Beginning my LCE

(journal entry from September 2, 2008)

Tomorrow I begin my Longitudinal Clinical Experience with a doctor in private practice at a clinic in west Phoenix. This particular doctor was high on my ranking list of possible preceptors, and I’m really glad that I was assigned to work with her. I put a great deal of thought into my ranking of the possible LCE clinicians, and I was drawn to this lady for a number of reasons. For one, her list of hobbies includes "ensuring quality sleep, finding balance between home vs. office, family vs. patients, me vs. the world," which by its own merit makes her shadow-worthy in my book. I hope to learn from her ways in which a physician can work to nurture both her personal life and her practice. She also works in a low-income neighborhood, which appeals to me since my professional interests are in the healthcare of underserved populations as well. Though she is currently in family practice, this doctor worked for several years in obstetrics/gynecology. My specialization interests are split between family practice and ob-gyn, so I hope to discuss with her the intricacies of both fields.

My biggest concern at this point is my knowledge (or lack thereof) of medical Spanish. Apparently Spanish is the primary language spoken by patients at this clinic. I love the language and can understand it with moderate alacrity, but explaining medical conditions in Spanish is another matter entirely! Basically, worst case scenario I envision myself trapped without an interpreter in an exam room trying to ascertain the 7 cardinal symptoms from a Spanish-speaking patient, tripping over my tongue and saying things like "you sit bad when you throw your cabbage" instead of "does it hurt when you turn your head?" I did some independent studying of the language over the summer, but as soon as school started with all of its concrete, tangible deadlines, the little bit of self-discipline I had was lost in a hurry. I anticipate that the learning curve will be pretty steep. In the long-run, I think this sort of forced immersion will be beneficial in helping me solidify language skills that I've been wanting to improve for quite some time now. There may just be some awkward encounters in the interim…

I am interested to see if there will be any socio-economic or racial barriers between me and the patients I interact with. I am part of a church that meets in a low-income area of South Phoenix, and I’ve been working with the teenagers in the church for several months now. They constantly highlight the racial and socio-economic barriers that separate them from me. (These are barriers that I have been laboring to break down. Yes, it is possible for a white person to have rhythm, and, far from being affluent, I am merely a student who gets hand-me-down clothes and whose net worth is currently around -$25,000.) I don't need to explain how these perceived divides create barriers to communication. My youth kids don't fully share their struggles with me because I "just wouldn't understand." I wonder if these sorts of barriers will translate to the clinic in West Phoenix, where I am again trying to gain the trust of people from a background different than my own. Will my patients will feel comfortable talking with me at ease, or will they withhold critical information because of a perceived divide? My experiences with the kids at my church lead me to believe that communication and friendship is possible; it just takes patience and time.

My hope is that through my longitudinal clinical experience I will be able to reinforce material covered in doctoring and other classes. I hope that I will be able to connect with my patients, hear their concerns, process what they tell me, infer what they do not tell me, and diagnose their ailments. I hope that I will receive guidance, patient critique, and encouragement from my attending physician. Above all, I hope that I will learn - how to speak, how to listen and how to understand.

Reflections on Clinical Anatomy

(journal entry from September 2nd, 2008)

Unnatural. The first word to cross my mind when we opened up the body bag on our first day of anatomy and saw the body of a woman cut from neck to naval was "unnatural." The aberrancy of the scene was worsened by the natural position of her body - she was lying off-center and had one knee slightly popped, with her hands resting palm-down at her sides. This was not the sterile picture of a cadaver that I had seen in text books. This was a woman who was dead and was lying with readily exposable organs in front of me.

Though the initial image was strikingly unnerving, after the initial shock wore off and we began to examine her internal organs I was more or less undisturbed. Before coming to lab on that first day I had tried to mentally prepare myself and put into perspective what I would be seeing and doing. On one hand, one could describe the ritual of anatomy lab as being grotesque. Students with little to no knowledge of the location of bodily organs try to gain an appreciation for said organs by burrowing elbow-deep in the innards of a complete stranger. One could also appreciate anatomy lab from a much more positive angle. In an indescribable act of altruism, 8 men and women donated their very bodies and thus gave all that they could in a profound, post-mortem way to further the education of 48 medical students who will one day improve the lives of the donors' children and their children's children. I had decided to take the latter of the two outlooks, and so as we reflected our donor's thoracic cage to expose the organs underneath, and as I picked up the towel laid across our donor’s head to peer at her face, I remembered and thanked God for her gift.

