Chapters 14 and 15:, and 16 Moving for Medicine and New beginings, New friends, becoming Doctors

 

Chapter 14: Moving for Medicine

              I would be moving across Washington state to the small town of Spokane to begin my medical school in just a few weeks. Immediately I realized how unprepared I was. I had no apartment lined up, I had not packed anything, I had no idea what I was going to bring. One saving grace was that I learned all of the reading and lecture material would be provided online and that there were no books that I needed to buy before. There was a small facebook group for the class that I had been invited to, where people started posting information they found about housing, gyms, and other relevant moving topics. I was glad to find it—I felt like with everyone in a similar boat it would all be OK, somehow.

              I went online and started browsing apartments that were close to Gonzaga University, where the University of Washington had leased space for the medical school campus in Spokane. I wanted to live alone if I could. In college I always lived with a roommate, which was fun, but now I wanted to be a bit more independent. I found a couple cheap apartments nearby. None looked particularly nice. I put in an application for a second floor apartment within walking distance, one bedroom, $500 per month. I didn’t have anytime to see the apartments before deciding, so it was a blind call. Looking at the pictures I was a little worried, but I needed a place to live. So I put down the deposit, and then began packing all of my things into boxes. My parents were going to help me move stuff down. We would take multiple cars and try to make it in one trip. We managed to fit my twin mattress, an ugly dilapidated green rocking chair I had kept all-through college, some cheap ikea furniture, a smattering of clothes and cooking equipment, and two plants that I had managed to keep alive all through college. The plants felt like an accomplishment and a commitment. I didn’t want to give them up.

              We began the long drive to Spokane. It took roughly 5 hours, a sunny straight desert the whole way. It was overall a nice drive. I listened to medical podcasts on the way, I wanted to develop some of my knowledge before classes began. In college I always tried to work ahead and prepare early. I thought that it was a habit that would help tremendously for medical education—I had heard that the initial learning is like drinking from a fire hose.

              We get to the exits for Spokane. The city is immediately more beautiful than I anticipated. It’s verdant with pine trees, there are a couple high-rise buildings that make up the center block, and a large river runs along the west side. We take the second exit off the freeway and drive down to my new apartment. The neighborhood appears a little rundown. There is trash on the side of the wide streets. The building itself is grey with horizontal wood panneling and pealing paint. There is a block of four apartments in the complex, all with separate outdoor stair access. It’s early afternoon. We go to what appears to be the front office and someone greets us. I tell them who I am, and they welcome me. They ask if I have the deposit check. I say I can write one, and ask if we can see the place. He says yes and brings us up. It’s the second-story unit on the left side of the street. The owner opens the door, which appears as though it has been forcibly opened in the past. I don’t own a lot of things, I’m sure that it will be OK. Inside appears a little musty. There is a shag carpet at the entrance, then a linoleum tile floor ahead for the kitchen/dining area, and a door at the end that leads to the bedroom—also shag carpet—which also has the door to the bathroom inside. There is an airconditioner in the bedroom. I go in and turn it on and keep all the doors open. The kitchen is the color of stained yellow that you associate with old 70s magazines. Likely sun-damaged paint. I begin to wonder if people smoked in here before. I ask, the owner says no. The apartment does have many windows and a good deal of natural light, which I am very thankful for. I walk over to the kitchen counter and write the owner the $500 check for the first month’s rent. He thanks me, then takes out the lease. The lease is for a year. I look over it quickly and sign—I want to get to moving stuff while my parents are still here. He tells me that garbage days are on Friday and you use the big boxes out front. That there is coin operated laundry downstairs, and that I have a small storage unit included in the basement with the laundry. He then informs me that quiet hours are from 10pm to 6 am. He hands me the keys and I thank him, then he goes down and shows me the laundry room. Another resident is sitting on his porch and I wave. He says welcome. I thank him and say hello. Now it’s time to start moving stuff. With my parents help we start with their car and move the bigger items first, it’s difficult bringing some of them up the stairs. I set my mattress on the floor in a corner in the bed room, we set the big green chair in the corner in the living room, it faces another corner where I put a small TV which I connect to the computer I built back in high-school (my entertainment center). We get the rest of the items into the apartment, most of it I leave in boxes in the living room. It begins to get late and we start to get hungry, so we begin looking online for food options. I thank my parents for the help and tell them that I can finish unpacking after dinner. We scout out a place on the Spokane River called “Anthony’s” Which appears to be a rather nice seafood place. I leave my car in the apartment parking lot. We pile in my parents car and start driving over to Anthony’s. It appears to be a very nice resteraunt—I am excited because I loved all the incredible food options in Seattle. They are able to sit us outside. It’s a beautiful setting, there is a hydroelectric damn with a waterfall in the distance with the river flowing briskly, with the lights of the distant city reflecting off the water. I thank my parents again for the help. They tell me how excited they are for me to start. They tell me how proud they are that I’ve made it this far. My dad tells me that if there’s anyone he ever knew who could become a Doctor it would be me. He tells me I have to perfect smarts and work-ethic to do it. I thank him, and then tell them I’m excited to start. I tell them that initially I was disappointed to find out that I’d be in Spokane and not Seattle, but ultimately that I thought this would be better (cheaper, smaller community, heard better things about Spokane from upper-classmen). All of this turned out to be true. They agreed. I ordered a nice fish and a glass of wine and we had a little celebration. My mom asked the waitress to take a picture of us, and she obliged. The picture would eventually end up on her facebook with some very wholesome comment. My mom was kind and asked if I were OK with her posting a picture of me first, I said yes, I thought that was very considerate.

