Month: February 2018

White Coat Black Lives

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When I discovered that it was possible for medical students to be involved in the admissions committee that was one of my goals that I  Immediately set for myself. I love the idea of being able to get involved in the college of medicine. I liked the idea of being accountable for helping t select the next class who would uphold the same values of community, altruism and integrity that i loved about Ohio State. I chose Ohio State for several reasons; I loved idea and culture that already existed but also the capacity for change that I saw. One of the things that I love about OSU is Dr. Capers. He saw a problem with the amount of diversity that there was in a medical schools, and thus the physician workforce and set out to change it. So at the same time I served on the admissions committee I also served as the admissions committee liaison for SNMA. Basically in this position my role was to reach out to all URM students who were interviewing and answer any questions that they may have and give them a general welcome. I hosted them when possible and found other URMs if not and most importantly I made sure either myself or another SNMA member was there to help to greet them at the interview lunch. Interviewing for medical school is not only about finding a place where you’ll get great training but also finding where you feel welcome. I liked being a small part of helping students who journey into the owls of medicine where they don’t see a lot of themselves represented feel welcome.
I firmly believe that as physicians we have a duty not to just treat our patients but to be their champions and lend our voices to the issues they face outside of our hospitals. A big part of my attraction to SNMA is their commitment to serve the community in which our school based. SNMA for me encapsulated a lot of the values that I held and gave me an opportunity to help fight for them. We did everything from volunteer at health fairs, offer multi level mentoring and landed our voices for many issues facing our community. We formed telephone lines  to call our senators in protest of the new healthcare bill that would have stripped insurance away from millions of our patients.
 After the numerous senseless killings of unarmed African-American men in our country we discussed and planned and eventually this led to the creation of a branch of White Coats for Black Lives. The organization was started in several medical schools across the country by with people with similar beliefs: that racism is a public health issue that threatens the lives of our patients daily. As physicians we must recognize that racism and racial bias is a threat to the well-being of our patients of color. Our organization staged a die in to protest police brutality and the senseless loss of lives with the FULL support of our deans. A goal of our organization what’s with knowledge they racial bias exist within our medical centers across the country in the lead to differences in healthcare and outcomes.  Having full support of our Dean here at Ohio State (something that did not occur many other places) Service school and really underlined that people were willing to try. Every time I turn on my TV or use my computer I can see a rundown of social injustices that are plaguing our country and our world. As physicians we cannot, I cannot simply standby and watch these injustices continue to occur and be unmoved. No matter what role I play in the healthcare system, be that medical student or physician, I will always lend my voice to the fight.

 

 

 

Professionalism CEO: Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice and a commitment to excellence in all professional and personal responsibilities

Black People Don’t Get Depressed

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Photo used for what depression looks like project

 

Depression is like our childhood fears, well the way we manage them anyway. We all had fears as a child that haunted us in the dead of night. From clowns to boogie men and all the things we thought lived under our beds. And for the most part we all handled it the same way – we buried our heads under our covers, squeezed our eyes shut and prayed we’d make it to morning. Because every child knows monsters cannot survive in the light of day. We treat mental illness the same way. We bury our heads in the sand, close our eyes tight and pray if we ignore it long enough or hard enough it’ll just go away. We pray that holding on tightly for one more day makes the difference in making our mental illness a figment, a nightmare. But unfortunately for us mental illnesses are not our childhood fear s- they do not fade under the light of a shining day, they don’t plague us only in the night.

Just as our culture influenced our childhood fears and the way we dealt with them, it also influences our mental health and our very acceptance of it.

Strength is a vital pillar of the black/minority community. A building block each parent takes as their duty to provide to their child. Black history is a difficult one. We were brought to this country as things to be bartered. We were stripped of our lives, our culture, often even our names – but we endured. That is the summary of black history, as I like to see it: we had the strength to endure every cruelty visited upon us and still stand strong. So strength is more than a pillar I should say, it’s our foundation. So it stands to reason that anything we perceive as weak is immediately rejected both consciously and subconsciously. And unfortunately that is what mental illness is portrayed as – a weakness. And we in the black community WILL NOT be labeled as weak. We will fight that label even if it costs us our lives. We will not endure the shame of being labeled depressed, anxious or bipolar.