I’ve really enjoyed my time in the anatomy thus far. The internal structure of the body is something I’ve wanted to understand for years now. I love learning how things fit together to create a bigger picture, and I’ve always seen the body as a sort of a puzzle or black box; food goes in, life comes out. It is truly satisfying to unveil the mystery and see how intricately interwoven and meticulously designed our bodies are.

My Calling

August 31, 2008

I didn't always want to be a doctor. Plenty of medical students recount early medical ambitions, citing experiences they had playing doctor with dolls as patients, experiences with family illness, etc. When I was young I wanted to be an actress. I spent my formative teen years seeking an agent, not volunteering in a hospital. At sixteen years of age I had not one Oscar award to my name (or even an agent for that matter), and I decided to rethink my life ambitions. I was good at math and problem-solving, and I really liked biology. All signs pointed to bioengineering, and my aim shifted from Hollywood to the University of Pennsylvania School of Engineering and Applied Sciences. I matriculated at Penn in September 2001 excited about my field of study and with lofty research ambitions. For my first year and a half as an undergrad medical school wasn't really on the radar. I hoped to finish my degree, move to a hub of bioengineering research (San Fran or San Diego - my eyes were again fixed on California) and work to improve the field of tissue engineering.

My change of heart was catalyzed by a very specific event. It was the spring of my sophomore year, and I was at an evening panel discussion called the Global Persecution Forum. The panel members were people from other countries (mostly in Africa and Asia) who had been severely persecuted for their spiritual beliefs. I listened in shock as these men and women recounted being tortured by captors. They had been burned with hot oil; they had seen children in their communities executed. These people didn't do anything to warrant such treatment. For perhaps the first time in my relatively sheltered life, I was confronted by injustice in all its ugliness.

I spent the rest of that evening and the entire next day feeling numb. My mind was overwhelmed with questions like "why them and not me?" and "what can I do?" My worldview had been shattered, my worldview had been awakened, and I did not want to do bench-work anymore. I thought long and hard about my former goals and how they fit into my newly developing priorities. This was the first time that the idea of becoming a physician ever seriously lingered in my mind. I realized that as a physician I could still utilize the strengths that led me to engineering: proficiency in math and the sciences and a love for analytical problem-solving. I would also be able to exercise another of my strengths: compassion. As a physician I could work to comfort, to restore and to heal those who are broken.

The next week I met with a pre-professional studies advisor on campus and learned that as second-year biomedical engineering student I could still fulfill all of my pre-medical requirements. Thus began my five and a half-year journey to medical school. The path was not without trial, and there were certainly instances along the way that made me question my medical school ambitions. In fact, the first time I applied to medical school I was not admitted. Though a disappointment, the news was really a blessing in disguise. The extra year "off" gave me opportunity to leave my corporate job and volunteer with Mercy Ships International, a floating hospital ship that provides free surgeries in countries with little to no healthcare infrastructure. My time working in Liberia on the Africa Mercy (Mercy Ships' vessel in W. Africa) re-sensitized my heart to the suffering of my distant neighbors after years of living in warm apartments with a wardrobe and a balanced diet had allowed me to grow somewhat complacent. In Liberia I participated in the post-operative care of a 12 year old girl named Elizabeth who had been previously unable to seek medical attention for the burn injury that left her unable to use her left hand for 9 years; I befriended a 21 year old woman named Betty who had suffered for 3 years from a vesico-vaginal fistula; I prayed with women who were being unjustly held at the Monrovia Central Prison without due cause or the promise of a trial. While I worked on the Africa Mercy and waited to undergo my second attempt at med school interviews I realized that I was made to serve. Whether as a physician or a professional blanket-giver or whatever, I resolved to dedicate myself to the amelioration of suffering. I was overjoyed when I learned of my admission to the UofA this past March; I am going to serve as a doctor.

