Jun 30, 2011

Thoughts from a Little Doc's [Dad]

Dear Annie,

When you were about 4 or 5 I took you to a weekend math conference I was speaking at in south Orange County. We stayed at the Westin Hotel and had a great time – swimming in the pool, watching TV, ordering room service. You didn’t even seem to mind sitting through my talk. After we got home, it was back to work as usual, and I don’t think we talked abut the trip again except for saying that it had been fun. About six months later we happened to be driving near the Westin and you said, “Look, dad. There’s the hotel we stayed at.” I said, “You’re right, sweetie,” surprised that you would remember the specific hotel. Then you looked right at me and said, “Room 405.”

It was then that I knew this was no ordinary child.

For you, information was always taken in, analyzed, catalogued, and stored in such a natural way that you were not even aware of the process. Details were useful, not threatening. Data about the world – both quantitative and qualitative – was always welcomed.

I think it has taken you most of your life to come to terms with the fact that you have a remarkable mind. Children can sometimes be unkind to a peer who seems a little different, especially if the genesis of that difference is intellectual. I know being a kid was rough on you sometimes. I tried to help – not always effectively – when you felt that the others did not understand you. The fact is, they probably didn’t. But I always knew that if you could reach the other side of childhood that you would have a remarkable adulthood.

And so you have.

At an age when many of those same peers are still trying to find their way in a complex grown-up world, you are leading the way. You are a doctor, Dr. Anne Kennard, perhaps the only palindromic OB/GYN in America. You are in a residency program at one of the top hospitals in the country, one of eight chosen out of more than eight hundred applicants.

They saw in you what I knew long ago: this is no ordinary doctor. Although just a first-month resident, your accurate diagnosis today of a breach presentation resulted in a good delivery in a situation that otherwise could have had a bad result. Once again, data was taken in, analyzed, and, now, applied. Mother and child are doing well.

I wonder if the mom, who is resting this evening after a busy day, is in room 405.



Jun 29, 2011

Changed For Good

I went to medical school at A.T. Still University, School of Osteopathic Medicine in Arizona. It was a brand new program, a school devoted to an innovative curriculum that gave students early clinical exposure, taught in a new inductive reasoning pattern, and valued underserved and primary care medicine.

Quite frankly, I didn't care much about any of these details. What I cared about was that this was the only school that I got an interview, and so I really wanted to be accepted there. Sure, I was fine with all the things that this school valued and taught. I think my natural bias was towards primary care to begin with, and I liked the idea of working with medically underserved people. But whatever. I would have gone to any school that wanted me, given that they were accredited and within the United States.

So, I was accepted. I started my first year with a trip with all my classmates to one of the Community Health Centers we would be rotating in during years 2-4 of school. And I was happy just to be there. The next year, our class of 100 was divided into ten groups of ten students, and we moved to our clinical sites at the community health centers. There were students in Hawaii, working primarily with homeless Hawaiians, students in suburban Seattle and Portland, urban Brooklyn, rural Ohio, South Carolina, and Alabama, Indian reservations in Arizona. My site was Central California, working with mostly Hispanic people who picked the great majority of the fruit for the nation.

I rotated through the different specialties, seeing these patients. I traveled to Hawaii's community health center, where I rotated through pyschiatry. I was exposed to different races, ages, citizenship statuses (or lack thereof), addictions, and problems, all united by poverty and limited access to health care. And I thought I understood, finally, why my school developed this new curriculum. They wanted to have us work in these settings to make us familiar with working in underserved medicine, in the hope that we might choose primary care and come back to be a doctor to people that desperately need one.

Then I graduated and started my residency, in a nice hospital that serves everyone from the very rich to people that just made it over the border. I thought more about my school, and the background it had given me with underserved medicine. And I think I understand that their vision, their goal in the grand scheme of medicine, was not to have doctors return to community health centers in primary care. Of course, this would be a wonderful bonus to their commitment to underserved medicine. However, I think they knew that by training young physicians within the lens of the underserved, we would be forever changed as doctors. Even if we chose the most sub-sub specialty in Newport Beach, California, we would always have the memory of working with those who had very little. And this, I think, is the heart of the program. Training doctors in the initial setting of underserved medicine forms a framework that affects the rest of a physician's career. I know for myself, my view of medical legislation, practice decisions and treatments are changed forever, no matter where or with whom I practice.

As I write this and think about these patients, I hum a song from my favorite musical, Wicked. As the song says, I have been changed for good.

I've heard it said
That people come into our lives
For a reason
Bringing something we must learn
And we are led to those who help us most to grow
If we let them
And we help them in return

Well, I don't know if I believe that's true
But I know I'm who I am today
Because I knew you

Who can say if I've been changed for the better?
(I do believe I have been changed for the better)
And because I knew you
I have been changed for good

Jun 28, 2011

Putting On My Gloves

Well, I've started work as a doctor. Two day shifts, one night...it hasn't been too different than being a medical student, except that I sign my own orders. But tonight was different.

