Ending thoughts, new beginnings!

Yesterday was my last day at ARMC OB/Gyn, and I have to say that the minute I walked out of clinic, I breathed a huge sigh of relief. The rotation was very hands on and I learned by collision, but there were many barriers to getting work done.

The morale of the nurse assistant staff is very low right now and as a result, the wait times for patients double. We had to run around looking for our assistants, sometimes met with an eye roll when we asked forthem to chaperone (which is required), and sometimes straight out shot down and told to find someone else. Not all of the assistants are like this, but I would say this was the only thing that made this rotation difficult for me, other than the lack of orientation. I am sure its frustrating for the staff to constantly have to deal with new med students who don't know what they are doing because of the lack of orientation. I certainly hope that they can get to the bottom of what is going on in clinic before patient care is affected.

I am happy that I had a chance to rotate at Arrowhead, and I learned tons about women's health on this rotation. I am glad I had to bust my butt in that hospital because my future patients deserve to have a doctor who put forth this effort to learn. I am just surprised at how various health care professionals can treat each other when the common goal is supposed to be quality patient care, individual health, and community healing. I will continue to approach healthcare with the perspective that we need to work cohesively as a team to increase the number of successful outcomes. If you choose to go into medicine, no matter what your specialty or position, you are making a commitment to help others and that service should bring you joy. Working in this field, you make many personal sacrifices- among the most important of things, your time and energy. It is good, honest work and those of us who choose to do it should be happy that we have the chance to work together in such a positive effort.

And stepping off of my soap box, I am so happy to head back to the Bay Area tomorrow to continue my life in Benicia with Walter! It has been 16 weeks since I slept in my own bed, woke up to the sun shining through the blinds, the birds chirping outside our bedroom window... man it will be good to be back!

I start Orthopedic Surgery at DMC on Monday, which is a 4-week rotation. After that I am doing a 2 week elective rotation at East Bay Cardiology, and a 2 week elective in PM&R near CPMC in the mission, SF City. So excited and happy to commute from my home in Benicia :) Until next time...

OB/Gyn at ARMC in Colton

Its a sunny day in Riverside- the high will be 78 degrees which is the norm in the beginning of November around here. We have veteran's day off, but I have not left the house yet because the Santa Ana wind is blowing at 20-30mph out there! Over all it has been interesting. Driving through the parking lot freeways on the morning has really been affirming the way I generally feel about this area. Think of the Weeds theme song- "Little boxes on the hillside..." There is a lack of variety compared to the bay area, and the people and generally a little nicer up there.

ARMC in Colton is a federally funded community hospital- Obama-care if you will. For the most part, it is a well-oiled machine. Some departments are functioning a little more smoothly than others. As it is a teaching hospital, you find that the lower you are on the totem pole, the more scut work you do, but you learn tons doing it!

All of the rotations I have had so far, I have been extremely blessed to follow an attending basically on my own. I even had 3 to myself during pediatrics in Humboldt. In this hospital, I interact with the attendings very little in comparison. The downside is that I don't get to see the way they interact with patients (very few still see clinic patients in person), the upside is that I get to interact with patients and learn what style works best for me. I research my patients' charts, take my own history and perform my own physical exams, write up my own SOAP notes, update the problem lists, and then formulate a plan going forward complete with which labs, imaging, and education is necessary. At this point in my third week, I have learned the basics and read enough that most of the time the attending checks my work and signs off on it. The only time I get to spend with the attending in the room is when I need him/her to check out something that deviates from normal in the physical exam, or when I need to do a quick abdominal or vaginal ultrasound.

This clinic is an especially important experience for me because I am helping high-risk OB patients, which unfortunately there will be more of as time progresses and society's habbits are too slow to change. Weight management, diabetes (both gestational and chronic), and twins are all sent to our clinic for the high-risk days. So we have these complicated cases, and we're expected to get through 45 patients in the morning and 35 in the afternoon on most days! Add to this a small amount of clinic space, too few computers, illegible handwriting in charts, nurses that are impossible to find sometimes or clearly do not feel like helping (although some are much nicer and more willing to help than others), and you get the ultimate high stress environment. Its no wonder the attendings mostly never leave the physician break room- its a war zone out there :)

I think what also makes clinic so difficult is the paperwork- there's a huge learning curve in the beginning getting used to it all. They expect you to only spend 30 min with returning patients and 45 min with new ones, but on the first day you're not even familiar with the charts, paperwork, EMR, or even where things are in the hospital yet (if you're completely new to the area like me). By the end of the second week I was golden in terms of all of that, but at the beginning of the second week we had new students from Western come, and training them was like the blind leading the blind. There is no real official orientation, so med students help each other as much as we can, while also trying to get our own work done.

