Med school refugees trapped at sea (& still studying!) →

Med Student Refugees

Hi Dr. Wible, I’m a current student at Ross University School of Medicine (which was located once on the island of Dominica) so we were in Dominica when Hurricane Maria Category 5 swept through and devastated the island. The hurricane was September 18, a Monday night, and Dominica lost power, running water, the roofs of homes. We woke up to what looked like the end of the world. No leaves on trees, power lines on the street, debris everywhere, doors scattered throughout, our school was destroyed for the most part.

Med School Classroom

Medical School Destroyed by Hurricane

It was chaotic but I found relief with my friends. We stayed focused, looking for a reliable water source to fill up our empty gallon jugs with. We needed water for washing our hands, washing ourselves, and for “flush water” (a few gallons per 1 flush for the toilet).

Flushing toilet water

Dominica is a humid island. So without air conditioning or showers, everywhere smelled really bad. We were dehydrated and sweating more than we were drinking water, and our urine smelled. Trash was burning, people were doing their laundry in the river, there was a curfew for 4 pm because of the looters roaming around with guns, crossbows and knives. It was pure survival mode: for med students, professors, deans, admin, local Dominicans, and even the Prime Minister of Dominica, who lost the roof of his house. Professors lost the roofs of their homes—some of them were alone during that trauma. Students lost their roofs but most were sheltered on campus. One girl broke her clavicle from the roof caving in, and there were other minor injuries. One pregnant woman got medically evacuated by helicopter.

Luckily, my apartment just had some flooding. Roof was intact.

I was grateful to my landlord, who, even though he had lost everything—his home was gone—he still had his apartment building which we lived at, where he and his family stayed for shelter, and he did his best to make sure the generator was working. So by Friday, we were able to shower again. And I took a long shower that day and broke down, finally, after spending the week coping with my friends by laughing and sticking to survival protocol: find water sources to fill up the bottles, make sure we are rationing the food, joke about how insane this is, etc.

Ferry Evacuation Medical Students

We got evacuated by ferry boats and cruise ships and anything that was available—evacuated to St Lucia at first. My evacuation group had about 40 people and we were on a small boat (the touristy type of boat that you spend an hour max on). Well, generally a ferry boat ride takes 3 hours to St Lucia, but it took 14 hours because of the debris in the water. We kept hitting it so we had to go slow. It was a very tumultuous journey. Once in St Lucia, the school put us in a hotel and we all cried with happiness from the buffet and the food and ate as much as we could… Then, the school put us on a charter plane to Miami and encouraged us to go home and bond with our families.

Med School on a Boat

So, we had a few weeks to debrief. And then the school decided to resume the semester on a boat, and many students opted out. But the ones who stayed, like me, are experiencing quite the journey. Med school on a boat, semester at sea. We have roommates. There is no privacy.

Bedroom/Closet Med Students

The professors also don’t have privacy because they all share on “office” and don’t get their own bathrooms, and they have to be on the boat at 4 am every day, so they come sleep deprived, and are also very vocal about how traumatic this experience continues to be. We are docked at a port in St. Kitts and are sometimes anchored out at sea all day, to allow room for the cruise ships coming in, so we are “trapped” on the boat until we get to dock. The wifi doesn’t always work. And we still take exams and study, albeit not in the most conducive conditions. But we are trying…

Med Student Studying

But I am wondering how this is going to affect us in the future. I’m ready to throw in the towel. Feeling like I chose the wrong path (how could I not?).

So, I just wanted to share a little snippet of a really crazy situation that I’m still processing. But I know that you would appreciate this unique story. All the professors, students and administration are looking forward to being done with the semester on January 4. We will get relocated to Knoxville, Tennessee, for next semester, luckily. So, here’s hoping this semester goes smoothly, academically speaking, so that these experiences will have at least been worth it!!

Warm regards,

Melissa

~ ~ ~

Wow Melissa!

You are a total survivor! I’m amazed. You’re so dedicated to your medical education that you rode out a Category 5 hurricane with sustained winds of 160 mph, floods, landslides, and total devastation to the entire country that left many dead.

You lost your medical school, all communication with the outside world, even access to drinking water. You wandered around dehydrated. You rationed food. You witnessed violence, looting, and the mass exodus of your classmates. Yet you remained.

You are obviously determined to complete your training. Trapped on a boat. Without privacy. And still passing your tests!

