"Doctor, am I crazy?!": Psychiatry rotation at Harborview

Eager for the first day!

I will never forget my very first patient.  It was the first patient, of the first day, of my first rotation.  My team was composed of an attending physician, a resident physician, another medical student, and myself, and we sat in a small conference room, with our patient seated directly across from us in what we term a "patient interview".  I watched on as the resident spoke with the patient about her most recent symptoms.  "Have you had any thoughts of wanting to harm yourself?"  "How are you sleeping?"  "Are you hearing things that others might not be hearing?"  The meeting seemed to be going relatively uneventfully, and I found myself relating with the patient, able to understand her frustrations at being kept in the hospital against her will.  I was just starting to let my mind wander in the midst of a seemingly uneventful encounter, when the resident asked the patient, "you seem distracted; is everything okay?"

"Yeah." the patient responded

"You seem like you aren't really paying attention to what I am saying anymore.  Can you tell me why?"

The patient's face stiffened, and eyes widened.  "Well, quite frankly, I don't appreciate you flirting with me right now!"

Hiding her surprise, the resident responded, "Would it help if I told you that I am not flirting with you?"

"No.  I know you're flirting with me, and I don't appreciate it!!"

With that, the patient rose from her chair, and stormed out of the room.  The other team members and I exchanged wide eyed glances, and tried to contain our snickers.  "WELCOME to Psychiatry!" chimed my attending physician.

From there, every day seemed to be filled with something incredibly exciting and entertaining - both from a medical standpoint, and from a purely "are you serious?!?!" standpoint.  The medical students would convene in our workroom at the start and end of every day, and exchange the bits of excitement we felt we morally and legally could (identifying details kept confidential).

The Harborview Psychiatry medical student workroom.  Most days Mt. Rainier could be clearly visualized out the window.

But as the drama of in-patient Psychiatric care at Harborview unfolded, I began to see something more, beyond the obscure and entertaining.

The psychiatry clinical rotation at Harborview is set up such that I worked with the same attending physician throughout my time there, and followed my physician's nine patients throughout their stay in the hospital.  I was assigned to follow two of the nine patients in depth, and when one of my patients was discharged, I would be assigned another, so that at any one time I was providing direct, in-depth care for two individuals (doing all pertinent research, obtaining medical records, calling consults, talking at length 1-on-1 with each patient after our group interviews), and following the other seven patients.

In spending significant amounts of time with just a small number of patients, and following the same patients from their admission to their discharge, I came to intimately know each individual.  With each passing day, each delving conversation, and each hurdle overcome, I came to know these individuals beneath the "crazy" the rest of the world had labeled them with - and that at times, they had come to label themselves with.  I came to understand these people as just that - people!

This was none more apparent than when I would have the opportunity to see a patient admitted with severe psychosis - where socially acceptable behavior was not possible, and the words from their mouth made little sense - and would watch on as the medications we prescribed had a chance to take effect, and the patient given a chance to find stability from their illness once again.  When the same individual who came in cursing and spitting, exclaiming that they were God and had all the powers of the universe, came to be a relaxed gentleman, rightfully frustrated with his illness and grateful for the chance at stability we were offering.  Or, when the same individual who came in after a serious suicide attempt and had to be restrained for repeated further attempts, came to the point he could share his hurting and broken story, and find hope in the life that could be. 

In coming to know some of the darkest and pain-filled lives, I began to see each as God's child whom he loves, and found myself in turn feeling legitimate love for even the most publicly outcast and despised.  That same person I had once stared at on the street corner, termed as "crazy", and wondered how they had let their life come to what it was - I came to recognize as an ill and hurting mind, desperate for someone to see their soul for its true worth.  I found myself questioning to what ends I would go if I were to see one of my homeless patients, after discharge, again roaming the streets of Seattle speaking to themselves for having mistaken the seeming stability they felt while on the meds, as healing that would sustain (and so stopping their meds).  And my heart hurt at the possibility of a relapse, for having seen what health and well-being meant for each individual.  I even came to see some of the "murderers" under my care as ill individuals with chemical and physical imbalances they could not control, who wanted nothing more than a way "out" - an out they could not find on their own.

In one scenario, having heard the patient's heart-wrenching life story, I found myself thinking, "How does a person go through this and not break?!"  And then I reminded myself...that's right, mentally, they have broken.  And then I would find myself wondering, "How does a person go through all this and continue to live?!"  And then I reminded myself.....that's right, they are here for having tried to end their life.

I was given the extraordinary gift of staring into the darkest of places alongside hurting and broken hearts.  I was allowed to see illness and brokenness like I had never seen it before.  And I was trusted and leaned on, purely for the white coat I wore.  I was unworthy to share such secrets and to take part in such life-giving transformations, but it was handed to me all the same.

The piece of their lives my patients shared with me were gifts more precious than gold, as they allowed me to see humanity and hurting in a new light. For each story is one to tell, each soul a unique creation, and each heart a broken heart.

Galations 3:28    There is neither Jew nor Greek, there is neither slave nor free, there is no male and female, for you are all one in Christ Jesus. 

