Dumb. And Dumber...

The ENT doc I'm with always tells patients with hearing loss that it makes them look "less smart" than they really are, "if fact," he says, "it makes you look dumb." It's his way of encouraging them to consider hearing aids, I think. And to sympathize with their frustrations.


Well, I wonder if I look dumb, standing in the exam room watching doctor-patient encounters. Because sometimes that's exactly how I feel.


Every once in a while, maybe more like every once in day, I feel especially dumb. I wonder why didn't I think to ask that question or look at that part of the exam or think of that diagnosis. I need to have "hindsight is 20/20" tattooed visibly somewhere on my body. Today was a day I asked those questions to myself more times than I care to remember and that always leads to the thought, I'm never going to be any good at this.

I realize the irrationality embedded within that statement. But, for a split second it's really what I think.

It's hard to be patient when I spend all day with a brilliant doc who has been practicing medicine for the better part of my existence. Comparing my abilities to his is an easy trap to fall into during just about every patient encounter. Plus, he makes what he does so easy, so easy.

Someday. Someday I'll read this and be thankful I'm not a student anymore. I don't like feeling useless. I like having jobs I feel competent doing and helpful completing. I'm pretty sure when I asked if there was anything I could do to help during a procedure today he handed me a band-aid to entertain my helplessness.

I'm learning it's a hard thing to be taught. It's far easier and more comfortable for me to be the teacher.

I'm also learning that as soon as I think I have figured out how to handle a particular situation, I'm usually missing something. Not hard things. But things I thought I wouldn't forget to do when interviewing, examining, or diagnosing patients. If they were hard things I was missing, maybe I'd be easier on myself. Maybe. Maybe not.

Pride comes before the fall. And the fall is never very much fun.

"To Know All Is To Forgive All"

A poem. Happy Sunday.

If I knew you and you knew me--

If both of us could clearly see,

And with an inner sight divine

The meaning of your heart and mine--

I'm sure that we would differ less

And clasp our hands in friendliness

Or thoughts would pleasantly agree

If I knew you, and you knew me.

If I knew you and you knew me,

As each one knows his own self, we

Could look each other in the face

And see therein a truer grace.

Life has so many hidden woes,

So many thorns for every rose

The "why" of things our hearts would see,

If I knew you and you knew me.

Nixon Waterman

The Weight of Glory

This is my summary (with the main point excerpts, at least to me) of CS Lewis in his message entitled, The Weight of Glory.He portrays a beautiful picture of what I think should motivate us, especially as Christ followers, to love.

"The negative idea of Unselfishness carries with it the suggestion not primarily of securing good things for others, but of going without them ourselves, as if our abstinence and not their happiness was the important point. I do not think this is the Christian virtue of Love."

Lewis goes on to describe heavenly glory as fame or good report:
"...not fame conferred by our fellow creatures--fame with God, approval or (I might say) appreciation by God...."Well done, thou good and faithful servant." ....I suddenly remembered that no one can enter heaven except as a child; and nothing is so obvious in a child--as its great and undisguised pleasure in being praised...And that may raise our thoughts to what may happen when the redeemed soul, beyond all hope and nearly beyond belief, learns at last that she has pleased Him whom she was created to please....To please God...to be a real ingredient in the divine happiness...to be loved by God, not merely pitied, but delighted in as an artist delights in his work or a father in a son--it seems impossible, a weight or burden of glory which our thoughts can hardly sustain. But so it is." 

And then connecting the weight of glory in ourselves to the idea of Christian love Lewis described first, He says:
"The load, or weight, or burden of my neighbor's glory should be laid on my back, a load so heavy that only humility can carry it, and the backs of the proud will be broken....Next to the Blessed Sacrament itself, you neighbor is the holiest object presented to your senses. If he is your Christian neighbor, he is holy in almost the same way, for in him also Christ vere latitat--the glorifier and the glorified, Glory Himself, is truly hidden."

Me, James, Taylor, and Clive

James Taylor's Pandora station makes me wish I was 24 in the 70's. It makes me wish I were a better guitar player and it's the station that most frequently accompanies me on a car trip longer than 20 minutes. Well, it shares a spot with Taylor Swift's new album Red to be perfectly honest. And I'll admit, the idea for a James Taylor station came from a line in Taylor Swift's new song Begin Again. And, can I just say, James Taylor and his music making friends make for a fail proof, dinner party kind of Spotify playlist. I'm kind of excited about it.

I started a new book. It was an impulse buy that had been mulled over many times beforehand, somewhat justifying the purchase. The Weight of Glory is a compilation of CS Lewis. It includes this quote from his speech Learning In War-Time I wanted to share in light of the current political loyalties...

There is therefore this analogy between the claims of our religion and the claims of war: neither of them, for most of us, will simply cancel or remove from the slate the merely human life which we were leading before we entered them. But they will operate in this way for different reasons. The war will fail to absorb our whole attention because it is a finite object and, therefore, intrinsically unfitted to support the whole attention of the human soul. In order to avoid misunderstanding I must here make a few distinctions. I believe our cause to be, as humans go, very righteous, and I therefore believe it to be a duty to participate in this war. And every duty is a religious duty, and our obligation to perform every duty is therefore absolute. Thus we may have a duty to rescue a drowning man and, perhaps, if we live on a dangerous coast, to learn lifesaving so as to be ready for any drowning man when he turns up. It may be our duty to lose our own lives in saving him. But if anyone devoted himself to lifesaving in the sense of giving it his total attention--so that he thought and spoke of nothing else and demanded the cessation of all other human activities until everyone learned to swim--he would be a monomaniac. The rescue of drowning men is, then, a duty worth dying for, but not living for. It seems to me that all political duties (among which I include military duties) are of this kind. A man may have to die for our country, but no man must, in any exclusive sense, live for his country. He who surrenders himself without reservation to the temporal claims of a nation, or a party, or a class is rendering to Caesar that which, of all things, most emphatically belongs to God: himself. 

And here are some photos from a recent trip to Mackinac Island with the Maxwells and Erin for a half marathon...probably my most favorite course to date.