Depression and mental illness are a weakness. That stigma is accepted as truth especially in the black community. In my family medicine clinic I had a young black female patient on follow up for weight loss. All her lab work thus far had been negative but in interview she was positive SIGECAPS. She had lost 15 lbs unintentionally, difficulty sleeping, difficulty concentrating. She endorsed feelings of guilt and hopelessness and passive suicidal ideation. When it got to the point in our conversation when I told her that her symptoms likely were due to depression she shut down. “No I’m not depressed.” she said, “I don’t do that depression and cutting stuff.” I spent over a half an hour in the room with the patient trying to educate her on depression and convince her talk to a counselor. My resident also spent considerable time doing the same but to no avail. I still think about her occasionally and wonder is she’s ok and if she ever sought help. Her case really solidified for me the need to change the conversation about mental health staring with education.

I was screening an older black female patient for depression when she asked what the questions were related to. When I explained she told me “Black people don’t get depressed.” I wish I could say this is the first time I had heard this but sadly I’ve lost count. African Americans and women in particular are a large percent of under diagnosed and under treated individuals with depression. My attending (a black woman herself) recently asked me about my specialty choice and when I told her she exclaimed, “Psychiatry! Girl you are black. You know black people don’t believe in psychiatry.” She went on to explain her struggles in getting her black pediatric patients into therapy when their parents refused to believe their diagnoses.

Black men experience depression at higher rates than their white counterparts. They also commit suicide at higher rates. I know countless black men who fight every day against the stereotype of the angry black man. But in that same accord those same black men cringe at the idea of being called sensitive or weak. Their masculinity in addition to their culture cannot abide weakness. They package their pain and the shame that comes with it and they bury it deep. They put on a brave face and pray no one sees through the cracks and exposes that lie that they’re “ok”. They will carry their pain as they march to their death as long as they can march strongly.

Speaking from personal experience I could not admit that I needed help. So I was “strong” and I endured. But the more I pressed down, the more I straightened my shoulders, and told myself to grin and bear it the worse it got. The harder I held on and gritted my teeth, the more rapidly I was losing control. And the loss of control was probably the most shaming of all. Because I should be stronger than this right? I should be able to control these feelings of depression but I just couldn’t. I remember talking to my oldest brother, finally admitting I was depressed and to my disappointment he reinforced what I thought. He told me “You’re not depressed, your Leslie. You’re stronger than all of us so you’ll be fine.” But I was. Both strong and depressed, the two do not cancel each other out. In retrospect it saddens me to see that I fell victim to that same subconscious association of depression with weakness and I suffered because of it. I have talked (bullied) friends into seeking treatment but somehow I failed myself.

We must start the conversation. We need to remove the taboo nature of mental health. We can begin this by simply starting the conversation – what is depression, anxiety bipolar disorder. I have been very open and forthcoming about my depression. I post about it on social media and have had numerous conversations with friends, classmates and families. The last time I was home catching up with friends a close friend of mine told me that she had been hospitalized for 2 weeks in undergrad and was so ashamed she made an elaborate story up about where she had gone. She has since started posting about her experiences as well and imploring others to get help.

We also must change attitudes towards mental health. I know first hand this is not an easy task because in doing so we must change our fundamental beliefs. Especially when it comes to suffering. Suffering is not a badge of honor. Suffering is not a badge of honor – this concept bears repeating. I grew up surrounded by people who took their pain and suffering and wore them as badges of honor. All of the things they suffered through silently in their lifetime they viewed as strengths. Suffering will never make us strong. Overcoming suffering is strength, fighting through suffering is strength but enduring is not. And enduring silently has dangerous consequences.

I occasionally saw frustration and weariness in the outpatient physicians when we had patients that were clearly suffering but refusing treatment. I hope that they stay the course because often they are not fighting a patient but a culture

 

My blog

 

 

 

 

 

 

 

Interpersonal Communication CEO 4.2: Understand how human diversity may influence or interfere with exchange of information.

 

 

The Fantastic Four and Other Superheroes

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When I first started my first year of medical I did as most medical students do I found my core group of friends. Being a very goofy person also slightly introvert I found people who are like me. And all friendships eventually come with their ups and downs. They come with defining moments where showing up as a must. Unfortunately for my friends our friendship was put through trail by fire. Because early in our friendship I needed them far more than I ever thought I would. My mom passed away in March of our first year, less than a year into my friendship with any of these people.

