Tuesday, September 28, 2010

You Have Just Been Empowered

patterns in ice
Putting my experiences in the PASS Program into words is becoming a work in progress. At first, I expected most of my posts would be diary entries, rather like those of my great, great, great maternal granduncle who was a circuit-riding Methodist preacher in the 1850s. Imagine the delight my ministerial self felt at discovering the daily grind to be more akin to revelation than mere reporting.
Of course, that's what makes it so difficult to verbalize, which explains why anytime you ask a question of a theologian, hoping for a multiple-choice type answer, you're likely to get the equivalent of an essay. The nature of the subject matter renders a yes-no response too simplistic to be meaningful. By the way, this is also a good reason to question any minister who presumes s/he can unveil the mysteries of the universe in three easy-to-follow steps.

Which brings me back to my original problem, namely, making sense of my experience here and why it is turning into a work in progress. If they were teaching a method, you ought to be able to order the CD and workbook for only $19.95 plus shipping and handling. But that's not what this place is about. We're learning how to think and that's a different animal altogether.

One of the things I'd hoped to do in my posts was discuss how it feels, being an older student, in an environment like this. Age, however, isn't a factor at all. While, as usual, I'm probably the oldest student here, as far as my driver's license is concerned, there are several others who've been around the block as well. Most are in their 20s and 30s, but our intention isn't to determine who's qualified to be a doctor by virtue of their age, gender, or social standing, but to gain whatever is necessary to pass board exams.

That said, we're all in a position of having to unlearn one way of dealing with the material and learning what I feel safe calling an entirely new one. In the process of delving into such organ systems as cardiology and neurology, students typically attempt to commit massive lists of diseases, signs, and symptoms to memory. The "time-honored tradition" of downloading information only to reproduce it for an exam -- called binge and purge learning -- becomes your default position until you've found a framework that fosters integration and the discernment of patterns.

For someone who has made his way through history and theology looking for connections, being shown how and then urged to apply that same inclination to medicine, is a radical departure from anything I might have expected. It's value, I think, lies not only in the way it promotes learning, but in the ways it builds upon strengths one already possesses. In other words, it's empowering, and that is something we all need no matter who, or how "young," (smile) we are.

(Public Domain image of Patterns in Ice via Wikipedia)

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Sunday, September 26, 2010

Mexican Food and a Saturday Night

Red Hot Chili Peppers live at Pinkpop Festival...So, there we were, the three of us, driving through downtown Champaign on a rainy Saturday night, looking for Mexican food. I was at the wheel, my room and classmate from school in the back, and a smart, sweet, down-to-earth young woman from Northeast Ohio was riding shotgun and deftly handling navigation. The Red Hot Chili Peppers were red hot on the radio but the outside temps rendered navy sweatshirts the evening's dress blues.

Now, I admit I wasn't sure what to expect. Mexican food can be good, great, or merely an approximation of edible, depending on what part of the country you're in. Back east, I'm afraid to say, it's called Mexican but that's about as close as it gets to the real thing. Illinois is closer to the Source, but one never knows. Anyhow, new in town and weary of our own cooking, any risk seemed tolerable as we pulled into the parking lot of what was probably once the home of fast burgers and fries. We were ushered without delay to a booth where our waiter, a gentleman of Hispanic descent, quickly placed a basket of fresh, hot chips and two bowls of homemade salsa on the table. One bite told me we'd made no mistake.

Crowded with students and parent-types, Dos Reales is clearly a local favorite and for good reason. I don't recall hearing Mariachi music in the background, but the walls are painted in desert tan overlaid with murals reminiscent of life in the Southwest, making me feel right at home. I ordered my usual chicken enchiladas while my partners, a poblano pepper dish and vegetarian something or other. I didn't quite catch the latter's name because the gal with us ordered in Spanish, a little tidbit I realized would be helpful when I asked the waiter for more time to reflect on the menus and he looked at me with a face like a question mark.

In between quizzing each other on board review questions -- this was meant to be a "working" dinner -- we made fast work of the salsa and then forgot all about the Comlex and USMLE when our meals arrived. The last time I recall having freshly made refried beans was in Southeast Colorado when I served as a substitute pastor for a small Hispanic church in La Junta. But that's what I discovered on my plate last night. I wouldn't be surprised if the tortillas were made on the premises. It was simply sumptuous. At one point, my female friend commented she wished she'd ordered more -- until she finished her meal, that is, and then said, "I couldn't eat another bite." We knew exactly what she meant.