…So this is what I bring to the table. I bring the mind of an engineer - a mind that loves analytical problem-solving and enjoys discovering all of the interwoven intricacies that allow our bodies to function together as whole, interdependent units. I also bring a deep compassion and an unquenchable resolve to help - in whatever way I can - right wrongs done by this world and to this world. I anticipate challenges, I anticipate discouragement, and I anticipate feelings of self-doubt. But I will be prepared for adversity; my roots are deeply planted in my faith, an enduring source of strength, and I have hope. Medicine is what I love. This is my calling.

I started med school! ...three months ago

I know. I fell off the face of the earth.

Not really; I've just been trying to get into my student groove, and that takes a lot of time. I love medical school!! It's a lot of work, but it's so interesting and vibrant! I prefer being busy to being unemployed and bored. I've never been one for channel surfing anyway. Studying till I crash is much more my style.

As part of my curriculum I've been keeping a medical school journal. I'm going to try to post my entries periodically to highlight some of my experiences/reflections. First entry coming soon...

Barfing in Baja

A couple of weeks ago I got to accompany my father on one of his business trips. I know that volunteering to go on a business trip isn't a typical choice for one's summer break, but this one was a week-long off-road racing expedition through the Baja Peninsula in Mexico. Seriously, the ability to buy fresh tortillas was persuasion enough for me to go, let alone that I would get to do some hard-core off-roading and spend quality time with the papa.

Needless to say, I was totally out of my element. My knowledge of cars extends to shifting gears and changing tires. My knowledge of racing...well... Luckily I didn't have to say much. Most of the time I just stood silently next to my dad while he talked about cars for hours. and hours. The whole ordeal was rather enjoyable. I like learning new languages, so I spent a significant time in immersion training learning how to speak Truck and Racing. Still, I comprehend better than I speak it. And when I was tired of immersion training I would go take pictures of the ocean. It was a win-win vacae.

The most colorful part of the trip was on our first day of pre-running. We drove over the entire ~440 miles of the course to make note of rough spots and danger zones. My dad warned me that I may want to take some preventative motion-sickness medicine before we hit the trails, but in stubborn self-sufficiency I insisted that I'd be fine. I mean, I've always prided myself on my tough stomach. I can eat anything (esp. inordinate amounts of sugar) without breaking a sweat, and I don't get motion-sick. I spent three months living on a ship and was fine. Some bumps and turns in a Hummer would be no problem. Yeah. I barfed 4 times before 9:30am. Seriously, it was pathetic. My dad, who was driving, eventually stopped pulling over for me. We got into a routine where I, limply belted to my seat with garbage bag in hand, would just hold the bag up to my face and heave. Dad would slow down so that the bumps in the road wouldn't send my bag contents flying, and I would reproduce my granola bar, my water, my water, and finally my nothing. Then he would stop so I could swish out my mouth, spit out the open passenger door, and reposition myself for the next gastrointestinal show.

Finally we stopped to refuel in Independencia, a barely-town that sold gasoline out of Sunny-D containers. In broken Spanish and hand motions I explained to the Sunny-D lady my pressing need for car-sickness medication, and she directed me to a small convenience store where she bought some earlier that week. Well, apparently she bought all of it earlier that week, because tienda #1 was out of stock. Providentially, the other store in town had some dramamine. The clerk opened up the package and counted out 8 tablets (waste not, want not) and consequently saved my life. I downed a double-dose and promptly passed out for the next two hours on the trail. Well, the phrase"passed out" might not properly illustrate the scene; "unconsciously flailed about wildly and uncontrollably restrained only by my belt for the next two hours" might me a more accurate depiction. After I rejoined the land of the living, I was FINE. Like, no more tossing cookies, totally enjoyed the ride. Which means that dramamine is my new favorite miracle drug. Placebo or not, that stuff kept my stomach contents locked away where they belong.

Even though the whole puking ordeal only took about 2.5 hours, various members of the racing team made sure to make fun of me for the rest of the week. But at least that gave us something to talk about.

