Me: I think I have a heart defect.
Friend: Why?
Me: I have to think about it. I just know it's an odd heart.
*
We've been learning about the heart. We've read about it from the point that two cells make one embryo, to how it functions in a baby, to how it morphs into an adult. We've seen our professor twist foam tubes to help us visualize (couldn't tell one end from another). We've watched animations on our computer on how the heart folds, closes, develops. We've detached the lungs from the heart in our donors, and held the heart in our hands--not fully, still clinging onto the body. We haven't seen the individual chambers yet, but we can peer at the vessels cut open on either side.
The heart, like everything when you really think about it, is complicated and simple. It is important and complex. It's a system, and of course another system could have worked, but it's this one that we have. It's an amazing one, but a million things can go wrong. In the end it's a fragile thing; it gets confused and malformed and tired out. It is so beautiful.
The fetal heart can't depend on lungs for oxygen. So it comes up with all these mechanisms to deal with it. It might make you wonder why the fetus doesn't just have functional lungs. But you don't instinctually think that. Instinctually you think that of course, it has to grow. Its starts one way and it learns and ends up in another way. It doesn't happen right away. I think it's funny, though, that the mechanisms the heart has to cope with not being fully developed yet, are just as complex as the development the heart is waiting for.
Sometimes the adult heart suffers because one of these fetal heart qualities persists, never goes away. In the fetal heart blood can travel between the right and left atria. In the adult heart, this portal closes. It should close.
In one of our case studies, a patient had a thrombus (clot) in his vein that traveled to his brain and caused a stroke. In a normal person, this clot would have traveled through his heart to his lungs and might not have caused much of a problem. But this patient still had the portal between his atria. So the clot has two paths: a normal one through one atrium to the lung and an abnormal one, through one atrium to the next atrium and to the body, to the brain. The clot in this patient took the latter path. An online animation showed the clot on its course, and I found myself mourning it aloud. Oh no. Oh, that's sad.
This is called a "paradoxical" clot, because it starts out in one system (pulmonary, that of the lungs), but it ends in another (systemic, that of the body). That's the price of staying undeveloped, of staying open, of leaving another path, one that's not right and not healthy. Your system hurts itself, makes a mistake, misjudges.
But you can't say it's unnatural, this so-called defect--it's natural, it's how you were made. And so what if you didn't make the decision to have it that way, to keep a remnant of your innocent, brand-new self? And so what if you still have the choice of two paths, when inevitably you are going to have to go down both and one will hurt?
I love the heart. It's so strong and vulnerable. It can adjust to some alterations, but it's particular. It needs certain things, and it needs them to give them away, all the while sustaining itself. I love the heart. But I don't think I will study it in isolation. Someone else should prevent strokes and the like, but me, I don't think I can look after odd hearts. I wouldn't want to fix them.
Wednesday, September 26, 2007
Monday, September 24, 2007
one part
I've been itching to write about old and new for the past month I've been here, but I honestly haven't had a period of time and space to do so. When I'm not in class or attending a meeting with a free meal or doing an anatomy pre-lab or in anatomy lab or eating pizza (New Haven = pizza town) or waiting for the ridiculous elevator in Harkness (my dorm), I'm having pure, concentrated fun with my classmates. I consistently push aside thought for experience. The entry I've been longing to write and thought I would write this weekend will remain a longing because I went to the beach and spent an evening playing board/word/kid games.
Last week I attended a reading by Christine Montross, a doctor-writer, who wrote a book based on her experiences in anatomy. A couple of weeks ago, our entire class heard Anne Fadiman speak, the author of a book about the role of cultural differences in caring for a Hmong baby with epilepsy. She said that she didn't choose to write the book; it chose her. The second she said that, I thought, nothing in my life has chosen me. I've chosen everything. And maybe that's why I haven't felt compelled to really write anything. Both Anne Fadiman and Christine Montross mentioned the importance of writing in the moment, as you feel, to gather your experiences, to journal. When I asked her how one goes about being chosen, Anne Fadiman interpreted my question as how do I go about being chosen and suggested that I draw upon everything that I'm seeing and doing now in medical school.
