Archive for tag: life

Lessons from Dr. Gawande, Enabling Well-Being

I am finally reading a book I got for Christmas, Being Mortal by Atul Gawande, a surgeon and a storyteller. The 10 hours of flights to and from Boston for an interview in Vermont are what finally got me to crack this book. It is a remarkable read, especially poignant in these last few weeks of medical school as I prepare to navigate this world as a doctor. It's a little funny to think that I require 18 more days, 432 more hours of life, before I can officially identify as a doctor. I feel like I'm already there. There is nothing like reading about the significance of a few comfortable and happy hours at the end of life to make the 432 hours between me and graduation day seem an insignificant barrier from doctorhood.

Early morning departure from Billings, headed east

In his book, Gawande writes again and again about the "vital questions" a doctor can ask a patient to understand things: "What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?" He writes that as doctors, "We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being."

Gawande is writing from the perspective of a surgeon and the cases he presents are from his personal life and from his professional life of advising terminally ill patients about their choices for surgery. Those of you reading this are most likely like me, we are not going to be surgeons, we are not going to be radiation oncologists or geriatric doctors (at least not officially, until Medicare recognizes our medicine...), but we are going to be enabling well-being for our patients, every day through primary care.

A poignant paragraph in "Being Mortal"

In our ideal naturopathic world, all of our patients are willing and able to attend to their basic determinants. They are willing and able to eat healthy foods, sleep through the night, reduce their work stress, leave their toxic relationships, eliminate endocrine-disrupting cleaners and other environmental exposures from their lives, and make time for rest and relaxation. But reality is that most everyone cannot improve all of these things so readily as we would like. We know our natural therapies will work better if the patient will just take care of these things! And we know that we can effectively use very low force interventions if everything else in life is made healthy. But, the majority of patients are just not going to show up to our offices ready, willing, and able to make all the changes necessary to their lives at that very moment.

While observing during an interview day for a residency position, I listened to a 40-something female tell about how in the past 4 months she has found a care facility for her disabled son, has got her troubled daughter into counseling, has changed her diet, has found a job, and has started seeing a counselor herself, but that she still lives at home with an abusive partner. This woman has better mental clarity, her stress is markedly reduced, and she feels good about having purpose in her work, but she knows one major obstacle to cure still remains and it will, for a while still.

Snowy April day in New England en route to interview

As NDs counseling patients and their families at the end of life, we can certainly ask Dr. Gawande's questions: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

But, we can also use these questions in caring for our patients who are not yet at the end of life. We can make sure they understand their picture of health and the possible outcome with treatment, or without it. We can ask them about their fears or their hopes in consulting us for our specialty, which is natural medicine. We can discuss the trade-offs they are willing to make for our natural therapies to work well -- are they willing to turn off the TV at night? Change their dinner menu? Make time for exercise in their already busy day? We can ask if the plan we've created serves their understanding of their health picture and their goals. These questions serve to create well-being for the patient, and therefore, they are part of everyday doctoring. It is this style of what I believe is called "Interpretive" doctoring that I hope to remember and use with my patients. This means advising patients of their options and giving your insight into which option you think best fits their needs. The place to start is by asking Dr. Gawande's questions, or at least keeping them very close in mind.

A Week of Heart Filling and Story Telling

Ahhhhh, a day off in the middle of the week! To start, thank you to our veterans for serving and for giving us a reason to take a break. We had Wednesday off this past week and I savored that free time. I had all those good intentions of writing up a case due at the end of the week, and getting started on a paper for pediatrics class, but in the end I took my day off to relax and do laundry (so exciting)!

Dinner, drinks and laughing with my ND-to-be girlfriends

As a med student, you really have to take advantage of any free moment. On Tuesday evening, knowing we wouldn't have class early the next morning, a few of my best ND student friends and I went out for food and wine. We cozied up to the restaurant's fireplace and the conversation never stopped. I rarely see all of these lovely friends because of taking the full-track option of classes. These days I spend most of my time on campus in the clinic, rather than in classrooms and hallways where I can cross paths with my buddies. Because of this, we had so much to talk about! We reminisced about our cadaver in first tri anatomy and discussed our visions for our future practices and families (JheriAnne is pregnant with twins!) I drove home that evening all filled up with loving support from my people; I am truly a lucky gal.

Speaking of good experiences, I volunteered to sit on the ND panel at Campus Visit Day this past weekend. I think I've volunteered for this position 3 or 4 times before. I keep coming back to sit and talk with prospective students because I love talking and articulating my excitement for naturopathic medicine! I always leave these panel sessions feeling even better about my choice of profession. One of the things that came up in discussion for all of us on the panel was that the ND students at NUHS form a very supportive community. We share study guides, organize study groups, encourage each other to take a break and get out, and generally do not compete with each other for grades. We are all here to build our profession, so what's the point of creating excess competition within our little community? 

