Cream of the Crop

By Andrew Park (’18).

By now we have seen the passage of two “quiz” cycles, which are rather erroneously named as they carry the weight of biweekly midterms. Inevitably, there are some of us in the class who have already begun to question our ability to succeed in medical school. Some of us have never received a failing grade ever and had to meet its bitter taste while in the first month of Geisel. (But in reality, this is another misnomer, because 70% is hardly a “failure.” We’ve been groomed to believe that this is “average.”)

And while there are still percentages floating around on these “quizzes,” it’s easy to fall back into our undergraduate mentality that can only lead to a competitive mindset. There is a reason we got into medical school in the first place, and it was not by ignoring the competition around us. Typically, those that make it into any medical school, and especially one of as high a caliber as Geisel, are accustomed to being at the top of their class. It started in kindergarten, when we were proud to turn in our sheet of capital and lower-case letters written on brown recycled paper; continued in high school, when our friends were intimidated by how many AP or IB courses we were taking; and ultimately continued into college, where we still somehow managed to graduate with honors.

Each step along the way, there was an elimination process with stiff competition. We were part of the cut that was permitted to proceed to the next step. And if you didn’t make it through the first time, you found creative ways to bypass the traditional pathways. There is a wrinkle in society that has groomed us to feel that those sitting around us in Kellogg Hall are all competition.

But medical school is not college, it’s not high school, and it’s certainly not a group of five-year-old kindergarten gunners. Medical school is the apex of academic achievement. There are no further educational steps after medical school, and there are no further cuts that will diminish your chances of becoming a physician in which competition is necessary. (I should clarify that internship/residency is not school, it’s a job where you get paid money, which you can use to buy things that you can own. Money—I know you haven’t heard of it, you should look it up. It’s been around for a while.)

Ladies and gentlemen, welcome to the cream of the crop. We are the cream of the crop, and the cream of the crop is not divisible into lesser- or greater-valued parts. If we were a crate full of gold, the gold on the bottom is valued the same as the gold on the top. So while the weight of medical school and “quizzes” are starting to get heavier on our shoulders and causing depression of the scapula, realize that there are no failures here. Some of us may still feel that admissions made a mistake in accepting us, but I am certain that those who support us watching from the sidelines—our families, our mentors, our friends, and society as a whole—do not share in this belief.

“Oh, (s)he got into an Ivy League-medical school? Must be dumb,” said no one ever.

Andrew Park (’18) graduated from the University of California, Berkeley, in 2012 and recently moved from Los Angeles to New Hampshire. He has also written for The Atlantic and The Week.

An Urban Health Immersion

Greater Lawrence Family Health Center

The Urban Health Scholars at the Greater Lawrence Family Health Center.

In early September, members of Geisel’s Urban Health Scholars program traveled to Massachusetts to attend several events that would give them a sample of some of the challenges and rewards of working with underserved populations in urban areas. A few of the scholars reflected on what they took away from the experience.

Thursday, September 4

Greater Lawrence Family Health Center
By Ali Corley (’17)

Our first stop on our 2014 Boston immersion trip was the Greater Lawrence Family Health Center (GLFHC) in Lawrence, Mass., just north of Boston. There we met with Dr. John Raser, a graduate of Dartmouth College and the Medical School, who showed us around and spoke about his work there. Dr. Raser is a family medicine doctor who lives and works in Lawrence and is an advocate for his patients both at the center and in the community. On our tour of the health center, Dr. Raser told us more about GLFHC and the type of medical care they provide. GLFHC has adopted a patient-centered medical home model, which emphasizes teamwork among health professionals and addresses health issues from many perspectives. They promote group health sessions, healthy lifestyles, and community-wide interventions to improve health in a lasting and effective way.

