August 25, 2011
By Melissa Marotta
I’ve spent most of medical school on a quest for “usefulness.” As a non-traditional student who had led a reasonably productive career in My Former Life before appreciating my calling to the study of medicine, there was a stark contrast between then and my early years of medical school, during which I was best at getting in the way, asking stupid questions, and feeling completely inadequate to ever one day contribute to people’s lives. This was until I found The Health Center, a rural federally qualified health center in Plainfield, Vermont. At The Health Center, under the guidance of dedicated mentors and teachers, I began my journey to rural family practice.
The Health Center is an amazing place. Started from scratch by a family doctor, it is now an interdisciplinary practice that provides primary care to more than 10,000 Vermonters, many of whom would not otherwise have access to care, and does so through the compassionate, collaborative work of family docs, physicians assistants, dentists, behaviorists, nurses, and more.
I had read about The Health Center before medical school, and I was tremendously inspired by the visionary way they met the needs of an underserved community. I decided that once I had the opportunity, I would seek them out, and spend all of my free time with them. So I did.
I spent hundreds of hours there during my pre-clinical years and several additional months later in my training, under the guidance of dedicated mentors and teachers. I accompanied them on home visits, getting to know patients and their families, spending time living in the community, and developing a deeper understanding of patients’ daily lives outside of the exam room. And last month, returning to The Health Center on a fourth-year elective, I had the opportunity to appreciate the rewards of continuity. Many of the patients I saw in clinic that month were folks I’ve met several times over the years: I remembered their families, their hobbies, their stories.
All of these experiences taught me the rewards of practicing medicine in a small, intimate community where I can understand so much more about the broader context of my future patients’ goals, values, and all of the other factors that underlay their healthcare decisions.
My most memorable moment, however, came on my last rotation there, when I was asked to see BL, a a 62 year old woman with refractory depression, anxiety, and a host of other chronic medical conditions whom I remembered meeting two years prior. BL had expressed interest in a project I’ll be conducting at The Health Center next month, a clinical trial using exercise heart rate monitors to provide cheap, portable biofeedback for anxiety reduction.
I remembered our previous meeting from two years ago vividly. Then a first-year medical student, I had the opportunity to spend 2 hours with BL to help her make sense of her 20+ medications and the difficulties she experienced managing them all. Timidly taking a seat across from her, I observed BL looking down at the floor, evading eye contact. She answered my questions with curt, single-word replies. She brooded and sighed, hunched over and staring at the 20 medication bottles sprawled before us on the desk.
I was humbled by how little I knew about anything likely to be relevant to improve her symptoms – but perhaps most importantly, I didn’t know anything about her life and how she saw the world. What was she scared of? What was important to her? Without that, I didn’t think I’d be able to help her – even with all the medical training in the world.
So I asked her. I talked with her about what it was like to wake up, move about, dress and eat and get about her day. I asked her what it was like to leave the house, to interact with her family, her doctors, the people at her church. What it was like to feel alone, discouraged – hopeless. It was an hour before I even brought up her medications (ah, the luxury of time for a first-year medical student!). Then, we went through each medicine one-by-one, as I attempted to empower her to appreciate herself as being in the driver’s seat, with complete control over the elements of her world. In the end, we worked together to develop her understanding of the role each medicine played in her life and some additional strategies she might take to enhance her self-efficacy.
That day, I also encouraged BL to “act opposite” her mood – to do something that she had once enjoyed years ago but hadn’t been able to bring herself to do now. For her, that was horseback riding. Promising that she would get back on her horse – literally – that day for the first time in 5 years, she took my hand and smiled. It was the first feeling of profound “usefulness” that I had ever experienced as a medical student.
It was that moment when I knew that I could and would never do anything else with my life.
Now two years later, here I was attempting to schedule her visits for my anxiety study. Sitting before me in a wide-brimmed straw hat, “I can’t come Thursdays, Melissa,” she explained. “I ride my horse on Thursdays.”
As a result of the hundreds of hours I spent at the Health Center during my training, I developed confidence – in my skills, in my goals, and in myself – and a sense of where I belonged in the world. And on my search for a way to make meaningful contributions to both individuals and to the community – that is, to be useful – I found family medicine.
The writer is a fourth-year medical student at the University of Vermont College of Medicine. She is currently applying to residency programs in family medicine.