter that is totally dedicated to roasting the medical school experience and the medical school faculty while also trying to convey some sort of more meaningful message. Yeah. But totally, I would really harp on the students do every single thing that you see from start to finish.

Gareema Agarwal:

Yeah. And it's way more than you think too. Of course there's the writing of the script, but there's so much that goes into set design, production, even the music, dancing. So there's room for anyone to get involved if they want to indulge in any sort of creativity, there's space for people.

Mackenzie Kay:

Yeah, huge shout out to the band and the stage design and everything. It was incredible. Can you walk us through how a show comes together?

Gareema Agarwal:

Yeah, so I think one of the really cool parts about it is that it's a very involved experience for whoever wants to be involved. It's not just a decision the five Czars make. We really try to include everyone who wants to be part of it.

So we start in the late summer with what's called a title night, and we essentially have everyone just come up with different movie ideas, TV show ideas, anything they want the show to be inspired off of. And we all just come up with different themes that could be good. And then we take a full vote and then we vote on, what is it, our top six or something like that. And then we host what's called a pitch night where different people volunteer to pitch the titles that were talked about during the last meeting and they develop this whole plot that they think would be good for it. And then again, everyone takes a big vote based on the different things that were pitched to us. And then from there we can start the writing.

Mackenzie Kay:

Just so the audience knows, we as the med school community and also I think the greater Michigan medicine community who is waiting with bated breath, we don't get to know what the theme or anything is about The Smoker until literally right before it actually happens. We're waiting and waiting and everybody who's in it or associated with The Smoker is sworn to secrecy.

Gareema Agarwal:

That's intentional.

Mark Adame:

Yeah.

Mackenzie Kay:

Which is so beautiful, but so frustrating. When you're in the writing process and trying to come up with which faculty to roast, how do you balance humor, writing jokes, with respect? Especially when you're trying to approach faculty, your assessors, sensitive topics in medicine, et cetera, how do you figure this out when you're writing the jokes?

Mark Adame:

It's a very iterative process. You get a lot of people that come into the writer's room every week. And it's not always the same people, and so sometimes you have a whole new batch of folks that are looking at a script that was written by different people. And it being iterative is helpful. They help refine jokes, decide if something has gone a little bit too far. Sometimes they totally change the trajectory of a joke or the trajectory of a scene, and then we have to reel it back because we're like, "No, I don't think that's what the original writer wanted."

But I would say that, you asked about faculty, I think that there are some faculty that are commonly roasted in The Smoker, and that's because of familiarity. We want to orient our audience, especially our medical school students that are in the audience, we want to orient them, make sure that people are on stage that they're familiar with. But at the same time, we don't want to keep rehashing the same jokes on the same attendings because it gets old and it's not very imaginative. We did a good job this year, I think, of bringing in someone who virtually nobody knew of. She actually did, she came to the show, it was her first time coming to The Smoker, and she's like, "I'll be back every year from now on."

Gareema Agarwal:

Yeah. And I think it's a balancing act too, because a large part of our audience is typically people who are in the M1 and M2 class. And so we also want to make sure we touch on faculty that they know because who they know from their preclinical lectures will be different from who we know as M3s, M4s and things like that. So we want it to be digestible for our audience too. I think that's a big component.

Mackenzie Kay:

Yeah, that's so true. I felt that there was a really good overlap as an M2 between some of the people that I was seeing on clerkships with some of my people that I was seeing in my lectures in my first year. So I felt like it was very accessible to me.

Gareema Agarwal:

That was the goal.

Mackenzie Kay:

Yeah.

Mark Adame:

Yeah.

Mackenzie Kay:

One of the other things that I love about The Smoker are some of the traditions. I was wondering if you could touch on some of them.

Gareema Agarwal:

Ooh. Yeah. So one of my favorite tradition that we do in The Smoker is on the actual show nights. We will switch out the actors for the actual faculty that are playing. And I think it's really fun for a lot of reasons. One, I think it gets the audience super riled up. But then two, I think it's really fun for both the faculty and the person playing them because it's a cute little moment that they can share together and remember. And it really helps bring the energy up on stage. So I think that's one of the really cute things that we do.

Mark Adame:

Yeah. The faculty cameos are really sweet. We set a record this year in 2026. Not intentionally, but we did.

Gareema Agarwal:

I think we had like 20 cameos or something.

Mark Adame:

We had so many cameos.

Gareema Agarwal:

Throughout the two days.

