HC students with me (an HC alum)!
Way to represent Broncos!
Six weeks ago, I was content with my life. I was working on research, I was eating food at my favorite restaurants (no matter how many great places I frequent, Big Dally's Deli and Back Alley Bakery will always have my heart) and I was enjoying random outings with my best friend in Hastings. I was in the recuperation stage of recovery. I was happy.
Or so I thought.
Six weeks ago, I started working as a TA for the Summer Medical and Dental Education Program (SMDEP). Six weeks ago, I started laughing so hard that my abs hurt every single day. Six weeks ago, I got to know 8 of my (former) classmates like never before. Six weeks ago, I met a group of 79 students from across the country that challenged me in ways I never imagined.
Six weeks ago, I re-discovered joy.
SMDEP TAs.
The best set of co-workers I could have ever imagined!
It's weird. I thought I was basically back to 100% before I started SMDEP. I was wrong. The students, my co-workers and even some of the professors (Captain Capow!) reminded me of the things in life that I love, namely laughter. I've now come through the personality recovery part of my journey towards health. I'm finally starting to feel like myself again. It's been well over a year since the last time I consistently felt this way.
My incredible TA group!
Now the students have all returned to their respective homes and I'm feeling nostalgic. Not for specific moments from the past 6 weeks (although I will miss the people with whom I worked and the laughs we shared), but for the Cambridge Tradition Program. CamTrad was 6 years ago (is that right...?) already, but I still love and miss the people I met there each day.
As I see my students post on Facebook about what an incredible time they had and about how much they are already missing the friends they made over the past 6 weeks, I remember bawling my eyes out for about 4 of the 8 hours of flight time back over the Atlantic. I also remember feeling like part of my heart had been ripped out and pieces of it were left in England and with each person I met. I remember the emptiness I felt upon my return to Nebraska consistently for several weeks and sporadically for months thereafter. Although I don't necessarily feel as empty as they currently do, I know what they are going through.
punting
Some of the best experiences I've had in my life were during CamTrad: HP7 book release with Henry dressed as Hagrid, the HP5 movie release, punting, eating at the Greek place with Alexia while everyone else was at internet cafe, the Trailer of Life food truck (est. 1992) in the town square, Ramesh's grad school graduation march across Cambridge, taking care of Lowell, laughing at/with my beautiful roommate Atma, long walks with my mini-me Alison, Pizza Express with the most delicious tortellini I've ever had, London, Canterbury Cathedral, photojournalism projects, brain tag for Med and the Brain, walking on the Jesus College lawn, and so many more.
Alexia and I.
CamTrad was another time I knew joy. I was perpetually laughing at Lowell, Atma, Alison, Alexia, Virginia, and even Ramesh. This past 6 weeks was a good reminder of that.
I still talk with my CamTrad friends...some more than others. But there's a solid group of us that stay in touch. Not bad for 6 years of not being together! We've reunited in the strangest of places, but there's this CamTrad time warp that makes it seem as though only days have passed since the last time we've seen/spoken to each other. I suspect that the SMDEP students will also have this experience. They are lucky that many of them may end up going to school together in coming years.
Atma and I at Pizza Express.
Don't mind my head looking like it's photoshopped on...
Although many of my classmates have decided on professions other than medicine (that was my "major" during the program), the program shaped each of us immensely into the people we've become. Regardless of if these students end up becoming doctors or dentists, this will be a time period on which they always look fondly.
This 6 weeks was good for me. This 6 weeks gave me the renewed confidence that I am really called to medicine. I cannot thank the SMDEP students and TAs for reminding me of that. I'm anticipating my share of frustration and exhaustion from studying over the coming years, but I do believe that UNMC is where I'm meant to be for now.
To my students and co-workers: thank you for the joy and laughter of the past 6 weeks. Thank you for reminding me who I am. Thank you, a thousand times, thank you.
No CamTrad post could be complete without a picture of me in overalls.
Mini-me, Alison!
Couldn't be more proud of this girl these days!
Surprise attack from one of my favorite people in the world, Lowell.
So, if you know me at all (or have read any of my blogposts), you'll know that I'm big into comprehensive sex ed. If you didn't know this, please go read more of my blog, because it's definitely a big deal to me and I think you should know about it!
Well anyway, I have been spending quite a bit of time with my fellow board members thinking through the way we are educating our youth at the youth correctional facility here in Omaha for the "do juSTIce" project. I've drawn on my background in "Sunny D's" and "PHIVE-O" and my work with Advocates for Youth to make the presentations exciting, but factual. Accessible to students, yet informative.
