Okay, I'll admit that I chuckled at this.
Just a little genetics humor since
we just finished a unit on genetics!
Yesterday, I took the final exam of the first semester of my medical school education.
What?!
Yeah...weird. It seems like just a few weeks ago I was stressing out about O-week and miraculously it's 18 weeks later and I am one step, although just a small one, closer to becoming a physician.
It's actually incredible how utterly different the atmosphere was before yesterday's exam as compared to our first few exams. We were all chatting about plans for vacation, and though there was a sense of urgency to just be done with the exam, there was a noticeable sense of calmness and congeniality that hasn't really been present before other exams so far this year. It really has been wonderful to get to know my classmates over the past semester and I look forward to the coming years as we transition into the workforce. I might be a little biased y'all, but I think the Class of 2016 is going to produce some seriously awesome physicians.
I have to admit that I was pretty pumped when I finished the exam. It was rough exam, sure, but it always feels good to finish an exam after studying for so long, plus it signified the beginning of a long break and, more importantly, the end of the semester. I survived! But even as excited and proud as I was, it was hard to really feel good about the day. Just before starting the exam, the news about the Sandy Hook Elementary tragedy broke and it was obviously heart-wrenching. It was/is hard to be happy about something that seems trivial comparatively.
I believe the English language fails us when it comes to articulating grief and sadness. Or maybe it just isn't the English language, but maybe just spoken and written language generally. The feelings experienced when losing people, whether just one or twenty-six, transcend the abilities of language. They cannot be talked about, but rather wholly and completely felt at our very core. Healing after something like this is not going to come easily, we shouldn't expect or hope it to. Human life is too valuable and precious not to fully honor it with the messy-ness/real-ness of our unencumbered emotions.
I am excited to have a break from school, but for now I mourn the lives of those lost in Friday's tragedy, as are thousands of other Americans. I also mourn those who have died as a result of less publicized acts of violence; their lives are just as valuable as those who have been, recently and unfortunately, thrust into the international spotlight, but too often they are out of sight and mind and ultimately forgotten. May a comforting Spirit be present throughout the United States, and the world, as we grieve for those lost as a result of all violent acts.
Santa, Dr. Binhammer, & one of my classmates leading the caroling.
caroling! Today we had a sing-a-long with one of our professors. It was a blast! We even got some delicious cookies too.
Christmas socks (the ones I've been wearing all year) to be socially acceptable!
gift exchanges at holiday gatherings with friends and family.
final exams (unfortunately). I keep seeing updates from my HC friends about almost being done with finals...I'm a little bit sad that I won't be done until late Friday afternoon with my exam.
Colored marshmallows,
whipped cream, caramel topping,
and mini chocolate chips!
It's low fat...right?
traveling--be safe y'all!
SNOW!! But we haven't really had any yet. I'm sort of okay with it though because snowy days make it infinitely harder to be motivated to go to class.
holiday races. Like this one in Memphis that I'm planning on doing this weekend. For those of you that know me well, you're sure to be surprised that I'm actually going to run, but the holiday lights make it seem more appealing. I'm still not convinced that running is fun.
hot chocolate. I needed a study snack the other night and this is how it ended up! Of course I couldn't just have normal hot chocolate. :)
holiday treats. I love dessert and this is the best time of year for it! Cookies, pie, cinnamon ice cream, cobblers, crisps, homemade candies...YUM! I'm looking forward to Christmas baking once classes are done.
Christmas sweaters. Whether they're ugly or not, there's something dang special about a good Christmas sweater.
rest and relaxation. The season of Advent is a season of waiting, take a moment (or several moments) to remember that each day amidst the business and commercialization of the season.
Enough about how awesome the holidays are, it's time to study.
Well, it's that time of year again...Christmas break is approaching and so are finals for most students. The time of year where you're tired of being in school and all you want to do is curl up and watch movies or go celebrate the season with your friends and family, but the looming exams (or papers!) prevent you from fully enjoying the greatness of Christmas. I'm counting down the days until I head to Memphis for a quick visit (T minus 7 days!) and home to Hastings after that. Unfortunately I still have a biochem exam separating me from my Southern vacation!
My exams sometimes feel like a fight-to-the-death match...
The Hunger Games don't have anything on medical school!
Yesterday we took our final ICE exam of this semester. It was over the stages of development from birth-death, mood disorders, death/dying/grieving. I didn't think it was too bad since I've covered much of the information before in my psych and Christian ed classes in undergrad. It's nice to have it out of the way though so that I can fully focus solely on biochem.
This biochemistry test will include genetics, bone/cartilage, blood, lymphatics, lipid & fatty acid metabolism, nucleotide metabolism, cell signaling & transport, and biochemical nutrition. Doesn't that just sound like the most fun a person could have?!
The countdown begins: 7 days and 30 minutes until our exam!
....and just because my main main Willie Smith is in this one! :)
Yesterday we had a lecture and 2 hours of small group discussion about death and dying from the medical provider's perspective. We talked about the ideal situations where our patients die peacefully with appropriate advanced directives after leading a long, wonderful life. But then we also talked quite a bit about the untimely deaths, especially of children, which can never be predicted or planned for.
Truthfully, I think that the reason death is so scary is that "the specter of death destroys any illusion that we are in full control of our lives..." (Bass, 161). I don't know about y'all, but I like things much better in my life when I feel like I have some semblance of control. I would venture to guess that this is why doctors struggle with dying patients so frequently...because we are sworn to protect life and death is an abrupt reality check that we are not in complete control of that very same life.
Because this is such a sensitive issue, we spent quite a bit of time actually talking about our feelings and experiences (not something we really do a whole lot of in medical school...feelings are just so touchy-feel-y!). Some of the questions that we talked about at some length included:
How do you cope with your patients, with whom you've formed very intimate relationships (in the sense that many people will only tell their docs their innermost secrets), dying?
How do you help the family cope with the death of their loved one?
What is your role in the dying process for someone with a chronic and progressive disease process?
What, if anything, do you do when a patient's quality of life drops below some vague, non-existent line demarcating "good" and "bad" lives? Is that even your jugement call to make as a physician?
All of these questions are obviously hard and, truthfully, there's not always a "right" or "wrong" answer for them. Sure, there are legal and ethical boundaries created for us, but they don't dictate whether or not you can cry in front of a patient or whether or not it's okay for you to send a card to the family or go to the funeral.
I guess I'm not all that nervous about these situations arising in my future. Obviously I don't look forward to them, but I'm not dreading them either. Let me explain... Death is inevitable; we all know that. I admit that it is often tragic too. My experiences working in a church have taught me that it can also be a beautiful process (clarification: beautiful, but not pretty...dying is very frequently an ugly and gross thing from a biological standpoint). I find it to be quite an honor to be included in some of the most intimate and loving moments experienced between families (I would like to add that many pastors agree with this sentiment on some level too). They are rich with family history because often family members are reminiscing about the soon-to-be-deceased/deceased. For those with awful chronic, painful diseases, dying ultimately becomes a reprieve from the pain of the physical world. Death is the end of suffering.
Do my personal religious beliefs skew my understandings of death? Absolutely. As a Christian I believe that God is stronger than death. That is the only way that resurrection of the body and soul are possible. I celebrate the Resurrection on Easter each year, but I realize that "even the resurrection does not erase from Christ's hands and feet the wounds of the crucifixion" (Bass, 168). Death is painful and ugly. too.
