Fertile ground for deep roots

Why am I here? I came to OHSU, those many moons ago, because I wanted to be a scientist. I was taught since childhood that “knowledge is the wings wherewith we fly to heaven,” and Science was my passion (that was Shakespeare, by the way). To be a scientist, I needed a Ph.D., and I thought OHSU would be the best place to complete a Ph.D. I never intended to become a student leader, yet here I am. In my first year, I was part of the group of ladies who started Women in Science. In my second year, I acted as representative to the All-Hill Student Council. In my third year, I was elected Graduate Student Organization (GSO) treasurer, my fourth year vice president, my fifth year president, and let’s stop counting and just say I am still president (I am planning on being done July 2017). I have acted as student chair to Research Week, I helped plan the first Women in Academic Medicine leadership conference, and I have seen the GSO renaissance. So you see, I have been around OHSU a while now. I have seen ideas about graduate education proposed, some come to fruition and some cast aside.

Throughout this calendar year, there have been fact-finding discussions on campus, many of led by the Creative IDEAS committee, collecting ideas about graduate education and the School of Medicine. The university is in a unique position to create a future graduate program apart from others, one informed by faculty and current graduate students who are facing the scientific, economic, and job realities of today. Synthesizing the goals and structure of the Graduate Program of Tomorrow began with forums hosted by the Creative IDEAS committee where students and faculty were encouraged to voice their opinions on what works, what doesn’t work, what should change and what shouldn’t change. It was an interesting exercise for me personally, because it stimulated a lot of reflection and introspection. There are a lot of things the School of Medicine Graduate Studies does well and I have always found faculty receptive to student issues. There are a lot of things the OHSU research community does well. As a prospective alumni, I have a vested interest in the continued success of graduate education here. I want it to continue to train successful scientists, with a foot firmly planted on the side of innovation.

What is the intent of graduate training? Introspection is an interesting phenomenon, and I have had my fair share of fantastic, life altering events and soul-crushing experiences in graduate school. Someone once told me that to pursue a Ph.D. is to resign oneself to semi-annual existential life crises (or maybe I read it in a comic…?).  Experiments work, experiments don’t work. It’s your fault, it’s not your fault. Your future is in your control, you have no control whatsoever. You work too much, you work too little. You want to finish, there is no end in sight. Your mentor wants you out, your mentor won’t let you go. Your mentor is a bully, you are too emotional. But ultimately these bipolar seesaws are OK because you will finish, you will be successful and you will go on to have a life. But then you hear that one story about that one student who did not graduate that one year and, in a panic stricken moment, you conclude that could be you.

I was once told by a faculty member that, in graduate school, I should be eating, sleeping and breathing SCIENCE every day, every hour. On the bus I should be reading articles. With my friends I should be talking nothing but science. While being told this prescription, I imagined a proverbial pilgrim from the Middle Ages, clothed in brown sac-cloth, crawling barefoot along the dusty path to some tottered monastery having been told it housed an ancient relic, let’s say the thumb, of a saint and that if touched would cure his blindness. While telling me to forget TV, forget movies, forget books, forget my friends and family, all I kept hearing was forget yourself. Is this what graduate education meant – that I was required to forfeit myself? Is this what Science demands – that it exists in a bubble devoid of life? And what about the University – surely it has responsibilities to me, the student?

What is a Ph.D.? A quick Wikipedia search tells me the modern iteration of the Ph.D. was first defined in Germany in the early 19th century, but its roots go much, much deeper than the 1800s. They trace back to the early Christian church, where the word Doctor was used to describe the apostles and early church fathers who taught and interpreted the Bible. The Latin word doctor means, simply, teacher, and thus the ancient doctors were religious leaders charged with saving people’s souls. According to Wikipedia, it took a papal act to allow the first non-sacred doctoral degree to be awarded in Paris somewhere between 1150-1200. With the Age of Enlightenment starting in the early 1700’s, and the emphasis on reason as the primary source of authority and legitimacy, scientific progress was reborn. Thus, the Ph.D. of today is a child of reason, of liberty, and of science. To me, a Ph.D. means I have furthered human knowledge. And while a Ph.D. says I have reached the level of teacher, it does not mean I will teach.  But the Ph.D. is the final product of the journey, not the journey itself.

