I spent today in surgery. 95% of this time was anus-related. When my preceptor left for clinic and handed me off to another surgeon, he looked at her next case on the board and said with a smile, "Oh, this can be your butt day!"
Among the lower GI tract things I saw was a colonoscopy preceding another operation. It was the first time that I've experienced the amazingness of all that gas they pump in you coming back out again. W.O.W. My wife and her brother on their worst days combined could not rival those amazing sounds. The human body does not cease to amaze.
But I digress. As the title suggests, what was most on my mind today was this other aspect of life in surgery: money and prestige. The dear safety-net hospital where I'm spending my third year is not exactly a hotbed of stereotypical egomaniac fancy-car surgeons. The attendings are by and large nice, even if their unanticipated questions can be scary, and with few exceptions actually seem to realize that they treat human beings rather than body parts.
But our residents are not from the dear little hospital. Indeed they are not. Now we've had nice residents, residents who like to teach, residents who send you home when they can. And we've had grouchy residents, apathetic residents, residents who say nasty things about patients or the medicine team. But before today I hadn't hung out with a cares more about money than people resident.
His reputation preceded him, having told my classmates that a gold-plated Mereceds was in his future. Needless to say, I went in with some trepidation, but I was still thoroughly dumbstruck. First I was put off when he returned from a consult saying "that patient was being an idiot so I had to put a nasogastric tube in him." Which is not only crappy and dehumanizing, it doesn't even make sense. Then, while closing up after a gall bladder surgery, he started telling me how he's really not sure what kind of surgeon he wants to be yet.
Him: I mean, realistically, you have to think of the money. The way things are going, you have to go into something you can count on. Really plastics is the only thing that makes sense.
I try to figure out what to say to him. Something like, "I'm pretty sure that all full-time surgeons are wealthy by any reasonable measure," might have been appropriate.
Him: But I really value being the best, and the best surgeons are really the transplant surgeons.
This sounded somewhat better to me... I mean even if he doesn't care too much about patients, I appreciate that he cares about doing a good job. But, of course, before I could say anything...
Him: But you know, different kinds of people need transplants. There's just no money in it, you end up having to take care of all these people without insurance and poor people.
So much for medicine being a service profession. This is when I was wishing that thinking, suturing, and speaking weren't so hard to do all at once.
Him: Or I could do GI. It's just a one-year fellowship so I could be making money right away. But you have to be on call. Really nothing makes as much sense as plastics. Even if Obama screws up health care more and reimbursement falls off, you can just do more cosmetic cases.
At this point I was in full-on medical anthropologist mode, taking mental notes on how not to be. Plus it was about his third nonsensical Obama dig of the morning, but in the moment I was more fascinated (car-wreck style) than pissed.
I'm not sure what bothers me more, that he seems to be more interested in money than patient care, or that he's so blatant about it. It's been said time and again, that going into medicine for money just doesn't make sense. Getting into a to business program is a much better return on investment by far. That knowledge just serves to piss me off further that people take up room in medical schools and competitive training programs when their end goal could be better served elsewhere and their spot could be filled by someone who wants to make peoples' lives better. When you have that value set, money over people, becoming a doctor strikes me as a cover. You can be an ass, but still get some social cred for doing good.
Not to mention that the idea of wanting a gold-plated Mercedes is totally outside my understanding of reality. I am more effected by the consumer culture than I would like to be, but I can still recognize that money and stuff won't actually buy me contentment. Money doesn't buy happiness, we know this. It seems like someone steeped in the culture of evidence-based medicine ought to delve into some sociology research and reexamine life choices.
8.18.2010
8.17.2010
Visiting
Through an incredible giftfromthegods type fluke, four of my outpatient clinic preceptors are on vacation this week, leaving holes in my schedule that even our incredible schedule populating program coordinator couldn't fill completely. What this means is that not only am I left with very few items on my "to-do right now" list, but also when an elderly patient I was on the phone with asked "couldn't you just come over?" I actually could.
For the people who know me and don't think of me as "shy," it might surprise you to learn that there are some things that indeed I am shy about. Visiting an old person in chronic pain at their apartment isn't exactly in my comfort zone. But much like cold calls to hospitals I've never seen and patients I've only met for 10 minutes, I'm trying to build a new comfort zone.
She lives in one of the many high-rises for older folks in the area, a drab construction with a surprisingly difficult to find front door. I managed to navigate the elevator conversation and complicated door-knocker situation. She steered her walker to the door to let me in, smiled to see me, and launched into a description of her current symptoms. She's feisty, but trapped in a cycle of chronic pain, with ever elusive solution. We talked for an hour, mostly restating the same problems differently. We made sure she had the right phone numbers to call for appointments and I cut some of her pills in half. In the end, we left with the same conclusions as the previous conversations we've had over the past two weeks. But if her resolve has moved only by inches, my ease of stepping across bounds I never saw before is growing by miles.
When I was a girl scout, I absolutely dreaded cookie drop off. Once the mountain was piled in our living room, it meant I had to call everyone I had sold cookies to, even my parents' co-workers, to tell them they were ready to be delivered. I can still feel the sense of cold foreboding that would fill my belly as my mother complacently handed me the phone. But these days my to-do list is increasingly filled by "call..." at first these were suggestions from others, but now I've found how easy it is to say "how about if I just call That One Clinic and find out what they think the plan is..." or whatever it may be. And it's not hard anymore.
For some people, it's over-stepping social bounds like touching others' naked bodies that really jar the ingrained sense of normal. For others it's asking deeply personal questions, talking about death or even just poop. We all have barriers in taking on this doctorish role. Today made me realize how much having assumed this new role has given me this space where pushing past my own fears is so much easier.
For the people who know me and don't think of me as "shy," it might surprise you to learn that there are some things that indeed I am shy about. Visiting an old person in chronic pain at their apartment isn't exactly in my comfort zone. But much like cold calls to hospitals I've never seen and patients I've only met for 10 minutes, I'm trying to build a new comfort zone.
She lives in one of the many high-rises for older folks in the area, a drab construction with a surprisingly difficult to find front door. I managed to navigate the elevator conversation and complicated door-knocker situation. She steered her walker to the door to let me in, smiled to see me, and launched into a description of her current symptoms. She's feisty, but trapped in a cycle of chronic pain, with ever elusive solution. We talked for an hour, mostly restating the same problems differently. We made sure she had the right phone numbers to call for appointments and I cut some of her pills in half. In the end, we left with the same conclusions as the previous conversations we've had over the past two weeks. But if her resolve has moved only by inches, my ease of stepping across bounds I never saw before is growing by miles.
When I was a girl scout, I absolutely dreaded cookie drop off. Once the mountain was piled in our living room, it meant I had to call everyone I had sold cookies to, even my parents' co-workers, to tell them they were ready to be delivered. I can still feel the sense of cold foreboding that would fill my belly as my mother complacently handed me the phone. But these days my to-do list is increasingly filled by "call..." at first these were suggestions from others, but now I've found how easy it is to say "how about if I just call That One Clinic and find out what they think the plan is..." or whatever it may be. And it's not hard anymore.
For some people, it's over-stepping social bounds like touching others' naked bodies that really jar the ingrained sense of normal. For others it's asking deeply personal questions, talking about death or even just poop. We all have barriers in taking on this doctorish role. Today made me realize how much having assumed this new role has given me this space where pushing past my own fears is so much easier.
3.13.2010
Change You
Back during the first weeks of med school last year, there was much talk of how medical education "changes you." It is something I still feel many ways about.
I can embrace being changed, when I view it as a sort of "change lite." This is the process of expanding knowledge of human function, emotion and disease, growing manual and relational skills. The most significant one here is control of affect, learning to convey empathy while withholding disgust, devastation, fear, etc.
The real change, though, the one that many seem to undergo in medical education, is one that I want to avoid. This is the evolution from to someone who doesn't just suppress emotions in front of patients until they can be experienced safely but who no longer feels many things. It is the process of replacing human patients with bodies and disease processes. I have been told that I cannot continue to feel the normal sadness I would have felt two years ago upon learning of the cancer diagnosis of an acquaintance or friend's child and survive in this profession. But I want to continue to believe that that isn't true. I think that these emotions are at the foundation of true empathy. There are these moments, when day after day of memorizing disease names and processes out of textbooks without attachment to the real people's live they impact, that I see that staying connected to my former self will require vigilance.
