For the next six weeks, my blog entries may appear to depart from what you're accustomed to reading. I'm heading mid-West to attend an intensive medical boards review course that promises to be a great learning opportunity. Because I've been led to believe it will combine time-consumption with brain-drain, I've been wondering if there might be a way to integrate this experience with The Beggar's Blog, rendering them complimentary, rather than conflicting, activities.
So, here's what I've come up with. Most likely, weekends (I'm crossing my fingers, here) will allow me a little more time to turn out the kind of thing you usually see, while weekdays offerings will probably be briefer, focusing on what it's like, being an older student in this kind of milieu. Some days may be more reflective than others, but it's hard for me to see beyond that since this whole thing is completely new for me. In any case, I hope it turns out to be a series of good reads.
Now, as to travel time, in this day and age one assumes internet access is universally available, but there are no guarantees. If you drop by and see nothing new, it's only because I haven't been able to find a plug for my computer. I'll be taking photos, naturally, of anything curious, intriguing, or worth taking a gander at, and I'll include those as well.
I expect to work extremely hard but I'm looking forward to getting started and learning new ways of thinking about the material my classmates and I have been dealing with these past few years. It's going to be an adventure and one that I'm eager to share with you. Next time you hear from me, I'll be somewhere out there, on Dylan's long, lonesome highway.
(Creative Commons image by Serge Melki via Flickr) 
He was working the ER when they were brought in. Holiday weekends like this one -- Labor Day -- are the playground for Murphy's Law, i.e. anything that can happen, is likely to, so don't be surprised when it does. He began covering holidays after the divorce; it kept his emergency skills up to date and it was better than sitting at home, wondering why "I do," at least in his case, inevitably led to legal fees.
He really had no place to go; his work had become his life, and the only family he had left was so scattered, they may as well have lived on the dark side of the moon. Busy is good, he thought, why not give someone else a break to be with their kids, instead? That was five years ago and it had gotten to be a habit. Besides, it allowed him to spend time with nurses like Halley Henry, who'd more or less "adopted" him during his fourth year emergency med school rotation to prevent him from accidentally killing any of his patients.
He'd been on duty since 6.00 AM -- early morning was never his best time, but since he didn't write the schedule, there wasn't much he could do about it. Close to twelve hours later, he was anticipating washing down a Swiss and mushroom burger with a bottle of Rock Art American Red ale at the Old Port Tavern, a favorite watering hole for the post-call crowd, when an ambulance showed up. He could have turned it over to the evening guy, but this one was too good to pass on: twin girls, born only a few hours earlier, found by a medical student in a trash bag on the side of the road. Neonatal care wasn't exactly his specialty, though he was competent to cover emergent cases and knew when to call in the cavalry. That was, what? thirty minutes ago? His initial exam complete, he decided they'd live -- after all they've been through, they'd damn well better, he thought -- and would benefit from observation in the Neonatal Intensive Care Unit.
Halley, who'd worked-up the case with him, was holding a twin in the crook of each arm and looking over his shoulder as he wrote transfer orders. "Who would do such a thing?" she asked, stressing the "do" a little stronger than the rest of her sentence. "Throw these little darlings from a car like a cigarette butt and then drive away."
"God knows," he responded wearily, "he'd better, I sure as hell don't."
"Don't mind him, dears," she said, glancing at him over the tops of her wire-framed reading glasses and feigning a frown, "he still hasn't learned not to use that kind of language around us girls -- despite more years than I'd like to admit of trying to teach him."
"Mmph. You should hear the girls I know."
"The girls you know ought to have their mouths washed out with soap -- they would if I was their mother."
"Honey, if you were their mother, they'd still be wearing skirts down to their ankles," he said, with a smile.
"Go ahead, dig yourself in deeper. You can "honey" me all you want; I've got a good memory and I get even."
