NDs Around the World

Over the weekend, I got to speak with one of my dearest friends for the first time in two years. She has been living in South Korea with her husband where they both work as teachers. Sara and I met when we studied abroad in Australia 8 years ago. In the years since then, I've been the lucky recipient of many visits from Sara and her husband wherever I've lived, all over the country. I have totally reaped the benefits of their summer vacations as teachers. This time, they are in the U.S. for a few weeks seeing family and I am so excited to pay them a visit in Michigan next weekend! It's my turn to make the trip to visit them.

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When Sara came to visit in me in Truckee/Tahoe.

One of the most important reasons I moved out west from New England after college (where I subsequently decided on naturopathic medicine as a career), was based on my experience of studying abroad in Australia with Sara. While studying on the other side of the globe, I met so many Americans who hailed from all the very different parts of the United States. I realized that I, an East Coast girl, was so different from those girls from the Midwest, or those girls from Southern California. We all came from very different American backgrounds, and yet these Australians, as well as all the other foreigners we met while out exploring, grouped me in with all the others. I was just another American girl to them.

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Adventuring in Australia -- getting inspired to explore my own country.

On account of this, I decided I had better go figure out what the rest of my country was like before I went travelling abroad again. While we all had some American patriotism and our language in common, I felt so different from so many of my countrywomen. I wanted to know what assumptions people might be making about me based on some other Americans they'd met who, as far as I could tell, were nearly as different from me as the Australian girls were, or the Germans.

Now that I can see the light at the end of the medical school tunnel, I am starting to think about where to explore next. I think I have a pretty good handle on what an "American girl" is, based on my experiences living around the country, so perhaps it's time to head into foreign lands!

Between binge-watching Anthony Bourdain episodes, perusing photographs of far away places on BuzzFeed, and reminiscing about our travels of the past, Hanzi and I have caught the travel bug. We regularly toss around the idea of living and working in another country, and have even set some lofty goals of learning a foreign language before we graduate with our respective master's and doctorate degrees (we haven't made any headway on this, yet). Even if we don't make it out of the country, we are ready to explore another region... perhaps Alaska, or Montana, or Maine...

Of course, I also have to think about actual employment after graduation, and for the record, I am equally excited to work as a doctor as I am to see new places. If you're like me and think you might want to explore, either now or later on, keep these resources in mind. There are several networks for naturopathic doctors around the world. Several of my friends at NUHS have traveled to work with Naturopathic Doctors International and Naturopaths Without Borders during their breaks between trimesters. My peers have returned with totally awesome stories of hands-on experience treating patients, living in rural areas, assisting in the delivery of babies by flashlight, and connecting with local people whose worlds are so very different from ours.

In addition to delivering care to the underserved abroad, naturopathic medicine is going global with the recent creation of The World Naturopathic Federation in 2014. This organization connects naturopathic doctors in 40 countries around the world, and endeavors to connect our work with that of the World Health Organization. We might be a small population here in the United States, but we are also out there, all over the world, sharing and advancing our medicine!

An Illinois Forest Bath

It's pouring rain right now. Our basement is probably flooding, slowly. But all that water coming down makes for crisp, clean air! *Takes deep breath in...*

A few weeks ago I read the abstract to a scientific paper out of Australia that aimed to quantify the effect of exposure to nature on participants' health, and to identify an ideal dosage of nature. The conclusion was alarmingly reductionist. How many trees should we plant on the roadsides in order to make people less stressed? How can we manipulate nature in order to best serve our health needs?

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A winding path

A practice called Forest Bathing started in Japan in the 1980s. It was developed as a treatment to relieve stress. Newer studies have recognized that a consciously meditative walk in the woods can boost the immune system by increasing natural killer cells. One set of guidelines on Forest Bathing suggests you spend 3 days and 2 nights in the woods if you really want to boost your immunity. Otherwise, you may choose to spend just one day Forest Bathing to reduce stress.

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Hanzi and me, out for a walk in the woods

Hanzi and I went for an extremely rejuvenating walk in the woods the other day. Relationships always take work, and my relationship takes extra work because I'm in medical school. We brought our cameras and our rain jackets, but nothing else. There is a trail that ducks off into the trees that I noticed when I first started commuting by train. I keep meaning to go find it, and we finally did. It was a rainy day, and cool. The forest was especially green and fragrant. We encountered two yearling deer; they were definitely curious and not afraid of us at all. We hung out in their presence for a few minutes while they devoured low-growing plants and watched us curiously through their sparkly black eyes. Hanzi and I chose to move on first; we left them to their lunch. 

