The Liberty Bell: Just the Two of Us

Well, I did it again, said I'd talk about one thing and neglected it for another. Yesterday's post was supposed to be about Independence Hall and the Liberty Bell, but reading over it, I'm darned if I can find any reference to a bell. What is it they say about good intentions? 

I suppose, without realizing it, the omission was intentional. Independence Hall was the main attraction and my primary reason for driving downtown in the first place. I really didn't think about seeing the Liberty Bell, despite all the times I've watched National Treasure (2004). It simply didn't cross my examination-addled mind.

That's the thing about medical boards exams, if I've never mentioned it before. They're exhausting. Whether they test your command of first year science material, second year disease processes, or physical exam skills, by the time you've finished, you've got every reason to be justifiably weary. Whoever first described them as "marathons" was exactly right. They feel like 26 hard-fought miles whose successful completion depend as much on adequate sleep, nutrition, and psychological preparation, as upon whatever study and skills review you may have done. Which helps explain why I couldn't entertain seeing both Independence Hall and the Liberty Bell at the same time; by then my brain had seriously limited space and Independence Hall won the toss.

The moment I saw the Liberty Bell, however, thanks to the comment of a passing stranger, was more than a surprise, though definitely all of that. The last thing I expected was that it might be even remotely accessible. Especially considering how my efforts to position myself on the Independence Hall side of Chestnut Street for a closer shot of Washington's statue were quickly suppressed by a guard whose face clearly stated, "Don't Tread On Me." Spending the night in the Philadelphia hoosegow didn't seem like the best way to pad my resume, so I retreated across the street like Washington's forces fleeing New York ahead of the British. 

Oddly enough, where the Liberty Bell was concerned, there were no guards to be found. Then again, the glass enclosure surrounding it isn't the sort of thing a graffiti artist with a piece of chalk could insult, whereas the brick facade of Independence Hall isn't quite so resilient. But I liked that, their absence, I mean. It gave me a chance to stand a mere few feet away from it, nose pressed against the glass like a Dickens character, just me and the Liberty Bell, just the two of us. Maybe it comes from all those days spent wandering the meadows among the trees as a kid, the sense that inanimate objects aren't soulless, but to me, it felt like I was in the presence of something sacred. 

The Liberty Bell hangs in solitude, as though nothing else is quite worthy of its company, and the structure in which it is housed could easily be a glass cathedral. Maybe my theological background is coming out and someone else might view all of this quite differently, and that's fair to say. Still, there's something about the Liberty Bell that made me feel it ought to be shown reverence. It was the only thing I wanted a photo of myself alongside that afternoon. The unnamed tourist, the one who drew my attention to it, was my photographer.

The memorial itself is a city block long and the President's House or it's framework, lies at the far end. Walking back toward Independence Hall, I had to stop and gaze at the Bell again, truly feeling loathe to leave. The hour was getting late and I needed to, but I didn't want to. I can't explain it, but there's a beneficence, or better yet, a holiness about the Liberty Bell. Not the fearful, overpowering mystery of a burning bush, more like the gentle, suffer the little children to come unto me, sort of holiness. A holiness born of vulnerability, one the Liberty Bell was foundered with and that became evident when it rang. But even now, when it appears silent, it is not silent.

Draw near. Closer. Closer still and listen. Listen as I did. Can't you hear it whisper? 



(Photo copyright 2013 by the author.)   

Independence Hall, Itching for a Fight

 
Like most kids raised outside of New England, I suppose my earliest tour guide through Colonial America was Walt Disney. Televised reruns of classic films like Johnny Tremain (1957) and the animated Ben and Me (1953) coupled with my imagination to turn me into an idealistic young member of the Sons of Liberty or Benjamin Franklin's collegial churchmouse, depending on the moment. By the time college rolled round, I was a prime candidate for a major in history and when 1776 (1972) was released, I fell in love. With the movie, that is. There was a girl at the time, but that's another story and love wasn't destined to be the key player in our plot line.

Independence Hall is another matter. When Benjamin Gates was there, in National Treasure (2004), I was still in the throes of seeking medical school admission. It was the second of a three year process that ultimately led me to Maine and a farm on the banks of the Saco River in a town founded in 1772. But medical school is time consuming and Philadelphia miles away. It wasn't until this past week that the spin of fate's roulette wheel dropped me into place within a stone's throw of the building in which the Declaration of Independence was debated and signed.