Last week, I sat with some students and a preceptor as we watched a video of a patient relating the devastating story of losing one of her twins in utero. As she spoke, I fought back tears, telling myself it wasn't the place. At the same time, a nagging fear crept up in me. If this wasn't an OK time to demonstrate sadness as a medical professional, when was? But as the clip ended, I turned around to see my instructor, suit-and-tie clad man in his 50s, had made no such effort at self-restraint. He audibly sniffed and tears tracked down both cheeks as he turned to us to open the discussion.
I can embrace being changed, when I view it as a sort of "change lite." This is the process of expanding knowledge of human function, emotion and disease, growing manual and relational skills. The most significant one here is control of affect, learning to convey empathy while withholding disgust, devastation, fear, etc.
The real change, though, the one that many seem to undergo in medical education, is one that I want to avoid. This is the evolution from to someone who doesn't just suppress emotions in front of patients until they can be experienced safely but who no longer feels many things. It is the process of replacing human patients with bodies and disease processes. I have been told that I cannot continue to feel the normal sadness I would have felt two years ago upon learning of the cancer diagnosis of an acquaintance or friend's child and survive in this profession. But I want to continue to believe that that isn't true. I think that these emotions are at the foundation of true empathy. There are these moments, when day after day of memorizing disease names and processes out of textbooks without attachment to the real people's live they impact, that I see that staying connected to my former self will require vigilance.
Last week, I sat with some students and a preceptor as we watched a video of a patient relating the devastating story of losing one of her twins in utero. As she spoke, I fought back tears, telling myself it wasn't the place. At the same time, a nagging fear crept up in me. If this wasn't an OK time to demonstrate sadness as a medical professional, when was? But as the clip ended, I turned around to see my instructor, suit-and-tie clad man in his 50s, had made no such effort at self-restraint. He audibly sniffed and tears tracked down both cheeks as he turned to us to open the discussion.
3.02.2010
Being a Doctor=Not Gay Disneyland
Shall we resurrect this blog? Indeed.
Tonight the LGBT student group at ye' olde med school hosted an "Out in Medicine" panel. It featured several faculty members who direct courses or lecture in the clinical years in addition to attendings and a resident. The ranged both in age and medical interest. They shared anecdotes and insights and answered questions. It was, among other things, good to remind myself that we are a plentiful enough bunch. Though this bunch had primarily spent time in the "Gay Disneylands" of Boston, San Fran and LA, they carried experiences from many kinds of environments.
It was, on the whole, an optimistic evening. All have had the luck of good careers and supportive colleagues. It is generally agreed that medicine is at least perceived as a conservative institution. That perception is all too often a reflection of reality and is one piece of the root of disparities in health care quality for LGBT people. Even so, it really isn't my colleagues in medicine that I worry about being accepted by. One can choose colleagues. Though it may be hard to really understand the culture of a hospital or practice before you get there, some insight can certainly be gleaned and changing jobs is not impossible. What I worry about, are homophobic patients and my own emotional resilience.
As a second-year student, I am not yet tasked with any real responsibility for patients' health. Every Wednesday, I meet with bored patients in the hospital and practice taking a medical history and performing a physical exam. My instructors grade presentations and patient notes that I write, but no one who actually cares for those folks will ever see my work. This is strictly practice and principally for my own benefit.
Several weeks ago, I interviewed an elderly gentleman. As he began to relate some of his health history to me, the middle-aged daughter of his roommate said good-bye to her father and headed home. Not five seconds after she closed the door behind her, this fellow smacked his hand down on the table and said "Well, let me tell you about that one." He went on to relate to me, in melodramatically shocked tones, that his roommate's daughter was gay, and had come to visit with her "girlfriend, or boyfriend or whatever they call it." What followed was the longest homophobic tirade I've been subjected to since being harassed by passers-by while protesting "Don't Ask, Don't Tell" in Times Square a few years ago.
And I absolutely did not know what to do. Though I subject myself to hearing such things in the news, I have been blessed to generally avoid similar confrontations in my personal life. I know that in this moment I maintained a pretty flat affect, and inwardly I laughed that laugh of dark humor and discomfort. For days I blew it off as unimportant, but the more times I shared the story with friends, the more I realized how much it had affected me emotionally.
So tonight, I went to this panel with just one question: what do you do about homophobic patients. Not the ones who don't want to see you if they know you are gay, the ones who do see you, whether they know or not. And the answer was what it so often is in this field: self-sacrifice. Redirect to the task at hand, point out that whatever they are saying, be it homophobic, racist, sexist, is not what we are talking about right now. "Maybe, just maybe, and only after much later," I was advised, you will be able to address it in the future when you have an established relationship. This is a hard pill to swallow. For years, I have embraced being visibly out and I have worked to find ways to call out homophobic speech and attitudes in those around me. And after all that, it's hard to accept the idea of anything other than a direct confrontation of homophobia. But, things are changing in my life. The best health care I can deliver, that is becoming my new goal. Now, to complicate that a little bit, I am stuck on the knowledge that inequality, discrimination and disparities are all detractors from the positive health of our community. Part of me thinks that in confronting such attitudes in patients, doctors can do positive work. Yet the more time I spend with physicians I respect and their patients, the more I come to understand that the doctor-patient relationship can be a delicate thing. And it seems unlikely that any such positive work could be done in the moment or on a first encounter. The resident on the panel seemed, to me, most astute: treat the tirade as information. People at the doctor, especially in urgent situations, are vulnerable. This can bring out many things, including the worst of people. He suggested that an impulse to change that person's mind in the moment is more for you than the patient. The information you have learned can help you care for this patient.
So I asked myself, "am I obligated to treat homophobic patients?" And I wasn't sure. So I asked myself a moral extreme: "Am I obligated to treat murderers?" Yes, I really think that I am.
Tonight the LGBT student group at ye' olde med school hosted an "Out in Medicine" panel. It featured several faculty members who direct courses or lecture in the clinical years in addition to attendings and a resident. The ranged both in age and medical interest. They shared anecdotes and insights and answered questions. It was, among other things, good to remind myself that we are a plentiful enough bunch. Though this bunch had primarily spent time in the "Gay Disneylands" of Boston, San Fran and LA, they carried experiences from many kinds of environments.
It was, on the whole, an optimistic evening. All have had the luck of good careers and supportive colleagues. It is generally agreed that medicine is at least perceived as a conservative institution. That perception is all too often a reflection of reality and is one piece of the root of disparities in health care quality for LGBT people. Even so, it really isn't my colleagues in medicine that I worry about being accepted by. One can choose colleagues. Though it may be hard to really understand the culture of a hospital or practice before you get there, some insight can certainly be gleaned and changing jobs is not impossible. What I worry about, are homophobic patients and my own emotional resilience.
As a second-year student, I am not yet tasked with any real responsibility for patients' health. Every Wednesday, I meet with bored patients in the hospital and practice taking a medical history and performing a physical exam. My instructors grade presentations and patient notes that I write, but no one who actually cares for those folks will ever see my work. This is strictly practice and principally for my own benefit.
Several weeks ago, I interviewed an elderly gentleman. As he began to relate some of his health history to me, the middle-aged daughter of his roommate said good-bye to her father and headed home. Not five seconds after she closed the door behind her, this fellow smacked his hand down on the table and said "Well, let me tell you about that one." He went on to relate to me, in melodramatically shocked tones, that his roommate's daughter was gay, and had come to visit with her "girlfriend, or boyfriend or whatever they call it." What followed was the longest homophobic tirade I've been subjected to since being harassed by passers-by while protesting "Don't Ask, Don't Tell" in Times Square a few years ago.
And I absolutely did not know what to do. Though I subject myself to hearing such things in the news, I have been blessed to generally avoid similar confrontations in my personal life. I know that in this moment I maintained a pretty flat affect, and inwardly I laughed that laugh of dark humor and discomfort. For days I blew it off as unimportant, but the more times I shared the story with friends, the more I realized how much it had affected me emotionally.
