It was so good to see Lisa and Marta :)
Alexis and I had very smooth travel to the hospital, with all of our luggage! The short-term associates' apartments were much nicer than I had anticipated, and I'm very thankful to have readily-available filtered water at home.
Still in the humid rainy season, it has been quite moist and hot here. Aside from mosquitoes, there are bugs that stealthily bite us, so we soon found ourselves with itchy blisters :( There are plenty of lizards and spiders, but maybe they're busy, too.
The hospital has been very overwhelmed with admissions, mostly for children with malaria needing medications and sometimes blood. The medical ward that's supposed to have 35 beds was housing 115 patients one day, with two children to each hospital bed. There were only three nurses and their aides! Sometimes discharge medications may not be exactly as we prescribed, just due to the chaos and patient load, but that's why we need prayers to cover every level of the patient's admission process: clinical judgment, medication processing at the pharmacy, payment process, blood donation and transfusion checking, and discharge medications, etc.
The hospital staff have been very welcoming and are very hard working. The interpreters are also very helpful and even try to teach me some words and phrases. The problem is then patients' parents start talking to me in their local language, expecting me to know what they're saying. :P
It's interesting while learning their greeting to find out that one always answer favorably. For example, your night always went well, you always say you're not tired, etc. Our patients' parents always answer each day the child is "better", before they list the complaints. It was a bit frustrating and feeling like it was a pointless exercise, especially when interpretation is involved; however, I thought about how it's the same with us, too. We always ask, "How are you?" We always say, "Fine. good. I'm doing all right. And you?" It's not exactly lying, but we do waste a lot of words.
Similar to some patients at home, I've come to find out I need to always prescribe something when I send them out of the clinic or from the hospital. One patient completed his course of antibiotics at the hospital and didn't have fever anymore, so I wrote to go home without any additional prescriptions. Later in the day or the next day, the father came and asked why the mother and child were sent home without anything? "Give them multivitamins," the nurse said to me. Sure, I can do that, but I don't think patients in the States would be that easily appeased. I also found it interesting that parents often complain of "eye infection", but on exam I would only find a kid with some crusting or gooey eye discharge where the tear ducts are. No sign of infection and probably just needs better hydration and cleaning the eyes with a warm wash cloth. I can't imagine how difficult it is for parents to not get antibiotic eye ointment when they think their child's eye is sick but the doctor is too busy to even explain why they're ignoring the problem. Unfortunately, they don't even have "the germ theory", so how do you know how much of what you're trying to say doesn't sound like "crazy Western magic" to them?
One theory why patients come to the hospital so late is that they consider illness to have a spiritual component, so when someone falls sick, families tend to first turn to traditional healers to request for charms or cutting. You would, too, if you believed your fever is the result of someone cursing you or you have done something to upset the spirit world. Also, it's easy to get a little flustered to see a child having been treated for malaria for the fifth time in the last two years. Not only is there problem with being over-treated, but why aren't they under mosquito nets?? It's not because they don't have them, because most of them do. Maybe they couldn't help but be reinfected. There are much I still don't know about their way of life and public health conditions. These are some of the obstacles that I've come to face.
Then there are the deaths. Right before we came, there was one night where 27 patients died in a 24-hour period. Since I've started to round on hospital patients, I've had about one or two die each night. Over the weekend, after being on call on Friday, I rounded on about 25 patients on Saturday. Thankfully, paperwork is a lot less than back in the States. There are, of course, pros and cons to that.
The death that hit me the hardest was a fifteen-year-old girl with intestinal obstruction. Shortly after I got an x-ray on her, she died. It caught me by surprise, but then I thought I should've known. I'm reminded of so many of my failures and shortcomings, but talking to Alexis and Marta helped me realized I couldn't have saved her anyways. It made me want to go home and be somewhere safe, where I can't be in power to take care of someone so critically ill. Yet, the next day, as I looked at children who were now perky and sitting up after being treated with medication and transfusion, ready to go home, I was comforted by some of the good I've been allowed to facilitate. Yet, when I think of a patient who got sterile abscess from the IM injection of quinine in the front thigh, I shudder at the thought of "how much harm is my current 'good' eventually causing"? Of course I won't know that, and the risk of a potential sterile abscess currently outweighs the benefit of saving a life from dying of malaria, but the pendulum just keeps swinging back and forth between "I'm glad I'm a doctor" and "can't I just be somewhere I can't mess up on life-and-death decisions?"
