Joanna Schneider '13
Student Director forBig Brother, Big Sister
Major: Sociology modified with Psychology; Minor in Chemistry
Other Campus Involvements: DOC; General Manager of Big Green Bus
Fun fact: She got involved in Big Brother, Big Sister in high school, over 7 years ago!
This summer I participated in the Dartmouth Partners in Community Service Program as an intern at New England Baptist Hospital. Although I spent much of my time within the walls of NEBH, the internship focused on the hospital's relation to the Boston community. Working out of the Community Relations department, I performed duties as varied as planning a Family Day for the Mission Hill Youth Collaborative to helping out with the Women's Health Network. The time that I spent within the hospital was invaluable in that I learned much about hospital functioning and administrative politics, but my work within the community was what made me feel productive and passionate about my internship.
I moved into my apartment five days before my first day of work, so I was able to get settled in and adjust to my new summer home. I lived with three other Dartmouth '05 women (Jess, Nicki, and Kelley), a Harvard law student (Jeff, a Dartmouth '02), and a Harvard undergraduate (David). The first time I saw the apartment was the day I moved in and I was very happy with the location and the set up: we lived in an old blue house on 7 Story Street that is a one minute walk from the Harvard Square T stop. I shared a room with Jess in the front of the house. We had a large beautiful bay window that lets in lots of sun. I love rooms full of natural light and I have had good living experiences with Jess before, so I knew this would be a great living situation. By the time Friday rolled around, I was getting anxious to start work: all my roommates kicked off their jobs and internships the prior week and I was getting lonely during the day.
Although I have, of course, lived "on my own" for the last three years in Hanover, something about this situation felt different. In my memory, I have always felt comfortable and at ease at Dartmouth, but perhaps I was nervous in the beginning. I spent my off term on campus working in a research lab and studying for the MCATS and during the summers I've either been living in my hometown or at school. I think one of things I would like to change most about myself is my inability, or perhaps just lack of confidence, to find my way around new places and feel comfortable doing so. This summer was the perfect opportunity to stick my feet in the water. I still had my three friends for help whenever I needed them, but Boston was a huge step from the Hanover and Potsdam small town comfort. My sense of direction is, um, less than desirable. In particular, I think this is something we develop when we learn to drive, which I have yet to do. However, at the close of my internship, I felt quite comfortable navigating Boston on my own.
The Sunday before my first day at New England Baptist Hospital (NEBH) I did a "practice run" to work. I had heard stories about the Roxbury area, that it wasn't one of the safest communities in Boston and that it had problems with crime and drugs. I set out of my journey, not quite sure what to expect. I wanted to time how long the commute would be, and confirm that I knew the route. I got on the red line at Harvard then changed to the E green line at Park Street. This all went very smoothly, though the clock was already at 40 minutes at this point. The last part of my journey to work consisted of a shuttle bus called the Mission Hill Link. This bus does not run on Sundays and I wasn't entirely sure where it stopped-and still now, I don't find it incredibly clear. At any rate, I was happy that getting to the bus stop was so straightforward and hoped the bus wouldn't add too much more time to the clock.
Sunday evening I proofread the first portion of my medical school application (the primaries). One applies to all of the schools at once though this central organization, AMCAS, and then each of the schools sends out individual secondaries. On Sunday, I sent out my primaries to 19 schools (the average Dartmouth applicant applies to 20!!). It felt good to have that taken care of before my first day at NEBH, but I think the feeling of loss of control when I sent it accompanied by my mild anxiety towards my first day of work (I always get nervous in new situations) made me have trouble sleeping that night.
Monday morning I hoped to arrive at work around 9, but left at 7:30 just to be sure I left myself ample time for getting lost. Unfortunately, that wasn't quite enough time. I arrived at the bus stop a little after 8:30 (I hadn't gotten lost, but it took more time than the day before because I had to wait quite a while when I switched trains at Park Street). This was unfortunate since the Mission Hill Link Bus was supposed to stop every half hour at the stop. I checked with the gas station attendant that this was in fact the bus stop and he confirmed that is was. Nine o'clock came and went and the bus did not come.
