Medicine: Art or Science?

At our Spring 2014 Fundraising event, Siloam Family Health Center had the pleasure of featuring Wendell Berry speak on “The Health of a Community.”

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As a Kentucky farmer, poet, essayist, and novelist, Wendell Berry may seem like an unlikely voice to speak into the matters of health and the work of medicine, but when one leans in to hear him speak, there’s an uncanny sense of insight that unveils the shadows of our modernity and brings truths to light.  His perception introduces a new way of thinking about health, where the body is more than a sum of its parts, like a machine, where the work of medicine is something much more meaningful than the tinkering of that  “machine.”

His essay, “Health is Membership,” explores this idea even more as Wendell Berry wrestles between the art and science of healing.

“I take literally the statement in the Gospel of John that God loves the world.  I believe that the world was created and approved by love, that it subsists, coheres, and endures by love, and that, insofar as it is redeemable, it can be redeemed only by love.  I believe that divine love, incarnate and indwelling in the world, summons the world always toward wholeness, which ultimately is reconciliation and atonement with God.”

With this thought that “health is wholeness,” Wendell proposes the notion that the work of medicine comes from love and can no longer fit within the confines of standardized practice alone—that seeking efficiency within medicine is a deficit when it allies with the paradigm of human health as a science alone, that the work of medicine should come from a place of love if it’s goal is healing in the truest sense of the word.

Delivered as a speech at a conference in Louisville, Kentucky in October 17, 1994, we invite you to read the full essay here.

Waterfall Refuge

Guest blogger Will Tucker, one of seven students in this summer’s Community Health Immersion, writes…

Rest is what we needed whether we realized it or not. Exhaustion is a safe word to describe the general state of our group. I don’t think we understood how tiring it could be to simply live.

“I don’t think we understood…”

If you had asked me heading into the CHI project if I thought I would be worn down from waking early in the morning, spending time with refugees in our complex and in clinic, and living in company with other like-minded individuals seeking to grow in Christ I would have responded, “Absolutely not, we’ll be doing good work,” but I was wrong. I realized quickly that work, no matter how good, can still wear a person thin and that rest, perhaps more appropriately refuge, is necessary. Where do people in Tennessee go when seeking refuge? It would appear they go to water holes, so we joined in. Cummins Falls was our destination and hopefully we could find rest there.

“Suddenly I recognized my own breathing…”

We hiked the trails all together, boisterously making our way over hills and back down again…over hills and back down again. We jumped this tree root and that one, avoiding walking into too much greenery and hopefully

Will Tucker is a rising senior at Union University.

Will Tucker is a rising senior at Union University.

poison ivy simultaneously. We walked down a hill, around a sharp turn, and back up again. Space between us grew larger and quiet ensued. Beauty surrounded us. As we continued walking along the path, just past a steep incline, I heard behind me Kenny voiced what everyone else was probably thinking, “Guys, I’m tired.” Suddenly I recognized my own breathing, the tiredness in my legs as I lifted for the next step, and the relief in hearing aloud exactly what I needed to hear.

 “There is no shame in acknowledging an unavoidable truth.”

The trail had done to us, exactly what the project had done thus far. It represented fairly well our journey together since arrival. Newness and excitement, work so new to us that it didn’t seem like work at all, the newness wearing off, and then exhaustion. Admitting, not defeat, but need for refuge is so important while you do good work. There is no shame in acknowledging an unavoidable truth. We are human, we need rest, and the only place to truly find the rest we so desperately need is in Christ. Even while we do good works, we must remember to come back to our Shepherd always, because He sustains us, knows us, and loves us more than we comprehend. He even invites us in Matthew 11:28, “Come to me, all who are weary and carry heavy burdens, and I will give you rest.”

“Come to me, all who are weary and carry heavy burdens,

and I will give you rest.”

We did make our way down through the small river, over enormous rocks, and past obstacles along our path to the falls. We climbed the ledges, finally finding ourselves underneath the largest waterfall surrounded by God’s beautiful creation and there we were overcome by relief as we stood beneath its powerful downpour.