Your strength has come from helping one another in community, huddling together with your classmates, staying in close contact with your professors (since you can’t escape the boat). Catastrophes bring out the best and worst in people. Yet ultimately everyone becomes closer. Disasters tend to tear down hierarchy. To survive we depend on human kindness. People are more real, vulnerable, honest about how they feel. Mental and physical health issues surface and you must be there to attend to each others needs without infrastructure. And you did it!

How will this impact you in the future? You won’t ever need to attend a resiliency class. Trust me. And residency should be so much easier than this!

If you need to talk, I’m always here . . .

So proud of you!

~ Pamela

Do you have advice for Melissa? Please leave your words of wisdom below. She (& her classmates) are reading all your comments for support.

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“Medical training nearly killed me (and my friend)” →

Depressed Doctor

“Hi Dr. Wible, I am a fourth-year resident in a combined five-year program and I am burned out. Last month, I totaled my car as I sleepily drove home after my 8th night shift in a row and am lucky to have walked away with only a broken clavicle. Of course I was required to show up the very next day despite the fact that I was so traumatized I broke into tears suddenly multiple times that day. The following week, my 28-year-old co-resident nearly died after having a seizure while on inpatient medicine due to sleep deprivation and intolerable stress. A patient on our team died yesterday and my first thought was, “great, that’s one less person I have to take care of.” I know it’s not safe to continue practicing like this, but this has become the norm. Everyone around me is like this and it becomes almost normal. But is it humane? I don’t know what happened to the younger version of me who wanted to comfort a dying patient or save a life or decrease a patient or family member’s suffering. I don’t know where I became lost, but after so many years of living as a cog in the wheel, I have become the hardened resident they trained me to be. And for that, I suffer and so do my patients. Thanks for letting me vent. Feel free to share my story but please omit my name because I would still like to graduate residency, if it doesn’t kill me first.” ~ Michelle

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Dear Michelle

I am so very sorry that our medical education system has destroyed your love for medicine and your compassion for your patients, that your residency nearly killed your colleague and almost took your own life. You do not deserve to be treated this way. Here are my thoughts.

1) You do not have “burnout.” You have been abused. Your human rights have been violated. You have not been allowed to sleep or eat properly, to take care of your own bodily needs (which you must do to stay alive on this planet). This is basic human physiology. Burnout is a victim blaming/shaming term that has been used to deflect attention to the victim and deflect attention from the perpetrator—your residency. Please use the correct terminology. We can’t solve a problem if it is shielded in euphemisms.

2) Your story matters. I am beyond grateful that you have the courage to share your pain with me and with the world. If we all keep pretending that this is okay, the mistreatment will continue. There is no excuse for a health care institution to place human beings in harms way. Sleep deprivation causes medical mistakes every day in every hospital. Sleep deprivation kills young doctors in the prime of their lives. We must all stand up and say enough to the rampant human right violations in medical education (especially residency).

3) You are a beautiful person who has been wounded. You care. You love. You have compassion for people innately. Your training program has snuffed that out and is sucking the very love our of your heart and the very joy out of your soul for healing and serving others. How? Because you have no time to care for yourself. You have been forced to live a fight-or-flight life. You are struggling for your very own survival (which is why you are having trouble caring for others).

4) The younger idealistic humanitarian still lives in you. You may need therapy to pull her out again. You are welcome to come to our retreats (scholarships available) so do let me know if you have any time off or want to set an elective in Oregon. I am here if you ever need to talk to me. I just tried to call you. No answer. You are probably at work. You can get your life back. You can once again comfort a dying patient. You can eventually help others with their suffering after you heal from the trauma of your medical training. Please know not all residencies are like this. I absolutely loved my residency. We can do better.

5) You are loved. Don’t ever give up. So many people love you. I am here for you. We are all here for you. Reach out to those of us who are resourced, who have survived what you are enduring now, those of us who are standing up to humanize medical education so that future generations of doctors do not have to suffer. Your life is too precious to give up. I have so much more to say. I’ll wait for you to call me. 541-345-2437

Pamela Wible, M.D., reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered.

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Why you should be a nurse practitioner (and NOT a doctor or PA) →

Be a nurse practitioner
Ethan Stuart, RN, sent me this email.  I’m publishing (with permission) exactly the way I responded. Ethan has severe anxiety. I strongly recommend those with pre-existing mental health issues consider the mental health impacts of a medical education given the suicide crisis among medical students and physicians.
 