 

Malachi 2:10  "Have we not all one Father? Hath not one God created us? Why do we deal treacherously every man against his brother by profaning the covenant of our fathers?" 

 

1 Corinthians 13: 1-3  If I speak in the tongues of men and of angels, but have not love, I am a noisy gong or a clanging cymbal. And if I have prophetic powers, and understand all mysteries and all knowledge, and if I have all faith, so as to remove mountains, but have not love, I am nothing. If I give away all I have, and if I deliver up my body to be burned, but have not love, I gain nothing.

 

***I take the faith my patients place in me extremely seriously.  No individual patient story has been shared, and every event referred to happened on multiple occasions across the wards - disabling any potential personalization by patients or their families.  I have paid careful attention to HIPAA and other regulations, as well as to how I believe my patients and sponsoring physicians would feel if they were to come across this.  If you have ANY concerns regarding this piece or pieces to come, please bring them to my attention as soon as you are able, in person, by phone, by Facebook message, or by e-mail.  Thank you!  isher@u.washington.edu

Depths, Darkness, and Doom: The Fight to Survive the United States Medical Licensing Exam (aka Boards)

From the end of the school year and White Coat Ceremony, to the looming Boards exam, we had roughly six weeks to prepare.  Six weeks to re-learn, cram, study, and come to understand all there is to know about the human body and what ails it (or at the very least, everything we had been taught over the last two years of medical school).

The logistics of the United States Medical Licensing Exam (USMLE, aka "Boards", aka "Step 1"):  Registration for the exam occurs about six months in advance, and costs roughly $600.   The exam is taken in a private testing facility off-campus (where finger printing, metal detectors, pat downs, and constant video monitoring can be done), and is composed of seven 1-hour testing blocks....with breaks, totaling 8 hours.  Each 1 hour testing block contains 46 questions, and the results of the exam are released 3-4 weeks after the exam is completed.  The consequences of failing the USMLE exam are immense!  One is not allowed to simply "retake" the exam, but must drop out of medical school a minimum of one year, and if a re-examination is permitted after a year, a person's record will always show that they failed that first attempt.  And that score, whether passing or not, determines much of what specialty (and general residency) one can get into.  And if the exam is passed, a student is never allowed to retake it...no matter how much one dislikes their score!!

In essence, this test tells the world whether or not you are prepared to provide basic patient care.  According to the National Boards Medical Examination website, the exam "is intended to ensure mastery of not only the sciences underlying the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning."

While the period of Boards preparation is stressful for all medical students that go through it, for me, it redefined isolation and inadequacy; I had no problem graduating at the top of my undergraduate university or passing my classes throughout the two years of medical school, but when it came to this, as I took and retook practice questions and mock exams, I was falling far short of expectations!!  I studied nearly every waking hour of every day; I turned off my cell phone, shut down my Facebook, and denied my e-mail, friends, family, and health...and yet I could not retain the information the way I needed, or mount to the practice scores required of me.  (It is a long story, which I have spent much time and energy analyzing, as to why I suspect I was not able to succeed as easily as others.  This will not be reflected on here, but has much to do with my background private life.)  

As my testing date neared, my grief and panic mounted...and of course, anxiety and productivity have an inverse relationship....so, my ability to succeed became less and less as that fateful day neared.

A few of the many scenes of intense Boards preparation!

There came a point in my preparation, in the days before my scheduled exam, that I realized there was a very good chance that I would not pass my exam.  With a sober understanding of the consequences, and with great humility, I requested from the top administrators of the medical school, permission to cancel my first 3 week clerkship rotation, in preference to the possibility of being forced to delay by a minimum of a year secondary to failing the exam.   In recognition of my unique circumstances (personal background not reflected here), I was given incredible grace by way of a three week extension.  THANK YOU, LORD!!  And thank you to an administration who truly wants their students to succeed!

A new lease on life, so to speak, I plugged away once again, hard core, and this time with the full force of every resource the medical school had to offer backing me!  Three weeks later, I knew I was much better prepared, but still doubted my abilities and felt crippling anxiety.  Emotionally, mentally, and physically exhausted, I sent a text message to my closest prayer warriors, asking for prayer backing.  And backing I did receive!  Prayers poured in from all over the country, and the world!  I felt the love, and so appreciate those who believe in what the Lord is capable of doing through my brokenness!  Truly, if you were a part of this, thank you!

I was overwhelmed by the sheer selflessness of a few select individuals.  I shall always remember the kindness and love of these loved ones, whether it was by way of prayers, texts of encouragement, patience through my absence and frustrations, or baked goods.

No matter how hard I tried, I was not able to sleep the two nights before that fateful day.  Insomnia is a beast!!!  But even so, I knew it was that test date or never.  As I readied myself the morning of, I spent a long while in prayer as I thanked God for the opportunity to celebrate many years of accumulated knowledge, and prayed that he would reign over the exhaustion felt in every inch of my being.