Chelsea Travis, Frances Cobb, and Reinie Thomas pause for a selfie during their trip to Cummins Falls in Cookeville, Tennessee.

Chelsea Travis, Frances Cobb, and Reinie Thomas pause for a selfie during their trip to Cummins Falls in Cookeville, Tennessee.

“This is fun!” … a Selfie on day one

Today marks the first day seven pre-medical students stepped into another world – the world of Siloam.

Caleb captures morning devotionals with several of the CHI students.

Caleb captures morning devotionals with several of the CHI students.

These seven are participating in a six-week community health immersion.  The morning started early with breakfast and devotionals for Chelsea, Davies, Frances, Kenny, Lauren, Reinie, and Tucker.  Co-directors Caleb and Stewart round at the team.  They arrived at Siloam by 8:00 a.m. to be quickly dispersed among various roles helping with “Refugee Mondays.” One student called out, “This is Fun!”

While living in a predominantly refugee apartment complex in south Nashville, they will train refugee lay health workers to work in the community, they will shadow clinicians at Siloam, and explore a Biblical theology of health care.  Pay attention to the “fun” they will have as they come and see* what God has in store for them this summer.

*John 1:39, Holy Bible

How Whole-Person Care Fosters Patient Engagement

Lauren Holmgren, former 4th year ETSU medical student who completed her rotation at our clinic in March 2014

Lauren Holmgren, former 4th year ETSU medical student who completed her rotation at our clinic in March 2014

Leaving Siloam yesterday was bittersweet.  Not only was I leaving a clinic I have come to love and people who had truly made me feel like part of the team, I was leaving behind my role as a medical student.  Yesterday was the completion of my very last clinical rotation of medical school.  I will never again walk into a patient room and introduce myself as “the medical student working with….”  Instead, the next time I walk into a patient room I will introduce myself as “Dr. Holmgren”.  As I reflect back on my time at Siloam, there is no doubt in my mind that as I transition to “Dr. Holmgren,” the way I practice will be shaped by the time I spent at Siloam.  I have, somewhat selfishly, spent a lot of time this month trying to figure out what it is that allows the patients and providers at Siloam to create such a nurturing and health promoting environment because it is exactly the type of relationship I hope to one day have in my practice.

The conclusion I have come to…. it’s a combination of a number of things.  First and foremost, the providers at Siloam are interested in the whole person rather than just the medical complaints of their patients—their dedication to providing care for all aspects of a patient’s life from their medical needs to their spiritual needs to their social needs.  This focus and dedication allows the providers to make the best recommendations for their patients but that alone is not enough to care well for their patients. The patients have to take an active role in their healthcare.  The care and dedication of the providers to take care of the whole person is something patients recognize and I think that greatly contributes to patients taking an active role in their own health, but Siloam also requires their patients to be responsible for their healthcare.  I see this as a critical part of the success Siloam sees.  Patients understand that the clinic is not going to ask them to contribute more than they can afford but at the same time, the patients understand that they have to be invested in their own care.
Additionally, the patients of Siloam are a wonderful group of people.  They have a wide variety of experiences that have shaped their lives but they are all grateful for what they have and the care they receive at Siloam.  All of these things together have made an exceptional place to learn and a great place for people to get exceptional care.  I am truly grateful to have had the opportunity to be a part of such a wonderful clinic.

 

Guest blog post courtesy of Lauren Holmgren

When the Best Medicine isn’t Medicine…

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Kristy Oman, a fourth year Belmont Pharmacy student who recently completed a four week rotation at Siloam

Three learning moments that will influence my future practice are also three lessons to carry throughout all aspects of life, not just in the practice of medicine.

1.  Health literacy does not equate with English proficient. I have encountered patients who did not have high health literacy, both before this rotation and during, who spoke perfect English. I have had the pleasure to meet several patients on this rotation who required a translator, yet were quite knowledgeable about their disease states and medications. As providers, we should be careful not to let the language of the patient influence your perception of their healthcare knowledge or health literacy level.

Lesson one: never judge a book by its cover.