And there is an amazing amount to draw upon. But the thing is--there is an amazing amount. Even in one day there is so much. Most days I spend two full minutes in awe of it. That doesn't sound like much, but how often do you spend two full minutes not really thinking anything but just in stupefied wonder? Instead of incompletely fleshing it all out, I let these things stack and build and sometimes topple. They don't dissipate in my mind, but I'm becoming so awash, so inundated that I'm resorting to bits and pieces. Which is maybe more realistic, more representative.
This is ending up to be ironic because I wanted to write about how I think I might have overcommitted myself here. But there are several things I'm truly excited about, and the idea of potential is always so nice to share. I've also been out of touch with the few of you who read this, so here's an update of one part of my life: the extracurriculars.
Atrium Magazine...So a few of my lovely classmates and I are starting a literary magazine for the students in all the health schools at Yale. We've named it ATRIUM, which calls forth a structural, living, artistic throb with and without analysis. I'm incredibly excited to create something from scratch, to see the talents of all the people here, and there has been so much enthusiasm and support already. The community is so small that most anyone in my class can come up to me and ask me about it. There is warmth in a communal recognition of one of your passions.
Haven Free Clinic...I'll be working in the Social Services department, something on which Harvard and Project Health have gotten me forever hooked. It's here where things are most basic and most complicated--people's baseline needs and the labyrinth you go through to get them. So many students are involved in the clinic that we work only a few weekends a semester, which is something I've been disappointed in here (the lack of more regular, long-term activities), but it does give exposure and allows room for other pursuits. A great deal of it focuses on insurance, which will be incredibly useful, and the experience will cover a lot of ground that school won't look down to see.
Immigrant & Refugee Services...Because of that, I looked for some things outside of Yale I could do more regularly, and found a really great program focused on helping refugees adjust to life in New Haven, in all respects--English tutoring, cultural adjustment, community outings, social services. They come from all over; each family is given individual attention. Today I was told that a mom, dad and one year old girl would be moving to New Haven from Somalia on September 24. Anyway, I just have a small commitment. I'll be taking people to doctor's appointments, helping them navigate the bus system to get back and forth and help make sure communication with the doctors are okay. Working with refugees is something I'd really like to do in the future, and this seems like a great way to get to know this town, its people and its transportation and neighborhoods and feel.
Educational Care Clinic...So this program is so much like ASK that I couldn't really pass up on it. The differences are that it's much less regulated (no doctor working with us, no actual clinic, less protocol and expertise overall), but a bit more narrow and personal (we have one student that we tutor regularly). We advocate for educational resources similar to the way we did in ASK, but more on our own (depending on how this goes, it would be nice to offer some of the things we did in ASK to this program). The appealing part is that we get to tutor at the same time, giving it a more wholistic character and real attachment. It's also a very new and rough program. Project HEALTH spoiled me with its ability to look at broad social structures and work personally with people too. I miss it.
Columbus House...This is another few-times-a-semester commitment that a whole bunch of the med students do because of the patient time. It basically involves taking histories from people getting free healthcare at a local homeless shelter. At school they devote a whole year to teaching us how to take a good history, how to elicit a patient's story. It's one of those things that make me feel that this fits.
But I also think I might not pursue this until next semester. I wanted to write about these things because each one makes me look forward and excited. It wasn't to show how much we do here, because most of the things don't require huge investments. I'm also not particularly ambitious, because a huge number of our class is involved in these things (class dynamic is a topic that will not go unwritten). Still, I'm overwhelmed, because somehow I've forgotten that I'm also in school and I need to learn things. And not just school, but school that is life not just in physical place and mental hours but in the way it grips you inside-out because it's what you feel and think and work for, hope for. More on that, little by little.
Last week I attended a reading by Christine Montross, a doctor-writer, who wrote a book based on her experiences in anatomy. A couple of weeks ago, our entire class heard Anne Fadiman speak, the author of a book about the role of cultural differences in caring for a Hmong baby with epilepsy. She said that she didn't choose to write the book; it chose her. The second she said that, I thought, nothing in my life has chosen me. I've chosen everything. And maybe that's why I haven't felt compelled to really write anything. Both Anne Fadiman and Christine Montross mentioned the importance of writing in the moment, as you feel, to gather your experiences, to journal. When I asked her how one goes about being chosen, Anne Fadiman interpreted my question as how do I go about being chosen and suggested that I draw upon everything that I'm seeing and doing now in medical school.