As I write about my personal beliefs, I must also acknowledge that we live in a multi-faith society and that many of my patients, as well as many others, do not share my personal beliefs on life and death. Not only do I respect that, I am grateful. I don't expect my opinions to be taken as Truth, but this is my blog after all, so I suppose my opinions are inevitable.
Throughout the discussion yesterday, I was reminded of one of my experiences in the pediatric neurology clinic at LeBonheur Children's Hospital in Memphis. I originally blogged about my experience in another blog, but below are excerpts that apply to this post specifically.
I was shadowing a doctor in the clinic when the family of an 11-year-old boy came in. He had a progressive epilepsy disorder which made him unable to do anything except drool. And smile. Both of which he did constantly. He wasn't always wheelchair bound and he wasn't always blind or mute. In actuality, he used to be a normal, rambunctious boy, but his disorder took away any hopes of a "normal" childhood, or life for that matter. His parents were in the office to plan for their son's imminent death.
The doc I was shadowing didn't give me any warning about what we were walking into, so I was quite overcome with emotion when I was suddenly part of the conversation about advanced directives for an 11-year-old. We just don't expect children to die. I know this conversation wasn't a cake walk for his parents either, after all, it was their only son, for whom they had initially had big dreams and aspirations. But, unfortunately, that wasn't how their story panned out.
They were actually there at the request of their son.
You see, shortly before he lost his ability to talk, he had a seizure early in the morning. This was not an uncommon occurrence. This particular night, his mom put on a pot of coffee and sat down to chat with him before he made any futile attempts at falling asleep. It was then that he told his mother that he was moving soon. As any recently aroused mother would do, she inquired more deeply as to just what he was talking about. He pointed up and said "I'm moving in with Him." Her natural response, and essentially any adult's response, was simply "Huh?" He explained that he had talked to God and that soon he was going to move. He asked his mom to let him go when the time came and not to hold onto him forever. He didn't want to be trapped here, on earth, in a body he could no longer use.
How incredible is it that a 10-year-old child embraced death more fully than those of us who are well beyond his years? I also think it's amazing and wonderful that his family is so "in-tune" with their sons needs and wants that they are able to overcome their own fears and hang-ups about death to honor his wishes.
That little boy is never far from my heart; I actually think about him more frequently than I could have ever imagined. Although I wrote that initial blog post almost a year and a half ago, I still think that it's as true now as the day I wrote it. I'm glad that I wrote about my experience while the emotion of the situation was still raw and pure, because it allowed me to be real and present in the moment.
Raw. Pure. Real. Present. These are things that I re-learned that day from this incredible boy that I had forgotten in my "old age."
Children like him inspire me to continue on my path to becoming a doctor because they teach me to become more fully alive than I was before meeting them. This is not because they are knocking on death's door and cause me to have nostalgic feelings about my own life and loves, but because they re-ignite a part of me that has been buried by years of growing up. I truly believe that children can teach us all what it means to fundamentally be a human, without all of the pollution and convoluted-ness of adult life that has barnacled itself to us as we have matured. He stands fearlessly on the cliff, from which we all must make our eventual plunge, prompting each of us to live again.
But most importantly he reminds me, reminds us all, to continue to smile.
Yesterday he was not only my reminder smile, but also a reminder not to fear death itself.
Quotations are taken from Practicing our Faith: A Way of Life for a Searching People (2nd ed) by Dorothy Bass.
I took this past week off from blogging (and from studying.... :/ whoops!) for Thanksgiving. It has been a really great (and necessary) break! And now, I'm sitting in Starbucks re-listening to a lecture and catching up on my studies. I'm not sure I'm ready to head back to school for the final 3 weeks of this core/semester. At the same time, I cannot believe that we only have 3 weeks left of the first semester of our 1st year! I don't think I could have ever imagined the year going this quickly when we started school 14 weeks ago.
Over the past couple of weeks, I've had some excitement interspersed with my studies. I've decided to give y'all a quick review of the highlights.
Stanley Hauerwas. He's an American theologian who is at Duke University. He came to UNL to talk about the "Church as a Politic". The lecture sort of ended up as a medical ethics lecture, which I totally LOVED! I miss that portion of my medical education...I need some humanities mixed in with my hard science. It was also great to see my friends/roommate from Lincoln!
NAP. I had a brief meeting with the Omaha office of Nebraska AIDS Project about volunteering as an HIV tester and counselor. I've been involved with HIV/AIDS prevention education for 7 years now and it's definitely become a huge part of my life. I just can't imagine giving it up in the future, so I'm happy to be partnering with them! Speaking of HIV/AIDS awareness...this upcoming Saturday (December 1st) is World AIDS Day. I will be spending the morning at Douglas County Corrections presenting about STD/STIs and testing for chlamydia and gonorrhea (Douglas County has the highest rates of infection of any county in the United States) and will definitely be wearing my red ribbon. You should too! You can do a quick google search to see if there are any World AIDS Day events in your area to attend to increase your own knowledge AND general awareness of the epidemic.
Sunny D's 2.0. Closely related to my meeting with NAP, I am actually working on a project with a local group of AmeriCorps volunteers to create a group which would give HIV/AIDS prevention education presentations at a local high school. When I was in high school, I was in a group called Sunny D's and they're trying to model the program after that. We will be in conversation in the coming months as they work to shape their program to fit their particular needs, but they are excited to use my experiences and knowledge of groups of the like (I was also in PHIVE-O, Peer HIV Education Organization, at Hastings College, so I have several years of experience with teaching this demographic and the administrative difficulties that sometimes arise) in the meantime. Perhaps I will even get to co-teach with some of their volunteers!
Do JuSTIce. I was lucky enough to volunteer at the jail again to test for chlamydia and gonorrhea. I led the short presentation this last time which was actually a bit nerve-racking. I made it through it without any major slipups. I'm excited to go back this weekend also!
EMET. We had a short information meeting about the "Enhanced Medical Education Tracks" at UNMC the other day. There are 6 tracks: Aging and Integrated Medicine, Auto-Immune Diseases, Clinical Quality and Patient Safety, Comprehensive HIV Medicine, Medical Humanities and Arts, Preventative Medicine, and Underserved Health Care. They are "an opportunity to perform in-depth study of an interdisciplinary field of medicine that enhances the required curriculum without extending the time needed to graduate from medical school." I haven't decided whether or not I will actually apply, let alone be accepted, to a track, but I really like the idea of them. Of course I am interested in several of the tracks, so we shall see what will happen. The applications don't open until the end of the week so I still have some time to think about it.
Student Delegates. Well, I joined another extracurricular group (...no one is surprise, I'm sure). I had some help getting there though. My good friend Paul convinced me to join the "Student Delegates" after he read my blog post about healthcare reform. Essentially this group goes to our local political representatives to discuss/lobby our positions concerning issues about medicine and even issues that students deal with, such as Pell grants. I do have a passion for this sort of thing and the first meeting was fun, so it wasn't hard to convince me to join. I'm excited to continue learning more about the topics that will be covered in the upcoming legislative session!
