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Thanksgiving

There are so many things that are worth writing about on and around Thanksgiving. 

 

For those of us interested in ancestral health and evolutionarily-appropriate eating it’s fun to explore what a pre-pilgrim Thanksgiving feast might have been.  Yesterday I spotted this article on Twitter discussing what a pre-pilgrim dinner would have looked like in Portland (the location of my penultimate residency interview!).  It is well worth a read.

 

My Thanksgiving feast this year is certainly of the ‘more traditional’ pilgrim/post-pilgrim variety, and will consist of a locally raised wild turkey and a Bourbon Red – a heritage breed turkey.  Incidentally, I don’t expect any Wild Turkey Bourbon will be consumed…

 

Thanksgiving is also a great, and thoroughly appropriate, time to talk about what we are each thankful for.  Family, friends, food, shelter, health; even the ‘least fortunate’ amongst us in the developed world are incredibly blessed when we look around the world and see those without access to clean water, basic medical care, or basic freedoms and security.

 

As I reach the end of my med school career, and pathologically over-think my future options, it seems like a very appropriate time to look back and think about what I am most thankful for from this rather lengthy journey.  Without a doubt, the thing I am most grateful for during the last 8.5 (*gulp!*) years is people.

 

As some of you may know, it was never my intention to be a doctor.  Truth be told, I never would have taken the MCATs (Medical College Admission Test) if my summer roommate hadn’t dared me to do it.  Nipa, though you won’t be reading this, Thank you.  On the day that I took the test I met a charming and chatty pre-med while we waited in line.  She thought my light-hearted approach to the MCAT was hilarious and offered me her AIM screen name so we could chat if I decided to apply to med school.  Without Jackie my AMCAS (American Medical College Application Service) application would have been submitted sans-personal statement, an act that certainly would have doomed my efforts.  Incidentally, Jackie and I ended up attending the same medical school, so I’ve had the opportunity (even as recently as a couple of months ago, since she pursued residency training locally) to express my thanks to her.

 

My large university had a “Pre-health” office that assists aspiring health professionals prepare their application for medical school.  When I called to ask if they would help me (only a month or so before applications were due), they told me that they could help me get my application ready… for the next year.  Fortunately the pre-health office at the woman’s college campus was willing to take me on (despite the fact that I wasn’t from her college), making my application to medical school a reality.

 

The day before my first medical school interview my college roommate asked me what I was planning to wear for my interview, telling me “I think people wear suits for med school interviews.”.  I laughed this off, but after a last minute email exchange with my advisor my roommate went shopping with me to help me find an appropriate suit.  I alternate between cringing and chuckling when I think about the response I would have received had I shown up to a med school interview in a tank top and cool Malaysian Sarong, my original plan!  Incidentally, prior to my residency interviews I headed to Long Island to meet up with this same friend for another suit-shopping experience (this suit is much sharper, if I do say so myself!).

 

I applied and interviewed for more PhD programs than I did MD/PhD ones (though since I only interviewed at four PhD programs that’s not saying much!).  I was very tempted by two of the stand-alone PhD programs, and my decision to pursue the combined degree literally came down to the final day.  I remember the day before the decision was due I met with an MD/PhD student who sold me on the virtues of a combined program.  Without Jay, it’s entirely possible I would have opted for a non-clinical route.  Another good friend, who’s opinion I still very much value, had warned me that “No sane person puts herself through the torture of med school unless she’s sure she really want to be a doctor.”.  I’m not saying he’s wrong- I’m sure there’s quite a list of people who have questioned my sanity over the years!

 

Someone who has contributed more to my medical education than he shall ever know is Russell.  I thank “Russell”, though I shall never know his real name.  Russell was a 74-year-old man who died of “coronary artery disease”, at least that’s what his cause of death was listed as.  While I became very familiar with his body, I will never know anything about his life.  From his lean and muscular body (Russell was short for “Russell the muscle”), I imagined him as a fit and active man, but I shall never know.  Books have been written about gross anatomy lab (including one written about the experience at my school- my anatomy teacher is on the cover of this book!), and I’m sure every student has a slightly different experience of this ‘right of passage’.  I feel safe saying that we are all, uniformly, thankful for the gift that our donors gave.

 

I’m not going to go through and thank all the people who helped me survive (I would not call it thrive) in medical school.  Completing my PhD was a particularly stressful time, and I am forever thankful for the many people who supported me through that experience.  Returning to medical school (after 4.5 yrs in the lab) was difficult, but made much easier by classmates who did their best to get me up to speed on the floors.  The three guys I did my first neurology rotation with were particularly kind in helping me hold-it-together while stressing out about how to present a patient to our attending physician for the first time.

 

I would be remiss for not recognizing the role that many of my residents played in my development as a future physician.  Some residents love to teach while others barely tolerate students, but even the grumpiest and most sleep-deprived resident shaped my experience in someway (for better or worse).  Likewise, various attending physicians have been mentors that I struggle to recall while others have truly fashioned some aspect of my clinical or personal development.

