Medicine from the heart . . . Megan Furnari

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.

In honor of National Rural Health Day, UMMS rural health scholar Megan Furnari, SOM ’13, writes about a clinical experience she participated in on Martha’s Vineyard. Far from the beaches of tourists is another aspect of the island, known only to the full-time inhabitants, made up of American Indians, veterans and many others.—Hugh Silk, MD

Island Counseling

I wake up in the morning to the clucking of chickens. The sun is rising, peaking up above the trees as I stumble down the stairs and out into the yard. The “ladies” rush to the edge of their fenced enclosure and watch me, closely. I almost fall on the dew-covered grass as I step into the wooden shower covered by honeysuckle and green twisting vines, 15 pairs of eyes still observing carefully. They flock to the shelf in their coop, where they can see me standing in the shower. I challenge their gaze with a fist wave, hoping they’ll look away as I attempt to start the shower. They refuse and I give up on modesty.

After a quick rinse off, I hobble back up the grass and stairs. I pull on my biking outfit, covered in dirt and grime, hesitant to use extra electricity for the washer on this self-sustaining homestead. My backpack is ready with poncho, water bottle, bike lock, journal and psychiatry textbooks. I hit the road.

Thirty-five minutes later, past a bakery, five lamas, one farm and some ups, downs and arounds on a washboard dirt road, I arrive at Island Counseling Center. I see a client/patient pulling into the parking lot in his SUV. ”Hey Doc,” he waves and smiles widely. I do the same. He comes every night to participate in the group sessions on addiction, once a week to meet with a counselor. Every time I see him he is smiling, hopeful. It is contagious.

The secretary is used to my arrival: hot from the 80 degree weather of July, covered in grease and dust from the road. She smiles warmly as I punch in the door code and head to the bathroom to transform into my medical student self. This only requires a new outfit and an ID badge, no white coat necessary, thank goodness. I like when my identity is preserved.

Some days I’m with the psychiatrist, others with social workers or mental health counselors. Often there is an evening group that I attend with individuals dealing with substance abuse or alcohol addiction.

Yesterday, I did a home visit and play therapy at a local park. This evening I’m hoping to take part in a therapeutic drumming circle for adolescent boys. During a rare pause in the day, I wander into an office and inquire on good reading materials. Within a couple of days, I have a stack of interesting books on subjects not taught in medical school like adventure therapy, attachment theory and cognitive behavioral therapy for pediatric trauma. My phone rings and a lovely counselor down the hall offers to take me to the Wampanoag reservation to visit an elder. I nod, hopeful to improve my understanding of mental health issues facing the tribe members here on the island. I check in with the psychiatrist and discover that he will be doing an intake with a new pediatric patient and her family later in the afternoon. He encourages me to join the discussion when I return, welcoming me to ask questions during the interview. The director of the center walks up to me holding an article from the recent Psychiatry Today about the challenges facing practitioners in the field, curious to see what I think. This is a sampling of Island Counseling.

Four weeks of incredible learning. Each day completely unique and different from the next, a new opportunity. I acquire knowledge and skills not taught in the pre-clinical years of medical school or in my third-year psychiatry rotation. The discussions about systems of care in a rural community and how they connect suddenly make so much more sense to me. I appreciate the interchange between different health care professionals with different training, combining perspectives and knowledge sets to provide optimal care. Martha’s Vineyard is also a very special community with providers who are truly dedicated to the wellbeing of their clients. Everyone knows everyone else. These are not the summer residents. These are the families that have lived on-island for years. This dedication to patient care and compassion fills my mind with an eagerness to learn, engage, and support. I start to get to know patients and recognize family names. From play therapy on the floor with Legos to the psychiatric medication visits to the philosophic discussions on how to approach therapy and intentionality, I love every moment.

One night I will never forget, I go to the veteran’s support group. A session held for two hours, once a week, attended regularly by about 15 to 20 men, almost entirely from the Vietnam War. That night changed my life. To hear and see the stories and bear witness to the suffering that these men hold in their minds and bodies every day without the rest of the world knowing or understanding. They don’t tell anyone else about it outside of the group, not even their families. The last man spoke about his one week of training to be a medic and then his immediate placement in Vietnam, deciding who would live or die for 72 hours without a break. In those three days, he lost his innocence; he lost his personhood. He knows that. I didn’t sleep that night. I couldn’t. They never sleep through the night.

As I walk toward the ferry heading home at the end of the rotation, my mind thinks through many things. Being a student doctor interested in a future leadership position at a rural community mental health center, this is a big step in my personal and professional development and education. This is the model that deeply resonates with me and is actually changing lives. I hope someday to return to Martha’s Vineyard for longer than one month with my medical degree in my back pocket, a residency completed, and my bicycle with a light to better see the path ahead on those poorly lit island roads.