Around 9:15 another women started waiting with me. I started a conversation with her: she too was planning to take the bus to NEBH because she had a 9:45 appointment. At this point, my late-for-work-on-the-first-day anxiety had been realized and I was so glad to have someone with me who also wanted to go to the hospital. She was so friendly, and I know she could sense my worry and was trying to calm me down. Looking back, this situation is slightly ironic as this woman and I demonstrated a role reversal: here was a woman who was enrolled in the free breast health program, the very program I would help out with as part of my internship. During most of my encounters with these women they were untrusting and guarded. Yet on my first Monday morning I was confused and vulnerable, and the kind patient was looking after me.
Finally at 9:35 when the bus was still no where in sight, she said she was just going to walk and invited me to join her. I had no idea how to get to the hospital, save this mysterious bus, so I was extremely relieved and took her up on the offer. The walk turned out take about seven minutes all together. I think the reason most people opt for the bus instead is because the hospital is on a big hill, so most of the walk is up a large hill. This morning, we walked slowly and rested a few times, but the kind woman made it in time for her appointment.
When we got to the front door she wished me luck and told me not to worry; her smile and gentle words made me feel much better about the bad start to my first day. New England Baptist Hospital sits on the top of Parker Hill Avenue, a largely residential street filled with apartment complexes and split-family homes in various sates of disarray. I found my way to the Human Resources Office and met Janice Sullivan, my supervisor. I already knew a little bit about her from our phone conversations and email exchanges, and from reading the reflection papers at the Tucker Foundation. She was very understanding about my tardiness, but I still felt bad about the situation. She introduced me to a few of her co-workers and gave me a hospital tour. The hospital seemed so small and intimate; Janice knew everyone by name that we passed on our tour, and even later when I was exploring the grounds on my own, everyone smiled and made eye contact. And when I looked the slightest bit lost or confused, people went out of their way to ask me if I needed help finding something.
After the tour, I had to watch a safety video and pass the safety test. I also got my official NEBH ID badge. By this time it was close to noon so Janice and I went to meet Dr. Robbins, my alumni mentor, for lunch. We ate in a conference room and had food delivered from the cafeteria. Dr. Robbins is a '59 and partially retired; on this first encounter, I found him slightly intimidating. He asked me a few questions about Dartmouth and my major. Right away I felt that I didn't have anything in common with him because I am a Genetics major and he was a History major and he seemed really disappointed by this disparity. But looking back on the situation, I think I was just over analyzing everything and I think he's just quiet at first.
Dr. Robbins told me about some of the past interns and some of the other interesting programs at the hospital. He asked me why I found myself here in Boston this summer, and why specifically this internship. He told me some things he hoped I would do when I was in Boston: experience the Boston restaurant scene, go to the Museum of Fine Arts, visit the symphony building, attend Shakespeare in the Park and the Lion King, and watch the fireworks on the esplanade. As a girl on a budget, I knew I wouldn't get to everything on his list, but I would certainly keep them in mind. Dr. Robbins ended the meal by announcing he was heading to China for two weeks, and I was slightly disappointed that so much time would elapse before we would meet again, but I knew once I started getting into a routine, two weeks would go by quickly. He left me his phone numbers in case I needed to get in touch with him.
After lunch, Janice gave me a few information packets about some of the community programs I would be working with this summer and sent me on my way because Jane, the anesthesia technician supervisor, was golfing that afternoon. Not a bad first day, despite the shaky start.
Tuesday morning I decided against the bus and walked up the hill. It's definitely faster because you don't have to walk to the bus stop (which is in the opposite direction from the T-stop) and you don't have to time the rest of your commute perfectly. When I told my mom I thought I would walk every day instead of ride the bus, she worried that it might be dangerous walking in such an unsafe area, but I feel that it is no more dangerous than waiting for 15 minutes at a bus stop. Besides, I feel more in control when I'm walking purposefully to a destination rather than waiting passively for a bus that may or may not arrive.