So tonight, I went to this panel with just one question: what do you do about homophobic patients. Not the ones who don't want to see you if they know you are gay, the ones who do see you, whether they know or not. And the answer was what it so often is in this field: self-sacrifice. Redirect to the task at hand, point out that whatever they are saying, be it homophobic, racist, sexist, is not what we are talking about right now. "Maybe, just maybe, and only after much later," I was advised, you will be able to address it in the future when you have an established relationship. This is a hard pill to swallow. For years, I have embraced being visibly out and I have worked to find ways to call out homophobic speech and attitudes in those around me. And after all that, it's hard to accept the idea of anything other than a direct confrontation of homophobia. But, things are changing in my life. The best health care I can deliver, that is becoming my new goal. Now, to complicate that a little bit, I am stuck on the knowledge that inequality, discrimination and disparities are all detractors from the positive health of our community. Part of me thinks that in confronting such attitudes in patients, doctors can do positive work. Yet the more time I spend with physicians I respect and their patients, the more I come to understand that the doctor-patient relationship can be a delicate thing. And it seems unlikely that any such positive work could be done in the moment or on a first encounter. The resident on the panel seemed, to me, most astute: treat the tirade as information. People at the doctor, especially in urgent situations, are vulnerable. This can bring out many things, including the worst of people. He suggested that an impulse to change that person's mind in the moment is more for you than the patient. The information you have learned can help you care for this patient.
So I asked myself, "am I obligated to treat homophobic patients?" And I wasn't sure. So I asked myself a moral extreme: "Am I obligated to treat murderers?" Yes, I really think that I am.
9.27.2009
I Love My Friends
When I was figuring out where to go to school, something that HMS students kept saying was that their classmates were the best part of medical school. Even so, I was pretty wary of who my partners in medical education would be. Until I met E, who has indeed become one of my best friends, at revisit weekend, I didn't click with a single person connected to this school. So I really just didn't expect to really get close to people I met in med school. Maybe because I have continued to be at least some what suspicious about my own reasons for going into this field, I was just kind of suspicious about my classmates.
But my fears were largely unfounded and not only have I met a diversity of genuine and down to earth people, I have made incredibly good friends. It's exciting, even after a year, to be still getting to know these people better, but already trusting and loving them. I'm feeling particularly gushy right now because we just had this fabulous bonding weekend. Four of my friends came out to our house yesterday for a perfect day of peach picking, swimming in the lake and incredible barbecuing. We ate tons of veggies: peppers, onions, sweet potatoes, mushrooms, tomatoes, with breaded tofu, and chicken sausage. Plus home-made guac and a fantastic peach cobbler for dessert. Icing on the cake is that these friends helped to clean up.
Then, because we are super-cool medical students, we cleared the table and returned with cups of tea and our weekend take-home quiz. Hey, who doesn't like some scintillating saturday night group study? After having our fill of that lovely activity, we talked into the night over cups of decaf and delish liquor provided by K and then had PJ cuddle time and a sleep over. This morning was pancakes followed by dance party to late 90's pop and then I sadly escorted them out the door. Partly it was just wonderful to get to seem them outside of school.
Sigh. I love my friends.
But my fears were largely unfounded and not only have I met a diversity of genuine and down to earth people, I have made incredibly good friends. It's exciting, even after a year, to be still getting to know these people better, but already trusting and loving them. I'm feeling particularly gushy right now because we just had this fabulous bonding weekend. Four of my friends came out to our house yesterday for a perfect day of peach picking, swimming in the lake and incredible barbecuing. We ate tons of veggies: peppers, onions, sweet potatoes, mushrooms, tomatoes, with breaded tofu, and chicken sausage. Plus home-made guac and a fantastic peach cobbler for dessert. Icing on the cake is that these friends helped to clean up.
Then, because we are super-cool medical students, we cleared the table and returned with cups of tea and our weekend take-home quiz. Hey, who doesn't like some scintillating saturday night group study? After having our fill of that lovely activity, we talked into the night over cups of decaf and delish liquor provided by K and then had PJ cuddle time and a sleep over. This morning was pancakes followed by dance party to late 90's pop and then I sadly escorted them out the door. Partly it was just wonderful to get to seem them outside of school.
Sigh. I love my friends.
9.02.2009
My Friends Just Can't Stay Out of the News
Maybe I would be in the news too if I didn't come home to walk my dog after school instead of rabble rousing all the time. Anyway, go them! Maybe it will make Howard Brody blog about the hallowed institution again.
9.01.2009
In The Thick of It
Seems like if I don't have a headache from too little caffeine, I have one from being dehydrated. And despite my best efforts over the summer and sticking to half decaf in the morning. Here I sit, jittery, headached, sleepy. And content.
It's days like today that make me look ahead to May and the beginning of my full-time clerkships and think "Dear golly, we have got to move into the city." It's the having such an abundance of work and commitments that I can't get home to see Lion before she's gone off for the evening that gets to me, and all I want is for us to live blocks from everything that takes us out of the house.
But then, I bike home from the train station through my wooded neighborhood. Harriet greets me with excited tail thumping and we run upstairs to the yard. There I discover that our lovely neighbors/landlords have gone to the trouble of installing for us a fantastic pulley-style clothesline to replace the one that I hastily stuck up in the shade without thinking twice eight months ago. And wonder how we'll ever bear to leave. There may be short commutes in Boston. There may be more action and there could even be other nice neighbors to be had. But there are not our neighbors. There are not our woods and our yard. Our house is not there. I only have eight more months before my schedule burgeons out of control, and I can't fathom that that could be enough time for us in what has become such a home.
It's days like today that make me look ahead to May and the beginning of my full-time clerkships and think "Dear golly, we have got to move into the city." It's the having such an abundance of work and commitments that I can't get home to see Lion before she's gone off for the evening that gets to me, and all I want is for us to live blocks from everything that takes us out of the house.
But then, I bike home from the train station through my wooded neighborhood. Harriet greets me with excited tail thumping and we run upstairs to the yard. There I discover that our lovely neighbors/landlords have gone to the trouble of installing for us a fantastic pulley-style clothesline to replace the one that I hastily stuck up in the shade without thinking twice eight months ago. And wonder how we'll ever bear to leave. There may be short commutes in Boston. There may be more action and there could even be other nice neighbors to be had. But there are not our neighbors. There are not our woods and our yard. Our house is not there. I only have eight more months before my schedule burgeons out of control, and I can't fathom that that could be enough time for us in what has become such a home.
8.24.2009
That paler side of leaves
Here, this week, leaves all around me are turning over. That duller underside is maybe something special, but less pretty and harder to like. School. Once again, I am passing my days (oh, such long, long days) in a lecture hall. Two weeks ago I could barely catch my breath as I watched the end of summer, my last summer off ever in my life, whiz by at acela express train speed. The thing about school is that I know it is good. And there are lovely friends around me, who make it really quite easy to slide back in and feel right about the world.
Rolling down the last hill into the Sharon train station each morning last week on my bicycle did wonders for spirits. So did that first sip of coffee from my most perfect travel mug. And lunch with friends in the grass of the quad. (Question for the group: What is your favorite part of medical school? Easily agreed upon answer: Recess!)
I think that it is just good to feel grounded. To have plans and routine. I am, as they say, on top of things. That is about the newest leaf I could ask for. Being not super stressed is a priority for me in medical school. Not least of all because stress wrecks havoc on my ability to interact usefully with the important folk in my life, and being mean to Lion is not on the list of "things that are OK." Last year my approach to being stress-minimal was to not worry about things very much re: school. I'm going to say that I squeezed by just fine with that attitude. My Pass/fail classes were passed and I managed to "bring it" for the ones I considered most important. But I'm not sure that I can approach the coming year with the same surfer dude type approach. So I am turning over that leaf to it's matte green underbelly. Dull, but satisfying.
Rolling down the last hill into the Sharon train station each morning last week on my bicycle did wonders for spirits. So did that first sip of coffee from my most perfect travel mug. And lunch with friends in the grass of the quad. (Question for the group: What is your favorite part of medical school? Easily agreed upon answer: Recess!)
I think that it is just good to feel grounded. To have plans and routine. I am, as they say, on top of things. That is about the newest leaf I could ask for. Being not super stressed is a priority for me in medical school. Not least of all because stress wrecks havoc on my ability to interact usefully with the important folk in my life, and being mean to Lion is not on the list of "things that are OK." Last year my approach to being stress-minimal was to not worry about things very much re: school. I'm going to say that I squeezed by just fine with that attitude. My Pass/fail classes were passed and I managed to "bring it" for the ones I considered most important. But I'm not sure that I can approach the coming year with the same surfer dude type approach. So I am turning over that leaf to it's matte green underbelly. Dull, but satisfying.
