Tandem Steps

Kelsey, Third Year Medical StudentIt’s a question I’m asked on a regular basis, in fact, it seems almost reflexive for people to ask it.  Like when people find out I’m from Kansas and they say, “Well, you’re not in Kansas anymore.” I have a whole host of sarcastic responses to this remark in my head, mostly to entertain myself, but usually I just laugh good-naturedly when people throw the Wizard of Oz line out there.  Admittedly, the general population can’t help it that Kansas is widely notable for very few things:  Dwight Eisenhower, Kansas University men’s basketball, and, of course, the Wizard of Oz.  Allowing that most people are not history buffs or NCAA Big 12 basketball fans, they must default to trying to connect with my Kansas heritage via Dorothy and her little dog, too. But, no harm done, whatsoever.

The  question comes up in  get-to-know-you type conversations conversations, in catch-up conversations with friends, in one-on-ones with family members,

“So is it hard for you guys, both being in medical school?”

Simply put, the answer for Cody and I is “no”. For one thing, we’ve never known anything different in our marriage because we took our summer after first year of medical school to get married and then travel (I highly recommend this, by the way). So our entire marriage so far has been contained to our years as medical students. Secondly, our crazy-busy stressful periods always coincide, so there is mutual understanding  that activities of daily living, like cleaning dishes or grocery shopping or watering the garden, might suffer, and no fingers of blame can be pointed because we’re equally occupied.  Third, we’re able to support each other in a way that a non-medical spouse could not (no insult to non-medical spouses, I know some really lucky med students with phenomenal wives/husbands). When I’m having a stressful moment/day, Cody is johnny-on-the-spot with words of encouragement and the foresight to remind me that we’ll be able to do somebody some good someday, even if we can’t right now.  There’s a solidarity between us that we couldn’t know unless we’d traveled this road in tandem steps.

It’s probably true that our lives are busier than many other twenty-something married couples.  But our lives are still lives of abundance, full of great friends, time with family, and even outdoor activities, probably more often than you’d think.

So, married in medical school? No problem.

And of course, I have to give a huge shout-out to my husband, who keeps me level-headed, and who shows me self-sacrificial love on a daily basis.

Hanford, CA

Kelsey, Third Year Medical StudentOne of best perks about third year is the freedom to do some of our rotations at other hospitals. So, my husband and I decided to take full advantage and sign up to our family medicine rotation in the Central Valley. We’d heard some really good things, like that family medicine residents were the only residents around, so they see not only family patients, but also several of the specialty patients.  After checking to make sure they could take the both of us at the same time (including providing a housing option where we could stay together, since we’re, you know, married), we agreed to spend our four weeks of family in Hanford, CA.

Ready for a little bit of an adventure, we were pleasantly surprised.  Here are just a few of the things we loved about Hanford.

1. The hospitality! Each one of the eight family residents, as well as the faculty, made a point to learn our names within the first two days we were there.  We quickly felt at home with residents as they reached out to help us in any way possible.

 

2. Dr. Engeberg, the family medicine residency program director. For Cody and I, he embodies many of the qualities we hope to possess someday as family physicians (did I mention I think I want to do family medicine?): Down-to-earth, unassuming, and very sharp, he is a man who cares deeply for his patients, cares about their stories.  To Cody’s surprise, and mine, he made several efforts to intentionally spend time with us. One morning, he sat down to breakfast with us just to get to know us better. Over the next few weeks, we often found ourselves seated on the couch in his office, listening to stories from his career or picking his brain about some aspect of family medicine. This kind of face time is hard to come by these days. We loved it.

 

3. Two great national parks, tantalizingly close: Sequoia National Park, and Yosemite. While Cody and I only had time for Sequoia, our one day among the giant sequoias while the snow was falling was magical enough for me to justify the entire month in Hanford.

 

4. Free food. Undoubtedly, this perk is enough to draw many medical students with our collective penchant for free things. We were unaware of this feature of the rotation until we arrived, so it felt a little bit like winning the lottery. Absolutely free food, any time we walked into the cafeteria, day or night.

 

5. Morning bike rides. I know not everyone would love a 6:15 am bike ride in 42 degree weather, but for some reason, it was really refreshing. The hospital was about four miles from our apartment, so it made for a nice half-hour ride in the mornings. Until, that is, the Tule Fog rolled in. The Tule Fog, we learned, is a dense fog particular to the central valley that is present most mornings throughout the winter. Thickest fog I’ve ever seen in my life.