All in a Day's Work

Today could have been ruined by a failed Synvisc injection beneath , putting my scrubs in the hamper with my watch in the pocket (don't worry, I was that med student digging through the laundry), or by my lack of attention and poor sterile technique. I could hear Dr. Steiner, my microbiology prof from Hillsdale, giving it to me from a distance, and Dr. Moody audibly telling me it was a good thing I had a scrub clinic to go to that afternoon.

But it was made up by the 40 minutes I spent with the patient (the failed Synvisc patient) telling me about the Latino dancing that happens every Friday night in Bay City--I can't wait to try it--and discussing how the simple phrase "get busy living, or get busy dying" applies in almost every situation. He was just kind of awesome.

Today could have been ruined by a 12+ hour day, with no lunch or dinner break. I did manage some small snacks...

But it was made up by the simple act of bringing a woman I saw in the nursing home a cup of coffee. And then watching her talk motivationally to her arm that had become immobile due to stroke. And then by being asked to join her in eating cookies and drinking coffee. Needless to say, I practically inhaled the cookie.

Today could have been ruined by seeing a 51 year old woman I had the privilege of seeing with dermatomyositis. This devastating disease has caused Raynaud's in her fingers, a severe rash, muscle pain and weakness, pulmonary fibrosis--her lungs sounded like the separation of velcro and her fingers were showing characteristic clubbing due to low oxygen--Sjogren's syndrome with subsequent severe dry mouth and eyes, scleroderma that was making if difficult to open her mouth and her skin dry and taught...oh yeah, and she has trouble swallowing.

But it was made up by her good sense of humor. Her amazingly calm spirit. Her willingness to let me examine all of her unique qualities. Her telling the doctor to stop being so serious about her and encouraging him to laugh despite everything going on. She doesn't have a good prognosis, in fact it's terrible. But, she doesn't let on to it. My goal? Be her.

Brought to you by Prius

This was a fabulous weekend. And I got to drive a fun little red Prius from fun thing to fun thing. My poor Focus is still in the shop...And when all is said and down, I'll be about $900 dollars in the hole. I highly recommend hiding your phone when driving to avoid the temptation of distraction. It can be expensive.

I made the trip to East Lansing where I met up with an old friend, my high school Young Life leader, Betsy. She and her boyfriend are both med students and we all share a very similar vision for where God is leading us in our future as docs. I can't really explain how much I loved talking with them. Betsy and I haven't been in touch for about 6 or 7 years, but you wouldn't have known. It was one of those moments where the interconnectedness of life makes me really, really happy. I was able to share about CCHF and CCDA, plus, I'll get to see them again in Louisville for round 3 of the Global Missions Health Conference. It was fun to say, "See you next month," as we said goodbye.

I was able to spend time with Heather that night, she's an amazing hostess...and then made my way down to Royal Oak to visit my dear Lindsey, newly engaged, and as always, so much fun to laugh and talk with. Then, I spent the evening with Alex and Bre in Northville where we went to church, made a delicious meal,  and ran the next morning. An amazing run, it hardly felt long or hard. Those are the best. Oh, and I was introduced to the wonderful thing that is Trader Joe's. Big fan.

Knowing the transiency of my time here makes me less motivated to stick around on the weekends. Especially when good times with awesome people happen outside of the 48708 zip code.

Patriotic Pacifism

Two entries in one week. And the week isn't even over yet. It just so happens I have to do journal club tomorrow...I do so many more things--like read books, blog, play instruments, and call friends--when the alternative is studying. Otherwise, I watch Dr. Quinn episodes. Or go to bed at 9. Plus, I'm reading this really good book.

When reading, I rarely remember more than one or two main points. I recently found one in the book, Reborn on the Fourth of July, that I feel compelled to document and share.

Logan Mehl-Laituri writes: ...I started getting approached by a number of other festival goers about my decision to file as a noncombatant instead of requesting discharge. But the most impressing conversation I had rarely touched on my decision. One woman didn't ask questions or poke around my beliefs. Instead, she shared urgently about someone she cared for, a Marine torn between the cross and the sword. She broke down and told me how much the church needs the message of patriotic pacifism, how much we need to articulate an alternative to the stark binarism between faith and service.

When young people get ready to face the world as emerging adults, they want to do good; they want to serve a greater purpose. The military provides a means of fulfilling those needs: by joining the military, they are "being all they can be" and become one of "the few, the proud." If they want to fight the good fight and do so in a morally captivating way, the military provides the structure through which they can sacrifice themselves, risking themselves out of loyalty to their fellow service members.

The church doesn't do this so well. When I was in youth group, I rarely if ever thought about whether or not I would die for the person sitting next to me. But in the Army, there was no question. Even in training, there was a good chance I could get hurt; if my battle buddy failed to pass his static line off properly as we jumped from an aircraft, I would suffer the consequences. On the range, we risked injury if someone failed to eject his or her excess rounds properly. The threat and the promise of service were very real, and you witnessed it every day. But in churches, it's not always clear where loyalties lie, whether someone is willing to die for (or with) you.

The woman recognized the magnetism military service has for people who want to be able to know, without much doubt, that they are doing something that works toward a better world. She knew the church had not properly prepared her loved one to express his desire to live sacrificially, that the narrative of the state had a monopoly on the language of virtue. 

Today I had some extra time with a patient who was proudly displaying his Vietnam Veteran hat adorned with an Air Force pin. So we got to talking. He'd served as combat air support from '67-'68 and served an additional three years afterwards. I mentioned this book to him and said that I've found the descriptions of war from an emotional standpoint intriguing. Particularly, Logan Mehl-Leituri's expression of PTSD. The gentleman then responded by stating that his experience with PTSD has intensified in the last 5 years..."and my experience was decades ago. "I never want to go back to Vietnam" he muttered, shaking his head. He described a few of the details before the doctor came back in and then near the end of the visit our conversation returned to politics and then foreign policy (doesn't foreign policy sound nicer than war?). I made a comment about morality in war, and he responded with, "In war, there is no morality." He was emphatic and looked me straight in the eyes. I felt ill-equipped to talk about war with someone who had experienced it so intimately. "Sometimes," he said, "you have to do what is right." I wanted to ask how you could do what was right while removing the concept of morality. Instead I mentioned that if the issues were black and white we wouldn't be having this conversation and left it at that. 