At the ND student panel for Campus Visit Day

We are certainly a group of healers who come to this medicine because we aim to doctor with caring support, rather than through sheer force, dominance or authority. It's a beautiful struggle to display authority with my patients so that they understand the importance of attending to their health and trust my knowledge, while at the same time allowing my innate compassion and tenderness to come through. Just writing this post has me all extra excited about our medicine again! It's that easy to love what I do.

If you're a prospective student with questions about being in an ND program, whether you're bound for NUHS or not, please do not hesitate to reach out to me! Email me at and I'll be sure to write back.

Storytelling, Salamanders, and Sol

A few weeks ago, before she left us (sad face) for her new position as an Assistant Dean in the Naturopathic Program at the University of Bridgeport, Dr. Stephanie Draus organized for a woman who calls herself Comic Nurse to come speak to us during a Tuesday lunch hour. Comic Nurse told us about how she uses comics with her patients and with the medical students she teaches at Northwestern to help tell the story of the healthcare experience. Whether it is getting patients to express their frustration with their doctors, or helping doctors-to-be address their anxieties about their future, comics have proven to be a remarkably effective form of expression.

Photo of hand drawn comic

Many of us think of comics as funny things that make us laugh, and with good reason, the adjective means, "to cause laughter." But we are talking about the noun here, and the noun is a form of storytelling that involves words and pictures and lets the storyteller use imagery to express those things that are sometimes too hard to express with words alone.

You can probably tell that I like using words to process my struggles and tell my stories. Some weeks though, those words just don't flow like I'd expect them to. I have the modern day equivalent of a trash can overflowing with crumpled up papers; too many untitled WORD docs in my "student blog" folder laden with half-sentences and stories that never came to fruition. Now I know an alternative outlet to get my creativity flowing!

No matter which medium you use, storytelling is a powerful tool for learning, for self-discovery, for communication, and for teaching. In PT Modalities class a few weeks back, Dr. Hill told us a story about chopping the legs off a salamander and then re-growing them with the application of therapeutic Microcurrent. So of course I remember that Microcurrent is indicated for tissue healing and repair! The rescue of quadriplegic salamanders is a pretty great memory tool.

Photo of hand drawn comic and McKenzie
My study comics, Piper and Sun King

I also tell stories to remember my botanicals. For a recent quiz, I had to remember Solidago virgaurea; common name Golden Rod, used for urinary tract infections and colds with a runny nose, and sometimes mistaken for ragweed in allergies. I associate the word Sol with Sun. So, there's this BIG sun god with a golden scepter and he's a super powerful diuretic/aquaretic! (This god always has to pee.) If you look at him directly, you'll start sneezing like crazy and you'll need him to cure your snuffles. You could think you're allergic to him, but you're probably wrong, this sun king doesn't wear rags.

Another favorite Bot Med study story is of Piper methysticum (common name, Kava.) Piper is an aging socialite in NYC who drinks too much wine while she lounges around, sedated on her couch all day, popping muscle relaxants and pining for the elusive man GSH who she loves but who does not love her back. Piper is also sad because she has a urinary tract infection and is very worried about her skin. As you can see, there is a lot going on here with Piper, so I'll spare you the medical translation.

Photo of comic on desk in LRC
Reading some medical comics in the LRC

Storytelling is one of the very best ways to remember and to process emotions, two things we must do often as medical students. If you're more of an artist than a wordsmith, try like Comic Nurse does and draw the story. Or, if you're neither good with a pencil nor crafty with words, screw it, try either one! Because it doesn't matter if the sentences are simple or if the characters are stick figures, what matters is self-expression and creative learning.

Examining Place - The Midwest

Ah, sigh. This weekend I finally got away into the outside world where the air is significantly different from here in Chicagoland. I took in gulps of fresh air and smiled. I experienced my first corn maze in the flat, flat Midwest and sat under a tree whose red leaves came drifting down into my lap as I chewed my apple brat. I ate a candy apple, but we didn't get to pick our own apples because we were a little too late in the season for that.


These past two weeks, for some reason, I've found myself answering questions about my life before medical school. People have been asking about the places I've lived and the cultures there. I'm quick to tell a story about places outside of the Midwest, so this weekend's little adventures served as a good tether to pull me back, and to examine my current place.

When I was studying non-fiction writing in undergrad, we often examined the concept of Place and wrote on the topic: what does it mean to be in a place, what makes a place yours, not yours, different, the same, why sit and become enveloped in this place now? It's a damn hard task, to sit patiently in place and observe it for what it is. This is especially difficult when your world moves so quickly and you are expected to work hard at attaining, achieving, getting there, making progress towards becoming a doctor.

Despite the rapid clip at which I am working to become a doctor, I try, try, try to slow down and observe this place, to take it in and notice the unique things. This weekend helped me to settle and gaze, to take in the flat farmland, to hug my boyfriend, to laugh with new friends, and to read through old physiology notes in order to refresh my memory and help me be more present in my current classes.


