Hello to everyone! I hope you enjoyed your summer and are ready
for what appears to be a great fall season!
I was able to relax a bit, recharge, hike some trails back home,
and be the first person at the top of Mt. Mitchell (highest point
east of the Mississippi at 6,683 feet) for sunrise one morning
during a hike. The view was incredibly beautiful and being able to
sit, think about the past few years of school, the challenges,
rewards and decisions to come while watching the sun rise over the
southern Appalachians was one of the more peaceful moments of the
past few years of my life.
At the same time during the break, I caught up on some personal
reading that I had put off for over two years as well as some
reorganizing, consolidating and reducing for the inevitable move in
about 8 months.
Now, for the homestretch in clinic!
Here is how the Naturopathic Clinic is currently structured:
Previously, 8th Trimester interns could only see other students,
not the general public. This left many students with seeing a new
intern every four months as ONLY 8th trimester students could see
other students. So, when an Intern moved to 9th trimester, they
would transition the student patient to a rising 8th trimester
Now, students and the general public have the opportunity to see
interns beginning in 8th trimester, and, if the condition warrants,
remain with that intern for up to a full year. This helps to build
rapport and trust with the patient as well as helps the Intern with
seeing a resolution to more ailments than was previously
Finally, the most appealing aspect to this new structure, in my
opinion, is that now our naturopathic medicine students are
spending half of their education in a clinical setting! Again, in
my opinion, nothing trumps experience and "hands on" training when
learning a new skill!
Time to get back to the books! Talk to you next week!
This morning, I sit at my spot by Lake Janse and watch my
classmates walk into their last few exams as I do a small
walkthrough of my last final for the trimester, Minor Surgery.
I think of all the preparation, stress, notes, charts, diagrams,
decision trees, memorizing, practicals, dissecting, adjusting
lab...ahhh! Adjusting?!?! I'm going to be a ND, why in the
world do I need to know how to adjust somebody?!?! This was
something I heard, and even said, early in my education here at
NUHS, a historically chiropractic school.
Well, as things turned out, adjusting was highly important for
me to remember in my first trimester as an intern. Three of my
patients required manual adjustments along with physiotherapeutic
treatments (ultrasound, etc.) and soft tissue (i.e. muscle, tendon,
etc.) manipulation. As a result, I was forced both to remember and
to go back to dig through old notes on modalities I thought I would
rarely, if ever, use in my practice.
The extensive therapy that these patients each needed to return
them to a basis for health included physical medicine, part of the
naturopathic therapeutic order, as well as some supplements and
analgesics specific to their needs.
My patients, through their needs, visits and therapies, helped
me to complete my physical medicine and manipulation requirements
for graduation in my first trimester in clinic! These are
modalities that are typically completed much later in the
naturopathic internship. My physical medicine patients this
trimester have taught me a number of invaluable lessons.
My experience with the physical medicine aspect of our training
here has given me a bit to think about over this coming break and
in the coming months. I am now considering, considering mind you,
pursuing a chiropractic degree upon completing my naturopathic
training here at NUHS. I feel that having both degrees will give me
a more complete tool kit to offer patients as a Natural Medicine
Primary Care Provider. Of course, time and financial resources are
considerations in that "consideration."
Finally, I feel it's important to mention that this past week
was President Joseph Stiefel's first graduation ceremony at NUHS. I
enjoy sharing a "Good Morning" and short conversation with Dr.
Stiefel as we pass on his walk from his home to his office each
morning. In the photo, each of us is getting a "dry run" on the
graduation portrait--his for about 200 graduate photos at the
ceremony and mine for roughly 8 months from now. I enjoyed seeing
him speak to our graduates and their families and am proud to have
Dr. Stiefel as our new President. (Small trivia fact: Dr. Stiefel's
wife, Dr. Holly Furlong, was the very first blogger for NUHS.)
So, with only two trimesters to go (or possibly more if I return
for the chiropractic doctorate), I am looking back at what I have
learned, what I need to brush up on and explore new skills for my
future practice. This is what I will think about when traipsing
over the mountain trails back home over the next two weeks. Until
then, may the rest of your summer be relaxing, fulfilling, and help
you make the decisions you need to guide your future in the proper
direction for you.
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,
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
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
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
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
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
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
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
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.
• Combined Classes
• Observing in Clinic
• Botanical Medicine
• Minor Surgery
• Intern Skills
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