The Summer of Snacks

Squirt gun battle fueled by grapes, apples, and tolerance of older cousins

Summer vacation is essentially over for me; my children went back to school a few weeks ago and I was ready for them to go.    In October, when the full impact of school, homework, and activities hits, I will wonder what I was thinking.   Right now, however, I am enjoying having more structure to their days.   There are no young kids on our street, so sending my kids outside meant that they would start a fight with one another out of sheer boredom within minutes and I would have to break it up and then continue to play referee all afternoon.    I wanted them to go back to school where someone else plays referee and I can actually get something done.    The boredom factor also applied when considering my children’s diet.  With relatives coming into town, birthdays, pool time, playing with friends, and barbecues, I noticed how much more we snacked during the summer months.   And being at home all day seemed to be license for regular trips to the fridge and pantry to see what there was to eat.

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5 weeks in Africa

This summer I spent 5 weeks in Africa with an organization called Work the World as a volunteer nursing student.  The first part of my time there was spent working in the Emergency Department in a government funded hospital in Arusha, Tanzania. Going there I thought I was going to help make a change and help educate people, the truth is what really changed was me; I was the benighted one in this new world with a lot to learn.

In this ED you can forget about clean beds, alcohol swabs or even blood pressure cuffs, you don’t have the luxury of tourniquets, thermometers or CT scans.  You can forget almost everything you’ve learned in your previous schooling because with their limited resources and lack of access to evidence-based practices you’re in their world and what you know is useless.  Working there taught me how to be innovative, and quick.   Someone needs a splint? There’s a cardboard box in the corner, make one.  Need to stop a bleed fast? Pull out your shoelace and use it as a makeshift tourniquet.

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Dissect

 

We first-year medical students had our first lab session a few weeks ago. We gloved up, scrubbed up, and wielded a scalpel – the key to uncovering the secrets hidden below our skin.

My team’s donor, an older gentleman who gave his body to the advancement of medical education, lay on his back. He was abnormally frigid and stiff to the touch; his face shrouded with a white cloth to protect his identity.

Without any exchange of words, we knew to pause and just soak in the gravitas of the moment. We stood, for the first time ever, in front of the manifest dichotomy of life and death. Yes, the man was deceased, but he still lay preserved as a symbol of a life lived.

What life had he lived? Was he a wise grandfather with wrinkles that deepened whenever his granddaughter made him grin? A spouse to a loving partner with whom he shared his halcyon years? Did he have a favorite song that reminded him of that middle school dance where he stole a kiss from Sally? Or was it Jenny? I wonder if he could remember.

He lay at the precipice of a life beyond and a life forgone. He was waiting for us – waiting for us to learn. A teacher who gave his life for students he had never met. Few causes can be as selfless.

Dissect, we are told, and so we dissect, fumbling tools and maneuvering skin folds in order to reach the structures we’re supposed to visualize in the times we are sandwiched between.

As I explore his body, I can’t help but dissect myself. Do my muscles look like that? Do I have that much fat layered upon them? If I felt my vertebral spinous processes, would I notice a lordosis, kyphosis, or, perhaps, some scoliosis from all that stooping I do while studying? Could I die of the same thing he did?

There are medical schools that are currently moving away from dissection and into pro-section, where the dissection is done for the medical student, and digital dissection, where your dissection experience is akin to that of a smartphone app’s. While those are certainly more efficient, there is a very visceral aspect lost in the transition; namely, a deep appreciation for just how paradoxically complex, simple, solid, and fragile our bodies are.

Even more importantly, it’s hard not to realize your own mortality as you slice into someone else’s. The truth is, dissection is as much exploration as it is self-evaluation. An exercise into equal depths muscles and memories, fascia and fears, bone and being – a discovery of what it really means to be human.

Perhaps that is the greatest gift these donors offer. For that, and more, we thank them.

A final farewell from Dr. Van Hook

Well hello to you, all of my long lost friends! It has been ages (years even) since I wrote to you about my graduate school happenings and I feel I owe you an update and a bit of an explanation for my absence.

First and foremost, I’M DONE! I did it, I pulled the sword from the stone, slayed the dragon, and kissed the fat lady on the cheek as she was singing my swan song. I am officially Dr. Van Hook forever!