When you talk about the Midwest with anyone, they inevitably say something about how nice people are here. My initial experience with this Midwestern friendliness involved some confusion, seeing as I come from Boston, a place where nobody acknowledges anybody unless they definitely want to talk. When I arrived in Chicago, a stranger would smile and ask me, "How are you?" I inaccurately perceived this as an open invitation for a full conversation. Over the past two years of living here, I've learned that friendliness does not necessarily equate to a desire to have a conversation, they're just being kind, I guess. I'm still a little weirded out by this; if you ask me how I'm doing, I still look at you sideways to figure out if you actually want me to answer that question, or not. On the other hand, my rather immediate assumption to jump into conversation has served me well, and I've made friends with shop clerks at nearly every place I buy goods and services.

Right now, the Midwest is my home, though perhaps not my truest Place. Here in Chicago, I've had to stumble along trying to navigate the culture, and I finally feel that maybe I'm able to catch these Midwesterners in stride and keep up. I have learned so much about life in the heart of classic America by living here. My greatest adventures so far have been getting to know a place by living in it, participating in the community, and feeling out the social habits of the people there. From this perspective, it's no wonder I feel so slammed with new information; it's not just the study of medicine I've been trying to assimilate, but the Midwestern way of life as well.


So being in medical school is more than just your peers, your books, your lectures, and the other trappings of studying medicine. Many of us move to a new place to start this journey into medicine, and the culture of that new place also provides us with struggles and triumphs. If we can find the time to sit with our new place, in addition to our books, we'll learn more about the world, which will certainly make us better doctors, right?

The Unbeautiful

All this talk of having found my path in life, the indications that I am "doing the right thing," the gallantry of studying medicine outside of our current paradigm, all the fun being had outside of class, and I forget to show you the unbecoming parts. Isn't that one of the major faults of social media? We share the beautiful pictures, post the good news, write the meaningful stuff.... But a capacity for occasional self-deprecation is pretty important; we're all fallible, and the journey is not always beautiful.

My grades this tri haven't been as satisfying as previous ones. I feel I haven't studied as regularly as I should (maybe the trappings of summer have something to do with it). A few weeks ago I crammed my preparation for a sim-patient and she called me out on it. I rushed through the prep because this was just a practice session; I would not receive a grade for it. To save time and energy when I wrote the instructions for my patient, I used medical abbreviations few non-doctors understand. In our review of my encounter, my sim-patient pointed this out and I responded honestly--I told her I'd banged it out during the boring lecture before this, and knew full well I shouldn't have used those abbreviations, but I did it anyways. She reminded me of the NUHS motto: "Esse Quam Videri" (which means "To be, rather than to seem to be.") Oops, lesson learned.

As for the whole life-outside-the-classroom part, my bathroom gets cleaned only when I can't stand it anymore, same goes for the kitchen. Laundry piles up around our apartment and coffee mugs cluster on any free surface in the living room (especially during midterms and finals)! Cleaning out the fridge recently was terrible; eating healthy food doesn't excuse you from the misery that results from neglecting to toss last month's leftovers. I don't think I've vacuumed my car since I drove it from California two years ago. When my mom came to visit and saw my kitchen sink full of dirty dishes she told me its OK to be messy because I am a busy student. That's some consolation, I guess. Also, last night I had ice cream for dinner because... forget it, no excuses, I just did.

I wasn't kidding about ice cream for dinner...(cherry with chocolate sprinkles)!

I constantly talk about all the things I'm going to do once I'm a doctor. And I don't mean the type of practice I'm going to create and the type of patients I'm going to attract. What occupies my thoughts is what I'm going to do with my time once I've passed that last exam. I talk about the music festivals I'm going to attend, the dinners I'm going to cook, the books I'm going to read. I have visions of a clean home and cooking with pricey ingredients like lamb and wild-caught fish. I also have this funny feeling that these aspirations are going to continue forever; I'll probably always know I'm going to do something wonderful just as soon as I finish with... [fill in the blank]. (Speaking of unbecoming, there are at least 16 I's in this paragraph.)

I want future students who read my blog to think; I want that! They should think, my life as a student will be glorious! It will have meaning! I will have purpose! It will; you will. will also likely fall apart in a few ways. You will have to push yourself to make time to catch up with your best friends because, well, you're so tired and you could be napping instead. Your family will have Sunday dinners and cookouts together while you sit grumbling at your desk, memorizing facts for tomorrow's exam on the bacteria that's potentially growing in their potato salad.

My desk strewn with papers...studying is rarely a photogenic event.

Or, there's always that realization that instead of keeping up with your laundry, you could be sitting still doing nothing for a moment. You could just sit and listen to no one, memorize nothing, share no emotion. I've come to appreciate even more the precious moments of alone time without my books, without anyone to talk to, or smile at, or try to understand. Interactions with people are ultimately what keep me going, but in this messy life of a medical student I am so thankful for Saturday afternoons like this one--home alone amid my mess, writing about the unbeautiful parts and bowing to reality.