My mother used to say: “when everything falls down around you, you would know who your true friends are”. And these people that I had met less than a year ago they showed up. After my mom passed away I was lost for a while and then I simply withdrew. It just seemed easier in many ways to be alone, to deal with my pain alone. I’m a very hard person to comfort I always have been. I’m not very good at leaning on other people or asking for help, its probably my kryptonite. I grew up in a family of seven children but i was the oldest girl. So while I was the 4th oldest overall I was the one everyone leaned on outside of my mother. My mother was not only my best friend but she was all also my confidant, MY shoulder to lean on. So when I lost my mother I lost the only support system I had.

But there were a few people in particular that did not leave me alone when I asked for it. When I requested the space and solitude to dwell in my own misery they refused. They saw through the fake smile and they knew I was not ok. And they cajoled, bribed, threatened and waited patiently until eventually I gave in. They shoved me until I had no choice but to lean on them. They made me recognize that what I was considering grief was not simply grief; I was depressed. And they made me get help. But they also did more than make me get help; they taught me a lesson the medical school had been trying to teach me from our numerous lectures and our yoga and meditation in LG. They taught me wellness. They pointed out that I would feel better if I was active so I exercised and I hiked. They encouraged me to take study breaks and start doing things I enjoyed, so I cooked.

One of my mothers favorite says was “You cannot pour from an empty cup” which is basically the principle of wellness. As a psychiatrist I will serve one of the most vulnerable populations in medicine. I will endeavor to always do everything I can to provide them with the best care. But this requires that I am at my best. It requires that I am a well rounded, balanced human being. And i have found what that means for me:  I don’t love yoga but i love hiking and thinking, I love writing and reflecting on my life. I know that wellness will be harder to maintain as I move along in my career especially as i move from medical student from intern but I also know vital it is. I also have a support system there to back me up when things get hard..

 

Hiking HIghbanks

Cincinnati Zoo

Cooking together Take 1000

Relaxing with a stranger things marathon

 

 

 

 

 

 

 

 

 

 

 

 

 

I read my brothers superheroes comics as a child and to this day they are still one of my favorite things in the world. I love the idea of superheroes – not in the cape wearing laser vision kind of way. But to me what makes a superhero is their story; they are inspiring, amazing people who embody characteristics we ourselves want to embody.

And that is who life was kind enough to allow me to find – 4 superheroes. They are not larger than life, they do not save the world in their free time — to my knowledge anyway. They do not have super human qualities they are loud, goofy, ridiculous people. But they are also simply amazing. And when they went on to 3rd year and I stayed behind I gained amazing mentors. So when I struggled in a rotation or simply needed words of advice or a laugh I didn’t have far to turn. And when I battled my sadness, my depression, and medical school they stood beside me and lent me their strength. They provided me a system of support and a foundation on which to stand . They have not only enriched my personal life but they have also taught me a fundamental principle that will enrich my future career.

My superheroes wear white coats not capes and they wield humor, love and friendship not swords. And in this stressful world of burnout and medicine im glad I have my fantastic four.

Step 1 studying “encouragement”

 

SNMA has also been a great experience in teaching me the importance of stories, heroes and having someone to look up to. SNMA as I always describe it is the minority association of medical students. It has thus far been one of favorite parts of medical school for the simple fact that representation matters. Its hard to see yourself in a career where you don’t see yourself. SNMA was one of the first organizations I joined in medical school. I have mentored fellow medical students and high school students and i have been mentored by residents and faculty that look like me. I am a black girl in medicine and that alone makes me part of a very small percent. But I also have a unique perspective in terms of my background.

I had a college student who once told me his biggest fear was that he wouldn’t fit in medicine. All of the black physicians and medical students he had met prior to me were all middle class and many had doctors as parents themselves. He was a very smart kid but grew up in a rough neighborhood. I was one of seven kids raised by a disabled mother. I grew up in the ghetto surrounded by abandoned houses, shady people and a neighborhood it wasn’t safe to walk in. I think talking to him was the first time it hit me how important our varied experiences are when it comes to mentoring. Our backgrounds, our childhoods and experiences are important; they help make us who we are. But they don’t determine our future and they definitely cannot and should not limit our future. But that is exactly the lesson I grew up being taught, it’s what many of us are taught – that doctors don’t come from neighborhoods like ours. One of main things I reiterate to myself as well as my mentees is: everyone’s story is important. The struggles, the failures, the success  –  all of it matters. And you never know who is waiting to be inspired by your story no matter how ordinary you think your story may be – everyone is someone’s hero. Each of us have fought and will continue fight our own battles, face off with our demons and in some cases we will take up the mantle for those who currently are unable to wage to their own defense. And though we may chalk this up as an ordinary life – someone will stand back and see a cape.

