Grad Studies: In case you missed …

We editors of StudentSpeak never tire of reading about the OHSU student experience. Our student bloggers are creative, often funny and always authentic. Due to their brilliance, several of our graduate student bloggers have graduated and moved on (it was inevitable, but we miss them!). So while we bring aboard some new bloggers, indulge with us as we take a stroll through several past posts which generated conversation. And don’t you worry – we’ll feature past posts by M.D., physician assistant and nursing students soon!

School of Medicine Dean’s office

Donor Memorial Service

I want to write about the Donor Memorial Service that we had for the men and women who donated their bodies to further our medical education. I want to write about the sadness and grief we shared, the inspiring families and loved ones who trekked up the hill for the service, and my amazing peers who planned the entire event, greeted our guests in subzero weather, presented thoughtful speeches and musical performances, and stayed late on a Friday evening to clean up after the event. I don’t think I can do the event justice, even in my own head. Instead, I will share with you the speech that I shared at the service. It follows.

Hello. I would like to welcome to this community. Thank you for being here. I am so, so sorry for your loss.

My name is Anushka. I grew up in Portland, and I am a first year medical student. On August 16th, my colleagues and I walked across this stage one by one, donning the white coats for the very first time. In four years, we hope to walk across this stage as doctors.

These ceremonies do not come without sacrifices.

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Turkey day as a medical student

The transition from the first to second year of medical school is fairly seamless as far as our daily routine is structured. In both years we’re mostly in the classroom, pouring through thousands of pages of medical facts and diagrams, learning PowerPoint slide bullet points and preparing to one day use this information to treat actual patients. Of course, the difference between our first and second years consists of more than that. We’re a year more practiced at seeing patients under the guidance of our preceptors and other physicians, we have most of the normal human physiology under our belts and by now, much of the pathology too. In essence, I can understand many medical conversations, though I’m still not great at participating in them.

There is another notable difference between first and second year that really came to life over Thanksgiving break, and that is how family and friends viewed me a year and a half ago compared to now. As a first year medical student, people are focused on the fact that you earned acceptance into medical school and are ‘on the road to becoming a doctor.’  Earning a spot on this ‘road’ is an accomplishment in itself, and therefore during your first year, you get a lot of congratulations, pats on the back, and maybe even a special toast during Thanksgiving dinner. As a second year, however, all that is behind you. Your acceptance into medical school is a distant memory, and now you are instead expected to be an expert in all things medical and health care related.

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Agree to Disagree

In many professions, “difference of opinion” is code for “all out conflict” or “war.” When you “agree to disagree,” you are often agreeing to part ways. This is the case in the political arena, where campaigns, interest groups, and even research organizations are often partisan, and even in the corporate world, where Boards of Directors and executives are chosen because of a shared vision of leadership. In our medical school class, we often agree to disagree, and our differences of opinion lead to thought-provoking and lively conversations. The differences of opinion I have with my classmates will make me a better physician.

A few weeks ago, we discussed motivation interviewing in our clinical medicine class. As a classmate and I walked out of Richard Jones Hall, I expressed an opinion on the lecture, and was surprised that he passionately and coherently expressed a different point of view. Should doctors confront their patients about harmful behaviors? What are the risks of doing so, and what should the practical and ethical considerations be? As we talked, several classmates joined us. Some contributed their perspectives, and many just listened. After a recent exam, a few of us discussed the best ways for scholarship monies to be divided amongst medical students. Should financial aid be merit based, need based, both, or neither? What other factors should be considered? Not only were we able to agree to disagree over this potentially contentious issue, the conversation continued within our class and with the administration. In fact, the administration has joined our conversation several times, when members of our class expressed strong opinions about our curriculum and its evolution. What say should we have in the changes to our curriculum? How accountable is the administration to its students? 

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The Hazards and Gifts of Caring

Well into the second term of this program, we are learning about and addressing some deep and emotional issues. This term is about chronic illness and in that, also death and dying. We have been inundated with the stories of people who have lived one of both of these experiences- speakers, patients, those whose blogs we’ve chosen to follow as part of an assignment, and even some of our classmates.

It has been a privilege to hear and see these stories and it’s also been emotional. I’m going to generalize for a moment and say that most of us probably chose nursing because of our desire to really care for patients. That being said, this term is calling on our abilities to cope with some big things and practice caring for ourselves.

If you read my last blog post, you can probably guess my take on things, but I have found a renewed sense of appreciation amongst the sadness of these topics. I find myself taking time to feel thankful for the relationships in my life and making an effort to make sure that family and friends know exactly how much I care for them. I have always been a sucker for the fall, but I’m pausing a little longer to appreciate it. I notice myself constantly trying to put my experiences into perspective of a larger picture, sometimes stopping mid-frustration to take a breath and think, “if this is my biggest problem today, it’s a good day.”

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Oregon medical students love the outdoors!

When you are surrounded with the green, scenic outdoors that Oregon has to offer it is hard to be stuck inside all day long. That is why Oregon students appreciate every opportunity to take advantage of nice weather and partake in outdoor activities.

Group bonding activity at medical student first year retreat.

Large circle group exercise.

This year started off with the perfect opportunity to exploit Oregon’s wilderness: an orientation camping retreat for the first-year medical students. Last year the second-year students hosted a camping trip for my class, and I think I speak for a majority of my classmates when I say it was unforgettable and influential event. This year, my second-year class tried to recreate that same bonding experience for the new students. The orientation camping retreat is an opportunity for new students to get to know each other and also solicit advice from recent survivors of the first year of medical school.  We chose Milo McIver park as the perfect location for the retreat, which took place on the weekend of Aug. 23.

