Laurel Hallock Koppelman, F.N.P., M.N.,
Thanks to Laurel Hallock Koppelman, F.N.P., M.N., a recent family nurse practitoner graduate of the School of Nursing, for sharing her parting words to the FNP 2013 graduating class here. Congratulations to all of the School of Nursing Class of 2013 graduates!
Last June, David McCullough, a high school English teacher, made global headlines as he and his speech to graduating seniors went viral on the world-wide web. The striking comment, the one that got the most attention from students and parents was, “You’re not special. You are not that extraordinary.” He was speaking to the point that while these 17 and 18 year-olds were graduating from high school, an accomplishment for many, this simple fact didn’t put them in a class above many others. He said, “Across the country no fewer than 3.2 million seniors are graduating. That’s 37,000 valedictorians . . . 340,000 swaggering jocks . . . 2,185,967 pairs of Uggs.”
Well, I’ve got news for David McCullough. In this hall today we have 398 BSNs, 68 MSNs, one Graduate Certificate in Public Health, six Post-Master’s Certificates in Nursing, five PhDs, and 14 DNPs . . . That means we’ve got more than 275 Littman stethoscopes, at least 300 pairs of Dansko clogs, a wide variety of colorful scrubs and 325 people who have realized that they are in fact SPECIAL and that they have a gift, an EXTRAORDINARY gift in the scheme of things, to put the health of others at the forefront of their lives. The people in this room have spent the last 2-4 years sacrificing sleep for studying, chosen ramen noodles over sushi so they can buy schoolbooks, put relationships with family and friends on hold so that they can better themselves to help others. How many of us can say we missed a chance to put our own children to bed while we stayed late at the clinic to care for someone else’s child? And how many of us gave up going to a concert or a party so that we could spend just a few extra hours at clinical learning how to suture? Why would we do this? Because we are special.
There is only so much you can cram into one day. Only so much you can do in a week. And when the year is over, only so much you can be proud to say you have accomplished and learned. Time constraints are the true enemy. We must all account for time in order to set realistic expectations. Or so I thought…
They say “time stops for no man,” but it certainly does for medical students, just check the fine print. Orientation week was when I first realized medical students expect to be exempt from mortal time limitations. For us, each day is 36 hours long, each week disguised as a month, and a year feels like a minute. When I first heard that in addition to our core classes, weekly preceptorship with a community physician, and weekly principles of clinical medicine course, there are also mandated electives to be completed within the first 2 years — my face fell into the expression of accepted defeat (I call it the eye-pop-smirk). Apparently, super-human memory and a B.S. in time travel are the only two pre-requisites for success.
I can’t believe we have one week left of our first year! I had such high hopes for writing these blog posts as a record of my medical school experience. Somewhere around February, though, when the weather was at its worst and I was caught in the doldrums of staying on top of my work and laundry, it occurred to me that much of this experience is intensely personal… and hard to talk about.
When people ask me how medical school is going, my answer is never simple—I try to condense the whirlwind down to a sentence or two, but they never quite do it justice. It occurs to me that the practice of explaining my experience to friends and family is an exercise in empathy. In the way we ask our patients to tell us how to they feel, where they hurt, how it’s affecting their lives, so should we practice trying to explain ourselves…
It’s been wonderful, intense, challenging, inspiring, heartbreaking, astounding, nuts. This year has been anything but middle-of-the-road—the most exhilarating learning moments (say, the first time I watched a ventilator adjustment correct a patient’s acidosis) snuggle next to days so steeped in doubt, I question my most fundamental understanding of myself. Recently, in one of our OSCE exams (where we interact with standardized actor patients to practice clinical skills), I was told that I needed to intersperse more empathy into my encounters. The standardized patient/actor gave me a couple buzz phrases to use in the future, and I found myself bucking against this recommendation. I don’t want to be told what to say to make myself sound empathetic; I want to continue to grow into what I feel is my most empathetic self, to be able to share this in a natural way, and I am up for the challenge of discovering it. In some ways, much of this year has been about that discovery—learning to be gentle with myself when I need a concept explained multiple times, learning to step back and watch myself conceptualize or frame a problem or conversation, listening intensely to my incredible classmates as role models and counterpoints. It’s an understatement to say that I’ve grown this year; it’s also an understatement to say that it’s been an honor. I’m still in awe of this small corner of the medical world I am allowed to inhabit, and I can’t wait to get more comfortable in it next year, and the next, and the next… and all those yet to come. I’m working on putting words to this experience, and I’m grateful for this space to share it… Happy summer!