I'm thankful for a event-full first week, and there are still many many lessons to learn.
Monday, October 1, 2012
Sunday, September 16, 2012
Unexpected DTR moment
Six days away from going to Niger.
I picked up my friend from the airport tonight, and she told me she has been accepted and is now an SIM missionary. Go, Alexis~~!!
It then dawned on me that I'll be going to Africa with the said missionary in six days. She is still my friend, and I know on a practical level every disciple of Christ has been "sent" to share gospel (the mission) with the rest of the world, but somehow that thought shook me.
How surreal that I would be traveling with a missionary?
She said, "No, you're one, too."
I told her I didn't feel like one.
Who do I think a missionary is? What do I think she looks like?
It's not a play on words, but it certain feels like these nouns carry different weights of burden for me tonight: Christian, disciple of Christ, missionary....
I realized the reason these words sound so unnatural and distant to me right now is because I still have not surrendered myself to the lordship of Christ on my life.
I mean, no matter how "servant-like" I aim to be, no matter how much I want to be well-trained to serve "the under-served", no matter how "good of a Christian" I hope to be... it's still ultimately framed around "how I want MY life." Is Jesus really my God, or is He an adviser and steward (in charge of the provisions), with me having the final say in how things should go in my life? It's frightening to realize how much control I had held on to.
If my actions and way of life reflect I'm treating Jesus, the Lord of lords and the King of kings, as my steward, then I have a big problem. I'm not living a life worthy of the name Christian, of being called a disciple of Christ, or of the gravity of a missionary, and I need to change. It'll be a growing process and only possible by the power of the Holy Spirit, but I pray this is a beginning in the right direction.
Dr. Rick Donlon once said during a talk in Global Missions Health Conference, "Instead of bringing your agenda, ask Christ for His and ask to be a part of it." If we are stubborn about wanting our own design for our lives, "All you give up to get your little dreams in the King of the Universe."
That, obviously, would not be wise.
So, Lord Jesus, you have shaped me and known me. What is Your agenda, and where do you see me fit in?
*For those who don't know this, DTR stands for "define the relationship", which I don't think it's a coincidence the timing of this realization happened after I just read chapter one of not a fan. by Kyle Idleman two days ago.
I picked up my friend from the airport tonight, and she told me she has been accepted and is now an SIM missionary. Go, Alexis~~!!
It then dawned on me that I'll be going to Africa with the said missionary in six days. She is still my friend, and I know on a practical level every disciple of Christ has been "sent" to share gospel (the mission) with the rest of the world, but somehow that thought shook me.
How surreal that I would be traveling with a missionary?
She said, "No, you're one, too."
I told her I didn't feel like one.
Who do I think a missionary is? What do I think she looks like?
It's not a play on words, but it certain feels like these nouns carry different weights of burden for me tonight: Christian, disciple of Christ, missionary....
I realized the reason these words sound so unnatural and distant to me right now is because I still have not surrendered myself to the lordship of Christ on my life.
I mean, no matter how "servant-like" I aim to be, no matter how much I want to be well-trained to serve "the under-served", no matter how "good of a Christian" I hope to be... it's still ultimately framed around "how I want MY life." Is Jesus really my God, or is He an adviser and steward (in charge of the provisions), with me having the final say in how things should go in my life? It's frightening to realize how much control I had held on to.
