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Our Neighbors.... Joanna Burns

There's a "new kid on the block" in the hallways and exam rooms of Raiter Clinic and Community Memorial Hospital. And though it will be a few years before medical student Joanna Burns can add the word "doctor" to her name, a big part of her has b...

There's a "new kid on the block" in the hallways and exam rooms of Raiter Clinic and Community Memorial Hospital. And though it will be a few years before medical student Joanna Burns can add the word "doctor" to her name, a big part of her has been immersed in the world of medicine all of her young life....

Burns, the daughter of Steve and Donna Burns, was born at St. Mary's Medical Center in Duluth seven weeks prematurely. She remained in the Neonatal Intensive Care (NIC) Unit for six weeks and remained under the close scrutiny of doctors long after that.

"After you've been in the NIC Unit, they watch you pretty closely," Burns explained. "They do a lot of follow-up, watching for neurological and motor problems - asking, 'Is the child sitting up when it should be? Is he or she rolling over or walking when they should be? Is the child developing cognitively?' If it's not meeting a lot of those milestones, then the flags go up and the doctors are suspicious of something and start looking more closely at what might be causing those delays."

Physicians first noticed something wasn't right during Burns' initial six weeks in the NICU. Her right side was weaker than her left, so the physical therapists gave her mother exercises to do with her from the start.

The Burns family later discovered the doctors had some suspicion that Joanna may have cerebral palsy (CP) for some time before they actually told her parents about it because they wanted to be sure. Their suspicions were all but confirmed when she had to have eye surgery when she was one year old.

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"My right eye wasn't tracking correctly," said Burns. "That might have been a clue that something wasn't right because CP can manifest itself in the eye muscles."

It wasn't long after that before her parents found out what the doctors had suspected all along.

"My mom and dad were pretty concerned and scared," she related. "I remember my mom saying they warned her that no one had any real knowledge at that point how able-bodied I'd be. CP is a neuromuscular disorder and it has a wide spectrum as far as how it manifests itself. You can be spastic, like I am, where muscles are tight, or you can be more flaccid. You can have cognitive impairment and a whole spectrum of disabilities. Fortunately, it turned out I was very mildly affected, which is good. I have a diplegic type of CP, which means it involves only my lower extremities and not my upper body."

Joanna's parents were understandably concerned that she might not be able to meet all the milestones a normal child would - but she surprised them.

"I walked a lot sooner than they expected," said Burns. "My mom was on the phone with a friend one day, and she looked over and I was walking! I know that was a big surprise because it wasn't that much later than a child would normally start walking."

As soon as doctors reached a diagnosis, Burns had to go in for physical therapy, so she spent her whole childhood, from infancy on, in PT. Her mom brought her in to Polinsky Medical Rehabilitation Center in Duluth three days a week up until she was school age.

"It seemed totally normal to me," said Burns. "That was what we did. Every Monday, Wednesday and Friday, we got in the car and went to Polinsky. I didn't know anything different. That was just the way it way it was. I remember my therapists were great and really liking them."

One of the issues Burns had to deal with as a result of the CP is the fact she has always has gait problems and had to use some form of orthodics or bracing to make everything as correct as it could be, given the situation.

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"I used to wear night splints to keep my heel cords stretched out so they wouldn't tighten overnight," she explained. "I also remember, as a three-year-old, having to wear what we called 'moon boots' around the house for so many hours every day. I hated them and would ask, 'Why do I have to wear these?' Of course, at that point there was no reasoning, and my parents just told me I was going to do it."

Burns had a second surgery when she was three for her heel cords because they were too tight and caused her to be "toe walker," walking way up on her toes.

The Burns family moved to Esko when Joanna was four years old, and she started Discovery kindergarten in Esko when she was five, going on to regular Kindergarten when she was six and getting her physical therapy at school.

"My mom said I've always been beyond my years as far as cognition," said Burns. "She said my older brother, Jeremy, had a kindergarten program when I was around two years old. The teacher said, 'If your last name begins with A, sit over here, and if your last name begins with B, sit over here.' I went and sat over with the Bs! And so, there was no question I would start school on time, and that kind of made up for the physical deficits."

As a young child going out into the world, however, it was difficult to relate to the fact she had a disability when she didn't feel all that much different than anyone else.

"I understood as long as I can remember that I had tight muscles and that my brain tells my muscles to be tight when they shouldn't be," she said. "That was pretty much my understanding of what I had. My mom had told me that the most anyone really knew about it was that I 'bleed' in my brain at some point, which, in some respects, is like a stroke.

