Tim's Blog

This week we had what I believe to be a unique experience among the naturopathic medical schools. We had a medical emergency during a follow-up visit with one of our simulated patients. I'm not aware of any other naturopathic med school that offers this intense experience for their students.

Dr. Ezra Cohen has set up our clinical training rooms with microphones, cameras and recording equipment to help us review and better understand our encounters with each simulated patient. These video records help both us, as students, and our faculty gain a better understanding of strengths and weaknesses of our interaction with our patients. Dr. Cohen warned us at the beginning of the trimester that we would have a simulated emergency at some point during the trimester. He also warned us that the cameras would be rolling to document the experience. The cameras were rolling, so to speak, as our follow-up visit began.

The follow-up visit started quietly. Our patient was an elderly female who had presented for persistent headaches. My team of naturopathic and chiropractic interns had completed the first office visit and initial intake with her the week before. We had come up with a good treatment plan for her that involved increased water intake, diet modification, a relaxing botanical tincture for the evening, along with some acupuncture and massage for her neck and shoulders to help with the headaches. This treatment plan was developed based upon many interactions with prescription drugs that our herbal tincture may or may not have along with our patient's daily activities, posture and goals for healing.

Well, as we were about 10 minutes into the follow-up visit with our patient, she started complaining of having difficulty breathing. As our patient began to clutch her chest and let us know she was dizzy, one of my team of Interns stepped beside the patient in her chair to steady her. Just as she was about to say another word, she grabbed her chest in a clenched hand and started to slump over in her chair! 

Another Intern stepped to her opposite side and as she slumped the two interns supported her and carried her to the examination table in the room, where they placed her in a "face-up" position lying down. I immediately exited the room to let Dr. Cohen know that we had an unconscious patient, who had clutched her chest while complaining of shortness of breath. I explained that I believed our patient was having a myocardial infarction (a heart attack) and asked Dr. Cohen to immediately call 9-1-1 (simulated, of course). 

Dr. Cohen called right away and I returned to the room. Upon my return, my teammates had started taking the patient's vital signs, were supporting her on the table to secure her from falling and both were talking to the patient to let her know that she was safe with her caregivers, emergency responders were on the way, and that her emergency contact had been notified. During this entire time our patient was alive, yet unconscious. After about five minutes, Dr. Cohen entered the examination room to declare the exercise complete.

Our team described what we would share with the emergency responders such as the patient's vital signs (with any differences before and after the incident), when they last ate, and current prescription drugs as well as a description of the patient's words, actions and the entire incident. This information is vital to the emergency responders' ability to care for a patient in an emergency situation.

Our patient suddenly "woke up" and was fine. She gave each of us excellent feedback on how the situation was recognized, handled by each Intern, and relayed to the first responders. Our simulated patients do an excellent job overall of discerning our actions, efforts and performances as Interns.

Thanks to Dr. Cohen and his efforts to ensure we are exposed to as many ailments, pathologies, life situations, and emergencies as possible, I feel that we will be better caregivers to our patients. After all, doctors (regardless of modality or specialty) are caregivers and as soon as we forget that we are dealing with a whole human being, then our capacity to be a "caregiver" diminishes. I am thankful for our professors at NUHS who teach us to be caregivers and not just a lens to focus on one pathology.

A bit of a short entry this week everyone. Suffice to say that I'm only four weeks into this trimester and I'm spent. After three years of classroom instruction, I'm tired of sitting in class and listening. Fifteen weeks of intensity followed by two weeks of absolute nothing, repeated 12 times and three more cycles of this before graduation. I revel in the lab time we have between our simulated patients, physical therapeutics lab and observation in the clinic.

Yet, each time that I feel that I have had enough and I'm ready to pack things in and return to the banking world, an unexpected event occurs that rattles me back to the reasons I entered this field.  

We had a simulated patient this week who presented with a chief complaint of depression. My lab partner (a chiropractic student) and I proceeded to take the case asking the usual questions and we noticed that the patient really wanted to talk. So, at that point, without any signal from each other, we simply started a conversation with our patient. We used phrases such as "Can you tell me a little more about this situation?" or "How does that make you feel?" Once we had the flow of conversation, we were able to hear the patient's history, understand where she was coming from, and determine the timeline of her depression, her history of medications, successes, failures, and how she feels in the present moment.

After the session, the simulated patient has the opportunity to give the students verbal feedback for about five minutes. She told us that she had never had students who were more genuinely empathetic and covered so much ground in the 45 minutes of the initial intake. All with a simple conversation. The relief I felt was profound!

I was coming directly from taking a quiz in the previous class that I was convinced I was ready for but ended up missing a couple of questions (not bad, a couple), yet I was ready to ace it! I was feeling like my best effort just wasn't up to par. Then immediately walking into a room with a patient who is presenting with depression and being able to make them feel heard, valued and optimistic that we could help her (without making any promises to her) reminded me that was why I am becoming a doctor - to help others regardless of the confidence, regardless of "having a bad day," to trust my training and my ability as a human being to connect with other human beings, and to get to the root cause of the illness, and next, working from that root cause to get the best outcome possible for the patient. That's a pretty good feeling! 

Finally, I did a lot of work on the Gathering this weekend. I spent some hours building a slide show for the video display in our bookstore window. The slide show will display information on the Gathering, the symbols of the Gathering, its history and the speakers for this year. 

I was also able to complete one of the wreaths for display during the event on the stand I showed you last week. This wreath is for Dr. Gerald Farnsworth (one of our oldest surviving pioneer NDs who was part of the startup of NCNM) to place on the stand during the opening ceremony. That's right! The wreath has a big "E" woven into it and the "E" stands for Elder, and I'm grateful for the Elders of our profession who paved the way and built the model of connecting with other human beings. A noble reason for being a doctor, and more so, to simply be a good person.