The exam itself was torture.  It was scheduled from 2pm until 10 pm, and as 8 pm rounded, my brain began to shut down.  No matter how hard I tried to focus on each question at hand, my mind could no longer comprehend what it was reading, and I felt as though I had never before seen or heard of much of the material staring at me.  I did my best to power through, approaching each question as though a new challenge.  But even so, my brain and pace continued to slow, and I watched as the timer counted down faster than the number of test questions remaining.  I was running out of time!  And my brain and body couldn't keep up!

With 30 seconds remaining, I still had three questions unanswered, so raced to each, and selected a random one of the multiple choices, and then read through as quickly as I could, to try and better answer at least one of the three.  I quickly raced to change my answer on one, and barely just made it as the screen suddenly turned WHITE.  I had run out of time.

In that moment, I completely broke.  So much energy, anticipation, emotion, and general life, had been poured into that moment....so much of life sacrificed....and as the screen flashed white....I realized that for better or worse, it was all over.  Still at the computer station, the only student left in the building at 10 pm, and with video monitors on me and chaperones watching from the other side of the glass, I laid my head onto my arms.

After a few moments, I pulled myself together and quickly scurried out of the room, put up with once again being fingerprinted, having my id checked, and being pat down, and then made a break for my car.  Once safely in my car, the tears I had denied for months broke free.  It was done.

Only once during Boards preparation had I emerged from my apartment with hair and makeup done, and that was for a single night, in order to support one of my dearest friends at the Miss Washington pageant.  I had gone for several months with minimal contact with friends, and with out seeing my family - and OH, how I missed my siblings and nephews!!  But, in the three day weekend between my Boards exam and starting my first clerkship, I reclaimed much of the life I had denied myself for so long. I traveled from Seattle, WA to Portland, OR to Moses Lake, WA to Spokane, WA, back to Moses Lake, and finally back to Seattle....and LIVED.  I reclaimed my life as my own!  And caught up on mass amounts of love and hugs that had been tragically denied for so long.

On the left: my typical day of Boards studying (no makeup, bun, glasses, complete emotional and physical exhaustion)  On the right: my one night out, for Miss Washington

 Catching up with my baby boy!!!  (my nephew)

The next three weeks, I lived in trepidation.  I went through my first clerkship rotation, not knowing if I was starting my clinical career "for real", or if I would receive my results 3-4 weeks after the fact, and be forced to drop out of my clerkship and re-enter the darkness of Boards studying once again.

Exactly three weeks after I had taken my exam, I received an e-mail alerting me that my results would be released at exactly 11 am Eastern Time that day (8 am my time), and I raced to find a computer at which I would be able to open my results.  At exactly 8:01 my time....I logged into the National Boards Medical Examination (NBME) website, and saw that magical word....."PASS".

My score report, showing a "PASS".

 I stared for a second, not blinking, and again, the emotions came over.  I fell back on the floor from my seated position, and just stared up at the ceiling as tears rolled down my cheeks.  It was really over.

My dear friends, I REALLY AM GOING TO BE A DOCTOR!!!!

And goodness, the grace of the Lord Most High, is beyond all comparison!  Continue to use my life as you will, dear faithful Father!

1 Chronicles 29:11   Yours, O LORD, is the greatness and the power and the glory and the majesty and the splendor, for everything in heaven and earth is yours. 

 

Romans 8:18 (NIV) “I consider that our present sufferings are not worth comparing with the glory that will be revealed in us.” - See more at: http://succeedasyourownboss.com/01/2013/13-bible-verses-every-small-business-owner-needs-for-2013/#sthash.UfnWkdmD.dpuf

James 1:2-4    Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.

 

Jeremiah 29:11  "For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future."

At Long Last!: The End of Classroom Learning and White Coat Ceremony

The four years of medical school are split up such:

(You can click to make this larger.)

The USMLE exam between year 2 and year 3 of medical school, has an impeccably horrendous reputation.  I remember first hearing about the exam on day one of Medical School orientation, and I just sort of nodded my head, as in "yeah, yeah, that's nearly two years away!"

First year went by, with challenge, but yet smoothly enough.  Then, second year, as the difficulty picked up, and reality of this approaching exam became more evident, things started getting a bit more stressful.  As the end of year 2 came upon us (March, April, May), things became more stressful than ever. Before we knew it, the days until this all important exam could be counted in just double digits (86 days and counting, etc.), and our every day of studying became more than just studying to pass a single class, but studying to pass the Boards, and by result, studying to pass all of medical school (and earn our Medical Doctorates)!

The end of this last school year, mid-May, was a joyous occasion!  After 7 years of college straight, and 384 college credits completed (yes, I really calculated this), the end of year 2 marked the end of all classroom learning!  The last lecture was perhaps one of the best attended of the year, and at the end, a couple classmates broke out silly string, and we applauded, hugged, and cheered!

 

Many cheers were had as we exited our lecture hall for the last time ever!!

Later that week, we had a "White Coat Ceremony" in which family from all over the world flew into celebrate with us at Benaroya Hall in downtown Seattle.  The White Coat Ceremony symbolically marked our exit from the classroom, and entrance into the clinics, and we were each individually brought to the stage to be handed our white coat, inscribed with our individual names.

But, as relieving as the end of the year was, and as joyous as the White Coat Ceremony was, what still loomed unspoken was this yet-to-be-completed Boards Exam....