              We finished dinner then went back to my new apartment. I thanked them again for their help and we said our goodbyes. They were going to go somewhere locally to camp before driving back to Seattle the next day. I walked into my apartment, it was a mess. I picked a box at random and began to unpack. I hooked up a speaker first to play music while unpacking. It went relatively quickly. Within about two hours or so I was fairly unpacked and organized. I stacked the boxes and put them in the corner of the living room. I was tired. I checked the facebook group for the medical school. It seemed that other people had been arriving today, I wondered if there would be any social events. Classes were to begin in about 2 days. People were planning to go to a bar tomorrow. I drank some water, got ready for bed, and lay down for the first night in my new apartment. I slept fairly well.

Chapter 9: new beginings, new friends

              The following morning and afternoon was a work-day for me. I inventoried all the things I had and still needed for my new living space, then drove off to Ikea and Target to pick up any and all missing items. I needed cleaning supplies, trash cans, some cookware, hangers, some pillows, among a variety of other items. I made my haul, brought it all back, continued to unpack everything. It was really feeling like my apartment. That morning I heard shouting and yelling and thumping from below my floor. It was my neighbor and his grandchild was visiting, who apparently was not behaving. I got worried for a moment that noise would be a problem that would make it difficult to study or sleep. I would just wait for now. I made a quick panini for lunch, finished setting up my entertainment zone, then got out my laptop and logged into the school system, where they had posted all of the virtual text-books and the initial reading lists. I downloaded the appropriate documents and imported them into one-note so that I could write on my tablet while reading. I began to read slowly. The first topic was biochemistry. I felt thankful because I had a strong biochemistry background from college. The information was dense. I took what I felt were good notes. About halfway through I got a message from the facebook group that people were going to go to a local bar in about an hour for a meet-and-greet. I close up the chapter, plug in my laptop, throw on a jacket, and get ready to go. I message that I’ll be there and that I’m excited to meet everyone.

              The thing about starting new like this is it allows you to reset. Meeting a bunch of new strangers who you’ll spend an enormous amount of time together with gives you a chance to be the best version of yourself again. I felt like I could shed the parts of my character that I was not proud of and lead only with the parts of myself I liked most. It felt like a chance to totally remake myself and I was very excited. I felt a little like the Greek ship of Theseus (If a ship leaves the port and every plank and piece of it is replaced during the journey, is it the same ship when it arrives at the next port?) In a similar vein I was planning to bring a different set of boards meeting these new people, and I was sure that I would be the same ship when I arrived, perhaps a new, sparkly better version o the same ship. A quick tangent: I think about this myth often now, given my current situation. Twice now I’ve had pieces of my brain removed, and other pieces destroyed by radiation, and the others are influenced by an aggressive cancer. The literal architecture that created the synaptic connections to create me has been permanently altered. Yet I am still here, and I still believe that I am me. I cannot see and interact with the world as I once could, I’m plagued by anxiety, I worry  that there are architectural deficits that I have yet to discover. Nonetheless, the way I interact with the world is forever and completely changed due to structural, anatomical differences. But I am still me, and I will continue to be me, even if more is lost. I guess the self is ephemeral and volatile and changeable. That’s a good thing and we should be OK with that, and have certainty in who we are no matter the change or circumstance. I mean, before all this happened, I was already tying to change out the planks to change myself at the beginning of medical school because I wanted to become the very best version of myself I possibly could and that’s OK. We value stability and static states much more than I believe is truly healthy.

              At the bar everyone is sitting around a round table, most have beers already. It’s a lively group, average age probably late 20s to early 30s. I go up to them and introduce myself, then I go and get a drink. A girl named Elizabeth pulls a chair over next to her for me to sit at. Little did I know, Elizabeth and I would later become absolute best friends. She was kind and decisive, which I appreciated. We get to talking as a big group. People share where they’re from. We share our mutual anxiety about starting in a few days. I’m reassured to hear that others are nervous too. Some people have come with families or are already married. We talk a little bit about hobbies and what we’re most excited for, and what we’ve learned about the city of Spokane. Some people share what they believe they want to do in medicine after all is said and done. There is a huge variety, some surgeons, some ER doctors, I say family medicine because I don’t know anything else. The evening finishes up. I try to remember everyone’s name. We make sure everyone is safe to get home and then we all head out.

