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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Transitioning to Fall…

Lauren-LieblingPhysician Assistant programs are notoriously rigorous.  As an incoming student, the years that lie ahead seem insurmountable.  And then … before you know it you’ve hit the ground running and you’re well on your way.  It’s now day 102 of what may very well be the most challenging 26 months of my life, but despite the challenges that PA school has thrown my way I couldn’t be happier.  I’m not trying to minimize the sacrifices that my classmates and I make in order to become PAs, but at the end of a long week of classes punctuated by a challenging exam I feel lucky to be here and truly excited by what I am learning every day.

Until this point, much of my progress as a PA student has been measured by practical and written exams. Throughout the summer I was presented with a range of classes from Anatomy to Pathophysiology; each one helping to build a strong foundation of knowledge that will support me in my clinical medicine courses. Coursework was condensed into questions that challenged my ability to synthesize tremendous amounts of information and begin to apply it in a clinical context. I felt the growing pains of once again learning to be a student – this time in an entirely different type of academic environment. For the first time everything I was learning in school felt relevant and important.  After all, one day someone’s life may depend on everything I was learning.

Fall quarter has now begun and there is a buzz in the air as we begin a highly anticipated mentoring program.

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Japan (As Magical As You Think It Is)

Christie-bannerSo it’s about 800 degrees centigrade and I’m wondering if I’ve lost my mind hiking Mt. Arashiyama in this heat. I turn and watch two children and their elderly grandparents skip gaily up the trail as if the incline and humidity are non-existent, and I curse their effervescence. I start gathering leaves and sticks to form a sort of make-shift grave site and mentally draft my goodbye note to my friends and family, because surely this is where I will die. How can people withstand this type of heat? Did you know that the back of your knees can sweat? Isn’t this the temperature at which meat starts to cook (and because I’m sweating so much does that mean I’ll start….poaching alive?)? I’m losing it.

In the distance I hear hoots and hollers, the call of one Japanese macaque to another, and I am reminded of what awaits me at the top: MONKEY PARK. “Do it for the monkeys!” I think to myself as I rise to my feet, “FOR THE MONKEYS!”

If I can give young graduate students any advice it’s this: APPLY FOR EVERYTHING. This philosophy is what led me to win a generous travel award through the Society for Neuroscience (SFN) that sent me to Japan to participate in the Japan Neuroscience Meeting. I got the news at around 7:00 a.m. after rolling over in bed to check my email on my cell phone.

If I can give young graduate students a second piece of advice it’s this: DO NOT RESPOND TO EMAILS AT 7A.M. ON YOUR CELL PHONE. I know this because instead of forwarding the email to my PI, I accidentally hit “reply” and sent the arbiter of the award an expletive ridden “OMG, I’M FREAKING OUT” style email. I’m a true beacon of professionalism.

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Let The Evening Come

David-Edwards-bannerThis is the beginning of my fourth year of graduate school, that membranous transition period between the eager expectation of third year and the panicked frenzy of fifth year. Many of my older classmates have told me that fourth year was unequivocally their most challenging, the one brimming with more knee-weakening moments of despair, self-doubt and raw frustration than any other.

(I know—what an auspicious start to the year. It’s the post-bac equivalent of your older brother telling you about the horrors of first grade. “Say goodbye to naptime, kiddo—you’re never gonna see it again.”)

Given this information, I’d be lying if I said I wasn’t nervous. I’m not looking forward to those inevitable moments lying in bed, thinking about alternative careers—does the Discovery Channel hire grad students as writers?—and attempting to fall asleep by counting failed experiments like sheep.

But I’m not completely afraid, either. Right now, there’s a mélange of fear, apprehension and…weird excitement. I’m excited not because I’m masochistic, although I did enroll in graduate school so perhaps that’s not entirely untrue.

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Choosing a surgical subspecialty: My path to Otolaryngology

Shabnam-G-bannerChoosing a career in medicine was one of the easiest decisions I ever made. Although I was the first out of a family of engineers to go into medicine, it was a natural choice for me. I loved interacting with people and thinking critically about the applications of science to the human body. My passion for medicine was clear. But, choosing a medical specialty was unexpectedly difficult.