Duh duh duh....duh.......

At Last, a "Has Been": My Year as Miss Moses Lake 2012

A few fun stats from my year as Miss Moses Lake: 63 "appearances", 17,000 miles added to my car odometer, 4700 views of my blog, from 350 to 820 Facebook "friends", COUNTLESS memories, and 1 God who held me together through it all!

It has been one crazy whirlwind of a year, serving as your Miss Moses Lake 2012, and I thank my Lord and I thank YOU for making it a year I will never forget!

Your new representatives of the Miss Moses Lake Scholarship Organization are:  Miss Moses Lake 2013 Catherine Watters; Miss Columbia Basin 2013 Shannon Tuohy; Miss Eastside 2013 Kelsey Schmidt; and Miss Moses Lake's Outstanding Teen 2013 Laurie Kautzman.  I encourage you to support these beautiful women throughout the next year, as they represent and serve you!

In the meantime, as I quietly take a step back out of the spotlight, I look back on my year of service and reflect with joy....

3 Favorite Questions asked of me this year:
1) Is your prince waiting for you at your castle??
2) Since you are Queen of Moses Lake, are you the one who made the rule that says I have to use a booster seat?  'Cause I don't like that rule very much!
3) Did you have to kiss a frog??

3 Favorite Appearances from the year (Appearance = An event at which the titleholder wears her crown and sash and volunteers/represents in some format):
1) Moses Lake community drug and alcohol awareness event, hosted by the Moses Lake Police Department - at one point in the evening, the local police had me put on "drunk goggles" and "walk the line" while several dozen on-looking children chanted "Princess!  Princess!  Princess!"  When I failed the test, I was "arrested", and placed in the back of the police car.  Afterwards, the Chief of Police came and personally thanked me for taking a public stand against alcohol and drugs.  But, I am still explaining away, to this day, the accompanying pictures that plastered across Facebook that evening.  ;)
2) Fundraiser for Moses Lake 5 Year Old, Lily, who has Leukemia - There are appearances for any titleholder at which we stand around, smile, and try to busy ourselves with out feeling too out of place - and then there are appearances like this one.  Though I picked this event up at the last minute (I had less than 6 hours notice, and was 3 hours away, in Seattle, when I received the call), it was one I will never forget, and one from which I walked away with tall shoulders, knowing that I, personally, had contributed.  But as much as I felt I was somehow able to contribute, what stands out in my memory is what I received in return.  I watched on, that evening, as an incredible community came together in unified support for one of our own.  With a heavy and humbled heart, at the end of the evening I said a small something into the microphone, and was received with tearful hugs and applause.  But in that applause I was not being recognized for the crown on my head, but for being a loving part of one of the world's greatest communities.  What a blessed woman I am to count myself one of you, Moses Lake!!
3)  Speaking at the Moses Lake Presbyterian about Acceptance of Ones Self, and Acceptance of Others - As many of you know, a few months ago I took a very difficult step, and came forward publicly for the first time about my history with an eating disorder.  I prayed about this decision for many months before choosing to do so, and yet still felt sick to my stomach as I hit "Publish" on the blog post that revealed such personal information.  But in the hours, days, and months that followed - it was as though the sea that had separated me from reaching so many hurting hearts, had suddenly parted.  In speaking at the Presbyterian church a few weeks ago, it was my first time bringing my personal story and message forward verbally - and again, while fear had kept me from doing so for so long, at the end of my message I looked out on to several young, tear stained faces, and KNEW that God was using my story for HIS glory, and to help relieve the pain of HIS children.  And there is nothing better or more "best appearance" worthy than that!!

3 Favorite Moments from the Year
1) Reading my favorite book from my own childhood, The Napping House, to the Moses Lake Christian Academy 1st and 2nd graders.  Talk about memory lane and a fun moment for me!
2) Hearing my name squealed in a very high pitch squeal "Analieeeeeeeesse!!!!" by a young girl.  When I turned around, a 7 year old girl I had spent a day with nearly a year previous, was running for a hug, followed by her mother, who had tears in her eyes.  The girl's mother explained the role I had played in her daughter's life our day together so many months before, and thanked me (for what, I am still trying to figure out) repeatedly.  I learned that day, that you NEVER know when you may just be substantially impacting a life!
3) Crowning one of my very dearest friends, Shannon Tuohy, Miss Columbia Basin 2013, and then allowing her to remove the crown from my head - and exchange it for a stethoscope. There is no-one else in the world I would have rather held my hand as I walked from one life chapter into the next, than my fellow future doctor and prayer warrior.

Thank you, truly, from the bottom of my heart to all who played a role in making my last year what it was.  I walk away with a new set of skills, and a whole host of incredible memories and friends, and I am a better person for it!  Thank you, thank you, THANK YOU.  Here is my farewell video, which captures my year in 3 minutes and acknowledges a handful of the key players (my Miss Washington sisters, included!!), and played in the final moments of my reign.