How should Ph.D. scientists be trained? Einstein once said that most people think “it is intellect which makes a great scientist. They are wrong: it is character.” He said he never taught his “pupils, [he] only attempt[ed] to provide the conditions in which they can learn.” Conditions. Any human knows that living conditions directly affect mood, performance, and health. Any lab dweller will tell you tools and conditions are important, be it incubator temperatures, humidity, light cycles, media, pipette tips, cage sizes, or antibodies. If OHSU wishes to produce Ph.D. scientists who rigorously discover and innovate, then it needs to mandate a training environment that supports, hones, directs, and challenges the candidate. Supports does not mean coddle or micromanage. Hones does not mean break down or limit. Directs does not mean rebuild or change. And challenges does not mean prevent, impose, or ostracize. I did my undergrad at Scripps College and on the wall by Honnold Gate is carved a quote from Ellen Browning Scripps, reminding the college that its paramount obligation “is to develop in its students the ability to think clearly and independently, and the ability to live confidently, courageously, and hopefully.”  Fifty years ago, to go to graduate school in research science meant you were going to become a scientist. It still does. What has changed is not the product, but rather the market that buys the product. The University has an obligation to recognize the changing times and adjust its training accordingly.

These ruminations are not to say that our training is necessarily lacking. I have taken my fair share of required classes, elective classes, classes I did not have to take but that were necessary for my research, and totally pointless classes. Some faculty are fantastic educators (I could list 10 here right now off the top of my head), some faculty are not. Here’s the thing, the bottom line: I did not come here to take classes, I came to become a scientist. I have yet to see data showing a direct positive relationship between hours spent in class and successful scientific endeavor.

Who are the scientists of the future? We all recognize that the world is being populated by Ph.D.’s in research science who are using their skill sets in environments apart from the lab.  The School of Medicine has already started to recognize this and The Career & Professional Development Center has done a fantastic job in helping students seeking both traditional and non-traditional jobs post-graduation. But this November I went to my very first Society for Neuroscience meeting. On the first night of the conference, I found myself sitting at a round table with my mentor (science father), his mentor (my science grandfather) and his wife (my science grandmother), and a PI who has been trained in the lab where my mentor did his post-doc (my science step-uncle?), and two other students. Thirty years of science, of stories about the people of science, the evolution of science, the future of science, sat at this table. I imagined we three students not continuing on, of slowly backing away from the table. Would these moments end? How will the culture evolve? Science is more than the bench, but the bench propels it forward in a wonderful symbiotic relationship. Graduate education should aid this evolution, facilitate it, and it allow it to grow.

To be good is to be great

Wychus Creek - 4I feel like I have been sucker-punched. I am sitting in my patient’s living room on the morning of November 9, trying to listen to him describe his low back pain, but all I can think about are the results of yesterday’s election.

During my family medicine rotation at OHSU’s Rural Campus in Klamath Falls I had the opportunity to be involved with the I-CAN project. This project brings together students from across OHSU’s professional programs to provide inter-professional care coordination to the most vulnerable of patients. The patients who chose to participate all have complicated medical histories compounded with huge social problems. We helped them navigate the healthcare system, expanded their health literacy, and acted as their advocate with other healthcare professionals. Our main job, though, was to sit and listen to people who feel they have been systematically pushed aside.

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Island at heart

OHSU StudentSpeak is pleased to present this guest post from Kelsi Chan, medical student in the Class of 2019. She and several OHSU colleagues organized OHSU’s first-ever lu’au in November 2016.

ohsu_luau_2016-030-lI am no stranger to living far away from home. Hawai’i is at least five hours away from land in every direction. As a young girl I often traveled to the states for various soccer tournaments, but I always had my people by my side, whether in the form of parents, family, friends or teammates. Trips were always fun because it felt like I was in a new place experiencing new things, but I always, always was in the comfort of being with people who knew me and understood me.

When I was a junior in high school, a Massachusetts recruiter saw me play in a tournament held in San Diego, California. It was my ticket to four years of higher education. When the day came for me to leave to start my freshman year, like many previous times before, I packed my bags and said good bye to Hawai’i, only this time, I would be thirteen hours away and for many months at a time. By then, I had seen snow. I had built a snowman. But I never knew what living through a Boston winter was like. It took a few months to get my footing, quite literally. I eventually joined the Hawai’i Club and immediately felt at home. I was a part of the school lu’au every year and loved sharing my culture with my non-Hawaiian classmates. Even though I was the furthest I’d ever been from that little rock in the middle of the Pacific, I found a home. I found the people who understood me and knew me without having to explain anything about myself.

Fast forward ten years, I am now a second year, soon-to-be third year medical student at OHSU. I am not ashamed to say this wasn’t my first application to medical school. After taking the years off between applications to make myself a more competitive applicant, I was finally able to get into several medical schools. I ended up choosing OHSU for many reasons, one of the most important being it was the closest to home besides the medical school in Hawai’i. At the time, I wasn’t quite ready to go home for good and OHSU as an institution was too renowned to pass up. When I got here for my first day, I was shocked to find in my class of approximately 140 students, I was the lone Native Hawaiian. At a school in Oregon.

