20 questions with… a medical student!

Aw, sweet little Kena Lackman. She lives just down the road from us here in the Pease Bottom and I babysit her and her little twin brothers. It’s so cute — she and her best friend, Morgan, dream of being doctors when they grow up!

Wait. Fast-forward 15 years to reality:  Kena Lackman is all grown up now, for real, and she and her best friend Morgan really are doctors! (Or, at least, they’re very close to being done with med school, in Kena’s case, and residency, in Morgan’s case.)

This little Montana town that we girls all grew up in has proudly graduated several future MDs. Because my sister Sue is one of them, I’ve got a little bit of an insider’s scoop on what the journey from rural Montana to Dr. looks like. But I’d bet many people aren’t apprised of the details — and because we all, at one point or another throughout a lifetime, will work closely with and/or depend on a physician, I figure it wouldn’t hurt a bit to get acquainted with the circumstances from which young doctors are coming these days.  (I think you’ll find, if you keep reading, that Kena is the sort of doc you’d be relieved and encouraged to cross paths with.)

Plus, little Kena just makes such a cute interview subject:


Oops, sorry — slipped back to 1995 again there!  These days I can attest that Kena is as golden on the inside as she is on the outside.

(In the background of this photo is the Yellowstone Valley sugarbeet farm where Kena was raised.)

Without further ado, the 20 questions I asked Kena before she recently jetted off to Costa Rica to celebrate the completion of the last exam of her medical school career.  (While she’s in Costa Rica, she’ll be helping a host family and polishing up on her Spanish.  One thing about med school… it’s where students learn to work even when they’re having fun!)

1. Hi, Kena!  We got this interview process rolling right around Christmas, so I asked you to describe a special holiday tradition in the Lackman family.  You said…

KL:  The food we eat over the holidays is probably the closest thing we have to a family tradition. My dad makes his special ham and beans out of the leftover ham from Christmas dinner.  Then, not every year but most years, my dad also makes homemade noodles and butter balls (a traditional German dish that his father made).

2. Describe your upbringing for readers who might not know you.

KL:  I never appreciated how unique growing up in a small farming and ranching community is, until I moved to Seattle and started medical school. I am so fortunate that I was raised in a loving household with two amazing parents and two awesome brothers.  Growing up, we were taught to work hard. I spent most of my summers irrigating sugarbeets, hoeing weeds out of the field, and working with my 4-H steers and hogs.  During the school year I worked equally hard on extracurricular activities like volleyball, basketball, FFA, and 4-H. I think that’s one of the best parts of growing up in a small community – you can be involved in everything!

3. What was it like growing up with a sugarbeet farmer for a dad?

KL:  My dad worked very long hours most of the year, but he always managed to put his family first. I can count the number of my high school ball games he missed on one hand, which is pretty awesome. If you know my dad, you know how quiet, calm, and level-headed he is. He is patient and a great listener. I continue to strive to be more like him. Growing up with a farmer as a father, our lives revolved around the weather. Want to go camping? Not unless it rains. Want to go on a trip? Better plan it in the middle of winter when the crops don’t need irrigating. Going on any trip to anywhere? Must plan on taking the scenic route to look at the local agriculture.

4. Ha ha!  Knowing your dad, I can believe that!  How about growing up with a teacher for a mom?

KL:  Having a teacher for a mother gave me so many advantages. It meant I grew up with parents who spoke to me as a child, who colored with me and read to me. I didn’t grow up in front of a TV screen. That interaction is pivotal to a child’s development. Then, when I started school, I was well prepared and ahead of the curve in some ways. My mom helped me with homework, and good grades were a priority in our family. It also is nice to have your mother in the school building with you… just in case you need a signature or lunch money!

5. How about those little twin brothers, both of whom are now bigger than you?

KL:  Being the big sister is a big job! I had two little brothers to keep in line. We were a wild group of kids, always wrestling. I could take both of them on for a good chunk of time, but the tides turned once we entered high school!

(I have never had trouble telling David and Shane apart, so they’ve never been able to switch spots on me or trick me. However, we do have baby pictures of them that we go back and forth on which one is which. I guess we will never know!)

