The Red Line To Our Personal Hell

I spent last night working at Washington Hospital on the northeast side of the city. In doing so, my travels took me aboard the red line Metrorail. I have found my time on the Metro to be an opportunity to reflect on the day. Grant it on the way back from the hospital this morning my time was mostly spent just trying to stay awake...I stood and watched the buildings in the crisp morning's sun. Irony of Washington Monument being in the same field of view of run-down housing can really put a spin on your day if you let it.So last night I worked in the Emergency Room (ER) or Department (ED) (pick your poison). Now that the shift is over I can say this, it was a surprisingly, relatively quiet shift. I worked with a really cool attending physician. The guy sincerely cares, which tends to be the theme around here, mind you. He and his staff worked hard to teach me, which was great in itself. He allowed me to do as much as I want to do, so I was prepping patients in no time flat. Fortunately, I will be working with him throughout the rest of the semester. Last night, I saw a lot of different diseases. What sticks with me through all the minutia is mostly the images of scared patients. Fear rests on our shoulders and grabs at our throat, perhaps one of our most important signs of humanity. I feel as long as I can identify with the fear associated with each patient, whether he/she be conscious or unconscious, dead or alive, sick or healthy, I will be guided. Things become complicated when drug addicts faking pain looking for a score, child/spouse/elderly abusers, individuals trying to get out of work, or looking for a reason to sue, etcetera enter the mix. Patients can have 10 of 10 pain no matter how bad it really is, which is frustrating but also very enlightening. Patients can be extremely scared despite what their disposition 'looks' to be, and fear can drive a person to do many things they normally wouldn't do. The patient with the perirectal abscess in Room 10 may be a jerk to everyone. He may be homeless. However, he needs help, so you jock up, try your best to overlook the fact that he is practically screaming at you, because he has had to tell the same story 4 times in the last 4 hours. By the way, waiting times of four, five, six, seven (you get my point) hours are the norm for non-immediate life-threats in major city hospital ERs. The truth of the matter is that he has probably lived with a bleeding abscess for quite some time, but last night was pretty damn cold. So you tell me, if you were in his shoes, which would be an extremely difficult image to picture, then what would you do...cold night out with a slow bleed in the area where sun doesn't shine or a warm Emergency Department with a bunch of questions thrown at you after a 4-hour wait followed by some medical student sticking you, swallowing some barium filled cranberry-like juice, and then being taken off for an image study and a likely surgery to fix a persistent abscess...oh yeah did I mention receiving a few meals. So, the Emergency Room is a place of battles. Some battles are fought and either won or lost in minutes, while other battles are almost purely ethical. The fact remains: people need help.

I Just Want To Be A Doctor.

I Just Want To Be A Doctor.

When standing face to face with a demon many thoughts may surface once you get over the whole shock and awe factor. I found my Achilles heel thus far on my journey through the world of medicine. Apparently, biochemistry takes the helm of this demon’s ship. Undoubtedly, another beast will replace this sinister creature, but for the time being biochemistry will do. After just barely passing the first exam as did most of the class, I stood there face to face with this vile gatekeeper. In all its wicked breath, it haunted me through the winter break, through January, and into February. Over a slow course consuming the last two weeks, the beast lies still, slain at its throat. Unfortunately, this story does not hold true for many of my fellows. The beast won many times over, a sad fact of the matter. I’m left with distasteful thought. At times when I can reason no rationale behind some of the necessary conquests on the horizon of a medical student or resident, a few thoughts come to mind. Most presiding of which remains to be: “I just want to be a doctor.”