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Not all information is created equal

David-Edwards-bannerAs I mentioned in a previous post, I’ve been a graduate student for four years, now starting my fifth. And as a result, I’ve reached a kind of informal, gray-haired milestone where I want to share everything I’ve learned with the younger generation. So gather ‘round, children, because I’m about to impart some “wisdom” (that last word notably accompanied by quotation marks).

I was recently asked the following: What’s the single greatest piece of advice you wish you had known when you started graduate school? It’s a pretty standard question—the “where do you see yourself in five years” of career reflection—but one I didn’t immediately know how to answer.

After thinking about it, I would say that the biggest thing I’ve learned is this: Not all information is created equal. It’s a simple realization, I think, but one that has played a significant role in shaping both my current trajectory through graduate school and my future career ambitions.

I should point out that the statement “not all information is created equal” is inherently prejudicial, asserting that some information is worth more than others. And I know it sounds antithetical when spoken at an institution of higher learning. We should value all information equally, right? When it comes to education, shouldn’t we take the Vegas buffet approach—to loosen our belts and scoop as much onto our plates as possible?

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The fourth trimester

Ally Gallagher, M.D. Class of 2020

Ally Gallagher, M.D. Class of 2020

After 40 plus weeks of laborious (pun intended) and miraculous work, a baby is born into the world. It is a long-awaited joyous day. For months, friends and family help prepare for the new addition. The nursery is arranged, clothes laundered, stuffed animals lined in a row, all ready for this little person to arrive. But after delivery, it is ironically the babies themselves who are not so ready for this new beginning.

Lo and behold, “the fourth trimester:” a name assigned to the first 13 weeks of a baby’s life. It is a period of great change and rapid development as a newborn adjusts to life outside the womb. Before birth, newborns have known a world very different than ours. One that is dark, warm and filled with muffled noise. One in which they are constantly held, fed and coddled. The transition earth-side is wrought with frightful stimuli. The lights, the sounds, the air! Newborns are forced to adapt to uncertainty and cope with insecurity as they learn to thrive in a new world.

As I began medical school with a three-week-old daughter (crazy, I know!), the irony was not lost on me that just as she was adapting to a new world, so was I. The white coat ceremony was a birth of sorts. Just as my daughter Sadie’s clothes hung in anticipation in her closet, our pressed coats waited for us as first years. On the day of our ceremony, we were welcomed into the world of medicine by OHSU faculty and alumni. Our families and friends celebrated and applauded this monumental milestone. While it was an exciting day, it also marked the start of a frankly frightening transition.

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When human health affects environmental health

OHSU StudentSpeak is pleased to present this guest post by M.S. student Brittany Cummings, a 2016–17 Robert E. Malouf Fellow funded by Oregon Sea Grant. She is pursuing a master’s in environmental science and engineering under the guidance of Tawnya Peterson, Ph.D., assistant professor, and Joseph Needoba, Ph.D., associate professor, both with the Institute of Environmental Health. The article originally appeared in Confluence, an Oregon Sea Grant publication.

Oregon Sea Grant scholar Brittany  Cummings samples Columbia River water to determine metformin levels. (Photo by Claudia Tausz, OHSU)

Oregon Sea Grant scholar Brittany Cummings samples Columbia River water to determine metformin levels. (Photo by Claudia Tausz, OHSU)

I am an Oregon Sea Grant-funded scholar who has been given the wonderful opportunity to attend the Institute of Environmental Health at OHSU in Portland.

Marine science at a school of medicine? That’s right! My research is based on the idea that our environment becomes unhealthy when its inhabitants are unhealthy. Under this guiding principle, my colleagues and I are trying to determine the concentration of the antidiabetic drug metformin and its main breakdown product, guanylurea, in the surface water and sewage effluent of the lower Columbia River basin. Since spring 2016, we have been collecting water samples at various points along the lower Columbia. We have also enlisted the help of volunteers from Columbia Riverkeeper to collect additional samples.

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What does my day-to-day job in a hospital teach me?

Suchi blog pic 350x211As I turned the last page of my text book “Your brain at work” by David Rock, I settled into my litany of thoughts of how my daily work at a hospital impacts my decisions. The book discusses how we can efficiently train our pre-frontal cortex in the brain to achieve maximum efficiency at work. I asked myself “How different would my career choices have been if I were not working in a hospital system like OHSU?” OHSU is academic health care system which has a hospital, a dedicated children’s hospital, research institutes, medical school, nursing school and dentistry school and a joint public health school (with Portland State University). It is a complex system which embodies different disciplines of health care.