Previous experience told him to drop it while he had the chance; outnumbered by a superior force of one, he turned back to the computer screen and finished writing orders. He started out as an opthalmologist -- a younger cousin, as close to a brother as he'd ever come, was blinded in a bike racing accident, and became his inspiration -- but went back after a few years and completed a residency in pediatrics. It irked his wife who liked an eye doc's income, but he loved kids and never having had any, decided caring for other people's might approximate a close second. It always seemed like first one thing then another had interfered with children until finally, he guessed he'd let the idea go. It's a moot point, anyway, what would I do with kids at 62?
An hour later, at the Old Port, the image of the twins wrapped in warming blankets and wearing little pink knit watch caps, like tiny imitations of fishermen down on the wharf, nagged at him. Halfway through his burger, he realized he'd made up his mind to follow their case as an interested bystander. No one would mind, especially since he'd been the one to see them in the ER. It's perfectly normal for a concerned doc to show ongoing interest. No doubt the PR department would love him for it, once they got wind. As if I care, he thought.
It was dark when he pulled in the driveway of his home in the Stroudwater historic district, and he was tired -- in a good way -- but far too tired to hear the engine of a Mack truck heading his way.
(Creative Commons image of "Day 2 -- Pink Hat" by Liz (byday) via Flikr)
Google and I have a love-hate relationship and by that I don't mean I love to hate it (them?). The truth is, I'm very fond of it (them). For one thing, they provide the software and storage space for my blog (thanks ya'll, in case I haven't said it before). They do a great job with email and the technical goodies they come up with for blogging are really useful for a techno-non-geek like me. But, here's the thing, have you ever tried to contact them? You know, drop a note, make a call, fire off a Fed-ex full of cookies (not the computer variety), or send flowers?
Now, there is Google help or as I like to call it, the Google Black Hole. You can post a question or you can scroll into the maze of previous questions looking for one exactly like yours. At first glance, posting your own would appear obvious. The answer you get, however, may be somewhat less so: "check the response to question 999." Now, I understand how time-consuming it can be, dealing directly with user problems, I really, really, really do. I'm sympathetic, I really, really, really am. But still in all, if I wanted to go dumpster diving into a black hole never to be seen or heard from again, I can think of easier ways to do it. How, you may ask? Well, have you ever dealt with the VA (Veteran's Administration)? 'Nuff said.
Anyway, I am an appreciative user of Google. Don't worry, that's not a code word for the excessive use of Google -- I don't let web searching interfere with my work or home life, so I'm only a social Googler and not a Googleholic. Nor do I attend the Church of Google where members have been known, in moments of ecstasy, to burst forth with spontaneous Googalalia. I couldn't be a fan because that would entail seeking autographs and somehow an email signature (if I could find an email address, that is, hint, hint) doesn't seem quite the same as a good old illegible scrawl on a napkin. I'm just an ordinary guy who'd like, once in a while, to interact with another ordinary gal or guy somewhere out there in Googleland.
Do you suppose it's a matter of incompatibility? Not software, hardware, silverware, or any other kind of ware, but r-e-l-a-t-i-o-n-a-l? Like maybe I've got an obscure interpersonal chemical imbalance-type disease I picked up while browsing online images of the Amazon Rain Forest? Could it be Transformers are real after all, and instead of a virus I've got a Decepticon hiding in my current version of Firefox? Where's Bumblebee when I need him?! Well, it beats me. Anything's possible and in the realm of computers, if you can't get "possible" now, wait a bit and your next Microsoft update will include it as a zip file.
So, it's Monday morning and this is my first serious issue of the week. Oh, I knew a vacuum repair person once and she explained my Hoover's failure to hoov as proof that it had "issues." She didn't describe the process of fixing it as talk-therapy, though I half expected her to. This was Boulder, Colorado, by the way, where everyone's either had issues, has them currently, or wants them so they have something to talk about at parties. Hey, I used to live there, what does that say about me?
(Creative Commons image of a Supermassive black hole by thebadastronomer via Flickr -- and a word of thanks to the folks at Google for being good sports!)
It's funny, the things that go through your mind, Chuck thought. He and his dog, Chester, were still catching their breath, having nearly been knocked to the ground by a classic Pontiac GTO convertible racing by in complete neglect of the speed limit. Country roads near his home were narrow, most qualifing for the name "road" in name only. More like glorified dirt tracks, they were paved over remnants of an era when rapid transit meant a fast horse.