During the first two years of medical school, students around the country are taught the foundations of clinical medicine. While there is some exposure to the various specialties, the focus of these years is to act as an introduction to medicine through lectures, textbooks and exams. In contrast, the third year of medical school transitions students out of the classroom to the bedside. Students rotate through clerkships in various specialties learning how to apply their knowledge to patient care. In this year, students begin to learn how medical teams function as well as understand the roles of the different specialties and how they work together. While some students enter these third-year clerkships already confident about their specialty choice, many students maintain an open mind.

In the fall of the fourth year of medical school, students then apply to residency programs in a chosen specialty. It happens very quickly. One minute you are being told, “You have lots of time, don’t worry about choosing a specialty yet.” The next minute you realize that you are the last one to decide and you should have been publishing research papers in the field since before medical school even started. Across the board, applying to residency has become increasingly competitive and showing commitment to the chosen field through research and letters of recommendation from faculty is important.

Halfway through my third year of medical school I remember starting to feel a little discouraged. I watched as my classmates decisively pursued their chosen specialties and met with faculty mentors to plan for residency applications. Meanwhile I continued to be undecided. I had enjoyed all of my third year clerkships so far. As I rotated through, I would try to convince myself that certain fields met some of my interests. But I was never able to wholeheartedly commit to a specialty. I had mentors in fields of pediatrics, family medicine, general surgery and radiology. None of which I wanted to pursue for the rest of my career.

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OneNote to Rule Them All, OneNote to Find Them…

Chris-Dirda-bannerSometime during the months before PA school I received an email recommending that I familiarize myself with note taking software. I didn’t think much of this message at the time. I mean, I had been pretty successful with a pad of paper and a pen all throughout undergrad, so why change what isn’t broken? Fast forward to my first day at OHSU, and I arrive with said pen and said paper in hand, ready to the face the barrage of information ahead of me. By the end of the week that pad of paper and pen were already collecting dust in my locker.

To fully appreciate how critical note taking software was, it is helpful to look back at the volume of material in the first quarter alone. We were responsible for a little over 150 lecture PDFs and each of these lectures contained between 35 and 100 slides. The bulk of these lectures were closer to 50 slides each, so I will use that value as an average. With 150 PDFs at 50 slides each, this comes out to approximately 7,500 lecture slides covered in three months’ time. If I had printed out every PDF it would have been prohibitively expensive, a vast waste of resources, and it would have taken up an entire closet of space to store it all. If I had just used pen and paper without printing anything out I would have been completely lost in tying notes to any particular slide. Cue the need for note taking software.

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Tiger Blood

Adalie-bannerThis week I will be sitting down with a group of applicants who are interviewing for positions in next year’s PA cohort. As the sage old PA student, I thought I would gather together my new-found wisdom to share with these potential students:

  • The first introductions with your new classmates can be intimidating. Getting into a competitive school like OHSU means that everyone is stupidly brilliant with seriously impressive work and volunteer backgrounds. Recognize that your feelings of imposter syndrome are normal, and will fade with each exam you crush.
    • If you still need a boost of confidence repeat to yourself this Charlie Sheen quote: “I have a different constitution. I have a different brain. I have a different heart. I got tiger blood, man.”
  • Don’t Lone Wolf your studies. Find like-minded students and study with them. It was wonderful to realize that OHSU doesn’t just preach a collaborative culture, but aims to actively create one. While I had never previously been a fan of collective studying, I now seek out small groups to work with, and am more successful because of it.
    • IE: Very bright people surround you. Dig into their minds for the knowledge you are lacking.
      • By this I do not mean to use your classmates’ brains as a zombie would. There is definitely a policy against that in the Student Code of Conduct.
  • Being a PA student can make you feel like your body is just a convenient way to transport your brain to and from class, but try and exercise daily. Then you can impress people with your razor sharp mind and your killer bod. Truly a win-win situation.
    • Also, this is the only time in the day to re-watch True Detective and not feel guilty.
      • Side note: Should one ever feel guilty about watching those modern day prophets Matthew McConaughey and Woody Harrelson? No sir.

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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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