"I can't solve the world's problems . . . but if you've got broken people, you put them back together. That just makes sense to me."

I saw the movie Living in Emergency, about Doctors without Borders today, and it was as excellent as I had guessed it would be. I first became aware of the movie yesterday, while driving home from Trader Joe's with Chloe. We drove past the Neptune, and the sign outside had the movie's full title, Living in Emergency: Stories of Doctors without Borders. Being the complete and utter medical dork that I am, I got all excited and pointed and said "Hey Chloe, look! Look at that!!" I may have literally stopped the car. I believe her response was something like "That's awesome . . . uh, the light's green."

Anyway, today the delightful Flannery agreed to go see it with me. It's a documentary that follows four doctors to Liberia and the Congo on their missions with MSF. There's some really amazing footage, from a medical point of view; one patient featured is this woman with a hernia so huge it literally looks like a second abdomen. Some of the medical footage is really intense, if you have issues with blood I definitely wouldn't recommend it; there's one scene where you actually watch a leg amputation, and another where you see close-up as the doctors trim off infected portions of a bowel and then put the rest back in the abdomen.

I think for me, the most interesting part of the movie was seeing how the four doctors dealt so differently with what they were faced with on their missions. One was this young guy, probably not too far out of residency, who had been placed in charge of a 40-bed hospital out in the middle of nowhere and was clearly just falling apart. One is a veteran, who's done a bunch of missions, and says from the beginning of the movie that this is going to be his last one. Another was this older guy who had practiced for 20+ years before starting work with MSF, and was on his first mission but seemed to be really thriving. And the fourth one was this French doctor who was just badass. Seriously, I want to be this woman when I grow up.

Anyway, the movie made me think about how I've been getting steadily more and more attracted to the idea of working in a rural area without many resources, how even though I've always said I want to be a pediatrician, I've been thinking about doing family practice with OB, and maybe getting double boarded in ER medicine, so I can work in an area like that. And I really think I want to try to do at least one mission with MSF in my life. I'm not sure what it is about it that I feel so drawn to. I think part of it is the idea of helping people who really, truly need help and would not be getting it if I weren't there. I think that's most of it. But then of course, there's also a more selfish level. When I went to Ephrata for HCASB this year, there were four doctors in the whole town, who saw patients in clinic and covered the ER. Those four guys run the show in that little town, and every day they get to see and do things that no single doctor, especially not a family practice doctor, in a big city is going to get to do. Something about that, about getting to be in charge and autonomous like that, really appeals to me. I mentioned that to one of the docs I work with once, and he smiled and said "Let's see if you still feel that way when it's you on the line . . . it's a lot different when you're not just watching." And he has a point. I have no idea if I'm cut out for that kind of work, especially the MSF part of it. I have no idea how much I can handle, or really even what I can handle. But, somehow, I know that I really want to find out.

HCASB

Greetings from Yakima! I wasn't sure if I was going to have the internet here, but it would appear that I do, which is pretty cool.

I'm here for Health Care Alternative Spring Break (HCASB), which is a student-run program at the UW to get pre-health students interested in rural healthcare. They send teams of students out to rural/underserved communities in eastern Washington where they stay with local families or at churches, shadow doctors/dentists/health professionals in their chosen fields, and learn about what it's like to practice medicine in a rural/underserved area.

My team is four people, all girls. Our team leader is Erin, a fifth-year senior who's graduating this year and has already gotten into med school. Then there's Catherine, who's a pre-med sophomore, like me, and Stephanie, who's a pre-pharmacy freshman from Taiwan. Oh, and there's me :).

We left the UW campus on Sunday afternoon in a rental car provided by HCASB. It only took a couple of hours to get to Yakima. The drive in itself was kind of an experience for me, since I've never been to eastern Washington before. I'm a straight-shot DC-to-Seattle transplant, so really, aside from Seattle and Olympia, I don't know Washington that well. I was amazed at how much the scenery changed after we went over the pass. Basically, it's like the primary color of the landscape changes from green to brown. On one side of the mountains you've got these seemingly never-ending forests of pine trees, and then you cross the mountains and you're practically in the freaking desert! Any longtime Washingtonian who's reading this will probably laugh at my ignorance, but it still kind of boggles my mind.

Anyway, we made it to Yakima in a couple of hours, drove around for a bit and got the lay of the land, met up with the other Yakima team and got some dinner, then went to our homestays (Catherine and I are staying in one house, Erin and Stephanie are staying in another). My host family, the Jennings, are so nice. The husband, Ron, is a pharmacist at the clinic where we're all shadowing (Steph is actually spending almost all of her time shadowing him, since she's pre-pharm), and the wife, Jeri, is a registered dietician who works mostly with patients on dialysis. They have really cute pets: Jammer the black lab, Boomer the pug-like mutt of indeterminate ancestry, and Duncan the gray-and-white kitty.