When I arrived at the office, Janice got me started on one of the big projects I'd be working on this summer: the 9th Annual Walk for Health. She gave me the disk that contained all of last year's documents and I browsed it and printed off important information for my file until 11:00 am. I learned that the Walk for Health was started in 1997 as part of the celebration of the 75th anniversary of the Harvard School of Public Health. The Mission Hill Youth Collaborative works with the community agencies and local institutions to plan this annual event. Now in its 9th year, the Walk brings together residents, community-based organizations, and area institutions to promote the healthy development of youth and their families. The Walk also serves as a fundraiser to raise money for local youth serving agencies. Since the first Walk for Health, $300,000.00 has gone directly to support summer camps, after school programs, and athletic programs that support the development of the youth in Mission Hill.
At 11:00 we went to a Walk for Health Planning Committee meeting. When we arrived the committee informed us that they had decided at the last meeting to postpone the Walk for Health to the spring because they were having trouble organizing the event since the head of the committee had recently stepped down. Instead, at this meeting, we decided to plan a Family Day for the community in lieu of the Walk. This would serve to keep the community informed about our plans for the Walk and also as fun educational event for the youth of Mission Hill.
I was elected to the position of coordinator of the Mission Hill Youth Collaborative for the summer. This committee is made up of representatives from nine community agencies and several supporting institutions. The community agencies represented are the Mission Main Resident Service Corp., Mission SAFE, The Mission Hill After School Program/Summer Program, Roxbury Tenants of Harvard, Sociedad Latina, The Mission Hill School Parent's Council, Mission Hill Community Centers, Project LIFE, and Whittier Street Health Center. Representatives of Harvard School of Public Health, Harvard Medical School, Harvard School of Dental Medicine, Dana-Farber Cancer Institute, Wentworth Institute of Technology, Massachusetts College of Pharmacy and Health Sciences, and New England Baptist Hospital regularly sit on the planning committee.
As coordinator of the planning committee, I planned and facilitated the weekly meetings including our expenditures. I also oversaw the Outreach and Logistics sub-committees. I spent a long time making an easy to use mailing list. I invited all of the youth agencies, the institutions and businesses, and State Representative Sanchez via letters and phone calls to Family Day. I sought donations and ordered and organized the dinner, the games and carnival booths, the information tables, and the program. I wrote the follow up thank you letters and put together a binder of all my work and research towards organizing Family Day.
I believe that events such as the Mission Hill Walk for Health and the Family Day I planned are vital to the Mission Hill Community in that they strengthen the tie between the institutions and the community in two ways. The community gatherings themselves are an enjoyable day for all who attend and are very visible in the community. Additionally, they serve as an opportunity for neighborhood businesses and institutions to support the community financially through its youth programs. The Walk for Health and the Family Day benefit local community-based agencies, which provide year-round services to local underserved youth; also these events ensure that youth in Mission Hill have a safe environment where they can engage in educational, social, and recreational activities. All of the funds raised support library and computer equipment, athletic programs, academic achievement projects, and educational and recreational field trips.
Family Day was a great success and an excellent time to celebrate the past and gain vision for the future. We kicked off the gathering with carnival games, fun activities, and information booths hosted by local businesses and institutions. Maria Dominguez of Phillips Brooks House ran the program, with the help of Representative Sanchez who opened the program by offering his congratulations to the community. Maria recognized and thanked those who contributed to the Walk for Health in 2003. The program was followed by two excellent performances by Mission Hill Youth. We ended the evening with a chicken dinner, music, and more fun and games. The Family Day was well received by the community and the planning committee remarked that the event was successful in many ways. It was an absolutely beautiful summer day and the energy of the participants was fantastic. The visit by State Rep Jeffrey Sanchez was a sign of recognition of the Family Day as an important community event. There were fun games and activities for the young people in addition to health and information booths. The food was excellent in both its quality and quantity.
On Tuesdays I had the opportunity to help out with the Breast Health Service. In the past ten years, the Hospital has expanded and enhanced its programs in primary care and prevention with emphasis on the areas of breast cancer and cardiac disease. This effort focuses on underserved populations in the City of Boston, especially in the Roxbury community. The hospital works with the immediate neighborhood of Mission Hill and works with community agencies and residents on their continuing health needs assessments to find the most effective ways the Hospital can address our community's health.
