Tag: oms2

I got a Nudge From the Universe Today…

Hello!

This is going to a bit more unusual of a post than what I normally post. So let me set the scene for you, and I’m just gunna jump right in…

A few weekends ago I was sitting in my favorite coffee shop in Joplin. I had just arrived and was starting to unpack all of my books and notes. I had a test the next day, and as always, was hoping to get in a few hours of productive study time. The mountain felt high, but I was hoping to chip off a little bit before the exam. Let’s call it extremely hopeful.

Yes, yes… I was that: hopeful.

I was still in good spirits, but also still feeling like I was drowning. Which is the usual feeling in med school.

In hindsight it probably didn’t really matter if I studied at all that day. But I digress.

While opening up my books, a man who had set himself up at a table nearby was walking back. He politely stopped and asked me what I was studying.

Now, I sometimes forget how friendly people are in Joplin. In Michigan, most people aren’t this friendly. And you usually aren’t approached at a coffee shop unless you dropped something or some girl wants to compliment your dress/shirt/bag. So I was a bit caught off guard.

The conversation went something like this:

“Oh, I have a really big test tomorrow, it’s on all of the cardiopulmonary system and the kidneys.”

“Oh? I have lots of people that I know that work in healthcare. In fact, one of them is a nurse. She is on dialysis…”

Hmm…Okay. Not sure why that was important. In fact, I was wondering why we were even going this direction. But alright, it’s conversation I guess.

We got to talking and I later learned his name. But for now, let’s call him M.

M eventually told me the the had interstitial lung disease which is now causing him some depression. Ah! I’m thinking, I actually know what interstitial lung disease is! I don’t know it well (even though I was supposed to know it for my last test… but hey, I know it). And before you ask “Joyce, where the hell are you going with this story?” The answer is I’m about to get there. Calm your tits. Please.

Anywho, long story short and he tells me he thinks medicine is poison.

An interesting stance. One that I obviously do not agree with, but one that I’m sure I will come across more than once in my future.

But a point that I nonetheless wanted to talk about today.

As someone who does not have a chronic illness and as someone who lives a relatively healthy life without many restrictions; I clearly do not have the same hurtles, experiences, or struggles as someone who does. I do not know what it is like to have difficulty breathing. To be gasping for air or feel like you might be suffocating on a fairly regular basis or even all of the time. I understand depression, but my encounter with that illness is different from his experience with it. Simply put, I cannot put myself in his shoes because I have absolutely no reference to base it upon.

But I can understand that he is struggling. That he isn’t happy with the cards he was dealt. And as a future physician, I need to be able grasp this.

This conversation lead me to multiple realizations:

  1. People want to be heard.

As a future a physician, it is our job to be able to lend an ear. Most patients don’t just want to be “fixed” or “cured”. They want to be heard. That their struggles are valid. That their emotions about their struggles are valid. Sometimes they just need to vent. And we need recognize that. Yes, you can say that they can be referred to someone else other than you for this. However, a part of our jobs are to have a human-human interaction. And sometimes, patients just need an our ear.

2. Perspective

I seem to be gaining a lot more of this recently. But perspective in the fact that we know what our lives are; we know our struggles, our obstacles, and what we have to do. But we sometimes don’t stop to think that our patients may have a much more difficult time doing the same things as us given their obstacles. It also reminds me that not everyone has a great experience with medicine. And with that, patients are scared, unsure, or may pushback more because of it.

3. It’s okay to disagree with our patients. Respectfully.

But it means we need to try to understand what is important to them. Their goals may be different than your goals. And sometimes as physicians we have to slightly re-align the goals to be more realistic. Other times, we just need to be on the same page.  Is their life meaningful? Can they do the things they enjoy doing? Do they still have the drive to do the things they enjoy? Can they work on accepting that it may take them longer to do a task now than it did previously? All of these are important. But taking time to just chat with your patient to get an idea of where they are at and sometimes gently nudging them or re-aligning their goals can help them immensely change their frame of mind.

4. And lastly and most importantly, we as physicians and as a medical culture need to stop being so afraid to allow death to happen.

This is the biggest thing that I think we sometimes all forget. Medicine can do many wondrous things. It can save lives, it can improve life and quality of life, and it can extend lives. But it can also extend life with the association of declining the quality of life. And that often times, we as physicians don’t do enough explaining or education that death is not necessarily something to be afraid of.

