Freedom

I missed mass last weekend while hiking at Glacier National Park.  I was privileged to be there with a good friend that I hadn't seen in years.  She told me that, although she has established herself financially, she feels alone in her city.  Lucrative business ventures, new sports cars, costly weekend parties, and exotic vacations seemed to be the passions of her peers and that she, with a broader vision, felt alone.
   When I returned, I went to confession and talked about missing mass as the only Catholic in my hiking group.  The priest said "Christianity is not about rules but about freedom.  We express it by being free from this world's materialistic, power hungry definition of success.  We are free to pursue justice, truth, virtue and beauty."  Later that evening, I went to a party with my friends in Sioux Falls; public school music teachers (in the worst paying state in the union), a primary care physician at a free clinic, a social worker, a few musicians, and the proprietor of the state's lone recording studio.  Each month and each holiday they gather, bringing home preserved jams and salsas, hand made jewelry and cards, and hand sewn aprons as gifts.  Some are athiests, others agnostic, others religious, but, to me, they exemplify this spiritual freedom.  When I think about the great circle of friendship and support which I have found in Sioux Falls, I feel very wealthy-- I think that such relationships are more difficult to cultivate than mere financial means.
  As I begin my new adventure and as I consider which specialty in medicine I will choose and where I will practice, my goal is to remain free.  Free to follow passion and to do what I love despite the lack of power or money involved.  I hope to gain the gift of rich friendships and a meaningful community.

In the moment

I was walking along the trail, talking with a friend about theories of romance, when a good looking, long haired man began walking toward us and stopped. "Look!"  he exclaimed and pointed.  Sure enough, in the bushes were two black bears.  They were near but not very photogenic.  Later on, a grizzly posed for a better photograph.  My visit to Glacier National Park was a reminder of the beauty possible if I pay attention to my environment-- and of the danger present if I do not.

Recently, I listened to a talk by Ellen Langer on mindfulness.  A professor of psychology at Harvard, she spoke about the rarety and importance of being present in the moment-- not dwelling on either the past or the future.  She also stated that worry is pointless because we have no mental concept of what the future holds, only that we'll bring ourselves and our characters to it.  One of her solutions is to try to continuously notice new things in our everyday environments and the people around us.  We can never fully know our environments and loved ones, instead we must constantly notice their changes and their possibilities in a changing world.  This keeps us oriented to the present and fascinated by the changes happening around us.  It allows us to be satisfied with what we have instead of thinking we only need new or change to stay interested.

During my in-between time, while camping, while helping with a new baby, while taking a class, while preparing for medical school, there is nothing within my control that I can worry about.  Medical school loans, whether I'll be able to cut it. etc., are wastes of time and energy.  This is a time for me to be present.  When I focus on the present, furthermore, I feel as though my mind is open to learn new things instead of running through the old familiar circuitry of anxiety and regret.

Blindness

In Luke 18:35-43, (NIV)

A Blind Beggar Receives His Sight

³⁵ As Jesus approached Jericho, a blind man was sitting by the roadside begging. ³⁶ When he heard the crowd going by, he asked what was happening. ³⁷ They told him, “Jesus of Nazareth is passing by.”
³⁸ He called out, “Jesus, Son of David, have mercy on me!”
³⁹ Those who led the way rebuked him and told him to be quiet, but he shouted all the more, “Son of David, have mercy on me!”
⁴⁰ Jesus stopped and ordered the man to be brought to him. When he came near, Jesus asked him, ⁴¹ “What do you want me to do for you?”
“Lord, I want to see,” he replied.
⁴² Jesus said to him, “Receive your sight; your faith has healed you.” ⁴³ Immediately he received his sight and followed Jesus, praising God. When all the people saw it, they also praised God.


As I say goodbye to good friends and loving relatives, I am struck by the blessing of learning who my friends really were.  As I changed courses and started from the ground up, I thought several times about the blind man's relationship with the crowd in this passage.  Several people in my life seemed part of the noisy but meaningless crowd.  With few hopes for themselves, they cautioned me to mute my dreams.  Before them, my words and my aspirations sounded clamorous, foolish.  
  In the other camp, Jesus told the blind man that his outspoken faith had healed him.  Unrealistic dreams, to Him, were not only good but the only method of solving the problem at hand.  Several people in my life emerged that (much to my surprise) either flat out encouraged and helped me, or made the commitment to love no matter what they thought about my decisions.  It is these people that I have grown to respect enormously.  Strikingly, these are all people who have successfully reached goals and dreams themselves.
  Especially humorous was that, when the man DID receive his sight, the crowd stopped criticizing him and praised God.  The most hilarious group I have seen were those that condemned me with the crowd at first and are now extremely encouraging.  Now I know that these people are good reflections of what I seem to be from afar... not much else.

