Master of What?

The other day in Master Clinician, we spent the afternoon with our "master clinician" at his master clinic. Yes, the program (one doctor works with a group of four med students as they see patients in the hospital) has kind of a funny name, but the experience is very helpful. And, our master clinician is a yoga/meditation instructor at the hospital when he is not seeing patients--very cool.

Before we saw any patients, Master C wanted to get to know who we were, our background/story, and then he told us that the next three years are going to change us. He said that we would change so much from second year med school to first year of residency that we wouldn't recognize the person we are today. Wow! I'm kind of excited about that, but don't worry, so far med school hasn't changed me too much.

I share a moment from last week's lecture as evidence.

There I was sitting in the second-year lecture hall, approximately three-fourths of the way back. The lecturer kept pacing back and forth in his white coat, hands buried deep in the side pockets. Most of the lecturers are really great, but this guy seemed to have missed the memo. He started off by declaring that his lecture was not intended to teach us the subject matter. That was for us to glean from reading the text--fyi, there is NO definitive text in medicine, rather a handful of beastly books that offer endless amounts of information, therefore no one reads the "text." What other platitudes he felt compelled to dispose on us at that time I cannot say. Instead of getting up and leaving the lecture outright, I tuned him out and pulled out a notebook to review material from previous lectures.

The pacing back and forth across the room went on, interrupted periodically with a question that he would pose to an innocent bystander in the audience. And of course, no one ever gave him the right answer. It was always, "well, that's pretty close," or, "not exactly..." He was rifling through the class sparing no one. I still wasn't paying attention to the lecture, but I soon realized that the probability of him calling on me was fairly high and climbing.

Then it happened. "You in the red shirt." I looked up to confirm that his pacing had stopped and that he was staring right at me. Confirmed. Our eyes met and he repeated his question that I missed the first time. "What is the first thing you want to know about this baby?" I stared back looking as neutral as possible. I tried to give a look that sent an ambiguous message of either I speak japanese so I cannot understand, or, I'm thinking deeply about the question, trying to narrow down between a few potential answers that were on the tip of my tongue. Then I felt some agitation building inside. Was that showing on my face? "Look contemplative," I told myself. "Look like I'm thinking between a few things, this will give him a little time to expound on the question." He took the bait and repeated the question with a little more information, "You walk into the NICU to see the jaundiced baby and what is the first thing you want to know?"

That was it, he had given me an out. "I would want to know which baby is my patient!" I replied sincerely and triumphantly.

To my surprise, the class let out an uproar. I expected some kind of a reaction, but this laughter was more boisterous than anticipated. I think we were all feeling the tension that had built up over the entire lecture.

I kept eye contact. The lecturer was stunned, caught off guard. He took one step to try to resume pacing but he couldn't find his rhythm. So he just looked right back at me. I smiled in return; the stir of my classmates really ignited a fire of laughter inside of me. He did not smile back. I then got a little worried. I tried to look innocent. "Put on your innocent face, you are innocent, just being sincere, Jeffrey, look innocent!" But his return stare was sucking the truth right out of me, he knew exactly what was going on and he wasn't going to back down. His stare was pulling away the innocence mask to expose the laughter boiling inside of me that I desperately fought to hold back. That would grant him a warrant to make some kind of a pedantic retort. He could string me up and use me as a lesson to the rest of the class regarding how to survive our next year on the floors. I saw my medical career flash before me, it started with medical school and ended second year of medical school, me, skinned like a cat, hanging from the tops of the lecture hall.

Just before I was about to bust up laughing, a miracle happened. He broke eye contact to fidget with his pager. Phew, that released his death hold on my soul and I could let out a tiny squeak of a laugh, a quiet chuckle, just enough to relieve the tension in my gut before he looked up again. I was spared. He worked back into his left-right pace, and over the remaining twenty minutes of the lecture, I let out the steam in my chest bit by bit each time his back faced me. That was a close one.

I am happy to reflect and see through this anecdote that I am still the same person that was often asked to leave the middle school classroom (Mom, did that get back to you in those parent/teacher conferences?) for like behavior. I'm even happier to report that the lecturer never asked another question of the class from that point on.

The Real Global Warming

So much time had passed that the mere thought of visiting, Simple Things, generated a sigh just strong enough to extinguish the last candle of hope. The idea of looking at the page, let alone writing, felt useless like checking in on a neglected fishing trap. Why bother pulling it up to the boat? There probably was a fish inside, but only its rotted remains could be there now for retrieval.

Fast forward.

I'm back in the Peds clinic. Time in the clinic means time to think. Everything outside of the clinic is time spent living: lecturers, study, eat, occasional exercise. But being in the clinic is not living. It is the closest I get to working. And it is at work that I find time to think i.e, to live.

Medical school tends to make one oblivious to the real world. If it wasn't for a roommate, and the janitorial staff talking loudly over their morning coffee in the hospital atrium, it could have been days before I knew anything about Haiti. However the clinic, this is where we get to interact with the real world. This is where we can live.

One example. I couldn't tell you anything about this year's American Idol, but I do know the song about, "Looking like a fool with your pants on the ground," because the five yr old boy who's little sister I was seeing sang that line ad nauseum throughout the visit.

Beyond pop culture, clinic presents patients. And what are patients? People: the essence of all culture. (Does that remind anyone of the merman commercial, Zoolander?) Anyway, it is never permissible to judge during a patient encounter, but one cannot ignore the bigger cultural/social picture that all of these experiences produce. One visit in particular is still on my mind. A Turkish family brought their adolescent child in for an evaluation. There was the father, who looked like a mafioso. The wife/mother, who looked like, well, the wife of a mafioso. And there was the translater/friend. Oh, let us not forget the patient. He was there too. A severely autisitic boy of probably eleven years. This little character ran around the entire visit while the parents and I negotiated a meaningful? conversation through the translator. Zoom, the child would pass by. Tug, the child was pulling on one of our sleeves. The thing that has stuck with me from that visit is that this Turkish culture, whatever it is, is going to get washed away sooner or later. The autism will stay, but the language will go, then the cooking, then the clothes. Or maybe it is the clothes first, followed by language. I don't know the exact order, but I'm sure that sooner or later we will all melt together in that great pot.

I remember the video from third grade where I learned that America was a melting pot. The cartoon showed people of all nations jumping into Lady Liberty's sauce pan to be stirred into one wonderful American chowder. I was happy that day. Now, I am sad to think of the outcome of all this stirring and melting. Oh, Christopher Columbus, what have we done?

Maybe forming the Rochester Minutemen facebook group a year ago was more than jest. Maybe.