Friday, July 30, 2010

The Throwaway and the Orphan

As salaam alaikum,

I'm currently in Kansas City (arrived safely, alhamdulillah) taking a break from my second day of this family medicine conference, and man, I am more than overwhelmed right now. I have all of this in front of me and I'm not sure what it all means...the sky's the limit, basically, and it's always been, really, but even so, I know this is what I want to do. This feels like what I was made to do, really. But I find myself in an interesting place...

One thing will be the topic of another entry, but I'm realizing this spiritual revival from within myself and by the grace of Allah (swt). It's bubbling up within me, and overwhelming me with a sense of peace, low key. It's nice, and I hope it only continues as I go forward.

The other thing is...I feel media aislada, haha, is the first way that I thought about describing it. It's not really big fish in a little pond...I feel more like a bird trying to swim in the ocean, is more like it.

They refer to us Harvard medical students as "orphans"...that is, we don't have family medicine programs affiliated with our university. And it's true. HMS does not have a family medicine program and probably will not have a department for a little bit, if ever. It's just the kind of place that HMS is. It's very much geared toward the specialties. They give lip service to primary care because I guess that's hot right now (at least that's the way I feel about the administration...[don't get me wrong, there are plenty of folks at the med school that are very passionate about primary care and do a lot of work to make Harvard not an entirely hostile place for primary care-leaning individuals to train]), but for them, academics, leadership and scholarship are their goals.

Serving your community and addressing that community's needs, not so much...

The way that I view family medicine is two-fold. Yes, there are skill sets that you are interested in and a knowledge base that you want to expand upon (for example, I'm all about maternal/child health), but a lot of where you choose to train and where you ultimately end up working depends on what community you want to serve, what challenges you want to face and tackle as a physician that exist with your patients and your community...things like that. I feel as if sub-specializing in other specialties are more about skill sets than community.

I love young families. I love their potential. I am particularly interested in maternal/child health, early childhood development and health education. I am interested in promoting the health of the family unit where it counts, which, for many if not most families, rests with mom. I'm also interested in how children develop in their first few years and how it relates to the health, health education and literacy of mom. I can focus on that through family medicine like no other specialty.

Another thing that family medicine is great for that no other specialty can quite touch...educating pregnant teenage mothers. If I can find an opportunity to do something like that in Boston during my public health year, I'd actually really look forward to that. Pregnant teenage mothers and young teen moms, helping them with contraception/family planning, their own sexual and reproductive health, their health otherwise, the best choices for their babies, and working within the challenges within their community. Like, what are their barriers to breastfeeding? Things like that.

Sometimes I wonder if, when I sat in that lecture hall during Alliance Weekend, the weekend for minority students accepted to Harvard Medical School, crying because I knew that I loved what I heard from the program here while knowing that I would lose an aspect of the way of life that I was making for myself...sometimes I wonder if I actually made a mistake by coming to Harvard. I love my education, the experience, the boundless opportunities to do whatever I see fit...but at the same time, more than just not having a family medicine department, you do feel like an orphan.

You feel like the child of the trauma surgeon and the pediatric intensivist who came of age never seeing either parent. Your parents work, but actually, they're old money, too (Harvard is old money...okay, we'll see if this analogy doesn't get out of hand). It's like, there's a lot of funds, the world is yours, the sky is the limit, you are of the most privileged people on this planet...but there's just something to be said about not being raised by your own parents. family bent is obvious in this analogy.

So you feel like the orphan, though you're not. Far from it. You just wish your parents had more hand in your raising, is all. And here you are, your parents specialized, and now you want to go into family medicine, and they don't support that. Why?

Because they see family medicine as an outcast, a reject...a throwaway specialty, if you will.

Family medicine, from a distance, does seem like a catch-all. You can basically practice whatever you want, do whatever you want, go almost anywhere you want, accepting that community's limitations. It is a job description that carries little prestige with your colleagues at the US News Top 10 programs across the country, little prestige among the sub-specialties. But people in family medicine are people who really don't care about prestige. You care about finding a community, a patient population, whatever, and being the best doctor you can for that population. I digress a little bit.

I've had people tell me that I didn't go to Harvard to become a family medicine doc.

Reference "My Indian Auntie." Yeah, it's totally narcissistic of me to block quote my own writing from not that long ago, but whatever...

Then randomly, after Sarah or Sofie [my best friend's sisters] asked me what I wanted to go into, and I responded "OB/GYN or family medicine," one of her random, pregnant aunts, I think one of her uncles' wi[ves], came out of nowhere and said, "Family medicine? No, I see you as an OB/GYN. You exude OB/GYN. Look at you! You go to Harvard Medical School. You don't go to Harvard Medical School and then go into family medicine. Do OB/GYN." - March 6, 2010
The thing about it is, some people in my institution will not respect my decision to go into family medicine, think that a Harvard degree (or two, as the case is, insha'Allah) to go into family medicine is overkill, whatever. I've known this, and this conference didn't teach me that.

Three years ago when I started medical school, I had some idea but at the same time little idea what I really wanted to do with my medical degree. I've grown in experience, still have a lot more growing to do, but based on all that I've learned about the field and myself, I'm ready. I know more now what I want out of the career and what I want to be as a physician.

Family medicine is in line with my values. It's implicit in everything about me. The fact that I place so much importance on the family unit for the health of entire societies, not limited to my own, the fact that I asked myself what type of doctor would I want to be if a family member came with a problem. I'd want to be their primary care doctor, I'd want to help manage their health, I'd want to be there when their kids are born and help them establish healthy families. I'd want to be there for the young women in my family who have children in their teens. It's implicit in my values.

It's implicit in the fact that--more important than my own career is the formation of my own family, and the importance of their health, and the importance of the raising of my own children.

I came to Harvard because I didn't know what type of physician I wanted to be and I wanted the opportunity to be anything that I wanted and do anything I wanted. There are few limitations that I face domestically or abroad because of the Harvard name, unfortunately...unfortunately, because I don't like riding the H, at all. It will probably help me get A Rose Much Desired published, maybe, but oh well. I digress.

But I guess this is the fair limitation that I face...a program without a family medicine department and with several members of the faculty not respecting the specialty. I guess it makes me feel a little bit striving to be Muslim with a Christian father who doesn't really support my life trajectory. It makes things harder only emotionally, and otherwise is not that great of a hardship at all.

At 22-years-old, wearing that white coat, I had no idea that I'd be going into family medicine...even less as I applied to programs that didn't particularly support it. I may have been mature but I was incredibly immature in so many ways, I'm realizing. I'm just growing up over the past two years, really, growing up from ways that I was still an overgrown child...

I didn't know what I wanted from medicine yet. Now I do. I happen to be in a place that's not the friendliest for it. Sees it as a throwaway. And it's okay, because people on the outside see me as an orphan but I'm not. I've got fam. I've got fam in all the Harvard kids that are with me on this conference today, were with me yesterday, sleep across from me.

And of course, there is always the wonderful Kathe Miller, the family medicine doctor who was my primary preceptor in the rotation that I did at Cambridge. She's my adoptive mother.

As I wrote in one of my first entries, I've found a love like Wilson Pickett. It's nice to fall into something that makes the most sense in the world, accept it for it's shortcomings, accept the challenges that you potentially face and accept there will be challenges that you can't anticipate, but go forward lovingly anyway... That's what I want marriage to be like for me., step two is to find the residency programs that are right for me. Thank God I have another year to sort all of that out! Alhamdulillah for public health school!


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