2.  High quality does not have to mean high cost. The care provided here at Siloam is outstanding, and everyone I have met demonstrates compassion and a sincere desire to provide the best healthcare to each and every patient. I have spent a significant amount of time trying to source medications for patients, whether that is from patient assistance programs, Dispensary of Hope, or the $4 generic list at Wal-Mart. There are times when treatment options are limited, but this month I have witnessed first-hand how diligently providers try to access the best treatment options available.

Lesson two: Where there is a will, there is a way.

3.  Treat the whole person. I was sent on a home visit to investigate possible triggers for a patient experiencing exacerbations of asthma. Quickly upon arriving in the home, we discovered a very possible source: mold. After speaking with the patient and educating her, she was surprised and thankful to realize there were things in her environment that were likely making her asthma worse: dust, mold, air temperature changes. Was teaching the patient how to spot mold directly related to pharmacy expertise? Not really. Was it the right thing to do and best for the patient? Absolutely.

 Lesson three: sometimes the best medicine isn’t a medicine. 

Guest blog written by Kristy Oman

Lunch Talk at Vanderbilt

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On Monday, March 10th, Dr. Ralph Wood will be having a lunch talk from noon to 1 PM at Vanderbilt Medical School titled the “Literature of C.S. Lewis and Considerations for Formation of Moral Character of Physicians.”   This event, sponsored by SSCD, CMA and MCF, is open to the public and will be a lecture in which the literature of C.S. Lewis is used as a lens through which to explore character formation in the world of the medical community.

For more information about Dr. Ralph Wood and the event, please visit the event’s website to learn more.

Impacting Lives – Helping Others

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Residency can be a daily grind of paperwork, conferences, and constant pages, running from patient to patient, to the point where a feeling of disillusionment can come over you at times as medicine just doesn’t seem all the grand things you thought it would be. Siloam is a place that reminds me of the excitement I had when entering medicine with the simple hope of impacting lives and helping others.

During my time at Siloam I was able to sit and just listen, which is so enjoyable as I am usually stretched thin for time. And I learned so much by just listening. One patient told me that her dizziness was cured by drinking water that had been boiled with garlic, which she said was a common remedy people have used in her family for years.

Another described to me the overwhelming feeling of confusion when going to a drug store and seeing 30 different name brands of ibuprofen in a foreign language and not knowing which is better or which one he should get; he wanted a prescription for ibuprofen so he could bring it to the pharmacist and have her pick it out for him.  These views into what it is like to wade through the healthcare world from a different background were interesting and enlightening.

It was also a good experience to work in a setting where I had fewer resources immediately available and so had to think broader and utilize a good thorough history and physical to guide decision making. I am so used to ordering a litany of labs and imaging without thinking of the cost, but when the patient before you will have to pay for any testing you order, it makes you think harder about what is really necessary and be more judicious.  We should do this all the time but we certainly do not.

I appreciated being part of a place where kindness and compassion infuse the daily work and the patients feel like they have someone who cares about them. At every step the patients are greeted with smiles and concern and open ears and hearts and I think this impacts their health and well-being in as much a way as the practice of medicine does. It is a beautiful reminder of the initial intent we all have when we choose to go into a field of service, but that can get lost in the years of training under layers of jadedness.  It’s nice to know the ideal still exists.

Guest blog written by Dr. Stacey Tillman.
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Dr. Stacey Tillman-
a Vanderbilt internal medicine resident
who recently completed four weeks of training at Siloam.

 
 

Dessert & Conversation with Mary Poplin

Note from the Director–

“The Siloam Institute exists to bridge the gap between academic medicine, the faith community, and the medically underserved.  As trainees at Siloam over the years are well aware, the worldviews of the clinician and patient alike have significant, practical implications for the work of healing.

In addition to training future health professionals to engage at this level (as recounted in stories on this blog), we periodically sponsor lectures or events that foster deeper dialogue around these issues.  With that in mind, we are delighted to co-sponsor an upcoming evening event on Oct. 23rd at Vanderbilt Medical School featuring Mary Poplin, professor at Claremont College and author of Finding Calcutta and Is Reality Secular? 