The houses told the tale. White clapboard and brick, many with attached barns, double doors wide open to the breeze, tractors peaking from the shadows. Signs marking 25 mph looked as out of date as the traffic they were once supposed to regulate, except on days like this when there wasn't a cop in sight and taking a walk meant taking your life in your hands.
Driving like a bat out of hell was an understatement. It seemed the car barely slowed before rounding a left-leaning uphill curve, but as it did, a passenger heaved a large, black plastic bag off the side. "The dump is on the other side of town," Chuck shouted angrily, and of course, the car was gone before his words could catch up. "A problem my physics professor would have loved," he said to no one in particular.
A few minutes later, the two were standing near the same spot, perpendicular to a small, grassy, rapidly-sloping space between the trees that ended in a perilous 30 foot straight drop into the river. Had it rolled a little further, he mused, whatever's in that bag would be on its way to the ocean, no doubt what they intended. In fact, it was snagged by the exposed root of a white pine that looked large enough to have been a sapling during the Civil War.
"I guess we ought to do something," he said to his dog, who smiled in assent, "but I think it's too steep to handle together. You stay here and I'll be right back." Be right back was their signal for dog guard duty and Chester took his seriously, watching intently as Chuck cautiously worked his way to the bag, wishing he was wearing hiking boots instead of cross-trainers.
Though far from full, the bag was heavy enough he was surprised it hadn't exploded on contact with the ground, chaotically scattering its contents every which-way. Chuck scrambled back up the slope with more care, not wishing to slip and find himself imitating Greg Louganis on a Sunday afternoon sans Speedo, falling headfirst to the river below.
Back on the road shoulder, Chester greeted him with happy licks as he wiped sweat and congratulated myself on being heroic, even if a little foolhardy. It was the same kind of thing he'd have done as a teenager, but back then the idea of falling would have triggered an adrenaline rush. It still did, but it was also coupled with the vision of his medical career coming to an abrupt and unpredicted close. "They were in an awfully big hurry to get rid of this, weren't they? I wonder why...shall we see what we've got? You know the saying, one man's trash is another's treasure."
The bag had built-in tie handles, but they must have been done in haste, because the knot unraveled quickly. At first he only saw dirty, soaked wads of paper towels and what looked like bloody rags. Before Chuck could stop him, Chester stuck his nose into the mass and in the confusion of trying to extract him from the bag, the trash shifted and Chuck saw a foot. A human foot about an inch or so long. His pulse rate racing upwards as rapidly as the escaping GTO, he dug deeper and found another, then two more, attached in pairs to infants with their umbilical cords dangling.
"Thank you, Lord," he said, grateful that somewhere out of the jumble of medical school minutiae, the basics of his advanced life-saving course surfaced. He called 911 on his cell, then held sunglasses to each face to check for breathing, felt for a pulse, and stripped off his T-shirt to wrap the twins the best he could and holding them to his chest until help arrived. Afterward, Chuck said he wasn't sure whose guardian angel whispered in his ear, but Chester leaned gently against the newborns and together, the two formed a neonatal sandwich there on the side of the road.
The ambulance and local police arrived, took his report, packed up the neonates -- both girls Chuck realized when he had calmed down long enough to look -- and headed off to Portland and Maine Medical Center. He visited them in the hospital the next day while Chester, sadly, remained in the car. He did receive a visit from one of the nurses, though, herself a dog owner who happened to have a Milk Bone in her car. It wasn't exactly a medal, but Chester didn't seem picky. The GTO was stolen, naturally, and found abandoned a few days later with no sign of its occupants. The treasure in the trash, as Chuck called them in a moment of irony, were another matter.
