Chikako San: How I got to Japan

I had no idea what to expect when I finally walked into the International Student Affairs Office at Nagoya University.  The only thing I knew about my month at Nagoya was that I needed to show up at that office at noon on Monday to meet Chikako.  I’d been emailing back and forth with Chikako over the last four months to get everything in line for me to come to Nagoya.  Before I arrived, she’d helped me complete my application, booked my flights here, found me a place to stay, coordinated my rotations, and answered my million questions.  After all the help she’d give me  I was looking forward to meeting her, but nervous at the same time.  I had no idea what she’d be like in person and she was the ONLY person I “knew” in the entire country other than my Aunt Reiko.   When I knocked on the door and heard a happy “Come in!” my nerve subsided and I knew I’d found the right place.  A beautiful, fashionably dressed woman greeted me by my name then gave me a big smile and a hug.  Her English was perfect and her quick laugh reminded me of my mom.  I instantly felt comfortable and reassured that this month would turn out just fine.

After taking care of a few business items, it was time for me to start my rotation.  I thanked Chikako and gave her the Tulane coffee mug and jar of Tony Chacheres seasoning I’d brought her from home.  After warning her that the seasoning was spicy and just try a little, she laughed and reassured me that she liked spicy food and sometimes Japanese food needs a little kick to it.  With that, my vacation was over and we headed to the gastroenterology Department where I’d be rotating.  Again, my nerves started to kick in; I wasn’t sure I was ready to be an American Medical Student in Japan.  But as it turns out, when the only person you know in an entire city reminds you of your mom, everything seems a little easier.

Aunt Reiko

Two years ago my Uncle Trent moved to Yokohama, Japan to become the Principle at Saint Maur International High School.  Within the year, he had fallen in love with Japan and with a Japanese woman.  Not too long after, he had the good sense to make Reiko his wife and now my aunt.  And most recently, they had the good sense to have a baby! Reiko is about 13 weeks pregnant and a tiny baby bump is starting to peak through her tiny little frame. 

I first met Reiko two Christmases ago and immediately saw how blessed we were to have her in our family.  Shy, kind, generous, funny, hard working and incredibly intelligent, Reiko was my first glimpse into Japanese culture.    Hearing her and Uncle Trent talk about Japan, I knew I needed to see it for myself.  So what better way to start out my trip than a weekend with Reiko in Yokohama!

Ironically, Uncle Trent flew back to Seattle for a short summer vacation the same day I flew into Japan.  Most likely we crossed paths thousands of feet in the air somewhere over Alaska.  It would have been great to see Uncle Trent, but I didn’t mind having Reiko all to myself for a few days.  After a long few days of travel via planes, trains, and automobiles, I gratefully rang the doorbell at Trent and Reiko’s apartment.  After a smile and hug, Reiko took my bag while I took off my shoes and she welcomed me to their home.  I asked for a tour and she proudly showed me their apartment, most notably the wonderful balcony with a gorgeous view of Nagoya, my Uncle’s impressive baseball hat collection hung on their bedroom walls, her bookshelf full of Japanese novels and English children’s stories (through which she taught herself to read English), and the pictures hanging on the refrigerator of my baby cousin from her most recent ultrasound.

I spent the next two days exploring Yokohama with Reiko.  She and Uncle Trent had planned out two action packed days for me and Reiko went out of her way to make sure I saw the best of Yokohama.  We ate street food in Chinatown, cheered on the Yokohama Baystars in the gorgeous Yokohama stadium, meandered along the Yokohama Port, ate Ramen, and grocery shopped.  And that was all on Saturday!  By the end of the day I was happily exhausted while Reiko looked like she was just getting started.  Where she gets her energy I’ll never know.  We got back to the apartment and Reiko handed me a beer that Trent had bought for me before he left.  I took about four sips before I fell asleep on the couch. 

On Sunday Reiko cooked me a delicious “American” breakfast before we headed out to visit the beautiful town of Kamakura just outside of Yokohama.  Beautiful Buddhist temples and shrines surround Kamakura, which also happens to right on the beach.  We visited The Great Buddha and ate green tea ice cream next to the temple.  When I told her how much I love the beach, we walked down to the water so I could feel the sand between my toes. We walked through the famous Hydrangea Gardens, visited the Kamakura temple, and shopped for souvenirs. Before we headed back to Yokohama, we made a short detour to buy Taiyaki, a delicious custard filled doughnut type desserts in the shape of little fish.  They’re one of Trent’s favorites and Reiko wanted to make sure I tried them too.   In case the day wasn’t amazing enough we finished it off with Udon for dinner at Trent and Reiko’s favorite Udon restaurant, then went to the top of the Marine Tower.  Reiko told me she wanted me to see how beautiful Yokohama is at night and there’s no better spot in the city.  Undoubtedly, the view was simply breathtaking.  All in all, I couldn’t have asked for a better  weekend or a better tour guide. 

Leaving Reiko and the comfort of her loving hospitality made Monday morning, well, a pretty miserable Monday morning.  But, by my request, she made me a “Japanese” breakfast, then walked me to the subway to help me buy my Shinkansen Bullet Train ticket to Nagoya, my final destination in Japan.  I’m not sure when I’ll see Reiko again, but when I do she’ll be a mother.  If the way she treated me this weekend is any indication as to her parenting skills, that little guy/gal is one lucky baby.            

With Love from Japan

Three years ago I set out on two ambitions missions.  One: Survive and thrive in medical school.  Two, Eloquently describe this adventure of becoming a doctor through a series entertaining, engaging blog posts.  I’ve almost succeeded on the former.   And subsequent to said former, I’ve failed drastically on the latter.  Having blogged in the past, I was aware of the emotional energy and time commitment required for a blog.  Not having a freaking clue about what medical school was like, I was naively blind to how emotionally draining and time consuming the whole Making of a Doctor process would actually be. 

I’m now technically a fourth and final year medical student.  The cadaver lab, endless lectures, late night study sessions and stressful tests joyfully lingering in my past. Only a few more clinical rotations of my choosing and the residency application and interview process keeping me from the loving arms of residency, where real doctors are made. 

Had I been blogging as promised, any faithful reader (most likely only my mom, grandparents, and a few others out there who love me enough to read this) would have known the difficulty and anxiety regarding my future in medicine that I experienced during my clinical rotations. All the horror stories I’d refused to believe about medical school came true.  I became the cynical, skeptical, cranky third year student I always begrudged for hating medicine. But that story if for another time and place. I really want to tell you about what’s happening right now.  

From the skepticism about medicine, and my future in it, came my attempt to figure out what the heck I’m doing with my life.   This search has manifested itself in me taking a one year hiatus in Atlanta, Georgia working for the CDC.  But before I leave for Atlanta, I jumped on the opportunity to finish my last medical school rotation for the year at Nagoya University School of Medicine in Nagoya, Japan.  I now right to you from my 7x11 foot bedroom in the international student dorms in this crazy country called Japan.

At the urging of my friend Adam to write a blog, I remembered that ambitious mission I set out on three years ago.  I technically already have a blog, neglected as it may be. But I’m not up late studying, so why not write about my experiences in Japan? And after ten days in this country, I’ve figured out how to do it.  Japan is a place of culture, tradition, ambition, honesty, ethics, orderliness, Buddhist temples, ancient castles, bullet trains and extraordinary cuisine.  It is also a place of Manga, Sumo, American baseball, Karaoke, and beer gardens.  But most importantly, Japan is home to some of the most amazing people I’ve ever met.  This blog will be about all those ideas, places, activities that make up Japan, told through the incredible people that have share those experiences with me. 

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.