Back and forth we went, quickly turning over the two exam rooms and getting through the long list of patients. The doctor walked swiftly with a gun strapped to her waist while my watermelon socks in snake print clogs nipped at her heels. The weapon looked out of place against the pale blue of her scrubs, yet it was essential for her protection. She slid open each door, snapped a purple glove on her right hand, lifted the sheet covering the patients bare, shaking legs on metal stirrups, and did a quick pelvic exam. An exam not medically necessary but required by the state in order for the patient to get the pill that would end her pregnancy.
It would be hard to miss her. She walked into the atrium, towering tall in a bright orange jumpsuit. She was led down the hallway, her handcuffed arms held straight out in front of her, palms parted as though to grasp a bouquet of flowers.
When we saw them later that afternoon, they were uncuffed, poking through flimsy sleeves of the hospital gown she was given. Without her body wrapped in its orange uniform, or the security guard sitting at the foot of her bed, you wouldn’t know she came from the prison. She now matched her neighbors, donning that sad sky blue material, that pitiful excuse for a color. The one decorating most healthcare facilities, the one that is supposed to warm up sterile rooms and hearts alike while failing at both. Continue reading “Welcome to Third Year”
I wrote this a while and submitted it to Physicians for Reproductive Health blog where it was published. Click here for a link to it, or read below.
Last summer, I received funding from the national network of Medical Students for Choice to do an externship in Mexico City. This externship consists of spending two weeks observing in an abortion clinic. But before this…a little detour to Oaxaca.
The week before starting at the clinic, my boyfriend and I planned a short but sweet three-day vacation in Oaxaca, just an hour flight away from Mexico City. The first day passed blissfully. We spent it strolling and tasting our way through the city’s cobblestone streets. The next day, we embarked on what was promised to be a beautiful adventure, hiking through the Mancomunados villages of the nearby Sierra Norte mountains. We started in a pueblo called Cuajimoloyas and headed out for the six-hour trek with our guide, an ageless local named Jose. Over and under trees we trekked, stumbling through fields of wild flowers, happening upon a newborn baby goat, discovering agaves with shoots 50 feet tall. I had asked Jose to share any knowledge he had of the plants, particularly the medicinal plants, which only seemed appropriate as a medical student.
He first showed us poleo, explaining how it is typically used for the stomach and digestion. As we had spent the previous day eating the entirety of Oaxaca’s food supply, these leaves looked quite tasty to my intestines. I popped a few in my mouth and on we went. When we passed another bush I snagged a few more, asking Jose if one can eat too much poleo.“No, no pasa nada,” he responded. And with the trust that comes from pure idiotic ignorance, I chomped on a few more.
We pressed on, heading to Latuvi, a small town perched high within a sea of mountains and known for its abundance of peaches and apples. Hours later I was hot and tired but motivated by the pulque tour and sweat lodge waiting for us at the end. However, when we made it to Latuvi that’s where it all ended. Or began. The poleo that Jose promised wouldn’t cause any harm decided otherwise. Continue reading “Pennyroyal: a less than royal mint”
Recently, I wrote this email:
Hi Dr. W,
I was a patient of yours in 2006 when I started at Scripps college.
I’ve thought about you many times as the years have passed, how lucky I was to receive such wonderful care. I am proud to say I have never relapsed since, and am strong, healthy and happy. In fact, I am now a medical student at Tulane, hoping to pay it forward.
Thank you for your work,
I’ve heard a lot about the self-pathologizing that happens in medical school. How everyone will start to think they have the various diseases we learn about. With my own family history of hyperchondriasis, I too, have been waiting to find my rare diagnosis. Waiting to learn about the condition that pieces together all the symptoms I didn’t even know I had. Luckily, by now we’ve gone those most of the bodies systems, and my bones, blood, and organs have come out “unremarkable”.
Then we started on the brain.
I have always been a wanderer. My mother always kept an eye on me as I would drift from the crowd to find a quiet place to play. On family bike trips I would speed past my family until the road came to an end, or sprint ahead on a hiking trail losing myself in the monotonous beauty of oak trees until I was called back by the shouting of my name as they searched for me. As social as I was, I always needed time to be alone, time to be bored. Time long enough for boredom to turn into daydreams, for daydreams to turn into fantasies, and for fantasies to turn into inspiration.
