“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, ‘I lived through this horror. I can take the next thing that comes along.’ You must do the thing you think you cannot do.” -Eleanor Roosevelt
Doctoring
Divided
For connection in the world,
yet yearn for privacy and aloneness.
I search within myself.
I try to discern the best way.
Balance living out faith for God and others,
While keeping true to myself.
Doctoring
An illness
Mental, Physical, Spiritual
A person
Momma, Poppa, and the Smiths
Oneself
Mentally, Physically, Spiritually
“The doctor of …
“The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.” -Thomas Edison, inventor
Boundaries of a White Coat
The matriculation into medical school is celebrated with the tradition of a “White Coat Ceremony” across the United States. This ceremony marks the day where a pre-med student is officially accepted into the profession of medicine, and, as the name implies, is the day one is given a physical garment to mark the profession- the White Coat.
Here’s the first time I donned my White Coat:
Medicine is a profession that is full of traditions. And, unfortunately, these engrained traditions are sometimes the very things that keep the profession from advancing forward and providing the best patient care. The White Coat is a perfect example of tradition hindering patient care.
Doctors are well aware of the phenomenon known as “White Coat Syndrome”. An example of this is a patient who has high blood pressure only in the doctor’s office. Going to the doctor can be anxiety-provoking and stressful. The White Coat is associated with this.
I am required, per school policy, to wear my white coat in clinical rotations. This same school has an entire curriculum that promotes patient-centered care, emphasizes responding to patient needs, and attempts to instill the values of empathy, compassion amongst others, in all of its graduates.
Some defend wearing the White Coat, saying then everyone knows we are medical students. I disagree with this. Some people in the hospital know that a short white coat= a medical student. There are a lot of others who think white coat in hospital = a doctor. This is also not true. If anything, wearing a white coat confuses people more. Doctors are not the only ones who wear white coats in hospitals. In fact, odds are that the person wearing a white coat is NOT a doctor. They could be a phlebotomist (person that draws blood), a pharmacist or pharmacy student, a nurse practitioner or nurse, or a physician assistant.
The only thing I find useful from wearing the White Coat is all the pockets. If I need to wear something to give me extra pockets, I’d prefer a nice sunny yellow one like this color yellow (below) + this style coat (Grey’s Anatomy brand) = a sunny doctor coat with needed pockets! And I could pretend that I was taking on a little yellow-coat style from the lovely Kate Middleton.
pic refs: kate: http://i.dailymail.co.uk/i/pix/2013/05/22/article-0-19F04DDD000005DC-706_306x1067.jpg
yellow shirt: http://www.elle.com/cm/elle/images/aI/ELLE-11-Zero-Maria-Cornejo-Pastel-Yellow-Tunic-xln-xln.jpg
Mental Scripts of a Med Student Taking a Test
Paragraph-long question.
Answer choices:
A Glucagonoma
B VIPoma
C Adenocarcinoma
D Insulinoma
E Gastrinoma
“Well, it must be something-oma. Hmmm…VIPoma is screaming pick me, pick me, I’m the VIP!”
VIPoma gets checked. It is right.
***
Page long question
Answer choices: A B C D E F G H I J K L M N O P
There goes all strategies of playing odds, and I bet C is no longer the most likely answer…Hmmm I have a 6.25% chance of getting it right. Dang it, now I have the ABCs stuck in my head. Now what was the question again?
***
Question that upfront gives you more demographic information about the patient than clinical symptoms or lab findings.
Every medical school preaches to keep a wide differential diagnosis, and to maintain a non-judgmental mindset about the patient. But somehow every test question with demographics screams only a shot gun answer, and it is always right…
Oooohh Babies!!!
Right now I’m on my last week of inpatient family medicine. I generally prefer outpatient medicine (working in a clinic) to inpatient medicine (working in the hospital). Except for today. Today I had the priviledge of rounding on the mothers and newborn babies that the family medicine service was caring for. For those that don’t know me well, let’s just say that I looove newborn babies. In fact, my favorite aged kid is 0-2 years old. Of course, my perspective might change down the road when I have my own family someday.
This morning, as I’m examining the newborns, I think to myself, “It is this little person’s very first day of life. This little baby is only hours old. ” To think of all of the possibilities, all of the dreams and goals and lives that will be be touched by this little new human being. It is such a miracle- an overwhelming thought indeed. And here I am, my novice ears trying to adjust to the fast-paced newborn’s heart rate as I try to drown out the crying and the loud heart to hear the lung sounds (yup, definately only heard heart sounds– I need sooo much more practice).