My career at OHSU started with working in the research lab. While working as a researcher, I always sensed the huge gap of information exchange between the researchers and patients. Even if the field of medicine has been progressing rapidly, the patients are still not up-to-date with the ongoing research. I wanted to fill that gap. As I work in a hospital, I come across patients all the time and my mind always asks, “Do these people know about the latest cool technology in medicine? Would a better knowledge of the changing medicine make them hopeful for a cure? Will that experience be positive?” These activities provoked the biological seat of my brain, the pre-frontal cortex and I took the decision that I wanted to pursue a career where I could communicate about the latest findings of medicine to the community. I enrolled in the MBA program at OHSU and am currently working on how to make patient lives better. Delving deep, I think working in a hospital trains our pre-frontal cortex better and as all good things come in small packages, training the pre-frontal cortex is primary to achieving self control, developing compassion, better problem-solving and developing empathy.

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Little joys

Kayly Lembke“One can have, it turns out, an affection for the war years.” – Steve Martin

Listicles are often berated as lazy, short, psuedo-pop articles not worth the time it takes to spell check listicle. Short? Yes. Pop? Sure. Lazy? But effective. I am, by nature, a list maker. As this is my fifth fall at OHSU, and fall is my favorite season, I have naturally been reflecting back on my time here as a Ph.D. student. For all the hard times in graduate school, for all the times the world was ending, or inspiration was gone, or hope had faded, there are some times to which I will always return with fondness, and some memories I shall always cherish. Here is a list of those memories, those little joys.

Things I love about graduate school:

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When seeing becomes a different kind of believing

There is something wonderful when you truly see a person for the first time. I’m not talking about “Hey, we ran into each other and now we’re friends,” but rather I mean the moment when you thought you knew someone or you had an idea about them and you realize you never really knew them at all.

Over the last six months in my Population Health course and while working at the Maybelle Center, this has been my daily experience in Old Town, a community in Portland’s historic Chinatown that is mainly filled with individuals who are marginally housed or living outside. The stark contrast between hospital and home is odd. Getting to know a patient, or even a colleague on an inpatient acute care unit, compared to getting to know them in the community is incredibly polarizing. In the community there is a type of vulnerability and unabashed honesty in seeing the lives of those we care for in the place that is their home.

During the first year and a half of my nursing education the majority of the work has been preparation. Prep the drug list for your patient tomorrow, prep the discharge planning, prep a care plan, prep what you think the priorities of care are (which you are usually wrong), read their notes from three years back in Epic (that probably no one has looked at for quite some time), prep your hand off, prep on the disease process, prep, prep, prep. Is this important? Definitely. Does this fully prepare you to see the patient in front of you and give them the care that they need? Not even close.

Last spring term, my partner and I were placed at the Maybelle Center for Community to care for and learn from individuals who were considered marginally housed. We sat in the community room after being introduced to our first client and exchanged maybe twenty words total, feeling as if we were probably the last people in the world he wanted to be drinking his coffee with. 

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The times, they are a-changin': When scientific research isn’t enough

David-Edwards-bannerI recently marked my four-year anniversary of starting graduate school. When I reflect on the years that I’ve spent here, embedded in the practice of science like a mosquito in amber, I’m reminded of a line from that Bob Dylan song: “Then you better start swimmin’ / Or you’ll sink like a stone / For the times they are a-changin’.”

The times are a-changin’ indeed. The biggest thing I’ve learned from my experience here is that science is everything. Science offers us students—most of us overeager, street-dumb twenty-somethings—an unparalleled opportunity to peek behind the curtain of existence. Science allows us to dive deeply into truth-with-a-capital-T and retrieve information to help save the lives of those around us. It’s amazing…and it’s why I entered graduate school in the first place.

But science isn’t exclusively good. Science, the exhausting, elbow-greasy practice of it, is also a blackened altar onto which we sacrifice so much of our lives and our freedom. Science is a jealous god, one who hears the cries of its greatest worshippers and sometimes, more often than we’d like to admit, capriciously holds back its favor and love. We become a wandering people looking to the sky for manna and seeing only thunderclouds forming on the horizon.

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Ever wondered what life is like as a student at OHSU? What does it take to become a researcher? Just how gross is gross anatomy? Welcome to the blog that answers these – and many other – questions. It’s students writing first-hand about their commitment to careers in science and health care. It’s honest about the challenges as well as the joys. It’s not always pretty. But it is our story. Thank you for sharing it with us. And please, let us know what you think.

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