Spirituality in Medicine

I had the utmost pleasure to go out of town a week ago, to an American Medical Student Association conference entitled Spirituality in Medicine, in the gorgeous mountains of Santa Cruz, CA. There were students from all over the county, and we spent the weekend talking about how spirituality plays an important part of a person's health, what our own spirituality was, and how to talk to patients about their spirituality. We had some amazing speakers - physicians who shared their personal spiritual journeys with us, and more importantly, how they incorporated their beliefs into their daily practices.

The weekend turned out to be the best retreat I have ever gone to (OK, maybe not as good as my yoga cruise to the Western Caribbean, but nothing can beat that...). The weekend was opened and closed by a native Chief who did the most powerful ceremonies that I have ever experienced, and that's after having spent the last ten years of my life doing native ceremonies.

The weekend succeeded in many things -

1. It totally recharged my battery. Being in a cabin in the redwood forests, with the sun shining all weekend, and a view of the ocean near by, and the glitter of stars visible at night, all this and more filled me with an incredible amount of energy and enthusiasm.

2. It reminded me who I am, and more importantly, that I already have the tools to make spirituality a part of my daily life. And furthermore, it's using these tools that will make my journey through medical school easier and more enjoyable.

3. I do not have to split my spirit and my mind to go to medical school, nor to become a physician. I don't have to pretend to be someone else! I can practice my spirituality while I am practicing medicine, and that for me, that is what medicine is all about in the first place.

For those that know me well, you are probably thinking, duh Valerie you already knew all that. But the weekend in the mountains solidified it for me in a way that has never occurred before. Maybe it was because I heard it all for the thousandth time, or maybe it was the call of the hawk, the beating of the native's drum, or the sunshine that turned the key for me. I've got it!

I came back from the retreat, not abhorring the thought of returning to my hectic life, but excited to walk the walk - to take my sense of calmness and clearness, and joy, into my daily life. So far so good! In fact, here is a grand piece of irony, or maybe just a grand piece of truth. The week following my retreat happened to be one of the most stressful weeks that we have experienced in med school so far. There were intense back to back assignments, and expectations for us, and you could see the unhappiness and stress just spilling out of every one's hearts. For me, just filled up with the energy of the retreat, I was so happy and grateful and optimistic (Yes I bet my classmates couldn't stand me). But here's the irony. After spending a weekend not studying, right before a big exam, and other things to get done, I actually did great! I did better on my exams than before, and the whole week was not very stressful for me.

You see, there is some truth to the belief that even though you cannot control the externals of your life (I cannot change the expectations that will pile on me in the next 7 years), but I CAN change my reaction to it. Once more I come back to what my friend Tiffany said to me in the beginning of the year, to not fight it, to go with the flow of the journey, to dive below the turbulent waves, and to come out refreshed and energized. Ho.

The Breakfast Club

I wish that you all could see the stack of books I've bought since September, as well as the stack of syllabi for the two classes I have survived; all together they come up to my waist, and I'm only half way through the first year! Gross Anatomy, Imaging, and Embryology is behind me, as well as Cell Structure and Function, which is also known as CSF by all of us students - another part of the new language we have adopted in this foreign realm of medical school. It's not unusual to pass by a student in the hallway and hear them say, "Yah, I'm so happy that SCF is over, but I wish that it was as easy as GIE was, and thank GOD SPH will be better, although we have that darn SRP to do and I need to finish my application for OCTRI for that summer OSLER grant!"

The day after CSF ended I received an email from the director of the class stating that I had missed 8 out of 12 small group discussions, and that even though I had gotten a satisfactory in the class, as far as he was concerned, I had not participated fully in the class. Because the small groups were student run, and because most of the rest of the class did attend all the small groups, my behavior was unprofessional. He was letting the Dean's office and the Progress Board know of my absences, and that my decision to not attend would have unintended consequences.

Can you imagine my surprise when I opened this email? A brief moment of panic set it, and then I called my fellow students in crime, the five of us who don't attend class regularly. They all got the same email, verbatim, with only the name changed. We all forwarded the email to the Dean's office with questions regarding the threatened "unintended consequences" and a few of us responded to the director of the class to explain that our absences were not due to laziness or lack of studying the material discussed, but rather, to make more effective use of our limited time to learn the vast amounts of information presented to us in CSF.