As I wrote yesterday, I'd been in Philly for a day -- actually, two, one to settle in and get a decent night's rest, the second to repeat a medical board exam. I wasn't sure when I'd be finished, so I scheduled my flight home for late in the evening. Done at three, there was time to drive by Independence Hall, if nothing else. At least I could say I'd seen it. Well, you can guess the rest. Once I saw it, I had to find a parking space that wasn't reserved for carriages, and get as close as I could. 

A skeleton crew of park rangers or police, I never quite figured out which they were, had everything cordoned off, but it was still possible to walk along South Fifth St. and place my hand on the outside wall of Philosophical Hall, that adjoins Independence Hall on the north. Philosophical Hall is where Benjamin Franklin founded the American Philosophical Society. Immediately across the street is the Library Building, the site of the first public library in America, also founded by Franklin, whose statue adorns the facade over the entry.

I wasn't prepared for how it would feel, seeing Independence Hall for the first time. It's different from Boston and Patriot's Day or Maine and First Parish Meeting House, where the Declaration of Independence was first read aloud in this part of the Colonies. After the battles of Lexington and Concord, the war moved south. One of my neighbors, or he would have been had I lived in 1775, Lieutenant Samuel Merrill (his restored farm is Jessie Livingstone's dream house in Pink Hats), fought at Bunker Hill. I'd have been there with him, if I could. But what I mean is, there is a comfortable quality, almost an ordinariness in the best sense of the word, about the Revolutionary period up here -- it seems less formal, cozier, more familiar. It's everywhere you look. It's like visiting an old friend.

Independence Hall is surrounded by downtown Philadelphia. It's an urban environment and it was back then, too. As urban as you could get in 1776 when street sweepers cleaned up horse manure rather than cans and candy wrappers. Once you get past that, there's a feeling that virtually seeps out of the cobblestones. It was as though I was part of something electric, exciting, on the brink. There's a tension in that historic square mile that hasn't dissipated one bit in three hundred years. Visit City Tavern and you're certain Jefferson and John Adams will be there, plotting Revolution over a pint. One sight leads to another and before you know it, you're reaching for your flintlock, itching for a fight. 

I liked Philadelphia. It's a young city and a friendly one. The residents drive like bats from hell on the highways, but meet them anywhere else and they're pleasant and easy to engage. It's a city, nevertheless, and Portland is big enough for me. I loved Independence Hall and the Liberty Bell, but I love our homespun version up here even more. I'm sure Lt. Merrill must have felt similarly, when he left Boston behind for his farm on the banks of the Saco River.  


(Photo copyright 2013 by the author. Additional images of Independence Hall may be seen here.)

Once Upon a Rainy Afternoon

I was standing across the street from Independence Hall when I heard a woman's voice behind me, "Turn around." I obeyed, and in the dim light of the rainy, grey, late afternoon, about thirty feet away, saw a golden outline. My breath caught in my throat as I said, "Oh my God, it's the Liberty Bell." I must have looked like a child on Christmas morning when another tourist and her husband smiled and told me where I could get even closer. I hurried to the window they indicated and there it was, as though waiting for me all these years.

I'd never seen Independence Hall, either, until minutes earlier. I was in Philadelphia for a medical licensing exam and had a few hours to kill before my flight home. The day before had already turned miraculous when, while searching for a discount store to purchase a few items I needed at the last minute, I noticed the sign for Valley Forge park. I couldn't believe it. I'd wanted to go there quite badly, but it looked too far on the map and this was a business trip, or so I told myself. Yet, there it was, as though it, too, had known I was coming and had waited long enough.

The park was closed, naturally, because of the governmental shut down. The Tea Party members of Congress, ironically named for those who sought liberty of conscience rather than the freedom to impose their views of conscience on others, weren't aware I'd be in Philadelphia, I'm sure. But Valley Forge had other ideas because Washington Memorial Chapel, dedicated to George Washington and located immediately across the street from Valley Forge, was open. 

I turned my rental car into the parking lot so quickly I'd have been a road hazard to anyone unfortunate enough to be following close behind. The church, an active Episcopal parish, is built in the classic English Gothic style with a bell tower drawing the eye skyward. Cannon -- period artillery pieces, some field, some naval, but all of them veterans that bombarded the British -- guard both sides of the entrance and line the grounds to the west and north.  