5.13.2009
On Death
Sorry, it's a long one...
My first patient was a gaunt and scruffy man in his fifties. Six medical students and three physicians crowded into his hospital room. We watched as one of our preceptors demonstrated the patient interview, asking the open-ended questions we would learn to emulate, expressing empathy, finding points of connection to this man’s life. He answered each with an affect so flat he seemed less than human. A nearly imperceptible moment of anger, a half smile to acknowledge enthusiasm for the Sox, these were the windows into his emotional life. The medical details of his case hardly mattered, advanced cancer, failures of compliance. After the interview we speculated on his personality, his attitude around his illness, the effectiveness of the interview strategy. And that night I summarized him into three boxes, chief complaint, history of present illness, and the more amorphous “patient as a person,” a place holder for more boxes to come. A few weeks later, debating the relative utility of silent pauses, clarifying language or casual posture that first interview came up again. As the conversation turned, our preceptor said casually, “He died, by the way.”
Months later, an unusual afternoon left me alone in for over an hour with a vibrant woman in her eighties. If one thing has become clear, it is that all lives that long carry some burden of personal tragedy. She spoke with zest, and a warmth that conveyed gratitude, about her work as an artist. She countered each mention of her illness with the assertion that she had lived a full life, that she had been lucky. When she stated that she would be dying, “maybe not the day after tomorrow, but three days, I think,” it was matter-of-fact. She seemed the picture of a perfect death, beyond denial, grateful for a life well lived. Two weeks later, I saw her again, being wheeled by slowly in the hallway. I greeted her, smiling to this women I now felt I knew so well. She had further thinned and paled. She did not acknowledge me, her eyes focused somewhere beyond the tangibles around us. Then again I saw her, still not dead, two weeks after that being taken from the lobby. This time I made no effort to say hello. She clutched at the thin blanket gathered around her legs, somehow appearing wholly gathered into herself.
“You can’t ask a person that when they’re dying.” He said in response to only my second question: “How are you coping?” My first, the standard “What brought you to the hospital?” he had answered with: “Well, I’m dying.” This was only a few weeks ago. I put my pen and notepad away. It is obvious that no one life, or “history” as we like to call it, can fit into the neatly categorized summary we have learned to create. But he in particular seemed uninterested in leading me through any discussion that would translate to a standard write-up. I have started interviews with patients who did not want to talk to me, and seen others do the same. These end fairly quickly and we move on to someone more willing. But this fellow resisted my questions, but not my presence. He was quick both to anger and apology. “How can you ask me about my family?” he would ask. “You do right all your life and then out of no where… how did I deserve this?” And then, “I’m being rude. I know. I shouldn’t be rude.”
Death may have much more to do with why I am in medical school than life. Not for the heroism that apparently medical students as a group tend to misperceive as their destiny, but for the experience. The sheer, visceral stimulus of standing nearby death. Yes, I hope to be part of keeping those not ready from the edge. Maybe it is our overly virtual existence or a sheltered first-world life, but there seemed to me to be something about death coming home. I saw it as a great and palpable event, the one thing that can fully remind us that we are alive.
And yet, death has not been what it seemed. Even to death, I begin to apply one-word labels. My first patient: denial. The second I mentioned: acceptance. The third: anger. But how could it be that that first petite, dull-faced man could both ignore the inevitable and then pass so casually? His death merited a mention but no fanfare. Looking back at my notes from this first interview it is barely noted that his cancer “was now considered terminal.” Here it was, September 18th, and I had already become steeled against even noticing that the person in front of me was actually going to die. I am no weak chicken. I don’t think that I needed to put up an emotional wall against such reality. And I don’t that’s necessarily what was happening either. I think I just didn’t know what death might look like. My grandfather died when I was sixteen. We were very close and my tight-knit family responded only as our irreverent selves could. We cried, laughed, hugged each other and found ways to remember. Anger and outright denial, while not a response I’ve experienced personally, still seem to me emotions fitting for the profound nature of death. And so from this first man I learned that death can be profound but it can also be blasé. That this man’s life, while it surely mattered greatly to him and to others, had reached a point where it did not need to matter to me.
My second patient seemed at first to be the picture of a respectable death, a life well lived. She expressed messy regrets that humanized her so completely. On what she named her deathbed she related to me her life story, her medical history only an aside. I felt a real connection with her. But she was not dying, not imminently. Her physician in the hallway suggested that she had months if not years, not days. I still don’t know what this can mean. The common knowledge is that people know themselves, that like cats who supposedly find somewhere warm to curl up when their time has come, the elderly make peace and bed down. Did her seeming readiness to go and surety that death was near make her suicidal? Certainly not, but what was it? And what could be the meaning of her blankness in the next weeks? Perhaps she and her physician were both wrong, and I just can’t know what she is really experiencing.
The angry man was the first patient who came close to my expected experience. While he began the interview with mostly quiet two-word responses, his anger showed through and became increasingly more articulate. And finally he turned the tables: “How would you deal with this situation?” I dodged and returned the question to him, but he called me out and threw it back. I still dodged, saying what I do now know, that “death is different for everyone.” And then, “how can I know what it will be like before I am there?” But what I really wanted to say to, and perhaps could have albeit stated more carefully was this, “I would be a hell of a lot better at this than you are. I would do what I could with the time I had left.” And that would be true, even with the details of his story that render his anger so justified. I would be inspirational, but now I’m not so sure that I wouldn’t also be full of it.
When he first told me I could not ask my questions of a man on his deathbed, I was not nervous or uneasy or excited. I was interested. I would have spoken with him for hours. I never wrote-up that interview. I never asked for his HPI beyond “cancer.” I don’t know what CC brought him in that week. The details on his social history are sketchy and tragic. He brought home to me that there are so very many things that I do not yet and cannot yet know about myself. He showed me that try as I might, there are also many things that I will not understand about others. But he did not ask me to leave, and I left his room with the clear sense that it still makes sense to try.
My first patient was a gaunt and scruffy man in his fifties. Six medical students and three physicians crowded into his hospital room. We watched as one of our preceptors demonstrated the patient interview, asking the open-ended questions we would learn to emulate, expressing empathy, finding points of connection to this man’s life. He answered each with an affect so flat he seemed less than human. A nearly imperceptible moment of anger, a half smile to acknowledge enthusiasm for the Sox, these were the windows into his emotional life. The medical details of his case hardly mattered, advanced cancer, failures of compliance. After the interview we speculated on his personality, his attitude around his illness, the effectiveness of the interview strategy. And that night I summarized him into three boxes, chief complaint, history of present illness, and the more amorphous “patient as a person,” a place holder for more boxes to come. A few weeks later, debating the relative utility of silent pauses, clarifying language or casual posture that first interview came up again. As the conversation turned, our preceptor said casually, “He died, by the way.”
Months later, an unusual afternoon left me alone in for over an hour with a vibrant woman in her eighties. If one thing has become clear, it is that all lives that long carry some burden of personal tragedy. She spoke with zest, and a warmth that conveyed gratitude, about her work as an artist. She countered each mention of her illness with the assertion that she had lived a full life, that she had been lucky. When she stated that she would be dying, “maybe not the day after tomorrow, but three days, I think,” it was matter-of-fact. She seemed the picture of a perfect death, beyond denial, grateful for a life well lived. Two weeks later, I saw her again, being wheeled by slowly in the hallway. I greeted her, smiling to this women I now felt I knew so well. She had further thinned and paled. She did not acknowledge me, her eyes focused somewhere beyond the tangibles around us. Then again I saw her, still not dead, two weeks after that being taken from the lobby. This time I made no effort to say hello. She clutched at the thin blanket gathered around her legs, somehow appearing wholly gathered into herself.
“You can’t ask a person that when they’re dying.” He said in response to only my second question: “How are you coping?” My first, the standard “What brought you to the hospital?” he had answered with: “Well, I’m dying.” This was only a few weeks ago. I put my pen and notepad away. It is obvious that no one life, or “history” as we like to call it, can fit into the neatly categorized summary we have learned to create. But he in particular seemed uninterested in leading me through any discussion that would translate to a standard write-up. I have started interviews with patients who did not want to talk to me, and seen others do the same. These end fairly quickly and we move on to someone more willing. But this fellow resisted my questions, but not my presence. He was quick both to anger and apology. “How can you ask me about my family?” he would ask. “You do right all your life and then out of no where… how did I deserve this?” And then, “I’m being rude. I know. I shouldn’t be rude.”
