Medical School at My Age

 
A week ago, a few days before graduation, I was asked the question I hear more frequently than any other: "Why did you choose to attend medical school at this time in your life?" My questioner went on to say he’d graduated in the late 1970s and couldn't imagine doing it "at my age." 

You'd think after six years I'd have gotten enough practice that answering questions like his wouldn't require much reflection. To a certain extent, that's true, except over time my understanding of why I undertook this process has grown, and along with it, the way I respond to questions related to age. 

Now, to be fair, some of it does have to do with how I read the the other person. What do they really want to know and how much time have they got? Is it polite cocktail party curiosity or are they contemplating a course correction in their own career? In this case, the question was posed by an attending anesthesiologist I'd just met and we scarcely had any time at all, so I talked briefly about pursuing a dream. As I walked to my car a bit later, it occurred to me how impossible it is to imagine myself not  being a medical student at this point in my life and how very little age has had anything to do with it.

Admittedly, that isn't entirely true. Before I undertook medical school, I argued vociferously against it, considering age my most salient point. I wanted to become a doctor and, particularly a psychiatrist. I always had, but the circumstances of life took me in other directions and it seemed ridiculous to suppose anyone would take me seriously now. Obviously, I eventually lost that argument and what I've realized over time is I never had a chance of winning in the first place. Something was afoot in my life that neither reason nor common sense nor anything else had the power to effectively counter, as I hope the following story reveals.

It was a Sunday night and my shift as a substance abuse therapist at a Boston hospital was 30 minutes away from being history when I was paged to the nursing station to handle an admission. My patient was an older, intoxicated gentleman, accompanied by his adult son. They were pleasant, intelligent, lived out on the Cape (Cod), and despite grumbling to myself about having a new admission so close to sign-out, I immediately took a liking to them both. A few moments later, while meeting with the father to sign his paperwork, he said to me, "Doctor, I want to tell you how all of this began..."  I ought to have told him I was only his therapist, but hearing the title, "doctor," honestly it felt so good, I just couldn't. 

I told myself I'd explain the next day and I did. I wasn't trying to mislead him, but it felt like unfaithfulness to something I didn't quite understand, to correct him. You might say he was under the influence and simply mistook me for his physician because I was an older male. I say in vino veritas. Unknowingly, and probably unconsciously, he saw into a deep and private place and called me by the name nobody, not my parents, my friends, or anyone else, had ever spoken. For the first time in my life it seemed as though someone knew who I was. How could I deny that?

Back then I wasn't so much thinking as feeling. Drawing near the end of this leg of the journey, I've done a great deal of thinking and I've begun to realize how very much it's been like growing into a father's shoes. When we're young, we slip into them and they're huge, so huge we can't walk without stepping out of them. One day, they've grown smaller and then smaller still until they fit us as well as dad. Why attend medical school at my age? I guess you could say, that's when the shoes finally fit.

In another life, to borrow from Katy Perry, whom I love, I might have gone to medical school "on time." The tricky thing about other lives is they don't come into being unless we find a way to make them. I didn't have the keys to a Delorean (Back to the Future) in my pocket, so reversing the time-space continuum wasn't an option. All I could do was be like the proverbial turtle, who never gets anywhere unless he sticks his neck out. Yes, I was older and by definition, that meant attending medical school as an older, rather than younger, adult. Age was a piece of my puzzle. But it was only a single piece and nowhere near my biggest one. Had I been born someone else, it might have been gender, race, or national origin. We all have something we can't change.  

George Eliot (pen name of Mary Anne Evans), author of Silas Marner, said, "It's never too late to be who you might have been," to which I'd add, until it's too late for everything but that final breath.  What has become clearer and clearer to me is how much medical school and now, residency, have come to mean immeasurably more than simply fulfilling a long cherished dream. They mean being true to what I've learned about myself as this process has unfolded and there really are very few things quite as important. They mean acting on the freedom to make choices of my own rather than making up excuses for denying them and then, trying to live with the consequences. They also mean, considering everything that lies behind and whatever lies ahead of me, there isn't anything to make me regret coming this way.


