The Celestial Language

Tonight was the Rochester Musical Fireside. What is a fireside? You might picture me sitting around the fireplace, blanket over my legs, cup of joe in resting in my lap, and the phonograph playing from the corner of the room. No. That is not a fireside according to Mormon lingo. So what is a fireside? I doubt there is a canonized definition of the term, but I think most Mormons would describe a fireside to be any kind of churchy activity held in the chapel that is not a “church service.” Does that make sense?

So the fireside tonight was a music fireside. Members of the church in Rochester, at least those who go to the same church building as myself (mostly students of one form or another) had the opportunity to showcase their musical talent. Lucky for us, the Eastman School of Music attracts some pretty amazing talent, and they did not hold out on us. Some amazing trumpet, French horn, opera, piano, and the act that won in my book was a violin piece. I couldn’t keep my lips from curling up into a smile during that piece. It was like the music entered my ears, vibrated that tympanic membrane, tweaked my mallaus, stapes and incus in just the right way to jiggle my cochlea in such a way that it fired off my facial nerve which then caused the muscles in my face to contract into a smile. Sorry, what I am saying is that the music made me smile.

Music is SO important to me, to my soul. I find it very, very, very difficult to describe its importance; but I hope that in the next few months I can sort this stuff out through a few blog posts. I am setting the goal right now to dedicate at least six blog posts over the next few months to music. So let it be said, so let it be done.

To be continued…

In the mean time, check this song out. Does the guitar remind you of another song? It isn't terrible similar to this other song I'm thinking of, nor is the other song terribly popular. But wouldn't that be fun if you guessed it!

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.

Scream I

Have you seen it? Where the Wild Things Are? Growing up, Spike Jonze was my favorite music video director. As a grown up, Dave Eggers is my favorite author that I've never read. The two creative masters somehow met, obviously in some creative way, and co-wrote the screenplay to the movie, Where the Wild Things Are.

One of the opening scenes, perhaps the very, portrays, Max, the pajama bearing protagonist exercising his own creative genius to ambush his teenage sister, Claire, & her friends with snowballs as they leave the house. His plan works perfectly, the kids exit the front door and Max's brilliantly choreographed attack ensues. Once his ammunition is out, Max triumphantly retreats to his igloo fort grinning ear to ear. All of a sudden, his mood is suddenly and literally crushed as one of Claire's friends pounces on the fort decimating it, burying Max and his bliss. The teenagers split, oblivious to the mess they've created and Max erupts with tears, snot and saliva. In this constellation, the flushed cheeks, runny nose, and agitated breathing, this is the first moment in the film where the audience is reminded of what it felt like to be nine. The rest of the movie, scene by scene, reminds the audience of that feeling in equally direct or more roundabout ways—not ignoring the bliss, but focusing on the frustration. From Max's tantrums at home to the howling on the island's cliffs, Where the Wild Things Are is one collective scream; a shout against the ineptitude of childhood; a cry against a world that is incomprehensible; a plea for attention; a yell for someone to come and institute some order and understanding on the island of prepubescence.

This collective scream reminds me of another epic yell. Did you see the movie, Garden State? Perhaps you heard of it. I actually didn't know who Zach Braff was before this movie—no Scrubs at that point in my life. I did, however, know all of the great bands featured in the movie's soundtrack. Basically, write a script about a pretty typical American twenty-something's life. Add an unusual element to the story for hipness—like a friend who has a mansion because he successfully marketed silent velcro—and then play a bunch of awesome songs in the background and you've got a solid movie, Garden State.

