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.