23

If there's one thing I miss about Ktown, it's Monday night CSC Prayer Time. There's just something about sitting around with a few of your closest Christian friends and pouring your hearts out to God that works wonders for a dried-out soul. Though individual prayer is definitely a needed discipline and effective, I think sometimes we need that group prayer time. I have to say I've been feeling really dried-out lately. I don't know whether it is the class load, the lack of daily Christian fellowship and accountability I had in Ktown , or what but I could use a little of that group prayer time.
So...I decided to list out 23 *blessings* and requests in attempts to create a pseudo-prayer time. Nothing incredibly personal since the whole world can read this; just some things on my heart:

1. *That God gave us each today to live to serve Him*
2.*That He has given me means such as education, money, car, etc... and that He has provided me ways to use those to help others
3. *Morales family*
4.*A wonderful Christian family all over the world*
5. That I will make it through the next 2 months and 9 tests (especially the 1 next week)
6. My friend/classmate Jennifer who is participating in HTI's MET program in Guatemala this summer
7. That we will never mistake wealth for blessing and only use wealth to be a blessing to others
8. That the church here will find a Hispanic minister and continue to desire to reach out to the Hispanic community
9. *My wonderful parents*
10. All the missionaries in all parts of the world: for strength, encouragement, and opportunities
11. Lopez family who just moved to Venezuela to work as missionaries for 7 years
12. My mission trip to Guatemala this summer in July and the Los Piñares del Norte church
13. That we never replace our love for Christ with a desire for his attributes such as love, patience, joy, etc...
14. That we are not content to be pew-warmers and social gathers but that we each yearn to fulfill our part in the "Great Commission"
15. Guidance with my future plans regarding med school and beyond
16. *A diverse and beautiful creation*
17. *A reason to celebrate Easter and the hope that gives us*
18. *Being at Quillen and my wonderful classmates and teachers*
19. That we won't let our fears and traditions stand in the way or be mistaken for truth and love
20. That God will raise up a campus ministry here at ETSU
21. *The campus ministries at places like UT and MTSU*
22. *All the teachers and mentors who have influenced my life*
23. That we wake up each morning and remember our purpose for being here

Just a few small requests. Prayer is a powerful thing (if you don't believe that then I can tell you some pretty amazing stories that would make even the most devout atheist a believer) and a wonderful gift. Have a blessed week!!!

"So keep'em coming these lines on the road

And keep me responsible be it a light or heavy load

And keep me guessing with these blessings in disguise

And I'll walk with grace my feet and faith my eyes."

-Caedmon's Call

What a Beautiful Day...

...for a birthday!

Yes, I've officially hit the big 23 (2 years away from being a 1/4 century old!!) I must say, so far, it hasn't been as bad as I thought it might be. It's funny how when you're younger you want to be old and once you're older you want to be young.
To celebrate the big day, some of my cronies from med school and I decided to venture out into the wilderness. It's kind of been a tradition for me to go hiking on Good Friday; there's something about being in God's creation that makes you feel closer to the one who created it. Needless to say, I was somewhat concerned when I woke up this morning and saw a solid band of green on the radar and a 40% chance of thunderstorms. Being the risk takers we are, Jennifer, JC, Candice, and I decided to take the chance and drive to Rock Creek Falls in Erwin, TN. I'm so glad we did. The clouds lifted, and by the time we got to the falls, the sun was shining brightly on the white spray of water on the rocks. Though not the 8-10 mile excursions I was used to in college, the four miles was a fun mix of crawling over logs, rock-hopping the creek, and the inevitable falling in and getting wet as comes with all un-bridged creek crossings.
Not wanting to waste such a beautiful day, Candice and I decided to make use of the VA's vast greenery in front of Quillen and study on a sunny bench. When I got home, I found a few cards and emails from real and church family in my mailbox.
I find the fact that my birthday is juxtaposed on Good Friday somewhat ironic. 2000 and something years ago, the day was obscured by my sins clinging to a man dying on a cross so that a little baby could be born 23 years ago only to be born again on June 28, 1992. This same man was left without a friend in the world that day so this girl could feel loved by those around her. Yes, it truly is a Good Friday in many ways.
Well, I think Mom and Dad are almost here (they're driving all the way from Smyrna to come celebrate this weekend) and they're bringing me birthday cake (calories don't count on your birthday do they?)
I hope you all have a wonderful Easter Weekend and reflect on what it means to you!!

