A common thread

Two weeks into my Acute (third) term in this program, I find myself feeling inspired on a daily basis. On Tuesday, I shadowed a nurse who, based on my observation, is exactly the kind of nurse that I want to become. She was incredibly competent and every single thing she did throughout her busy day was patient centered. My patient these past three days is a real life example of what resiliency and strength looks like and I feel so thankful to have become a part of her journey. Today, I got to see what a balancing act floor nursing really is and how a wonderful nurse is able to manage it. And then, I was able to attend “Ethics Rounds” today at lunch. Talk about inspirational!

I don’t know what my expectations were when I walked into that room but they were exceeded in every possible way. Various medical professionals chose to attend and the topic today was counter transference. However, this was no conceptual lecture, nor was it a time to “fix” a problem. This was a time dedicated to voluntary sharing of stories about patients that someone became emotionally connected to. Many people shared emotional stories of patients that they’ve lost, patients that reminded them of themselves, a loved one, or just one that for whatever reason really tugged at their heart. It was a safe space to discuss these very personal and moving stories and I was so impressed that this hospital (and many others nation wide) set aside this time to have these very discussions.

I was also struck by how many of those stories came from physicians today (some of whom were surgeons). It is so very easy to begin to buy into stereotypes about each field in some way- nurses care, doctors solve medical puzzles, surgeons are cold, etc. It was a humbling and profoundly moving reminder that all of us in this field share a common thread of caring, and of wanting to be helping professionals. In so many ways, today exemplified the new model that we are moving towards in this school, and in the medical system of interprofessional collaboration. Various professions came together to talk about the thing we all share. We all have so much to offer to a team.

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Get lost in a story

Stories have been told since the beginning of civilization – sharing our own or listening to another’s. We love to get lost in stories: films, books, readings, theatre – we are drawn to the lives of characters whose heartbreaks and triumphs we connect with and can reflect on as our own. I hope you enjoy this blog as it is another avenue for storytelling, one in which tales of research, medicine, patients, and education all converge.

A very powerful story I encourage you to read, especially as part of the medical community is  “The Spirit Catches You and You Fall Down” by Anne Hadiman. Compassionately narrated, the author examines the cultural, medical, and language barriers of a refugee family from Laos and the medical community of Merced, California as they treat Lia Lee, a Hmong child diagnosed with epilepsy. This story embodies the term “narrative medicine.” Narrative medicine is not about medicine and technology but rather about people, their cultures, foundations, beliefs, denials and acceptances of patients within the healthcare system.

I have been witness to many stories during the past year at OHSU and the VA Medical Center on my rotations. These stories have been filled with hope and fear, science and faith, brilliance and doubt. The purest essence of storytelling exists in these wards and on these floors we have all come to know so well. In medicine, we tend to forget that we all have a story. We come in naïve, innocent, and open. We are trained, coached and critiqued on factual truth. We forget that History really means “his story” and “her story.” We talk about someone in the context of their illness – Mr. C with Type II Diabetes, Mr A. with a pneumothorax, Ms. R with cellulitis and COPD. When we talk to a person, we help him write his story, how he came to be where he is and how he is handling the issue. Family members and friends help enrich the story, allowing us to tease out the details and nuances.

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Fireside diagnosis

During medical school, we are awash with a non-stop flow of information. It can be overwhelming at times, and we occasionally wonder whether the material will actually stick over the long term. Our last class, anatomy, finished a couple months ago, but the amount of information we have learnt since makes it seem as if it were years ago.

Sometimes, though, life presents opportunities that reveal just how much medical school is actually training you.

During a recent break, an acquaintance* and I were chatting by a fire pit when he brought up his upcoming surgery. He lifted his left hand and said, “Yeah, I’ve had some trouble with my left hand. It hurts these days, so the doctor is going to do some surgery on it to make it better. I forgot what he said it was.”

Instantly, my mind started analyzing his problem. Left hand pain; my knowledge base whittled it down to muscular or neurologic. “You’re left-handed right? You write with your left hand?” I asked.

He nodded, “Yeah, that’s actually when I first started noticing the pain; whenever I would write it would hurt.”

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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!

Rob
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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Camaraderie

“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.

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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