Death may have much more to do with why I am in medical school than life. Not for the heroism that apparently medical students as a group tend to misperceive as their destiny, but for the experience. The sheer, visceral stimulus of standing nearby death. Yes, I hope to be part of keeping those not ready from the edge. Maybe it is our overly virtual existence or a sheltered first-world life, but there seemed to me to be something about death coming home. I saw it as a great and palpable event, the one thing that can fully remind us that we are alive.
And yet, death has not been what it seemed. Even to death, I begin to apply one-word labels. My first patient: denial. The second I mentioned: acceptance. The third: anger. But how could it be that that first petite, dull-faced man could both ignore the inevitable and then pass so casually? His death merited a mention but no fanfare. Looking back at my notes from this first interview it is barely noted that his cancer “was now considered terminal.” Here it was, September 18th, and I had already become steeled against even noticing that the person in front of me was actually going to die. I am no weak chicken. I don’t think that I needed to put up an emotional wall against such reality. And I don’t that’s necessarily what was happening either. I think I just didn’t know what death might look like. My grandfather died when I was sixteen. We were very close and my tight-knit family responded only as our irreverent selves could. We cried, laughed, hugged each other and found ways to remember. Anger and outright denial, while not a response I’ve experienced personally, still seem to me emotions fitting for the profound nature of death. And so from this first man I learned that death can be profound but it can also be blasé. That this man’s life, while it surely mattered greatly to him and to others, had reached a point where it did not need to matter to me.
My second patient seemed at first to be the picture of a respectable death, a life well lived. She expressed messy regrets that humanized her so completely. On what she named her deathbed she related to me her life story, her medical history only an aside. I felt a real connection with her. But she was not dying, not imminently. Her physician in the hallway suggested that she had months if not years, not days. I still don’t know what this can mean. The common knowledge is that people know themselves, that like cats who supposedly find somewhere warm to curl up when their time has come, the elderly make peace and bed down. Did her seeming readiness to go and surety that death was near make her suicidal? Certainly not, but what was it? And what could be the meaning of her blankness in the next weeks? Perhaps she and her physician were both wrong, and I just can’t know what she is really experiencing.
The angry man was the first patient who came close to my expected experience. While he began the interview with mostly quiet two-word responses, his anger showed through and became increasingly more articulate. And finally he turned the tables: “How would you deal with this situation?” I dodged and returned the question to him, but he called me out and threw it back. I still dodged, saying what I do now know, that “death is different for everyone.” And then, “how can I know what it will be like before I am there?” But what I really wanted to say to, and perhaps could have albeit stated more carefully was this, “I would be a hell of a lot better at this than you are. I would do what I could with the time I had left.” And that would be true, even with the details of his story that render his anger so justified. I would be inspirational, but now I’m not so sure that I wouldn’t also be full of it.
When he first told me I could not ask my questions of a man on his deathbed, I was not nervous or uneasy or excited. I was interested. I would have spoken with him for hours. I never wrote-up that interview. I never asked for his HPI beyond “cancer.” I don’t know what CC brought him in that week. The details on his social history are sketchy and tragic. He brought home to me that there are so very many things that I do not yet and cannot yet know about myself. He showed me that try as I might, there are also many things that I will not understand about others. But he did not ask me to leave, and I left his room with the clear sense that it still makes sense to try.
4.27.2009
I DID IT I DID IT
I finally cleaned out my email inbox! OMG this has been weighing down on my for maybe two months. So totally absurd that I could be weighed down by my email inbox, but true nonetheless! As my number of unread emails bounced between 200 and 400 I was starting to go slowly insane and constantly anxious that those messages held important information that I was just simply ignoring.
In the end, I didn't miss much by reading only the subject lines. After a valiant struggle, I have zero unread emails. ZERO.
Ok, whoa. I got two emails while writing that short paragraph (see why this is so hard for me??). I have now dealt with those two emails and I am back to zero. WHEW.
In other news: I finished our wedding invitations today. For whatever reason we have ended up sending them out in waves as we finished gluing them together. The final batch is enveloped and stamped. Another huge weight off of our shoulders. To be totally fair and with the giving credit where it's due stuff: Lion did the vast majority of the work.
It is always amazing to me how good it feels to accomplish tasks you've been putting off. Why is it that I can be smart at some things and yet rendered so miserable by procrastination?
Similarly, there are about 100 pairs of scrubs bound for a medical school in Nepal currently hanging on my clothesline. When was I supposed to get those washed? Hmmm.... December?
In the end, I didn't miss much by reading only the subject lines. After a valiant struggle, I have zero unread emails. ZERO.
Ok, whoa. I got two emails while writing that short paragraph (see why this is so hard for me??). I have now dealt with those two emails and I am back to zero. WHEW.
In other news: I finished our wedding invitations today. For whatever reason we have ended up sending them out in waves as we finished gluing them together. The final batch is enveloped and stamped. Another huge weight off of our shoulders. To be totally fair and with the giving credit where it's due stuff: Lion did the vast majority of the work.
It is always amazing to me how good it feels to accomplish tasks you've been putting off. Why is it that I can be smart at some things and yet rendered so miserable by procrastination?
Similarly, there are about 100 pairs of scrubs bound for a medical school in Nepal currently hanging on my clothesline. When was I supposed to get those washed? Hmmm.... December?
4.21.2009
Medical School? Check.
I finally began feel like I am in medical school about six weeks ago. Before that I had certainly felt like I was in school. Make no mistake, there was a lots of studying and a veritable mountain of molecule names and body parts to commit to memory.
In terms of intellectual stimulus, the whole thing had been underwhelming. Intellectually hard, yes, by nature of the sheer and insurmountable volume of information to commit to memory, but infrequently inspiring in an academic sense.
And then came physiology. I should have known that I would like it. The physicsesque prefix, the geeky "ology" suffix all added up to the most fun version of "The Way Things Work" I've engaged in. Unlike tinkering with my bike or pulling apart old telephones, considering physiology was about the machine that is always with me. Though a lot of the inner workings were what you can't see, things like respiration and heart rate I could feel in myself. Suddenly I was reading notes on the train with one finger on my carotid and holding my breath or thinking about the catecholamine release and resultant speeding of my heart brought on a sudden blaring announcement over the loud-speaker. There was just something about it. Like the inside of a clock, it's just plain neat.
Physiology came as a relief to my overly self-analytical self. A relief to the constant question: should I be doing this? I haven't wondered if I really want to take care of patients, to be involved in the nitty-gritty of people's lives at their moments of encountering illness, life and death, in solving the puzzle of maintaining their own health. Each Wednesday afternoon we tromp out to one of the myriad of hospitals in this flagship city of health care to practice our patient interview skills. In those moments, the act of doctoring has clearly presented itself as a good path. But here I was, months into school, and I kept thinking "didn't I used to really dig science, too?" It's OK, I believe now, that cell biology, molecular biology and anatomy, weren't awe-inspiring to me. The study of how our body works on a macro scale has the most clear relevance to the practice of medicine, and so I was thrilled that I liked it the best. The last month we've sauntered into immunology and pathology. Though In some ways a step back into molecule hell and the tyranny of three letter acronyms, it is made up for by the fact that we are now learning about diseases. And diseases always feel relevant.
In terms of intellectual stimulus, the whole thing had been underwhelming. Intellectually hard, yes, by nature of the sheer and insurmountable volume of information to commit to memory, but infrequently inspiring in an academic sense.
And then came physiology. I should have known that I would like it. The physicsesque prefix, the geeky "ology" suffix all added up to the most fun version of "The Way Things Work" I've engaged in. Unlike tinkering with my bike or pulling apart old telephones, considering physiology was about the machine that is always with me. Though a lot of the inner workings were what you can't see, things like respiration and heart rate I could feel in myself. Suddenly I was reading notes on the train with one finger on my carotid and holding my breath or thinking about the catecholamine release and resultant speeding of my heart brought on a sudden blaring announcement over the loud-speaker. There was just something about it. Like the inside of a clock, it's just plain neat.