If my actions and way of life reflect I'm treating Jesus, the Lord of lords and the King of kings, as my steward, then I have a big problem. I'm not living a life worthy of the name Christian, of being called a disciple of Christ, or of the gravity of a missionary, and I need to change. It'll be a growing process and only possible by the power of the Holy Spirit, but I pray this is a beginning in the right direction.
Dr. Rick Donlon once said during a talk in Global Missions Health Conference, "Instead of bringing your agenda, ask Christ for His and ask to be a part of it." If we are stubborn about wanting our own design for our lives, "All you give up to get your little dreams in the King of the Universe."
That, obviously, would not be wise.
So, Lord Jesus, you have shaped me and known me. What is Your agenda, and where do you see me fit in?
*For those who don't know this, DTR stands for "define the relationship", which I don't think it's a coincidence the timing of this realization happened after I just read chapter one of not a fan. by Kyle Idleman two days ago.
Thursday, September 13, 2012
Docs Who Care
Docs Who Care is an organization in Olathe, Kansas, that helps match small hospitals with medical providers (doctors, physician's assistants, and nurse practitioners), so small town family doctors can get a break, while someone comes and provide coverage.
This past few days was my first shift working for Docs Who Care, and I was in a small town a little less than 1300 people. I was there from Sunday night until Wednesday morning, and my duties included covering the ER, acute clinic patients during the day, and inpatients during the night. The local doctor was still in town but his partner had CME (continue medical education) days off, so I think he just wanted the extra help; so, overall, not as busy as I thought it would be.
On Monday, I saw four patients in the ER, and two of them came back later, so I saw six total that day. For those not in the medical field, this is called a "bounce-back" when they come back in the same day, or within a relative short time, for the same thing, and this is NOT COOL.
One of the patients that came back is a lady who first came in for migraine headache. Before I even walked into the room, I got warned by two staff members about how she would come in often and even visit other ERs to get pain medicine. One time, I was told, she went to the ER in three different small towns on the same night or within a short time and got three different CT scans of the belly for stomach pain. Now, please correct me, my radiology friends, but I believe a CT scan is about 100-250 times the radiation one would get with a plain chest x-ray, so she got the equivalent of at least 300 x-ray radiation that night!! Since then, the nearby ER's had communicated with one another and found out she was going to different places with various complaints of pain.
Pain is one of the hardest things to live with, and it reinforces the unhealthy cycle of poor quality of life and poor physical health.
While I talked to the patient, I found out she had real physical problems, too. There were some things in her medical history that cannot be made up. So, yes, she had been through quite a bit medically and physically, but her lack of social support (no one except for her significant other) and poor living habits (like cigarette smoking) all contribute to her non-ideal state today.
The usual treatment for a persistent migraine headache is IV fluids, toradol, phenergan, and maybe magnesium and prednisone. She said she just wanted to get the toradol and phenergan shots and go home to sleep. She didn't want the IV fluids because she had been to the hospital so many times that the veins we usually use for access were injured and difficult to find or access. When she left the ER, she said she was a little better.
In less than three hours, she came back with her friend. The headache didn't go away but returned "full blown", and she threw up once.
This time I ordered the IV fluids, but the nurses tried hard with both arms without success. He got flashback (blood return to the needle, showing the needle is in the vein), but he was not able to get the saline water to flow into the vein. It was too soon to give her another dose of Phenergan, so I gave her dexamethasone and reglan to take by mouth.
I also spent more time just talking to her. Aside from her primary care doctor, she was seeing five specialists. She had called her neurologist for a refill on her headache medicine, but she hadn't heard back from them. Her gastroenterologist wanted her to take one medicine to help her stomach, but he wanted her neurologist to take her off of another medicine, so they don't interact. She also had some psychiatric illness but hadn't been seeing her therapist because of cost and lack of transportation.