Do I want my future patients to die? Of course not! I want to give them a fighting chance when it is something that they want and it is within reasonable limits. But I also want them to know that it is okay to decline extra surgeries or procedures. It is okay to say no more. Especially if it may prolong their lifespan, but decline their quality of life.

There comes a point in someone’s life where the answer isn’t always a clear “yes, make me better so I can live longer”. When we are young or younger I should say, the answer is always make it longer. Give them a full life. But when you take someone who is chronically ill or elderly, the amount of sickness or chronic diseases start to pile up. I’m not sure our bodies were ever meant to live as long as we typically do nowadays. And as all of those start to pile up, the quality of life goes down. Sure, most of them are easily fixable on their own. Or if they had a perfectly healthy immune system getting something like pneumonia or a urinary tract infection would be easy to clear. But when put with someone who does not have a healthy immune system, it can seem like attempting to move a very large boulder that is constantly trying to squash you.

So too that, I think as a future physician myself and a lot of my future colleagues need to put our egos aside. We need to start having discussions earlier with our patients about their wants and wishes. So that when shit hits the fan, their family members who aren’t ready to let them go don’t contradict what the patient wants. Because not all family members will agree with what your patient wants. They may be selfish about what they want instead. And even just having that conversation early allows your patients to have the ability to take time and think about what they truly want. Because in some situations, it is better to grant their wishes or let them have a natural death to where they aren’t dying with tubes out of every orifice and hooked up to multiple machines. Or when their heart starts to give out, their defibrillator isn’t constantly shocking them, prolonging death and causing pain.

We also need to be better at discussing that death is not always traumatic. A lot of times, when chronic sickness takes over, your body doesn’t necessarily “kill you slowly”. A lot of times, you will go unconscious because your blood pressure is too low, or you are septic, your metabolites build up in your system, or your heart just gives out.

But it also leads me to this point…

I was sitting there having this discussion with M who I don’t know. This man who clearly wants to vent but also wants to be validated. I thought to myself: I am so wrapped up in my own problems that I forget I have a very fortunate life and situation.

As someone who just came back from Kenya, it is seriously embarrassing to admit that it only took 2 months to forget the perspective I learned while there.

But I also needed this conversation. Call it a nudge. Or maybe a little wind blew in my direction from the universe.

I needed to be reminded of where I was. That yes, this was hard, but that I was doing this so that when a patient like M walks into my office, I can have this conversation with them. That I can reassure them. Listen to them. Allow them that space.

Humans need to feel connected. In a world where we try so hard to be connected via social media, we don’t do a very good job of actually forming connections with people. I’m going to run into having patients who just want to see me to discuss that they are unhappy. To talk it out. For me to remind them or gently nudge them to find the things that they find pleasure in life with. And once that is gone, we should discuss where to go next.

I was at a crossroads in my life before this conversation. The universe gave me a little nudge to remind me that what I’m going through now won’t be the rewarding part. That what I’m doing right this second isn’t what it will be like in practice. That the conversations I have with my patients will be both heartbreaking and rewarding, but worth my white coat.

Just wanted to throw that out there today.

Kenya Series! Why Did I Choose To do a Medical Mission Trip?

Welcome Back!

I flew back into this side of the world less than 12 hours ago (at the time of writing this), and of course I can’t sleep to save my life… So I’m up writing this instead!

Doing a medical mission trip is a great way to get more experience outside of your traditional learning environment. As a current medical student, this is a great way to actually see patients and improve your clinical skills while still being supervised. The more medical experience you have, the less you will need to be supervised. If you are an undergraduate student, this is a great way to get experience via shadowing, observing, or helping with other tasks in the area.

As part of KCU, we worked with an established clinic outside of Kisumu, Kenya. We did not do a pop up clinic. The clinic we assisted/worked at is currently a non-profit organization in an area where getting medical help is more difficult. Prior to the clinic being built, the community was unable to either travel or afford to get medical help. Others didn’t want to know their HIV status or were worried about stigma. Since the clinic has been operating, more people have access to some healthcare, and the clinic assists with much more as well. Including: counseling services, rides to bigger hospitals, dedicated eye/dental days, assistance with scheduling surgeries or other consultations with outside hospitals, sponsorship programs for orphans and children to go to school, and assistance with parents for improving education. Not to mention the entire center is a safe space for kids to play at.