The Beginning of A Love Story with Family Medicine
Family Medicine. It is what I love in medicine. It is what I strongly and passionately feel called to do in life. It complements my strengths. It challenges my weaknesses. It makes me excited to get up everyday and go make a difference for others: educate, advise, support. And it all began in a restaurant, working as a waitress, in college.
I took the job at the Mexican restaurant because I wanted to use and improve my Spanish speaking abilities. But God had another plan in the works. One night a customer heard my Spanish, and inquired about what I was studying in school. Not knowing it at the time, I later found out his wife was a family physician in town. I was offered a job interview that night to go work for the doctor- she was looking for a bilingual office assistant.
Over the next 3 years, I learned what it was like to be a solo family physician in a rural town of 5,912 people. The town had a 42-bed hospital. The ER and the inpatient service was run by family physicians. The babies were delivered by family physicians. The colonoscopies were performed by family physicians. My meticulously planned out future never included falling in love with broad-scope family practice. In fact, I didn’t even know that family physicians could do all of these things! I grew up in a small, rural town but I always planned on escaping away to the big city and never looking back…until I became more aware of who I was as a person…until I listened to the deep gut instinct within me…until I went abroad on missions to the middle of nowhere Mexico, Guatemala, and Chile and felt the strongest feeling in the world that I would return to care for the sick…until I accepted my calling and trusted that God knew what He was doing…until I fell in love with rural broad-scope family medicine.
Medical school is a long, arduous process. There are plenty of days filled with doubt, anxiety, and lack of sleep, not to mention an endless to-do list. But then I remember how I got here and why I am here. And every so often, for that extra reassurance, I read my personal statement that I wrote years ago when I first applied to medical school:
Patient A declares to me, “All doctors are money scoundrels,” as I record her blood pressure. She is the first patient of the day in Dr. P’s family practice clinic. “This is why I am interested in taking up herbal medicine,” her frustrated voice continues. Her mention of herbal medicine evokes a memory of the conversation I had with a Mayan healer in the small village of Tinum, Mexico, just months prior. Diverting from the harsh comment, we converse about pros and cons of herbal and modern medicine. Her mood lightens just in time. I need to interpret in room two.
Patient B greets me with excitement. “¡Has regresado, que bién! ¡Te extraño! ¿Cómo fue México?” We know each other. I was her interpreter two years ago, in her third trimester of pregnancy. Today, I take a brief history of her symptoms, and I am amazed at how much her 15-month-old daughter has grown. Our reminiscing is ended by a call for me.
Emotional and nervous, Patient C barrages me with questions over the phone. “These spots are not cancerous, right? I’ve never even smoked a cigarette, why do I have something growing in my lungs?” I want to reassure her as I read the X-ray report on the small basal nodules. I vividly recall a summer day in the morgue when my fingers moved over the dull, rigid, foreign growth that had taken a lung cancer patient’s life. I want to have an answer for her; she had been my mentor for years, providing inspiration and a listening ear. Nevertheless, we are still waiting for a PET scan and pulmonologist consultation. For now, all I can do is provide inspiration and a listening ear for her. I say a silent prayer as I gloomily hang up the phone.
My mood lifts with Patient D, the fourth patient of the day. She anxiously awaits a colposcopy after receiving abnormal Pap smear results. I know something of HPV and her condition; I spent a summer researching cervical cancer and recently learned how to differentiate ASCUS, LGSIL, and HGSIL cells with a pathology resident. I confidently reassure her that abnormal pap smears are not always cancerous. At her side during the procedure, I keep her comfortable and still until all of the biopsies are taken. Afterwards, my mental image switches from cervical cells to blood cells as I prepare to draw blood from the next patient.
“Please don’t dig for the vein; I would rather have a second poke if needed,” Patient E tells me before I even have a chance to introduce myself. Her words are not foreign to me. My mother, who has a long history of hospitalizations, always warns nurses to not dig for her veins. I am glad that I draw the blood on the first try, and send Patient E away content. Spinning down the SST tubes in the centrifuge, I recall the hot afternoons in the laboratory at El Hospital de la Amistad, Corea-México. I assisted with processing blood and stool samples, using the same automated technology we use here in Indiana.
