At home over the holidays I watched more news in a few days with my Dad than I do all year long. As I was finishing my morning oatmeal (Bob’s Red Mill, my longtime favorite) and Dad channel surfed, I asked, to no one in particular, “Have you noticed how many people have lost their head these days?”
I am not talking about the newscasters ranting over political debates – I’m talking about the ones where the pictures are focused solely on a person’s torso. Millions of headless photos highlight the national obesity epidemic every day in the media. As a student and a soon to be Registered Dietitian, I immediately choked down a swelling fear – “I am going to be a Registered Dietitian in a few months, this is my issue! I need to do something. What am I going to do to help these folks?”
We live in a challenging food environment that makes it difficult to make the healthy choice. Food marketing and advertisement is ubiquitous, literally at every turn of our day, encouraging you to eat everything, literally. We have normalized so many products as “food,” I find myself in a constant struggle to actually classify these items as food. When and how did picking up “food” in a white sack from a window within 45 seconds of ordering it become normal much less considered food?
First off, I want to apologize to the two people who actually remembered I had written here (hi Mom and Dad!) for not writing anything new in, well, almost a year. Things have been uniquely chaotic for me over the past year. I’m reminded of the apocryphal story about a sultan who asked once King Solomon if there was anything that would be universally true in any situation, regardless of whether it was good or bad. Solomon replied, “This too shall pass.”
Indeed they will. It’s not just an OK Go song, although everything does sound better when sung within a Rube Goldberg machine.
Instead of posting a quippy 300-word article about my graduate school experience (sorry Mom and Dad), I thought I would write a 200-word poem about that experience. I’m not saying the poem is good; I’m saying that what follows are more than 200 words grouped into stanzas. Writing poetry is much harder than writing prose, which is why I generally avoid it, but blizzards help make people wistful and unconventionally inspired. (That’s why Percy Bysshe Shelley was such a huge fan of Dairy Queen.)
In the breast pocket of my white coat, I carry the beat-up business card that a patient gave me. Every month or two, when I bend over, the card falls out and I remember one of the most remarkable conversations of medical school:
Me: “What do you do for a living?”
Him: “I’m a ninja.”
He was not joking. I was not in the psych ward. It turned out Mr. P was a martial arts expert and professional fighter. I’m not sure if he was an actual ninja – he wasn’t wearing black pajamas or a gold butterfly medallion – but the exchange helped me understand why he may have come into the hospital with a sudden loss of consciousness. More important, it helped me understand why my patient seemed surprisingly unconcerned about his potential head injury and eager to return to his dojo and Shaolin wine. We spent a few minutes talking about his work, his training regimen, and how a ninja likes laid-back Portland life. I don’t know if the conversation helped him feel more comfortable or better understood, though I hope it did. I do know that it made my day wonderful.
When I sat down at my computer to write this, my first blog post since last March, I was not exactly sure what to write. Over the past ten months I have attended the Drosophila Neurobiology Cold Spring Harbor course (which changed my science life), written a qualifying exam, done edits to my qualifying exam, achieved candidacy, presented a poster at the Drosophila Neurobiology Cold Spring Harbor conference, had margaritas with my great science grandfather, and even managed to go to Disneyland when it was all over. Last year was a roller coaster with very high peaks and very low valleys and I think I am not yet convinced that the ride is over; at any moment I expect another spiral, turning my graduate experience on its head. Looking back on the last ten months and conversations I have had with various people about what it means to be a graduate student, what we are supposed to do, and what we actually have to do, it strikes me how little most people know about today’s graduate student experience.
Graduate school is a purely unique experience in education. We are here to be trained as scientists. We are given a general outline of when to take what classes, a general window during which we are supposed to take an exam, and we must balance our classroom studies with what we are actually supposed to be doing, i.e. research. Some faculty understand this, some do not. The graduate school experience is formed by individual student-faculty, student-postdoc, student-technician, student-student, and faculty-faculty interactions. There is no guide on how to deal with criticism, communication breakdowns, personality conflicts, privacy violations, and multiple, sometimes divergent opinions. Neither are there guides on how to deal with general depression or unrest in the work environment – students sense faculty unrest and when faculty are unhappy, students are generally unhappy too. There are therefore many intangibles in our daily lives that we, the student, do not and cannot control.
I started PA school in July, and it’s hard to believe that we’re over halfway done with our first year. Studying medicine at OHSU has been an incredible opportunity so far–it’s a privilege to to be surrounded by so many brilliant and motivated people, and I’m very grateful to be a part of the class of 2015. That said, it’s also probably one of the most challenging things I’ve ever done.
PA15 girls after the half marathon
It’s funny to reflect back on interview day, when the question was posed to us: “are you ready to take on the rigor and time commitment of PA school?” We all nodded eagerly, but I wonder if anyone truly understood the depth of the commitment. It’s certainly a challenging amount of work, and while I can’t quite say there’s an equal balance of work and play, we do manage to find some time for fun.
Students are asked to write reflections as part of their nursing curriculum. Recently, the students were asked to read an article and compose a response based on what they were experiencing in the program. Ruby Engreitz was kind enough to share hers with us:
I think it is best that this reflection writing is happening a few days after my first clinical day as a nursing student. Don’t get me wrong, there is huge value in physically writing down your feelings and emotions immediately after a new experience, but this time I think I needed a few days to let my thoughts about the day really sink in.
I just got back from a really fun self-care weekend of skiing at Mt. Bachelor. I am extremely happy and relaxed. And this has made me realize exactly how tense and anxious I was during and immediately after my first clinical day. Now, after completing the roller coaster cycle between super-anxious and super-relaxed, I can truly piece together how I was actually feeling this past Wednesday.