For someone with mental illness, a supportive network of friends and family would be so crucial, but this patient had poor relationship with her family, and she wasn't involved with any group of people. All she had was her significant other. She said she used to go to a church and had counseling by the pastor, which was helpful, but then she stopped going one day, her depression got worse, and she stopped calling the pastor. I encouraged her to call the pastor again because from my own experience I knew how embarrassing the thought of going to a church one hadn't been to for a while was, but I also knew, on the other side, how wonderful it was to hear from people we lost touch with but cared about. I also encouraged for her to talk to her primary care doctor (a doctor in the clinic attached to the hospital I was working at) about her medical conditions and which medications may be duplicates, with so many other doctors involved.
After a while, she said she was feeling better and wanted to go home and rest. I spent some time praying with her and her friend, because the issues in her life were too complex and broken for any one person or specialty to take care of. Only God can truly heal her completely with the new life in Christ.
As one could imagine, it'd be challenging to spend that much time talking to patient in a busy ER, so I was glad I was in a small town, where the average ER patient flow was 1-3 a day. Even though I had my reservations for how much she actually listened to me, if she truly was a master manipulative patient who had visited many ER's, I was thankful God gave me the time and concern to encourage her to make better choices in her life and brainstormed with her some ideas for implementing those changes.
The next morning I admitted an elderly woman through the ER, and I only had one clinic patient in the afternoon. Ironically, it was the lady with migraine from the day before! Well, I did tell her to see her primary care provider (PCP), and with her PCP not being available that day, I was the on-call clinic doctor to see her. Oh, God is quite humorous sometimes.
This was a continuation of a lesson God had been teaching me, though. For me, it had often been easy to be caring and put forth my effort during one encounter or one event, to take the best care of someone; but it had been challenging for me to continuously be gracious and caring and loving toward someone who repetitively sought my attention. For example, I could stay up for 30 hours and give it my all being on call, but if I had to be sleep-deprived for a week, then I would lose my altruism very quickly. Perseverance is an acquaintance I'd like to make a close friend, but we're not there, yet.
When I saw the name of the lady as my clinic patient that afternoon, I said a prayer in my heart for wisdom and strength. I walked into the exam room. She said the migraine was still there and got worse in the middle of the night. She called the neurologist's office again, but no one had called her back, or they said they couldn't leave a message because her cell phone message box was full. I thought the buck should stop here, so I called the neurologist's office, partially to verify her story, and partially because often it was easier for physicians to get a hold of other physicians.
We were able to clarify several issues during that visit, and the patient said she appreciated me calling the neurologist and wondered "how come the doctors can't communicate with one another"? She thought I was more involved in her care because her PCP wouldn't have called the neurologist for her. I said, "To be fair, it's a lot easier for me to do this when you're my only clinic patient for the day."
Maybe God put me there this weekend just so I could help her with some of the doctor-to-doctor communications that her regular PCP didn't have the time to do, or maybe I was there to encourage her to reconcile with her family and to re-establish contact with her pastor. However it turned out, I pray God will continue to work in her life and bless her, so she may live more fruitfully and joyfully, with the strength from God to handle her multiple medical conditions with grace, rather than being a "victim" of the current medical system, lost in a sea of broken communication and discontinuous care.
I'm not blaming the medical system, although it does room for improvement. I acknowledge the patient also had to take many responsibilities. For example, later a nurse who knew the patient's situation and family told me transportation was not a problem for this patient, so this could not have been an excuse for her missing appointments with her neurologist. The neurologist's nurse told me this patient had stopped medications on her own or changed her story about what worked and what didn't work for her, so it was very challenging for her doctor to know what to do with her.
This is a complex world, and we have limited resources and abilities. I thank God I'm not as gullible as when I first started residency, but I also pray I'll be able to meet each patient with the same degree of love and concern I would want for my family and friends, without the baggage of labels such as "drug seeker" or "manipulative patient". I pray God will continue to give me wisdom to discern what someone truly needs and when they're putting on a mask to hide their real problems. I pray God will keep me true.