Inside is a lovely nave with stained glass on four sides. But it's not ornate, as you might expect, and the only statue is one of a young Washington on the side of the bell tower. It has the feel, however, of a castle, but since I've never been in a real one, it's really how I imagine it to be. I encountered a parishioner near the altar who answered my questions and listened, indulgently, as I described the turn of events leading me there. And that's how it seemed, as though my presence was no accident, even if it was.

Behind the church is a log cabin replete with walk-in fireplace that serves as a gift shop. At first, I thought I could be happy with a large mug bearing the image of winter 1777, but then I noticed the brass cannon. A British six-pound field gun, the staple of the Continental Army. Solid brass, about ten inches long and four high, I could see it sitting in my study, alongside smaller versions from the battlefield of Saratoga, Ft. Ticonderoga, and Maine's Ft. Knox, named for Henry Knox, who directed cannon fire against the advancing British at Bunker Hill. I left with the mug and the cannon.

Valley Forge is beautiful this time of year and probably more so at Christmas. The Christmas of 1777 was different. Wind blowing off the Delaware River, snow mixed with icy rain, Valley Forge was anything but beautiful to the sick and starving, ill-clad Continental Army, nearing total collapse. On a good day with mild traffic, you can drive the 43.5 miles from Valley Forge to Trenton in less than an hour. Marching the same distance, feet wrapped in rags, must have been agony. If you haven't seen The Crossing (2000), with Jeff Daniels as Washington, I'd encourage you to see it. Even members of the Continental Congress were unaware how close was defeat that bitterly cold Christmas morning.

I can easily identify with George C. Scott's character in the 1977 film, Patton, standing among the ruins of ancient Carthage and recounting how it was when the Romans conquered the city. Not that I believe in reincarnation, I don't mean that; it's just that history has always been a living thing for me and visiting those places where the course of human events was profoundly altered, I can't help but feel as though I was there, if only for a while, once upon a rainy afternoon.

Tomorrow, Independence Hall and the Liberty Bell.     

(Photo copyright by the author, 2013. Additional images of Valley Forge may be found here.) 

Behind the Scenes with Dr. Neal Cross

Like many medical schools, fairly early in the first term mine presents a memorial service for families whose loved ones donated their bodies as cadavers for Gross Anatomy. While I've referenced our service in another blog post, I've never revealed how I came to be one of the student speakers for the service celebrated by my entering class, the UNE Class of 2010. 

It came about in the late evening chill of September 17, 2006. September usually acts like summer in my native Colorado, unless it gets a wild hair and decides to imitate winter with an early season snowfall, as it did in 1997, dropping 30 inches overnight. Here in Maine, there's no denying September is autumn, especially in the evening and especially near the coast. My school is within walking distance of the Atlantic Ocean and even though days are comfortably warm, when the sun goes down so goes the temperature. 

For our service, the new class is positioned on the east side of the staging area. They're really present as witnesses, but because they constitute a wall protecting the celebrants and families from intrusion, I like to think of them as Guardians of Reverence. The previous year's class, the one for whom this service is most meaningful. is seated with the family members and faculty. An honor guard, led by a piper, opens the ceremony. Clad in dark blue Yankee uniforms from the Civil War and bearing Old Glory and the state flag of Maine, they are a sight to see.

Why the Civil War and not modern uniforms? This is New England and history is honored here. Our service and the internment of ashes takes place on the rim of a cemetery on campus that dates from the 1600s. Old slate gravestones mark the names of those whose sons and daughters gathered at First Parish Meeting House that used to stand on this very spot (it has since been relocated a mile away) and listened as the Declaration of Indepedance was read aloud in 1776. I stopped once on my way home, and at the invitation of a groundskeeper, stepped inside. It is plain and simple, with white wooden pews covered with black velvet seat pillows. Along the back walls are photos of veterans dating from 1861; the smells of must and dust and time are as vivid as the afternoon sunlight that streams through old, single pane windows. In the silence, you can't help but hear, "We hold these truths to be self-evident..."

Following an introduction by the Anatomy faculty, two or three students take the podium to speak on behalf of their classmates and try to put into words what it's meant to work so intimately with the bodies of persons we've never met. There are words of thanks and appreciation that we hope become words of comfort to family members who've waited a year to see their loved ones laid to rest, here, at the end of the world.