Physiology came as a relief to my overly self-analytical self. A relief to the constant question: should I be doing this? I haven't wondered if I really want to take care of patients, to be involved in the nitty-gritty of people's lives at their moments of encountering illness, life and death, in solving the puzzle of maintaining their own health. Each Wednesday afternoon we tromp out to one of the myriad of hospitals in this flagship city of health care to practice our patient interview skills. In those moments, the act of doctoring has clearly presented itself as a good path. But here I was, months into school, and I kept thinking "didn't I used to really dig science, too?" It's OK, I believe now, that cell biology, molecular biology and anatomy, weren't awe-inspiring to me. The study of how our body works on a macro scale has the most clear relevance to the practice of medicine, and so I was thrilled that I liked it the best. The last month we've sauntered into immunology and pathology. Though In some ways a step back into molecule hell and the tyranny of three letter acronyms, it is made up for by the fact that we are now learning about diseases. And diseases always feel relevant.
2.07.2009
NAME THAT CLOUD
That's right, everyone, this is what I was actually doing when I told Lion on the phone that I was "studying."
How much do I rock?
How much do I rock?
12.18.2008
Dear Mr. Obama: We're Still Hurting
At this moment I wish very sincerely that Barack Obama could have felt the way I did on election night. I don't now believe that he has any real understanding of what it meant for LGBT Americans, so many of whom worked tirelessly to put him in office, to watch the passage of Prop 8 in California. To see not just rights denied as in the many other states that have passed similar measures, but rights taken away from those to whom they had been granted, that was just crushing. We are still licking our wounds, even those of us who watched from across the country unable to do much more than send a bit out a medical student's living allowance to help the cause. If anyone reading this wants to get a better sense of that pain, go over to Lesbian Dad and read pretty much any entry from the last three months. And so, to choose Rick Warren to speak at your inauguration in the name of inclusion, just pretty much redoubles the pain we had barely begun to heal from. Why is it so important to include those who campaigned against Obama, but not those who worked for him? It is NOT OK for Rick Warren, a man who has equated Lion's and my upcoming wedding to a grown man marrying a child, to speak at inauguration, I don't care how eloquently the man talks about climate change. Look, I know that Obama doesn't openly support gay marriage and he hasn't been awesome on all of the the LGBT issues, but he opposed Prop 8 so it's not like this man is representative of his position. We are still hurting, Mr. Obama. It was disappointing enough for you to tease us with the possible appointment of a lesbian for labor secretary, but please don't give a national microphone to someone working to invalidate my life. DAMMIT. It's personal.
I guess what matters is that people who think with Warren hold a great deal of power in this country.
For some good analysis, see Bilerico, Pam's House Blend,
I guess what matters is that people who think with Warren hold a great deal of power in this country.
For some good analysis, see Bilerico, Pam's House Blend,
12.11.2008
New Arguments
At this point in the game, I am sometimes shocked when I discover a new argument for gay rights or any other position I've been engaged in mulling over for some time. After many years as Captain Gay of many a gay club, and far too much blog reading it's just not expected. And of all sources, I hardly expected it to come from Jon Stewart. In the video below, which I stumbled across via feminsting, he takes on Mike Huckabee on same-sex marriage. Most of the discussion is old-hat, though interesting to hear played out face-to-face. What struck me was the point that Jon makes that one is much more likely to choose their religion than to be gay and that we protect people's religious practice as a right.
Now, I'm not really one for the "is it a choice or not" debate. A good liberal arts grad knows that the answer is unlikely to be either/or but rather both/and. BUT I often hear that things such as sexual orientation and gender identity do not deserve to be protected classes because one can't prove them to be inborn and unchangeable in the same way that skin color is largely inborn and unchangeable. While I've always rejected the premise of the argument that rights ought to be doled out on the basis of provably inborn and unchangeable-ness it never plum occurred to me that one could counter that so very simply and elegant with the example of religious choice. Holy rebuttal, batman!
Now, I'm not really one for the "is it a choice or not" debate. A good liberal arts grad knows that the answer is unlikely to be either/or but rather both/and. BUT I often hear that things such as sexual orientation and gender identity do not deserve to be protected classes because one can't prove them to be inborn and unchangeable in the same way that skin color is largely inborn and unchangeable. While I've always rejected the premise of the argument that rights ought to be doled out on the basis of provably inborn and unchangeable-ness it never plum occurred to me that one could counter that so very simply and elegant with the example of religious choice. Holy rebuttal, batman!
12.07.2008
Moms and Forgetting
Something adorably funny and oh-so-typical for our family happened to my mother this week. Dad reports in smatters:
I’m just going to get it out there: I have a horrific and unreasonable Mommy complex.
1. I antagonize my mother at strange times for no significant reason.
2. I love, respect, ask for, value and am interested by her advice. And yet I am unthinkably skeptical the moment she offers it.
3. I am afraid that she’ll direct my choices for me even though she’s always encouraged me to be strong and independent (see 2).
4. I am afraid that I’ll become her, because we went to the same prep school and did some of the same things and now I’m in med school and interested in basically the same field of practice that she’s in. I’m worried that I choose these things because I already know what they look like from watching her, not because they are what I really want. At the same time I'm afraid I can't live up to her.
What’s crazy about being worried about being so much like her is that she is awesome as a role model and a mom. She is awesome in all ways! I mean, she is actually the kind of person that I do want to be. She is a great doctor. She’s very well respected in the community where I grew up as well as in her field. In fact, I had no clue how impressive and unusual her practice was before I started med school. She is a family physician who provides a huge range of care even beyond what the majority in her field do, such as c-sections. When I tell my classmates about her, they usually respond with “I had no idea that was even possible!” For the most part I’m probably more worried about living up to her example than anything else. This is why my dad's story is so awesomely comforting. I have always thought that I learned things best when I had to really articulate them to someone else. Thankfully, the educational method at this med school of mine makes me do that quite a bit. Hence, it has been really frustrating to realize that I can explain something quite well to a friend and then see it on an exam a week later and not really remember what it was. Knowing that not only do my mom and I share an amazing ability to underestimate how long things will take, over schedule, forget meetings, leave important items in restaurants/on trains, double-schedule, repeat conversations we’ve already had… but we also share the awesome ability to forget information we taught to others.
“[My Mom] was doing an on-line recertification quiz late last night. It was one of those things where they ask you the question, immediately tell you if you’re wrong, and if so, they give you references to the right answer. She got one wrong and looked at the reference. It was a paper she had co-authored herself.”Oh, the comfort I draw from such stories!
I’m just going to get it out there: I have a horrific and unreasonable Mommy complex.
1. I antagonize my mother at strange times for no significant reason.
2. I love, respect, ask for, value and am interested by her advice. And yet I am unthinkably skeptical the moment she offers it.
3. I am afraid that she’ll direct my choices for me even though she’s always encouraged me to be strong and independent (see 2).
4. I am afraid that I’ll become her, because we went to the same prep school and did some of the same things and now I’m in med school and interested in basically the same field of practice that she’s in. I’m worried that I choose these things because I already know what they look like from watching her, not because they are what I really want. At the same time I'm afraid I can't live up to her.
What’s crazy about being worried about being so much like her is that she is awesome as a role model and a mom. She is awesome in all ways! I mean, she is actually the kind of person that I do want to be. She is a great doctor. She’s very well respected in the community where I grew up as well as in her field. In fact, I had no clue how impressive and unusual her practice was before I started med school. She is a family physician who provides a huge range of care even beyond what the majority in her field do, such as c-sections. When I tell my classmates about her, they usually respond with “I had no idea that was even possible!” For the most part I’m probably more worried about living up to her example than anything else. This is why my dad's story is so awesomely comforting. I have always thought that I learned things best when I had to really articulate them to someone else. Thankfully, the educational method at this med school of mine makes me do that quite a bit. Hence, it has been really frustrating to realize that I can explain something quite well to a friend and then see it on an exam a week later and not really remember what it was. Knowing that not only do my mom and I share an amazing ability to underestimate how long things will take, over schedule, forget meetings, leave important items in restaurants/on trains, double-schedule, repeat conversations we’ve already had… but we also share the awesome ability to forget information we taught to others.
11.26.2008
A Final-y Post
My Anatomy final is in twenty minutes.
And so this may seem like a strange moment for a post to a blog that has been sparse for many months. But I am feeling a bit zen. Or may it's "in the zone." Upon reviewing my note cards from early in the class, I discovered that I no longer have any trouble keeping the cephalic and basilic veins straight. I am always certain which is the zygomatic and which is the sphenoid. Also that the scaphoid is in your hand and sphenoid in your head.
