The White House reflections

Kakaday-BannerI have been lucky to somehow accomplish a number of milestones in my lifetime: graduate college, enter medical school, build a company, spearhead a premiere medical technology conference, pen a blog with over 10,000 followers and, now, in what seems like the largest stroke of luck, receive an invitation from The White House, under the direction of President Barack Obama’s Office of Science and Technology Policy (OSTP), to assist in the newly launched Precision Medicine Initiative.

Just recently, I traveled to Washington, D.C. to attend The White House OSTP and Stanford Medicine X joint workshop on “Engaging Patients as Partners in Research.” When I first received the invitation a month prior, embellished with the official logo of White House, I had to do a double-take and then verify the legitimacy of the sender. Indeed, everything checked out and I had been officially invited. Mom was the first to know.

After I received my official appointment badge, passed through security and entered the White House campus, a chill ran through me. I was entering arguably the most powerful building in the world, in which decisions are made that have effects and ripples everywhere. The gravity of my involvement was not lost on me. Determined to represent myself and OHSU’s innovative ethos well, I strode past doors that read “National Security Council” and “Office of the Vice President” with a resolve I hoped didn’t betray how giddy I was inside. Once all 50 or so guests assembled inside our conference room, the workshop kicked off.

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Thailand Experience – Culture of Wellness

Norma is part of cohort of nursing students traveling and studying in Thailand. Learn more about OHSU Global Southeast Asia.  Read about the recent trip to Thailand in this exchange

Norma-Bono-BannerClose your eyes…Now imagine yourself in a sauna and you’re profusely sweating. Your pores open, you breathe in, and it’s like breathing in nothing but steam. Now imagine you have stepped out of the sauna and have proceeded into the showers. Your body cools down, you towel off and you have now returned to your air conditioned room. You now feel refreshed, relaxed and energized all at the same time. You think to yourself, “Wow, I feel great!” – This has just described how I felt everyday while in Thailand. Yes, it was very hot and very imagehumid, however, it was a good feeling over all. What made it even better was remembering why I was there in the first place – for an amazing learning experience!

This opportunity offered a basic understanding of the current healthcare system in Thailand. We resided in Bangkok and visited outlying areas that surrounded the city. The visit and presentation at the Ministry of Public Health was a fundamental source of information, that allowed for greater insight into their healthcare system and infrastructure. The healthcare reform goals were shared with us, and one that stood out the most was the integration of Traditional Thai Medicine (TTM).

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Through the eyes of a “difficult” patient

Moss-BannerDuring shift change you get a hand-off on one of your patients, “a 68 year old Chinese man who was admitted again for fluid over load because he continues to be noncompliant with his medications and diet. His provider prescribed the meds to manage his heart failure related to his chronic unmanaged asthma. Adult protective services recently removed him from his home where he was living with his son, because it was pretty apparent his son was neglecting him. I mean you should read the case file, the guy’s bathroom was covered in feces from a broken toilet, his floor was caked in black mold. Watch out for the son, he keeps causing a scene every time you try to talk to the patient. And the patient wants to move back in with his son, but that is obviously not going to happen because this guy cannot take care of himself and it’s pretty clear his son is not going to take care of him. Get ready this family is difficult. I would stay outta there as much as you can.”*

I have had a hand-off like this, and I am sure you have too. One that makes you automatically develop an image of who you are about to care for, and often put them into a category of “this is what they are going to be like” before you even meet them. Often times the person who is sharing this with you is usually trying to help prepare you, while also decompressing from what was most likely an extremely long 12 hours. The problem here is when we are presented with a patient that is labeled difficult it allows us to detach from them before we even introduce ourselves. And when we detach from the beginning, we miss the opportunity to learn about their truths of how they got here, what they really need from us to leave better than when they arrived and most importantly eliminating our ability to provide truly compassionate care.

