Into the Wild
David Yu (2016)
The grizzly bear sow and her four cubs crossed the alpine trail about 50 meters ahead, ambling slowly as they munched their way through the blueberry patches that grew abundantly on the mountain top. The sow lifted her head and looked at my hiking partner and me as we waved our arms and shouted ourselves hoarse trying to get them off the trail. After several minutes of fruitless efforts, we broke off the trail and trekked towards the top of the ridge, keeping the family at a respectable distance. We reached the top, breathless both from the altitude and from the spectacle of miles of pristine forest and snow-crested mountains around us, interrupted only by the turquoise-hued inlet knifing its way from the ocean to the Alaskan city of Juneau. A faint whomp-whomp broke the silence as the scarlet shape of an Airlift Northwest helicopter streaked by to the hospital where I was doing my emergency medicine rotation.
My foray into the wilds of Alaska was part a journey that my classmates and I call “the Safari.” While no African wildlife are spotted on the trip, bears and moose are plentiful, and the journey traverses over a quarter of the United States landmass, from four-room clinics serving towns of a few hundred people to the massive edifices of a level one trauma center and tertiary care university hospital serving five states. For those unfamiliar with the program, the University of Washington is the only allopathic medical school in the “WWAMI” region, consisting of Washington, Wyoming, Alaska, Montana and Idaho; the school has clinical sites and regional teaching campuses in each of these states. Come third year, students can request rotations in the multiple hospitals in Seattle, or rotate at the regional sites. “Completing the Safari,” which sounds vaguely like a college dare, indicates that a student had rotated in all five states prior to graduation. Prior to my Safari, I had completed my basic science and organ system courses in Seattle at the main campus, and thought that my physician-professors led an ideal career — a well-balanced combination of teaching, research and clinical care. Many professors have authored chapters in textbooks, gave keynote addresses at national conventions and were mentors to students, residents and junior faculty. It was not until I began my clinical rotations that I began to experience hospital life in the community. By the end of medical school, I will have spent five months in Montana and two months each in Wyoming, Alaska and Idaho.
The Safari is not for everyone. Moving sites every four to six weeks, living out of a suitcase and re-learning all of the parking spots, bathroom locations and nurses’ names can be exhausting, and near-impossible if one has a significant other and/or children. I had neither during my third year, which gave me logistical freedom but could make recovering from long days on the wards incredibly taxing, physically and emotionally. The cowboy appeal of saloons with riding saddle bar stools and antler wall decoration wears off, and even the breathtaking panoramas on top a mountain peak are less uplifting without someone to share it with. Living at the regional sites can also present challenges for a person of color used to living in the politically liberal bubble of cities like Seattle, Boston and New York. Questions regarding my appearance (“Why do your people have slanty eyes?”), country of origin (“Where you from? I mean, originally?”), or my fluent English (“Wow, you have no accent”) may seem offensive in the Pacific Northwest, and initially caught me off guard. However, I had to learn to suppress any reflexive feeling of offense and realize that such comments are not likely out of malice, but similar to other questions regarding healthcare (“Why do I need to take this medication?” “Well, what if I don’t want to quit smoking?”). I learned to respond in a cordial but constructive way. One particular patient recognized me at a remote roadside diner from when she saw me in an elevator in the hospital. I initially marveled at her memory, but then realized that given that I had seen no other ethnic minority for the past four weeks, I should not have been surprised. While a full discussion of race relations in doctor-patient interactions would merit its own article, the exposure to new political environments have been eye-opening and enables more compassionate care.
Despite these challenges, my experience in the region has been overwhelmingly positive — the nursing staff knew my gown/glove size, referred to me by name rather than as “the med student,” and I had all my attendings’ cellphone numbers, whom I texted regularly. Students are welcomed as future colleagues; no one asked me to “just get me your resident,” because there often were no residents. The staff encouraged me to do everything I could, from placing arterial lines to intubating, to speaking with the patient’s family after a procedure. I experienced a small slice of both the extraordinary sense of reward and frustrations with a Byzantine healthcare system that community physicians feel. From a social aspect, I have formed closer friendships with other medical students also on their own Safari rotations, and have many classmates to thank for their company and advice. Indeed, one of my favorite moments during my medical school years involved preparing Thanksgiving dinner in a purportedly haunted mansion in Wyoming, surrounded by howling negative 10-degree wind chill, but cozy inside with a turkey (compliments of the hospital) in the oven and spiced wine and 1970s Trivial Pursuit on the table.
The path of my future career remains uncertain; I appreciate aspects of academic, subspecialty and community-based medicine. Prior to my Safari, I was grooming my CV for an academic career, spending my undergraduate years and MS1 summer working in research, generating publications, and serving on curriculum committees. My mentors speak of the familiar “three legged-stool” of physician careers, whose legs represent research, teaching and clinical work. As optimistic as it would seem, most physicians find it difficult to maintain a perfect balance between their career “stool legs.” My experiences on the Safari have encouraged me to further contemplate the balance of my own career stool and ultimately broaden my residency application to include community programs with equal consideration as traditional academic institutions. Even for my colleagues who are set on pursuing research and academic medicine, I would urge them to complete a clinical clerkship at a rural site and venture into the wild.