Me and 3 of my siblings in our childhood neighborhood after church

Systems Based Practice CEO 5.4: Identify and utilize professional role models as a means of growth and accept the responsibility of acting as a role model and teaching and training others

The Art of Recognizing Death

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“Despite what some people may tell you mental illness is a disease and it can complicate the care of the patients you treat” – wise words from a nurse named Nicole on my Transplant Surgery rotation. We had a patient struggling to thrive after her Roux -N-Y complicated by the death of her parents 2 weeks post op. Her surgeon was growing very frustrated and was unable to fathom how she was allowing this to interfere with her health. She wasn’t thriving or obeying the rules she had previously agreed to before her surgery. Nicole commented on how it’s very tempting to judge her and discuss how she should push through and want to do better but it wasn’t that simple. We had a great conversation about the nature of depression and grief. She cautioned us not to be the doctor who doesn’t address their patients’ mental illness when treating it is guaranteed to improve their health. She said she had seen depression cause everything from hospitalizations to organ rejections.

She talked about how cynicism and complete disregard towards mental illness was something she sees in a  greater degree in our generation of upcoming physicians – something I hope is not true. Even if we can’t understand out patients’ mental illness we at least need to understand that it matters and it affects their recovery and outcomes. It may complicate your care or prolong your visits but mental illnesses are not something we can ignore. One of the reasons I am drawn to psychiatry is the stigma associated with mental illness even in the medical community and my desire to advocate for my patients. We advocated for this patient to have a psych consult, a very vital component to her health management.

As I move forward in my career I will endeavor to never underestimate and never overlook recommendations of team members no matter how tired or busy I may be. Nicole had sat with this patient and she had heard her story and everything she was struggling with outside of her recent surgery. She offered valuable insight that completely changed they way we viewed this patient and what she needed to best address her long term management. Nurses, PCAs, social workers are all members of the team that interact with our patients in different ways and each of them bring unique viewpoints. Patients will always be better served when the entire medical team is working together in their best interest.

This case also reinforced in me the need to always see my patients as a whole – not just a disease or a problem. We see patients in snap shots, isolated moments in time when they come to us to address a specific need. But we need to remember that they are people outside of their diseases; people with experiences, concerns and worries that can complicate their health.  I truly felt for this patient and I understood her struggles. I lost my mother my first year of medical school and I understood grief. Grief is a monster that we all struggle with in different in ways but one thing it never is, is easy. Grief is not always so easily compartmentalized for the sake of your health, your relationships or even your future. And when complicated by mental illness grief becomes a whole new monster. My own struggles and those of my patients have emboldened me to speak up when I feel the situation calls for it. I may not be a psychiatrist yet but since the moment I put on my short white coat, I am a patient advocate. And I will always ensure that their diagnoses are not ignored no matter how “inconvenient” they may be.

My patient and I both shared a love of writing. She kept a daily diary following her parents’ death as a way to cope based on a recommendation from her therapist. I’ve loved writing since I was a kid. I used to write everything, from poems to my mother when she wasn’t feeling well to reflections about the world I was growing up in. When I mentioned my love of writing to my psychiatrist he recommended using it as a tool to cope and heal.  The following is an essay that I wrote and got the courage to submit to our literally magazine Ether Arts about my own struggle with grief and depression. I won first prize in prose for my submission.

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The Art of Recognizing Death

It seems a simple thing that doesn’t even need to be taught especially for medical students, right?

Death can be defined in many ways, cardiac arrest or simply enough the absence of life.  According to any of those definitions my mother died on March 22, 2014. But for me she died December 12, 2014. It took me almost nine months to recognize death.

I was the normal medical student in the spring of my first year of medical school pushing through a grueling Neuro block when the call came. My mom had been hospitalized again. She had been in out of the hospital numerous times leading up to that day but this time was different. The doctor called needing my consent to do an emergency surgical intervention. I dropped everything and rushed home. Thinking back now I can’t recall when I left school or how long I was gone and I have no idea when I even made it back. When I got home I knew this was not another “routine” hospitalization to stabilize her and send her back home.  Her ejection fraction had been steadily dropping but now it was so low there was barely enough blood perfusing her body.  She was no longer in heart failure, her heart had failed. It had reached the end of its ability to do what nature intended; it was no longer able to sustain life on its own. And as many of us know when we reach the end of our body’s capabilities we have two options: to set it free of our demands or intervene. And intervention in this day and age has extensive possibilities that are steadily growing each day. But limitless as these interventions are they are not always desired and that was the case for my mother.