The labor and delivery floor works much differently than clinic. Our duty as med students is to help out the flow of the prep room, which is like emergency triage for pregnant women. We see the patients, find out what they're there for, present to the residents, and help see to it that they are admitted, watched, or discharged smoothly. On the floor, we chase residents around making sure that we help them with efficiency, scrub in on bilateral tubal ligations, cesarean sections, dilation and curettage procedures, and vaginal deliveries. We can follow the uncomplicated patients and personally help with placenta and baby delivery. We can also shadow attendings in the gynecological surgery OR and scrub in on procedures like total hysterectomy and total salpingo-oophorectomy (removal of uterus and ovaries). Overall, if you are ambitious and determined, you get to see tons.

So overall, this has been an incredible learning experience. I practically feel like a resident with the responsibility I have and the skills I have acquired. This rotation alone has actually gotten me more excited about residency because I feel like its less of a mystery to me now, and I know that I can do a good job when the time comes. Although its not easy, it is also not thankless- the patients are very gracious and nice here and you get the feeling that you're really helping make their lives a little better one visit at a time.

This windy day off is a perfect day to catch up on quizzes and reading, so I am signing out and heading down to Denny's ;) I'll check in again at the end of the rotation. Next up is orthopedic surgery back at DMC in San Pablo.

Pediatrics in Humboldt

Much to my dismay, I am close to the end of my pediatrics rotation in beautiful Humboldt County. My preceptor is Dr. Ted Humphry from the Open Door Clinic, and I would often shadow Dr. Wirthlin and Dr. Heise when Dr. Humphry was out of the clinic. Having all three of them to myself was amazing- no other students or residents with whom I needed to compete for their attention. It was nice to see their individual methods of blending intuition with medical knowledge. I would go to the clinic every day for outpatient experience, and in the mornings I would make inpatient rounds. I was also called in at all times of the day to watch and eventually participate in C-sections and make rounds on inpatients.

My favorite part of this rotation was when I got to see patients on my own. I would take a brief H&P, report with my assessment to the attending, and then we would go in together to close up the visit. I also wrote SOAP notes after some of them- totaling about 2-3 per day. The only downfall of this rotation was not having Internet access. I had to wait until I got home to work on quizzes. I am going to miss the people of Open Door Pediatrics in McKinleyville and the physicians with whom I rotated. Not only were people courteous and welcoming, but they helped advocate for my ability to learn and participate in patient care.

I will also miss Humboldt County- such a beautiful place with fresh air, a slower feel, and might I say, tons of great food. I will be back, especially since I have much more north coast left to explore!!!

Next stop, SOMA Fall Convention, then OB/Gyn at Arrowhead Regional Medical Center in Colton. So far I have been away from the Bay area for 9 weeks and it won't be another 7 until I can finally call it home base again. I have missed Walter terribly, but thank goodness for g-chat with cameras and the fact that this place is only 5 hours away. We saw each other every weekend of my NMM rotation, and every other weekend during my pediatrics rotation. I thank him for being endlessly patient with me. Thanks for reading- don't hesitate to message me if you have any questions on how to rotate in Humboldt, leave a comment below if you don't have my contact info.

Neuromusculoskeletal Medicine in Humboldt

In case there are any 2nd years who are still actively reading my blog, I wanted to share about my NMM/OMM rotation with Dr. McCaffrey in Humboldt.

She practices OMM at her clinic, called Redwood Osteopathy. She takes PPO/HMO/Medicare patients, and she has the MediCal patients come to the Student Clinic, where you take a history/physical, create an assessment and plan (including treatment), present to Dr. Kate, and then treat. I found it to be exactly like suitcase clinic, but you take care of the visits on your own (unless someone is rotating with you, in which case you could see the pt together if you wanted) If you are uncomfortable doing this on your own right off the bat, you can let her know and she will be happy to have you observe for a couple of visits before you jump into it.

You also help her with the intake and follow-up visits for non-MediCal patients- you take notes onto the computer for her and help her treat, sometimes you go in with the patient and start taking the history/physical and present to her. You'll see 5-8 patients per day,sometimes more! It's good, solid work and I not only learned new
treatment techniques; I experienced continuity of care. Its nice to see how patients do after you treat them! I also feel like my hands have turned on again, if that makes sense- I had not practiced much OMT between May- Aug before the rotation.