I wrote this guided imagery (with editing help from my dear friend Janell Senn) for a group project in response to an experience one of my classmates had with a client like the one in the above hand-off report as part of our presentation. I wanted the rest of my peers to reconnect to the part of them that makes it difficult to shut down and shut off, and for any of you that listen to this – I want that for you too. The next time you meet a person that makes you feel frustrated for the way they live or have a patient you want to call “difficult” or “non-compliant,” you might step back and examine your own compassion switch and be honest if you need to turn it back on.

(To play audio click your mouse on the empty space to the left side of the audio toolbar next to 00:00)

*hypothetical patient

Mortal responsibility

Pham-BannerIf you know anything about me, you probably know that I love to read. As a kid, I was what you could call a “half-tomboy/half-bookworm.” I could usually be found doing either one of two things: rolling around in the water or engulfing myself into whatever book I had my nose in that day.

Expectedly, as I began refining my intellectual pursuits, my personal reading choices concurrently evolved. As I got older, I nurtured a deeper interest in nonfiction, albeit my love for historical fiction, and eventually stumbled upon the world of medical nonfiction. Instantly I became enamored with the written works of Abraham Verghese, Atul Gawande and most recently, Paul Kalanithi. Each author’s prose is built upon his own personal experience, and the pages are filled with clinical stories and perspectives that are all so uniquely articulated. Their narratives allow readers into their minds, allowing us to observe their thoughts and to listen to their inner monologues; through their voices I learn what fuels them, what inspires them and why they practice medicine. Despite their narrative differences, perhaps what I appreciate most about these authors/physicians is their overall commitment to viscerally capturing the moral, ethical and practical hurdles that health practitioners inevitably face when dealing with life-threatening situations. What makes these individuals remarkable is their natural ability to articulate these situations with eloquence (and impeccable word choice), leaving me inspired to cultivate my own nursing practice with a similar sense of poise and relentless passion.

Up until very recently, these moral dilemmas I read about were hardly a reality; facing death was never something I contemplated seriously. I mean, I had always understood that death is inevitable– a rite of passage, so to speak. However, it was nonetheless hypothetical, a life event that would eventually happen some day, after I had lived a long, fruitful life of experience and contentment.

This changed very quickly several weeks ago. I was driving home after dinner with a friend, and a moped driver recklessly made an unprotected left turn across a line of traffic. Although I had the right of way going straight, neither of us saw the other, and I t-boned him. The moped driver instinctively jumped off of his moped to clear his leg from the collision with my bumper, instead somersaulting onto the hood of my car and falling violently onto my windshield.

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Not a fish

Thruston-BannerIt took a full minute of back scratching and hair stroking before she stirred.

“Hey, girlie,” I whispered as I leaned over the bed. “I’m going to work now. Can I have a big hug and a kiss?”

Without opening her eyes, she stretched her arms out, wrapped them around my neck and planted a kiss on my cheek.

“Are you going to go do surgery on people?” she asked, eyes still closed.

“Yep. Go back to sleep, kiddo. I love you.”

She rolled over and pulled the blanket up, and that was it. I lingered for a moment, expecting a screech of protest, but it never came. It was the first time since I’d started rotations almost 9 months ago that there was no demand for me to stay. At the very least I expected her to insist on being carried to the porch to wave goodbye to me as I left, but nope – she was out.

My rational brain knew I should be glad. Standing outside in the dark to wave goodbye to Mom at 5 a.m. every day wasn’t exactly best practice for a restful night’s sleep. The fact that she had stayed in bed was a sign that she was adjusting, normalizing, settling in. “All good things!” the voice of reason firmly reiterated, but in my gut I could already feel the cold grip of Mommy Guilt taking hold, and there really is no way to come back from that

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A lot like love

StudentSpeak is pleased to present a guest post by first-year M.D. student Alice Rear.