I am now in the trenches of the second year of medical school. Most hours of my day are spent juggling studying neuro-anatomy and physiology with fending off anxiety about the upcoming USMLE Step 1 boards. It is exhausting to say the least. Rest is not an option. Not only because there is no time, but also because of the associated guilt. The only salvation from this endless cycle is using any extra time I can find for involvements that are truly meaningful. One of these extra-curricular activities is something that I am particularly excited about because it is a reminder of what initially drew me to the field of medicine.
During the ages of 12 to 18 I was responsible for accompanying my grandparents to their doctors’ appointments. From dentist, to ophthalmologist, to cardiologist, I helped my parents out by being a translator while they were at work. It may have seemed like a part of my chores at first, but it quickly became an exciting challenge and learning experience. Even filling out the paperwork required phone calls to my mom for translations or acting out the medical words I did not know. The experience was invaluable and continues to influence every aspect of my life. I developed my love of languages and discovered my interest in patient care in those waiting rooms and doctor visits.
On the other side of almost two years of training I am surprised that my outlook on this very influential experience has changed. Lectures on cross-cultural communication and experience working with non-English speaking patients have made me reconsider the use of family members (especially young children) acting as medical interpreters. While I know from my own personal experience that I did the best that I could, with the best intentions for my grandparents, I know that certain aspects of patient care were lost in translation. Consequently, I am happy to see that there have been strong efforts to increase access to interpreters and provide resources for improved cultural competency in health care. Many hospitals are now mandating that interpreters be available for patients at each visit, either in person or via telephone. OHSU has recently updated their own policy and now requires providers who wish to speak to patients in a non-English language to be certified. These steps may be costly, but I am beginning to see the immense importance of this type of standardization and training.
Two weeks into my Acute (third) term in this program, I find myself feeling inspired on a daily basis. On Tuesday, I shadowed a nurse who, based on my observation, is exactly the kind of nurse that I want to become. She was incredibly competent and every single thing she did throughout her busy day was patient centered. My patient these past three days is a real life example of what resiliency and strength looks like and I feel so thankful to have become a part of her journey. Today, I got to see what a balancing act floor nursing really is and how a wonderful nurse is able to manage it. And then, I was able to attend “Ethics Rounds” today at lunch. Talk about inspirational!
I don’t know what my expectations were when I walked into that room but they were exceeded in every possible way. Various medical professionals chose to attend and the topic today was counter transference. However, this was no conceptual lecture, nor was it a time to “fix” a problem. This was a time dedicated to voluntary sharing of stories about patients that someone became emotionally connected to. Many people shared emotional stories of patients that they’ve lost, patients that reminded them of themselves, a loved one, or just one that for whatever reason really tugged at their heart. It was a safe space to discuss these very personal and moving stories and I was so impressed that this hospital (and many others nation wide) set aside this time to have these very discussions.
I was also struck by how many of those stories came from physicians today (some of whom were surgeons). It is so very easy to begin to buy into stereotypes about each field in some way- nurses care, doctors solve medical puzzles, surgeons are cold, etc. It was a humbling and profoundly moving reminder that all of us in this field share a common thread of caring, and of wanting to be helping professionals. In so many ways, today exemplified the new model that we are moving towards in this school, and in the medical system of interprofessional collaboration. Various professions came together to talk about the thing we all share. We all have so much to offer to a team.
Stories have been told since the beginning of civilization – sharing our own or listening to another’s. We love to get lost in stories: films, books, readings, theatre – we are drawn to the lives of characters whose heartbreaks and triumphs we connect with and can reflect on as our own. I hope you enjoy this blog as it is another avenue for storytelling, one in which tales of research, medicine, patients, and education all converge.
A very powerful story I encourage you to read, especially as part of the medical community is “The Spirit Catches You and You Fall Down” by Anne Hadiman. Compassionately narrated, the author examines the cultural, medical, and language barriers of a refugee family from Laos and the medical community of Merced, California as they treat Lia Lee, a Hmong child diagnosed with epilepsy. This story embodies the term “narrative medicine.” Narrative medicine is not about medicine and technology but rather about people, their cultures, foundations, beliefs, denials and acceptances of patients within the healthcare system.
I have been witness to many stories during the past year at OHSU and the VA Medical Center on my rotations. These stories have been filled with hope and fear, science and faith, brilliance and doubt. The purest essence of storytelling exists in these wards and on these floors we have all come to know so well. In medicine, we tend to forget that we all have a story. We come in naïve, innocent, and open. We are trained, coached and critiqued on factual truth. We forget that History really means “his story” and “her story.” We talk about someone in the context of their illness – Mr. C with Type II Diabetes, Mr A. with a pneumothorax, Ms. R with cellulitis and COPD. When we talk to a person, we help him write his story, how he came to be where he is and how he is handling the issue. Family members and friends help enrich the story, allowing us to tease out the details and nuances.
During medical school, we are awash with a non-stop flow of information. It can be overwhelming at times, and we occasionally wonder whether the material will actually stick over the long term. Our last class, anatomy, finished a couple months ago, but the amount of information we have learnt since makes it seem as if it were years ago.
Sometimes, though, life presents opportunities that reveal just how much medical school is actually training you.
During a recent break, an acquaintance* and I were chatting by a fire pit when he brought up his upcoming surgery. He lifted his left hand and said, “Yeah, I’ve had some trouble with my left hand. It hurts these days, so the doctor is going to do some surgery on it to make it better. I forgot what he said it was.”
Instantly, my mind started analyzing his problem. Left hand pain; my knowledge base whittled it down to muscular or neurologic. “You’re left-handed right? You write with your left hand?” I asked.
He nodded, “Yeah, that’s actually when I first started noticing the pain; whenever I would write it would hurt.”