Naturopathic Medical School: The First Two Months

So far my classes have been what I would expect to find in any medical school. This summer I started my education with lectures in histology (the study of cells), biochemistry and embryology. I’m loving every moment of it. I don’t feel like I’m learning the material just for the test, but because it’s the first step to understanding how the human body functions and I hope that one day I can use the knowledge to help patients.

Histology has been the subject that has really started to transform my way of thinking about the human body. It is unlike any class I have had before. Looking under the microscope the first day of lab, all I saw were designs of varying shades of blue and pink (1). But by the end of the eight week term we could differentiate between cells of the intestine or the bladder, between tendons, skeletal, cardiac or smooth muscle, and between bone or cartilage. We observed how different stains transform what we see. With the addition of a special stain, new fibers appeared, as if by magic. It made me wonder how much we miss of what exists in the world because of the limits of the detail our eyes can make out, the wavelengths of light we perceive and the sound frequencies our ears can detect.

After biochemistry, I know what nutritionists mean when they talk about an omega-3 vs an omega-6 fatty acid, what the EPA and DHA mean on my fish oil supplement and what it means for a fat to be ‘trans’. I’ve been introduced to bits of relevant information about diseases and pharmacology. I now have a basic understanding of why some red blood cells of people with sickle cell anemia take on the sickle shape and a basic concept of how warfarin/coumadin (a common blood thinner) works. 

Embryology continues to baffle me a bit. It is hard to wrap my head around the fact that we started out as a single cell, that turned to a special arrangement of cells within a larger sphere, and eventually something like Littlefoot from The Land Before Time, before actually looking like a baby. But it helps us understand how the tissues in our body are related and hopefully will aid us as we start to study anatomy. I’ve certainly developed an appreciation for the complex signaling that is particularly crucial as our bodies start to take shape. It’s phenomenal that the DNA in a single cell provides the blueprint to put five toes on each foot, the nose above the mouth and on the side of the head that we expect it to be. 

In these science heavy classes it’s easy to get caught up in the textbooks, note taking and studying, and forget the eventual goal of working with patients. While we certainly need to learn this material to practice as doctors, I can’t help but wonder how much our performance on exams correlates with our future competence as healthcare providers. Even if we know the material down cold, how much will we connect with our patients? Will we be able to apply our classroom learning in patient care settings? Will our patients start to feel better? I’m looking forward to the courses that will introduce us to the principles behind the type of medicine my classmates and I hope to practice. Some of our classes this fall are Constitutional Assessment, Naturopathic Theory and Practice and Therapeutic Alliance.

(1) the most commonly used stains color structures intensities of blue or pink depending on the strength of negative or positive molecular charges

New Beginnings

My new home 

Moving and starting something new is an exciting and scary time. It’s easy to wonder if change was in fact the right decision, or if it would have been better off staying in the comfort of somewhere familiar. Every era of my life has given me the opportunity to grow. But here at Bastyr I think I have found something particularly special. Since I first visited the campus 2 years ago I knew I needed to be here. Now that I am finally here, I am certain I have found what will be my home, at least for the next 4 years, and that these are the first days of the rest of my life. Yes, it’s cliche, but as I meet my current classmates and future colleagues, as I learn material that I care about retaining long after the final exam, as I encounter a wealth of people with whom to talk about the things I care about, I know I am slowly developing the strength to take everything I will be learning back into the ‘real world.’ 

It helps that the move went smoothly. I arrived in Seattle on the evening of July 4th. It’s interesting how things change with perspective… from thousands of feet into the air, fireworks aren’t quite as impressive as they are from the ground. The next day I woke up in a state park. I can’t express how lucky I feel to be living on campus and yet surrounded by grass and woods and wonderful running trails and just a 20 minute hike down to Lake Washington. We make up for that with the fact that using public transportation it takes 90 minutes to get into Seattle or anywhere of interest besides the grocery store. 