Dance. I'm sure some of you are starting to think I'm a broken record, but I still really love going to dance class. It's such great stress relief and even better exercise! This is really the first time in about 10 years that I haven't been dancing for some sort of team performance or competition, so it's definitely something that I've had to get used to. I look forward to that hour and half of not studying/not thinking/not stressing/not sitting every week!
LCE. I spent another afternoon in the clinic this past week. I always enjoy my time with patients, so it was a good way to end a short week of classes. This upcoming week I will have my final visit of the semester. Don't worry, I will be back for 5 more visits next semester too!
Thanksgiving. Even though I'm a vegetarian, I was absolutely looking forward to Thanksgiving this year. Seriously, what could be better than green bean casserole, mashed potatoes and gravy, corn, and pie!?? Nothing! As an added bonus, I got to spend time with my wonderful family and take some time off from studying to relax. Lucky for me, we celebrated Thanksgiving over an entire week this year, so I got to spread out my food-induced comas. I'm also looking forward to the leftovers I have since home-cooked food is just so much better than some of the meals I make for myself on a regular basis.
Christmas Tree. Our Christmas tree is up! The weather has started getting colder practically overnight, Thanksgiving has come and gone, and December is just around the corner! I can't believe it's already the holiday season. This year I will be spending some time in Memphis and then time traveling around Nebraska catching up with friends and family. Just 3 weeks of classes and 2 tests are separating me from break...
So if you haven't noticed already, this blog has sort of turned into a way for me to process the things that I'm experiencing at and beyond school. I suppose that I've always known that part of me is an external processor, but I guess I didn't realize the extent to which I need to process the things going on in my life with the people around me. I'm an only child, I didn't have anyone growing up to share my life experiences with. Even now, I'm a pretty independent person, I tend to do things on my own and prefer not to "check-in" with anyone about day-to-day things. Yet this blog has sort of become my "place" that holds me accountable and helps me organize my thoughts and experiences.
I've purposefully shaped my posts to be a reflection of what is happening in my life, to a certain extent, and to (hopefully) not offend anyone. I've also shaped them so that things I write could not be held against me at some distant point in the future as a practicing physician.
But I believe in the power of truth. And so sometimes I feel guilty because I haven't been as transparent in my posts as I really would like to be.
Let me just clarify and say that I have not been lying in my posts. Everything that I have posted, I absolutely believe to be true in the moment that I post it (remember, this is all about processing the things I learn in and outside of school...perhaps I have or will change my mind on a few subjects as I continue to learn and process new information). But I have been omitting a few key details.
So this post is about the truth of my life.
The truth is...
Medical school is hard. SO much harder than I could have ever imagined it to be. Not that it's "hardness" is inherently a bad thing. For the first few weeks I woke up every single day dreading going to school because it seemed like such a big upheaval. Two more years of hitting the books didn't seem all that appealing. I'm not going to lie, it sucks. I cannot imagine waking up every day of my life to go to a job that I hate. Just a few weeks of hating school was defeating enough for me. Older med students always say that it gets better after the first two years, I hope they are right. I truly and wholly believe that I am called to this profession and that medicine is one part, of many, of my vocation. Thinking about the people that have supported me in my journey thus far was the only thing that kept me going to class. No matter how independent I am, I didn't want to let these people down.
Medical school is lonely. My classmates are wonderful. It takes time to get to know people and you don't get the luxury of having much of that in the first weeks of medical school. I love people and I thrive in knowing the stories of those around me. For the first time in my life, the people around me were too busy to be sharing their lives with me. We are all in this together, but unfortunately "together" means that we were all studying near and at the same time as others, but we didn't get the chance to really get to know others. Not only that, now that I live 3 hours away from my home/alma mater, I didn't even have the direct support of those that I love at home. This situation is getting better now as the year progresses, but it's still tough. I cannot express in words how grateful I am to have Megan going through this process with me. She is my savior and my sanity.
Medical school is boring. Really boring (also, interesting, but definitely boring). Until recently, I really didn't have much else to do other than study all day. And truthfully, that's not all that fun. I am glad to finally be involved with groups where I can do something other than study for a few hours. If any of you knew me before this year, you'll know that I tend to be over-involved with extracurriculars. As drained as it often made me, it is just something integral to who I am. I'm sure as my tenure at UNMC continues, I will continue to become involved in other groups. I find myself wanting to join something new almost daily in the hopes of reducing the monotony.
I was sick during the first 3 months of class. Truthfully the being sick part sucked the most. It made each of the above truths much more drastic. I'm getting better now, but it's still not super easy going. My body was essentially attacking itself and I was tired all the time. And then I lost my appetite. And then I was tired because I wasn't getting enough nourishment and the cycle persisted. Now throw graduate level classes and studying into the mix of an exhausted, malnourished girl and you end up with the mess that was me. I only made it harder on myself because I tried to hide my exhaustion and sickness from those around me because I didn't want anyone to know, which ultimately exhausted me even further.
I hate when people use words such as "retarded" and "gay" in a derogatory sense. One of the biggest disappointments so far in my medical school career is the number of times a day that I hear these words from my colleagues. It's not professional nor is it cool. Please stop. It's offensive. While you're at it, please take phrases out of your vocabulary that deal with rape and suicide. If you've known someone who has committed suicide or has been raped (or if you were raped yourself) you can understand why these phrases are offensive. I KNOW that I'm not perfect at this, but taking into consideration what those around you have experienced before you decide to speak could really go a long way in this world in spreading less hate.
I love what I'm doing. I have good days and bad days, just like any other person. I'm doing what I can to survive and thrive while I'm here and learning. The body is a truly wonderful and incredible thing. I feel blessed to get the opportunity to learn about it, even when I'm overwhelmed.
Thank you to all of you who have and who continue to support me. Your encouraging statements, love and thoughts are what get me through my days. I hope that I can continue to write posts that are as transparent as this one because I feel that the bad days/experiences are as much a part of the journey as the good.
So you've had to been hiding under a very well secluded rock to not know that Barack Obama was re-elected. Moving beyond my personal political beliefs about whether this was a great move or a terrible move for the country, I want to talk about the election from the standpoint of someone going into the medical profession.
Truthfully, we don't know exactly how this is going to affect the future of medicine. But one thing is for sure, it's going to change it. While I know that many practitioners are upset about this (electronic medical records are evil, billing is a nightmare, etc), I don't think that change is necessarily a bad thing, but it definitely is something new and different. Further, I am in the really lucky few years where things won't be a change for me...I actually am going to be trained under the new system! The transition towards ObamaCare actually started way back in 2010, so that means that the kinks are already starting to be worked out in various parts of the system. In addition, other parts of the law will be introduced in the coming years, so it's not going to be a monumental change all at once like some people are imagining it to be.
