Hello from Montana!

Hello from Montana! Hanzi and I left Chicago after clinic on Friday, spent the night in Minneapolis with one of his oldest friends, and then drove 13 big hours to Billings on Saturday. We arrived at night, tired, hungry, and ready for bed.

2016-02-05_truck
Truck all packed up ready to head out.
(We did strap a tarp over everything; don't worry.)

On Sunday we drove all around town without our GPS/Google maps in order to get acquainted. We found the local Co-op and stocked up on the essentials for my kitchen. We explored the rims to the north of Billings where the view is spectacular and simply cannot be captured by me on camera! I tried though.... Out here you can watch the weather move about, you can see the grey sheet of precipitation a few miles away, and then minutes later it's upon you as whopper snowflakes (this happened today!) 

I'm writing this post on my second full day in Billings, at the end of my first day shadowing at the Yellowstone Naturopathic Clinic. Hanzi flew back to Chicago today, though not without some difficulty.... It's been dumping snow in Denver, Colorado, and so his first flight was cancelled. OK by us though! He got to explore some ranchland 10 minutes outside of town with his camera, and we shared lunch before his flight out.

2016-02-05_camera
Hanzi exploring/photographing on the rims to the north of Billings.
(That's the city down there behind him.)

I could go on about each little remarkable thing I've observed in this town in the past 2 days, but what's more important is how I'm actually feeling in this experience. Let's recap here. In the past week I have: packed up all my stuff into the back of a truck, driven 1800 miles in 1.5 days, moved into a cozy basement apartment in a Western town I've never been to before, and Hanzi headed back to Chicago, leaving me to live alone for a few months after 8 years of sharing our everyday lives.

These are all big and stressful changes, but I welcome them because I've already learned so much at the clinic here from witnessing how NDs in Montana practice. I'm scribbling notes about products and treatment plans, and am exploring a new dispensary. I am learning what I know and what I do not know about how to provide primary care. I am a sponge and it's totally awesome.

I highly suggest setting the goal of spending time here, or at any other clinic, so as to suggest to the universe that this is the right path for you. There is so much to learn from watching doctors work that simply can't be taught in a lecture or by trying to do it all yourself. I gotta tell ya, I'm feeling right at home in this thriving naturopathic practice.

A Big 4-Day Week

Looking back at it now, this past week was hugely busy, despite being only 4 days long due to the MLK Day holiday. On the holiday, I met up with a few friends in the city for lunch as a little send-off for Guy who graduated in December. Afterwards, I got to introduce my good friend Alex to Hanzi, and we sat around chatting over tea for a while. It was lovely!

2016-01-29_friends
MLK Day lunch date with NUHS friends

On Tuesday, I worked a double shift at the Salvation Army and Lombard clinics, then headed straight home to work for several hours on my grand rounds presentation. Wednesday was the day I gave my said presentation titled, "ADHD and The Italian Grandmother." This was my last big assignment of medical school! My presentation was centered on a case I saw in clinic, and examined research on naturopathic treatment options as well as obstacles to cure in treatment of a pediatric case of ADHD. 

I was nervous about presenting until I realized several of my friends came to watch me speak, AND that they were each wearing a piece of clothing I had given them! It made my heart sing! Because I am moving, I gave away some scarves and tops and a handful of my girlfriends all happened to wear these things on the day of my presentation! 

Another friend stopped by before my talk to give me a little gift. All the support from my buddies calmed my nerves and by 10 minutes into my presentation, the jitters were gone and I hit my groove. Thank you all for tempering my stress!

2016-01-29_truck
Hanzi hanging out in the new truck

On Thursday, I worked another double shift at both clinics and then did one of the most grown-up things I've ever done; Hanzi and I bought a car! We've been scouring the Internet for a car in preparation for my leaving for Montana and taking our one vehicle away on the trip. Now, we are the proud owners of a little red Tacoma truck. It's so funny; it has Bluetooth and a touchscreen but crank windows and manual door locks. Anyway, it's exactly what we've been searching for and I feel much better knowing I'm not leaving my partner immobilized in Illinois while I head off on an adventure.

Speaking of this adventure, I leave at the end of the week and should arrive for my first day at Yellowstone Naturopathic Clinic on February 1. Hanzi will come along for the ride and then fly back to Chicago to keep working and job searching. I cannot express how much gratitude I have for my clinicians and peers who have helped me get things done so that I can go learn in another environment. I am especially grateful for friends who prioritized a surprise baby shower for our girl JheriAnne so that I could participate in celebrating the twins she and her husband Shane are expecting in April! I wish I'd had more time to hang and say bye, but such is the nature of medical school; stuff happens all at once and then bam! -- It's on to the next thing!