(Photo copyright 2013 by the author)

Becoming Experienced

Here's the difference between Dante, Milton, and me. They wrote about hell and never saw the place. I wrote about Chicago after looking the town over for years and years. ~ Carl Sandburg
It's not fair, I realize, but there's nothing to be done about it. Since we can't speed up the clock, we just have to put up with it, and besides, if we rush, once we get there, we'll wish we'd taken our own sweet time. Oh, and then we'll be p.o.ed because we missed out on a ton of good stuff along the way. I'm talking about gaining experience. When we don't have any, we want it, though in order to obtain it, we may have to get run through the ringer. Not every time, thanks be to God, but with enough regularity that it's worth writing about this morning.

You see, the problem with becoming experienced is, we get experience. For instance, drug and alcohol counselors often have a personal history of substance abuse. Now, nobody in their right mind becomes an alcoholic in order to counsel with other alcoholics. Wait, I take that back, I've known a few narcissistic types who were sufficiently inflated and insight-less to try. But for the most part, while those who have a substance abuse background value what they've learned, they're not proud of the way in which they learned it.

Then there's the idea of vicarious experience, which is another way of saying we learn by observation. Medical students know a lot about this one. We "assist" in surgery, for example, by holding a retractor and watching while the doctor dives into an incision, in order to benefit from her experience. You wouldn't list this on your resume, but being present and having something to do with your hands besides keeping them folded so you don't inadvertently contaminate anything important -- like the patient -- is one way of learning.

And theoretically, it contributes to a body of knowledge that we can use as a guide to reduce the number of mistakes we'll eventually make on our own, mistakes that have the nasty habit of constituting real experience. Thankfully, there's more to this process than making mistakes or getting into trouble, but occasionally that's how we figure out how to identify and stay away from them. Though not always.

Growing up around large animals, my father taught me to never allow a horse to get ahead of me on lead. In other words, make sure I walked next to his head rather than behind it. Naturally, being young and invincible, I figured his advice was for the old and feeble. Then came the cold, snowy afternoon when I was drug 50 feet by our usually well-mannered Appaloosa stud horse and my left hip became unpleasantly acquainted with his left rear hoof. The bruise was the size of a watermelon and I limped for days. Let's say I never made that mistake again. Chalk up another one for the Old Man.

Sandburg had a point (see quote), it's one thing to talk about hell and another to spend your days and nights wondering what in the hell you did to get yourself there in the first place. Which wrong turn did you take, which right one should you have taken, and why didn't someone tell you about the fifty two warning signs (billboard sized) printed in black, block capital letters on fluorescent orange in plain English posted at regular intervals on your side of the road? Honestly, there are days when we just can't see them, not even if we've stopped, gotten out of the car, walked up, and stuck our noses against them. For good or ill, we have to drive off the precipice, blind as bats until we hit bottom. And then we have experience.


(GNU Free Documentation image via Wikipedia)

An Element of Coincidence

I love coincidence and Saturday evening's dance class -- my second -- cooperated nicely. After practicing the previous week's Salsa steps, we began a nameless something you'd see on syndicated reruns of The Adventures of Ozzie and Harriet or American Bandstand. It was probably a variant of Swing, and to do it properly, one ought to be dressed in jeans with the cuffs turned up or saddle shoes and bobby socks. The only thing missing was Ricky Nelson singing, Hello Mary Lou. If I can get this one down, I'm either going to be very popular with the younger women at my friend's wedding whose boyfriends think it's outdated -- or their grandmothers, I'm not sure which.

An element of coincidence enters in when you recall that I was dreaming this past Friday morning about Elvis Presley, and the next night, learning to dance to his music. This has happened to me on other occasions. I'll dream about someone or a particular situation and within a day or two, the theme reappears in an unrelated, real life encounter. It's almost as if the universe is determined to reinforce a message it wants me to receive, loudly and clearly.

Carl Jung called the overlap of seemingly random and unrelated events, synchronicity. He wasn't suggesting that a mystical force engineered the circumstances of our lives, but rather our interpretation of these events can reveal unconscious material in the psyche. It's the same process that motivated his fascination with the I Ching. As with dreams, the one who is in a position to determine the true significance of apparent coincidence, is the person involved, because it's their unconscious at work. Still, I'm open to suggestions.