Ordinarily, I'm all for a bedtime snack, despite the fact that my instructor has admonished us that any food consumed after 8.00 PM gets metabolized straight to cholesterol -- an fyi to anyone who wants to lose weight and, like me, can't always resist a late evening close encounter with the refrigerator. Last night, the thought never even occurred to me. If I was rich and self-indulgent (which I'm not -- rich, I mean) it would be tempting to fly out here just to have dinner now and then.

If you're ever on a trip and you can reroute near Champaign, I'd encourage you to do so. Dos Reales is located on North Prospect Ave. and my guess is, all you have to do is follow the crowd and bring an appetite. The staff is attentive, unobtrusive, and the food, like my program, is one of the mid-West's best kept secrets.

(Creative Commons image of The Red Hot Chili Peppers via Wikipedia)

Friday, September 24, 2010

A Fellowship of Failure

It's fair-skies and 48 this morning and the view from my patio penthouse includes the sun trying to reach me through the cottonwoods. Maybe by mid-October they'll feel more generous, but right now they're holding onto their leaves as though the last days of summer depended entirely on them. If they know Wednesday evening saw the Autumnal Equinox, they're not telling.

I was thinking, the other day, about the one thing nearly all of us have in common (aside from being medical students) -- failure. Some, to be sure, come simply as a supplement to their education -- not a bad idea at all, frankly. They’ve yet take their stand in the middle of some dusty street at high noon while spectators scurry for safety and then anxiously peer from windows or peek around corners, waiting for the bad guy (board exams) to go for his gun. But, they're in the minority; most of us have had that experience already, at least once, and the outcome hasn't been pretty.

I suppose this is why we’re inclined to be accepting of one another, why no one sighs impatiently when another student doesn’t correctly answer a professor's question, why hands don't shoot up like a flock of geese startled by sudden movement, eager to show they know what you don’t. Perhaps this is why asking the instructor to repeat a point isn't accompanied by snickers and rolling eyes and why busy hands copy down what their owners also missed the first time around.

I've often wondered, quite truly, what it would be like if a class was almost entirely composed of people like me. Not like me in the sense that everyone has creaky knees (I've known athletes with them in their 20s, by the way, so there) or can't wait for the 9:30 coffee break. Nor people like me who pound the treadmill in the late afternoon hoping to generate sufficient energy to keep the Rack Monster aka Mr. Sandman at bay long enough to spend the evening studying. 
I mean people who've had to wrestle with medical school – people like Jacob, who dared wrestle with an angel, holding onto him with all his might and through gritted teeth declaring, "I will absolutely not let you go until you bless me." People who, like Jacob, got the blessing all right, but had to pay for it when the angel dislocated his hip, so that he walked with a limp the rest of his life.

People like that.

Well, now I know. To tell you the truth, it's been refreshing. For one thing, it's delightful seeing the faces of my MD colleagues light up when I've done a little osteopathic manipulation on their cramping wrists after a day of writing like their lives depended on it. They've heard about our little secret, they know us DO types can do things with our hands they never learn, but seeing it up close and personally, they act like any one of us would when a magician pulls a rabbit from a hat and this time you know the magic is real.

More than that, it's good being among persons who’ve seen failure face to face and are determined to not let it define them. Part of this stems from the atmosphere created by our professor who knows from his own experience what it's like to have a dream behave like your nemesis. Medical school was hard for him, too. So was life, growing up on the South Side of Chicago. In his family, new clothes meant a trip to the Goodwill, not Macy's. He told us his story yesterday, holding back none of the unpleasantness, describing how he discovered the Faith that changed his life.

He reminds me of something I wrote in my very first blog post, i.e. he's one beggar sharing with others where he's found bread and then showing them how they can find it for themselves. In so doing, he inspires confidence when things seemed very much in doubt. As you walk in the main entrance, six metal letters are arranged on the counter in front of you, spelling out the word "Believe." Every day, someone on the staff drives home the message that our achievements depend as much on faith in ourselves and each other, as they do hard work. In this fellowship of failure, I suppose you could call it, we're becoming not only better future doctors, but better people. Little did we know.

(Photo copyright 2010 by the author)
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Sunday, September 19, 2010

Hard Places

Happy Sunday Everyone!Good Morning, Happy Sunday, Greetings from the Trenches.

The sky from my patio perch is cloudy gray mixed with distance blue; I'm not complaining, though, because it's pleasantly cool. By Tuesday, it will be in the 90s again, as autumn continues to play a waiting game here.

I had an interesting conversation over breakfast this morning with one of my roommates, who happens to be a veteran as well as medical student. Despite my having not served, it wasn't hard to establish a meaningful connection. For one thing, I know the life and for another, at least right now, we're in the same foxhole. And even after we've advanced past the current obstacle, we'll always be comrades in arms.