I've also stumbled upon a few other resources that I think are good. One completely re-frames the way we talk about sex. I think it's a healthier way to think about sex as well. And of course, it comes from someone at a Ted Talk (nerd alert, anyone?). The other is a blog post from a high school English teacher about talking to her students about rape. It was interesting to read about their perceptions about what is and what isn't considered rape.
So here goes.
Al Vernacchio. You are genius. I hope to someday meet you.
The current predominant metaphor for sex is the game of baseball (pitcher, catcher, switch hitter, strike out, etc). This is heterosexist and competitive. There are always winners and losers in baseball and so with this metaphor, there are winners and losers in sex. It's not a healthy way to think about sexuality (not to mention it perpetuates the culture of rape that is rampant in the US).
And now enter the pizza.
Pizza is enjoyable. It can be consumed whenever and however you want pizza. We eat pizza with, not in opposition to, each other. It requires open lines of communication..."What type of pizza should we have tonight?" and "Do we want the usual tonight or something more adventurous?" There are so many types/toppings of pizza, that cause "difference" instead of "rightness and wrongness" of the pizza experience. Pizza is tailored to the people enjoying it. With pizza, no one "wins," but you move towards the question of satisfaction. It gives the people involved the power to say "no more" or "let's try something else next time."
This pizza metaphor is not heterosexist dominant nor is it competitive. It moves away from the language that perpetuates rape as the victims fault and that only one partner is in control of the situation (but still allows for one person to be "in charge" if that's the flavor of pizza you're going for). It's non-judgmental and open. Baseball is all commands. Under the pizza model, they are all questions that the people experiencing the pizza get to decide the answers to. My favorite quotation from the video is below...it's about implementing the pizza metaphor into our schools for comprehensive sexuality education.
We could create education that invites people to think about their own desires, to make deliberate decisions about what they want, to talk about it with their partners, and to ultimately look for, not some external outcome, but for what feels satisfying.
With the pizza metaphor, sex no longer is the dirty, nasty thing that you do behind closed doors with someone that you love very, very much. Pizza is satisfying.
And now a little poetry.
So Ms. Norman's lesson was about deconstructing an ambiguous poem. As it turns out, the students thought the poem was about rape (admittedly, I did to when I read it). This then sparked conversation about the Steubenville, OH rape case that got quite a bit of press over the past few months.
As it turns out, the students didn't really make the connection that the boys convicted of raping the girl were, in fact, rapists according to the law. They just understood that they were athletes that were going to lose their scholarships (discussing our culture's idol worship of athletics is for another post...) and they thought that was unfair. The action of the boys never once entered their minds--the media coverage of the case is more than partially to blame on this one. But it's not just the media's fault. Adolescent brains are actually not wired to critically evaluate information on this level, but instead, just repeat the news that they have heard. Sometimes it's hard to remember that those neural connections are not yet formed when we expect students to miraculously understand the weight of situations such as these without prompted discussion from an adult. Ms. Norman writes,
My students are still young enough, that mostly they just spout what they have learned, and they have learned that absent a no, the yes is implied....Standing in front of my classroom and stating that a woman's clothing choice is never permission to rape her should not be a radical act. But only a few heads nodded in agreement. Most were stunned, like this was a completely new thought.
Thankfully though, some young people get it.
"Ms. Norman, you mean a woman walking down the street naked is not her inviting sex? How will I know she wants to have sex?" A surprisingly bold voice came out of a girl in the back "You'll know when she says, you want to have sex?!"
Unfortunately, the statistics point towards these students "getting it" because they, or someone close to them, has been sexually assaulted. They had to learn the lesson the terrible way. But for others, this issue is never discussed. It's the elephant in the room (and I mean an astronomically large elephant).
We need to be teaching our young people--it really couldn't hurt if the adults learned it too--about what consent really means. Ms. Norman links to this blog about what the definitions of consent are.
Consent is not "well, he didn't say no."
Consent is not "I guess so."
Consent is not given from someone too drunk to stand.
Consent is not something wrung from someone after weeks of badgering.
Consent is not "giving in."
Consent is an enthusiastic, unequivocal yes.
Consent is asking at every step "Is this okay? Does this feel good? Can I touch you here?" and getting an unequivocally positive response before proceeding.
Consent is asking permission every, single time because consent given once is not consent given for all time.