It reminds of me this prayer: God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

The Gray

So much has happened since the last time I wrote. If only I'd taken the time to write every time I thought, I don't want to forget this. But alas, life is too short to dwell on the should haves and what ifs.

I attended the CCDA (Christian Community Development Association) conference in Minneapolis, MN last weekend. Minneapolis is a cool city. The conference was wonderful. I ran into my friends from Benton Harbor, caught up with Natalie over a coffee, stayed in a hostel, packed only one small backpack for the entire trip, discovered the food truck craze, spent time traveling and discussing how transforming the message of the Gospel is with Nancy, worshiped in different languages, heard stories about Native Americans, Palestinians and Israelis, and kids in prison that made me anxious for the coming of God's Kingdom, experienced Chicago at 2AM...it was wonderful. It made me want to be a pediatrician again...can you imagine doing house calls as a pediatrician? Kinda cool, right? We'll see...



While there, I also picked up a book Reborn on the Fourth of July by Logan Mehl-Laituri. It talks about the challenge of faith, patriotism, and conscience. After joining the military as a future Air Force doc in 2010, I've been challenged by friends, books, like Irresistible Revolution, and stories told by those involved in war to consider the role of Christians in times of war. More importantly, I've been challenged to examine whether my true loyalty stands with God or America by virtue of my actions, not just my words. So far this book has exceeded my expectations and I highly recommend it to anyone, whether in the military or not.




I like answers. Answers that are clear cut and straight forward. The conference gave me a lot to think about. Another thing I've been thinking a lot about is how medicine is best practiced. Every doctor has a different way of doing the same thing. But more and more I am learning that life is gray, not black and white. Be it in the question of peace and war or the practice of medicine. This verse in John 16:33 has been my go to lately. Christ tells his disciples, "I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world."

Three other quick noteworthy events:

1. I rear-ended a Yukon in my little Focus. In case you were wondering it happened on a Monday. It was a sad day.
















2. The other pictures are from a spontaneous Sunday drive I took to Port Austin, MI. I went hiking at the state park, met an awesome older couple from Austrailia who were so excited I was studying osteopathy--we talked about the documentary Forks Over Knives and agreed that what people need is more nature in their lives.

3. While on my road trip I drove accidentally (well, sort of accidentally, sort of on purpose) onto private property where I met a family that was nice enough to let me hike back onto their property to get an up close view of  this beautiful, miraculous piece of nature. How trees grow on that rock is beyond me.

Geriatrics

So I really liked peds. But, there's not a substitute for the lady I saw with the doctor today.

Doctor: How was your cataract surgery Mrs. _____?
Patient: Well, they only did one, but I can see so well! And you know what else?! I told my daughter I looked in the mirror the other day and realized I didn't even recognize myself! Were'd all these wrinkles come from?!
Doctor: You tell your optometrist you don't want the other eye done if it's going to give you more wrinkles!
Patient: You're right doc! I don't need anymore wrinkles! And he gave them to me!

or....

The old man who told the doctor he was "practically in love" after I performed his prostate exam. What he meant was he was in love with my finger that was about a quarter of the size of the doctor's finger. I hope that wasn't too much information. It probably was...I hate it when old men make me blush. Then point it out, unfortunately it happens more regularly than I'd like.

or...

The long list of complaints written out in perfect cursive handwriting. Most of them only require reassurance. It's kind of the same as when a dad brings his kids to the pediatrician with a list from his wife, but either way, I like the lists.

or...

After listening to a long list of aches and pains and requests for a walker and wheelchair, it always makes me smile when they turn, look at me, and say, "You know those golden years everyone always talks about, they aren't golden! These are no golden years. You're young! You better have fun while you can." If I had a dollar for every time I heard the words "golden years"...

Newborns. Newborns!

Yesterday, I examined a newborn baby girl. She was 2 days old. She was so tiny. And she kept her big, beautiful eyes open the whole time. (Perfect for seeing a good red reflex--thank you little girl for helping me feel competent). There's nothing like a newborn. Even in one month they are so much more grown up.

She was tiny. I was nervous that they could see I was nervous. But, I was also happy. So so happy. And nervous. But, they were awesome. Baby, Mom, and Grandma.

I was on one side of the table, mom on the other, and then Grandma got up and starting taking pictures as I examined her newest grandchild. I tried to look especially doctorly.

Newborns are a miracle.

Also, on a side note, Dr. Quinn (Medicine Woman) is awesome. Erin has all 6 seasons. And I'm obsessed. She makes me feel like I can do anything. Like harvest foxglove in a garden to make digitalis for heart problems.

Also, check this out...my mom sent it to me yesterday. Note the "Crayola Oblongata: Relays impulses to shove objects inside nose and/or VCR)."

Let Food Be Thy Medicine

That's what Hippocrates said over 2000 years ago.
Maybe it should be incorporated into the Hippocratic Oath??

Of course...everyone knows "it's important to eat healthy." Lately, I've been a little obsessed with nutrition after watching two documentaries about food, Forks Over Knives and Food Inc. My obsession is only fueled by seeing a near total lack of nutritional knowledge and/or concern in most of the patients I see each and every daily.

But, does society really know how to eat healthy? I'm becoming more and more convinced that we don't. I thought it was crazy to hear about infants and toddlers being fed coffee in Haiti. Welp, here in America we feed our kids pop from a bottle. (That's straight from Bay City, MI) How about a 3 year old girl who weighs 60 pounds (...that's 20lbs above the average weight for a 3 year old!) and is still being fed from a bottle at night before bed. It's made me question our approach to medicine. And if we need more dietitians than primary care docs.

With all the regulating and big business that goes on in the food industry, with all of the recommendations supplied by the USDA, and with our superior American lifestyles, I'm realizing, through daily encounters with patients, we are often just as far from health as the people in Haiti. Maybe because some people just don't know, but I think it's that most people really don't want to try. Or maybe just aren't willing to change. After all, I suppose it's human nature to want what is easy.

