Monday, March 7, 2016

Reflection at Shiprock

Jessica Hoy, MD
Resident in Medicine at BWH

As I drove from the airport several hours along a long dark road to the Indian Health Services in Shiprock, New Mexico, I found my mind wandering to the last leap of faith I took nine years before.  I was a new college graduate. Friends were starting their consulting or investment jobs or graduate school pursuits.  I was traveling in the front seat of an Egypt Airways truck without a seat belt in the early hours of morning to the Nairobi Airport for my puddle-jumper to Kisumu, then on to a small town in Western Kenya where I was about to spend a year.  I had the great fortune of winning a grant during college for a year of purposeful travel, where I was to discover myself and find my way after years of clear direction and advancement during boarding school and college.  I found my first weeks in my small village to be painfully chaotic; for the first time in my life I lacked a sense of purpose or a set of skills to develop.  I spent my time working at a local health center.  Skill-less in the medical realm, I was an extra pair of hands in the small cinder block building that served as an outpost of medical care for the community of mud huts that sprawled through the dusty red hills under a never ending sky. 

Sunset from the Hospital
I felt a similar fear of the unknown as my rental car sped towards Shiprock along the dark flat landscape that pulsed beyond my high beams.  I was leaving the comfort and certainty of residency, of early rising and the rhythm of rounding, of familiar faces of attendings and common concerns of patients for a part of the country and a patient population to which I had no knowledge or connections.  The timing was not a mistake.  I was leaving exactly in the middle of residency, with 18 months behind and 18 months ahead, just as it was becoming acceptable for attendings to ask where I would end up next year, guessing that I, as a passionate defender of primary care, would be seeking a career rather than a fellowship.  But as that time approaches, I have been feeling unease as I picture myself in my mentors’ shoes.  Despite so many people that I love and admire at the Brigham, I haven’t been certain about where I fit and where I will fit when the thrilling adventure of residency ends and everyone moves on in their set path.  So here I am at the Indian Health Services. The circumstances are different; I arrived in Kenya with no skills and a desire to assert my independence; I arrived in Shiprock with the tangible skills and personal touch of a soon-to-be primary care doctor, jumping into a new medical record system, and appointments with patients with common concerns, and early morning pre-rounding on sleeping patients who groggily answer my time-honored questions.  I am working with doctors who have preserved the old traditions of primary care—admitting and discharging their own patients from the hospital, attending intensive care rounds every morning, sharing knowledge and community with each other in this small outpost of health care, hours from any city, perched on a plain with the most dynamic sunsets I’ve seen.

My days at Shiprock have been packed with the activity of how primary care once was.  In one day, I go from ICU rounds where I’m caring for a newly diagnosed AIDS patient with pulmonary, neurologic and gastrointestinal symptoms to an early morning Tumor Board meeting where specialists from larger cities weigh in about the course of treatment for our patients.  I then start clinic, where patient panels consist of about 400 patients each and appointment lengths are flexible.  At lunch I return to the ICU to perform a lumbar puncture on my AIDS patient and then I spend the afternoon helping in walk in clinic, caring for my hospitalized patients and admitting any new patients.  The rhythm is satisfyingly diverse and challenging, allowing for the full cycle of care for patients in a way I have not yet seen.

I chose to spend a year away after college because I was afraid that in all of the specialization of my lab work and thesis and team sports and club participation, I was missing something greater about myself and my future.  I worried that the set path of graduate school would be connecting some pre-determined dots in a pattern that I didn’t like.  So I left all of the comfort of the world that I knew for a mud hut without running water or electricity.  In contrast, I am not roughing it here in Shiprock; I have the privilege of a sleek rental car and comfortable dorm room and a cafeteria with vegetarian options, but the perspective I have gained away from my current life as a fast paced resident in a fast paced program is as immeasurably beneficial.   In taking the time away to pause, I have been able to further appreciate the wealth of resources the Brigham provides, to find the words to my uncertainty, and to reflect on my values and how will they shape my future career.

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