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
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
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
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
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.
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
Dinner, drinks and laughing with my ND-to-be
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 email@example.com
and I'll be sure to write back.
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.
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.
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.
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.
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
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
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?
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
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
I wasn't kidding about ice cream for dinner...(cherry with
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. But...life
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
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.
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