Reading back over Saturday morning's post, two things from my dream stand out. First, appearances can be deceiving, and second, it pays to be patient and observant. While it looked like I'd been cheated out of my opportunity to meet Elvis, in fact, by waiting rather than arguing for that which was mine by right, I gained far more. I got to make contact on a genuine human level.

Dancing can be a fairly intimate thing. While I still know comparatively little about my student-partners as persons, I'm finding out such things as how they carry themselves and who is more comfortable matching my long stride. Learning a step from Elvis' time ties the message of the dream with music and movement, making it deeply personal. Apparently, the "lessons" of this dream are ones my unconscious fully intends me to take to heart. And since I don't know when the final exam is scheduled, I'd better be diligent about studying.
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Persons of the Cloth: Evening the Score

One of my favorite comments is, "Well, Beggar, you're not like any minister I've ever met before." It's important to emphasize the second contraction in that statement, not only out of respect for today being National Grammar Day, but because that's how they say it. A little incredulous, they mimic Mr. Spock arching an eyebrow, and look at me a little sidelong, as though they're not sure whether I'm lying about my credentials.

My first inclination is to ask what kind of ministers they have met previously since you'd like to know the competition. Usually, it's either been one who was dismissive of evolution, inclined toward fundamentalism, or didn't drink, smoke, chew, or go with girls who do (spoken in jest out West) and criticized anyone who did. From that company, I'm delighted to be distinguished. Not that there's anything wrong with holding those views -- it's a free country -- but they aren't mine and if I'm going to be blamed for something, I'd like it to be true of me and not someone else.

Somewhere along the line, the idea came about (propagated mostly by ministers themselves, I'm guessing) that being a Person of the Cloth meant one shouldn't be human. The irony of it is, the model, at least in my tradition, was so incredibly human it was possible to accuse him of drinking, partying, and hanging with prostitutes and tax collectors (the ultimate low-life in those days). So, why didn't he change his ways? Basically, it was because those people were the ones most aware of their imperfections.

If one becomes a minister because they're "holy" and therefore, predisposed to a life of self-denial, I'm in deep trouble. For me, it resulted from a sense of calling, not at all dissimilar to the one we talk about in medical school. It's the kind of thing you feel like you're supposed to do even though you can't really explain why. You may have to make sacrifices to do it well, but the fulfillment you gain makes it worthwhile. It can evolve, as well, as it has in my case, leading me to medical school (see 1/16/10).

As time has gone along, I've become more aware that being a minister means being a ministering person in the larger context of life rather than being employed in a church, but it still doesn't negate my humanity. The ministry isn't about me and it's sure not about trying to make people into my image. It's about being available to people and willing to help, if and where you can. I'm bringing this up today because it occurred to me, of all the times I've mentioned it, I've never explained why I became a minister and that just didn't seem fair. I guess you could say I'm trying to even the score -- hope I done good (chuckle).

Chris Del Bosco: It's About Perseverance

When I was a kid, my favorite parts of a movie were typically the action sequences. I still feel that way, though to a lesser extent. I've grown to appreciate the stories behind the characters and therefore, what it means to them to be participants in the action. Their passion gives it significance. I feel the same way about the Olympics. The personal interest segments that interrupted my childhood absorption in the events, are now the very things I want to hear about most.

Ordinarily, these involve a family member with a chronic illness, the loss of one or both parents, a family overcoming financial difficulties and making sacrifices to drive hundreds of miles one way so a child can practice their sport. They're about people you'd like to have for neighbors, relatives, and best friends. People you talk about over dinner and wonder how they manage to do it all. Chris Del Bosco's, however, is one you don't generally talk about. Chris Del Bosco's story is about addiction.

He was fourteen when he had his first drink. At 17, he was kicked off the U.S. Ski Team for testing positive for marijuana. Over the next few years, he was arrested three times for driving under the influence and might have died one evening when he fell into an icy stream in his hometown of Vail, Colorado. A passing stranger saw him, called emergency services, and he awoke in the hospital with no idea where he was or how he'd gotten there.

Eventually, he got into treatment and has been sober the past three years. A chance encounter between his cousin's wife and a representative of the Canadian Ski-Cross team led to an offer and now, at 27, he's at the Olympics, his life beginning again, one day at a time. Keep in mind, there is no "ed" at the end of recovery, only an "ing." The process is ongoing with the end never in sight. But don't feel sorry for Chris; recovery isn't a burden, it's freedom. For the first time in a long time, he's in a position to address life on his own terms, not those dictated by alcohol.

