Are we there yet?

Lauren-LieblingWhen I first started at OHSU I had a certain impression of how the next 26 months of my life would unfold. Like so many of my peers, it had been a while since I had experienced a full-time classroom immersion. I anticipated that the didactic year of the program would be the more challenging of the two years that lay ahead. I had visions of few hours of sleep, little free time, high levels of anxiety and a sigh of relief come June of 2016 when I would become a clinical year student. I expected the clinical phase to be challenging in its own ways, but also somewhat comforting and reminiscent of my life before I enrolled at OHSU.

I know that I am not alone with this impression; in the early weeks of school as my cohort and I adjusted to our new roles, I often heard rumblings intended as encouragement, “We just have to make it to June… we just have to make it to clinical year.” Many spoke as if in the moment that we were cut loose from the classroom, school would suddenly feel easier. As the day that I transition to clinical year draws nearer, I must admit, my sentiment towards the didactic experience and the unknown chapter ahead have shifted.  

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At home on the range

StudentSpeak is pleased to present a guest post by Karli Erickson. Karli’s husband, Anfin, is a third-year medical student who hopes to specialize in general surgery. Together they enjoy two lively daughters and an 80 lb. Goldendoodle. When she’s not practicing the (very fine) art of homemaking, Karli is an OHSU Resource RN on 12C Labor and Delivery.

Ericksons-SS

“I think we should take up bird hunting,” my husband, Anfin, and 3rd year medical student says to me when I arrive in Heppner, Ore. with our two daughters. “Because we love dogs,” he adds to my furrowed brow. A few weeks into his rural rotation and that’s the big discovery he’s made.

For five weeks 3rd year medical students work on their clinical skills in smaller communities. We were in Heppner, Ore., population 1,307 according to Wikipedia. So just a touch smaller than Portland. The rotation is a great clinical opportunity for students, but logistically challenging for students with families.

For starters, timing. I was on maternity leave for the rotation. I’d make a joke about our perfect timing, but I’d only partially be kidding. When the rotation rolled around, our daughters were 2 months and 21 months. Families are welcome to accompany the student, but are responsible for their own housing.

In Heppner, the one and only housing option we found was a lodge that did long-term rentals. We will forever be grateful that the Kilkenny’s lodge was available to rent, and that the Kilkennys were both kind and accommodating. With cost and time constraints we only spent the last two weeks with our student, aka Papa, but it was worth it.

Out at our 20 acre lodge we had workable wifi and cable television, which is a television more than we ever have. Cell service, however, was limited in the area. The hospital had service; Verizon worked in the lodge; and according to our hosts, AT&T in the front yard. Alas, we mistakenly did not prepare a flow chart of protocol for communication mishaps.

See, we only had one car. If post-clinic Anfin was called into the ER, it could make for a late night. I would have had to wake the girls and pack them in the car to go fetch him. Thus, nearly every day the girls and I chose isolation and adhered to bedtimes over having a vehicle. As luck would have it, the one day we kept the car to explore Heppner’s very nice playground, disaster struck.

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Ready

Kakaday-BannerOriginally published on The Biopsy.

“Are your ready to see this patient?” asked my attending.

This patient was a young mother-to-be, otherwise healthy with her first baby on the way. I had hardly conducted any prenatal checks myself nor led a gynecological exam. I was vaguely familiar with the questions I should ask and distantly comfortable with the physical exam maneuvers I was to perform.

I had done them before, once, in a time that seemed so far past. Mentally, I weighed the pros and cons of leading this appointment. The cons seemed to stack up.

“Are you ready?” echoed in my head.

The hollow spaces hissed back, “No.”


She withered into a sliver of a woman after I told her the news, “Stage 4 pulmonary adenocarcinoma. You have lung cancer that has spread throughout your body.”

“But I was so healthy?” You could see her life decisions replaying in her eyes through a lens of doubt, questioning everything.

“I am incredibly sorry. I honestly don’t know what to say.”