Picture This!!

If a picture is worth a 1000 words, then I've already got 2000 for this blog. I finally developed my film and uploaded some pictures. You'll find them interspersed throughout previous blogs like "Reflections on this Week" and "A Saturday in Sneedville" Below are two of my favorite pictures from this roll. The first was taken with some MET friends (Jason, Rosser, and Holly) at the Dallas Medical Missions Seminar in January. If you ever get a chance, I highly recommend going and also attending the smaller version right here in Johnson City in September. The second picture is of two precious Guatemalan blessings that entered my life about a month ago along with their mom, dad, and siblings. Their names are Emilio and Delmar. A supposed "quick" visit to see how they were doing last Friday turned into a shopping trip to Walmart when I found out they didn't have any food for that night nor the next week. On the way to WallyWorld, Delmar told me it was his birthday last week; however, due to lack of funds, he didn't get to celebrate. I think it's a travesty to not celebrate your birthday so we went all out with a $6 Walmart cake,decaf Pepsi, and some Little Cesar's pizza. You should have seen the look on little Emilio's face (and Delmar's too!) when we brought the cake home.


Meeting up with MET friends


Happy Birthday to You (and me)!

A Saturday in Sneedville

Dr.Michele?

This was taken in Smyrna after a long day of preceptoring

Sneedville: home of mussels, Melungeons, and where I spent the majority of my Saturday with Rural Track personnel. I must confess that I wasn't overjoyed to give up my one day to sleep in to drive 80 miles to the poorest community in Tennessee to see the opening of the hospital. However, the trip was well worth the drive and lost sleep. I thought knew what the term "rural" meant before journeying to Sneedville, after all don't all of us Tennesseans run around barefoot and chewing tobacco and saying words like "y'all" and "aint?" I was greatly mistaken. After we drove through Rogersville, the road narrowed to two lanes traversing a countryside of trailer homes and cows. As the ETSU university cars begin to ascend Clinch Mountain, I felt like I was back in Honduras driving over the mountain to Orica and Montaña de la Flor. The road switchbacked up the side of the mountain and below was poverty spread out to the horizon in the form of small farms and rundown houses. The scene reminded me of one of the "Feed the Children" commercials about Appalachia that used to run on Sunday mornings after church.
Our first few hours consisted of meeting with the Mayor of Sneedville, the county clerk, and Congressman Jenkins, key players in acquiring the approval of building a new hospital. Both the county clerk and mayor of Sneedville were of Melungeon descent, and both had gone to college and obtained an EdD. Poverty and isolation seem to breed the same characteristics in every community: a sense of dispair, a lack of vision, a lack of education, yet a wealth in the form of relationships and a strong sense of community. As the men told us of how the old hospital closed 12 years ago and about the town of Sneedville, I saw all these characteristics, and I admired the mayor, the county clerk, and all others who had fought to build a new hospital for having determination and vision.
Their stories impressed upon me the important role a physician plays in a rural community and how much of a difference a doctor can make. It frustrates me to no end to see students pursue a career in medicine solely for the monetary value and prestige of holding the title of MD. There are much easier ways of earning such salaries without having to put in the grueling hours of studying or the long years of schooling. Do they not realize that what they do is not just a 9-5 job but that their decisions will not only affect the patients' lives, but also their families' lives and maybe their community as well? And it is this I love most about rural medicine, whether it be in Latin America or in Hawkins County, Tennessee, the ability to make a difference in someone's life. Not only does a rural physician prescribe medicines for minor infections, but a physician may also save the life of a mother seriously injured in an MVA so that she might raise her children to pursue an education such as an EdD when she would have died had there not been a physician in the community.
At 2pm, all of the Rural Track students, myself included, attended the landmark opening of the new 12 bed hospital in Sneedville, Tennessee. Almost the entire community showed up to partake in the grand opening. Everyone from the young pregnant mother to the old, toothless gentleman in the bib overalls wearing a "Vote for Congressman Jenkins" hat was present. You would have thought the State Fair had arrived or some well-known rock group instead of the local gospel trio singing in what will soon be the reception area. As a favor to Wellmont and part of our research, we conducted a survey asking two questions to those present, "What do you think is the greatest healthcare need in Hancock County?" and "How will the opening of the hospital affect your use of healthcare services?" With broad smiles many answered the first question with, "Well, I think we already have the answer to the question; we got the hospital now didn't we?" Many responded to the second question by saying, "I won't have to find a ride over the mountain to go into Rogersville or Morristown an hour away just to see a doc."
Not only was a hospital opened today in a little community that many have never visited, but also hope was given to a people without much hope, hope that an elderly lady won't have to live in fear of dying of a heart attack because the nearest hospital is an hour away, hope that their children can seek immediate treatment for a broken bone, and hope that someone actually cares about Sneedville and its people. Furthermore, one medical student went away with a greater appreciation and understanding of community, small town life, and the impact that healthcare can have in a rural community. If the Latin America missions thing doesn't work out, I think I might just find me a holler back up in 'dem hills of Tennersee and open me a practice there.