This leaves me with the question.  In my relationships with other people, which side will I be on?  Will I encourage faith and impossible dreams?  Will I join the crowd in beating people down? In other words, am I healed of blindness to hope and potential?

University of Wisconsin

By February, I thought it was all over.  After all, so few applicants are granted acceptance to medical school, and here I had mine.  I had interviewed with the University of Iowa in January but it did not seem, to me, a good fit.  I began looking for future room-mates in Vermillion, South Dakota.  Then an email came from the University of Wisconsin's School of Medicine and Public Health.  I remembered putting almost no time into that school's secondary application because they accepted only 2.5% of out of state applicants--I thought I wouldn't stand a chance.  I had applied, however, because friends of friends had talked about the school being really neat and because it had a unique emphasis on both medicine and public health.  I also had to apply to a few schools in the "top ten" bracket because my surrogate mom insisted, and this was #9 nationally.

When I looked on the accompanying website to find lodging in Madison for my interview weekend, there was a list of hostels, one in a Benedictine monastery (which, sadly, was full) and a hostel international (HI) house.  I booked a bunk in the 6 women dorm at HI.  My car then went to the shop for a "routine" checkup, ended up in major surgery, and I drove a rented car over to Madison.

The first cold night (-40C windchill, warmer than South Dakota's -60C) the medical students invited all interviewees to an informal talk, strictly off the record, to ask about anything we wanted to know.  I noticed that, even though we were all seated around a big table, it was easy to discern who the medical students were and who the applicants were.  Medical students were snacking on the food provided.  Introductions involved each of us saying something unique about ourselves.  At the U. of Iowa, fellow applicants talked about the speed at which they could read, or the extremely expensive sports they played.  I only felt comfortable enough to talk about vegetarian cooking.

At the U. Wisconsin, however, one curly read headed medical student said he had spent a summer in Uganda, and the applicant to my right had grown up in Iraq.  I easily stated that I had done the Peace Corps in Uganda, had grown up in Jordan, and that the three of us should get together to speak different languages, but that I was working on English.  The medical student replied "I think your English is great," to which I was a little confused.

I returned to the hostel that night to find, not five snoring women, but only one dorm mate (I guess -40C is not tourist season).  She was a retired lawyer turned art writer.  We discussed her advocacy work for mentally ill persons in the justice system late into the evening.  The next morning, she reminded me to wake up after I dozed following my alarm.

Interview check began at 7:30 and although I was staying less than five miles away, I left at 6:45.  There were so many people and bikes on the street both morning and evening that a car had a hard time of it.  If it had not been a formal suit interview at -40C, I would have joined the full masked, snow suited mob.  Imagine a city where pedestrians not only outnumber but intimidate vehicle operators? Paradise, perhaps.

When I finally rounded the bottom of the medical school stairs, I saw a big sign "Welcome UWSMPH interviewees" it stated.  "I wonder who those important sounding people are?" I thought, confused by all of the letters.  It took me a while to realize that this was the University of Wisconsin School of Medicine and Public Health, and that sign was for ME.  I glanced up the stairs to see a crowd in suits descending.  Defrocked of heavy winter coats and wearing neat name tags, they looked like an army.  "I am late, I must have misread the schedule (which put check in from 7:30 - 8:00am), I should just drive home!" was my first thought.  I then thought about all the money I spent on the car rental and that it should not be wasted.  I ascended (7:45), prepared to be simply turned away.

When I reached the office, I found that I was within the appropriate time window, and checked in.

I had worn my interview suit, which was purchased with my grandmother as fashion advisor par excellence, two years earlier in Aberdeen, South Dakota, for this very moment.  It was the suit I had worn to my previous interviews, but at the U of Wisconsin, for the first time, I was not the best dressed applicant present.  I merely fit into a very good looking crowd.