3 Things I am looking forward to MOST in the next year
1) Finishing my last year EVER in a classroom!!  After 7 years of college, this is something to CELEBRATE!!
2) Sky Diving!!!  Call me crazy, but sky diving doesn't have anything on this world traveling, athletic, medical school, beauty queen chic.  ;)  May 18th, that plane and parachute had best be ready for me!
3) Redefining Analiesse.  I do not type this lightly, and the details do not belong here in a public post.  But as many have already noted my choice to not run for Miss Washington 2013, my decision to discontinue modeling, my descent to further involve myself in national conferences and media highlights at this time, and many other tangible shifts - there is certainly some undeniable change happening!  I assure you it is all good change, and all God-driven change.  :)

And that brings us to one of the most beautiful things about this life....the fact we serve a merciful and loving God who allows fresh starts; the ability to redefine the way we live!  I encourage you to take a moment, step back, decide what you want your life to look like, and then make the choice to make that happen, no matter the work and discomfort required.  Be intentional about life!  Write the next chapter in your life, the way you always wanted it to be read!

With Much Love and Many Heartfelt Prayers,

Analiesse Marie

Colossians 3:23   Whatever you do, work at it with all your heart, as working for the Lord, not for men.

Jeremiah 29:11    For I know the plans I have for you," says the LORD. "They are plans for good and not for disaster, to give you a future and a hope.

Psalm 107:1  Give thanks to the LORD, for he is good; his love endures forever.

"So what is it you do in Haiti, exactly??!" Part 2: Medical Consulting

WARNING:  This is not one of my typical, easy and fun to read, Miss Moses Lake posts.  Enjoy or skip on to the next as you like!!  :D

If I am trying to make what I do sound really exciting, I will tell you "I do independent medical consulting for clinics in Haiti!!"  But I mean, really!?!  What does that mean??  In reality, not much.  :)   But here are some of the basics in a bite-size portion.   

In a nut shell: I combine my experience in Haiti with my growing medical knowledge and connections (the Clinton Global Initiative, contacts in Haiti, and friends that run medical clinics), and upon request, help various short term medical mission teams in Haiti transition their care to a more sustainable, culturally-sensitive, and continuity-based practice. 

 

After the earthquake, we saw a lot of crush injuries, and similar ailments.

I am extremely blessed to have been given such a unique set of experiences within Haiti.  My first trip to Haiti was prior to the earthquake, when few knew of Haiti (multiple individuals asked if Haiti was in Africa when I mentioned going) and when walking through Port au Prince, Caucasians were so seldom seen that Haitians would come outside to point and take pictures of my team.  With so little outside help (as illustrated by the rare Caucasian sighting), I was privileged to see what the Haitian healthcare system looked like on its own, and how a visiting mobile clinic functions.  After the earthquake, I was able to travel back to Port au Prince when the massive influx of emergency healthcare was present, and I have watched as Port au Prince (and the greater Haiti) has gone through massive transitions (Cholera epidemic included!) in the three years since the earthquake - not all in positive ways.

 Much of the medical care in Haiti is now provided by short term medical teams, usually run by Haitian individuals (or similar) with no medical background, and staffed by American and European medical professionals with little or no experience with the Haitian culture.  These teams often are in country for 1-2 weeks, and a new set of team members come every additional trip (usually only a few trips a year for such an organization).  While these groups provide an incredible experience for the team members, and often bring many smiles to the faces of the Haitians they serve, with time I began to question the true impact these teams were having (or not having) on the long-term health and potential of the people they serve.  And I realized how much additional good could be done with some simple, mindful adjustments.

 To illustrate the point, the one thing I have devoted my time to more than any other, is the creation and implementation of patient record systems.  Many of the groups I work with do not keep any record of a patient and the care provided from one visit to the next.  So while a patient may walk away with a 14 day supply of antibiotics to cure an infection, when/if a team comes back several months later and the infection is not gone, there is no record of what antibiotic was tried previously (and the patient has no idea; "it was a white pill!"), and so the same antibiotic will likely be given once again, and once again it will not cure the infection.  Similarly, one blood pressure reading can tell you little, but several blood pressure readings over time can tell you a great deal!  But if you are not keeping track from visit to visit, it does little good to take blood pressures at all!  So why are these teams not keeping patient records?

A medical clinic's "patient notes" prior to my work with them: wadded up pieces of paper stuffed into gallon sized plastic bags, and later thrown away.

The same medical clinic's patient record system after Emily Fry and I worked on its implementation.  Patient files are separated first by village, and then by last name.

I argue this break in system is because the Haitian directors with no medical background do not fully understand these principles (as you wouldn't expect any non-medically trained individual to fully understand!), and because the medical professionals who come and go do not recognize how little continuity is being applied from their visit to the next medical team's visit.  So, while I am far from the most qualified person for such work, I have decided to use my experience in Haiti and growing medical knowledge to act as a sort of "Bridge Figure" between these two: the Directors of the Clinic with no medical knowledge (usually Haitian), and the Medical Volunteers.

