Despite it all…

Despite your birth defect/congenital anomaly..

-we were impressed.

-first you were born

-then you learned how roll over and crawl (although you only combat crawled…tisk, tisk)

-then wonders of wonders you learned to walk.

-then you grew up

wow.

Despite your chronic illness

-we were impressed

-you got up this morning

-you brushed your hair and put on clean clothles

-you got to work on time and were engaged in activity

Despite your use of a wheelchair

-you can drive a car

-You can carry your own stuff

-you can play sports

-you go out and do fun things

Despite your disability or as the ED puts it “health setback”

-you showed up

-you did all the requirements

-you were professional

-you did everything your peers did

-including doing better than average on the exam

Acceptance is very simple it will happen when society realizes that its not despite it I did this or because of it I did this…

Acceptance is… I do. I did.  I will do because I am a human being first and foremost.

diversity essay

….despite my recent cynicism I managed to put it aside so that I finally live the dream and become a poster child for WF.    This is going on the medical school’s diversity materials and recruitment materials.

“This is an example of a potentially poor outcome.” the nurse told me matter-of-factly. I look down and see tiny hands grasping mine and bright eyes exploring my face.  My medical training registers the curl of his fingers, the shape of his eyes and the dimple over his lip that defines his diagnosis. But I don’t see a poor outcome. I see a child. I also see myself.  25 years ago I was the baby in the nursery who was thought to be a poor outcome.  I have a disability that stems from a genetic bone disease that I was born with.  I am a patient and a student doctor. My disability was my first attending and it is my constant board exam. It has taught me compassion, humility and grace throughout my life and even more so in medical school.

Just like my classmates:  I take call, I write notes, I learn how to do procedures, I deliver babies and I rotate through all the required specialties.  I do this by using a manual wheelchair to round, an amplified stethoscope to auscultate and a stool to suture or assist in the OR.  Unlike most of my colleagues I can sit down next to my anxious or weeping patient and relate to what its like: to undergo anesthesia , or receive bad news from their doctor or go through rehab after a trauma or a major surgical procedure or even be denied health insurance.

I have never had a patient who didn’t want me to be a part of their care because of my disability but I have had many thank me for sharing my own struggles and stories. I have occasionally encountered an attending or a colleague who was skeptical. But in the end in nearly every situation by the end of the rotation I found that we have learned from each other’s perspectives and become better physicians.

As a patient, as a disabled individual I am a member of one of the largest, most underserved minority groups.   The disabled community makes up 11% of the US population but less than 1% of medical school graduates. I am grateful to Wake Forest for catching the vision and realizing that physicians with disabilities have something not just to learn but also to teach.   I believe my patients are grateful too.  They know that I provide excellent care. They also know most of all that I do not see the labels of illness or disability or poor outcomes, I see them first and foremost as human beings like myself.

Dr. B wants me to write a reflection about my experience as a disabled physician for the new “Inclusion and Diversity” page.

He introduced me today as an important part of diversity at Wake Forest and a national advocate for medical education for the disabled.

awesome.

last week we decided that there should never be another me but this week we love me…….

in summary our current disability policy is biopolar.

Strange Bedfellowes

I woke up this morning and pulled on my chacos and some leggings. Over the leggings I put my African Kanga.   I put on my Masai earrings and my special necklace made for me and given to me by a disabled woman in a small village in the valley.  Today was Global Health Day.  Every day of my life is Global health day. I think about my friends and times abroad at least 20 times a day. But today other people thought about it.

Because I am sort of a global health nut and because Dr. B who happens to run the medical school likes me I got asked to go to the OTHER GLOBAL HEALTH DAY and speak.  OTHER being code for where we raise money for the new global health program. It was in the medical school board room.  It should be noted that I had to ask directions to the medical school board room. It should also be noted that my two compatriots were in suits.

The table was set  formally. It had ALL THE DIFFERENT TYPES OF FORKS.  There were three.   3 forks!!! 3 forks to raise money for people with no forks.  It dripped of old south. We had sweet tea with lemon to drink, three courses, key-lime pie and a waiter for the main table who was quite sadly one of three African Americans in the whole room. There were name cards.  I set next to Dr. B at the head of the table.

Most of the attendees were older than my grandparents. . They were retired physicians, people with foundations to their names. And there was me staring down at my forks in my kanga wondering how bizarre life is.  And thinking that I felt more at home in a Masai hut made from cow dung and mud drinking chai with flies than I did in this room in the heart of  my school, in my country.

I spoke, sat down and pondered about trying to describe this scene  to the Kenyan mothers who had braided my hair and trusted me with their babies. What would I say?   Well a bunch of rich white people got together and ate too much so other rich white people could go and take care of babies.

They would stare and laugh. And say doctari nywara your country is a strange place with strange ways.

and I would say.

ndio ndio.

circles….

this is long I apologize…..but it was a life altering day.

April 2006…I was a basket case. I had a broken arm, a bad case of seasonal allergies and I nearly died in a car wreck (Mom and I were 20 cars back from a 4 person fatality on our way back from Cincy last week). For those of you who knew me the last month of my Senior year. I apologize.

Here is a sample just to prove my point and set the stage for those of you who did not  (UVA nightmare, I make a list, The list gets longer and I decide on Wake and have the craziest week of my life thus far.)