Dr. McCaffrey also teaches you about billing/charting/EMR, and how to run your own business. As far as hours are concerned, Tues, Weds, Thurs you are there for about 9 hours each day with a long lunch break, then on Friday its a half day (3 day weekends!). There is a compassionate pain management group that she has students join during their time at the clinic to get an idea of how facilitated groups
work. This is a beautiful group and you might be surprised at how much you learn about yourself and others during the short meeting. The office staff and medical massage therapists who she supervises are very nice and like to share knowledge during in-services. You can also trade OMT/ medical massage with them ;)

I'm still in Humboldt- now rotating with Dr. Humphry, Dr. Wirthlin, and Dr. Heise for inpatient/outpatient peds. I literally have all 3 of them to myself! If you are interested in rural medicine or peds and you want to know more about this rotation just let me know. Dr.Humphry is the director of the Open Door Clinic and loves to teach medical students. It is a very loving, educational environment.

Humboldt is very much in need of people from our generation to come up there to practice since many of the current physicians will be retiring within the next 5-10 years. This is why they really want us to come up there and they make sure we get the special treatment- a good education and friendly interactions.

General Surgery - a short conclusion, after 4 weeks.

As amazing as surgery is, I probably won't become a surgeon. I want to know medicine inside and out, perform the occasional procedure, possibly know how to do a cesarean....but I just don't see myself being a surgeon day in and day out. That said, I want to absorb all the information I can while I am on these rotations so that I can be extremely knowledgeable about when it is appropriate to refer. It is also important to have a good grasp of what my colleagues do, and what my patients will go through when they have surgeries so I can care for them properly before and afterward.

Even if I do not picture myself in particular fields in which I am required to rotate, I'll have fun with it, learn as much as I can, and I'll always be humbled by how much I still don't know. So excited to follow the life-long pursuit of acquiring knowledge-- next up, ten weeks in Eureka (4 OMM, 6 Pediatrics). Will update soon!

Success seems to be largely a matter of hanging on after others have let go. -William Feather

Callie Moore

http://www.digstation.com/ArtistAlbums.aspx?albumID=ALB000051124

Callie Makes me happy.

2010 SDN Scholarship in Community and Preventive Medicine

http://www.studentdoctor.net/2010/06/robyn-young-awarded-2010-sdn-scholarship-in-community-and-preventive-medicine/

I donated a large fraction of my scholarship money to the South Vallejo Free Clinic project by purchasing glucometers, test strips and lancets for the clinic (will deliver within the next week). Things are really getting off the ground and I hope to remain involved for years to come, when I am away on rotations/ residency. I know this will develop into a valuable center for the Vallejo community with everyone's help.

Here is my scholarship essay:

Describe the work you have done in the field of community medicine and your future career plan.

Deepak Chopra, M.D. has said,” Everyone has a purpose in life… a unique gift or special talent to give to others. And when we blend this unique talent to service others, we experience the ecstasy and exultation of our own spirit, which is the ultimate goal of all goals.” I believe my unique gift is the ability to recognize and bring out the healing potential of individuals and groups of people. As a physician, I will use my passion for preventive medicine to bring heath care professionals together in a community clinic setting. The ultimate goal of this teamwork will be to empower patients with the tools they need to heal themselves and their community.

My experience with community medicine began as a volunteer at an undergraduate clinic for the homeless called The Willow Project in Sacramento. As a health screener, I got to listen to the clients’ unique stories and health concerns. A majority of our clients would present with poorly controlled hypertension and diabetes; two very preventable conditions which lead to serious complications if they are not treated. Clients would explain that they lack access to healthy food, sometimes just eating what they can find, or what the food banks give them. With my limited role and an even more limited amount of time, I would take five minutes to explain the importance of nutrition and exercise to clients. Eventually, I realized that I could make even more of a difference if I helped create opportunities for them to eat well.

After learning of our clients’ lack of access to nutritious food, I joined a group of advocates called Food Not Bombs, and helped collect healthy, nutritious, vegan-vegetarian food from participating restaurants and markets. With this food we cooked creative, multiple-entree meals and served them to the community as often as we could. People would come to eat, and we would discuss current issues that affect their community as well as listen to each individual's story. We encouraged the community to be conscious of waste production and to value collective, creative cooking. I realized that it is more powerful to show the community that food is medicine, rather than to just tell them about proper nutrition. To this day, I am still an active in community cooking. Our patrons remind me of my clients at Willow Clinic when they tell me that they have changed their life style and feel healthier after participating in our meals.

In addition to cooking, I continue serving the community by coordinating an OMT station at Suitcase Clinic in Berkeley. Every Tuesday, the undergraduate suitcase team provides a two-hour clinic and safe space for the Bay Area homeless community. Clients can sign up for foot washing, shaving, clothes and food, medical care, eye care, legal council, and many other services. I coordinate the effort of Touro osteopathic medical students working in pairs to do H&P's and treat a total of ten clients. As we treat our clients, we teach them muscle energy techniques that they can do on their own. This empowers clients to take charge of their health and helps maintain the changes we have made with our osteopathic manipulative treatments. At Suitcase Clinic, I have gained unique exposure to the bay area homeless community, listening to their stories and examining their physical and mental status. I am now very well versed on the public health services offered in the Bay Area, as I am constantly advocating for clients to receive the help they need.