              The next day I go on a long run in the early afternoon. I love long-distance running at the time. Spokane is a beautiful running city. There is the centennial trail only a few miles from my apartment that I run to. My thoughts feel as  though they are falling through a sifter and becoming organized. My anxiety fades, I begin to feel ready for classes to start the next day. There are a lot of other residents out running as well. I finish up, clean up, then read a little bit more of the syllabus in preparation for tomorrow. Before long it is time to make a quick diner and go to sleep and be ready for tomorrow. I have a glass of wine at dinner to calm me down. It’s relaxing. A simple pleasure. I enjoy living alone and having so much freedom, although I do miss having a constant friend and companion nearby. I go to sleep. Tomorrow is the first true day of medical school.

Chapter15: becoming doctors

              We’re informed that the first week will be almost entirely orientation. No science classes or anything like that. Together we would learn physical exam skills, interview skills, be introduced to the “College morning,” wherein every week we would interview a patient in the hospital and present them to a group as practice—the interview and presentation is at the core of medicine—we also were divided into our colleges with mentors, smaller groups for the college mornings, designed so that we always had a team of people who could support us with a faculty member who could help out as well, and then we were given our embroidered short white coats and instructed that we were required to wear them in the hospital. It was all so exciting. Then they gave us a list of items we should purchase, as well as a couple of helpful reference cards, and a ceremony was held to hand out stethoscopes that had been donated by the alumni association. Most colleges looked at the supply lists together and agreed to buy for the group and share because of cost, which is exactly what we did. Finally, we were given small leatherbound journals and told that because medicine could be so stressful and different and emotionally exhausting, we would regularly meet as a college and journal about certain topics and share with each other. Our mentor, Denise Pounds, a wonderful woman told our group that she thought this was very important. I agreed and was really happy that it was happening. Coming from a liberal arts education and having read several books written by physicians prior to starting, a favorite being Rita Charon’s “Narrative Medicine,” I firmly believed that the reflection was essential.

              We were given the schedule for the week. It was time now to go to the first workshop: heart and lung examination and vitals. We were taught to use the blood-pressure cuff and listen for the blood pressure and measure it. Then we removed our shirts and donned gowns, certainly a great way to meet and greet people, and practiced listening to each-other’s hearts and lungs. Before starting, the instructor was sure to ask if anyone had any health problems that they knew about, because we did not want to discover them here. No one did. We listened to each other and tried to describe what we heard or saw using a brand new vocabulary that was provided with a reference sheet. We were instructed to practice over and over again. It was a bit of a fun exercise. Learning to do the physical exam elements and understanding what I was observing and how to describe them made me feel like I was really becoming a Doctor. I was learning the actual physical skills to examine another person. Afterwards we moved on to the abdominal exam, and then the musculoskeletal exam, and eventually the skin exam. It was a good day. We were informed that there would be a monitored exam at the end of the week to see what we learned. Immediately people began attempting to set up practice sessions at they’re respective homes. The class seemed like a really good group of people, and I was grateful to be among them. We finish up these first workshops, Denise tells our college group that we’re going to go outside and have a journal session now. We follow her out onto a nice pad of grass outside the medical lecture building (which resembles a giant concrete Teepee and is incredibly ugly, this becomes a running joke in the class). Denise gives us a prompt to write about, “What are you hoping most to learn about or do, and what are you worried most about?” Individually we all start writing. Denise tells us that we’re allowed to do anything we want, even if that’s drawing a picture. About 15 minutes later everyone seems relatively finished. Denise tells us it’s time to stop and share now. Brooke is excited to learn to talk to patients, but worried about her relationship with her family given how busy medical school can be. Kristen is excited for the anatomy lab—she wants to be a surgeon, she is worried about balancing her time in medical school. I say that I’m excited to learn more about structural social-justice in medicine and maybe start some clubs or activities to that end, given my background, and I am most worried about the emotional aspects of dealing with sickness and worry that I’m not yet emotional mature for it and hope to grow. A few others share. Denise thanks us. I’m happy that we had that time to reflect and share. The day is over. We meet up with the rest of the colleges. There’s talk about going to a bar tonight again to hang. It sounds fun. For now I want to go home and run and process everything that happened today.

              The bar that night is fun. I begin to feel like I’m really getting to know some of  my classmates. I start to wonder if I’m going to meet my life partner in medical school. It seemed like every single book I read written by a physician they talk about meeting their person in medical school. I looked around. Nothing had seemed to come up yet. I wanted that for myself, if it happened. I wanted companionship and a “partner-in-crime” as I went through this new life journey. I guess all I could do at this point was stay open and continue to lead with my best foot at all times.

