More Than Just a Piece of Paper

 
That's what we say, sometimes, when we're tired, when burning the candle at both ends seems to have done little to bring the end of a long academic journey into view. "___ more months, ___ more rotations," we say, "I'm going to get my piece of paper and I -- am -- gone."

I've said it. After slamming into another obstacle that meant I'd graduate another year later than my entering classmates, I've said it. On good days, I tried to act a reasonable approximation of my age and call such things "character-building." On bad days, they were miserable. The truth is, the good ones really did outnumber the bad by several factors of ten, no whitewash -- except on bad days and then they seemed to multiply as fast as zits on a teenager's face.

Medical education is a group effort and a personal one. We begin in community, like runners in the Boston Marathon, and we string out along the way. I lived off Beacon Street in Boston for a while and stood within inches of the Marathon as it passed by. First came elite runners, like the Kenyans I got to know in Boulder while walking my dogs, some in training for Boston. Long after they were out of sight, came local runners, wheelchair athletes, and those for whom a personal best was the point.

Every year there are runners who, for reasons of their own, cross the line at Boylston Street, where the bombing occurred, way late, maybe after midnight. A father, pushing his wheelchair-bound son, someone else who was injured and refused to quit. It could be anyone. There have been times in this process, when I felt like that, hell-bent on crossing the line whether anyone was there or not, and not really expecting anyone to be, certainly not at that late hour. The virtual presence of more than a hundred cheering friends on Facebook showed me how wrong a guy can be and how amazingly good it feels to discover them waiting for you.

But that's how things can go. All the potential in the world can't ensure the medical education master plan is carried out without a hitch. Something happens, then another, and before you know it, you've had to stop and regroup. Most students make it by the clock (four years), some say they made it by the grace of God and maybe they did. Maybe that's how all of us make it, even when it seems like sheer, dumb luck.

Anyway, yes, I called it a "piece of paper," especially when circumstances and/or my own frailty conspired to raise the bar -- and right when I was starting to get good at reaching it! One of my favorite Robert Browning lines goes, "A man's (person's) reach should exceed his (their) grasp." Well, gee, thanks, Bob, bet you never went to medical school, huh?!

Eons ago, when I was a kid watching classic movies about doctors and psychiatrists on our black and white TV, medical school was something other people did. To me it was as far away as growing up. Eventually, however, I did grow up or at least got taller, and found my way to medical school. When my diploma finally came in yesterday's mail, I can tell you, it was much more than just a piece of paper.

A friend, on his graduation day in 2010, waved his diploma in its protective cardboard mailer and shouted to me, "Don't forget, Beggar, there's one of these with your name on it!" I thought about him as I walked back to the house, carrying mine the same way he had. I thought about him again, opening the package and seeing my name. He was right; there was no mistake.

How does it feel, having finally crossed the elusive finishing line with my diploma in hand to prove it?  It feels empowering. Better than all those other times the bar was raised and I cursed and swore and stretched and strained and reached with all my heart and realized I could reach higher and farther still. It feels right. Residency is fast approaching (Please, God, let it be psychiatry) and it feels like I'm in the starting grid at Indy, waiting for that cute little country singer to finish the National Anthem so I can hear the words I've waited a lifetime to hear: "Ladies and Gentlemen, Start Your Engines!"

Varoooooooooooom! 

(Photo copyright 2013 by the author)

Contraception and the New Fisherman

 
What's going on in Rome, lately? Is there a new voice crying in the wilderness? Pope Francis declaring the Church has become obsessed with birth control, abortion, and gay marriage? Shades of Anthony Quinn.

Who's Anthony Quinn? He was an actor probably best known for his roles in Zorba the Greek (1964) and The Guns of Navarone (1961). He was also cast as the first Russian pope in the film, The Shoes of the Fisherman (1968). What brings him to mind was his character's willingness to drain the Vatican of its wealth and holdings in order to feed a starving Chinese nation and stave off World War III. For him, charity took precedence over tradition. I wonder if that may be true for Pope Francis as well.

Whether it is or it isn't, he's certainly not afraid of going out on a limb. In an interview published in September, 2013, he stated: "A person once asked me, in a provocative manner, if I approved of homosexuality. I replied with another question: 'Tell me: when God looks at a gay person, does he endorse the existence of this person with love, or reject and condemn this person?' We must always consider the person."* This is fairly radical, it seems to me, bending Church doctrine around the needs of people rather than the other way around. 