Being a communal cook and health clinic volunteer has ignited a spark within me to continue serving the community with a public health perspective. As I complete my medical education and obtain my license to practice family medicine and OMM, I want to start giving back to the community where I started my medical education, Touro University – Mare Island. Touro is located in Vallejo, one of the most impoverished cities in California. The city lacks resources and money to provide an adequate police force and education system. As our university has become more established over the past ten years, we have increased the number of colleges and the diverse variety of students and professionals in Vallejo proper. I want to utilize the minds and energy of these eager students and professionals to create a space in Vallejo that promotes the health and overall wellbeing of underserved individuals.

My plan is to recruit public health volunteers, medical students, pharmacy students, and a team of rotating physicians who can dedicate four hours each night of the work week to seeing clients in a free community clinic. The goal will be to teach clients about health maintenance, give referrals, and connect them with local resources. The community center will provide programs that reinforce the six areas of wellness, which are physical, mental, spiritual, occupational, social, and intellectual. We can create space for a communal kitchen with dinner served each day, community member-lead yoga and exercise classes, an OMT clinic run by Touro Students, health education workshops, peer facilitated support groups, and meditation classes. This community project can become a reality with grants, fundraising, and dedication by the Touro University and Vallejo community. We have already established a facility for a free clinic this year. I look forward to the creation of a supportive center in Vallejo that can successfully promote preventive health practices among the entire community.

Just as the human body is a unit, each part working to maintain homeostasis, so are our communities. I believe I can help the citizens of Vallejo realize their unique roles in the greater health of the community, and reinforce their capacity to heal through education and preventative action. As our community center gains momentum, the idea can be passed along and implemented in many other rural cities. It will be the highest honor to dedicate the rest of my life to helping patients and their communities realize their healing potential.

“A doctor’s mission should not be just to prevent death, but to improve the quality of life. That’s why when you treat a disease, you win, you lose, but when you treat a person, I guarantee you win, no matter what the outcome.”
- Dr. Patch Adams

The picture above was painted by Alex Grey, a favorite artist of many of my professors and physicians around the world.

Your Thoughts Become Your Destiny

Watch your thoughts; they become words.

Watch your words; they become actions.

Watch your actions; they become habits.

Watch your habits; they become character.

Watch your character; it becomes your destiny.

Healer, ground and protect thyself.

In the art of helping patients heal, we must connect and synchronize with our patients. This puts us in a very vulnerable state. If we do not know how to properly ground and protect ourselves, we can potentially take on the dysfunctional patterns that exist in our patients. I'll give an example- when you help a patient release the energy built up in a tight muscle, that stored energy becomes kinetic and moves out of the body. Some energy is also lost as heat. Where else might that energy go? Into you, the physician. What kind of energy is it? Charges, emotions, it varies from patient to patient. But honestly, how long will you last if you have no protection against that energy, or grounding to help you center and realize the potency of your own healing mechanism?

There's something to note about the ALS researcher who ends up dying of ALS, and the motor accident researcher who dies in a car accident. A life's passion could consume a person so much that it ends up being the device of her demise. Grounding and protection is the only way to explore that passion and creative energy without letting something in that could potentially weaken or destroy the spirit.

Grounding- imagining there is a solid connection between you and the center of the earth. A tether, going from your core, to the earth's core.

Protection- a filter through which only the things on your frequency can pass through. Everything else bounces off and is not integrated into your persona/spirit.

I have to work on this a little bit every day. Hopefully I can become strong enough to have a long, healthy career empowering patients with the ability to realize their healing potential.

I have one month until step 1 of my boards! Time is ticking but I am trying to stay motivated, focused, clear-headed, and calm. I now have the ability to get 7-8 hours of sleep every night, exercise for at least 20 minutes every day, and spend evenings with the bf, so I am overall feeling more healthy and happy. Please keep me in your thoughts and wish me success :)

After boards, Walter and I are staying at a B&B in Napa, and then I'm off to Chicago for SOMA Convention and to visit with my sister, Jer, Ty, and the Ander family. Then, July 19--- General Surgery!

"Marching Bands Of Manhattan"

If I could open my arms
And span the length of the isle of Manhattan,
I'd bring it to where you are
Making a lake of the East River and Hudson
If I could open my mouth
Wide enough for a marching band to march out
They would make your name sing
And bend through alleys and bounce off all the buildings.