In Forks Over Knives, it highlights two doctors who shop with patients and show them how to cook. Maybe that's what it takes. Maybe I'll start making house calls as a doc someday. I think I might like that.

Dr. Esselstyn promotes a whole foods, plant based diet in Forks Over Knives. No meat, eggs, cheese, or milk. His reasons for doing so are medically motivated and based on published research in medical journals, but still, he said he knows in America this diet seems extreme. I love his response to those who think his diet is extreme (myself partially included). "A half a million people in this country this year, who will have to have their body divided, their heart exposed, then veins will be taken from their leg, and sewed onto their heart. Some people would call that extreme." Touche.

How do I get people to change their diet as a doctor? Especially when they claim they don't have any money, don't have any time, don't care (it's been said by more than one patient...), or especially when they are already totally dependent on their "cholesterol lowering, blood pressure controlling, insulin providing, depression treating, erectile creating, pain eliminating cocktail" they take every day with breakfast and dinner. How do I do it when I (the big talker at this current moment) have a hard time eating veggies over Oreos dipped in peanut butter dipped in milk sometimes? Habits are hard to change. Food rehab perhaps?

I think doctor's worst enemies in successful nutrition treatment for problems like heart disease and obesity are themselves. It's too easy to take a pill. And they're too easy to prescribe.
(And maybe fast food, too. It's too easy to pull into a drive through. Trust me..I know. But driving by the long lines at the drive thru are starting to make me cringe).

Mr. Gas Man

Dear Mr. Sam's Club Gas Attendant,


You made my day. Thanks. I hope your sweet corn grows better than it ever has.

Sincerely,
A Ford Focus owner drenched by the rain






When I switched lanes at the last minute and decided to get gas at Sam's Club I didn't know it would become the highlight of my day. It's not everyday I interact with a gas station attendant out roaming the pumps who starts up a casual conversation with a, "Did ya get the rain I sent?" ...as I got soaked stepping out of my car. He then preceded to tell me how high his sweet corn was growing, how many pepper plants were blooming, and encouraged me to start a tomato garden in my house. "Why wait til next summer?" he said. He was an older gentleman, which while in my pediatric rotation, was a good reminder of why I'm not sure if I could give up working with people over the age of 65.

Also, he was an inspiration to me to never let life get dull. To go out and make it interesting. There are no excuses for being bored or stuck in a circumstance that is not seemingly ideal. I've never wanted to be a gas station attendant until tonight. But that man seriously made me want to be one. I think I'll always go there to get my gas. 100% worth it. I danced in my car the whole way home.

Forgetting

Whenever we find that our religious life is making us feel that we are good—above all, that we are better than someone else—I think we may be sure that we are being acted on, not by God, but by the devil. The real test of being in the presence of God is that you either forget about yourself altogether or see yourself as a small, dirty object. It is better to forget about yourself altogether.

CS Lewis

Really Good Days

There are good days, and then there are really good days. Today was really good.

Here's why:
- I forgot to tell the pediatrician I had a meeting this morning, but he was late too and I still met him and got to see two brand new babies this morning. After the nurses told me he still hadn't arrived after our meeting, I silently thought to myself, "Everything always works out." And smiled to myself.
- I really like pediatrics. The kids are so great, even the parents that everyone seemed to complain about. Some of them (most of them) so obviously love their kids.
- I got to see some patients on my own. I love doing that. I kinda feel like I'm still playing doctor.
- I'm learning SO much. It's worth feeling like I still have SO much to learn.
- An 11 year old asked me a series of questions that made me smile: Are you new here, I've never seen you? Are you going to be a CRNA? Do you work at the hospital? Will you always be here? How old are you? Do you have any kids? Can I look at that (in reference to the otoscope)? Can I listen to that (in reference to the stethoscope)? She ended with a statement, You're really pretty. She was cute. That last part made me really like her.
- I saw a patient with severe autism--he was nonverbal and rambunctious. He also had an autistic brother with him. After leaving the doc said the main reason he wanted me to see that patient was to meet his caretaker (their Grandma). They were her son's kids. He'd passed away in a car accident and their mother had substance abuse problems and wasn't able to care for them. She was amazing. He told me in his Indian accent, "There are some really special people in the world, I wanted to you to meet her because she is definitely one of them." She was amazing. I loved how much the doc praised her and pointed that out to me. If a heart could smile, mine was.
- I was so motivated to study today after work. There is so much to learn! Motivated studying feels good for a change.
- I finally saw what an ear infection looks like. It's been so vague and hard to appreciate. But today it clicked and I saw it.
- I listened to a girl with pneumonia...she had text book lung sounds and a textbook x-ray. Thank you girl with pneumonia.
- I have a new favorite drink. Vitamin Water Zero: Squeezed. It's lemonade flavored and delicious.

If I was a pediatrician I could decorate with pictures like this! 

Friends

I was asked to share a little about how the Christian Medical and Dental Association has blessed me since starting med school and wanted to document it here. I feel so lucky to have been at MSU and to have met the people I have. If I had a dollar for every time I told someone about my awesome friends from school, I don't think I'd need the military to pay for med school. 

The best part about my first 2 years of medical school has been, without a doubt, the people I've met through our CMDA group. [And, to be complete here, some others outside of it too...] They've become like family. To have their encouragement has been 100% invaluable.

 Beginning at MSU, I could not have imagined how much my faith would be challenged and strengthened. Through our weekly Bible study, one-on-one spiritual mentoring with our CMDA staff on campus, attending conferences and retreats, experiencing missions with a team in Haiti, and gaining insight from local physicians on practicing Christian healthcare, my vision for practicing medicine has become more of a lifestyle and less of a career. It's taken on a God must become more, and I must become less approach that I'm learning to incorporate into my life as a student. 

In fact, using Luke 12 as our guide, another CMDA student and I sat down and wrote a detailed covenant that explains how we commit to building the kingdom of God as physicians by focusing on relationships, finances, and the community. We've promised to continually examine each other's lives to live and work according to God's Word, not the world. I am more aware of the physician God is molding me to be and so so thankful that I have the accountability through my friends from CMDA to encourage me to stay true to my calling as a disciple of Christ. 

