death and dying.

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. 

giving thanks.

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...

Truth.

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.

Beauty can be found in the simplest of things. 

politicality.

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!

Intersection

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.

Finally...an update!

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!)!!