The Beginning of the End

Welcome back for Spring Tri and my very last one at NUHS! Congratulations to all my fellow 10th tris on making it this far, oh my god! The 10 of us ND 10th tris had a pretty good break working at the clinic. We had a generous number of days off around Christmas and New Year's and got to see plenty of patients, as well as give each other some well-deserved treatments. Two of us finished and sent off our residency applications -- a very exciting and curious process. I am proud to share with you that I finished up my numbers at the end of last trimester (Disclaimer: the way to do this is to never think of your patients as numbers!), and am preparing to head out to Montana for a preceptorship in Billings starting in February. So, get ready for stories from the West! But first, let me fill you in on the latest.

2016-01-22-fam
Made it back East to celebrate Christmas with my family

This first week back I worked at the Salvation Army clinic in the city, where I got to suggest treatment options and watch my fellow DC interns do rehab with their patients. The most striking case was a patient with a history of a self-inflicted gunshot wound to the foot. The patients at the Salvation Army clinic are all residents of a program for recovery from drug and alcohol abuse and/or addiction. They live and work in the same building as the clinic, and come in for supportive care during their stay in the program. The patient population at the Salvation Army clinic helps to put into perspective some of our patients seen in the Lombard clinic. In Lombard, it is easy to get worked up over the evils of gluten and a lack of sleep, but working with patients who have spent the past months to years addicted to cocaine and living on the street sure provides some valuable perspective on the definition of health and disease.

2016-01-22-intern
DC Intern Andrew checking out the view from his office at the Salvation Army Clinic

In preparation for my departure for Montana I've been getting all my ducks in a row. Lately, I've been catching up on some volunteer hours with the very organized Oak Park Food Pantry. This past week has served to remind me of all the different types of people out there in the world that I can help by sharing my medicine and my time. 

2016-01-22-twins
Holiday twinset photo with Dr. Dybala taken by Dr. Coe

At the Lombard clinic I've been tying up all the lose ends, preparing a Grand Rounds presentation for this week, and spending time transitioning my patients to their new interns. It is hard to say bye to my patients! They have taught me so much and I like to think I've really helped them to feel better, too. Thankfully, I know they are in good and capable hands, and will get to learn and heal with the help of different minds than mine. If all goes according to plan, you should be reading one last post from Chicagoland, and the rest will come from Montana! Here goes the beginning of the end!

Good People

My wonderful peers rallied around me when I started coming down with a migraine in clinic last week. I collected 2 more secondaries to help get everything accomplished for my patient's visit. It was a testament to hardworking peers, helpful friends, people who are prepared to drop everything and help you and your patient, and of course, it was a testament to that ever-present need to care for myself.

2015-12-09_trees
Foggy morning on campus; finals are beginning

I slept very little during the week due to waking up early to finish assignments at the last minute. I know better; if I don't sleep enough I can be sure I'll face the consequences in the form of a nasty headache.

I had an amazing team. My clinician used up every ounce of thumb strength pressing on trigger points to keep the nausea at bay while I finished writing up my chart. Some of the greatest gals helped me collect products from the dispensary, and others helped me chart my findings and watched my work while I performed the physical exam. I finished up the entire appointment swiftly and smoothly because of the ready help that came to my rescue.

On a side note, I currently don't have any patients scheduled for Thursday this week and I wondered why until I recalled who I saw this past Thursday and the week before that. All of those patients who had been seen on Thursdays have gotten better! Oh my god! (Not feeling great? Perhaps you should come see me on a Thursday, the odds are looking good...) I saw a chronic condition improve dramatically in 2 weeks. I saw one acute condition improve 80%, and another clear completely with full patient compliance with my treatment choices.

I was given a few beautiful reminders this week, the least of which was the obvious one that our medicine, nature cure, absolutely works (and that I need to use it to care for myself). The other reminders involved giving thanks to friends and coworkers. Thank you to my people for carrying me along during that impending headache situation and letting me draw on all your strengths to bring about a personal success. Thank you also to the kind ones who complimented me this week on my hard work and my easy patient interaction, and who told me it would be fun to work with me in the future.

