Thank You!!! and Good Bye for Now

I'm writing this post from my last day in my little office at the Yellowstone Naturopathic Clinic as I prepare to take a few days off for hot springs-hopping, fishing, general unplanned adventuring, and visiting with friends here in Montana before I drive back to Illinois for graduation. Whoa, Graduation! Huge congratulations to my Tri 10 buddies -- we did it! Most importantly though, I would be remiss not to thank all the incredible people who've encouraged me on this path to becoming an ND.

In my happy place, out for a drive into the foothills on National Forest land.

Thanks of course to all my professors from first tri on up, for filling my brain to the brim, and to my clinicians AND my patients for your patience with my wild, learning mind. Thank you SO MUCH to my family for cheering me on and supporting me unconditionally in my currently alternative career choice (Not for long! Our medicine is bound for greatness!). Thanks to my friends and peers at school who shared in this whole experience (whew!), and to my partner Hanzi for hangin' in there while I cried in a heap in his lap in the midst of midterms and was quite frankly too exhausted to help cook dinner most every night for the past 3.5 years. Thanks is especially due to Hanzi for taking my mind out of medicine whenever he could, to engage me in conversation about the rest of life and the world; I cannot express how much that saved my sanity and kept my heart whole. 

2016-04-14_houseHanzi checks out this spectacular historic home for sale in Virginia City, MT -- a town of all dirt roads.

Thanks also to my friends, near and far, who've kept tabs on me by reading this blog, and who I assume will forgive my absence in your lives as medical school has ravaged my free time these past several years. I cannot promise I'll come roaring back on the scene, but I'm ready to engage you all with more effort. Thanks and boundless love to Arthur for reminding me that I'm kicking butt at school each time I talk to him -- your path will illuminate, brother -- I promise. Thank you to my most special ND friends, the original Team Shakira, for experiencing with me the realness of bodies in those first few months of medical school, in the anatomy lab. That was a truly unforgettable chapter, and those are the people I am sure I was meant to meet, a large part of why I was called to attend NUHS.

Thanks is also due to the administration at NUHS for finally helping me leave campus for life under the wide Montana sky, where I've learned invaluable lessons about naturopathic doctoring in a licensed state. Thank you to Marie Olbrysh, the wonderful blog coordinator who emailed me nearly every week to remind me to send in my posts, and who made me feel like my writing was worth the read!

We lived out of our truck for a few days, here, a stop for a soak at Chico Hot Springs.

Thank you, of course, to all the doctors here in Montana at YNC who've elevated my understanding of naturopathic doctoring. Dr. Beeson, Julius, and Dr. Holl, I can hardly tell you how grateful I am for your friendship and for making Montana truly feel like home.

Thanks to all of you out there (there are more of you than you may think) who've told me after reading a post or two that I must write a book some day. I'm going to do my darnedest to follow your advice and make that happen! In the meantime, you can follow my thoughts and ruminations on naturopathy, and can watch my life as a doctor unfold over at -- that's me, just about! My website should be up and running within a week or two, thanks for your patience!

I suppose the final thing to leave my readers with is that naturopathic medical school is totally, absolutely, the bee's knees. If you've ever thought this might be the path for you, please attend a visit day, explore campus, and ask questions. It is an incredibly challenging and incomparably rewarding experience. The people you will meet are unique, the professors are dedicated, and the medicine absolutely works. It's a long road to becoming a doctor, but it's been the most true and gratifying work I've done so far in my relatively short life.

Our camping spot outside Ennis, MT.

Thank you, readers, for following along with me over these past few years! I am sure my successor will continue to tell you good stories from the ND student world -- please enjoy them! And, if you'd like to continue reading my own stories, you'll know where to find them. Lastly, if you need to find me in person, I'll be somewhere out in the American West, Montana for now, stimulating the Vis with everything I've got!

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.

You Should've Seen Me When I First Came Here

Today I listened while two doctors discussed a patient who is also a friend. This patient has alarming findings on MRI of the spine, and spends his entire day in active, physical work I got an excellent refresher on spinal pathology and also a glimpse into what it's like to provide medical care to someone you've come to know well, and really love as a member of your own community.

Kaila loving the big sky before snowshoeing.