The clinic does charge to see patients, but it is usually very little. The fees are more of a “don’t take advantage of the system” then an actual fee. And if those seeking help cannot pay the small fee to get your name on the list, the fees are usually waived. If the patient needs additional medications/treatments/care, there may be more of a fee? I believe it was mostly to cover the cost of supplies, but in general most of the care was free. This tidbit wasn’t completely shared with us, but this was the most information I could muster from a few people.

Dr. Bonyo, Dr. Desai, Dr. Abraham, Marylyn, and the students on our first clinic day.

We worked with Bonyo’s Kenya Mission. Feel free to click the link to learn more about this particular clinic. KCU brings students here twice a year. Once for 2.5-3 weeks (which is the one I did) and another that is a longer rotation for 3rd and 4th year students. We worked along side local staff and physicians. There is always an attending on call. All of the lab staff, pharmacy staff, counseling services, and nurses were present at the clinic when we were there as well. Without the staff, we couldn’t have assisted and seen the patients that we did.

While we were there, it was advertised in churches as free health care which caused a massive influx of patients. This is not normally the flow that they see. When we come, we provide manpower; and the community advertises for them to see us so they can get anything taken care of while we are there.

It really is a win-win. The community gets care that they need or otherwise wouldn’t have attempted to get, and we get to improve our skills and be reminded of why we wanted to be physicians in the first place.

While reflecting back on the amazing time I had, I want to discuss my personal reasons as to why I chose to partake in this experience. So let’s talk about medical mission trips today!

Goals before my trip:

While deciding if I wanted to do this trip, I made a list of all of the things I wanted to accomplish while there. I wanted to assess what I felt I needed to improve on as a student and hoped that these could be aligned in some way with doing this trip.

  • The biggest reason I wanted to go was to improve my skills. I wanted to improve my ability to take a history. My ability to do a physical exam, and do so confidently. My ability to present to an attending like I would in my rotations and eventually as a resident. I wanted to improve my basic medical skills such as taking pulse, blood pressure, etc. Even though I had experience through SP’s my first year, I wanted the experience of not knowing the category of the chief complaint. I wanted to test and improve on how I could take care of patient that I had no idea why they were coming in and weren’t reading off a script.
  • I wanted to improve my compassion and my ability to see patients. And I wanted to do it without knowing that if I failed I could just repeat seeing a patient. This goes back to the SP thing, but it really is a completely different experience seeing real patients instead of the conjured ones you see in medical school for practice/assessment.
  • Confidence. I wanted to be able to take all of the above and try to improve my confidence in being a future doctor. Medical school is really good about beating you down or making you second guess your abilities. This trip was to help me realize that I can do this, and that I can get good at it in my future.
  • An experience of a lifetime. I had never travelled to the other side of the world before. I was scared shitless for this. Most people do not (usually) travel to developing countries for vacation. People think of going to Cancun, or Italy, or the Caribbean for vacation. I wanted to experience another country and all of its culture & the people.
  • On this note, I also wanted to be humbled. I wanted to be reminded that even though I have my problems, I wanted perspective that most of my problems in my cushy, developed country of good ol’ US of A were not nearly as difficult as those in a developing country.  The work and labor that I saw people do on a daily basis was astounding. Yet at the same time, it is their way of life and they know no different. I needed to be reminded of that perspective. And what a more perfect time than to do it after completing one whole year of medical school.
Why I chose to go with KCU?

Honestly, I’m a scared little bitch and was too afraid to go to the other side of the world by myself to a country that I had never been to.

Really, that was a huge portion of it. I knew KCU would guarantee as much safety as they could in another country. I researched several other companies outside of KCU to originally go with, and it came down to KCU and one other country. I mainly chose KCU’s trip for safety reasons.

The other main reason is I wanted to make sure I wasn’t going to unintentionally harm a potential patient. With KCU, I knew we would have a professor present with us to sign out and help us learn and treat patients. The added assurance that there was a licensed physician present who could help me learn and grow while still  making sure I didn’t kill or hurt my patient was a pretty great bonus. I could not handle the responsibility of seeing a patient on my own without someone else there after 1 year of medical school.

If you think you can do this without guidance, Imma slap you. You literally know next to nothing in patient care after one year of school. Knowing that there were attendings present helped foster growth. A theme I wanted to stick with on this trip. I was less afraid to learn and try something knew because I knew at the end of the day I would have guidance available.

