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Student Notebook

Adventures in Asia

By Katherine Kosman

Everything prepares us for the journey ahead. My path to Dartmouth Medical School was not direct, but instead followed a road less traveled. After earning an undergraduate degree in electrical engineering, I spent four years working in industry as a risk manager before answering the call to serve others as a doctor. I bravely exchanged my employee ID for a crisp Dartmouth Medical School white coat. And so my new journey began.

Duringmy first year at Dartmouth Medical School, in March 2008, I traveled to Vietnam as part of a small team led by Dr. Joseph Rosen, a DMS plastic surgeon. We journeyed to a rural hospital in Thai Nguyen to test a telemedicine ultrasound system. This technology will help link the radiology departments at regional hospitals in Vietnamto one another as well as to experts at Dartmouth's Thayer School of Engineering. In addition, the team worked in Hanoi, doing pediatric hand and craniofacial surgery, including fixingmany cleft palates, birth malformations, and poorly healed injuries.

Kerosene: I will never forget a 12-year-old girl who had been badly burned while carrying kerosene to a fire. I was surprised and saddened to hear that the accident had happened many years before and that she was just then getting care—abdominal skin grafts—to repair the wounds that had deformed her entire face and hands. As I got to know patients beyond their case descriptions, I grew to love the patient visits as much as the surgery itself.

Seeing us enter a room in our white coats, children's parents would smile and nod, anxious for our help. One afternoon, a mother sat on a hospital cot and held her small son, who had multiple deformities. She extended his little hand and, to demonstrate that his fingers were solidly fused together, drew her finger between each of his as if to ask if we'd be able to recraft his hand. Though it is possible to surgically liberate fused fingers and to remold a deformed face, the risks of surgery that day on that boy were too great. He had a cold, and there was something about his chest x-ray that concerned the medical team. As the mother watched the doctors frown and shake their heads, her expression said that she knew—even without translation—that they weren't going to be able to help her son that day. The doctors moved to the next room and called me to follow, but my shoes were glued to the floor. I had looked back and seen the mother sobbing.

Who knew risk management could be so heartbreaking? It was in that moment that I saw my past, present, and future lives merge into one: the past of my analytical engineering training and the risk and opportunity management seminars I'd once taught, the present ofmymedical school student status, and a future filled with the responsibilities and privileges of my new field. I suddenly realized there is no greater motivation than a life of service.

As painful as making patient rounds could be, it was extraordinarily rewarding to revisit patients we had been able to help and to see them slowly recovering and healing. As we removed the bandages from one particular patient, I was inspired when I learned from a Vietnamese doctor that our patient was an amazing gradeschool teacher in spite of her facial deformities.

Crowded: The patients never complained about their situations, their pain, or the crowded hospital rooms they shared, often with five other families. I toured the neonatal department and saw incubators holding three infants nestled side by side. I peered into pediatric oncology rooms to see six or more patient beds, little children everywhere, and a single doctor sitting at a wooden desk in the middle of the room, frantically but carefully composing a handwritten note.

Since returning to the U.S., I have wrestled to come to terms with the sensory overload from my Vietnam experience. Our luggage was lost by the airline on our trip home, so I returned with only a backpack, a camera full of photographs, and a gift of a hospital lapel pin from our rural ultrasound visit. In many ways, it was a blessing to travel lighter as I reflected on my wealth of new experiences: the endless number of one-room shops filled ceiling to floor, the rhythm of the haphazard motorcycle traffic, the poverty, the manual laborers in rice fields, the hospital courtyards crowded with patients waiting for care. I am sure that we could have worked endlessly, day and night, for much longer and still not have helped all the little kids who needed us. Remembering the families and children crammed into a single hospital room, I wonder about the balance in medicine. How do we keep humanism, compassion, and heart in medicine and not drown in the unbearable pain and suffering we witness along the way?

Avenues: As I drafted these thoughts on the bus ride back to Dartmouth, I felt gratitude for these experiences, which better preparedme for the road ahead. I was looking forward to continuing to learn at DMS and to working as a Schweitzer Fellow at the local Good Neighbor Health Clinic. And I anticipate other business and engineering avenues opening up at Dartmouth asmy past, present, and future paths merge into the one I will someday walk as a doctor.

Reaching into my backpack during that bus ride back to campus, I found a small blue box. It contained the tiny gold hospital lapel pin—perfectly designed for a white coat—bearing a Vietnamese inscription. I looked out of the bus window at the nearly empty highway rolling across the New Hampshire hills. I couldn't help but smile. There is no journey more rewarding than a road less traveled.

The Student Notebook essay offers insight into the activities or opinions of students and trainees. After earning a B.S. in electrical engineering at Washington University in St. Louis, Kosman was employed for four years as a risk and opportunity manager at the Raytheon Company. She is now a second-year student at Dartmouth Medical School. To read about another outcome of DMS's presence in Vietnam, see the story "When bad things happen to a 'good person'."

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