A note to my new classmates

Classmates,

We are finishing our first day of our medical school career. It's been a long day. Two and a half hours of anatomy lab, an hour of embryo lecture, 2 hours of clinical skills introduction to H&P and 2 hours of small groups...and inevitably you spent at least 2 more hours in the lab because you didn't get your dissection done in the first shot. Of course you probably should have wedged a few hours of studying in there too. I don't know about you, but I'm exhausted. And a little overwhelmed. And it's only day one. Seven more class days until we have an exam (yikes!).

But we can do it!

If you didn't know already, I have already done part of this year and I have a request for you over the next 10 weeks. Actually, the favor doesn't just end after the next 10 weeks, it applies for the next 30 years as well.

Don't let medicine make you hard. You are a human with feelings. Use those to your advantage. They will make you a good clinician. I actually wrote about this a little bit last year with the help of someone WAY smarter than I. You should read this post first, called Letter to a Future Doctor.

I read a book this summer with a similar sentiment that I wanted to share...yes, this goes for you too, my old M2 buddies! Here's a short excerpt from The Spirit Catches You and You Fall Down by Anne Fadiman.

The desensitization starts on the very first day of medical school, when each student is given a scalpel with which to penetrate his or her cadaver: "the ideal patient," as it's nicknamed, since it can't be killed, never complains, and never sues. The first cut is always difficult. Three months later, the students are chucking pieces of excised human fat into a garbage can as nonchalantly as if they were steak trimmings. The emotional skin-thickening is necessary--or so goes the conventional wisdom--because without it, doctors would be overwhelmed by their chronic exposure to suffering and despair. (274-275)

You are already getting more proficient at dissection. Don't let your schooling make you desensitized and machine-like. I'm sure today was a bit rough for a few of you who were just seeing your very first cadaver or possibly having your very first experience with someone who has died. It is overwhelming to think about all of the pain and hurt that our patients experience each day. But you do not need to be a hard person to survive in this field. You can be a caring individual who is also quite knowledgeable about all things medicine related (except biochem...let's be real. No one knows what's going on there).

Empathy will be one of the greatest skills you learn over the next four years, if you haven't already mastered it. It's one of the PEARLS that you'll learn about in a few weeks during ICE lecture. Use it to your advantage. One of the awesome things about medicine is that we can treat disease and care for illness while simultaneously having reverence for life and the person living it.

Just this morning we learned about the first 28 days of life during embryo lecture. The beginning of life is seriously incredible! If you don't think so yet, just wait until we learn about how many things can go wrong at every. single. step. of development. Life truly is a miraculous event!

For the next four years you are a medical student, but you are also a human. Don't forget that side of you amongst all of the books. As a person who frequently uses the healthcare system, I prefer well-rounded clinicians that I can talk to and that show empathy, but may have to look up small details about obscure complications more than I like someone who has all of the anastomoses of every artery as well as the 5 billion biochem pathways memorized, but can't hold a conversation with me.

Just remember, we're hoping to treat people, not machines. Good luck with the first exam. You survived the first day! Just a few hundred to go until you're called Doctor.

Much love,
-j

Ancient Medicine

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!