Saturday, September 1, 2018

The Yachats Gazette, Issue 84, September 1 2018


Dr. Stephanie Bosch is a family practice physician. She recently finished her residency in Corvallis, Oregon, and has joined the medical staff full-time at the Samaritan Waldport Clinic.

TYG: So what brought you into medicine?
Stephanie: I have written essays about that question at least five times in my life, and yet every time I'm asked it, I always have to review the entire story in my head to remember, and really be able to articulate why. [pause] So, as I remember it—my Dad will tell a different story—I decided to go into medicine in the tenth grade, because what I would watch after school on the television when my homework was done, was re-runs of M*A*S*H*...

TYG: I'm afraid I don't know that show.
Stephanie: I don't know if this makes sense, if you don't know what M*A*S*H* is. M*A*S*H* is a show from the 70's, and it takes place during the Korean War, but it was filmed during the Vietnam War. So a lot of the show is honestly commentary on the Vietnam War. It takes place in Korea at a Mobile Army Surgical Hospital (MASH). So it's a hospital unit of the army that is generally stationed for a long period in one-ish place, and gets wounded soldiers, and there are doctors there that fix them up real quick and try to get them to a safer place. One of the several main characters was Benjamin Franklin Pierce, who goes by "Hawkeye." I think he was a cardiothoracic surgeon from somewhere in New England. And he, like most of the male cast, was drafted into the army to serve in the war, and he was really bitter about it. [...] In general he's a pacifist, so throughout the show he [wonders], "Why is this war going on? This is a hellish place we're in. All these people are being killed. There's very little I can do for my patients here, because they come to me busted up and dying, and I have to try and put band-aids on them to keep them alive enough to get them to a higher level of care that can take care of them." You could say he's the main character. And so a lot of the show is dealing with his mental / emotional / moral struggles of being a physician during the Korean War.

So, the point of all of this: I'm in tenth grade, for the most part I've finished my homework at school or I don't have much, and I'm watching television because that's what I do, and I'm watching one to two hours of M*A*S*H* re-runs every day. [laughs] So what I'm seeing is this character that is in a terrible situation, someplace he doesn't want to be, doing what he views is this kind of bastardization of what he thought his job was—he didn't go into medicine to try and perform what he called "meatball surgery," he went into medicine to actually make a difference in people's lives. And there are other characters in that show—they had their own reasons for going into medicine; some of them were drafted, some of them were career Army, many of them physician characters.

But throughout all this complaining about the terrible situation he's in, he's always the very first one that, if something's going wrong [and somebody else suggests], "Okay, we should give up on this person, they're just going to die anyway;" or, "Hey, there's this enemy soldier over here that's in poor health, but they're an enemy soldier, let's just let them die;" or "There are some Korean citizens over here, and they may not be enemy soldiers, but we're here to help the Army kids, not any of them" kind of thing—he's always the first one to be like, "No! That person's a human being. I am here to help them." And there are multiple instances throughout the show where he's like, "We're in this monstrous situation and I hate it here," but he never lets that dampen his compassion and his humanity.

TYG: Quite the doctor!
Stephanie: Yes! And so at a time when I was like, "I don't know what the heck I want to do with my life," I was really interested in the sciences, I was just getting into social justice movements through my church at the time, I'm watching this guy on television in a less-than-ideal situation, not letting it stop him from being a very compassionate human being. So essentially, it's my recollection that at that point I decided, "Hey, maybe medicine would be pretty cool. That's the person I want to be, that's who I want to emulate." So... yeah. That's what brought me into medicine. [laughs] So I decided to go into it, and I spent the next decade working toward it.

TYG: Yes, it's not a short career path.
Stephanie: No. So part of that drive, as I said, was wanting to emulate that fiercely compassionate character, and I alternated on what I wanted to be in medicine various times. I was set on doctor, but what specialty? At one point I wanted to go into infectious disease, because I'd read The Hot Zone and I was like, "Man, I want to work for the CDC and do a bunch of research." [laughs] At one point, I wanted to be a pulmonologist, because my grandmother was dying because of complications due to emphysema. But when it came time to actually choose what I wanted to go into, which happens the third or fourth year of medical school—and in part the design of medical rotations is to help with this, to get a flavoring of what different specialties and practices are like—I realized that though the TV characters that inspired me are generally surgeons, the kind of medicine I want to practice is really embodied best by family practice. He may have been a surgeon, but Hawkeye would have been a phenomenal family doc. [...]

