Sunday, June 21, 2009
Tuesday, June 9, 2009
blather.
I want to become a doctor to provide exceptional primary care in an underserved community. This is not a goal I have worked toward haphazardly or on a whim: I have weighed the costs meticulously over the course of a decade, and have carefully considered options that would be less rigorous. My decisions in life grow out of two basic criteria. These criteria have guided my choices since adolescence: firstly, that what I do is of service to people in need, and secondly, that what I do makes good use of both my time and my talents.
I have done fairly well by these parameters thus far, if one looks at the basic framework of my life since college. After graduating with a broad, interdisciplinary major, I spent three years working in elementary education on the Hopi reservation in northeastern Arizona. When I left the high desert to return to the east coast, I found work as a nurse aide in a long term care facility, and I continue to work there, close to five years later. These eight years have certainly been time well spent, whether in providing quality instruction and nurture to children from difficult backgrounds or in furnishing daily care, with dignity, to elders in the last chapter of their lives.
However, my self-prescribed algorithm has not been fully followed when it comes to the wise use of my talents. While the classroom and the nursing home have afforded me much in terms of deepening my creativity, flexibility, and compassion, neither setting has provided an intellectual challenge.
Beneath the exterior trappings (job, place, education) of my personal history runs an undercurrent that stretches back to my sophomore year in college, when I decided to stop taking requisite premedical classes. This was a decision of convenience: I wanted to participate in several off-campus semesters, which made completing those laboratory courses logistically impossible at my small college. No matter, I thought: there are ways other than becoming a doctor by which I can serve people and use my time and talents wisely.
Undoubtedly, this is true for many people, as I am clearly not the only person in the world who lives by this sort of ethic. However, it has not proved to be the case for me. After researching, shadowing, interviewing, or experiencing close to ten other career options and concluding that none were a good fit, I resumed the premed track. I did this in a somewhat unorthodox manner, piecing the classes together in a way that allowed me to continue my current job, coaching myself for the MCAT, and learning the application process as I went.
An unsuccessful application season last year gave me the opportunity to reevaluate, even more critically, whether this goal was simply starry-eyed or if it had roots tenacious enough to merit a stronger fight. Toward that end, I began volunteering at a low-income clinic in my city. Since February, I have been spending one evening a week shadowing providers as they see patients, and helping as needed in the medical records department. This has been an excellent fit for me, as the context is exactly the sort in which I hope to work as a physician. I have been struck by the creativity demanded when providing care for people who are uninsured: for example, finding a medication that is both effective and affordable, which is perhaps not the textbook treatment for that condition.
The need for committed primary care physicians in this country is undeniable. It is arguably even more urgent given the trend toward nurse practitioners and physician assistants providing more of these services. As more patients become less insured, the need grows for a primary care physician to be able to give care that might generally be referred to a specialist, care that an NP or PA might not be able to provide. This is the niche I seek to fill.
Clearly, I will not become rich or famous in this profession. I will have patients who are noncompliant with treatment, narcotic-seeking, and belligerent. I will work long hours, see much of my pay go toward malpractice insurance, and wrestle with dysfunctional systems of health care delivery. Nevertheless, I am confident that I will also have patients who are grateful, resilient, and hopeful. I will be of service to people who may not otherwise have access to a good primary care doctor, and I will undoubtedly be making good use of both my time and my talents.
I have done fairly well by these parameters thus far, if one looks at the basic framework of my life since college. After graduating with a broad, interdisciplinary major, I spent three years working in elementary education on the Hopi reservation in northeastern Arizona. When I left the high desert to return to the east coast, I found work as a nurse aide in a long term care facility, and I continue to work there, close to five years later. These eight years have certainly been time well spent, whether in providing quality instruction and nurture to children from difficult backgrounds or in furnishing daily care, with dignity, to elders in the last chapter of their lives.
However, my self-prescribed algorithm has not been fully followed when it comes to the wise use of my talents. While the classroom and the nursing home have afforded me much in terms of deepening my creativity, flexibility, and compassion, neither setting has provided an intellectual challenge.