Earpieces, Enchiladas, and Ideas

Whoever would have thought that I would be required to go to church or salsa dancing as part of my medical education? This year as part of the Rural Track Program, we have to conduct an interdisciplinary research project with students from nursing and public health. Seeing my ability to speak Spanish as an asset, I joined the group concerning obesity among Hispanics. This involves bi-weekly meetings to assess the needs of the community and our role in addressing this health issue. Since my group is working with a population of another culture, our professors desire that we experience that culture through various required outings including things such as community meetings with the Hispanic Coalition, a visit to the migrant worker clinic, and also options such as attending a church service in Spanish or going salsa dancing in Asheville (guess who’s dancing shoes are making a trip out on the floor in a few weeks?)
Tonight was our first meeting with the Hispanic Coalition of Northeast Tennessee. I went expecting a great catered Mexican meal and discussion about obesity, and I came away with ideas buzzing in my head as much as the simultaneous translation device in my ear. It was interesting to see the barriers that had to be crossed to facilitate the meeting between members of the Hispanic community, our medical professors, and the students. To ease the language, two wonderful translators were present, and all of the non-Spanish speakers wore earpieces that allowed us to hear the translator simultaneously translate Spanish into English. Since I knew both languages, it was extremely difficult to me to hear both languages at the same time and even more difficult when I tried to speak to the members of the Hispanic community while simultaneously hearing an interpretation of what I just said in my ear.
As the night progressed, our talk didn't center around obesity; rather, it was unfolding of the hardships and ubiquitous needs of the Hispanic population and of the misshapen paradigm we "Americans" have in regard to those who don't "speak our language." We talk about how "those people" come here and take away our jobs and live for free off our hard-earned tax dollars. Then tell me why is it that taxes get taken out of their paychecks, taxes they never see, just like ours? Tell me why the poorest city in Tennessee, Sneedville, and the one with the highest unenployment rate has migrant workers because those unemployed people would rather live off of our hard-earned tax dollars than take a job that a Hispanic person will? We talk about equal rights for all, yet we hand a scared teenage Guatemalan girl a phone to talk to her when she is giving birth instead of taking the money we just spent on remodeling the hospital cafeteria and hiring an actual human being to translate. I met a girl tonight who is in high school, at the top of her class, bilingual, and sweet as can be. However, instead of getting a scholarship to an Ivy League school, she'll have to cross the border and hopefully find work. We call ourselves a land of the free and a land where one can pursue the American Dream but only if one has had the privilege of being born "American." I know, you're thinking "but these are just a bunch of illegals that need to be shipped back where they came from." Tell that to my brother in Christ, Amado. Tell him he has to go back to a land where his children won't be educated because there simply aren't schools where he lives, his children will suffer disease from lack of medical care, and a land where he can't provide for his family. Didn't our ancestors all come to this land with the same dream Amado and his family came with: to have a better life?
So what can you do about this? You can sit on your comfy couch comparing your NCAA picks with the game outcomes and priding yourself for being an American citizen and not one of "those poor Hispanic people" and think there's nothing you can do. On the other hand, you can write your representatives and senators and urge the to support the Dream Act which allows non-US citizens the opportunity to get a college education provided they've been in the US school system for 15 years. You can urge them to support better working conditions for Hispanic laborers (don't even get me started on the working conditions of most Hispanic laborers), or you can even just reach out and get to know those in your Hispanic community through afterschool programs or church. You may not be a Thomas Jefferson or a Rosa Parks but you can make a difference. Isn't that what we're here for, to minister to the oppressed, the poor, the broken-hearted? It's just that some of them may not speak the same language as you.
The decision is yours.
I ask for your prayers that God works through the leaders of this community to bring better healthcare to the Hispanics of this community and that a sense of understanding and community prevails between both ethnic groups. I ask for your prayers that God continues to bring workers such as yourself to all parts of the world and the US to help those who are in need, whatever that need is, and that He allows us to realize that we are all His children no matter our place of birth or the language we speak.