Mark Adame:

And everyone, the sound guy, our videographer who have been doing The Smoker for decades, they were shocked when they saw the list of faculty we were bringing on stage. Something that I really enjoy, even though it's mostly for The Smoker cast and crew, is the roasting of dead Czars. So Gareema and I and our other three co-Czars are all technically dead at this point. And your death is on the final show night.

Gareema Agarwal:

It's a big dramatic thing.

Mark Adame:

Yeah. But every year, the last year's Czars are roasted. Themselves are roasted in the next Smoker. And I love that because the audience may not always get it. And so it doesn't draw a lot of laughs, but everybody in the cast and in the band and the crew who know that dead Czar, they get it. And that's enough. It's kind of just a thing for us.

Gareema Agarwal:

It's like an if you know, you know type thing.

Mark Adame:

Yeah. Yeah. It's like an inside joke. Yeah.

Gareema Agarwal:

Yeah.

Mackenzie Kay:

I love that. Can you walk through all the different Czars that there are for The Smoker?

Gareema Agarwal:

Yeah. So typically there are five Czars who are running the entirety of the show. And then we have a couple of demi-Czars too, which I'll get into. But there's two director Czars, so Mark and I. And so what that entails is that we are leading the actual acting rehearsals themselves as well as the music and chorus rehearsals. And then we have two production Czars who are the ones building the sets, doing all the costumes and things like that. And then we have a flag Czar who helps fill in just wherever we need in terms of what's going on. And then we have a few demi-Czars too. So we have an amazing band that you guys heard. And so we have a few Czars leading that. We have Czars leading the dance team. And then we actually created a new role for this upcoming year for a chorus demi-Czar for all the singers, which I think will be really helpful because I was doing that this year. It was a tough undertaking to say the least.

Mark Adame:

Gareema was a superhero. I don't know how she did all that. She helped run rehearsals and ran all of chorus rehearsal, which takes six hours on every Monday.

Gareema Agarwal:

Yeah, it was a little brutal, but it was fun.

Mackenzie Kay:

You said that maybe the bulk of your time was January, February. It seems like that maybe overlaps a little bit with interview season and-

Gareema Agarwal:

Yes.

Mackenzie Kay:

... things like that. So, wow.

Gareema Agarwal:

So luckily, I was able to schedule most of my residency interviews for October to December. I think I only had two in January. So luckily that wasn't too big of an issue, but it was still a big time commitment for sure.

Mackenzie Kay:

Yeah. Wow. No, and I'm glad that the demi-Czar for the chorus is coming in. That's going to be great. What type of skills do you think that you came away with or that you discovered while you were a Czar that you feel like were applicable to medicine?

Mark Adame:

I'm taking immediately back to Tech Week, which I really underestimated. I remember leading-

Gareema Agarwal:

You were a star that week too.

Mark Adame:

Leading up to Tech Week, I remember Gareema and I were talking and she said, "I'm starting to get kind of nervous about Tech Week." Tech Week is where we move all our stuff into the theater, all the set pieces and hang everything, and we start running rehearsals and running transitions and we get ready. And I really underestimated just how stressful that would be and how much it would require of us.

And some insider info that no one else really knew. We were cut short a day. We lost our Monday altogether pretty much. Kind of unavoidable, but we sort of knew about it a whole year in advance. There's just nothing we could do about it. So we were already working with limited time.

And one of the key things that we do as Czars is communicate with our stage manager. We sit in the house and watch the show as they rehearse and we communicate by a headset to the stage manager in the back. And I took the lead on communicating with Dan, our stage manager. And I have never felt more locked in.

Gareema Agarwal:

You were.

Mark Adame:

Like in my flow state, in my zone, coordinating with Dan, coordinating with the band, running that show from start to finish. And I was so calm and collected. I was like, "Man, maybe I will do crit care. I don't know. When things just seem to be going crazy, it's like I can really lock in."

Mackenzie Kay:

That's beautiful.

Gareema Agarwal:

Because that was another thing too. We were down a few headsets because usually that's how we talk to everyone who's backstage and all that stuff. But it ended up being that I didn't get to do one. And so Mark had to do all the work for the both of us, which again, that's why he was a star that week because it was tough.

Mackenzie Kay:

Yeah, my next question was going to be about challenges. It sounds like you really stepped up in that time. That's amazing. It sounds like a difficult time. Were there other sticking points in the production of this most recent Smoker while you guys were Czars?

Mark Adame:

There definitely were. The blessing and the curse of The Smoker is turnover. There are new Czars every single year and there's a lot of information to hand down. And we do have what's called a manifesto, but it is-

Gareema Agarwal:

It's like over a hundred pages long or something like that.