We can't continue to assume that students understand what the definition of consent is and is not. The stats are astounding (and horrifying)--1 in 6 women and 1 in 33men are sexually assaulted each year in the US (http://www.rainn.org/get-information/statistics/sexual-assault-victims). That works out to be about 20 million Americans who have been the victims of sexual assault.
Ignoring the stats about STD transmission and unplanned pregnancies (for another blogpost, perhaps), it's obvious that the way we are currently talking and teaching about sex isn't healthy or effective. A paradigm shift is needed ASAP.
And we over at "do juSTIce" are trying to be part of that change. Let's actually educate and empower our youth to make healthy decisions for themselves. This conversation is not giving adolescents and young adults an automatic "go ahead" to having sex with anyone and everyone, but rather, a way to make an educated decision about their health and desires when they feel ready. As my good friend and role model Judy Sandeen says, "This is information for a lifetime."
Anyone want to go for some pizza?
The poetry and rape discussion is from Abby Norman's blog Accidental Devotion. The particular post I referenced can be found at the hyperlink in-text or here: http://accidentaldevotional.com/2013/03/19/the-day-i-taught-how-not-to-rape/. The quotation about consent can be found on the Faith and Feminism blog by Dianna Anderson. The particular post referenced is: http://diannaeanderson.net/blog/2064. (Admittedly, I have not yet read more of Dianna's blog, but I plan to in the coming weeks. My guess is that I'll find many interesting talking points from her writing.)
As of today, I have officially decided to go back to medical school this fall!
I was always hoping to go back, but I needed to wait and assess my health before making a final decision. It looks as though things are on the up-swing and so it seems that I will feel well enough to head back into the craziness.
Thank you to EVERYONE who has supported me throughout the past few months. There are too many of you to name individually, but know that you have blessed me beyond measure.
Y'all are awesome! And now a cartoon to celebrate my return to the gross anatomy lab:
This morning it is taking all that is within me to not head back to my bed and go to sleep, hoping that I'd wake up in a more peace-filled world. In my bed, I feel safe. In my bed, I haven't heard about the sad things that are happening in the world. In my bed, I am wrapped in warmth and am left to analyze the somewhat strange dream from which I just awoke. In my bed, I can claim blissful ignorance.
But I'm already out of bed and it seems that my boots are heavy. "My boots are heavy" is a phrase from the book "Extremely Loud and Incredibly Close" by Jonathan Safran Foer. It's a book (and later a movie) about a boy whose father dies in one of the World Trade Center towers on 9/11. He uses this phrase to describe how he feels when things are too much, when things in the world are too heavy, when he is overwrought with sad emotions.
Today, my boots are heavy.
My boots are heavy because Trayvon Martin is dead. Whether or not I agree with the jury's decision about George Zimmerman, sending a person to jail (or in this case, not sending him) does not bring justice to the family of the deceased.
My boots are heavy because a Florida mother is going to jail for 20 years for firing warning shots (that didn't injure anyone) at her abusive husband (against whom she already had a restraining order) to try and avoid another beating. Now, her child will be living with her abusive father, while her mother lives out her life in jail for trying to protect her. Somehow self-defense is okay for George Zimmerman, but not Marissa Alexander, though she didn't take a life.
My boots are heavy because of domestic violence and rape.
My boots are heavy because I know that people of all ages, colors and creeds are getting killed each day by violent means and for whatever reason our society doesn't acknowledge these people's lives. Whether it's from genocide, war, domestic abuse, gang violence, or other means, these deaths are silent because the media doesn't recognize these people as worthy. I lived in one of the roughest neighborhoods in Memphis, I know that there were lives lost daily that I never read about in the newspaper or heard about on tv. I still live in a fairly violent neighborhood and honestly a few weeks ago I wasn't sure whether I was hearing gunshots or the beginnings of the firework season, but I heard no mention of either in the news.
My boots are heavy because we still don't have stricter gun control laws, even after decades of mass shootings and daily occurrences of people getting killed by nature of another person holding a gun.
My boots are heavy because Texas women had tampons and maxi pads confiscated from them upon entering the capitol building (On a lighter note, how hilarious would it have been if people started using tampons as projectiles? Ladies, way to instill fear and stick it to the men since clearly they aren't allowing us to make choices about our own bodies these days), yet guns were still allowed in the building. Which is a more deadly weapon?
My boots are heavy because this country is still so divided on issues of race, gender, sexual orientation, and socioeconomic status.
My boots are heavy because two young people in my city are dead after hitting a brick wall at a high rate of speed, just a few blocks from where I live. The building, which I pass every single day, is utterly destroyed. Emergency personnel didn't even realize that the two boys involved in the accident were inside until hours later because the damage is so extensive.