It's All in a Name

I'm back at Quillen, and life is hectic as usual. I'm only two days into classes, and I'm already struggling to keep up with the work. This block is definitely going to be a beast which means little sleep and not much else but studying. I'm special enough that Quillen is giving me a holiday on my birthday (actually it's Good Friday), but it looks like I'll be spending it in Stanton Gerber reviewing biochem and phys notes. Oh well, turning 21 +2 isn't such a big deal anyways, just another year.
Anyways...
Being on Quillen's "Ask a Student" page has recently sent a rash of questions my way and almost every email begins with "Hi Michelle." Even my professors address me as "Michelle" in their emails. If you're like 90% of the population, you address me this way too. You see, my name is not "Michelle" it's "Michele." That's one L not two LL's. I suppose my parents were trying to be clever or creative when they named me, but it's been a curse all my life. Maybe if I were named something really strange like "Kyoo" or "Shanika" or "Loan," people might notice the spelling. However, since "Michelle" is such a common name, the spelling is taken for granted and my name goes unnoticed. In fact, when I was 4 years old, I demanded to change my name only to have my parents tell me that I'd have to go by my middle name which I like even less. I can't tell you how many certificates, birthday cards, medical records, etc I've had addressed to "Michelle" instead of "Michele" Sometimes I fight it, but usually I just resign to the fact that my name will never be spelled right.
So, the moral of the story is, be considerate to us oddly-spelled named people. It may be another letter to you, but it's our name that's at stake. Be kind to your future children, name them something outrageous or just give them a normally-spelled name. Otherwise, they may have to join me in the "Misspelled Names Anonymous" group.
Hope you are all enjoying this crazy Tennessee weather. Hasta luego!