 I call it "consulting" to make it sound fancy, but really all I do is explain to the directors the importance of patient records, help in the implementing of patient record systems when appropriate, and speak for the need to think about medical care in long-term, continuity-based ways: "Hey, what about returning to the same village every two months, and providing 60 day supplies of medications when we go....that way we can actually treat chronic medical problems in a proficient, life-changing way?  And we can track progress in our notes!"  It truly is unexciting work in many ways.  But I believe this is how I can make the greatest difference in the lives of the Haitian people, long-term, given the unique set of experiences and knowledge God has given me.

Working with a clinic in rural Haiti on the use of their new patient record system (note clipboards in providers' hands).

I also speak to the medical volunteers, new to Haiti, about the fact that first world medicine cannot  simply be applied to a third world setting with no fault!  In one sad illustration, a five year old Haitian boy had hydrocephalus: "water brain", treated in the United States with the placement of a shunt shortly after birth.  If not treated, it leads to severe mental retardation.  A neurosurgical team traveled to Haiti, found this 5 year old boy, and performed a "miracle surgery" of a shunt placement....and then left back to the United States.  Three weeks later, this boy was dead.  Why?!  Because the application of healthcare that works in one corner of the world, does not always work in another!  In this case, there was increased bacterial risk in Haiti, the mother did not understand the warning signs to look for, and the mother did not have access to follow up care.  While this is a large example, similar principles exist in the every day primary care clinic as well.

 Please understand that I write all this with love.  I understand that many of my readers may put their heart and soul into providing care for those in need.  I do not aim to undermine such efforts, here in my writing or in the work I do, but simply to suggest that each of us individually, and as teams, need to pull back and re-evaluate the true impact outside aid is having on a nation we love. 

Also, please note that what is written here is extraordinarily watered down.  I have much additional experience and insight (from experiences in Haiti and working with outside groups, like the Clinton Global Initiative), and there is much more to what I do (teaching healthcare classes, hands-on healthcare providing, consulting with Electronic Health Record suppliers, etc.), and if you ever want to sit down and have a meaningful discussion, I would be more than happy to!

At the Clinton Global Initiative - U 2012

If you would like a bit more colorful description, with some fun background, here is a magazine article written on my background and work in Haiti, published a year ago.

Teaching a class on Cholera Prevention and Treatment.  One of several other things I have aided in.

Romans 12:5-8   We have different gifts, according to the grace given us. If a man's gift is prophesying, let him use it in proportion to his faith. If it is serving, let him serve; if it is teaching, let him teach; if it is encouraging, let him encourage; if it is contributing to the needs of others, let him give generously; if it is leadership, let him govern diligently; if it is showing mercy, let him do it cheerfully

Colossians 3:23    Whatever you do, work at it with all your heart...

"So what is it you do in Haiti, exactly??!" Part 1: School Sponsorships!

Nearly every time I bring up Haiti, I am asked the same question, worded the same exact way: "So, what is it you do in Haiti, exactly?!"  As I gear up for my 7th trip (maybe 8th? you know you've been to a country your fair share when you lose track), I thought I would take a second to clarify this deep, dark mystery!!

The work I do has two completely separate parts to it: Education and Healthcare.  First up, Educational sponsorships!!  I will post again in the next few days about the healthcare portion of what I do!

Education Sponsorships:  THIS!  Is the fun stuff!!!

The last three years, I have spent MANY days working with young students in Moses Lake, explaining to them the privileges we inherently have by living in the United States, and convincing them that no matter their age, race, or background, they can make a HUGE difference in this world!  Many of the classes I work with locally, then decide to do coin drives for the young students in Haiti.  This work in the local classrooms, and the connections I then make on their behalf in Haiti, serve as my Miss America Organization "Platform", which I call "Lighting a Fire Within: Inspiring Others to a Life of Service".  But, don't be mistaken, I have been doing this work long before Miss Moses Lake ever came to my attention!  Being Miss Moses Lake simply opened the doors to having an even larger impact!

Speaking with Chief Moses Middle School students about our power to change the world!  This year alone, this school raised $1600 for educational sponsorships in Haiti!!

Working with an impoverished Haitian family, and my translator.

I find it an absolutely humbling and amazing experience to then take these local students' gifts, and facilitate the sponsorship of young individuals in rural Haiti who need it most.  I travel to places where few other aid workers ever traverse (most all aid groups stick to Port au Prince, or a couple of the other large cities), and create relationships with the area school principals, who help me locate the families in the area who are struggling most, and who would give most anything for the opportunity for their children to attend school.  I then work with these families to come up with the best, most sustainable way that I might be able to aid them.

Keke's farm in Haiti, before and after the planting of donated seeds.

For one family, the thing they needed more than any other, was seeds for the father's farm.  The mother of the family had passed away two years previous, and the seeds sold to pay for her burial.  Helping the family back up on their feet, with a business loan of sorts, meant they could better provide for themselves - and in this way, our giving did not create dependence!

All this work is not simply a matter of dropping money and leaving, but I return regularly to speak with the recipients, principals, teachers, and students' guardians, and in effect, I am what the Haitian culture calls an "education guardian".  When I am not in country, I work with my on-ground "fixer", Gardy, who makes bi-weekly phone calls and checkups to ensure all continues to go well, and reports back to me with any concerns.