Such a pope might prove to be a powerful ally at a time when faith-based groups are arguing for exemption from the stipulations of the Affordable Care Act regarding coverage for contraception. Bearing in mind their legitimate concerns about conscience, it helps to bear in mind another, equally legitimate concern, namely, of the four million births in the United States in 2011, 393,772 were to mothers ages 15-19. What is that, about 10%? The picture is complicated by the fact that teen pregnancies are associated with greater risks for low birth weight, preterm birth, and death in infancy.

How many of these births could have been avoided had their mothers had access to contraception? All of them, potentially. What if one was your daughter or mine? Which would we prefer, to discover she was having unprotected sex whether we approved of it or not, exposing herself to sexually-transmitted disease and unwanted pregnancy? Or to be assured that even if she was having sex, her future (and ours, by the way) was far less likely to be altered, negatively, by an unwanted pregnancy? 

I don't think there's a parent on the planet who welcomes the thought of their daughters or sons being sexually active teenagers, but it happens. It happens to the best of families in the best of communities. It happens to families of faith as well as families with no faith. It happens to Democrats and Republicans, Whites, African-Americans, Hispanics, and everyone else. It just happens.

Effective parenting is not ideal parenting because there are no ideal parents. There's only us and we try to do rightly by our children and sometimes that's not enough. An ounce of prevention is worth a pound of cure. Admitting the truth is hard, but the consequences of denial are much harder. Preparing our children for adulthood entails protecting them from the impact of their own impulses. I can't be with my children 24 hours a day and expect them to grow into independent, functional adults. I've got to give them a measure of freedom and that means taking a few risks. Of all the ones I must take, an unwanted pregnancy is not one of them. I hope it turns out, the New Fisherman agrees with me.

*Citation from The New York Times, 9/20/2013.

(Creative Commons image by twm1340 via Flickr)

The Laboratory and The Pulpit

While yesterday's post was obviously humorous, it demonstrates the use of creative license. A "Hearing Curve," in actuality, is the product of an audiogram, a clinical measurement of hearing loss, though it easily became something else in the service of a story. Its use illustrates how we can apply a term in a number of ways, some more accurate than others. 

Take "myth," for example. The way I used it and recently, its most common use, suggests a fairy tale at best and an outright falsehood at worst. As I've said before, however, "myth" refers to a fictional story that serves as a vehicle for truth. Notice the difference. Not a "false" story, but a fictional one that may have some connection with history. It's like a film credit attributing the screenplay to "real events" while certain details having been altered to render the story more interesting. 

The myth of Jason and the Argonauts and the pursuit of the Golden Fleece depicts the extent to which one will go and the dangers one will face, to lay hands on a treasure. For all we know, Jason may have been an ancient Greek sailor known for acts of bravery and a desire for wealth, but even if he wasn't, we can identify with him. My journey through medical school was definitely one in pursuit of "treasure." I even seem to recall facing the many-headed Hydra in the form of first-term gross anatomy. I'm sure I wasn't alone in that experience.

Myth represents a type of creative license, taken for the purpose of communicating truths that might otherwise elude us. Truths that do not lend themselves well to factual or common sense explanation. The writer of Genesis was confronted by such a difficulty. How to explain why people do terrible things, why evil seems always present, even in the very best of circumstances.

Imagine a quiet, solitary oasis somewhere out on a Middle Eastern desert, a few thousand years ago. The night sky is littered with stars and a family sits round a campfire telling stories before the children are shooed off to bed. One of them asks her father, why do bad things happen? The father gathers his thoughts and says, "Mm, well, once upon a time, before there was anything at all, there was God and everything was peaceful. Then he made humans and gave them the capacity to love and make decisions in the same way he was able. Things were fine until their choices went awry, creating a pattern subsequent generations have followed far too closely. In short, my daughter, evil is present because some of us act evilly and have done so since the dawn of time. We are responsible for much of the evil we see."

Problems arise when we insist the elements of a myth have greater significance than its meaning. The first chapters of Genesis weren't meant to explain the origin of life. They were meant to explain how humans, even when they reside in paradise, will make bad choices. An ideal environment can be the setting for murder as easily as a ghetto. Genesis was intended to set forth the basis for ethical behavior and mutual responsibility.

Science and religion really are talking about two different things. Conflict results when persons of faith mistake the language of myth for fact and persons of science believe them. Darwin wasn't the enemy and our children don't need protection lest "evolution" turn them into amoral beasts. Faith poses no threat to science because faith, from the beginning, has been about relationships. Literalism is the enemy, attacking both science and faith with equal ferocity, utilizing "divide and conquer" as its chief strategy. The laboratory and the pulpit are where this battle should be fought, faith allied with science, determined to overcome ignorance and do so together.   

