Tuesday, June 20, 2017

How to be Good

“Make me good God. Make me good. But not yet.” – Nurse Jackie

The literal dividing line between anesthesia and surgery is a rather thin, sterile paper, blue drape. Anesthesiologists have kind of a thing about it actually. Everyone likes to secure the drape differently. I swear as long as I live, I'll never do it right. Even the most laid back resident has redone my perfectly secure drape. The art of drape folding is shockingly not something taught in medical school, so the first time I clamped down on the IV pole, cracking the plastic clamp and sending pieces of it flying precariously near the surgical field.

I’ve never seen that one before,” the resident said, quickly fixing my mistake-- and never trusting me with his sacred drape again.

Starting IVs is another thing they let the med student struggle with. The very first time an attending suggested I start one, my hands were shaking so badly I couldn’t even grab the needle from the drawer. He took one look at me, and then kindly suggested we "do this one together." Even when I did manage to get to the stage where you poke the skin, I was missing almost every one. Even in the SIM session we did. Every single stick on those stupid unrealistic plastic mannequin arms I was missing. They bleed food coloring. After a while even the saint like patience of the resident I was working with was growing thin.

You’re not looking at the catheter,” he said grabbing it out of my hands. 

I am looking,” I say back rather annoyed.

Not you’re not,” he insists, "watch me," he says sliding the needle effortlessly into a vein. 

We would do well to be a little more real about the learning curve regarding practical skills—especially cynical, impatient little busybody me. I don’t know how to fill a syringe with propofol without spilling it all over the place.  But because I spilled it, I now know how not to. You get good by being bad. How unfair.

Struggling and messing up is where the learning happens. Its important to try to run into situations where struggle might be possible, instead of avoiding them. For example, I tried every IV I had the opportunity to. And I missed a lot of them. But I am getting better. Well…at least I can grab the needle out of the cart…and I call that progress.

Intubation is another one of those skills that's semi-important on the patient’s not dying front. It can be tough, because getting the feel of the blade, the tongue, knowing what it is you’re supposed to see—that takes practice and it takes struggle. During one such attempt I looked up at the resident with those big “help me I’m stuck” eyes. “I’m just going to let you struggle,” he said like he had read my mind. Ugh. And struggle I have. 

I have found a million things I’m terrible at doing. A million more ways to mess stuff up. Umpteen questions I cannot answer, words that I do not understand. My facial expressions as of late alternate between raised eyebrows, nodding and my personal favorite—the blank stare.

But the more I try, the luckier I get. The days where I get both the IV and the intubation have increased in number. And that makes me feel good. And then the thought creeps into my head that maybe I’m actually good at this. Maybe I can actually master the art of drape clamping. And just when my step has a little swagger to it, the resident asks me to grab the IV for her. I pull the bag off of the tubing and am promptly doused from head to toe in a liter of saline. 


“Make me good God. Make me good. But not yet.”


Friday, June 9, 2017

23&us

It started like junk mail....

Hi, I just tested my DNA on 23andME and it says we are first cousins!?! Not sure who you are, but would like to find out more and see if this is in fact true. My name is David and I'm 36 years old. take care

I ignored it. Probably some guy in his mom’s basement sending weird messages to girls. Gross. I almost hit delete, but got distracted and just closed my computer instead, and promptly forgot about it.

A couple months later I signed into my 23&me account. And there he was…a stranger...in my gene pool. Who is this guy and why are we 12.5% related. And then I remembered the strange message from earlier. I decided to reply with facts about these tests being horribly inaccurate and who knows what they really tell us. And as I started typing I looked at the next closest related person to me…0.6% related, is my next “relative” on 23andme. 12.5% well that’s first cousins…and I knew I had to know more. Even if it was some guy in his mom’s basement.

Hi David, Yup-- this is super weird. I thought that I knew all of my first cousins because I have a fairly small family. Where do you live? -Fiona

Hi Fiona, I live in Canada just outside Toronto. I thought I knew all my first cousins as well, but now that I think of it, I do remember hearing a few years back that one of my Uncle's (who is now in his late 60's) got a girl pregnant in high school and she was "sent away" somewhere to have the baby. Not that I think that plays into this circumstance, but it just reminded me of the fact these things were kept hidden in the past!

Oh Jesus Christ. Is that baby me? Have my parents concocted some really convincing and elaborate story about having me? And also why then do I have my Dad’s forehead? Being some secret love child didn’t really appeal to me. Unless I’m a princess, then I’m game.

