Independence in Learning

A treat! Another day off during the summertime! Happy (belated) Independence Day! I went to the beach (again) on our day off with my boyfriend, my friend JheriAnne (also an ND student), and her husband Shane. During our afternoon and evening spent grilling, swimming, laughing, and lounging on the beach, JheriAnne and I talked about school (can't escape it!). Particularly relevant to the holiday was our conversation on independence in our studies and decision-making as we plan our schedules and careers. 

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Thanks to JA for capturing this picture of me on Independence Day
with the sun setting into the palm of my hand.

Let me preface this by saying that I am eternally grateful that I can be dependent on my friends at a moment's notice when the work overwhelms me or I have an idea that needs friendly scrutiny. My friends are there for me, and I am there for them. On the other hand, we can all too easily get wrapped up in each other's lives. As students, we spend around 30 hours together each week in class, and then also spend time outside of class recharging in each other's company. I've had to remind myself several times that I am, in fact, on my own journey here, despite how tightly bound my experiences are to those of the students around me.

One major challenge I experience daily is to break away from the established opinions and habits of students I study with, and those that came before me. Both positive and negative judgments about all things from professors to textbooks to scheduling are passed down from upper tri students and have, at times, been toxically pervasive among my peers. As medical students, we are juggling many balls at once, and it is easy to adopt an existing opinion (especially when you've just been thrown into 25+ credits of professional school), but I implore you to never forget to form your own opinions, no matter how exhausted you become. I truly believe independent thought wins when it comes to learning, which is after all, what we're here to do (whether we feel like it today, from this professor, or not.)

I am not suggesting that we just ignore all advice coming from upper tri students.  I am suggesting that we always take that advice with a grain of salt and view the issue through our own eyes, as we experience it on our own, individual journey through medical school.  Remember this tenet of our medicine: every person is different.

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John, Dr. Brad, Mia, Nadene, and a tree circle up
for a short group meditation session beside Lake Janse.

When I was 19, I worked for my mom, an MD, answering phones and filing charts at her dermatology practice. My first free lunch from a drug rep and his conversation with my mother was one of those experiences that every child dreads. I ate my free sandwich in horrified, bug-eyed silence as my mom interrogated this rep about the studies behind the drug he was touting. I swear that man shrank into his chair with every "Yes, but where is the research? I want to see the actual paper you keep referring to." For whatever reason, whether he was new or wasn't given the tools, this drug rep could not provide my doctor mother with the published paper showing the effects of the drug that this lunch was supposed to make her want to prescribe. By the time he slunk out of the office, promising to return with a copy of the published paper for this crazy doctor, I was just about never going to forgive my mom for displaying such unrelenting behavior. She sensed my anxiety and proceeded to explain that she would never prescribe a drug to a patient without knowing as much as possible about it. She would form her own independent opinion based on the evidence, and would not consider prescribing the drug until then. As NDs, we may not have a future full of lunch dates with pharmaceutical reps, but companies pushing supplements, diagnostic tests and other tools might surely come our way in this same fashion.

So, to my peers, I thank you for exercising your independence and forming your own opinions while on your individual journey. At the same time, I thank you for doing so as part of a team of students or interns who are present, ready to learn, and aware that we are all on our own path to doctorhood. And of course, thank you for allowing me my moments of dependence in the form of a hug, an ear, a shared moment of frustration, or a quiet group meditation session.

Maybe This Will Touch Your Heart Today

OK readers, I did it! I decided. My parents were a reliable sounding board in a conversation last week and while I trust my own intuition and will follow it even in the face of resistance, being reassured with parental support really sealed the deal. I plan to start the massage program in September!

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Source: www.ieet.org

Trusting intuition is something we address in class from the very first trimester. Mostly, we have these discussions in our naturopathic theory classes, although this week in Homeopathy 1 we started a topic on How To Take the Case, which is inseparable from learning about becoming a true healer. "Taking the case" means listening to our patients without any preconceptions; it means forgetting ourselves, and dissolving the boundary between the self and the world so as to note every important detail.

