Saturday, September 25, 2010

Origins and Orientation

Until I've caught up on the first 1.5 weeks of orientation and 4.5 weeks of medical school, this will still seem too disorganized to me. Thankfully, probably no one other than me will care. So, as the saying goes: Let's take it from the top!

ORIENTATION (8/12/10 - 8/20/10)
The very first lecture I had in med school has easily been the most inspiring one so far: "What does it mean to be a physician/healer?" given by Dr. Richard Colgan. He spoke to us about the history of medicine, the art of healing, and a slew of thoughts for me to come back to for the rest of my career. It sounds cheesy and exaggerated, but it isn't at all.

We learned about many medical greats, most of whom I admit I hadn't heard of before, but I haven't been interested in history until now, so I suppose that comes as no surprise.
Hippocrates: First do no harm
Sir William Ostler: Equanimity and imperturbability
Francis Well Peabody: 'For the secret of the care of a patient is in caring for the patient'
William Carlos Williams: One of the best trainings you can have as a writer is to be a physician - people will tell you the most intimate details of their lives that they may never have told anyone else before and won't tell anyone else again
Theodore Woodward: 'Don't be a slip doctor'
Dr. Kalia (sp?): 'When you're not sure what to do, remember: focus on the patient'
Dr. Colgan: 'What does it mean to be a healer? Smart. Philosopher. Loved and hated. Case worker. Patient's advocate. Respect and disdain. Accountable. Challenged.'

I only wrote up tidbits from a handful (the ones I managed to scribble down legible quotes for), but the talk, the history, was inspiring in its entirety. The rest of the talks were well and good, but nothing quite stood out the same way, with the same relevance and gravity.

A couple of days later, we were introduced to the wonders of the MASTRI center, which is the simulation lab on the UMB campus. The traditional saying in medicine, especially regarding surgery, goes: "See one, do one, teach one." As the MASTRI tech put it, "See one, simulate many, do one, simulate some more, and then maybe you can hopefully teach one." After watching a couple of fellow classmates take a shot at simulated gall bladder removal, all I can say is, I'm definitely hoping.

Next up, medical ethics. This is an area I've always been very interested in, but my undergraduate schedule conspired against me whenever I tried to take a class in it. It focused more on breadth than depth, but even the brief overviews gave plenty of food for thought.

Four approaches:
  1. Utilitarian philosophy - end justifies the means
  2. "Rules" - No matter what good you might do by breaking the rules, you must always follow the rules
  3. Virtue ethics - do you act virtuously?
  1. Case-based decision-making - can you do each case on an individual basis?

Four principles:
  1. Beneficence - doing good
    Nonmalificence - or at least, do no harm
    Should this be put above all else?
  1. Autonomy - patient has a right to drive their own info, make their decisions, etc.
  2. Justice/equity - should be some rough justice with how patients are treated
  1. Integrity - of us individually and of the system

Of course, the complications arise in how you apply these approaches and principles. What happens if they conflict? What if you and your superiors don't see eye to eye? Or you and the family? You and the patient? Where do you draw the line at determining whether a patient is of danger to him/herself? How much responsibility can you assume in the doctor-patient relationship? There are so many more questions, but I have no basis to evaluate them on right now, so this will definitely be revisited.

Also, Dr. Mallott is a fantastic speaker. Just for kicks: "One day, my kids asked me, 'What do you do?' This is when I was in the in-patient psych ward at the hospital. 'Mostly I deprive people of their civil rights.'" -Dr. Mallott

Sometime after, we had career counseling with Dr. Martinez, another fantastic speaker, super-cool guy, and his presentation was simultaneously informative, nerve-inducing, and reassuring. Don't ask me how he pulled all of those off together, but he did. He threw a bunch of career ideas and summer opportunities at us, then promptly forbade us from thinking on it until after the first exam. Mostly, he left us with: "Learn to be comfortable with being uncomfortable." Yessir!

There were a few other highlights, too. The fashion show was entertaining, though I was heartbroken to learn I could no longer take my exams in my wallowing sweatpants. Also, tragedy of all tragedies, I don't have a sewing machine. Dr. Dolan held a talk on study tips and academic counseling with Dr. Keller, which gave us some vague ideas on how to kick our first week off right.

I think that closes out orientation week. Somewhere in the midst of all that, on the 15th, I made my first foray into having a 'thought of the day' (which I subsequently abandoned for a week). Here it is again:

 It's finally starting to hit me, the weight of responsibility that promises to grow heavier with each passing day, every ounce of knowledge. The idea is too much to wrap my head around.

