On Love and Medicine

Part old, part new. The first part was originally posted November 15, 2010, about halfway through my third year of medical school (edited for length). It takes place during my anesthesia and integrated medicine/neuro/psych rotations. Rereading, though I have changed many descriptors and diseases, I can picture the patients again. Still. What remains is what matters. Then, I had many fewer patients and many fewer responsibilities; in some ways, it was easier to really care. There was more space and time.

And the second part was written tonight.

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November 15, 2010

Fresno and San Francisco, California

MSIII

I think a lot about “for better or for worse” these days. In medicine, you see a lot of “worse” and “worse”, and I see a lot of partners who are there for both. For anything. Siblings, children, grandchildren, nieces, nephews, friends. I guess these would be the ‘chicken soup’ or whatever stories (are they even still publishing those?) But it’s true – rushing around, where so many things are difficult and sad – it’s something to stop and think about. Or try to remember to stop and think about. With the sickest patients, it’s their loved ones that I know. The ICU patients, the altered mental status patients, dementia, kids…whatever. I’ve spoken with a lot of family members. In anesthesia, wheeling people into surgery, you leave Loved Ones at the corner. (They call it the ‘kissing corner.’ Really). And you see them into the waiting room, point it out, say go get coffee or whatever, we’ll be ____ hours, and don’t worry, we’ll take really good care of X. Your X. I’ve seen the wide eyes when we push through the doors again, X is barely waking up from surgery, likely has an oxygen mask over her face, and we’re rushing into the PACU. It doesn’t mean anything’s wrong. It’s normal, and it means the surgery’s over, and if people don’t look like they’re freaking out (The doctors), everything is probably fine. It’s a vulnerable position to see someone in. And in the OR, they’re alone.

There’s the couple who came in with the wife’s entire medical history typed out – each had their own version – with a list of questions. She suddenly went blind, no one has any idea why, no one has any idea if it’s part of something more progressive – probably. So they’re searching. And with each doctor, they get more frustrated at not having answers. But the other point, to me, is that it’s always both, it’s really about their health, and the patient is – almost – both. Making sure you do speak to both.

Communion

Yaoundé, Cameroun

Centre Hospitalière Universitaire (CHU)

April 2013

Last day at CHU

                              

I flipped open my patient’s blue cardboard folder. Groupe sanguin. Blood type. ---

***


The day before, I'd gone to the blood bank at CHU.

It was the first time I'd ever donated – my more than 6 months straight in Western Europe since 1980 disqualify me by Red Cross standards (mad cow disease/CJD). And even if that ever changes, after living in Africa, there's no way I'll ever be able to donate blood in the States.

The irony. I can donate in Cameroun. I explained to the phlebotomist that I can't donate blood in the US, trying hard to make my explanation make sense, without the questionable undertones of the Red Cross rules rejecting African or "African-ized" blood. It was my last day at CHU. In a month, I had watched people die, and I had maybe, minutely, helped. I had spent a night on call learning about how overstaffed the hospital really is, when compared to the resources they have for patients. Compared on that alone. The nursing censuses are lower. The doctor censuses, even, are lower. There were so many eager med students (their education, not mine), working zealously on med student-thorough, handwritten H&Ps in French or in English, that they sent me to the resident call room for an hour or two of sleep. The GI fellow was in there, and she woke up enough to kick off her shoes, move over, and give me part of the twin bed. I felt hesitant and unnerved; they were treating me like a doctor (and four months later, firmly enmeshed in my intern year, I finally don’t jump to attention at the appellation “med student”).

The transition from dark to dawn is the same in every hospital. There are the early evenings hours. There are the middle ones that stretch forever—nothing good happens, then. Either people are asleep. Or they are very sick. It's the slight undertone to complacency on a quiet night. In the US, we have pagers; if you lie down, you will be awoken. In Cameroon, there are cell phones, of course, but there is almost no reception in the hospital. And no one knows who is there.

Peripheral

NYC


I look idly at the hand grasping the laundry basket. “That’s a beautiful vein,” I think. “Someone would be lucky to get to slip an IV into that.” And like everything that gets accidentally carried back from the hospital—venipuncture kits, 4cm x 4cm gauze (think: measures I am learning), alcohol swabs, tape, fecal occult blood cards and guiac solution, gloves—I have the materials to do it. But I’m not the one I would need practice on. It’s the patients with scarred veins  (drugs, fistulas, too many hospital visits) or overloaded with fluid—the “vasculopaths”— that take skill. A patient with good veins is a good patient. Ones that don’t roll or slip away from you. Ones that leap to attention under tourniquets and alcohol.

We are vampires not only at night.

It’s using your hands (not trusting your head), taking ownership of each step of the process, delegating tasks (most) that don’t take a medical degree to yourself.

I’ve caught myself thinking “I wish I had a med student for this.” To get patients’ weights while standing (find the heavy scale, wheel and weave it through the hallway, support the hesitant frame). To get orthostatic vital signs (vital. Life. Here, to check the difference in how fast and how hard the heart beats, how much the veins and arteries contract and relax, when equilibrating between lying down and standing up). It takes minutes. Five. Or more. I picture third year of med school, two hours per patients, an afternoon to sit and talk…

Or carry blood.

When Patients Care About Doctors...

http://primarycareprogress.org/blogs/16/276

And now introducing

I'm starting residency. Tomorrow is the first day I will introduce myself as "Doctor" to patients.

I'm in the Primary Care/ Social Internal Medicine program at Montefiore Medical Center, in the Bronx. More on that later. In essense, public health + internal medicine + primary care.

Two years ago, I was taking a leave of absence from medical school to pursue an MFA in poetry at Brooklyn College. I had started my fourth year prior to leaving, and had thus spent close to three months in the "sub" intern role, with a greater degree of autonomy and individual work with patients than during my third year.

Prior to leaving, I wrote a blog post called "The Luckiest," referring to (at the time) medical students, poised on the path of an incredible career. (Reposted below)

This is something to recall, and something that, even on the bad days, is still true.

Today, tomorrow is the first day, but it's also the nth day of a path I've been on for a long time. Steep learning curve, steps you learn how to barely jump or grasp with determined fingertips. I'm still convinced--and I hope to remain convinced, most of the time--that, for me, this is one of the best things, and it is absolutely the right thing. Right now.

The Luckiest

I wrote this in the middle of my fourth year of medical school, before taking a year off to go to New York for an MFA in poetry.

August 2011


It’s said in many ways.

Absence makes the heart grow fonder.

Nostalgia in looking back.

Selective memory.

And, per Ben Folds, “The Luckiest.”

This usually refers to, I think, people/place/thing. Certainly people. Certainly place. Time period. Self at a different stage of life.

It’s not usually used in reference to career.

It’s now been three days since I was an active medical student.

And I miss it. A significant lot.

I can’t wait to be a doctor.

Before I started med school, I couldn’t believe how lucky I was to get to go to medical school. I’ve had a lot of privilege in my life. This is one of the greatest, most amazing, most incredulous ones.

What I’ve done, what I’m doing, what I will be doing.

I was let into this hallowed profession – in some places, hallowed, darkened halls – in which I get to learn all about the body. Get to. And I get to interact with people in the most intimate way, at their most vulnerable – they trust me, let me in. I have to earn that trust.

Starting, and before starting, I didn’t understand that sacred trust. It’s something I continue to learn, every day. And I am amazed.