"being with"

how many times a day do i tell my patients, 
take some slow, deep breaths.
as i listen to their lungs
and how many times do i tell myself to do the same?
not often. 
physician, heal thyself.

in true reflection, we embrace our existence.

i miss the therapeutic outlet of writing. i've been clammed up, probably from working so hard that the last thing i want to do is sit down and think through everything that's happened in the whirlwind of the last 5 months. also, with HIPAA rules i absolutely have to be very judicious about what i even process through about work on the public channels.

it's hard. which puts the onus on me to really take the time to debrief in-person on challenging or emotionally rending patient situations with my co-residents and faculty, so that it doesn't become a big ball of darkness and fury that continues to consolidate over my residency, leaving me drained and burned out. i refuse to lose my personhood! i will fight the tendency to minimize my feelings and experiences in an effort to be stoic and advance forward.

Senior Moments

Oh elderly folk, how I adore ye.  

A little background on my interest in senior citizens-- apart from some geriatric medicine experiences during inpatient and outpatient rotations, I had not had a chance to really spend some quality time with senior citizens in a few years, and I missed it.  Before med school, I served as a companion for hospice patients and learned a great deal about how  hospice programs do such excellent work in holistically taking care of the multifaceted needs of dying patients and those who love them.  I also had the chance to work with an awesome grassroots org, Bridging Communities, where I assessed the needs of at-risk Detroit elders and connected them with resources to ensure basic needs were met and support services in place, allowing clients to age with dignity, surrounded by supportive community.

Which brings me to my most recent experience, volunteering at Luther Manor, a skilled nursing facility right down the street from where I used to live.  There is something so excellent about being connected to someone familiar with a past you've never personally known - to hear their perspectives on how things have changed, or stayed the same.  To bask in nostalgia over a cup of ice cream with 50s tunes filling our ears.  To do a twirl and a dance step from decades past.  With every set of fingernails I painted, every family photo album we paged through, each row of knitting/pearling that we took turns on, something special happened.  These simple activities allowed me to see a light in each resident I had the chance to get to know - their passions, values, heartaches...

It was not always fun and games.  No matter how excellent the care a facility offers, I expect that there is always going to be some element of suffering that permeates any "old folks' home".  Common themes that I noticed were expressing frustration of overwhelming physical ailments, reflecting on the pain of injustices endured from their past, and mourning lost independence in the face of isolation.  I think it's easy for younger, able-bodied people to think, it's for your own good that you're here; it's not safe for you to be home alone.  But we don't often acknowledge the trauma of being forced to leave one’s home due to inability to live independently, and having to live in an unfamiliar environment against their will.  It was good therapeutic practice to explore some of these feelings with residents, and to remind myself that this is a not uncommon sentiment that I should continue to be aware of as I care for nursing home residents in the future.  

Soup Kitchen Insights

I wanted to highlight another pretty great organization I volunteered with in Saginaw, the East Side Soup Kitchen.  This is a charitable organization that has been around for almost 35 years.  We had originally learned about ESSK through our Leadership in Medicine for the Underserved (LMU) program, but unfortunately I hadn't had a chance to work closely with them until after graduation because they operate a full-service kitchen Monday-Friday (a great service to its attendees, but not an ideal schedule for a busy med student!).  In addition to the daily lunches, ESSK also provides bag lunches to latch-key programs and hosts periodic optical & medical volunteers.

Food for the Soul

Finding myself with some extra free time during my downtime between med school and residency, I was looking for a volunteer opportunity that would leave me feeling soul-filled.  I remembered a pretty awesome organization that does amazing work in the Saginaw community, First Ward Community Center.  First Ward is a support/advocacy network, providing services for children, adults, and seniors.  

The east side of the Saginaw River, where First Ward is located, is generally the part of the city most fraught with poverty, crime, abandoned homes, etc.  For some people, it's a no-man's-land, a forgotten sector where few outsiders dare to traverse.  If only they knew the richness of community and the incredible potential hidden within...

