Wednesday, February 4, 2009

Living the Dream...

I just had a life-alteringly amazing "life moment," set up by a series of life-alteringly amazing events composed of life-alteringly amazing subtleties. How could I not write?

Even as a toddler, I remember being told that I can be and do anything I want. As far as empowering, supportive parents, I have the best. Over time, of course, realism did rear its ugly head; no, I can't be a professional figure skater; no, I can't be a game show host; no, I can't be the princess of a country I invented. But also over time did I get pretty darned good at finding "that point" just the other side of the realism line -- that was just enough unrealistic to be qualified as a pipe dream but close enough to actually do. Wouldn't it be cool to quit your job and teach Spinning all day? Wouldn't it be great to just DECIDE that your greatest life weaknesses just... wouldn't exist anymore? Wouldn't it be sweet to become a doctor, despite having taken no science courses ever?

Fast-forward. November 3, 2007. It's three nights before my UVM admissions interview, and I'm prepping like the all-star interviewer I am. I decide that, since the majority of Vermont is rural and I the New York urbanite know absolutely nothing about rural medicine, it's pretty unacceptable for me to NOT change that before I showed up. That night, I reviewed probably 50-something articles, commission reports, governmental policies, etc. that came to bear on rural healthcare in Vermont -- I couldn't get enough. I read one article three times. A Dec. 2006 piece in Vermont Business Quarterly about a clinic started by a Vermont physician, who trained somewhere fancy but decided it would be his life goal to set up an interdisciplinary center in the middle of rural Vermont that would be the go-to place for everyone's needs. He had NOTHING -- but brought all these people and resources together and just DID it. It was the best thing I'd ever read, ever. And I decided that I simply needed to be accepted to the University of Vermont so that I could somehow go meet this guy and learn from whatever enabled him to accomplish this ridiculously amazing feat.

I didn't tell my interviewer this. But I did tell him that I absolutely couldn't train anywhere else, that it had to be here - that it was an absolutely perfect fit, and how I've never been more excited about anything ever in life. Bouncing out of my seat and talking at the speed of sound probably lent some authenticity to that representation.

January 3, 2008: I get in. I'd learned about a program for first-year med student at UVM called "Doctoring in Vermont" - wherein you get assigned to a primary care preceptor and shadow him or her and start to interview and examine patients under supervision. Perfect. I'd write this guy, tell him how awesome I think he is, and get out there. Did it matter that the clinic was an hour away and I didn't REALLY know how to drive? Nah.

Except I never wrote. Fearing rejection, I was simply too intimidated to write. I figured that I'd get assigned somewhere random -- somewhere closeby, no less -- and that any clinical experiences was going to be good experience, and that was that.

January 2009: I go hear a talk from an organization that, among other important activities I don't actually know about, funds medical students to help healthcare organizations with research/public health projects. One of the projects listed? Outcomes assessment (my pet research area) to reduce drug interactions at... this clinic. No way.

After several effusive emails, I get hooked up with the medical director. Super-nice guy. I effusively rant that I'm stoked about this project, that it's right up my alley, and I'd love to spend all my free time with him and his colleagues and soak up whatever I can. He's probably amused by the anxious overeagerness of a first-year medical student. But he tells me that I can carve out whatever experience I'm looking for, and they'd love to have me -- and will even put me up at a house they own nearby.

I skipped school today to drive out there. 45 mins on I-89, my former arch nemesis, and about a 10 minute drive through completely wide-open space. This marked the first time that I was so comfortable on the interstate. I was rockin' out, cruisin' along, changing lanes up the wazzoo... with NO panic attacks. I was even able to employ my peripheral vision to enjoy the absolutely breathtaking views (previously UNHEARD of! I NEVER turn my head even for 0.5 seconds when I'm driving or biking... I don't have the motor skills). The whole time thinking, "Daaaaaaaaaamn. I'm really going to this place." This place that I "simply had to be."

I was a little bit early and was famished, so I stopped at a local general store to pick up some nuts or something. My first-ever general store experience. The store clerk was very plain-looking; no smile. I said hello and smiled, and she reacted awkwardly. I felt uneasy -- as though it became quite clear that I did not belong in rural Vermont. I'd planned for this: dark colors, as plain as can be, right on that line of "business casual but I can't tell if you're dressed up." No makeup. But it wasn't my look; my energy level was what set me out of bounds, it became clear. Note to self: tone it down.

I get there and the doc I'm supposed to meet isn't there yet. An administrative assistant takes me around - introduces me to a few PAs and one of the other doctors. Doctor says, "Hey, want to come see a patient with me?" WHAT? I clarify what my purpose there is - that I don't actually know anything, and that I will be in no way useful to her.
"Nah, don't worry, just sit quietly in the corner and observe. Come on."
UM, WHAT? Best thing ever? Yes. Couldn't believe this was happening.

