Hannah Takahashi Oakland, MD Student, Class of 2015, reflects on her participation in the Interclerkship Ambulatory Care Track (InterACT). InterACT is a 13-week integrated clerkship which provides select third-year medical students with a longitudinal clinical experience grounded in the foundations of ambulatory medicine, chronic illness care and care for vulnerable persons.
On my third visit, the most extraordinary thing happened–Ms. F said hello back to me when I entered the room! And over time, although I never exchanged more than that word with her, I felt as though I truly got to know her. Those pictures that I questioned at first became part of my understanding of her. As I got to know her facial expressions, a grimace on one day, an increase in eye contact another day, these became in some way our dialogue, although I never had a conversation with her. And in knowing her, I began to sense that she was deeply saddened by her situation. I spent an hour with her one morning doing as much of a depression screening as I could with her. There are only yes or no questions, but she could only answer the simplest ones. She said yes when I asked if she was sad. She answered no when I asked if she loved her life. We framed it as a palliative measure to her son, and were able to begin her on an anti-depressant.
This home aide and I had a conversation about the Miralax at least 5 times, and yet I don’t think a single thing changed over the year. What surprised me, though, was that I began to look forward to seeing her and got the sense that she began to be happy to see me. When I would call on the phone, we would have more and more to talk about, and she would volunteer more information, saying “I have been waiting to tell you this!”
InterACT sometimes made me uncomfortable. The first few times, I was nervous to go to Ms. F’s house, although I could not have been less physically intimidated by her, her aide, and her beautiful Upper West Side neighborhood. I was nervous about the interpersonal interaction because it was so unlike any other I had ever had. The three of us could not have been more different from one and other, but that meant we had so much to teach each other. The funny thing is, in retrospect, I pretty much failed in my Miralax and urination lessons for the home aide, but she and Ms. F managed to teach me volumes. I learned so much from Dr. Ripp about wound care, pressure ulcers, and constipation. I would show up to the visit with prepared questions about each of these problems: how are her bowel movements? any fevers? how often is she being turned? And then there were the lessons I learned that completely surprised me, that I learned when I was quiet and just listened: what is it like to be you?
During its first 4 years (2010-2014) InterACT was fully funded with a grant from the Josiah Macy Jr. Foundation titled: Educating Future leaders in the Primary Care of Persons with Chronic Illnesses and the Medically Disenfranchised through Longitudinal Clinical Experiences.