Orientation

August 29, 2008

I completed my orientation to medical school this week, and in a few days I will begin my studies.  As I expected, it was an overwhelming week.  There were lots of new people to meet (178 people in my class), and lots of new information about our M’12 (Medical class of 2012).  Additionally, I was adjusting to a new commute and new schedule, which didn’t feel routine yet.  I was pretty exhausted, and wasn’t tempted to join my classmates who were scheduling evenings at the bars every night.  This reminds me of what a recent medical school graduate said to me when she found out I am starting medical school… “How’s your liver?”  Perhaps being married and living far away from campus will save me from potential liver-damage.

Even without any drinking, my memories of orientation are like a colorful blur.  We learned about safety… what to do in case of fire… in case blood splashes in our eyes.  We heard many compelling welcome messages which congratulated us and described the gifts and responsibilities of being a physician.  We heard the goal was to make us excellent clinicians, which is the part of medicine that excites me the most.  We read and signed a statement about HIPAA- the government’s act to ensure patients’ privacy.  We lied on the floor, did some deep breathing, and learned about stress management. We were certified in adult, child, and infant BLS (Basic Life Safety).  We learned about student activity groups, and purchased stethoscopes, opthamascopes (tool used to look into the eye), odoscopes (tool for ears), and sphygmomanometers (blood pressure measuring cuff).***

The most interesting day was spent on a field with small group activities including wheelbarrow racing, balancing an egg on a spoon, and water-balloon tosses.  I discovered I am terribly out-of-practice at wheelbarrow racing, and my shoulders are terribly sore.  My least favorite part was all the “Where are you from?” questions.  I never have a good answer to that question since I’ve lived so many places.  I always dread the going around in a circle and saying “quick” names and where you are from.  Should I just make-up a short answer, or really try to explain my identity crisis?

We discussed diversity in medicine, and the issues of language, race, religion and all the many things that make the doctor-patient relationship so complex.  The relationship is apparently like “a dance.”  I met interesting people, and all the physicians who spoke made excellent role modles.  Overall I feel good about being in my medical school.   The “dancing,” lying on the floor, frolicking on a field, and kind words were evidence that my medical school is more of a touchy-feel-y place than I thought it would be.  I am a touchy-feel-y kind of person, so I am thrilled to make this discovery.

***I wish to note that I didn’t understand these words when I first saw them this week.  Medical terminology is like a foreign language, and I will obviously have to learn more before I can use these terms without feeling self-conscious.

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Posted by Liz

My First Patient

August 18, 2008

Sometimes when I am really bored with memorizing basic scientific facts, I think about Viktoria.  She is one reason why I want to learn medical knowledge- because she needed help to solve her painful mysteries, and I wasn’t able to solve it myself.  Her black and white scans looked like abstract paintings, and even after the doctor named her condition, I felt clueless.  I think of her story, and I feel motivation to learn more…

I will always consider Viktoria to be my first patient.  Her mother Dana came to me in tears (which was unusual because Ukrainian women rarely cried, especially in front of strangers).  She explained the situation.  Her daughter was 8-years-old, and over the past two years had developed a knot in her upper spine.  She was in chronic pain, and slowly losing movement in her arm.  She couldn’t afford to pay for care, but the doctors in Lviv had suggested she contact a hospital in Warsaw, Poland where she might receive free care since Viktoria was a young child.

Dana made a great effort to obtain the proper visas to take Viktoria to the hospital there, and the Warsaw clinic agreed to perform an MRI free of charge.  The results clearly showed a tumor, however language barriers and time limitations prevented further discussion with the Warsaw doctors. When they returned to Lviv, the doctors explained that they were afraid to operate because they could not tell if the tumor was cancerous, and if it was, it could metastasize quickly and be fatal.  Additionally, the location of the tumor, between C3-C4, was near the brain stem and the doctors felt it was too risky for their facilities.

Dana did not know what to do next.  She had been agonizing over her daughter’s condition constantly, and was not able to receive any response from the Lviv Red Cross.  After hearing her story, I met Viktoria.  She seemed to be a healthy 8-year-old who hid under a baseball cap.  She was blonde with freckles, and practiced a couple English phrases she knew.  She drew me a beautiful picture of a princess.

I was compelled to try to help her even though I didn’t understand anything about her situation myself.  Dana provided me with her MRI scans, and I spent a lot of time on my town’s slow internet connection trying to find information about spinal tumors.  I e-mailed an organization which assists American children with spinal tumors, and eventually found the e-mail address for a specialist from John  Hopkins.  I didn’t think anybody would respond to my e-mails, but they responded almost instantly.  The specialist wanted to see the MRI images.  The director of the organization wrote a heartfelt message that I later translated out-loud for Viktoria’s mother.  She cried again.

Over the course of many months to follow many events occurred.  First, upon receipt of the MRI images, the US doctor quickly affirmed that Viktoria’s tumor was “Osteoid Osteoma” (a rare bone growth that is not cancerous).  The location made the surgery tricky, but he was confident that it did not require great expertise.  With the help of Ukrainian Peace Corps doctors, I was able to locate a clinic in western Ukraine that would perform the surgery, and I gave the information to Dana.  I am still not sure how she collected funds for the operation, but Viktoria finally had the surgery in April 2007, after I was already living in Boston.