We're all shadowing at Yakima Neighborhood Health Services. When I got my assignment, I was a little bummed that I didn't get to go to some teeny-tiny, middle-of-nowhere town, just because that's something I've never experienced before and I'm all about trying new things. But I now realize that the upside of going to a slightly larger town like Yakima is that I get to shadow at a place like YNHS, which is a pretty big clinic, so I get to see a variety of different things. They have internists, pediatricians, family practicioners, an OB clinic, a pharmacy, a dental clinic, a WIC program (which provides information on breastfeeding, etc. to new mothers), a walk-in clinic, and a clinic for the homeless. I'm going to get to shadow at least once in most of those areas during my stay here. I'm pretty psyched.

Our schedules are divided up so that we're all separated and each of us is paired with one professional in the morning, and one in the afternoon. This morning, I shadowed Kelli, a nurse practicioner who works in the homeless clinic. I think the most striking part about that was seeing how important it was to most of those patients just to have someone to talk to, even for fifteen minutes (the allotted time for appointments there) about what's going on in their lives right now. I suppose this is true for a lot of people who go to the doctor, but many of the people I saw today don't have a circle of family, friends, etc. They don't often get asked "What's going on with you today?" or the equivalent, especially by someone who really wants to know the answer. Oh, the OTHER most striking part of the homeless clinic was the somewhat mentally-off-kilter guy who heard that I was from the University of Washington and decided instantly that I must be a doctor (he decided this despite Kelli clearly stating that I was a student). Of course, this guy also said that his job was "tracking various patterns around the state for the betterment of all of us" so I suppose deciding that I'm a doctor is not the least rational of his thoughts. Anyway, he started telling me all about how he wanted me to "pull strings" with my "connections" to get him in to see a doctor at the UW Medical Center (psshhh, I would be hard put to get myself in to see a doctor at UWMC). At the end of the appointment, Kelli told him she was going to leave and would be right back with his prescriptions, and he said "Leave me with her. I have a lot more that I need to tell her!" Fortunately for me, Kelli said "Sorry, she needs to stay with me today," and we left. I guess the poor guy thinks I'm the worst doctor ever.

In the afternoon, I shadowed Dr. Prier, a pediatrician, which basically just re-affirmed my belief that I want to be a pediatrician. I saw a lot of physicals, a few cold/flu/sick stomach/sore throat visits, and one obesity consult with a little girl who was seriously overweight. The doc said that obesity in kids is one of the main problems she encounters in her average day, and that thus far neither she nor any of her colleagues have been too successful in reversing the trend among their patients. One interesting thing about working with her was that all the patients she saw today were Spanish-speaking (at least the parents were. Most of the kids spoke English pretty well). I never took Spanish, and could not carry on a conversation in it to save my life, but I was pretty surprised at how much I can understand, just from context and cognates. I really want to learn Spanish now, though, it seems like it's really important. I mean, the clinic has translators, but it seemed like the fact that Dr. Prier knew Spanish and was able to go without a translator just added this whole new level of trust between her and her patients. My favorite visit of the day was a mom with two little girls, ages four and two, who were both there for their physicals. When the two-year-old was getting her physical, the four-year-old was being kind of disruptive, trying to get mom's attention while Dr. Prier was trying to explain something, climbing on things, etc, so I gave her my notepad to draw on (it helped that I happened to have a purple pen today). She talked to me in a mixture of English and Spanish, and I talked to her a little bit in English, but mostly just nodding, smiling, and hand gestures. She said something to me in Spanish that mom overheard, and mom said to her (I understood the Spanish but I won't try to write it here cause I'd butcher it), "She doesn't speak Spanish, you know." The little girl looked very indignant and said "Yes, she does!" We all burst out laughing, because I hadn't said a single word in Spanish since we'd walked into the room, and had been talking to the little girl only in English, but she was so positive I could speak Spanish. Lol kids are awesome.

We finished clinic at 5:30ish and went home, where Jeri fixed us delicious soft tacos. We've just been chilling out, and I'll probably be in bed before 10:30. I could so get used to this whole early-bedtime, eight-hours-of-sleep, normal-workday-hours type deal, but I guess I'd better not if I want to be a doctor. Anyway, I shadow in the OB clinic tomorrow. I've never done that before, so that should be exciting.

My New Job

This week, I started doing clinical training for my new job (in addition to Bright Horizons) as a medical scribe at an ER near Seattle. The word "scribe" makes it sound like my job should involve a large and fancy quill pen, but alas, it does not (how sweet would that be, seriously?). What a scribe does is follow a doctor around over the course of one of their shifts and do most of their charting for them. The goal of this is to minimize the amount of time the docs have to spend on paperwork and maximize the amount of face-to-face time they can have with their patients (e.g., a doctor who has a scribe can actually sit and listen to a patient's explanation of what's wrong, when their symptoms started, etc., rather than clacking away at the computer the whole time so they don't forget any information that might be important later. I get to clack away at the computer instead).