And then the other one... [laughs ruefully] This one is actually harder for me to leave in the conversation. It's actually two television characters that inspired me to go into medicine. And this was the absolute hardest part of writing medical school essays... "Man, they're going to really turn their nose up at the fact that I watched so much television as a child!" But that's where I drew inspiration from. Though it's not actually the TV version. It was Dr. Leonard H. McCoy from Star Trek.

TYG: Oh! But that makes sense! [laughs] 
Stephanie: They're very similar characters. McCoy is not necessarily in a constantly awful situation, but he is often in terrible situations where he has to make hard medical decisions and the very first thing he lets guide his medical decision-making, is, "What is the most compassionate thing to do? How can I save as many people as possible in the best way possible?" I've never really watched much of the original series, because when I try to watch it it's kind of boring. It pains me to admit that—I love the movies, but I hate the TV series—I don't hate it, but... [ensues a long conversation on the merits of various Star Trek series and spin-offs] 

TYG: So, what brought you to this area? 
Stephanie: I moved to Oregon for residency, having gone to high school and medical school in Texas. I really liked Oregon. I decided, once I was here, that I didn't want to leave. So then it was a matter of, "Hey, how where can I find a job that fits my needs that's still in Oregon?" Preferably in the western half, because I'm not really fond of it when white stuff falls from the sky and it gets too cold. So yes—after residency I was looking for a job where I could see a variety of age groups, not just adults but also kids. I wanted a practice where I could do a variety of procedures. And then this one popped up! I'd done residency with Samaritan, so I already knew how Samaritan worked, and when I was looking at jobs in the Samaritan system, the one in Waldport was the one that fit me best. Living by the ocean is pretty sweet. I do like that the weather is not in the 90s right now, and my understanding is that it doesn't get in the 20s, either.

TYG: I've never heard of it going [that low]. We've gotten some snow a few times, though!
Stephanie: Well that happens everywhere. I've lived in a desert in California and we've gotten snow a couple of times. [...]

TYG-Editorial Assistant: So what do you like about Oregon?
Stephanie: A number of things. I like that it's a blue state, and I like that it's a green state. I like that within a relatively short time you can be in a variety of different climates. I grew up in California, and that's one of the things I missed about California. Living in Bakersfield...

TYG-EA: [winces] Ooh.
Stephanie: The great thing about being from Bakersfield is that you're no longer there. But, you are an hour and a half from the coast, an hour and a half from some nice places in the mountains, and an hour and a half from some gorgeous desert. [...] And now, Bend is maybe five hours from here? I want to say three-ish from where I was in Albany. Having lived a significant amount of time in Texas, that's nothing.

TYG: It's a beautiful drive, as well!
Stephanie: It's a lovely drive. Whereas in Texas, it would be a hideous drive. So yes—[Oregon] is a gorgeous state that has people who are genuinely friendly and don't take themselves too seriously, as frequent friends of socks and sandals have shown.

TYG-EA: Very informal culture.
Stephanie: Which I like! [...]

TYG: How has the job been going so far?
Stephanie: It's going well. We're still working out some kinks. I'm not able yet to do all the procedures I'd like, because we don't have the materials. I have a particular interest in women's health; I'm able to place long-acting, reversible contraception, and we just don't have that available in the clinic yet. But once it's there, which we're working on, I'll be able to do that. Which is actually one of the things that drew me to the clinic, because I understand that there's a lack of it there. I thought, "Hey, I get to do it!" Other than that, it's going really well. We have a great group there. People allow me to make jokes. [laughter]

TYG: I'm so happy that docs like you are finally starting to move in. My dad's worked at the clinic for a long time. And for so long it's been so under-staffed and under-tech-ed, so having this is so nice. Finally now, thank goodness, the Samaritan residency program is starting to come on-line. So it's finally allowing a lot of places like Waldport and Newport to get the people they need.
Stephanie: Totally. [everybody knocks on wood] Our residency program, I want to say—I'd have to look it up to be sure—I think this is currently their tenth year. And the vast majority of residents that have graduated have stayed in the state of Oregon, which was one of the main purposes—to keep them in the area. And quite a number of them have stayed with Samaritan in its various locations. So I think it's doing a pretty good job.