              We finish up at the bar. I go to bed. I’m ready for the next day. Over the next few days we finish-up the elements of the physical exam, including the neuro exam, skin exam, head, eyes, nose, and mouth exams, and ear exams. One of the mentors brings in her kid so that we can practice a pediatric exam. Later we’re told that they hired models for the reproductive exams. For the pelvic exam, we’re divided into groups of two, one guy one girl, with one mentor chaperone who would guide us through the exam, obviously after studying extensively prior to starting. I walk into my room with my partner. There’s a woman on the exam table in stirrups. Denise is in the room too. She welcomes us. We introduce ourselves to the model—it’s unsurprisingly an incredibly awkward introduction. Denise explains what we’re going to do. I’m elected to go first. Denise helps me through the whole process. I’m nervous because I read that it can be incredibly uncomfortable and painful. It overall goes well. I thank the model. Now it’s my partner’s turn. She does well. After all is done, the model cleans up and puts back on her pants. I ask her how she gets into stuff like this. She tells us that there are local companies for medical education that do this. She tells us that it pays relatively well, which I’m grateful to hear. Then tells us how when her 5 year old daughter found out what she was doing, her daughter asked “what are you going to do with all your vagina money?” It was probably the funniest thing I had heard all day. We debriefed with Denise. She told us what she thought we did well, and what we could improve upon for next time. Now it was time to go to a different part of the building for the penile and prostate exams. The setup was similar. They had a box with a model prostate to practice on first so that we would know what we were trying to feel for. It was fairly straightforward. And then the strange day was over. I went for a run as usual, this time no bar, made a nice diner and went to bed.

              Over the next few days we would learn elements of the medical interview, and empathetic techniques to better connect with patients while obtaining sensitive medical information: the elements were the history of present illness (why were they there), medical history, surgical history, medications, allergies, social aspects including drug and alcohol use, family members, job, travel exposures, other exposures, and sexual history, and then family history, and at the end a review of systems, which was essentially a laundry list of questions that might not otherwise be asked regarding other organ systems in order to make sure nothing was missed. We were brought to the hospital to practice this with patients under the supervision of our college mentors. And afterwards we were instructed how to present the information we gathered to the rest of our college as practice, usually in front of the patient so that they could better understand the process. I was grateful that these patients were giving us their time, even though they were sick in the hospital. My first patient was a middle-aged man who had bilateral broken legs and hip fractures after a sky-diving accident. He never pulled his chute and described himself as a lawn dart. For such a dreadful situation, he had an incredible sense of humor about the whole thing that impressed me. His wife was in the room with him and quite displeased with him. I do my interview, I thank him for his time, I present to the group. Denise asks him if he will ever sky dive again and he says yes. His wife’s brow furrows. I give him a thank-you card. We give thank you cards to all the patients we see in the hospital when learning. We leave the room. Denise debriefs with me about the interview and the presentation. I jot down a few notes and thank her. Now it’s time to repeat this exercise with other patients and other memembers of our college group. It’s a good day, seeing and hearing about patients—I’m starting to feel like I’ll really become a doctor. Then we go to a conference room and Denise uses the whiteboard to teach us briefly about some of the diseases we heard about from patients today, making sure to mention the most common and lethal complications, and elements of the interview or physical exam not to miss no matter what. It’s my favorite day of learning so far. Then she goes through with us how to make a differential diagnosis, one of the most important things in medicine when you encounter a new problem. She hands us some laminated cheat cards with the information. Then the day is over. The orientation is mostly concluded, but there is a retreat for team-building tomorrow.

              The next day we show up at the lecture building and there is a bus waiting to take us to this retreat. They tell us that medicine is a team and that the team-buildling exercises will help us all work together. It’s nice to be outside on a warm day, but it’s a fairly typical corporate-style team building camp. We divide into groups and start with some popsicle towers. Everyone is fairly competitive. Then we’re given a lecture about leadership, and how it’s important to always choose a leader. Next we link hands in a circle and have pictures taped to our chest, our goal is to arrange the pictures in order without breaking hands. It’s difficult, one classmate clearly rises up as a leader, Justin, who successfully leads his group to finishing the task. My group does not finish. Then we get together for a task where we need to move around some sticks, then moving a rope. It is fun working with everyone, but I’m quite skeptical about the utility of these exercises and any long-term learning benefit we’re truly gaining. At the end the faculty tells us that there will be elections for class leaders later. Everyone is in agreement that Justin will likely be our class president after his performance today. He eventually is elected as president. Now we’re given some time to play in the lake. They have a number of rowboats and floaties. It’s a fun time. A girl named sylvia swims to the other side of the lake and back, she apparently has an incredibly athletic background. Then the retreat is over and we have another reflection session with our college groups. That’s the day. Real classes will start tomorrow.