Ethan: Hi Pamela, I have a question about my future career choice, and even though it is more complex than what I will write here, I will try to hit the main points. You seem like a smart, understanding, and compassionate person.
 
Pamela: I AM! 🙂
 
Ethan: So I thought I would send you an email. 
 
Pamela: YAY!
 
Ethan: Basically, my struggle is this: I am a current RN and would like to do primary care in the future (family medicine). However, I am torn as to whether I should try to become a family physician or become a family nurse practitioner. 
 
Pamela:  My first thought is NP right off the bat.
 
Ethan: Here are the things that attract me to becoming a family MD/DO: #1 = Autonomy 
 
Pamela: You can have autonomy as an NP – in your own practice. Listen to this interview I did with the happiest NP in Alaska. (Note: PAs actually can not practice with autonomy and require a collaborating physician so that makes the NP degree much more valuable in my opinion—especially if you want to launch your own independent practice one day!).
 
Ethan: #2 = Knowing that I became the best that I could be and didn’t settle because it was hard (probably the main reason).
 
Pamela: There are NPs who are better than doctors. DEFINITELY less abused and have more self-confidence as NPs.
 
Ethan: #3 = The opportunity to acquire a deeper and wider knowledge base (probably the next main reason).
 
Pamela: Your knowledge base is directly related to your level of curiosity and your dedication to being a lifetime learner.
 
Ethan: #4 = Ability to practice internationally.
 
Pamela: Not sure about this one.
 
Ethan:  Here the things that attract me to becoming an FNP: #1 = Better work-life balance.
 
Pamela: YES.
 
Ethan: #2 = Faster/cheaper More flexible should my interests change I can work and go to school part time I can directly choose to study what I am interested in (rather than have to go through many rotations in medical school that I might not be interested in).
 
Pamela: YES.
 
Ethan: #3 = I must say, too, I am a person who does not want to train/work in a toxic environment, and I know medicine seems to have plenty of that. I see it daily as a nurse. I also have anxiety that can flare up pretty severely and tend to get burned out if I have to go through a demanding schedule for too long, as I naturally give a lot to people and have to have time to care for myself. If I could get down to the bottom of my indecisiveness, the thing that causes me the most uncertainty/anxiety, I think it would be this: I would like to pursue medicine because I prefer the medical model more and because I would like to be the best I can be, even if it is more difficult. But I am very worried about the price I would pay to get there and the toll it would take on me and my family—I am married now, and my wife will likely have kids by the time I would be in my training.
 
Pamela:  YOUR MENTAL HEALTH & OVERALL HEALTH will be WAY better as an NP.
 
Ethan: As you know, you can’t help anyone if you can’t help yourself. I don’t mind becoming an FNP, as I think my dedication to learning will make me a great provider regardless. But I also am not sure I am philosophically on board with the nursing model per se, and it is mainly attractive me for PRACTICAL purposes, not intellectual ones.
 
Pamela: Your intellect can take you anywhere you want to go. Degree really doesn’t matter. It’s your initiative.
 
Ethan: The rub is I don’t want to pursue being an FNP (or an MD/DO, for that matter) for the wrong reasons. Lastly, I also have many hobbies, and though I would enjoy the knowledge base that physicians have and the autonomy, I am not sure I would like the stress and any longer hours that comes with it. 
 
Pamela: NOT worth all the extra training. You could get an NP in an 12-18 month accelerated program for 10% the cost of getting an MD/DO. AND you can earn MORE than a doctor!! (see above video).
 
Ethan: And I realize one may not be able to have one without the other. I may just have to accept that there will be trade offs either way. What do you think? 
 
Pamela: I think you should design your dream clinic/practice FIRST—then reverse engineer the steps to get there choosing the fastest, least costly method to get there.
 
Ethan: Based on your personal experience as a family MD, what would you advise me to do?
 
Pamela: Go for your NP degree.
 
Ethan: THANK YOU for your time and for all your wonderful work. No doubt you are such a treasure to many. Most sincerely, Ethan
 

Pamela: Can I publish this on my blog as I think lots of people would like to know the answers to these questions. Also after you read what I suggest tell me what you decide. I’m not attached either way.