MicheLe

Reflections on This Week

Smyrna's New Hospital


I've officially finished my week of preceptorship with Dr.Thompson, the family practicioner. It's been an incredible week, and I couldn't have asked for a better mentor, a doctor who doesn't have a God complex and who actually cares about the well-being of his patients. It's been a week of seeing those random facts and figures I've learned brought to life through actual patients and a reaffirming of my desire to be a family practicioner. I've had the blessing of being able to see a broad range of illnesses and diseases from DiGeorge's Syndrome to tracheomalasia to erlichiosis to the common everyday cold. Though it's going to be a long 6 years, I couldn't have chosen a better career.
One thing that frequently came to my attention during my preceptorship was the number of obese people that came through the office. In fact, I think it would be safe to presume that our patient load would be cut in half if obesity was not the epidemic that it is. How many problems coudl be prevented such as diabetes, high cholesterol, hypertension, joint problems, and sleep apnea if obesity weren't an issue? No, this isn't a blog bashing fat people; however, seeing so many cases of obesity brought to light issues within the spiritual realm.
Like many of the patients I saw this week, how many of us are carrying around hundreds of pounds of excess "baggage" in our own lives in the form of unwanted sin? How many of us are obese spiritually because of our lack of self-control and self-discipline or our unwillingness to shed our excess baggage? Not only is the excess fat of a person a problem to the patient, likewise it is a problem for the physician. It's not easy trying to listen to the lungs or heart when you have two extra inches of insulation in between. Nor is it easy to measure a blood pressure when the patient's arm is as big as my leg. In the same way, we want God to work in our lives and clear out any "infection" but we don't give the Great Physician a chance to come close and really find out what's going on because of our own insulation in the form of our sins, our habits, and our stubborn wills. At the clinic, we would try to counsel our patients, setting up dietary modifications, plans of exercise, and rewards but the bottom line was the patient's will to lose the weight. No amount of counseling or plans from the physician could make the patient take that first step to losing the weight. I think it is the same in our lives. Let's face it, sometimes we like the comfort zone we've established in our lives. We like our "habits" and we all have things and reoccuring sins that we struggle with on a daily basis. We'd like to grow in our faith and let the Great Physician draw nearer to us but we are unwilling to take that first step from shedding the unwanted "baggage" we carry so that nothing will hinder us from running the race God has set before us.
Just some thoughts I had from this week's experiences. Pictures should be up as soon as I develop my roll of film and scan them in my computer. Two more days of freedom :o).

Eureka!

I found it. It was in the basment piled up with the plethera of items my brother left at our house when he moved out: a Eureka! Tetragon Tent for three. While it is a bit too big and too heavy for backpacking, it will be perfect for my trip out West this summer (though friend's homes are also suitable habitations :o)). This was one of a few pleasant surprises discovered in the past 24 hours.
The other pleasant surprise is that Smyrna now has it's very on El Salvadoran restaurant specializing in one of my favorite Central American foods, pupusas. Who would have ever thought that Smyrna would get a hospital or a Starbucks, much less El Guanaco? Since I haven't convinced mom and dad to go to Central America yet, at least I can bring Central America to them in certain respects. Guess where mom and I will be eating when we go out to shop tonight? ;o)
Today was a great day at the clinic considering I didn't have to go in until 9am and got off at 1:30pm right after a lunch of Asian cuisine catered by the Clarinex drug reps (ask your doctor for Clarinex because they bring good food). The slip of paper in my fortune cookie read:

"You have natural grace and a great consideration for others."

I don't know if this is true or not but at least it wasn't something stupid like, "You will soon inherit a large sum of money."

The case load was pretty uneventful though I did get to help with a 6 month well child visit. Did I ever mention how cute little babies are? Why do they have to grow up, and why do they have to start crying as soon as I put the baby stethescope on their chest? Tomorrow I'll let you guys know how everything went this week because I have a lot I could type (or you could just call and I'll tell you over the phone). I hope you are all enjoying this lovely day wherever you are! Ciao!