Here's a quick run down of just a few things that have changed or will be changing as a result of the Affordable Care Act (a.k.a. "ObamaCare"):
insurance companies can no longer discriminate against adults and children with pre-existing conditions
more (but not all) Americans will be insured under the individual mandate/Medicaid/Medicare/private health insurance (people can pay a fee to opt-out of insurance if they'd like)
insurance rates should become more competitive in the public sector
Medicaid and Medicare reform...it's not perfect, but it's a start!
more of each dollar spent on medical care will actually be going to medical care--80-85% must go to care instead of administration, etc, or else the provider must reimburse the patients
more emphasis on preventative health care (if you know me, you know that I think this is GREAT! If you don't know me, you can read about my feelings here.)
children can be covered under their parent's insurance until the age of 26
better prescription drug coverage for seniors who are in the Medicare donut hole
funding and loan repayment for students interested in healthcare fields
Lastly, but I think pretty darn importantly:
moving from a fee-for-service system of care to a system of quality-based care
It's nowhere near perfect, but it's still reform. If we look at the Protestant Reformation (y'all know that studying Religion from an academic perspective is another one of my passions too, right?), we see that reforming things takes time. Although Martin Luther is often credited with starting the reformation with the 95 theses in 1517 CE, we know that it started before his time (don't get me wrong, I think Luther is SUPER awesome and if you want to know why please ask!). The beginnings of reformation can be traced back to the Council of Constance (1414-1417 CE) and even to the Great Schism (1378-1416 CE), far before Luther's time. And it didn't end until after much blood was shed in the Thirty Years' War (1618-1648 CE) and the Treaty of Westphalia (1648 CE) was signed.
So if it takes the Church almost 300 years to reform its system (let's be real, no church really is ever done reforming...or at least it shouldn't be because that's when it dies), why would we think our medical system would be any different?
It's going to take time. But this is just one step. Hopefully a step in the right direction for the good of our PATIENTS.
Because patients are what it's all about anyway.
My information for this post was derived from http://obamacarefacts.com/affordablecareact-summary.php and http://www.healthcare.gov/law/features/index.html. Please feel free to check my fact-checking abilities and let me know if I've screwed something up!
So this post actually isn't about med school. Well not directly, at least. But it's loosely about how I intend to practice medicine. Regardless, I decided that it's my blog and I can write about whatever I want, dang it!
The altar at the Church of Reconciliation in Taizé
I have this book that I read on a nightly basis. It's a meditation book that I got when I visited Taizé. For those of you who don't know, Taizé is a monastic community in the south of the Burgundy region in France. The brothers of the community invite young people (generally ages 16-29) to join them in ecumenical prayer and monastic life. It truly is an incredible experience! Taizé style worship is characterized by long silences and repetitive, chant-like music. You can listen to one of my favorite songs here. Many of the songs are sung in varying languages based on the populations of people visiting Taizé that week (the particular song I linked to was in French, but I've also sung it in English and German). The brothers try to be inclusive with the languages used when reading Scripture, song choices and prayers so that everyone can participate in the worship experience. I could talk about Taizé for years, but that's really not what this blog post is about, so back to the story...
So this meditation book seems to always have the perfect meditations for each night. I really don't know how that is possible, but after almost 3 years of owning the book, I've stopped asking questions. The reading on Halloween really struck a chord for me:
The vast possibilities of science and technology are able to alleviate sufferings, and to mitigate famines. Indispensable though they may be, however, these powerful means by themselves are not enough. If we were to wake up one fine morning in societies that were functional, highly technological, but where the confidence of faith, the intelligence of the heart, and a thirst for reconciliation had been extinguished, what then would be the future of the human family? --Peace of Heart in All Things: Meditations for Each Day of the Year, Brother Roger
Wow. What a thing to read while you're studying medicine and have spent your whole life interested in the sciences.
But, wait. That's not completely true.
I've also spent the better part of the past decade interested in religion, from more than just a faith-based perspective. During undergrad, I was a religion major and in a program for my Christian Ministry minor. We lovingly/creatively dubbed said program as "the program," and it had/has a much greater part in each of our lives than I think many of us want to admit. While in the program, the goal is to begin working towards discerning our call, our vocation. We talked quite a bit about how this discernment process isn't a 'one and done' kind of thing, but rather it's a continual process that we will grapple with for the remainder of our adult lives. There's some sort of peace that comes in knowing that our vocations may change over time and that we don't have to get it perfectly right when we begin the process.
Throughout my tenure at Hastings College, I discerned my call to be somewhere in the intersection between medicine and ministry. I adore medicine (admittedly this is true some days more than others) and I also love being a ministering presence to others (similarly to medicine, this is true some days more than others). I didn't know what this meant for me for much of my undergraduate experience and, truthfully, I'm not sure that I know any better now. BUT I know that it brings me great joy to be involved with both medicine and ministry. So that brings me to this meditation.
Last year when I interviewed for medical school, I was asked what one thing worried me about the future of medicine (or something to that effect, I really don't remember the exact phrasing of the question). I said that I was worried about all of the technology involved in medicine and that I worried that it took away from the actual practice of medicine. Last January, I traveled to Trinidad and Tobago where they only have one to two MRI machines for the entire country and yet their medical care is better than ours in many respects. Fast forward to this fall and now I'm learning about these technological advances and how they are changing the accuracy of medicine. Here I am as one overwhelmed student interested in the intersection between medicine and ministry.
How can I balance technology with good ole, tried and true patient interactions that are NOT technologically dependent? How can I do this while being a thorough and accurate physician? How do I avoid becoming addicted to technology personally so that I can remember what it feels like to have conversations without some sort of screen interface? Going back ideas I brought up in my healthcare reform blog post, how can I responsibly order tests without ordering unnecessary procedures/labs and spending money that my patient/the government/the hospital doesn't need to spend?
I don't know the answers to these and many more questions, but I'm okay with that. For now, I will continue to discern what it means to be at this intersection between medicine and ministry. What I do know is that I will never force my religious beliefs onto my patients, or on my friends for that matter. I do know that I will work hard to be the best doctor I can be by taking advantage of as many opportunities as I can for patient interactions and other learning experiences while I'm still in school. I do know that I will attempt to balance my personal ties as well as my professional connections with the technological world.
My apologies for taking so long to write an update. The past week or so has been absolutely nuts! I am officially finished with October (thank God!!) and with the 4 weeks of testing that it entailed. I survived anatomy and we've moved on to "Cellular Processes," a.k.a. biochemistry. The biggest transition between the two cores is that we now have 4 hours of lecture each morning instead of only 1-2 hours of lecture with 1-2 hours of lab. I realize that 4 hours is only half of my day and that it truly isn't that long in the grand scheme of things, but sometimes it's a little rough to get through. Even though biochem isn't the most thrilling topic I've ever studied (not that it's the most boring subject I've studied either), I'm learning quite a bit. Actually, the more I study cells and the longer I'm in school, the more I realize how truly incredible it is that our bodies work and work correctly (for the most part) all the time. It's hard for me to not sit in class in awe of the biochemical processes inside of me that are taking place without me even noticing or controlling them.
Beyond lecture, this week has also been a busy one. Wednesday morning I got my flu shot. This really wasn't anything that took much time or kept me all that busy, but there has been some talk between my classmates about whether or not they were going to get one. Although this was actually my first flu shot (I'm really not sure why I haven't been on top of this in past years), it was a no-brainer for me. Several of my classmates don't want to get one and quite the ethical conversation has sparked from that. I personally think it is our ethical responsibility as healthcare providers to be up-to-date on all of our vaccinations, the flu shot included. This year they were offered at no cost for the students (well I'm sure the cost was worked into our tuition somehow...) and they were given right on campus, so there's not even an excuse that you couldn't make it to the clinic site. I think that as healthcare providers we have a responsibility to our patients to protect them from any sort of diseases that we could give to them. For me, it's akin to washing your hands before an examination or using sterilization procedures before a surgery. We spend quite a bit of energy protecting ourself from diseases that we could possibly acquire from patients by using standardized precautions (basically if it's wet, sticky and not mine, I am to wear gloves/mask/eye protection/gown/etc), I don't understand why we wouldn't give our patients the same treatment. But in the end, each of us get to decide whether or not we feel comfortable getting the shot.
