As much as I love microbiology, I was reminded today of why I will never go into infectious disease. Or ophthalmology. I did a google image search of roundworms (ascaris lumbricoides) in order to supplement our lecture. There was a picture of a roundworm in someone's eye. I'm not sure why but eyes REALLY freak me out. An eye + a parasite visibly swimming in it = enough to make me almost want to quiet med school.

Yet I know that I am a med student because as much as it freaks me out, it is kind of cool...

Dr. Harrison

Dear Dr. Harrison,

I was fortunate enough to hear you speak last fall when you visited my southern medical school. As a first year, I sat wide eyed listening as you eloquently explained your motivations to provide comprehensive women's health care, your drive to ensure that all women have access to safe abortions, and the factors you have had to overcome in order to offer these services. The stories you told of the patients you have encountered inspired me. I have no doubt that these patients, and so many more, are standing with you now in solidarity.

I spoke with you briefly after the presentation, asking if it is better to do the MSFC externship between first & second year vs. during 4th year electives. Along with replying that 4th year is preferable you also suggested that I should come to your clinic to do it. As someone struggling with the conservative nature of my school's OB/GYN department, that warm and welcoming invitation is something that I will always carry with me. It is a rose among the thorns of naysayers and hurdles trying to keep me from being trained as a provider. Just as you did not hesitate to offer yourself as a teacher and mentor, I promise to never hesitate in pursuing my education. In following your lead, I will not let obnoxious barriers keep me from providing safe and affordable care to women in need.

Thank you for all you have done. Thank you for believing in women's rights, and for letting these beliefs shape your actions. Thank you for being a warrior on the front lines. Thank you for inspiring all of us future providers. Thank you for paving the way for me and my peers to be abortion providers, to be guardians of women's rights, and for showing us that we can actively model our values and beliefs. You are leaving us with mighty big shoes to fill. While we might not be able to fit in them perfectly, I can promise you that we will continue to march on. Your patients need us to, the women of Arkansas need us to, the women of The United States need us to, as well as the rest of the women in this world.

While the words will never be big enough, they are the best I have:

THANK YOU FOR ALL THAT YOU HAVE DONE,

(just another MSFC member and future abortion provider who is inspired by you)

Listening

For one of our classes we have to write "personal development essays". While rushed and somewhat BSed it still provides some insight into my inner musings. Plus one of my classmates posted her's, leaving me to think "why not?". So, this is my first one of 2nd year:

As a child my parents made sure to teach my brother and I the difference between “listening” and “hearing”. According to them, listening was a passive act that held little meaning and respect. Instead of having us listen, they wanted us to hear what was being said. They wanted us to be actively engaged in dialogue and to put effort in to ensure mutual understanding. Their distinction introduced us to the value of not spacing out while listening to someone, not interrupting, or otherwise being inconsiderate in conversation.

Later on, through group facilitating experience I was introduced to the idea of active listening. While I have learned that there are many ways to do this, one of the most meaningful ways I have experienced involves having one person speak for a set period of time while the other(s) remains totally silence. When the speaker has said all that they have to say, they end their session by saying “I have spoken”; the other person(s) respond by saying “I had heard” and nothing else, never responding to what was said. Then it is the other partner’s turn to speak. This interaction tends to feel very unnatural and uncomfortable at first, but manages to create an extraordinary safe space for significant interactions to occur. There is a shared trust that a scared space has been created, and that you have as long as you need to process what you are saying while you are saying it. In theory listening to others should be an intrinsic ability yet activities such as these make me feel that it is much more of an acquired skill.

I guess that I should not be surprised that truly listening is a challenge. We live in a world where we are constantly on the go, constantly multi-tasking, and being completely self-consumed with our own lives. Our society appears to no longer values face-to-face conversation (at least outwardly), having instead replaced it with the instant gratification of e-mail, text messages, and cell phone conversations. The problem with these forms of communication is the difficulty in staying actively engaged, and the ability to misinterpret what the other is saying. I have more than one string of e-mails turn sour due to misinterpreted words, leading to more e-mails in order to rectify the situation.

