Saturday, June 11, 2016

Say Anything

How many evaluations are there about you? Dozens? Hundreds maybe? Some are down on paper- hurriedly scribbled and passed into your hands. Most are no doubt floating around in the ether of cyberspace, 1’s and 0’s representing a collective opinion of critics and evaluators. Some criticism—perhaps the worst kind--exists only in our minds—words engraved so deeply on our gyri they buzz like gnats on quite nights when you’re trying to fall asleep.

We learn early on that feedback and constructive criticism is an important and vital part of training to become a doctor. And while that may be true, it doesn’t change the very real problems with trying to sum up 8 weeks of hard work on an evaluation—much less an evaluation that impacts our chances at residency.

I’m on Internal Medicine at the moment. Overall, its been good. I like most of the people I work with, the patients are interesting and for the first time in a long time, I feel like I’m getting closer to becoming a doctor. My time on the wards is a mash up of rounds, being asked questions I don’t know the answers to (and a few I do), presenting patients, examining people, lunches at the cafeteria downstairs, on and on, around and around.

I have never given of myself like this before. Mind, body, spirit, blood, sweat and tears- I’m all in. And getting up at 4:30am is just the start. I am emotionally involved, not only do I worry about how my patients are doing and about their diagnosis and their lives—I am also emotionally connected to the people I work with. I want the interns and residents and Attendings—heck even the other med students to like me. As you can imagine this leads to a great deal of over thinking, always on replay in the background of my mind.

“Was I weird? Oh my God, I was weird.”

“Ugh, that's not right. It’s the lung, not the kidney. Dumb. So dumb.”

“Should I go see this person again? Should I ask first? No. Wait. Maybe I’ll Google it.”

The last 8 weeks on medicine has been a journey like no other. I’m a wards warrior.

There have been highs and lows, death and tragedy. Really fun days that inspire me and leave me wanting more and days were I barely have the energy to be in the hospital and long to return to the comfortable safety of my bed.

I—like all of my classmates worked as hard as I could on this rotation. And at the end of it, our time, our energy, our hearts will be judged. A reckoning of sorts to be filled out by the residents and attendings. They can say anything they want. We’ll never know who wrote what—although its often not hard to tell. Its tough to offer yourself up to judgment like that, looking back on all that we go through on a rotation. Harder still when our evaluations culminate in a P on our transcript. That’s it. Just one letter indicating that you can move on to the next thing.

Being a medical student means that we are constantly judged and measured and tested. The things that we do and say are carefully scrutinized—by ourselves first and foremost. Although we also fill out evaluations of attending doctors, they never seem to hold as much weight as the other way around. Our grade depends on what people say about us—and while we have precious little control over what that may be—its hard to offer yourself up for judgment when we’ve already opened our hearts and our minds to this experience. Its scary. And I imagine this feels similarly to what a patient in the hospital may feel--vulnerable and at the mercy of others.

There are limits to how much weight one person’s opinion should hold. So Dear Reader, the next time you are reading someone’s thoughts about you remember the wise words of the food critic Anton Ego from Ratatouille.

In many ways, the work of a critic is easy. We risk very little, yet enjoy a position over those who offer up their work and their selves to our judgment. We thrive on negative criticism, which is fun to write and to read. But the bitter truth we critics must face, is that in the grand scheme of things, the average piece of junk is probably more meaningful than our criticism designating it so.”

Go boldly forward friends. Give of yourself fully. Do not be constrained by the judgments of others, or haunted by the words of critics and evaluators past. Fall asleep peacefully by putting words that have been said about you to rest. And may your last thought before drifting into dreams be, "I worked as hard as I could."


Friday, June 3, 2016

A Million Ways to Die in the West

I’ve been wearing the same green shirt for seven days. My life has become like some fucked up Irish Groundhog Day. When I left my apartment to rush my Mom to the hospital, I didn’t know what lay ahead, so I didn’t bring a change of clothes.

Everything is harder in a hospital- eating, showering, sleeping, studying, even using the bathroom. It’s uncomfortable at best and next to impossible at worst—and I’m not even a patient.

My mom has pancreatitis.  A blur of white coats and ugly (albeit extremely comfortable) clogs schlep in and out of the room. Our days blend into nights that turn into days again. My mascara is halfway down my face. I’m starting to look haggard.

They say a little knowledge is a dangerous thing—especially true where med students are concerned. First Aid also says that intellectualization is an immature coping mechanism. I’m not exactly sure how humor is considered mature and looking things up on PubMed isn’t—but perhaps that’s because no matter how far and wide I search, no matter how many papers I read—the article I’m looking for isn’t there.

I want to find a paper to tell me everything will be okay. But I can’t find one.

What I did find were publications with phrases like “potentially life threatening” and “hypovolemic shock,” and “mortality rate.” Once I’ve read them, I can’t get them out of my mind and the words circle through my brain on a constant loop. My stomach is a vice grip and my head a leadened sack getting more and more difficult to keep upright.

Last night I got a text message from a friend—she’s a resident at the hospital. “You need a drink,” it read. We devoured the leftovers in her fridge and cracked open a bottle of red. I was gushing about all of the data I had discovered while at the hospital. I droned on about the different levels of data and evidence and imaging and sensitivity and specificity. She sipped her wine. “You can do everything right,” she said. “You can treat a patient perfectly, according to the data and prophylaxis for DVT and infection and everything else under the sun that you can think of. And bad things still happen.”

“Um. No.” I protested. “I don’t think so.”

I spent four years in college, and then six years in graduate school earning three master’s degrees and now, halfway through medical school I am not about to admit that sometimes you can’t help. That sometimes life has other plans. The idea that bad things can happen—that they do happen, gnaws at me with a deep existential ache. Surely if we study hard enough, get up early enough, read enough—it’ll keep death at bay.

I’m slated to take Step 1 in April. My mother’s hospital room has become my new study spot--in between talking to doctors and the IV pump going off, my face is permanently attached to my books—well, just one book actually.
First Aid is full of things that can go wrong with the human body. But up until now its never really felt real. But now I find myself glued to the pages, hungry for answers, not facts. The descriptions of all of the horrible, terrible things that are part of the human condition are there—in plain text. Phrases like “outcome is poor” or “typically fatal” just hang out—often on the same page as completely benign conditions. Who gets what just doesn’t seem fair, it just doesn’t make sense.

While I can’t wrap my mind around why a person, going along, living their life should suddenly become ill—I can at least make the descriptions and findings of the various diseases and their treatments more meaningful. For example, next to the section about lead poisoning, I write Flint, MI in the margin. First Aid says that exposure to lead in children can cause mental delay. And I think of the communities of children who will now suffer life long consequences.

I write “Jen” next to the section about Multiple Sclerosis and “James” next to the section about Marfan’s.  Friend’s of mine who remind me that the words on the page don’t define them but also that life can be so brutally unfair. Making the conditions and treatments we study more personal, more human, helps me remember why I’m in medical school at all. And I think that’s the most important lesson we could ever learn from that book.

As my mom sleeps a Dilaudid induced slumber, I turn to the pages that describe coping mechanisms—both the mature and the immature alike.

And I write my name in the margin.