Here are some pictures from Baja (barfing pictures not included):

Baja 500

an update on Betty. wow.

Sometimes getting woken up at 6:30 on a Saturday morning is awesome.

Just a half an hour ago I was lying in bed, pondering life (okay, so technically I was already awake. sad, I know) when my cell phone rang. I hopped out of bed and picked it up. It was Betty.

Betty was my second adopted patient on board the Africa Mercy. (see my post about Betty) She was a 21 year old girl in for a VVF repair (see my post about VVF) who had been leaking for 3 years. Before Betty had left the ship we exchanged phone numbers. I told her I would call her after I got back to the US. But since as many of you know I am in the running for World's Wort Pen Pal, I haven't called her yet.

Well, this morning Betty called me. It took me a while to realize who was on the other end when I picked up, but once I recognized her voice I couldn't contain my excitement. I asked her how her surgery went, and she responded "If you call me back I will tell you." (smart girl) So I rephrased the question, saying "Betty, are you dry??" (meaning, 'was your surgery successful?'), she promptly replied "Yyyyessss!", and we both said "PRAISE GOD!"

See, I had told her last October that she should call me after she had her third-attempt VVF repair so that she could tell me she was dry and I could say "Praise God!" with her.

Amazing.

----------

Isaiah 35
Joy of the Redeemed
The desert and the parched land will be glad;
the wilderness will rejoice and blossom.
Like the crocus, it will burst into bloom;
it will rejoice greatly and shout for joy.
The glory of Lebanon will be given to it,
the splendor of Carmel and Sharon;
they will see the glory of the LORD,
the splendor of our God.

Strengthen the feeble hands,
steady the knees that give way;
say to those with fearful hearts,
"Be strong, do not fear;
your God will come,
he will come with vengeance;
with divine retribution
he will come to save you."

Then will the eyes of the blind be opened
and the ears of the deaf unstopped.
Then will the lame leap like a deer,
and the mute tongue shout for joy.
Water will gush forth in the wilderness
and streams in the desert.
The burning sand will become a pool,
the thirsty ground bubbling springs.
In the haunts where jackals once lay,
grass and reeds and papyrus will grow.
----------
and the ransomed of the LORD will return.
They will enter Zion with singing;
everlasting joy will crown their heads.
Gladness and joy will overtake them,
and sorrow and sighing will flee away.

nicknamed. the saga continues.

So I was back at youth night tonight. Half the kids are still calling me chronic. The others are trying to get me to adopt a new nickname: "Dody." Having learned my lesson, I refused their Dody advances. After our meeting, Booboo pried "whyyyyy won't you let us call you dody??" I told her I'd tell her next week. I knew that I needed to look up the term on urbandictionary.com, my new favorite online resource.

Just as I suspected:
1. dody: weed; marajuana; pot; lye
i.e. where da dody at?
pass dat dody.
wanna buy sum dody?
2. dody: a show of extreme slowness in mental capacity.
i.e. how dody is that...?


Herein lies the dilemma: the kids refuse to call me Marla, they have rejected all of my pre-approved suggestions, and all of their names ideas are actually illegal substances. Does anyone have any suggestions? They've already shot-down the following:

1. Marz Barz
2. Mar
3. Doc
4. Stumpie
5. stumpAH (actually, when I mentioned this one they all started to laugh and said "no! that sounds like a white rapper's name!" I bit my tongue.)

Any/all ideas are welcomed. Please run your suggestions through urbandictionary.com to screen for drug and/or sexually explicit references.

Chronic

So I've started helping out with the jr/sr high youth group at my church in South Phoenix. Tonight was my second time, and I'm still trying to get 'in' with the kids. Upon hanging out with a bunch of the kids who happen to be nick-named after popular candies, 'Skittles' told me that I was not allowed to be named Marz Barz because that's a chocolate name and I'm not black. Instead they dubbed me "Chronic" allegedly after an energy drink.

I later learned that chronic is a slang term for pot.

Dr. Marla?