(Creative Commons image by the mad LOLscientist via Flickr)

Scientific Myth-Busting and The Hearing Curve

It is a little known otologic fact that hearing improves with age. 

You don't believe me. 

You've heard and read and perhaps even experienced the opposite. Well, I'm sorry to tell you this, but hearing loss in adulthood is an urban myth desperately in need of busting and we're going to do that, right here and now.

The truth is, hearing develops, declines, and recovers in a manner comparable to an inverse bell curve, a phenomenon known as The Hearing Curve. We start out hearing rather well in our elementary years as evidenced by the fact that our parents can't open a can of pop on the other side of the house, quietly as a mouse, with the barest hisssss of carbon dioxide escaping, without us hearing them and calling out, "I want some!"

With the onset of puberty, hormonal changes occur, resulting in observable physical changes such as increased vertical growth, the appearance of secondary sex characteristics, and gradual hearing loss that peaks at about age 16, usually coincident with the passing of one's driving test. We know this to be true because teenagers listen to LOUD music, particularly in the car. They talk LOUDLY and make LOTS of noise doing absolutely nothing.

Adulthood is marked by the gradual recovery of hearing acuity, accelerated in some cases by childbearing and child-rearing, and becoming most noticeable in the mid-40s to 60s. Adult hearing can actually become highly sensitive to the most subtle of sounds. For instance, the creek of the front door when teenaged son creeps in past curfew can awaken the soundest of sleeping fathers more readily than a gun fired off beside the bed. The best medical evidence for hearing improvement in adulthood, however, derives from the observation that parents the world over shout at their teenaged children who, naturally, are listening to LOUD rock and roll, "Turn that crap down!" It's obviously painful, otherwise why say anything at all?

So much misunderstanding and familial conflict could be avoided if parents only knew the truth. When asking, for instance, if their teenaged daughter or son was "deaf" when told to take out the trash, help with dinner, or clean their room, what a great thing to know that, yes, their teenagers were in fact, quite deaf or so close to it as to make no difference. Furthermore, that it's only temporary, literally "a stage" they're going through. On the other side, just as it takes becoming an adult to realize one's parents aren't stupid, it takes becoming one to be able to hear what they're saying without misinterpreting their shouting as expressions of anger or frustration. Everyone benefits.

It's really quite amazing what the teensiest bit of scientific myth-busting can do to improve our lives and relationships. And we did it all without mentioning "evolution." Isn't that amazing?

(Text copyright 2013 by the author -- written with tongue firmly planted in cheek)

(Creative Commons image by Rob Gallop via Flickr)

Doc Bugs and Me

One of my favorite places to shop is anywhere Christmas decorations are sold. When I was growing up, my mother instilled in me a real love for rare, unusual, or antique ornaments. Thanks to her, the drawers of my ornament cabinet contain bells and glass bobbles that date from her childhood before the War (as World War II was known in our house). Over time I've added my own preferences for traditional wooden soldiers, dogs, moose, and cartoon characters, notably Snoopy and Woodstock.

One ornament has special meaning for me -- the one in the photo. I picked up Doc Bugs, as I call him, in a little out of the way place called The Spruce House, in Estes Park, Colorado. It must have been late fall, during my first year of premedical studies, when I found him hanging on a rack all by himself. Lone ornaments are hard to resist, especially if they stir up an emotional connection and you realize leaving the store without them is a mistake. 

Well, Bugs Bunny and I go way back. Tall, wise-cracking, with big feet, like me, he was my favorite cartoon character when I was a kid. Only this time, instead of his trademark carrot, he was holding a stethoscope and smiling as though he knew a secret I didn't. Right off I was certain he'd been "waiting for me" and took it as a sign that someday I'd be in his shoes, or paws, as the case may be. The next year, I came upon another version of the medical bunny, a ceramic Bugs looking rather distinguished in a long white coat holding a hospital record, another portent (except for the "distinguished" part). 

It's funny how, when pursuing a dream, you latch onto things that symbolize its fulfillment to give you hope. I'm not superstitious, but I definitely believe in the power of images to fuel our ambitions and sustain us spiritually. When such things hang on a Christmas tree, itself a very rich symbol of life and new birth, they take on deeper significance. It's as though they participate in all the tree represents and pass it along when we're most in need.