One of the last conversations I remember having with my mother was her asking me if she was doing the right thing; she needed assurance that she wasn’t making a mistake.  Many people, even some in my family, saw her refusing intervention as giving up.  So they raged.  They forgot  the twenty-year battle she had waged with her body and soul to get her to that point. They forgot the twenty years of ten pills a day, hundreds of days spent in the ER and a lifetime of pain. She saw it as an answer to her prayers, God telling her it was time to come home now.

I looked at her and said, “What do you want to do Mama?”

“Les,” she said, “I wanna go home.”

So that was what I did.  I signed a DNR, and took my mother home knowing even then I was welcoming death to follow us there. But it still took me nine months to recognize that it came and left in a flash.


When I was younger and my mom couldn’t sleep I used to read to her. I read her poems, short stories, goofy things, sad things– really anything that was available. It became our tradition for years. I would sit on the floor by her bed reading until her eyes closed and I could tell she was asleep; then read a bit longer. When she was in hospice, I remember vividly recalling one of the poems we had read, and debated the meaning of endlessly. Dylan Thomas’ “Do Not Go Gentle Into That Good Night”:

 

“Do not go gentle into that good night,

…Rage,

rage

against the dying of the light.”

 

It was like a terrible song that gets stuck in your head; the more you ignore it the stronger it becomes. For a while I raged.  The part of me who only wanted her mother and cared less about the consequences of extending a painful life, raged against the dying of her mother’s light. I wanted so badly to gather the dying embers of the life I saw fading and keep them going.

I called the funeral home to pick up my mother on the night of March 22nd. Sometime after that, on a day my mind has refused to remember, we had a memorial service for her. Around that same time, my mind and soul decided to go on vacation, as one last act of defiance or defense when faced with a terrible but irrefutable truth. We’ve all seen it right? That dramatic scene in the movie where the person stands still as everyone bustles around them. It is the most vivid and accurate picture I can paint. I was still moving forward and yet stuck. I carried on surviving but not living; doing but experiencing nothing. I felt no pain, no joy, no hope but no despair. Until I was jarred awake and reminded that no one is allowed to hide from death forever. Nine months later, on my birthday no less, death made me recognize its face.

On the morning of my birthday December 12, 2014, I made the mistake of eating meat. A mistake for me because I have Eosinophilic Esophagitis; basically the foods I eat sometimes cause inflammation in my esophagus and gets lodged there. So I spent my birthday with food in my throat in the ER. This culminated in them putting me under to take it out. Unfortunately, I also didn’t react well to the anesthesia. It affected my breathing and took awhile for me to wake up. As the anesthesia wore off and I kept opening my eyes trying to wake up, and saw no one beside me– this, this is when I recognized death. But perhaps I should go back a few years…

When I was twenty years old, I had to have a tonsillectomy. It was a pretty routine tonsillectomy but in this instant as well, I reacted badly to the anesthesia and took awhile to wake up from it. As I went in and out of consciousness I remember my mother standing at the end of the bed and every time I opened my eyes she said,

 

“Its ok Leslie, I’m here”.

 

So on December 12, 2014 as I came in out of consciousness, death came into focus more and more. I kept opening my eyes hoping the scene would change but it didn’t, and couldn’t. With every raise of my eyelids, I could no longer deny death its recognition. I knew without a doubt if not for death she would have been there. If not for the absence of life, the cessation of her heart, the extinguishment of her light she would have been right beside me telling me,

 

“Its ok Leslie I’m here.”

 

She was my beacon, my light not only in waking from anesthesia but also in my everyday life. Her voice started and ended my day. It was her hugging me as if I had been away a thousand years that brought me home. Without her light mine dimmed considerably for a short while. Lying in that hospital bed I felt so keenly the lack of her light in me. So perhaps this is the basis in the art of recognizing death.