After the service is over, people mingle and chat, the first years leave early because Gross Anatomy for them is far from over and it seems there's always an exam pending. I wandered over to Dr. Neal Cross, our professor and the director of the anatomy program, and we talked about this and that. I was struggling in anatomy, despite having done well as a premed, and he and I had discussed my situation in detail. The truth is, I was afraid my first term in medical school would be my last. Somewhere in the mix, Dr. Cross said to me, "You should be a speaker next year." 

I responded, "You really think I'll still be here?" I resisted adding, "Are you nuts?"

"You'll be here," he said, nodding, "though I may not be. In either case, I'll make sure you're on the list of student speakers." He asked me to keep it to myself, which I did, but he was contemplating accepting another faculty position elsewhere and mine proved to be his last year teaching in Maine.

I went home with a small, dim but real, glimmer of hope that helped get me through the rest of the term, despite the fact that I'd have to repeat anatomy the following summer. Dr. Cross was right. I made it to next year and the years following, all the way to graduation. I don't know what he saw in me or what he knew. I didn't ask and he didn't say. Some things, I guess, are best left where they lay, behind the scenes. 

This past weekend, Dr. Neal Cross passed away, far too young and far too soon. I'm told a motorcycle accident was partly to blame. Though we never had any contact after he moved on, I've never forgotten the faith he gave me that night and I never will.

Thanks, Neal.  


 (Photo of Dr. Neal Cross courtesy of the University of New England, all rights reserved)

Medical School Without a Doubt

"Regrets, Eric, that you're not down there with them?"

"Yeah...no doubts, though."

These words pass between coach Sandy McGrath and runner Eric Liddell in the film Chariots of Fire (1981).  Sitting in the stands, they're watching the 1924 Olympics event in which Liddel refused to participate because it was held on Sunday. 

As you may recall, Liddell was firm in his religious convictions, including keeping Sunday as the Lord's day. Adherence to his beliefs brought him into conflict with the Olympic Committee whose members found it incredible anyone would place God above King and Country. Seeing his teammates run without him, he wishes he was among them -- even with strong convictions, he's still human -- but it's a wish unaccompanied by doubt. In his final race, a competitor says of him, "He has something to prove. Something personal. Something guys like (our) coach would never understand in a million years."

Probably the second most common question I get about attending medical school at my age relates to whether I have any regrets about my decision. "Now that you're here, has medical school lived up to your expectations? Would you do it again, knowing what you know now? Is the pursuit and presumed attainment of a dream everything it's cracked up to be?"

Truthfully, it depends on the dreamer. For me, it certainly has been, and continues to be, as fulfilling as I hoped it would be, and in ways I couldn't have imagined what seems like a lifetime ago. In part, this is because I haven't been aiming at achieving a distant goal nearly as much as I've been engaged in a daily process of achievement. 

Life is a terminal illness for everyone and waiting to live is folly. Sure, like the rest of my classmates, I can hardly wait for the day I get my first paycheck as an attending physician, but delaying enjoyment of what I'm doing until then is like carrying a dream around in a bucket that has a hole in it. You wake up one morning to find your dream has dribbled away when you weren't looking.

This is why I try to take every day as another chance to work at being a doctor, even one in training, though may I forget, as we all do. Distracted by a mistake or worried about my performance, I stumble over my own frailty, and then a nurse asks me what she should do next or a patient smiles after we've discussed her upcoming procedure and I remember. Doctor is who we are on the inside, long before our names are punctuated by the initials D.O. or M.D. on our white coats.

Would I do it over again, knowing what I know now? I've probably answered that one already, but let's just say a person can arrive at the point where living authentically is more important than playing it safe. You bet I'd do it again, though, with the virtue of hindsight, there are a few things I'd do differently along the way. For instance, I'd make the acquaintance of Francis Ihejirika, MD, much sooner. Francis is the founder of the PASS Program in Champaign, Ill., and even more than successfully preparing me for board exams, he taught me how to think as a medical clinician. Eight weeks of being challenged, encouraged, patted on the back and kicked in the pants were life changing. "Thank you" is scarcely enough.