This is something I can't ever quite get over. It surfaced the other night as well, while chatting with a young woman who is a student in a neighboring state. One minute we were strangers and two days later, we're pals. I'm talking, of course, about the instant intimacy that so easily develops between medical students and physicians. To a certain extent, it's as though our radar is attuned to picking up on another of our own kind.

Part of this may be simply due to the fact that we're all immersed in a community of intuitive types, but I've run into it in other contexts as well. Medical ones, that is. Where it hasn't always been so readily apparent, oddly enough, has been among ministerial colleagues. I've often wondered about that and I really haven't come up with a satisfying explanation. I've noticed that whenever I've met up with a minister who's been battered by a pastoral experience or had some sort of personal crisis like a divorce, the camaraderie is there, right off.

Just thinking out loud for a minute, I wonder if hardship is what makes the difference. Seminary is tough, make no mistake, but it's not tough in the sense that it confronts inadequate defenses, teaching you to build up new ones in their place. The ministerial focus is on formation, challenging one's thinking processes and predispositions, but it seems less painful in retrospect. As a result, it's not until life gets to that point, i.e. painful, that collegiality becomes so important.

As you've probably guessed, I'm not one of those who thinks pain is, by definition, a bad thing. Where it takes us can be destructive or constructive, depending on our disposition and willingness to change in response to its presence. The more willing we are to adapt, the more benefit we obtain. It's only when we become stubborn, resistant, and determined to head-butt our way through circumstances that are less amenable to power-oriented approaches that we come away with a headache.

Furthermore, it seems we most often find kindred spirits when we're in situations that tax our abilities to cope. Speaking for myself, those relationships are the ones I value most, those formed in hard places with persons I've never met, who nevertheless know what it's like to be me. And among whom I know what it's like, being them.

(Creative Commons image by Te55 via Flickr)

Saturday, September 18, 2010

REO Speedwagon Way

REO SpeedwagonI'm guessing the 80s rock group, REO Speedwagon, must have gotten their start here in central Illinois because there's a street named after them in downtown Champaign. I ran into it by accident on my way "home" from running a few errands, one of which took me to the northern edge of the University of Illinois. I was driving through the Greek community (sorority/fraternity row), when a turn onto my street led me across REO Speedwagon Way aka Main Street.

I'm mentioning this because it just seems so unlike what I expected. This is corn country where multiple FM stations broadcast church services on Sunday and you can walk around the local mall without feeling like you've tried out for an Iron Man competition. Saturday is clearly market day and the traffic reminds me why I've come to appreciate life in Maine so much. Not because people drive crazily -- far from it -- but simply because there are so many going the same direction as me. It was as though they all decided, "There's Beggar, let's follow him," while I felt like saying, "No, no, I'm new here, follow someone else!"

The past couple of days we've been reviewing the key elements of biochemistry, learning how to abstract a whole series of medical tidbits from a single concept. For example, let's take proteinuria, which means protein has been found in the urine. Now, urine is not where you'd ordinarily expect to find protein, any more than downtown Champaign is a place I'd have expected to find REO Speedwagon Way.

If a patient is losing protein, they would likely present with weakness, shortness of breath, elevated heart rate, and have problems tolerating exercise. So, then you start asking yourself where the protein might be coming from. It could be muscle tissue, maybe the kidneys, and that leads you down the path toward diagnostic possibilities. It's the kind of process a person would use in a clinical setting. Applying similar principles to taking an examination reduces the amount of brain cells you have to devote to rote memorization. And since I seem to have a relatively limited number anyway, memorizing tends to use them up fast.

Once again, I find myself surprised over what I'm discovering here. It's kind of like, who knew there was so much tucked away in middle America and all a person had to do was look.

(Creative Commons image of an REO Speedwagon by jcbwalsh via Flickr)

Friday, September 17, 2010

The View from the Treetops

The best laid schemes of mice and men gang aft agley ~ Robert Burns

Boy, did he ever get that right. I was planning on stealing a few minutes every day for writing, even if it was only a paragraph or two. Turns out, this program is just like medical school. Now, what madness possessed me to think it would be otherwise? I know, it's a review course. Uh-huh -- that and a buck something will buy you a cup of coffee at MacDonald's.

Let me tell you, as I said to one of my roommates, a fourth year student from Chicago preparing for step two of the USMLE, "I feel like I've been rode hard and put up wet." He knew exactly what I meant. And that's one of the things I've always loved about being part of the community of doctors and medical students. You can't be so tired, so overwhelmed, or so overworked that someone can't empathize and generally does. It's wonderful.

