First-Year Journal—Part II “A Scent of Maine”

Beginning a Life in Medicine

In the Fall issue, medical student Sarah Cook shared her thoughts and feelings as she took the first steps toward becoming a physician. Rejoin Sarah as her first year of medical school winds down and she travels to Maine for a summer externship in rural medicine.

BY SARAH COOK

“I realize that a family practice physician really does need to be prepared for anything. More importantly, I know that someday I will be a rural family practice doc.”

Sarah Cook

MARCH 12, 2000—Back in St. Louis after an amazing trip home to Hingham. Dave arrived in Hingham on Thursday afternoon, less than an hour after Casey, Nancy and I had walked through the front door. Within minutes, we were hanging out like old friends. It was an unseasonably warm day, so I took them out to World’s End, a local conservation area, to walk through the woods and out to a point where the Boston skyline is visible across the harbor. As the sun set, a March chill came over us and we hurried home for dinner. My stepdad Charlie had made salmon, asparagus and rice—yum! Mom had a big chocolate birthday cake for Dave with a little rowboat and a fishing rod on top. The weekend flew by and it was time to head back to St. Louis. As I said goodbye to Dave and we left for the airport, I was filled with incredible memories of the weekend and dreams of the summer to come in Maine. And now, I’m back in St.Louis. I feel good about the upcoming exams. I have been on top of the material all semester and now have a few days’ rest under my belt. The heavy-duty studying begins today.

March 21

I am being buried alive under mountains of books and notes! A card came from Dave in the mail last night. Perfect timing—he sent a sprig of balsam fir. The fresh scent of Maine and his words of encouragement were desperately needed. This week may easily be one of the roughest that I’ve ever had. I don’t feel like I have even had a chance to stand back up between the steady stream of punches. My whole body is fighting back—my head is pounding, my stomach is a bundle of nerves that just wants to hurl, every muscle in my body is sore, and to top it all off, I have such a sore throat that I can barely swallow—a true indication that I will be good and sick just in time for spring break! Enough complaining. Only two more exams and 72 hours to go. I think that I will just collapse at the end!

April 4

I have been placed at the Aroostook Valley Health Center in Ashland, Maine for the summer. Dave responded to my e-mail of the news with a YIPPPPPPPPPPPPEEEEEEEEE! YAHOOOOOOOOOOOOOOO! The health center is only about a third of a mile from Dave’s house! It is incredible that out of about 30 possible sites, I was placed in Ashland. We must have a guardian angel working some magic.

April 11

I have been working on the immunization drive for next fall. I spoke with all kinds of people in the St. Louis Public School system and in the Missouri Medicaid office. To be eligible for our vaccination program, kids have to be without health insurance or on Medicaid. Unfortunately, about 70 percent of the 45,000 kids in the St. Louis public schools are in this boat. The good news is that my friend and classmate Rachel and I are planning to expand the immunization drive beyond anything that Washington University could ever imagine! We are going to set up a center at a local neighborhood gym or club–the kind of place that has after-school athletic programs to keep the kids off the streets. I have spoken with the human relations people at the schools, and we are going to send flyers home with the kids informing parents about vaccination requirements and our immunization drive. The school health department was really excited to have some help. Apparently tons of kids couldn’t start school last year because they hadn’t been immunized. Not gonna happen this year!!!

April 14

I saw a copy of this year’s Study of Medicine for the first time today. It was strange to open the front cover and see my story and picture in the “Student Spotlight.” I am truly grateful to be at a school that in the midst of cutting-edge research and undoubtedly a few future Nobel laureates, recognizes and supports students with “simpler” goals like mine.

April 22

I met my new little brother through the Pediatric Outreach Program! His name is Daniel, and he is four. Daniel was even more excited about having a big sister than I had ever dreamed—he ran out the front door of his Grandma’s house and jumped into my car as soon as I pulled up. I hadn’t even met him before, but he knew that I was his big sister! I asked Daniel what he would like to do. He replied “go places.” So, we did. We spent the afternoon at the St. Louis Zoo. I feel privileged to be a part of Daniel’s life and very fortunate to have been matched with a child who is so appreciative. As I gave Daniel a piggyback to the car, we talked about all of the fun things that we want to do this spring. We have so many places to go!

April 26

I received an e-mail from a friend back at Massachusetts General Hospital that my paper was published in this month’s issue of Gynecologic Oncology. I am sooooo excited–my first paper as first author! So, I went to the library, picked up a copy of Gyn Onc and started leafing through it. What a feeling when I hit the pages with COOK ET AL. in bold letters across the top! Thank you so much for the incredible opportunities Dr. Seiden! All of the hard work was well worth it.

