Archive for August, 2010


Yoo-Hoo

Dilapidated brown bag in hand, the Publix bagger flatly told me that they can’t all be winners. I literally laughed out loud; at him, the bag, the time (9 p.m.), the array of pathetic purchases I had made that evening (coffee, cotton balls, bread), and all of it.

You can tell a great deal about a person by what they are buying at a grocery store. For instance, the man right after me in line was buying some sort of nasal spray, a single can of Foster’s, and Triscuits (low sodium). The bro who had just finished an extremely intense work out prior to arriving at the grocery store (so intense that he had no time to either shower or put on a shirt with sleeves) was purchasing milk (2%), a frozen pizza, a Yoo-Hoo (which I thought disappeared off the face of the planet in like, 2000-they’re still around in case you were wondering), some scotch tape, and multivitamins. And a bunch of bananas.

I’d like to amend the “being able to tell a great deal about a person” bit by saying that this only applies to people in the “10 items or less” line. Mom of 16 buying groceries for what appears to be a trek across the Oregon Trail, which is actually just a week’s worth of sustenance for her clan, does not reveal anything about her personality by purchasing countless cartons of chicken nuggets. Unless, of course, she throws in the occasional Bella Sera Chardonnay (because it was on sale).

Making my way out of the store, I thought about what I left behind me and the motley crew of late night grocery enthusiasts. My own purchases were by no means anything to speak of, but if you think about it, it was just what I needed at that moment. And maybe a Yoo-Hoo was just what The Hulk needed, at that very moment.

As the paper bag containing all my items ripped in half and splayed its intriguing contents across the parking lot, I thought about what the bag boy had said. Even though he had thought he was thwarting a potentially inconvenient circumstance for me by giving me a non-dilapidated bag, mine had still ripped. Who knows-maybe if the two crappy bags had combined, together they may have made one solid, non-crappy bag. Or maybe they would have just been crappy together. At that moment, gathering my purchases up off the asphalt, I was definitely not a winner. We can’t all be.

Sir William of Ockham

Occams’s razor is an ideal that dates back to the 14th century logician William of Ockham. It is the idea that, when solving a problem, one should make as few assumptions as possible. This rule of simplicity, if you will, is applicable even to the medical realm. It is the idea that when approaching a patient with an illness, it is more likely that he or she is ailing from a myriad of common symptoms rather than one extremely rare disease. The clinical applications of such an ideal are valid, yet if you disposed of the concept of sick or well, dying or living, virus or bacteria, Occam’s razor still applies. Without a person with the pathological reason they are unwell, a patient to some is nothing more than the bacteria plaguing them. But Occam would say that the less assumed the better. Why not, then, treat the patient as you see him or her first: a human being?

Although this concept of keeping things simple may seem commonplace to some, it may be the most challenging of tasks to others. There is no glory, after all, in solving a problem that is not difficult or complex. Sometimes in all of the learning we do, we miss the most important and simple of all lessons, which is the notion that we are no different than our patients on the inside. Therefore there is no reason they (our patients) should be treated differently on the outside.

When one thinks about this idea, it might seem a little contradictory to the entire concept of medicine. Is it not more important to heal the person’s illness than to worry about the person? Would it be better in the long run to know that a physician who is unperturbed about your fears was methodical when approaching your care? Perhaps it may seem this way to an outsider. However, we are all patients at one time or another. Even the most stoic must be faced with the concept of immortality at some point. It is a frightening moment when one’s life is in another’s hands; and that is what some doctors fail to remember when making rounds on the day to day hospital or outpatient circuit. For the man or woman lying in the bed in front of you is a person, and he or she is composed of the same parts as you.  

We have come to a place in medicine in which the most human of all vocations has been found to require an inhuman amount of composition. It is an irony that somehow we have arrived here. Subsequently, it must seem especially ludicrous to be at the receiving end of this irony. To a patient receiving a life-changing diagnosis from a tersely composed physician, the very moment must seem altogether nightmarish. It is one of the most puzzling of all scenarios in medicine, one which requires the least assumptions to remedy.