 

6. Specialty clinics/No other student competition: We actually spent only half of our time in a family medicine clinic, the rest was spent working in specialty clinics, including Neurology, Orthopedics, Ophthalmology, Surgery, HIV clinic, Obstetrics, among others. Almost always, it was just the resident and I working with an attending who loved teaching to a medical student, as students are more of a rarity away from the academic institutions. This definitely made our days fly by, as we were always seeing something new.

Medicine Without Walls

Kelsey, Third Year Medical StudentI was unavoidably aware of how incongruous my business professional clothes were as we wandered across Secombe Park, looking for Dr. Carla Toms. Earlier in the day, I’d worn the same clothes in clinic and hadn’t given them a second thought. Here, in the heart of San Bernardino, 6:00 pm, they feel a bit pompous and I’m borderline embarrassed we pass a group of elementary kids playing soccer, sidelines scattered with parents and toddlers. Cody, my husband, and our friend David and I are the only white people in sight. I’d never met Dr. Toms, never participated in a street clinic, and dusk was settling in around us. The coming night had all the possibilities of a great adventure.

Fortunately, Dr. Toms did not disappoint. A tall, slender woman equipped with a backpack of medical supplies, we found her examining a woman in the backseat of a truck. Apparently, the woman had been having episodes of vertigo for quite some time. Dr. Toms finished up with the woman, and we began walking to another corner of the park, listening to Dr. Toms’ “Street Medicine History 101” lesson, interspersed with her calls of “Hello! Anyone need a doctor?” to anyone we passed.

We came upon a Caucasian man and an African American woman sitting on a bench, both appearing to be in their fifties, both appearing to be homeless.  Dr. Toms explained that we were from Loma Linda, that we were doctors and medical students, and that we come bearing socks, underwear, and free medical care if anyone needed it. I stood toward the back of the group (only about six of us were there), unsure of my place in our “street clinic” and highly curious to see how Dr. Toms interacted with these patients. And here, in this small interaction, I saw how different our clinic without walls was, how powerful it was. Within two minutes of us meeting these patients, they were equipped with socks, underwear, they were being examined by medical students, while Dr. Toms was furiously scribbling down names and numbers of resources for them to contact for dental and other services. She was asking them their stories (How long they had been homeless? Did they have other friends on the street? Where could we find them? If we came back to the same spot next week, would they be here at the bench?). The man admitted that he’d been stabbed about a week earlier and had been to the ER. We looked at his wound, which was healing well.

The power-structure reversal was unmistakable. Instead of asking our patients to find their way to our clinic, where they might wait an hour or more to see us in a small room where we swoop in for a mere 10-15 minutes and then hasta luego, here was Dr. Toms, giving her own time, seeking these patients out on her own, and then trying to stuff as many resources into the hands of the patients as possible. But these are not just any patients. Street medicine patients are the patients that show up in the ER because they have no other place to go, often for simple measures such as asthma inhaler refills, forcing ER physicians to act as primary care physicians to these patients, further driving up the cost of health care. It was all clicking in to place for me. Since coming to medical school, I’d been looking for a way to find these marginalized people and make a real difference in their lives. Enter Carla Toms and Street Medicine. I was buying in.

From the park, we walked to an empty lot next to a cemetery one of our patients had pointed out as housing several homeless. We walked around mimicking Dr. Toms’ call, “Hello! Does anyone need a doctor?”. Sometimes we realized we were calling out to piles of rubbish, sometimes the piles would move and a human would emerge.

After we had canvassed the field, we drove to an overpass where Dr. Toms had been told we might find some people. We all scrambled our way down the dirt slope under the bridge to find a single man there, a fairly young man who had been riding the trains for 10 years, and who only needed some socks. He seemed extremely kind and was grateful for the new socks. He told us the next overpass south of where we were might have some more people, so we tromped the half-mile to the next overpass. Cody, David, and I were simultaneously in awe of Dr. Toms and her passion for street medicine and completely invigorated by the adventure unfolding in front of us. Up to that point in our medical school career, no one had challenged us to take the skill set we’d built (albeit small), and go climbing around under bridges and other forlorn places at 8:00 in the evening, in San Bernardino no less.

After finding one more patient under the next overpass, we started heading back for the cars. Dr. Toms shared her dreams for the street medicine program as we walked. I’ll include some information below about the clinic if you’d like to know more about street medicine or participate in one of the “clinics” on Tuesday nights.

Careful though, it’s contagious.