Rear-Alice“What do I do with my hands?” The question occurs to me as soon as I walk in the room. I thought I had considered every aspect of this encounter: how I would introduce myself, how much eye contact was appropriate, how I could express empathy without sounding insincere or patronizing. I never considered how my appendages would feel flopping by my sides or resting listless on my lap. Giving hand gestures a try makes me feel like a traffic director, and I immediately abandon the strategy. Taking a seat, I wonder if I should cross my legs on the low stool. I experiment crossing and uncrossing them, then cross them again. I uncomfortably commit to the crossed conformation, regretting it instantly. My questions, which felt fluid when rehearsed, are now awkward, jarring and disjointed. Realizing my speech has become incomprehensibly rapid, my face grows warm and flushed. I am certain my smile, expression and posture radiate my anxiety.

My first clinical skills exam feels uncannily like a first date gone wrong. In many ways this is an apt comparison as medical school inspires many of the same emotions as a romantic relationship. It can be as elating, disheartening and all encompassing as falling in love. Interactions as a training physician can be vulnerable in a way I did not anticipate, and in the same way I have learned about myself from loving another person, I have uncovered new aspects of myself while studying how to care for a patient.

Walking into an exam room, particularly during clinical skills tests, I often feel like I’m being evaluated not just as a student, but as a person as well. My empathy, vocabulary, skills and style are all open for critique and discussion. There have been instances where I have walked home feeling raw, questioning my ability to be a doctor and my place at OHSU. Interactions with the standardized patients have also been some of my most elating moments. Getting the correct diagnosis is great, but being told that the patient felt heard, safe and that they were comfortable with my clinical manner makes me feel real joy.

I had a similar moment during the medical specialty “speed dating” event held at the end of last term.

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It all comes down to this

Steinhardt-BannerAfter 30 applications, 35,000 miles in the air, 1,000 miles on the road, 14 security lines, six hotels rooms, eight homes of family and friends, 16 dinners on my best behavior and 22 days of fitting into (what used to be) my slim-cut suit, I can finally say that residency application and interview season is complete. Rank lists are in and as they say, the hay is in the barn. An exciting, introspective, anxiety-provoking and eye-opening process, match season is the culmination of all of the work we’ve done in medical school, even dating back to our previous jobs and undergraduate studies. After countless late nights, more exams than we’d like to admit, clinical clerkships in every wing of the hospital and extracurricular activities of our choosing, we put everything we’ve accomplished on paper in the form of an application. We talk about it with faculty members, chairs of departments and program directors of residency programs around the country, and then we make our rank lists based on 6 hours of face time with a department in a city we’ve often never visited before.

An average interview experience goes like this: There is generally a dinner the night before. These range from expensive meals with white tablecloths and bottles of wine to burgers and beers. It is often said that this is one of, if not the most important part of the interview “day,” as only residents (and no faculty) attend, none of what you say (supposedly) affects your ranking (unless you embarrass yourself terribly) and it gives you a glimpse into what the residents are like outside of the hospital. It is a “red flag” if no residents have time to attend a dinner, and it’s encouraging when people bring significant others and seem like they’re all friends, provided that’s what you’re looking for in a program. The next morning, official interview days generally start around 7 a.m. with coffee and breakfast. There is a presentation by either the program director, chair, or both, highlighting the program’s offerings. Then there is a combination of a tour of campus, a lunch with residents and interviews, the number of which can range from two to ten depending on the specialty and the program. Most days end sometime in the mid-afternoon.

During the interview season, you smile a lot, you schmooze a lot, you make a lot of small talk. By the end, I think I said “where are you from?” hundreds of times. This is perhaps the most difficult part of the trail, because after long hours and days on the road, it can be tough to keep up the energy to make conversation. Luckily, the world of medicine is small, and each specialty is even smaller. As a result, I started running into more and more applicants that I knew as the season went on. By the end, I recognized nearly half of the applicants at my interview days. If all goes according to plan, some of these people will be my colleagues in a matter of months.

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Predicting the future of science and the Ph.D.

David-Edwards-bannerAs a child, whenever somebody asked me about my future, what I planned on doing when I grew up, I already knew the answer: I was going to be a physician. I enjoyed medicine, I liked helping people, and doctors, as a whole, seemed confident and glamorous. Becoming a physician was a confluence of everything I loved and wanted in a career. The question wasn’t hard, and the answer never changed.