I just want to be a doctor. At three A.M. with my notes and flash cards spread out all over my desk and highlighters gone wild, I just want to be a doctor. Spending an entire day in the same lecture hall listening to lecturer after lecturer speed through their bit, I just want to be a doctor. With my arms shoulder deep in somebody’s bowels, I just want to be a doctor. At eight in the morning running off of 5 hours or less of sleep for the sixth day in a row, I just want to be a doctor. As I slowly accrue more debt than I care to admit, I just want to be a doctor. While I put my life in a holding patter at 10,000 feet, I just want to be a doctor. Watching my friends, at times, struggle right along side of me, I just want to be a doctor. Damn it you wretched demon, don’t you get it…it’s going to tell a hell of a lot more to get me to even budge.

I’ll leave this commentary with one final thought. Why is it that we allow some of America’s brightest and finest students to walk such a gauntlet? These souls live so that they may make the lives of others at least just a little better, so why is that we try to bury them along the way? I just want to be a doctor.

Now what...

Twenty four hours ago I asked myself what the hell I was thinking…medical school…I must be out of mind. All week I recited the same line over and over again from time to time. Examination time always makes a person reevaluate decisions. Today I completed an examination of the entire body. The rules were quite basic: 1) Anything regarding the HUMAN body goes and 2) Gray's Anatomy textbook is the bible. Needless to say, the conditions were ripe for people to fall into the grips of panic, anger, panic again, more anger, and ending with the final statement of 'Oh shit what is that test doing in front of me.' So far in life I've learned a few powerful lessons:

1) If you don't know where to start then just start.
2) Hard work pays off.
3) Don't be afraid to get dirty.
4) Believe in yourself.

These four lessons helped me tremendously during the 500 lb gorilla of medical school, Gross Anatomy. Something in me changed during the course of that class. I don't know when or where it happened, but something changed. Socrates' famous quote makes me smile. "All I know is that I know nothing" could never be more true than to the field of medicine. In a way, Gross Anatomy sobered me up more so than any other time in my life. I learned how impossible it is to learn everything about the human body much in the same way clinical cases relate to medicine as a whole. I now have in me a body of knowledge that could make me quite dangerous. Or should I say, the potential of this acquired body of knowledge makes me dangerous. The true irony of medicine is the more you know the more dangerous you become. It is the 'sober' physician and surgeon who make the best doctors, i.e, the ones who know they do not know everything and will not know everything. No wonder why Gross Anatomy remains the hallmark of a medical education...

I wonder what med school will be like now that I'm not elbow deep in a cadaver every Monday, Wednesday, and Friday afternoon (at least).

I was pimped twice this last week.

Pimp (verb): to make use of often dishonorably for one's own gain or benefit. –Merriam-Webster OnLine

I was pimped twice this last week: once during lab and once during lecture. Pimping is an unwritten passage that ALL student physicians must come to terms with early on in their careers. Call it an initiation. But, also, understand, pimping makes physicians better physicians. Pimping is sort of a one-sided dialogue, a barrage of questions directed from the senior to the newbie or rookie or underclassman all the while putting the student on the spot under a floodlight in the stark of night. These questions are designed to find the edge of student's knowledge and then push the envelope a few notches. The effects are two-fold: 1) reminder of humility and 2) reinforcing continued education. Excellent physicians and surgeons keep true to both, i.e. humility and education. They go hand-in-hand. Medicine is a field of humility encompassed by in depth, continued education: those who can do for those who cannot with selfless actions built on years and years of training.

Like Ducks...

Tuesday of this last week, I was told that Labor Day weekend was this coming weekend. To be honest, I was completely clueless of such a three-day weekend. Yesterday, the remnants of a hurricane / tropical storm paid us a visit...again, clueless of such a storm brewing off the eastern seaboard. Since starting, school has become my universe, and for the most part, I'm ok with that. I enjoy what I am learning. I pray that the information sticks in my head so that I can remain in this privileged profession. I'm so focused that when I learned it was a three-day weekend the first thought in my head was (as with most of the class): awesome another day to catch up. For most students, there are those freakish exceptions without any such gauntlet, the gauntlet of medical school does not reside in scientific theory. If one has a sound foundation in the basic sciences (biology, physics, and chemistry), then the theory, found throughout medicine, digests without much difficulty. The gauntlet pretty much comes down to the volume, the amount of information. I have tried to use the fire hose analogy a few times, but then I realized accuracy wasnt up to par. Better to compare medicine like this: take two or three fire hoses of information, turn them full throttle, and stick your mouth on the outlets. Comfort comes when one realizes that others past and present will or have walked the same bumpy road. Last week a fellow classmate and friend told me a good analogy she had once heard:

