Understanding the symbolic power of my white coat, part II

A few weeks ago, I wrote a post about deciding whether or not to wear my white coat at a protest about recent events in Ferguson, MO, and Staten Island, examples of the more widespread problem of violence against communities of color in this country. As I’ve considered these events and their implications, I find I have a bit more to say.

On International Human Rights Day (December 10th), 20-30 OHSU students lay down in the atrium of the CLSB for four minutes, representing the four hours that the teenaged, unarmed Michael Brown lay on the pavement after being shot by a police officer. Unlike Michael Brown, we were not alone. Students from over 70 medical schools participated in this symbolic gesture and the hash tag #whitecoats4blacklives was trending on Facebook by the end of the day (you will not find OHSU’s name on the list of schools participating, as students were instructed to cover the logo on our white coats and not to affiliate ourselves with the university*). I participated in this gesture with tears in my eyes and hope in my heart. Just a week before, I wondered about the validity of wearing my white coat to a public protest – why was I OK with participating in a national movement that prominently featured this symbol?

I realized that I consider structural violence a public health issue. Put more simply, I think that when young black men unnecessarily are killed, this is a public health issue, just like preventable deaths from suicides and car accidents are public health issues. I also consider it a human rights issue.

I understand that there is often disagreement about what constitutes a public health or human rights issue.

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Why I’m Here

You get that phone call. You’re in! You’re excited. You’re beyond excited. You’re ecstatic! You call your mom. Then all your friends. Then you post on Facebook. Then you walk around for a few months whistling a happy tune, skipping along, so grateful, vowing this gratitude will carry you through the dreary winter months when your life is an endless lecture and you dream of words such as pemphigus vulgaris. Then you get here. It’s summer.

And you’re overjoyed! You promise yourself you’ll work hard. And you do. You do your best. Perhaps you struggle a bit at first, as I did, to find a place where you are comfortable. Ha! That’s a joke. You never get comfortable. In fact, you are uncomfortable pretty much all the time. Because, after all, everything is brand new and you are doing so many things for the very first time. But you are learning so much and are confident that the process will make you an excellent clinician. And you have so much support. Classmates. Faculty. And you are still excited. Still so grateful to be here. But the days get shorter and then fall comes. Then the winter. And you study, and study and study. And it gets tough. No more Walking Dead marathons. Less time with family and friends. Still time to cook, run, call everyone weekly, date night and a Friday night chill-out session, whatever that looks like for you.

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Future of Nursing: Campaign for Action National Summit

StudentSpeak is pleased to offer this guest post from Jake Creviston, a current Doctor of Nursing Practice Student at the OHSU School of Nursing. After a stint as a search and rescue boat captain in the Coast Guard, Jake became a nurse in 2008. Since then he has worked in critical care, administration, academia, primary care and now as a psychiatric nurse practitioner in an integrative clinic in Portland. He has a passion for leadership, patient-centered mental health promotion and quality improvement.

 

Phoenix, Arizona November 17-19, 2014

My time at the Future of Nursing: Campaign for Action (CFA) National Summit, entitled Leadership and Legacy: The Future is Now, held in Phoenix, Arizona this last November was both rewarding and exhilarating. The CFA, a joint effort between the Robert Wood Johnson Foundation and AARP is now in the fourth year. The campaign is dedicated to seeing the four key messages and eight recommendations of the Institute of Medicine’s 2010 Future of Nursing: Leading Change, Advancing Health (FON) report come to fruition. Each state, and Washington D.C., has an “Action Coalition” dedicated to doing the work on the ground. I was able to attend the summit as both a Breakthrough Leader in Nursing and as an Oregon Action Coalition steering committee member.

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Lessons learned

StudentSpeak is pleased to feature this excerpt from Caitlin Harrington Brown, MS2. Caitlin’s original post appeared on the web site for Women in Thoracic Surgery.

