Overwhelmed

I’m overwhelmed.

Overwhelmed by the immensity of medical knowledge smothering me every day. 

Overwhelmed by the devastating poverty of knowledge, health, hope, and resources I see in my patients every day.  

I spit hairs learning the distinguishing characteristics of diastolic vs systolic heart failure and the various methods of medicating those hearts based on their presenting symptoms. But what I really want to do is listen to my patient’s story, sit on her front porch, visit the grocery store with her, and understand how her body decayed into such disrepair.

I finally realized why so many of my patients are so sick. It dawned on me while listening to my 58 year old patient explain to me that no matter how badly she wants to keep working at the Waffle House, the joints in her knees, ankles and shoulders simply can’t take the on-your-feet, running around, 12 hour shifts. She comes home every night in agonizing pain. Her husband finally convinced her to stay home and apply for disability. 

When their education level disqualifies them from any job other than physical labor, men spend their teens, twenties, thirties, and forties in ship yards, oil rigs, and sugar cane factories.  Women work as waitresses, janitors, home health aides. Their bodies suffer from decades of demanding physical labor and abuse that people in the middle and upper middle class can barely imagine. After their knees give out or they strain their back lifting their 10,000^th 2x4 over their head, they lose their sole economically viable commodity- their physical bodies.  

Decades of abuse on their joints and muscles, getting paid barely minimum wage, with no health insurance.  When their bodies finally breakdown, they’re labeled as lazy leaches to our society.  They don’t want to go on disability. They don’t want to sit at home feeling emasculated, crippled, and worthless. But after spending their lives serving us our food and literally building our roads, homes, cars, endless goods we buy at Wal-Mart, we deny them basic access to health care and support the need simply because they are poor.  This is the definition of injustice.

Don’t get me wrong, I know people abuse the system. Everyday. But let’s not to be quick to judge who we think is abusing the system and who isn’t.  White collar crime robs people of their life savings and financial independence. While the crimes of the rich are scandalized, they are also backed by government bailouts. So the rich still go home richer. But crimes of the poor are demonized, stereotyped, and perpetuated.

I’m overwhelmed because I turn one way and I face an endless body of knowledge amassed and indoctrinated to “fix” the human body.  So much knowledge that every day I learn more and go home realizing how much more I have to learn. I want to know it all and I feel as if everyday I’m falling farther and farther from that goal. And when I turn to the other side, I face a humanity so broken that no amount of medical knowledge that I learn can “fix”.  Ultimately, what I really want to “fix” is poverty and injustice. But I can’t learn that in a medical text book.

My heart wants to fulfill two overwhelmingly large and in many ways contradictory tasks. I know with time and patience, my dream of using my medical knowledge to, in some small way, stop injustice will come to fruition. 

But for now, I’m just overwhelmed. 

Childbirth...

I witnessed my first Spontaneous Vaginal Delivery tonight.  i.e. I held a young woman’s leg in the stirrups as she sweated and pushed a beautiful baby boy into the world.  Childbirth is absolutely a beautiful thing.  But it is simultaneously the most disgusting thing I have ever witnessed.  I don’t understand how any woman could do that twice. Props to you, Mom.

A Little Self Motivation

I grew up hearing Mother Theresa's wisdom that, “There are not great acts, only small acts done with great love”.  And I’ll never forget the sign hanging in the stairwell of my high school with the famous quote by the cultural anthropologist Margaret Mead, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”  What role do these motivational quotes play in our society? I believe that when individuals find themselves challenged to act with great love, when they are presented with a situation in which they are capable of becoming a thoughtful, committed citizen, they are buoyed by these bits of wisdom.