Liz: Med students are like ducks.
Me: Like ducks, Liz?
Liz: Yeah like ducks. We look completely calm and put together on the surface, but when you look below the water, we are frantically kicking and moving around just trying to stay afloat.

You work very hard. You play hard, and if there is still time left, then you sleep, or, in my case, you write.

In some ways I have already changed greatly. In others, I'm the same. As a student doctor, I met my first living patient this last week on Tuesday. Sounds early, doesnt it? But, this was exactly what I wanted from a medical school. Although Irma (my groups cadaver, we assigned the body a name as a sign of respect) will teach my fellow lab partners and me very much, she cannot communicate back to us. Medicine is as much about science as it is about human relationships, a balance of science and art. This first living patient really left an impression on me. I will not speak of our communications, just of big picture stuff. His condition was congenital, meaning from birth, and very debilitating in the eyes of the healthy, non-deformed population. He however looked at life very differently, in the most pleasant and refreshing of ways. To him, life embraced a blessing. He does not see debilitation; he sees a challenge. During the visit, he smiled the entire time; his undertone spoke of running downhill on a nice fall day in lieu of running uphill and against the wind in the snow. His love of life, his outlook just completely amazed me. I hope when I am infirmed and/or injured, as I will be...we all will be, that I can take life by the balls and hang tight like this patient, this fellow human being.

A New Life...

Monday, 14 of August, 1330 hours, in the bowels of the medical school, we stood among our first patients. The pungency of formalin righteously inflamed our nostrils. I sat there and thought about the next few minutes. The potential whirlwind of emotion, touching the dead, cold, yet moist body, nobody knows how they will react under such circumstances. I remember looking up and around before we started. Everyone, and I mean everyone, stood dead serious. Upon completion of prayer, our instructors asked us to commence, starting with removal of the denim, plastic, and white cloth. While looking up at each other, my lab partners and I stepped into almost robotic procedure of pulling back the cadavers covers. She was old, her skin no longer soft. Her head and arms were still wrapped and contained. Some of us placed our hands on her body in an attempt to reach out and thank her as she would reveal some of her deepest secrets. She knowingly gave up her body to allow us to learn in the name of science, of humanity, of humility. Our scalpels in hand, we questioned how much pressure to avoid causing harm to our first patient. Although I had dissected many animals, this would be my first human. The first cut came easily as did the second and third. We became more engrossed in making sure we didnt damage the body in a way to lessen our learning experience and less in the fact the person before us was living at one point. As the week rolled on, our cadaver revealed more and more secrets. It took little time amidst a human dissection to realize the complexity of the body. So to keep this experience personal and not remove ourselves from the fact the cadaver was once living and breathing, we decided to name our cadaver, as is the case with many lab groups at this school and most others around the world. A few of us started to brainstorm as we worked our way through the muscles and vasculature of the back. Irma, Irma was the perfect name. Irma spoke of a grandmother; a grandmother who taught her grandchildren about life and that is exactly what she is in the process of doing. The students of Irma use her name with the utmost respect and in some ways she lives with us everyday.

NASA NO LONGER

I am NASA no longer. A divorce` of our manned space program, I have no privilege to know the inside scope, mission detail, etc. Sadly, the papers and TV news generally get the truth all screwed up, which has always rubbed me the wrong way. Ratings, ratings, ratings.

But, what did I learn along the way? Does NASA have it all wrong? Is space exploration not right for us right now? What of this shuttle? What of this space station? What of our future?