"If I really started to notice that anything was different about me, it was when I started school because I began getting physical therapy there," she continued. "Very few, if any, of the other kids were doing that. I had to take time out of my day to go to therapy, and though it was still fun and I loved my therapist (to this day, we still get together for lunch!), that's when I started to realize this was something different. Kids can be mean and they start to ask questions and tease. Elementary school wasn't always fun in that way."

In the meantime, however, Burns was figuring out things her own way, along with the patient help and guidance of her family.

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"Things like riding a bike took me a long time to catch onto," she said. "I don't think I started riding a two-wheel bike without training wheels until I was 11 or 12, after my friends had all been doing it for years.

"My parents were pretty inventive," she continued. "When we were still living in Cloquet, my dad would tie me down to the trike because I couldn't stay on it because of my tight heel cords. Then he would take me to the top of the sidewalk on 16th street and I would ride down the hill. In the meantime, he would go in the garage and start doing something, and there I'd be, down at the end of 16th Street, yelling, 'Dad, come turn me around!' Finally, he bought me a horn so I could beep the horn when I was ready to be turned around. I rode a trike for a long time, and finally they got me a bike with training wheels, and at last I caught on. I think I've been able to do pretty much everything I've wanted to. It's just that sometimes it takes me a little longer, and I have to figure out a way that works for me. I love to ride my bike now, and I ride all over the area and on the bike trail, but I can't get on it like a normal person would, by stepping in to it or throwing a leg over. I have to lay it down first."

Around the same time she started school, Burns discovered something she was not only good at - but even better than many of her classmates. She started riding horses with North Country R.I.D.E., a rehabilitative horseback riding program based in Esko.

"I remember the day my parents asked me if I would be interested in horseback riding, because I was afraid of big dogs," she said. "But I didn't equate a horse with a dog, so I said yes. At first, I had to have two people on either side of me and someone leading the horse. My parents were really good about getting me involved in a lot of activities. I took swimming lessons, cross country skiing and dance lessons, all for kids with handicaps. But I didn't always relate to them, because so many of them were much worse off than I was. What I loved about riding is that as I progressed, they progressed with me. As I got older and they realized I could do more, they let me do more, and by the time I finished my lessons there, I was jumping and doing a lot of other things."

When Burns was in ninth grade, her parents bought Deacon, one of her favorite horses at North County R.I.D.E., and they moved him to a nearby farm where she rode him all on her own, though she continued to go back to North Country R.I.D.E. as a volunteer helping with the classes.

"That was my sport and it gave me my wings," she said, "because I could do something and be really good at it for a change - and it was something that not everybody around me was good at."

The challenges for Burns were ongoing, however. She was a junior in high school when they had a two-week session on roller skating in gym class.

"I did my best to keep up with everybody in gym, but when we found out we were going to be roller skating, I said, 'You've got to be kidding me. There's no way I'm going to be able to roller skate!' I had a really great gym teacher named Gary Beaudot, and he said, 'Oh, yes you are!' We went back and forth, but he insisted. I was 16 or 17 years old, and all my friends were playing games on roller skates and doing all the fancy moves, and there I was out in the hallway. Mr. Beaudot said, 'Put those skates on. You really need to do this.' They took a long runner-type carpet, and Mr. Beaudot and the man from the skate rental place went along on either side of me, holding me up.

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"That was Monday, and I was just barely shuffling down the carpet," she continued. "On Tuesday, the guy from the skate place went into the gym to be with all my classmates, and Mr. Beaudot stayed in the hallway shuffling up and down the carpet. Part of me was still saying, 'I can't do this. This is dumb and pointless. Let me just go on with my life, go to a study hall, anything else but this!' But by the end of the week, I was out on the gym floor, by myself - still shuffling - but I was there. Mr. Beaudot said, 'See, I told you you could do it! I'm going to see you roller blading by my house some day!'"

Though Burns' disability prevented her from playing sports such as basketball, volleyball or softball in high school, she instead took part in things like Math Team, Knowledge Bowl and other such pursuits, and she came to love high school and had a great experience there. When she graduated in 2000, she was one of four valedictorians in her class that year. And by then, she'd already figured out what she wanted to do with her life.

"I've known forever and ever that I wanted to be a doctor," she smiled. "I think it was because I was always so immersed in that environment. When I had my second surgery at the age of three, I brought my Fisher-Price doctor's kit with me! It wasn't just a flighty thing. I was serious. As I got older, I was pretty interested in physical therapy, but I decided I liked the idea of medicine better because it was a little more comprehensive and I liked the idea of working with all kinds of people."

