Med School Firsts and More Traveling

Another good week come and gone and we're already a month into the Fall Tri! This past week was marked in particular by more travel and some med school firsts: suturing and a Grand Rounds presentation.

Wendy, Mallory and Lisa prepare to learn suturing

For years I've watched my dermatologist mother suture her patients after removal of suspicious moles or biopsy of suspicious skin conditions. She works so methodically, looping the long end around the forceps and securing a tight knot in one smooth motion. After my first attempt at suturing I can tell ya, it's harder than it looks! However, after another hour of practice following that first attempt, I'm already feeling better about it, though I still need more practice. The tricky part is focusing on all the components; holding the tools properly, spacing your stitches just right, and pulling them just tight enough, but not too tight....

Lisa performs her first sutures on a plastic arm!

I also gave my first Grand Rounds presentation to a room full of interns, clinicians and students from lower tris. In 9th Tri we present for about 30 minutes on a clinical question, whereas in 10th Tri we spend an hour discussing a case and research. As I mentioned last week, I presented on The Case of the Missing Organ. My talk focused on the concept of considering a new basis for health in patients who present for care after having an organ removed, and on the importance of identifying the cause of dis-ease if removal of the organ has not solved the problem. This presentation was inspired by two of my patients, one who has had the colon removed, and another who has had the gallbladder removed. I was nervous, but it seems to have been well received and now I can check that off my to-do-list for the tri!

After an interesting week I took to the skies again for a trip to Vermont to celebrate the marriage of one of my very oldest friends. In addition to getting all dolled up with a delightful group of young women (I also wrote about them in a post from March: Crunch-Pop and Lovely Intelligent Women), I got to go for a beautiful, brisk morning stroll with my mom and discuss patient cases, and danced with my dad to music played by a live band. Everything about the weekend was beautiful!

A view from the top of The Flume, a little hike in northern NH.

Hanzi and I made a point to stop for a walk in the woods of the White Mountains on our drive back to Boston, where we caught an early flight back to Chicago the next day. We also got to watch the lunar eclipse/blood moon with my parents on their back porch. I hope you all got to see that celestial masterpiece; what a perfect symbol of the impressiveness of this world that has conspired to bring about all the things from the marriage of two wonderful people this past weekend, to my reaching this stage of naturopathic medical school. 

Hanzi checks out the White Mountains scenery from a covered bridge.

Speaking of a world conspiring to bring about things for us, please do not hesitate to email me with any of your questions, thoughts, concerns, or celebrations from your process of applying to, or considering this Naturopathic journey. I am never too busy to reply; I love your emails! You can reach me at

Clinic Collaboration, Gorgeous Weather, and Work To Do!

In preparation for some days I'll be missing for wedding travels, I did a double shift in the clinic last Friday. After working 7 to noon for my regular ND shift, I tagged along on the DC side from 1-6. It was definitely a long but rewarding day.

Gone apple picking on a beautiful Sunday!

While on the DC shift, I consulted with a DC intern friend of mine on his patient who recently experienced symptoms of a GI bleed. I helped put together the puzzle pieces to recognize that the likely culprit of this patient's gastrointestinal misery was the prescription NSAID he has been taking for his knee pain, and not the GI support supplement recommended by another ND intern. It is well known that GI bleeding is a side effect seen with use of NSAIDs due to their capacity to degrade the mucosal barrier of the GI tract.

I was also able to help my friend understand the source of his patient's pain based on the fact that cortisone shots work to control the pain. Cortisone blocks phospholipaseA2, an enzyme that mobilizes arachiadonic acid. This step is at the very tippy top of the biochemical inflammatory cascade. Picture a large family tree where arachiadonic acid is the great grandparent. There are good cousins and bad cousins, and by blocking the cascade of the family tree way up at the top we block both the good cousins and the bad cousins from ever being conceived. Eradication of the bad cousins makes pain decrease significantly, but blockage of the good cousins, or the healthy inflammation, ultimately causes degradation of tissue from loss of a healthy inflammatory response.

If corticosteroids work to decrease pain, we can extrapolate that the patient's pain is caused by inflammatory cytokines (bad cousins). While prescription drugs work to block this inflammation, many botanicals and nutrients (as well as proper nutrition and exercise) can also work to modulate the inflammatory response that causes pain.