6. I’ll admit it, even though I’m a former babysitter, I still have trouble telling them apart!  Anyhoo… since you left home, your life has been mostly about education.  Bring me up to date on the education you’ve received so far.

KL:  I graduated from Hysham High School in 2008. I then completed my Cell Biology and Neuroscience Bachelor’s Degree at Montana State University in 2012. I took a year off and applied to medical school, and started at the University of Washington School of Medicine in 2013. I am now completing my final year of medical school and will graduate in May 2017, and next I will start my Family Medicine Residency in June 2017.

7. When did you first think you might want to be a doctor?

KL:  I went to college with the idea of becoming a doctor. As a senior in high school I thought, What do I become if I like science and math?  The answer, for me, was doctor. In a way I think that was because not many careers were modeled for me growing up in a small agricultural community, but I did know Dr. Grierson, Dr. Gallo, and Dr. Thomas. I knew about the WWAMI program, and then those physicians encouraged me along the way.  It also paid off big-time that my best friend, now Dr. Morgan Cunningham, was pre-med at MSU then and wanted to go to medical school. She helped guide my decision.

(Editor’s note:  The WWAMI program Kena mentions is a partnership between four states that lack medical schools — Wyoming, Alaska, Montana, and Idaho — and the University of Washington, which, in an effort to remedy the shortage of primary care physicians in rural areas, encourages and helps medical students to begin their educations in the four partner states and later serve in small communities.)

8. Now that you’re almost done with med school, Kena, you have to decide:  What kind of doctor are you going to be, and why?

KL:  I’m going to be a family medicine doctor. There are a few reasons why family medicine is the perfect fit for me. First, I’m a relationship person and family medicine is all about really forming longitudinal relationships with your patients. Second, I love the continuity that family medicine provides. There is something so amazing about taking care of a woman’s pregnancy, delivering her baby, seeing the baby and mother back in clinic, and taking care of the rest of the family. Third, I really want to return to rural Montana to practice, and Montana needs family medicine physicians everywhere.

9. Describe a day in the life of a med student.

KL:  The first two years of medical school are lecture/classroom based. I completed my first year of medical school in Bozeman on the MSU campus. We were in an old-school, cramped classroom for 6-10 hours a day, 5 days a week. Second year was completed in Seattle, where I was in a class of >200 students for around 4 hours a day. Those first two years, I spent most of my time in the classroom and studied for an hour or two most evenings. Many of my weekends were spent prepping for exams.  We also spent about a half-day each week in clinic or hospital with attending physicians teaching us.

The last two years of medical school are much more fun. They consist of “clinicals,” or rotations, that last from 4 to 6 weeks and take the students to varying locations. The core “clinical” blocks of medical school are family medicine, general surgery, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, emergency medicine, chronic care, and neurology. During these rotations, I would see patients with whatever attending physician I was assigned to work with.  My days would include clinic work, seeing patients in the emergency department, hospital work, surgeries, and even delivering babies!  During some rotations I would work close to 80 hours a week, but most rotations are more like 40-60 hours a week. There is still plenty of studying that occurs during clinical rotations, since most of them have an exam at the end of the rotation.

10. Describe a day in the life of a resident.

KL:  Residents are officially physicians, but they are still training and learning from attending physicians. Similar to medical school, most residencies use block schedules (to provide a well-rounded educational experience for residents and also to get a lot of work out of the residents!).  A typical day on an inpatient medicine block might include rounding on my patients in the hospital starting at 6:30 a.m., forming a plan for each patient’s healthcare for the day, presenting the plans to my attending, placing orders and writing notes, then racing to a half-day of family medicine clinic in the afternoon. Worked into the blocks are call days and nights. Similar to medical school, residents often work close to 80 hours a week, but have some blocks where they only work 40-60 hours a week.