2015-12-09_house
Study break -- getting out of our creepy pink house to go for a walk

I am going to miss the people here more than I know when I leave NUHS for the big wide world. I work with some who challenge me every day. And I work with others who seem to exist simply to lift me up; they make me laugh, they give me words of encouragement, they laugh at my absurdities and help me tether my mind-floating-away-with-possibilities.

And I can't leave this last post of the trimester without saying huge, enormous CONGRATULATIONS to all of our 10th trimester interns graduating next week, OH MY GOD! You did it! I am so incredibly proud of you and am grateful for having had the opportunity to work and learn with you! This is the first time I've felt really connected to those who are graduating and my heart is bursting with pride; you're a smart bunch! As us 9th tris would say, go out there into the world and Stimulate the Vis... Doctors!

The Distraction of Residency Options and Thanksgiving

Lately I've been consumed with the idea of a residency after graduation. The list of sites for 2016 just came out and the application process is beginning! We do not have a residency coordinator for the ND students here at NUHS so we get information through our clinicians and our own research. I think we may be getting an informational meeting from the director at Bastyr over the Internet sometime this week, which is great news.

2015-12-04_1
Blurry but festive! Hanzi and me in front of an enormous decorated tree in Grand Rapids

Because of the relative lack of guidance when it comes to naturopathic residencies, I'll give you an overview of what I understand about the process. Remember, this is what I've found from my own research, this information may not be perfectly accurate.

First of all, in mid-November a list comes out with the residency sites. Sites are at various outpatient clinics and some of the naturopathic schools. Each residency has a doctor listed with the clinic that I presume we work under during our tenure. The next things to consider are which sites look good to you, and which 3 faculty you will ask to write your recommendations. In addition to recommendations, the application process involves a personal statement, a general application, a CV/resume, and essays that are specific to each site. The more sites you apply to, the more essays you have to write, so be judicious. After applications are submitted (by January 1st), the interview period begins. If you interview with a site, then you are allowed to put it on your match list. If you apply to a site but are not asked for an interview, then you can cross that one off your list of possibilities. After interviewing takes place, an official match session happens where you select your top 3 spots, and the sites select their top choice candidates. If you match with a site -- which means you chose them and they chose you -- then you get offered the position!

I've started this process by reading about the clinics and doctors listed for each site. As Hanzi put it, I really worked myself into a tizzy over feeling like I have to decide RIGHT NOW where I want to live FOREVER. This is plainly not true, but all this future-talk has me absolutely shaken. I spent this weekend combing through websites, diving down those rabbit holes, and surfacing just long enough to make myself a cup of tea, or realize I'm super hungry, or remember there's been laundry sitting in the washer for 3 hours. 

2015-12-04_2
Our gray drive to Grand Rapids to meet Hanzi's parents for Thanksgiving

Over the past few days I've learned a whole lot about the current residency opportunities, and now I'm both excited and overwhelmed. If you asked me to choose my top 3 right now, I just absolutely couldn't! And, of course, I don't have to just yet, so that's totally fine. Do you see what I'm doing to myself here?!? While washing dinner dishes tonight I reminded myself (out loud) that first things first, Miss Mackie! I have to finish my assignments for this trimester, which include a business plan, a case write-up, a research paper, and several exams. Then, I need to focus on finishing up things in the clinic and getting all my ducks in a row to try to take an externship during my 10th trimester. Somewhere in there I'll finish applying to these residencies.... Then, I have to graduate. After that, I have to study for boards for 3 months and then I have to pass those. If I don't have a residency to head to come Fall 2016 I'll find myself a job, or create my own! 

And here I thought my last trimester of classes was going to end peacefully, with the typical wind-up and wind-down. I figured I'd just coast into winter break with a handful of patient visits to complete and a spring of exploring ahead of me. I always imagined I'd apply for a residency, and now that the time has come I am overwhelmed with ideas. If I could just set aside those thoughts of my future for a few hours, I'd be golden. Instead, I spent my 4-day weekend fretting about a future I absolutely cannot affect from this point in time. Minds are tortuous things sometimes, you know. All in all, I'm so thankful for my wild mind; the one that takes me on fabulous theoretical adventures at the slightest suggestion of life in places like Montana, Vermont, Colorado, or Alaska.

And speaking of thanks -- a happy belated Thanksgiving to all! We traveled to Grand Rapids, Michigan, to meet Hanzi's parents halfway to celebrate the holiday. I hope you had a lovely, delicious holiday, too!