surviving

I like to do my laundry and clean my room before I leave it on vacation (or in this case, Boards-study) so that its openness and togetherness welcomes me upon return. This time around, because my subletter hasn't completely moved out yet, my room is less able to fulfill its role, the cluttered surrounds mirror what this period of time has been.

Before we assume our roles as third years in the hospital (the wards), we have two weeks of "Survival Fair." We didn't know what it meant either, other than that it's an orientation designed to prevent us from being stupid on the wards. It turns out that the first week is mostly a warning: we will be stupid. We will be told so, made to feel so, and we are legitimately so.

I've never been so scared, so excited, or so scared and excited at once, to be beginning something. Part of this stems from the mystery that enshrouds medicine. Survival Fair consists of lectures, workshops and hands-on sessions that prepares us for 1) stress (details on what will stress us, how to cope) and 2) practical skills (putting in an IV, advanced CPR, learning the hospital computer system). I feel like a big number three is missing, the one that tells us what we'll actually be doing, what our responsibilities are. I know that this is hard, varies not just from department to department but from doctor to doctor. I also know that just as with our first two years of book learning, these next years are about figuring out for ourselves what we need to know and do. Still, somehow knowing we're about to descend into a black hole (in both positive and negative terms; I mean, it sounds bleak but it's kind of cool) without any remote idea of what makes it black is disconcerting. Though I guess that element is part of it.

As much as I don't like it, I admit it is probably good to coat this anticipation with a guard against the negative aspects of medicine. It seems we've been told over and over that we will be criticized, a lot; that people will be mean to us, a lot. It's been good advice to not take it personally because people are at their worst when stressed and sleep deprived, but among our class the natural response has been: why must this be true? I know that for myself I'm more easily irritated and more quickly take it out on people around me when stressed, and rather than falling back on that, I should avoid that crutch. I suppose that the warning to grow lizard skin is for the inevitable fallbacks.

But the nurse who taught us how to scrub in for surgeries left us with the advice to be nice. It goes without saying you should be nice to your patients, but she told us to be nice to everyone, to our doctors and medical teams and to each other. It also kind of goes without saying that you should be nice to your doctors, but I got the feeling she meant, nice in thought and not just in action-for-show. She herself was not about nice-for-show; she was rough when things were rough and kind when kindness was sincere.

Rough is necessary in surgery. I'm looking forward to being involved in them, but it's natural to feel more apprehensive. We had a two-hour session about how to prepare for one. Scrub your arms and hands for five minutes: 10 strokes on each side of your fingers, five across the webs in between, circular motions across both surfaces of your hands, turn the scrubber to the other side and continue the circles as you rotate your arm back to front, two inches above your elbows. We learned how to put on gloves (if you look this up on the internet, you'll find there is a five-step procedure for putting on gloves), how to put on a gown (this entails holding onto a tag at an exact spot and spinning around; I've already forgotten whether it's clockwise or counter). I learned that my glove size is the same as my shoe size. Then stand for upwards of 7-8 hours, half of which might consist of leaning over a patient holding an instrument in place and in place means in place, and remaining aware of what every inch of you is touching (lean on a patient out of fatigue and he may wake up with a hematoma). This indeed means holding your bladder for the duration of the operation. No scratching your face. If you sneeze, that will stay in your face mask until you're out. They've warned us back to back that we will be yelled at, blamed for everything we do wrong and for things not our fault. All while being asked questions to name what's before you, things that are less clear when real than when etched in a deliberate textbook.

In a timely turn of events I just read the Diving Bell and the Butterfly, the book whose words streamed from the blinking of a completely paralyzed man. He talks a little about his medical caretakers, and a lot about his world, the one which in our highest aims we seek to reach.

I haven't decided yet whether the negativity is a necessary tool or an unfortunate byproduct, or where it falls on the space between, but I do think that Survival Fair and third year in general is about pushing us to find ways to fight against it, and in the process, remembering or finding anew or finding for the first time what this is for. It's not for us, or at least not the majority of it. I don't intend to forget myself, though I know that may happen often. I want badly to take care of myself: write, drink milk, run twice a week, respond to emails, talk to people, eat fruits and vegetables. I'm trying my best to keep it simple and possible (I decided against making any resolution about cooking, even just once a month). We already know that there may be months when this list will be tough, but I know how much better I will feel to have things to control and give myself.

On the other end of that, like the operating room nurse told us, this isn't just about us. For the person whose literal cluttered insides are vulnerable and open, and not in the openness of a clean room but of an honest one, we go through what we do and we work to do the most we can. It shouldn't wear you away completely, but perhaps there is reason to wear a little. It wouldn't be realistic to bestow purpose to all negative; some crappy things are just crappy. But I think what drives us is the belief and hope that to see things as they are, messy or clean, is worth it.