The short answer is yes, you do. Your mission, should you choose to be a great clinician or scientist, is to recognize your biases and not allow them to color your daily decisions or affect your ability to assess the evidence.
Bias is, to put it simply, a preference for something over another. There is a more complicated definition but that’s the gist. As humans, there is evidence that we are all biased. If you prefer the color blue over red or are a dog person rather than a cat person, you are biased. Likewise are our thought processes and decision making. Everything that happens in our lives colors our world view, and within that world view lie our biases. Therefore, cognitive biases are part of life, everyone has them. They color our personal interactions and impressions of other people. They also affect our ability to accept new concepts and change our mind on topics when new data is presented.
Bias is an important consideration in medical and basic science research because of its subconscious impact on rejection or acceptance of new concepts or theories. There are many examples of times that scientists had a belief that an experiment would turn out a certain way, and lo and behold, it did so. This is sometimes because they were right. We hope so! However, there is always the possibility that subconscious action on the part of the scientist influenced the results of their experiments.
In one of my favorite fictional book series is a gem of truth which has stuck with me since I first read it many years ago. Terry Goodkind said in his book Wizard’s first Rule: “People can be made to believe any lie because they want to believe it is true, or because they are afraid that it is true.” At the time, I thought this an exaggeration. Then I began to pay attention. There is substantial evidence in the events of the past decades that if you play to people’s preferences or fears some will believe almost anything, regardless of the lack of or weakness of the evidence. This concept seems especially true of the general public when it comes to medical research. One published paper covered by the New York Times can and has sent people into a panic and changed the behavior of millions, potentially endangering society. On the other hand, this response could be to the benefit of society, it all depends on the quality and accuracy of the research that lead to said panic.
1. A three day weekend = catch-up lab time.
2. You reason against showering because no one outside of lab will see you that day.
3. You get up at 5:30 AM to get out of lab by 8:00 PM.
4. Your calendar is planned around all the free food activities on campus.
5. You got really excited about new data and a week later saw all of it in a newly published journal article, i.e. YOU GOT SCOOPED!
6. Bleach spots dot your clothing.
7. There are even more holes than bleach spots in your clothing.
8. You hear the word “cell” on the street and have flashbacks to every graduate class you’ve taken.
9. The instructor specifically said there would be no derivations on the exam. Then you get to #3.
10. Pandora is your bff.
11. When someone on the street asks you what you do, you freak out and don’t know how to answer.
It’s been such a pleasure to write for the Student Speak blog this year. I am incredibly impressed by the innovative and inspiring words my colleagues present. I thought I’d make my final post one that hopefully seeks to inspire as well, through the unparalleled opportunity I had in addressing students during my own graduation ceremony. Thank you so much…
Commencement Speech by Nathaniel Warren, MPH Candidate
There must be some irony in that I’m speechless for this incomparable honor…thank you all so very much for the opportunity to share my thoughts. I am so grateful to have had such a supportive group of friends, family and faculty leading to this culminating event of graduation.
Sports announcers sometimes talk about “Cinderella stories” – athletes that advance much further than anyone would give them credit. I want to draw comparison through one such story, about a man who did the impossible. Despite childhood abandonment, a brother lost to violence, homelessness and constant poverty, at 62 years old, Charles Bradley landed a deal with the famous Daptone Records, top bookings at music fests like SXSW and Bonnaroo and an international tour spanning 17 countries and three continents. How was this possible? Pushing forward against all obstacles, Bradley’s talent, heart and perseverance won the war for survival and ultimately, success.
“9 is arrogant”, he calmly tells me as if we’re on the same page.