Anyway, this program is very much like medical school. You see, I've had the sneaking suspicion the material we cover in our first two years, that accumulates as rapidly as blizzard-quality snow piling high against the side of my barn, needs to be boiled down to the essentials for board preparation. It simply has to be. Some things are important and others are so insignificant even the writers of board questions don't care whether we know them or not.

The process of boiling down is what our professors here have undertaken on our behalf (thank God), teaching us how to look at our education and see what is critical, namely, the big picture. Now, the truth is, I really should have written, the BIG picture, because it's more accurate that way. There is an amazing amount of material to handle in the course of eight hours of lecture and Socratic dialogue each day.

I'm having a great time, rest assured, but it's still a lot of work and some days, like yesterday, I'll drag myself up the stairs to my third-floor apartment wishing the management office had seen fit to put me on the ground floor, instead. I like my treetop patio, and this morning, at 49 degrees, the solitude (excluding the traffic on the main road) is refreshingly delightful. But the intensity of learning and then knowing I've got 40 pages of notes to go over, reminds me that even when breaking things down to their essentials, the view from the treetops can be formidable in its own right.

(Photo by the author, copyright 2010)
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Tuesday, September 14, 2010

Hogwarts West

HogwartsThat's how I'm coming to think of this place, though the reason has nothing to do with the overt expression of magic. It's more about finding oneself, like Harry Potter, in an environment where others have similar abilities as yours and have also had difficulties using them to their best advantage.

In other words, stuck out here near the mid-point of the mid-west, is a haven for conceptual thinkers and intuitive types, your typical odd-persons out. These are the people who, upon entering a home, notice a potted plant and begin talking about Africa, while everyone else is discussing home decor. The reason is, the plant reminds them of an article they've read in National Geographic about native flowers in Gambia. In other words, they deal in connections in much the same way as analytical types deal in facts and figures.

In the real world of clinical medicine, the ability to establish relationships between seemingly random pieces of information is important. As a result, my classmates will find they possess a definite advantage when it comes to determining what we call a differential diagnosis, i.e. one that rules out various possible explanations for a disease in the effort to establish the one that is most likely to be correct.

In medical school, however, especially during the years devoted to the basic sciences, conceptual types appear to be at a disadvantage. For one thing, they generally need more time to think through the implications of the material before them and under the pressure to digest massive amounts of it, resort to memorization. You'd think this would be a viable solution; it's not, however, because information thus acquired lacks the organizing principles these types rely on to make sense of things.

Enter a program such as this one, which not only celebrates conceptual-intuitive thinking, but teaches us how to use it effectively in the service of mastering physiology, the most basic of medical sciences. Not only that, it supports our need for interrelatedness by pulling pharmacology, anatomy, and all of the other subjects we rely upon as future doctors, into the overall approach. So, rather than thoroughly tackling one subject at a time, which appeals to linear thinking analytical types, we do better by taking on several at once, in order to help determine patterns that aid retention and deepen understanding.

In psychoanalysis, we call those instances when a patient arrives at a new insight about themselves, the "aha" moment. Many of these occur in the course of a typical day here. Concepts we've learned, relearned, examined, and dissected, are revealed as processes we can think through, demystifying them and helping us realize we really knew far more than we imagined. It's still a lot of work but it's not drudgery. Instead, there is an excitement involved in discovering our strengths are not the liabilities we feared. They are assets that just need affirmation and further development.

Welcome to Hogwarts West.

(Image of unknown licensure via Wikipedia)

Friday, September 10, 2010

From Maine through the Berkshires

I had just crossed the state line between Maine and New Hampshire when Mick broke into Gimme Shelter. By the time I was nearly across Massachusetts, it was the Boss with Born in the USA on Boston's 104.5 FM. That's one of the funny things about New England, or so it seems to me, being from the mountain West. You can pick up a strong radio signal and follow it across the state. Of course, it helps if driving 50 miles places you halfway there.

Take today, for instance. I started out in Southern Maine and less than six hours later, had driven through portions of three more states (NH, MASS, NY), and completely across one of them (MASS). The same amount of time might have gotten me from the Colorado-Wyoming line to New Mexico or, had I been driving west from Dallas, somewhere still in Texas.

But it was a beautiful drive, especially once I got into the Berkshires, in the northeastern Appalachians. The colors are just starting to turn and the air is cool. By the time I come back through, on my way home, autumn may very well be past-peak, it's difficult to say. Then again, I may be posting photos that will knock your socks off.

So, tonight, I'm in Albany and tomorrow, heading west once again, this time along the Erie Canal. Remember the lyrics from elementary school? "Low bridge, everybody, down; Low bridge cuz we're goin' through a town. And you always know your neighbor, you always know your pal, if you've ever navigated on the Erie Canal." My sixth grade music instructor would never believe it.