I am a second year medical student at Oregon Health & Science University School of Medicine. I started medical school with an interest in cardiothoracic (CT) surgery and that interest was quickly confirmed by early exposure to the field in the fall of my first year. For the purpose of this article, I have chosen the five most important “lessons” I have learned in my exploration of CT thus far. These lessons are the products of a careful analysis of the past year-and-a-half of my life, during which I have attended weekly surgeries, clinic, tumor board meetings, M&M conferences, fellowship teaching conferences, weekend rounds and simulation events with the perspective that medical school is the beginning of my training. This exposure has allowed me to learn technical and clinical skills and experience moments that will stay with me for the rest of my career. It has also helped me to recognize that for all that I have learned in the past eighteen months, my experience, knowledge base and technical skills have not yet begun to penetrate the surface of what I will need to excel in this field. Thus, it is in my best interest to be humble, work hard, listen, read, be grateful and squeeze every drop of wisdom I can out of the CT surgery team at my school. Read the full article on Women in Thoracic Surgery.

The question we all know is coming

I am halfway through my third year of medical school and so far, I absolutely love it. I feel one thousand times more like a doctor than I did six months ago, and I’ve learned more in these six months that I had in the six years prior. And I’m not just saying that – third year is high yield beyond belief.

By this point, we’ve all answered the golden question hundreds of times. Everybody asks it – family, friends, doctors, patients, strangers on the street – they ask in all types of ways, but it’s always the same underlying inquiry: “What are you thinking of doing after med school? What specialty are you going into? Have you thought about what kind of doctor you want to be? So, David, have you given any thought to what you might actually want to do with your life?”

As a first year student, I would answer this pressing question with whatever I felt like in the moment – cardiothoracic surgery one day and dermatology the next. If I had just read an article about ICU medicine, “pulm crit care” would roll right off the tongue. For most of my first two years, these words were sexy-sounding ideas that would light up people’s eyes and had no base in reality: “Wow, David, you’re going to be a plastic surgeon!?” Which was my cue to say, “Yep, absolutely, it’s a done deal.”

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Understanding the symbolic power of my white coat

Like many Americans, I have been confused, surprised, angered and saddened (often all at the same time) by recent events in Ferguson, Cleveland, New York and too many other cities across our country. More specifically, I cried when I learned of the grand jury’s failure to indict Darren Wilson in the murder of Michael Brown, an unarmed, black teenager in Ferguson, Missouri.

In response, for the first time ever, I decided to attend a rally and march in Portland protesting these events and the underlying challenges they present for our society. For me, this decision also required me to consider for the first time the role of my white coat in making a statement at the rally. Would I attend the rally as a future physician, a citizen or some combination of both? And what is the significance of my choice?

Our white coats, short though they still are, are symbols of our profession. Our profession is one held up by many in this country as one of educated, responsible, kind individuals, and we are conferred rights, privileges and responsibilities by virtue of our engagement in this profession (much like, some might comment, police officers). We were told so at our white coat ceremony, when we stood and took the Oath of Geneva for the first time. We are told so when we are held to the highest standards of professionalism, defined by our profession and our academic institution.

Can I, then, represent my profession, not just my person, at this protest? I protest what happened in Ferguson as an American, as a person of color, as a citizen, as a civilian and as a human being. Do I also protest it as a medical student?

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Trust the Process

Ann McWhorterStudentSpeak is pleased to publish this guest post by Ann McWhorter. Ann is in her last week of the Accelerated Nursing program at OHSU.  Nursing is her second career, after more than 20 years practicing law.  She intends to pursue a career focused on older adults and end-of-life care.

As I near the end of my journey through OHSU’s accelerated nursing program, I am reminded of the mantra we heard so often at the beginning: Trust the process.

That first term, I was struck by the warmth and generosity that surrounded me – in the faculty and in my classmates. As a second-career student, I have studied and worked in many settings where standards were high and the people around me were impressive. But never had I been in an environment so filled with smart, impressive people motivated not by personal gain or competitiveness but by the desire to be of service.

It was clear from the outset that the faculty had the best of motivations. They are, after all, nurses. And they are among the best and brightest nurses. They wanted us to succeed. They wanted us to grow into well-rounded professionals, equipped with knowledge and skills ranging from pathophysiology and patient assessment to a broad and deep understanding of the healthcare system and opportunities to improve it, the experiences of patients and families, and the social and economic determinants of health. They worked hard to keep improving the program, coordinating content and timing across courses to reinforce concepts and make our learning experience the best they could. In short, I could see quickly that these nurse educators were good people, worthy of my trust. So I relaxed my guard, and I trusted the process.