I'd also be less afraid, if that's possible and maybe it isn't when you're trying to swim against fifty-foot waves that drown the biggest ships as though they were the tiniest toys. But that's what medical school can seem like. We start out feeling vulnerable -- much like we do in those crazy dreams where we're naked and everyone else isn't. You've had those, too, huh? Funny how I never manage to have Daniel Craig's physique (Casino Royale, 2006), despite what Freud said about dreams representing wish fulfillment. Anyway, we end up finding out the individuals we thought were the smartest, the most gifted, and presumably, the most invulnerable, have have been battered by the waves, too. 

Medical school is a huge undertaking; it's the hugest thing most of us have ever attempted. I can't stress this enough. Honesty forbids me from coloring this truth in anything but black and white. Nothing I know of can adequately prepare a person for the volume of material they're going to face, the hurricane force at which it strikes, or the feelings of aloneness that surface in the wee hours before exams. It's something you have to experience to know. But looking back, I can see how I've grown in the confidence surviving brings and without a doubt, I'm braver because of it.

(Creative Commons image of Eric Liddell via Wikipedia)

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)

Noticing

When the dogs and I stepped out of the house this morning, the lane was littered with oak, elm, and magnolia leaves so thick our feet (my feet, their paws) barely touched the blacktop as we walked along. It rained last night, not a gentle, soaking, spring-like shower I imagine makes the trees lift their limbs and whisper to one another, "Psst, pass the soap, will you?" This one was intermittently wind-blown and down-pouring, scattering leaves and drenching the countryside. It was the kind of rain that rinses the air clean as a whistle and whets sunlight sharp as a tack.

As we walked up the road, morning business on our minds, something unusual caught my eye. A single leaf, a tiny piece of oaken gold, hung spinning in mid-air, its stem caught in a single strand of spider web, like an arboreal ballet dancer dancing as though her moment had come and never would again. I'm reminded of the line by Mark Twain, Sing like no one's listening, love like you've never been hurt, dance like nobody's watching, and live like it's heaven on earth? That's what she was doing, drifting and swaying to music beyond my hearing. I was mesmerized.

Some people never notice the things that render life more than a matter of getting by, those side-long, fleeting instants when eternity opens a window, reaches through, and taps us on the shoulder. Sort of like what happens in the film, Babe (1995) with James Cromwell as Farmer Hoggett, a man who notices. Hoggett lives on a sheep farm in Queensland, Australia, and to his family, he seems a bit odd now and then. They're solid, ordinary people who are nevertheless, completely unaware that eternity has not only opened a window, it's climbed through the frame, unpacked its bags, and taken over the guest room.

Hogget knows something is happening. He can't explain it, neither does he bother to try; some things you try to explain and their significance gets lost in the details. He simply lets it all in and follows its lead. Presented with possibilities others would dismiss, he can't help but take them seriously,

For instance, when he notices how Pig interacts with his sheep, he allows the little guy a chance to prove himself. Hoggett sees what no one else can or will, and while he's a man of few words, his actions are as pregnant as a woman at nine months who;s about to pop. Only he doesn't just notice things, he responds to them, opening a creative space in which they can unfold at their own pace. We're often in such a hurry to find out things will turn out, perhaps because we're in doubt they will, that we forget about everything that comes before. Hoggett's efforts are ridiculed, of course, even by his family. But then comes the final scene, when the crowd that jeered goes crazy, cheering its heart out over the little pig that could.

Hoggett knew what Pig was capable of because he'd witnessed it. He noticed something unusual and instead of blowing it off as nonsense, he did what most of us are too afraid or too embarrassed to do, he gave it credence. He did the hard thing and in the end, he wasn't disappointed. It really all begins with noticing.


(Creative Commons image by Lord Mariser via Flickr)

"Hard" Wood Floors

"I found him first!" said Jake, proudly. "I sniffed and licked and made it all better." Actually that's not quite how things went, but as Jake was first on the scene, I'd say it's close enough for government work. I wish his licks had made it all better so I didn't have to spend the day hobbling round the hospital, but he was well-intentioned and I welcomed his support.

What happened was, I'd entered my study this morning to open windows and let in the morning breeze, such as it was. I didn't bother with a light since I thought I could see where I was going. So, there's this metal fence type of thing that I connect to Jake's crate on days when the dogs have to be alone, giving him an indoor "yard" where he can have potty papers. I'd folded it up and leaned it against an end table out of harm's way. Famous last words. When I turned away from the window, my right foot caught a corner and you can imagine the rest. A flight like that is not one I'll be eager to repeat anytime soon.