“Why do you think that?” I ask, trying to wrap my head around this alien concept.
“Obviously it has the right to be, but I don’t know the exact reason.”
“No, there’s nothing obvious about it, but what are some other examples?” I intriguingly prod this sophomore who has stayed around after class to discuss with me the recent discovery of his rare form of synesthesia. He quickly rattles them off.
The grades are in and my first solo teaching experience is complete. Starting back in January, I embarked on a 4 month teaching odyssey at Lewis & Clark, designing, organizing and delivering a PSY280 class called “Brain & Behavior”, which can essentially be thought of as an introduction to neuroscience. Even before beginning at OHSU, I knew that I wanted teaching to play a role in my future career in science. So why not get started now? Of course, OHSU doesn’t have the undergraduate population for which our mentors, on one knee (or whip), send us off to fend for ourselves teaching their intro courses or grading their exams. Instead, luck, motivation, and more luck enabled me to score mini teaching opportunities across Portland which culminated last fall in being accepted as a visiting adjunct course instructor in the L&C Psychology Department. Yep, it came with an office… that had a window! Note: both are rare luxuries in the graduate student world.
This past weekend I took two hours off from writing and lab work, drove myself to the movie theater, and saw the breathtaking wonder that is Jurassic Park in 3D. JP holds a special place in my heart because, as a little girl, it enchanted me in much the same way as Willy Wonka and the Chocolate Factory. The power of what humanity can do and not do inspired me, even at 4 years old. In fact, I credit this movie as my very first exposure to science. You might laugh at this thought, looking now at the “science” presented in the movie, but such is the naivete of youth.
Like all classic films, there are themes in JP that transcend both the early 1990′s and the idea that we can isolate dinosaur DNA from fossilized mosquitoes, do some quick pipetting and virtual simulation, and wam-bam-boom have a baby dinosaur. BIG questions are posed in this film. What are the limits of scientific discovery? Can we control the natural world? How responsible are scientists? And of course there is also the famous line, “God created dinosaurs. God destroyed dinosaurs. God created man. Man destroys God. Man creates dinosaurs….Dinosaurs eat man. Woman inherits the earth;” quite the commentary on human progress……I doubt Spielberg meant this movie to be a specific commentary on the scientific community. But the scientific community is nothing more than a microcosm of society, and these are certainly ethical questions scientists, including young investigators, are met with everyday. Sitting in the theater as a second year graduate student beginning to start drafting qualifying exam materials, there were some lines that particularly struck me:
“Life finds a way.”
“God help us, we’re in the hands of engineers.”
“What’s so great about discovery? It’s a violent, penetrative act that scars what it explores. What you call discovery, I call the rape of the natural world.”
In a “former life” as an emergency preparedness specialist with the Red Cross, part of my job was to educate community members on everyday practices that can support their preparedness for disasters. A suggestion I often cited was, in order to make the task of building a “bug out bag” (emergency items to help you survive) and the magnitude of facing disasters less daunting, creating a “culture of preparedness” is crucial. A few examples for this included: picking up extra cans of food during routine grocery shopping, creating a game out of identifying emergency meeting places (or practicing fire, earthquake and other drills) and justifying card game purchases as emergency items (to stave off boredom – an incredibly important aspect of survival). Essentially, those in the classes began to view preparedness not as a chore or an insurmountable achievement once they saw that they could work within their inherent interests, tastes and schedule.
Similarly, through work in various public health capacities as I navigate through my degree, I believe a “culture of public health” can make intervention strategies towards improved wellbeing achievable…and even fun! In attempting to become a healthier individual myself and possibly spread ideas a bit further, here are a few ideas I’ve tried to build a “culture of public health” for my own sake.
- On campus days, I take the bus then the tram to “Pill Hill.” Even if I can’t always afford the time on the way up, I’ve been making an effort to get off several stops early and walk the rest of the way home (and sometimes forgo the tram and bus completely). If that’s not possible (or for extra opportunities), opt for stairs over elevators, or better yet, get a dog so they’ll force you to walk daily!