Physicians, never forget your WHY…

 

Dear Blog,

Last Friday, as I sat finishing up notes on the last of my almost 30 physicals (this number is never any surprise for us Pediatricians this time of the year, it’s back to school week, so every Thomason, Dickinson and Harrison is lining up for sports physicals and regular physicals and all sorts of clearance and medication forms that need to be filled out and turned in “yesterday”) I took a deep breath and exhaled, my mind filled with the events of the day. As is customary, my beloved patients often postpone their physicals all summer, in search of sandy beaches and clear blue vacation skies, so it’s usually a mad rush the first week of school.

I found myself reflecting on the patients I had seen that day as I often do at the end of my day. Most of them were mundane well baby and well child checkups, nothing really of note, a few of them had minor issues to clear up before returning to play…but one of them stood out clearly like a lily in a field of carnations…a 16year old we shall call “Maya”. I have met Maya only a couple of times in the past and I have known her to be a troubled teen, plagued with depression and anguish, never really smiling, not much eye contact, not much of an affect…just sad. I have tried to manage her depression the best I can with counseling in the office, a referral for proper psychotherapy. My good friend, and child psychiatrist sees her regularly and has placed her on an appropriate dose of antidepressants, and she reportedly goes to counseling regularly, all with little or no change in her mood(s)

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She came in that day in the company of her mother and her older 17yr old sister. I sensed something wrong right away, but I continued my usual intros and salutations and other little talk. Her mom could not stop fidgeting, with the characteristic continuous knee shaking. Her sister’s face was buried in her mobile device for pretty much the duration of the visit, except when I inquired about her. It turned out her sister was also to be seen that day. Both mother and child proceeded to explain to me that her sister needed to be seen for “stomach problems” that only happen at her high school, stemming from her “unique eating habits”, and her lunch time not being fixed at a particular time of the school day. This apparently never happens at home or during the holidays or vacation, when she reportedly “has her own eating schedule”. She wanted a note from me to the school nurse authorizing her to eat her lunch at the exact time she wanted, or she would develop abdominal cramps, nausea and headaches and “get so sick” she would end up being sent home from school. This story line and request stuck me as bizarre, I recognized a familiar thread of possible anxiety in her sister, and maybe some co-dependency in her mom, but I digress…

Maya on the other hand, wore a thick black sweat shirt and jogging pants…mind you, it is 105F outdoors in San Antonio Texas in July! As I indicated in my first two Kevinmd articles https://www.kevinmd.com/blog/2018/07/a-pediatricians-healing-spirit-treating-depressed-anxious-and-suicidal-teens.html, and https://www.kevinmd.com/blog/2018/08/why-this-physician-quit-her-job.html

I somehow am a magnet for depressed and suicidal teens, and Maya, was no different. She made absolutely no attempt to engage with me, no eye contact, shoulders drooped over, melancholic and flat affected. She appeared pale, ashen and sullen, with dark circles around her eyes, she simply looked like she could use a looooong-warm-heart-filled-hug. During the physical exam, she hesitated to take off her sweat shirt, but I insisted, eventually, her mother ordered her to do so. She did so veeerrry-reluctantly, and immediately pronated both forearms…I gently supinated them, and to my horror, revealed numerous, clearly visible, freshly carved cuts all over her forearms, extending from her wrists all the way to her elbows, on her left and right forearms respectively. I said nothing, gently turned them back to her preferred position, completed her examination, and walked back to my seat. I then calmly asked her mom about Maya’s depression and how her cutting behavior was fairing. She hurriedly replied “oh, a lot better, she is receiving counseling, and has not cut in 2years. 2yrears?? I thought to myself, more like 2days!!… Her response immediately made me stop typing on my laptop EMR,  I looked up at her, made sure my words came out clearly and as gently as my rapidly beating heart could muster, as I said, “No ma’am, I am afraid but I have to tell you that Maya has fresh cuts on her forearms and wrists, that are probably not more than 2 days old…”Self-inflicted lacerations on arm of man : Stock Photo

The rest of the visit was a bit awkward. Her mom asked to see the cuts, Maya vehemently refused, and an uneasy silence set in after I explained to mom that, she would probably do better waiting until they got home to approach her alone in her bedroom. Meanwhile, we should probably revisit her counseling sessions, and explore the possibility of an in-house facility if possible, especially since her self-completed PHQ-9 score that day was a total of zero.

I write this story today to remind myself of my why. To urge each one of us doctors to remember our why(s) Never lose sight of the reason you went into medicine, no matter what. We are a special breed, a unique set of like-minded individuals who choose service to humanity above all. We choose to make a difference in our patients’ lives regardless of all the administrative, legislative, personal and sometimes insurmountable difficulties we face daily in the field. I was reminded that day of my reason for leaving my beloved 9-5 job to follow a passion of fighting to end teen depression and teen suicide. I was reminded to follow my heart and believe in my dream. I was reminded to stay the course, because, for every Maya in my office, there are a hundred or even a thousand more out there, so, I must go forth. “The harvest is plenty, the laborers, few…”, Luke 10:2

rear view of a boy sitting on grassland

#endteendepression

#endteensuicide

#askdocotorlulu

BB

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!

My name is Dr. Uchenna Umeh and I am an immigrant (Physician)

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Dear Blog,

As far back as I can remember I’ve always wanted to be an architect. My journey to becoming a physician started somewhat as a dare. I was born in Nigeria, the first child of six children from middle class parents. My father served in the Nigerian Air Force, my mother, a Banker.