TYG-EA: How did you come to choose the residency program in Oregon?
Stephanie: This is kind of harkening back to an earlier question. So I decided "family practice," and then I said, "Okay, where do I want to do my family practice residency?" The very first criterion, the most important, was that it was not in Texas. I had a number two and three that were pretty important, but I can't remember at this point. Oh, I guess I didn't want it to be in a giant city. Having lived in a number of major metropolitan areas, I'm not particularly fond of it. First I started looking on the West Coast—as I said, I grew up in California. I'm a D.O., so [...] I decided to apply just to D.O. programs, and ones that were "dual accredited," so accredited by both [M.D. and D.O. agencies]. In California, most of those programs are around major cities, so like in the L.A. metroplex or others, and I just had no interest in living near L.A. So I ended up spreading out along the West Coast: California, Washington, Oregon. Wyoming sounded like a nice place, Colorado, Montana. And then I was like, "Sure, I'll try the East Coast as well." Technically I was born on the East Coast, but I don't remember anything about Virginia. So I [thought] I'd try in the New England area, because they're pretty blue. So I ended up interviewing at places in Washington, Oregon, Wyoming, a whole bunch of places in New York state, New Hampshire, and Maine. My top two programs, the two that I was [choosing between, were] the program in Corvallis, and the one in Bangor, Maine—so, opposite sides of the country. [Maine] still does sound like a phenomenal state, and I'd love to visit again. They had a phenomenal program, but I'm really glad I ranked Corvallis number one and made it into [the program]. So, I think the question was, "Why the Corvallis program?" It was a phenomenal program with phenomenal people. When I interviewed there, everyone seemed like a big, supportive family. Considering my closest relatives are in southern California, [that] was really important to me. [And it was] in a beautiful state, that wasn't Texas.

TYG-EA: What made, or makes it, a phenomenal program?
Stephanie: Part of it is the sort of family-like feel that we have. The entire program was, and remained, and continues to be, run sort of with the idea that the residents are in one of the best positions to find what the weaknesses are in the program, so "Hey, let's listen to them about what these weaknesses are." And then residents and faculty all work as a team to fix it.

TYG: That's especially nice if it works.
Stephanie: Oh, it does! I thought the program was really great going into it, and by the time I graduated, I [thought it] was an even better program, and it's going to be even better within the next three to five years, once we see how it's going to improve and offer even better education for its residents. So you have this supportive environment to learn in, which is the best kind of learning environment; you have a hospital that gets a variety of patients and that is decently large without being so enormous that you can get entirely overwhelmed by patient load. You can still get overwhelmed, but it's not like the weight of a state hospital system is resting on your shoulders kind of thing. When I was going into it, I was looking at the availability of [obstetrics] training as a plus, because I was considering doing OB as part of family practice, which I eventually decided not to. At that point, you could use electives and get a decent amount of OB experience. I think those things: a variety of electives, the ability to take a variety of electives, so you could identify your own weaknesses and fill those; as opposed to a lot of programs where you have very few electives so you don't get a lot of that flexibility of education. I was one of the first residents that started out from the onset in our three separate continuity clinic locations; the Corvallis residency is centered in Corvallis, so that's where your residency is, but we have "continuity clinics" that the residents do there, [which means] seeing your own patients as part of your residency, and "your clinic" as opposed to going to somebody else's clinic and watching, or helping them do their thing. Mine was in Albany; there's another one in Lebanon. I was excited about the opportunity to help start that, and blossom that for the program. Because there had been residents that were brought into those clinics, in their second and third years, but I was one of the ones that started out there first year and was there all three.

TYG-EA: So how does it feel to be completely out of the nest?
Stephanie: There are some things that are like, "Yeah, this is awesome!" For example, when I can just sign an order and I don't have to co-sign it with anyone, or I don't have to co-sign my notes with anyone—I just do things without having to go through the rigmarole of double-checking things, particularly when I already know the answer and I know I can just do this thing. But then it's also terrifying in that I don't have anyone double-checking all my work! [laughs] 

TYG-EA: That is one of the reassuring things about being a PA; I'm required to have my supervising physician sign off on at least ten per cent of my chart notes, so I make it a point to send him all of the notes about situations that are a little weird, or a little bit touchy, or a little bit risky—I make sure that somebody else is taking a look at these less-than-ideal situations. 
Stephanie: Which is another thing that I kind of really like about our clinic, which is that I have multiple times now just peeked my head into people's office doors or banged on the office doors and like "Hey! There's this weird thing! Tell me if the decision I made sounds legit to you, or if it was shady!" [laughs] So there's the reassurance of, "No, no, that sounds pretty reasonable."