Gardy is my #1 Haitian employee: Translator, Guard, "Fixer", Friend.

It should be briefly noted that there is ALWAYS "concern".  Whether it be a need to buy new shoes or uniforms, attendance concerns, behavioral problems, government test registration, or dealing with impacts from Hurricane Sandy - there are always things that need attending to!

All this has led to an education being made possible for several young Haitians who otherwise would likely never even step foot into a classroom!  And perhaps just as importantly, the students in Moses Lake have been able to see (in a very tangible way!) the life-changing impact they are capable of making in another corner of the world!!

The students sponsored in Haiti thus far, by students in Moses Lake!

(I always bring the pictures, thank you notes, and stories back to the local students, to demonstrate what they personally did for others in need - this is where the water works flow, and difference is made.)

 In the past, students have also assembled Oral Rehydration packets for the treatment of Cholera.
 

This is the fourth academic year I have been doing this, and recently I had some of the first students I worked with, come up and tell me how their connection with Haiti changed their world perspective, and their concept of their ability to make a difference. THAT is what this is all about!

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I am often criticized for my work with statements like "What about your own country?!  You turn your back on America to help Haiti!"  But, let's be honest.  While yes, there is great suffering here within our own borders, as a general statement, there is much greater need in Haiti.  Because of this, for the same amount of effort and money, a much greater impact is possible in Haiti.  And there truly is no comparison!  We have the privilege to attend school no matter our circumstances (there are even free school buses if one cannot afford transportation!), we have access to emergency healthcare no matter our ability to pay (in Haiti you can't simply pick up the phone and call 911, or walk into an Emergency Room), and if needed, we have access to food stamps, welfare, medicaid, etc.  It is my belief that God created every single individual on this planet to be of equal worth, and the fact that I am so incredibly blessed with the opportunities I have, is no more than a simple "birthday gift" - a chance occurrence (or act of God) that I was born within the borders or a privileged nation, and not elsewhere.

So, ask yourself, why should you deserve greater privileges and comforts than any other person on this planet; what did you do that someone in an impoverished nation did not?
 

Acts 20:35   ...by working hard in this manner you must help the weak and remember the words of the Lord Jesus, that He Himself said, "It is more blessed to give than to receive." 

 

Matthew 25:40   And the King will answer and say to them, '"Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me."

The Truth Behind the Physique: From Eating Disorder, to Overweight, to Healthy!

I take great pride in telling people, “I’ve lost 50 pounds!!”  But what I am not so proud of, and am slower to offer up, is the greater story behind my physique.

As a child, life in my home was not always easy.  My brother and sister each responded in their own way, and I responded by developing a subconscious need for perfection.  By early middle school, I was the youngest individual on the state championship science team and the top competitor on my school’s math team.  By late middle school, I was excelling through advanced math classes - having to travel by car to the high school as the classes I required were not offered at the middle school.  In the 8^th grade, I was captain of the math team, president of the science team, first chair flute, leader/drum major of the band, and successful in a small number of sports.

It was around this time that I also began to develop a new need for perfection and control – that of what I consumed.  It started simple enough, with heading out the door without breakfast.  But it soon progressed to refusal to eat in the school cafeteria during lunch, and then to skipping out on snacks and dinner.  Involved in so many activities and sports, I was gone the majority of the daylight hours, and with my mother working night-shift (and my father not in the home), it was easy to go through a day without anyone noticing.  If on the weekend I ate what I considered “too much”, I would make up for it by cutting back further on what I consumed during the week.

This continued on into high school, and developed into a mixed exercise-obsession and calorie control.  In my sophomore year, however, I began to have significant health consequences.  Of course, neither I nor anyone else recognized them as disordered eating related (I was, after all, eating normal meals on occasion, even overeating to the point of being ill at times), and many doctors visits and medical tests followed with little conclusion as to what could be causing my digestive system problems.

Over the next few years, I went through periods of eating "dysfunctionally", and eating normally, until I decided to get as far away from my hometown as possible at the end of community college.  A new mindset on life, and a fresh start, once at Western Washington University (five hours from my hometown, and with VERY FEW individuals who knew me previously), I could start over.

In starting over, however, I literally did not know how to eat "normal".  A controlled 3 meals a day, of "normal" proportions, was not natural to me!  As such, I began to pack on the weight.  In speaking with countless others who have struggled similarly with eating disorders, I have learned that this is a relatively common phenomenon....that once an individual cycles into regular eating, and normal proportions and food choices are not something that have been practiced before, a reflexive weight gain is seen.  For me....this meant not your typical Freshman Five or Fifteen....but rather 55!!!

I did not realize that I was overweight for quite a while.  Sure, I was not fitting into my previous clothing and I was eating more, but that was expected!  It was not until I returned home from a trip abroad, looked through hundreds of pictures of myself on the trip and refused to show 90% of them to friends because of their "bad angle", that I realized "Oh my goodness gracious!!!  I really am overweight!!"

The picture that spoke louder than any other:  It was time to take my health/weight seriously!

My change in facial structure, alone, amazes me!

Using triathlons as a fun way to lose weight!