Over forty of us, of different ages, backgrounds, and nationalities listened to multiple presentations from deans and professors.  I found that, following each presentation, I had a relevant question or two, and most presenters answered 3-5 questions.  My first question, of course, was "How much of professor promotion and tenure is determined by teaching and mentoring reviews and how much is determined by research publication?"  At the University of Iowa, I was informed that research presented the sole criteria for professorial promotion, but that all the professors were "such good people" that they mentored and taught with excellence as well. hmmmmm.  At Wisconsin, I was told that without good teaching evaluations, professors have lost their positions and been unable to gain promotions.  Other questions were more specifically relevant to the presenters, such as one UW hospitalist who spoke of using her research to inform advocacy for ACA (Affordable Care Act) legislation.  I asked which channels she used to pursue legislative advocacy, and she replied she had a contact in congress.  Another interviewee asked this same presenter to explain, again, what a hospitalist was... I felt bad for him.

As time drew near for our interviews, three of us were ushered toward offices on a different floor.  As I, the last, stepped off the elevator, a man using the wheelchair tried to load but the door began to close on him.  I hung a few paces behind my group trying to hold the door open but it continued to shut.  "This is dangerous!" I exclaimed, and I pushed the "open" button and made sure the man was secure before exiting the elevator.  I found it remarkable that the other two interviewees (one of them a paramedic) had not responded, but chalked it up to my profound ability to walk behind the others in my group.  I guess I had been trained well by my last name : )

I was led to the Global Health Institute office.  Inside, colorful paintings and masks, from different parts of the world, all of which I could identify, donned the walls.  My interviewer discussed the work of the GHI-- developing a national emergency medicine system with the government of Ethiopia and building and training professors for medical schools across sub- Saharan Africa, including Uganda.  We talked about Makerere University and Mbabrara Univerisity's medical school as partners in improving Uganda's medical infrastructure.  He only asked me one question "What will you do in medicine?"  I replied that I did not know which specialty I would choose but that I would bring myself into whichever it was.  I wanted to offer immediate medical problem solving, and to use my experiences in the clinical setting to inform advocacy work relevant to my community.  I told him that women's health was a good candidate but that, given the public policy implications in the US, psychiatry may be promising.  I mentioned the National Health Service Corps, and he replied "You don't want to do that.  Wouldn't you rather be building medical schools in Uganda?"  "That was my retirement plan," I replied.  "That's the problem" he said "we need young people who make this their career."  Ok, yes, I was in a state of bliss.  Yes, it may have been too good to be true, but if not....

Lunch with my fellow interviewees found myself and an environmental science major as the only non-engineers at table.  One biomedical engineer designed prosthetic devices for a living and we began to talk about 3-D printing.  He used it every day, I only knew what I'd heard on NPR.  Another fellow had been a childhood Olympian and had attended MIT.  I didn't even know what to talk with him about.  I munched on my hummus pita (vegetarian option) with a quiet resolve. "Wow, this would have been an amazing place to go if I had made different choices and become an engineer or something" but as it was, I did not see how I could surpass these fellows' resumes.  

After this, I was interviewed in a group of three interviewees by two students.  My interviewers were much like the other medical students I had met at UW that weekend, long droopy green and brown colored sweaters.  Girls with long hair and scarves. Men with slight beards at times. Warm, relaxed, welcoming. Smart but not intimidating, not snobby.  These were the cool kids.  I kind of wanted to just stay and hang out.  I found it interesting that the students had the ability to veto candidates they didn't feel would fit the character of the school.  High bar for me, to be sure. 

The three of us interviewees were first asked to name our college majors.  It sounded like this "Engineering, social work, environmental science."  Wow, did I feel out of place!  We were asked questions such as "If there was no illness or disease, what career would you choose?"  I answered that there would still be disparities and struggles over limited resources, so that I would want to be an advocate for disenfranchised groups-- go social work!  We were then able to ask questions, and I was glad I was in the middle.  My partner on the left asked a question, then I asked two, then my partner on the right, then I two.. then left, then me two... finally the guys on the end were done and I had the questions to myself.  This may have been slightly uncool, but this was my chance!  Here were two medical students to myself with 15 minutes to really dig down to what their lives were like, how they hoped to incorporate community advocacy into their practices, why they wanted to practice medicine, how they studied, etc.  I could not let the chance pass at any cost.  At that point, I felt as though I may not be accepted, but that I could glean valuable information from these students to inform my own medical studies in South Dakota.

