Goodbye, Fres-YES

I am the last remaining person at the med student compound. Outside it is raining heavily and there is the eerie central valley fog that is as mighty as anything that has rolled over the Pacific to devour San Francisco, but much creepier because, where does it come from? It settles from the sky, rises from the ground, and i am in a hidden forgotten land. A land rife with every known restaurant chain store known to man, but hidden no less.

7 weeks of my training in neruology and psychiatry in these rich agricultural lands have been completed. I have been here before, i know i saw such a small thin slice of this world. But like most natural phenomonon each slice and sub slice contains an infinity of complexity as well as paperwork.

In reflection, i have learned to improve my neurological exam and psychiatric assessment. I can consistently elicit a brachioradialis reflex, i can better judge intent for suicidality, i can recognize emergency overdoses of anticonvulsants, antipsychotics and anti depressants, and what to do (in theory) for status epilectus (but in fact, i would probably hyperventilate and hide behind a resident, shouting "ATIVAn"). In fact, most problems appear to be addressed with ativan, and very bad ones with ativan and haldol. I know the procedure for legally hospitalizing someone in a psychiatric facility against their will.

More broadly i have watched the pain of veterans, and feel greater empathy for the jingoism of Red America. Warriors, willing and unwilling alike, appear to be made of the same stuff of everyone else, mostly fragile human flesh, including the fragile souls--neurotransmitters and all. Their mangled limbs and head trauma, their PTSD and alcoholism, sprung from World War II, from last year in Afghanistan. A few were never put back together again. And those for whom the wars was the good times, and it was a life time of hard manual labor, that was what relentlessly ripped away at their nerves and tendons their might sinews now collapsing at age 55, the oxes and mighty bears of our society now cringing from perpetual pain, and the betrayal of their lungs and heart. Young and old, all men, used up by and for our ferocious society. The ones that were ok--well they had wives. Wives of fragile flesh, frail and leathered, tediously listing their husband's medications, heartily wheeling his obese body through narrow halls, observing his forgetfullness, his saddness, his incontinence that he was too ashamed to describe himself. We discuss this amid the aging creeking VA halls, plastered with mighty photographs of bomber jets, flags, the president's picture. Perhaps this is the greatest therapy of all. The reminder that the pain and sacrifice had meaning. That these were the glories of battle wounds, and not the mere decrepitude assigned to all mortals.

And i have watched the coldness of hospitals, and i have shamefully relished it. The clinic, the clinical, the analysis of the most devastating tragedies. So you want to kill yourself? Tell me about that. So you are on dialysis and you are afraid to die? So you are 30, beautiful, strong, smart and suddenly woke up with hemiparalysis and been diagnosed with HIV this morning? So you have 48% Total Body Surface Area burns and face multiple operations? So during your entire childhood you were sexually abused brutally and your family refused to help you? So all your children died in this automobile accident that has also completely mangled you? So you have lost your job, your wife, the vision in your left eye due to diabetes and are now impotent? So you have a few months to live from your metastatic cancer? So you are afraid of death and pain and loss?

How does that make you feel?

Yes you can ask these things while looking people in the eye. Sometimes, you might even help.

In the city of Fresno, there many daily triumphs and tragedies. On the final day a shoot out between cops and a rural compound brings down 3 officers and fills the ICUs wall to wall with red eyed cops and their devastated partners, children, brothers, sisters. But you walk out again from the front doors and you believe like everyone else beyond those walls, that you will live forever.