Mark Adame:

It is perfectly described as bloated. It is from like a decade ago, not been updated. Updates are in a different color, but nothing's deleted.

Mackenzie Kay:

It's like note bloat, but like-

Mark Adame:

Exactly. It's a mess and a half. So we have these meetings to hand off to the incoming Czars, and it's just really hard to cover everything. And so we learned the hard way some things that came up involving the band or involving accessibility that we had to face last minute. Fortunately, everything came together and our band is stupendous-

Gareema Agarwal:

So good, yeah.

Mark Adame:

... and so talented. But yeah, there were lots of challenges. I think just things fall through the cracks and then you don't realize it until the week of show.

Gareema Agarwal:

Yeah, totally. And to your earlier question too, I think learning how to adapt to the unexpected like that I think is something big that we learned throughout the process. Because as much as you do prepare for stuff, it's not always going to pan out the way that you want, and that's just how things go. And so learning how to be flexible in the moment I think was a big takeaway that we got from this year.

Mackenzie Kay:

That's beautiful. Yeah, but I can't stop fangirling over The Smoker. And I honestly can't imagine Michigan Medical School without The Smoker. And I'm just wondering how does The Smoker contribute to the overall culture of the school or represent the culture of our school?

Gareema Agarwal:

I mean, I think one of the awesome parts about The Smoker is that it truly is inclusive. No matter what your background is, if you've ever done acting, singing, production, whatever it is, we will accept you with open arms. And that is one thing that we can always guarantee is that we all want to create a comfortable, supportive environment. We all want to be friends with each other. And so we put whatever differences we have aside to just create something special, which I think is really awesome.

Mackenzie Kay:

I feel like this school is the nice med school, the fun med school, and I feel like The Smoker just embodies that. Another thing that I was percolating on, and it's a question that I have for you, Mark, earlier you were talking about how long the list was for faculty when you were in doing the tap-outs. I was wondering, walking back to when we're choosing the characters for the show, what is the process of choosing the faculty? And then how do you actually reach out to the faculty? At what point do you do so to tell them that you want to do the tap outs? And how do they usually respond?

Mark Adame:

So I'll answer the second question first. There's no set deadline to reach out to faculty. Once the script is written, then it's up to the performer to reach out to the attending and say, "Hey, you're being smoked. Tradition is we meet with you and we collect your white coat and get to know you a little bit firsthand." A lot of these attendings are pretty used to that, and so the response rates are pretty high. And then when it comes to deciding which faculty to portray, I would say it comes after you decide what you want the story to be.

Mackenzie Kay:

That helps so much. I was super curious about that process. I know that some of the faculty are included on the one sheet, the poster when you do announce the show. Are the faculty too then sworn to secrecy?

Mark Adame:

Well, they don't know that they're on it.

Mackenzie Kay:

They don't know that they're on it.

Mark Adame:

Yeah.

Mackenzie Kay:

Even though they know that they're part of the research, they know that they're being smoked.

Mark Adame:

Right. They don't know the theme.

Mackenzie Kay:

Theme. Okay.

Mark Adame:

Yeah. So everyone knows The Smoker will roll around in February. No one knows what it is until we put that poster up.

Mackenzie Kay:

Okay. So they just have a med student who's just studying them and their mannerisms-

Gareema Agarwal:

Exactly.

Mackenzie Kay:

... and their life and everything.

Mark Adame:

Exactly. Exactly.

Mackenzie Kay:

Okay. Method acting, so to speak.

Mark Adame:

Yep. Exactly.

Gareema Agarwal:

There you go.

Mark Adame:

Yes. Yes.

Mackenzie Kay:

I just want to spend the last 10 minutes asking you about how this has shaped your med school experience. First of all, I know you still have some time left. You're not done, Mark.

Gareema Agarwal:

Unc status.

Mark Adame:

Unc status. No.

Mackenzie Kay:

But Gareema, you're almost done. You're one week until graduation, which we're so happy for you. How has, so far, The Smoker shaped your time here at UMich?

Gareema Agarwal:

Yeah, I mean, I think it's undoubtedly been my favorite part of medical school, and I think that's for a few reasons. I think The Smoker really does attract people who are just very down to earth and people who just want to have a good time, because I think it's really easy to get stuck in the books and medical school and just really be narrow-sighted about things. But I think everyone who is part of The Smoker, they really value balance and creativity. And so I think it's just provided me to such an awesome community. I've met some of my closest friends through The Smoker, which has been such a privilege.