The discussion centered on going back to the reports, reading the radiologist's notes, and stepping away from the emotion of it all. The collaboration between these two docs bounced back and forth from supremely rational to emotionally weighted. They made a concerted effort to remove their worry about their friend from the case analysis. They discussed referral for a second opinion, and reread the reports several times. In the end, they concluded that perhaps things weren't as bad as they thought, and that first things first, they must check in with the patient regarding actual symptoms.

I spoke to my mother, a dermatologist in the Boston area, over the weekend and she told me that four of Friday's patients thanked her for being there. My mom's comment was, "You probably hear that all the time." She's right, I do. It's probably every third patient I see that tells me I should've seen them when they first came in here. They tell me Dr. Beeson has completely turned their life around. Dr. B always smiles, hugs, thanks them for their kindness, and remembers to acknowledge that very little could actually come of her doctoring if the patient wasn't ready and willing to contribute their own effort.

Off the Beartooth Highway near Red Lodge.

Doctoring is absolutely an art. Yes, I'm learning about when to order which type of ultrasound, but I'm also learning a heck of a lot about the core of just being there so that the patient who needs the ultrasound comes seeking your help in the first place. Last week, my classmate Kaila came to stay with me here in Billings for a residency interview at YNC. It was such a treat to have her company while dancing to live music on Friday night, followed by a trip over to Red Lodge for a spectacular snowshoe hike in the mountains on Saturday. I loved sharing an appreciation for being outside in the sun and snow with all that crisp fresh air all around! And, we got to talk and talk about our respective experiences of applying to residencies and the stress of not knowing what happens next. It was a relief to realize she also has had a lot to mull over concerning the future.

Where Kaila and I went for a drive after our hike.

I recently took stock of the past few years of my life. It's silly, but I did this partially by looking through my Instagram feed (@zoozzah). What I learned in looking back is that I've really thrived by studying hard. I am enlivened by intellectual conversation and by practicing medicine. I'm so excited to start life as a doctor, and also to have my conversation partner back in my life. Hanzi comes to Montana next week! He will help me wrap things up here, and then we will make the drive back to Chicago for graduation. The day is fast approaching! Just a few more posts from me, and then you'll be hearing from a new blogger -- speaking of which, anyone out there interested?

A Change in Adventure

Life's adventures are changing. While in medical school, I knew that my adventure was to make it through all those exams and cram all that information in my brain. Now that I'm on the tail end of school, beginning life as a doctor is the new adventure. But, at one point I thought once school was over I'd be right back to more typical adventures -- trips in the outdoors, flights to distant places for travel on the cheap, festivals and camping, and any number of parties that filled my life before medical school. Now, I'm realizing that the adventures I'm going to have over these next many years may seem tamer, but they are no less life changing.

A gorgeous sunny day out skiing before the resorts close for the season.

Hanzi and I pinky swore we'd have an adventure once we finished grad and med school. He reminded me of this the other day; not that I think I needed much reminding -- I'm all for it!

My recent big decisions involving the unknown are in sharing the responsibility of another's well-being, in addition to deciding which place to move to next. I've always said I like to operate outside of my comfort zone, and thank goodness that's the case, because doctoring means doing that every day, especially at this point. I'm learning that there can be just as much puzzlement and curiosity involved in doctoring as there is in setting off on a trail into the mountains I've never hiked before. It's a different kind of thing, of course, but it's just as engaging. 

Contemplating the Beartooth Mountains during a break in my ski day.

I'm learning to define adventure not only as time spent without showering, cooking over a camp stove, sleeping in a tent, or clinging to a mountainside, but also as time spent puzzling through another person's story to connect the dots and bring about better health. It's certainly not every person who identifies with adventures in the outdoors, but I'm sure every new doctor's understanding of their place in a community changes as they begin to take on their professional role. It's a conversation I've had recently with one of the residents here at YNC -- the balance between holding your professional values close, and finding ways to connect with the people in your community. It's part of growing up, and especially, growing into a confident doctor.

Drove northwest to Helena through spectacular scenery for a residency interview last week.

Part of my everyday adventure is making other people feel well enough that they are capable of having their own daily adventures. And what greater reward? Because hiking mountains and skiing slopes only translates into doing something for others when I am getting outside to maintain or rejuvenate my own heart. If I were to spend all my days gallivanting around the hills and the globe, feeling cold snow on my face, or rough rock under my fingertips, I would be missing an essential part of adventure, of life, which is to do something for someone other than myself. Even better if I can do things for many someones beside myself! I know I'm meant to serve people as a naturopath, and to serve them best I've got to keep adventure alive in both my body and my brain.