I remember stepping into a snow bank once, high up in the Rockies, and thinking, as my knee twisted and I went down, "So, this is what it's like to break a leg." I didn't, miraculously, but the memory has stayed with me. There was no premonition of personal damage this morning and I think it's because I didn't have time to think or was too caffeine-deprived.

At any rate, lying there on the knotty pine floor with Jake inspecting me like a medic on the battlefield, I stretched a leg, then palpated my rib cage -- no fractures. My head, on the other hand, is so hard I was more concerned about the floor. It's funny how we hurt more after the bruises start to appear than we do at the moment of impact. And that's how it came about that I spent the day nursing a sore knee and rubbing an even sorer set of left-sided ribs (numbers four through six for inquiring medical students/residents).

I did learn one thing from this experience, however, that I'd like to pass along. They don't call them hard wood floors for nothing.


(Creative Commons image entitled "Flight" by k-girl via Flickr)

It's the People, Not the Place

If I were to say it's harvest time, you might glance at the calender and wonder if I didn't need some of the chemical dependency treatment I've been trying lately to provide, except for one thing. My hayfield is getting its first buzz-cut of the year. In a couple of months, we'll get one more "cutting," before the growing season settles in for a long winter's nap. All of this means the sound of a tractor engine is added to the bird songs coming in my study window, blending with the rhythmic inhalation-exhalation cycle of sleeping dogs. These are the sounds of Maine mid-summer mornings I love best.

They are especially nice when heralding the onset of a three day weekend. I know, you thought I couldn't wait to get to the psychiatric unit each morning, what gives? Well, Saturday morning reverie like this feels like pushing yourself back from the table after a holiday meal with family and close friends, a meal with all the trimmings that satisfies like no other. The past four weeks I've tucked in with a huge napkin draped over my shirt and my plate has overflowed.

If I were called in, I'd be glad to go, but that's not going to happen. Students don't have "call" on this rotation, so I'm spared the necessity of being available, though like I say, I wouldn't mind. One of the docs has the duty this weekend and he'll cover the adult, child-adolescent, and chemical dependency units. Basically, he needs to touch base with every patient once in the course of 72 hours and take care of emergencies and new admissions. But I remember my first night on-call during pediatrics and this is his first weekend in the same role, only with more responsibility, and it's easy to commiserate. Besides that, he's a really nice guy whom I've enjoyed getting to know.

That holds true for everyone I've worked with thus far. I realize I've said this before, but it's hard to say too often. I'm truly grateful for the generosity these people have demonstrated, how they've taken me in as a quasi-staff member, overlooking my occasional and predictable mistakes, and accepted my efforts to do well with appreciation. For all the reasons I'm not looking forward to the end of this rotation, the people I've worked with are at the top of my list.

I think the reason for this comes about from a paid employment history that includes two hospitals. I've been a member of a treatment team where people are counting on me to do my job. Medical students are permitted certain tasks but none of them are essential in the sense that, in your absence, there is no one else available to do them. On this rotation, however, the entire staff, from the unit secretaries to the physicians, have not only treated me like someone they enjoy having around, they've taken my contributions seriously. They make me wish this hospital had a psychiatric residency program.

One of them, a social worker, does something no one else has ever done -- he insists on calling me "Doctor." Not "Student Doctor," but Doctor in the same way, with the same tone of voice he uses when speaking with the psychiatrists. I told him one evening, as he was preparing to leave and I was still at the computer, writing progress notes, that getting into medical school had been a struggle and staying in was a full-time job. Even though I had no legal right to the title, it meant a great deal to hear him use it. He ducked his head, smiled, and said I deserved it. That blew me away.

I'm not sure I deserve anything, really, but working with folks like him makes me realize, when it comes to being happy, more than anything else, it's the people, not the place.


(Creative Commons image of the Joint Medical Group by Defense Images via Flickr)

First Lessons

I almost became a veterinarian. A horse doctor, as the cowboys called them when I was a young teenager, distinguishing between the large and small animal variety. Back then, I'd occasionally drop the "doctor bomb" on my parents, testing the waters to see if anything had changed in their perceptions of my future. For reasons I never understood and she could never quite explain, my mother felt my severe needle phobia disqualified me for human medicine but made me a perfect candidate for vet school.