TYG-EA: It's been a very supportive environment. How much of that is our particular group versus Samaritan, I don't know, not having worked in primary care for other Samaritan [offices]. But there's a very nice tone there. 
Stephanie: And having only ever worked in resident groups as part of Samaritan, once again, having chosen the residency based on that kind of support, I like to think it's a Samaritan culture kind of thing. Partially because, not even in primary care, but working with specialists, just how interested and involved they are in teaching residents, that you have to have some kind of openness to questions and support in order to be able to do that effectively.

TYG-EA: There isn't a hazing culture.
Stephanie: No.

TYG-EA: I've experienced that elsewhere during my training, and I certainly see products of it elsewhere, with providers who grew up in that hazing culture, and seeing how that behavior continues. 
Stephanie: "I went through this, so you have to go through this too."

TYG-EA: Right. [...] So, I'd be interested to hear why you chose not to do obstetrics in family practice, and also the things that you are doing that may be a little special. 
Stephanie: In the end, I chose not to do obstetrics partially because it takes a lot of effort and a lot of time, and I already don't sleep very well.

TYG-EA: You'd probably get a lot of calls in the middle of the night.
Stephanie: Yes. A lot of calls in the middle of the night. And it's not just a simple answer, or a simple "Let's go and evaluate the patient." Obstetrics is you stay with the patient, and you continually evaluate them, for hours. It's very stressful and overwhelming. Is it a phenomenal feeling to catch a baby? Yes. Is it a phenomenal feeling to be able to go with a mother or a set of parents on this journey of their little fetus-nugget growing, and they get to hit all these benchmarks even in utero and learn all these new things even if it's their third or fourth or whatever child? Yes... but I really like sleeping. [laughs] 

TYG-EA: I suppose if obstetrics is most of what you do, you can schedule things around your call day. But if you're trying to do that...
Stephanie: In addition to family practice...

TYG-EA: Right.
Stephanie: It's a lot harder to juggle in family practice than when you're primarily an obstetrician.

TYG-EA: Two different kinds of work, with two completely different schedule types. 
Stephanie: As for the second part of your question, I did mention earlier that I have a particular interest in women's health, and that includes things like cervical cancer screening, making sure women are up-to-date on breast cancer screening, and also just contraception management, because there's a wide variety. In this country, in this modern world, if a woman does not want to get pregnant, she does not have to get pregnant—it is preventable. I particularly enjoy opening people's eyes to the variety of ways that you can plan pregnancy for when it's convenient to you, or not have one if it's never convenient to you.

So what I was talking about earlier, the LARCs—the long-acting reversible contraceptives, which are things like Nexplanon and inter-uterine devices. Essentially, these are forms of contraception that are one way or another put in a woman's body, and they provide anywhere from three to five years, depending on the type, of really reliable birth control. You don't have to remember to take a pill, you don't have to remember to put on a patch, or remember to get a shot every three months, or anything like that. It's like it's there for this period of time, it offers extremely reliable—and I'm talking about 98-99.5%—effectivity. And the other thing is that it's long-acting, but also reversible. So the Nexplanon, for example, is the little rod thing that goes in a woman's arm. Say a woman has it in there for a year and a half, and says, "Well, I'm ready to get pregnant now." Well, we just take it out and she can get pregnant pretty darn quickly after that!

TYG: Simple enough... 
Stephanie: Yes! Same thing with the IUDs. The Mirena is the five year hormonal IUD. Say she has it in for three years, and is like, "Man, I want to get pregnant. I'm ready now, we're planning this." We can just take it out and she can get pregnant pretty quickly afterward. Totally reversible. So yes—they're super-effective, generally really safe, long-acting, reversible forms of birth control. I'm just a big proponent of it because of all those reasons. I'll be the only one in our clinic doing those. It's my understanding that you previously had to be referred to the women's clinic in Newport. And it's my understanding that Nickki [Dorr, FNP] wants to learn how to do the Nexplanon and the IUDs as well, so hopefully, eventually we'll have two of us who can do that. Just makes it easier for the women in the Waldport area, who find it difficult to get up to Newport—it makes it more accessible for them.

TYG-EA: So, outside of the office, what do you really enjoy?
Stephanie: I like reading—mainly fiction, but as you can see, also some non-fiction, mainly along the revolutionary war era; histories, but not like the super-dry textbook history, but the "I wrote it kind of in the form of a story" type history.