So I guess this post is about realizing the aspects of our personality that we need to keep alive while in the midst of changing ourselves and our presentation to match that of a doctor. There's a lot of responsibility involved in fostering the connections we make as doctors. Learning to balance personal life with professional strengths and ethics seems like it might be just as central to developing as a doctor as is learning to diagnose disease.

On Montanans and Thriving Outside

Thanks to new friends here in Billings, I spent most of the day this past Saturday climbing again, outside in the sun. It got so warm and wondrous that I had to hide away in the shade to keep from getting sunburned! In March! After hours of belaying and getting up on a few routes myself, I sat and watched the sun begin to set from our perch up on the rims north of town. I'd been outside on those rocks since noon, and was wishing I'd brought a picnic dinner so I could stay up there until the daylight left. All this time outdoors is absolutely bringing me alive. In one of my residency interviews, the doctor asked me how I refresh, how I ground myself, or how I rejuvenate. It took no thought at all to answer that I do this by spending time outdoors.

At the end of a brilliantly sunny day out climbing.

On Sunday I didn't manage to do anything serious like file my taxes or study for boards, but I did spend an hour or so running along the rims, drinking up the sky and clouds. After my run I headed to a backyard goodbye celebration for Dr. La Deana Jeane, one of the associate NDs at YNC who is leaving to do some doctoring that doesn't require her to sit at a desk all day. We ate delicious food (NDs have a way of providing the most spectacular spreads at their get-togethers), and sat around the fire playing games and music until it was dark and chilly. By the time we left, we all wore that wonderful smoky fire smell heavy on our clothes and in our hair.

Backtracking to Friday, I found myself again at the Yellowstone Valley Brewing Company dancing to Jalan Crossland's lively guitar-picking and foot-stomping. I followed for a few spins on the crowded dance floor, and was asked if I was a Something. People who've been in this part of the West for decades know each other by their family names. I, apparently, look like one of the Something girls (I can't remember the family name). I've been asked 3 times if I'm part of this native Montana family, and each time I say, "No," I kind of wish I could say, "Yes." I've heard it's hard to get in with these folks if your family hasn't been ranching in Montana or Wyoming since the Homestead Act. It seems that there's something about a doctor though, and a naturopath especially, that I think might cracks this insular world.

Entering the Yellowstone Naturopathic Clinic.

I've met several of the members of these old Western families at the clinic. Through our interactions, I've learned that they do not want to operate within the system, and that they've used natural medicine on their animals forever. This combination brings them to Naturopathy, because in Montana, our medicine still operates outside of the conventional healthcare system. Also, NDs and ranchers have a shared understanding of how the natural world affects both our individual and community health. 

I love the stories that come from the ranchers that visit the clinic. One woman illustrated the level of her fatigue by exclaiming, "I used to go out and lamb three hun'red head a' ewes, and now I can barely stand to lamb a hun'red!" Another rancher claims he can't make it in that week because it's calving season and they're just too damn busy for him to see the doctor about this virus. Another young rancher, when asked about her daily exercise tells us that she runs on the treadmill at least once a day, but really she's outside lifting and hauling, feeding cows and hefting her little boys around the ranch all day. She supposes that she gets plenty of exercise just by living her life, and she's absolutely right.

In the hallway at YNC.

I'll be perfectly honest here, a few weeks away from providing patient care myself, and I notice I'm losing some of the details of medicine because they sink into the depths of my brain as I fill it with organizing residency interviews, observing people, and spending time outdoors. One of the residents here at YNC confirmed for me that this is natural; she feels she lost some of that more immediate knowledge as soon as she finished school and played the waiting game on starting her job at YNC. She reassured me it'll just take spending some time with the material to get it back to the front of my brain. 

After this recent revelation, I know I'll need to make the effort to spend more time with my books again. I also know that I have more energy and I feel lighter every day since spending time outside on a regular basis. So, I guess it's OK that I've taken a break from the intensity of studies. For the first time since I started the ND program at NUHS, I feel a desperate need to move my body and burn up energy at the end of the day. This feeling solidifies the fact that I thrive in a place with accessible nature and sky. One more month for me here in Billings before I head back to Illinois for graduation... let's see how much time I can spend outside under this big sky!