I wish we could open our eyes
To see in all directions at the same time
Oh what a beautiful view
If you were never aware of what was around you
And it is true what you said
That I live like a hermit in my own head
But when the sun shines again
I'll pull the curtains and blinds to let the light in.

Sorrow drips into your heart through a pinhole
Just like a faucet that leaks and there is comfort in the sound
But while you debate half empty or half full
It slowly rises, your love is gonna drown [4x]

Your love is gonna drown [4x]
Your love is gonna...

Say what you need to Say

Take all of your wasted honor
Every little past frustration
Take all of your so-called problems,
Better put 'em in quotations

Say what you need to say [x8]

Walking like a one man army
Fighting with the shadows in your head
Living out the same old moment
Knowing you'd be better off instead,
If you could only . . .

Say what you need to say [x8]

Have no fear for giving in
Have no fear for giving over
You'd better know that in the end
Its better to say too much
Then never say what you need to say again

Even if your hands are shaking
And your faith is broken
Even as the eyes are closing
Do it with a heart wide open

Say what you need to say [x24]

John Mayer

The Value of Time

Every Sunday, I get an E-mail from Rabbi Kalman Packouz (Aish.com) on insights to life, personal growth, and the Torah. I love this E-mail because there is always great advice and sayings from famous Rabbis of the past, and there's usually a very clear interpretation of what we're reading in the Torah each week. Its silly, but I also like the way each E-mail starts with, "GOOD MORNING!" I usually wake up on Sundays feeling a little dull because I know I have 8-10 hours of studying ahead of me, but when I read that "GOOD MORNING!" I really do feel like its going to be a good morning- it just makes me smile.

Anyway- to the point-

Today's E-mail was about the value of time. Rabbi says, "The Torah teaches us to value time. Every moment is precious. Every moment a person can do good, perfect his character, make the world a better place. The Almighty gives us a limited amount of time and it is up to us to make the most of it."

Then he included this quote by anonymous:

"Imagine there is a bank that credits your account each morning with $86,400. It carries over no balance from day to day. Every evening deletes whatever part of the balance you failed to use during the day. What would you do? Draw out every cent, of course!

"Each of us has such a bank. Its name is TIME. Every morning, it credits you with 86,400 seconds. Every night it writes off, as lost, whatever of this you have failed to invest to good purpose. It carries over no balance. It allows no overdraft. Each day it opens a new account for you. Each night it burns the remains of the day. If you fail to use the day's deposits, the loss is yours. There is no going back. There is no drawing against the "tomorrow." You must live in the present on today's deposits. Invest it so as to get from it the utmost in health, happiness and success! The clock is running. Make the most of today!"

I read something similar to this in the Tibetan Book of Living in Dying- about the value of time. This prompted me to think about my propensity towards distraction, sometimes visiting addicting websites like facebook instead of studying. It all starts with a break- thinking that I have studied for a good 1-2hrs, and now I need a short 10-minute breather before I move on. So I visit facebook and then 30 MINUTES LATER I realize that I am way distracted and off track! Then I think about the idea of using each second to the fullest, and I try to restart my studying engine. It is harder to get back on track after visiting distracting websites- you have to buckle down and get in the study mode again, which takes up valuable time. Instead of being angry at myself for falling victim to the internet, I just need to think, "OK, this world is distracting, and for a moment I allowed myself to get off track, but now I am going to click that red dot at the upper left hand corner of the browser window and get back to work." Sure, I am allowed to have breaks, but that's what stretching, JAMA, and going outside is for. Oh I guess I need to eat, sleep shower, and exercise, too right? Can't forget about that stuff or I am guessing I will have to worry about others being angry at me even more than me being angry at me :)

Hope you can take something from the quotes about time that I pasted above, and feel free to share anything in the comments about your efforts to live each second to the fullest. Thanks for reading.

Rotations!

We got our 3rd year rotations schedule yesterday. Got my 3rd choice, so I can't complain. I still have to work out a few kinks, but thats what is great about the bay area traveling schedule- very flexible from what I have seen thus far.

General Surgery - San Pablo
OMM/NMM - Eureka
Pediatrics - Hopefully Eureka
Ob/Gyn - ARMC in Colton
General Surgery - San Pablo
Elective TBD
Psychiatry - Stockton
Family Medicine - San Pablo
Internal Medicine - San Pablo
Family Medicine - Glenn Cove

Once, when I was still a student, your heart leapt up to meet me
and thrilled against my palm. I'd read about this
but never guessed how it would feel like a kiss,
like a hummingbird beating against the cage of your ribs.
Rheumatic fever, 14 years old. Congestive heart failure.
You were not my only, but you were my first, and Moses
I want you to know: part of me is still standing there,
my hand on your heart like a promise
your name in my throat like a stone.
I scribbled that you were "decompensating"
-because we never say patients are dying,
because we are cowards, because
we are human, because
all of our hearts betray us.