In discussing both homeopathic and naturopathic theory, our professors have talked about mirror neurons, a term that defines how empathy is evidenced in brain scans; the listener's brain lights up in exactly the same places as the storyteller's brain does. Our goal as doctors is to use our mirror neurons.

One of my peers asked about how, on the one hand, we dissolve the boundary between ourselves and our patients' stories of suffering, and on the other, maintain our own sanity and refrain from shouldering the burdens of every sick patient that walks through our doors.

It is a good question. How many mirror neurons can we afford to use? Turns out, the answer is different for every doc. Of course we knew that, everyone (every case, every patient) is different, after all.

One professor told us that he sits behind a desk, with the patient opposite him; this provides a physical boundary to remind him. Another professor spoke on how her spirituality and the healing cannot be separated. Her spiritual practice involves dissolving boundaries and finding compassion for every single living thing.

During several of these class discussions our professors have sited an author named Dr. Rachel Naomi Remen, a doctor known for her work teaching other physicians how to heal from the heart. On her blog, Remembering Your Power to Heal, Remen writes of physicians: "Our habitual way of seeing things and even our expertise can blind us to the meaning of even the simplest of our daily interactions and relationships." This tendency towards blindness is an obstacle to cultivating the healer in us, and comes at least in part, from our training. One of Dr. Remen's tools for learning to see through "new" eyes is to keep a "heart journal" in which you answer three questions each day.

The Heart Journal

The first question is: "What surprised me today?"

The size of the nose ring on the girl sitting next to us at the beach; it was huge but I figured she probably loves it that way!

The second question is: "What moved me or touched my heart today?"

On our way to the beach, Hanzi was looking out the window and said, "That was cute!" I asked what, and he told me that a little girl was leading her grandmother in an investigation of something smooshed on the sidewalk.

And the third question is "What inspired me today?"

The camaraderie of the group of "Bears" gathered at the beach, all bobbing together with their big bellies in the chilly Lake Michigan water.

If this exercise is something Remen thinks we should do as professional physicians, why not start practicing it now? In addition to practicing things like taking blood pressure, evaluating cervical range of motion, or taking a history from a SIM-patient, we should probably be cultivating the healer through exercises like this.

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Hard to believe, but I did study at the beach. Here's the evidence!
Want to find a Chicago beach to visit? It's easy: CPDBeaches.com.

The skill set of a healer includes knowing how to find the beauty in the midst of the suffering we are exposed to daily for the duration of our professional lives. So, to my fellow students, don't write in a journal every day if the time commitment freaks you out, but at the very least, have these conversations with each other. Try to talk about the heart-full things, rather than the test you're dreading or the professor you can't stand. Look for the things that inspire you, the things that touch your heart, and the things that surprise you. Forgetting to cultivate our eye for these things will, I suspect, prove a grave mistake whose consequences we will learn when we go out into the real world and try to heal people.

So, I encourage you to notice the things that make you smile more than the things that make you groan. You may even find less to groan about....

To Enjoy a Gorgeous Carrot

Our long weekend off due to Homecoming has come to a close and I am so, so thankful for having had those extra days without classes! While I suppose I could have joined in the festivities on campus, I decided instead to take advantage of 48 extra hours of unscheduled time and do some Mackie things.  

Don't worry! I did contribute to some Homecoming prep; we worked on beautifying the garden with more weeding and new mulch! Current students, if you'd like to stay up to date on garden happenings, check out the NUHS Botanical Garden Project on Facebook!

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After classes ended for the week on Wednesday (amid the cracking of a powerful thunderstorm, the lightening vivid in the grey sky), I joined some ND girlfriends at a nearby wine bar for a drink and some appetizers. The five of us each toasted to intelligent and loving company, the beauty of a steel-grey sky amid the storm, and our ND student friend Anayibe, who took this tri off to go on an adventure to the World Cup in Brazil, and to visit her family in her home country of Colombia. Ana is a vibrant friend, so positive, so present, so quietly loving and funny. She may be only 4'11-¾" tall, but her presence is huge; we feel her with us every day. It is a powerful thing to find a friend like this, and I speak for many when I say we miss her in a wild way.