So today I walk into Senior Seminar in my business casual: laughing, talking with all my friends about my new condo in Cincy, vacation, how lame these lectures we have to attend for three weeks are and how dumb it is we have to have it the big auditorium where there are no computer plugs (which  means if you are awake you have to listen to the lecture).

My broken arm is healing and is doing so well I can go without any padding on the elbow. I can wear contacts again after a week of terrible allergies.  I even managed to get my hair to lay flat for once. I almost look like a semi-well adjusted young professional. Maybe, just maybe I could pass for a doctor. The first lecture was actually sort of awesome. It was about what to do if  on a plane and they come over the loudspeaker and say “IS THERE A DOCTOR ON BOARD?”    I TOOK NOTES.

yeah I know…I should have seen it coming. But there I was there like a sitting duck confident, ridiculously happy and completely for a moment unaware that I was about to be betrayed by something I hold incredibly close to my heart.

The next lecture was on the new procedures curriculum.  It was led by two ED attendings (one of who was chief among you can’t graduate in less you suture at 4AM with a broken arm posse). Our class were the guinea pigs for this new curriculum. We read some modules and tracked what we did. But had no real requirements. But those who come after us…they have to pass a test to show they are proficient in procedures. This will be a GRADUATION REQUIREMENT…. I had heard rumors of this but I had been reassured that this would not happen like this.  My happy bubble got a small hole.  You see this isn’t about me…..

I can do most procedures. They are not my strong suit but I can do them with a little extra time and grace. Heck I can suture and do joint taps with a broken elbow! But I am an exception in the land of disability. I can stand for a while. I can get out of my chair. I have relatively minor hand issues. But for someone in a chair, for someone with hand issues or a visual impairment or even a more severe hearing impairment this could be the end of their medical school career at Wake.

My happiness made me brave. I went up after the lecture thinking well I am untouchable at this point. I got into a first rate peds program and am graduating.  Oh how wrong I was.

Dr. ED 1: Hey you passed the ED!  (he thinks this is why I am coming up to see him little does he know he just made me braver).

Oh great! I say. SO I have a question for you guys.  What happens if you have a student who has a more severe disability than me and is a student here?

Dr ED 1: Well we accommodated you…I mean sure you took a extra time and well your work was not always the same…qual..

Dr. ED 2: Not the right word.

(no joke)

Um this isn’t about me. This is about future students at this school. For example if a student like JL who graduated here after a spinal cord injury in his third year what would you do?

Dr. ED 1:  We helped JL…he went to some PMR program in Texas. Not sure what happened after that.

(no he didn’t, it was in Charlotte after Wake int medicine rejected him because of his disability)

Actually he is an attending now and running a spinal cord program and doing some great research. But this isn’t about him either. What would you do if you had a student who could not perform these procedures in the traditional way? What about intermediaries?

Dr. ED 1:  Obviously there are some students who just can’t be doctors.  And we here at Wake have decided these procedures are required for graduation. You have to be able to do a physical exam with out an intermediary and the same with these procedures.

(WE HERE AT WAKE….WHEN DID WE  GET INVOLVED….becuase my Wake…my Wake I chose over UVA.  Because UVA had technical standards that included a list of procedures, was downright clueless, admitted me for fear of a lawsuit and had no accessible classrooms! My Wake told me that they wanted disabled students, they wanted doctors who were going to serve all people and include all voices. My Wake told me that I was an asset not a burden. And this was such a compelling story that my parents gave me early inheritance so I could stay here. My Wake that I have gone to the AAMC (American Assoc of Medical Colleges to talk about TECHNICAL STANDARDS and spoke in glowing terms of my experiences and used as a model of medical school working for students with disabilities….When did my WAKE ….when did WE decide that my tribe wasn’t welcome here?)

So do you think that this should be part of admissions criteria (technical standards)?

Dr. ED 1: Yes.

Have you been in touch with the committee on technical standards that rewriting them? (I am a consultant for this committee)?

Dr. ED1: No, no  but you know I will e-mail Dr. BIGSHOT today about that.  And thanks again for being a part of the procedures curriclum pilot. Oh and congratulations.

I walk away. I don’t fight. Even though every fiber in my being that was so happy, so confident wants to fight, wants to scream. I e-mail Dr. BIGSHOT who happens to have written a letter of rec for me and thinks disabilities are neat….I think…. I tell him I am concerned.  He e-mails me back a two sentence e-mail about looking into it.

And I leave feeling…… GUILTY.  I know that is crazy.  But I am the ambassador here for my tribe.  And I wish I could have not broken my arm under Dr. ED’s nose. I wish I could have sutured better. I wish I could have done chest compressions on a 3001b man with one arm. I wish I could been sharper on adult medicine last month. I wish I could have done something, anything to convince him that WE (as in the TRIBE) have a right to be here. And that doing things differently even in medicine is not a crutch…its just doing things differently.  But more than anything I want to know where I went wrong in that after eight years….HOW can I still feel like I am fighting for a place at the table. Fighting for the right to be able to stand up and say I am a student here too and my school actually is not afraid to admit it….

and I just have one question left what was the congratulations for?  For becoming a doctor? For being the last medical student with a disability admitted to this school?  nope I think I know.

after eight years….more money than I care to admit….countless hours of studying….of dreaming….of cheering….of singing your praises…. you have finally  made a cynic out one of your biggest fans.

Congratulations Wake Forest. We did it.

(at least until I find a way to fix it). (you know in the next four weeks…before I graduate and leave and will no longer be that awkward thorn in their side)