11. Will you be paid for your work as a resident?

KL:  I will! The average family medicine resident salary is around $52,000 in the U.S.!  So if I average working 60 hours a week for 48 weeks of the year, that comes out to $18.05/hour!  Better than working at McDonald’s, but only by a little! Plus, I will have completed 8 years of schooling beyond high school, so I think it’s reasonable that I will make more than I would working at McDonald’s!

12. Bet that’ll be nice after years of paying to work hard!  Just out of curiosity, what’s the cost of a medical education these days?

KL:  Tuition changes every year, but currently it’s around $45,000 at UW. Completing the first year in Bozeman is quite a lot cheaper; I recall tuition being around $16,000. Then there is the cost of living, books, travel, board exams, etc.  The 4 years of medical school have cost me close to $200,000 so far, plus $20,000 interest on my student loans. I would say this is less debt than most of my classmates are in. I lived fairly frugally during medical school, and was fortunate to go to UW, which is one of the most affordable schools. Private medical schools cost $60,000+ in tuition alone per year.

13. Do you follow national healthcare and insurance issues?

KL:  I stay very up-to-date on healthcare and insurance issues, as my future livelihood and, more importantly, the health of my future patients both depend on the changes our country is going through and the decisions our politicians make.

14. So what’s your favorite way to keep up with the news?

KL:  I subscribe to daily updates from several professional organizations. They include the American Medical Association (AMA), National Rural Health Association (NRHA), American Academy of Family Physicians (AAFP), and Physicians for a National Health System (PNHP). Most of the public media is biased to one side or the other, but I do read The New Yorker and The Wall Street Journal, and I listen to National Public Radio (NPR) most mornings. All of the above have websites that are easily accessible by the general public and have accurate information about healthcare policy.

15. Do you think your rural upbringing influences your doctoring style?

KL:  I definitely was very sheltered and naïve before medical school. I really didn’t understand the horrible conditions that many people right here in the U.S. live in and are raised in. I didn’t know about all the different illegal substances out there and various forms of abuse.  I tended to be very trusting of what my patients told me and sometimes missed when a patient was lying to my face. Now I’m more informed, and skeptical at times, but I still get caught off guard once in a while.

Still, I think my naivety and trusting nature are good things.  I want to be able to form trusting relationships with my future patients, and I want my patients to feel like they can tell me anything without being judged or ashamed.

I would also add that being raised in a rural environment has influenced my thoughts on issues like working in areas with limited resources, the cost of healthcare, and insurance for patients.  With the closest Walmart 70 miles away growing up, we had to get creative to solve problems. The same thing applies to rural healthcare.


16. What’s the grossest thing about being a doctor, in your opinion?

KL:  Suctioning an intubated patient. I have a strong stomach and can tolerate about anything, but I could never be a respiratory therapist since they have to suction intubated patients. The stuff that comes out of lungs grosses me out!

17. What’s the most rewarding thing?

KL:  Helping people lead healthier, longer, higher-quality lives is very rewarding. It does not happen every day, but when I can solve some problem for a patient and see how grateful they are, that is a very rewarding day. Most people are very grateful for the care they receive.

18. What’s your idea of a perfect day?

KL:  Waking up on the farm, drinking my coffee while watching the sunrise, visiting with friends and family, and playing cards or board games. Maybe I trick a neighbor into letting me help gather cows, or get called to the hospital to deliver a baby. Every day that I deliver a baby is a great day!

19. Tacos or spaghetti?  Dogs or cats?  Farmers or cowboys?

KL:  Tacos, cats, and any small-town guy who can jitterbug (or is teachable)!

20. Finally:  Where would you like to be in 10 years?

KL:  I see myself returning to Montana to practice rural, full-scope family medicine. Miles City or Lewistown are both high on my places to return to. Both deliver babies and have a critical access hospital, and both are fairly close to my parents and brothers in Hysham. By that time, I hope to have tricked some poor cowboy or farmer into marrying me, and maybe we’ll even have a couple kids running around.

Tami Blake: We always wish you the very best, Kena!  I will keep an eye out for the perfect cowboy for you!  Thanks for taking the time to answer my questions… and I hope you come back close so you can babysit my kids!

© Tami Blake

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