The walk to class 

In general, the Pacific Northwest doesn’t feel like a huge adjustment from New England. In the past few weeks there have been less than a handful of cold and rainy days, but I’ve been warned not to get used to this. The biggest change is actually the amount of sunshine and daylight! At this point in the year it doesn’t get dark until 10. Which means that the time that I intended to go to bed quickly sneaks up on me. But I’m not complaining. It’s nice to go out for a run at 7pm and not have to worry about bringing a headlamp. We’ll have to make up for it in winter, when the 4pm December Maine sunset will seem late. 

But back to the idea of ‘New Beginnings.’ With new environments there is new opportunity to learn more about ourselves. For me I’ve discovered 2 things about how to help myself function at my best. 

1. Sharing a kitchen with 11 other students kills my bad habit of procrastination of cooking and dishes. Thanks to our wonderful RA and divided chores, the house is impressively clean and I would feel too guilty to leave a pile of dishes in the sink. I have no choice but to learn the habit of cleaning up as I go. Plus, living with other students of natural health I feel positive peer pressure to take the time to cook something nutritious. 

2. The move plus a visit to the dentist inspired me to make a change and buy a semi-nice electric toothbrush. Brushing my teeth is no longer a chore. I don’t need to worry that I’m doing it right and it gives me reminders every 30 seconds to switch to a different quarter of my mouth. No longer do I have to tediously watch the second hand of the clock. It’s the little things. Really. 

Why I Chose Naturopathic Medicine

As I embark on this 4 year journey I want to articulate why it is that I chose naturopathic medicine so that on graduation day I can look back and reflect on whether it has been what I expected it to be. To start I will mention the principles of naturopathic medicine (as found on aanmc.org, the association of accredited naturopathic medical colleges)… 

First do no harm 

The healing power of Nature 

Identify and treat the cause 

Doctor as Teacher 

Treat the Whole Person 

Prevention 

A few months into my work as a scribe, one of the doctors asked me if working in the ER had made me interested in allopathic medicine. I had to admit that it had in fact made me feel more strongly about pursuing naturopathic medicine. While I had once considered going the MD or DO route for education, thinking it would be a better way to reach a wider range of people and get the message out about naturopathic ideals, after enough time in the ER this became less tempting. There are three primary reasons for this. 

1. Limited treatment options 

One thing I hope to get across as someone who hopes to practice naturopathic is that I am not against mainstream medicine. It has many uses. Drugs and surgery can be life savers. But they are also limited and can have potentially life harming consequences. 

As for the limits, there are many instances when doctors tell the patient that ‘there is nothing more I can do for you’ and send them back to their primary care doctor or ship them to another specialist. Naturopathic medicine opens the door to treatments that may include herbs, physical medicine and lifestyle modifications that can be profoundly effective. Naturopathic education also recognizes the importance of something called the therapeutic alliance. A treatment plan can be considerably more effective when the patient feels that their own needs and goals are acknowledged. 

Allopathic doctors (MDs) are taught to ‘First Do No Harm’ yet so many of the drugs and procedures they prescribe may harm more than help. It seems only right that, in non emergency settings, a doctor use the least invasive and least toxic therapy first, before advancing to something that has potential for serious side effects. 

2. Holistic care (the lack of it)

In an emergency setting it is clear that there is a necessity for speed. These days, even outpatient doctors are pressured to see more and more patients in a day. There is only time to address the acute problem and prescribe a remedy (and never to Identify and Treat the Cause). Patients often hint at the stress or other circumstances that may be underlying problems but doctors only have a moment to nod sympathetically and go on their way. There is limited time to even explain the disease or condition that the patient has and what treatment they are receiving. MDs don’t have the time to be a teacher. Personally I hope to be more than a teacher. Teacher/student seems to imply a one way street. I strive for collaboration where patients can teach me how I can best help them and others like them. This brings me to the fifth principle, ‘Treat the Whole Person.’ Naturopathic medicine respects that each person is different. No one medication, herb or diet will affect someone in precisely the same way. I think that acknowledging this has powerful potential. 