 

It takes a village to raise a child, but it takes a hospital to make a doctor.  When you are a medical student or resident-physician, nurses, physician assistants, therapists, and social workers can make or break your day.  The reality is that these people frequently know more than you about what your patient actually needs.  Speaking of patients- they are, of course, an integral part of medical education.  Many are lost in my memory, but others will stay with me throughout my clinical career, for the impact they had on my medical knowledge and the impact they had on me personally.

 

As important as all of these people have been to my development as a clinician and a person, I am most grateful for my friends. I have loved the poem “A Prayer” by Frank Dempster Sherman (1860-1916) since college, and as I travel around the country interviewing for residency programs (and catching up with friends along the way), it has never struck so true.

 

Screen shot 2013-11-27 at 3.10.34 PM

 

I have a fantastic network of friends, one that I am truly thankful to have nurtured over the years.  In an era when the word “friend” may conjure up thoughts of a virtual connection on facebook (especially when in the same sentence as the word “network”), it can be easy to lose touch with people that matter or let friendships devolve into a series of “likes” and “pokes”.  On the other hand, online social networks can help make connections that have been lost.

 

When I interviewed in Vermont I met up with a friend I have not seen since High School. On my way home from an interview in New Hampshire I spent the weekend catching up with friends in Boston. Before heading to Colorado for an interview I went to play polocrosse (imagine a combination of polo and lacrosse) for the first time in 2.5 years, in Texas.  There I saw friends that I have literally not seem for years, but who opened their homes and stables to me without hesitation.  With the exception of one upcoming interview, all of my interview travels are combined with a visit with one or more friend.

 

When I entered medical school I was unsure whether I would ever use my clinical degree in practice.  The medical knowledge would be useful for asking relevant research questions and the clinical knowledge would be useful when friends and family needed phone-a-friend medical advice, but I certainly was not sold on the idea of being a clinician when I entered medical school.

 

Now I am sold- I do want to practice clinical medicine (as well as be involved in research and academics), and I am forever grateful to all the people who have helped me find my way along this path.  My desire to be a fount of knowledge for my friends and family is still one of my greatest drivers, and it is certainly a large part of why I have chosen to pursue family medicine.  I’ve been warned many times that friends and family make the worst patients- they’re notorious for not listening to someone they’ve known since “way back when”. That’s fine- I really am OK with that (just keep your griping to a minimum when your low-fat, low-cal, low-“food” diet fails to leave you feeling great.). I do hope, however, that when my friends do need me, I can live up to the last line of that fantastic poem.

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Oh, and if you’re curious, this is polocrosse.  Check out americanpolocrosse.org for more info. 

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!

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There are a lot of smart people who are interested in ancestral and evolutionary health. Personally, I find it very encouraging to see people from various backgrounds thinking deeply about how looking back into human history can help us improve our present-day wellbeing.  These people come from all walks of life and each person has come to this way of thinking by a unique path, but many have similar stories.  Sharing a story breeds camaraderie, and I think part of the reason the “paleo” movement has developed such a strong online community is because of the solidarity that comes from sharing a similar personal journey (that’s not to say there isn’t division and strife in the community- there is plenty!).  Sharing core principles also promotes professional camaraderie. Alas, few of us in the medical profession share an interest in ancestral and evolutionary thinking.

 

I have been very fortunate in my brief clinical experience to have worked alongside and under (medical academics is definitely a hierarchy) people who have indulged me in conversations about how evolutionary and ancestral theories apply to modern medicine. But while some are happy to talk about select topics in ancestral health, few think about it deeply or use ancestral thinking in their medical practice.  There are physicians who think about ancestral health and evolutionary medicine, and I am always enthusiastic (perhaps a little bit too enthusiastic?) to meet and interact with physicians who share my academic interests.

 

As I said above, sharing a journey breeds camaraderie (that definitely seems to be the “word-of-the-post”), and it frequently seems that the tougher the journey, the greater the camaraderie. Medical training is a gauntlet. After an undergraduate degree, medical degree, internship, and residency (to say nothing of longer residencies, an added fellowship, or additional degree(s)), a physician in the US has spent a minimum of 11 years in “higher education” to become a practicing clinician. As I wrote in my last post, “nocturning“, clinical training is physically and mentally exhausting (and decidedly unhealthy). Other allied-health and research professionals also travel long academic roads, and surely the trials and tribulations of the academic journey of each profession fosters camaraderie within each group.  Similarly, for those of us who have achieved a PhD- we may have done research in different labs, under different mentors, and in very different fields, but there is a mutual understanding of what one endures to finally earn those three letters after one’s name.

