Journey back to Portland

As always, packing took a wee bit longer than anticipated. ;) I finally hit the road around 5PM. It was hard to drive away from my apartment. It's been such a special 4 weeks in Baker.

I drove toward I-84, but I had one more important stop to make: Truck Corral. Wow. Talk about amazing. They have a cafe and country store, and the latter is filled with tons of souvenirs and cultural relics. :) I bought some cowboy boot earrings, a magnet, and several postcards. I wish I had had more time to linger, but I needed to get back. After making my purchases, I began my long journey home.

Doodad-lovers' dream come true :)

I drove without stopping (how my bladder managed this still surprises me) and got home around 9:30PM. It was strange driving up the hill to the co-op. I really hadn't been there for about 11 weeks, since I spent 6 weeks at home in the Bay Area before beginning my rural rotation. When I flew back to school from Oakland, I only spent two nights in Portland before heading to Baker.

The drive went relatively smoothly; I encountered some rain that poured down relentlessly for about an hour, but other than that it was smooth sailing. I employed the "Cruise-control-at -72" technique I learned from Paul. :) Sarah McLachlan and Alison Krauss kept me company on the way home. These two artists remind me of my time in Baker since Dr. Schott often listened to them in his office.

I arrived at the co-op exhausted. My car remained full of my belongings. Unpacking would have to wait. I don't think I had the strength to bring much more than my backpack and toiletries in.

The following day (yesterday), my classmates and I presented our community projects to one another. It was fun to learn about each other's clinics and experiences. This rural program is so awesome; we students are so lucky to have this opportunity to experience life in rural communities and practices! It's been quite formative for me as I'm sure it has also been for several others. After the presentations, we had a great discussion lead by Dr. Dodson about different learning issues we explored while on our rotations. Again, it was fun to share with one another and swap stories. We all laughed about how no matter what city we where in, it seemed that the grocery store was the spot to run into people that one knew--especially patients! There wasn't a single time that I went to Safeway where I didn't see at least three people I knew. At least I knew where to go if I was feeling lonely. :)

I wore my EOMA shirt that Cindy and Erin had kindly ordered for me. I also wore my new cowboy boot earrings. It felt good being robed in EOMA garb. :) I so miss the place and feel so lucky to have been there! Dr. Dodson and others said "They really have a great clinic out in Baker. Those are some cool doctors!" Amen, sister. Several others also commented on how EOMA is so "progressive, innovative, and cutting edge." I look forward to keeping in touch with my new Baker friends and I can't wait to return in January and hopefully sooner! Thank you so much EOMA, and especially Dr. Schott, for such an awesome experience. I'll treasure my time with you all. Thank you also, Dr. Dodson and the AHEC office for making this possible! This has been such a memorable rotation.

Thank you for joining me on my journey!
Till next time,
Stephanie

My last morning in Baker

Today I head back to Portland. It's been an incredible four weeks here, and I'll miss EOMA and Baker tremendously. I'm glad it's only about 5 hours away; I look forward to visiting during the summer and coming back next January for another rotation, which will include the medical mission to Honduras with Dr. Schott and company. :)

This morning I updated the whiteboard in my apartment. It's full of great recommendations already, but I added D&B Supply (love this place!), Inland Cafe, Paizano's, El Erradero, Chameleon Cafe, and Truck Corral (Dr. Schott tells me this is a cultural experience in itself. Cindy said the best time to go there is 1AM lol). I'll be heading to Truck Corral on my way out of town.


It was a wonderful last day at EOMA and St. Elizabeth. Dr. Schott and I rounded on our patients in the morning and then headed back to EOMA. Cindy took me out to lunch; we went to El Erradero. So good!! I can't believe I almost didn't go there this trip. Some of the tastiest Mexican food. Thank you, Cindy!!


Back in clinic, I joined Dr. Schott and saw three patients, one of which I have seen three times now. It felt apropros seeing him and his daughter on my last day.

A very special patient with whom I met a few times. :)
(Photo taken with patient's permission)

Dr. Schott and I worked on notes and then headed to the hospital to check on our patients. I said goodbye to the two I have been following as well as the nurses that worked on the Med-Surg unit.

