As a volunteer Referral Coordinator at a local community health clinic, I was reminded daily that one does not need to travel far to find disparities in healthcare. Without the help of the clinic, many homeless, minority and uninsured clients would be forced to choose between basic necessities and healthcare; a choice no one should have to make.
I will never forget my conversation with a homeless woman who refused to schedule a necessary radiology exam. She could not bear the thought of accruing additional medical expenses. The woman declined my efforts to connect her with financial resources stating she was more afraid of debt than death. It is her story and countless others like it that fuel my passion to work as a Physician Assistant (PA) with marginalized populations in rural and underserved communities.
I was asked today what it was like to be a graduate student. The actual question was: “I could never go back to school. I’m too old. How do you do it all and still keep a smile on your face?”
Actually, if they could see the jelly of uncertainty, the butterflies of “Just what have I gotten myself into” under the skin, they would wonder that I could ambulate and make any kind of sense come out my mouth.
But in all honesty, despite the struggle I and every other full-time student goes through, I would not miss the opportunities that this experience is giving me. I bite my nails until the final grades come down; I try to balance family, work and school; I’m in a perpetual state of “am I really getting it?” My job has increased hours recently beyond my normal full-time; I carry a full load as a graduate student; my grandchildren want time with Nana; my children, though grown and parents themselves crave my time, my compassion and my advice; co-workers who suddenly change attitude after 18 months and a husband who requires some snuggle time. I have projects on my ToDo list. Yikes! How do I even find time to breathe?
During my first year of medical school, I looked forward to writing blog posts. Back then, everything was new so I had a lot to say about what I was experiencing—the clinical exposure, the white coats, the late hours in the library, even the studying itself. The amount of information was overwhelming and the hours slowly melted from day to night, but being a medical student was a new adventure I was just beginning, and I enjoyed it immensely. As a second year medical student, I am still very happy. However, the studying, in my mind, has changed. It’s not new anymore, and as a result the volume of material is starting to feel laborious, the hours a little long, my back a little sore.
The transition from winter to spring as a second year medical student is not a cup of tea. The USMLE Step 1 board exam is fast approaching (we take it in June), so while most people are getting ready to grab a blanket and Frisbee and hit the park, we’re scoping out which local libraries stay open the latest. Just a couple of weeks ago, we took our “mock boards,” pretty much your standard practice test in order to find out how we’d score if we were to take the Step 1 exam right now. The experience helps to clarify the amount of work that will be necessary to successfully prepare for this single 8-hour exam, and while certainly eye opening and even a little scary, it actually feels exciting, too.
I have been a student for many years. First in grade school, then high school, the GED program, trade school and then college. I will always be a student; I will never stop learning. But as a student, sometimes I need help.
As a nursing student, there are practicums and clinicals that take place on campus and in other locales. There are on-site proctors, clinical instructors and a myriad of site-specific persons that are dedicated to helping the student nurse learn.
Master of Nursing students have practicums. Depending on the discipline, there could be simulations, clinicals, and residencies. Clinical instructors, proctors and lead staff involved in the clinical or practicum are standard fare as well. Most of the people involved with students are high caliber who bring a personal touch, personal experience and professional passion to enhance the experience for the student.
Almost four years ago, we embarked on an adventure that we now know as medical school. Each of us, I’m sure, had thoughts and ideas of what the road to becoming a physician might be like. I was often wrong and frequently surprised!
The first two years of medical school were academically challenging as we began to understand the complexities of the human body. In stark contrast to this rigorous experience, we enjoyed numerous parties, consumed delicious Portland food and drink, and explored beautiful Oregon.
It has been a pleasure to watch my classmates succeed in their respective interests, present research they toiled over, become leaders, find loving partners, have children, overcome hardships, celebrate their successes, and, most of all, learn to be humanistic physicians.
For two harrowing weeks, I experienced the health care system from the other side. My grandmother, visiting from India, had a fall that turned into an emergency room visit that turned into an electrolyte imbalance that turned into an idiopathic neurological problem that turned into a coma that turned into her unexpected death. Less than two weeks after what seemed like a routine fall, she died.
The ten days my grandmother spent in the hospital confused all of us. One night, she got two CT scans and an MRI (she was under-insured and no one gave us a straight answer about billing). She saw a doctor roughly every twelve hours, and we relied mostly on her nurses for information about her health and schedule. We got excited about an occupational therapist who never showed up. A young, probably exhausted resident ordered an extensive procedure without explaining it, her attending canceled it, the specialist ordered it again, and finally, it was not performed. We had to remind her health care teams to change her, move her, give her medications, and even take the necessary labs. My father and I ensured that one of us was always in the room, but we were both moved almost to tears on several occasions by the difficult of receiving not only care but also basic information about her status.
I have been thinking for awhile about what to write for my first blog. As I was thinking about what to write a word came to mind: diversity. I started to think about how I might be diverse from others here at OHSU and what that brings to our collective educational experience.
Clearly I’ve circled the sun a few more times than my class colleagues (more than a few professors as well). I’ve had some experiences working and visiting overseas but so have some of my colleagues. I am changing careers but so are some of my colleagues. I’ve earned a masters degree in a math intensive field but so have some of my colleagues.
And now we wait.
After spending roughly 2,000 hours in a classroom, 4,000 hours in clinics and hospitals and thousands more studying or taking tests, my classmates and I are ready to graduate from medical school. We are moving on to residency, the yearslong apprenticeship that teaches newly minted MDs to apply many of the concepts we’ve struggled for years to learn, to forget others and to subvert a few. We’re ready to take charge of our own patients in a real hospital.
We just have no idea which hospital, in which state. That we learn on March 21. On that day, at the same hour (9 a.m. Pacific), every graduating medical student learns where he or she will live and work for the next three to seven years.
The process is called The Match. It’s mildly nerve-wracking.
It’s a first class problem to have so many interesting/inspiring topics to talk about that you are unsure of which one to write about in your blog…but that’s where I’m at lately. I’m just about done with my third term of five in this program and I’m chaotically busy but loving every minute. Do I choose to write about the issue I researched that is so near and dear to my heart? Do I write about how I’m beginning to think like a nurse and finally feel like I will be ready to be a new graduate nurse in a few months? Do I write about the very impressive nurses and faculty I’ve had the opportunity to work with and how they have inspired me to potentially teach students later in my career? You can understand my dilemma.
What I narrowed it down to is really the thing I’m loving most, and that is my rotation in pediatrics. I came to nursing school knowing it is what I wanted to do. But getting to do it- well it’s brought me more joy than I thought possible, already.
Not too long ago, I was faced with a choice; do I take undergraduate organic chemistry with the “easy” professor or the professor with a reputation for being incredibly difficult and robbing you of all free time?
I chose the latter. My peers with the easier professor excelled with lesser efforts, while I toiled away at Grignard reaction mechanisms in the recesses of the library. Though I did well, the course was so difficult, it redefined what I thought I could handle.
Recently, we completed one of the most difficult courses in medical school – biochemistry. Coming from an engineering background, the level of detail and intricacy of biochemistry was daunting; the mastery biochemistry demanded set a new precedent.