That night, I called my grandmother in South Dakota and told her how wonderful the interview and school had been.  I did not ask for it, but she gave me permission--- "Sarah, if you are supposed to go to the University of Wisconsin, don't worry about me and your grandpa, we'll be ok"  I needed that liberating love.  Later, when my hostel roomate came home, she showed me her swollen knee and asked if I could do anything for her.  I looked at my hands and wished they had the knowledge to do something practical, but they did not.  "Maybe you'll lean how in Wisconsin!", was her cheery reply.

I drove home, listening to Barbara Kingslover's "Animal, vegetable, miracle" and planned for how to eat a more environmentally balanced diet next frozen South Dakota winter in Vermillion.

On March 7, I recieved a call from the head of admissions at the University of Wisconsin-- I was offered a position.  I paused.  The woman asked "Hello?"  I replied "Doesn't everyone pause when they get this kind of news?"  "Do you call everyone who is accepted?" I asked." Yes." "Do you have to call the ones who aren't accepted?" "No, I don't have to call them."  "Wow, I don't know if I want to go to medical school, your job sounds like a lot of fun."  We laughed.  Later that day, an email came to me from the University of Iowa.  It directed me to log onto their admissions portal, a decision had been made.  After I entered my identifying number, a prerecorded message and computerized confetti popped up.  I had been accepted. I didn't even watch the message, I declined the offer out of hand.

I -- the little girl in the trailer park who wished I could become as successful and stable as our mail carrier.  I-- the one with the hand me down sweatshirts with names of places I have never been.  I-- who, while visiting the doctor with medicaid as my insurance, said I wanted to become a physician.  I have been accepted into three good (2 of them top) medical schools.  Can I say it? Hallelujah!

My friends and support network in Sioux Falls have lovingly released me and although I really hate to move, I think UW is the best fit for me.  On Wisconsin!

Morning

Cool, dark night
So beautiful your smothering shroud
You gave me a stone fortress
in which to lie down.

But while swaddled , I dreamt
of color

and In my night sweats,
I imagined heat

Now, long awaited Dawn
in chariots of fire
melts away dank, diaphanous slumber

No more cover, pretenses, or dream
Instead the light of truth,
victory, defeat

I am almost done with my job and actively packing up my apartment while becoming very aware that I enter a new phase of life.  While here in Sioux Falls, at my job, etc. I had a sense of security and safety.  I knew that "if everything fell apart" I would still have my job and my little apartment and survive.  There are several college graduates who do the same work as I and choose not to advance up the company ladder or into other institutions where they could practice at the tops of their licensure.

That is just not me.  I have seen so much pain and I have actively sought to find my place and my calling for so long that I cannot simply concede.  To do so would be, to me, a sort of blissful, mundane death.  This job was what I needed to learn about direct patient care, to have a sense of calling and mission while I prepare for medical school, and to financially survive.  This season is now ending.

So I move forward into my next venture.  At this transition, however, I am very aware that I move from a comforting, safe (but deadly) night, into the blazing, challenging, honest light of day.  No more security blanket, it would have become too soon a shroud.

When able to DO in full light, instead of only DREAM, my upcoming challenges will be full- hearted and robust.  My battles will not be dreams but true, as will be my victories and defeats.

Rethinking waste

After an unexpectedly extended Memorial Day visit to my grandparents' house, I returned to a suspicious looking pot of vegetarian chili in my fridge.  Crafted with much love and care, it tasted (except for some burnt bits) just right.... last week.  I do not usually allow such food waste and felt great remorse as I poured the chili into my compost corner.  Soft, rich, black soil from two summers of composting and turning generously folded over the decaying slop.... not a total waste, I hope.

I just finished taking vows of perpetual poverty and obedience (and very likely chastity) as I signed my medical school loans.  (Who would want a partner with that much debt??)  One fleeting panicked thought was, "I should not have wasted so much time before medical school.  I should have started making money and paying off medical school debts by now."  Following this logic, every year making less than a certain defined income goal is simply wasted time and one does not begin "really living" until one is reeling in cold hard cash.
 
BUT  another way of looking at it, after calculating a modest expected lifetime income, my impending debts, and what I will need in my old age, is that I will earn an excess of what I truly need.  What will that represent?  Purchasing of stuff that, like my nearly perfect chili, will wind up in the trash? Producing profligate progeny through excessive spending?  Are not these the ultimate forms of material waste?  Perhaps it could be used for thoughtful, sustainable charitable work?  That would require a richer character than pocketbook.