(Photo of sunset in the Berkshires copyright 2010 by the author)

Thursday, September 9, 2010

That Long,Lonesome Highway

Lonesome HighwayFor the next six weeks, my blog entries may appear to depart from what you're accustomed to reading. I'm heading mid-West to attend an intensive medical boards review course that promises to be a great learning opportunity. Because I've been led to believe it will combine time-consumption with brain-drain, I've been wondering if there might be a way to integrate this experience with The Beggar's Blog, rendering them complimentary, rather than conflicting, activities.

So, here's what I've come up with. Most likely, weekends (I'm crossing my fingers, here) will allow me a little more time to turn out the kind of thing you usually see, while weekdays offerings will probably be briefer, focusing on what it's like, being an older student in this kind of milieu. Some days may be more reflective than others, but it's hard for me to see beyond that since this whole thing is completely new for me. In any case, I hope it turns out to be a series of good reads.

Now, as to travel time, in this day and age one assumes internet access is universally available, but there are no guarantees. If you drop by and see nothing new, it's only because I haven't been able to find a plug for my computer. I'll be taking photos, naturally, of anything curious, intriguing, or worth taking a gander at, and I'll include those as well.

I expect to work extremely hard but I'm looking forward to getting started and learning new ways of thinking about the material my classmates and I have been dealing with these past few years. It's going to be an adventure and one that I'm eager to share with you. Next time you hear from me, I'll be somewhere out there, on Dylan's long, lonesome highway.

(Creative Commons image by Serge Melki via Flickr)

Tuesday, September 7, 2010

Pink Hats and a Mack Truck

He was working the ER when they were brought in. Holiday weekends like this one -- Labor Day -- are the playground for Murphy's Law, i.e. anything that can happen, is likely to, so don't be surprised when it does. He began covering holidays after the divorce; it kept his emergency skills up to date and it was better than sitting at home, wondering why "I do," at least in his case, inevitably led to legal fees.

He really had no place to go; his work had become his life, and the only family he had left was so scattered, they may as well have lived on the dark side of the moon. Busy is good, he thought, why not give someone else a break to be with their kids, instead? That was five years ago and it had gotten to be a habit. Besides, it allowed him to spend time with nurses like Halley Henry, who'd more or less "adopted" him during his fourth year emergency med school rotation to prevent him from accidentally killing any of his patients.

He'd been on duty since 6.00 AM -- early morning was never his best time, but since he didn't write the schedule, there wasn't much he could do about it. Close to twelve hours later, he was anticipating washing down a Swiss and mushroom burger with a bottle of Rock Art American Red ale at the Old Port Tavern, a favorite watering hole for the post-call crowd, when an ambulance showed up. He could have turned it over to the evening guy, but this one was too good to pass on: twin girls, born only a few hours earlier, found by a medical student in a trash bag on the side of the road.
Neonatal care wasn't exactly his specialty, though he was competent to cover emergent cases and knew when to call in the cavalry. That was, what? thirty minutes ago? His initial exam complete, he decided they'd live -- after all they've been through, they'd damn well better, he thought -- and would benefit from observation in the Neonatal Intensive Care Unit.

Halley, who'd worked-up the case with him, was holding a twin in the crook of each arm and looking over his shoulder as he wrote transfer orders. "Who would do such a thing?" she asked, stressing the "do" a little stronger than the rest of her sentence. "Throw these little darlings from a car like a cigarette butt and then drive away."

"God knows," he responded wearily, "he'd better, I sure as hell don't."

"Don't mind him, dears," she said, glancing at him over the tops of her wire-framed reading glasses and feigning a frown, "he still hasn't learned not to use that kind of language around us girls -- despite more years than I'd like to admit of trying to teach him."

"Mmph. You should hear the girls I know."

"The girls you know ought to have their mouths washed out with soap -- they would if I was their mother."

"Honey, if you were their mother, they'd still be wearing skirts down to their ankles," he said, with a smile.

"Go ahead, dig yourself in deeper. You can "honey" me all you want; I've got a good memory and I get even."

Previous experience told him to drop it while he had the chance; outnumbered by a superior force of one, he turned back to the computer screen and finished writing orders. He started out as an opthalmologist -- a younger cousin, as close to a brother as he'd ever come, was blinded in a bike racing accident, and became his inspiration -- but went back after a few years and completed a residency in pediatrics. It irked his wife who liked an eye doc's income, but he loved kids and never having had any, decided caring for other people's might approximate a close second. It always seemed like first one thing then another had interfered with children until finally, he guessed he'd let the idea go. It's a moot point, anyway, what would I do with kids at 62?