James (RT), Jaimie (RN), Riley (RN) at Med-Surg

Shortly therafter, Dr. Schott and I joined Dawn and the boys at the Geiser Grand for their famous pasta night! It was a lovely dinner with the Schotts. I am so grateful for their hospitality and friendship! It's been awesome spending these past four weeks with them, and I look forward to seeing them in January if not sooner. :)

Dawn, Steven, Dr. Schott, and Alexander

After dinner, I went back to EOMA and gathered up my belongings and headed home. I was sad to leave EOMA; it's been such a home away from home. I think I spent more time there than at my apartment! Everyone at EOMA is so tight-knit; they truly are a family and I will miss them dearly!!

Well, I must get to packing. I've got a 5-hour long drive ahead of me. I'm keeping my fingers crossed for good road conditions!

Quick post: on call, last day tomorrow.

Today was my last official full day here at EOMA and St. Elizabeth Hospital. Dr. Schott and I have been on call since last Friday. It's been a busy few days but SO educational! This rotation has truly been a blend of family medicine, internal medicine, emergency medicine, OB, and more. What's cool is that rural family medicine encompasses all of these areas. These last couple of days have been "internal medicine" heavy since we've spent the majority of our time admitting and following patients at the medical-surgical unit. Goodbye comfort zone, hello steep learning curve. :) While intimidating at first, this "internal-esque" business is gradually getting more comfortable, rather I'm feeling more comfortable with it. Dr. Schott has been giving me tons of realtime feedback, which has been incredibly helpful. He also gives me the opportunity to do TONS, so I feel like I learn so much just from the variety and spectrum of experiences. I hadn't yet really written orders or felt confident in doing so. Especially in this last week, he's helped me arrive at a place when I am essentially the patient's doctor, and Dr. Schott is my supervisor and co-signer, but he lets me take charge of my patients. It's exciting, exhileration, empowering, intimidating, fun, challenging...all of the above. I'm getting more comfortable with writing orders and being confident about my clinical decisions. He and the other doctors have been super helpful and have encouraged me to trust what I know and just take a stab at diagnoses, treatments, and other decisions related to patient care. Thank you all for being such awesome teachers! Tomorrow, I will round on my patients in the morning and then see some of my patients in the afternoon at EOMA clinic. I'll also watch my first thoracentesis. I have to dictate a discharge summary, and gosh knows that being speedy at dictations is not one of my strengths...so gotta go! :)

Week 4 reflection

I'm sad that I have to leave Baker in a few days, but I'm so thankful for the time I've been able to spend here. It's also nice knowing that I'll be coming back (and this time with Mike!) for a rotation next January. What's really awesome is that we will be joining Dr. Schott and the gang on their annual medical mission to Honduras.

It's been a great week. A busy week. As I've mentioned in previous posts, the scope of practice of Dr. Schott and his colleagues is quite astounding. We go from delivering babies to admitting patients to the medicine unit to seeing patients at EOMA to seeing patients at Pine Eagle to attending hospice meetings. And we see so many types of patients, ranging from complex geriatic patients with several chronic conditions to more straightforward acute presentations to well-childs and so much more. That's the beauty of family medicine for ya. :)

Carol posed this question to me: "How much of yourself can you see in these rural docs?" and I've been thinking about this for quite some time now. I think that my enjoyment here has a lot to do with how much I enjoy being with my preceptors. I enjoy spending time with them in clinic as well as out of clinic. I feel like we share similar values and interests, professionally and personally. For instance, in the context of medicine, I feel we all value relationships, continuity of care, comprehensive care, and understading our patients as whole people (values shared by family medicine doctors both rural and urban it seems). More broadly, I identify with the emphasis these doctors place on community, at the clinic and in Baker as a whole.

To echo what I've stated previously, the old adage that "everyone knows everyone" in small towns rings true based on my experience in Baker. This has pros and cons of course, but I've found that the positive aspects of this phenomenon outweigh the negatives. Indeed, one of the most meaninful aspects of this experience has been the opportunity to get to know my preceptors, the rest of EOMA staff, and my patients so well since I see so many of them on a regular basis. A sense of community pervades EOMA and Baker as a whole.

