The Evergreen Prescription
By Carolyn Shea
everyday work that is the real satisfaction
of the practice of medicine...
the actual calling on people, at all times
and under all conditions,
the coming to grips with the intimate conditions
of their lives, when they were being born,
when they were dying, watching them die,
watching them get well when they were ill.”
— American poet and practicing physician,
William Carlos Williams
Health care reform, rapidly expanding scientific knowledge and shifts in the nation's economy and demographics have all fueled the dialogue on health care in America. As the provisions of the 2010 Affordable Care Act roll out, debate continues about how best to break down barriers to access, enhance choice and quality, and fix an ailing system.
Often lost in these larger discussions, though, is the human dimension of health care: the face-to-face relationships between patients and practitioners. Thousands of Evergreen alumni have gone on to work in health careers: diagnosing, treating, administering round-the-clock care, and meeting the myriad medical needs of the people who depend on their expertise, from newborns to the terminally ill.
Evergreen alumni are generalists and specialists, in private practice and public health. They work in hospitals, offices, medical laboratories, and residential care facilities—as acupuncturists and surgeons, midwives and geriatricians and many professions in between. As diverse as they are, they share a passion for the meaningful work they do and a desire to use their scientific knowledge and skills to make a difference by serving those in need.
Mark Stevens ’93 works as a flight paramedic, responding to emergencies in a single engine aircraft in a remote region off Alaska’s Bering Sea, where “conditions can be quite severe, with winter temperatures reaching well below zero and limited infrastructure for moving patients from the village clinics, which serve as an initial care site, to the aircraft for transport,” he says. He serves a population of about 25,000 Alaskan Natives living in 58 villages along the Yukon and Kuskokwim rivers and the tundra between—an area about the size of Oregon. “I have never felt so appreciated for what I do in my whole life. Every day when I take someone to the hospital, I feel like a hero.”
“Many times patients are not critical,” says Stevens, who got his emergency medical technician and paramedic training in Detroit, partly through the Detroit Fire Department. “We try to get ahead of it and make sure they get in before it gets that critical. But with some diseases, they progress rapidly and get very sick very fast, so we can find ourselves behind the curve very quickly.” An emergency call can entail a flight of more than an hour, then a trip to the patient’s village, which might mean “hopping on snowmobiles or 4-wheelers, sometimes dragging them in a sled at 30 below back to the aircraft,” he says. “It’s very dangerous. At some level, you have to say that what I’m doing is valuable enough that it’s worth the risk. These people would perish if we didn’t take that risk.”
Photo courtesy Mark Stevens
Dr. Steven Konicek ’81 is an internist who has worked for an Indian Health Service (IHS) clinic on the Navajo Reservation in Arizona and the Franciscan Medical Group in Tacoma. A graduate of the University of Washington School of Medicine, he’s currently a doctor and assistant professor of internal medicine at Madigan Army Medical Center. At IHS, he says, “I got a chance to learn and do the romantic picture of what a doc does: Take care of babies and older folks, fix broken bones and still do internal medicine.” At Franciscan, he says, “I got to know my patients pretty well and I enjoyed it a great deal. That’s what I’d gone through all the training and worked for. It’s wonderful!”
At Madigan, which provides medical care to the second largest military retiree population in the nation, Konicek sees patients ranging in age from 20 to 90—with an average age of about 75—in the medical center’s clinic. Most are veterans, but they also include active-duty soldiers and their dependents. Before he started working at Madigan, he experienced the continuing pressure on the business side of medicine and the increasing “pressure to see more patients every day. It was very unsatisfying,” he says. Now he gets to spend more time with them and less time dealing with paperwork and bureaucracy. “It’s been very liberating,” says Konicek, a trustee for the board of directors of the Pierce County Medical Society.
“I got to know my patients pretty well
and I enjoyed it a great deal.
That's what I'd gone through all the training
and worked for. It's wonderful!”