I propose, therefore, a redefinition of time wastage.  Wasted time is that which is not spent growing into a more deeply connected, compassionate, and ethical being and helping others to do so.  Anything else, especially material expenditure, easily becomes waste... most likely non- biodegradable to boot. 

Accepted and Embraced

On November 14, I had two interviews at the University of South Dakota's medical school.  I was informed that both interviewers had read my 15 page AAMC (American Association of Medical Colleges) application, which includes everything I've done since high school, my family history, and essays on a few experiences and ideas.  I was also told that the interview day was supposed to be fun; which I took to be an attempt at calming nervous applicants.
  Most medical schools accept 5% of applicants while 95% of matriculates make it through the process of medical school and residency to become physicians.  The application process is the bottleneck.  After submitting my AAMC application and my secondary set of essays for each specific school, I had a third hurdle; the interview.  I had stopped my former career path, taken undergraduate courses, been ridiculed for my age, striven to make ends meet on a ground level job, and now it boiled down to this set of interviews.
  I practiced answering interview questions and perfected my outfit; a grey suit and periwinkle top that I had purchased two years earlier in anticipation of this moment.  I arrived at Dr. F.'s family practice office at 8AM (after working until midnight the night before) on Thursday, November 14.  He was engaging and gave a welcoming smile along with a "Sanford Clinic" water bottle.  I asked, "Is this water supposed to be better than Avera (the competing health system) water?"  "We put a little Prozac in ours," with a smile was the reply.  The interview was on.  Over the next hour, Dr. F. asked questions about living in Uganda and Lesotho and the marvel of returning to the US.  I told him about boiling my drinking water over the stove my first day back and the marvel of plumbing.  He had conducted a missions clinic boat across the Amazon, and we talked about how our experiences changed our priorities.  I happened to know of the football coach at his undergraduate institution, and he spoke fondly of the winning coach's non- aggressive tactics.  I asked him about incorporation of obstetrics into family practice, and he related the joy of delivering babies while being involved in the family's ongoing care.  He asked how my parents' difficulties affected me and I told him about the other caring adults that had become my surrogate parents, about my grandparents and my adopted mother.  When he stated that I am now a mentor, I shared stories of the sisters in Uganda and how they had raised so many children.  By chance, his aunt was a nun and we enjoyed some reminiscence about our religious sisters.  At one point, when I stated "In my young adulthood, I...." he looked at me quizzically--- "You are still in your young adulthood!" he interjected.  "Sorry, I feel so much older than other applicants..." and he confessed that he had not begun medical school until he was 30 years old and that he felt that medical students with life experiences brought distinct advantages to the profession. I did not want the interview to end.. but it did and I drove to the medical school for the next.
  The second was with Dr. S. Ph.D.  Evidently wearing clothes she had made (because of an exceptional fit and unique fabric, Dr. S. had been teaching at the medical school and sewing for the community theater for decades.  She said that my grades and MCAT scores were great so we could talk about more interesting things. (Who hears such affirmation during a medical school interview??)  She, by chance, taught epidemiology and we enthusiastically exchanged thoughts about the comorbidity of Tuberculosis and AIDS in Lesotho.  She asked about my path, the reasoning for my choices, and I tried to explain my consistent desire to work with underrepresented communities along with my previous thought that I needed to support my family.  I explained my need to find out where I belonged in the huge world I had grown up in.  She said the word she heard most from me was "community."  We talked about the new curriculum, 18 months of basic sciences, 9 months of clinical rotations and 18 months of building my own experiences to fit the residency I chose.  This was hard to understand... "You and your advisor build your work plan during that time."  She emphasized that, at that point, a student could pursue additional information and training in whichever field interested her and that most hospitals and clinics in the state were happy to accommodate her.  She talked about doing research with Hutterite colonies (and the potent Hutterite wine) or building clinical rotations in desired fields, or framing international rotations.  Most people do a combination of these.... WOW! That sounds like me!
  I left with a jaw in pain from smiling so much. 

  Two weeks later, I had my confirmation in the mail--- I had been ACCEPTED to the University of South Dakota Medical School.  Moreover, I felt that my sense of community here, my understanding of the school and curriculum, my opportunities to work with rural and underrepresented populations fit like a glove.  I was not only accepted, I was embraced, and I enthusiastically returned the hug.