Brave Advocacy

When I was at a meeting of some of the awesome leadership of MedFLAG (Medical Friends of Lesbians & Gays, the queer/ally group of my med school), I remember one person brought up her frustration with always having to carry the burden of being the "spokesperson" for her class, the token med student who could explain concepts that were foreign to her colleagues, like how to avoid heteronormative speak when interviewing patients, how to be culturally sensitive with LGBT folks, etc.  While it can be rewarding to be an advocate, of sorts, for oppressed individuals and communities, it can also be exhausting to seemingly always have to be the one person who addresses problematic issues - like lobbying for a unisex bathroom that is inclusive for transgender/genderqueer people, or campaigning to bring more diverse faculty members into an ethnically homogeneous academic environment.

Male Sexual/Reproductive Health

I've been meaning to post about an interesting topic that piqued my interest at the Michigan Academy of Family Physicians (MAFP) Scientific Assembly -- men's health.  This talk was given by Dr. Wendy Grube, sexual health guru at Penn School of Nursing.

FUN FACT:
2/3 of female teens get STI/HIV/pregnancy counseling, compared to only 1/3 of their male counterparts.

"The History of the Medical Treatment of Homosexuality"

I heard an interesting talk from Dr. Alice Dreger this spring about how homosexuality has been approached in the medical sphere over the past century or so.  Dr. Dreger's research focuses on what she refers to as "norm-challenging bodies", including disorders of sexual development (e.g. intersex), conjoinment, dwarfism, and cleft lip.  


Her talk at MSU touched on the issues related to medicalizing homosexuality, and how LGBT advocacy has led to more progressive attitudes in the medical field towards sexual minorities.



Dr. Dreger explained a general shift in societal views of homosexuality over the centuries:
Sin (pre-19th century) → Crime (19th century) → Disease (20th century) → Identity (21st century)

Lack of Research Ethics: Lessons from Tuskegee & Guatemala

Last month, I attended a lecture given by Dr. Susan Reverby, Escaping Melodrama: On Telling the Histories of the Infamous U.S. Medical Research Studies in Tuskegee and Guatemala.  Reverby has devoted a great deal of scholarly work to these clinical trials that are infamous for their lack of research ethics.

source: http://www.sbs.com.au/dateline/story/about/id/601221/n/Infected

A quick timeline for reference:
1932 Tuskegee study begins
1943 Penicillin discovered as effective treatment for syphilis
1946-1948 Guatemala study
1972 Tuskegee study ends
1997 Apology from Pres. Clinton for Tuskegee
2010 Apology from Pres. Obama for Guatemala

Making Strides Against Breast Cancer

Today I participated in the American Cancer Society's Making Strides Against Breast Cancer walk in Grand Rapids.  It was a really powerful experience and I'd like to share with you why I walk.

I'd like you to meet an amazing woman, Nancy Nell, my mother.  

Mom and I in 2006

my take on "it gets better"

Dr. Ng: My Hero in Transgender Healthcare!

Things have been surprisingly busy in this strange transitional phase between med school and residency.  So pardon the cobwebs and I'll do my best to keep this more current!  But in the meantime, bear with me as I play catch-up and try to cover a few awesome things I've been able to experience over the past month-- beginning with an LGBT-positive experience I had at MSU!

Motivational Interviewing: Tricks of the Trade

Motivational Interviewing (MI) is a great tool not only for therapists but for any clinician hoping to advocate for behavior change in their patients-- a very important skill for primary care physicians!

Lynn Massey, an LMSW skilled in brief ED interventions with substance abusers, explained many important characteristics of MI in a recent workshop I attended.  In addition to well-known approaches such as empathy and collaboration with patients, she emphasized the importance of evocation (eliciting, accepting, and understanding patients' ideas about behavior change) and respecting patient autonomy, because in the end, it is the patient's choice to change a behavior or not.

It's also important to realize that motivation, or readiness for change, is a very dynamic process that is the deciding factor when it comes to patient adherence to treatment plans, behavior change, etc.  In fact, there is a model for understanding the process of change that can be very helpful for the frustrated clinician:

source: adultmeducation.com

National Public Health Week Part 3: Racial Disparities in Healthcare

I'd like to close out NPHW with one more topic inspired by an amazing doc and eloquent storyteller who we were fortunate to meet at our public health conference this past week.  Dr. Camara Jones is a well-known family physician, epidemiologist, and research director on Social Determinants of Health & Equity at the CDC.  While many people have a general idea that racial/ethnic minorities generally experience poorer health care and health outcomes, Dr. Jones really helped us understand the roots of some of this by explaining the multiple levels of racism that can lead to health disparities.