On Thursday, I visited my preceptor for the third time. I actually got to interview and examine a few patients on my own before the doctor came in. As we progress in our education, we get more opportunities to do this. I know that each of us are thankful for these patient-encounter opportunities. There was nothing truly that remarkable about this visit...nothing to write home about, at least. Regardless, it was a great experience!
Friday wrapped up my hellish 4 weeks of examinations with my first "Objectively Structured Clinical Examination" (OSCE). Truthfully, I didn't even know what OSCE stood for until I just googled it. But essentially it is a clinical skills examination. We will have one more of these this year and then two during each the 2nd and 4th years. They get progressively more complicated as our training develops. This OSCE was supposed to represent "normal" everything, although some of the standardized patients actually didn't have normal examination results. I don't think I can actually talk about the questions on the examination because questions are used for several years and it's a test required for medical students across the nation...I know that some of my friends reading this will be experiencing an OSCE in next few years and I don't want to give away all of the fun! I didn't realize I would be as nervous for it as I ended up being, but I think it went well! The standardized patients and the M4 students who graded us were all very nice. After our OSCEs (Megan and I just happened to be scheduled for the last exam period on Friday afternoon...what luck!) we enjoyed some cupcakes from Jones Bros cupcakes. What a great way to celebrate the end of a difficult month! I also supported the students fundraising for their medical mission trips over spring break by going to a wine tasting at a local wine store. It was quite fun! It was also a nice way to celebrate the end of a tough 4 weeks, and more importantly the official end of our first core of our M1 year. I'm still trying to process how the past 11 weeks went by so quickly! It's absolutely mind-boggling!!
This morning I had quite the wonderful experience. As many of you know, I have been involved in HIV/AIDS prevention education for the past 7 years or so (holy moley, has it really been that long?!?). When I came to UNMC, I was worried that I wouldn't have any time to continue with peer education of that sort because it had become a real passion of mine over the years. Luckily, there is a program associated with Douglas County Correctional Facility where med and nursing students from UNMC and Creighton go and complete chlamydia and gonorrhea testing. There's actually a program that they're implementing within the next year in association with the state department and Nebraska AIDS Project (NAP) to do HIV testing, which is totally awesome! But anyway, Douglas county, for whatever reasons, has the highest rates of chlamydia and gonorrhea in the country!! The numbers for Douglas county are astounding...significantly higher than the national and state average. To try and reverse this, the Do JuSTIce program was created. It was so much fun! We give a short presentation on common STD/STIs and prevention methods, and then test those who would like to be tested. It's quick and completely pain-free. The best part of the whole situation is that we test for the STDs that can be treated...and treated easily. This is great news from a public health standpoint so that, hopefully, overall rates of infection decrease within the county. I seriously feel lucky to be part of this group! Earlier this week I attended the training for the HIV testing program and am excited for it to get started soon. I know that many of my classmates are nervous about the idea of being in a jail with inmates talking about that icky, awkward subject of sex, but I found this morning that actually the men I talked to were far more interested and mature than many of the college students I gave presentations to in the past 4 years. It's interesting how that works out, eh? Later this week we will go back to give treatment to those who need it. Love, love, love! I finally felt like I was back in my element for the first time since school started. I may have also used my stunning good looks to convince a few men to get tested...I guess you have to use the tools you have at your disposal...? Haha I'm so hilarious, I crack myself up.
This upcoming week will also be a busy one, but thankfully one without an exam. Thank you to each of you that has supported me throughout this transition to school. I'm still doing the best I can to get used to this whole graduate school thing and not a day goes by that I don't thank God for each of you. Happy Mo-vember y'all (No-shave November?...whichever floats your boat!)!!
Right around the Olympics this summer, there was an internet photo running rampant of the "first picture of Michael Phelps." It featured a single spermatozoa swimming faster than others on its journey towards fertilizing the ovum. While this was clever and entertaining, it actually wasn't the first picture of Michael Phelps.
Well actually, hopefully that was obvious to everyone. Because it was a cartoon and not an image of the innards of Mama Phelps, but what I mean is that we (scientists) can actually take a picture of people long before they are even spermatozoa...that's way before people even have enough genetic information to be considered a person!
Okay, mind blowing. This might need some unpacking.
This past week we learned about primordial germ cells in embryology. For the purposes of more clearly explaining these cells, we are going to hypothetically assume that I am pregnant (in real life I am NOT pregnant nor do I plan to be for many, many years). Back to primordial germ cells. These cells develop in the gonads of the fetus/child/baby/person that I am carrying. So basically these cells are my GRANDCHILDREN. And we can take pictures of them as early as 4 weeks after my child is conceived. That's a good 20-30 years before there are any baby pictures of them! Perhaps I will print out a copy of the picture (below) and frame it alongside copies of ultrasounds of my unborn child. Then everyone could see a picture of my child with his/her unborn children by their side.
Primordial Germ Cells. 4th week gestation Thanks to Dr. James Turpen, PhD for this photo.
Whoa. Science is cool. And doesn't that picture just look awesome anyway? The colors are pretty and the pattern is sweet too. And then you realize what the picture is actually of, your jaw drops, and you silently thank the scientific community for the work that they do.
As I wrap up this post, let me just reiterate that I am NOT actually pregnant, but that I just pretended to be for this blog post so that you could better understand primordial germ cells.
Test on Saturday. I can't believe I only have a few more days left of the first core of my medical school experience. After Friday, I will never again have a formal anatomy class as a medical student. The past 9.5 weeks have flown by! Just 6.5 weeks until Christmas vacation :)
It may disappoint some of you to know that this blog post has nothing to do with the most recent health care reform which was declared constitutional this summer and will be put into effect in the coming years. While I do (mostly) support so called "Obamacare" in theory, I am still suspicious about how it will actually be put into practice. Beyond that, I don't think that the most recent "reform" really even scratches the surface of the reform needed in this country in order to actually become healthy. But none of that really pertains to this post, so back to the real reason I'm writing.
Tonight I went to a documentary showing put on by an interdisciplinary group on campus. The documentary was "Escape Fire: The Fight to Rescue American Healthcare" and you can see the trailer below:
It was hard not to get inspired once I saw the trailer. I was hooked and needed to see the whole film. I've kind of been on the whole healthcare reform train for a few years, so really this isn't anything new, but it's always good to continue learning about topics which you are passionate about. Sadly, there wasn't a great turnout for the showing of the film because it truly was great.
The issues presented in the documentary are as follows: (descriptions are taken from the "Escape Fire" website which can be found here: http://www.escapefiremovie.com/issues)
An Entrenched System: Pharmaceutical companies, medical device manufacturers, hospitals, and insurance companies are all profiting on our declining health. And all those companies spend their money lavishly – millions of dollars go to Washington lobbyists – to ensure that nothing ever changes.
