A comparison

Who I would like to picture myself as



Confident, razor witted, curmudgeonly, secretly wise.



with awesome biceps.


Or



Powerful, commanding, seductive.



The boss of stuff.



But mostly i feel




Concerned. Nice. Cutesy. Terrified.



Or bureacratic. Paper tiger. Effete and futile.

But i think, someday, i will learn to flower as myself.

Things i want a lot but cannot afford

My funding this year is pretty miniscule. And it is coming to my attention that my perpetual hiding in higher education will end one day and i will have loans to pay. A lot of loans. Like, numbers with a great multitude of zeros that follow them. Also that residents don't make much money. (on the other hand since my only other proper jobs have been in cafes, book stores, and grading logic homework, being a resident will be the richest i will have ever been and i am quite excited). Despite this, i have discovered over the last several years that (1) i like nice things (2) that despite what i was otherwise led to believe by Berkeley Bohemia, it can cost quite a bit of resources to experience nice things (time, attention, and money).

Ah, but to live in San Francisco, to be devoted to a great art, to be youngish...so a la Hemingway's Moveable Fest, I will sate my appetite by aromas. To begin, a menu.

Things i desire and cannot afford (in time, attention or money)

1. A haircut
2. To fix Ravelstein the shattered iphone
3. beautiful lingerie
4. a car
5. a parking space to the put the car in
6. a television
7. time to watch a television
8. a knowledge of films
9. a thoughtful fashion sense
10. healthier eating habits
11. regular massages
12. membership to an institution with a sauna
13. children
14. a dog, to watch/herd the children
15. an apartment with a living room
16. a garden
17. a knowledge of Wittgenstein
18. travel to faraway lands and then staying at midrange hotels instead of haggling with broken down hostels with no running water
19. to whisk my sweetie away to a beautiful place with no worries (for a little while)
20. world peace

an overhaul

bc i find it physiologically difficult to study multiple choice questions for more than 10 hours a day, and bc i like to sit in front of my computer instead of engaging in aerobic exercise, and bc i have the time and space to reflect on my training, existence and future (at the expense of you, the taxpayers of California, and me the future loan payer), and above all bc i have a gorgeous sexy new love affair, namely with a shiny 2010 macbookpro (aka Osler's Beast, alas to replace my previous beloved machine, ruthlessly stolen) i am inspired to relaunch a different purpose with my online blathering ("different" as in having one at all).

I am searching now meticulously through examples of other doctor and medical student blogs and finding many good things, to my pleasure and joy. I will hand pick some eventually. for now i will share this from Axis Deviation.

25 Things I Didn't Do Before I Entered Medicine

Wake up before 8am.
Go to sleep after 2am.
Look forward to sleeping nearly every night.

Wear a shirt and tie to work.
Shave more than three times a week.

Stick my finger up peoples' butts.
Ask people how many people they’ve slept with.
Ask men to tell me about their erectile dysfunction.
Ask for men to show me their penis.
Dread seeing vaginas.

Be able to tell police officers what to do (in the hospital, at least).
Talk with police officers.
Talk with prisoners.

Slam the phone on people.
Hate pagers.
Hate anything that beeps.

Drink at home, alone.
Want to drink this much.

Be thankful I am alive.
Hope that certain people would die.

Struggle for money.
Dream of money.
Despise people with money.
Despise people.

Wish I didn't enter medicine.

studying

Studying for the second boards has so far been profoundly different from the first boards. One reason is because i am not also hyperventilating in an attempt to finish and properly format a master's thesis. Yet another is that all these abstract lists of previously nebulous and nonsense strings of fact have profound meaning.

Third year was hard for lots of reasons, not least of which is constantly being surrounded by death, suffering and dramatic events. This is of course the point, as the entire existence of the job depends on people getting run over by cars and having heart attacks. I suppose the training is so long so that after several years of seeing it, instead of weeping and gasping at the sight of hemorrhage or the slow overtake of a human life by a monstrous cancer, as a normal healthy human being should, instead one is competent technician and numb enough to do something useful. Technician in the broadest sense--to be able to insert a swan ganz catheter into the right place to speak and drug away an impending suicide attempt to break devastating news with compassion. All very difficult techniques.

The technique matters. The knowledge matters. The most important thing i did third year i suppose was observe. And the funny thing about having such intense imprinting of the memory given its tremendous affective weight and existential gut kick, is that the most odd facts have seared themselves into my brain. Cocksakie virus is the number one infectious cause of myocarditis = 38 year old man in the ICU, h/o of hodgkin's, heart failure, delayed biopsy, his powerful muscular chest strung with endless tubes and wires, his aghast stoic young wife sits by in pink sweat pants. He dies the next week. Never treat sinus tachycardia= M&M rounds with the senior resident who did precisely that in the midnight transfer, a 32 yo woman decompensating from sepsis, shot up with beta blockers, the resident presents the facts with a steady strong voice, but i see her crying in the hall later. Aminoglycoside nephropathy, serotonin syndrome, cardiac tamponade -- how odd these are, how real, how their string of greek and latin artifice become such moments of terror, anguish...and potential triumph.

the multiple choice test is suddenly a richer, more interesting thing.

