Changing Perspectives: Sage Timberline '15

Shepherd Intern at the Downtown Health Plaza in Winston-Salem, N.C.

Thump. I release my bike from my hands as I finally get to the bottom of three flights of stairs.

Watch check: 6:46 am. And off I go, the wind in my face and my feet coming down on the pedals harder every time with that burst of morning energy I always get. My morning bike ride has become a game, a race against yesterday - I know when each light will turn green, I know which cracks to swerve around and which bumps to power through. It is humid this morning, but the slightly downhill nature of the ride helps whisk away the beads of sweat forming on my face. Then suddenly I screech to a halt. Every day I pass a bridge where homeless people gather to sleep, and this morning there is a child there. It shouldn't surprise me - I know a full THIRD of Winston-Salem's children go hungry on a daily basis - but I still feel shock and a lump in my throat whenever I lay eyes on a malnourished child. I quickly search through my backpack and come up with an unopened water bottle, a bag of trail mix, a piece of paper, and a pen. I rip off some of the paper and write the Downtown Health Plaza's address and that of the nearest homeless shelter, and then leave it carefully pinned under the trail mix. The child sees me and looks frightened. I attempt a smile and wave, and then get back on my bike reluctantly. I have no idea if they will be able to find those addresses. I wish I could stay and help them.

Before too long, I pull into the hospital's massive parking garage, chain my bike behind a bush, and head in to get changed. Thanks to the employee discount, I get two scrambled eggs and an apple from the cafeteria for $1.49, and head up to the 10th floor.

Baker, the resident who has taken me under his wing, hands me today's list of patients, and Margaret and Kristina, two medical students, pat the seat between them for me to sit. They've been here since before I even woke up this morning. I study the patient list, trying to get an accurate picture of each patient's story before we begin rounds.

Watch check: 8:01 am. Johnson, the 6'3" attending, comes to the workroom, and we begin rounds. The first patient we see has serious chest pain that worsens with movement. Baker, always seizing opportunities to teach me something, beckons me over to listen to the patient's heart murmur. Then he pulls up the patient's chest x-ray for me to read. (A, B, C, D, E - Airway, bones, cardio, diaphragm, everything else.) It doesn't look so good. The patient tells us that he walked five blocks here with chest pain because he didn't want to pay for the $700 ambulance ride. He doesn't have insurance. The doctors are sympathetic in the beginning, but when they find out he has been kicked out of the Wake Forest dialysis center because of inconsolable rage and refusing treatments, they raise their eyebrows. The patient defends himself. "Who wants to spend five hours three times a week in a room with only a machine?!" The more questions the doctors ask, the angrier the patient gets, and finally he yells, "Won't you just get out and let me get some sleep?" On our way out, I close his curtains and wish him a good sleep. "Thank you!" He tries to say it angrily, but his voice breaks and it makes him sound almost tearful. When we get into the hall, I can't resist asking, "Isn't there anything we could do differently for him? Couldn't he do overnight dialysis?" Baker looks at me sadly. "He would need a family to help him with that. And besides, he told us he can't sleep during dialysis." This is a very typical patient - long list of chronic illness including diabetes and heart trouble, no insurance, bad hygiene, mental health issues - but the pain of feeling unable to help never feels typical. We continue, seeing a dozen more patients, some more satisfying and some equally heartrending.

Suddenly, Johnson (the attending) points at me. "Sage! ADLs and IADLs. Go!" Darn, I was hoping he would forget. He assigns everybody topics to research and present to the group, and makes no exception for me. Nervously facing all seven doctors on the medical team, I begin. ADLs - Activities of Daily Living - describe the basics of self-care, such as bathing, dressing, eating, moving, and using the restroom. IADLs - Instrumental Activities of Daily Living - are activities considered necessary to living alone, but not essential for fundamental functioning, such as shopping, getting around, and managing medications. I explain that these are used in a scale to assess patient progress and to develop a plan of care. "And why are these particularly important for the underserved population?" Johnson asks. "The underserved generally have access to fewer resources than others, which makes our job slightly more extensive," I explain. "Using ADLs and IADLs helps guide us in determining which resources we need to get the patient access to, creating a sort of protocol for a more comprehensive patient care plan."