I have a little news to share (that most blog-readers probably already know)... I'm going to medical school next year!!! That's right. Bring on the late nights and the pj pants. Bring on the cottage cheese and cereal dinners. Bring on the extra-curriculars and the spring breaks. I'm in for 4 more years!

Really, I feel soooo undeserving and thankful to have been given this opportunity. The premed process has been arduous, and I'd be lying if I said there weren't times I second-guessed my desired future. Some of you may remember that I became quite interested in studying clinical engineering as an alternative career choice after serving as a biomedical technician on the Africa Mercy. But these days I'm feeling confident about my decision to go to med school in the fall. I had been thinking and praying about med school and clinical engineering a lot over the last few months, and it seems that both are options that would allow me to glorify God (top priority), and I think I would really enjoy both (also very important). A downside of clinical engineering is that it doesn't quite offer the patient interaction that medicine does. When I first got back from the Africa Mercy I really just wanted to get back to the international missions field asap, because it was so clear in my mind how much need there is, and clinical engineering was appealing because it would allow me to get back to the field sooner. But now that I'm 3 months removed from the post-ship buzz, in the long run I don't mind that I'll be in training for 4-7 more years before I can really throw myself out there. I figure that in our fallen, pre-second coming world, the need will always be there. I've also realized over the last few months that I really miss school! In Jan/Feb I took an engineering class at a near-by community college (had to withdraw from the class once I started working again), and I loved it. I'm really excited about being in classes again. Please remind me how much I love school when I'm studying for my boards and ready to pull my hair out.

OH, and I almost forgot to share where I'll be going: The University of Arizona!!!! This has been my top choice for several years now, so I'm tickled. The school colors are red and blue, which conveniently correspond to the colors of my alma mater, the University of Pennsylvania.
GO WILDCATS!

London

...and here are some of my London pictures. again, about 2 months overdue.

London

I decided to extent my stopover in London to 3 days, since I'd never been to England before and don't know when my next opportunity will be. Tim, the boyfriend of my dear friend Ruth, very kindly picked me up from the Airport at 1:30am and let me crash at his flat in Roehampton. Outfitted with Tim's extra mobile and a map of London, I set off into the city the next morning. I did a lot of wandering, a favorite pastime of mine, and I was able to meet up with a few friends in the city. The trip was a great time of relaxation and introspection, and I think it helped ease my adjustment back into life in the good ol' USofA.

The Canary Islands

...here are some photos from the Canary Islands. They're about two months overdue, but that's how I roll these days...

Gran Canaria

After our outreach in Liberia, the crew of the Africa Mercy set sail for the Canary Islands. The ship spent a couple of months in the islands over the holidays so that it could be repaired and prepared for its next 10-month expedition. I was able to enjoy 5 days in this European vacation hot-spot with my fellow crew members. It was a special experience to re-enter Western society with other Mercy Shippers. Together we were able to freely gawk at the paved roads, the order, the variety of food, the electricity, etc.

more photos

Dock and Ducor Palace

Here are some photos of the ship, the dock, and Ducor Palace. Ducor was at one time one of Liberia's most prestigious hotels. It is seated at the top of the highest hill in Monrovia and has some of the best views of the city and sea. The hotel was looted by rebels during the war and was closed for business. Later it became a shelter for thousands of refugees. Now it remains guarded and deserted.

Boomerang Child

...So yeah, I'm slightly embarrassed that I haven't updated my blog in about a month and a half. Motivation is low because I feel like Gilbert isn't quite as interesting or noteworthy as Liberia. But that's a bad attitude; there are events-a-plenty around here.

After 5 days in the Canary Islands and 3 days in London, I headed back to AZ via a direct flight on British Airways. (direct flight=super exciting) And then, I entered what I now refer to as The Time Warp. I slept a lot and then got sick and slept even more and then it was Christmas and then I went to the East Coast to visit friends and then I started to take a class and continue the med school application process and look into some other graduate schools and now I'm here. Really I can't believe I left the ship over a month ago. I've gotten to reconnect with several Mercy Ships friends state-side, which has been such a blessing!

I'm going to sift through my thousands of pictures from last fall (no joke) to find some fun Canaries and London shots for da blog. So stay tuned...