My boots are heavy because of structural violence that keeps the poorest of the poor, poor in our country and beyond. This violence allows for healthcare disparities. This violence allows for the vast majority of the obesity problem in the United States to affect people of lower socioeconomic classes because healthy fruits and vegetables are much more expensive than the processed, non-nutritious "food" that is sold in stores and fast food restaurants. It's this violence that often makes it easy to assume that a person is sick because of non-compliance of medications or other prescribed therapies without thinking about other social factors that may have prevented that patient from following doctor's orders (cost of therapy, ability to find a ride/gas/money for the bus to return for follow-up appointments, cultural beliefs about Western medicine, language/cultural barriers to receiving instructions about therapy, etc, etc).
My boots are heavy because I'm reading about the Hmong (pronounced "Mong") people and the Quiet War. The Quiet War was a covert CIA operation that continued to fight the Vietnam War after we officially pulled out of Vietnam. Except that we were no longer using American lives in the war. We found an ethnic minority to fight for us. And fight they did. They lost their lives at a rate about ten times as frequently as Americans did during Vietnam. And they were cheaper too. An undersecretary of the state named U. Alexis Johnson once said "I personally feel that although the way the operation [in Laos] has been run is unorthodox, unprecedented, in many ways I think it is something of which we can be proud as Americans. It has involved virtually no American casualties. What we are getting for our money is, to use the old phrase, very cost-effective" (The Spirit Catches You and You Fall Down, 128). Being proud to be cost-effective? Seriously?! Losing a life, no matter whether it's an American life or not, should not be considered more or less cost effective. Just thinking about war makes me sick to my stomach. And I know that the US is not the only world power to do this. The Romans and Greeks were doing it in biblical times and world powers have taken note ever since. But it still makes me sad that this is how we choose to live out our lives on earth.
My boots are heavy because of these reasons and because of so many more. We are a broken people and sometimes it's just too much for me to handle. Today I am not going to fake optimism. Today is not a "fake it 'til you make it" day. Today is a day to let my boots be heavy. To grieve the sadness of the world. Today is a reminder for all of the other days about why I want to be a doctor, about why I want to change the ways of the world, about why I wish this world were a less violent place, and about why I truly hope that God and Heaven are real.
The part of me that thinks about marketing and PR (it's a very small part of me, but it's there nonetheless), always cringes when I make a post without at least one picture. But sometimes I just don't know what sort of pictures would be appropriate for the topic I'm discussing in a blogpost, so I don't make the effort to find any pictures. But then I feel guilty.
So this post is dedicated to pictures. Nerdy science pictures and other miscellaneous things that I find cool. Without further ado...
This is your body. With all of the arteries and arterioles filled with red latex.
You've got a lot of nerve...
Oh. My. God. Oh my god. Ohmygod, ohmygod, ohmygod. This is such an awesome picture!! It's all of the nerves (well not the teeny tiny minuscule ones that reach the periphery) of the body. The nervous system is so darn cool--when it works...when it doesn't, it's terrible and awful.
Well anyway, that's enough nerding out.
These would be SO cool to own!! Maybe I'm not quite done nerding out about the brain...
This kitty's ADH is all sorts of inhibited.
This is nerdy in a different way. But seriously, how hard would this be?!?
TA domination volleyball team. Unfortunately we did not dominate with the playing of the sand volleyball.
The SMDEP TAs and RAs enjoying the zoo!
And finally...
Hahahahaha
Hope y'all have a good week! More nerdiness to come in the future...
So the SMDEP students are required to read two books while they are here in Omaha. The first is "The Immortal Life of Henrietta Lacks"--if you haven't read this and you have any interest in ethics, you need to stop what you're doing and read it now.
Well anyway, as far as the other book goes, the students are split into two groups and each group is assigned a book. The two books are "The Scalpel and the Silver Bear: The first Navajo woman surgeon combines Western medicine and traditional healing" and "The Spirit Catches You and You Fall Down: A Hmong child, her American doctors and the collision of two cultures."
I have yet to read "The Spirit Catches You and You Fall Down," but this post is mostly about the first book and my philosophy of treating patients.
If you've read many of my previous posts, you'll know that I believe that wellness comes from working towards being healthy in mind, body and spirit. This was a philosophy I picked up from Church Health Center in Memphis, TN. (As a side note: I wrote my senior thesis paper for Religion on the "Theology of Illness," which is really interesting in hindsight when I know now that I obviously spent much of my time this year being ill and is pertinent to this particular blogpost...sometimes we are drawn to learn about certain topics without really knowing why and then life throws us a curveball).