Perplexing as her logic was, it provided the motivation to hang closely with the veterinarians who came to treat our animals, particularly Charlie Vail, DVM. who not only taught me how to administer sub-cutaneous injections (a skill that translates directly to human medicine) but to understand the mind of the horse as patient. A positive treatment outcome can depend as much on the doctor-patient relationship as the nature of the treatment.

You might think it's harder to establish a connection with an animal than a person because animals can't express themselves verbally. In point of fact, not all humans can either. For example, some who are in pain will only tell you, "It hurts." If you ask where their pain is located, how severe is it on a scale of 1-10 (not a very accurate measure, by the way), when did it start, what makes it better or worse, and does it refer to other parts of the body, they respond, "I'm telling you it hurts. What more do you want?" They can no more refine their complaint than a horse could put it into words in the first place. Excepting Mr. Ed, of course.

In psychiatry, you'll hear, "I'm depressed." When you inquire how your patient knows they're depressed, they'll say, "I just am, I know it, that's all." Explain how depression shows up with sleep disturbance, changes in appetite, concentration, memory, or the loss of interest in pleasure, and they'll look at you as though you had three heads. What's perfectly obvious to them ought to be to you. Verbalizing the nuances of feeling is not always within the realm of their possibilities and some of them think it's unnecessary. I'm depressed is equivalent to I'm sick, now fix me. Times like this, you envy the horse doctor.

Speaking of whom, I ought to write Charlie and tell him how his eager student is finally becoming a doctor. He probably won't remember -- it's been years -- though I'm sure he'll remember my father. Everyone from that era remembers dad. Maybe that's why I'm thinking about Charlie this morning, because tomorrow is Father's Day. Because my father was willing to spend the family vacation to make certain I had a horse. Because it was a veterinarian who gave me some of my first lessons in what it means to be a doctor.


(Creative Commons image by Peter Gene via Flikr)

Leave the Light on for Me, Mom

I feel like I've been far away and coming home, I'm not sure what to expect. I know what home is like, having lived there, and I know what the people are like, having grown up with them, but I'm still a little nervous. It's been a while. Living and learning among those who speak a different language and have different world views, well, it changes a person. There is an African saying I've quoted before, He who never travels, thinks mother is the only cook. What I'm wondering is, how's mom's roast beef and apple pie going to taste now?

Probably as good as it always did, maybe better. Having gotten accustomed to the equivalent of curry, jalapeno, oregano, and a pinch of sea salt, picking up on the nuances of her spice list will resemble listening to a symphony in stereo instead of the old monaural clock radio by the bed. A unitary sound exchanged for multiplicity, becoming complexity, yielding to sublime simplicity. That's the beauty of mom's cooking. I don't know if she ever read the manual or not and it's debatable how much of her efforts are science or art, but what comes out of the mix, sometimes, is pure magic.

She's a tough cookie, all right, no pun intended, and a demanding taskmaster. She may start out a little later in the morning and punch out a little earlier at night, but there's sweat pouring off her brow in between. If you're going to keep up with her, you'd better be prepared to have your preconceptions challenged and your previous experience called into question. She'll have your head spinning with recipes you're certain she's made up out of thin air and when you try to take a short-cut through the micro-wave, she'll firmly remind you that anything good takes time.

Working in mom's kitchen isn't for everyone and not everyone likes to be reminded of it. Some think once you've been exposed to her way of doing things, the fat lady's come onstage and you'd best pack your bags. Some genuinely appreciate her contribution and wish they'd paid her closer attention when they had the chance. And some just scratch their heads, wondering what's a nice boy like you doing here when the whole world could be at your feet?

If you haven't yet guessed, all this is metaphor. My mother is years gone and I have no immediate plans to head for Colorado. I'm not even contemplating a quickie flight out to Dallas for a warm visit with close friends and some real Mexican food, pleasant prospect that it is. No, I'm talking about beginning my long-awaited rotation in Psychiatry tomorrow. Six weeks of inpatient, outpatient, adults and children, coming home in a place I've never been before. It's going to be interesting, it's going to be fun, and because I'm not the same person I used to be, it's going to be new.

Leave the light on for me, Mom.