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And when it rained and poured we went for some pseudo-nature at the climbing gym

I found an article written a few years ago by our newest clinician Dr. Denis Marier titled, "Ecotherapy: Embodying the Vis Medicatrix Naturae in Clinical Practice." In it, Dr. Marier writes about the relevance and importance of incorporating nature into naturopathic care. I love the idea of taking a "Natural History" with each patient in an effort to understand the patient's exposure to and experience with the natural world. Naturopathic doctors believe in working with the Vis, or that healing power of nature "which always endeavors to repair, heal, and to restore." This is evidenced in those walk-in-the-woods smells of new greenery, the mud and wet grass, and damp rotting wood. The natural world turns over, heals itself. So too, do humans, who are just as much a part of nature as new leaves, mushrooms, and rotting stumps.

Besides going out to seek nature, I am particularly fond of Dr. Marier's idea of "naturalizing a part of your clinic grounds." Even a city office can be naturalized with potted plants and fresh air. One aspect of my vision for my future practice includes an outdoor space where I can consult with patients. In his piece, Dr. Marier also suggests assigning a Medicine/Nature Walk, which he describes as a 3-6 hour fast from food, people, and electronics. He encourages patients to notice how they are observed by nature, rather than focusing only on their subjective experience. This makes me think of the deer on my walk the other day; they were so curious! I was observed. And I observed, too.

Resources:

Patients Change the Way I Study

One of the more frustrating things about taking classes while also spending 18 hours a week in patient care in the ND clinic is that I'll be in the midst of studying, you know, really getting things done, when all of a sudden I'm -- Whoops! -- off down the rabbit hole! I'm irresistibly curious about how this particular botanical applies to that patient case and... then all is lost. I may be losing my knack for efficient studying, but I must say, I am really, truly LEARNING.

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Morning coffee, study mode

I've had this conversation with ND student friends before; wouldn't it be nice to spend some more time in the clinic earlier in our education? While I agree it would be rewarding, I realize now that having done all the groundwork, I am much more prepared to effectively approach a patient case. A mere 2 trimesters ago I was on clinic observations, and while there were a handful of things I couldn't quite wrap my mind around, I really thought I was ready to be seeing patients. Now that I'm actively involved in providing care, now that I'm responsible for the thinking and problem solving, I realize that I know SO MUCH MORE than I did as an observer.

The difference between then and now is that I've had classes that teach me how to actually make decisions and proceed with care based on what I've learned about how the body works. By now, I have tools to create an actual treatment for a patient, whereas before I had merely the understanding of how it all works, what can go wrong, and why. Still, in every lecture I am collecting strategies and clinical pearls for helping my patients. I am learning about what works, what doesn't, and where to begin. I still have a lot to learn; I have many more tools to add to my belt.

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Down the rabbit hole

Medical school has definitely taught me to acknowledge what I do not know. Each trimester I learn more than I thought I could have ever known about a particular topic, and I am rewarded with a deeper understanding that makes it easier to translate what I've learned in a classroom to patient care. With this in mind, I should pick up where I left off studying botanicals... before that patient case wiggled it's way into my brain, tore me away from routine studying, and inspired this post!

A Dormant Part of Me is Waking

There is this lively little part of me at my core that I was beginning to mourn having lost in the midst of school, but surprise! It's waking up! The first time I can remember discovering this glowing gold piece of my heart was when I lived in Wyoming, and it brightened significantly when I lived in California. Hunkering down to study, living in the suburbs, losing touch with music and wild land slowly shuttered me, dimmed that glow, and caused that spirited part of me to go dormant.

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Sunset on a satisfying day in the clinic

I saw my first patients last week and the experience cracked my heart open, in the best way. I also made the decision to drop a few massage courses this trimester, including my clinic shift, which has opened up more hours in my week and also lifted a large burden from my shoulders. I'm taking only one massage class; it's perfect. I get to focus on my priority of becoming a naturopathic doctor.

This feeling I'm welcoming home is hard to explain, but it feels so much like me! I know I've mentioned before how my life here in Chicagoland is significantly different from what I feel brings me most alive. Maybe it's the realization that I have only one year left, and that the wide world is waiting for me over there next April. Mostly, I think it's the opportunity to practice actual doctoring that's waking this sleeping glow.