— Internist Steven Konicek
Another Greener, Leann Drake ’93 and ’97, works as a registered nurse with the Portland VA Medical Center in a program called Home-Based Primary Care (HBPC), an effort to improve access in rural communities. She covers rural Willamette Valley to the Oregon coast, delivering primary care to homebound veterans who are at high risk for recurring hospitalizations. She is part of an interdisciplinary team that visits, assesses and treats patients at home, helping to prevent setbacks and improve the overall quality of their lives. Once an intensive care nurse, Drake also had previous experience in acute home care, primarily with elderly patients who could not easily be cared for on an outpatient basis. In home-based care, she says, “You’re looking at the whole patient in a way you can’t in a clinic. It’s a much more intimate type of care. You get to know the people, their homes and their lifestyles.”
As the point person for case management on her team—which also includes a nurse practitioner or physician assistant, an occupational therapist, a psychologist and a social worker—Drake says she is “working with patients to work out whatever their barriers are. It’s a whole-person, big picture perspective. If their psychological symptoms are such that they can’t cope in other ways, they’re not going to make changes to improve their health. This model provides supportive care to the whole person to optimize what’s important to patients. If they want to go outside to tend their tomato plants without being short of breath, that’s a meaningful goal. I love this model because we have the time and support system to do that for so many people.”
“You're looking at the whole patient in a way you can't in a clinic.
It’s a much more intimate type of care.
You get to know the people, their homes and their lifestyles.”
— Registered nurse Leann Drake
Last summer, Drake got a whole new perspective on health care when she was diagnosed with Stage I breast cancer. “I completely understand what my patients are going through now...at a gut level.”
She says her prognosis is excellent and when “things settle down,” she will continue pursuing the master’s degree in acupuncture that she started and had to put off. “Western medicine does some things that are incredibly important, like cancer treatment. But there are also things that Western medicine does not do well that complementary medicine does, whether it’s naturopathy, acupuncture or massage,” says Drake. “That quality of touch is completely lost with Western medicine—human touch and time. I try to bring these to home care. I have time to talk, listen and touch, which is especially important with older people, who are often touch deprived. I try to do it in a way that seamlessly blends in with whatever else I’m doing.”
Photo courtesy Leann Drake
Laurie Steelsmith ’88 took the alternative medicine route after leaving Evergreen by becoming a licensed naturopathic physician, acupuncturist and practitioner of Chinese medicine. Trained at Bastyr University in Seattle, Steelsmith says she knew from childhood that she wanted to help people. She opened her own office, the Steelsmith Natural Health Center, in 1996, building her thriving practice, in part, through her love of teaching: “I did a lot of public speaking,” she says. “I educated people about the field. I had come from Seattle, the mecca of alternative medicine, where there’s a high level of acceptance in the medical community, to the culture of Hawaii, where it was not accepted and not known by the medical establishment.” Her well-attended talks, on such topics as naturopathic treatments for the symptoms of menopause, led to a monthly column in The Honolulu Advertiser, Hawaii’s highest-circulation daily newspaper, which she wrote for 10 years.
“The bottom line is that a true doctor
is going to take care of their patients,
no matter what.”
— Naturopathic physician Laurie Steelsmith
In 2005, Steelsmith’s book, Natural Choices for Women’s Health, was published by Three Rivers Press, an imprint of Crown Publishing. Her talks, newspaper column, book and other media appearances have been a springboard to creating greater awareness about natural medicine and how to take care of one’s own health—not only in Hawaii, but also across the United States. She loves helping people get well and empowering them to lead healthier lives. “Working with patients is really my passion,” says Steelsmith, who will provide pro bono care to patients unable to pay for services. “The bottom line is that a true doctor is going to take care of their patients, no matter what.”
After all, it is patient care, the hands on, personal attention to and treatment of the sick and injured that is at the heart of health care, one of the nation’s largest industries. In 2008, health care provided 14.3 million jobs. According to the Bureau of Labor Statistics, ten of the 20 fastest growing occupations are health care related and over the next eight years, the field will generate more new jobs than any other industry because of the increasing number of elderly Americans. “People will always need us,” says Stevens, the paramedic. “The health care field is recession proof.”
Beyond that, he says, “I believe society is strengthened by us helping those who are least able to help themselves. That’s why I got into the medical field.” Konicek, Drake and Steelsmith would surely agree.