(Creative Commons image by lux increscis via Flickr)

Rural Medicine and Splitting Hairs

So, tomorrow begins my rural community health rotation, which basically means private family practice in a rural area. I've always thought that was a bit of an inside joke since the entire state of Maine is classified as rural, but I'm probably splitting hairs. From the standpoint of population, my last rotation was actually more rural, since tomorrow's is only six miles from a town of eight thousand. I'm probably splitting hairs, again. I think the idea is to get me somewhere off the beaten path.

You might be wondering why I'm doing a rotation like this in the first place. The most obvious reason is because, well, I have to. While rural medicine is an elective at other medical schools, mine requires it. We train mostly primary care physicians and the average patient, if we decide to practice in Maine, will likely resemble those we see on this rotation. It's also a way of getting students out of their comfort zone, though for me, rural life is like biscuits and gravy. I was raised in the country and practically learned "down home" before English.

As to what I'm expecting, it's going to be family practice. Lots of colds, flu, and diarrhea. There may be opportunities to learn how to suture cut fingers and I suspect, like most family docs, my guy is also the local shrink. That will be fun. I'm hoping for a chance to get my physical exam skills back up to speed and use the OMM skills I've been practicing the past month. And I hope my preceptor eventually feels comfortable enough to allow me to work up a few patients on my own.

For most students, rural medicine seems to come along later in the rotation cycle, so they've had a chance to learn a few things before showing up at "Doc Hollywood's" front door. Because I had to retake boards, my cycle is slightly different, so rural medicine is my opportunity to get into shape before diving into the hospital madhouse routine. I'm not sure one way is better than the other, it's simply the way things are. I'm just glad to have boards behind me and be seeing patients for a change.

From the perspective of my dog and cat, this will be a lot easier than the PASS Program. Last fall, as you may recall, I was in Champaign, Illinois for eight weeks and the three of us chewed up the phone lines every night. This time, I'll be out of town four days out of seven, but it's only a two hour drive away, and I'll be home on the weekends. We'll go for walks, watch movies, have morning snuggles with the cat on my lap, and bake cookies before I head back on Sundays. Pretty much life as usual. Considering subsequent rotations may send me further afield and for longer periods, this will be a good transition for them. And for me.

Anyway, there will be more to come and we shall all see how it goes. Oh, and yes, I'll take photos.


(Creative Commons image of the Kennebec River by qnr via Flickr)

Making a Difference

Doctors don't get snow days. Neither do students on rotations, but today is an exception and instead of driving through forty miles of cold, wind-blown confetti, I'm sitting here by the fire, comfortably watching it fall. Ordinarily, and that includes tomorrow, I'll take a winding country road that skirts Sabego Lake (photo) north to a small town in the foothills of the White Mountains, from which Mt. Washington, the highest point in New England, can be seen on a clear day. There, along with my preceptor, I'll work my hands around, under, and over sore muscles, tender points of lymphatic congestion, and arthritic joints, learning how to translate osteopathic manipulation from a classroom exercise into a meaningful therapeutic experience.

In a lot of ways, that linguistic process underlies everything we do in medicine as students, whether we still sign our names MS-I, II, III, or IV (medical student plus our current year) or append the long-dreamed-of counterpart, PG-I, II, III, IV (post-graduate or resident and the year) to a quickly and sleepily scrawled signature. Yes, even residents have classwork, homework, journal articles to read, and papers to present. It's not all hands-on.

But the translation is the best part, I think, or at least it is for me, right now. I like working with the structure and mechanics of language -- grammar, syntax, the nuances of word meanings, the distinctions between dialects. Learning the language of medicine is a student's first task and it takes two years to become vaguely familiar with the vocabulary. But it's like my first year high school Spanish class. We memorized dialogues and repeated them as though they meant something, but in the real world how many times can you ask, "Hola Juan, donde esta la biblioteca?" before people start avoiding you?

I'm not opposed to learning those dialogues -- next time I'm in Cancun I'll have no trouble finding the library, as long as the guy I'm talking to is named John. Anyone else and I'm in trouble. Language has to be applicable to be meaningful. And getting the hang of meaningfully applying what we've faithfully tried to memorize -- or better yet, learn and understand -- is ongoing. It's like the pursuit of virtue according to the fourth century Church father, Gregory of Nyssa. He said the process is eternal and we never arrive at a point where there isn't something else just ahead. Thinking you've got it made is proof you don't. Continuing to try is how we ultimately get to make a difference.


(Photo copyright 2011 by the author)

You Have Just Been Empowered

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)

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)