Climbing Again and the To-Do List Remains

After a week full of residency interviews, pediatric cases, diabetic patients who resist going on insulin, and Pubmed searches on sacroiliac fusion and green-light laser for prostatic hypertrophy, I took to the hills. I made a few new friends during the course of a day of climbing some cliffs outside of Red Lodge, where I went for a drive a few weekends ago. It felt SO GOOD to be back in that world, drinking a cold beer with tired hands after all day outside pulling on rock and belaying other climbers. I remembered how clear I feel squatting in the dust, cutting chunks of cheese and apple with my pocket knife and devouring that food to feed shaky muscles.

Snack break, out climbing in Red Lodge

After years away from it, I got that carefree feeling of slinging my pack into the bed of a truck and hopping in for a ride out of town. It was one of those times when you find friends because you share an interest in an activity that doesn't involve any monetary compensation, or studying.  So refreshing!

At the end of a day climbing those rocks behind us

I've been attending a weekly yoga class held here at the clinic. It's taught by a man named Greg who takes inspiration from Foundation Training, a series of exercises designed by Eric Goodman, DC. If you're curious about an incredible way to build core strength, I highly suggest you look it up on YouTube. Anyway, Greg is also a potter, and he and his artist wife Nancy collaborate to make some absolutely remarkable pieces. 

Greg and I attended a yoga class together on Saturday morning at the YMCA, and after class he brought me to see his and Nancy's home gallery and studio. They each have their own studio -- hers is above their home, and his is out back. Their living space is decorated with their work, and they have installed track lighting so that they can host gallery showings from home once a year. Their motive is not to get famous making art. Greg makes practical, useful pieces and with Nancy's added decoration/painting, these pieces win awards and are featured in art books. Greg has strong feelings against the concept of the gallery, where his pieces are marked up 100%. He and Nancy have built a very practical and authentic life around their art, which allows them to study all number of other things that bring them alive; Greg studies yoga, Nancy was off at a print-making workshop that morning.

I know I've got to make some money to get by in my life, but I am more inspired now than I was in Chicago to focus on what makes my heart sing. I've turned down two opportunities for second interviews for residencies because after the first interview, they just didn't feel right. I want to provide primary care to all sorts of people. I want to learn to practice in a licensed state so that I am comfortable going anywhere. I want to live with my radical partner (who I miss very much!), and I want to spend time outside. I suspect if I keep focused on my goals, the right experience will come my way. 

My book of treatment notes has filled up over these past few weeks

And to be transparent about all the things, I do have all those flatly practical goals too. I just received my boards study books in the mail and want to get to work on that. I want to find a job for the summer, as I study for boards in August, that allows me to pay my bills. I have a checklist of things to read, topics to research, phone calls to make, and flights to arrange. I guess what I'm saying is that whatever's on your to-do list, I hope you want to do it, or that you want the end result of all the doing. As a medical student, sometimes all you can do is keep your eyes on the prize and remember the end will come. Then, when you're reaching that end of school, your to-do list remains, but your world opens, you meet artists, and you get out climbing again.

A Supportive Community - Wherever That May Be

I went to the Billings premiere of the film "Makoshika," which is about the boom and bust cycles of Eastern Montana and Western North Dakota. The current cycle of this involves the Bakken oil field. The crew filmed from 2014 til 2016, which means they captured the full scope -- the boom, and the bust. The price of oil recently dropped below $50 a barrel.

Flyer for the film "Makoshika"

There was a big turnout of locals to support these young filmmakers, probably all about my age. There was humor and there were images that made me grimace. The scenes of change from quiet country road to lines of trucks in traffic contrasted sharply to the scenes of fifth generation farmers driving ancient Fords along empty roads to their pastures. There was the shot of light from the oil well flickering through the drawn blinds on the front windows of a farmer's home that was hard and sad to see.

At the end of the film when the credits rolled to a standing ovation, I saw a long list of local Billings family names as donors to the group's effort. The filmmakers expressed, over and over again, their gratitude to this community that got their project off its feet and into film festivals at Big Sky and in Europe. There was some serious pride in the air at the Babcock Theater, and it came from that whole Billings community. The whole group of them really is what made that film.

A weekend hike with resident Drs. Schenewerk & Phillips-Dorsett

At a live blues show on the weekend, I watched and danced as a group of spectacular local musicians played in support of a local non-corporate paper called The Last Best News, and rallied around one of the guitar players, a man who is dying of cancer. The Billings community came out in force that night, bidding on a silent auction and packing the brewery with boogying bodies. You should know that it's the doctors at YNC who took me out to these events and who danced until they closed down the dance floor. They're the docs who remarked to me the amazing community they live in. Some of the younger, newer docs will avoid their patients in public environments, but these older and wiser ones just get right in the middle of things and embrace their community full on. I know that confidence and the ability to meld the doctor-patient relationship into everyday life takes practice and time. So, I'm watching and making mental notes.

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10th tri almost-docs! (Minus Kaila, fingers crossed for a good interview!)