TYG: David McCullough! Fantastic for that sort of thing. He's written loads of histories about that period, like big, 600-page histories—fascinating. 
Stephanie: Not like "date," and then "this done on this date"...

TYG: No, not at all. 
TYG-EA: Great biography of John Adams. 
TYG: And George Washington as well.
Stephanie: I watch a large amount of Netflix as well. [laughs] Videogames. I'm a very casual gamer. Some casual gamers will say, "You seem more hard-core than me!" But I'm comparing myself to my three brothers, who are steeped above their heads in videogame culture.

TYG: I definitely call myself a casual gamer. I know a few tricks. 
Stephanie: I play a game, off and on, every once in a while, for ages, until I get bored with it, and then I'll start a second game. Whereas all my brothers seem to be playing in-depth, super-intense, five games at once. I'm like, "I don't understand how you have time for this!"

TYG: Well, they might have the time because they don't do anything else.
Stephanie: Exactly. Let's see... I collect unicorn-themed items. What you see is the smallest modicum of my unicorn collection—most of it is still packed away. [laughs] And tea. Tea is a hobby of mine. I have a collection of teas. I have a collection of tea cups, a collection of tea pots, a collection of tea-making things; a lot of tea-related paraphernalia.

TYG-EA: Have you been to the Green Salmon in Yachats? 
Stephanie: I have not!

TYG: Probably the best tea place around. 
Stephanie: It's a tea place? I thought it was a restaurant!

TYG-EA: It's also a coffee place. It's also a bakery. 
Stephanie: There's also a place in Seal Rock—La Faye Art Studios.

TYG-EA: Was there anything else you wanted to talk about?
Stephanie: It's super worthwhile to adopt a senior dog, because they're cute and calm and generally already trained.

TYG: Thank you so much for your time!


September 9, 2018
Drive Electric Yachats  is a one-day  free event, Sunday  Sept. 9, starting 10 AM at the Yachats Commons Picnic Shelter. This year’s event includes a free showing of the movie Revenge of the Electric Car.

Drive Electric Yachats is part of National Drive Electric Week, September 8–16, 2018, a nationwide celebration to heighten awareness of today's widespread availability of plug-in vehicles and highlight the benefits of all-electric and plug-in hybrid-electric cars, trucks, motorcycles, and more.

From 10 AM to 3 PM you can visit and speak with local electric vehicle owners. Look under the hood. You will be surprised. Try a test drive and learn more about this new  rapidly changing  technology. Electric vehicles  are fun to drive, are less expensive and more convenient to fuel than gasoline vehicles. EV’s are better for the environment, promote jobs, and reduce our dependence on foreign oil. Are you considering going electric? Come talk to owners who have successfully done so.


As part of their 75th  anniversary  celebrations,  Central Lincoln PUD is sponsoring a free showing of the highly praised, 88 minute film Revenge of the Electric Car. Revenge follows four entrepreneurs from 2007 through the end of 2010 as they fight to bring the electric car back to the world market in the midst of the 2008 global recession. The documentary premiered at the 2011 Tribeca Film Festival on Earth Day, April 22, 2011.

We are still looking for EV owners who are willing to let a novice explore  their car. It is your decision what you allow guests do with your electric vehicle: look at it, sit in it, ride in it, or drive it.

If you are an EV owner and wish to sign up and show off and share  your EV, please sign up at: . National Drive Electric Week is presented by Plug In America, Sierra Club, and Electric Auto Association. Drive Electric Yachats is produced by Polly Plumb Productions, and  sponsored by the Drift Inn Hotel and Restaurant, the Yachats Chamber of Commerce, and Central Lincoln PUD.

For more information  call 541-968-6089, or  contact

Find us on Facebook:  Drive Electric Yachats


Get your tickets now for the 18th Yachats Celtic Music Festival, Friday through Sunday, November 9-11, at the Yachats Commons and other venues around town. Plans include day and night time events including concerts, dances, stories, talks, whiskey tasting, workshops, vendors, the sunset “Piper on the Point,” plus surprises, with a variety of free and paid activities scheduled.

The early Friday noon opening was very popular last year, and that is planned again. This creates an opportunity to enjoy live music and have a Celtic inspired snack or beverage before the afternoon concerts begin. All ages are welcome at most events.