Dr. Raser discussed the importance of health professionals being involved in the communities that they work and live in. Doctors have great potential to be local leaders and can use their knowledge and respected positions to initiate healthy programs and initiatives. In fact, Dr. Raser recently started a project to open a bike shop in the community. We detoured along our tour of the health center to visit his shop, BiciCocina, which he started to fill the need of the city, which hasn’t had an operating bike shop open in several years. With BiciCocina, Dr. Raser hopes to promote active lifestyles and safe streets through youth programs and community events. We took the scenic route back to the health center and had the opportunity to walk through some of the Lawrence center streets and the common park. Lawrence is a unique combination of city and small town. We saw Italian, Greek, Irish, Dominican, and Haitian churches and buildings and were able to appreciate the diversity of the Lawrence population.

Back at the center, Dr. Andy Smith joined us for dinner and discussion. Dr. Smith spoke to us about the overlap between urban and global health and gave us a presentation about the qualities required to deliver care in both settings while also managing to maintain optimism, idealism and compassion. We learned about the special challenges that come with working in a primarily Dominican community and how the ability to relate to patients is enhanced when you speak their language or have been to their home country. Dr. Smith told us about cultural differences concerning patient-doctor relationships and how the strict professionalism we are taught in school may need to be adjusted depending on the patient. For example, he greets some of his patients with a hug and kiss on the cheek, which is custom in many Latino cultures. For others, he finds that showing them pictures of his family helps strengthen his relationship with patients and break down barriers to trust.

The Greater Lawrence Family Health Center offers programs for residency training and rotations in family medicine, with opportunities for Spanish language learning and immersion. After our vist to Lawrence today, I think many of us will consider pursuing these opportunities in our third or fourth years and beyond.

Friday, September 5

Revitalizing the Hennigan Elementary School with Harvard Pilgrim, the Celtics, and City Year
By Brendin Beaulieu-Jones (’18)

We kicked off the second day of our Boston immersion trip at Hennigan James Elementary School, where we joined Harvard Pilgrim, the Boston Celtics, and City Year for a morning of community service. Before jumping into the work, we heard from the principal of Hennigan James Elementary School, who stressed the importance of providing a warm, learning environment for children in order to contribute to a healthier, stronger community. The school is currently expanding to include sixth- through eighth-graders, and it serves as a pre-K learning center, Boys and Girls Club, and recreational center for the community.

After some additional opening remarks by the presidents of both the Celtics and Harvard Pilgrim, we enjoyed some brief entertainment by Lucky the Leprechaun (the mascot of the Boston Celtics) before heading out to start our work. A few of us painted the exterior of the school, including the courtyard, four-square courts, and main entrance, while others removed some weeds and debris from the neighboring fields. It was refreshing to have the opportunity to serve the Jamaica Plain community and help contribute to a more positive learning environment at Hennigan.

Meeting with Dr. Megan Sandel
By Hayley Jones (’17)

After an exciting morning working with the Boston Celtics and Harvard Pilgrim at the Building Healthy Communities day of service in Jamaica Plain, we headed to Boston University’s medical school to meet with Dr. Megan Sandel, a graduate of Dartmouth’s medical school, for a Q&A about Boston’s Medical-Legal Partnership. Dr. Sandel’s enthusiasm and understanding of the social determinants of health were engaging and exciting to hear about. Even better, work that she has done has helped to create laws that holds landlords in Boston responsible for basic upkeep so that apartments in Boston are less likely to make people sick. The law addresses mold, mice, and other infestations that can adversely affect the health of inhabitants. Dr. Sandel’s exuberance for understanding how housing status affects health outcomes from children to HIV positive individuals was outstripped only by her determination to search for a solution. UHS took away much more than information from the Q&A.

Boston Health Care for the Homeless
By Cristina Alcorta (’17)

On Friday afternoon, we had the opportunity to meet with Dr. Jim O’Connell, President and one of the founding physicians for the Boston Health Care for the Homeless Program (BHCHP). We were very much looking forward to meeting the man who established the nation’s first medical respite program for homeless persons and implemented the first electronic medical record for a homeless program.