I do not wander to get lost, although it sometimes happens. Two feet guide my steps, the right slightly larger than the left. Two hands balance my stride, one soft holding no expectations, while the other clutches to a small hope for discovery.
At the library a few weeks ago, I asked to share a table with a girl pouring over pages of organic chemistry. Because I cannot help myself (I am my mother’s daughter after all), I asked what she was studying. She told me she was studying for the MCAT exam. I could have guessed from the tired and desperate look in her eyes. A look I haven’t seen on myself for a while, but remember all too well. I sat down and pulled out my books on pathology and Step 1 Exam prep.
I promise it gets much more interesting, I said with a smile. Continue reading “Unsolicited Advice”
That day I was supposed to be the patient.
The nurse putting the blood pressure cuff on me was the same one who always takes my vitals. She likes to chew gum; you can see her tuck it between her teeth and cheek as she walks into the exam room. A slight bulge pumping against her straight hair. Today it is dyed a reddish-brown.
As her hands wrapped around my arm, my eyes landed on small blacks on her left wrist.
“Is that a semicolon?” I asked.
“It is,” she replied as she shimmied her stethoscope up around her ears.
“Can I ask if there’s a story behind it?”, a tactless way of indirectly asking the question anyways.
“It is for suicide awareness,” she replied. Continue reading “the girl with the semicolon tattoo”
The million do$$ar question:
What do you think your voice and sense of social responsibility is as a physician-in-training?
A first year medical student’s answer:
I would not say that I stumbled into medicine. It requires too much hard work to be an accident. But it was an unanticipated deviation from the original career path I had started down. The latter was a life in the non-profit world, centered around social justice with a focus on women’s international human rights. My move towards medicine was not a break from this work, but rather an opportunity to address it from another direction. I believe that healthcare, as a basic human right, is foundational to any fight for justice. As such, I came to see how the practice of medicine is the use of set tools to effect tangible change.
I love the notion medicine as a practice of the art of healing. It is a precarious balance of holding compassion in one hand and objective decision-making in the other; it is a creativity to read between the lines, hear between the breaths, and feel the silence of emotions between words. Much of the art cannot be taught in a textbook, or a lecture, but from the humility of failing over and over and over again in the hopes that maybe next time you will get it right.
Amidst these lessons, our training places us at a unique intersection of our hippocratic oath, legal mandates, and our own moral codes. Sometimes these align, sometimes they stand in staunch opposition. Sometimes we must suspend our personal beliefs at the door to provide the best care for a patient, but to also not forgetting to to pick them up on our way out.
It is an difficult role for it requires numerous character changes: a patients’ confidant at the bedside, an advisor to a business, an expert at a court hearing, as well as a friend, a lover, a caregiver, a family member, and an ordinary citizen. In choosing this career, one necessarily chooses involvement in issues they have never experienced and is confronted with questions they have never had to answer. Sometimes they are small, like helping a patient figure out transportation options to ensure they make their next appointment, or finding a free clinic for an uninsured patient to get affordable prescription medication. Sometimes they are much larger, like how to respect a family’s religious requirements for burial while also complying with state mandated autopsy orders or organ donations.
As physicians-in-training, we are no longer isolated to the problems and injustices that impact us personally. When we commit ourselves to the care of a patient, we must seek to address their well-being. Our white coats with embroidered names place us in a unique social hierarchy that values our voices. While we cannot take on every struggle nor pick every fight, we can, and should, advocate for our patients. To do so it to take on someone else’s struggle as our own. And when we speak out from a truth rooted in their stories, whether at an institutional, local, or national level, we help amplify their voices, moving them beyond to walls of the exam room.
This work is not about being a do-gooder, or completing a class requirement; it is about committing to a job that requires more than diagnostic skills and memorization of medications. As we discover our strengths and weaknesses, we learn better what tools are available, figuring out how and when to use them. And it is in this creative process that perhaps we will master the art of practicing medicine.
“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.” — Charles Darwin
There is a girl in my class who always asks the smart questions. She and I were talking after class.
Me: Hot damn! Always asking them fabulous smart sounding questions lil lady!”
Her: Well, I have studied this before.
Me: Oh phew, thank god. Cuz I have no idea what is going on. Want to teach me all the things?