May 7

Dave came to St. Louis! We had a fabulous weekend—we ran in Forest Park, went to the Soulard Farmer’s Market, took Daniel and his sister, Ebony, to Turtle Park and Grant’s Farm, and had a cookout with friends on Saturday night. We also spent a lot of time just hanging out and talking. I confess that I was confused as I dropped Dave off at the airport tonight. How do I know if this is right? If it is right, how are we going to survive the next few years apart? Maybe I am just over-tired and thinking too much. I should just let it go—if it is meant to be, it will be.

May 12

We are heavy into the neuroscience course now! I am finding the class fascinating and have learned about all kinds of things that I have always wondered about. For instance, I’ve discovered why it is that when you shine a light in one eye, both pupils constrict. I’ve also learned a lot about the mechanisms of pain sensation and potential targets of treatment for pain. I am fascinated by the formation of memory, and how sleep–something medical students don’t get enough of—is critical to that process. I wonder how I am going to keep it all straight and retain everything to apply to our neurology course next year.

May 25

I made it!!!!! Today was the last day of finals. I can’t believe that the year is over and that I survived. Both the neuroscience and clinical epidemiology exams went well. I know that I learned an astonishing amount this year, but sometimes I feel as if I haven’t learned enough. I guess that I better get used to that feeling!

June 27

My first day of work at the Aroostook Valley Health Center. I arrived at 6:45 a.m. and met John, the physician’s assistant, who greeted me with a warm and friendly welcome. He gave me a tour and showed me the office space that I would share with him for the next six weeks. A mounted black bear, the tail of a white tail deer, and many fishing pictures hung from the walls. Dr. Goselin’s dog, Moses, sat in the corner of the office. This was definitely my kind of place!

The first day was incredible … a well baby check; a physical on a 50-year-old female with a history of breast cancer; a young teenage girl requesting birth control; a teenage boy with severe acne; a 73-year-old alcoholic in renal failure; a 35-year-old man who had just suffered a serious accident with a band saw; a 55-year-old man recently cured of lymphoma. The list goes on and on. We even made house calls. The first to an 82-year-old man suffering from congestive heart failure. He lives back in the woods in an old trailer with no running water and no power. His medication needed to be adjusted and without a phone, it was necessary to make the trip out of town. Later we visited the home of an elderly woman whose husband is dying a slow death from emphysema. We made the house call to assess the situation and to identify resources to assist her in the care of her husband. By the end of the day, I had been challenged by an overwhelming diversity of diseases and medical emergencies. In less than 12 hours, I learned more than I ever thought possible. I realized that a family practice physician really does need to be prepared for anything. More importantly, I know that someday I will be a rural family practice doc.

July 16

My birthday weekend! Dave and I traveled home to Woodland to spend the weekend with his family. As we pulled into the drive on Friday night, his nieces, sister, Mom, Dad, cousins, aunts, uncles and Grandma all poured out of the back door. Dave had not warned me that everyone would be there! I had been expecting to spend a quiet evening with his parents and was blown away by the warm welcome and huge birthday cake. We spent Saturday at camp on West Grand Lake. The day was extraordinary– warm sunshine, a cool breeze, countless coves to fish, big juicy steaks cooked over an open fire … That evening we went to a birthday party for a family friend in Grand Lake Stream. The whole town turned out! On Sunday, we went to church with Dave’s Dad and sister before heading home to Ashland. I really felt like I was with family.

August 2

I am leaving Ashland today. As I pack my things, my mind is flooded with thoughts and memories of the summer. I fell in love this summer … with the wild beauty of Aroostook County, with the people of Northern Maine, and with the challenge of a rural family practice. Maine has truly carved its beauty deep within my mind and soul.

August 18

I have been working furiously to get ready for the immunization drive. We will be holding the drive at the Mathews-Dickey Boys Club this year. There are so many details to be dealt with! The vaccine has arrived. I checked the order and stored the supply in the refrigerator at the Family Care Health Center. I made final changes to the training manual that I put together this summer. It is practically a book, but should help the first-year volunteers. I ordered additional supplies–syringes, saline, alcohol wipes, gloves … for the student training session and the drive. I hope that the shipment arrives in time! I still need to track down the folks in Respiratory Therapy for an oxygen tank, ambu bag and mask. Dr. St. Geme has recruited about 10 physicians to assist with the drive and has been an incredible help with everything! My mind is a scattered mess of “to-do lists.” I really hope that the drive is a success!

August 20

Tonight marks the official end of my first year of medical school. As I reflect on the past year, I realize how significantly my life has changed. I have gained an incredible body of knowledge and experience, I have made amazing new friends, I have built memories that will last forever, and I have met the man with whom I will spend the rest of my life. Tomorrow morning I will begin the next segment of the journey. I am both excited and terrified. This is the year in which I will begin to build a foundation of REAL LIFE clinical knowledge! It is also the year for which medical school gains its notorious reputation. I have been told that the second year is analogous to drinking from a fire hose. Well, I’m ready to drink from that fire hose! Bring it on!

Editor’s Note: Sarah and Dave were engaged in October. They are to be married next September in Grand Lake Stream, Maine.