This past few days was my first shift working for Docs Who Care, and I was in a small town a little less than 1300 people. I was there from Sunday night until Wednesday morning, and my duties included covering the ER, acute clinic patients during the day, and inpatients during the night. The local doctor was still in town but his partner had CME (continue medical education) days off, so I think he just wanted the extra help; so, overall, not as busy as I thought it would be.
On Monday, I saw four patients in the ER, and two of them came back later, so I saw six total that day. For those not in the medical field, this is called a "bounce-back" when they come back in the same day, or within a relative short time, for the same thing, and this is NOT COOL.
One of the patients that came back is a lady who first came in for migraine headache. Before I even walked into the room, I got warned by two staff members about how she would come in often and even visit other ERs to get pain medicine. One time, I was told, she went to the ER in three different small towns on the same night or within a short time and got three different CT scans of the belly for stomach pain. Now, please correct me, my radiology friends, but I believe a CT scan is about 100-250 times the radiation one would get with a plain chest x-ray, so she got the equivalent of at least 300 x-ray radiation that night!! Since then, the nearby ER's had communicated with one another and found out she was going to different places with various complaints of pain.
Pain is one of the hardest things to live with, and it reinforces the unhealthy cycle of poor quality of life and poor physical health.
While I talked to the patient, I found out she had real physical problems, too. There were some things in her medical history that cannot be made up. So, yes, she had been through quite a bit medically and physically, but her lack of social support (no one except for her significant other) and poor living habits (like cigarette smoking) all contribute to her non-ideal state today.
The usual treatment for a persistent migraine headache is IV fluids, toradol, phenergan, and maybe magnesium and prednisone. She said she just wanted to get the toradol and phenergan shots and go home to sleep. She didn't want the IV fluids because she had been to the hospital so many times that the veins we usually use for access were injured and difficult to find or access. When she left the ER, she said she was a little better.
In less than three hours, she came back with her friend. The headache didn't go away but returned "full blown", and she threw up once.
This time I ordered the IV fluids, but the nurses tried hard with both arms without success. He got flashback (blood return to the needle, showing the needle is in the vein), but he was not able to get the saline water to flow into the vein. It was too soon to give her another dose of Phenergan, so I gave her dexamethasone and reglan to take by mouth.
I also spent more time just talking to her. Aside from her primary care doctor, she was seeing five specialists. She had called her neurologist for a refill on her headache medicine, but she hadn't heard back from them. Her gastroenterologist wanted her to take one medicine to help her stomach, but he wanted her neurologist to take her off of another medicine, so they don't interact. She also had some psychiatric illness but hadn't been seeing her therapist because of cost and lack of transportation.
For someone with mental illness, a supportive network of friends and family would be so crucial, but this patient had poor relationship with her family, and she wasn't involved with any group of people. All she had was her significant other. She said she used to go to a church and had counseling by the pastor, which was helpful, but then she stopped going one day, her depression got worse, and she stopped calling the pastor. I encouraged her to call the pastor again because from my own experience I knew how embarrassing the thought of going to a church one hadn't been to for a while was, but I also knew, on the other side, how wonderful it was to hear from people we lost touch with but cared about. I also encouraged for her to talk to her primary care doctor (a doctor in the clinic attached to the hospital I was working at) about her medical conditions and which medications may be duplicates, with so many other doctors involved.
After a while, she said she was feeling better and wanted to go home and rest. I spent some time praying with her and her friend, because the issues in her life were too complex and broken for any one person or specialty to take care of. Only God can truly heal her completely with the new life in Christ.
As one could imagine, it'd be challenging to spend that much time talking to patient in a busy ER, so I was glad I was in a small town, where the average ER patient flow was 1-3 a day. Even though I had my reservations for how much she actually listened to me, if she truly was a master manipulative patient who had visited many ER's, I was thankful God gave me the time and concern to encourage her to make better choices in her life and brainstormed with her some ideas for implementing those changes.
The next morning I admitted an elderly woman through the ER, and I only had one clinic patient in the afternoon. Ironically, it was the lady with migraine from the day before! Well, I did tell her to see her primary care provider (PCP), and with her PCP not being available that day, I was the on-call clinic doctor to see her. Oh, God is quite humorous sometimes.