And there is an amazing amount to draw upon. But the thing is--there is an amazing amount. Even in one day there is so much. Most days I spend two full minutes in awe of it. That doesn't sound like much, but how often do you spend two full minutes not really thinking anything but just in stupefied wonder? Instead of incompletely fleshing it all out, I let these things stack and build and sometimes topple. They don't dissipate in my mind, but I'm becoming so awash, so inundated that I'm resorting to bits and pieces. Which is maybe more realistic, more representative.
This is ending up to be ironic because I wanted to write about how I think I might have overcommitted myself here. But there are several things I'm truly excited about, and the idea of potential is always so nice to share. I've also been out of touch with the few of you who read this, so here's an update of one part of my life: the extracurriculars.
Atrium Magazine...So a few of my lovely classmates and I are starting a literary magazine for the students in all the health schools at Yale. We've named it ATRIUM, which calls forth a structural, living, artistic throb with and without analysis. I'm incredibly excited to create something from scratch, to see the talents of all the people here, and there has been so much enthusiasm and support already. The community is so small that most anyone in my class can come up to me and ask me about it. There is warmth in a communal recognition of one of your passions.
Haven Free Clinic...I'll be working in the Social Services department, something on which Harvard and Project Health have gotten me forever hooked. It's here where things are most basic and most complicated--people's baseline needs and the labyrinth you go through to get them. So many students are involved in the clinic that we work only a few weekends a semester, which is something I've been disappointed in here (the lack of more regular, long-term activities), but it does give exposure and allows room for other pursuits. A great deal of it focuses on insurance, which will be incredibly useful, and the experience will cover a lot of ground that school won't look down to see.
Immigrant & Refugee Services...Because of that, I looked for some things outside of Yale I could do more regularly, and found a really great program focused on helping refugees adjust to life in New Haven, in all respects--English tutoring, cultural adjustment, community outings, social services. They come from all over; each family is given individual attention. Today I was told that a mom, dad and one year old girl would be moving to New Haven from Somalia on September 24. Anyway, I just have a small commitment. I'll be taking people to doctor's appointments, helping them navigate the bus system to get back and forth and help make sure communication with the doctors are okay. Working with refugees is something I'd really like to do in the future, and this seems like a great way to get to know this town, its people and its transportation and neighborhoods and feel.
Educational Care Clinic...So this program is so much like ASK that I couldn't really pass up on it. The differences are that it's much less regulated (no doctor working with us, no actual clinic, less protocol and expertise overall), but a bit more narrow and personal (we have one student that we tutor regularly). We advocate for educational resources similar to the way we did in ASK, but more on our own (depending on how this goes, it would be nice to offer some of the things we did in ASK to this program). The appealing part is that we get to tutor at the same time, giving it a more wholistic character and real attachment. It's also a very new and rough program. Project HEALTH spoiled me with its ability to look at broad social structures and work personally with people too. I miss it.
Columbus House...This is another few-times-a-semester commitment that a whole bunch of the med students do because of the patient time. It basically involves taking histories from people getting free healthcare at a local homeless shelter. At school they devote a whole year to teaching us how to take a good history, how to elicit a patient's story. It's one of those things that make me feel that this fits.
But I also think I might not pursue this until next semester. I wanted to write about these things because each one makes me look forward and excited. It wasn't to show how much we do here, because most of the things don't require huge investments. I'm also not particularly ambitious, because a huge number of our class is involved in these things (class dynamic is a topic that will not go unwritten). Still, I'm overwhelmed, because somehow I've forgotten that I'm also in school and I need to learn things. And not just school, but school that is life not just in physical place and mental hours but in the way it grips you inside-out because it's what you feel and think and work for, hope for. More on that, little by little.
Subscribe to:
Posts (Atom)