Catching Up

The past few days have been a flurry of activity as I've tried to make the most of the few precious days of Spring Break I had and make the trek from Johnson City to Smyrna, TN. It's been nice catching up with old friends whether that be a hike up House Mountain in Ktown, hanging out until the wee hours of the morning, or sharing photos at a small corner table in Starbucks. You don't realize how much you miss someone or how long overdue a visit was until it actually happens and you wonder where the time since the last visit went.
I started my preceptorship this week. Though somewhat of a break in the fact that I don't have to study, it has been far from the definition of "break" in the fact that I've put in two 10 hr days with hardly a break for lunch and an average of 40+ patients per day. Despite the long hours and sore feet from standing so much, I'd do this any day over classwork. The only problem with having a creative mind is satiating its creativity when your entire life consists of memorizing seemingly random facts about rare diseases and biochemical pathways. However, this week has been a much-needed experience that puts all those random facts in perspective. I'm beginning to see the necessity in knowing the characteristics of DiGeorge's Syndrome or neurofibromatosis or the differences in nasal epithelia.
The actual practice of medicine reminds me of the practice of music. Both have their sets of rules: the notes, rhythms, scales and the anatomy, physiology, and pathology. However, the real practice comes in learning the rules so well that you know when to break them. Music is never made by simply playing the notes on the page; rather, it is through the observances of the subtle nuances of the composer's intentions and the performer's interpretations that a piece is brought to life and evokes a response from the audience. Likewise, I'm learning it is the same with medicine. Though it is important to learn all the seemingly trivial facts, it is the ability to apply those same facts and to integrate them with other facts and predisposing conditions and to treat the patient with genuine compassion that makes a good physician and is truly practicing "good medicine."
It is for these reasons I chose Dr.T as my preceptor (they always say to learn from the best). He is one of the few doctors who I've seen genuinely show compassion for his patient from the poor in Honduras to the TennCare patient to the high ranking businessman. So many people try to fake compassion. It's easy to be a good person and to treat people well, but if you don't have that genuine desire to actually serve your patient, the patient knows. I'm afraid many of my comrades sell out to power and money and put themselves above their patients, so it's really nice to work with a doctor who is an exception to this.
Just in two days I've seen a broad spectrum of cases from flu to emphysema to ingrown toenails to psychological issues to skin lesions to physicals. I've seen people from 5 months to 85 years and people from all walks of life, all just wanting to be treated by their family practicioner. I won't bore you with the details of what I did other than the fact that a Hispanic man came in who didn't speak any English so Dr.T let me do the full work-up on him (in Spanish) from vitals to physical exam, and then Dr.T just checked everything out to see if it was ok. This med school nerd thought that was pretty cool. Anyways, I'm tired and I don't have to go to the hospital tomorrow until 1pm so I'm going to take advantage of that and sleep in for the first time in a month. G'night!!

Life in a Small Tube

Knock, knock, zzrrr. bam! Thunk!

No I haven't been reading the latest comic book action scene. I had the joy of spending 30 minutes in a 2 foot tube being absolutely still while a huge magnet reorganized every dipole moment in my entire body and gurgled like some underfed monster. I had had one done a few years ago when they thought my naturally goofy nature must be attributable to several loose screws in my head. When they didn't find any loose screws they just chalked my goofiness up to the fact that I'm Michele. However, I had forgotten how as soon as they wheel you in the tube, a sudden sense of claustrophobia develops and how it seems at that moment that the room is filled with itching powder because you have to scratch your nose and you can't for 30 minutes because you have to be absolutely still. Needless to say, I had no qualms about leaving the tube when they were done imaging my spine.
The mystery of my back pain may finally be uncovered soon or I may be back at square one (word to the wise: if you match up a Toyota Corolla with a Dodge Ram 3500 truck, the truck's going to win and the Corolla will get smushed). Being the med school nerd that I am, when I was done with the MRI, I asked for films. Nothing looks incredibly out of place, but then again I'm a first year med student which means I know absolutely nothing about medicine nor reading MRIs except what I had to learn to ace the anatomy exams. That being said, it looks like it may just be muscle damage which means back to Pilates and Yoga and maybe massage therapy (which is perfectly fine with me :o)). No spinal alignment from some chiropractor for me. My spine is perfectly in line thank you.
So we'll see, and I'll keep you posted. More thoughtful posts to come as soon as my brain recovers from this week's series of exams.