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!).

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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.

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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.

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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.

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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.

A Daytrip, Turmeric Dust, and Schwag

This week we got a reprieve from the clinic grind in the form of a visit to Integrative Therapeutics in Green Bay, Wisconsin. It's a long bus trip; we spent about 7 hours on the road and even paid a short visit to a seedy neighborhood gas station in South Milwaukee.  In reward for our long daytrip, the company fed us three meals and sent all of the tri 8 and 9 ND interns home with generous goodie bags!

Integrative Therapeutics is a supplement company whose products we use in our clinic on campus.  The company also supports our Naturopathic profession in many ways, including sponsoring a residency every year at a rotating site.  I always see their table at the conferences I attend, and our student rep on campus, Bonnie Brock, is totally accessible if anyone ever has any questions about the products.

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These tour outfits, though.

When we arrived at the company headquarters our hostesses immediately provided us with lunch (a good call for our road-weary group) before sending us off on tours of the facilities.  Before visiting the areas where products are made, we suited up in enormous blue smocks and donned safety glasses, hairnets, beardnets where applicable, and booties.  Our tour guide took us around the white-walled space full of stainless steel tanks and machinery.  We got to peek into a room where a man operated a machine that methodically spit out capsules of white powder, and into another room with bright orange turmeric dust all over the floor.  Most of the workers we saw in action were cleaning.  We learned that while it might take only 3 or 4 hours to complete the process of sifting, processing, and encapsulating, it takes at about 8 hours to clean the area and the zillion machinery parts afterwards.

In the next portion of our tour we watched chemists pipette bright yellow liquid under a fume hood, and looked at a lot of expensive machines that calculate the amount of heavy metals in a sample, or confirm the identity of botanical powders. 

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Lab bottles

After wandering the premises, we headed back to a conference room for education on various product lines.  I learned that Nature's Way products, which you can find in many retail stores, are made in the same facility as Integrative Therapeutics products, and are held to the same standards as the professional line.  This is worth remembering if you are ever in a pinch and need to pick up a reliable supplement at a big box supermarket or drug store. 

On that note, we would do well to remember the implications for greater social and environmental impact when choosing our supplements. In last week's post I wrote about seeking connection with the source of the food on our plate.  It is also important to recognize where our supplements come from, what measures are being taken to ensure they are true to their labeling, the quality of the product we put into our bodies, and what kind of company stands behind the product. 

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New medicine, old medicine

Thank you to Integrative Therapeutics for giving us insight into the business of supplement creation, and for shedding some light on the process of production.  My curiosity is piqued!  I hope in the future I can visit the facilities of other supplement companies so I can ensure I am giving my patients reliable, high quality medicines.

From Bathtub to Dinner Plate

I was small when I figured out what it really meant to eat meat. There were a bunch of brownish-red lobsters in the bathtub. They twitched their antennae and crawled around on the bottom under several inches of water. My mom brought chopsticks into the bathroom and we stuck them down into the open claws of the lobsters and they grabbed at them! I watched the bionic things bumble over each other in the blue tub of the downstairs bathroom until it was time to cook. Their antennae kept moving as my dad lowered the creatures into the pot and when it came time to eat, my dad cracked my lobster open in front of me, and a green, grainy goo came out. That was gross, but I knew I liked lobster. I'd had it before and it was yummy. So I tried to ignore the green guts and dipped my morsels in butter, then sucked the rich meat out of those recently active claws. I didn't eat a whole lot of lobster that evening but I did do a lot of little-kid thinking.

This is what I remember about learning how things go from living in the bathtub to becoming dead on the dinner plate. I didn't grow up in a family of hunters and fishermen. Since then, though, I've found myself in the brilliant presence of one.

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The ducks that became dinner.

I once half-watched Hanzi clean a beautiful mallard he shot out of the sky that morning. After I ate its delicious and gamey breasts for dinner, Hanzi tied one of the perfectly shiny purple and green feathers into my long hair with the clever use of some fly-tying supplies.

I kind of know how to clean a fish: I could do it in a pinch. But I still don't like encountering the bones in a trout on my dinner plate. One time when we were unemployed, poor, and hungry for anything free, we cooked a gift of pheasant legs like chicken wings. There were more bones in that meal than meat. It was tasty, but we understood why the hunter was happy to give them away.

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My first trout caught on a fly.

Hanzi tells a story of shooting a chickadee with his bee-bee gun once. Rules were: if you shot it, you ate it. So, nine-year-old Hanzi set to work cleaning that little bird. It took a long time, and when he cooked it he got only one little bite of meat. That's the last time he shot a little bird for fun.

Now, I think it's really important to acknowledge where our food comes from, and how it was treated in the process of becoming dinner, lunch, or breakfast. As NDs-to-be we are already teaching our people about the importance of eating good food. Part of knowing our food is good lies in understanding how it was grown, or what it ate. We want our foods to be organic because that means they were grown with minimal synthetic chemical help. We want our meat to come from the bodies of animals that were given space to move and the kind of food they are meant to eat. What we're really going for here is nutrient-rich sustenance that our bodies can use to make all of our parts work well. What we're also endeavoring to do is help our patients connect with the world around them and acknowledge the wisdom in living by the laws nature. And so I challenge you to think about it if you haven't already; how do you connect with your food on, and off, your plate?

Knowing When We Need Healing

I am so grateful for my NUHS community! Not only have all my Tri 8 buddies made a kick-ass team through these midterms, but also I have finally made the time in my schedule to be seen as a patient in the clinic, and it feels fabulous.

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Beautiful day on campus

Once you make it into clinic as an intern, it can be hard to find time to be seen as a patient. But let me tell ya, it makes a big difference if you can make that time for yourself! This goes along with my broken-record line about taking the time to work out or do something that makes you laugh while you're in school... You know, the physician-heal-thyself thing.

This morning I had a lovely DC intern friend treat me, and it set me on just the right track for the rest of the day. I received a little bodywork, a few adjustments, and some acupuncture. The treatments left me feeling great, but I have to say, simply letting someone else care for me was probably the most important part. And, it certainly doesn't hurt that I got the kind of attentive musculoskeletal care my body has been craving.

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NUHS botanical garden in full bloom!

In addition to seeking the skilled care of my peers, I recently decided to embrace my exhaustion and practice some doctoring on myself. Inspired by the success of an adaptogenic tincture I made for one of my patients, I ordered the ingredients to create my own botanical pick-me-up. I know it's not great to treat yourself, but every naturopathic student falls prey to his or her own brain at some point or another. And, my busy class and patient schedule hasn't allowed time for me to be seen by my fellow ND interns. I purposefully try not to over-think my own experiences of health, healing, illness, or discomfort, but I'll eventually hit a critical mass of either exhaustion or uncomfortably tight muscles and will begin to experimentally treat myself.

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Med school jokes, spotted this bumper sticker today and had to share. Poor design choice.

Now I realize I must distinguish between physician-heal-thyself and be-your-own-patient; I do not think these are the same thing. While it is important to understand our own bodies and the effects of the treatments we will ask our patients to undertake, it is more important to avoid over-treating ourselves. I'm no saint when it comes to this, but seeking the objective care of one of your peers is probably a better idea than deciding you need a particular remedy without any input from another doctor-mind. Physician-heal-thyself asks us to recognize that we need healing, and to seek it out. It asks us to make time for self-care like meditation, exercise, and good food. It does not ask us to be capable of radical self-healing. Dr. Lou shares a powerful story about this important distinction in one of our case discussion classes... If you haven't heard it yet, I won't spoil that story! What I will do is tell you that your interns are over there on the east shore of Lake Janse, waiting to care for you!