 

I have been fortunate that I have built some strong personal relationships in the ancestral health community.  One of the first “ancestrally minded” people I met in real life was Dr. Emily Deans– a psychiatrist with a deep interest in the interaction between nutrition and mental health.  While we are separated by some distance, it is good to have a friend who not only shares my passion for ancestral and evolutionary health but who also understands the arduous journey of becoming a physician. In the past couple years I have also met a number of other physicians; first online, and then last August at the Ancestral Health Symposium (AHS) I had the pleasure of meeting many in person.  Less than a year ago, a few likeminded physicians thought it would be beneficial to form an organization for physicians (MDs, DOs, and international equivalents) interested in ancestral health. This idea blossomed at AHS, and in the last few months a meeting was organized to bring such an organization into fruition.

 

This past weekend I travelled to Salt Lake City for the Physicians and Ancestral Health (PAH) Winter Meeting.  Leaving the northeast as a blizzard approached to head to snowy Salt Lake City seemed a bit like jumping “out of the frying-pan and into the crockpot” meteorologically speaking, but personally and professionally the trip was fantastic (and people in Utah seem to handle the snow in stride, quite unlike home in the northeast!).  This was the first official meeting of PAH, and twelve physicians from around the county (and Canada) got together to discuss what we know, what we’d like to know, how to share our information, and what we need to do to grow. We discussed different types of research, the need for more research investigating and supporting an ancestral approach to medicine, and the importance of producing and publishing results.

 

A word on research…  Physicians are not scientists (save for physician scientists, a truly minuscule blip in the Venn diagram of the ancestral health community) and while anecdotes can be powerful, they are not the kind of evidence that will sway physicians, scientists, and practice.  I recognize that as an MD/PhD student I am well positioned to make some waves in this area- I’ll try not to get too overwhelmed by the thought!  Fortunately, there are already some physician scientists producing data and publishing papers, one of whom I got to meet this weekend.

 

I had a bit of fun making a Venn diagram… nothing is to scale, but you get the idea…

 

venn

 

A slightly more amusing diagram might looks something like this… 

 

I highly recommend checking out PhDcomics.com, and “What should we call med school” as well as “What should be call paleo” if you find yourself represented above. (Sorry, I'm not blog-literate enough to hyperlink from the image!)

I highly recommend checking out PhDcomics.com, and “What should we call med school” as well as “What should be call paleo life” if you find yourself represented anywhere above. (Sorry, I’m not blog-literate enough to hyperlink from the image!)

 

In addition to setting up the framework for our nascent organization and discussing how we might foster ancestral-thinking in modern medicine, this meeting was an opportunity to form new friendships and strengthen old ones.  As the lone medical student at the meeting, I felt very fortunate to interact with enthusiastic and supportive physicians from several different fields who all share an interest in ancestral health.  I enjoyed talking about research with Dr. Lynda Frassetto, who’s papers I frequently reference when talking about the benefits of an “ancestral” diet. It was great to get a chance to talk about functional movement with Dr. Jacob Egbert and then go to Ute CrossFit where he led a practical session.  I’m straight out of my Ob/Gyn clerkship, so I loved sharing stories with Dr. Don Wilson, an Ob/Gyn from Canada with first hand knowledge of the health of indigenous First Nation people.  I had the chance to talk about the opportunities I’ll have if I decide to pursue a residency in family medicine with Dr. Rick Henriksen and other family docs.  It wasn’t all a rosy picture (though Rick is nothing if not enthusiastic), but I got a lot of honest and useful information from these physicians. There was also a preponderance of psychiatrists (or is that a contemplation of psychiatrists?), including my good friend Emily Deans, as well as a cardio-thoracic surgeon. I’m glad to have met Dr. Ede, and to have been introduced to her impressive website Diet Diagnosis.  It was also a pleasure to catch up with Dallas Hartwig, from Whole9 Life, who spoke with the group about functional medicine.

 

A nature break- some ancestrally minded physicians snowshoeing in Wasatch National Forest.

A nature break- some ancestrally minded physicians snowshoeing in Wasatch National Forest. From left to right, Polina Sayess, me, Don Wilson, Emily Deans, and Jacob Egbert

 

A lot of knowledge and information was shared this weekend, and I think we all walked away from the weekend with new friendships, a renewed sense of camaraderie with fellow physicians, and thoughts on how we can each do our part to help promote ancestral health.  Personally, I have a number of goals, not all of which I need to share.  I will say, however, that I feel there is a strong need to champion non-nutritional aspect of ancestral and evolutionary health. As the Hartwig’s book beautifully argues- It Starts with Food– but there are many other ways to incorporate ancestral and evolutionary thinking into modern medicine. That is one of my goals on this blog, though of late I have been writing more random ramblings than thoughts on distinct elements of evolutionary medicine.

 

As I officially make the transition from MSIII to MSIV (as of today I have completed all the 3rd year requirements of my medical degree), I hope that I’ll have more time to write about a number of topics in evolutionary medicine. Until then, I appreciate that readers follow along with my random ramblings, and am very glad that there are physicians who share a passion for understanding human health in the context of our evolutionary past.

 

PAH doesn’t have a website up yet, but for more information you can go here.

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