Maybe the art of recognizing death is seen in the dying of the light. Not necessarily the dying of the light in those who we lose, but the dying of their light in us. Our lives in this world are so inexplicably intertwined. We meet people and engrave ourselves in their hearts; shining our lights on theirs and receiving light from them in return. In times of struggle when our lights dim and flicker, loved ones gather around shining their lights even brighter giving us the strength to keep moving forward. They hold us up ensuring that though we may waver, our lights are never extinguished completely.

So perhaps this is why I stood still, to give my light time to be strong in the absence of hers. Her light was the basis on which I learned to build my own. That nothingness in which I dwelled for months, call it depression…absolutely, coping…maybe, reigniting the fire…definitely. Maybe I stood still to allow my light time to remember how to burn bright on its own.  It should be no question then why soul mates that were married for 50 years die so close together. They have shined and nurtured each others’ lights for so long, took turns being the one shining and the one needing the light. It’s no wonder then why when one light is extinguished, the other cannot keep burning for too long on its own.

And knowing this, how much we affect the light in others and they in us; is it really so hard to understand why we

 

RAGE
AGAINST
THE DYING
OF THE

lights…

 

 

 

Patient Care CEO  1.1

Approach the care of patients as a cooperative endeavor; integrating patients’ concerns and ensuring health care needs are addressed.

Leslie Pillow and the Imposter Syndrome

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It started on the first day of orientation. I remember coming into Meiling Hall and seeing a sea of faces. By the time we were through orientation I can remember thinking to myself numerous times, “Why am I here?” I met students from John Hopkins, Harvard and Cornell and  students who’s family members were physicians, engineers and scientist. “Why am I here?” I was an average student from a state school in Indiana raised by a single mother who was an accountant before she had to quit working. “Why am I here?” it became a constant refrain for the next several years of medical. I was an average medical student until my life got complicated. I never struggled to understand the topics, I never felt lost but I was just average. A fact that underscored and gave more power to that constant refrain in my head.

 

When I began to struggle in school with my medical knowledge it was from sheer exhaustion and its what promoted me in a large part to take a LOA. I got to the point where I was overwhelmed, exhausted and burned out fro everything else in my life that medical school took a back seat. When it came to dealing with studying and learning I was going through the motions and it started to show. I knew that the first two year were about building foundation and that this knowledge I would need in the future to be the best physician I could be. So I took a step back. Outside of the amazing tutor, Dr. Covington, I sadly remember much about studying for Step 1 just feeling like I wanted it to be over. I finished my score back and did just okay. “Why am I here?”

 

We had Dr. Capers as a speaker for SNMA one evening and I took far more from our talk than I thought I would. He came in and said, “Let me just start by saying none of you are here by accident. You didn’t sneak in the back door unnoticed or fly under our radar and might get caught eventually. We specifically chose you. You’re here for a reason.” He went to explain that this was called impostor Syndrome. ‘Oh my God it has name and I am not alone ‘- my most clear thought at that moment. I remember a friend of mine turning to me and saying, “Well that explains a lot. I definitely have that.” I grinned and replied, “Me too.” He went on to discuss how it was common in minorities especially ones like me. Minorities who have no family members in medicine and who grew up in lower socioeconomic groups. More importantly he also discussed the ramifications of Impostor syndrome and how it affected performance, stress and well being.
I could see this affected my life and my medical school experience. Now I loved third year it was a great experience for me. Actually using the knowledge I learned from the first tears and using it to apply to my patients problems was and still is one of my favorite parts of medicine. But if questions were asked during rounds I would stay quiet. You see I thought I might know the answer but that person beside me they definitely know the answer for reasons X, Y or Z. There were very few times that I came up against a patient and couldn’t generate a differential or was completely lost. It was just having the confidence to speak up.
I had to change my attitude. It wasn’t enough to just know what I needed to know I need to speak up and to challenge myself to use my knowledge and clinical skills confidently. I found that even when i was wrong I learned something – being wrong and being taught why actually taught me ore than my silence ever did. I realized in order to be a good physician my patients need me to be confident in my knowledge and in my diagnosis. It would be pretty hard for a patient to trust me if I was so unsure that I barely trusted myself. And while I always did good on clinical rotations they got better, they felt better. And step 2 was considerably better – both due to the lack of chaos and dysfunction of my life and due to the change in view.  Going forward I know there are things that I need to learn and ways I will continue to grow. But intern year will be considerably harder if I spend half of my energy doubting what I know. I’ve wanted to be in medicine since I was a kid and more importantly I belong here.