It's going pretty well, so far. Before I started I was warned that it could be a very fast-paced, hectic job, but clearly the people who warned me about that have never taught preschool. I'm still kind of intimidated by the doctors, not gonna lie. During one of my training shifts, this one doctor called me "Bernice" the entire time, and I couldn't even bring myself to correct him, which was highly amusing to the girl who was training me. I just figured as long as I was making a good impression he could call me whatever he wanted. It's really cool to see the different doctors with their patients, though. In particular, the doctor who calls me Bernice has an amazing bedside manner with kids. He can literally get a screaming, justifiably pissed-off two-year-old with an ear infection to stop crying and sit calmly while he looks in their ears. He does all the regular tricks, like shining the light in his own ears first, so they can see it doesn't hurt, but I've seen other doctors do that without the same effect. It's mostly just something in his personality, or tone of voice, or something else; I don't know what. Talk about a useful skill for a would-be pediatrician . . . if I learn one thing doing this job, I want it to be how he does that.

I like writing HPIs (history of present illness); it's kind of fun jotting down all the random things that a patient says and then trying to form it all into a succinct but informative, professional-sounding summary of why this person is in the ER. And sometimes the reasons are pretty hilarious, which sounds really insensitive, but if you are going to do something like punch a tree and then come to the hospital because the hand you punched the tree with hurts, then I am sorry, but my sensitivity for you is going to be in short supply. That was the funniest thing I've seen in my three shifts at the ER; this dude hurt his hand punching a tree (he was okay, it wasn't broken or anything, I'd feel slightly bad making fun of a guy with a broken hand). I was standing in the room listening to the doctor interviewing the patient and trying not to laugh. I greatly enjoyed writing the sentence "Insert Name Here is an x-year old male who presents with contusion-abrasions and pain in the left hand following a physical altercation with a tree."

Just a simple question . . .

I've always been very cautious about HAVING AN OPINION. Let me clarify that this is different from simply having an opinion, or even having a strong opinion. If you have an opinion, or a strong opinion, that means you are at least reasonably well-informed about a certain issue, that you take a definite stand on it, and you enjoy learning about it, talking about it, even a good heated-but-civil debate about it. If you HAVE AN OPINION about something, that means that your interest in an issue is so strong that it's emotional as well intellectual, that you will respect someone less if they disagree with you about it because you are so sure that one way of looking at it is right and the other is wrong, and that you may actually try to avoid talking about the issue in a casual setting because you feel so strongly about it that you're afraid you might get upset and make people uncomfortable. For example, I have opinions, some stronger than others, about foreign policy, the environment, the economy, vegetarian/veganism, and raising/educating young children. I HAVE OPINIONS about civil liberties and gay rights. I've also always thought that people who have too many OPINIONS are annoying and hard to talk to, so I try to make sure I know a lot about an issue before forming an OPINION.

Anyway, yesterday, I went to my aunt's writing center at UW to work on my application for Health Care Alternative Spring Break. HCASB is a program that sends college students to rural areas to shadow doctors and learn about rural medicine, so the application asked about why I was interested in rural medicine. I wrote about how underserved rural communities are (not-so-fun fact: one-fourth of the population lives in rural areas but less than ten perecent of doctors practice there. What?!), and how, while I'm not certain rural medicine is what I want to do (I'm leaning more towards Doctors Without Borders), it would certainly be an opportunity to help people who need it desperately, and to rectify a little bit of unfairness, both of which are reasons I want to be a doctor. Anna, the tutor I was working with, commented, "I really like how you talk about the human aspect of medicine in this part . . . maybe you could expand on that a little . . . like, how do you feel about health care in America right now?"

I was pretty surprised about what came out of my mouth: "I think it's absolutely ridiculous! I think that health care is a basic human right and it shouldn't depend on who you work for or how much money you make. I think the idea that someone who's sick has to worry about paying for it rather than about just getting better is insanely unfair!" I wasn't so surprised about the words themselves, just about how firmly and fast I was talking, and at the sense of outrage that welled up in me just at the thought of what health care in America is like today. It's certainly something I'd thought about, especially since I chose my future profession. But it took that simple question from the tutor to make me realize that I HAD AN OPIONION that I didn't even know about.

The upshot is that I think this is something I want to get more involved in. I did a little googling last night about organizations that work for improvements in the healthcare system, and I'm seriously considering volunteering with one of them (just have to do a little more resarch so I can pick one). I think that now, as it's becoming increasingly more evident that America's health care system is failing it's people, doctors (or 19-year-old students who desperately hope they have what it takes to become doctors, as the case may be) have a responsibility to argue and work and fight for something better.

Also, as a diversion from this very serious/wordy post, I will share that I came into work this morning and cheerfully greeted my boss, only to have her respond with, "Good morning, Beatrice . . . you don't work Thursday mornings, remember?" Um, OF COURSE I remember that . . . that's why I dragged my exhausted ass out of bed two hours earlier than necessary this morning. However, on the bright side, forgetting I didn't have to come to work and doing it anyway gave me time to go up to school early, sit in Suzzallo Espresso, and write this, so I guess it's okay.