Our conversation went on over the coming weeks. Sometimes we just asked each other more about our lives, and sometimes we dived deep into the nitty gritty of our families. We imagined secret affairs and adoptions and immigration stories of all kinds.

Hi David,
My mom's parents do live in England, but they were displaced german jews and relocated from Germany after WWII. My dad's dad still lives in Scotland and he has three children, my dad, my Uncle Mark and my Aunt Kirsten. My uncle Mark actually lived in Toronto for a while during the Vietnam war-- pretty sure he was dodging the draft.
-Fiona

Hi Fiona,
The only new thought that has crossed my mind today is that my maternal grandfather fought in WWI and would have been in Europe for a few years at that time. Does that somehow play into it? This is kind of exciting! take care, David

And just like that, we were both hooked. We looked up old newspapers and online archives trying to find a relative we might share. I was in full on detective mode. And David was right, this was kind of exciting. I only did 23&me for extra credit in a genetics class I took during college. The class was boring and I didn’t really find 23&me particularly interesting….until now that is.

And then one day, while lying in bed, trying to fall asleep. I knew. 

David lives in Toronto. The same city that my Uncle Mark went to grad school in. David and I share 12.5% of our genes. First cousins. First cousins share a set of grandparents. First cousins have parents who are siblings.

It became more and more clear to me—and perhaps you may have already figured it out—how we are related. But the thing was….David hadn’t.

How do you ask someone how sure they are about their mom and dad actually being genetically related to them? I just couldn’t do it. I stopped answering his messages.

While I was taking a break from our now 17 page long conversation thread. I called my Dad.

Does Mark have a son?” I asked him.  Because I think I’m talking to him and his name is David and he’s 36 and he lives in Toronto.”

I can’t remember exactly what it was my Dad said. But I’m guessing probably some explicative coupled with shock and an “are you sure” thrown in for good measure.

David kept sending me messages about his family. His British grandparents in WWII. His father’s family who have lived in Canada as far back as anyone can remember. On and on into marriages and births, the Great Depression, the Cold War. It was the most epic history lesson I have ever had.

I plied David with occasional messages back. I told him about a half uncle I have. The 4th child of my grandfather. I told him how much I love Canada and how attractive their Prime Minister is. And I asked him what he did for a living and about how high the snow drifts get in the middle of winter where he lives.

Hi Fiona,
I am an anesthesiologist. Maybe medicine is in our genes!-David

Anesthesia you say? In our genes indeed. And somehow him being a doctor made things a little easier. He knows how it works. He knows genes. He knows science. I tell him about school. He replies with “Don't worry it gets better after med school.”

Oh, he’s such a Canadian. And so so nice. So after much debate and a large glass of wine, I sent him a long and rather cryptic message suggesting that perhaps my Uncle Mark might be his father. He wrote back with a longer and more confusing message about how I might be the daughter of his uncle. I asked him about his forehead. My grandfather, my uncle, my dad and me…well we have a serious case of forehead going on. And I bet David had it too.

Hi Fiona,
Regarding my forehead I would say it is normal size.- David

I sent him my LinkedIn profile so he could see a picture of me. He wrote back…

 Hi Fiona,
Your forehead is not that big. David 

And then a few days went by…and I got this message.

Hi Fiona, Are you able to call me?

Oh God. He figured it out.

I called him from a friends house, excusing myself from the libations to talk to him in the stairwell of their condo. He had driven across the city to ask his mom about who is father was. And there in his 75 year old mother’s living room on a freezing winter night in Canada, a 36 year old learned that his father was not a genetic relative, his sister—actually a half sister. His parents were unable to conceive children, so used a sperm bank. My Uncle Mark, desperate for money during graduate school had been a donor.

The last message David and I exchanged on 23&me reads,

Hi Fiona, It was great to chat with you tonight. I guess the mystery is solved. We started off thinking about secret love affairs in the distant past, never in my wildest dreams did I think the true story would hit so close to home. take care, David


David and I still keep in touch with the occasional email. He was actually able to meet my Uncle Mark and my Dad at the wedding of my half Uncle. David has a loving family of his own, and his parents are still just as much mom and dad as they were before. And I guess if I’ve learned anything from this experience, apart from reaffirming my love of Canadians. Its that we are all related. We are all family. We're all cousins. David and I just like to think that now he has a bonus family. A slightly crazy, overbearing, large foreheaded bunch of British people who really don’t care what percentage of genes we happen to share.