Sarah Leeper
JAMA April 7, 2010

Cytomegalovirus. This is the coolest virus because A) It has "mega" in its name B) Its watching you.... with its owl eyes :) C) It remains asymptomatic in 80% of the population, so it infects with out you ever even knowing its there and then stays for life to cause problems later on. Ah, viruses, the cause of mucho anguish and controversy!

Love

The Line

"The partition separating life from death is so tenuous. The unbelievable fragility of our organism suggests a vision on screen: a kind of mist condenses itself into a human shape, lasts a moment and scatters." Czeslaw Milosz (1911-2004)

I found this quote in the March 10, 2010 issue of the Journal of the American Medical Association (JAMA). When I read this, I immediately thought of a poem my friend Asher wrote. Asher truly understood the impermanence of life, and was not scared by it. In fact, the only fear he ever had was leaving his loved ones behind to handle the grief of his death. Asher loved everyone and everything in his life unconditionally. He understood that life is a beautiful tragedy- with moments of profound beauty, moments of profound ugliness, and everything in between. He taught me that all moments should be appreciated to the same degree, as they all teach us lessons. Sometimes, the only thought that can get me through loss or profound hardship is the idea that my heart ache will lead me to wisdom.

In January, right before spring semester started, I picked up The Tibetan Book of Living and Dying. It had been sitting on my "fun reading" book shelf collecting dust for the past year and a half. I only had time to read excerpts of it, and I think one of my favorite parts was when Sogyal Rinpoche talked about acceptance of impermanence- the idea that everything is always changing, and that makes change the only constant in life.

Thursday, April 15, 2004 8:01 PM

As I Stand In The Rain
By: Asher Sirkin

Rain drops hang
Off moon lit branches
And sparkle like diamonds
As if magnifying that spark
That passion and life
Flowing from every leaf
And every other living thing.

A manifestation
Of the overwhelming emotion
Once suppressed
Hanging in the air
Lingering
Waiting
For a release...

I watch them hang there
Twinkling
Slowly losing their grip
And falling to the pavement
To join their fallen brothers
In a collective pool beneath my feet.

How clearly they reflect
The clouds hanging above
Embracing the earth
As they shed their tears
Of longing to be more
Than puffs of smoke and dust

The night is full of borrowed life
The moon pretends to shine
But it is only pretending
Acting out the part of a star
With a costume it borrowed
From the sun as it slept

And I stand here
A witness to this masquerade
And soaking somewhere in the middle
Between the sky and the ground
Just staring at this tree
Giving rest
To those shining clear
Pellets of water

As they make their journey
From their birth in the clouds
To their destination
Beneath my feet

To me, this poem is about the beauty of impermanence- said beautifully by my amazing friend Asher Sirkin, who taught me what it means to breathe. Asher spent his life healing others, and continues to do so through this forever cascading ripples on man kind.

I read in the Tibetan Book that the key to finding a happy balance in modern lives is simplicity. "Our task is to strike a balance, to find a middle way, to learn not to overstretch ourselves with extraneous activities and preoccupations, but to simplify our lives more and more." And perhaps this will give us more time to pursue spirituality and knowledge, and magnify the human experience. Less is more, quality over quantity. Live today doing the things you would do if you were given 3 months to live. As Lee Lipsenthal MD asked us in lecture this Monday, "Is today a good day to die?" All of this thinking about impermanence and simplicity, and living a meaningful life has inspired me to start drafting my bucket list. Its still in the works, but here is the start, with items in no particular order...

Strive to live the kind of life which will lead to no regrets.
Rise above diffusion of responsibility.
Spread as many positive ripples on humanity that I can.
Travel and see the world.
Get married and have children.
Spend lots of time with family.
Become a compassionate and competent physician.
Help people find the healers and teachers within themselves.
Embrace change and impermanence.

If I managed to hold your attention up until this point, thank you for reading- and I encourage you to think about your bucket list, get started on it, and think about what it means to live a simple life.

Foundation

"I am simply trying to teach you what you are; to get you to realize your right to health, and when you see the cures wrought here, after all other means have failed, you can but know that the foundation of my work is laid on Nature's rock." AT Still, Autobiography p. 288

I will teach my my patients how to facilitate their own healing. My hope is that they can find a safe, loving, non-judgmental space in which to heal.

Back to the books- block II exams start on Monday!

You are elected AOA President. What would be your platform; and how would you proceed to achieve the core priorities of your platform?

