A Baltimore med student gets to know her patient population riding the bus

Op-ed: A UMD medical student offers up advice and restraint on the Charm City Circulator.

"Eww, what is that?" she said staring at the slides I was reviewing. "It is hookworm, a parasite that can live in your intestines" I replied. Nervously, she asked, "Can I get that?" "It would be highly unlikely," I comforted her, "it has mostly been eradicated in the U.S. thanks to sanitation efforts and public health campaigns to wear shoes."

Interactions such as this one are routine on my 20 minute bus ride to the University of Maryland. I, along with many Baltimore residents, rely heavily on the Charm City Circulator to get around. As the only free mode of transportation in Baltimore, the Circulator attracts many riders: from tourists visiting the Inner Harbor to families heading to the hospital and homeless individuals seeking warm shelter. As a medical student, riding the circulator is appealing in a city with expensive parking options. Additionally, I try to squeeze extra study time during my commute. However, most days my efforts are futile — interrupted by loud conversations or questions on the slides I am reviewing.

At orientation, one of the deans reminded us that when you wear your white coat people assume you know as much as any physician. They will consult you about their chronic back pain or raised mole. As a second year medical student, I can describe disease processes or list drug side effects, but I have a few years to go until I can give a proper diagnosis. Intensive study takes up most of the first two years of medical school, and while we learn to how to take a history and perform a physical exam, we have few patient interactions.

The dean's comment frequently rings true as I am reviewing bacterial infections and the passenger next to me proceeds to ask why she is experiencing dizziness. Afraid to give her wrong advice, the best I can come up with is: "I am not sure, but if you are concerned, you should definitely get it checked out."

In fact, I am not the only rider being consulted for medical issues. Several weeks ago, while reviewing lung diseases, I overhead a young man advising his friend: "stay away from alcohol, but cigarette smoke can't do much harm." Hearing this advice required me to muster a lot of self-control not to turn around and show him the slide on my lap of a black inflamed lung from a chronic smoker.

Despite not completing my flashcard review, it is my daily commute that reminds me why I came to medical school in the first place. With minimal clinical exposure, speaking with my fellow commuters makes up some of the only conversations I have with the Baltimore patient population. Many of them are impoverished and describe being unable to afford their medications or living too far from a primary care physician. Hearing their stories pushes me to work hard in school and reminds me what the ultimate goal of all this studying is. When I get off the bus, I am reinvigorated, determined to get through another day of school.

My commute also further reinforces my decision to take on an extra year of school to pursue a master's degree in public health. When I see a pregnant woman finishing her cigarette as she boards the bus, or overhear a homeless man complaining of there being nowhere to refill his HIV medications, I am eager not only to treat patients, but also explore the illness prevention strategies Baltimore City desperately needs. With childhood asthma rates at 33 percent, high blood pressure at almost 40 percent, and nearly one in four Baltimore residents in fair or poor health, there are numerous health care disparities to tackle in this city, and it is my fellow commuters who inspire me to address them.

With only two months left before starting clinical rotations, I am anxious to be done with the didactic part of school and excited to start seeing patients. But before I start my clerkships, there is the United States Medical Licensing Exam to get through in June. This cumulative exam has implications for residency and is highly anxiety producing. I am not looking forward to those intense five weeks locked up in the library. I plan to take the circulator just like I do now, though, in the hopes that as I get off the bus every morning, I will once again be inspired to get through another day of studying so that I can eventually care for and address the totality of my future patients' needs.

Talia Kozlowski is a second year medical student at the University of Maryland, where she is also working toward a master's degree in public health; her email is Talia.Kozlowski@som.umaryland.edu.

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