Saturday, April 23, 2011

Dance Steps They Don't Teach in Medical School

So, here I am, finally back home and it feels like a typical Saturday. The dog, cat, and I snug in my study by the fire and there's snow falling -- on the day before Easter. The fire is a necessity since the furnace tends to treat this end of the house like something to be avoided at all costs, but the snow was a complete surprise. Alas, it doesn't show in the photo -- so much for good intentions.

On Monday, my Obstetrics-Gynecology -- OB/GYN for short -- rotation begins at Maine Medical Center. In the meantime, my head is still revolving around pediatrics, an experience that turned out to be as surprising as this morning's snow. I had some contact with children during my rural medicine rotation, although not enough to describe it as traditional family medicine. It was mostly an adult practice, but what I learned applied to every age group. A physical exam is still a physical exam, whether the patient is seven or seventy.

One thing I noticed from my first day in pediatrics was how much more fun it was, working with kids, than adults. I mean, you can play with kids and they appreciate it, even when they're sick. That said, playing has a significance few realize: it's not simply about being charming or cute. And this is something I knew going in, thanks to a number of children who, over the years, have been willing to be my tutors. Play is the language children speak, particularly with one another, and not all adults are familiar with it.

I love words, written and spoken, their derivations, structure, the interplay of grammar and syntax that may span what we fear is an uncrossable abyss of hurt feelings, anger, and disappointment. I love it, too, when communication sidesteps the vocal cords and heart to heart is the dialect spoken eye to eye. Play is like that. When you let down your guard and become genuine with children, allowing yourself to be as vulnerable as they are, you make connections and establish rapport, sometimes without even saying a thing. Not unlike psychotherapy.

Before this rotation, I wasn't aware how essential play is for me as a clinician. I mean, I've always tended to joke with patients whenever it was appropriate because humor can be disarming; it creates a space in which we may be mutually human. But with children, it's not so much about creating a space as it is stepping into one that already exists, and the question becomes, can we forget ourselves well enough to become real with children, and believably so?

The hardest part, it seems to me, is relating to kids in ways they find meaningful and their parents endearing while maintaining an air of professional competence at the same time. It's one of those dance steps they don't teach in medical school. I suppose that's also why they call medicine a practice -- even on the best of days you're never completely certain you haven't tread on a few toes.

(Photo copyright 2011 by the author)

Sunday, April 10, 2011

Thoughts on Pediatrics from a Cemetery

"Thickly Settled," read the yellow triangular traffic sign. Not the usual warning variety, I'll admit, but it works for Hancock Village, a double row of houses and a Baptist Church situated almost right on the state line between Western Massachusetts and New York. Greater Hancock extends further north, past Jiminy Peak Ski Area, to Williamstown, but the Village itself is smaller. I'm writing, on this warm, quiet-as-a-grave, Sunday morning, appropriately enough, from the Hancock Cemetery. It isn't that I'm particularly fond of cemeteries, but my guess is the dead are less likely to bother interrupting me to ask what I'm doing, so as long as my computer battery holds out, here I sit.

There's nothing like a rotation in pediatrics to remind you how little you know about children. What's this got to do with cemeteries? Nothing, really, I just wanted to share where I was writing from and how I'd gotten there. My real topic is pediatrics. So, anyway, six years as a Scoutmaster I thought might give me some expertise and I suppose it did, at least where boys age 11-18 are concerned.

Theirs was the generation of Arrowsmith and Guns N' Roses and my Bronco II rocked to their beat along the highways and hedges of Texas. Among their fellows I can count my classmates and future colleagues. Does that make me feel old? Hardly -- they got me out of myself and into life in ways that endure to this moment. Because of them, my CRV rocks to Lady Gaga and I'm not afraid to walk into an examining room with a kid with undiagnosed ADHD, bouncing off the walls.

Some things you don't get in the rarefied atmosphere of Scouts. For instance, a little guy who tinkered with the tiny flashlight at the end of my stethoscope, a trinket I claimed from Army recruiters who visited my school a couple of years ago, before allowing me to listen to his breathing. His mother said, more than a little surprised, "He's afraid of men, but he's good with you..." I resisted pushing the envelope to look in his ears. He didn't like the idea and I wasn't willing to risk our nascent therapeutic alliance, shaky as it was already. Besides, the nurse practitioner would have to do it immediately after me and once was my patient's limit. I'll see him eventually for a follow-up visit and hope the rudiments of our friendship are still intact.

There are little girls, seven going on 27, and others so shy they can't tear their eyes away from the shadow of daddy's chest and it's a challenge to do anything. We manage, sometimes with tears and mostly without, for which I'm grateful. A visit to the doctor can be traumatic even when there's a lollypop waiting at the end of it. Kids need to know coming to see the likes of me isn't always a reason to be sad.

It's more the therapist in me than anything else, whispering the wisdom of Carl Rogers, i.e. every patient deserves unconditional positive regard, whether they're old enough to put it into words or not. A smile, a wave goodbye, or the five year old who insisted I get a sucker, too, it all spells out the same. We find a space outside fear and uncertainty where we can connect.

I'll walk to my car sometime around five or six in the afternoon, dog tired.

And feeling good.

(Photo of historic Hancock Cemetery copyright2011 by the author)

Saturday, April 2, 2011

You Only Live Once

To be completely honest, I've rocked back and forth between remiss and downright absent-without-leave more often than not these past three weeks. And for that I sincerely apologize. The intellectual drain of rotations is as severe as the physical strain and it's getting so that weekends are my only time to contemplate writing. I do fantasize about it at other times, but usually when something cute, wonderful, or memorable has occurred, by the time I'm home, my mind is lucky if it can say, "Huh?"

Now, this condition is not uncommon. Most of my friends are tap dancing around their mid to late 20s and when one of them comes home, so slow and heavy are the footfalls up the stairs, you'd think they were summiting Everest. Rotations are tough and residency is tougher. I've got pals here from my entering class in psychiatry, surgery, and internal medicine and they're the pudding's proof. Tired R All of Us.

But there's more than that and I'm thoroughly enjoying the dormitory environment here in the "osteopathic ghetto," as I've christened it, since the apartments in our converted house are occupied by my classmates. Barely a knock before opening the door to shout is about as polite as we get.

About week ago, a few of us spent Friday evening playing Guitar Hero, a serious challenge, I discovered, for those of us who really know what to do with a six string. The game is about counting but we want to get down with the rhythm and be "big rock stars and live in hilltop houses, drivin' fifteen cars," even if the audience is only electronic and fame and fortune as fleeting as a flip of the switch.

Oh yeah, that's right, you read it here first, Beggar plays Guitar Hero and will again -- first chance he gets. I may have a hard time getting my brain to think in the evenings, but chasing that neon rainbow? Hey, you only live once.

(Creative Commons image by Kermitz72 via Flickr;
I Wanne Be a Rock Star, words and music by Nickleback)
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