Beneath the exterior trappings (job, place, education) of my personal history runs an undercurrent that stretches back to my sophomore year in college, when I decided to stop taking requisite premedical classes. This was a decision of convenience: I wanted to participate in several off-campus semesters, which made completing those laboratory courses logistically impossible at my small college. No matter, I thought: there are ways other than becoming a doctor by which I can serve people and use my time and talents wisely.
Undoubtedly, this is true for many people, as I am clearly not the only person in the world who lives by this sort of ethic. However, it has not proved to be the case for me. After researching, shadowing, interviewing, or experiencing close to ten other career options and concluding that none were a good fit, I resumed the premed track. I did this in a somewhat unorthodox manner, piecing the classes together in a way that allowed me to continue my current job, coaching myself for the MCAT, and learning the application process as I went.
An unsuccessful application season last year gave me the opportunity to reevaluate, even more critically, whether this goal was simply starry-eyed or if it had roots tenacious enough to merit a stronger fight. Toward that end, I began volunteering at a low-income clinic in my city. Since February, I have been spending one evening a week shadowing providers as they see patients, and helping as needed in the medical records department. This has been an excellent fit for me, as the context is exactly the sort in which I hope to work as a physician. I have been struck by the creativity demanded when providing care for people who are uninsured: for example, finding a medication that is both effective and affordable, which is perhaps not the textbook treatment for that condition.
The need for committed primary care physicians in this country is undeniable. It is arguably even more urgent given the trend toward nurse practitioners and physician assistants providing more of these services. As more patients become less insured, the need grows for a primary care physician to be able to give care that might generally be referred to a specialist, care that an NP or PA might not be able to provide. This is the niche I seek to fill.
Clearly, I will not become rich or famous in this profession. I will have patients who are noncompliant with treatment, narcotic-seeking, and belligerent. I will work long hours, see much of my pay go toward malpractice insurance, and wrestle with dysfunctional systems of health care delivery. Nevertheless, I am confident that I will also have patients who are grateful, resilient, and hopeful. I will be of service to people who may not otherwise have access to a good primary care doctor, and I will undoubtedly be making good use of both my time and my talents.
Wednesday, July 16, 2008
casting bread
June slipped by without mention, but I'll give a nod to July. The garden is a tangled jungle, feeding both me and assorted deer. All my prerequisite classes are behind me, the MCAT is taken and scored, preliminary applications submitted. What remains are a few secondary applications (which will feel like leisurely stretches after the contortions I went through for the first ones), and the waiting. I won't really know anything until next spring. But either I'll be starting school in Washington DC, Philadelphia, or Syracuse, or I won't.
Wednesday, May 7, 2008
seedlings
It's a miracle that never fails to amaze me, year after year. We scratch some lines in the dust, scatter seed. And in the alchemy of sun and water, the tiniest of plants spread their first two leaves.
Spent a few hours at my garden this morning, planting some more stuff, soaking in the sun, and being generally amazed by the effortless perfection of it all: how even the youngest seedlings are unique--spinach, kale, chard, lettuce, beets. Planted okra, tried again to read the runes scrawled on the surface of each seed.
Finished reading David Kline's Scratching the Woodchuck today. He quoted John Muir: "When we try to pick out anything by itself, we find it hitched to everything else in the universe."
Seems the more I understand of the science beneath everything, the more I stand amazed.
Spent a few hours at my garden this morning, planting some more stuff, soaking in the sun, and being generally amazed by the effortless perfection of it all: how even the youngest seedlings are unique--spinach, kale, chard, lettuce, beets. Planted okra, tried again to read the runes scrawled on the surface of each seed.
Finished reading David Kline's Scratching the Woodchuck today. He quoted John Muir: "When we try to pick out anything by itself, we find it hitched to everything else in the universe."
Seems the more I understand of the science beneath everything, the more I stand amazed.
Sunday, April 20, 2008
why bother?