For years I was intimidated to go to medical school. It took me until I recognized I was ready to BE the doctor, rather than just work for the doctor, to even take the steps to apply for school. Now the end is in sight, and I have so much to learn! How am I ever going to fit it all in to one year? I'm really excited and actually totally floored to watch it happening. All of a sudden, there was a patient in front of me, asking me for help, answering my questions, asking me questions... And then there was another one! Another patient sat in front of me, answering my questions, looking to me (and my clinician) for answers. I guess I always knew this was coming, but I have completely shocked myself by letting it actually arrive.

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Lisa and me, and Wendy's FABULOUS lunch bag; it's how we feel!

I guess this feeling that's reemerging, slowly simmering in my core, is one of cautious confidence, of belonging, of good trepidation and that delightful unknown. I'm treading lightly so as to not snuff it out. Now that it's back, I'm going to do my darndest to nurture it, which I think means being truest to myself. I am wide-eyed and curious.

Holding Space and Learning What I Am Not (Yet!)

What roles do we play; what shoes do we fill for our patients? I just spent the weekend holding a wide, firmly calm swath of space for my mom, her siblings, and my grandparents (their parents) as everyone prepared for a move from Michigan to Massachusetts.

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Family time, my grandmother and her kids, visiting her father's resting place

My grandparents are in their mid-80s and have lived in Michigan their whole lives. My grandmother has always lived in Kalamazoo, and it seems that the entire city knows her. The reasons for their move are simple and complex all at once. Not only is it easier to bring food down the road than to have it delivered by a stranger, but standing in the same room softens the frustration of repeated instructions or stories.

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Visiting the war memorial in Kalamazoo, my great-grandfather, Arthur D. Bush

This past weekend I was a space-holder, a hugger, a cheerleader, and a diffuser of tension. It's an exhausting task but I'm proud to say I think I'm getting rather good at it. It took less than 24 hours for my auntie to tell me she was glad to have me there. I tempered anxieties, I held my grandmother's hand, I hugged my grandpa and delivered him snacks. I think I tactfully cut some sharp remarks short and replaced them with gentler words. I believe even my kindergarten report card said I was a quiet problem-solver, the voice of reason, or something more suited to a 5-year-old, but to that same effect.

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With my brave, supportive grandparents who told me, "There's no point
in procreating unless you improve on what came before... It worked!"

Now I'm riding on a swaying train, headed back to Chicago an hour late, rocketing into the setting sun. The train is full but I'm alone in my head, a welcome respite after 2 days of definitely having a presence. 

All of my medical school peers play different roles in our NUHS family. There are the out-spoken ones, the dissatisfied ones that cry for and produce change. There are the quiet ones that follow really well and help turn those tides. There are the ethereal ones who view the world as if through a smoky crystal ball, predicting the future, intuiting things to my amazement, sometimes struggling to see the point of the this-here-learn-it-now. There are the people who wisely listen and nod when you bitch, and there are the ones who reply quickly, ready with advice.

There are the doctors to whom patients turn for strict rules, for holding them to their word. There are doctors to whom patients turn to alleviate their suffering, sometimes only with a pill, sometimes with an ear, a hug, and an unconditional presence.

There are patients who look to their doctors for their willingness to be held on a pedestal and consulted as the wise sage. There are patients who look for the doctor that allows them to talk, and talk, and talk. Some doctors are best for the realism, their ability to break bad news in the most frank and comforting way. There are other doctors who act as cheerleader to the patients that seek them, and readily share their big hearts.

There are doctors who are sought for their acknowledgement of all the possibilities, others for their specialty. There are yet more doctors whose strength is their positivity and their smile. And there are many doctors who fill many of these roles, perhaps all of them.

I go to school with all of these types of people and I am learning what kind of doctor I am becoming. I am learning why people seek me out, and why they don't. The hardest thing for me to own is that there is a population of people out there that won't want me for their doctor because I can't be who they seek, whether it be due to lack of prescriptive rights, the way I look, my liberal morals, or that infuriating way I explain their condition. 

I am learning about being present for each patient, which means putting aside all of my "stuff" so that I can arrive and be ready for that person alone. I don't need to parade my morals ahead of me; I can just sit and be open, accepting, and ask questions in order to better understand. Until writing this, I thought I should just exist and see which patients showed up to receive my care. Now, I'm realizing there are holes in that theory. As an intern and soon-to-be baby doc, I should strive to make myself available and appealing to everyone, and so I should maybe seek out those patients who might not come knocking of their own volition. Alas, my sit back and let the world unfold attitude will have to change, at least a little bit. How will I learn if I don't make an effort to attract the education?