Endurance measures how much we can take. Perseverance, how many times we get back up after we've been knocked down. Chris fell during his final run in the ski cross last night. As John Lennon said, "Life is what happens when you're making other plans." Not so very long ago, he might have resorted to drinking. That's no longer an option, not if he wants to live, and it looks to me like he does.

Recently, he said, "People were there when I needed help and told their stories. I'm in a place where I can help." Considering how far he's had to come, simply being in the Olympics is huge. Winning can be inspirational and falling at the critical moment heartbreaking, but that experience gives him just one more opportunity to get back up and show us we can do the same. It's another way of helping.

Perseverance. That's what he's about now. Go, Chris.



"For ski cross racer Del Bosco, new sport offered a fresh start," by Vicki Michaelis, USA Today, January 14, 2010, www.facesandvoicesofrecovery.org)

The Men in Her Dreams

One of the turning points in my own life took place in the mid-90s when I encountered depth psychology. It came about at a time when I was looking for a way to better interpret and make sense of the ways life had unfolded, and its emphasis on symbolic images within the psyche was very appealing. Even more helpful was time spent with a Jungian analyst, who insisted the image was less important than the way I took it to heart.

Two of these images are ones that appear in the dreams of men and women, usually in the form of contrasexual figures. Sometimes they are recognizable, a friend, former or current lover, and sometimes we can't place them at all. In any case, their function is to reveal aspects of ourselves that have been neglected or have the capability of enhancing our lives. They don't represent real persons, however, and instead, they are symbols of the persons we wish to become, of directions we need to take in personal growth.

Jung called the female figure, the anima, and the male figure, the animus. The former shows up in the dreams of men and the latter in those of women. Now, to be sure, there are other figures who populate our dreams, and we can get to them as time goes along. For now, though, I'd like to concentrate on the animus. Tomorrow we'll develop the anima.

The first thing to keep in mind is, these do not represent a man's "feminine side" or a woman's "masculine side." We often speak in those terms because we associate certain qualities with masculinity and femininity, something reflected in dream imagery. But strictly speaking, the attributes revealed by the anima and animus transcend gender. Personally, I think assigning gender to the traits revealed by these figures gets in the way of what we need to learn, but that's me.

It's simplest to try to visualize the animus and here the film industry comes to our aid. In the movie, Medicine Man, biochemist Rae Crane is sent by a drug company to the Amazon basin in search of a missing scientist, the reclusive Robert Campbell.
From their first meeting, Campbell challenges her assumptions. This is one of the things an animus does for a woman. She begins the film relying on a corporate image for self-definition and ends it finding one that is uniquely suited to her.

Anima/animus figures can be negative (inhibiting, persecuting) or positive (promoting growth). For Crane, the negative animus is associated with conventional thinking and represented by a wealthy young man to whom she has become engaged. Pointing out that her fiance is a major financial contributor who comes from "good stock," Campbell suggests her choice may not reflect her own preferences. When a woman chooses conventionality over originality, it's because she has given in to an image of womanhood derived from the expectations of others. Her task is to establish an identity based on what she envisions for herself, something which may or may not be congruent with an assigned role in society.

As a positive animus, Campbell forces Crane to not only examine her choices and her reasons for making them, but also to look closely at the resources she possesses for dealing with life. Hiking through the jungle, she develops a massive headache and asks Campbell for an aspirin. He brushes her request aside and hands her a more effective local remedy made from the bark of the Yoko tree. In essence, this tells us she is in a place where she needs more than what is provided by the conventional world. She needs a more instinctual approach, one in which she relies on her own very adequate resources, including her intuition and good sense.

In a late night encounter with the village medicine man, she receives a tatoo on her forehead marking her as in transition. She is moving away from the person she was toward a stronger character. By the end of the film, she has abandoned the heavy boots she wore in the opening scene, representing protection from the passion of real life, and now walks on bare feet through the jungle, more sensitive, more aware and open to possibilities. Furthermore, instead of making what she once considered the right choice and marrying her fiance, she decides to remain with Campbell, suggesting she has come to trust her own instinctive sense of what is appropriate.