I wonder sometimes if I am romanticizing the "small town" thing. My preceptors have been honest with me about some of the disadvantages of living in a small town, and I appreciate their candor. I feel it helps me paint a more complete picture. However, I've found that my experience in this rural community has been an overwhelmingly positive one. I feel that my preceptors' values and ideals resonate with me, and I share their love of this lifestyle and this beautiful land. It feels so good being able to just look out into infinity and be surrounded by mountains. Indeed, we are in the mountains. Baker's elevation is 3,451 feet afterall. It's so grounding being here, and I love that everyone is so close to the land. Side note: at the Kelleys a few weeks back, I was told that "everyone who moves to Baker eventually buys an animal or two. And dogs and cats don't count." We're talking horses, cattle, sheep, llamas, goats, pigs, chickens, and the like. :)

Another thing I've been thinking about is how progressive EOMA is. They are a patient-centered medical home, something we've learned a lot about from Dr. Saultz and others at OHSU. To see a PCMH in action is exciting. This innovative model is defined as follows: "The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner." Similarly, at EOMA, "Our philosophy is simply to treat you as we would want our family to be treated. From our receptionsists to our providers and management, we aim to provide the highest level of care we can with a sense of caring and compassion. In trying to achieve this goal, we have attempted to design the clinic and its flow to optimize efficiency and comfort. As you will see, this may mean encountering new ways of doing things that we are all going to have to adjust to. The changes we feel will help improve your access to the providers and our access to knowledge."

Dr. Schott really does embody that first phrase, and treats his patients as if they were family members. I can tell that his patients appreciate this and that he is well-loved and respected by his patients. Dr. Schott is incredibly hard-working, and several of his peers have recognized this as well. In fact, last night, I had a chance to meet Wanda, mother of Mercy (owner and landlord of my apartment and sister of one of Dr. Schott's best friends), and she shared glowing remarks about Dr. Schott, "Jon has always been so hardworking. I'm so happy that he became a doctor. Baker is so lucky to have him." It's not uncommon for me to hear comments like this from several of Dr. Schott's patients and friends. From what I can tell, it seems that the other physicians here are also greatly admired and respected by those in the Baker community, and it's an honor to be working with them.

Back to the PCMH, Jacque Cobb expressed, "What's great about EOMA is that we have doctors that have traditional values, like family and relationships, who are also really progressive when it comes to the way they practice medicine." Well said, Jacque. I've noticed that all of the docs here are incredibly up-to-date with regard to patient care. On more than one occasion, I've heard, "An article just came out a few months ago that says [this treatment] is better than [that treatment]..." or "A study published a few weeks ago indicated that a more effective treatment for [this condition] is [this lifestyle change] in combination with [this medication.]" In this way, their practice of medicine is truly evidence-based and cutting edge. It's wonderful to see this juxtaposition that Jacque described of traditional values and progressive practices. I think these doctors are providing excellent care, and their patients are happy to boot!

Baker Bangs

I wanted to go for the full immersion experience here in Baker, so I scheduled a haircut and style at Lavish Salon with Kelly, who was recommended by Angie. I showed up after clinic around 5:30 and left about two hours later with a totally new 'do! Here's before:

And after:
I wasn't sure what to expect since I was going to leave it up to Kelly to decide exactly what type of cut to do. All I knew was that I wanted some bangs. I've been thinking long and hard about this, and I think that if I used the right products and styled it just the right way, I could have a mullet. That'll be my project for when I get back to Portland. ;)

Anywho, thanks for the 'do, Kelly!

Kelly with her daughter, Savannah

It's midnight...