It has been hard, hard work. It has taken humility and perseverance to make my way through this learning experience. But as I near the threshold of my new career and a lifetime of continued learning, I look back satisfied that my trust was well-placed.

Algorithmic Medicine

C++, JavaScript, HTML5. These languages are the backbones to the computer programs we take for granted every day. My mom, a software engineer, will repurpose symbols and codes into commands that yield computer applications and webpages. What is software? No idea. But what I do know is that there are commands and functions that allow a user to interact with the computer and perform specific tasks.

To me, medicine seemed like the furthest thing from software engineering. It is about patient relationships, communication, and improving quality of life. Yet, somehow, I discovered a connection between algorithmic codes and the practice of medicine. The challenge of the third year of medical school is not only the long hours and new expectations; it is learning the codes and cues that make up the language of medicine. I spend every day trying to rewire my brain; creating algorithms that I can access on command. This may be a gross over-simplification, but let’s just run with it. In my new system, symptoms are no longer descriptions of a patient’s experience but a command input that enters my brain to trigger an output that stipulates the possible diagnoses, work-up, and treatment.

For example, a patient in the ER tells me he is having chest pain. Input: chest pain. Output: 5 most dangerous causes of chest pain: myocardial infarct, aortic dissection, pulmonary embolism, pneumothorax, Boerhaave’s syndrome

I tell people that “I am working” to simplify what I am really doing: creating a systematic thought process that I will hone over my career. Two years of lectures, excessive highlighting, and one USMLE national exam later, I have a lot of data with no organizational system. My brain feels like a file cabinet that needs to be alphabetized, cross-referenced, sorted based on pre-test probability, and then converted into electronic format. Needless to say, there is much work to be done. Every day a new piece of the puzzle falls into place.

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What is a preceptorship?

That was the exact question I was asking myself when I started medical school and even up until my first day at the clinic. There isn’t a very good definition on Wikipedia and it’s definitely not in ye ole trusted Miriam Webster. Even asking older students led to a multitude of definitions ranging from “glorified shadowing” to “being a doctor’s assistant.” Both of which were not entirely satisfying. It wasn’t until I started a couple weeks ago, that I uncovered what a preceptor was: a role model for patient interaction.

It’s difficult to learn how to build a relationship with a patient or deliver bad news purely from reading journal articles and practicing with classmates. Reading evidence-based practices for introducing yourself and shaking hands is helpful, but not the same as doing it with someone you’ve just met. Sitting down and setting an agenda for a fake patient interaction with your friend that you spent all of last night studying metabolism with, is not the same as starting your first conversation with a patient. As much as you pretend to not know each other and create that reality, you can’t help but talk about that one quiz question from last week or your fellow classmate’s birthday dinner tomorrow night. It’s great practice – with your classmates you can feel free to completely mess up, to forget a couple points and try out new questions – but not the same as sitting down with someone who is genuinely sick or in terrible pain and trying to communicate with them. Class gives you the tools to communicate with patients, but preceptorship allows you to watch a professional do what you’ve spent weeks practicing with style and grace.

In my preceptorship, we work with many people who are needing end-of-life care. Most of our patients are very sick and have been sick for a number of years.

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New Kid on the Block

I’m in grad school.

It’s kind of weird for me to say that because it still feels new to me.  I’ve been in the Behavioral Neuroscience Graduate Program at OHSU for just little over a month, and there are so many things I want to share: moving to a new city, my first rotation, being back in class after a two year hiatus… I’ll spare you from most of it for now.

I imagine my first month in Portland has been similar to the initial response a mouse experiences in the open field arena.  You know, novel environment, isolation from cage mates, and all that.  There’s a fear of danger but a desire to explore the unknown.  I’ve already learned a lot from my initial exposure to grad school though.  For example, homesickness can hit you hard no matter how short the time away.  Cry, call home, do what you need to, but remember to appreciate that you have a home worth missing.  Or on a more practical note, with the recent power outage on campus, I’ve learned class material—like what to do in the case of missing data—can quickly become relevant during your rotation.  (I mourn your loss, missing circadian activity data.) And of course there’s the scientific research, the reason I’m here.

When offered an opportunity to write for StudentSpeak about my graduate experience, my interest was immediately piqued.

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