My DC intern friend and I had a great conversation about the difference in response he sees with different rehabilitation patients. The patients that respond best to his exercise prescriptions are most often physically fit, they consume a relatively healthy diet, or their injury is relatively new or benign. The majority of patients who do not recover well are either non-compliant, or often have poor eating habits or poor body composition; they live their daily lives in an inflammatory state.

Our conversation was a testament to why we naturopathic doctors/interns always address the basic determinants with our patients. No matter how much physical medicine we try, it will undoubtedly work better if we attend to the first 3 levels of the therapeutic order as well. We must establish reasonable nutrition, support the vis, and attend to engaged or compromised organs and systems. More on our Therapeutic Order at another juncture!

Night out with my ND faves

Besides all this excitement of collaboration in clinic, we had an absolutely beautiful weekend! I got to spend a night out enjoying live music and food with my ND student friends, and Hanzi and I went apple picking! Now, I have to buckle down and prepare my presentation for Grand Rounds. It's called "The Case of the Missing Organ." Stay tuned....

This Sweet, Fresh First Few Weeks

And, we're back! 

I'm sitting at my kitchen table with a glass of wine while a pot of risotto stews on the stove, salmon is marinating and waiting for the oven, and the first week of the tri is complete! It is important to remember to do as much regular living as possible before we hit Week 4 and midterms are upon us. There's something sweet and fresh about the first 3 weeks of the tri that really should be savored.


My first week back was short; we had the holiday on Monday and thank goodness for it! I flew back from Washington, D.C. early Monday morning after an intense and amazing 4 days of an IV Nutrition Therapy Seminar, taught by some outstanding NDs. I am now certified in IV therapy!

IV therapy is a topic we cover in our Minor Surgery class in Tri 9, but due to the nature of practicing/interning in a pre-licensed state without an MD here on staff at the NUHS clinic, we cannot actually perform IV therapy treatments in our clinic. The course taught me so much useful information applicable to my practice of the future, and I got to apply the skills that I don't get to use actively in our clinic here. I am now confident that I could, at the very least, rehydrate a patient, and at the very most offer basic nutritive support to any variety of sick patients. The group also offers further education in IV therapy on specific topics such as cancer support and detox. Judging by my great experience with the basics course, I'm likely to take more in-depth courses in the future. I highly suggest the course if you can find the time and funds to make it happen.


My friend Guy, a 10thtri intern, also attended the course with me. He leaves at the end of Week 2 for an externship in Montana (licensed state)! He expects to use his newfound skills in IV therapy at the clinic in Billings, where he will work for the next few months before graduation. I'll keep my fingers crossed that I can follow in his footsteps next tri... imagine the stories I will be able to share from the West! (Wishing Guy safe travels on his upcoming adventure!)

View hi-res photo

Back to my reality, or at least sort of. I spent the first weekend back at school attending the wedding of two dear friends. Hanzi and I traveled to a club in Pennsylvania and besides watching Hanzi rock it as a handsome groomsman, I got to go for a paddle in a solo canoe, catch up with college friends I haven't seen in 6 years, dance 'til I could dance no more, and shoot trap with some excellent help from the resident shooting instructor. I have returned from the weekend fully revitalized! 

My old college friend Harrison put it pretty well at the end of the weekend, "I hate hangovers, and I especially hate goodbyes." It was hard to leave such a beautiful place and such beautiful friends, but I have returned to campus ready to rock! And speaking of friends, a handful of my closest ND student buddies who started in January 2013 with me are now 8th tri interns in the clinic, and I am so, so excited to have them there with me! Congratulations to ALL the new interns entering this next stage -- DC, ND and AOM alike.


And now the risotto is demanding my attention and the salmon must go in the oven... Hanzi returns from work at the library momentarily and we'll sit down to enjoy dinner together during one of these rare early-in-the-tri nights with no assignments hanging over my head quite yet. Welcome back all; let us have a fabulous fall!