As your president, I will see to it that we affect real change in our osteopathic community, while improving the integrity of our profession. This change must come from the AOA, our nation-wide community of physicians, pre and post graduate medical education systems, and our students.

We in the AOA must collaborate with other osteopathic leaders, such as OPSC, to make sure our profession maintains osteopathic autonomy in the medical community. The recent merger of the Naturopathic Medicine Committee into the Osteopathic Medical Board of California (OMBC) is an example of the work we have to do to educate leaders of our country about osteopathic medicine. ABX420 was signed into law as part of the “urgent” budget process as of October 23, 2009, and allows naturopaths to sit in judgment over osteopathic physicians who come before the licensure board. In California, naturopaths are not trained clinically, cannot prescribe medications independently, and cannot perform surgery. The California state legislature saw osteopathic physicians equivalent to naturopaths, and it did not cross their minds that this kind of merger would possibly endanger patient safety. Part of my solution to this is to hold DO Day Nation-wide this year.

I am holding a meeting with the AOA leadership this month to plan our next DO Day effort, which will target the capitol of each state. We can educate state governments about osteopathic medicine and our role in health care reform. The state governments should know that osteopathic physicians are living advocates of more cost effective, preventative, and high quality health care. We will indicate the trends; osteopathic physicians are less likely to perform expensive procedures and more likely to treat the whole person by looking at the root of the problem. Osteopathic medicine effectively helps prevent chronic diseases like diabetes; the management of which comprises a significant amount of the health cost in this country. We will advocate that as we are physicians, it is important that we maintain our autonomy in licensing, practice, and legislative influence. We will ask for their support in our advocacy against ABX420. Our visit may even convince them find osteopathic physicians to care for their families.

In our political efforts, we will increase collaboration with the AAO to make sure that in our actions and advocacy, we have osteopathic principles and practice at heart. We will focus on the osteopathic core principles while educating politicians and the public about our profession. Osteopathic manipulative medicine sets our profession apart from allopathic medicine, and we need to show the public that this approach is beneficial for a population with increasing chronic health problems.

And finally, we cannot hope to maintain our autonomy as a profession or educate the public about osteopathic medicine unless we start with osteopathic medical education. We must make it easier for our schools to provide the best quality OMM education necessary so that future osteopathic physicians feel comfortable treating their patients with OMT. We can do this by increasing the amount of student fellowship positions at each school to one fellow per twenty students. Students will be able to get the personal attention they need with this increase in faculty. In addition to increasing numbers, we need to increase the quality of OMM knowledge with which we teach our students the theories behind osteopathic diagnosis and treatment. OMM faculty and fellows should be well versed in current osteopathic research to back the techniques they teach, and there should be an increase in OMM research efforts. We will provide grants to schools for faculty to initiate preliminary studies with their fellows and medical students. We will invest in a research-consulting firm to work with our principle investigators on maximizing the scientific validity of their studies. We need to produce more DO’s who use OMM in order for us to get the national recognition that we deserve, and we need to prove that our techniques produce real, reliable results.

I would also like to draft an equality resolution that indicates that the AOA is in support of equal opportunity for osteopathic physicians and students regardless of gender and sexual preferences.

Osteopathic physicians provide health care consistent with the needs of the average American family. We will propagate this message by advocating maintenance of our autonomy in the health care field, reinforcing the core principles in our osteopathic medical schools, and by increasing efforts to conduct scientifically sound osteopathic research. As your president, I will do everything in my power to help achieve these goals during my term. Thank you.

Given extensive resources, how would you realistically and effectively promote osteopathic medicine and the D.O. profession?

National osteopathic leadership, practicing osteopathic physicians, and medical students need to work together to effectively promote the osteopathic profession in our predominantly allopathic medical community. For several years, the AOA has tried an awareness campaign, and has invested money in opening up more schools. These efforts have not significantly improved public knowledge of our profession. If we change gears from expansion to quality improvement, we will increase opportunities for students to reach their full potential. When improvements are made to our educational system, quality osteopathic physicians will be the result, and our profession will thrive.

Let’s first start with improvement of our existing educational institutions. Increasing the quality of didactic and practical education during the first two years starts with investing in greater basic science material presentation. Each osteopathic school should be given the tools to start a summer program for the incoming class, where students can begin their biochemistry, genetics, and embryology curriculum. The same professors who teach this course should be recruited to teach these subjects during the school year. This thorough coverage of basic science should set precedence for the importance of mastering this material, and will boost board scores. OMM curriculum taught at each osteopathic school should be more standardized, so that the students at all schools are learning the same core techniques. Lab sessions can cover more than the basic techniques, but each school should be required to cover muscle energy, counter-strain, soft tissue, HVLA, facilitated positional release, ligamentous articular release, myofascial, and cranial osteopathy in depth. Coverage of these crucial techniques will give each osteopathic student an opportunity to determine what they want to practice on rotations and ultimately, which tools they prefer to use when treating patients.