I also knew that this was an established clinic that KCU had worked with for years. Knowing that I was going to assist in a clinic that existed and would continue to exist after I was going was something important to me.

What I learned:

So much. So, so much.

I’m not even sure I can really put this into words. But Imma try lol.

For one, I gained some confidence. My first two days in clinic I was super nervous; I felt like I had forgotten everything we had learned in our PCM course (or “How to be a Doctor” course) despite having gone over basic skills the night before our first clinic shift. I was scared and unsure how to handle having translators. I was scared to have to practice. We could only order limited labs and imaging was out of the question; so trying to manage that and understand it was new.

I was all of a sudden expected to act in the capacity of a resident per se without much prior experience.

And my professors could tell that I was nervous and not super confident when first starting. They gave me a lot of crap about that. But after day 1.5 I would say, I finally got into the swing of things. And I was KICKING ASS.

Confidence really does carry a long ways though. Your patients feel better when you are confident knowing that you can take care of them. My classmates all told me that I seemed to have it together and that I was kicking butt… even though I was seeing just as many patients as them. (Thanks loves!) And the clinic staff were more likely to help me if I was more confident in what I wanted.

The other obvious thing I gained this summer was improvement in my skills. I didn’t get to see as many patients in Kenya for varying reasons, but without doubt improved my skills in every aspect: osteopathic manipulation, physical exam,  presenting, and overall just owning what was given to me. I came back ready to rock and roll this year and was WAYYY less nervous to perform than I was first year.

But lastly, I gained a whole lot of perspective. My friends and family asked if I became depressed because of what I came into contact with in Kenya. Being an emotional being, I was also expecting that.

However, majority of the people I met and took care of were just happy and content with life. The kids were just happy to be playing. The elders were just happy to sit in the shade and talk and hang out. The women in the fields that we passed by every day to get to clinic were ecstatic just to get their picture taken.

Obviously, as majority of my classmates and I are Mzungu’s (foreigners; white), and we were met with sad stories in an attempt for us to give money. But overall, the people were sweet, friendly, and happy. While away from the US and my stressful life as a medical student, I was reminded of just how truly blessed I was to be where I am. To be in a country where my considered “necessities” are mostly luxuries in developing countries. That I too can appreciate the small and wonderful things in life, and be content on much less.

Like I said before, I am overflowing with what I have experienced in Kenya that it is hard to put it into words.

For undergrads:

I’m well aware that there are several students, particularly undergraduate students, who do “medical mission trips”. I put this in quotes because you likely haven’t learned any basic medical skills yet or have much in the way of medical knowledge. When this is the case, these trips are designed more for exposure with the added bonus of travel for you. You legally cannot do anything medical, and during these trips the company you are with likely won’t teach you how to do anything either. (There may be a few exceptions, but for the most part if you don’t know how to do something they aren’t going to take the time to teach you).

Because you cannot do much in the way of actual medicine, you will usually be involved in more global health tasks. Such as:

  • Teaching English
  • Doing epidemiology in the region you are in
  • Teaching on improved health practices
  • Assisting other medical team members who are seeing patients
  • Shadowing local physicians/observational roles
  • etc.

Why won’t they allow you to practice if you have no experience? 

Well. I’m so glad you asked. This topic is pretty irksome for me.

In the United States and most developed countries, you cannot practice medicine or do basic medical skills on another human being without training. Of any sort. Whether that is a completion certificate for EMT or nursing aide, OR a degree.

Which is my point exactly. 

You likely wouldn’t want to be worked on by a 20 year old without any medical knowledge. It isn’t fair, nor is it ethically right to try to take advantage of those in a developing country. So please don’t expect to be able to do something that you are not qualified to do in another country, just because they don’t have as strict of safety laws or ethics preventing it.

If you want to be a doctor, nurse, or PA and you think you can take advantage of another human in a different country, please bow out of medicine now. You will never ethically be able to justify doing this. 

But overall, doing a medical mission trip is a really great way to get your feet wet. Both before medical school and while currently attending.

I don’t suggest that this be your only exposure before medical school to medicine though. Try to be more well-rounded than that in your application. Having more than one experience (which many can be in your community) and increased exposure to draw on will always help you.

I hope you gained some insight on medical missions trips in the post. Feel free to leave a comment, share, or send me an email with any questions!