Towards the end of my secondary education (I attended an all-girls boarding secondary school, F.G.G.C Bakori, making me a Bakorian for life!) my father asked me the natural question, “So what are you going to study in the university?” I eagerly answered “Architecture!” He went on to say the words which hit me like bricks. “Nne, you are a woman, architecture? why don’t you study pharmacy like your (female) cousin? I was bewildered but not for too long, you see, in the Nigeria of my father’s and my childhood, certain professions were still “meant” for certain sexes. I gently and calmly explained to him that I would rather study medicine if I must do something in the “medical field”. Then he added, “But medicine is for men, why don’t you do something more feminine?” At this point, I promised him I would work really hard to prove to him that I could and would become a doctor, regardless of my sex. After completing medical school (I was one of a few females in my majority male graduating class) I decided I would like to go to the US for my residency, and I wanted none other than Howard University in Washington D.C. This decision was again met with “But you are a single female”, “America is so huge, and we really don’t know anyone there”, “How are you going to manage on your own?” “I hear that everyone uses drugs out there”, “You are not married yet”, “What about children?”, “Will you meet a nice Naija guy to marry?”, “Don’t forget your Igbo o”, on and on and on …

Foreign medical graduates take the ECFMG/USMLE exams to get into residency in the US. These exams are tough, they are expensive, and those of us from Nigeria, had to travel to Ghana to take them, because it was the only country with test centers in West Africa at that time. After scaling each exam with one try, I applied for residency. After my experience with the entire process, I became a believer in the power of speaking one’s destiny into existence. I applied (from my home in Nigeria) to a total of seventy-five different residency programs. Eight of them responded, six turned me down, and only two invited me for interviews. In the process of raising money for my trip, obtaining a visa from the US Embassy, and finally “coming to America”, I made it just in time for my interview at Miami Children’s Hospital, but I arrived at Washington D.C, one day late for my interview at Howard University Hospital.

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Now I need to explain to you that while I was in Nigeria, I somehow managed to keep and maintain a line of communication with the secretary of the department of pediatrics at Howard University Hospital. I called her frequently, closely following the progress of my application, and folks, that singular act, ended up saving the day. She amazingly recognized my voice, the lady that had been bugging her all the way from Nigeria! Thankfully, she was able to secure another spot for an interview for me, only by the good grace of God. I must mention here, what my odds were: I was a day late for my interview, there were over 4000 applicants, there were fourteen positions, and I got matched! How’s that for fulfilling my destiny?

As a “newbee” in America, I had many memorable firsts. My first greyhound bus ride from New York to the Nation’s Capital, the first Bratwurst hot dog I ate on the streets of New York, the sounds and smells of the subway stations of Washington D.C and New York, the sheer number of homeless people on the streets, the huge number of teen-aged mothers pushing baby strollers on every corner of the streets of Queens, my first encounter with a flasher on a Brooklyn-bound New York subway train, etc… but the cherry on top was undoubtedly the golden opportunity to train at Howard University, and to have matched at my very first try!

Residency itself, was not particularly difficult. The hospital had enough Nigerian residents and faculty for my comfort. However, as a recent immigrant, I had to adjust my ears to understand the American English, its many accent(s), and its unique vocabulary. I remember especially having a hard time with phrases like “glove compartment” not pigeon hole, “flash light” not torch light, and “diaper rash” not nappy rash. Never mind the new spellings of words like color not colour, tire not tyre, pediatrics, not paediatrics or estrogen, not oestrogen. I also had to re-learn old medications with new names like “Tylenol”, instead of Paracetamol/Panadol, “Amoxicillin” not Ampiclox, and the fact that there are absolutely no antimalarials, or typhoid medications being prescribed anywhere! I was puzzled by the fact that most people I met were impressed by my English language and vocabulary. “Where did you learn how to speak English?” they’d ask, “You ain’t gat no kids at twenty-seven years old?” and one of my favorites was “How did you get to America, did you fly? to which I would usually respond “No, I sailed on La Amistad to the shores of Georgia, and swam the rest of the way”(seriously??, rolling eyes emoji), and there was the occasional “So you are Nigerian, do you happen to know Hakeem Olajuwon?”, to which I would gladly say “No, but maybe you know Michael Jordan?”… I tell ya…! SMH

I eventually completed residency, got married, moved to South Carolina and started a private practice. With a J-1 VISA, I had to start up in a Health Professional Shortage Area (HPSA) in Lancaster county, South Carolina. I adjusted well. I had one son at the time, and my practice was doing okay, until one fateful day, a disgruntled mom reminded me that I was far away from home with the words, “Go back to your country and stop taking our jobs!” I’m like…what? These words came from an unemployed citizen who felt I had to give her child antibiotics for a cold or else…(…more eye rolling) Funny enough, these days, I sometimes ponder on her words, how she could have ever imagined I was taking her job? or how I could have been of any sort of threat to her source of livelihood? Other than that, and a few other interesting comments like “Ma’am, I love your accent”, or “Doc, I don’t want to mess up your name, so I will just spell it out”, or, “You have an accent, is it Jamaican?” life in these united states has for the most part, been good.

It has been nearly twenty-five years since I first came into this country, nervous, afraid, but bright-eyed and determined to get into residency, at none other than the Howard University Hospital.

H.U!

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“Obstacles do not block the path, they are the path”       -anonymous

 “I didn’t come this far, to only come this far”       -anonymous

“Believe in yourself and all that you are, and know that there is something inside you that is greater than any obstacle…”          – Christian D Larson

 

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!