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
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
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
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
Hanzi checks out the White Mountains scenery from a covered
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 email@example.com.
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
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
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
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....
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 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
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
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
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
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.
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
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
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
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.
• Leaves, Flowers, Berries, and Bark
• Farmer's Market
• Should I Study Massage Therapy, Too?
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