Hebrews 12 has never been so true for me: 

Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us, ² fixing our eyes on Jesus, the pioneer and perfecter of faith. For the joy set before him he endured the cross, scorning its shame, and sat down at the right hand of the throne of God.³ Consider him who endured such opposition from sinners, so that you will not grow weary and lose heart.

What to do?

I can't stop thinking about the last patient I saw today in clinic.

From an objective viewpoint, this middle aged man was in a wheelchair, over 400 pounds, had severe lymphedema (he was retaining tons of water in his legs), and, he radiated a painful odor. I've never experienced anything like it. He was in atrial fibrillation, and the reason for his visit was to monitor whether his coumadin level was still within a therapeutic range. So, that's what we checked. His INR. But unfortunately, the only thing most of the medical team talked about during his time in the office was the odor. It quite literally would take your breath away. But, as we saw him, talked with him, and rushed out of the room, I couldn't help but wonder why the most obvious clinical finding, the one everyone was talking about, was being medically ignored. 

It broke my heart. Because from a subjective, humane viewpoint, he was kind. Verbally expressing his desire to not cause difficulties and seemingly cheerful despite his current state.

I wondered, who was going to take care of his smell? Who was going to investigate it? Who was going to touch him or help clean him? Yeah, the schedule said INR check, but was that really his chief complaint?? It wouldn't be mine...I asked the resident who was supposed to take care of the patients sores that had begun to ooze and smell, a complication of his lymphedema and immobility. I wondered if maybe it should be mine.

In a world of specialties, we are so quick to assume it is someone else's responsibility to tend to problems we either feel inadequate to address or simply don't want to address.

I don't know this gentleman's story. But, I wonder what he'd say if I asked. He is a modern day Leper in our world today. I have to figure out how to be a third year medical student, with limited capabilities and a chain of command, in which, I am at the bottom, while still being the hand of Christ, filled with compassion, that reached out and healed the leper. Where and when can I treat patients the way my heart tells me to and where and when do I just do as I am told? And am I making the distinction more complicated than it needs to be? I don't think I can just stand back for two more years, though. With a little creativity I hope I won't need to.

God doesn’t require us to succeed; he only requires that you try.

- Mother Theresa

Year 3

Today is sort of like the first day of my third year of medical school. Step 1 of boards is officially behind me, I found out last night that I passed! So far things in Bay City are going well. It recently dawned on me that this isn't just a short shadowing experience as we've started to see the same patients back for follow-up and I've started scheduling some rotations in the next few months. It finally feels real. Also, my preceptor is awesome. I kinda wanna be her. 

A brief update...

1. Bre Marchand becomes Bre Maxwell!

2. Kaylyn Blaauw becomes Kaylyn Piaskowy!

3. Katie Hunt becomes Katie Mueller!

4. I love dancing at wedding receptions!

5. Mal got toxic shock syndrome and proves to me that disseminated intravascular coagulation (DIC) can happen outside of the text books. I've learned a lot from her about what not to do as a doctor and what patients actually care about as a patient.

6. Moved to Bay City. This already marks week 3. Time flies. 

7.Started working at the resident's clinic and am realizing I really like the pediatric patients. I also met a foster family. It made me wonder if I may ever want to be a foster parent..??

8. I purchased an ENO hammock for camping/relaxing in our backyard. I spent the night in it this past weekend. I love it. A lot.

9. Super fun camping explorations in Little Rock, AK and Missouri in June on our road trip to Bre's wedding. It made me want to drive and camp everywhere and not fly ever again. It's so much fun to explore. Shout out to Amanda, Erin, and Megan...I've never had such a stress free, fun, relaxed camping road trip. Next time I think I want to conquer the great north...the UP.

10. And lastly, here's to trying not to become jaded by the medical system. And to more importantly loving patients (and co-workers) with patience and selflessness. 

Gratitude

I am so thankful for rest.

I will always fight for it. To have rest and reflection is to have life.

While unpacking and repacking to move to Bay City, I have thought numerous times, I have too much stuff. As I dropped a glass Pyrex bowl on the garage floor, and it proceeded to shatter into a million pieces I thought to myself, "Good. One less thing."

Having things is stressful. Simplicity as a basis for living is especially attractive as I have all of my things in one place and not enough places to put them. It makes me reminisce about life in Haiti. I'm doing some major down sizing. One Pyrex at a time. It's incredibly freeing. I'm tempted to try to not buy one new thing for year (inspired by a story of a woman who did this).

This is where I admire my Mama. She lives a life of simplicity. I was using my parents bedroom as a temporary storage space and amidst the clutter, noticed a book entitled One Thousand Gifts on her dresser. The subtitle reads, a dare to live fully right where you are.

I skimmed the pages and found this quote:

Gratitude bestows reverence, allowing us to encounter everyday epiphanies, those transcendent moments of awe that change forever how we experience life and the world.
- Sarah Ban Breathnach

It made my heart happy. And reminded me of the many things for which I am grateful. 
- I am thankful for friends; like Katie, whom I was able to spend a few hours with over out-of-our-price-range-but-seriously-delicious seafood. 
- I am thankful for my home. 
- I am thankful for my dog. 
- I am thankful for neighbors who I can drink wine with on their back porch and who let me go walking with them around the block. 
- I am thankful for my car that just drove me to a beautiful wedding celebration in TX and is about to take me to Chicago for another. 
- I am thankful for dancing. 
- I am thankful for Spotify. 
- I am thankful for the redeeming love of Christ and how it transforms lives.  
- I am thankful for the coming year in Bay City. 
- I am thankful for skirts. Especially the one I just realized can also be a dress.
- I am thankful for camping and perfectly roasted marshmallows. And stars. And rivers.
- I am thankful for people who challenge me. 
- I am thankful for cocoa puffs.
- I am thankful for nail polish and cuticle pusher backers. 
- I am thankful for everyday epiphanies. 
- I am thankful for this journey of life and for its many encounters with our one true Creator. 