This post is a link post, serving both to direct you to a recent Michael Pollan article in the New York Times and to prevent me from losing it. This article caught my attention on several levels. I'll be co-teaching a Sunday school class this summer using the Simply in Season cookbook as a tool to talk about food and sustainability, and this piece might be useful for that. Pollan asks some familiar questions, invokes Wendell Berry for some analysis and answers, and then waxes poetic about gardening. His words also uncannily dovetailed the sermon I listened to this morning: "Or you could try this: determine to observe the Sabbath. For one day a week, abstain completely from economic activity: no shopping, no driving, no electronics."
Tuesday, April 8, 2008
so, why med school?
There are several angles from which I tend to attack this question, which I've been fielding from friends, family, coworkers, and random strangers for over a year now. Mid-summer, I'll need to craft my response a bit more articulately for application essays, and by winter--hopefully--for interviews.
Sometimes, I answer the long way, painting this decision as a process of elimination that's taken close to a decade. Sometimes I'm feeling flippant, and reply that I'm lazy and bored, and I think this career path might keep me awake. Occasionally I tell a story that I took as a sort of divine nudging. Other times I focus on the end result, and talk about the kind of practice I want to be involved in. Or I'll set my response like a recitation of rebuttals to the challenges I've heard. If you catch me when I'm feeling particularly loquacious, you might get the whole shebang, like Ben and Amy last weekend, who were captive in a moving vehicle.
So this will be good practice, like all the conversations have been thus far, as I talk my way toward something hopefully clearer. (Thanks for the suggestion, Ann. And Ro, don't fear. I AM a wimp, and will write about that someday.)
Deciding to pursue medical school has been a sort of process of elimination. I started college as a pre-med student, and shifted course mid-way through my sophomore year for two reasons: I wanted to travel, and, having hit the first class I needed to actually buckle down and study for, I had a vivid and unappealing vision of myself stuck in a science building for eight years. So I switched to a Humanities major, and spent semesters in London, Oregon, and Tanzania. I graduated and moved to Arizona, and for three years worked in elementary ed on a reservation in the desert. I moved back to Pennsylvania, and got a job in direct care at a nursing home (translate: absolute bottom of the medical world) near friends and family.
I considered getting a teaching credential, but wasn't sure I liked myself in a teaching role. I thought about journalism, but felt too old to get into that game. I researched public health programs, even taking the GRE, but felt like the market was too limited. Considered nursing, but wasn't sure I'd be content.
Segue to the divine-nudging story. My friend Nicole's father is a physician, and from my early pre-med days, his home was a once-or-twice-a-year destination for college breaks, drawn as we were by the winning trifecta of Jim and Pam's good company, a hot tub, and the pantry's well-stocked liquor shelf. Jim was an advocate for me to stay pre-med from the start, and I remember being hassled by him on more than one occasion after I changed my major.
Time passed, as it does, and about five years after I'd graduated another college friend got married in that area, and Jim and Pam hosted a bunch of us for the weekend. I distinctly remember groggily padding into the kitchen the next morning, intent on easing into awakeness with my first cup of coffee, and being intercepted by Jim: "So. Winona. Give me one good reason why you're not in medical school right now."
And then, as if that were not enough, he was soon joined by a friend with whom he had done his residency, and both docs proceeded to whittle down whatever arguments I offered. I sat on this conversation for a few months. Didn't really do any research, or intense soul searching, or planning. Didn't really talk with anyone about it. Just went through daily life, with that possibility like a quiet omnipresence.
My parents, bless their hearts, have never given me grief about not using the degree they helped to pay for, or goaded me too much about wasting talents or time. They've just kind of listened, asked good questions, and generally affirmed my situations. One day several months after that wedding weekend, I was driving somewhere with my father, who is even quieter than my mother about the subject of my career, or lack thereof. I don't think we were even talking. He turned to me and said, "I still think you would have made a great doctor."
It's not a burning bush, or Lazarus brought back to life, or a sheet brimful of unclean animals, but it felt like divine direction to me. Though it's probably not salient to an admission committee, for me it's an important piece of the whole.
The laziness, boredom, long-range plans, and rebuttals will have to come later. This is already a much longer post than any committed reader should be subjected to. And o grief! To think I've got to say this stuff somehow succinctly and scientifically!