After three weeks in Franklin, I’ve realized I’m in that exact situation.  Just to give you a bit of context… Last Tuesday, Josh (the other Tulane student living and working here in Fraklin) and I were invited to attend the Rotary Club meeting.  The Rotary Club commonly has guests and visitors from out of town. But rarely do they have two new, young future doctors move into Franklin to live there for nine months.  They asked Josh and I to speak about ourselves, the TRIP Program, our time at Tulane, and our future careers.  We did just that, plus answered their questions about our experiences with Rural Poverty and our opinions on “Obamacare”.  Unbeknownst to us, we were being videotaped.  After our presentation Mr. Robinson, the owner of the local television station and co-host of Teche Talk, the local morning talk show, asked if he could feature us on the show the next morning.  Since then, I’ve met countless people in Franklin that happily shake my hand to tell me they saw me on TV and that they’re so happy to have a Tulane medical student here in Franklin.  My favorite was the woman at the Nursing Home that called me over and with a sweet grin on her face asked me, “Didn’t I see you on TV this morning?” Turns out small town morning talk shows are quite popular…where else can you hear who’s died, who got married, upcoming events AND the school lunch menu?  

Needless to say, I now have even more motivation to keep working to bring about some type of positive change in Franklin.  I can dutifully work every day in the clinic and the hospital, seeing patients and adjusting their medications.  And I can spend my free time studying, running, and relaxing along the bayou.  But in addition, I can challenge myself to becoming a force of change, a positive new energy in small town Franklin.  I can use the skills I learned in my Public Health education and practice the lessons I took away from my time in Chile and Kenya.  I can work with the wonderful people of Franklin that are excited to have me in town to make some positive impacts in the lives of my patients and perhaps the entire community in some small way.  This is why I wanted to do TRIP in the first place right? To become an active, invested member of a small community? To use my unique talents and skills to bring joy, light, and hope into the world? 

Seen cynically, perhaps I’m suffering from the Big-Fish-in-a-Little-Pond Effect.  But I like to think that I’m in a manageable situation with Kayla-sized problems that I can help address.  I can’t help but continually see similarities between Franklin and Karungu, Kenya (where I volunteered for 8 months before medical school...see kaylainkenya.blogspot.com) Both places filled beautiful people in a beautiful place doing beautiful things and with beautiful potential. 

My only prayer now is that I find the courage and strength to keep acting with great love, to continue taking these small steps.  I know I’m not going to leave Franklin in 8 more months with every Diabetic patient with a HbA1c under 7%, every obese person with a BMI down to 26, and every smoker having thrown out their last pack.  But I can work with local people using local resources to address local problems.  So I’ll get back to reading up on what’s been done in other communities, what’s been shown to work, and what I can do to continue acting with great love.

**Attention: this blog post was written mainly as a method of Self-Motivation.  Thank you for bearing with this therapeutic effort.  Stay tuned for updates on the coming results of the motivation derived from this Blog Post. J**

Time to Make a Move

There’s something powerful about moving. The act of picking up your life, moving it somewhere else, and slowly starting to put the pieces back together.  In one sense, its just stuff.  Your clothes and toiletries, pictures in their frames, coffee mugs awkwardly stacked in their boxes.  But its so much more than that. it’s your comfort, your routine, your order. You have to break through the inertia of your secure, predictable life and remind yourself that change is a good thing.  You’re making moves to make new memories, new experiences, new challenges. 

I began this process of moving almost 4 months when I started packing up my things from my apartment on State St Drive.  I’d decided back in January to participate in TRIP, the Tulane Rural Immersion Program.  I’ll give you more details about the program soon, but in the mean time, I’ve moved myself to Franklin, Louisiana for the next nine months to complete my third year of medical school.  Franklin is home to about 7,000 folks right in the heart of Acadiana, otherwise known as Cajun Country. 