Ethan: Thank you for the quick response and specific answers. I honestly have known which path would be better for me personally for a while, but there has been that small part of me that doesn’t want to completely rule out medicine because of the reasons I listed. Be that as it may, I want to be healthy and happy and do what’s best for me and my family—which will make me a better provider and family member. 
 
And, of course you can publish this on your blog. I’m honored! You can even leave my name if you feel inclined, although I don’t think it’ll make me an overnight sensation. *:P tongue
 
Will keep following all your great work. I just have to say—I really, really admire your courage. Thanks for leading the way—hopefully the rest of us can follow suit. 🙂 
 
What do you think? NP? MD? DO? PA? Other?
Want to fast track your dream? Join our teleseminar or retreat (or jump on the fast track here).
 
Physician Retreat - Join Us!
 
 
ADDENDUM 11/29: This is my advice for Ethan. My advice for you may be totally different based on your life circumstances. I love doctors. I love being a doctor. I loved my residency and the last 2 years of medical school. I am the happiest I’ve ever been in my life practicing medicine in our community-designed ideal clinic (solo doc for 12+ years). My greatest joy is helping all health professionals find their joy no matter what the “official degree.” We are all valuable.
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Doctor-bashing (dead) doctors →

Dr.-Bashing

Dr. Jon Azkue dies by suicide and media reports his death as an “inconvenience to patients.” He’s treated as if he is guilty of a crime. No sympathy. No sadness for the loss of a man who dedicated his entire life to helping others. I contacted ABC News to express my concern about slandering and dishonoring this caring physician. I never heard back.

Dr. Trevor Wesson has been missing since October 6, 2017. Media accuses him of abandoning 1500 patients. He is also accused of not paying his rent. No concern about the doctor’s well-being. Doctors are at high risk for suicide. Dr. Wesson has been missing for 2 months. Police have not intervened on his behalf. Rather a court injunction is being issued to prevent him from accessing his patient files during his “mysterious absence.”

I wrote the reporter. I’ve not heard back.

Email-Reporter-Doctor-Bashing

I’m praying that Dr. Wesson is found alive and receives the care that he so desperately needs. As for Dr. Jon Azkue, he will be honored in the forthcoming documentary Do No Harm.

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Pamela Wible, M.D., reports on human rights violations in medicine. She is author of Physician Suicide Letters—Answered.

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Words that blame doctors →

Dr. Kat Lopez: “Today I’d like to share with you some words used by the medical-industrial complex to blame doctors for the problems—including human rights abuses—that they are perpetrating upon these poor enslaved employees.

These words include burnout—blaming the victim who is enduring human rights abuse on a daily basis. RVUs. Work-life balance impossible to achieve. Benchmarks. Metrics. Inefficiencies. Efficiencies. Unprofessionalism. FTEs.

The word resilience is a frequently used word to blame doctors who are truly among the most resilient human beings on the planet and need no further training in how to be resilient; they simply need to be treated with respect and valued for the incredible value they have to society. Disruptive physicians who stand up and say no. Availability. Patient satisfaction surveys for 5-15 minute visits.

The concept of residents committing violation of their work hours for meeting the requirements of their residency programs. Patient contact hours which basically means working for free to complete the paperwork etcetera administrative work related to caring for the patients. Quality improvement metrics. Quality assurance. Maintenance of Certification—huge financial racket for unclear benefit in terms of patient care. Population health and its metrics. As well as our favorite, meaningful use.

Now the end result of these words that blame disempowered doctors for the abuses committed by the medical-industrial complex assembly-line medicine and corporate medicine itself is that unfortunately it creates disempowerment, hopelessness, feelings of being stuck, anxiety, and depression that at the end of the day, the year, the residency, the ten years—results in physician suicide.

Here we have an altar composed of our fallen brothers and sisters, beautiful photos of them and their families in their primes, as well as elegies to their love and their incredible patient care over the years of their careers.”

Pamela Wible: “This is psychological warfare on really amazing physicians by a system that perpetuates human rights violations on some of the most beautiful people in the world. What do y’all think about that?”

Doctors: “Yes”

Pamela Wible: “Is there anything else you want to add Kat or anyone? I think this speaks for itself.”

Kat Lopez: “I think this speaks for itself.”

Words That Blame Doctors

Can you think of any others? Please submit additional words that blame doctors in comment section below.

Pamela Wible, M.D., is the author of Physician Suicide Letters—Answered. Need help? Contact Dr. Wible. Photography & video by GeVe at our fall physician retreat.

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