With open arms, he welcomed us to his brainchild. Starting our tour off with a little history, Dr. O’Connell brought us to the historic main entrance of the old Mallory Building, describing its historical roots as Boston’s center for medical pathology research and city morgue from the 1930s to the 1990s. We then shuffled to a conference room for a discussion about homeless health care and street medicine. Here, we learned about the Family Van, which brings necessary items such as blankets and warm soup to individuals on the streets. Dr. O’Connell feels that it is important not to offer medical services right away, because homeless individuals are often wary of the medical system. “They feel like they are going to get locked up, or taken away,” he explained. Instead, Dr. O’Connell simply lets them know he is a physician as he leaves and that they can approach him if they ever want or need to.

Under the Affordable Care Act, affordable insurance is no longer an issue for the homeless. However, that does not mean problems have subsided. Ten percent of the BHCHP participants are chronically homeless. That is, they have been living in the streets for over one year. Fifty percent of the first-come-first-served beds taken up each night are used by that ten percent. Individuals not only need services, but support to find housing and manage a stable household. Unfortunately, many do not find the support they need to be on their own. Many do not find comfort in shelters: some fear large crowds; couples refuse to be split up; others feel enclosed. A patient once said to Dr. O’Connell, “I do not like the shelter because I cannot tell which voices are mine. . . . When I’m on the street I know which are mine and which aren’t.”

In addition, the majority of homeless individuals suffer from major, incapacitating mental illness. Those suffering from substance abuse have a difficult time staying sober and continuously fall back into the cycle of hard-core, chronic addiction. Overall, mortality rates continue to be high.

Our tour continued. A personable, compassionate man, Dr. O’Connell stopped at various points during our tour to introduce us to a patient or a dermatology resident to get a glimpse of their experience with the BHCHP. He shared deep and personal stories of the homeless individuals he has met throughout his time with BHCHP which encompassed both sad and triumphant anecdotes of his dearest patients. We saw several facilities, including the dental offices, pharmacy, inpatient floors, and the outdoor patio meant for moments of relaxation.

At each stop, we learned about the several services offered to patients: dentures, medications, prenatal care, walking aids, and initiatives to accommodate transgender individuals. We saw the rooms where patients slept and the rooms where they played bingo, cards, and pool. Though the homeless world faces strenuous trials each day, BHCHP seems to provide at least an iota of stability and calm in a sea of chaos.

Some of the hallways proudly display photos of the smiling faces of former patients of the BHCHP. “Turns out they wanted to have their pictures taken. It made them happy,” said Dr. O’Connell. Most, however, had already passed away at too young an age.

Mattapan Healthcare Revival
By Fernando Vazquez (’18)

“When you connect with Mattapan Community Health Center, good things happen.” The organization’s motto is quite the understatement. For nearly 20 years, Mattapan Community Health Center has been organizing a revival; a festival centered on enabling community members to become more competent in taking charge of their health. From cholesterol screenings to dental checks, the event brings together an underserved community and not only educates them, but also urges attendees to spread the word to neighbors that help is available to all. Geisel’s Urban Health Scholars capped an immersion weekend with the valuable lesson in the importance of true integration into the communities we will go on to heal and serve.

A French Major Considering Med School? Pas de Problème!

Eiffel Tower

By Lauren Fall (’18)

Don’t know which ventricle is right and which is left? Not a problem. Haven’t heard the word “organelle” in a couple of years? Awesome. Never smelled formaldehyde? Well, then do yourself a favor and remain in ignorance until after you’ve committed to a medical school. More comfortable around Shakespeare than a cadaver? Good—for the sake of your social life, you should probably keep it that way. Nervous about entering medical school as a non-science major? So was I.