Occam’s theory can be loosely translated from the Latin, “entia non sunt multiplicanda praeter necessitatem” to mean “things must not be multiplied more than necessary”. In other words, do not complicate the uncomplicated. Do not allow what once may have come as second nature to be lost in years of training and expertise. Even with the honing of skills we undergo, it is quite possible to retain the human touch we as people must incur to become better doctors. Seeing a patient as more than a disease, more than a bed, and more than a “teaching opportunity” is something that is so critical to the field right now, yet is something that is hard to apply. Quite simply, it can be stated as this: see the patient as you would want yourself seen. This is the most inherent and obvious approach, with the fewest assumptions. If doctors follow this path, all of the care and medical knowledge that follows will surely not be lost. They will give the patient what he or she needs most, which quite simply consists of a human being speaking to another human being. This is the heart of medicine; this in itself is the answer to the incongruities which plague the physician-patient relationship today.

We are given a task as a future doctor that is far from easy. While learning the science and practice of the field, we must not forget the true meaning and value of what we are doing. It is an incredible gift to be chosen to heal the sick; a gift that is even frightening at times. Yet we were chosen for a reason. Regardless of where this journey takes us, we will be faced with difficult trials along the way. It is imperative that even in the face of the most difficult of moments, we remember the Razor. For it is in the face of adversity that we find our strength and even the answers to the most challenging of life’s questions. Sometimes, the answers are lying right in front of us. Yet it may be a test of strength alone to choose the simplest one.

Hex

Facebook is a blessing, and it sure as anything is a curse. I think it’s actually mostly a curse.  It has become a staple of my age group (and even the generation before mine, as I was oh-so-thrilled to see my mom’s name come across wanting to add me as a friend ). As a medical student, it is really the only way to keep tabs on what the “outsiders” are doing with their lives, as yours is in a stand still. I say facebook is a curse because until you become acutely aware of how much your peers live’s are progressing, you are really not too upset about how mundane yours is. It is until you come across “Album Three of the World’s Most Perfect Wedding” (or its equivalent) that you are totally and completely in the blissful bubble of life as a medical student. Which I think equates to no life at all.

I started thinking about the time warp of medical school last year when I went home for Thanksgiving. My best friend from childhood whom I have known for roughly 20 years, announced to me that her and her boyfriend of a year were getting engaged soon and are even looking at rings. She asked my advice on what rings I liked. I sat there with her for an hour, flipping through catalogs and websites, saying “Oh this one is nice,” and so on. The truth was that I was totally clueless as to what advice to give on picking out an engagement ring. I realized at that moment that even IF (and that is a big if, so it seems) I had that special someone in my life right now I would not be ready for picking out rings. Or flowers. Or places to live. Or compromising on last names (I have always wanted to hyphenate). Or deciding where to spend the holidays. Or any of that “rest of your life” stuff that so many of my peers have already dove head first into. It’s not that I don’t think I could ever be ready for that; I just think that my life as a 20-something has been time-warped away from me and I am so focused on only what is going on in my immediate schooling that my brain just rejects thoughts of engagement rings. Or anything ring-ish.

I’m definitely not criticizing getting married right now. If you are lucky enough to have found the person you want to spend the rest of your days with, by all means, lock that down! I’m just stating that at this point, I can’t imagine myself saying “I do”.

And so the warp continues. By the time I get out of medical school, I will have hit 26, and as women we all know, 30 is right around the corner at that point. By that time all the people that said their vows during my second year will have a soccer team of kids. I hope I at least have a dog.

inches

We are taught to start,
out-crawling.
To use our bodies to somehow
move, not gracefully as our
Elders may
but moving.
We aren’t told to RUN
before we can walk
but start small
crawl

what if we never walk we just crawl
what if we can’t fly?
but Creep by on the ground
one inch
at a time

For I am still
Crawling-
-and I may never
fly
like my Elders do
(or so it seems).
The best part about Crawling,
Though
is that it gets you
where you need
to Go.