It was about 10:30 pm, and I had just finished helping to deliver a baby. I sat down to write my delivery report, and heard a nurse call "911 to triage!" I watched a couple nurses run after her and then decided that since I am a doctor now, perhaps it wasn't a bad idea for me to go too. I wasn't stressed because I knew the 911 pager had been activated, which meant that a group of residents with actual experience and an attending would show up soon. But I decided I would go and just be there in the meantime.

It turned out to be a patient that had shown up to triage when completely dilated and was starting to push her baby out. I introduced myself, and asked her a few questions, in Spanish, keeping an eye on the door for someone that would know what I should do. No one came, and the nurse handed me a set of sterile gloves, and said "put your gloves on."

And I did. I pulled on the sterile delivery gown and pulled on my gloves, and delivered the baby just as the more advanced resident and attending arrived. I stood there holding that baby, knowing that this mother was my patient, and that me being there had mattered. I had put on my gloves, and was a doctor.

It was a great feeling and an I think an important transition, as I start my residency, and gives me a lot of excitement for what is ahead.

Jun 7, 2011

Thoughts From a Little Doc's [Mom]

Dearest Annie,

You indeed became a physician yesterday. As we have enjoyed the festivities of this weekend, I have reflected on the journey of the past four years. You have grown and changed quite a bit over these years. But you are not the only one who has grown and changed. I have also grown and changed as I have watched your journey. With that in mind, I will reflect on a few of the moments that were touch points for me.

Did you say “thank you”?

Although many years and experiences went into the making, the real journey began when we flew to Arizona for the interview at ATSU. You called excited with the news that you had been granted an interview, but that the interview was to occur within a few days. ATSU had invited you to bring a family member along. They were keenly aware that the rigors of medical school would require a support group that was “on board” with your goals. So, after a whirlwind trip to Nordstrom with your dear sister to pick out an interview suit, we were off to Arizona.

I knew that I had one job on this trip: to deliver you to the interview on time. Having never been to Phoenix before and not yet in possession of a GPS unit, I must have reviewed the route from the hotel to ATSU twenty times. I breathed a huge sigh of relief when we entered the parking lot. Because of my fear of screwing this up, we arrived forty-five minutes early. Not a moment too soon, in my book.

It was a grueling day for both of us. I was allowed to be with you for all but the hours of direct interview. You were poised, confident, and charming. I tried to strike a balance between sharing things about you that I thought the interviewers should know and coming off as a stage mom/helicopter mom/hopelessly doting and tiresome parent. You nodded enthusiastically as the presenter reviewed the curriculum and testing schedule that would be yours if you got in. I wondered if anyone could possibly live through it. After a grueling ten-hour day, we walked through the exit. Before I gave it a moment’s thought, I said, ‘Did you say “thank you”?’ The look on your face reminded me that this was not our usual exit together after a birthday party. You had just made it through a very grown up day. It was time for me to grow up, too.

“Back to School” Shopping

A favorite tradition in our family over the years was the annual “back to school” shopping trip to Staples for school supplies. The aroma of freshly sharpened pencils evoked excitement for a brand new school year. The list included the usual items such as binders, folders, college-ruled paper, a pencil pouch, and a supply box for the top of the desk. There was a yearly discussion between you and Jennifer on the merits of colored pencils versus felt tip markers. Crayons were a “must have” at any age. A box of sixty-four with the built-in sharpener could be counted on to increase your popularity when it came to choosing partners for group projects.

The night before, we looked at each other and wondered what one should bring to the first day of medical school. ATSU had issued you a computer “tablet,” which was the latest technology for new medical students. Were you supposed to bring the computer in a backpack? What else should go in that backpack? We settled on the usual assortment of items, including the crayons. Maybe you would need to color and label pictures of anatomy. Who knows?

*a note from the little doc: the other students laughed at me about the crayons in my bag. And then wanted to borrow them.

Over time, we knew that all of these items were necessary and useful. What we didn’t know is that Dad and I should have bought stock in the company that makes 3 x 5 note cards. You must have gone through thousands in the last four years. The other important purchase was “Phyllis.” Phyllis is a full size skeleton that shows important landmarks such as the origin and insertion of the major muscles. Phyllis has oddly been a source of encouragement, having been named for Dr. Phyllis Agran (a pediatric gastroenterologist) who guided you through a rough patch in your own health during your middle school years. Like the box of sixty-four crayons, Phyllis ensured your popularity in your early days of learning anatomy with your peers. She also provided comic relief when dressed up in a myriad of outfits.

Mom, I’m calling to tell you that I am on my way to the E.R.

In fairness to me, this was not the first time that I had heard these words from you over the telephone. You have had a series of mishaps over the years, including numerous painful ear infections, a broken toe, a concussion, a pierced eardrum, pneumonia…. Need I go on??? The fact that they were uttered at 10:00 at night did nothing to ease the immediate panic. You found my panic to be hilarious and said, “I’m working in the E.R., not going to the E.R!” Frankly, this possibility did not even occur to me.