And of course, last week on the phone with my mother, I used about fifteen words that I have never ever used before. Thusly, I believe that I have officially become conversational (that's the one before fluent) in medicalese. The kinds of sentences that flew out of the mouths of so many in my parents' social circles as I kid that I reacted to rather disdainfully are now wandering from my own mouth.
I knew it would happen. They tell you that medical school changes you. They urge us with worried eyes to hold onto our ideals. Be humble, they say. And we try! But then, here we are, talking in this high falutin' language. Arm will never again be arm, and leg no more leg. How appalling to discover that it isn't actually called a "hamstring."
And so this may seem like a strange moment for a post to a blog that has been sparse for many months. But I am feeling a bit zen. Or may it's "in the zone." Upon reviewing my note cards from early in the class, I discovered that I no longer have any trouble keeping the cephalic and basilic veins straight. I am always certain which is the zygomatic and which is the sphenoid. Also that the scaphoid is in your hand and sphenoid in your head.
And of course, last week on the phone with my mother, I used about fifteen words that I have never ever used before. Thusly, I believe that I have officially become conversational (that's the one before fluent) in medicalese. The kinds of sentences that flew out of the mouths of so many in my parents' social circles as I kid that I reacted to rather disdainfully are now wandering from my own mouth.
I knew it would happen. They tell you that medical school changes you. They urge us with worried eyes to hold onto our ideals. Be humble, they say. And we try! But then, here we are, talking in this high falutin' language. Arm will never again be arm, and leg no more leg. How appalling to discover that it isn't actually called a "hamstring."
11.23.2008
Wedding Dresses
Yes, this is a post about wedding dresses.
On the prosected-cadaver viewing sandwich that was my yesterday, watching Lion try on wedding dresses was the bread. My anatomy final is on Wednesday, and so she used the excuse of my cadaver-viewing to schelp into Boston for some over-the-top dress exploring.
Yes, she's planning to wear a wedding dress. Like a white one. This is because she is a virgin and wants the world to know that true love waits. OW! Ok, that's not why. Actually, despite the ridiculous patriarchy juice flavor of many traditions that swirl around marriage we're swallowing, even wanting some of them, and it's been hard to know why. The dress was something I sort of resigned myself to, not wanting one myself but knowing it was part of her vision I figured, "why not, she'll look real pretty?" Now I get it. I even get why it is that even people like us sometimes spend more on wedding dresses than I did on my lovely used Subaru.
We had said that the schmancy schmance Boston shops (one of which was Vera Wang) were just for fun, you know, so that she could get a good idea of cuts and colors and lines and whatever it is that makes for a wedding dress. I expected to be vaguely bored but appreciative of watching my honey try on pretty dresses. But then, four dresses or so in, she walked out of the dressing room and suddenly I was almost crying. This is a way that I have felt occasionally in museums and at plays. When I read poetry. Things like that. It's art. It's for your body. And it is beautiful and damn classy. And suddenly I'm wondering if it's stupid to sell my car to buy clothes for Lion to wear for six hours.
Vera Wang came after I spent a couple of hours in the anatomy lab studying. I think the helpful dress wrangler person smelled the formaldehyde on me because she seemed to keep a distance. Lion floated in and out of the dressing room, and I looked on with a visiting friend from college. We nodded and smiled mostly, but with one or two dresses our breath caught and we found ourselves "oohing" against our will. Beneath the layers of meaning and the unwieldy traditions there is this glowing in-love person ensconced in art.
We ended the day at David's Bridal, hoping to talk ourselves down from the illogical afternoon couture. And really, she tried on some gorgeous dresses there. I'm sure she could fashion a mumu out of duct tape and I'd appreciate it. And she really did look beautiful, even under the harsh lights of the Wal-Mart of weddings. But, I had to admit a sense of resignation when she looked down from her little block in front of the mirror and said, "you're not crying, though."
All sorts of ideas about consumerism and values and how we value what and where we put our money are filling me in a whole new and interesting way. Is it definitely better to spend $600 on a pretty ivory-colored dress than it is to spend $6000 on a piece of stunning well-crafted art you can wear? When it comes to the sad state of overspending on this tradition and widespread pressure to go over the top on everything, which is worse? In the scheme of things, this wedding shin-dig we're having is very much on the cheap. My grum's backyard, mostly doing the food ourselves, etc. And my outfit costs like $60. Buying cheap badly-made things because they are cheap is part of the problem, right? And obsessively cutting costs can be a kind of greediness that I don't find palatable either.
The reality is that we live off of student loans and a TA stipend. Yes our parents are helping pay for the day, but the economy sucks and we don't equate special, personal, important landmark with spending a buttload of cash. If you had asked me Friday how much we'd spend on Lion's dress, I probably would have said $300, tops, and even that would feel like a lot. But then I saw her in that blush Badgley Mischka. And it changed my world.
On the prosected-cadaver viewing sandwich that was my yesterday, watching Lion try on wedding dresses was the bread. My anatomy final is on Wednesday, and so she used the excuse of my cadaver-viewing to schelp into Boston for some over-the-top dress exploring.
Yes, she's planning to wear a wedding dress. Like a white one. This is because she is a virgin and wants the world to know that true love waits. OW! Ok, that's not why. Actually, despite the ridiculous patriarchy juice flavor of many traditions that swirl around marriage we're swallowing, even wanting some of them, and it's been hard to know why. The dress was something I sort of resigned myself to, not wanting one myself but knowing it was part of her vision I figured, "why not, she'll look real pretty?" Now I get it. I even get why it is that even people like us sometimes spend more on wedding dresses than I did on my lovely used Subaru.
We had said that the schmancy schmance Boston shops (one of which was Vera Wang) were just for fun, you know, so that she could get a good idea of cuts and colors and lines and whatever it is that makes for a wedding dress. I expected to be vaguely bored but appreciative of watching my honey try on pretty dresses. But then, four dresses or so in, she walked out of the dressing room and suddenly I was almost crying. This is a way that I have felt occasionally in museums and at plays. When I read poetry. Things like that. It's art. It's for your body. And it is beautiful and damn classy. And suddenly I'm wondering if it's stupid to sell my car to buy clothes for Lion to wear for six hours.
Vera Wang came after I spent a couple of hours in the anatomy lab studying. I think the helpful dress wrangler person smelled the formaldehyde on me because she seemed to keep a distance. Lion floated in and out of the dressing room, and I looked on with a visiting friend from college. We nodded and smiled mostly, but with one or two dresses our breath caught and we found ourselves "oohing" against our will. Beneath the layers of meaning and the unwieldy traditions there is this glowing in-love person ensconced in art.
We ended the day at David's Bridal, hoping to talk ourselves down from the illogical afternoon couture. And really, she tried on some gorgeous dresses there. I'm sure she could fashion a mumu out of duct tape and I'd appreciate it. And she really did look beautiful, even under the harsh lights of the Wal-Mart of weddings. But, I had to admit a sense of resignation when she looked down from her little block in front of the mirror and said, "you're not crying, though."
All sorts of ideas about consumerism and values and how we value what and where we put our money are filling me in a whole new and interesting way. Is it definitely better to spend $600 on a pretty ivory-colored dress than it is to spend $6000 on a piece of stunning well-crafted art you can wear? When it comes to the sad state of overspending on this tradition and widespread pressure to go over the top on everything, which is worse? In the scheme of things, this wedding shin-dig we're having is very much on the cheap. My grum's backyard, mostly doing the food ourselves, etc. And my outfit costs like $60. Buying cheap badly-made things because they are cheap is part of the problem, right? And obsessively cutting costs can be a kind of greediness that I don't find palatable either.
The reality is that we live off of student loans and a TA stipend. Yes our parents are helping pay for the day, but the economy sucks and we don't equate special, personal, important landmark with spending a buttload of cash. If you had asked me Friday how much we'd spend on Lion's dress, I probably would have said $300, tops, and even that would feel like a lot. But then I saw her in that blush Badgley Mischka. And it changed my world.
10.24.2008
Cuz She's in Doctor School
The words of our 8-year-old neighbor to her friend, as I shooed them away so that I could "do homework." This is an increasingly popular scenario at our house as our neighbor scoots down to play with our dog (a welcome distraction) and I inevitably have to toss her out to hit the books.