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“Any questions?” the admissions panel member asked.

My hand shot up, “How competitive are your students amongst each other?” Other premed applicants nodded their heads in approval; it was floating around their minds too.

If there was ever a question I made sure to ask during interview season, it was that one. Given the swelling number of medical school graduates for an unchanging number of residency slots, the spectre of a premed redux was omnipresent. Why go through that gauntlet again?

In the run up to a recent exam, my class’s Facebook page exploded with activity. Fellow students shared helpful study links, corrected each other’s mistakes, and bridged each other’s knowledge gaps in realtime. We estimated how hard the test was going to be; one student asked, “Describe this test in three words.” To which a half-joking response of “medical school dropout” was posted. We all nervously chuckled at our desks as we furiously crammed those last few structures into our memories.

The next day we took the test, or rather, the test took us. It was hard. Most of us coped. All of us survived. Yet, what was most remarkable was that, after the exam, few left without a partner to decompress with or a group to commiserate in. Later that evening, one student posted on Facebook, “Looking around in the practical test…I can’t help but think about how lucky and fortunate I am to be in this position. See you all tomorrow!” And in that one post, he succinctly demonstrated why I am fortunate to have the classmates I have.

At the end of the day, after all the facts and figures are crammed into our memories, after we’ve surpassed our mental limits, and exhausted our supply of precious coffee beans, we can rest easy knowing that we are in it together. And in an age where your network can make all the difference, that is incredibly important.

Camaraderie; it’s what helps to keep us going.

On the Horizon

In a mere ten weeks, my life as I knew it had been completely transformed. From day one of nursing school, I was quickly immersed in a deep sea of knowledge – without really knowing how to swim. I envision myself in a scene from Yann Martel’s recently popularized novel The Life of Pi – trying to survive in the ocean with but a few tools onboard, and attempting to make friends with (or simply avoid being eaten by) a large tiger that I’ve named Pharmacology, and a spotted hyena called Pathophysiology, who I often prefer to evade. It has been over three months since the program has started, and I’ve only just begun to figure out how to construct the raft that will help me stay afloat during my journey.

Perhaps a feeling shared collectively amongst new travellers is one of uncertainty, and a fear of what is to come. Along the way of an adventure, there are beautiful sights and panoramas that will take one’s breath away. However, there may also be rough, murky waters, and storms that threaten to overthrow us. There is often the worry over losing one’s way, and perhaps even the idea that we may not be able to navigate ourselves back to shore.

I believe that the AccBacc program at OHSU is much like the adventure that Pi Patel embarks on in the ocean. It is a journey that compels us student nurses to appreciate small moments of beauty and clarity; it is a process that illuminates the transience and meaning of life. We are given a few tools in order to succeed, but when it comes down to it, what is important is that we believe in our story. This will allow us to keep going, so that we continue to survive, and learn the study skills, tips, and tricks that will eventually help us thrive.

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“…just, like, acting like a human.”

“It’s just, like, acting like a human.” A fellow first year medical student eloquently summarized our Principles of Clinical Medicine class. The “techniques” we practice seem basic on first glance: Express the patient’s Chief Complaint in their own words. Ask the patient to describe the Onset of his or her symptom, what Provokes or Palliates it, it’s Quality, and so on and so forth to the tune of a convenient acronym. Explore socioeconomic or psychological drivers of a patient’s ailments by asking how her life is going, what affects her the most, and how she is coping. Always, always, even when the acronym does not explicitly ask, show Empathy. Also, wash your hands and clean your stethoscope between patients.

As an altruistic human being who has chosen the Noble Path of medicine, practicing these “common sense” communication skills should be easy for me.  It’s just, like, acting like a human.

Two days before our first GIE exam, tensions were notably high. I found myself snapping at a lab partner, interrupting her question to ensure that we finished our dissection. I was terse with my boyfriend: when he expressed a long-standing and perfectly valid concern about our relationship, I burst into tears and sidetracked the conversation with my own issues. Strangely, the “basic human skills” taught in PCM slipped to the wayside when “medical school emotions” turned on high. I did not ask my partner when the Onset of his frustration was, or how I could Palliate it. When a student asked one too many questions during a review, I did not reflect on her psychological state. I did not repeat my lab partner’s Chief Complaint (or question) back to her in her own words, ensuring that it was answered comprehensively. I showed a marked lack of Empathy for fellow drivers on 26W.

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Finding the “click”

Well I’ve survived one term of my program and I can happily say that I’m 1/5 of a nurse! I’m excited and nervous to start term #2 and anxious to get into the hospital this time around. I think getting to apply some of our new knowledge in clinical situations is going to teach us so much more than our books ever could by themselves.

In thinking about being in the hospital, I’m also thinking about where I hope to end up in my career someday. My largest areas of interest are pediatric critical care and pediatric oncology. I often get asked why I would want to work in an area that would inevitably be sad sometimes. My answer to that is not a simple one but I will do my best to explain it.

Cancer, in all of it scary awfulness is a unifying entity. Nearly everyone is touched by this disease at some point in their life. Whether it be through a loved one, a friend, or a personal journey, it’s a unifying terror of a disease. I have sat by a beloved relative’s bedside after a diagnosis that stunned and scared all of us. I have witnessed her strength and courage through chemo therapy and multiple surgeries. I have felt the joy of the words “cancer free” and the relief of her returning health. I have read a close friend’s story of triumph and heard her openly discuss the aftermath of the disease she beat. Cancer touches most of us, in one way or another.

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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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