Illustration by Rigel Stuhmiller - www.rigelstuhmiller.comIn the spirit of my friend Anayibe, I watched an episode of Anthony Bourdain's newest show, "Parts Unknown," (a food travel show), that takes place in Colombia. Now I can't wait to tell Ana about my hopes that she'll take me on a trip to her country and show me around! (Maybe we can even apply our ND training somehow; I guess we'll see when the time comes for adventure…)  The best line in the show came from a Colombian musician-turned-chef who tells Bourdain, "I believe more in a beautiful carrot than in a good recipe." 

Thank goodness for chefs like this!  To me (and in the context of this show), a beautiful carrot signifies the harmonious interaction between humans and nature, the ability for humans to enjoy a gorgeous carrot born of the earth and to glean both nutrition and pleasure from it. According to naturopathic philosophy, if one lives by nature's laws, health is "the innate and natural state of being" because humans evolved on this planet, selecting for traits that allow for survival in harmony with the environment here. We practice Earth Medicine because we do so on Earth.

When I lived in the mountains of Northern California I got a CSA (community sustained agriculture) box bursting with fresh produce once a week. When I moved to Chicago, I vowed that no student budget would keep me from living close to nature through my food. As Michael Pollan says in his book The Omnivore's Dilemma, "Eating's not a bad way to get to know a place." I shop at the farmer's market here in Oak Park every weekend.

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Last weekend a few NMSA members met at the farmer's market
to stock up on veggies, flowers, and yes, those irresistible donuts, too.

Supporting local farmers, especially those who use organic or hazard-free methods, ensures that I get the most nutrients through my food. It also allows me to participate in one important aspect of my community that supports the basic determinants of health (hydration, sleep, nutrition, breath, and rest & recreation aka Vitamin R) that lie at the core of naturopathic medicine. In the back corner of the market there are always musicians gathered for a bluegrass jam session, the local church sells irresistible donuts to support their work, and the high school athletics department sells baked goods to raise money for travel and equipment.

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The vegetable scene at the Oak Park farmer's market.

The weekly market cultivates community, good nutrition, rejuvenation and belonging. Some might say that life in the city is irreconcilably distant from the natural world, but I argue otherwise. I have found, through my friendships and through my community, many ways to live by nature's laws. To name a couple, I eat good food, and I take a wine break every now and then to stock up on some Vitamin R.

On Finding Your Favorite Tools

I'm deciding whether or not to study Massage Therapy while I'm here at National in addition to getting my ND. Many of my peers get dual degrees, whether it be ND/DC or ND/AOM because the modalities and philosophies run in parallel and allow us to expand our scope to meet our interests and passions, especially in unlicensed states. Part of the adventure of studying naturopathic medicine is learning what aspects of our vast toolbox suit you best, and then exploring ways to pursue those interests.

I struggled for a few weeks last fall with whether or not to enroll in the AOM program, because Chinese medicine is so wise and its application is so broad and increasingly accepted by mainstream medicine. It serves as an excellent adjunct to naturopathic medicine. Many of our professors use it. Ultimately though, I realized I do not absolutely, definitely, no question, want to be a master of Chinese medicine in the kind of way I know I want to be a naturopathic doctor. And, I am not willing to invest all the time and money in something that doesn't feel quite right for me.

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In E&M Extremities class, Meg demonstrates a gait anomaly as the rest of us analyze it.

Over the past few trimesters, I have gravitated towards physical medicine in application with naturopathic medicine. I was totally surprised when I enjoyed E&M class and found that I was actually pretty good at adjusting. I realized that I know my body and its relationship to weight-bearing and careful maneuvering through my experience of being a competitive athlete. It's been years since I gave up competitive sports in college, but I still have that knack for acquiring muscle memory and fluidity in movement, and it pays off in understanding how the body should, or wants to, move.