She'd also figured out she wanted to go to The College of St. Scholastica because she wanted a small college and didn't want to get absorbed into a major university somewhere and become a number. She had also heard really good things about the school and its premed program, but she was a bit uncertain about what degree to pursue as an undergraduate.

"I started looking at their biology major, and they offered great classes with small class sizes," she related. "It was things like immunology, embryology, histology - to me, that was just like Christmas morning! It's all based on human biology, and I thought that was great. I decided to take a biology major and hope for the best as far as getting into medical school."

Though the thought of how many years of schooling it takes to become a doctor crossed her mind on occasion, she remained undaunted.

"It seems like it goes by so fast if I really take it one step at a time," she said. "It's going to take me a good seven years after college - but why not?"

Burns graduated from CSS in May 2004 with a Bachelor of Art degree in biology and had already been accepted into medical school at the University of Minnesota-Duluth.

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"I knew that UMD would be great for me - a smaller school and local, and I was interested in family medicine and that was their big emphasis," she said.

She started medical school the fall 2004, but in the meantime, her body was not holding out for her very well. When she was midway through college, she'd begun to experience a lot of back and foot pain and started hurting a lot more than she'd ever experienced.

"Up until then, I had never had pain issues," she confessed. "Having this disability, I don't really know what it would be like to be normal because I always felt really normal. I never really had any issues - even with my gait, though I know it's abnormal, but to me it's normal because I've never really known anything different. When I was a sophomore, I started to hurt and it was pretty new to me. I told my parents and wondered if I'd thrown something out of alignment, but it just didn't get better. I kept plugging away at school but was kind of miserable."

Just before the first year of medical school, however, she hit a real low.

"Everything hurt and at times it was hard to study," she said. "Yet, I decided I was going to keep going. I started to wonder if I'd made the right choice by going to medical school because obviously it's a very physical profession and you have to be on your feet a lot and put in long hours. But I couldn't imagine myself doing anything else.

I had gone through a little rebellion in junior high and high school where I just quit going to doctors and therapy and decided I was going to go about life. Now, I decided I'd better go back to my doctor, who tried botox injections with little success and a lot of frustration."

The summer before medical school, she kept complaining that she hurt, so her doctor suggested she get a gait analysis at Gillette Children's Hospital in the Twin Cities, where they have an entire center devoted to gait analysis. After the testing, the physicians recommended Burns have a complete bilateral surgery from the hips down in an effort to try to fix what was going on.

"It wasn't what I wanted to hear," admitted Burns, "especially at that point in my life. I got the gait analysis in July, I got the results at the end of August, and I was starting medical school the next week. I was devastated. So much of my life, whether I'd realized it or not, had been spent just trying to be normal and doing what everybody else does and not letting the disability stop me. Now it was like, 'You're telling me that I have to have all of this surgery? I can't do all this and do what I want to do.' That was really tough and I was really nervous about how that would impact medical school."

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All that fall, she went to classes and brooded about it. The doctors had told her she should have the surgery done sooner than later because most of the procedures were ones they normally did on children, and if she waited too long, she might not recover like she would if she were a younger person.

"I knew if I was going to be a good doctor I was going to have to take care of myself," she admitted. "Cerebral palsy doesn't progress, so the disability isn't going to become worse. It just is what it is. But because my muscles were tight and things were out of alignment, as I got older I would continue to have joint issues and pain issues. That was the whole idea behind the surgery."

Next, she had to try to figure out how she was going to fit it in. The surgery included bilateral reconstruction of both sides of her lower body, which involved extensive surgery and recovery time.

She decided to take advantage of the two-month break after her first year of medical school to have the surgery.

"School ended on a Friday, and I was at Gillette Monday morning and had my surgery," she said. "I was in Gillette for almost a week, came home, and my parents had a hospital bed set up for me in my dad's office on the first floor of our house. I went home in a wheel chair and was casted from my knees to my toes and had knee immobilizers so my legs were straight out. For someone who was trying to be so doggone independent, it was really tough. It was July and it was hot.

"The whole experience will make me a much better doctor, though, because now I know what that's like," she continued. "I couldn't even roll over on my own, and I had a baby monitor next to my bed so I could call for help in the middle of the night. I never had a muscle spasm in my life up until then. It was pretty brutal."

She remained totally bed bound until the beginning of August, and then she had to face the difficult task of learning how to walk all over again.