Whatever your own faith background, we hope you will consider joining us for dessert and provocative discussion about how to integrate personal conviction and professional practice.”

Oct-23 Lecture Flyer

Stress at Home?

This question asked by Dr. Nathan Bullington, a third year Internal Medicine resident completing a primary care rotation at Siloam, opened the door to new insights.

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Dr. Nathan Bullington, Vanderbilt Resident PGY-3

Dr. Bullington writes…

Ms. “H” had labile blood pressures.  A foreign-born, uninsured female in her late 30s with a diagnosis of hypertension was not uncommon.  However, her blood pressure fluctuations throughout the day were not making sense. 

She would sometimes have low readings before her medicine and high readings afterwards.  Sometimes she would have high readings before then drop her systolic blood pressure by 100 points after the medication. 

I stopped our conversation to ask how her home life had been going. 

“Do you have new stress at home?” I asked.  Immediately her eyes welled with tears and she began crying uncontrollably.  She was having immense difficulty with her son’s behavior along with strong feelings of guilt. 

Thankfully, she was open to meeting with Siloam’s behavioral health consultant and praying with the staff pastor before leaving.  This eliminated the need for any new medicines or medicine changes.

It is not unusual for our residents, students, and staff practitioners to ask one more question – perhaps a rephrased one – that opens the door to deeper pain within our patient’s life that is negatively affecting their physical health.  With this new insight, they are better able to direct a plan of care that addresses the patient as a whole person

Curry and Questioning – Part 2 of 2

My Burmese family, the refugees and immigrants who are my neighbors, and of course, the staff at Siloam have stretched me, pushed me, and challenged me from all different directions.

Students have enjoyed the heartfelt worship of a local Burmese congregation.

Students have enjoyed the heartfelt worship of a local Burmese congregation.

I can only hope that the result is a transformed individual, armed with the means to enter the healthcare field to both serve my patients and my Lord. I have been exposed to so much this past month I don’t believe I can make a sound judgment yet on how I will be able to live out all I have learned or exactly how much I have changed – I may never truly know.

Right now, however, I am at a crisis stage.

Four weeks into the project, I have gotten too comfortable. Most of the “newness,” adventure, and uniqueness of Siloam has worn off. I am still excited to wake up every morning but it isn’t the same. In two weeks my life will be turned back upside down and I don’t know how to approach it. I am scared of leaving and going back to my old way of life.

After witnessing so many people invite God into the workplace as well as their heart and mind, how can I let go of myself and allow Him to work through me? And why is it that even though they were forced to flee the homes that they love, the faith of the Burmese has been unwavering and full of thanksgiving, while my life of blessings only yields further questions for the God I love?

Perhaps these questions – while frustrating in the moment – will produce a stronger faith. For now, there are many thoughts I have had which will influence how I intentionally approach not only my career but my life in a more humble and Christ-driven manner.

In her book, No Greater Love, Mother Teresa speaks of humility and how it is a way of drawing closer to God. After laying down most of my luxuries so far this summer and experiencing several aspects of poverty I have been able to reflect a lot on myself and what it means – as Jesus said – to “sell all your possessions and give the money to the poor and then follow Me.” (Matthew 19:21)

Mother Teresa says in her book, “Needs increase because one thing calls for another. This results in uncontrollable dissatisfaction. Let us remain as empty as possible so that God can fill us up.”

For me, this summer has severed the desire for more needs and placed me in a better position to empty myself and allow God to fill me up. So far He has filled me with a greater desire to pursue Him and to look for the presence of Jesus in other people. Witnessing this happen in the interactions between practitioners and patients at Siloam gives me an even greater desire to pursue medicine as a career.

Despite all of the questions I have accrued, I know that I will continue to gather more as my walk continues. Hopefully, these last few weeks will answer many of them. But in the likely case that they aren’t answered, I can find peace in the fact that searching for them will produce even greater knowledge and that my faith will be made stronger by surrendering it all to God.

Manzella, Elias - 2013  Elias is a participant in Siloam’s Community Health Immersion.