I first want to address the reason for my radio silence all these long (and I’m assuming painful for you) months. I stopped writing in part to give the newer students a chance to share their stories, but also in part because during my final push toward graduation I was a whirling dervish of emotions…most of them unsavory to say the least. It felt for a while that every time I sat to write a blog post, I had nothing productive to tell you. Experiments weren’t progressing, my dissertation wasn’t shaping up into a glorious book chapter or Cell paper and I felt less like a runner elated to cross the finish line and more like dead weight being dragged toward completion. In a nutshell, I was broken down and embarrassed. We all want to hit a grand slam and make it look easy in the end, right?  

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Medicine, trades, and cuisine in Guatemala

Somos Hermanos summer 2013 at Lago Chikabal

During the first three weeks in Guatemala our days were filled with excursions and cultural conferences. One of the presentations that was particularly interesting was by a comadrona (midwife) who discussed some of the common cultural remedies that are used during the entire birth process; from herbal teas for different stages of labor to comprehensive massages to induce lactation. The presentation gave us a glimpse into how medicine is able to serve entire communities without the use of modern technology and medications. She passed around branches of the dried plants that have been used for centuries for various problems from anesthesia to inducing labor. While stopping a hemorrhage with the application of a plant-based paste seemed unlikely, there were aspects of the practice she described that I think western medicine can learn from. Comadronas do not have privileges in local hospitals and therefore deliver about 80% of rural births without the use of ultrasounds, modern anesthesia medications, or C-sections. She described the massage practices that she has used for over 30 years to ascertain the positioning of the baby and also to rotate a baby that is in the breech position. The success rate of rotating breech babies instead of opting immediately for the invasive C-section, that has become so commonplace in the United States, made me think that perhaps access to invasive procedures is diverting us from easy solutions. I know that there are a lot of things we can teach developing countries about medicine but there are also things we should learn from their practices.

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The competition is over

An anonymous author once said, “It is amazing how much you can accomplish when it doesn’t matter who gets the credit. ” To this author I must inquire: were you also a nursing student? On the first day of my nursing school career I met my fellow cohort members (after weeks of reaching out to one another via social media), purchased my nifty new stethoscope, and took a seat in a lecture hall where my cohort was flooded with factoids and prep for the quarter ahead.

Sure, I adored Linda Felver from the get-go with her heart model, pill bottles, and color -coded syllabi. And of course I exhaled a deep sigh of relief when our clinical instructors said, “Look, you’ll understand the flow soon enough. This is confusing. We know!” But what I remember most about that day was the phrase, “The competition is over.”

We were encouraged repeatedly to metaphorically pat ourselves on the back. We had gotten into the accelerated nursing program, and now it was time to learn collaboratively. But after years of competition in education and priding myself on high marks and success it took a little while for this new “way of learning” to sink in. Here I find myself in the middle of Week Seven—a bit overwhelmed and scrambled, but having survived three midterms, a dosage calculations exam, and a physical assessment. Let me tell you I now understand more than ever why nursing school is collaborative and why it cannot successfully be a competitive environment. Without the support of my colleagues there were days I may not have been able to turn my attitude around, there were exam concepts that I might not have mastered as well, and there were some laughs that made the “Felver Twelver” and long Mondays and Wednesdays all the better.

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First lessons in Nursing School

 It’s hard to believe that my first 6 weeks of nursing school are already over! I feel like the amount of information my brain has taken in already is enormous. It’s stressful and exhausting. It’s challenging and so demanding. It is also fun and interesting and I am loving it!

 Here is a list of some of the things I have learned so far:

1) I am in the presence of some truly amazing and wonderful people with so many diverse things to offer to their peers and to and the world of nursing! Acc Bacc programs cultivate such a wonderful mix of people!

2) Being a nurse is an awesome responsibility and there’s far more to it than I ever fully understood before starting this program.

3) Trying to give up coffee in the first term of nursing school is setting myself up for failure (and if you don’t have the Perka app, you are missing out!)

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The Godfather

One month in Roatan has felt like a lifetime. I find that when I travel to a new place, the more different the daily life is from my own, the more the experiences stand out in my mind, and therefore the longer each day feels. It makes me think that the richest life of all would be to consistently have new experiences, but that’s a different topic altogether.

Learning from the Godfather himself

Suffice it to say that my life here has been a stark contrast from daily life as a med student in Portland. It has been two parallel stories; the first story is that of five medical students (and one communications expert) traveling to Roatan, Honduras as part of a global health initiative to volunteer at a health clinic and serve the local community, which is as a whole in serious need of medical education and resources. The second story is that of the same five medical students living on the beach of a gorgeous island, enjoying a unique opportunity to experience the sunlight, turquoise waters, and breathtaking wildlife of the Bay Islands in the Caribbean Sea. Each day both stories have played out, and trying to balance them has been challenging, but it’s been the very best type of challenge, at times exhausting, but always educational and exciting.