Lessons learned (Cliff Note version):
1) Public enemy number one unfortunately has buried itself deep in every mind on this Earth. Public enemy number one is we. When we choose death over saving life, when assets of war take shape as human life or a lack thereof, and when protecting our way of life necessitates pulling a trigger we have become our own worst enemy. Homo sapien has walked the Earth for over five hundred millennia. Ingenuity has brought us from smacking stones together with hopes of fire to channeling fire to propel human beings onto the Moon and beyond. Yet, we still to this day wage war. We still take life away as if it was ours to take away. In America, we debate the death of serial killers, rapists, etc, but what of innocent lives lost at the hands of those who exist almost solely to take it away. This deep-rooted evil festers amidst us. As a species, we have these wonderful abilities and awesome responsibilities. So when will we stop? Will we ever stop? Will we ever stop being our own worst enemy.
2) Where are we? Why are we here? Such are age ole questions. Mothership Earth. We are on a spaceship traveling at 18.5 miles/sec, 30 km/sec (or 66,000 mph) through the heavens. Mysteriously, we exist here on this ship. Why are we here? I dont know nor do I really ask this question with the same ferocity I once did. I have chosen to focus more on my purpose.
3) Go for it. If you have a dream, then go for it. How do you know unless you try? Study up on your dream, understand it, then so be it. Let it roll. Not necessarily caution into the wind but rather rid yourself of regret. Life is a journey of the body, mind, and spirit. Challenge yourself, because who knows...who truly knows. Live a happy fulfilling life.
4) Find what makes you truly happy and cherish it.
5) Try to do everything without arguing or complaining. (yelling, screaming, losing your cool type of arguing, not to be confused with the intellectual argument)
6) Nothing wrong with stating your opinion, but try to understand the whole perspective.
7) Keep your morals. Morality is a fiber. The more you wear it out, the less there is of it.
8) One of my favorite topics, space exploration. Why do we go? Do we need to go? The long answer is a book, but such a book would end with the following: we must go, because our very existence depends upon it. The future of our children and our childrens children rests in how we spend our lives whether it is in the name of peace and survival or in the name of war. To some degree, we can decide our own future. Ultimately, our very ability to move life from this rock, this mothership, will decide whether or not we Earthlings survive, and this realization may be sooner than we think.
9) What of the space shuttle. Often called the most complicated machine ever built by human hands, the space shuttle is something marvelous and special. But, Space Shuttle is not our future. It is our past. A design of compromises, the vehicle does not fit our needs. We must be bold. We must progress and not digress.
10) Space Station. Space station holds many secrets, not of the treasure chest type but rather of the fulfilling awesome type. The public misunderstands Space Station. For instances, the press likes to get the public bent out of shape over scientific research on board Space Station. They speak of the Space Station budget, making sure to broadcast budgets at every chance. They demand answers to myopic questions. The International Space Station stands for so much. Please allow me to divulge a little. Fundamentally, a bridge to our future, an analog to voyages beyond LEO (Low Earth Orbit), we use Space Station as a dry run to solve problems of long duration spaceflight. An exploration mission to Mars involves so many challenges. Once you leave Mothership Earth, the opportunity for coming back outside of the mission plan in the event of a contingency becomes more and more remote with each second. A broken screw, a stuck hatch, compromised seal, debunked water system, bacterial or fungal growth on equipment could all become huge problems. Crewmembers for such a mission must be Supermans in their own regard: handyman, EMT/nurse/physician, spacewalkers, martianwalkers, friends, scientists, explorers, etc. For most of these roles, Space Station remains the primary means of perfecting or growing in these roles as zero-g complicates the daily course of life roughly 2 fold. E.g., completing a task in zero-g when compared to on Earth requires double the time in space. As weird as it sounds space exploration still resides in its infancy; therefore, Space Station must be if we want to continue in space.