God is so good. 

Moving/Reflection Day

Times flies. Mom, Dad, and Ryan came to move everything out of my apartment and into our garage until I can get my life back in order after I take a board exam Monday (!), travel to TX and Chicago for weddings and camping adventures (!!), and start rotations in Bay City (!!!). My place is emp-ty. It's so weird.

Also weird is the fact that only two night of sleep separate me from step 1 of the board exams for medical school. I'm actually at Fee Hall right now. Studying on the floor is not ideal. I would have laughed if you'd told me I'd be here a few days before boards, but I'm tired of coffee shops and my apartment. Blah.

But, I was just thinking that I should add some of my thoughts here so I can look back and relish in the fact that I am no longer in this stage of life someday.

- I can't stand working by myself. I go kind of stir crazy. Thus I am a terrible serious studier. It took medical school to make me realize this. I used to think I was kind of good at it. I am not.
- I can't wait to work with people in 2 weeks. I get to work with people in two weeks!! That seems unreal.
- I wondered today if First Aid or the Savarese study review books or perhaps endless numbers of pharm and micro notecards will be useful for the next couple board exams...this was my thought as I thought about all the ways I'd wished I studied these materials throughout the last year. Kind of a "welp, I hope going through them now is still helpful down the road." We'll see...
- I feel like I did after finishing organic chemistry in undergrad. My thought is that if I could do it over, I'd do a lot of things differently and thus make the whole experience less stressful. To be clear, if I could do these two years over, I would not. Not that I wouldn't choose to be a doctor, but it's a once and done forever kinda deal. I wouldn't discourage people from doing it, just to really know you want to be a doctor.
- Studying is a lot like exercising. Both beneficial and not bad once you get your butt out of bed and start at it. It's the starting that's the hardest part. And the more you just think about doing it, the more discouraged and unmotivated you get. As Coach Boze once said, "Don't think. Just do."
- I'm incredibly thankful for a group of friends in medical school who are supportive and encouraging. Never slow to remind me that this test, while cumbersome and irritating, ought not be given higher priority than it deserves. For example, we can still be the same kind of doctor we aspire to be whether we score in the top ten percent or just barely pass. And for friends and family who aren't in med school, to remind me of my life outside of studying.
- I'm scared I may not pass. A ridiculous statement, I know, but I really am. But, experience for the past two years has taught me that that fear of not passing is often inaccurate. I've been afraid before, and passed, so...no worries, right? It also reminded of this quote from The Alchemist:

The Alchemist: Tell your heart that the fear of suffering (or failing) is worse than the suffering ( or failing) itself. And that no heart has ever suffered (or failed) when it goes in search of its dreams, because every second of the search is a second’s encounter with God and with eternity.

Santiago: When I have been truly searching for my treasure, I’ve discovered things along the way that I never would have seen had I not had the courage to try things that seemed impossible for a shepherd to achieve.

Quinoa Tabbouleh

 Quinoa Tabbouleh Ensalada! 

Probably not the most time efficient meal to make one week before boards, but the slicing and dicing was therapeutic...and the meal, fresh & healthy. Plus I've been wanting to make this for forever.

Combine the following in big bowl and refrigerate. 

1.5 C Quinoa (cooked, using 3 C water) It's ok if the quinoa is still warm when you add it

3 Tomatoes, diced (next time I will use a pint of cherry tomatoes halved to save time...)

1 Cumcumber, diced

about 1/3 of a bunch of mint, finely chopped

1 bunch of flat leaf parsley, finely chopped

3 cloves of garlic, minced

15 oz of garbanzo beans

1 lemon squeezed over top of it

And I added parmesan cheese on top too, but I don't think it's necessary

Original Recipe here: http://thegingersnapgirl.blogspot.com/2012/02/quinoa-tabouli-salad.html

Papa

Ryan has been wanting to make a stepping stone in honor of Papa to put in the cemetery. Papa loved to fish. Ryan loves to fish. So Ryan made a fishing inspired stepping stone with some of Papa's lures and we shared some of our favorite Papa moments.

Papa was the best at sitting and swinging. Nana said the other day she could hear his voice saying, Why don't you just sit and stay awhile? as she left the cemetery on Memorial Day. I never saw him in a hurry. It's getting harder to remember him exactly as he was. So I'm becoming more and more thankful for times when we tell stories and remember him. Remembering feeding the squirrels, picking veggies from their amazing garden, his instant coffee (now that I'm a coffee drinker I don't know how he drank that stuff), his big green chair, and my favorite, when he whispered in my ear that as he watched me get baptized it "brought a tear to his eye." I love playing his mandolin. I try to imagine him playing it and it makes me smile. 

Ryan said the sinkers in the stone are there because, "Papa told me that if you put sinkers on your line you can cast twice as far. And it's true. It really works." 

CCHF: Nashville

 I'm in Nashville, TN for my second CCHF (Christian Community Health Fellowship) conference.




























Community: Jesus style
I don't want to be anywhere else. It's been awesome. Just what I needed in the midst of the Board prep. It seems like I'm getting exponentially more emotional with every breath I take, but I had to fight back tears multiple times today. I think it's because I feel as though I've suppressed the part of my heart that I treasure so much; that is healing for broken people. Healing for broken people is a blanket statement in every sense of the phrase. But, I feel like it's been overshadowed most recently by studying/being preoccupied with boards. Not only for other people, but also for myself. I've forgotten my brokenness has been healed. I've unknowingly placed my desires before the path the Lord has called me too.

The moments that I want to remember:
1- Hearing John Perkins and H. Spees recount the reconciliation they saw in Mississippi. It's what marked the beginning of CCHF.
2- Listening to the stories of two nurses in Grand Rapids who serve and empower the homeless in their city.
3- The powerful words of Psalm 23 that penetrated my heart.