The culture of medicine seems to add even more difficult to listening. From day one in medical school we begin learning a new language, one that is efficient, relatively exact, and completely foreign to the majority of our patients. We are also taught the importance of time management; learning early on that time is limited and valuable. While many of us have the best of intentions, these lessons can easily put distance between us and our patients. Leading us, their doctors, to ask questions without waiting for answers, correct their statements with authoritative-knowledge, and dismiss their concerns with our lack of time. While we many think that we are listening to our patients with the 15 minutes we have for a visit, we are never doing it for more than a few seconds at a time and we certainly are not hearing what they are telling us.

Through my work at the student clinic(s) I am already starting to sense how easy it is to feel rushed and inpatient during visits with our patients. When I ask a question such as “have you have a TB test before?” and get a long winded response, it takes effort to not interrupt to ask “yes or no?” However, the tiny bit of effort that it takes to bite my tongue produces valuable awards: the privilege of hearing personal stories and a better understanding of my patients. I hope that throughout my medical career, especially when feeling overwhelmed, I remember the value in active listening. The valuable lesson to strive beyond listening, to work to hear, is one I will carry with me throughout my career and will hopefully play into all my future.

Research

Research is a necessary evil of medical school. Yes, it is possible to go through the educational system without doing research. It is even possible to do well and match in a good residency without a publication. But as someone interested in academic medicine, research is basically a required optional activity. The process fascinates me. The ability to spend time questioning, exploring, and explaining speaks to my inner child. However, the process also creates an emotional roller coaster which drives me nuts. There are constantly ups and downs, with very little balance between the highs and lows.

Currently I feel overwhelmed by the lows of the process. My abstracts from this summer need to be submitted this week, yet are stuck in the in-box of my PI waiting for revisions. I can't imagine how he's going to edit them in time, and being 3000 miles away limits my ability to nag him about it. If he does get them back to me, will they still need work before submission? How does one even submit abstract proposals to a conference in the first place? (I am sure I will learn as I go, I'm just not sure that timing will allow me to learn with these abstracts). What will happen if they aren't ready? Will this be the end of everything I worked on this summer?

The second project I've been involved with is currently stuck in the IRB labyrinth. We submitted our application for exemption on Thursday, right before the Friday deadline. This was our last chance to submit and get a reply before our intended (and non-negotiable) project start date. Late Friday afternoon we were informed there is a snafu in our application, and it may be insurmountable. I may have thrown a temper tantrum yesterday morning when I found out about this. I may have acted immature and unprofessional by sending out a rather pungent e-mail to my adviser and co-researchers, an e-mail I now can't take back. I intellectually know why the IRB is necessary but am so frustrated that silly bureaucracy (relating to intellectual property rather than ethical concerns) may impede on interesting and important research, biased opinion of course. Not to mention that this is research I WANT to spend my time doing instead of just doing it for the sake of my future... but maybe that is the problem. Being so attached to the topic might be increasing the emotional weight of every set-back. I guess you can never win...

"Letting Go"

Here is another amazing article by Atul Gawande. He speaks of issues that make us Americans very uncomfortable: end of life care. It is not surprising to anyone that a disproportionate amount of our health care spending goes towards those facing death; is it worth it? When do we say that enough is enough? While drawing concrete lines that such and such a procedure under x circumstance is wasteful doesn't seem so hard; it all changes when talking about a specific person. How do we create a fair, finically responsible and sustainable medical system? How do we do it while valuing each individual life as priceless? Thoughts?

My inner-anthropologist thinks that we need to come to terms with death being a natural, and sometimes even desirable, end to life. As doctor's we need to stop seeing death as failure on our parts, and need to start seeing palliative care as an alternative option. We also need to really listen to our patients, identifying what their true desires about end of life care and encourage them to share this information with their loved ones.

Lonely

"If your heart is bleeding make the best of it"

This video is absolutely beautiful and resonates with me on a personal level. Living in the South, I often find myself lonely in a way that I haven't since I was an uncomfortable middle schooler. I can be surrounded by people, knee deep in medical school text books, stressed about the 100s of different thoughts flying around in my head and yet feel totally and completely alone. It often happens when surrounded by people who don't understand (or know about) all the unique paradoxes that define me. The loneliest times are shabbat days that I stay home to study, feeling completely cut off from both my Jewish and non-Jewish communities.