 

 

 

Medical Knowledge & Skills CEO 2.1:  Demonstrate a broad working knowledge of the fundamental science, principles, and processes basic to the practice of medicine and apply this knowledge in a judicious and consistent manner to prevent common health problems and achieve effective and safe patient care.

Walking the Tightrope

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 My family…God love them. My family is a essential part of me, being one of seven kids makes that an undeniable fact. Seven kids ranging from 36 to 19 years old and all so vastly different too. But if I could use one word to describe my family it would be close. Rather this closeness was a the result of of being seven children raised by a single mother or a consequence of having a sick mother who was in and out of the hospital, I don’t know. Its likely a combination of both. In the general line up I am number four, but the oldest girl. An important distinction because it was essential to the role I was given to play. I was/am their anchor. I am the advice giver, the counselor, baby sitter, life coach and the list goes on and on. I can remember being a teenager cooking dinner while my mom was in the hospital and trying to convince my second oldest brother to take his medication. Selfishly so, because I was too worried about my mother to have the energy to have to look for him if he wandered off again. This was never an issue, it was just the way life was. But after my mother died their dependency on me intensified and it was a responsibility that got harder to shoulder. Even before medical school, before my mom passing my family required a lot of energy. After my mom’s passing I barely had energy to carry my own issues and let own enough energy to carry theirs too.
When my sister moved in with me I was fully on board with taking care of her but terrified I was going to do something wrong – similar to what I assume actual parenting is like. I truly thought raising her would be my number one family stressor. But surprisingly raising my sister and being her weird sister/mother figure (smother as I like to call myself) was one of the easiest and brightest parts of the last few years. I will not deny that there were struggles but we made it through therapy, graduation, first jobs, and first dates. Does she annoy me – yes frequently, she’s a teenager. Does she make me question my sanity – once a day and twice on Sundays. But she gave me focus, she brings me joy and I cant imagine my life without her in it.
 
But my family is a huge responsibility. My family has a unique ability to be my solace and my misery. They bring me joy, they help me de-stress and I have a ton of nieces and nephews that brighten my day. But their one sided need for me to solve all of their problems was slowly turning to frustration and resentment. I was struggling constantly with being a good sister, cousin, aunt and niece without letting it overcome me. In their defense change is hard. This is the way life has always been. Further complicating this is my resemblance to my mother. As I’ve been told the older I get the more I look, think and sound like her. My siblings aren’t the only culprits I have aunts and uncles who saw my mother as their anchor and in that place they have substituted me. My Uncle Michael once told me he called me to reminisce and ramble so frequently because I look, think and sound enough like my mother that he can pretend he’s speaking with her. As problematic, for many reasons, as that statement is he is not alone in doing this.
 
So changing how I interacted with my family and changing how they viewed my role in their life was an uphill battle. While many of them adamantly refuse to try this new two way street of support a few of them do try. After I spent several weeks talking to my older brothers about being supportive he called me and we had the following conversation that I actually posted on Facebook with his permission because it amused me:
Older Brother: Hey I need to talk to you ’cause Rickii [my sister in law] made me so mad yesterday. Apparently I’m being supportive now so what do you want me to do so I can complain.
Me: You could just ask me about my day.
OB: How was your day Leslie now that we being formal?
Me (laughing): It was good. I ..
——- 5 mins later
OB: Cool, cool. Anyway…..[conversation and complaining session continues for the next 20 mins]
This is my family and this them literally trying. And I love them for it.
I spent over a year of my life working on my own wellness and balance including in dealing with my family and my responsibility to them. So I’m walking a tightrope. In finding my balance I made a goal for myself: to be there for my family as much as I can without letting it get to the point that I  have taken on so much that I am no longer enjoying my family. So I know longer stay up until 5 AM to talk to my family when I have school the next day and I know longer go home on the weekend even when I don’t have time because they asked me to do so. I go home on holidays and special occasions and i keep my nieces and nephews if I have a free weekend. This was necessary for my long term wellness and career. This approach has received mixed reviews to say the very least. But it works for me. I love my family always and I am here for them if they need me but it feels great to see them as less of a duty and more of a gift.

 

Practice-based & Life Long Learning CEO 3.4:  Identify one’s own strengths, weaknesses, and limits; a) seek performance feedback, b) maintain an appropriate balance of personal and professional commitments, and c) seek help and advice when needed.