Sometimes, I answer the long way, painting this decision as a process of elimination that's taken close to a decade. Sometimes I'm feeling flippant, and reply that I'm lazy and bored, and I think this career path might keep me awake. Occasionally I tell a story that I took as a sort of divine nudging. Other times I focus on the end result, and talk about the kind of practice I want to be involved in. Or I'll set my response like a recitation of rebuttals to the challenges I've heard. If you catch me when I'm feeling particularly loquacious, you might get the whole shebang, like Ben and Amy last weekend, who were captive in a moving vehicle.
So this will be good practice, like all the conversations have been thus far, as I talk my way toward something hopefully clearer. (Thanks for the suggestion, Ann. And Ro, don't fear. I AM a wimp, and will write about that someday.)
Deciding to pursue medical school has been a sort of process of elimination. I started college as a pre-med student, and shifted course mid-way through my sophomore year for two reasons: I wanted to travel, and, having hit the first class I needed to actually buckle down and study for, I had a vivid and unappealing vision of myself stuck in a science building for eight years. So I switched to a Humanities major, and spent semesters in London, Oregon, and Tanzania. I graduated and moved to Arizona, and for three years worked in elementary ed on a reservation in the desert. I moved back to Pennsylvania, and got a job in direct care at a nursing home (translate: absolute bottom of the medical world) near friends and family.
I considered getting a teaching credential, but wasn't sure I liked myself in a teaching role. I thought about journalism, but felt too old to get into that game. I researched public health programs, even taking the GRE, but felt like the market was too limited. Considered nursing, but wasn't sure I'd be content.
Segue to the divine-nudging story. My friend Nicole's father is a physician, and from my early pre-med days, his home was a once-or-twice-a-year destination for college breaks, drawn as we were by the winning trifecta of Jim and Pam's good company, a hot tub, and the pantry's well-stocked liquor shelf. Jim was an advocate for me to stay pre-med from the start, and I remember being hassled by him on more than one occasion after I changed my major.
Time passed, as it does, and about five years after I'd graduated another college friend got married in that area, and Jim and Pam hosted a bunch of us for the weekend. I distinctly remember groggily padding into the kitchen the next morning, intent on easing into awakeness with my first cup of coffee, and being intercepted by Jim: "So. Winona. Give me one good reason why you're not in medical school right now."
And then, as if that were not enough, he was soon joined by a friend with whom he had done his residency, and both docs proceeded to whittle down whatever arguments I offered. I sat on this conversation for a few months. Didn't really do any research, or intense soul searching, or planning. Didn't really talk with anyone about it. Just went through daily life, with that possibility like a quiet omnipresence.
My parents, bless their hearts, have never given me grief about not using the degree they helped to pay for, or goaded me too much about wasting talents or time. They've just kind of listened, asked good questions, and generally affirmed my situations. One day several months after that wedding weekend, I was driving somewhere with my father, who is even quieter than my mother about the subject of my career, or lack thereof. I don't think we were even talking. He turned to me and said, "I still think you would have made a great doctor."
It's not a burning bush, or Lazarus brought back to life, or a sheet brimful of unclean animals, but it felt like divine direction to me. Though it's probably not salient to an admission committee, for me it's an important piece of the whole.
The laziness, boredom, long-range plans, and rebuttals will have to come later. This is already a much longer post than any committed reader should be subjected to. And o grief! To think I've got to say this stuff somehow succinctly and scientifically!
Sunday, March 9, 2008
a challenge for you, the reader
The post following this one ("on gardening") is a piece I wrote and read at a sustainable food and farming conference this weekend. I registered without realizing that one of the planning committee members was college friend Neil. As emcee for the storytelling time on Saturday night, he cajoled me into writing something. Actually, it didn't take much cajoling. It was good to write again.
Thus, given my several-month absence from this thing, I'm issuing a challenge. If putteringgreen has been changeless for a long time, send me a topic and I'll see what I can do.
Thus, given my several-month absence from this thing, I'm issuing a challenge. If putteringgreen has been changeless for a long time, send me a topic and I'll see what I can do.
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