An hour later, at the Old Port, the image of the twins wrapped in warming blankets and wearing little pink knit watch caps, like tiny imitations of fishermen down on the wharf, nagged at him. Halfway through his burger, he realized he'd made up his mind to follow their case as an interested bystander. No one would mind, especially since he'd been the one to see them in the ER. It's perfectly normal for a concerned doc to show ongoing interest. No doubt the PR department would love him for it, once they got wind. As if I care, he thought.

It was dark when he pulled in the driveway of his home in the Stroudwater historic district, and he was tired -- in a good way -- but far too tired to hear the engine of a Mack truck heading his way.

Creative Commons image of "Day 2 -- Pink Hat" by Liz (byday) via Flikr)
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Monday Morning Issues and the Google Black Hole

Google and I have a love-hate relationship and by that I don't mean I love to hate it (them?). The truth is, I'm very fond of it (them). For one thing, they provide the software and storage space for my blog (thanks ya'll, in case I haven't said it before). They do a great job with email and the technical goodies they come up with for blogging are really useful for a techno-non-geek like me. But, here's the thing, have you ever tried to contact them? You know, drop a note, make a call, fire off a Fed-ex full of cookies (not the computer variety), or send flowers?

Now, there is Google help or as I like to call it, the Google Black Hole. You can post a question or you can scroll into the maze of previous questions looking for one exactly like yours. At first glance, posting your own would appear obvious. The answer you get, however, may be somewhat less so: "check the response to question 999." Now, I understand how time-consuming it can be, dealing directly with user problems, I really, really, really do. I'm sympathetic, I really, really, really am. But still in all, if I wanted to go dumpster diving into a black hole never to be seen or heard from again, I can think of easier ways to do it. How, you may ask? Well, have you ever dealt with the VA (Veteran's Administration)? 'Nuff said.

Anyway, I am an appreciative user of Google. Don't worry, that's not a code word for the excessive use of Google -- I don't let web searching interfere with my work or home life, so I'm only a social Googler and not a Googleholic. Nor do I attend the Church of Google where members have been known, in moments of ecstasy, to burst forth with spontaneous Googalalia. I couldn't be a fan because that would entail seeking autographs and somehow an email signature (if I could find an email address, that is, hint, hint) doesn't seem quite the same as a good old illegible scrawl on a napkin. I'm just an ordinary guy who'd like, once in a while, to interact with another ordinary gal or guy somewhere out there in Googleland.

Do you suppose it's a matter of incompatibility? Not software, hardware, silverware, or any other kind of ware, but r-e-l-a-t-i-o-n-a-l? Like maybe I've got an obscure interpersonal chemical imbalance-type disease I picked up while browsing online images of the Amazon Rain Forest? Could it be Transformers are real after all, and instead of a virus I've got a Decepticon hiding in my current version of Firefox? Where's Bumblebee when I need him?! Well, it beats me. Anything's possible and in the realm of computers, if you can't get "possible" now, wait a bit and your next Microsoft update will include it as a zip file.

So, it's Monday morning and this is my first serious issue of the week. Oh, I knew a vacuum repair person once and she explained my Hoover's failure to hoov as proof that it had "issues." She didn't describe the process of fixing it as talk-therapy, though I half expected her to. This was Boulder, Colorado, by the way, where everyone's either had issues, has them currently, or wants them so they have something to talk about at parties. Hey, I used to live there, what does that say about me?

(Creative Commons image of a Supermassive black hole by thebadastronomer via Flickr -- and a word of thanks to the folks at Google for being good sports!)

Monday, September 6, 2010

Pink Hats 1:The Treasure in the Trash

It's funny, the things that go through your mind, Chuck thought. He and his dog, Chester, were still catching their breath, having nearly been knocked to the ground by a classic Pontiac GTO convertible racing by in complete neglect of the speed limit. Country roads near his home were narrow, most qualifing for the name "road" in name only. More like glorified dirt tracks, they were paved over remnants of an era when rapid transit meant a fast horse.

The houses told the tale. White clapboard and brick, many with attached barns, double doors wide open to the breeze, tractors peaking from the shadows. Signs marking 25 mph looked as out of date as the traffic they were once supposed to regulate, except on days like this when there wasn't a cop in sight and taking a walk meant taking your life in your hands.

Driving like a bat out of hell was an understatement. It seemed the car barely slowed before rounding a left-leaning uphill curve, but as it did, a passenger heaved a large, black plastic bag off the side. "The dump is on the other side of town," Chuck shouted angrily, and of course, the car was gone before his words could catch up. "A problem my physics professor would have loved," he said to no one in particular.