I have one last patient to help before going to class. She needs to see a specialist to discuss her pain medications, but is reluctant to let me schedule a referral. I quickly discover she is tired of going to so many doctors who are unable to ease her pain. I know firsthand the frustrations of seeing multiple doctors, waiting for appointments, and struggling to pay medical bills. But inconvenience aside, I also know that the multiple appointments are sometimes necessary for the best treatment options. I convince her to try this specialist and schedule the appointment just in time to drive off to class.
Patients, ringing phones, pre-authorizations, and blood draws are left behind as I take out my notebook and pen to write down the lecture notes. Today’s lecture happens to be on Candida albicans in Advanced Microbiology class. By the end of the class, I know how to identify the fungus under a microscope, what diagnostic tests to use for identification, and how Diflucan, commonly prescribed in Dr. P’s office, works to treat it. After class, I sign up for a Habitat for Humanity workday, spend the evening tutoring a student in chemistry, and discuss definitions of good and evil with my roommate in preparation to write a Christian Humanist Manifesto.
I climb into bed tired, briefly reflecting on my day. My mind wanders back to Chile with Habitat for Humanity. My friends and I spent days on rooftops, attempting to hammer tongue-and-groove boards to second story beams without falling to the ground. More nails bent than went in, and we sawed more cuts off the line than on it. But with a person on each side to lend their expertise, support, and a hammer swing, we finished five houses for five deserving families.
Each day brings unique challenges and experiences when working with people. There are days of endless paperwork and phones that constantly ring. There are times of frustration and times of success. And through it all there are smiles, tears, “Thank you’s”, friendships, and mutual understanding. I love all that medicine has to offer. As I close my eyes, I know that the only day better than today will be the day I walk into my own office, prepared to handle whatever the day may bring.
The Judge
Is in both you and me
The piece that rationalizes, assumes, predicts
To you why I am the way I am
To me why you are the way you are.
If not controlled cautiously,
It writes a story
In your mind about me
In my mind about you
Without a plot in real time.
It lacks the genuine uniqueness
Of what makes me me, and you you.
And its plot of me is made by you
And your plot is made by me.
So I say to you- Don’t write my story!
Honor what makes me me
And you you.
With understanding
Let us both
Tame the judge.
Find the listener
That is in both you and me
So the real story
We will both see.
Serving the Homeless
Dear Mom,
For the next two weeks, I am working in clinics that serve the poor and homeless. As I drive to the clinics, I know what you would be saying to me if you knew where I was at-“lock your car doors! don’t walk alone! or simply, this is not a good area in town”. Upon hearing I spend one-on-one time with drug addicts, ex-prisoners, the severely mentally ill, and the homeless, you would worry about me.
Yesterday the doctor I work with said, “If you told me in medical school I would be working in a clinic like this, I would’ve said you are crazy. I never imagined myself working in a clinic here, with this population of patients.” My thought to myself when she said this was, “This type of clinic is all I have ever imagined doing since I was in high school…”
I remember in 8th grade when I was devastated about Hurricane Mitch’s damage in Honduras and moved to help organize a community drive to send needed supplies. You were behind the scenes helping and supporting my efforts.
I remember those Sunday afternoon drives into downtown to take me to the Young Women For Change meetings, and your stories about homeless people coming up to you asking for food and money.
I remember the church youth group food drives, car washes, and Habitat for Humanity build days, which you encouraged (and probably made me) do. You were right by my side helping.
I remember our disagreements when I insisted on going to various summer camps and travel/volunteer excursions throughout Latin America. You worried about me, but always were able to put that aside and let me go since you knew it was best for me.
I remember your insistence over the years that I learn Spanish, and as a result was fluent by the time I finished high school. I know I was a stubborn kid who hated learning ABCs, but because of your tough love, I now know two alphabets.
I remember the struggles of divorce, the pain of courts and custody battles, and my first court experience on the day I had to go talk to the judge. You continued being the same “strict” mom you had always been, and lead by example how important it is to keep faith and embrace the changes of life.
I remember how you served for years with the church jail ministry team, even though it was a weekend commitment and you had other things to do. You would go anyways, and return home with broadened insights about the people you served.
As I prepare for another week of yet-to-be-had patient encounters, I realize that I am more prepared than what I think I am. For it is not the memorization of exam skills or even clinical knowledge that is needed to best serve these people, but it is the skills you have been instilling within me for years. I know as a Mom you still worry, but know that each day I am living out what I have felt called to do for years, and know that I am well-prepared in large part because of the lessons in life you taught me.
A heartfelt thank you, Mom, for being the water, sun, and soil to allow a little seed like me grow and prosper and serve.
Demolition, Dirt, Dresses & Doctoring 