Because, indeed, I am in doctor school. And this is something that I have many thoughts on. It is busy, it is a lot of work, it is messy, complicated. Suddenly I feel like I don't know what I want to be when I grow up. On the train home today I found myself making lists of my values and interests, trying to keep track of what I get passionate about. I may have put a bit too much caché in the ability of medical school to define my life trajectory. There are still oh-so-many choices.
The best and hardest part about school is having found a wide number of people with genuine interest in social justice and health and how that all comes together. I say hard because between the exposure, in lunchtime talks sponsored by student organization and in our required (hooray!) social medicine and global health class, to reading and lecture after reading and lecture about just how dismal the state of health is in this country and the world it all feels about overwhelming. Suddenly the idea of how to shape the kind of medical practice I would like to have and how to ensure that it fits with the overwhelming need I am feeling to be part of the solution of widespread health disparities is constantly in the forefront of my mind.
I feel so full of statistics and measures that outline the problems. Today's lovely tidbit highlighting part of the impact of life as a Black woman in this country: infant mortality rates among Black women with a college degree is higher than that of white women who did not graduate from high school. There's one to chew on. I've also been stuck on the knowledge that Native Americans have about the worst population health in this country, and yet we have about the least amount of measured data on that population to really assess the problem. Perhaps the real kicker has been realizing more fully how little the actual health system does to address the health of the USA. Even when you're insured and well-insured and you have great doctors, our society is just set up to make us unhealthy. Here's what's on my mind. Perhaps I will begin to actually blog again.
8.13.2008
Home Differently
Here we are, barely a day away from leaving Xela. I am so not ready! Not only do I feel that I have not quite so much exactly had a vacation these past five weeks, I am going to start La Escuela Medicina on Monday.
MONDAY! Less than a week! Have I paid my termbill? Have I read that biochem book? Sent them my transcripts? Filled out that mini-survey??? No, no, no, no, no.
But, indeed all that is far off on distant shores and I refuse to feel stressed about it until at least Sunday.
Meanwhile, Guatemala. It has been mad fun. My Spanish is way better (for about the 10th time in my life) and I swearrrr that I'm going to keep practicing at home. I will not lose the subjunctive again! Well, I might. But I really am going to get me a volunteer gig that involves hablando. This country! This town! I want to stay. And I want to go home, too. Turtle says that a big reason to travel is to experience home differently when you get back. And I suppose it is true. The difference between here and the HV or Boston, which I suppose is home now, are striking and yet not so striking at times.
This is a shockingly beautiful country. Especially the mountains, from which we have not strayed far for fear of malaria. Though the bus rides have been insane and nausea-inducing at times, the vistas were almost always worth it. Lion and I spent the last week doing a little circle through the middle of the country. We lounged on the shores of Lake Atitlan, spent a quasi-terrifying night in Guatemala city (scary movie, only people in the theater, late show, appallingly bad sound quality, ominous guidbook warnings, bedbugs) then cruised through the friendly town of Jalapa, where Lion's mom lived when she was in the Peace Corps 40 years ago. After that we went up to see Semuc Champey. Champey is frequently described as "the most beautiful place in Guatemala." But people are almost always at a loss to explain it. Don't worry. We took video. Soon enough YouToo will experiene its badly-filmed greatnes. It was a magical day, to be sure. Followed by zip-lining through a coffee plantation.
What could be more quintessentially eco-touristy than zip-lining through a cooperative, shade-grown, organic coffe plantation? I dare you to come up with something.
We spent an eye-blink in Nebaj, notable for its annual festival gearing up last weekend and insanely over-priced laundry service. We actually almost cried when she told us how much she wanted for cleaning our clothes. Actually, Lion probably did cry, as is her way.
Now back in Xela, we're chilling out at CBA and getting somethings done on the "Proyecto" we're helping them with. This has included sign-painting and shakey video taking, among other things. This has been a good month, especially for reflection. On human rights, on what one needs, on what constitutes being poor, being happy, being friendly, being thoughtful. Hugo and ElBia graciously tell us that we're not like other USAers. From the gringo conversations we overhear somedays in cafes, I dearly hope we're not. But then there are also many more dedicated and interested and thoughtful as well. Ah, well. More serious stuff later.
MONDAY! Less than a week! Have I paid my termbill? Have I read that biochem book? Sent them my transcripts? Filled out that mini-survey??? No, no, no, no, no.
But, indeed all that is far off on distant shores and I refuse to feel stressed about it until at least Sunday.
Meanwhile, Guatemala. It has been mad fun. My Spanish is way better (for about the 10th time in my life) and I swearrrr that I'm going to keep practicing at home. I will not lose the subjunctive again! Well, I might. But I really am going to get me a volunteer gig that involves hablando. This country! This town! I want to stay. And I want to go home, too. Turtle says that a big reason to travel is to experience home differently when you get back. And I suppose it is true. The difference between here and the HV or Boston, which I suppose is home now, are striking and yet not so striking at times.
This is a shockingly beautiful country. Especially the mountains, from which we have not strayed far for fear of malaria. Though the bus rides have been insane and nausea-inducing at times, the vistas were almost always worth it. Lion and I spent the last week doing a little circle through the middle of the country. We lounged on the shores of Lake Atitlan, spent a quasi-terrifying night in Guatemala city (scary movie, only people in the theater, late show, appallingly bad sound quality, ominous guidbook warnings, bedbugs) then cruised through the friendly town of Jalapa, where Lion's mom lived when she was in the Peace Corps 40 years ago. After that we went up to see Semuc Champey. Champey is frequently described as "the most beautiful place in Guatemala." But people are almost always at a loss to explain it. Don't worry. We took video. Soon enough YouToo will experiene its badly-filmed greatnes. It was a magical day, to be sure. Followed by zip-lining through a coffee plantation.
What could be more quintessentially eco-touristy than zip-lining through a cooperative, shade-grown, organic coffe plantation? I dare you to come up with something.
We spent an eye-blink in Nebaj, notable for its annual festival gearing up last weekend and insanely over-priced laundry service. We actually almost cried when she told us how much she wanted for cleaning our clothes. Actually, Lion probably did cry, as is her way.
Now back in Xela, we're chilling out at CBA and getting somethings done on the "Proyecto" we're helping them with. This has included sign-painting and shakey video taking, among other things. This has been a good month, especially for reflection. On human rights, on what one needs, on what constitutes being poor, being happy, being friendly, being thoughtful. Hugo and ElBia graciously tell us that we're not like other USAers. From the gringo conversations we overhear somedays in cafes, I dearly hope we're not. But then there are also many more dedicated and interested and thoughtful as well. Ah, well. More serious stuff later.
7.21.2008
Guatemala Loves Lesbians!
Ok, that is probably just blatantly untrue. But, so far, Guatemala seems fond of this odd specimin of sapphic gringa. In some ways this is the first time that I have really come out to people in the direct "I have a novia" kind of way. My maestro, Roberto, as well as a few other folks it´s come up with have been somewhat curiously delighted. None of them seem to have ever been aware of a lesbian in their midst before. I´m enjoying it. Roberto seems intent on being overtly accepting. Last week he told me that he was also a lesbian because of his significant affection for women. Though his jokes are frequently problematic and he´s not quite able to understand why they´re sexist when they´re "only a joke," I appreciate that he´s trying. He delights in using Lion in sentance examples and asking questions about when she´s getting here. Marcos was his personal brand of energetic and relaxed about the whole thing. He reported later to DHM that I was his first, and like a pro she corrected him, "first you who knew about." She also took him to task later for his off-hand comment that he didn´t like it when women spoke. Boy did I enjoy watching himself try to dig himself out of the "but women are delicate" hole. Tee-hee! And Julio! Well done, despite his quite Catholic ways! He even copped to know some gay dudes at his Universidad.
Lion and Turtle should be here in less than an hour. I can´t wait. I have received some news related to the impending doom that is medical school (buy this book and re-learn biochem, or else!!) which has set me on edge differently than I have been since we got here. Bueno. Necesito hacer mi tarea.
Lion and Turtle should be here in less than an hour. I can´t wait. I have received some news related to the impending doom that is medical school (buy this book and re-learn biochem, or else!!) which has set me on edge differently than I have been since we got here. Bueno. Necesito hacer mi tarea.
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