3. Burnout 

Sometimes it seemed that the doctors in the ER might prefer to practice medicine without dealing with the patients. After I started working as a scribe I began to read about burnout. It was much more commonplace than I had expected. When I researched burnout among naturopathic doctors I could hardly find any information. Based on my observations I would guess that there are a couple reasons for this. 

Burnout increase if someone is not enjoying their work or doesn’t feel that it is meaningful or making a difference. Some doctors may have entered the field for fame and money, but usually there is some element of interest in medicine and patient care. Having worked in the ER I saw so many cases where patients presented with complaints that could not be explained, or patients who kept returning with little to no resolution to their symptoms. So many doctors became frustrated and cynical of these people. The current healthcare environment leaves doctors too emotionally exhausted and too crunched for time to feel any sort of empathy. 

Since naturopathic medicine is not part of the mainstream medical system, naturopathic doctors (NDs) graduate with more freedom to mold their career into something that works for them. Many work in private practices that don’t accept insurance so there is less paperwork. Often, practices are individual or small teams so the group can decide their own working hours and how long to schedule patient visits. NDs are at lower risk for lawsuits since their treatment methods tend to be less risky than pharmaceutical drugs and surgery. NDs also tend to have less of a leadership role in the office. It can be stressful when doctors, particularly in a hospital setting, and sometimes in outpatient offices as well, are constantly being looked to for direction, especially since med school may not teach leadership skills. 

We shall see. Hopefully a few years down the line I will be able to report back if naturopathic education has been all I hoped it would be. 

School's Out: Navigating 'Real Life'

For the first time since I was 2 years old September came and went and I did not start a new year of school. The prospect of not having homework was exciting. But I don't think I realized just how much would be different. Nearly a year from graduation day I find myself reflecting on what I've learned outside the classroom. 

1. Time goes by faster as you get older

Adults always say this, but there's nothing like experiencing it for yourself. Intuitively this makes sense since as you age, one year is a smaller fraction of your life. But I've discovered another important factor is the lack of regular intervals of change. So far, each year of my life has been marked by a new grade level or two semesters of college. These past 9 months have been a blur, probably because I have been working in the same location with the same group of coworkers, living in the same apartment, interacting with the same people. Life after school is marked by milestones, such as new jobs, positions, starts of relationships, breakups, marriage(s), the birth of a child, moving, buying a house, etc. but they are no longer scheduled at predetermined times. 

2. College gave me a skewed vision of success

I often felt inadequate during college. It seemed that everyone else was having more fun, participating in more activities, getting better grades and working towards a better future. I went to a school where we were expected to be leaders and encouraged to be the best we could be. Successful graduates came back to campus to give talks about how far they had come, the businesses they had started or the nonprofits that had led. It was hard not to hold yourself to those standards. 

This year I am working in an emergency room. There are opportunities to interact with EMTs, security guards, housekeepers, nurses, radiology technicians and doctors, as well as the wide variety of patients that walk through the doors. I don't quite know how to put it, but by seeing that all of these people are living their lives, I have developed a different understanding of success. Having the means to provide for and take care of yourself and your family and the resourcefulness to experience happiness and satisfaction in your life is a great achievement. In the ER I come across many people who are struggling to make ends meet and have little energy to spend taking care of their bodies made weaker by chronically unstable blood sugar or other complicated medical problems. Others struggle to keep their family together or hold a job as they battle mental illness or addiction. 

There is nothing wrong with the high expectations that we, our families, our colleges or our communities hold us to, but I have learned for myself that it is possible to always strive for better while also acknowledging and appreciating where I am and how far I have come.  

3. There is so much that school doesn't teach us  

I imagine that most students at times wonder when they will ever use what they are learning in 'real life.' At younger ages it is easier to justify. We need to know how to read, write and do basic math in order to function as adults in this society. Then we begin to analyze literature, memorize historical facts, write theses and learn algebra. It seems that school is geared to those who intend to continue on into academia where they job will entail doing more research and writing more papers. 

