Looking into the Crystal Ball

Dr. A: Do you know what you want to go into yet?

Me: I don't know, I've really liked everything I've been exposed to.

Dr. A: Yeah, I can tell you are going to go into Family Medicine. You don't care about making money and I can tell you really care about the people.

Me: Yeah, (nodding, slightly flattered, slightly disturbed)

....Same day, three hours later...

Dr. A: So why did you go into medicine?

Me: Oh, I (Dr A cuts me off)

Dr. A: You probably went into medicine because you want to help people

Me: Yes, that's why I wanted to do medicine. I'm sure I would have been happy doing a lot of different things, but there is nothing I really WANTED to do like medicine.

Dr. A: Most people go into medicine because they want to help people out, but the truth is that you can't really help anyone change. They have to be the one to change.

Me: Yeah

Dr A: If you go into medicine wanting to change people, you are going to have a very unhappy life

Me: Yeah, I get that

Dr A: I think you would definitely suffer an existential crises if you specialized.

Me: haha, yeah, I could see that, haha (slightly flattered, slightly disturbed)

“This is not my beautiful house?”

Some classmates were talking about this program yesterday over our advisory dean lunch. It is a TV documentary that follows seven Harvard medical students from their first day of medical school in ~1985 and then looks at where they are now. You can watch six minute clips of the show but I warn you that you can't watch just one… I highly recommend the program.

http://www.pbs.org/wgbh/nova/doctors/program.html

I watched it last night as I finished up some work for today. I think I watched it out of curiosity. I wanted to know what medical school was like in the eighties. Was it any different? Was it any better? I think I was just curious to learn what this medical school experience meant to others with the hope that that would tell me what this experience meant to me.

I am sure I will spend the rest of my time here at Rochester trying to figure out what it is this experience means to me. These are not questions like, what am I doing here? Is this the right place for me? These are questions like, what does it mean that I spend all of my days looking at or talking about illness/health? Will the next five minutes of what the lecturer says affect a patient's health at any point in my future career? Will the feeling of not knowing enough go away tomorrow? Do I "work"? Am I asking the patient this for her sake? For mine? Where is my place in society? What is a medical student?

Dr. E shed a little light on the answer to that today. This afternoon, half of our class went to their respective clinics and the other half stayed at school to learn about the knee and ankle exam. I and eight of my classmates spent the afternoon with Dr. E, a world renowned orthopedic S. He spent the earlier half of the week with the Cornell Law faculty and students. According to him, law school doesn't really make the student think; he followed that with an equally presumptuous claim that he got the feeling that medical students are smarter than law students.

Just to clear his name (for all lawyers in the audience), Dr. E is a genuinely good man, a really caring doctor. He belongs to the old class of physicians who should have retired twenty years ago but they can't hang it up. They love to teach, they love patients, they love students. I am so lucky to have so many professors like this. Unfortunately, their passion for medicine can lead them to say things that aren't true.

Wrecking Ball

Working in the community health clinic makes me feel like I am on one of those Japanese game shows where the contestants attempt to navigate an impossible course of physically challenging and utterly embarrassing stunts. Here is how the sequence of events went today. Got out of lunch meeting late, got to the clinic late, nurse hands me a chart the second I walk back to the doctor offices, seconds later I am sitting down with a 52 yr female patient and her husband trying to go through the thick, cluttered PAPER medical chart while listening to her in Spanish as she rifles off a litany of symptoms, writing down what I deem pertinent, asking questions I deem relevant, and listening to her husband in English as he talks to me and to the patient.

I, myself started to feel a little sick trying to process all of the above. The first five or six minutes of the visit were almost completely lost. I did get some helpful information, but I felt so out of control that it was hard for me to recognize at the time that the information was salvageable, that it was actually telling me anything. With the rash and the fever I was thinking about the microbiology I studied on Saturday. The issues of vertigo had me thinking back to HSF and the inner ear complications. Her uncontrolled diabetes was working like a wrecking ball destroying the city of organization, the city of understanding that I desperately hoped to erect in my mind.

Then, after I accepted that the first five minutes was a loss, I observed the damaged city and was able to sift through the rubble to move the visit forward with an albeit tenuous plan. Some patients I present to my preceptor having a pretty good idea that my exam covered the right bases and led to the right diagnosis/plan. Then there are visits like this one where I report a weak hypothesis, essentially a white flag, to the preceptor and hope that he or she will look upon me with compassion. Today felt like there were only white flags, but now that I think about everyone I saw, I realize I forgot some of the simple, stress free victories of the day.

One reason why I might feel like there were no victories today was because before I leave the office in the evening, my preceptor and I sit down to go over any questions about the day's cases. I usually ask a couple, and then I have to answer her questions. It is a fun game we play, doctor vs student, and I actually like that I never win! I better get out my anatomy text already.

 

War, What is it Good For?

Is it any wonder this man was known for his skills with the ladies? Something he is somewhat better recognized for are his books: the ones that he wrote. This is, indeed, the young Lev Nikolayevich Tolstoy, the world's greatest novelist.

I finished, War and Peace, over the Christmas break. It took me about a year of reading here a little, there a little. Now I frequently pull the book out at night to thumb through my favorite passages.

Here, read this is one: Just to explain a bit of the piece, Boris and Nickolay Rostov are soldiers in the military, they are also childhood buddies. Enjoy!

At that instant the door opened.
"Here he is at last!" shouted Rostov. "And Berg too. Ah, petisanfan, alley cooshey dormir!" he cried, repeating the saying of their old nurse's that had once been a joke with him and Boris. "Goodness, how changed you are!" Boris got up to greet Rostov, but as he rose, he did not forget to hold the board, and to put back the falling pieces. He was about to embrace his friend, but Nikolay drew back from him. With that peculiarly youthful feeling of fearing beaten tracks, of wanting to avoid imitation, to express one's feelings in some new way of one's own, so as to escape the forms often conventionally used by one's elders, Nikolay wanted to do something striking on meeting his friend. He wanted somehow to give him a pinch, to give Berg a shove, anything rather than to kiss, as people always did on such occasions. Boris, on the contrary, embraced Rostov in a composed and friendly manner, and gave him three kisses. It was almost six months since they had seen each other. And being at the stage when young men take their first steps along the path of life, each found immense changes in the other, quite new reflections of the different society in which they had taken those first steps. Both had changed greatly since they were last together, and both wanted to show as soon as possible what a change had taken place.

Don't you feel like you were inside Rostov's head, yet totally aware of what is going on with Berg and Boris? I especially relate to Rostov and his struggle to do something with this unique, intense feeling of love, friendship & celebration. Yet Tolstoy had it right. This is how it often plays out. The two people do whatever is customary even though it may fall short of what they truly feel. And it's all right because that is all we've got: the customary.

Another comment about this piece, it reminds me of a comment I posted long ago on a Writing Fellows blog in college. I was making a case for Americans to greet one another with a kiss like the Latin culture does. It just feels better. I remember citing that Christ's apostles greeted one another with a "holy kiss," so we should at least go for a greeting kiss. Maybe I've lost some of the love over the years because I don't think I endorse such a policy now. I even feel awkward customarily greeting a latina. Pobrecito, yo. Maybe that will change again after this summer...