This was a continuation of a lesson God had been teaching me, though. For me, it had often been easy to be caring and put forth my effort during one encounter or one event, to take the best care of someone; but it had been challenging for me to continuously be gracious and caring and loving toward someone who repetitively sought my attention. For example, I could stay up for 30 hours and give it my all being on call, but if I had to be sleep-deprived for a week, then I would lose my altruism very quickly. Perseverance is an acquaintance I'd like to make a close friend, but we're not there, yet.
When I saw the name of the lady as my clinic patient that afternoon, I said a prayer in my heart for wisdom and strength. I walked into the exam room. She said the migraine was still there and got worse in the middle of the night. She called the neurologist's office again, but no one had called her back, or they said they couldn't leave a message because her cell phone message box was full. I thought the buck should stop here, so I called the neurologist's office, partially to verify her story, and partially because often it was easier for physicians to get a hold of other physicians.
We were able to clarify several issues during that visit, and the patient said she appreciated me calling the neurologist and wondered "how come the doctors can't communicate with one another"? She thought I was more involved in her care because her PCP wouldn't have called the neurologist for her. I said, "To be fair, it's a lot easier for me to do this when you're my only clinic patient for the day."
Maybe God put me there this weekend just so I could help her with some of the doctor-to-doctor communications that her regular PCP didn't have the time to do, or maybe I was there to encourage her to reconcile with her family and to re-establish contact with her pastor. However it turned out, I pray God will continue to work in her life and bless her, so she may live more fruitfully and joyfully, with the strength from God to handle her multiple medical conditions with grace, rather than being a "victim" of the current medical system, lost in a sea of broken communication and discontinuous care.
I'm not blaming the medical system, although it does room for improvement. I acknowledge the patient also had to take many responsibilities. For example, later a nurse who knew the patient's situation and family told me transportation was not a problem for this patient, so this could not have been an excuse for her missing appointments with her neurologist. The neurologist's nurse told me this patient had stopped medications on her own or changed her story about what worked and what didn't work for her, so it was very challenging for her doctor to know what to do with her.
This is a complex world, and we have limited resources and abilities. I thank God I'm not as gullible as when I first started residency, but I also pray I'll be able to meet each patient with the same degree of love and concern I would want for my family and friends, without the baggage of labels such as "drug seeker" or "manipulative patient". I pray God will continue to give me wisdom to discern what someone truly needs and when they're putting on a mask to hide their real problems. I pray God will keep me true.
Sunday, September 2, 2012
Home Start
There was a quote I learned from psychology class that paraphrased to the idea only by having a safe home to go back to can a child feel free to explore the world. It makes sense, therefore, the first part of my wandering requires paying a visit to family and friends who have brought me to who I am today.
A few days after my official last day at the Via Christi Family Medicine Residency, I packed my bags for the suburb of St. Louis where my mom lives. It was a treat from God that my aunt, cousin, and my sister also chose to go at that time, so we had a rare reunion of three pairs of sisters. Oh, the dramas and shopping sprees that ensued.... There is something about being around family you haven't seen in a while. Despite thinking you've grown up, old habits and feelings tend to ruthlessly surface when deep patterns of interaction exhibit themselves, as if routinely. If I were not careful to remind myself of who I've become, I would easily fall back into my seventeen-year-old self, and that's just not productive in any aspect.
Being with family also forced me to see my faults and to see how narrowed my worldview has become since I started medical school. My family's mission to revamp my wardrobe was just the tip of the iceberg. The week challenged me to reevaluate who I am at this point in life, in light of where I've come from, hopefully to guide where I'll go from here.