Despite several years of concentrated outreach to women of color and poor women, there is still a disparity in breast cancer mortality rates between women in the general population compared to women of color and poor women. The Hospital launched a breast screening initiative in 1993 which expanded in 1998 to include the Women's Health Network. The goal of this program is to reach women of color, underinsured and underserved women, including older women, to reduce this disparity. The long-term goal is to increase early detection of breast and cervical cancer in order to reduce mortality rates.
The goal for Fiscal Year 2003 was to screen 90 women and the hospital screened 89, with significantly increased diversity of the patients. The percentage of African-America women screened more than doubled from 15% in FY 2002 to 36% in FY 2003. This can be attributed partially to the expansion of the provider pool to include a Haitian gynecologist.
Unfortunately, most of the time I was behind the scenes doing data entry and paper work. I was surprised to learn how much of a paper trail was involved in getting these women the health care they needed. There were so many boxes to fill in numbers and so many documents and excel spread sheets that had to be sent out to various providers and funders, it almost seemed like a waste of time. It really made me wonder about why hospitals and community health agencies function the way they do, and if there isn't a better way.
Many patients just did not show up for their scheduled appointments and those that did were often extremely apprehensive and nervous. Susan Judge-Burns, the nurse practitioner that conducts the exams would often get a refusal when she asked the women if I could be present for the exam, so often I just served as a receptionist or worked on data entry. In July, one woman in her late forties came to the clinic for the first cervical exam of her life. She smiled as I handed her the paperwork, but anxiety and mistrust were evident in her eyes. I mentioned that I was considering donating blood later that day; she told me she could not because she had the "sickle-trait". I explained that I had learned in a biology course that people with one sickle-cell anemia mutation are more protected from malaria. This patient was so fascinated by this fact that suddenly her expression softened and she opened up to me. I ended up giving her a mini-genetics lesson by sketching a punnett-square on the back of a flyer. Making connections such as this and having meaningful conversations with patients and community members made this internship worthwhile and exciting for me.
At times I was frustrated that I did not do more direct community service during this internship; such frustrations reaffirm my desire to go into clinical medicine where I will achieve direct patient contact. Although the administrative and organizational ends of community service are needed and often underestimated in terms of how much time and energy must go into a seemingly small event (like Family Day!), I find more personal satisfaction in the actual delivery of community services. This is something I should keep in mind because as a doctor, although there will certainly be opportunities for me to do direct community service, this internship has exposed to me that I will need to do lots of behind the scenes planning and organizing as well.
The other half of my internship consisted of helping out in the operating room. I worked with the anesthesia technicians, the support people for the anesthesiologists. I helped restock drawers between surgeries, cleaned cables and monitoring devices, and delivered tools and equipment to anesthesiologists in the operating rooms when they called for them. My afternoons in the OR fascinated me: the environment that I worked in was so unique and the pace was so fast that each day was a new learning experience. Constantly I was exposed to new surgeries, innovative perspectives, and different specialists. I observed a total hip replacement, the removal of part of a cancerous lung, and a pancreatoduodenectomy. Not only did the technical skill required leave an impression on me, but also the massive team effort poured into surgical operations specifically and medicine in general left me in awe. Nurses, doctors, and technicians worked in unison to make the operation go safely and smoothly.
Whether I am working at the bank, the library, the lab, or the OR, I find the people are my favorite part of the job. Case in point is anesthesiologist Dr. Daniels; he is fantastic. He is a stocky man of 5'6" who walks about grumbling, always looking for a misplaced clipboard or a spare pair of gloves. Whenever I observed him inducing a patient, he always explained a new aspect of the operation to me. He actively involved me in the induction process and his thoughtfulness extended to the patient though his gentle touch and kind voice. I asked him why anesthesiology and he said because anesthesiology is all about taking the pain away.
One afternoon I met seventy-three year old Mrs. Wood when she came to the OR for hip surgery. She rolled off the elevator and through the OR double doors, trembling and fearful, with her eyes squeezed shut and her fists clenched. Under her blue hair net I could see tight white curls piled atop her head and her nails were painted bright red. Dr. Daniels held her hand and brushed her head and murmured reassurances to her in attempt to calm her. The primary and overriding duty of the doctor is to their patient. Indeed, medicine is about the patient; about making them comfortable and healing them and taking away their pain. In that simple gesture, Dr. Daniels illuminated that for me. He focuses intently his patients; when I watch him, I know that is how I want to spend my professional life.