Being Present at the End of the Tri

I've received some good reminders lately to remain present despite my excitement about the near-ish future. My fellow 8th tris and I didn't have class this past Friday because our professor was gone at the American Association of Naturopathic Physicians (AANP) conference in California (don't worry, we made up for it last week with 3 extra hours of class, yikes!).

Fellow ND student Miranda and me on her birthday!

I got to spend the morning catching up on charting, and then we celebrated our friend Miranda's birthday with a group lunch outside. That was followed by a pleasant discussion in the sun on past-lives and the purpose of life, the sheer size of the universe, and how the job of doctoring that we've been chosen for is a beautiful and difficult one. In the midst of all this self-exploration we are also showing up every day for all the other people in the world, namely our patients.

After that sunny, grounding, expansive discussion, I helped a 9th tri friend make the final edits on his application for externship, something I'm really hoping I get to experience, too. To help him, I put on my doctor hat and helped him clarify the answers in his own words by facilitating the articulation of his story. Eliciting the story with my patients, friends, and family is one of the ways I am pulling myself out of my daydreams of the future and into the present.

Evening study sesh, sunset out my window

So what are these daydreams of the future, anyway? Well, Hanzi and I have our eye on the West, perhaps even as far out as Alaska. Hanzi finishes his degree before I do, and will hopefully move out to get settled somewhere. I'll join him a few months later when I'm done with school. I'm also excited about the possibility of doing an externship, which means learning from doctors in Montana and/or California during my 10th trimester. In case you're curious, you must get your patient numbers done, as well as a total of 850 primary hours before you can be considered a candidate for externship.

The trimester is almost over and I just registered for my very last round of medical school classes ever! I'm excited to move on to 9th tri where I'll be in the clinic 5 days a week; a more realistic picture of life after graduation. I'm also thrilled to be joined by a handful of the ND students I started the program with back in January 2013. I was the only one of our group to continue on the full-track schedule and I'm so excited to have them back in my world on the regular! The friends you make at the start of medical school are hard to beat; the work is so consuming and the bonds you make with those people while studying a cadaver, or during those late nights in the library will likely last a very, very long time.

So good luck to all my fellow students as we prepare for, and take, our final exams! It is finally (almost!) time for summer break -- enjoy it! I'll be back in September with more tales of the naturopathic student life.

All the Experiences Shape Us As Doctors-To-Be

It's already Week 13! This is crazy! The trimester has flown by. I attribute the recent rapid passage of time to a couple things: busy clinic shifts, a late start to hot summer weather, and learning so much directly applicable information in my classes.

Making time for laughs and good company during the school day at group lunch for Brad's belated birthday!

In my first 11 weeks as an intern, I've treated a urinary tract infection with botanicals, treated neurological side effects of anti-depressants with supplements, staved off headaches and jaw dysfunction with physical medicine and tinctures, improved mental capacity with botanicals, ruled out a GI bleed, worked to transform nutrition status, identified and treated high cholesterol, and counseled many patients by listening to their stories of health and dis-ease.

Yesterday, while sitting in the backyard reading for class with a North wind buffeting around me, I realized that all my experiences really have condensed into this one of becoming a naturopathic doctor. I studied ecology in undergrad and, especially lately, have found myself applying my understanding of the network of the natural world to the care of my patients. I also studied non-fiction writing, and in the process of researching for a paper, I realize I am co-creating stories with my patients about their healing journey. I am using my education in writing and reading to make help me hear their tales. The years I spent working for various doctors means that I read countless SOAP notes in some form or another, and so the language is familiar. This makes my own charting experience a little less foreign.

Over the weekend my friends and I celebrated our friend Shama who is getting married over break!

Our life experiences leading up to medical school shape our learning and progress in ways we cannot imagine until the moment arrives, or after the moment has come and gone. The people we know or have known, the jobs we've held, the challenges of communication we've faced, all of these things contribute to our development as doctors-to-be.

As our trimester ramps up to the finish, remember that medical school is hard for a reason: it challenges us so that we are ready to step up to the plate when a difficult patient presents for help. On that note, I'll finish up this post and dive into the research and puzzle through how I'm going to help one of my challenging patients. 

Oh, one last thing: in the midst of all the pressure, don't forget to spend time with friends and laugh! Our profession also requires us to cultivate a good sense of humor and connection.