Her: Heck yea! If you will teach me about culture…and how to dance…and…the world.
Me: I got you there! That’s more my strength for sure.
Her: Wouldn’t it be great if we could just combine ourselves? It would be the perfect person!
We both laugh. Partly because we are silly, but mostly because that is the actual the dream both of us are trying to find. How to be good at it all.
There is this fun new thing many medical schools are trying to do: embrace and incorporate the humanities. There are a few ways they are doing this. One is by incorporating the social sciences into their natural science based curriculum. This harkens back to the olden days when medicine was not defined as “the science or practice of the diagnosis, treatment, and prevention of disease,” but as the art form of healing. Some schools have medical humanities electives involving drawing, theatre, or writing classes. Others have joined the narrative medicine movement started at Columbia University, with student-run publications, lunchtime literary clubs, and lecturer series. Each offers a forum to discuss the importance of personal narratives in both the diagnostic and healing process.
Here at Tulane there is a program called Foundations in Medicine. It offers biweekly class involving shadowing doctors, simulation exercises on plastic dummy patients, roleplaying sessions with standardized patients (whose outside identities are an eclectic array of professional actors, historic tour guides, bike carriers and the like), ethics discussions, and personal journaling exercises. Essentially, they are our doctoring classes, trying to teach compassion, empathy, and most importantly, how to be a good listener. We even have a group called Students Against Right Brain Atrophy, which, as its name indicates, encourages a variety of art forms. Furthermore, our performance is not measured by grades but by a pass/fail system in hopes to eliminate an aggressively competitive atmospheres.
They other way medical schools are embracing the humanities is through their admissions process. No longer are the top candidates 21 year-olds with the best grades and MCAT scores. Now the ideal medical student has a lil bit of it all. Such as a pre-med who majored in the social sciences, has traveled the world, worked in the non-medical field as well as is published on scientific papers, a trained EMT, who is also an award-winning quilt maker, or olympic contestant, or has some other form of creative mastery. It is someone who is well-rounded; someone who is competent and driven, yet gentle and kind. A woman who worked in admissions for a long time at UCSF described it to me this way: it is the person you would trust to care for your mother or would want sitting by your child’s bedside.
As a former Humanities student, a dancer, and a hard-core crafter, I have been thrilled about these changes happening in medical education. They offer a breath of life and lightness into the daunting seriousness of this field. Our school encourages us with lectures about the mental health resources available, how to look out for one another, where to report concerns, while also highlighting the importance of maintaining our identities and sense of self. I’ve been enthusiastically applauding these efforts and truly believe they are meant with the best of intentions.
But as I continue to nod in agreement each time the term “Self Care” is thrown about, my neck is starting to get sore. It has become the catch-all phrase whose meaning seems to fade with each use. Its utterance has come to stand for what it means to evoke, it has replaced the very action of caring for our selves.
In medical school, Self Care embodies the expectation of being able to do it all: balancing our rigorous studies, clinic volunteering, interest groups meetings, and personal hobbies, alongside maintaining relationships, exercising, eating well, and sleeping 8 hours a night. All this while our inbox is flooded with invitations to more lunches, talks, and social events than hours in the week allow for. None of these things are required of us per se. Yet we put the demands on ourselves. Because as much as some of us (me, myself, and I) try our darnedest to hide it with our laid-back affect, let’s face it, all medical students are some degree of neurotic.
And don’t get me wrong, these are all great problems to have. The opportunities are endless and to have them offered and encouraged as much as they are is a blessing. It is all done with good intentions and the data to back it up: new studies show that a well-balanced person makes the best physician. But that is the catch. Now with the b-word dropped into the equation, it sets off the perfectionist’s alarm. So we get to work, tweaking the scales back and forth in search of this best-making equilibrium. We make schedules so perfectly crafted that even our moments to pause for thoughtful self-reflection are planned—ten-minute meditations in the morning, gratitude journaling before bed, self-love chants during teeth brushing. If calculated correctly, all this should result in our true happiness and utter appreciation of our new-found medical profession.
The problem with this of course is that stress and emotions don’t follow rules or timelines. They don’t stick to calendars nor are confined to hourly block schedules. They are mercurial in presentation and their timing can be alarming. They don’t ask when they can come out, where they are coming from, nor how long they plan on sticking around. They range in their presentation and are rarely logical, for it is not in their nature. Recently, I’ve been finding myself stumbling into emotions that were not supposed to be there. They always surprise me, for I hadn’t planned for them.