...and I'm going to get up in a few hours, but I feel the need to write. It was a wonderful day, and this evening, I had a chance to be involved in a very special delivery. All deliveries are incredibly special, but tonight's somehow had a profound impact on me. This was the mom's first baby. She's just shy of twenty and is a sweetheart. I first met this petite lady earlier in the day when she wasn't yet completely dilated. She had a long labor and almost went to C-section. In the end, she was able to deliver vaginally. I am so moved by each delivery I witness...there is so much emotion, magic, rawness, and beauty in these moments. I see women who are so courageous even in the face of the unknown, for a lot of them (though even for multip moms, each delivery is so different and unpredicitable). Something about tonight's delivery was especially powerful. I think it had a lot to do with the young lady giving birth. We broke down the foot of the bed, and her legs were being held up by her husband and mom. Dr. Smithson and I stood at the foot of the bed, watching baby slowly descend and eventually begin to show herself. Baby crowned for a long time and finally delivered a good 5 minutes after first crowning. During her contractions, mom kept looking at me since I was standing more centrally. Her husband and mom were on either side of her, her nurse was at her side, and Dr. Smithson and I were at her feet, and we were all yelling Push push push go go go that's the way! Just like that! Strong pushes! Good! I wondered for a split second what someone standing outside the room would think of our chorus of voices. What a unique time. A woman surrounded and supported by a group of people all waiting for a mini human to come out of her. I kept thinking of Dr. McKenna, my anthropology professor at Notre Dame, who always talked about the pelvis-and-head dilemma (how over eons of time, our brains kept growing, meaning babies' heads keep getting bigger but the pelvis does not!) I looked up briefly at everyone's face in the room. Mom had a look of fear and pain, dad had such a sweet earnest look of encouragement, grandma was fiercely supporting her own baby "Go baby girl! Get mad! You can do it!", nurse was solid and saying words of encouragement...I can't even find the words to describe the heightened sense of something in that moment. Somehow it feels right to describe it as a moment in which we were all so alive, so human, so authentic. Mom and I locked eyes several time. She seemed to have an expression like "Get this baby out of me!" Actually, she did say this aloud. But her eyes were full of urgency, vulnerability, desperation. Just making this eye contact somehow moved me. I looked right back at her and tried to affirm what she was doing...I nodded...you are doing it you are doing it, that's it, almost there, keep pushing...I felt the need to be grounded and strong. She was looking at us with desperation; indeed, for a long time she had been saying "Use the suction, I can't do this, get her out!!!" She'd say "I can't do this" over and over, and we'd all affirm her, Yes you can. Yes you are! She did it, she gave it all she had. She was utterly exhausted, but she did it. Baby came down and I got to catch her and lay her on mom's chest. That moment always chokes me up. Mom is always yelling because of the watermelon lemon thing and it's always fascinating to me when that scream of pain turns into a scream of delight and sheer joy and relief. Mom, partner, (and probably baby too!) always seem stunned. What a moment of pure connection and oneness. So beautiful. It's such a privilege to witness and take part in this magical event. I can't get over the beauty of birth and I don't think I ever will...tonight's whole experience seemed especially gratifying since her labor was so long and she almost went to section...in the end, everything turned out so well. We thought we'd have to use the vacuum or perform an episiotomy at the very least...but the universe had other plans. She did fabulously and fought through to the end.
I should get to bed. Sorry this blog has kind of been an ulfiltered, stream of consciousness type of thing. Thanks for bearing with me. But I just had to write. I've been wanting to write more about some of the deliveries I've seen...so now I finally am. Birth is just so beautiful! Well, off to bed. Alarm's set for 4 hours from now!

When in Rome...

When in Baker, go belly dancing! Baker has a great place called Crossroads Art Center that "was established to aid, encourage, advise, and correlate activities to promote and sustain the creative and performing arts in Baker County andneighboring communities. [They] sponsor classes in drama, music, dance, oil painting, watercolor, sculpture, pottery, creative writing and other disciplines as well as adult and children's performances and visual art exhibits."

One of my patients had talked about a tribal belly dancing class she attended, so I thought I'd check it out. I attended the class tonight. Everyone was really friendly and welcome and tolerant of my lack of dancing abilities. These ladies are so good! I especially enjoyed watching Tymmera, the teacher (who, as it turns out, is the dental hygienist I had met before at the Halfway Pine Eagle Clinic!).

The regulars perfomed a "Basket Dance" they have been working on for quite some time. It's such a beautiful dance form! I feel inspired. :) I bought this album that Tymmera recommended: Migration by Gypsy Caravan. This the type of music we danced to tonight. It's hard not to move when you listen to it! Speaking of music and dance, check out this video called "The Musical Brain." It was shown on my United flight last month and is absolutely fascinating! Here's an interesting article on the same topic. Very cool! Reminds me discussions we had during my Anthropology of World Music class at ND with Stephan Fior. We humans are meant to make music and dance!