There's the Billings community, and then there's the naturopathic community. My 10th tri buddies all had their send-off dinner with Dr. Lou -- a tradition that all 10th tris partake of during Dr. Lou's last week in Lombard during their last ever trimester. True to their word, they Facetimed me and I got to wave hello to everyone around the table! Oh! It made me miss their good company. They happened to call before I had left the clinic for the day so I ran over to Dr. Beeson's office and let her and Dr. Lou say hello --theirs is an example of those amazing friendships formed between remarkable NDs. That night, Dr. Beeson had me up for dinner, stating that all my buddies were having their celebratory dinner and I should have mine, too! We ate tuna caught by one of her patients, and plenty of delicious vegetables. These communities are the kind that I really want in my life. When people ask me what my plans are, or where I'd like to be next, I think the most accurate response is to tell them I want to be in a supportive community, wherever that may be.

Connecting in Montana and Leaving Illinois

Time is speeding up again. For a while there, when I first arrived in Montana, one week felt like a month, now I can't believe February is almost over! Things are getting real for Hanzi and me; he just moved all the furniture out of our apartment in Illinois and is preparing to move up to Michigan at the end of the week. I am doing all those annoying things you have to do when you move; canceling the Internet service, submitting a change of address with USPS, talking to Hanzi every day about what to keep and what can go from our apartment. Hanzi has been my remaining connection to home in Illinois and as soon as he is gone that will change. I am very grateful to have a partner who defines home for me, and I wonder how much more I'll connect with Montana once he leaves Oak Park.

Lately, I've been receiving messages from friends from all parts of my life about people they know who live in Billings, Montana. One former sorority sister from undergrad told me, "I don't know many people who move to Billings, so I thought I'd get in touch!" She has a cousin who's a nurse here, and another college friend has an aunt and uncle in Billings who would love to have me over for dinner. An old summer camp friend reached out to me because he and his family will be visiting his sister over in Bozeman this week, so we have plans to meet up for dinner. It feels like the powers-that-be are encouraging me to get connected in Montana, as if it's a place I'm going to be for a while. This kind of thing didn't happen for me when I moved to Illinois. Yes, I made many wonderful friends through school, but the community connections didn't come flowing in like this, without my trying. I am cautiously optimistic about it.

Statue for auction at the Casting for Recovery Gala

Over this past weekend one of the resident naturopathic oncologists at YNC invited me to be her guest at an event for Casting for Recovery, an organization that takes women with breast cancer, or who are in recovery from it, on fly-fishing trips. Dr. Jennifer Krieger got to connect with the local chapter organizer and discuss providing a survivorship talk at their weekend retreat in Big Sky this summer. You may remember that Hanzi is a fly-fisherman and has taken me fishing in some spectacular places including the Truckee River in California, the Wind River Range in Wyoming, and the Driftless Region in Wisconsin. My waders are currently in the mail from Illinois so that Dr. Krieger and I can do some fishing here in Montana sometime soon!

Grooving at a Railroad Earth show.

Dr. Krieger also accompanied me to a Railroad Earth show on Wednesday night and we danced to some jammy bluegrass until midnight. Later in the week I contributed to a Bon Appetit-inspired dinner club with two other residents, Drs, Schenewerk and Phillips-Dorsett. Dr. P-D made delicious short rib enchiladas, which we all helped to assemble and then voraciously ate a little while later. I've had a surprisingly busy social life here lately. I am also starting to take on some more work for Dr. Beeson, including small research projects for patient cases. Recently, I recruited Russ, our reference librarian at NUHS, to help me hunt down research on prophylactic treatment of malaria with Artemesia and its synthetic derivatives for a patient who is traveling to Uganda at the end of the month. 

Drove as far as I could into the mountains.

I have to tell you that I managed to get out for another little adventure, this time to Red Lodge, about 60 miles southwest of Billings. I drove as far as I could on the road through the Beartooth Mountains toward Yellowstone National Park (the spectacular part of the road is closed for the season), and then went for a gorgeous, sunny, and snowy hike. And now, I have to wrap up this post and head to the post office to mail my apartment key to my landlord in Illinois. It feels good to know I'm sending off some of the last of my belonging to that place because I'm ready for these new experiences, though I do think I'll miss our curious little apartment in the dilapidated pink house.

Out of My Shell

I'm finally out of my shell. I think I mentioned before how intense it was to pack up and move everything to a totally new place, and so just this past week have I really started to unwind. It's things like my sense of humor and self-confidence that are crawling out of that deep part where I hide my personality when things are just too new and different.

I've had an interesting run as a true introvert these past few weeks. I didn't do a whole lot this weekend because I had a residency interview in the middle of the day on Saturday, and then just wasn't feeling great on Sunday. Instead of going out for an adventurous walk with some of the residents at YNC as planned, I took an Epsom salt bath and a nap to kick a headache (physician-heal-thyself!). After waking, feeling much better, I prepared a thermos of tea and set out for a drive. I kind of forgot that when you drive in wilder places at dusk you have to be vigilant about watching for deer and pronghorn, maybe elk, too. I drove south of Billings into predominantly ranch land. Thankfully no ungulates (have your dictionary handy?) tried to cross the road as I drove, though I did stumble upon this spectacular evidence of recent road kill when I pulled over to take a picture of the sunset.