So I sat there while she delicately sobbed her regrets away. My hand reached out and held hers. I’d occasionally add prognostic words – chemo, palliative, radiation, family – but they just evaporated into the room’s dark cloud.

“I’m not ready for this,” her eyes pleaded with mine.

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Finding ohana at OHSU

Pham-BannerHaving attended the University of California, Los Angeles for my first degree, I was initially drawn to Oregon Health & Science University for its reputation as one of the nation’s leading medical institutions. Upon the completion of my undergraduate career, I explored avenues in nursing-related research that worked mostly with underserved populations. OHSU’s outstanding research accomplishments pushed me to apply to its School of Nursing.

Being from Honolulu, Hawaii, I was initially hesitant to attend OHSU because I had never been so far removed from the comfort of family or friends (or the ocean). However, I ultimately chose OHSU because of my interview experience; I was especially impressed with the admission committee’s emphasis on working with the underserved. In my own life, I have undergone a range of meaningful experiences that have empowered me with the sensitivity to better understand the structural causes of health disparities. I have made it a priority to maintain this social awareness in a way that prioritises a balance between professional growth and personal health. OHSU wants to help its students maintain this balance. Students are given a plethora of resources that promote self-care and personal attentiveness. There are meditation rooms, student lounges stocked with coffee and tea, counseling services and even a light therapy room – all places where students can give themselves “personal attention.”

On a smaller scale, it is quite comforting to be able to walk through the halls of OHSU and be greeted with familiar faces and kind smiles; as an island girl, it makes my transition to the mainland not as intimidating and so much easier. The smaller university setting provides the opportunity for the cultivation of genuine relationships between the instructors and their students. Here, professors know your name, and questions are not considered a nuisance or a disruption during class time. OHSU gives students the opportunity to develop quality connections with clinical instructors and academic advisers because the small student-to-faculty ratio provides faculty with the space to be attentive to each student’s individual needs.

My feelings may be best encapsulated through a quote from the film, Lilo and Stitch. Lilo reminds us, “Ohana means family. Family means nobody gets left behind or forgotten.” In Hawaii, your ohana means everything, and I am so eternally grateful to be a part of the OHSU ohana, because boy, we sure do stick together!

(excerpted from the original blog post found at Times Higher Education)

“PA school cannot be done alone.”

Chris-Dirda-bannerI heard some variation of this phrase throughout my application process – during admissions lunches, from current students and from practicing providers. Prior to PA school I was usually a pretty independent person when it came to studying, and I took this to reflect on changing these habits to adopt a more group-study focus.

Six months into the program I found that this saying had a much broader meaning than I originally thought. I found that I had to rely on my family more than I could have even anticipated. For example, some nights before tests I’m not home until well after my wife and child are asleep. And my wife took a big risk in quitting her job and moving to a city where she had no connections. It was, and continues to be, difficult for me to ask them to make the sacrifices they do, but I know I could not make it here without them.

Beyond family, I found that I’ve needed my classmates more than I ever did in undergrad. By spending such an incredible amount of time with these people they became intimately involved in my life. Outside of studying, we commiserate, vent, blow off steam, explore Portland and have gotten to know each other well. Classmates regularly scheduled activities and get-togethers, especially after major hurdles in the program, and many turned out for them. The other day I thought about what an amazing job the admissions committee did in choosing our class. It really made all the difference in getting through these first few quarters.

For future PA students, or anyone in related programs, my advice would be to really get to know your classmates and spend time outside of class with them. It will be almost impossible to avoid doing this given the nature of these intense programs anyway, and it will make the time that much more enjoyable. If you do have family joining you through the experience, thank them regularly for the sacrifices they make to support you.