Stigma plays a big role in poverty. This stigma forms a barrier. This is perhaps the biggest barrier the outreach will face. Talking to a homeless person require you to face despair and suffering.  You will be changed by this experience.  You will lose your ability to look away, to see homeless people as somehow less than people.  You will have to face the profound failure of our societal institutions. You will have to confront your own comfort in the face of another person’s desperation. You will have to come to grips with your own sense of duty and our responsibility to one another.
During street outreach, you will talk to vulnerable, mistrustful, disillusioned, and alienated people and, more importantly, listen to them. You will be asked to approach strangers and initiate conversations with them. You will be asked to listen to them as they talk about their problems, their needs, their strengths, and their hopes. You will be asked to be gentle and kind and patient. You will come to know them and to care about them. You will touch them, hug them, and worry about them. They will become part of your world.
                                               — Dr. Carla Toms, regarding Street Medicine
Resources for Street Medicine
www.streetmedicine.org
www.nhchc.org
If you’d like to join the email list for the Loma Linda Street Medicine Outreach, please email: CToms@llu.edu

Exam Week

Kelsey, Third Year Medical StudentI know it’s exam week for the first and second year students. Not just any exam week, but the very first exam week of the year. The fool-proof signs of haggard students and smell of stress that waffles up from Alumni and Centennial buildings are unavoidable.  I remember those weeks all-too-well, a constant feeling of tightness in my face, periods of unprovoked tachycardia, a nearly insurmountable urge to give up sleep to gain more study time.

On Sunday, as I finished up my 15-hour call at 10:00 pm, I realized how much gratitude I ought to have for where I was at that moment. Walking down the dank southeast staircase in the children’s hospital, I realized that even though I was tired, the old stress that used to make me constantly furrow my eyebrows in concentration was long gone. Instead of a drive to stay awake all hours of the night to study, I was going home to sink into bed, satisfied that I had cared for patients that day.

Last year about this time, my husband heard me turn over in the wee hours of the morning and mutter, “Staph saprophyticus” in my sleep.  No doubt my mind had not left my microbiology notes even as I slept. Only a couple of weeks ago now, my husband heard me roll over in the middle of the night, but this time, a big, deep, belly laugh came out.

My point? Hang in there, first and second years. This too, will pass. And though third  year brings with it long hours on the wards, caring for an actual human being is far more rewarding than correctly answering multiple choice questions on a computer screen.

Two Years and Counting

Kelsey, Third Year Medical Student“You’ll hate your patients one day, too. It happens to all of us,” he said, his eyes not leaving the computer screen as he spoke to me.

Wait. What? His words came in response to my teasing about his complaint that he was going to have to go see one of his patients. It was my very first day of medical school. Well, kind of. It was my very first day of freshman wards, before any of my classes had even begun.

I giggled a little nervously, thinking he would join in my laughter at any moment and assure me that his words had been in jest.

Silence. He continued to stare at the patient information on the computer screen. He’d forgotten I was there.

He was a first year general surgery intern, and I’d been assigned to follow him on the vascular surgery service for the next two weeks. Most of my other classmates had been assigned to follow much more accommodating, friendly third year medical school students who could sympathize with the ignorance of us first-years (newbs, if you will), but not me.  I was just hanging out with the residents, who didn’t know why I was there or seem to understand that I hadn’t had a lick of medical school education.

I watched him continue perusing his patient charts on the computer, and I felt the blood start to pound in my ears.

What have I signed myself up for? Am I going to become a jaded, hard, unsympathetic doctor who groans at the thought of actually going to see a patient? Am I going to become a monster?

I was getting really nervous. This wasn’t at all how I thought it would be. Only a short while later, the attending showed up to begin our morning rounds. To the disgust and nervousness that had already settled in my stomach for the morning, I added fear. This man was dangerously soft-spoken, you know, the quiet, seething, angry type that blows up without warning. If my intern was a monster, this man was a fire-breathing dragon. Once I dared to look him in the eyes, and I swear I saw flames.

I felt my stubbornness kick-in only a few hours later, as I watched monster and fire-breathing dragon interact with patients throughout the day. I refused to accept that what I was seeing was the way it had to be in medicine. I refused to cede to the idea that I, too, must become rude, hardened and distanced from my patients.

That was August, 2009. Now, as a third-year student on my surgery rotation, I’ve got two brand-new first year students working with me. Seeing them start their own journeys has made me reflect back to two years ago, when I wasn’t sure that I should have signed off on all those students loans.  Two years later, through a multitude of positive interactions with excellent surgeons, I’ve finally been convinced that all surgeons, contrary to my personal belief for the past two years, are NOT monsters. I’ve even been persuaded that surgery can be a deeply satisfying career for somebody who plans on having meaningful patient interactions.

Two years later, I’m ironically a little bit thankful to have experienced the adventures of monster and fire-breathing dragon. Without them, I might not have so stubbornly decided to always respect and listen to my patients, even when at the height of exhaustion, hunger, etc. Oddly enough, I suppose they made me a better (future) doctor.