What to do next

Here are some career fantasies:
(1) Finish medical school
(2) Finish residency

and then?

I think i am in love with HIV. It is too rich, too big. It is horrible, ruthless. It attacks us through our love lives. It is wiping out, has wiped out an entire generation, entire societies. It travels with tuberculosis. It revolutioned immunology. It is a disease of gay men, of Africa, Haiti, of hemophiliacs and children who had no choice.

The glory days of HIV in San Francisco, the sheer terror and fear of a deadly miasma that takes the young and bohemain, the time for great courage, the time of surgeons drenched in poisoned blood, came and went. now the battle is quieter, it is tedious, but it still there. Now it is a battle of pharmaceutical patents and global distribution of testing equipment, of chipping away at lymphoma and heightened rates of diabetes and salvaging kidneys in old age.

So then. what would i do? get work. Begin working.

emphatic addition to previous post

A new oath

A few weekends ago, i went to a day long retreat of medical students in some nearby forest. I joked it was a hippie get away for medical types. Indeed, we arrived at an old building embedded in a bay area secluded forest, decorated with healing wheels and crystals and our facilitators were gentle and soft spoken. But the building in its regular life most often hosted retreats for those dying of cancer. And our facilitators were a palliative care physician and nurse, whose daily work was in hospice, in guiding fellow humans to their end of day, ensuring that foley catheters were functioning and that morphine was sufficient; but also that people might die with dignity in the company of those with compassion and humility in the face of the greatest abyss.

I went because i was hurting, hurting for myself, i knew that car ride through winding Hwy 1 with my classmates would be therapy i was desperately thirsty for, to salve the hurt that was mostly in my ego. I had finished my clerkship year of medical school and the year previous that had careened wildly through my master's write up. I was exhausted, overstimulated, and felt desperately inadequate. I spent the year in a fishbowl, perpetually under evaluation, and i in turn watched the patients in another embedded fishbowl, while they did godless things, like bleed, give birth, suffer, die, come to life again. An onslaught of human triumph and tragedy and very little sleep in between. I felt shattered and confused. I felt alone.

I cannot describe all the beautiful things about that day amid the quiet trees and these other people winding through their own journey. But i was salvaged indeed, and i was glad to work again. A nice exercise we did towards the end was make our own sort of Hippocratic oath, which was then sort of edited together. I found it very moving, that these future surgeons and emergency room docs and psychiatrists and general practititioners (some to be interned as soon as June) were so soulful, and i was inspired by their passion for their work. Here is are some snippets, as well as the collected oath we formed:

Personal MISSION STATEMENTS



v v v

Help me to approach every patient with patience, even if I am exhausted and overworked.

Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen

v v v

Help me let go of fears, prejudices and distractions, so that I can be truly present with patients

Help me apply technical skills within the context of trust and compassion

Help me make decisions that support healing of the whole patient, and not merely fixing of parts

v v v

May my work be an artistic expression

May it be a practice of grace

May it be a movement of justice

May my work be a dance towards self

May it be a reflective reading of the poetic prose of human experience

v v v

Help me to listen—to hear the story, to understand what is being asked

Help me to see—to observe carefully and unveil the truth

Give me the knowledge and patience to teach so that the people I care for can care for themselves and others

Help me to touch—to feel, to discover but also to mend and reassure

Teach me to find and share peace in the face of sickness, death and life

v v v

Help me to hear with my mind and heart

Help me to stand in power

Help me to remain compassionate, present and invested

Give me strength to know when to keep going and when to stop

v v v

Help me to care for myself as I care for others

Guide me as I develop wisdom to go along with knowledge

v v v

Help me to be courageous in walking with patients in their suffering

Help me to serve with relentless hope and compassion

Help me to be confident and authentic in who I am as a physician

Help me to be innovative in how I provide care

v v v

Hold me long enough so I know I can stay or go anytime

Keep my eyes open to that moment when patients are ready to really feel what is going on

Calm me

Remind me that I always can choose

v v v


Collective:

Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen

Help me let go of fears, prejudices and distractions, so that I can be truly present with patients

May it be a reflective reading of the poetic prose of human experience

Give me the knowledge and patience to teach so that the people I care for can care for themselves and others

Remember to always be present, honest, and human

Help me to hear with my mind and heart

Guide me towards balance professionally and personally

Help me to be present to each person I encounter, with humanity

Help me to be confident and authentic in who I am as a physician

Calm me.

I want a dog