A new school year begins….

 I’m four weeks in to my new life as a graduate student, and the intensity of OHSU’s program has already become apparent.  I knew that the PA school would be challenging, but I didn’t fully grasp the concept until I actually got here. Even though I no longer have time for watching old episodes of The Office, or going for three hour bike rides several times per week, I’m pretty thrilled by this new endeavor.  Even more importantly, I’m ecstatic that I chose this particular program. I’m so impressed by my classmates and by the faculty and staff–and to make things even better, Portland is an amazing city. Coming from Colorado, I wasn’t quite sure how I would transition to living in the pacific northwest, but it’s been a remarkably easy process.

The rapid pace of the program has definitely been tough, but so far we’ve been able to squeeze in a little time for fun, too. Last Saturday, a large portion of the class volunteered at the Oregon Food Bank.  We spent the morning sorting and packing food, which was slightly reminiscent of the infamous candy factory episode of I Love Lucy. Afterward, we toured the impressive facility, which distributed over 43 million pounds of food last year to Oregon residents.  (No small feat!)

The Food Bank also has some really great sustainable food initiatives as well, including a learning garden, where anyone in the community can come learn how to grow their own food. Their emphasis on fresh food and nutrition was really evident, and it was inspiring to see all the different ways that a person could grow their own vegetables, even without a yard. I filed a few ideas away in my head for next year when I (might) have a little more time to grow a few veggies. Overall, it was truly a fun way to spend a Saturday morning, and I’m sure a lot of us will be back again. 

 

 

 
 

Alii from Koror, Palau!

 

A view from the big island, Babeldoab.

After frantically packing, unpacking, and repacking my bags (50 pounds is really quite limiting), I jetted out of the U.S. of A. on the Monday after our MS1 finals to embark on my lengthy journey across the globe (literally) to the Republic of Palau for the summer. After a whole day of traveling, I arrived safely, got settled into Koror, and began work at the Health Policy, Research, and Development office (HPRD) of the Ministry of Health. Needless to say, the first week was quite a blur of battling jet lag and attempting acclimation.

Checking out the night market for fresh food, music, and (of course) dancing.

Palau on World Map

See that little circle? That’s Palau!

Let me back up for a minute, though. Many of you may be asking yourself “Palau? Where is Palau?” Well, I’m glad you asked. The Republic of Palau, known as Belau to locals, has a rich and rather complicated history. Palau is a country of about 250 islands located slightly north of the equator making for sweltering and humid summers (speaking from personal experience here) and is a little more than 500 miles southeast of the Philippines. Palau is now an independent nation as of 1994, but in the country’s 3000 year history (yes, you read that right) it was under Spanish, German, then Japanese, and post-WWII, even U.S. rule. Because of this, the national languages are Palauan and English with some states speaking Japanese as well. The culture here reflects some influence from all of these countries, yet the Palauans are bursting with pride for their heritage and have truly embraced their independence.

My neighborhood – T Dock in Koror.

Ocean view from T Dock.

I’m living in the T-Dock neighborhood of Koror, by far the largest city in Palau. My apartment has a slight, but still existent ocean view (it’s a glamorous life, what can I say) and am but a stroll away from my favorite night swimming spot at Sunset Park on T-Dock itself. Each morning, I am awoken by countless roosters (better than any iPhone alarm app) and howling dogs which stir up the neighborhood around 5:30AM. So much for sleeping in! My apartment is a 15 minute walk (more like leisurely stroll) to the central, lively city center where countless restaurants, minimarts, the country’s two main grocery stores, parks, souvenir shops, and Palau Community College campus are located. The HPRD office is located smack dab in the middle of the PCC campus, so I’m surrounded by the hustle and bustle of the city.

I’ll never tire of the Palauan sunsets.

My summer will be spent analyzing data from the Ministry of Health about betel nut chewing (more to come on this topic later) in pregnant Palauan women. To satiate my clinical hunger during my stay, I will also be traveling to remote islands and towns to help out in the community clinics and at home visits. This means I will hop on boats and drive along dirt roads out into the distant reaches of the country, all in the name of health care accessibility! I plan on immersing myself fully in the Palauan way of life now that I am starting to be recognized not as a tourist, but as a “local”. And while I stand at least a head taller than most of the true locals, I’m doing my best to eat from Palau, get active with the community members, and spend my free time exploring the culture and islands. More to come on my transformation into a Palauan!

 

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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