Over-medication: We spend roughly $300 billion annually on pharmaceutical drugs – nearly as much as the rest of the world combined.
Over-treatment: One of the hardest things to understand as a patient is that “more” doesn’t necessarily mean “better.” But it’s imperative that we do. Recent studies have shown that “more” can often mean “worse” when it comes to our health.
Paying More, Getting Less: We pay more, yet our health outcomes are worse. We give well-intentioned doctors, nurses, and hospitals the wrong tools and the wrong incentives, and it results in higher costs and poorer health.
Preventing Disease: 75% of healthcare costs go to treating diseases that are largely preventable. That’s a lot of unnecessary money, and worse, a lot of unnecessary disease.
Reimbursement: The healthcare system often uses a “a fee-for-service” model of payment – government or private insurers pay a hospital or a physician every time a procedure is performed.
Treating the Whole Person: Your body isn’t a car, but that’s how it’s handled when you take it into the doctor’s office. Instead of being treated as a person, your broken parts get fixed separately, one by one.
After viewing the documentary, several points are still resonating within me. The point was made time and time again that our current system is a flawed, fee-for-service system. The trailer even called attention to the fact that spending 5 minutes with a patient before performing a surgery could earn a doctor $1,500, but spending 45 minutes with a patient determining feasible treatment routes would only earn a doctor $15. That seems utterly backwards. Moving beyond the money, our current system does not reward patients or doctors for healthy behaviors, but instead keeps us coming back for more. One quotation from the documentary, "We don't have a healthcare system in this country, we have a disease management system" (Dr. Andrew Weil, Founder of the University of Arizona Center for Integrative Medicine) was especially poignant if combined with a point made by medical journalist, Shannon Brownlee. She talked about the fact that our current system doesn't actually want us to become healthy (to be fair, it doesn't want us to die either) because then the system doesn't make money. We are simply managing diseases in many cases (several of which are fully preventable), instead of encouraging health because it keeps us coming back for more in order to keep the industry alive.
I know that this reform will not be easy. It will require overhaul of several, very politicized lobbies of people. These include insurance companies, hospitals, pharmaceutical companies, the farm lobby (in spite of my Cornhusker heritage, I can recognize that the subsidies for corn are not beneficial to national health...you will be hard pressed to find foods that do not contain corn or corn byproducts on the shelves of our grocery stores which are truly not all that healthy for us...this also will require elimination of food desserts...oh now we're into a whole other bird's nest of issues), schools (health classes that actually teach healthy behaviors, school lunches that provide adequate nutrition to students, etc), fast food corporations, all food production corporations, and many, many more.
This is no feat to be taken lightly nor will it be easy.
If reformed, Americans would have to begin living in a manner which is completely foreign to many of us. No longer would we be managing disease, we would be maintaining health. Our lives as we know it would be over. Over in an absolutely terrifying, but absolutely rewarding way. Benefits to better healthcare would include, but not be limited to:
Better health. Simple as that! (this is not to say that we will be in perfect health as a nation. There are still germs present within our lives, but many major chronic conditions which affect millions of people nationwide could be drastically reduced)
Increased life expectancy (clearly this leads to the problem of over-population, but that's for another blog post...)
Reduction of preventable chronic conditions such as diabetes, hypertension, high cholesterol, heart disease, certain cancers, etc.
Decreased insurance premiums.
Increased productivity at work...better health=more energy=ability to accomplish more.
Reduced national deficit.
Lowered incidents of mental health fatalities and associated stigmas.
Fewer unplanned pregnancies, abortions, and reduced STD/STI transmission.
Increased education. When people, especially children, are healthy, they are capable of learning. And eventually they can do something productive with that knowledge. Perhaps even change the world.
Moving beyond my concerns as someone who loves the practice of medicine for its scientific components, as a person of faith, I personally feel that I am even more obligate to help my patients work towards being healthy in mind, body, and spirit. My philosophy on this front is highly influenced by Dr. Scott Morris of the Church Health Center. I've written about CHC on other occasions, so I won't bore you by rehashing the details, but Dr. Morris believes that we, as a Church, are called to preach, teach, and to heal. Generally, we do a pretty good job of preaching and teaching and not so great of a job with healing. At some point in history, we adopted a dualistic philosophy (thanks a lot Descartes...not!) and our bodies, minds, spirits became considered separate entities causing physicians to stop treating the whole person in our medical clinics. I cannot, in good faith, treat a person without considering their mind, body, and spirit as a budding physician (or in science-y terms, without considering a patient's biopsychosocial situation), Christian, or a human. The current system of practicing medicine does not allow for me to fully treat patients with this approach.
Don't get me wrong, obviously I still like Western medicine. After all, I am writing this critique on a blog about becoming a medical doctor. I have even taken full advantage of the student health program here at school this fall. It's not that the system is worthless...it helps millions of people each year. BUT (a big, emphatic "but" at that) it doesn't provide infinite amounts of health care. It also doesn't provide care in cost effective manner. Not only that, we currently allow for millions to fall through the cracks of the system, never seeing, preventing, or treating their health concerns.
We are in dire need of an overhaul. My generation is sitting on the horizon of change, I hope we are able to enact it, so that our patients/the nation can work towards becoming healthy in mind, body, and spirit. I know that I'm still in school and ideology overshadows what will likely be actual experience, but without acknowledging that there IS a problem, we can never work towards solutions to said problem(s). At the very least, I now open the floor for conversations to begin about healthcare for those of you who read this. I look forward to our discussion!
We are overly-medicated, overly-treated, overly-charged, disease-ridden people. It's about time that changed for the better, if you ask me.
"Let your food be your medicine and your medicine be your food." -Hippocrates
Today I went to a local assisted living nursing home to screen some of their residents for hypertension. I only performed blood pressure checks on 3 people before this and even then I struggled to hear the Korotkoff sounds, so I was nervous. But as a general rule, elderly people are pretty patient, so I wasn't stressed to the max about it.
Turns out, it was loads of fun! I pretty much love anything I get to do where I actually have patient interaction these days. As expected, I learned quite a few more details about each of the residents than I needed to know for the screening, but I still love talking to people, so I wasn't upset about it. It reminds me a little of the days of volunteering at Good Samaritan Village in Hastings (I was volunteer of the year one year...not to brag or anything ;) ).
I am no longer nervous about checking blood pressures. Something about taking 10+ pressures in a half hour makes it less scary to do! Each of us are assigned a certain day and a certain assisted living facility throughout the year to do these checks. I think it's a great idea! It gives us practice and its goal is to help keep the residents healthy...I'm all about preventative medicine!
Today was also the start of a new unit. We are beginning the pelvis/lower limb unit--our last unit of anatomy! I cannot believe I'm already 8 weeks into my first year of medical school. During orientation week my M2 buddy said that the days would drag on for seemingly ever, but that weeks would fly by. Boy was she correct! It's crazy how quickly the year seems to be going.