I am starting to understand the naive idea of wanting children in order to have something that needs and loves you. I know that I am not ready for children, but I have been starting to contemplate getting an animal. With 12 to 15 hour days spent studying at school, and the reality that impending rotations will keep me away from home at random hours, a dog seems out of question. A cat might be a good fit though. However, I worry it will fast track me to "crazy cat lady" status. That if I get too comfortable with a cat at home to talk to and cuddle with, I'll have no motivation to ever leave home and/or look for a significant other. Also that it'll make me the stereotypical lesbian. Though the true stereotype involves 2 lesbians, multiple cats, and a Uhal. A friend responded to this fear by stating that one doesn't necessarily need a cat to become a crazy cat lady. Helpful, right?

going gay

My medical school went gay last week.

Okay, fine, let me try rephrasing that. After a lot of work, meetings, and jumping through hoops, we finally got an LGBT and allies student group approved at the medical school. While not as hard as I feared it would be (and with a lot less backlash) this was still a rather difficult task as we had to defeat the overwhelming amount of stress induced apathy. But advocacy and grassroots organizing paid off. We are now a guaranteed student group with all the rights and privileges such a status bestows... all $300 or so a year to put on events with, events we were already putting on. The money wasn't the point of creating a student group though; rather it was to create a visible and inclusive community fully supported by the administration.

To celebrate we had a gay happy hour outing Friday afternoon. There was an excellent turn out and people seemed to enjoy themselves. Meeting some of the first years was lovely. The surprise of the night? Learning there are nearly 15 openly (out) identified (L/G/Q/insert proper identity term) students in the first year class. That is as many as the other 3 years combined! While it still represents less than 10% of their class population, it is a HUGE number for a medical school class, especially medical schools in the South. I'm taking it as a positive sign for the ability to change the system and encouragement to keep fighting for LGBTQ visibility. I'm also really interested to see if this increase in population will have any effect on perceived community dynamics. Or for that matter, on my personal life (so doubtful)....

Broken, part 1

"Medicine used to be simple, ineffective and relatively safe; now it is complex, effective and potentially dangerous." -Cyril Chantler

This is the first part of what I am sure will be a many part saga; an epic about how broken the US health care system currently is. I say all of this with the caveat that a) I'm really not sure what would be better; b) if I did, I'm not sure I would know how to transform our current system to this new shiny, effective, and cost efficient system; and c) as imperfect as I know single payer systems to be, I support systems that acknowledge my belief that health care is a right. However, I am never really sure what to say when asked "how much health care is a right?"

Two things happened last week that made me think about how broken our system is. The first was a public health class on health care management. We spent 5 days sitting around a room, shooting for the moon with our ideas about what health care should offer. We then discussed authentic leaders, and how to use leadership to make these things happen. In 20 years it will not surprise me to see these classmates transforming the way health care is delivered; and with the ideas that were shared, I pray that these minds are able to make an impact much sooner than 2030.

Second, I received two e-mails. The first from a friend worrying that her birth control pills were fallible. This friend should have been educated about all the possible signs and symptoms that may present when put on the pill. The lack of premptive education caused needles worry, undue anxiety, and possible misstrust in the system. The fact that she came to me (a know-nothing medical student) instead of her clinician speaks to the inaccessibility of educational services. Second, another friend, with a history of asthma ended up with multiple time-consuming and stress-inducing specialists appointments because of follow-charts. She saw her clinician presenting with shortness of breath and heart palpitations which automatically sent up the red-flag for cardiac trouble. While this red-flag supports the effectivness of the system (along with the fear of malpractice litigation), no one took a time out to actually think about the situation. The fact that she's young, healthy, had a normal EKG in the office, and that her signs and symptoms were consistent with her asthma regiment. If this thought process had been followed, she would have been saved excess time, money, use of precious resources, risk of added interventions, and excess time before the necessary change in asthma medicine.

I may be a naive medical student. Maybe you don't agree that these examples illuminate some of the many issues with our medical system. But, even still, can you really say that our system isn't problematic? And should we settle for something so broken?