Though I’ve been known to sarcastically claim to have become a French major because of the language’s direct application to medicine, I really became a French major because I loved it—everything from culture to conjugations. Like many of my colleagues here at Geisel, the liberal arts inspired my curiosity and provided me with intellectual balance, with sanity, in other words. The prospect of entering medical school, however, is daunting by itself, but entering without prior experience in anatomy, physiology, histology and metabolism (just to name a few) borders on terrifying.

In thinking about what my first term at Geisel would be like, the adjective “overwhelming” immediately came to mind. Although this turned out to be true, what I didn’t realize at the time was how awesome it would be to feel that way—I failed to recognize the beauty of the word. At Geisel I feel overwhelmed by the generous support of the school and local community; by how invested the faculty members are; by how helpful, brilliant, happy, and impressive my classmates are; and by how glad I am that I came to Geisel, even as a French major.

For those of you that are nervous, as I was, about being overwhelmed in medical school, here is the evidence-based (see, even French majors can be taught to write like scientists) advice that I have for you: it’s okay. Throughout the first two years of your medical school career, you will be learning everything for the first time, which is actually an incredible thing. Like the first time that you rode on a roller coaster, or tasted ice cream, or read a book, the things that you learn will fill you with awe, curiosity, and wonder. Your science-major classmates will feel this, too, but you will be able to remind them that all of it is pretty darned cool and they will have the opportunity to learn to be teachers, providing you with support and help—mutualism at its finest.

And where is the evidence as promised, you ask? Well, after our first quiz a fellow student lamented his status as a “Fysio Failure” on the class Facebook page and another student responded with the comment, “Welcome. Thanks for your share. You’re safe here.” Twenty-two likes—numerical evidence proving that truer words were never written. The conclusion: prepare to be overwhelmed with knowledge and support.

So, here is my last piece advice as a French major to a potential medical student: being nervous is okay, and when you find yourself beginning to be overwhelmed, remember that ooh la la, it’s the best kind of overwhelmed.

Lauren Fall graduated from Centre College in Kentucky in 2014 as a French major and she is thrilled to return to her hometown as a member of the Class of 2018 at Geisel. At Geisel, Lauren hopes to get involved in global health programs as well as health education in the community. She is excited for the next four years!

Superheroes, Autophagy, and Medical School

Superhero

By Andrew Park (’18)

At some point before we submitted our applications to AMCAS, we dreamed of saving somebody’s life, or at least of making the lives of others better, and, by gosh, that’s what we’re here at medical school to do. I don’t mean to sound pompous, but we are in the process of becoming superheroes. Like all superheroes, we soon find out that we have to shed all traces of what has shaped us to this point in life. It is simply a matter of necessity: the material tested on a midterm as an undergrad is equivalent to about one day’s worth of material in medical school.

And so our minds undergo a form of autophagy, removing the unnecessary bits of information to make room for the new. It matters very little now if you can still remember how many times Ross and Rachel were “on a break,” or what that song was that you learned in second grade to help you recall all 50 states. (The only states that matter now are New Hampshire, Vermont, Massachusetts, and, of course, California in third year. Maybe New York, too—the city, not the state.)

I wish that the premise of the movie Lucy were true—that we only use 10% of our brain. I know it’s not, but it would certainly be useful, as the after just the first couple of days in class our minds have been bombarded with material to the point that we don’t even know how to feel overwhelmed.

That feeling of half of your brain imploding? That’s simply your brain making room for what you’re about to learn. It’s autophagy alright. Our mind is eating itself to get rid of a big chunk of our self-centered desires to make room for the reason we came to Geisel. We are here to bring healing to the world, to bring a smile to a sick child, and to put others before ourselves. So while that feeling of a numbing headache is still fresh in our minds, let’s take time to reflect on our old selves. It’s now time for us to put on our undergarments over our trousers and face this new chapter in life.

Andrew Park (’18) graduated from the University of California, Berkeley, in 2012 and recently moved from Los Angeles to New Hampshire. He has also written for The Atlantic and The Week.