It occurs to me that it might come across as defeatist, which was entirely NOT the idea behind it. In fact, that very weight and enormity is incredibly galvanizing, almost uplifting, and I hope it remains to be so. 

Friday, September 17, 2010

Initials: JCT

It seems fitting somehow that the first person whose story I tell is my grandfather. And in a way it’s my own story, too – his started long before me, but mine started with him. This journey I’m now embarking on, this started with him, too.

Barepapa loved to spin a good tale, some true, most humorous. Growing up, I knew him as a singer, a jokester, a caretaker, but first and foremost, a friend. He was my first playmate, and we were thick as thieves. Being a grandparent means being the designated keeper of illicit secrets – Mister Rogers TV marathons, extra trips to the park, a third helping of ice cream.

My memories of him make up a good portion of my childhood. Our ritual of walking to school started in kindergarten, when school was actually right down the street. I had PM classes – he would get me ready, feed me chicken noodle soup, and off we went. When I came home, I would take a nap with my head in his lap, on my favorite baby pillow. He and I had a game, where I would try to sneak up on him from behind, treading softly on my tip-toes. His hearing was so sharp, he never missed a beat, always turned around and swung me up before I even got close.

He loved to take us all to the park, pushing us on the swings and vainly trying to keep his little terrors in line. I remember he always dressed sharp. Every day, he had on his dress pants, a nice button-up shirt, and a belt, with his favorite sweater vest over top, rain or shine.

Barepapa dedicated much of his life here to raising us and looking after Barimama. She passed away my first year of high school, and Barepapa took it the hardest. He suffered a string of health setbacks, and very slowly began losing his recent memories. He had begun down the path with Alzheimer’s, and it was a roller coaster from there – frustrating for him to ride, and heartbreaking for us to see. One of my saddest days was when I successfully snuck up on him, and he didn’t hear me, didn’t see me, didn’t turn around.

In his spare time, before his eyesight and motor control began to deteriorate, Barepapa had filled journal upon journal with his poetry, shairo shairee. Any time we got together for prayers, he sang his favorite bhajan, “Aye Mere Gurudev Karuna,” and as he lost his memory, that refrain increasingly echoed through our home, a lament and a prayer.

I started college close to when he began losing his memory. Every time I left for school after a weekend home, he would slip some pocket money into my hand, tell me to study hard and come back soon because the house was too quiet with me gone.  

Soon after, his memory took a steeper decline. He steadily lost his sense of self, his awareness of everyone else. I came home one weekend, sat down to tell him a story I’d heard; he sat there listening, and as I looked at him, I realized there wasn’t the faintest glimmer of recognition in his eyes. He didn’t remember who I was; that knowledge never came back, and I knew I’d lost him, thought it could never hurt more than it did then.

This past year he couldn’t take care of himself anymore. Barepapa, once such a proud, self-made, independent man, was suddenly dependent on everyone around him. The fact that he wasn’t aware of the autonomy he’d lost made it that much harder to watch, to help him.

And these past two weeks were a different kind of torture. He stopped eating two weeks ago, and I was at school, away from home, away from family, away from him, confused about how to deal with this on my own. I came home the weekend before my exam because Mama wasn’t sure he would make it to Monday afternoon when I got done, and I’m so glad I got a chance to see him, to talk to him, even if he couldn’t respond. My leaving didn’t make the house quiet; his leaving did.

When he passed away Thursday morning, I somehow felt I hadn’t just lost my grandfather, my oldest and dearest friend, but also lost my last connection to my grandmother. They both made me who I am, were my inspiration, my driving force my entire life, and I didn’t know how to handle the thought of losing both of them, what felt like a second time.

And then one of my closest friends in high school, whose grandfather passed away a year after Barimama, wrote me a beautiful e-mail. She said, “One of the only things that made me smile when my grandfather died was something you wrote me in a card that I’ve always kept. You asked me to imagine our grandparents sitting in heaven somewhere having tea together, happy and free of all their earthly burdens.” She re-gifted me a precious image, of Barepapa and Barimama meeting again, sitting on a bench somewhere, spending eternity together sipping chai and gossiping about the rest of us.

Throughout high school and college, he would write me little notes, and I always kept one with me in my wallet, reading it when I was thinking of him. The latest one was a quote he transcribed for me:

“Everything will straighten itself in time
Only we need patience, faith, self-surrender,
The Lord is great
HE knows best the purity of every thought, action, and motive.”
-Swami Chinmayananda

And he also wrote something it seems especially for us today:
“We should never be afraid of tears. They soften our hearts, wash our eyes, and clear our vision.”