From there, I knew it was going to be a battle, but I was determined to be healthy.  Genuinely healthy.  First things first, I took fast food and all-you-can-eat buffets out of my diet completely, started shopping healthier at the grocery store and keeping healthy snacks around me at all times, and became active again.  Always the wannabe comedian, I called my weight loss plan GOYBADS: the Get Off Your Butt And Do Something plan!  Trust me, it wasn't an easy path; I had to work hard!  Then, to keep myself going towards a goal of fitness with a definitive date, I signed up for my first pageant.  BUT, to insure that a "healthy weight" truly meant "healthy" this time, and that I did not go overboard, I found myself a diet and fitness accountability partner.

Before and After

Today, I am at a very healthy and happy weight, and doing well!!  However, it is a sad and unfortunate thing that I report, to this day, I still struggle with some of the long term health consequences of a prior eating disorder; I may be eating "normally" and exercising well, but I am now trapped with long term consequences of my unfortunate, younger decisions.  (I am choosing to not disclose the personal medical details here, but I am certainly willing to discuss such with anyone interested - whether it be a medical colleague looking to provide better care, or an individual looking within or to those around themselves.  Just message/ask me!)

So, why do I write this?  Surely not to out myself!  In fact, making this public for the first time comes with great anxiety.  But rather, I aim to create a better understanding, particularly for my pageant, teaching, coaching, and medical friends.

So, who is at risk, and why?  First, please recognize that an eating disorder can develop in an individual of either gender and at any age, and is equally common among all races.  However, it is most common in females between 14 (soon after the onset of puberty, when body parts naturally expand) and 25.  Additionally, eating disorders can develop for a number of reasons, including: a need for perfection or control over an area of life, pressure to perform in a specific area, a desire to be "model thin", or a misconception of ones own appearance (not seeing in the mirror how others see you, known as "Body Dysmorphic Disorder", which may also contribute to the rebound weight gain one does not recognize, as I noted earlier).

The concept of "Body Dysmorphic Disorder"

One of the most common manifestations of eating disorders today is known as the Female Athlete Triad.  In the Female Athlete Triad, three conditions are commonly seen together in active females, and they are: eating disorder/low energy availability, amenorrhea (irregular or lack of periods), and osteoporosis (an increased risk of fracture, including stress fractures).  This is most common in individual sports that stress leanness and self-control, including long distance running, gymnastics, figure skating, ballet, diving, and swimming.  In the female athlete triad, the body becomes so deprived of energy/nutrients via the decreased consumption and increased use of energy, that the body's systems begin to shut down, including the reproductive system and the process responsible for building bone density.

Eating disorders are INCREDIBLY dangerous!  About 8% die within 10 years of the onset of the disease, and 20% will die prematurely at some point from complications related to the eating disorder (heart failure is frighteningly common)....making eating disorders the MOST LETHAL of any mental/psychiatric disorder!!  While I thought I was handling the stress of my environment "well", in fact, I was causing myself more harm than if I had chosen to do any number of other "unwise" things!  And for those choosing life with an eating disorder in order to become more attractive, stats like these CERTAINLY do not make an individual more attractive to any future mate!

Please educate yourself.  Look within, and keep a loving eye out for those around you.  Consuming less than 800 calories a day is NEVER okay!!  Even on the strictest diet!  (The nationally recommended lowest is 1200 calories per day.)  Just because your stomach no longer tells you that it is hungry, does not mean that your body isn't starving!

Trust me, I get it.  As a "pageant girl" and occasional model, with a high stress lifestyle, I know the pressures....very well.  But there are healthier ways to gain control, to get the appearance you want, or to perform at the highest standard.

If you have an eating disorder, please consider speaking with someone on the outside of the situation, whom you trust.  It is important to get help, and there are places to receive that help.  If you feel comfortable, please feel free to message or speak with me - I would be happy to listen, and to help you on the first step to a healthier way.  If you suspect someone you love has an eating disorder, please recognize that blatant accusations will result 95% of the time in denial and increased distance.  There are other ways to express your concern and get your friend/colleague/student/athlete help.

As I discover what a healthy me looks like (and experience some mild weight fluctuation as I figure that out), one thing I have found incredibly comforting is knowing that I am enough, just the way I am; right here, right now.  This has taken me some time to understand (and I'm still working on it!), but the more I come to terms with the fact that I am enough just as I am, the more at peace I find myself.  I don't need to lose weight, I don't need to gain weight; God simply asks that I take care of the body He has given me, to the best of my ability.  And similarly, I do not need straight A's, earned titles, or other accomplishments....all God asks is that I live each day according to His love for me and those He places in my life.  If I can learn to live for that love...I truly am Perfect just the way He has made me, the rest of the "imperfections" and all!!  AND SO ARE YOU!

You truly are PERFECT, JUST THE WAY GOD MADE YOU!!!!

Psalm 139:14 I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well. 

 

Matthew 6:25 “Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing?" 

 

Song of Solomon 4:7 You are altogether beautiful, my love; there is no flaw in you. 

  

 

 

                     With Much Love,
                               Analiesse