College is considered the key requirement for upward mobility but often it is just more research and paper writing. Talking to college seniors there is generally more fear about what comes next than excitement about finishing another phase in life. Many graduates have had little experience working full time jobs. Students are told to focus on academics, but if I were looking for a new employee I would probably rather hire a new grad with experience in my field but a 2.9 than a clueless valedictorian. 

There is too much focus on equating school success with life success. It is true that school teaches us to be prompt, manage our time and heed deadlines. We learn that we ought to follow rules and treat others well or else we will be disciplined or disliked. But succeeding as an adult requires a variety of skills that aren't necessarily learned in the classroom. Personally I think it would be awesome if there had been classes starting in high school that taught more life skills. We could also take classes about interviewing, paying taxes, keeping a good credit score, health insurance options, balancing a personal budget. In health class we had to carry around an egg for a week pretending it was a baby. Why not carry around a notepad and paper for a month and find out how much money everything you use costs? Then compare that to what you might make in different jobs. 

4. Doctors are people too

In science it seems that doctors are at the top of the totem pole. They are the students who were smart enough to top grades and high scores on the MCAT. They are the ones who are leaders, start clubs, raise money for good causes, do volunteer work to help the less fortunate, etc. They are the super people. 

Now that I spend 40 hours per week watching a doctor's (almost) every move I sometimes wonder how they got there. Did medical school applications really select out the capable doctors from the not so capable doctors? Good grades and extracurricular activities are poor preparation for the stress and responsibility of being a doctor. People expect a lot from you and sometimes your decisions make the difference between disability and full recovery or life and death. Particularly in the ER it can seem that you never get a second to think. Once you're on the floor you have to keep track of multiple patients at once, order tests and medications, ensure that said tests are running, and consider the potential diseases the patient might have. You have to be a good listener and be able to respond tactfully to the complaints of angry patients and their family members. On top of that everyone seems to need your attention all at once. The nurses, the mid-level provider (NP, PA), the doctor on the phone, the upset family member all have a million questions for you. Just hope you don't forget something. 

But the take home message for me is that doctors are regular people. They just have an extensive education and had the dedication to get through it. Some of the doctors I work with inspire me. Others have qualities I hope to avoid. 

It's hard to say for sure, but I think I've learned more this year than any year I've been in school. 

Why I Write

For many years I dreamed of writing books. While I still plan to one day write a story that I can share with the world, I do not yet feel ready to commit to the process of creating characters to enact a work of fiction. For now I will start with more manageable and bite sized blog posts that keep me grounded in the present. There are three primary reasons I wanted to create this space.

1. To document my thoughts and perspectives to allow me to see what changes with further experience

I often find myself trying to look back and understand my thoughts and perspectives last year before I started living on my own and working in an Emergency Room. It is impossible to grasp what I thought about medicine, perhaps less because I had never written about it and more because I didn't have much of a clue about how the medical system worked. I expect that as I continue to create my own space in the world, pursue further education and (hopefully) start practicing medicine, my 'musings' will morph.

2. To put my thoughts down on paper and perhaps create a space for dialogue

Writing usually feels very cathartic to me. I often find myself lost inside a swarm of thoughts and ideas in my mind. In an attempt to clarify things I spew it all out to my friends and family but I never seem to be able to say what I mean. So maybe, just maybe, this blog will allow me to formulate what I want to say a bit more clearly.

I appreciate open dialogue and hearing other perspectives. To anyone who finds themselves here, please feel free to comment.

3. To share 

It is a crazy world where anyone has the ability to post their words for all to see within seconds. But in busy lives this can be an opportunity to stay connected to people you know and to share ideas with wider groups of people. My sister was in Bolivia last semester and she kept a blog. While reading some of her posts I felt I was getting to know her in a way I hadn't before.

This year I have come to appreciate the internet more than ever as I have tried to navigate life in my own apartment. As I make decisions about what to cook and how to clean I have found myself stumbling open the blogs of people I have never met. I am grateful that they have posted their experiences and made me feel that I am in good company with others just trying to figure it all out.