To the Editor:
I wake up in the morning to the clucking of chickens. The sun is rising, peaking up above the trees as I stumble down the stairs and out into the yard. The “ladies” rush to the edge of their fenced enclosure and watch me, closely. I almost fall on the dew-covered grass as I step into the wooden shower covered by honeysuckle and green twisting vines, 15 pairs of eyes still observing carefully. They flock to the shelf in their coop, where they can see me standing in the shower. I challenge their gaze with my own, hoping they’ll look away as I attempt to start the shower. They refuse and I give up on modesty.
After a quick rinse off, I hobble back up the grass and stairs. I pull on my biking outfit, covered in dirt and grime, hesitant to use extra electricity for the washer on this self-sustaining homestead. My backpack is ready with poncho, water bottle, bike lock, journal, and psychiatry textbooks. I hit the road. I wave to my wonderful host family, reading at the picnic table and working in the garden, as I turn my bicycle down thewinding drive.
Thirty-five minutes later, past a bakery, five lamas, one farm, and some ups, downs, and arounds on a washboard dirt road, I arrive at Island Counseling Center. I see a client pulling into the parking lot. “Hey doc,” he waves and smiles widely. I do the same. Every time I see him he is smiling, hopeful. It is contagious.
The secretary is used to my arrival, hot from the 80-degree weather of July, covered in grease and dust from the road. She smiles warmly as I punch in the door code and head to the bathroom to transform into my medical student self. This only requires a new outfit and an ID badge, no white coat necessary, thank goodness. I like when my identity is preserved.
Some days I’m with the psychiatrist, others with social workers or mental health counselors. Often there is an evening group that I attend with individuals dealing with substance abuse or alcohol addiction. Yesterday, Idid a home visit and play therapy at a local park. This evening I’m hoping to take part in a therapeutic drumming circle for adolescent boys. During arare pause in the day, I wander into an office and inquire on good reading materials. Within a couple of days, I have a stack of interesting books on subjects not taught in medical school, like adventure therapy, attachmenttheory, and cognitive behavioral therapy for pediatric trauma.
My phone rings and a lovely counselor down the hall offers to take me to the Wampanoag reservation to visit an elder. I nod, hopeful to improve my understanding of mental health issues facing the tribal members here on the Island.
I check-in with the psychiatrist and discover that he will be doing an intake with a new pediatric patient and her family later in the afternoon. He encourages me to join the discussion when I return, welcoming me to ask questions during the interview. The center’s program director walks up to me holding an article from the recent “Psychiatry Today” about the challenges facing practitioners in the field, curious to see what I think. This is a sampling of Island Counseling Center.
Four weeks of incredible learning. Each day unique, a new opportunity. I acquire knowledge and skills not taught in the pre-clinical years of medical school or in my third year psychiatry rotation. The discussions about systems of care in a rural community and how they connect suddenly make so much more sense to me. I appreciate the interchange between each health care professional with different training, combining perspectives and knowledge sets to provide optimal care.
Martha’s Vineyard is a special place with providers that are dedicated to the wellbeing of their clients. Everyone knows everyone else. These are not the summer residents. These are the families that have lived on-Island for years. This dedication to patient care and compassion fills my mind with an eagerness to learn, engage, and support. I start to get to know patients and recognize family names. From play therapy on the floor with Legos to the psychiatric medication visits to the philosophic discussions on how toapproach therapy and intentionality, I love every moment.
One night I will never forget, I go to the veteran’s support group, a session held for two hours, once a week, attended mostly by Vietnam veterans. That night changed my life. To hear and see the stories and bearwitness to the courage and grace with which these men live their lives after the suffering they’ve experienced and continue to face. I didn’t sleep that night. I couldn’t. I’d never seen this side of war before.
As I walked toward the ferry heading home at the end of the rotation, my mind thinks through many things. Being a student doctor interested in a future leadership position at a rural community mental health center, thisis a big step in my personal and professional development and education.
This is the model that deeply resonates with me and is actually changing lives. I hope someday to return to Martha’s Vineyard for longer than one month with my medical degree in my back pocket, a residency completed, and my bicycle with a light to better see the path ahead on those poorly lit Island roads.
Thank you Island Counseling Center. Thank you to all the people who let me learn from their personal experiences and stories. Thank you to all the Islanders who welcomed me with so much warmth andallowed me to learn and thrive in your community.
Yet another dream made possible.
Megan Furnari is a fourth year medical student at the University of Massachusetts Medical School and a participant in the Rural Scholar’s program.