A few minutes later, the two were standing near the same spot, perpendicular to a small, grassy, rapidly-sloping space between the trees that ended in a perilous 30 foot straight drop into the river. Had it rolled a little further, he mused, whatever's in that bag would be on its way to the ocean, no doubt what they intended. In fact, it was snagged by the exposed root of a white pine that looked large enough to have been a sapling during the Civil War.

"I guess we ought to do something," he said to his dog, who smiled in assent, "but I think it's too steep to handle together. You stay here and I'll be right back." Be right back was their signal for dog guard duty and Chester took his seriously, watching intently as Chuck cautiously worked his way to the bag, wishing he was wearing hiking boots instead of cross-trainers.

Though far from full, the bag was heavy enough he was surprised it hadn't exploded on contact with the ground, chaotically scattering its contents every which-way. Chuck scrambled back up the slope with more care, not wishing to slip and find himself imitating Greg Louganis on a Sunday afternoon sans Speedo, falling headfirst to the river below.

Back on the road shoulder, Chester greeted him with happy licks as he wiped sweat and congratulated myself on being heroic, even if a little foolhardy. It was the same kind of thing he'd have done as a teenager, but back then the idea of falling would have triggered an adrenaline rush. It still did, but it was also coupled with the vision of his medical career coming to an abrupt and unpredicted close. "They were in an awfully big hurry to get rid of this, weren't they? I wonder why...shall we see what we've got? You know the saying, one man's trash is another's treasure."

The bag had built-in tie handles, but they must have been done in haste, because the knot unraveled quickly. At first he only saw dirty, soaked wads of paper towels and what looked like bloody rags. Before Chuck could stop him, Chester stuck his nose into the mass and in the confusion of trying to extract him from the bag, the trash shifted and Chuck saw a foot. A human foot about an inch or so long. His pulse rate racing upwards as rapidly as the escaping GTO, he dug deeper and found another, then two more, attached in pairs to infants with their umbilical cords dangling.

"Thank you, Lord," he said, grateful that somewhere out of the jumble of medical school minutiae, the basics of his advanced life-saving course surfaced. He called 911 on his cell, then held sunglasses to each face to check for breathing, felt for a pulse, and stripped off his T-shirt to wrap the twins the best he could and holding them to his chest until help arrived. Afterward, Chuck said he wasn't sure whose guardian angel whispered in his ear, but Chester leaned gently against the newborns and together, the two formed a neonatal sandwich there on the side of the road.

The ambulance and local police arrived, took his report, packed up the neonates -- both girls Chuck realized when he had calmed down long enough to look -- and headed off to Portland and Maine Medical Center. He visited them in the hospital the next day while Chester, sadly, remained in the car. He did receive a visit from one of the nurses, though, herself a dog owner who happened to have a Milk Bone in her car. It wasn't exactly a medal, but Chester didn't seem picky. The GTO was stolen, naturally, and found abandoned a few days later with no sign of its occupants. The treasure in the trash, as Chuck called them in a moment of irony, were another matter.

(Creative Commons image of Maine barn by HuTDog83 via Flickr)

Sunday, September 5, 2010

The Price of Dawdling

Ordinarily, I write on a laptop, but for the next few days, I'll be paying the price for dawdling. You see, my power cord has been leaving yellow post-it notes on the computer screen for the past few weeks, informing me that it won't last forever. I've read them, dutifully, and even stacked them neatly like pages in a book in plain sight to further remind me to get a new cord. Well, yesterday the inevitable happened and all my efforts to convince my cord to last another day fell on deaf ears. Instead of powering up the laptop, it just laid there, with blank, unseeing eyes fixed on a final note of farewell which read, "I told you so."

In terms of writing, this means resorting to the table-top model in the upstairs bedroom with its now alien Microsoft ergonomic keyboard. A gift of the gods while writing the final draft of our book, I loved this thing. I'm a big guy with proportionately large hands and months of late nights in its company convinced me I'd never adapt to the comparatively tiny geography of a laptop. Man, was I ever wrong. Now here I am, fumbling around doing a virtual hunt and peck because my fingers seem to have forgotten what to do with the equivalent of West Texas beneath them. If you've never driven across West Texas, think "vast expanse" and you'll get the idea.

Anyhow, that's how this keyboard feels. I've alternated between laying it on my lap, hoping familiarity will overcome awkwardness, and using the desk top, and either way, the keys don't seem to get any closer together. Not that I expected it to morph into the neat shape that nestles tidily onto my lap, but a little approximation would have been welcome. I suppose you could equate it with the resumption of dating after a long relationship. It's unfair to expect someone new to feel quite as comfortable as did Ms. What-was-her-name-again?, but you'd at least like them both to be the same species.