Watch check: 11:27 am. Time for Morning Report. This is where a few doctors get together and present a recent interesting case. Usually there is a lesson to be learned at the end - today's lesson is that we shouldn't forget about the most common ailments just because they present themselves with uncommon symptoms. I follow the doctor-language as best I can, but my mind is still on the patient with chest pain.

Margaret says I should come to the lunch lecture with the medical students (which I usually do) but today I promised Honey, a retired doctor who runs the Community Garden at DHP, that I would get back to the clinic to water the plants. So I wave goodbye and hop back on my bike to head downtown to the clinic. It's only another 3 miles, but the ride starts with a humongous hill and it is nearly the hottest part of the day. On my slow and steady way up the hill, a guy in a tight biking suit flies past me. I am surprised and suddenly competitive, and I make my legs work way harder than usual. I make it up in record time. It's amazing what humans can accomplish when they are in competitive environments. I am filled with a sudden appreciation for W&L.

I get to the clinic and water the plants while I nibble on my lunch, admiring how well the herbs are growing. Then I head inside to change again.

On my desk, I find lots of veggies from the garden that Honey has picked, weighed, and bagged. I head down to the Internal Medicine clinic, and begin handing them out to patients. Most people look sheepish, and need a little encouragement before they will accept. But as soon as I convince them, they always have lovely things to say. "I'm gonna put this in my juicer!" says a woman who just got a bag of carrots. "This is dinner fit for a king!" says a young man with a bag of cabbage greens. I've never seen people so excited about vegetables. I tell two little boys to wash their cucumbers before they eat them, but they take them out of the bag and start nibbling anyway. When I catch them, I give them a fake-mad face and shake my finger at them. They giggle and speak rapid Spanish to each other, and then shake their fingers back at me. I show them where the sink is, and they happily splash water over their snack.

Watch check: 3:54 pm. The day has flown by. For the next hour, I work on making health posters - four to promote the new chronic illness management class that DHP is hosting, and two others to encourage staff to support their food bank. Finally, I collapse beside my backpack and pull out my athletic clothes to put back on. I head out to the garden to join Honey in planting the zucchini and squash and picking some green beans before I head back home. Honey tells me some great stories from "back in the day", when she was trying to pick her specialty. We have a few good laughs. She always makes me think about what my priorities should be - is it more important for me to help as many people as I can, or have as fulfilling of a lifestyle as I can? How much do I care about salary? Is it important to get a year or two off on the long path to becoming a doctor?

After an hour in the garden, I hop back on my bike. It is hot and I have a much harder ride home. But I am grateful because a long ride always gets my thoughts rolling. I speed off up the streets of Winston until I can't see DHP anymore. I think about the patient with chest pain. Was there something the doctors were missing? Is there a place we should have referred him? Would he really listen to us if we did? I think about the people sleeping under the bridge this morning. What would that child do if he developed chronic diabetes and needed dialysis three times a week like the patient with chest pain? Suddenly, my wheel is dragging. I make a quick detour and pull up to a gas station. I pump up my tire, but it doesn't hold air. Then it begins to rain. HARD. Here I am in the middle of Winston after a long day, in the rain, with a heavy backpack and a bike, no cash on me, getting weird looks from passersby, but too stubborn to call a friend for a ride. I resort myself to the long walk home. I am only halfway through my route, which means I have about 2.6 miles left. I start to despair. Maybe this is what poverty feels like, I think to myself. The impoverished are on a long, hard road with no option but to keep putting one foot in front of the other, trying desperately to hold on to their dignity. I close my eyes for a second and immerse myself in the feeling.

Watch check: 6:42 pm. I suddenly pause. This isn't poverty. I have a watch that works even when it rains. I have a phone in my backpack, with a GPS and about 100 people I could call if something goes wrong. I have an apple leftover from lunch, a bag of almonds, and a water in my backpack, should I happen to get hungry or thirsty in the next 45 minuets. I have different clothes at home that I can change into, a hot shower, a clean towel, a comfortable bed. Even when I feel the most hopeless, I am nowhere close to impoverished. With a newfound motivation and sense of duty, I finally return to the condo, dripping, with my tire trailing, barely attached to the rim. I smile as I realize exactly which day I will write about for my Day In the Life Essay.