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Residency Physiatrist, Physical Rehabilitation

In the banquet room of an Italian restaurant in Northern Alaska, my high school track coach addressed his team and their families at the end of the season. Most senior athletes were complimented on either a winning season or a season of hard work. I had accomplished neither. In addressing me in front of the crowd, he said: “Despite what the record books show, I know Karen is the best triple jumper to ever compete for this school.” I was so proud to hear those words 

after a season that began with me favored to win the league title and break the school record, and ended without me having the chance. My senior season turned into months of physical therapy, sitting on the bench and hoping for a chance to get back to the form I once had. Although my injury kept me from breaking that record, the lessons I learned during that time have proven to guide me in my career choice.

Since then, I have been drawn to a career where I am involved in helping people achieve optimum function and recover from similar experiences where dreams seem lost, and rehabilitation can be complex. I had my first hands-on experience with the field of rehabilitation during college when I volunteered at the first rehabilitation hospital to open in my hometown. I worked in the Transitional Care Unit, leading activities including wheelchair aerobics, art therapy, and pet therapy. The physicians and therapists I met there played a role in encouraging me to apply to medical school.

During my first two years of medical school, I was able to work with three different Physiatrists introduced me to a field where I witnessed the long-term relationships that developed between doctor and patient, as well as the opportunity to be the leader of a rehabilitation team. Both of these aspects of the specialty are important to me and coincide with my strengths, which include strong interpersonal skills and the development of relationships, as well as a love of organizing and motivating people. The ease with which I work with all types of people has always been one of the areas where I have been complimented most by others. 

In my third year, during my family medicine and internal medicine rotations, I found my interest in the specialty confirmed by my enjoyment of workman’s Compensation and orthopedic surgical recovery patients. I now look forward to broadening my exposure to the field of Physical Medicine and Rehabilitation during the two elective rotations I have in October and November.

In residency, I hope to attend a program that will provide a solid foundation in the pathophysiology and the clinical practice of rehabilitation medicine. I value structured training with a diversity of exposure to patients and facilities. I want to learn in an environment that encourages a close relationship with the patients and other residents and faculty.

As far as my goals after residency, I would like to continue my education with fellowship training in either musculoskeletal or sports medicine. I aspire to a career in clinical medicine with opportunities to do clinical research and possibly supervise medical students and residents. I love the academic community environment and especially the constant learning that accompanies the field of medicine.

Anyone living in Big Town, USA, can attest that its streets foster a sizeable homeless population. About a block away from my apartment lives a homeless veteran who finds shelter in the entrance to our neighborhood video store. Mark is living with an above-the-knee amputation after losing his leg to diabetes nearly a decade ago. He roams the streets in a dilapidated vinyl wheelchair, toting an old prosthesis on his lap along with an occasional bottle of alcohol. Mark and I have gotten to know each other over the years; we pass each other nearly daily. We have discussed his struggles living homeless with an amputation, and the barriers posed by his disability.

Years before I became interested in Physiatry, I would ask myself, “What role did Mark’s disability play in his homelessness?” With added resources and support, could Mark have better overcome the loss of his leg?” Later, as a second-year medical student interested in Physiatry, I wondered what impact an interdisciplinary rehabilitation team could have had in maximizing Miles’ functional outcome, addressing his psychosocial needs, and imparting the vocational adaptations necessary for Mark to resume working. Having gained experience in Physical Medicine and Rehabilitation, I have found many answers to my questions. I compare Mark to Nick, a 55-year-old diabetic who also lost his leg to amputation, was wheelchair dependent, and never planned to walk again until four years ago when he was fitted for a prosthesis. He has since become a world traveler. He has hiked the Rocky Mountains, seen the glaciers of Alaska, and kayaked the Colorado River. In fact, these have been the happiest years of Jim’s life. Jim now volunteers his time helping other amputees overcome similar obstacles to achieve the independence and inner peace that he has obtained from his rehabilitation. 

Through relationships with patients like Nick, I realize the tremendous impact I can have on my patients’ lives as a Physiatrist. Physiatry appeals to me as a humanistic field. Physiatrists coach their patients through the stages of loss, helping them turn denial into acceptance and anger into motivation for rehabilitation. This leads to a more positive attitude and renewed appreciation and perspective on life. It is a privilege to care for a patient population that demonstrates such resilience, focus, and optimism. I also appreciate the practical guide of Physiatry on those aspects of recovery that most concern patients. After suffering a stroke, patients do not ask what artery was occluded; instead, they want to know whether they will walk, work, dress, and toilet again without assistance. As a Physiatrist, I will help my patients work to find the answers to such questions. I will care for my patients, treat them with dignity, and never lose sight of the fact that medicine is a form of service before science. Indeed, I cannot imagine anything more productive or satisfying than dedicating my knowledge, skills, and life toward helping others liberate themselves from the confines of chronic disability. I now realize that well before I understood the field of Physiatry and even before I was interested in practicing medicine, certain life events and personality traits have made me uniquely qualified for this specialty. Growing up with a deaf brother, I learned the challenges and limitations of handicap. I witnessed firsthand the pervasiveness of disability in all of life’s domains, along with the inflexibility and harsh judgment passed by the society. This awareness has imparted me with a drive to serve others faced with such obstacles. I have also realized that only through focusing on ability can one hope to overcome or adjust to a disability. I believe that this exposure has helped me to maintain a broader, more holistic appreciation for the human rather than the constituent systems, and the individual rather than the disability. 

Through my volunteer work and through medical rotations, I have witnessed the unfortunate realities of neurologic impairment, along with the pain of knowing the limitations of science. Only through continued research and preventative education can we hope to overcome these afflictions. I teach the realities of drugs, gun violence, and high-risk behavior to children through my work with the Adopt-A-School program via lectures, presentations, role-playing, and field trips. Simultaneously, I have worked diligently throughout medical school researching the functional organization of the human brain and the implications of aging and disease through the use of Functional Magnetic Resonance Imaging. Only through understanding the active organization of the healthy brain, and its reorganization in response to aging and illness can we appreciate the mechanisms which underlie recovery of function after brain injury. Research is an integral part of my life and gives me much gratification; I have devoted a significant portion of my time before and during medical school to dozens of research studies leading to multiple publications and presentations. I plan on continuing these efforts through residency and beyond. 

Through my research, I have come to appreciate the need for increased empirical study within the field of Physiatry. I plan on devoting my research interests and abilities toward this requisite. I seek a residency program in an academic setting that promotes and supports resident research, while offering comprehensive clinical education in a dynamic teaching environment. I am interested in a program with a strong reputation that provides both inpatient and outpatient training opportunities in multiple clinical settings with ample procedure opportunities. The location of the program, the diversity of its population, the social and cultural changes outside of residency, along with the conduciveness of the setting toward the pursuit of my interests in distance running, road biking, hiking, mountain climbing, and scuba diving are all also important considerations. 

Indeed, having completed nearly twenty years of education to get to this point, I cannot wait to embark on my formal residency training in Physical Medicine and Rehabilitation. Not only have I come to realize the impact that I can have on people like Mark, but also the deep sense of enrichment that practicing Physiatry will bring to both my life and the lives of my patients.

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