I know, computers are computers, and it could be worse, I might still be hammering away at the manual Smith Corona typewriter I had in college, the keys of which I pounded nearly into oblivion. So, yes, I am grateful for what I have, especially since errors like the thousand or so I've made since starting this post, are corrected so easily. I mean, it really would be inconvenient if I had to clean the White Out off the screen before beginning each day, wouldn't it?

(Creative Commons image by canuckshutterer via Flikr)

Saturday, September 4, 2010

Those Who Have No Stripes

This post could get me into trouble, but hopefully, not too much. For quite some time, long before I became a medical student, I've reflected on what I thought clinical education should include. Often as not, these contemplative moments occurred while I was working as a hospital-based therapist and had the opportunity to observe third-year students doing their psychiatry rotation through my department.

What intrigued me was their tendency to stick close to the physicians. This only makes sense; if you're going to move up the ranks, so to speak, you want as much time as you can in the company of those who've already earned their stripes. Well-intentioned as it is, however, this can turn out a limiting factor in your education. The reason is, much of the blood and guts patient care that takes place on psychiatric, as well as primarily medical units, is done by non-physician staff. The things they know.

Consequently, I've come to believe students should have to spend a portion of their time working under the direct tutelage, not only of doctors and nurses, but also mental health counselors, unit secretaries, social workers, and recreational or occupational therapists -- those who have no stripes on their "uniforms." I realize a four week rotation provides barely enough exposure to begin getting one's feet wet, but closeness to the other team members broadens the learning experience tremendously. For one thing, it gives a person an idea how the other half lives.

What I mean is, it's easy to get locked into ivory tower thinking about hospital staff roles and patient care. Doctors have traditionally been at the top of the food chain, and frankly, working with non-physician types nurtures a healthy sense of humility. The initials we place behind our signatures say a lot about us but what speaks even louder is the way we treat the people under our authority. Doctors who are beloved tend to be those who are more interested in supporting the contributions of the rest of the team than they are in being impressive. A little modesty goes a long, long way.

And if someone is not naturally inclined toward a modest self-estimation, rotations are a place to learn its value. I may have gotten four years of college and more of graduate school but it doesn't make me special. Special is the nurse who, instead of going home at the end of the day, works an overnight shift to cover for another who's ill. Special is the unit secretary who catches the error in your prescribing orders, saving you from having to explain yourself to your attending. Special is the janitor who cleans up after the detoxing patient who's vomited in the bathroom. Becoming a doctor is an honor, not because we're entitled to recognition, but because we're privileged to work with people like these and be counted among them. That's what's special.

(Creative Commons image "4 Stripes" by ianmunroe via Flikr)

Thursday, September 2, 2010

The Category of Impossible Things

Why, sometimes I've believed as many as six impossible things before breakfast.~ Lewis Carroll, Through the Looking Glass and What Alice Found There

Occasionally someone who's
genuinely curious but has no personal interest in becoming a physician, asks me if there are advantages to attending medical school as an older student. This is a hard question because it sounds like they're asking if there is something to be gained by putting medical school off until later in life. I can say with confidence, that was never my plan. As a matter of fact, there have been numerous occasions along the way when I've wished the path of my life had led to medical school, but I couldn't see how to alter my direction at the time. Consequently, the choices I made and continued to make only reinforced the route I had already taken.

What I believe people are really wondering when they bring up the subject of "advantages" is, "Are there good reasons for pursuing medical school later in life?" Now, that is a question I can answer, having decided for myself, there definitely were. And those take a person into the realm, into the category, of impossible things, and I'm convinced that's where medical school (and graduate school, generally speaking) dwells.

It's the nature of impossible things to expect and even demand more than any person could possibly deliver and presume it's perfectly normal to do so. At some point, I'd wager every medical student comes to this conclusion, no matter what their age. It just feels that way.

Impossible doesn't mean it can't be done, because it can and this is where we get to the good reasons part, one of them being, it's impossible not to go, i.e. it's impossible to delay any longer. A person arrives at a point where they realize there is a life within them that will remain unfulfilled unless they do something about it. And, frankly, refusing to leap into whatever darkness they will face seems more unbearable than anything they might encounter afterward.

This is all deeply personal, but to my way of thinking, the best of the good reasons comes down to the only reason: it's something you have to do. It's the kind of decision that conditions all of those to follow. Whether it comes about as the desire to go to seminary, attend college for the first time, or try to enter medical school, when the heart speaks, you are compelled to listen. And then, you close your eyes, cross your fingers, whisper a silent prayer to whomever you hope is listening, and step across the threshold into the Looking Glass.

Come what may.

(Creative Commons image of Alice Through the Looking Glass by sammydavisdog via Flickr)

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