I’m just a medical student – what can I do? I thought to myself as I was taking another history with a patient in the small Emergency Department of Louise Marshall Hospital in Mount Forest, Ontario. It was my first clinical experience in a rural setting as well as my first week of clerkship and the patient in front of me was worried about breast cancer. They also confided in me about some stressors they were experiencing at home for the past year. This patient looked at me with anxious yet trusting eyes and I wanted to help them, but I felt severely unqualified and worried about making things worse.

I still remember making the hour and a half long drive up to Mount Forest, to live for two weeks in a small town where I knew no one, and I could not stop anxious thoughts from crossing my mind. What if I disappointed my preceptor or made a mistake with a patient? And what if I did not belong there at all? Was I just a “big city” person with no place thinking I could fit in a rural town?

This was my second time coming to Mount Forest. I had been there once before for “Rural Skills Day” – a one-day event organized by the doctors to introduce medical students to rural medicine. Prior to that event I had never seriously thought about rural medicine as a career, mostly because I knew almost nothing about it. I am still surprised at how much one day can change everything. At Rural Skills Day, not only was I introduced to suturing, casting, intubating and interpreting chest x-rays for the first time, but I was also introduced to a rural community. The physicians were so kind and generous with their time, staying longer after lunch to answer my many, eager questions. They described how happy they felt there, able to work with a wide scope of practice, often with fewer resources than bigger centers have access to. And they told me how warm and welcoming a small town can be.

Suddenly, I was transported back to Ukraine, where I was born and grew up for six years in Zalishchyky – my grandmother’s village. It did not have fancy restaurants, highways, or even a Walmart, but it had large, green fields full of the tallest sunflowers I had ever seen and orchards with cherry, apple and apricot trees. It was the place where the neighbors would come over almost every day, giving no warning except our dog barking at the gate. My grandmother would always have tea brewing in the afternoon and some biscuits ready just in case they would come. It was the place where you would have a fire roaring most evenings and sit together with your family telling stories. I have often thought of that village since then and how much I missed its calm and peaceful atmosphere so different from living in Toronto for the next 17 years of my life.

Mount Forest, although bigger than my village, gave me the same feeling of warmth that day and I promised myself that I would come back there for a clerkship elective to experience rural medicine and decide if it is the right career path for me. Although I was incredibly nervous, I also felt excitement for how much I would see and learn over the next two weeks. I was fortunate enough to be staying with one of the residents and she was encouraging and helpful, guiding me through the next few days as I got settled in. I was surprised at how kind everyone was and I did not feel like an outsider at all. My preceptor checked in with me frequently, asking if I was feeling overwhelmed or what else I would like to be doing to achieve my learning objectives. Truthfully, it was better than I ever could have hoped for my first two weeks as a clerk.

I also continued to develop my passion for rural medicine. I have always loved variety and I got my fill at Louise Marshall Hospital. We saw inpatients every morning, went to the nursing home to see patients one day, then worked at the family medicine clinic other days and even worked at the emergency department. I was able to suture, perform joint injections and other procedures which I really enjoy. I was also lucky enough to have seen a patient discharged from the ward come back for follow up at the clinic – it was an incredible feeling to be part of such continuity of care and to get to know patients so well. I started to build confidence and would take histories independently.

It was on my second emergency shift that I was to see the patient worried about breast cancer. I took a few deep breaths before entering the room and then introduced myself and proceeded with asking the usual questions around symptoms, protective factors, past medical history and family history. However, medicine is both a science and an art and although I was still very inexperienced, I could sense that right now this patient needed my skills in the art aspect of medicine. I thought of the cases I had seen with my preceptor over the last week and let my experience guide me. I put my clipboard on the table in the room and took a seat beside the patient. I told them that it is normal to feel scared and overwhelmed at times and that we were there to help. I also assured them that it’s okay to take a break and look after yourself and then I invited them to discuss their stressors in more detail and listened intently. At the end of the visit, the patient smiled and thanked me. Although it was not much, I was able to help them feel a little better. And although I may be just a medical student, I learned that there is always something I can do.

By:  Ms. Anastasiya Lezhanska  - Hamilton, ON