Three tips for Step 1 studying

Ally-Rich-bannerFrom what I can tell on social media, these lists of things are really popular to read. So, I give to you, the second year medical students, THREE TIPS FOR STEP 1 STUDYING:

  1. DO identify a person in medical school a year or two ahead of you to whom you can relate. For example, if you have a tendency toward anxiety, appreciate highly structured days, and tend to panic when plans don’t go exactly your way, I could totally be your person. I had a person like this who told me exactly what she did to prep for Step 1 and it was extremely helpful in creating my own plan. I identified with her when she spoke up at a peer-to-peer advising event, explaining that she spent Spring Break of her second year studying for Step 1, something that was entirely unnecessary. The connection was immediate.
  1. DO figure out what you need to succeed during study period. Then, block out what everyone else is saying that they are doing. Have confidence in your plan and stick to it! My person didn’t start studying during Spring Break because she thought she required this extra time to gain a knowledge advantage (I believe the popular term for this type of student is ‘gunner’), but because she knew that if she didn’t study she would spend her Spring Break stressing about not studying. It was for peace of mind. The daily exercise that one of your classmates may require may only add to your stress. Maybe what you need is a healthy pint of ice cream, or a family dinner, or a long walk with your dog. If I’m your person, you either need a brisk jog or a glass of wine. Stress. Evaporated.
  1. DO prepare for the feeling that you are failing Step 1. I hope this doesn’t trigger panic, as that is not my intention. On the contrary, I hope that you can acknowledge the feeling, take it in stride, and not let it affect your performance. I am happy with how I did on Step 1, but somehow I missed the memo about how terrible Step 1 makes you feel. I remember having a moment in the midst of the exam where I imagined what my life would be like if I simply went back to waiting tables. As a side note, I don’t recommend zoning out in the middle of Step 1, as the time crunch is real.

I hope that you enjoyed reading this list. Maybe it will get shared across all of Facebook and I’ll be a social media CELEBRITY. Hopefully it helps one or two of you MS2s during your study period and beyond. Also, I’m really not an anxious person. I just run a lot and drink wine occasionally.

The Power of Continuity: Reflections from the Safety Net

StudentSpeak is pleased to present this guest post by Sylvia Peterson-Perry, MS3 who is dually-enrolled in the M.D. and MPH programs. 

Sylvia-sharpI first met John* while on my 3rd year inpatient internal medicine rotation at OHSU. He came in to the hospital for a swollen, painful left leg, was a current active IV heroin user, was homeless, and had no possessions but the dirty clothes he was wearing. He ate the hospital food more eagerly than any other patient I had during my 5 weeks on the wards, and was so excited when he was able to shower and change into hospital clothes. Not long into his hospital stay, John was found to have a huge intramuscular abscess, which we drained and treated with IV antibiotics – the medical management of his condition was relatively straightforward. However, the rest of John’s care was anything but – this hospitalization had been a wake-up call to him, and he was hoping to get in to treatment for his opiate addiction; he had no place to stay after we discharged him (with a still draining wound); he had no way for us to contact him for follow up; he didn’t even have clean or warm clothes. Most of the time, I think this would have been one of those cases that contribute to the depressing research on medical students losing their empathy and becoming more cynical during their 3rd year**. From my understanding, the usual situation for a patient like this would be a conversation with a social worker, who could maybe provide a few days in a motel and a list of shelters and places to go for donated food and clothes, encouragement (and maybe a list of resources) to stay off of heroin, and then discharging him essentially to the streets, where using again and being hospitalized again for the same condition is almost inevitable. This then contributes to burnout and associated victim-blaming thoughts and comments from providers that patients like this never change and aren’t worth putting effort into, because they will just go back out and use.

Fortunately, this was not the case with John.

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My First Patient

StudentSpeak is pleased to present a guest post by radiation therapy student Annie Mae Jensen. This post is adapted from Annie’s remarks at the 2015 Donor Memorial Service, which honors the anatomical donors and their families who support OHSU students through a gift to the Body Donation Program.

TeamRuthie

Team Mildred Ruth, a.k.a. Ruthie! We’ve learned so much from you. Thank you for your beautiful gift! We may never know who you really were, but you will forever be our “First Patient.”