A very dead animal, and a pretty sunset!

On my way back into town, I drove through an area that has recently seen what I presume to be wildfire. I remember stretches like this in Nevada and California, but forgot how eerie those blackened trees look, especially when the color goes out of the sky as the sun sets. I didn't stop to take a picture; I just kept on so I could pass through that uneasy place.

Taking a break during a run along the rims after an interview.

After another recent residency interview I had to get the shakes out, so I took off before sunset after work for the rims above town, this time in my running clothes. The weather has been so mild here; I was able to run along the trail overlooking the city, with its lights flicking on, in just a long-sleeve and vest.

So you probably want to hear more about my preceptorship too, huh? I can't say it enough times; I'm so, so grateful for this experience. Some combination of time and exposure has brought me to a significantly more comfortable place with just about everyone who works at YNC. As you know, I sit in with Dr. Beeson's appointments and learn while I watch her work, but I also get to follow her around when she discusses cases with her residents, or when she gets called into another exam room to confirm their findings on physical exam. I get to watch two doctor-minds thinking together, and add mine to the mix (though I mostly just absorb.) In this way, I am seeing even more cases throughout the day! Dr. Beeson is great about asking if I have any questions and making sure I get to see/discuss the cases I am most curious about or have had little exposure to. 

Happy belated Valentine's Day! I made these for the lovely folks at YNC.

Despite having worked with doctors over the past decade and crossed paths with many different complicated patient cases, there is a definite change to how I view these cases now that I have an educated mind. Even as an almost-baby-doc, my depth of understanding is so much greater than it was one, two and three years ago, before I learned all the things about how the body works, what goes wrong with it, and how to fix it. If there's one thing I've learned for sure over these past few weeks, it's that I will never be done learning those three things: how the body works, what goes wrong with it, and how to fix it. Doctoring is learning forever.

Music, Art, Hiking, and a Whole Lot of Medicine

It's the end of my first week at Yellowstone Naturopathic Clinic (YNC). I cannot believe it was only a week ago that I was driving through North Dakota en route to Billings - that feels like it was a month ago!

I'm renting a small basement apartment in Dr. Margaret Beeson's house, so this weekend she came down the stairs and invited me to join her and her son Julius at a live show by a local band one night, and for the Artwalk, an event that happens 5 times a year in Billings, the other evening. I followed these two around downtown, stopping in to galleries and watching them greet their people, appreciate local artists, hand out free Bernie stickers, and pass out flyers in support of the local co-op here.


The band Satsang, playing to a full house at the Yellowstone Valley Brewing Co.

At the show, I danced to some groovy reggae-inspired roots music and watched the people of Billings love on this local band (check them out here: I hope I grow into the kind of healer and community member who knows someone everywhere I go and laughs as much with her people as Dr. B does.

As for medical things I've learned this week -- oh, my god -- where do I begin? Like I said in my last post, there's no comparison to learning by watching a doctor work. At YNC, there are 3 associate docs besides Dr. B, and 4 residents. There's also a chiropractor, an acupuncturist, and a massage therapist. There are 2 front desk ladies and about 4 or 5 other employees working in medical records, dispensary, and other management positions. It's a busy place! 

All of the doctors are willing to engage my questions and teach. In this way, I get to understand a little bit about how each one thinks and works differently from the next. I've watched some prolo and PRP injection therapies, listened to a patient's story while he received a vitamin C IV as supportive treatment for cancer, and watched Dr. B doctor and refer a 70-something patient in need of back surgery.

I've learned from one of the associate docs about the difficult experience of having to tell her patients she is leaving the practice to do some volunteer work and ponder her next move. Her advice to me was "If you know where you want to live, go there and start your practice. It is so hard to leave your patients!"

Sheltering from the wind, taking in the view (this does not do it justice!)

Speaking of knowing where you want to go, now that I'm in the West, I am have a hard time picturing myself anywhere else. It feels really, really good to be here, under this big sky, with ranchers at the table next to me in the restaurant, and patients driving 3 hours from their very rural home to see the naturopathic doctor. It is very different from the big city, and that weight of millions of people has lifted from my shoulders; it feels much more like home.

In other news, I'm starting to hear from residencies and am hoping the communications continue through this next week. I'll try to keep you posted on progress with this, but at the same time not get my hopes up. I'm trying my best to relax into the process and trust that I'll end up wherever is best.

Strolling the ridge after scrambling up a cold north-facing trail

To take my mind off things, I went out for a little hike at Phipps Park to the west of town. It was brilliantly sunny, the view was expansive, and I found a cave to sit in for a few moments, out of the wind.

Lastly, I can't end this post without mentioning that many of my ND student buddies took boards last week. Congratulations to all of you on making it through that hugely exhausting experience! May the answers you didn't know be the same ones nobody else knew, either!