Until, that was, I entered college. For a variety of reasons, I realized that I preferred medical research to clinical practice. I switched my interests over to graduate school instead of medical school and, years later, I am the struggling, nervous, easily excitable fourth-year graduate student who’s writing to you now.

And yet, despite this seemingly decisive change in my professional aspirations, I never regained that confidence I had as a child. I recently had my dissertation committee meeting, and when I was asked directly about my future plans (academia, industry, etc.), I admitted somewhat sheepishly that I didn’t know.

That’s the truth—I don’t really know. I have no idea about my future, other than (a) I will probably graduate with my Ph.D.; and (b) I will have significantly more white hair as a result of the effort.

But the indecision isn’t unique to me (despite the Imposter Syndrome-like feeling sometimes that I’m the one graduate student unable to pick a freakin’ lane career-wise). Not only are other students also having these tumultuous self-reflections, the entire scientific Ph.D. enterprise is undergoing seismic evaluations of its utility and effectiveness in training the next generation of scientists.

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Let’s get colorful!

StudentSpeak is pleased to present a guest post by Rajkaran “Raj” Sachdej, a second-year M.D. student and member of the Middle Eastern & South Asian Association (MESAA).

Yai re, yai re, zor laga ke naache re. Yai re, yai re, mil ke dhoom machaye re. Chal mere sang-sang. Le le duniya ke rang. Ho ja rangeela re.

MESAA-flashTrace your steps from the last time you walked into the Collaborative Life Sciences Building (CLSB). You jumped off the yellow and blue streetcar, trod neon-green bike paths, tripped over the silver tracks, smirked at the “platinum” LEED award and slammed the blue handicap entry access button – only for the colors to cease as you face white walls and concrete floors for the rest of the day.

Don’t get me wrong. The CLSB and its sleek, modern design has its merits. However, when it becomes your second home for 10 hours each day, cabin fever begins to set in and the chair sounds of 2-South certainly don’t help. Short of playing indoor paintball to break the monotonous stress of studying in a building lacking campus culture, on November 9, 2015, MESAA found a way to paint the town red.

MESAA, the Middle Eastern and South Asian Association, is a new student-led interest group. We aim to highlight medical and social issues of our communities while celebrating and sharing our iridescent cultures. Where better to show off those colors than the blank backdrop of the CLSB?

Aside from finding ways to bridge the spectrum of cultures, MESAA had one goal – to make people smile. But how? It was pretty obvious to us. Dancing is an integral part of both Middle Eastern and South Asian childhood experiences. From Bollywood performances at Diwali to dabke at your cousin’s wedding or bhangra for Vaisakhi to talent show belly-dancing – these experiences paint the pictures of our childhoods. Immediately, plans for a dance flash mob formed.

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So you want me to climb Everest?

Moss-BannerI was lucky enough to attend the annual OSNA Convention at PCC Sylvania where nursing students from programs all over Oregon came to expand their horizons as future or current nurses. There were breakout sessions led by professionals from many different areas of health care and leadership, from flight nursing to social innovation, and everything in between. I had the opportunity to sit in on a few breakout sessions, one of which delved into healthcare equity, and I was amazed, yet again, at the depth and width there is in the nursing profession.

The women who led the Healthcare Equity session, Nancy Sullivan and Christine Tanner, walked us through the limitations and injustices within our current insurance system. They not only shared statistics, but also stories about the people behind the numbers: stories about families crippled by monthly medical expenses and individuals who still aren’t able to navigate our convoluted system. Sitting there trying to soak in, question, and grapple with everything these women were sharing, I began to feel like I was dropped off in front of Mt. Everest and expected to give it a go – I mean for the sake of humanity. I’m the person that shows up without a rain coat or accidentally wanders off a trail because I am out of breath a quarter mile in. Everest has about zero appeal to me, and actually the idea of climbing it makes me want to pass out. Essentially, the level of brokenness in our healthcare system was so overwhelming it made me want to pass out a little.

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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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