During the end of my internship I watched a pancreatoduodenectomy which is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct, with the reestablishment of continuity of the biliary, pancreatic, and gastrointestinal tract systems. The surgeon removed the pancreas and put it on the operating table and showed me the tumor. It was so tiny-smaller than my pinky finger nail. It's extraordinary knowing this woman will ultimately die of this small cluster of abnormal cells. The nurse explained to me that they were performing the surgery to alleviate the patient's discomfort, but unfortunately it would not heal her. Soon after the surgery, she would start an aggressive chemotherapy regime. It was sad knowing this 38 year old women was in the middle of a cancer battle and it made me wonder how I might deal with such a situation when I encounter it with my own patients years down the road. As I stood and observed in my scrubs in operating room 14, the emotional strain gave me a lot to think about: being exposed to a cancer patient whose case does not look very hopeful is difficult to accept.
Over the course of my ten week internship I met with Dr. Robbins, my alumni mentor, five times. I think this was a very important component of my internship. This relationship provided valuable opportunities for reflection on my experiences and their meaning, and Dr. Robbins and I also engaged in discussion about my life and career choices. I am a perspective medical student and in the process of applying to medical school; Dr. Robbins shared a lot of stories and advice with me regarding the road ahead. He also stressed that he wanted me not only to have a good experience working at the hospital, but also a good experience in Boston. I took his advice to heart and I visited the Museum of Fine Arts, spent an afternoon at the New England Aquarium, and went to the Lion King. I also watched the fire works and went to Much Ado About Nothing with my roommates. I think some of these endeavors I would have taken on, regardless of Dr. Robbins' interest; but challenging me to explore the area this summer was Dr. Robbins' way of reminding me to always look for new experiences and to take advantage of opportunities. This summer, he said, was about much more than nine to five.
The last, but certainly not least, quality that struck me about Dr. Robbins was his commitment to his community. He has always dedicated a lot of time and money to community projects and is responsible for a lot of the community outreach at NEBH. In our last meeting, I wrote thank you notes to Dr. Robbins, Jane Kelley, and Janice Sullivan, sharing with them how the experience has changed me and how much I appreciated the opportunity. I also wrote a special note to my favorite OR tech, Norma. Norma and I became very close during the internship. She really appreciated my presence as she is the only female on the staff. We got to know each other well and we went out to dinner together on my last night in Boston. Norma is kind and bright and I really hope she finds the courage to pursue her goal of nursing school, where I know she will succeed.
My role was not clearly defined at the beginning of my internship. I had hoped to make more direct community contacts and to work more in the Breast Health Project. This frustration, however, did have a purpose: I did learn a lot about how a hospital is run and how much is involved in the planning side of community service. This summer, I have grown and gotten in touch with a world outside of Dartmouth. The challenges that I faced and the rewards that I received reaffirmed and expanded my interest in my community and my knowledge that I want to continue to serve my community. In ten years, I envision myself using my skills as a doctor to aid my community by sharing knowledge and information about women's health and offering a service similar to the Women's Health Network to underserved women. This internship stimulated both reflection and action regarding good citizenship and service to others and has reaffirmed my strong desire to pursue a career in medicine.
At the conclusion of my internship, I am able to look back and feel that I had done something meaningful. I have been given the opportunity to see surgeries I never would have seen, to be close enough to touch the operating table. I was exposed to medically underserved women and the poor Mission Hill Community and learned that caring, well-thought out guidance and service can make a difference. Observing the doctors and being in a medical environment reaffirmed for me that medicine is such an amazing field; it's one of the most honorable professions. The practice of medicine offers a daily sense of fulfillment that is rare. As a lifelong commitment to society, the medical profession most completely encompasses my career goals and moral values. I believe that one of the greatest joys and privileges of physicians are their abilities to directly aid and affect their communities.
Last Updated: 8/7/11