One of the closing scenes portrays the main characters of the film donning trash bag rain coats standing on top of an abandoned bus that sits at the bottom of a landfill—I think, can't actually remember if it is a natural gorge or landfill converted junk yard. At this point in the film, the crew has spent the entire day running errands, to what is an unclear end. Regardless of whether they are winners or losers, what is obvious is that they are at the end of their scavenger hunt. Rain is coming down, and it is time to call it quits. Just as the audience settles into emotional coma, Zach and his two friends climb unto this bus and scream, first Zach, and then all three in unison. They scream with everything, they scream with every respiratory muscle from feet to lips. This is it; this is the moment where the film transcends from musical candy to art. This is where the predominantly twenty-something audience wakes up and feels a personal connection, because this is the scream of our generation, the howl of generations past. It is the yell against a world of insurmountable problems--poverty, global warming, war, social security, health care; it is the scream of the heart ache of understanding; it is the yell for being empowered and accomplishing what feels like nothing; it is the scream of emotional incompetency still unshaken from childhood; it is the cry for dead loved ones; it is the yelp for dead love; it is the cry for control in an uncontrollable world. It is the cry for someone to fill the hole in the ozone of adulthood. It is the scream that we all let out when we realize that after all we've done and may hope to do, we are in a giant junk yard, wearing trash bags, and standing on a bus that doesn't work.

Dr. Jerry

I'm afraid that I'm falling in love, and I can't fight this feeling anymore. This letter is a small token of the significance of this new relationship. I blotted out the name of the sender per our discussion in "advisory dean lunch" about posting patient information on the Internet. Three cheers for HIPAA.

I saw, EB (this is how the medical/science world refers to a patient in public), last week in my preceptor's office. The first thing that caught my attention on her chart was the fact that she was 93. Yes, 93! The laundry list that followed--pneumonia; breast cancer; lower back surgery; vertigo; diabetes--actually seemed short for someone who has lived through two world wars, two influenza pandemics, two atomic bombs, two towers crashing, two presidents Bush, two panda bears born at the DC zoo. It is like she's lived twice, already.

Anyway, I looked up why she was in today, reviewed some lab values in her chart and entered the exam room. I was expecting someone much...older looking, er, someone with less pep. I expected a walker or cane, or a crumpled husband to be at the patient's side. Instead, there was this feisty old woman sitting upright in the chair giving me the sternest yet friendliest of looks. I shook her hand and took a seat as I introduced myself. I then put her bible sized chart on the counter to my side so I could focus on her and not the 93 yrs of health records straining my arm.

I can't remember the details of the visit as to the specific order of things we covered, but somehow it wasn't long into the visit and we were talking about her restaurant that she owned, that was so, so long ago to her. Even longer back was the divorce of a loveless marriage. Her mother died when she was only 16 (also felt SO long ago for her), leaving a handful of siblings for EB to raise. EB didn't think she would ever marry, at least she would completely take it off the table after the age of 25. Well, luck would have it that at 24 she started dating a young man who eventually proposed to her. She remembers that day at the altar, remembering that she did not love this man, and somehow, the Father understood this, but counseled that this was the right thing to do.

Hello! Can you believe that? This visit started to feel less like I was interviewing a patient and more like I was reading a James Joyce story (The Dead, specifically)! My brain continued with the interview but my mind caught up trying to process the significance of that statement in the patient's life. To live seventy years knowing that you were once married, and divorced of a man you never loved. She went on to tell me more about that situation and others that I would like to write about; but I feel mentioning those things would somehow invade her privacy, even with applying the cloak of anonymity, er, I just want to keep that between us. After the divorce, and back on her own, she dedicated most of her life to raising or caring for extended family, nieces and nephews. A life of total service.

She can't fly on airplanes because of her vertigo. She tires easily, and her hearing is going. She was very supportive of my desire to live to 100, but she had no interest in living another seven years. Despite her indifference over being a centenarian, she seemed so vibrant to me. I don't know, I think she can make it.

There wasn't anything interesting, medically, about this visit. Later that day, and yesterday, I saw some very interesting cases. Cases where I actually knew what I was doing, knew what I was finding on exam. That was really cool. But EB's visit was different. It was one person putting enormous trust into an encounter, the other, putting a lot of honest effort, and hope, and a little bit of expertise; It was two strangers meeting and leaving as friends.

EB stopped in the office the following week to give me this letter. In it was a medallion of the Virgin Mary. It is called the, Miraculous Medal. I am going to keep it in my white coat for as long as I practice, or as long as I wear a white coat, as a reminder of the miracles.

So I'm falling in love with patient care, with internal medicine. I can't help it. And actually, that scares me. I honestly was hoping I'd fall in love with something that pays my loans off. But that is another post...