A few days after my official last day at the Via Christi Family Medicine Residency, I packed my bags for the suburb of St. Louis where my mom lives. It was a treat from God that my aunt, cousin, and my sister also chose to go at that time, so we had a rare reunion of three pairs of sisters. Oh, the dramas and shopping sprees that ensued.... There is something about being around family you haven't seen in a while. Despite thinking you've grown up, old habits and feelings tend to ruthlessly surface when deep patterns of interaction exhibit themselves, as if routinely. If I were not careful to remind myself of who I've become, I would easily fall back into my seventeen-year-old self, and that's just not productive in any aspect.
Being with family also forced me to see my faults and to see how narrowed my worldview has become since I started medical school. My family's mission to revamp my wardrobe was just the tip of the iceberg. The week challenged me to reevaluate who I am at this point in life, in light of where I've come from, hopefully to guide where I'll go from here.
Friday, August 31, 2012
New Beginning
Take a deep breath. Here I go.
I stand at the edge of the rest of my life with a sense of uncertainty. After 11.5 years of higher education (3.5 years of college, 4 years of medical school with 1 year of pathology externship in the middle, and 3 years of residency), I am now free.
For the first time in my life I have no one to set my schedules or tell me what the next step is because there's no "set curriculum" or certain ladder to climb anymore. By the power of education I am now free to choose where to go--within the realm of family medicine, of course. I'm free to choose what to do--or what not to do. I am keenly aware of how precious this kind of freedom is, and I don't intend to waste it.
I jokingly say I'm now unemployed, which I know isn't very funny to my parents. The more accurate term would probably be "in between jobs", as I do have shifts signed up with a local urgent clinic and a locum tenens agency. The uncertain feeling is like one who has leaped and is in midair, having left the ground she is familiar with but has not yet landed on that promised soil ahead. What will I find when I land? Will I fall? Will the earth crumble under my poor judgment of a landing? Will I be doomed to so worry about the unknown that I cannot enjoy the fact, for this brief time, I'm light and free and happy?
Such are the feelings as I set off to my wandering, which is my rough draft for this next year. There are certain goals I hope to reach by my travels to small Kansas towns, Niger, and possibly Haiti, China, and Taiwan. I know I will be challenged, humbled, and changed, and I hope to emerge with a better sense of where I'm off to next. This is why I especially appreciate Lisa's quote to me, "Not all those who wander are lost", taken from Tolkien's Lord of the Rings:
I stand at the edge of the rest of my life with a sense of uncertainty. After 11.5 years of higher education (3.5 years of college, 4 years of medical school with 1 year of pathology externship in the middle, and 3 years of residency), I am now free.
For the first time in my life I have no one to set my schedules or tell me what the next step is because there's no "set curriculum" or certain ladder to climb anymore. By the power of education I am now free to choose where to go--within the realm of family medicine, of course. I'm free to choose what to do--or what not to do. I am keenly aware of how precious this kind of freedom is, and I don't intend to waste it.
I jokingly say I'm now unemployed, which I know isn't very funny to my parents. The more accurate term would probably be "in between jobs", as I do have shifts signed up with a local urgent clinic and a locum tenens agency. The uncertain feeling is like one who has leaped and is in midair, having left the ground she is familiar with but has not yet landed on that promised soil ahead. What will I find when I land? Will I fall? Will the earth crumble under my poor judgment of a landing? Will I be doomed to so worry about the unknown that I cannot enjoy the fact, for this brief time, I'm light and free and happy?
Such are the feelings as I set off to my wandering, which is my rough draft for this next year. There are certain goals I hope to reach by my travels to small Kansas towns, Niger, and possibly Haiti, China, and Taiwan. I know I will be challenged, humbled, and changed, and I hope to emerge with a better sense of where I'm off to next. This is why I especially appreciate Lisa's quote to me, "Not all those who wander are lost", taken from Tolkien's Lord of the Rings:
- All that is gold does not glitter,
- Not all those who wander are lost;
- The old that is strong does not wither,
- Deep roots are not reached by the frost.
- From the ashes a fire shall be woken,
- A light from the shadows shall spring;
- Renewed shall be blade that was broken,
- The crownless again shall be king
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