Whether a woman chooses to use dream imagery or depictions in film or literature as a guide, the image of the positive animus points in the direction of wholeness. It urges a woman to be true to herself, trust her own judgment, and develop new avenues for growth and fulfillment. The women I described in my recent post on relationships are all ones who have nurtured healthy relationships with their animus, becoming not less feminine but more so, as they become more completely themselves.

Making a Difference

Image via Wikipedia

"What motivates substance abuse, anyway? How did I get myself in this position?" he asked.

"Well, how much time have you got?" I responded, because it's like that. To begin with, I don't think there's a person alive who sets out to become substance dependent. "Wait a minute," you say, "what about genetics? Doesn't that have something to do with it?" To a certain extent, yes, but it's not like having blond hair -- you're born with it so either deal or get acquainted with Lady Clairol. Instead, it's a case of a genetically-vulnerable individual being more susceptible to addiction when they expose themselves to a given chemical agent.

It's not automatic -- the nurse swabbing your arm with alcohol when you get a flu shot isn't going to turn you into an alcoholic. One current theory suggests that alterations in the enzyme that breaks down alcohol may permit some persons to imbibe greater amounts before experiencing adverse effects. People who seem to have low levels of this enzyme (see post of 5/23/09) are less prone to alcoholism because they experience those effects more easily. Drinking for them, especially to excess, turns out to be not a lot of fun.

Choice is definitely involved, but if a person is raised in a family where alcohol dependence is rampant, for example, their choices are highly influenced by parental/sibling modeling. Where there is chronic stress, psychiatric illness, or the message that drinking is appropriate and expected, it becomes more difficult to "just say no." And in some cases, "no" isn't even part of the vocabulary.

At the same time, I've known people who came from alcoholic families and never touched a drop. They'd experienced so much pain as a result of mom or dad drinking, they determined it would never happen to them and it didn't. They may have attended Al-Anon or Alateen, associated with non-drinking friends, gotten involved in spiritual groups, or a combination thereof. Just like attaining sobriety, avoiding dependence is easier with support.

I've been referring, mostly, to alcohol and, honestly, there are a number of theories out there to help explain who, when, how, and why substance abuse and dependence of all types develop. None of them are universally applicable but they don't have to be in order to be useful. We don't have to know everything to do something meaningful nor do we have to do everything right to make a difference.


(Image of DNA molecule via Wikipedia)

A Place in the Colony

It's often assumed, particularly by patients, that if someone's working in addiction medicine it's because they have a history of chemical abuse or dependence. As a result, I used to get the question, "Are you in recovery?" quite often. And, as a beginning therapist, I wasn't sure how to go about answering it. For one thing, I didn't want therapy to revolve around me when it was supposed to be about the patient. For another, I'd learned as a teenager (you never know where the lessons of therapy are going to come from) that giving advice could very easily blow up in my face.

It was a pretty serious dilemma because trust is the critical element in any helping relationship and I'd been informed that many substance abusing patients wouldn't engage with a therapist who hadn't "been there." I wasn't about to lie and yet I had to find a way of communicating that I knew what it was like to have been kicked in the teeth without spelling out details. One day I tried a little experiment. I was leading a therapy group when I got "the" question, so I looked the patient in the eye and said, "I'm in recovery from life, how's that?"

To my surprise, it went over very well. Not only was he satisfied, many group members smiled, nodded their assent, and we went on to talk about what it meant. As I attempted to explain my own perspective, it became clear it was more important for them to assign their own meaning, having discovered I wasn't an outsider after all.

I still like the phrase because it relates the essential truth that no one gets through life cleanly. Everyone picks up some dirt along the way. As bumper sticker philosophy maintains, @#%$ happens and it happens with disturbing regularity. Recovery doesn't involve ridding ourselves of the filth as much as it helps us learn to live with it. That's a disappointment to some who are new to sobriety because they fear their past behaviors have rendered them untouchable, like lepers in a new disguise. Once they realize we are all lepers, in one form or another, with our own baggage of doubt and fear, self-acceptance becomes easier.

It's really a matter of finding one's own place in the Colony.


