Jennifer Tsai (14 Posts)Writer-in-Training and in-Training Staff Member
Warren Alpert Medical School of Brown University
The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.
I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!
The cultural competency framework that has become the mainstay of medical education is often times employed in incredibly reductionist ways. It seems to propose that exposing physicians to homogenized, static and packaged ideas of culture will aid them in estimating patient behavior, preference or response in the clinic, thereby diminishing health care inequality. Training like this paves the way for even well-intentioned student-doctors to be explicitly ignorant under the auspices of clinical benefit. It spoils the good intent to create better patient outcomes by legitimizing the validity of stereotypes and the development of physician bias.
My cadaver has pink fingernails. I saw them on the first day of class, after we pulled back the white plastic sheet with the number “22” scrawled on it with permanent marker, and cut away the damp cloth that had been covering her cold skin. Her arms were folded across her chest, and on her fingers was a sparkly, ballet-pink polish, not chipped or peeling despite having been there for the 13 months since she’d died. I don’t know why it’s there. I don’t know if she painted them thinking she was going to survive to enjoy it, or if she was someone who always wanted to look her best, even in death.
Vaccines have become a cornerstone of modern public health and have greatly reduced the burden of infectious disease across the globe. They are also the center of major debate in America. Conjuring furious arguments with divided opinion, where vaccine safety gets more attention than vaccine effectiveness. In the era of Facebook, Twitter and every imaginable social media outlet, opinions and facts flood computer screens, distorting truth and instilling doubt. To support an argument, it is not difficult to find an article or group that agrees with you. Medical professionals constantly find themselves concerned and restrained by an apathetic response to reason and science.
The images of water from Flint, Michigan water came into my mind and I lingered at the sink a few minutes too long. I became heartbroken for the children whose bodies may have been irreversibly and negatively impacted. I became enraged at a system that would prioritize saving pennies over properly protecting its citizens from preventable harm. Governor Rick Snyder, his appointed “emergency financial managers” and other leaders allowed this crisis to develop over years as they mistreated Black citizens through racist policies, violated the public trust, and endangered lives. A significantly poor and majority black city was told it was okay to use polluted water to prepare their children’s dinners. Families washed their dishes in what could be mistaken for urine. They scrubbed their pearly whites with toxins to avoid cavities.
Although there is really never a right time to die or even witness death, it is important to acknowledge that death is a reality, and one to which all health care practitioners will be subjected at some point in time. For that reason, I raise the question: is there an appropriate time to lose a patient? From my perspective the answer is yes, and for good reason.
At Albany Medical College, upon our orientation to gross anatomy, we are asked to draw our feelings on blank index cards prior to entering the cadaver laboratory. As we progress through the year, our sentiments regarding anatomy may remain the same, or may change, and these drawings allow us to look back at this milestone we crossed as budding medical students.
Before my year abroad, I decided to pursue a masters of public health at the Brown School of Social Work at Washington University. During the weeklong MPH orientation last fall, we had an eight-hour mandatory session on cultural awareness, which included drawing our cultures with crayons on blank sheets of paper and sharing them with the group. Throughout the day, one of the students kept emphasizing how much she has been grappling with her white privilege lately. At the time, I had trouble appreciating what she was referring to, but after almost four months in Africa, my “whiteness” is part of my daily thoughts.
It is 1 p.m. on a Wednesday, and 250 medical students are filing into the lecture hall to listen to a lecture on health care and society. The chatter is not one of excitement, but of disconcertment. Many students complain that their time would be better spent studying hematology. These are not uncaring students who disavow the needs of the disabled, but a generation that demonstrates a palpable reaction to the way that medicine is taught. We may be quick to fault them for their alarming aversion to a discussion on ethics, but we must also consider: is ethics meant to be force-fed?
“When I was in Laredo, I studied cello when I was in undergrad. My ultimate goal with the cello I guess “professionally” was to play cello with the Laredo Philharmonic Orchestra, which I did in April of my senior year. It was a huge deal for me. Since I was really young I always wanted to play with them — [it was] definitely my ultimate goal in music.”
Few doctors in the modern era have established themselves so securely as both doctor and writer as to be easily recognized in both circles; this is perhaps because of the difficult and time-demanding nature of both careers. One notable exception is Dr. Atul Gawande, a renowned general surgeon in Boston, MA, who also happens to be a widely published and well-known author of several books. In his most recent book, “Being Mortal,” it is clear that he has grown, not only as a writer, but as a doctor and a human being as well – which, after all, is what this book is all about.
One of my housemates and I decided early on in my time in Malawi that we needed a code word that would mean, “Austin, stop worrying about money and schedules. Just enjoy the experience and let go.” We decided that “chocolate chips” would be our secret phrase for capturing this sentiment. That way, regardless of the social situation, my housemate could remind me to let go of control and just be.
How can doctors-in-training take advantage of the distinct liberty they have to bond the patient Stephan, a fourth-year medical student in Cincinnati when interviewed and now an ophthalmology resident, reflects on how the art of connecting deeply with patients is not prioritized — but this can be remedied. He tells a story about a patient he met on his internal medicine rotation that illustrates how medical students are in a unique position to cultivate relationships in health care.
Annie Robinson (52 Posts)Curator of Inside Stories and in-Training Staff Member
Columbia University
Annie Robinson completed a Master of Science in Narrative Medicine at Columbia University in 2014. She previously studied the healing power of stories as an undergraduate at NYU’s Gallatin School of Individualized Study.
Annie works as Narrative Coaching Specialist with Eating Disorder Recovery Specialists, helping individuals in the early stages of eating disorder recovery through mindfulness, meditation, yoga, and narrative practices. She is also the Program Officer at Health Story Collaborative, a non-profit that creates forums for individuals to tell their stories of personal health challenges, and curates another oral narratives projects called On the Road to Recovered: Voices from the Eating Disorder Recovery Community.
Annie is a coordinator and full-spectrum doula for The Doula Project in New York City, providing compassionate care for women during experiences of abortion, miscarriage, and fetal loss.
As a yoga teacher, writer, educator, and co-founder of NYC-based wellness community Pause, Breathe, and Connect, Annie shares her passion for integrative approaches to wellbeing. She is dedicated to creating spaces for people to explore the healing potential of interweaving of stories, spirituality, and somatic experience.
Inside Stories
Inside Stories is an oral narratives project which invites medical students to share their experiences in medical school in the form of brief podcasts published and archived on in-Training. The project aims to provide a means of personal healing, self-realization and empowerment through the sharing and receiving of personal stories, as well as to cultivate community among students in the often isolating medical school environment. The title Inside Stories reflects the project's mission to encourage students to go inside themselves and bring forth things that often go unspoken. It also represents the inside look listeners are granted into the sometimes private, challenging and confusing experiences students may have.
Made possible in part by a grant from the Arnold P. Gold Foundation and FJC.