So back to this book...
It's really interesting that ancient cultures were so interested in treating people as a product of the biopsychosocial environment--aka treating their mind, body and spirit--since we have somehow lost that in our industrialization and perfecting of Western medicine. I'm not saying they got it all right and there's no merit in medicine these days. In biblical times, the though was that disease and illness were due to sins of the patient or sins of their parents. But they got it right in the sense that we need to treat a patient as a whole person.
Where did we go wrong if we are just now learning this in our culture of medicine? These are not new ideas, yet our society, not to mention healthcare professionals as an overarching generalization, are still hesitant to talk about mental health. Or spiritual health for that matter.
The Navajo people are not only concerned with a person as a whole, but the person within their environment (both physical and communal environment). There was one example in the book about some sort of disease that was spreading through the Navajo people a few years back. The US media picked it up and blew it completely out of proportion. The Navajo medicine man said that the illness was due to the increased rain that year. Obviously for Western medicine, that didn't make any sense.
Turns out, the medicine man was right. The rains caused an increase in the rodent population. This disease that was ransacking the Navajo people was due to infected rat feces. The rain really was the issue. Luckily the CDC listened to the medicine man eventually and figured out an anecdote to the poison. Lori Arviso Alvord, MD (the author of the book and the first female Navajo surgeon) writes,
"One Native American write and healer, Brooke Medicine Eagle, points out that the word heal comes from the same root as whole and holiness. For Navajos, wholeness and holiness are the same thing. The system of life is one interconnected whole. Everything is related, according to Navajo beliefs--its an organic and integrated way of looking at the world. The causes and cures for illness are woven into everything else." (Alvord, 113)
Dr. Alvord discusses how this Navajo belief has changed her practice of medicine. She no longer allows anger or harsh words in her OR when patients are under--there's even some evidence in Western medicine that supports this...we really aren't sure how much patients can understand subconsciously when they are under anesthesia and health outcomes are connected with the amount of stress/distress or positivity a patient has. Unless it's an emergent situation and the patient is unable to decide for themselves, she refuses to proceed with surgery if a patient and their family aren't completely comfortable with the procedure. This is a harder problem than one might imagine in our Western culture, but Navajo people have plenty of distrust towards White people and their medicine because of the way our nation has treated them in the past. Navajo medicine is slower. It uses the family unit as a support structure.
How would our patient outcomes change if we used slower medicine? If we incorporated the social aspect of a person's illness more into their treatment?
Don't get me wrong, medicine is moving this way. It's very prominent in the treatment of chronic and mental health illnesses. But it's not everywhere yet. It's also becoming more prevalent in large institutions (such as UNMC) when the patient's financial status is considered before ordering tests and procedures. [I could write books about how a person's economic situation affects their health outcomes, so I'm not going to delve into that here...one book to read if you're interested on the topic is "Infections and Inequalities: the modern plagues" by Paul Farmer (he's one of the co-founders of Partners in Health!)]
The Navajo people aren't the only culture that do this. Ayurvedic medicine from India is all about balance. Traditional Chinese medicine includes acupuncture, massage, herbal medicine, exercise and diet (whoa...exercise and diet are included in medicine...what a novel concept. Way to be about a billion years behind the times Western medicine...). And there are more examples. We seriously need to catch up with the times!
These medical practices can often (not always) diagnose the problem without imaging. Without even taking blood tests. If we have the most sophisticated form of medicine and we often can't diagnose things without these tools, what does that say about our powers of observation? About our reliance on technology?
We do have a great system of medicine. We just need to smooth out its rough edges. That's what reform is all about.
It was an excellent read about living between two different cultures. I can relate in many ways, although obviously I'm not Navajo (I do have some Native American heritage though!) I highly suggest you read it if you're interested in a more well rounded approach to medicine. I think my favorite quote from the book is this:
"Knowing and treating my patients was a very profound privilege, I realized, and as a surgeon I had license to travel to a country no other person can visit--to the inside of another person's body, a sacred and holy place. To perform surgery is to move in a place where spirits are. It is a place one should not enter, if they cannot enter with hózhó (beauty, harmony-a concept of living in harmony and balance)."
It is a privilege, whether or not we are surgeons and get to see the inside of a patient, to be invited into the most intimate and scary moments of another person's life. Clergy also get to be part of these sacred moments. We HAVE to remember how sacred and special these moments are when we are with patients and treat them as such!