But yeah, I think it's also taught me just how important it is to have those outlets. And that's something I definitely... Obviously, I won't have time to write a musical in residency. But I know for sure that I want to continue maintaining my hobbies as a resident and even as an attending, because it is something that's kept me feeling really whole throughout medical school.

Mackenzie Kay:

I know. I've loved talking to the attendings who are still involved in local choir and playing music. Having creative outlets just feeds you.

Gareema Agarwal:

Yeah.

Mackenzie Kay:

Yeah. How about you, Mark?

Mark Adame:

Yeah, I think because I am here for a long time, the transitions between med school and grad school and grad school back to med school are historically hard. And from experience, they were way harder than they're made out to be. And that's because the friends I started med school with all leave and go off to residency. And I had a particularly close group of friends from med school. And I was not particularly close with the people in my graduate phase for a number of reasons.

But because of The Smoker, I have this whole other community that is neither here nor there. And they're people from all other classes. So even though all my friends from medical school may leave, I am still friends with the people that I will graduate with ultimately in 2028. So for me, it's a really nice way to stay connected vertically with the earlier classes. And not to mention, I mean, it's a lot nicer than just going to vertical integration events because it's a smoker and it selects for people that want to perform and want to go and build something from scratch and be funny and be talented. I don't know. It's just an amazing group of people. It shocks me that all these people at the end of rehearsal or at the end of the show will go on to match into crazy specialties and revolutionize science or whatever. Yeah, it's remarkable.

Mackenzie Kay:

That's awesome. And then do you guys have a favorite memory from The Smoker that you feel comfortable sharing?

Gareema Agarwal:

I feel like I have so many. Honestly, I would say one of my, this is also recency bias, but I remember Thursday of Tech Week was the day where we did our full dress rehearsal where everyone was in their full costume and makeup, and we did the whole show through from start to finish. And I remember getting emotional that day because we saw all of everyone's hard work come to life because we had been working on it for the past eight months. And to see everyone's hard work and talent come together, that was just so gratifying from our perspective. And so that was definitely one of my favorite moments.

Mark Adame:

I was going to say a similar thing about sitting in the house. I think maybe it was opening night and I finally, I was so tired. I was like, oh, I was so emotional and I cried during Defying Gravity. And I was like, "Oh my God, this is amazing." But I would say that before that, during rehearsal, which can get a little, I don't know, I would describe it as gray and repetitive and people are stressed out. There are exams and not everyone is bringing their top game, including us, not always showing up in the best mood and the most patience.

But I remember one time there's a scene where it has basically the entire cast in it. I think it's the closing scene or one of the act one closers or something. And we never invited everyone to come because they only had to be there for 10 minutes. We're like, "Not going to make everyone come just for 10 minutes." But as we got closer to Tech Week, we're like, "All right, you guys have to come. Even though you don't have a line, you still need to come because we got to block this." And so everybody came and having everybody in the room to run that scene completely changed the scene. It was 10 times funnier, way more active. And I remember thinking, "Oh my God, these people are going to kill this." Especially when they're with each other, the energy starts building off each other and compounding. It was really special that moment. Just what seemed probably to them like an average day in rehearsal was to me like, "Oh my God, this show's going to kill [inaudible 00:25:06]."

Mackenzie Kay:

And it totally did. It was so fun.

Mark Adame:

Yeah.

Mackenzie Kay:

All right. Well, with that, I just want to wrap it up. I want to thank you guys so sincerely for coming on. Congratulations for such an amazing show and for all of your efforts and hard work for putting it together. It was really great to have you on the podcast to talk about your experience today.

The Smoker may take the stage for just two nights a year, but as we heard today, its impact lasts far longer. For the students who bring it to life, it becomes a space for creativity, connection, and reflection, a reminder that even in the intensity of medical training, there's room for humor and community.

To our Smoker Czars, Gareema and Mark, thank you so much for sharing your stories and for the countless hours you put into sustaining this tradition. And to our listeners, thank you so much for joining this episode of UMich Med Mosaic. We'll see you next time.

If you loved today's conversation, share it with a friend. If you are a Michigan medical student and are interested in being a future guest, check out the class pages on Slack for open calls for episodes. Umich Med Mosaic is produced by Michigan Medicine Department of Communication in partnership with the University of Michigan Medical School. Find us and subscribe wherever you listen to podcasts. Thanks for listening and we hope to see you soon.