I have kept in touch with her family, and she seems to be doing well, although recently Dana was concerned because Viktoria’s recent MRI seemed to show another growth (at least that is what the doctor had warned).  Again I e-mailed the specialist from John Hopkins, and again he promptly responded by telling us that the MRI was not  good quality, so it did not show anything clearly and ought to be repeated .  Knowing the complications of obtaining an MRI, I doubt it will be possible for Viktoria to get another MRI soon.  However, I assured her mother that it did not show the tumor was growing back, and the fact that Viktoria is pain-free is a great sign of improvement.

I wonder what would have happened to this young girl if Dana and I had never met.  Would Viktoria still be in pain?  I think of all those people in the world who have chronic diseases and nobody to provide them with clear answers and care.  In Ukraine (and in many places) there are countless people who cannot get care- who die of cancer without ever knowing what was wrong with them.  What a huge difference it made to have people offer free scans, explanations, and eventually surgical expertise.  For Viktoria, it was the difference of a slow, painful disability, and a normal life.

After following Viktoria, another father came to me to talk about his deaf daughter, Alina, who now has Cochlear implants.  She is the first girl in Sokal to have them, and he writes me descriptive letters overjoyed at the number of words she knows.  Modern medicine is miraculous- the deaf can hear, and the suffering are healed.  And when they cannot be, even the understanding of disease (insightful communication and compassion from others) can relieve grief and suffering.  In the course of a lifetime, we all will experience suffering and death.  But, Viktoria was an inspiration to me that least everybody should be able to understand their condition and avoid unnecessary additional suffering.

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Posted by Liz

Starting Medical School in a Week!

August 18, 2008

I enjoyed keeping a blog when I was a Peace Corps Volunteer serving in Ukraine 2004-2006.  The blog encouraged me to think reflectively and summarize major events.  Additionally, it allowed me to occasionally look back over my experiences and realize where I had grown, or laugh at a memory I had forgotten.  Others were able to read and share thoughts with me when they had time.  Life is full of interesting endeavors, and my Peace Corps blog was a good way to keep an account of a big life event.  Now, as I approach medical school, I feel as though I did when I was about to leave the country for Peace Corps service- like standing in line before a big, scary roller coaster.  I know I will get on the ride soon, and I’m thrilled and well as full of butterflies.

How did I get here?  While in Peace Corps, my primary goal was being a Teacher of English as a Foreign Language (TEFL) volunteer, but as part of this program I was also encouraged to work with local people to develop the community.  I discovered that I was most enthusiastic about teaching others when the topic was related to healthcare.  I learned that health was THE most important thing- absolutely essential to people’s well being- and I felt a soar of energy when I spoke with those who needed understanding or help with a health issue.  I met many who were not healthy, as well as coming face-to-face with trauma and injury, and I was not scared and I did not fall apart (like I feared I would).

I’ve always known I wanted to help people in my career. As a volunteer, I realized I loved to listen, problem-solve, and share compassion with others. While still in Peace Corps, I learned what is required to apply to medical school, and was accepted to begin a post-bac premedical program (which is a slightly more structured way for “older” graduates to complete undergraduate prerequisite classes).

Since I moved back to the USA my life became filled with basic science classes, a part-time job at an organization for thyroid patients.  I was challenged by the lack of creativity (often memorization and formulaic writing was required rather than presentations or discussion).  I got used to larger classes with daily pod-casts available online, and curves that could turn a 57 into a B-.  However, the worst part was the fear that occasionally consumed all of my peers- that getting into medical school was an unreachable goal, and that the only people who could be doctors were flawless.  I tried not to believe the fears because I know many doctors who aren’t perfect.  After all, there are many types of doctors because they are all human.

In nearly two years- I have completed the classes, taken the MCAT, and been accepted to start medical school.  It’s astounding- almost unbelievable, especially when I remember that in addition to this new career direction, I have settled into a long-term relationship.  I married the man I became close friends with in 2004 when we were volunteers training together in a small village south of Kyiv called Mironivka.  Ben is a great partner, and when I compare my feelings about my husband with my career, I feel much more solid about my marriage than anything else.

So, here I am- a new wife, and soon-to-be medical student.  I wonder how being married and a bit older will set me apart from most of my classmates.  I hope it will only make my experience easier and richer.  Our orientation starts on August 25th, and I am slowly getting myself prepared for what is to come.  This involves submitting paperwork, an online training, and occasionally lying in bed thinking about the choice I’ve made.  I think about the cost, and the loans I may accumulate.  I think about whether I will be able to have children before I am 35- before I am financially stable- and whether I will be able to devote myself to my family with a demanding career.  I wonder whether I am too compassionate, and if I will cry in front of my dying patients or faint during surgery.  But at this point, I know I have overcome most of my fears in life by facing them, and I trust that I got here because I can be strong.  I will learn to be a doctor now- at least that’s what I keep telling myself.

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Posted by Liz