Right now we are amidst a crazy few weeks of tests. It all started with our thorax/abdomen exam on this past Saturday. This week we have an ICE midterm (the class where we learn clinical things: professionalism, standard precautions, performing exams, etc). Next week we will have our lower limb anatomy exam on Saturday morning and then finally we will have our OSCE (I don't actually remember what this stands for) late the following week. During the OSCE we are given 10 minutes to perform a certain task with a patient. Possible tasks could be taking vitals, getting an accurate history, performing cranial nerve testing, and many, many others! This OSCE has 4 patient tasks and will take 40 minutes to complete. We will get a week off from testing after the OSCE before we have our first biochem exam. Yikes, what a daunting schedule! I'll just have to take it one test at a time...
I got to see my parents this weekend, which was a wonderful refresher. I've been missing them quite a bit lately. It was also a plus that I got to have my mom's home cooking! They sent me back with bags full of groceries and clean laundry (which I did by myself...I'm not completely worthless domestically) to face another week. I'm looking forward to having them in Omaha later this month too!
And thus begins another week in the med school grind.
Say "ahh."
Just a hint, this is not how human throats look. Or at least they shouldn't.
Quite obviously I'm learning lots of very valuable information at medical school...
you have a dream about the pathway that food takes from ingestion until it leaves your body. Not only that, you are diagramming said pathway and the nerves and arteries that supply those areas.
As embarrassing as it is, the above situation is not a hypothetical situation. That was one of my dreams last night. Anatomy has truly become all-consuming in my life! I frequently will wake up in the middle of the night and find myself tracing the course of arteries through a specific area or naming the muscles which a specific nerve innervates.
I suppose it's good that I'm fully dedicated to studying...? Exam on Saturday!
Today was our video-taped interview with a standardized patient. The patient was purposefully an easy patient, so that we didn't have to worry about the medicine part of the interview and could concentrate on our interviewing skills. Before entering the room, we were provided with some vitals (blood pressure, pulse, respiration rate and temperature) and then we were sent into our respective rooms (there were 16 of us interviewing various patients at a time). We had no idea who would be sitting behind those exam room doors nor did we know what sort of medical issue we would encounter.
I suppose that's one of the exciting things about medicine...depending on your specialty, you may not have any idea about what you'll experience on a daily basis and medicine stays fresh and exciting because of that. You are always on your toes and always learning. The further along I get in my education, I realize how much I truly just love learning. I feel very blessed to be able to learn for the rest of my life!
But back to my patient. The interview actually only lasted about 5 minutes. Immediately afterward our patients critiqued our interview skills. The gentlemen that played my patient was a kind, retired gentlemen with a sweet sense of humor. He has been a standardized patient for 9 years at UNMC! I hope that someday I will be able to be a standardized patient...except I doubt the students will describe me as a kind old lady...I will be quite the trouble maker, I'm sure! :)
He said that I built a good rapport with the patient very easily and that if the patient had something more serious than a cold, he would feel more than comfortable with bringing it up with me. It was really great to hear that! Obviously knowing a patient's anatomy is important, but it's just as important to be able to talk with them. If nothing else, this interview was a nice confidence booster that yes I am, in fact, in the right profession. After a short patient interaction break, I'm off to hit the books to review the cardiac plexus and the peritoneum.
I didn't even have a rough day, but tonight I had plenty of laughter! Megan and I went to see the movie "Pitch Perfect" and I laughed incessantly! It was hilarious (mildly inappropriate) and adorable. It's about a women's a capella group and is also a sappy romantic comedy complete with singing and dancing...so basically I was bound to love it!
Today I interviewed my first standardized patient! Truthfully, I think it was more intimidating to talk to the patient because I had a roomful of my classmates observing and not because I was actually nervous about talking to a patient.
Just so everyone is clear, standardized patients are local people who are trained by UNMC to adopt personas that allow students to practice patient interview techniques in a safe environment. We actually don't even meet with these patients in an exam room setting (except for test days), we meet with them in small classrooms. These patients are trained to critique students on specific interview skills that we're supposed to be practicing. We have the ability to "time-out" at any point during our interview to ask for guidance from our classmates or our preceptors (my group has a general practitioner and a microbiologist leading us) or to simply just to reorganize our thoughts. It's really helpful, although seriously intimidating, to have 10 other students surrounding you and supporting you while you're talking with a patient. Because we haven't had much practice, if any, with these skills we often are unorganized in our interviewing and we can also tend to forget important questions to ask, so our colleagues (holy goodness...not only are these people my classmates, they're actually my colleagues! That's pretty cool!) can redirect us or make helpful suggestions about good questions to ask.
One set of skills that we were supposed to be working on can be summarized with the acronym "PEARLS." Basically, the purpose of PEARLS is to validate the concerns of and empathize with the patient ("Yes, I can see why that would worrisome to you..."). The letter 'R' in PEARLS stands for 'respect'. One of my classmates asked "How do we do respect?" today and I replied, "Ask Aretha Franklin." Only one of my classmates chuckled--I'm assuming it was because she's the only one that heard me and not that people didn't get the joke and/or I'm not actually funny. But anyway, enjoy a little Respect from Aretha!
Friday is our video-taped interview with a standardized patient. I'm sure glad that I got my first small-group standardized patient interview under my belt before then!
Y'all are in for a treat today! I'm going to introduce you to the contents of my "doctor bag!" Yes, I really do have an actual black "doctor bag" that I keep things in when I'm at home to stay organized, but when I go to clinic I just stuff these tools in one of the million pockets I have in my white coat. "Doctor bags" really aren't very popular any more, but I still like mine because it reminds me of the TV show "Dr. Quinn, Medicine Woman" which I watched quite a bit growing up and it makes me feel all official/like a real doctor.
Here's what I have:
safety pins, alcohol prep pads, ophthalmoscope, otoscope, reflex hammer, tape measure, tuning forks
(starting in lower right corner and moving clockwise)
Safety pins: These are used in testing sensory portions of the nervous system ("Can you feel this if I poke you with the really sharp pointy part? What about now, if I poke with the rounded part?"). Also they come in handy if you snap a button off a dress or your pants are too long and need a quick fix.
Alcohol prep pads: These are used in many instances, but basically the purpose is to get something clean. We use these if we are sharing tools between pairs of people when practicing and also to get marker off our skin after drawing muscles, ribs, lungs, hearts, etc on each other to get a better understanding of where these structures reside in the living person.
Ophthalmoscope: We use these scopes to look in eyes. We might be looking for pupillary reflexes, the red reflex (this is what makes red eyes when you take pictures!), at the retina, optic disk, optic cup, veins, arteries, etc. Ophthalmologists look at quite a few more things and fully understand all of the tricks of this tool, but at this point I just know to look for the things I've already listed.
Otoscope: Similar to the ophthalmoscope, these are multi-use! As the name implies (oto-), these are used to look in the ears. There are disposable tips in the picture too, which we use so we don't have to sterilize the scope after each use! Doctors also will use this light to look in the nose and in the mouth at the back of the throat (uvula, tonsils, etc) [Say Ahhhhhhh!]. This light can also be used to check pupillary reflexes, but definitely not to look at the eyes because you will gouge the patient's eyes out if you try!
Reflex hammer: This tests reflexes, just as the name suggests. This particular one is used by neurologists more than any other specialty, but it does the same sort of thing. The handle can also be used to check some sensory information (Is this cold or hot? Smooth or sharp?).
Tape measure: Well this measures things. Y'all have seen these before. We may use them to measure the circumference of the head in children or many other things!