The director responded to my email, stating that it wasn't all about me, that I could not pick and choose the parts of the curriculum that worked for my learning style. He assured me that my classmates noticed my absences, and that I missed educational opportunities that could not be compensated for by studying at home by myself. More importantly, I got a call from the Assistant Dean (on Saturday night!), assuring me that it was not going on my "record" and that it was not unprofessional to have missed these small groups. We agreed that it was a communication misunderstanding, since in the syllabus it stated the small groups were worth 1% of our grade, and no where did it say that they were mandatory. I chose to forgo that 1% in order to preserve my sense of sanity, which is in a precarious balance these days.

One my fellow other derelicts wondered if we were all going to get a Saturday detention, solidifying the notion of our group as the breakfast club. You remember that 80's movie and the theme song....."Don't you forget about me, Don't Don't Don't Don't, Don't you forget about me..." That's us all right, going against the norm, getting in trouble, but at least weren't not smoking pot in the OHSU library.

So with this heavy on my mind, I started the first day of the next class, Systems Processes and Homeostasis, (remember, after an exam, there is no break; you go to your student mailbox and heft out the next three inch deep syllabus that you know you will only have eight or ten days to learn), and decided to go to at least some of the lectures. In addition to feeling chastised, I also realized that I am lonely studying by myself all day at home. So I went to all the lectures, with vigor and excitement, being greeted with smiles from the many classmates that I haven't seen very much. The new class, SPH, is very different from the other two classes in that it is more conceptual. We can no longer just memorize enzymes or body parts, we have to understand how the systems in the body work, right down to the molecular level. Great! Finally something that seems more relevant to the future clinical aspects of actually taking care of patients and managing their diseases.

The bubble popped when I failed the quiz we had on Thursday, and when I had to study 24 hours this past weekend in order to read all the information required to understand the material for the exam we had this morning. Darn it! I had to learn the hard way, again, that there is no time for me to go to lecture when I learn better from reading than from listening. In a perfect world, I would do both; but I am not superwoman, and I should learn to follow the advice of second and third year students in med school - learn what works and keep doing it.

So I am back to studying alone starting tomorrow morning, diving into the cardiovascular system. Last night, before falling asleep with goo goobs of medical information swimming around my brain, I had, for the very first time, the feeling that I do not like what I am doing. My life is so out of balance, and I study so hard to just pass! I wish it was that easy to let go of my inherent perfectionism. I know intellectually that I cannot possible know it all, and furthermore, that I don't need to know it all in order to be a great doctor, but I just can't switch off that emotional switch. That nagging little voice that says "You are not good enough if you don't get Honors." I thought that I had destroyed that button years ago, but there it is, lurking in the back of my mind, to rear it's ugly head after I get an average grade in exchange for phenomenal effort.

So my dear friends and family, I am asking you to become part of my "breakfast club". To keep me in your mind, to send me positive thoughts and encouragement, to counteract that negative committee in my head. Call out my name when you walk by, and don't forget about me!

Healer's Art

Last week I started an elective class called the Healer's Art. It is a class created by a physician Dr. Rachel Remen, who wrote a wonderful book, "Kitchen Table Wisdom." This book of incredibly moving short stories was of the few encouragements I had when choosing to enter medical school. It gave me hope that there would be a place for someone like me, someone with a big heart and strong desire to help those in need.

Dr. Remen started her classes first for burned out physicians. She discovered what she calls the "doctor's dilemna". The force or spirit of service that inspires students to enter the medical profession is slowly over time squeezed out, so that physicians no longer remember who they are, and why they had choosen a profession that left them so tired and unfulfilled. After teaching the class to physicians for many years, she started teaching it to students at medical schools as a sort of "immunization" - a way to learn how to NOT get burned out, how to NOT forget the connection to that internal spirit that drove us here in the first place.

I am delighted that OHSU is one of 50 or so medical schools (out of the 126 in the US) that offer this elective. It is so refeshing to be surrounded by others students who have the same concerns that I do - that the process of learning in medical school, and the incredible demands of the profession, will turn us into negative, cynical physicians. It reminds me of a quote I heard on NPR many many years ago, that stated the results of a study of third year medical school students. 75% said if they knew what it was going to be like, they wouldn't have gone to medical school, but that it was too late to turn back. I remember at the time thinking, I bet I wouldn't be one of those students.

And, so far, I am not. I still feel like this is absolutely the right path for me, and there is nothing else I'd rather be doing. I have worked towards this goal for so long, and had so much time to do other things, that I am here, in body and spirit, 100%. My whole life is focused on how to learn what I need to learn, in a balanced way so that I can retain my sense of individuality. In the Healer's Art class we were reminded by one of the physician's leading the class, that our patients' want us to be a witness to their journeys. Yes, they want us to be competant, but just as importantly, they want us to listen to their stories, to learn from them, and to be human.