They often come on my bike rides, the rare moments of the day when my mind gets to breathe from the hyper-organized timeline I have it running on. As much as I work to manage my emotions, these moments seem to tell me otherwise. Not just that I am, in fact, stressed or anxious, but that the coping tools I have always relied on, no longer seem to work in this new context.
So when people ask if medical school is hard, the unsurprising answer is always yes. But what makes it hard is not just the endless amount of information we are supposed to understand and remember. With time, discipline, and repetition, this is challenging, but doable. What I find makes it so hard is a matter of identity. It is the challenge of merging an old life with this new one, of figuring out what to hold onto, what to let go of, and accepting that I only have two hands with which to do so. It is trying to redefine what Self Care means in this new phase of life when nearly all the variables have changed. And most importantly, it is having the patience to let myself figure out the answer. An endless work in progress.
So as I am about to enter my twenty-eighth year of life, here is a toast to change…life’s only constant!
It’s the night before my first exam in medical school.
Excusable emotions would be somewhere around anxious, nervous, terrified, or bubbly confidence. But more than anything I feel an intense sadness.
Today was the first time I got to step into the shoes of what owning a white coat means. An acquaintance, someone I’ve hung out with only about half a dozen times, asked me to help him change his wound bandaging, since he needed someone he knew who wouldn’t be “freaked out by blood”. Since I am now officially a medical student, he assumed I would be the right person to ask; if not for that we aren’t close enough for him to choose me as the person for such a favor. I knew little of his condition but that I was in for a surprise. The preceding weeks I got a picture of him in a hyperbaric chamber and the word encephalopathy in a text. With a medical education of eight days, most of which has been spent dissecting a dead woman face, I did what any good student does and turned to google: a disease in which the functioning of the brain is affected by some agent or condition (such as viral infection or toxins in the blood). Vague enough to be confusing, specific enough to be alarming.
When I came in, he was sitting at the kitchen table with clean towels spread over it. There were the orange stains of iodine, a pile of used alcohol wipes, and medical instruments sealed in their sterile wrapping. A paper facemark covered his mouth but his eyes gave away a smile as I walked in.
“So,” I said, “will you please tell me what the hell is going on with you?”
He took a breath. “We’ll get there. I just need to talk about normal things for a while.”
I stood corrected, smiled at him, and replied, “totally fair. What should I do first?”
I got my hands washed and sterilized. We moved around each other slowly, We showered him with alcohol wipes to clean around the IV in his bicep. Using small motions, we cleared the crusted pus that has been unattended to all week. Communication was short, either instructional or a sarcastic joke to maintain a light giggle in air air. As we worked he told me the IV was for an intravenous antibacterial he was taking. And for the many other meds he was pushing through it. Anticoagulant, another protein-biding something or rather, words I recognized but had no idea what they meant.
After we finished an hour later, we sat on the couch and he taught me how to slowly push in his meds. 10 secs for each mL. If you go too fast he gets a stinging in his mouth and eyes. He slumped down to the floor afterwards resting his head on my knees. I started massaging his tight shoulders.
Slowly, his story unfolded. It is an intracellular infection. They don’t know where he got it. Probably somewhere tropical, maybe out on one of his adventurous off the map camping expeditions. Nor do they know when. Months? Years? No way of knowing. Could have been sitting dormant for quite some time. Until it woke up, and started exploring its new home. It started spreading through small spaces, finding its way up to his blood stream and taking a ride up to his brain. It is a mercurial little devil; showing itself in odd neurological ways. Sometimes full body pains, sharp or dull, shooting vibrations down the limbs, sometimes he feels and hears things that aren’t there.
Worst part is, like most neurological diseases, its hard to diagnose. It took a few tries by a few different doctors to identify the bacteria correctly. But knowing it doesn’t make it any easier to treat. The only cure is to kill it, and that is proving rather hard to do. The medications have helped lessen the symptoms, but they come with side-effects.
What can I do when my new identity as a medical student proves utterly useless? I suppose to be the best patient advocate I can be, a friend who sits in the silence and listen when it is broken.
So for now we wait and hope for the miracles of modern medicine to prove itself once again.