Tuning forks: Well these are used in neurology fairly frequently. But we just used them in our head and neck unit to test for deafness (and to distinguish between conduction and nerve deafness).
Don't worry, that's not it! There's more....! I also have two stethoscopes. One is for adults, there's nothing particularly exciting about it. The other one is a pediatric stethoscope. I just got it in the mail this week. It's seriously awesome....look!
It's rainbow!!! It also has my name on it (thanks Aunt Lorraine and Uncle Dick!). I'm super stoked about it!
BUT WAIT. That's not all!
It's a DINOSAUR!! How sweet is that?!
I can't wait to go into the clinic and have this super awesome cover!
I also have a Dalmatian cover, so I can switch them out!
So that's what I have in the bag. I also have an eye chart and a few other helpful tools that I keep in my white coat that never make it to the "doctor bag." I'm excited to continue learning about these tools and to expand my clinical knowledge. This week I have my first videotaped interview with a standardized patient. It will be interesting to watch and critique my own patient interactions!
Other than the grammatical error, this holds pretty true!
So I've been feeling really unbalanced lately. Almost like I've been missing something. Throughout the entirety of my college career, I balanced my studies in the science-y genres with my Christian Ministry minor and Religion major classes in the humanity genres. But for the past 5 weeks I've been solely doing science--and quite a bit of science at that!
So today, I poked around until I found an email that I saved over 2 years ago just in case I would ever need it. This email contained a letter from the founder of Church Health Center to future doctors. Many of you already know about Church Health Center (CHC). But if you don't, here's a quick run-down:
CHC is a non-profit in Memphis, TN which provides medical care to the working uninsured of Memphis. In addition, they have a preventative health/wellness center with all of the amenities that you would of expect of a YMCA on steroids. They have childcare (where I worked for a total of 6 months), physical therapy, a sports court, exercise classes, healthy living classes, healthy cooking classes, outreach programs, and much, much more. This place forever changed my life and the people there also have greatly impacted who I've become. Well anyway, Dr. Morris (the founder) believes that Christians are called to preach, teach and to heal and that we, as a church, don't do so well with the healing part. Essentially the CHC crew works to help patients and members to be healthy in mind, body and spirit.
Recently I've noticed how much I've been missing the "spirit" portion of my education since starting medical school. I understand that I'm hear to learn the "hard science"part of medicine, but I still feel drained. This letter was just what I needed to "fill my bucket" amidst the grind of anatomy.
Dear Future Doctor,
Congratulations on entering medical school. I know it has been a long, difficult path to get to this point, but you have made it to the beginning of a life-changing experience. What I hope is that it doesn’t change you too much.
Most students just starting out still identify more with being a patient than a physician, but the moment they place that white coat on your shoulders, you will begin the transition, both intellectually and spiritually, that will make you a doctor. The part of this path that teaches you the skills to care for people is a good thing, but there is a negative side of this transformation that I hope you will fight.
This will begin the day you walk into the anatomy lab. It is a surreal experience to be in a room with a collection of dead bodies that you and your classmates will cut and dissect over several months. Someone will make a joke about how creepy it is, and then the bodies will be given nicknames that will make you laugh. But remember that your cadaver was once a real human being who cared enough about your medical education to give you his or her body to learn from. What a remarkable gift! This lifeless corpse was once someone’s father or mother, who had dreams and aspirations, just like you. They loved and cried but, when you do your dissection, you will not find the source of these vital parts of life. We need to offer the body the greatest respect. God’s gift of this mortal coil is part of what makes us human. All too often, however, medical students in anatomy class lose reverence for the body, and for some students, this begins to erode a sense of awe for life itself. Don’t let it happen to you.
For the next two years, you will spend endless time in a classroom and feel great pressure to accurately regurgitate information that you have memorized. You will see the students in classes ahead of you as mentors, but remember they have only a little more experience than you. Do not try to impress your teachers with how familiar you are with the practice of medicine when, in reality, it is all still very new to you.
When I was a second year student, my partner in our physical diagnosis class began a presentation to the attending by saying, “This was not a very interesting patient. She only has diabetes.” I have now been a practicing physician for 25 years and, even now, I learn new things about diabetes. Surely, one of the first times you are seeing a patient with this disease it should be interesting, but even more so, objectifying the person in your care to only their disease is wrong. This is not a way to become a healer.
Some teachers will tell you that you should not allow yourself to get close emotionally to your patients. In order to keep your mind clean, they will say, you must stay objective and learn to keep your distance. Nothing is further from the truth. We do not need to teach people how to keep their distance from other people. We do that naturally. We need to teach how to become close to another person in a professional manner. To practice the art of medicine, we must learn how to care for people.
Still, no matter how hard you try, at some level you will be converted to the religion of medicine and, trust me, it is a religion unto itself. There are fundamental beliefs that cannot be violated; holy places and sanctuaries of learning; prophets and high priests of the profession; and a way of seeing the world that changes how you see yourself and others. Many medical students and residents get to a point that they cannot talk about anything except medicine, so when they go to parties, they either gravitate to the other true believers like themselves, i.e., other medical students, or they bore other people with self-centered monologues. I urge you to continue to have a life outside of medicine. Learn to listen to other people’s stories and pay attention to what matters to them. It will make you a better physician.
Still, medical school will change you. One day, as a third-year student, I was doing CPR on an elderly woman and the resident came into the room and began taking orders for pizza when the “code” was over. A person’s life was literally underneath my hands, and while I was doing chest compressions, I was thinking about whether I wanted mushrooms on my pizza. In that moment, I knew medical school had changed me, and I am embarrassed today to admit that I had those thoughts. When I realized what was happening, I promised myself to never let it happen again.
When you graduate from medical school, you will no longer identify yourself as a patient. Now you will see yourself as a “doctor.” This is a good thing – something to be proud of and to build on. But, during these arduous four years, my prayer for you is that you do not lose your love and reverence for life along the way. Remember that God has given you the ability and the skills to become a physician in order to keep life holy. Being a physician will allow you to more fully answer the call to discipleship – to preach, to teach and to heal.
You are on a spiritual journey, and medical school is giving you the skills to help you and others live life in the fullness that God intended. These four years, though difficult, constitute the beginning of your own full and well-lived life.
With great hope for your future,
G. Scott Morris, M.D., M.DIV
I'm feeling better about my bucket being filled and my spirit being renewed. I am so thankful for the great people at CHC to remind me of such things from afar. I am also glad that Dr. Morris addresses that fact that none of us know what we're are doing. Today we had our very first standardized patient. These patients are trained to know how to evaluate the skills which we are supposed to be practicing and such. Today we were just supposed to work on patient histories. I didn't interview anyone today, but it was a really great experience seeing several of my classmates go through the process. We were all scared, we were all nervous, and none of us knew what to do. But it was okay, actually it was a good sign. It meant that we took it seriously--that we realize how much of a responsibility it is to be in charge of the care of a real human being. These standardized patients are a great way for us to practice in a safe environment so we are fully prepared when we are actually in the clinical setting. I'm nervous and anxious for my standardized patient next week! Until then, I will continue to learn about the thoracic cavity and rejuvenate my spirit.
"Be aware of wonder. Live a balanced life--learn some and think some and draw and paint and sing and dance and play and work every day some."