"Everything was different," she explained. "They had moved muscles, they had broken and realigned bones. Everything my brain had known was different now. Because I knew I had to get to back to school, they had me up as soon as I could bear weight. Our house has a short hallway, and just to get down there, it would take me half an hour and I would break out in a sweat. I told my parents, 'Don't ever take one step for granted....' because it was so difficult. I thought I had had a lot of medical experience prior to that surgery and that I wanted to be a doctor because of it - but after going through all of this, I felt even more convicted because this was the real thing."

She started with a walker and was receiving physical therapy at the Cloquet hospital five days a week, two hours a day, for a good chunk of the summer. She went back to school on crutches, and the medical school rearranged her courses so she could have a schedule that included all classroom work. A good friend of hers from Esko she'd known since the age of five and who was also attending UMD drove her to school every morning and her mom picked her up at the end of the day.

Today, in her third year of medical school, Burns is now moving forward on an even keel, and the opportunity to participate in the Rural Physicians Associate Program (RPAP) in Cloquet presented itself as the opportunity of a lifetime.

"I worked in the medical records department at Raiter Clinic through high school and college," she explained. "At that time the clinic had an RPAP student, and that's how I first started to learn about the program. The student was a medical student but got to be at the clinic for nine months, and that sounded really interesting to me."

Third-year medical students at the University of Minnesota have the chance to elect for on-the-job experience either by going through RPAP at a rural medical facility or by rotating through different departments of Twin Cities hospitals every six weeks to complete their required course work.

Burns knew that coming to Cloquet might be a possibility, so she applied to the program. She had been doing some of her second year clinical work at Raiter Clinic with Dr. Kenneth Ripp, so when she interviewed she really liked the idea of going to Raiter Clinic. It was up to Raiter Clinic, however, to decide if they wanted to participate and what courses they could offer her.

"At the last minute, just as the school was about to post the sites," grinned Burns, "I was told I got Cloquet! It was really exciting."

In order for a site to take a student, one of the doctors there has to say he'll take that student on for the nine months she's there, and Raiter Clinic's Dr. Tom Osborne was the one who stepped up to the plate.

"I'm very grateful that he did it," said Burns. "It's a big commitment on his part, taking on a student for nine months. I'm also splitting a lot of my time between him and Dr. Beth Mork."

Burns' first day in the community was Oct. 9 and she will remain here until the end of June. While she's here, she's doing her official courses in primary care clerkship (family medicine), emergency medicine, general surgery, and orthopedic surgery. And so far, she's as happy as a kid in a candy shop.

"Part of what I love about it is that I have no idea what each day is going to be like, even if I think I do," she mused. "On the most average of days, I'm in the clinic from 8:30 a.m. to 5 p.m., seeing patients with Dr. Osborne and doing clinic stuff. Now that I've progressed, a lot of times - with the patient's permission - I will go in first, talk to the patient, get the history, do a little bit of a physical exam, and my wheels start turning as I think about the diagnosis, what I think is going on and the list of things it could be. Then I will go out and give Dr. Osborne a presentation on what I found and think is going on, and the two of us talk about a plan and what we need to do about it. Then he'll go in and see the patient, double check me on things that are really significant, and kind of go from there. I'm gaining more independence as I go. By the end of this, I want all of my plans to jibe with his plans, and have him say, 'Yes, Joanna, that's exactly what I would do so let's just do it...' I'm not quite there yet, but I'm getting there!"

She is also taking call duty with both Dr. Mork and Dr. Osborne on some overnights and weekends, has done a couple of overnight shifts in the Emergency Room, and has followed some of the patients from the clinic all the way through surgery, including helping to deliver babies.

"Sometimes I just watch, and sometimes I'm a lot more involved," she said. "So far, I definitely like everything about OB. It's just fun to be a part of that and to be in the office when they bring their baby in for its one-week checkup. It's just so cool to think I've been a part of that. I also like the continuity of family medicine. There have been times when I've seen every member of a family and followed them along, and you do get to know people and that's fun. You don't get that anywhere else in medical school unless you do RPAP, and that's one of the unique things about it."

After this experience, Burns will go to the Twin Cities to finish up the balance of the required rotations not offered in Duluth, and she plans to graduate from medical school in May 2008. Then she will go through residency, hopefully somewhere in the Midwest region, for the next three years and take the last of her medical board tests.

And then at long last, after all of the challenges and schooling, she will be exactly what she's always wanted to be - Dr. Joanna Burns.

"It's coming sooner than later!" she grinned happily.

Pine Journal Publisher/ reporter Wendy Johnson can be contacted at: wjohnson@pinejournal.com .

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