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Cranial Sacral Massage elective class with our professors,
Dr. Patricia Coe and Dr. Heather Wisniewski

Also, having never taken any kinesiology classes, I figured I was doomed when it came to grasping biomechanics. As it turns out, knowing my body and its movements has made learning biomechanics and adjusting a lot easier. Inspired by my propensity for understanding and applying physical medicine, I asked for a recommendation of who to talk to or what other avenues to explore beyond the classroom. Dr. Pearson, one of the family practice interns, directed me to Dr. Coe, massage program supervisor and instructor (and totally awesome ND/DC/MT/photographer/character/mentor). I signed up for her massage elective class on Cranial Sacral technique and discovered this awesome new dimension to add to my ND toolbox. By using what I learned in Dr. Coe's class, I continue to study through experience on my friends and fellow classmates. I am learning how to listen with my hands, follow what I find, and make people feel better.

Inside Outside Muscle Hand by Katherine Du Tiel
"Inside/Outside: Muscle/Hand" San Francisco, 1994. Photograph.
U.S. National Library of Medicine. Katherine Du Tiel (b. 1961) [artist]

So, in an effort to distract myself from the stress of 3 exams and 2 assignments due in the upcoming days, I've tracked down Dr. Coe and picked her brain on my options for adding the Massage Therapy coursework.

I also reached out to a recent NUHS grad who tutored me through Phase 1 and studied in the massage, chiropractic and naturopathic programs during her time here at National. She offered some solid advice. (Even after they're gone from campus, NUHS folks are still accessible and willing to help you!) Now I have to make some decisions. It's probably time to make a pros and cons list and a phone call to Mom and Dad, who always offer pretty good advice. Part of what makes naturopathic medicine so strong is this great big toolbox we're given. It also presents a fun challenge to us students: to discover our strengths and trust the process!

For the Few Joyous Starfish

To catch a fish on a fly rod, you first assemble all the parts of the rod. Next, you select a fly appropriate for the fish you are trying to catch. Practice your cast in order to land the fly where you want it on the water in the vicinity of a curious fish. Tug on your line so that fly moves over or through the water like it was alive. Watch carefully as the fish goes for the fly and right as she takes it, pull up on your line to set the hook! When I caught my first fish (a bluegill) on my very own fly rod (a Christmas gift) on Friday after class, the hardest part was figuring out what to do once I'd hooked the fish. It wriggled around in my hands; I even dropped it twice before asking for advice. 

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On Tuesday, Dr. Sheppard told us a story in Homeopathy class. A man walks down a beach strewn with stranded starfish. He encounters another man on the beach who is tossing the starfish back into the ocean, one at a time. The first man asks him why he bothers, "There are so many doomed starfish here! You can never possibly save them all…."

"At least I can help a few of them," the other says.

In casting about for our fish, after assembling our rods and choosing the right flies, my peers and I watch, work and wait to set the hook for the completion of our naturopathic studies. We can see the fish under the surface, and mind you, she always looks bigger underwater than she is in reality. The thrill of the catch is preceded by the calculated maneuvering of our fly across the water, pulling it back and taking another cast, trying to land the fly closer to our target to make it look more appealing. The more practice, the more accurate our casts, the more realistic our fly, the closer we come to catching the end of school. We are thankful for the challenge, for what would fly-fishing be if all we had to do was cast once and the fish would come all of its own accord? Where is the fun in that? How do we improve if we must never send out another cast?

Those who are less familiar with our medicine come across us, tossing starfish back into the ocean, one at a time. What's the point? There are so many sick, over-medicated, complicated patients with no knowledge of what real food looks and tastes like, no memory of what a good night sleep feels like. Well, we'll go out into the world of the sick and help put a few starfish back in the water. I read once that only 20% of scientists, but 80% of doctors, have some form of belief in a higher power, some spirituality. Perhaps this is because we can throw back only a few starfish, even after setting that cast so carefully on the water and watching with our full attention as the fish takes the fly. 

I cannot be sure, but I imagine fulfillment comes from the joyous response of those starfish that do make it back into the ocean. I do know for sure that if you do not keep practicing your cast, you lose some of the finesse. It becomes harder to catch the fish, less intuitive. So, let a few happy starfish motivate you to keep practicing your cast, all the while keeping your eye on that fish, the one that looks bigger underwater than she is in real life -- the one you're not quite sure how to handle once you catch her.