(Creative Commons image by Saynine via Flickr)

The Mystery of the Missing Pants

Image via Wikipedia

"Ah cahn't find me pahnts," he said, his Irish as thick as the scent of old whiskey on his breath. Standing there at the nursing station in shirt, undershorts, and socks, it was obvious something was missing. Patrick been brought into the substance abuse unit by the police, after having been found wandering the Bunker Hill Monument soliciting tourists. I took him back to his room and thus began what would henceforth be known as the Mystery of the Missing Pants.

"Where did you leave them?" I asked, as he crawled back into bed. He looked at me like I had two heads -- from his point of view, I probably did -- and fell asleep. They've got to be here somewhere, I thought, and began to search his belongings, then the closet, under the bed, around the window, even above the foam ceiling tiles. Nothing, not a sign. It was as though I'd walked into an episode from The Twilight Zone.

I was about to leave when Cathan, the second-generation Irish charge nurse, poked his head in the door and asked, "Any luck?" I shook my head no, he shook his in disbelief, then pointed to the window and suggested it might easily have been mistaken for a dresser drawer under the circumstances. So, out I went, and digging through the bushes (intentionally avoiding the curious glance of a hospital security guard), found only aluminum cans, paper cups, and cigarette butts. Whatever had been thrown out the window at one time or another, it didn't include the faded and worn plaid wool pants I'd seen when my patient arrived in the company of Boston's Finest.

A week later, at discharge, Patrick was decent: we'd found a pair that fit in the stock of spare clothes kept for such occasions. When we relocated from the second to the eleventh floor of the hospital we did a more thorough, albeit informal, search and still, no pants. Eventually, the tale became part of unit lore, recounted at Christmas parties and during long evening shifts when snoring echoed down the halls like the rumble of hot rod glasspack mufflers at a stop light.

Several months went by -- it was late September -- and as I was preparing to leave Boston for Colorado, I decided to take the Green Line downtown for one last walk through Boston Common. I'd just gotten off at the station when I felt someone in the crowd grab my elbow and whisper in a thick, whiskey-laden Irish accent, "Ah, Lad, tell me now, didja ever fahnd me pahnts?"


(Image of the Bunker Hill Monument via Wikipedia)

(Note to the reader: as always, names and details have been altered and/or fictionalized to protect patient anonymity -- and make for a better story!)

Falling Down a Hole

There is a story I love that goes like this. A guy's walking down the street and without warning, falls into a big hole. The walls are so high and steep he can't climb out, so he begins to call for help. A priest happens by and he shouts, "Hey, Father, can you help me? I'm stuck down here!" The priest stops, writes out a prayer, drops it down the hole and walks on.

The next person by is a doctor and our guy calls out, "Hey, Doc, can you help me? I'm stuck in this hole." The doctor stops, writes out a prescription, drops it in the hole and walks on. Finally a friend comes along and the guy says, "Hey, Joe, it's me -- can you help me out?" Joe stops and jumps into the hole. Our guy says, "Oh, this is great, now we're both stuck!"

Joe replies, "Yeah, but that's okay because I've been down here before and I know the way out."

I've always felt a little sheepish as a minister and future doctor that both my career paths fail to "get it" in this tale. And of course, the story is intended to demonstrate that isn't our social role, but the consciousness of our own vulnerability, that makes us healers. I may have mentioned this in a previous post and if so, forgive me for repeating myself -- my friends will tell you I do that from time to time -- C. G. Jung said, "Only the wounded healer heals."

What he meant was, it's the conscious awareness of our own pain that renders us effective with others. In a culture that values strength, capability, and invulnerability, this is ironic, yet, true. One of my closest friends reminds me, "You can't really be a good grief counselor until you've lost a parent." I can't speak for anyone else, but I know my own effectiveness as a therapist increased exponentially following the death of my father.

It's not always what we know or who, but where we've been and what we've been through, that counts. More importantly, that we don't try to hide who we are and what we've experienced. I'm not suggesting we should wear our lives on our sleeves. We all know someone who's far more interested in being noticed for their pain than helping anyone with theirs. But between avoidance and flamboyance lies the quiet memory of what it was like down in the hole. If that doesn't motivate us to grasp someone else's hand, nothing will.

(Reference: Story paraphrased from The West Wing, Episode 32 "Noel," written by Peter Parnell)