For the well being of our patients, please leave your children at home.

I saw this notice when signing in for an appointment with Dr. Thanos, the gynecologist/obstetrician who delivered Jennifer. As every parent knows, memories of your children when they are young are very vivid and can feel as if they happened yesterday. Sometimes you are startled to see your child standing before you today and you wonder how she got there. As I absentmindedly read this sign, my sense was that you were home being cared for by Grandma while I was at the doctor’s office. I was glad that I had not offended anyone by bringing you with me. Then it occurred to me that you were actually in the office, because you were doing a rotation with Dr. Thanos. As a student doctor, you said that the sign was more appropriate than anyone knew.

*note from the little doc: Don't go to the gynecologist with your mother. Not as a child, and ESPECIALLY not as the doctor. Even if you are curious about her DEXA scan results.

Stay away from that, it has germs on it!

A mother should have a nickel for every time she has said these words to a child. With this kind of money, she could book a week in paradise, complete with margaritas. I spent years steering you away from anyone who was coughing, sneezing, or had a runny nose. I quarantined you or anyone else in the house that had a fever, and zapped every surface you touched with Lysol. I kept your little yellow immunization card in a lock box with birth certificates, passports, and the deed to the house.

Bird flu, swine flu, tuberculosis, flesh-eating bacteria. All of these were the subjects of sensational news stories during your clinical training, complete with dire predictions of uncontrolled global outbreaks. My usual admonitions to stay away from germs no longer applied. Those who suffered needed you. I could only pray for your protection.

Yes sir, that’s my baby. No sir, I don’t mean maybe.

By now, you have delivered numerous babies and provided care to many who are sick. You have shared joyful news with some families and devastating news with others. I know that you are ever mindful of the awesome responsibility and profound privilege of being present during a family’s moment of greatest joy or deepest sorrow.

In looking back over your life, your innate character and experiences have led you directly to this moment. I do not remember a time when you did not want to be a doctor. This drawing is from a school assignment that asked "What do you want to be when you grow up? What does that person do?" You drew it when you were about seven years old. Twenty years later, it is time to say, “Congratulations, DR. ANNE KRISTEN (BONSANGUE) KENNARD!” You finally made it. I love you very much.



Jun 3, 2011

Today, I Am A Doctor

I've watched friends go through bar mitzvah celebrations. This Jewish coming of age ritual occurs when the thirteen year-old child becomes responsible for his actions, is considered "adult" in the community, and is privileged to uphold Jewish law, tradition, and ethics. He undertakes years of preparation and study, and finally stands in front of his congregation, proclaiming "Today, I am a man."

Today, I am a doctor.

I spent four years preparing to get into medical school. I spent another four learning about the human body and how to help and heal. I took the Osteopathic Oath, promising to honor the medical profession and my patients, practice ethical medicine within my scope of practice, and to uphold the tenants of osteopathy, joining generations of healers who have gone before me. I stood before my family, friends, and teachers, and felt the weight of the doctoral hood placed on me, it's long length and green stripes proclaiming to all that today, I am a doctor.

The thing is, a bar mitvah-ed "adult" is still a thirteen year-old kid. I'm still a little doc, just in a long white coat. And even though I am considered a doctor, I still start over, for another four years, as a resident, the doctor who is the least experienced and needs to learn the most about her chosen specialty. I'm hoping that somewhere, in this transition to fully-trained physician, I'll feel like my new coat fits.

The transition is joyful. I can't help but grin as my white coat brushes my knee instead of my hip. I love writing my new name (which is a natural palindrome): Dr. Anne Kennard. I am humbled and honored to be considered an "adult" in the medical profession, at the same level as my teachers and role models. I think about an office full of people waiting, a patient on an operating room table, a tray of sterile instruments set out. How could these things all be for me? I've wanted to be a doctor since I was eight years old. This is truly a lifetime dream come true.

The transition is also scary. I think about what the added twelve inches on my coat hemline adds to my life. I am responsible for patients, and since I am in obstetrics, I care for two or more patients instead of only one. I need to be an excellent diagnostician, a gentle and effective healer; not because my malpractice premium depends on it, but because it is my responsibility as Doctor. My decisions, my words, my touch will tremendously impact others. Consequences for mistakes rest with me alone; I have lost the safety net of being a "student doctor." I could really hurt somebody. But, I can also really help someone.

Even though a thirteen year-old is still a kid, the bar mitzvah is significant, celebrated, and honored. To that community, he is an adult. I'm still the little doc. But today, I was welcomed as a physician into a community that includes Hippocrates (Greek "Father of Medicine"), Paracelsus (Renaissance physician who pioneered use of chemicals in medicine), Andrew Taylor Still (founder of Osteopathic medicine), the Mayo brothers (founded the Mayo Clinic), Jonas Salk (first effective polio vaccine), Donald Pinkel (my mentor, discovered ALL cure and founder of St. Jude Children's Hospital), and generations of surgeon generals, centuries of healers.

Today, I am a doctor.