National Public Health Week Part 2: Green & Healthy Homes

Now if there is one overarching theme that everyone should understand regarding public health, it's that one's health is profoundly influenced by one's environment.  It's not just a matter of individual choices - I choose to be healthy, therefore I am - but a complex manifestation of multiple factors, both internal and external, that lead to one's health status:

National Public Health Week Part 1: Childhood Obesity

I was fortunate to participate in a Community-Based Public Health Conference in Flint this week and learned a lot of really interesting tidbits related to key public health issues.  I'll do my best to share some of these topical issues in the next couple posts.

One of the topics presented during the conference was the increasingly infamous issue of childhood obesity, a well-known public health problem due to Michelle Obama's extensive initiatives to address this epidemic.

HIV: When to Treat?

Well, I'm finally home in Saginaw and I just wanted to write a concluding post for this elective on an important topic that is the subject of continual debate in the field of HIV medicine -- when should HIV-positive patients begin HAART (highly active antiretroviral therapy)?

Gender Transitioning

HAPPY LGBT HEALTH AWARENESS WEEK!

I kicked my final week of this rotation off with a workshop I facilitated with the women of trans experience and gender non-conforming clients at the Bronx Community Pride Center.  The topic was Gender Transitioning: A Medical Perspective, and it was such an energizing hour of dialogue with these amazing folks, who were so engaged in the discussion, asking really informed questions, and contributing their thoughts on controversial issues such as black market hormones.

So what are some general requirements/recommendations for individuals interested in transition-related health care?

LGBT: An Underserved Demographic. What can we do?

When you think of medically underserved communities, what comes to mind?  Ethnic minorities?  The uninsured?  The poor?  How about the LGBT community?

LGBT Hot Topics: Contrasting Views

Over the past few weeks, it has been fascinating to hear different perspectives from LGBT-identified individuals as well as allies on some often hotly contested topics, which I'll share below.



Issue #1: Philosophical Issues with the LGBT Umbrella
Some people feel that the increasingly long aconym referring to the queer community (I think the latest was LGBTQQIA) is not only unwieldy but has its own issues.  Several transgender individuals with whom I've spoken have vented concerns that lumping trans with LGB issues is problematic.  One trans woman stated that she feels uncomfortable going to a "gay center" for services because she identifies as a heterosexual woman.

This brings up an important point mentioned before; sexual orientation ≠ gender identity.  

HIV/AIDS work

During my time here in the Bronx, I have been fortunate to work with a number of great clinics and community-based organizations, two of which are focused on HIV/AIDS management - the South Bronx Health Center for Children and Families (SBHCCF) and the Adolescent AIDS Program housed in the Children's Hospital at Montefiore.

Trans 101

Today I had the opportunity to meet and do some planning with a few members of the amazing staff of the Bronx Community Pride Center (BCPC). We came up with some really exciting things that I can help contribute to, with a primary focus on transgender health and programming.

Vocab

So what does it mean to be transgender?

"This is a broad term indicating a person whose gender identity and expression do not 'match' the sex assigned at birth, in whole or in part." -- Community Healthcare Network

Street Outreach to Youth

Today was the beginning of my adventure on my final rotation of medical school (last but not least!). I'm living and working in the Bronx for the next month as I delve into the study of LGBT health - or for those of you who are less-than-savvy on the latest acronyms, Lesbian/Gay/Bisexual/Transgender health.

For Day 1 of the elective, I joined some of the amazing staff of the New York Children's Health Project through their ongoing mobile clinic campaign. There is a medical clinic bus (where I worked) and a dental clinic bus that set up shop at various locations throughout the week. Monday mornings are spent parked outside of the Safe Horizon youth shelter in Harlem, and the afternoons are based at the StreetWork drop-in center reserved for "street-involved" youth (currently homeless, previously homeless, or otherwise at-risk).