Doc Bugs has done that for me the past fifteen Christmases. Each year, taking him out of his box and hanging him in plain view has been an act of faith and each year I promised myself my time was coming. Last night, bringing Doc Bugs out once more, I said to my long-eared alter ego, "Well, Bugs, this is your first Christmas as a real doctor." It just so happens, it's mine, too.

May you have the most wonderful and joyous of Christmases and the happiest of Holiday Seasons.

(Photo copyright 2013 by the author)
   

The Night Train to Christmas

 
"Nite train!" he called, waving with one hand and holding his daddy's with the other, as they walked out the door. I'm guessing he was probably four years old and he'd been playing so quietly, it wasn't til he spoke that I realized what held his attention. 

I was wandering through my favorite toy store, Tree Top Toys, in the Old Port. The Old Port is a gentrified section of downtown Portland that abuts the harbor (hence, the name) and could easily be mistaken for the backdrop for A Christmas Carol, especially during the Holidays. My attention was held by a Schilling display of wonderful classic tin toys that echo a time before batteries, when toys were wound up by keys and ran on pure imagination. 

The store was crowded, though not so much you couldn't move, and he stood in a corner, near the entrance. His father watched from a few feet away, holding baby sister in his arms and ensuring both daughter and son were kept occupied, freeing mommy to play Santa. I noticed them at first just in passing, like I'd noticed other shoppers, picking up puzzles or stuffed bears, turning them over to look for prices or stroking their soft fur and turning into children as if on que. Some items go to the cash register right there and then, others wait for dreams of sugar plums and a jolly old man with a sleigh to find their way "home."

Like a fictional doctor of my acquaintance, a four foot tall stuffed giraffe resting high on a display rack with a smaller one planted between his hooves and a smaller one yet, between his, caught my eye. The clerk told me she'd recently sold one exactly like the tallest to a little girl who saw him last Christmas, fell in love, and saved her allowance the entire year to raise the purchase price. I brushed away tears at the thought of her carrying him home. Christmas brings out the magic of the heart in ways we rarely anticipate.

 Working my way back to the entrance, I heard a small voice call, "Nite train!" and looked over to see him leave with his parents and wave as though the cars and engine understood. And maybe for him, riding the night train to Christmas, they did, indeed.

(Photo of horse-drawn carriage in the Old Port copyright 2013 by the author)

So Much Fun

 
The snow started so timidly last night, I could count the flakes drifting cautiously past the shadow of my CRV, as though they felt self-conscious being seen. By midnight, their courage having grown in proportion to their numbers, enough had gathered for me to shovel an inch off the front patio; by morning, they reached, shamelessly, halfway to my knees. 

Depending on your inseam, that can be a lot or a little. Mine's 36 inches, so this was a lot. The dogs, by the way, agreed with me. When we went out for morning bathroom break #1, my Yellow Lab took one step, then looked at me and intuited, "Where did all this come from?" 

"From the sky, big guy," I responded, aloud.

Now, if I was a kid, an arguable point on days like this, I'd be torn between anticipation and lament. Anticipation because it snowed and that meant play, lament because it fell on Sunday and not Monday, guaranteeing a snow day. Overall, though, I'd be gladder than sadder since this much, this close to Christmas, ensures this year it will be white. 

We didn't spend much time shoveling snow when I was younger, certainly not in comparison to what I did today. My father would clear off the back walk to enable my mother to reach her car, but otherwise, we'd trudge through the drifts to the barn to feed the horses. If we'd had a snow thrower, it would have been different, but as they hadn't been invented yet, it makes no difference. Besides, dad was raised on a ranch where knee-deep snow was common and no one thought twice about it. 

I probably wouldn't think about it either, but for the fact that snow accumulates in Maine. At the foot of the Colorado Rockies, where I grew up, snow is like a relative, just passing through. Back here, the snow moves in and sets up housekeeping. I can count on the fingers of one hand the number of snow days I had in high school. Back here, it takes both hands and a few toes to keep track of them.

One thing is incredibly similar, though, between the snows of my older youth and those of the younger one I discovered as a medical student, and that is, any snowfall is a chance to play. My new snow brush -- the one I use on the car? -- has a  movable head that lets me pull the snow off the car in sections, creating little avalanches as I move from the hatchback to the windscreen. 

With snow flying in all directions and oblivious to the cold, it came to me: I cleared the cars the same way as a kid. All I had then was a straw broom, so my avalanches had to move away from me. The push broom from my father's shop was okay, but the brush was too soft to work very well. My new one is perfect and as it was then, creating avalanches is still, so very much fun.

Am I ever glad.

© 2013 All Rights Reserved (text and photo) by the author.