I’m living in adorable little cottage on small plantation owned by my landlord, Mr. Blum.  Mr. Blum, or Gary as he insists I call him, is a perfect southern Gentleman.  When I arrived this afternoon with my car packed to the brim, his two lawnboys moved everything inside as Mr. Blum gave me the 411 on Franklin and the Who’s Who of the area.  Moments later, Ms. Luke knocks on my door to introduce herself.  She just happens to be on the Board of Directors of the local Franklin Foundation Hospital where I’ll be working and also good friends with Gary. When she found out a medical student was moving to Franklin, she immediately began recruiting me to come live and work in Franklin…forever.   Later Mr. Blum drove me into town to introduce me to Ms. Cheryl whom he declared would be my adopted mother while I’m in town.  Ms. Cheryl runs The Franklin House, a bed and breakfast owned by Mr. Blum. She’s a joyful, welcoming woman who greeted me with open arms and pleas to come back soon so she can cook me something.  Next we met Sam, the town socialite.  He’s in his early 30s and Mr. Blum deemed him the person for me to know to be connected in Franklin. And to top off this fantastic welcome to Franklin, Gary drove me to Winn-Dixie so I could do some quick grocery shopping.  Now that’s what I call a great Landlord. 

Overall, the first day of my new life has been pleasant.  This evening I settled in, cooked myself dinner, did some laundry, and busied myself with the art of starting a new life in a new place.  The hard part of the transition is over.  I’m here.  Tomorrow I start my Family Medicine clinical rotation at the Teche Action Clinic.  I’m excited to see what Family Medicine looks like in the trenches and I’m ready to get in on the action.  I’m ready to keep moving, both literally and figuratively, through this crazy journey of becoming a doctor. 

Third Year Medical School: How to Look, Think, and Act Like a Doctor

It hit me today.  Smack in the face while I laid in resting pose at the end of a great yoga class.  Not sure why I took me so long to realize it, but then again, I can be a bit slow when it comes to really obvious things.  So here’s what I realized… I’ve finally made it.  All these years of dreaming about life as a doctor.  Imagining what it would look like to take care of patients.  Wondering if I’d ever be smart enough to make the right decisions for people that trust me with their health and well being.  I’ve been doing all of things for the past eight days and it only really sunk in today.  Its just the tip of the iceberg (cliché, I know), but now the I’m a third year medical student doing my clinical rotations, I’m finally translating that medical textbook knowledge into hands on, real life, “you are my patient and I’m going to do whatever I can to help you” experience.

Ok, so yeah, I’m not quite a doctor.  But I spend 10-12 hours a day working in a hospital. I walk around in “professional attire” covered by my white coat (whose pockets are stuffed full of reference books, extra pens, a stethoscope, and granola bars). I use said stethoscope to listen to my patients hearts, lungs, and bowel sounds. I ask patients embarrassing questions about their bowel movements and sexual history.  And I answer their questions about what the heck is going on with their bodies.  I come up theories about why my patients are sick, develop their treatment plans, help place those plans into action, and make sure that what we’re doing is actually helping.  So yea, I’m just barely over half way through medical school, but if I look like a doctor, talk like a doctor, and act like a doctor, then…

I obviously still have infinite amounts to learn, but the important thing is that I can talk to my patients, listen to their stories, understand their bodies, and make suggestions on how we can help them.  I’m only beginning to appreciate why medical school is four years of intense studying and work followed by three to four years of more on the job training.  I joyfully accept my new role as apprentice as my attendings and residents take time out of their ridiculously busy schedules to teach us the basics of therapies, the rational about diagnostic decisions, and the ins and outs of how to get things done in the hospital.  They teach by example and with a patience I could only hope to one day achieve.  They ask us challenging questions to keep us actively involved, they fill in the gaps when we (occasionally) can’t extract the correct answer from the dark recesses of our brains.  And they help us take the next step of becoming a physician by encouraging us to develop our own differential diagnoses and therapies.

Perhaps it was the hectic transition of jumping head first into my medical rotations that kept me from fully appreciating it.  Those 5:30 am wake ups make introspection and reflection rather difficult. That constant deer-in-the-headlights feeling probably suppressed any possible insight I could have had about this momentous occasion.  Ok, so it took 8 days to realize the beautiful, humbling, awesome vision that my life is finally playing itself out. But I figured it out. So tomorrow isn’t just another be on time, complete my tasks and impress my attending kind of day.  Tomorrow is a learn everything I can, love my patients as much as I can, cherish every moment of this awesome life I’ve worked so hard to create kind of day. 

And if I start to forget that, please remind me to go back to yoga.