This article originally appeared in the Spring, 1996 issue of the Murmur, the newspaper of the students of the University of California, San Diego School of Medicine.
"Fourth year is the best year of your life." I've heard it from dozens of interns, residents, and attendings. Now that I'm in it, I believe it. In addition to having a more relaxed schedule, far fewer exams, the excitement of impending graduation, and the thrill of the Match, there is a lot of opportunity to travel and see how medicine is done outside of San Diego County.
I took one such adventure this past October. In July of my third year I received a letter from the OSA about a rural medicine clerkship in Chinle, Arizona. In spite of having spent some time in Arizona, I had never heard of Chinle. From the description, though, it sounded like a place I wanted to visit -- I've long had an interest in rural health care and have enjoyed working with Native Americans in the past. I called immediately.
Only two slots were available: August and October. (Second years take note -- you need to contact them early!) Though I really like the heat, I decided that August would probably be a bit too warm, and would likely interfere with studying for the USMLE Step II exam. I opted for October, fifteen months down the road. (It's best to make some of your fourth-year plans early; see sidebar.)
I had nearly forgotten about the rotation when the time came to actually go. It was kind of stressful, packing for a month when I knew almost nothing about what to expect when I arrived. Once I hit the road, though, the stress of my first three years of medical school seemed to melt away. I had decided to drive the 700 miles (by scenic route) rather than fly into Gallup, New Mexico and have to negotiate the 200 miles from there to Chinle. The weather was perfect for the trip, which took a leisurely two days of driving and top-down sight-seeing. Eastern California and Arizona have the most beautiful desert landscapes in the world. (If you plan to go, and would like information on interesting routes that avoid the oh-so-boring Interstate highways, email me at ron@risley.net or visit Another Universe.)
What I found when I arrived exceeded all my expectations. Chinle is a destination for tourists visiting the Canyon de Chelly, a breathtaking canyon filled with artifacts from Anasazi, Hopi, and Navajo cultures. It is almost dead in the middle of the Navajo Nation, near the Four Corners area. Though there is not much that a San Diegan might think of as civilization nearby, the Indian Health Service (IHS) hospital is a modern 90 bed acute-care hospital and clinic a little over a mile out of town. They have an intensive care unit, 24 hour emergency room, a pediatrics wing, a surgical suite, chemistry lab, dental clinic, radiology department, and even a mental health unit. They have large, busy pediatric and adult outpatient clinics, a well-stocked pharmacy, and specialty clinics that operate on scheduled days each month.
The IHS provides housing a short walk from the hospital. I stayed in a clean and comfortable three-bedroom house with two roommates: Leigh was a physical therapy student visiting from New Jersey, and Sue was a family practice resident from Colorado. Like the majority of the staff and patients at the hospital, my roommates were friendly and helpful. There's a grocery store in town (Bashas', a major Arizona chain), so keeping the kitchen well stocked wasn't a problem. Note, though, that the reservation is dry. If your idea of a full refrigerator is six cases of Old Milwaukee, you'll have to drive the 200 miles to Gallup (also the location of the nearest CT scanner).
I worked in the pediatric and adult clinics at the main hospital, and also in the emergency room. I also worked in some of the IHS satellite clinics in "nearby" Tsaile and Pinon. The attending staff, nurses, and administrative staff were the friendliest, most helpful people I have met in any hospital. The patients, too, were by and large wonderful, grateful folks whose untiring but largely unsuccessful efforts to teach me Navajo touched my heart.
The weather was perfect while I was there -- mid 70's most days, clear, with a gentle breeze. You can't count on that, though. The desert there is beautiful, but known for its weather extremes. There are endless opportunities for recreation, from mountain biking on the mesa behind the house to horseback riding through the Canyon de Chelly. You can buy beautiful works of art and crafts from the local folks. A day or so away there are natural wonders like the Grand Canyon and Arches National Monument. For me, though, the biggest thrill was the chance to experience medical practice the way I imagined it would be when I applied to medical school. I felt close to the patients I treated, and also felt -- more than at any time since starting school -- that I was making a difference in their lives.
I took an extra-long 900 mile route home in order to see the Grand Canyon. Though I was anxious to see my friends again, I was sad to be leaving such a beautiful place. I did get a rather pleasant reminder of my trip, however. The rotation pays a stipend of about $500, which I received a few weeks after my return.
In the months since returning from Chinle, I have had a lot of time to reflect on what I learned during the rotation. More than anything else, it restored my commitment to primary care medicine, and reminded me that medicine can be what I dreamed of before I started working in a tertiary-care university medical center. If you've ever had an interest in rural medicine, or just wondered what it would be like to have patients who were really members of a community, you owe it to yourself to experience a rotation in Chinle.
Date created: May 19, 1996
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Copyright © 1999-2000 Ron Risley