We saw an 70-something year old woman. I knew nothing about her going in, so I just tried to pick up what I could from the conversation. They discussed her meds -- and I actually knew what they were. They were things I'd actually learned about, even from that heinous biochemistry course I took. Allopurinol for gout. Warfarin as an anti-coagulant (made a mental note to self to wonder what her diet was like). I scribbled down any drugs I didn't know, made a mental note to look them up later. Scribbled down a reasonably intelligent question I'd eventually ask the doctor. The woman was trying to quit smoking, tried everything. Seemed to be setting back every time she was stressed; hadn't developed any alternative coping mechanisms over her 60 years as a smoker. What impressed me most was how on top of her medications and their effects she was -- and it turns out, that's because it's an actual center-wide policy to train their patients to be that way. They have med cards that need to get filled out and reviewed. One aspect of my summer project is going to be to optimize this. More later. Anyway, shocked at how much I recognized. Shocked at how comfortable I felt. One tricky issue was setting a life policy that I would NOT speak -- that my role was to quietly sit in the corner. This was hard when this lovely woman made any self-deprecating comments about her inability to quit smoking. I so very much wanted to encourage her on her progress thus far and reassure her when she said something over-the-top. The physician I was observing was very empathetic and supportive, but her style was not as interventional as I would have been. So nobody counteracted these self-deprecating comments, and I felt awkward NOT saying anything -- yet hadn't been given permission to actually speak. But this was so unofficial; when I'm observing for real, I'll know to clarify the talk vs. silence issue in advance.

So I come out of the exam room. The medical director had arrived. I cannot describe him other than the coolest human being I've ever met. So laid-back. Just so AWESOME. Right away, tells me all about this project and how it relates to the clinic's impressive outcomes in challenging areas, things that I had actually already just seen in practice in the exam room. He offers to get me hooked up and funded to go to a conference on this topic, tells me I can do anything in the world I want, validates an idea I had to incorporate (integrating my interest in measuring dietary awareness as it relates to drug interactions), gives me a tour (imagine? He didn't even have time for lunch, but walked me all around and introduced me to everyone). Physical therapists, dietitians, neuropsychologists swarming -- and he tells me I can hang out with all of them whenever I want. Offers to be my "Doctoring in Vermont" preceptor so I can start hanging out next month, instead of the summer. What?! AMAZING.

Our conversation is interrupted by the doctor whom I had just observed, now initiating a discussion of a difficult patient. I am then treated to a serious discussion of what to do about the drug-seeking behavior of an abusive patient, and the legal ramifications. Just like that.

"What do you want to do with your summer?" he asks.
I have no idea. I'm so overwhelmed by the sheer volume of opportunities afforded to me just by having access to this one place. I tell him this. He smiles and says that this is a great thing.

He then took me in to attend his staff meeting, where all the doctors and PAs discussed challenging cases of the day. Including That Guy who inspired me to uproot my whole life and move to Vermont on the random chance I could get to meet him.

I see, right then, why this place is so amazing. It's little mini-consults like the narcotics abuser. It's practice-wide consults. Bringing really brilliant people all together to brainstorm. It's systematic quality control by communication. At the end of the meeting, That Guy circulates about 25 different articles on recent research -- they do this weekly, to ensure that even in their rural isolation, they're on top of what's going on in academia. Again, quality control by communication.

Couldn't believe I was sitting in a meeting with all these awesome people talking about such awesome things. Couldn't believe this was my life.

I get back in the car. Sunglasses on, beautifully gorgeous sun shining - warming my face through the windshield. Coincidentally, the song I most associate with "empowerment" cued up on my stereo. I break onto I-89. I'm tearful. This is my life.

What that moment was, right there, was an appreciation of how utterly limitless "what I'm going to be" really is. That "what do you want to do with your summer?" question really was "what do you want to do with your life?" Because like that toddler version of myself was told, I actually in fact really can do ANYTHING. That's huge. I'm tied to nothing. Absolutely nothing. I'm in this completely new world, with a completely new sub-culture, and there's absolutely nothing interfering with my ability to immerse myself COMPLETELY in it and try it on for size.

Is it important to me to avoid being tied to something? No. I've always been able to make time for the things I want to make time for. Is it convenient that I don't have a person, place, or thing committing me to any particular life course? Absolutely. I've been spending time with a new character lately -- and, to be honest, it's refreshing to approach the acquaintance-making with a breath of detachment.

I thought about something pseudo-cheesy (but pretty awesome when I got the dramatic timing down with the music... which honestly was only really one time) I said during my New Year's Eve ride. During the start of the third climb, I asked my class to give themselves permission to dream -- what do they want more of? What do they want less of? What would they do if they knew they could not fail? I actually need to start thinking about that. I can hang out with these people and haphazardly "soak up" things -- but how much more effective would it be if I had specific things I wanted to see and learn about? How much more focused could my efforts be to collect the data I need to decide what I want to do and where I want to be?

I was behind a huge-ass FedEx truck, going too slow to not obstruct my view but going too fast to safely pass. I tried several times but really couldn't justify going fast enough to pass him, as the interstate was quite winding. In the left lane, I couldn't do more than to ride on-pace with him -- and when I did, I caught up in the truck's shadow (the sun was at the perfect angle to get obstructed). Not exactly claustrophobia but it's the word that comes to mind. I trailed behind and returned to my awful spot behind him in the right lane. Tried again. Same outcome.

Third time's a charm. Straight stretch -- visualize it, accelerate, NAIL it.

Wide open road ahead...

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