Dr. Cameron started the term with our entire class in a lecture hall, where he explained to us what a beautiful gift we had waiting in the next room. He cautioned that it was an amazing thing that these individuals wanted to support education even after death, however it might be difficult to meet our donors for the first time. He also cautioned that many students are affected more than they expect, and to extend respect to our donors, as well as our fellow classmates as they coped with meeting their first patient.

I was determined to not be “that girl” – I heard his words and I took it more as a challenge, blindly, to not let this meeting affect me. I didn’t want to appear weak in front of my peers, so I tried to suppress my emotions and empathy, which was, for me, very out of character.

We were assigned to inter-professional groups; each student in my group was a new face to me: one physician assistant student, two dental students, and myself, a future radiation therapist. My group was designated “7B.” I wanted to avoid appearing unprofessional to these new acquaintances, and it relieved me not to know the name or story of the donor I was assigned. We all stood together around our donor and introduced ourselves, and I jokingly said we were the Lucky Team #7! We all smiled and started to leave the room, but I felt compelled to stay behind for just a bit and whisper to my donor, “Thank you for your gift.”

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Dear Future Me…

Marisa-banner-newClinical rotations in PA school are all about learning. You see patients with conditions and diseases that you have read about during didactic year and learn how to manage them in the “real world.” You become more familiar with the inner workings of various clinical settings: emergency departments, operating rooms, outpatient clinics and inpatient wards. You learn just enough about insurance, billing and coding to make you teeter on the edge of sanity and be thankful that there are wonderful, capable people who manage those areas of clinical practice so it doesn’t fall on you to count bullets or verify ICD-10 codes for each diagnosis you make (though they can be amusing to peruse…my favorite? W61.62XD “Struck by a duck, subsequent encounter”). You master (well, try to master) the nuances of different electronic medical records and are amazed at how much easier holistic healthcare can be when all patient records are available for you to see.

The thing is, you end up learning about way more than just medicine. You learn about yourself and the kind of provider you want to become. You leave your comfort zone and embark on a 13 month adventure that takes you to clinics and hospitals throughout the Pacific Northwest. This journey has you living with classmates, honing your physical exam skills in urban and rural communities and meeting countless mentors, preceptors and patients. Along the way, you absorb all that you see and experience. Some of it you internalize, adding it to your ever-growing clinical practice toolbox. And some of it a bad attitude, a confusing explanation, things that just don’t fit who you are are thoughtfully discarded. Through this process, we begin shaping who we ultimately will become as healthcare providers.

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The Real Rural World

Joseph-Sedillo-banner“This is the true story of seven strangers picked to live in a duplex, work together and have their lives interlinked, to find out what happens when health students leave PDX…and start getting rural.”

Okay, so it’s not QUITE the salacious prologue to a hit MTV series, but it doesn’t make it any less valid for those involved. In truth, most of us (three PA students, three med students, one dental student – and one PharmD student who we didn’t live with but worked with) did not know each other before we started this adventure. The idea* seemed simple enough: bring OHSU students from myriad fields of medicine, assign them to a community project, and see what happens. And while there were many program goals to be met, it was what happened behind the scenes that really made a difference.

Week One was like the beginning of any other clinical rotation. Trying to get a feel of what your preceptor is like, what their expectations are, having moments of, “How did I miss that massive systolic murmur in a patient with aortic stenosis?!” And of course, getting to know a new town, voicing frustrations that they don’t have your favorite brand of hummus, and missing your boyfriend, your friends, and your creature comforts – #privilege.

But then came the weekend. You go crabbing on a boat, fraternize with other students, see some local events, and get a little taste of the culture surrounding you. You take a breather, put your game face on, and recognize that it’s not about you, it’s about the experience. And most importantly, it’s about being exposed to a different patient population, and that’s when everything started to sink in.

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StudentSpeak

StudentSpeak

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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