(Creative Commons image of Maine barn by HuTDog83 via Flickr)
Ordinarily, I write on a laptop, but for the next few days, I'll be paying the price for dawdling. You see, my power cord has been leaving yellow post-it notes on the computer screen for the past few weeks, informing me that it won't last forever. I've read them, dutifully, and even stacked them neatly like pages in a book in plain sight to further remind me to get a new cord. Well, yesterday the inevitable happened and all my efforts to convince my cord to last another day fell on deaf ears. Instead of powering up the laptop, it just laid there, with blank, unseeing eyes fixed on a final note of farewell which read, "I told you so."
In terms of writing, this means resorting to the table-top model in the upstairs bedroom with its now alien Microsoft ergonomic keyboard. A gift of the gods while writing the final draft of our book, I loved this thing. I'm a big guy with proportionately large hands and months of late nights in its company convinced me I'd never adapt to the comparatively tiny geography of a laptop. Man, was I ever wrong. Now here I am, fumbling around doing a virtual hunt and peck because my fingers seem to have forgotten what to do with the equivalent of West Texas beneath them. If you've never driven across West Texas, think "vast expanse" and you'll get the idea.
Anyhow, that's how this keyboard feels. I've alternated between laying it on my lap, hoping familiarity will overcome awkwardness, and using the desk top, and either way, the keys don't seem to get any closer together. Not that I expected it to morph into the neat shape that nestles tidily onto my lap, but a little approximation would have been welcome. I suppose you could equate it with the resumption of dating after a long relationship. It's unfair to expect someone new to feel quite as comfortable as did Ms. What-was-her-name-again?, but you'd at least like them both to be the same species.
I know, computers are computers, and it could be worse, I might still be hammering away at the manual Smith Corona typewriter I had in college, the keys of which I pounded nearly into oblivion. So, yes, I am grateful for what I have, especially since errors like the thousand or so I've made since starting this post, are corrected so easily. I mean, it really would be inconvenient if I had to clean the White Out off the screen before beginning each day, wouldn't it?
(Creative Commons image by canuckshutterer via Flikr)
This post could get me into trouble, but hopefully, not too much. For quite some time, long before I became a medical student, I've reflected on what I thought clinical education should include. Often as not, these contemplative moments occurred while I was working as a hospital-based therapist and had the opportunity to observe third-year students doing their psychiatry rotation through my department.
What intrigued me was their tendency to stick close to the physicians. This only makes sense; if you're going to move up the ranks, so to speak, you want as much time as you can in the company of those who've already earned their stripes. Well-intentioned as it is, however, this can turn out a limiting factor in your education. The reason is, much of the blood and guts patient care that takes place on psychiatric, as well as primarily medical units, is done by non-physician staff. The things they know.
Consequently, I've come to believe students should have to spend a portion of their time working under the direct tutelage, not only of doctors and nurses, but also mental health counselors, unit secretaries, social workers, and recreational or occupational therapists -- those who have no stripes on their "uniforms." I realize a four week rotation provides barely enough exposure to begin getting one's feet wet, but closeness to the other team members broadens the learning experience tremendously. For one thing, it gives a person an idea how the other half lives.
What I mean is, it's easy to get locked into ivory tower thinking about hospital staff roles and patient care. Doctors have traditionally been at the top of the food chain, and frankly, working with non-physician types nurtures a healthy sense of humility. The initials we place behind our signatures say a lot about us but what speaks even louder is the way we treat the people under our authority. Doctors who are beloved tend to be those who are more interested in supporting the contributions of the rest of the team than they are in being impressive. A little modesty goes a long, long way.
And if someone is not naturally inclined toward a modest self-estimation, rotations are a place to learn its value. I may have gotten four years of college and more of graduate school but it doesn't make me special. Special is the nurse who, instead of going home at the end of the day, works an overnight shift to cover for another who's ill. Special is the unit secretary who catches the error in your prescribing orders, saving you from having to explain yourself to your attending. Special is the janitor who cleans up after the detoxing patient who's vomited in the bathroom. Becoming a doctor is an honor, not because we're entitled to recognition, but because we're privileged to work with people like these and be counted among them. That's what's special.
(Creative Commons image "4 Stripes" by ianmunroe via Flikr)
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)