Changes in the curriculum are essential to improving osteopathic medicine, but we also need to carefully screen the students who are accepted into osteopathic medical school. Each applicant should be carefully assessed to determine if he or she is truly open to osteopathic manipulation, and not just looking at osteopathic medicine as a backup. Each school should require their applicants to shadow osteopathic physicians, instead of just recommending it. Schools should recruit applicants who are interested in practicing rural primary care, as these people are likely to fill residency spots in rural areas, where there is high demand for health care of underserved communities.

In addition to ensuring dedicated applicants are chosen, and improving the first and second year education, we should invest in more clerkship opportunities for our third and fourth year students. Rotation opportunities should be expanded on the west coast and in major cities that have primarily MD residencies. The AOA and COCA should invest in a task force to prevent other schools from buying out osteopathic rotation slots.

In big cities, competitive allopathic primary care residency opportunities are continually increasing for osteopathic students as fewer allopathic students are choosing primary care. We need to give our DO students the tools to be accepted into these programs. When the best and brightest osteopathic students break barriers and start training at these powerhouse programs, the survival and growth of osteopathic medicine will be ensured. Expansion and improvement of Osteopathic Graduate Medical Education opportunities starts with education of the hospitals about what we do. One idea to better educate hospitals about OMM is to help them see it in action, and observe the real results. The AOA and AAO could help osteopathic graduates who enter allopathic programs open OMM Clinics in their respective hospitals.

Practicing osteopathic physicians nation wide can also help promote our profession by performing community outreach and service. CME credits and additional incentives should be provided for their effort. The goal would be to influence consumer choices and towards preventive, quality-based medicine. Physicians should be encouraged to become involved in city council and town hall events to expand knowledge in their respective communities.

Rather than advertizing through commercials and expanding in number, we should focus on improving the quality of physicians who enter the osteopathic profession, and increasing opportunities for osteopathic students to practice in the allopathic health care system. By improving osteopathic educational opportunities at our existing schools, infiltrating allopathic hospitals, and advocating at the community level, we can promote the values of osteopathic medicine to reach more people than ever before.

February 14, 2010: I'm waking up today.

Being a first year osteopathic medical student was wonderful and difficult. At first, I had a hard time with the life-style changes and the pace of class. The drinking from a fire hydrant analogy really does it descriptive justice. I was able to get through each day and feel satisfied with my work just by putting in my best effort. When I was having a bad day, I could just put myself on coasting mode until the next day. I had the excitement of knowing that I was finally heading down the path that would lead to me becoming a doctor, living my dream.

The second year of medical school has proved to be quite different. After an amazing summer filled with travel, family, and friends, I stepped back on campus to find that I was needed for my mentorship- by the first years and pre-meds. Now I find that coasting mode is not an option, because there just isn't enough time in the day for it. I have to study for classes and block exams, rapidly increase the amount of time I study for boards each day (I take step 1 in June), think more seriously about what field I want to go in to, research rotations, maintain my extra curricular activities (president of a club, and in charge of a group that volunteers at a clinic), etc! To top that off, I really want to have some time to relax, work out, eat well, and be a good girlfriend.

When I applied to osteopathic medical school, I knew that starting down this path would not be easy. I had two goals in life: #1 Teach people how to heal themselves and #2 Be a good person. There is no doubt that medical school will help me with #1, but if I don't figure out a way to be less distracted and chaotic, I am afraid that I will lose track of #2. I really like to try to live in the moment and life one day at a time, but at this point in my career there is still so much to plan for... and of course that is very anxiety provoking.

What lies ahead for me? I have two blocks left to take at school, followed by my board exams, which I am still scheduling. I have not yet completed the USMLE scheduling process. I am taking my COMLEX, the osteopathic step 1, on June 18th. I will be passing on my leadership positions at school to first years, and possibly taking on a National SOMA leadership position. I will start my 3rd year rotations on June 21st in the bay area and Eureka/Humboldt area, and I will start studying for step 2 shortly after. I'll schedule my 4th year rotations, including my showcase/audition rotations, take step 2, and then start my 4th year. Hopefully I will finish my showcasing rotations by December of my 4th year. Then the matches happen for residencies! I'll match into residency, take my step 3, graduate, and start my residency. By that time I'll be almost 28 years old.

I don't think anyone is going to read my blog, but I am going to keep it up- its a great exercise for me and who knows, it just might help someone.

Namaste

Robyn