Community: Restaurant Style
Tonight I went to dinner with some friends at a old home turned into a family style restaurant where the menu included: cornbread, homemade peach jam, biscuits, pickled cucumbers and beets, mashed potatoes, fried green tomatoes, turnip greens, fried catfish, fried chicken, ribs, beans, banana pudding, sweet tea...you get the idea. The way it works is as soon as you get there you join a table of people who are already there. The tables are huge. So we had dinner with 3 other groups of people--all at the same table! No cell phones are allowed. And you all share the same dishes which must be passed to the left. So you're asking a complete stranger, who is now a friend, to pass the sweet tea. So cool. Every restaurant should do it. It makes everyone happier. The world would be a better place.

Prayer Rocks

These are "prayer rocks" in the Himalayas in Nepal. Three things about them:

1. I like that they are called "prayer" rocks. I feel as though I've done a lot of that since starting med school

2. Prayer Rocks = Prayers Stones; 

                             Prayer Stones = Milestones; 

                                                      Milestones = Finishing traditional academic classes FOREVER!

3. This picture is dedicated to my Nepal loving friend.

It was bittersweet leaving Fee Hall today. Yelling across the parking lot to friends I won't see until graduation. Eating Breakfast alongside people who made med school both barely tolerable and occasionally more stressful--I guess that's the reality of going to school with about 300 type A personalities. 

Now to Traverse City! To visit the Christiansen Family! and run a half-marathon...

Maybe eventually I'll get around to studying for this board exam...Everything always works out. Maybe not in the best way...but it always does. Proof lies in the fact that I am done with the first two years of medical school. 

The Imagination Phase of Education

Life has been and continues to be so cyclical.

In high school, I started out as a freshman, no real direction, and a set curriculum. By junior year, I felt established, played varsity sports, and was looking at colleges...I was excited and full of ideas and opportunities for the future.

In college, once again, I started over with a very rigid schedule full of core curriculum requirements. Then after a couple years, I decided on a major and began to dream about who I really want to be or where I wanted to invest myself; it became more my own.

Then I got to med school, where the same cycle is being repeated for the third time.[And will again for a fourth time once residency begins.] For the first two years there has been very little input on our part as to how our schedule looks. Some electives to choose from, but for the most part they are one time shadowing experiences and seminars that only last for a portion of the semester. You do as your told. But, now that second year is wrapping up, the exciting, what do I do after this 4 year cycle ends question is on my mind.

This morning we had a meeting on our third and fourth years of med school. And that's what got me thinking about all this...

Reality finally set it. It's so exciting to be back in the imaginative phase of the education cycle. To let the reality that it's actually time to start dreaming about where I'd like spend rotations in another state or country is scary, because I don't feel ready, exhilarating, because I am tired of the rigors of traditional academia, overwhelming, because it seems like there are so many awesome options to choose from, and nostalgic, because I can't believe how fast time has flown, I can't believe it's really time to think about these things.

I remember hearing about people ahead of me who were in my position 3 or 4 years ago. I was so envious of them. Now, I'm envious of those same people who are now graduating or beginning their internships. I caught myself longing once again for that feeling of having "arrived." I wanted to finally be out of the 4 year cycle of having to start from scratch. To finally be what I wanted to be when I was grown up. What if I could see myself as I saw other med students before I actually was one. I am where I wanted to be in that sense, but, I can't believe it.

Today I choose to believe it. To live today content and feeling as though I have arrived. Because as much as I want to bash medical school and studying, I'd be disappointed if I wasn't here. I pray that I don't wish to be graduating tomorrow or for a wealth of experience under my belt. I pray I'll be the inexperienced, eager, terrified, childish medical student I feel like. And that dreaming and planning about where the next two years will take me will motivate like it used to.

I'm so excited. I'm more excited to go to the CCHF conference and talk to people about where to do rotations because I'm finally at the stage where it's necessary to think about. I feel like I'm not just going for fun or the awesome stories, as has been the case in the past.

All this is motivating my boards studying...and blogging. :) 

The Little Engine That Could

A long time ago, I received an analogy that describes life, not as a roller coaster as is often the temptation, but instead as a railroad track; two parallel lines, coexisting, and only complete if both are present.

Why? Because life isn't full of ups and downs. Life is full both of ups and downs, usually side by side, coexisting, and only complete if both are present at the same time.

This analogy reminded me of The Little Engine That Could book.
I never imagined relating so well to a personified steam engine.

This weekend I was overwhelmed with both discouragement and joy. Contentment and restlessness.

Alison got married! I saw many dear friends and had some great overdue conversations. I was filled with nostalgia as I drove US-12 from Hillsdale to Saline as I had done so many times during college, passed the 7 eleven were my family stopped every Wednesday night after youth group, and ran a 5k with Kirsten that ended on the Eastern Michigan University track where I've run many memorable races.

Not surprisingly, the discouragement and restlessness was rooted in all things medical school. I never would have imagined how hyper-emotional the stress of preparing for exam after exam along side a couple hundred people who seem way smarter than me could be. But, I laugh when I think about how ridiculous all of this will seem in just a year down the road.

The book I mentioned in my last post, A Minute of Margin, has been my go to lately. Today's message was especially relevant. If you've ever experienced doubt or disappointment due to unmet expectations I encourage you to read the following:

Expectation overload is one of the most difficult overloads to control...We expect health, wealth, and ease. But reining in expectations is a human possibility. Instead of following the "more and more" of progress and the "you deserve the best" of culture, we can follow the "be content with what you have" of Scripture. Our lifestyles can relax, our spirits can rest, our relationships can thrive, and our margin can replenish. If you give your expectations to God and then accept what the day brings, you'll discover a rare freedom.

Margin

http://www.richardswenson.org/books/minute-of-margin.html

My Uncle Dave gave me this book. The author, Dr. Richard Swenson, says this in the intro:

Margin is a space, specifically the space between our load and our limits. It is this space that enhances vitality and resilience. It is this space that guarantees sustainability. It is in this space where healing occurs, where our batteries are recharged, where our relationships are nourished, and where wisdom is found. Without margin, both rest and contemplation are but theoretical concepts, unaffordable and unrealistic. 

I've realized more in this past week that margins are something you have to fight for. If you don't, the inherent vortex of modern society and progress will suck anyone in. It sucked me in.

This book is set up in one minute, daily reflections. At the beginning there is a quote and at the end a prescription; practical ways to start creating margin (This guy is a doctor after all...).

Rx: Make an intentional decision about how much marginlessness--this is, how much overload--is acceptable in your life...For me, getting off of Facebook has been that. I feel no less connected to the world. It's helping me be where I am. For me, something that was meant to enhance life by making it easier to stay in touch, was only making it more complex. It opened more relationships and opportunities than I could handle well. Its benefits have encouraged me to look to simplify my life in other ways. As my mom has always said, less is more.

Happiness is a place between too little and too much. 
-Finnish Proverb

A List Update

It's been awhile, I've been unmotivated. First, because I was deathly afraid of failing my respiratory course and couldn't justify blogging. And second, because once I was done and found out that I had passed, I was too happy and tired of thinking that searching Pinterest or sleeping or baking just sounded better.

So, an update!

1. Respiratory is over! By the grace of God, I passed and no longer have to carry that burden of a class.
2. I got to see tons of family in the last week or so. One of the many reasons I'm glad to be in MI for now.
3. I observed 3 autopsies at the forensic pathology department at Sparrow Hospital in Lansing. Maybe more on that later. Or in person. It was quite the experience and I'll leave it at it kinda caught me off guard. Crazy cases you only thought existed on CSI really do happen in real life.
4. Today I took the COMSAE which is a practice exam for our Board Exam this June. It marks the first real beginning of studying for yet another exam. It's 8 hours long...and I learned today I have a lot of studying and concentration practice to do.
5. Veggies = self esteem booster. There's something about cutting them up by hand and eating them for an entire meal that make me feel really good about myself. And perhaps, want to have a garden.
6. Currently neglecting the guitar...sad.
7. I got a cavity. I'm really bummed about it. And nervous, it's my first one. I was also scolded for not flossing. They said I was showing signs of gingivitis. haha I'm going to start flossing!
8. I'm one chapter away from finishing another book! Irresistible Revolution.
9. I've started moving out of my apartment. I feel like I just got here!! I also feel like I know less then I did when I got here.
10. That leads me to this....I wish I had less things. I'm working on simplifying my life.
11. I'm really liking life without facebook. I got back on today, thinking I'd stay, only to deactivate it again. Maybe after boards are over I'll reconsider.
12. I bought a new Dr. Seuss book. I Had Trouble in Getting to Solla Sollew. I love it.
13. Grandpa told me this weekend that he would hitch hike 1000 miles from Norfolk, VA to Wisconsin to see Grandma back when he was in the Navy. One guy even had him drive the car, while he slept in the back! I wish you could still hitch hike across the country. How could so much have changed in so little time?
14. It's about to be Wedding season...7 Weddings this spring/summer/fall, all for very good friends. I'm excited!

Breakdown Number 3

These are my favorite posts to come back to and read months or years later...

I had my third major breakdown since being a medical student yesterday. Just to be clear, I define major breakdown as an overwhelming feeling of inadequacy to the point of tears. It's usually accompanied by feelings of guilt (I think..."My life isn't that bad?!...I really shouldn't be upset") and confusion (thinking..."So...why in the world do I feel this way??"). There's also usually a run.

The conclusion and the good part? of what went down: I need more discipline in my life.

I read Proverbs 25:28 and immediately understood where most of my feelings yesterday had come from. "Like a city whose walls are broken down is a man who lacks self-control." I felt attacked. Every little thing felt like an attack. I usually pride myself on being flexible. Pride goes before the fall...I know. I know that now unfortunately better than I did before. Instead of meeting unexpected changes throughout the day with ease, they were obstacles.

The obstacles in the bad day included pressing snooze at least 6 times, a broken bike so I couldn't bike to school or to meet Alison for dinner, I had to do my taxes and the Internet kept going out...so I had to start over, I burned my tongue, I found out about a class I have that I didn't know I had coming up...what about studying for boards?!? and it involves group paper writing which is my least favorite thing ever, Meijer is reorganizing everything, so finding anything is more difficult, I had to go there because I ran out of toilet paper that morning, I failed my respiratory test the day before--ok, that was not unexpected, but still, didn't make me feel good, I tried listening to lectures, but couldn't speed them up and the professor talks so slow...And I cried. I hate crying. It feels ridiculous to write it out the day after. But it happened. And it happened because I was avoiding something I needed to realize.

Sometimes I use my relationships and connections outside of school as an avoidance to the reality that I am here. That I have really do have to study. I want to be a doctor more than I used to, mostly because that means I will no longer be a medical student. But, I have to be a student before becoming a doctor. Bummer.

So. I deleted Facebook. Which subsequently means no more Spotify. And it feels good. Being productive, having a balance, feels good. I'm trying harder to regain discipline I used to have, while maintaining an easy going, flexible spirit. Balance, why is that so hard?! Ah to be a sophomore in college. Better yet, a junior in high school. The good ole days...when I was disciplined. And life was slightly less complicated. Discipline is freeing for me right now. Deleting Facebook was freeing.

Unrelated. Amanda shared a new song with me. And I'm going to pass it along. It's an attempt to end positively.

Una siesta por favor?

I can tell by the number of posts in the past week or so that my attention span is running super low.

This time, I am here to tell you I feel slightly gypped.

(I had no idea that was how gypped was spelled...Did you??)

Why don't we have a siesta?

It would do wonders for every person's psychological well being. No doubt.

It would this girl, I know that.

You know how people are all concerned about their health....

So. Why no siesta??

I think it'd s-l-o-w everyone down. Waaay down.

Can you imagine?!

Wikipedia says: "Einhard's Life of Charlemagne recounts the emperor's summertime siesta: 'In summer, after his midday meal, he would eat some fruit and take another drink; then he would remove his shoes and undress completely, just as he did at night, and rest for two or three hours.' "

I say: "Yes. Yes, please. Pretty please?"

This guys has it down. Fo sho.

For now, I am living vicariously through each one of these pictures.

But, I'm not giving up on the dream...I'm gonna make it happen someday. Someday!

Until then:

and...

I'm making it work for me.